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Alex Chehrazi-Raffle, Lihua E. Budde, Sumanta K. Pal
Nature, 6.11.2023
Tilføjet 6.11.2023
Dailey Garnes, Natalie J.M.; Kontoyiannis, Dimitrios P.
Current Opinion in Infectious Diseases, 6.11.2023
Tilføjet 6.11.2023
Purpose of review Mucormycosis (MCR) is a common opportunistic mold infection, and Mucorales were recently designated by WHO as priority pathogens. The interest in this infection has risen significantly since the major outbreak of MCR in the context of the COVID-19 pandemic, particularly in India. Herein, we summarize recently (last 24 months) published information regarding clinical aspects of MCR. Recent findings The disease remains protean in its clinical presentation, difficult to diagnose, and challenging to treat. In 2021, cases of COVID-19-associated mucormycosis (CAM) exploded in India during COVID-19 and manifested primarily as sino-orbital or sino-cerebral disease. Its classic risk factors included the triad of COVID-19, uncontrolled diabetes mellitus and use of corticosteroids. Despite difficulties in the timely diagnosis of MCR, significant progress has been made with the use of molecular techniques in blood to assist with earlier diagnosis, which can facilitate earlier appropriate therapy and improve outcomes. In addition, advances have been made in the use of imaging to stage the disease, determining what types of multimodal therapy are required depending on staging, and tissue-based identification of Mucorales. Summary Although the outlook for MCR has improved, effective new antifungals, risk stratification, and the optimal multimodality approaches remain an unmet need.
Læs mere Tjek på PubMedBahr, Nathan C.; Thompson, George R. III
Current Opinion in Infectious Diseases, 6.11.2023
Tilføjet 6.11.2023
Purpose of review The endemic fungi are a significant cause of morbidity and mortality in effected patients. The range of endemicity for these are expanding with infections observed outside of traditional locations. Enhanced diagnostic and treatment practices may significantly alter patient outcomes. Recent findings Recently completed clinical trials have focused on an assessment of improving efficacy while minimizing patient toxicity. Practice changing trials have been completed in histoplasmosis showing the utility of a single up-front liposomal amphotericin B dose followed by standard itraconazole dosing. The recent evaluation of several antifungal options including isauvconazole in the treatment of coccidioidomycosis also show promise for additional therapeutic agents. A recently conducted trial has also shown the superiority of amphotericin B therapy over itraconazole in the treatment of talaromycosis. Summary The increased range of endemic mycoses coupled with the growing immunocompromised patient population mandates continued investigation of improved diagnostic and therapeutic options. Advances in these areas have led to more rapid diagnosis and more efficacious antifungal therapy.
Læs mere Tjek på PubMedPortillo, Vera; Neofytos, Dionysios
Current Opinion in Infectious Diseases, 6.11.2023
Tilføjet 6.11.2023
Purpose of review Although invasive mold infections (IMI) are a major complication in high-risk populations, treatment duration has not yet been well defined. Recent findings Guidelines suggest documenting clinical/radiological resolution and immunological recovery before stopping antifungal treatment, after a minimum duration of treatment of 3 months for invasive pulmonary aspergillosis, while longer (up to 6 months) duration is proposed for the treatment of invasive mucormycosis. However, data on and definitions of clinical/radiological resolution and immune recovery remain scarce. Limited real-life data suggest that often much longer courses of treatment are given, generally in the context of continuous immunosuppression, occasionally defined as secondary prophylaxis. However, clearcut definition and distinction of secondary prophylaxis from antifungal treatment remain to be defined. Summary Decisions to stop antifungal treatment are based on poorly defined treatment responses and immune reconstitution and experts’ opinions. More evidence is needed to determine the optimal duration of treatment of IMI. Well designed, easy to use, and realistic algorithms to help clinicians decide when to stop antifungal treatment are urgently needed.
Læs mere Tjek på PubMedIerano, Courtney; Hall, Lisa; James, Rod
Current Opinion in Infectious Diseases, 6.11.2023
Tilføjet 6.11.2023
Purpose of review This review aims to discuss the current state of surgical antimicrobial prophylaxis (SAP) evidence for surgical site infection prevention. Despite decades of research, knowledge gaps persist in identifying optimal SAP regimens. Recent findings Recent randomised controlled trials highlight ongoing heterogeneity in study design. Key new findings support the use of oral preoperative SAP for colorectal surgery and advise against the use of SAP for transperineal prostate biopsy. There is growing evidence for culture-based SAP over empiric use for transrectal prostate biopsy. Contentious issues remain regarding topical antimicrobials for cardiac procedures involving sternotomy, the necessity of SAP for wire lumpectomy and laparoscopic cholecystectomy for both mild or moderate acute cholecystitis. Procedures where SAP is not indicated, yet research is still being conducted on this topic include dental implants and clean orthopaedic procedures. Summary Research efforts continue with numerous trials published and registered to determine optimal SAP regimens. However, many efforts are suboptimal due to poor statistical design and redundant questions already answered by existing literature. To improve practice and influence surgeons prescribing behaviour future RCTs should be well powered, with large sample sizes across multiple sites, focusing on clinically relevant questions.
Læs mere Tjek på PubMedJung, Jae; Cozzi, Francesca; Forrest, Graeme N.
Current Opinion in Infectious Diseases, 6.11.2023
Tilføjet 6.11.2023
Purpose of review This review will describe role of shorter antibiotic therapies, early switch from intravenous to oral therapy, and artificial intelligence in infectious diseases. Recent findings There is evidence that shorter courses of antibiotics are noninferior to standard durations of therapy. This has been demonstrated with Enterobacterales bacteremia that can be treated with 7 days of therapy, community acquired pneumonia with 3 days and ventilator associated pneumonia with just 7 days of antibiotic therapy. The conversion from intravenous to oral therapy in treating bacteremia, endocarditis and bone and joint infections is safe and effective and reduces line complications and costs. Also, for clean surgical procedures only one dose of antibiotic is needed, but it should be the most effective antibiotic which is cefazolin. This means avoiding clindamycin, removing penicillin allergies where possible for improved outcomes. Finally, the role of artificial intelligence to incorporate into using antibiotics wisely is rapidly emerging but is still in early stages. Summary In using antibiotics wisely, targeting such as durations of therapy and conversion from intravenous antibiotic therapy to oral are low hanging fruit. The future of artificial intelligence could automate a lot of this work and is exciting but needs to be proven. Video abstract http://links.lww.com/COID/A50
Læs mere Tjek på PubMedPuerta-Alcalde, Pedro; Garcia-Vidal, Carolina; Soriano, Alex
Current Opinion in Infectious Diseases, 6.11.2023
Tilføjet 6.11.2023
Purpose of review We provide an update on the recent literature on Clostridioides difficile infection (CDI) in cancer patients. Recent findings Distinguishing between colonization and infection remains challenging in cancer patients. Many patients with negative toxin analysis are still treated for CDI, and some meet criteria for severe cases. The incidence of CDI is high in cancer patients, especially those with haematological malignancies. Disruption of the gut microbiome due to antibiotic consumption, chemotherapy and radiotherapy is the primary factor contributing to CDI development. The severity of CDI in cancer patients is often unclear due to the absence of well-defined severity criteria. Certain microbiome species predominance and specific ribotypes have been associated with worse outcomes. Whole genome sequencing could be helpful for differentiating recurrence from reinfection and exploring potential nosocomial transmission. While certain new drugs such as fidaxomicin or bezlotoxumab show promise, the optimal treatment and prevention strategies for CDI in cancer patients remain uncertain. Faecal microbiota transplantation (FMT) holds potential for reducing CDI recurrence rates. Summary Further studies are needed to provide robust recommendations for diagnosis, grading severity, and therapeutic management of CDI in cancer patients. Recurrences are particularly concerning due to subsequent exposition to CDI risk factors.
Læs mere Tjek på PubMedLee, Yu-Lin; Hsueh, Po-Ren
Current Opinion in Infectious Diseases, 6.11.2023
Tilføjet 6.11.2023
Purpose of review This systematic review aimed to explore the recent trends in the epidemiology, risk factors, and antimicrobial susceptibility of two emerging opportunistic pathogens, Stenotrophomonas maltophilia and Elizabethkingia anophelis. Recent findings Since 2020, numerous outbreaks of S. maltophilia and E. anophelis have been reported worldwide. Most of these outbreaks have been associated with healthcare facilities, although one outbreak caused by E. anophelis in France was considered a community-associated infection. In terms of antimicrobial susceptibility, trimethoprim/sulfamethoxazole (TMP-SMZ), levofloxacin, and minocycline have exhibited good efficacy against S. maltophilia. Additionally, cefiderocol and a combination of aztreonam and avibactam have shown promising results in in vitro susceptibility testing. For E. anophelis, there is currently no consensus on the optimal treatment. Although some studies have reported good efficacy with rifampin, TMP-SMZ, piperacillin/tazobactam, and cefoperazone/sulbactam, minocycline had the most favourable in vitro susceptibility rates. Cefiderocol may serve as an alternative due to its low minimum inhibitory concentration (MIC) against E. anophelis. The role of vancomycin in treatment is still uncertain, although several successful cases with vancomycin treatment, even with high MIC values, have been reported. Summary Immunocompromised patients are particularly vulnerable to infections caused by S. maltophilia and E. anophelis, but the optimal treatment strategy remains inconclusive. Further research is necessary to determine the most effective use of conventional and novel antimicrobial agents in combatting these multidrug-resistant pathogens.
Læs mere Tjek på PubMedPaula Leona T. Cammayo-Fletcher, Rochelle A. Flores, Binh T. Nguyen, Andrea Gail M. Villavicencio, Seung Yun Lee, Woo H. Kim, Wongi Min
PLoS One Infectious Diseases, 6.11.2023
Tilføjet 6.11.2023
by Paula Leona T. Cammayo-Fletcher, Rochelle A. Flores, Binh T. Nguyen, Andrea Gail M. Villavicencio, Seung Yun Lee, Woo H. Kim, Wongi Min Riemerella (R.) anatipestifer poses a significant threat to ducks, resulting in mortality rates ranging from 5–75%. This disease is highly infectious and economically consequential for domestic ducks. Although other avian species, such as chickens, also display susceptibility, the impact is comparatively less severe than in ducks. IL-17A has a pronounced correlation with R. anatipestifer infection in ducks, which is less in chickens. This study performed an in vitro transcriptome analysis using chicken splenic lymphocytes collected at 4-, 8-, and 24-hour intervals following R. anatipestifer stimulation. The primary objective was to discern the differentially expressed genes, with a specific focus on IL-17A and IL-17F expression. Moreover, an association between specific miRNAs with NOS2 and CCL5 was identified. The manifestation of riemerellosis in chickens was linked to heightened expression of Th1- and Th2-associated cells, while Th17 cells exhibited minimal involvement. This study elucidated the mechanism behind the absence of a Th17 immune response, shedding light on its role throughout disease progression. Additionally, through small RNA sequencing, we identified a connection between miRNAs, specifically miR-456-3p and miR-16-5p, and their respective target genes NOS2 and CCL5. These miRNAs are potential regulators of the inflammatory process during riemerellosis in chickens.
Læs mere Tjek på PubMedHideto Taga, Tsunao Kishida, Yuta Inoue, Kenta Yamamoto, Shin-ichiro Kotani, Tsujimoto Masashi, Osamu Ukimura, Osam Mazda
PLoS One Infectious Diseases, 6.11.2023
Tilføjet 6.11.2023
by Hideto Taga, Tsunao Kishida, Yuta Inoue, Kenta Yamamoto, Shin-ichiro Kotani, Tsujimoto Masashi, Osamu Ukimura, Osam Mazda Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic disease for which no effective treatment is available. Transforming growth factor-β (TGF-β) is thought to be involved in the pathogenesis of IC/PBS, and previous studies have suggested that administrations of a TGF-β inhibitor significantly ameliorated IC/PBS in a mouse model. However, the molecular mechanisms underlying the therapeutic effect of a TGF-b inhibitor on IC/PBS has not been comprehensively analyzed. TGF-β has a variety of actions, such as regulation of immune cells and fibrosis. In our study, we induced IC/PBS-like disease in mice by an intravesical administration of hydrogen peroxide (H₂O₂) and examined the effects of three TGF-β inhibitors, Repsox, SB431542, and SB505124, on the urinary functions as well as histological and gene expression profiles in the bladder. TGF-β inhibitor treatment improved urinary function and histological changes in the IC/PBS mouse model, and SB431542 was most effective among the TGF-β inhibitors. In our present study, TGF-β inhibitor treatment improved abnormal enhancement of nociceptive mechanisms, immunity and inflammation, fibrosis, and dysfunction of bladder urothelium. These results show that multiple mechanisms are involved in the improvement of urinary function by TGF-β inhibitor.
Læs mere Tjek på PubMedIbrahim A. Naqid, Ahmed A. Mosa, Shah Vahel Ibrahim, Nizar Hussein Ibrahim, Nawfal R. Hussein
PLoS One Infectious Diseases, 6.11.2023
Tilføjet 6.11.2023
by Ibrahim A. Naqid, Ahmed A. Mosa, Shah Vahel Ibrahim, Nizar Hussein Ibrahim, Nawfal R. Hussein Background and aims Healthcare staff are at high risk of occupational exposure to Hepatitis B and other blood-borne diseases. Lack of education about the knowledge of Hepatitis B virus contributes to an increase in cases. This study aims to determine the knowledge of the Hepatitis B virus among the medical professionals in Duhok province, Kurdistan Region of Iraq, and to determine their knowledge of the importance of vaccination. Materials and methods This cross-sectional study was conducted in Duhok province, Kurdistan Region of Iraq, among medical science students from November 2022 to February 2023 and a total of 511 students participated in the study. A Self-administered questionnaire comprising 22 items categorized into five sections was distributed to the students either electronically or by paper and pen method. The survey utilized a Five-point Likert scale when assessing respondents’ opinions on knowledge, attitude, and practice (KAP). Microsoft Excel and GraphPad Prism 9 were used for statistical analysis. Results A total of 511 responses were collected from medical, dental, pharmacy, and laboratory students. The average age of the participants was 20.74 ±1.43 years. Among the respondents, only 96 (18.8%) were fully vaccinated against the Hepatitis B virus (received 3 or more doses of the vaccine), while 294 (57.5%) were not vaccinated. Lack of vaccination programs was the major reason for not receiving a vaccination (n = 182, 62%). About 286 (55.96%) of the participants had good knowledge, attitude, and practice on Hepatitis B, manifesting median scores of 26, 18, and 20, respectively. Conclusion In our study, half of the students were found to be unvaccinated, mainly due to the absence of vaccination programs. Vaccinated students exhibited better knowledge, attitude, and practice toward the infection than non-vaccinated students. Therefore, we recommend the implementation of a vaccination program as well as training on infection prevention guidelines to increase awareness and encourage vaccination.
Læs mere Tjek på PubMedHarshita Sharma, Rakesh Sehgal, Nishant Shekhar, Gaurav Shoeran, Upninder Kaur, Bikash Medhi
PLoS One Infectious Diseases, 6.11.2023
Tilføjet 6.11.2023
by Harshita Sharma, Rakesh Sehgal, Nishant Shekhar, Gaurav Shoeran, Upninder Kaur, Bikash Medhi Leishmaniasis is a vector-borne parasitic infection caused by the infective bite of female Phlebotomine sandflies. Treatment of leishmaniasis by conventional synthetic compounds is met by challenges pertaining to adverse effects which call for the discovery of newer anti-leishmanial molecules. This study was performed to evaluate the effect and modes of action of a sesquiterpene alcoholic molecule Farnesol on Leishmania major, the causative agent of Zoonotic CL. The cytotoxic effect of Farnesol against L.major promastigotes, amastigotes and macrophages was assessed by MTT test and counting. The IC50 on promastigotes by Farnesol on L.major was also evaluated by flow cytometry. In the findings, promastigotes were reduced at 167μM. The mean numbers of L.major amastigotes in macrophages were significantly decreased on exposure to Farnesol at 172μM. In addition, Farnesol induced significant apoptosis dose-dependent on L.major promastigotes. In silico protein-ligand_binding analyses indicated the effect of Farnesol in perturbation of the ergosterol synthesis pathway of Leishmania with attributes suggesting inhibition of Lanosterol-α-demethylase, the terminal enzyme of ergosterol synthesis machinery. Findings from flow cytometry reveal the role of Farnesol in apoptosis-induced killing in promastigotes. Farnesol was effective at very lower concentrations when compared to Paromomycin. Further studies are crucial to evaluate the therapeutic potential of Farnesol alone or in combination with other conventional drugs in animal models.
Læs mere Tjek på PubMedHari Prasad Gandikota, Abirami S., Sunil Kumar M.
PLoS One Infectious Diseases, 6.11.2023
Tilføjet 6.11.2023
by Hari Prasad Gandikota, Abirami S., Sunil Kumar M. Pancreatic cancer (PC) is a very lethal disease with a low survival rate, making timely and accurate diagnoses critical for successful treatment. PC classification in computed tomography (CT) scans is a vital task that aims to accurately discriminate between tumorous and non-tumorous pancreatic tissues. CT images provide detailed cross-sectional images of the pancreas, which allows oncologists and radiologists to analyse the characteristics and morphology of the tissue. Machine learning (ML) approaches, together with deep learning (DL) algorithms, are commonly explored to improve and automate the performance of PC classification in CT scans. DL algorithms, particularly convolutional neural networks (CNNs), are broadly utilized for medical image analysis tasks, involving segmentation and classification. This study explores the design of a tunicate swarm algorithm with deep learning-based pancreatic cancer segmentation and classification (TSADL-PCSC) technique on CT scans. The purpose of the TSADL-PCSC technique is to design an effectual and accurate model to improve the diagnostic performance of PC. To accomplish this, the TSADL-PCSC technique employs a W-Net segmentation approach to define the affected region on the CT scans. In addition, the TSADL-PCSC technique utilizes the GhostNet feature extractor to create a group of feature vectors. For PC classification, the deep echo state network (DESN) model is applied in this study. Finally, the hyperparameter tuning of the DESN approach occurs utilizing the TSA which assists in attaining improved classification performance. The experimental outcome of the TSADL-PCSC method was tested on a benchmark CT scan database. The obtained outcomes highlighted the significance of the TSADL-PCSC technique over other approaches to PC classification.
Læs mere Tjek på PubMedYushan Peng, Menglin Ni, Xiaoying Wang
PLoS One Infectious Diseases, 6.11.2023
Tilføjet 6.11.2023
by Yushan Peng, Menglin Ni, Xiaoying Wang This paper uses the test proposed by Generalized Supremum Augmented Dickey-Fuller to identify whether there are multiple bubbles in copper price. The empirical results show that base on market fundamentals, there are seven bubbles existed from January 1980 to March 2023. Through analyses, the first two bubbles can be explained by the demand from Japan by the industry concentration and persistent supply constraint. The third to sixth bubbles are mainly negatively impacted by the global financial crisis and growing demand of China. The last bubble is caused by the economic recovery from Covid-19. The logit regression has stated that aluminum price, copper production, all metals index and GDP have a positive impact on copper bubbles, while China’s copper imports and precious metals price negatively explains copper bubbles. The main contributions are the investigation of the copper price bubbles, its determinants and the different technique of GSADF to detect copper price bubbles. Furthermore, it provides helpful information for those investors to make reasonable investment decisions and thus, avoid potential price risk.
Læs mere Tjek på PubMedAnnalisa Bergna, Alessia Lai, Carla Della Ventura, Bianca Bruzzone, Alessandro Weisz, Morena d'Avenia, Sophie Testa, Carlo Torti, Caterina Sagnelli, Angela Menchise, Gaetano Brindicci, Daniela Francisci, Ilaria Vicenti, Nicola Clementi, Annapaola Callegaro, Emmanuele Venanzi Rullo, Sara Caucci, Vanessa De Pace, Andrea Orsi, Stefano Brusa, Francesca Greco, Vittoria Letizia, Emilia Vaccaro, Gianluigi Franci, Francesca Rizzo, Fabio Sagradi, Leonardo Lanfranchi, Nicola Coppola, Annalisa Saracino, Michela Sampaolo, Silvia Ronchiadin, Massimo Galli, Agostino Riva, Gianguglielmo Zehender, SARS‐CoV‐2 ITALIAN RESEARCH ENTERPRISE – (SCIRE) collaborative Group
Journal of Medical Virology, 6.11.2023
Tilføjet 6.11.2023
Zhen YangYiwen ZhangSenyan DuQin ZhaoXiaobo HuangRui WuQigui YanXinfeng HanSanjie CaoYung-Fu ChangYiping Wen1Research Center of Swine Disease, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China2Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, New York, New York, USA, Guy H. Palmer
Infection and Immunity, 6.11.2023
Tilføjet 6.11.2023
Lei QinFandan MengHaijuan HeSiqi LiHongliang ZhangYuan SunWenlong ZhangTongqing AnXuehui CaiShujie Wang1State Key Laboratory for Animal Disease Control and Prevention, Harbin Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Harbin, Heilongjiang, China2Laboratory Animal Centre, Qiqihar Medical University, Qiqihar, China3Institute of Animal Husbandry, Heilongjiang Academy of Agriculture Sciences, Harbin, Heilongjiang, China4College of Veterinary Medicine, Northeast Agricultural University, Harbin, Heilongjiang, China5Heilongjiang Research Center for Veterinary Biopharmaceutical Technology, Harbin, China6Heilongjiang Provincial Key Laboratory of Veterinary Immunology, Harbin, China, Kimberly A. Kline
Infection and Immunity, 6.11.2023
Tilføjet 6.11.2023
Infection, 6.11.2023
Tilføjet 6.11.2023
Infection, 6.11.2023
Tilføjet 6.11.2023
Abstract Purpose To determine characteristics associated with inappropriate antibiotic use amongst children hospitalised for influenza. Methods We performed active surveillance for laboratory-confirmed influenza hospitalizations amongst children ≤ 16 years old at the 12 Canadian Immunization Monitoring Program Active hospitals, from September 2010 to August 2021. Antibiotic use was presumed appropriate if any of the following indications were met: age
Læs mere Tjek på PubMedInfection, 6.11.2023
Tilføjet 6.11.2023
Abstract Purpose The prevalence of odontogenic infections remains one of the highest in the world. If untreated, odontogenic infections can break through the limitation, disseminate to other organs or spaces, and cause high mortality rates. However, it is still difficult to rapidly target limited or disseminated infections in clinical practice. The type of disseminated odontogenic infections and the responsible bacteria have not been described in detail. Methods Search databases (e.g., PubMed, MEDLINE, Web of Science, Embase) for reports published from 2018.1 to 2022.9. Use search strategies: (“odontogenic infections” OR “pulpitis” OR “periapical lesions” OR “periodontal diseases”) AND (“disseminated infections” OR “complication”). Results Fourteen different types of disseminated odontogenic infections, most of which are polymicrobial infections, can spread through the body either direct or through hematogenous diffusion. Multiple microbial infections can be more invasive in the transmission of infection. Secondary infections are commonly associated with bacteria like Fusobacterium spp., Streptococcus spp., Peptostreptococcus spp., Prevotella spp., and Staphylococcus spp. Antibiotics with broad-spectrum activity are fundamental as first-line antimicrobial agents based on the microorganisms isolated from disseminated infections. Conclusion This review elaborates on the epidemiology, microorganisms, risk factors, and dissemination routes, and provides evidence-based opinions on the diagnosis, multidisciplinary management, and prevention of odontogenic infections for dentists and clinicians.
Læs mere Tjek på PubMedAdiatma Yudistira Manogar Siregar, Mery Nurma Juwita, Donny Hardiawan, Adhadian Akbar, Zulfa Haitan Rachman, Muhammad Dzaki Fahd Haekal, Yuvi Siti Marwah, Tarinanda Adzani Putri, Fani Fadillah Rakhmat, Mawar Nita Pohan, Miasari Handayani, Tri Indah Budiarty, Nurhalina Afriana, Bagus Rahmat Prabowo, Rudi Wisaksana
Tropical Medicine & International Health, 6.11.2023
Tilføjet 6.11.2023
Infection, 5.11.2023
Tilføjet 5.11.2023
Abstract Purpose Post-acute sequelae of COVID-19 (PASC) affect approximately 10% of convalescent patients. The spectrum of symptoms is broad and heterogeneous with fatigue being the most often reported sequela. Easily accessible blood biomarkers to determine PASC severity are lacking. Thus, our study aimed to correlate immune phenotypes with PASC across the severity spectrum of COVID-19. Methods A total of 176 originally immunonaïve, convalescent COVID-19 patients from a prospective cohort during the first pandemic phase were stratified by initial disease severity and underwent clinical, psychosocial, and immune phenotyping around 10 weeks after first COVID-19 symptoms. COVID-19-associated fatigue dynamics were assessed and related to clinical and immune phenotypes. Results Fatigue and severe fatigue were commonly reported irrespective of initial COVID-19 severity or organ-specific PASC. A clinically relevant increase in fatigue severity after COVID-19 was detected in all groups. Neutralizing antibody titers were higher in patients with severe acute disease, but no association was found between antibody titers and PASC. While absolute peripheral blood immune cell counts in originally immunonaïve PASC patients did not differ from unexposed controls, peripheral CD3+CD4+ T cell counts were independently correlated with fatigue severity across all strata in multivariable analysis. Conclusions Patients were at similar risk of self-reported PASC irrespective of initial disease severity. The independent correlation between fatigue severity and blood T cell phenotypes indicates a possible role of CD4+ T cells in the pathogenesis of post-COVID-19 fatigue, which might serve as a blood biomarker.
Læs mere Tjek på PubMedInfection, 5.11.2023
Tilføjet 5.11.2023
Abstract Purpose Lung transplant recipients are at increased risk of severe disease following infection with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) due to high-dose immunosuppressive drugs and the lung is the main organ affected by Coronavirus disease 2019 (COVID-19). Several studies have confirmed increased SARS-CoV-2-related mortality and morbidity in patients living with lung allografts; however, detailed immunological studies of patients with SARS-CoV-2 infection in the early phase following transplantation remain scarce. Methods We investigated patients who were infected with SARS-CoV-2 in the early phase (18–103 days) after receiving double-lung allografts (n = 4, LuTx) in comparison to immunocompetent patients who had not received solid organ transplants (n = 88, noTx). We analyzed SARS-CoV-2-specific antibody responses against the SARS-CoV-2 spike and nucleocapsid proteins using enzyme-linked immunosorbent assays (ELISA), chemiluminescence immunoassays (CLIA), and immunoblot assays. T cell responses were investigated using Elispot assays. Results One LuTx patient suffered from persistent infection with fatal outcome 122 days post-infection despite multiple interventions including remdesivir, convalescent plasma, and the monoclonal antibody bamlanivimab. Two patients experienced clinically mild disease with prolonged viral shedding (47 and 79 days), and one patient remained asymptomatic. Antibody and T cell responses were significantly reduced or undetectable in all LuTx patients compared to noTx patients. Conclusion Patients in the early phase following lung allograft transplantation are vulnerable to infection with SARS-CoV-2 due to impaired immune responses. This patient population should be vaccinated before LuTx, protected from infection post–LuTx, and in case of infection treated generously with currently available interventions.
Læs mere Tjek på PubMedInfection, 5.11.2023
Tilføjet 5.11.2023
Abstract Purpose To describe clinical features and outcomes of viral lumbosacral radiculitis (Elsberg syndrome). Methods Nationwide population-based cohort study of all adults hospitalised for viral lumbosacral radiculitis at departments of infectious diseases in Denmark from 2015 to 2020. Results Twenty-eight patients with viral lumbosacral radiculitis were included (mean annual incidence: 1.2/1,000,000 adults). The median age was 35 years (IQR 27–43), and 22/28 (79%) were female. All patients had urinary retention, with 17/28 (61%) needing a catheter. On admission, at least one sign or symptom of meningitis (headache, neck stiffness, photophobia/hyperacusis) was present in 18/22 (82%). Concurrent genital herpetic lesions were present in 11/24 (46%). The median cerebrospinal fluid leukocyte count was 153 cells/µL (IQR 31–514). Magnetic resonance imaging showed radiculitis/myelitis in 5/19 (26%). The microbiological diagnosis was herpes simplex virus type 2 in 19/28 (68%), varicella-zoster virus in 2/28 (7%), and unidentified in 7/28 (25%). Aciclovir/valaciclovir was administered in 27/28 (96%). At 30 days after discharge, 3/27 (11%) had persistent urinary retention with need of catheter. At 180 days after discharge, moderate disabilities (Glasgow Outcome Scale score of 4) were observed in 5/25 (20%). Conclusions Urinary retention resolved within weeks in most patients with viral lumbosacral radiculitis, but moderate disabilities according to the Glasgow Outcome Scale were common at the end of follow-up.
Læs mere Tjek på PubMedInfection, 5.11.2023
Tilføjet 5.11.2023
Abstract Background Antimicrobial stewardship (AMS) programs are effective tools for improving antibiotic prescription quality. Their implementation requires the regular surveillance of antibiotic consumption at the patient and institutional level. Our study captured and analyzed antibiotic consumption density (ACD) for hospitalized pediatric patients. Method We collected antibacterial drug consumption data for 2020 from hospital pharmacies at 113 pediatric departments of acute care hospitals in Germany. ACD was calculated as defined daily dose (DDD, WHO/ATC Index 2019) per 100 patient days (pd). In addition, we analyzed the trends in antibiotic use during 2013–2020. Results In 2020, median ACD across all participating hospitals was 26.7 DDD/100 pd, (range: 10.1–79.2 DDD/100 pd). It was higher at university vs. non-university hospitals (38.6 vs. 25.2 DDD/100 pd, p
Læs mere Tjek på PubMedInfection, 5.11.2023
Tilføjet 5.11.2023
Abstract Purpose Streptococcus pneumoniae (Spn) is a major cause of child death. We investigated the epidemiology of S. pneumoniae in a pediatric fever clinic and explored the genomics basis of the limited vaccine response of serotype 14 strains worldwide. Methods Febrile disease and pneumonia were diagnosed following criteria from the WHO at the end of 2019 at a tertiary children’s hospital. Spn was isolated by culture from nasopharyngeal (NP) swabs. The density was determined by lytA-base qPCR. Isolates were serotyped by Quellung and underwent antimicrobial susceptibility testing. Whole-genome sequencing was employed for molecular serotyping, MLST, antibiotic gene determination, SNP calling, recombination prediction, and phylogenetic analysis. Results The presence of pneumococcus in the nasopharynx (87.5%, 7/8, p = 0.0227) and a high carriage (100%, 7/7, p = 0.0123) were significantly associated with pneumonia development. Living with siblings (73.7%, 14/19, p = 0.0125) and non-vaccination (56.0%, 28/50, p = 0.0377) contributed significantly to the Spn carriage. Serotype 14 was the most prevalent strain (16.67%, 5/30). The genome analysis of 1497 serotype 14 strains indicated S14/ST876 strains were only prevalent in China, presented limited vaccine responses with higher recombination activities within its cps locus, and unique variation patterns in the genes wzg and lrp. Conclusion With the lifting of the one-child policy, it will be crucial for families with multiple children to get PCV vaccinations in China. Due to the highly variant cps locus and distinctive variation patterns in capsule shedding and binding proteins genes, the prevalent S14/ST876 strains have shown poor response to current vaccines. It is necessary to continue monitoring the molecular epidemiology of this vaccine escape clone.
Læs mere Tjek på PubMedInfection, 5.11.2023
Tilføjet 5.11.2023
Abstract More than half of the world’s population are colonized with H. pylori; however, the prevalence varies geographically with the highest incidence in Africa. H. pylori is probably a commensal organism that has been associated with the development of gastritis, ulcers, and gastric cancer. H. pylori alone is most probably not enough for the development of gastric carcinoma, but evidence for its association with the disease is high and has, therefore, been classified by the International Agency for Research on Cancer as a Class 1 carcinogen. Bacteroidetes and Fusobacteria positively coexisted during H. pylori infection along the oral–gut axis. The eradication therapy required to treat H. pylori infection can also have detrimental consequences for the gut microbiota, leading to a decreased alpha diversity. Therefore, therapy regimens integrated with probiotics may abolish the negative effects of antibiotic therapy on the gut microbiota. These eradication therapies combined with probiotics have also higher rates of eradication, when compared to standard treatments, and are associated with reduced side effects, improving the patient’s compliance. The eradication therapy not only affects gut microbiome but also affects the oral microbiome with robust predominance of harmful bacteria. However, there have been reports of a protective role of H. pylori in Barrett’s esophagus, esophageal adenocarcinoma, eosinophilic esophagitis, IBD, asthma, and even multiple sclerosis. Therefore, eradication therapy should be carefully considered, and test to treat policy should be tailored to specific communities especially in highly endemic areas. Supplementation of probiotics, prebiotics, herbals, and microbial metabolites to reduce the negative effects of eradication therapy should be considered. After failure of many eradication attempts, the benefits of H. pylori eradication should be carefully balanced against the risk of adverse effects especially in the elderly, persons with frailty, and intolerance to antibiotics.
Læs mere Tjek på PubMedInfection, 5.11.2023
Tilføjet 5.11.2023
Abstract Purpose We aimed to explore the clinical characteristics of Campylobacter bacteraemia and identify the trends, risk factors for mortality, and antimicrobial susceptibility patterns from clinical samples. Methods This retrospective cohort study included patients confirmed to have Campylobacter bacteraemia from seven hospitals between January 2010 and June 2021. Data on demographics and underlying history, clinical manifestation, and antimicrobial susceptibility patterns were collected and analyzed. Annual cases of Campylobacter enteritis were extracted from a public database. Results A total of 108 patients were included, and five species were isolated. Campylobacter jejuni accounted for 54 (50.0%) cases and 17 (16%) patients had no symptoms other than fever. In-hospital mortality occurred in 14 (13.0%) patients. C. jejuni bacteraemia was associated with lower mortality compared to non-C. jejuni bacteraemia. Underlying cancer and septic shock were the significant factors associated with in-hospital mortality. Quinolone resistance was high (59%), whereas only 4% of isolates exhibited macrolide resistance. There has been a significant increase in the number of Campylobacter enteritis cases, which was strongly correlated with the number of Campylobacter bacteraemia cases (Pearson’s coefficient: 0.953; p
Læs mere Tjek på PubMedInfection, 5.11.2023
Tilføjet 5.11.2023
Abstract Purpose We aimed to assess IgG antibodies against the SARS-CoV-2 spike protein (anti-SARS-CoV-2 S IgG) in vaccinated mothers and their infants at delivery and 2–3 months of age. Methods We conducted a prospective study on mothers who received at least one dose of the COVID-19 vaccine (Pfizer-BNT162b2, Moderna mRNA-1273, or Oxford-AstraZeneca ChAdOx1-S) during pregnancy and on their infants. The baseline was at the time of delivery (n = 93), and the end of follow-up was 2 to 3 months post-partum (n = 53). Serum anti-SARS-CoV-2 S IgG titers and ACE2 binding inhibition levels were quantified by immunoassays. Results Mothers and infants had high anti-SARS-CoV-2 S IgG titers against the B.1 lineage at birth. However, while antibody titers were maintained at 2–3 months post-partum in mothers, they decreased significantly in infants (p 0.8, p
Læs mere Tjek på PubMedInfection, 5.11.2023
Tilføjet 5.11.2023
Abstract Purpose Blood culture obtainment prior to antibiotic administration, in patients with suspected infection, is considered the best practice in international guidelines. However, there is little data regarding the effect of a single dose of antibiotics on blood culture sterilization. Methods We conducted a prospective study, enrolling consecutive patients with suspected infection, hospitalized in an internal medicine ward between December 2019 and January 2023. Included patients had a positive blood culture prior to antibiotic administration and a set of blood cultures taken within 24 h after a single dose of antibiotics. The rate of patients with pathogen isolation after antibiotic administration was assessed. Logistic regression was performed to examine factors associated with blood culture positivity. Results A total of 155 patients were recruited for the study of which 131 (50.8% female 77.5 ± 13.4 years) met the inclusion criteria. The overall rate of patients with a positive blood culture after a single dose of antibiotics was 42.0% (55/131 patients). Increasing time between antibiotic administration and post-antibiotic culture was an independent predictor for blood culture sterilization (odds ratio 0.89 [95% confidence interval, 0.83–0.97; p = 0.006] for every 60 min). Blood culture volume was an independent predictor for blood culture positivity in a sensitivity analysis which included 82 patients (OR = 1.26 [95% CI 1.03–1.57] for every 1 ml increase; p = 0.024). Conclusion Blood culture positivity is reduced by antimicrobial therapy but remains high after a single dose of antibiotics. If cultures are not obtained prior to antibiotic administration, they should be obtained as soon as possible afterwards.
Læs mere Tjek på PubMedInfection, 5.11.2023
Tilføjet 5.11.2023
Abstract Introduction Falciparum malaria remains one of the deadliest infectious diseases worldwide. In Germany, it is mainly an imported infection among travellers. Rates of coinfection are often unknown, and a clinical rationale for the beneficial use of calculated antibiotic therapy in patients with malaria and suspected coinfection is lacking. Methods We conducted an analysis of all in-patients treated with falciparum malaria at a German infectious diseases centre in vicinity to one of Europe’s major airports for 2010–2019. Logistic regression and time-to-event analysis were used to evaluate predictors for bacterial coinfection, the use of antibacterial substances, as well as their influence on clinical course. Results In total, 264 patients were included. Of those, 64% received an additional antibacterial therapy (n = 169). Twenty-nine patients (11.0%) were found to have suffered from a relevant bacterial coinfection, while only a small fraction had relevant bacteremia (n = 3, 1.4%). However, patients with severe malaria did not suffer from coinfections more frequently (p = 0.283). CRP levels were not a reliable predictor for a bacterial coinfection (OR 0.99, 95% CI 0.94–1.06, p = 0.850), while another clinical focus of infection was positively associated (OR 3.86, 95% CI 1.45–11.55, p = 0.010). Conclusion Although bacterial coinfections were rare in patients with malaria at our centre, the risk does not seem negligible. These data point rather towards individual risk assessment in respective patients than to general empiric antibiotic use.
Læs mere Tjek på PubMedInfection, 5.11.2023
Tilføjet 5.11.2023
Abstract Objective Carbapenem-resistant Enterobacteriaceae (CRE) pose a significant threat to human health and have emerged as a major public health concern. We aimed to compare the efficacy and the safety of ceftazidime–avibactam (CAZ–AVI) and polymyxin in the treatment of CRE infections. Methods A systematic review and meta-analysis was performed by searching the databases of EMBASE, PubMed, and the Cochrane Library. Published studies on the use of CAZ–AVI and polymyxin in the treatment of CRE infections were collected from the inception of the database until March 2023. Two investigators independently screened the literature according to the inclusion and exclusion criteria, evaluated the methodological quality of the included studies and extracted the data. The meta-analysis was performed using RevMan 5.4 software. Results Ten articles with 833 patients were included (CAZ–AVI 325 patients vs Polymyxin 508 patients). Compared with the patients who received polymyxin-based therapy, the patients who received CAZ–AVI therapy had significantly lower 30-days mortality (RR = 0.49; 95% CI 0.01–2.34; I2 = 22%; P
Læs mere Tjek på PubMedInfection, 5.11.2023
Tilføjet 5.11.2023
Abstract Background Infection-associated secondary hemophagocytic lymphohistiocytosis (sHLH) is a potentially life-threatening hyperinflammatory condition caused by various infectious diseases. Malaria has rarely been described as trigger. The aim of this study is to collect data on frequency, clinical spectrum, and outcome of sHLH induced by malaria. Methods We collected case numbers on malaria and malaria-associated sHLH from specialized centers in Germany from 2015 to 2022. In addition, we conducted a literature search on published cases of malaria-associated sHLH and systematically analyzed the literature regarding clinical and diagnostic criteria. Results We obtained data from 13 centers treating 1461 malaria cases with different Plasmodium species, of which 5 patients (0.34%) also were diagnosed with sHLH. The literature search revealed detailed case reports from further 51 patients and case series comprising the description of further 24 patients with malaria-associated sHLH. Most cases (48/80; 60%) were reported from Asia. The median time interval between onset of malaria symptoms and hospital admission was 7 days. Severe complications of sHLH were documented in 36% (20/56) of patients, including two patients with multiple organ failure in our case series. Only 41% (23/56) of patients received specific treatment for sHLH, nevertheless the mortality rate (CFR) of 5% is lower compared to the CFR reported for sHLH triggered by other infectious diseases (e.g., 25% in sHLH due to EBV infection). Conclusion Malaria-associated sHLH appears to have a comparatively good prognosis but may still represent an underdiagnosed and potentially fatal complication of malaria, especially in resource-poor settings.
Læs mere Tjek på PubMedInfection, 5.11.2023
Tilføjet 5.11.2023
Abstract Purpose Sex differences in infective endocarditis (IE) are reported, but patient characteristics are sparse and conflicting findings on the association between sex and short-term outcomes demand further research. We aimed to characterize sex differences in IE in terms of patient characteristics, frailty, microbiology, socioeconomic status, management and outcome on a nationwide scale. Methods Between 2010 and 2020, we used Danish national registries to characterize patients with IE according to sex using ICD codes and microbiological lab reports. Frailty was assessed with the Hospital Frailty Risk Score. Mortality was reported with Kaplan–Meier estimates. Logistic regression and Cox regression were used for adjusted analyses. Results We included 6259 patients with IE with 2047 (32.7%) female patients and 4212 (67.3%) male patients. Female patients were older (median age 75.0 years (64.3–82.2) vs. 71.7 (61.7–78.9)) and more frail (Intermediate frailty: 36.5% vs. 33.1%, High frailty: 11.4% vs. 9.2%). Staphylococcus aureus-IE were most common in both sexes (34.6% vs. 28.8%), but fewer female patients had Enterococcus-IE (10.5% vs. 18.1%). Female patients were less surgically treated (14.0% vs. 21.2%). Female sex was associated with increased in-hospital mortality (adj. OR 1.33, 95% CI 1.16–1.52), but no statistically significant difference in associated 1- and 5-year mortality from hospital discharge were identified (adj. HR 1.09, 95% CI 0.95–1.24 and 1.02, 95% CI 0.92–1.12, respectively). Conclusion Female sex is associated with increased in-hospital mortality, but not in long-term mortality as compared with male patients. Female patients have a lower prevalence of Enterococcus-IE and rates of surgery. Further research is needed to understand these differences.
Læs mere Tjek på PubMedClinical & Experimental Immunology, 5.11.2023
Tilføjet 5.11.2023
AbstractTransient Hypogammaglobulinemia of Infancy (THI) is one of the most common forms of hypogammaglobulinemia in the early childhood. THI is usually associated with chronic, recurrent bacterial and viral infections, life-threatening in some cases, yet its pathogenesis is still largely unknown. Since our previous findings indicated the possible role of Treg cells in the pathomechanism of THI, the aim of the current study was to investigate gene expression profile of Treg cells isolated from THI patients. The transcriptome-wide gene profiling was performed using microarray technology on THI patients in two time-points: during (THI-1), and in resolution phase (THI-2) of hypogammaglobulinemia. As a result, a total of 1086 genes were differentially expressed in THI-1 patients, when compared to THI-2 as well as control group. Among them, 931 were up- and 155 down-regulated, and part of them encodes genes important for Treg lymphocyte biology and function, i.e. transcription factors/cofactors that regulate FOXP3 expression. Thus, we postulate that Treg cells isolated from THI patients during hypogammaglobulinemia display enhanced suppressor transcriptome signature. Treg expression profile of THI children after normalization of Ig levels largely resembles the results obtained in healthy control group, suggesting THI Treg transcriptome seems to return to that observed in healthy children. Taken together, we suggest that THI pathomechanism is associated not only with transiently elevated Treg cell numbers, but also with their enhanced regulatory/inhibitory functions. These findings expand our knowledge of human Treg cells and may be useful for the future diagnosis or management of THI.
Læs mere Tjek på PubMedClinical & Experimental Immunology, 5.11.2023
Tilføjet 5.11.2023
AbstractT cell engaging bispecifics have great clinical potential for the treatment of cancer and infectious diseases. The binding affinity and kinetics of a bispecific molecule for both target and T cell CD3 have substantial effects on potency and specificity, but the rules governing these relationships are not fully understood. Using ImmTAC (Immune mobilizing monoclonal TCRs Against Cancer) molecules as a model, we explored the impact of altering affinity for target and CD3 on the potency and specificity of the re-directed T cell response. This class of bispecifics, exemplified by tebentafusp which has recently shown survival benefit in a randomized phase 3 clinical trial1, bind specific target peptides presented by human leukocyte antigen (HLA) on the cell surface via an affinity-enhanced T cell receptor and can redirect T cell activation with an anti-CD3 effector moiety. The data reveal that combining a strong affinity TCR with an intermediate affinity anti-CD3 results in optimal T cell activation, while strong affinity of both targeting and effector domains significantly reduces maximum cytokine release. Moreover, by optimising the affinity of both parts of the molecule, it is possible to improve the selectivity. These results could be effectively modelled based on kinetic proof-reading with limited signalling. This model explained the experimental observation that strong binding at both ends of the molecules leads to reduced activity, through very stable target-bispecific-effector complexes leading to CD3 entering a non-signalling dark-state. These findings have important implications for the design of anti-CD3 based bispecifics with optimal biophysical parameters for both activity and specificity.
Læs mere Tjek på PubMedInfection, 4.11.2023
Tilføjet 4.11.2023
Abstract Purpose Post-acute sequelae of COVID-19 (PASC) affect approximately 10% of convalescent patients. The spectrum of symptoms is broad and heterogeneous with fatigue being the most often reported sequela. Easily accessible blood biomarkers to determine PASC severity are lacking. Thus, our study aimed to correlate immune phenotypes with PASC across the severity spectrum of COVID-19. Methods A total of 176 originally immunonaïve, convalescent COVID-19 patients from a prospective cohort during the first pandemic phase were stratified by initial disease severity and underwent clinical, psychosocial, and immune phenotyping around 10 weeks after first COVID-19 symptoms. COVID-19-associated fatigue dynamics were assessed and related to clinical and immune phenotypes. Results Fatigue and severe fatigue were commonly reported irrespective of initial COVID-19 severity or organ-specific PASC. A clinically relevant increase in fatigue severity after COVID-19 was detected in all groups. Neutralizing antibody titers were higher in patients with severe acute disease, but no association was found between antibody titers and PASC. While absolute peripheral blood immune cell counts in originally immunonaïve PASC patients did not differ from unexposed controls, peripheral CD3+CD4+ T cell counts were independently correlated with fatigue severity across all strata in multivariable analysis. Conclusions Patients were at similar risk of self-reported PASC irrespective of initial disease severity. The independent correlation between fatigue severity and blood T cell phenotypes indicates a possible role of CD4+ T cells in the pathogenesis of post-COVID-19 fatigue, which might serve as a blood biomarker.
Læs mere Tjek på PubMedM Suárez, A Pérez-Landeiro, A Sanjurjo, O. Lima, A. Sousa, A. López, L. Martínez-Lamas, X. Cabrera, M Rubianes, MT Pérez-Rodríguez
International Journal of Infectious Diseases, 4.11.2023
Tilføjet 4.11.2023
Dalbavancin is a lipoglycopeptide antibiotic that has a lipophilic side chain that gives it a long half-life, allowing weekly or every two weeks administration [1–3]. It has been approved for the treatment of skin and soft tissue infections [2]. Its innovative posology could offer great advantages in the consolidation treatment of infections that require prolonged antibiotic treatment, such as infective endocarditis (IE), and osteoarticular infection [3–5].
Læs mere Tjek på PubMedBMC Infectious Diseases, 4.11.2023
Tilføjet 4.11.2023
Abstract Background Neurological disorders are still prevalent in HIV-infected people. We aimed to determine the prevalence of neurological disorders and identify their risk factors in HIV-infected persons in Taiwan. Methods We identified 30,101 HIV-infected people between 2002 and 2016 from the National Health Insurance Research Database in Taiwan, and analyzed the incidence of neurological disorders. We applied a retrospective, nested case–control study design. The individuals with (case group) and without (control group) a neurological disorder were then matched by age, sex and time. Factors associated with neurological disorders were analyzed using a conditional logistic regression model, and a nomogram was generated to estimate the risk of developing a neurological disorder. Results The incidence of neurological disorders was 13.67 per 1000 person-years. The incidence remained stable during the observation period despite the use of early treatment and more tolerable modern anti-retroviral therapy. The conditional logistic regression model identified nine clinical factors and comorbidities that were associated with neurological disorders, namely age, substance use, traumatic brain injury, psychiatric illness, HIV-associated opportunistic infections, frequency of emergency department visits, cART adherence, urbanization, and monthly income. These factors were used to establish the nomogram. Conclusion Neurological disorders are still prevalent in HIV-infected people in Taiwan. To efficiently identify those at risk, we established a nomogram with nine risk factors. This nomogram could prompt clinicians to initiate further evaluations and management of neurological disorders in this population.
Læs mere Tjek på PubMedBMC Infectious Diseases, 4.11.2023
Tilføjet 4.11.2023
Abstract Background Tetanus is a life-threatening vaccine-preventable disease found more commonly in tropical climates. It accounted for up to 60 deaths annually until the introduction of the tetanus toxoid. It is now rare in Canada by immunization. This study aims to describe a case of tetanus in Saskatchewan with possible occupational exposure. Case Report We describe the case of a vaccinated soil expert with tetanus resulting from skin abrasions. This report highlights the early diagnosis, atypical presentation with possible vaccine attenuation and management approach, including acute care, intensive care unit referral, surgical management and physical rehabilitation. We also describe the public health management provided in this case. Despite the severity, the patient returned to his previous home environment with minimal motor sequelae. Conclusion Occupational exposure to tetanus is an important risk, even in regions where the disease is rare. Prevention through vaccination is a key public health intervention that must be encouraged to avoid health complications that are often fatal.
Læs mere Tjek på PubMedInternational Journal for Parasitology, 4.11.2023
Tilføjet 4.11.2023
Publication date: Available online 3 November 2023 Source: International Journal for Parasitology Author(s): Christa M. Seidl, Francisco C. Ferreira, Katy L. Parise, Kristina L. Paxton, Eben H. Paxton, Carter T. Atkinson, Robert C. Fleischer, Jeffrey T. Foster, A. Marm Kilpatrick
Læs mere Tjek på PubMedDavid Niklas Springer, Elisabeth Reuberger, Christian Borsodi, Elisabeth Puchhammer‐Stöckl, Lukas Weseslindtner
Journal of Medical Virology, 4.11.2023
Tilføjet 4.11.2023
Tahoora Abdolahi, Gholamali Maamouri, Maryam Behmadi, Sara Mirzaeian, Hassan Boskabadi, Raheleh Faramarzi
Journal of Medical Virology, 4.11.2023
Tilføjet 4.11.2023
Immunity, 4.11.2023
Tilføjet 4.11.2023
Publication date: Available online 3 November 2023 Source: Immunity Author(s): Ruoke Wang, Yang Han, Rui Zhang, Jiayi Zhu, Xuanyu Nan, Yaping Liu, Ziqing Yang, Bini Zhou, Jinfang Yu, Zichun Lin, Jinqian Li, Peng Chen, Yangjunqi Wang, Yujie Li, Dongsheng Liu, Xuanling Shi, Xinquan Wang, Qi Zhang, Yuhe R. Yang, Taisheng Li
Læs mere Tjek på PubMedOlivier Paccoud, Xavier Chamillard, Eric Kendjo, Isabelle Vinatier, Laure Surgers, Denis Magne, Benjamin Wyplosz, Adéla Angoulvant, Olivier Bouchaud, Arezki Izri, Sophie Matheron, Sandrine Houzé, Marc Thellier, Alioune P. Ndour, Pierre Buffet, Eric Caumes, Stéphane Jauréguiberry, French National Reference Center for Imported Malaria Study Group
International Journal of Infectious Diseases, 4.11.2023
Tilføjet 4.11.2023
Post-artesunate delayed haemolysis (PADH) is a common non-recurring adverse effect of artesunate during severe P.falciparum malaria, which occurs after the first week of treatment in an estimated 10-30% of cases in non-immune travelers [1,2]. Reports of positive direct antiglobulin tests (DAT) in patients experiencing PADH suggest an immune-driven process [1,3]. In a systematic review, 44% of patients with PADH had a positive DAT [4]. Most prior reports focused only on patients experiencing PADH and not other patients with severe malaria.
Læs mere Tjek på PubMedLee, Laurie A.; Foster, Jennifer R.; Nikitovic, Dejana; Garros, Daniel; Ryan, Molly J.; Moghadam, Neda; Slumkoski, Corey; Walls, Martha; Curran, Janet A.; Seabrook, Jamie A.; Burgess, Stacy; Betts, Laura; Barclay, Amanda; Choong, Karen; Fontela, Patricia; Murthy, Srinivas; Nicoll, Jessica; O’Hearn, Katie; Sehgal, Anupam; Tijssen, Janice; for the Canadian Critical Care Trials Group
Critical Care Explorations, 4.11.2023
Tilføjet 4.11.2023
CONTEXT: PICUs across Canada restricted family presence (RFP) in response to the COVID-19 pandemic from allowing two or more family members to often only one family member at the bedside. The objective of this study was to describe the experiences and impact of RFP on families of critically ill children to inform future policy and practice. HYPOTHESIS: RFP policies negatively impacted families of PICU patients and caused moral distress. METHODS AND MODELS: National, cross-sectional, online, self-administered survey. Family members of children admitted to a Canadian PICU between March 2020 and February 2021 were invited to complete the survey. RFP-attributable distress was measured with a modified distress thermometer (0–10). Closed-ended questions were reported with descriptive statistics and multivariable linear regression assessed factors associated with RFP-attributable distress. Open-ended questions were analyzed using inductive content analysis. RESULTS: Of 250 respondents who experienced RFP, 124 (49.6%) were restricted to one family member at the bedside. The median amount of distress that families attributed to RFP policies was 6 (range: 0–10). Families described isolation, removal of supports, and perception of trauma related to RFP. Most families (183, 73.2%) felt that policies were enforced in a way that made them feel valued by PICU clinicians, which was associated with less RFP-attributable distress. Differential impact was seen where families with lower household income indicated higher RFP-attributable distress score (2.35; 95% CI, 0.53–4.17; p = 0.03). Most respondents suggested that future policies should allow at least two family members at the bedside. INTERPRETATIONS AND CONCLUSIONS: Families of children admitted to PICUs during the COVID-19 pandemic described increased distress, trauma, and removal of supports due to RFP policies. Vulnerable families showed an increased odds of higher distress. Healthcare professionals played an important role in mitigating distress. Allowance of at least two family members at the bedside should be considered for future policy.
Læs mere Tjek på PubMedRamadurai, Deepa; Kohn, Rachel; Hart, Joanna L.; Scott, Stefania; Kerlin, Meeta Prasad
Critical Care Explorations, 4.11.2023
Tilføjet 4.11.2023
OBJECTIVES: To evaluate the association of race with proportion of time in deep sedation among mechanically ventilated adults. DESIGN: Retrospective cohort study from October 2017 to December 2019. SETTING: Five hospitals within a single health system. PATIENTS: Adult patients who identified race as Black or White who were mechanically ventilated for greater than or equal to 24 hours in one of 12 medical, surgical, cardiovascular, cardiothoracic, or mixed ICUs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The exposure was White compared with Black race. The primary outcome was the proportion of time in deep sedation during the first 48 hours of mechanical ventilation, defined as Richmond Agitation-Sedation Scale values of –3 to –5. For the primary analysis, we performed mixed-effects linear regression models including ICU as a random effect, and adjusting for age, sex, English as preferred language, body mass index, Elixhauser comorbidity index, Laboratory-based Acute Physiology Score, Version 2, ICU admission source, admission for a major surgical procedure, and the presence of septic shock. Of the 3337 included patients, 1242 (37%) identified as Black, 1367 (41%) were female, and 1002 (30%) were admitted to a medical ICU. Black patients spent 48% of the first 48 hours of mechanical ventilation in deep sedation, compared with 43% among White patients in unadjusted analysis. After risk adjustment, Black race was significantly associated with more time in early deep sedation (mean difference, 5%; 95% CI, 2–7%; p < 0.01). CONCLUSIONS: There are disparities in sedation during the first 48 hours of mechanical ventilation between Black and White patients across a diverse set of ICUs. Future work is needed to determine the clinical significance of these findings, given the known poorer outcomes for patients who experience early deep sedation.
Læs mere Tjek på PubMedSeymour, Christopher W.; Urbanek, Kelly Lynn; Nakayama, Anna; Kennedy, Jason N.; Powell, Rachel; Robinson, Renã A.S.; Kapp, Kathryn L.; Billiar, Timothy R.; Vodovotz, Yoram; Gelhaus, Stacy L.; Cooper, Vaughn S.; Tang, Lu; Mayr, Flo; Reitz, Katherine M.; Horvat, Christopher; Meyer, Nuala J.; Dickson, Robert P.; Angus, Derek; Palmer, Octavia Peck
Critical Care Explorations, 4.11.2023
Tilføjet 4.11.2023
BACKGROUND: Sepsis is a common and deadly syndrome, accounting for more than 11 million deaths annually. To mature a deeper understanding of the host and pathogen mechanisms contributing to poor outcomes in sepsis, and thereby possibly inform new therapeutic targets, sophisticated, and expensive biorepositories are typically required. We propose that remnant biospecimens are an alternative for mechanistic sepsis research, although the viability and scientific value of such remnants are unknown. METHODS AND RESULTS: The Remnant Biospecimen Investigation in Sepsis study is a prospective cohort study of 225 adults (age ≥ 18 yr) presenting to the emergency department with community sepsis, defined as sepsis-3 criteria within 6 hours of arrival. The primary objective was to determine the scientific value of a remnant biospecimen repository in sepsis linked to clinical phenotyping in the electronic health record. We will study candidate multiomic readouts of sepsis biology, governed by a conceptual model, and determine the precision, accuracy, integrity, and comparability of proteins, small molecules, lipids, and pathogen sequencing in remnant biospecimens compared with paired biospecimens obtained according to research protocols. Paired biospecimens will include plasma from sodium–heparin, EDTA, sodium fluoride, and citrate tubes. CONCLUSIONS: The study has received approval from the University of Pittsburgh Human Research Protection Office (Study 21120013). Recruitment began on October 25, 2022, with planned release of primary results anticipated in 2024. Results will be made available to the public, the funders, critical care societies, laboratory medicine scientists, and other researchers.
Læs mere Tjek på PubMedKaplan, Lewis J.; Levin, Scott; Yelon, Jay; Cannon, Jeremy M.; Mehta, Samir; Reilly, Patrick M.; Kovach, Stephen J. III; Donegan, Derek J.; Claycomb, Kierstyn; Savchenko-Fullerton, Maisie; Filonenko, Evhen; Maiko, Vyacheslav; Kuzmov, Roman; Radega, Yaroslav; Pashinskiy, Viktor; Demyan, Yuriy Yurievich; Plesha, Petro; Demyan, Yuriy; Vinnytskiy, Dmytro; Gaulton, Glen N.; Brennan, Patrick J.
Critical Care Explorations, 4.11.2023
Tilføjet 4.11.2023
Humanitarian crises create opportunities for both in-person and remote aid. Durable, complex, and team-based care may leverage a telemedicine approach for comprehensive support within a conflict zone. Barriers and enablers are detailed, as is the need for mission expansion due to initial program success. Adapting a telemedicine program initially designed for critical care during the severe acute respiratory syndrome coronavirus 2 pandemic offers a solution to data transfer and data analysis issues. Staffing efforts and grouped elements of patient care detail the kinds of remote aid that are achievable. A multiprofessional team-based approach (clinical, administrative, nongovernmental organization, government) can provide comprehensive consultation addressing surgical planning, critical care management, infection and infection control management, and patient transfer for complex care. Operational and network security create parallel concerns relevant to avoid geolocation and network intrusion during consultation. Deliberate approaches to address cultural differences that influence relational dynamics are also essential for mission success.
Læs mere Tjek på PubMed