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American Journal of Tropical Medicine and Hygiene, 5.09.2024
Tilføjet 5.09.2024
Journal Name: The American Journal of Tropical Medicine and Hygiene Volume: 111 Issue: 3 Pages: 546-553
Læs mere Tjek på PubMedYiyun Xu Ji Wang Xiaosong Qin Jianhua Liu Department of Laboratory Medicine, Shengjing Hospital of China Medical University, Liaoning Clinical Research Center for Laboratory Medicine, Shenyang, China
Virulence, 28.08.2024
Tilføjet 28.08.2024
BMC Infectious Diseases, 27.08.2024
Tilføjet 27.08.2024
Abstract Cryptococcal infection of central nervous system commonly involves meningitis or meningoencephalitis, but rarely mimics inflammatory myelitis. We present short segment myelitis as a dominant manifestation caused by Cryptococcus neoformans in a patient with nephrotic syndrome under immunosuppressive therapy. This case report highlights Cryptococcus neoformans as a potential etiological factor for short segment myelitis in immunocompromised hosts.
Læs mere Tjek på PubMedPelle Trier Petersen, Jacob Bodilsen, Micha Phill Grønholm Jepsen, Lykke Larsen, Merete Storgaard, Birgitte Rønde Hansen, Jannik Helweg-Larsen, Lothar Wiese, Hans Rudolf Lüttichau, Christian Østergaard Andersen, Henrik Nielsen, Christian Thomas Brandt, the Danish Study Group of Infections of the Brain (DASGIB)
Clinical Microbiology and Infection, 23.08.2024
Tilføjet 23.08.2024
To investigate whether there is a dose-dependent association between empiric dexamethasone and outcome in viral meningitis.
Læs mere Tjek på PubMedMuttalib, F., Memon, Z. A., Muhammad, S., Soomro, A., Khan, S., Bano, S., Jawwad, M., Soofi, S., Hansen, B., Adhikari, N. K., Bhutta, Z.
BMJ Open, 23.08.2024
Tilføjet 23.08.2024
ObjectiveTo describe presenting diagnoses and rates and causes of death by age category and sex among children with acute illness brought to a district headquarter hospital in Pakistan. DesignProspective cohort study. SettingSanghar district headquarter hospital, Sindh, Pakistan between December 2019 and April 2020 and August 2020 and December 2020. Participants3850 children 0–14 years presenting with acute illness to the emergency and outpatient departments and 1286 children admitted to the inpatient department. Outcome measuresThe primary outcome was Global Burden of Disease diagnosis category. Secondary outcomes were 28-day mortality rate, cause of death and healthcare delays, defined as delay in care-seeking, delay in reaching the healthcare facility and delay in appropriate treatment. ResultsCommunicable diseases were the most common presenting diagnoses among outpatients and among inpatients aged 1 month to 9 years. Non-communicable diseases and nutritional disorders were more common with increasing age. Few children presented with injuries. Newborn period (age
Læs mere Tjek på PubMedJournal of Infectious Diseases, 20.08.2024
Tilføjet 20.08.2024
Abstract Cryptococcus neoformans, Cryptococcus gattii and Candida albicans are opportunistic fungal pathogens associated with infections in immunocompromised hosts. Cryptococcal meningitis (CM) is the leading fungal cause of HIV-related deaths globally, with the majority occurring in Africa. The human immune response to C. albicans infection has been studied extensively in large genomics studies whereas cryptococcal infections, despite their severity, are comparatively understudied. Here we investigated the transcriptional response of immune cells after in vitro stimulation with in vitro C. neoformans, C. gattii and C. albicans infection of peripheral blood mononuclear cells (PBMCs) collected from healthy South African volunteers. We found a lower transcriptional response to cryptococcal stimuli compared to C. albicans and unique expression signatures from all three fungal stimuli. This work provides a starting point for further studies comparing the transcriptional signature of CM in immunocompromised patients, with the goal of identifying biomarkers of disease severity and possible novel treatment targets.
Læs mere Tjek på PubMedClinical Infectious Diseases, 15.08.2024
Tilføjet 15.08.2024
Abstract Background In mid-2018, the Australian childhood 13-valent pneumococcal conjugate vaccine schedule changed from 3+0 to 2+1, moving the third dose to 12 months of age, to address increasing breakthrough cases of invasive pneumococcal disease (IPD), predominantly in children aged >12 months. This study assessed the impact of this change using national IPD surveillance data.Methods Pre- and postschedule change 3-dose 13-valent pneumococcal conjugate vaccine breakthrough cases were compared by age group, serotype, and clinical syndrome. Annual rates of breakthrough cases were calculated (per 100 000) using respective birth cohort sizes and 3-dose vaccine coverage. Using time-series modelling, observed IPD rates in children aged 12 months was 2.8 per 100 000 (n = 557; 11 birth cohorts). Serotype 3 replaced 19A as predominant breakthrough serotype (respectively, 24% and 65% in 2013 to 60% and 20% in 2022) followed by 19F. In breakthrough cases, the most frequent clinical phenotype was bacteremic pneumonia (69%), with meningitis accounting for 3%–4%. In cohorts eligible for 2+1 versus 3+0 schedules, rate of breakthrough cases was lower for all vaccine serotypes, except type 3 (incidence rate ratio, 0.50 [95% confidence interval, .28–.84] and 1.12 [0.71–1.76], respectively). Observed compared to expected IPD was 51.7% lower (95% confidence interval, −60.9 to −40.7%) for vaccine serotypes, but the change for nonvaccine types was not significant 12% (−9.6 to 39.7).Interpretations The 2+1 schedule is likely superior to 3+0 for overall IPD control, a finding that may be worth consideration for other countries considering or using 3+0 PCV schedules.
Læs mere Tjek på PubMedMusa Mohammed Ali
PLoS One Infectious Diseases, 10.08.2024
Tilføjet 10.08.2024
by Musa Mohammed Ali Background Meningitis poses a significant challenge to public health in low-income nations, such as Ethiopia, with a particular impact on newborns. The magnitude and etiologies of meningitis vary based on geographic location and age of patients. There is limited data regarding the magnitude and etiology of meningitis from Sidama Regional State, Ethiopia. This study aimed to determine the magnitude and bacterial profile of meningitis among newborns aged less than 90 days at Hawassa University Comprehensive Specialized Hospital (HUCSH). Methods A retrospective cross-sectional study was conducted among newborns under 90 days who were suspected of meningitis at HUCSH from January 2019 to July 2023, and for whom Cerebrospinal fluid (CSF) culture was performed. At HUCSH, bacteria are isolated and identified using standard microbiological techniques. Socio-demographic characteristics and culture results were extracted from the laboratory register. Data were entered into Excel and exported it to SPSS version 20 for analysis. Results Overall 1061 newborns suspected of meningitis were included in the study. Among the participants, 767 individuals (72.3%) fell within the age range of 8 to 90 days. Of the total participants, 437 (41.2%) were females. The magnitude of culture-confirmed meningitis was 90(8.5%) 95% CI: 6.8%−10.1%. The magnitude of culture-confirmed meningitis among newborns aged 0−7 days and 8−90 days were 1.6% and 6.9% respectively. The proportion of bacteria among newborns aged 0−7 days and 8−90 days were 18.9% and 81.1% respectively. Coagulase-negative Staphylococci (CONS) were the most common bacteria (n = 26; 28.9%) recovered followed by Acinetobacter species (n = 12, 13.3%), Escherichia coli (n = 9; 10%), and Klebsiella pneumoniae (n = 7; 7.8%). K. pneumoniae was the predominant bacteria among newborns within the age group of 0 to 7 days while Acinetobacter species was the most common among newborns within the 8 to 90 days age group. The prevalence of culture-confirmed neonatal meningitis was found to be greater in male newborns (x2 = 1.74, p = 0.18), newborns aged between 8 to 90 days (x2 = 0.07, p = 3.4), and newborns admitted in 2022 (x2 = 2.4, p = 0.66), Conclusions In this study, the overall magnitude of culture-confirmed meningitis was relatively high. Culture-confirmed meningitis was high in newborns within the age range of 8 to 90 days. The most common bacteria were CONS in both age groups followed by Acinetobacter species, E. coli, and K. pneumoniae.
Læs mere Tjek på PubMedGroeneveld, N. S., Bijlsma, M. W., van Zeggeren, I. E., Staal, S. L., Tanck, M. W. T., van de Beek, D., Brouwer, M. C.
BMJ Open, 8.08.2024
Tilføjet 8.08.2024
ObjectivesDiagnostic prediction models exist to assess the probability of bacterial meningitis (BM) in paediatric patients with suspected meningitis. To evaluate the diagnostic accuracy of these models in a broad population of children suspected of a central nervous system (CNS) infection, we performed external validation. MethodsWe performed a systematic literature review in Medline to identify articles on the development, refinement or validation of a prediction model for BM, and validated these models in a prospective cohort of children aged 0–18 years old suspected of a CNS infection. Primary and secondary outcome measuresWe calculated sensitivity, specificity, predictive values, the area under the receiver operating characteristic curve (AUC) and evaluated calibration of the models for diagnosis of BM. ResultsIn total, 23 prediction models were validated in a cohort of 450 patients suspected of a CNS infection included between 2012 and 2015. In 75 patients (17%), the final diagnosis was a CNS infection including 30 with BM (7%). AUCs ranged from 0.69 to 0.94 (median 0.83, interquartile range [IQR] 0.79–0.87) overall, from 0.74 to 0.96 (median 0.89, IQR 0.82–0.92) in children aged ≥28 days and from 0.58 to 0.91 (median 0.79, IQR 0.75–0.82) in neonates. ConclusionsPrediction models show good to excellent test characteristics for excluding BM in children and can be of help in the diagnostic workup of paediatric patients with a suspected CNS infection, but cannot replace a thorough history, physical examination and ancillary testing.
Læs mere Tjek på PubMedAmerican Journal of Tropical Medicine and Hygiene, 8.08.2024
Tilføjet 8.08.2024
Journal Name: The American Journal of Tropical Medicine and Hygiene Volume: 111 Issue: 2 Pages: 251-258
Læs mere Tjek på PubMedBMC Infectious Diseases, 7.08.2024
Tilføjet 7.08.2024
Abstract Introduction Intracranial fungal infections’ (IcFIs) varying clinical manifestations lead to difficulties in diagnosis and treatment. African populations are disproportionately affected by the high burden of the disease. There is a lack of clarity as to the diagnostic and treatment modalities employed across the continent. In this review, we aim to detail the management, and outcome of IcFIs across Africa. Methods This scoping review was conducted using the Arksey and O\'Malley framework. MEDLINE, EMBASE, Cochrane Library, African Index Medicus, and African Journals Online were searched for relevant articles from database inception to August 10th, 2021. The Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews guidelines were used to report the findings of the review. Results Of the 5,779 records identified, 131 articles were included. The mean age was 35.6 years, and the majority (56.4%) were males. The majority (n = 8,433/8,693, 97.0%) of IcFIs presented as a meningitis, the most common communicable predisposing factor of IcFIs was HIV/AIDS (n = 7,815/8,693, 89.9%), and the most common non-communicable risk factor was diabetes mellitus (n = 32/8,693, 0.4%). Cryptococcus species was the most common (n = 8,428/8,693, 97.0%) causative organism. The most commonly used diagnostic modality was cerebrospinal (CSF) cultures (n = 4,390/6,830, 64.3%) for diffuse IcFIs, and MRI imaging (n = 12/30, 40%) for focal IcFIs. The most common treatment modality was medical management with antifungals only (n = 4,481/8,693, 51.6%). The most commonly used antifungal agent in paediatric, and adult patients was amphotericin B and fluconazole dual therapy (51.5% vs 44.9%). The overall mortality rate was high (n = 3,475/7,493, 46.3%), and similar for both adult and paediatric patients (47.8% vs 42.1%). Conclusion Most IcFIs occurred in immunosuppressed individuals, and despite the new diagnostic techniques, CSF culture was mostly used in Africa. Antifungals regimens used was similar between children and adults. The outcome of IcFIs in Africa was poor for both paediatric and adult patients.
Læs mere Tjek på PubMedJournal of Infectious Diseases, 31.07.2024
Tilføjet 31.07.2024
Abstract Introduction There is no licensed vaccine against gonorrhea but Neisseria meningitidis serogroup B outer membrane vesicle-based vaccines, like MenB-4C, may offer cross-protection against gonorrhea. This systematic review and meta-analysis synthesized the published literature on MenB-4C vaccine effectiveness against gonorrhea.Methods We conducted a literature search of electronic databases (PubMed, Medline, Embase, Global Health, Scopus, Google Scholar, CINAHL, and Cochrane Library) to identify peer-reviewed papers, published in English, from 1/1/2013–7/12/2024 that reported MenB-4C vaccine effectiveness estimates against gonorrhea and gonorrhea/chlamydia co-infection, and the duration of MenB-4C vaccine-induced protection. We estimated pooled MenB-4C vaccine effectiveness (≥1 dose) against gonorrhea using the DerSimonian-Laird random effects model.Results Eight papers met our eligibility criteria. Receipt of ≥1 dose of MenB-4C vaccine was 23%–47% effective against gonorrhea. Two doses of MenB-4C vaccine were 33–40% effective against gonorrhea and one dose of MenB-4C vaccine was 26% effective. MenB-4C vaccine effectiveness against gonorrhea/chlamydia co-infection was mixed with two studies reporting effectiveness estimates of 32% and 44%, and two other studies showing no protective effect. MenB-4C vaccine effectiveness against gonorrhea was comparable in people living with HIV (44%) and people not living with HIV (23%–47%). Pooled MenB-4C vaccine effectiveness (≥1 dose) against gonorrhea was 32.4%. One study concluded that MenB-4C vaccine effectiveness against gonorrhea may wane approximately 36 months post-vaccination.Conclusion MenB-4C vaccine is moderately effective against gonorrhea in various populations. Prospective clinical trials that assess the efficacy of MenB-4C against gonorrhea, gonorrhea/chlamydia co-infection, and duration of protection are warranted to strengthen this evidence.
Læs mere Tjek på PubMedClinical Infectious Diseases, 25.07.2024
Tilføjet 25.07.2024
Abstract Background Cryptococcal meningitis is a leading cause of AIDS-related mortality. Cryptococcal antigen (CrAg) predicts the development of meningitis. Historically, despite standard- of-care fluconazole, 25%–30% of asymptomatic CrAg-positive persons develop breakthrough meningitis or death. We evaluated whether adding single high-dose liposomal amphotericin B to standard pre-emptive fluconazole therapy could improve meningitis-free survival.Methods Participants with human immunodeficiency virus (HIV) and asymptomatic cryptococcal antigenemia in Uganda were randomized to liposomal amphotericin B (10 mg/kg once) with fluconazole or fluconazole alone through 24 weeks. We compared 24-week, meningitis-free survival time between treatment groups. After the second interim review, the Data Safety and Monitoring Board recommended no further enrollment of participants with low plasma CrAg lateral flow assay titers (≤1:80) due to futility. Herein, we present the results of participants with low plasma CrAg titers.Results 168 participants enrolled into the ACACIA trial had low plasma CrAg titers (≤1:80). During 24 weeks of follow-up, meningitis or death occurred in 14.5% (12/83) of participants randomized to liposomal amphotericin B with fluconazole versus 10.6% (9/85) assigned to fluconazole alone (hazard ratio, 1.42; 95% CI, .60–3.36; P = .431). Adverse events were more frequent in participants assigned to the intervention versus standard-of-care (28% vs 12%; P = .011).Conclusions Among CrAg-positive persons with low titers (≤1:80), the addition of single-dose liposomal amphotericin B to fluconazole as pre-emptive therapy provided no additional clinical benefit. This trial provides supportive evidence that, in asymptomatic populations with low plasma CrAg titers, lumbar punctures are likely unnecessary as administration of meningitis treatment did not improve outcomes.Clinical Trials Registration Clinicaltrials.gov (NCT03945448).
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