Abstract
Background:
Effective antibiotic stewardship programing in clinical settings necessitates a good understanding of local prevalences of antimicrobial resistance and important patient and community risk factors. However, most studies are limited in sample size and geographic coverage.
Methods:
This study utilized phenotypic resistance data of Escherichia coli from the Veteran’s Health Administration of the United States (U.S.), incorporating 126,777 unique cultures from veteran outpatients from seven Midwest states from 2010 to 2023, to examine the spatial pattern and important individual- and county-level risk factors for resistance to four important classes of antibiotics. We utilized Bayesian conditional autoregressive zero-inflated Poisson regression models to generate smoothed rates of resistance in each county and multilevel logistic regression models to detect risk factors for resistance.
Results:
High overall rates of resistance were seen for fluoroquinolone (29%) and TMP-SMX (22%). Geographic variation was seen among and between antibiotic classes. Certain urban regions in the southern parts of Illinois, Indiana, and Ohio had higher local resistance rates for fluoroquinolone and TMP-SMX. Being male, having diabetes, and previous exposure to antibiotics are significant risk factors for all classes of antibiotics while the significance of other risk factors varied across classes.
Conclusion:
Diverse geographic patterns of resistance level may reflect differences in local prescribing practices, while the differential correlations with risk factors likely reflect their clinical indications and prescribing patterns in clinical settings. The local resistance rates and risk factors for different classes of antibiotics should provide important guidance in practicing empirical prescribing and antibiotic stewardship in clinical settings.
Infectious and parasitic diseases, Public aspects of medicine
This study was aimed at investigating the viral diversity associated with marine organisms in the South China Sea, to improve understanding of the region’s viral ecosystems. Viruses profoundly influence aquatic ecosystems, by affecting marine biogeochemical cycles and posing threats to marine organisms. Nonetheless, a comprehensive study of marine organisms’ viral diversity in the South China Sea remains lacking. We collected gill and viscera tissue samples from three marine phyla ( Chordata , Arthropoda , and Mollusca ) along the South China Sea coast. High-throughput sequencing and bioinformatics analyses were conducted to identify and characterize viral communities within these samples, with a focus on both viral composition and potential zoonotic threats. We observed distinct viral composition patterns across tissues and phyla, notably involving Adintoviridae and viruses within the Herpesviridae and Dicistroviridae . The presence of zoonotic viruses in economically important aquatic organisms suggests potential risks. This study contributes to broader understanding of viral diversity, by suggesting potential epidemic causes and illustrating genetic relationships among viruses associated with marine organisms. By extending the virus distribution map for this region, our findings underscore the need to consider the viral microenvironments surrounding marine species, and their implications for marine and human health.
Infectious and parasitic diseases, Veterinary medicine
Abstract Objective To investigate risk factors associated with long-term mortality in patients with stage II and III tuberculous meningitis (TBM). Methods This retrospective analysis examined patients who were first diagnosed with stage II and III TBM at West China Hospital of Sichuan University between January 1, 2018 and October 1, 2019. Patients were followed via telephone and categorized into survival and mortality groups based on 4-year outcomes. Multivariate logistic regression identified independent risk factors for long-term mortality in stage II and III TBM. Results In total, 178 patients were included, comprising 108 (60.7%) males and 36 (20.2%) non-survivors. Mean age was 36 ± 17 years. Compared to survivors, non-survivors demonstrated significantly higher age, heart rate, diastolic blood pressure, blood glucose, rates of headache, neurological deficits, cognitive dysfunction, impaired consciousness, hydrocephalus, and basal meningeal inflammation. This group also exhibited significantly lower Glasgow Coma Scale (GCS) scores, blood potassium, albumin, and cerebrospinal fluid chloride. Multivariate analysis revealed age (OR 1.042; 95% CI 1.015–1.070; P = 0.002), GCS score (OR 0.693; 95% CI 0.589–0.814; P < 0.001), neurological deficits (OR 5.204; 95% CI 2.056–13.174; P < 0.001), and hydrocephalus (OR 2.680; 95% CI 1.081–6.643; P = 0.033) as independent mortality risk factors. The ROC curve area under age was 0.613 (95% CI 0.506–0.720; P = 0.036) and 0.721 (95% CI 0.615–0.826; P < 0.001) under GCS score. Conclusion Advanced age, reduced GCS scores, neurological deficits, and hydrocephalus were identified as independent risk factors for mortality in stage II and III TBM patients.
Isadora de Lima Xavier Andrade, Percival Henrique de Sousa Fernandes, Alexandre Albuquerque Bertucci
et al.
Introdução: Comprometimento gástrico pode ocorrer em doenças oportunísticas na AIDS, tanto de origem neoplásica quanto infecciosa. Linfoma gástrico, Sarcoma de Kaposi, infecção por citomegalovírus têm sido as mais relatadas. Objetivo: Relatar um caso de histoplasmose disseminada com acometimento do estômago como primeira manifestação de AIDS. Relato de caso: Homem, 64 anos, natural de Regente Feijó/SP e procedente de São Gabriel do Oeste/MS, trabalha como caseiro de fazenda, limpeza de terrenos e de galinheiro. Referia, à admissão, dor em andar superior do abdômen há 20 dias, com piora progressiva da intensidade. Além de sensação febril e calafrios diários em período vespertino, adinamia e perda ponderal de 11 kg em 2 meses. Referiu também tosse seca. Negava comorbidades. Ao exame físico apresentava-se com Índice de Massa Corporal (IMC) de 14,9, abdome escavado, doloroso à palpação superficial e profunda de hipocôndrio direito, sem hepatoesplenomegalia palpável. O hemograma à admissão era normal. A sorologia de HIV foi positiva e a contagem de células CD4+ foi de 29 células/mm3, a carga viral do HIV foi de 833.386 cópias/mL. Foi submetido à endoscopia digestiva alta que evidenciou lesão gástrica úlcero-infiltrativa sugerindo neoplasia gástrica avançada com classificação endoscópica de Borrmann III. O exame Histopatológico (HP) descartou malignidade e estruturas fúngicas leveduriformes sugestivas de Histoplasma capsulatum foram visualizadas na coloração de Grocott. A tomografia de tórax mostrou incontáveis nódulos e massas pulmonares esparsas por todos os lobos pulmonares, algumas com escavações centrais e vidro-fosco periférico. O HP de uma massa pulmonar biopsiada também revelou presença de presença de estruturas sugestivas de H. capsulatum. A sorologia de H. capsulatum por imunodifusão dupla foi positiva com titulação de 1:16 e antigenúria foi detectada pelo teste rápido. As culturas da mucosa gástrica, da massa pulmonar e do aspirado de medula óssea foram positivas para H. capsulatum. Foi iniciado tratamento com itraconazol VO 600 mg/dia por 3 dias e após 400 mg/dia. O paciente apresentou melhora clínica e alta hospitalar após 14 dias para seguimento ambulatorial. Conclusão: O caso ressalta a importância da histoplasmose ser investigada como causa de lesões gástricas em pacientes com AIDS, mesmo em pacientes sem hepato-esplenomegalia e com hemograma normal.
Acute nonbacterial gastroenteritis is ubiquitous, and noroviruses are considered to be among the most common etiological agents. Noroviruses affect people of all ages. As a rule, infections caused by them are mild and self-limiting within 1-3 days but there is always a risk of a more severe course, especially in infants and the elderly. Being considered as mild and fast transient, noroviruses receive less attention than other infectious pathogens. The clinical and economic burden of norovirus gastroenteritis is often underestimated. Detection of the etiological role of noroviruses is essential not only from the clinical point of view, but also from the economic one because of the damage that norovirus infections cause to tourism and food industry. At present, prevention and counter disinfection measures are the only weapon against norovirus infections. In this narrative review, results from a non-systematic search on the recent literature on noroviruses are presented. The review describes the basic biological characteristics of noroviruses, their genetic diversity and current classification, as well as the epidemiological aspects of the norovirus infection, its clinical manifestation, the diagnostic approaches, prevention and control measures and current state-of-the art for norovirus vaccine development.
Measles is a highly contagious, acute febrile illness that results from infection with measles virus (MV). MV is a single-stranded, negative-sense RNA virus in the genus Morbillivirus of the family Paramyxoviridae. The wild-type MV consists of 24 genotypes, three of them (B3, D8 an H1) have dominated circulation in the world. MV is transmitted by the respiratory route and illness begins with fever, cough, conjunctivitis followed by a rash and measles enanthem (Koplik spot). Laboratory confirmation of measles is provided by serological (ELISA test for detection of IgM and IgG antibodies), molecular (detection of viral nucleic acid) and viral isolation in Vero/hSLAM cells methods. As a vaccine-preventable infection, measles has a global importance and is a target of WHO strategic goals in the European region. Despite significant progress in measles control in recent years, it is necessary to improve the national vaccination coverage, and the epidemiological and laboratory monitoring of the infection. High vaccination coverage across all of the population is crucial to reach the goals of measles elimination.
Yue Wang,1 Qun Lin,1 Zhongju Chen,1 Hongyan Hou,1 Na Shen,1 Zhen Wang,2 Feng Wang,1 Ziyong Sun1 1Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China; 2Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of ChinaCorrespondence: Ziyong SunDepartment of Laboratory Medicine, Tongji Hospital, No. 1095 Jiefang Avenue, Wuhan, Hubei Province, 430030, People’s Republic of ChinaEmail zysun@tjh.tjmu.edu.cnBackground: To establish a risk prediction model for carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infection (BSI) in intestinal carriers.Methods: CRE screenings were performed every two weeks in hematology department and intensive care unit (ICU). Patients with positive CRE rectal swab screening were identified using electronic medical records from 15 May 2018 to 31 December 2019. Intestinal carriers who developed CRE BSI were compared with those who did not develop CRE infection. A 1:1 matched case-control study was conducted. The control group was selected by stratified random sampling based on the department to ensure that all the departments were represented. Univariate logistic analysis, multivariate logistic analysis and stepwise regression analysis were carried on a variety of patient factors and microbial factors.Results: A total of 42 cases were included. Multivariate analysis showed that gastrointestinal injury (OR 86.819, 95% CI 2.584– 2916.592, P=0.013), tigecycline exposure (OR 14.991, 95% CI 1.816– 123.737, P=0.012) and carbapenem resistance score (OR 11.236, 95% CI 1.811– 69.700, P=0.009) were independent risk factors for CRE BSI in intestinal carriers (P< 0.050). They were included in the Logistic regression model to predict BSI. According to receiver operating characteristic (ROC) curve analysis, the cut-off value of the model was 0.722, and the sensitivity, specificity and area under the curve (AUC) were 90.5%, 85.7% and 0.921, respectively.Conclusion: The risk prediction model based on gastrointestinal injury, tigecycline exposure and carbapenem resistance score of colonizing strain can effectively predict CRE BSI in patients with CRE colonization. Early CRE screening and detection for inpatients in key departments may promote early warning and reduce the risk of nosocomial infection of CRE.Keywords: carbapenem-resistant Enterobacteriaceae, colonization, bloodstream infection, risk factor, risk prediction model
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is the cause of the current global pandemic and has affected more than 188 countries worldwide. Infection by the virus can have diverse clinical manifestations, with one of the most severe clinical manifestation being respiratory failure and the development of acute respiratory distress syndrome. Clinical manifestations of acute respiratory distress syndrome secondary to SARS-CoV-2 are also diverse with a lack of diagnostic tools to distinguish between primary viral infection and secondary bacterial infections. This was a single-centre, retrospective case-control study of bronchoalveolar lavage fluid cell counts, flow cytometry and culture results from mechanically ventilated patients with SARS-CoV-2 (COVID-19) pneumonia and acute respiratory distress syndrome. Neutrophils were the predominant cell type in bronchoalveolar fluid samples up to 2 weeks into mechanical ventilation. There also was a strong correlation between positive respiratory cultures and significant elevation in bronchoalveolar fluid neutrophil counts/percentages and serum C-reactive protein levels. Absolute levels of T cell subtypes correlated with reduced lung compliance measurements. Patients with SARS-CoV-2 and severe respiratory disease are at risk for secondary infections. In some COVID-19 patients, serum C-reactive protein and bronchoalveolar fluid neutrophils may be correlated with a secondary infection.
Rabies is a severe zoonotic disease in China, but the circulation and distribution of rabies virus (RABV) within animal reservoirs is not well understood. We report the results of 15 years of surveillance of the first Chinese Rabies Surveillance Plan in animal populations, in which animal brain tissues collected during 2004–2018 were tested for RABV and phylogenetic and spatial–temporal evolutionary analyses performed using obtained RABV sequences. The results have provided the most comprehensive dataset to date on the infected animal species, geographic distribution, transmission sources, and genetic diversity of RABVs in China. In particular, the transboundary transmission of emerging RABV subclades between China and neighboring countries was confirmed. The study highlights the importance of continuous animal rabies surveillance in monitoring the transmission dynamics, and provides updated information for improving current control and prevention strategies at the source.
Ronaldo de Carvalho Augusto, Nadjiya Merad, Anne Rognon
et al.
Abstract Background Freshwater snails are the intermediate hosts of a large variety of trematode flukes such as Schistosoma mansoni responsible for one of the most important parasitic diseases caused by helminths, affecting 67 million people worldwide. Recently, the WHO Global Vector Control Response 2017–2030 (GVCR) programme reinforced its message for safer molluscicides as part of required strategies to strengthen vector control worldwide. Here, we present the essential oil from Eryngium triquetrum as a powerful product with molluscicide and parasiticide effect against S. mansoni and the snail intermediate host Biomphalaria glabrata. Methods In the present study, we describe using several experimental approaches, the chemical composition of E. triquetrum essential oil extract and its biological effects against the snail B. glabrata and its parasite S. mansoni. Vector and the free-swimming larval stages of the parasite were exposed to different oil concentrations to determine the lethal concentration required to produce a mortality of 50% (LC50) and 90% (LC90). In addition, toxic activity of this essential oil was analyzed against embryos of B. glabrata snails by monitoring egg hatching and snail development. Also, short-time exposure to sublethal molluscicide concentrations on S. mansoni miracidia was performed to test a potential effect on parasite infectivity on snails. Mortality of miracidia and cercariae of S. mansoni is complete for 5, 1 and 0.5 ppm of oil extract after 1 and 4 h exposure. Results The major chemical component found in E. triquetrum oil determined by GC-FID and GC/MS analyses is an aliphatic polyacetylene molecule, the falcarinol with 86.9–93.1% of the total composition. The LC50 and LC90 values for uninfected snails were 0.61 and 1.02 ppm respectively for 24 h exposure. At 0.5 ppm, the essential oil was two times more toxic to parasitized snails with a mortality rate of 88.8 ± 4.8%. Moderate embryonic lethal effects were observed at the concentration of 1 ppm. Severe surface damage in miracidia was observed with a general loss of cilia that probably cause their immobility. Miracidia exposed 30 min to low concentration of plant extract (0.1 ppm) were less infective with 3.3% of prevalence compare to untreated with a prevalence of 44%. Conclusions Essential oil extracted from E. triquetrum and falcarinol must be considered as a promising product for the development of new interventions for schistosomiasis control and could proceed to be tested on Phase II according to the WHO requirements.
Serological detection of echinococcosis is crucial for diagnosis and management. We evaluated the new blot assay Euroline-WB (ELB, Euroimmun) which consists of a Western blot with vesicle antigens and a line blot part with recombinant antigens from (, genus-specific EgAgB) and (species-specific Em18 and Em95), in comparison to a commercial Western Blot (EWB, LDBio) for detection and species differentiation of echinococcosis within routine laboratory diagnostics. Thirty-five serum samples from 35 patients classified according to a standardized classification were included in the analysis. Out of 24 cases of proven and probable infection with or 16 (66.7%) and 15 (62.5%) were correctly identified on species level by EWB and ELB, respectively. False species were assigned in two cases by EWB but none by ELB. Negative blot results in patients with proven infections were noticed in 8.3% (ELB) compared to 4.2% (EWB), but were limited to patients with antiparasitic therapy or post-surgery indicating a treatment-induced loss of antibody activity. Thus, identification of infection at least on the genus level was possible in 23/24 (95.8%) and 19/24 (79.2%) of patients by EWB and ELB (or 22/24 patients (91.7%) including borderline results of ELB), respectively. Recombinant Em18 and Em95 were highly specific for detection of infection but differed in sensitivity (Em18 56% and 80 %, and Em95 22% and 20% in proven and probable infections, respectively). Advantages of ELB are the standardized analysis of the banding pattern by EUROLineScan software and a faster turn-around-time.
Zeina A. Kanafani, Aline El Zakhem, Nada Zahreddine
et al.
Background: Ventilator-associated pneumonia (VAP) is associated with significant adverse outcomes in critically-ill patients admitted to the Intensive Care Unit (ICU). Systematic data from Lebanon on VAP are not available and large epidemiological studies from the region are scarce. Methods: We conducted a retrospective study over a 10-year period at the American University of Beirut Medical Center (AUBMC), a tertiary referral center in Lebanon in order to describe the incidence, microbiology, and temporal trends of VAP in the medical/surgical ICU. Results: A total of 162 patients developed VAP over the study period and the overall incidence of VAP was 7.9 per 1000 ventilator-days. There was a statistically significant decrease over time in the incidence of VAP, from 13.1 in 2008 to 1.1 per 1000 ventilator-days in 2017. Multidrug-resistant (MDR) Acinetobacter spp. was the predominant pathogen, both in early- as well as late-onset VAP, followed by Pseudomonas aeruginosa. Conclusions: Following significant efforts from the Infection Control and Prevention Program, a considerable reduction in the incidence of VAP was achieved at AUBMC. The predominance of MDR Acinetobacter spp. should be taken into consideration when deciding on empirical therapy in patients with VAP. Keywords: Ventilator, Pneumonia, Intensive care, Acinetobacter, Lebanon
Infectious and parasitic diseases, Public aspects of medicine
Background/Aim. Although rare, parasitic infection can cause acute appendicitis and result in contamination of the peritonea during appendectomy. The goal of this study was to summarize our experiences with parasitic appendicitis and describe a novel laparoscopic technique to prevent contamination.Method. All patients diagnosed with acute appendicitis who underwent appendectomy between January 2016 and January 2017 were included in the study. All appendectomies were performed using the standard three-port laparoscopic method, and a video recording was made of each procedure. Following separation of the mesoappendix, a single endoloop was placed in the base of the appendix, and the appendix was then transected 3-4 mm above the clamp with the aid of a thermal cauterizing/sealing device. The appendix was extracted from the 10 mm trocar hole below the umbilicus and placed inside a bag prepared from a glove. After pathological confirmation of parasitic appendicitis, medical records were retrospectively analyzed in each case for whether peritoneal contamination had occurred or not.Results. Out of 97 appendectomies, parasitic infection was observed in 4 cases, as confirmed by pathological examination. In two of these patients,E. vermiculariswas detected, while the other two were infected withBalantidium coli. Intraoperative contamination did not occur in any of the cases, and retrospective review of the video recordings indicated no peritoneal contamination.Conclusion. As a result of the coagulation and sealing effects of thermal devices, airtight seals were created on the residual appendiceal stumps, and consequently, no contamination was observed in any of the cases.
Henk van den Berg, Michèle van Vugt, Alinune N. Kabaghe
et al.
Abstract Background Increased engagement of communities has been emphasized in global plans for malaria control and elimination. Three interventions to reinforce and complement national malaria control recommendations were developed and applied within the context of a broad-based development initiative, targeting a rural population surrounding a wildlife reserve. The interventions, which were part of a 2-year research trial, and assigned to the village level, were implemented through trained local volunteers, or ‘health animators’, who educated the community and facilitated collective action. Results Community workshops on malaria were designed to increase uptake of national recommendations; a manual was developed, and training of health animators conducted, with educational content and analytical tools for a series of fortnightly community workshops in annual cycles at village level. The roll-back malaria principle of diagnosis, treatment and use of long-lasting insecticidal nets was a central component of the workshops. Structural house improvement to reduce entry of malaria vectors consisted of targeted activities in selected villages to mobilize the community into voluntarily closing the eaves and screening the windows of their houses; the project provided wire mesh for screening. Corrective measures were introduced to respond to field challenges. Committees were established at village level to coordinate the house improvement activities. Larval source management (LSM) in selected villages consisted of two parts: one on removal of standing water bodies by the community at large; and one on larviciding with bacterial insecticide Bacillus thuringiensis israelensis by trained village committees. Community workshops on malaria were implemented as ‘core intervention’ in all villages. House improvement and LSM were implemented in addition to community workshops on malaria in selected villages. Conclusions Three novel interventions for community mobilization on malaria prevention and control were described. The interventions comprised local organizational structure, education and collective action, and incorporated elements of problem identification, planning and evaluation. These methods could be applicable to other countries and settings.
Arctic medicine. Tropical medicine, Infectious and parasitic diseases