Clinical Infectious Diseases最新文献

{"title":"Derivation and Validation of an Electronic Health Record Penicillin Allergy De-Labeling Prevalence Measure","authors":"Kimberly G Blumenthal, Bohang Jiang, Andrew J King, Jushin T Mann, Yuqing Zhang, Alysse G Wurcel","doi":"10.1093/cid/ciae641","DOIUrl":"https://doi.org/10.1093/cid/ciae641","url":null,"abstract":"With no standard method to capture penicillin allergy de-labeling prevalence across populations, we developed and validated a simple penicillin allergy de-labeling prevalence measure from electronic health records that achieved perfect sensitivity (100.0%), high specificity (99.4%), and strong agreement with a comprehensive algorithm that included free-text manual review (Kappa=0.997).","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"31 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital toxoplasmosis: Fewer clinical signs at 3 years of age over the last 15 years but stable risk of materno-fetal transmission","authors":"Martine Wallon, Elea Ksiazek, Antoine Journé, Damien Dupont, Jean Menotti, François Peyron, Christine Binquet","doi":"10.1093/cid/ciae634","DOIUrl":"https://doi.org/10.1093/cid/ciae634","url":null,"abstract":"Risk and severity of congenital toxoplasmosis were estimated using data from 2,455 consecutive mother/child pairs. Clinical signs at 3 years were halved in the 177 children born since 2009 compared to 1996-2008 (OR=0.49; 95% Confidence interval 0.28-0.85). Maternofetal transmission rates remained stable from 1992 to 2021.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"86 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142858418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-COVID Condition Risk Factors and Symptom Clusters and Associations with Return to Pre-COVID Health—Results from a 2021 Multi-State Survey","authors":"Stacey L Konkle, Reed Magleby, Robert A Bonacci, Hannah E Segaloff, Lina V Dimitrov, Parag Mahale, Bozena Katic, Miriam Nji, Betsy Cadwell, Jean Y Ko, Dena Bushman, Julie Rushmore, Jennifer Cope, Sharon Saydah","doi":"10.1093/cid/ciae632","DOIUrl":"https://doi.org/10.1093/cid/ciae632","url":null,"abstract":"Background Little is known about how symptoms or symptom clusters of Post-COVID Conditions (PCC) impact an individual’s return to pre-COVID health. Methods We used four state-level COVID-19 case reporting systems and patient-reported survey data to identify patients with PCC and associations with an individual’s return to pre-COVID health after laboratory-confirmed SARS-CoV-2 infection. Participants had a positive SARS-CoV-2 test between March–December 2020. Weighted regression models were used to 1) estimate prevalence of PCC; 2) identify risk factors associated with developing PCC; and 3) examine associations between PCC symptom clusters and return to pre-COVID health. Factor analysis was used to statistically identify post-COVID symptom clusters. Findings Prevalence of PCC in this population-based sample was 29·9% for persons with SARS-CoV-2 infection, during the pre-delta variant period (March–December 2020); 77·2% of persons experiencing PCC had not returned to pre-COVID health within 8–60 weeks after infection. Female sex, acute COVID-19 illness severity, and number of pre-existing comorbidities were significant risk factors associated with PCC. Myalgic encephalomyelitis/chronic fatigue syndrome-like symptoms, upper-respiratory symptoms, and gastrointestinal symptoms were significantly associated with not returning to pre-COVID health. Interpretation Understanding PCC symptom clustering may provide insight into pathophysiology, severity of PCC, and management for patients who have not returned to their usual state of health after SARS-CoV-2 infection. Tracking PCC can help measure the impact of COVID-19 vaccination and acute COVID-19-specific treatments on reducing PCC in the US.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"31 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142867253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reinfection and resistance associated substitutions following a minimal monitoring approach for HCV treatment in MINMON trial.","authors":"Win Min Han, Sunil Solomon, Laura Smeaton, Anchalee Avihingsanon, Sandra Wagner-Cardoso, Jiani Li, Aiyappa Parvangada, Mark Sulkowski, Susanna Naggie, Ross Martin, Hongmei Mo, Evguenia Maiorova, David Wyles","doi":"10.1093/cid/ciae627","DOIUrl":"https://doi.org/10.1093/cid/ciae627","url":null,"abstract":"<p><strong>Background: </strong>Simplified approaches to HCV treatment delivery are needed to meet elimination goals. However, the impact of low-touch strategies on individuals at higher risk due to treatment failure or reinfection is unknown. We estimated HCV reinfection rates, and the impact of resistance associated substitutions (RASs) on response in the ACTG A5360 (MINMON) trial.</p><p><strong>Methods: </strong>HCV RNA evaluations were scheduled at weeks 0, 24 (sustained viral response [SVR] visit), 48 and 72. Participants with post-entry HCV RNA ≥ lower limit of quantification (LLoQ) had deep sequencing of NS5A and NS5B genes performed. Phylogenetic analysis distinguished between reinfection and treatment failure. Reinfection rates per 100 person-years (PYS) were calculated with 95%CI constructed using Poisson distribution.</p><p><strong>Results: </strong>Of 397 participants with post-entry HCV RNA, 29 had ≥LLoQ and available sequencing data. Of those 29, 5 participants initially designated as non-SVR, and 12 participants initially attaining SVR (evaluated at week-24) were determined to have reinfections (total 17 reinfections) (reinfection rate 3.9/100 PYS [95%CI 2.4-6.2]). All 17 participants with HCV reinfection were male (13 MSM and 15 with HIV). Of 29 had ≥LLoQ, 12 were identified as treatment failure. SVR (excluding reinfections) in presence and absence of baseline RAS was 93.5% (43/46) and 97% (337/346), respectively, with an overall SVR rate of 97.0% [95%CI 94.8-98.3] (385/397).</p><p><strong>Conclusions: </strong>Accounting for reinfections, SVR in MINMON was 97.0% further supporting simplified HCV treatment. No significant difference in SVR was found by baseline velpatasvir RAS. The high reinfection rate, especially among MSM with HIV, underscores the need to scale-up evidence-based interventions to reduce reinfection.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of diagnostic algorithms in patients with invasive pulmonary aspergillosis.","authors":"Stefan Hatzl, Christina Geiger, Lisa Kriegl, Laura Scholz, Alexander C Reisinger, Philipp Kreuzer, Sonja Fruhwald, Albert Wölfler, Andreas Reinisch, Dirk von Lewinski, Gernot Schilcher, Martin Hoenigl, Philipp Eller, Robert Krause","doi":"10.1093/cid/ciae633","DOIUrl":"https://doi.org/10.1093/cid/ciae633","url":null,"abstract":"<p><strong>Background: </strong>Invasive pulmonary aspergillosis (IPA), once limited to immunocompromised patients, is now a severe complication in critically ill ICU patients without classic risk factors. Due to the difficulty of obtaining histological evidence, its diagnosis relies on poorly tested algorithms in real-world settings.</p><p><strong>Methods: </strong>We conducted a retrospective multicenter (n=9) cohort study including 202 patients with IPA. Patients were classified using a multistep process based on the European Organization for the Research and Treatment of Cancer/Mycosis Study Group (EORTC-MSG), Invasive-Fungal Diseases in Adult Patients in Intensive Care Unit (FUNDICU), Aspergillus ICU (Asp-ICU), and Asp-ICU with biomarkers (Asp-ICU-BM) criteria. We then evaluated the predictive performance of these criteria against the clinical cohort and histologically proven cases.</p><p><strong>Results: </strong>Among 202 patients, 78 had EORTC-MSG host factors and were classified accordingly, with the EORTC-MSG criteria achieving 100% agreement in identifying clinical and histologically proven cases. In 112 ICU patients without EORTC-MSG host factors, overall agreement was 53% for FUNDICU, 4% for Asp-ICU, and 26% for Asp-ICU-BM compared to the clinical cohort. Validation against histologically proven cases showed FUNDICU had 44% sensitivity and 75% specificity, Asp-ICU 6% sensitivity and 100% specificity, and Asp-ICU-BM 28% sensitivity and 63% specificity. Adding acute respiratory distress syndrome (ARDS) and post-cardiac surgery to the FUNDICU criteria improved sensitivity to 97% with a specificity of 63%. The remaining 12 patients lacked EORTC-MSG host factors and were not in the ICU, highlighting a novel classification system.</p><p><strong>Conclusion: </strong>EORTC-MSG and FUNDICU IPA classification systems are useful for the assignment of most patients with IPA. Incorporating post-operative complications after cardiac surgery and ARDS enhanced the diagnostic accuracy of FUNDICU.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to Staphylococcus aureus Blood Culture Positivity as a risk marker of Infective Endocarditis: A Retrospective Cohort Study","authors":"Martin Strömdahl, Karl Hagman, Karolina Hedman, Anna Westman, Magnus Hedenstierna, Johan Ursing","doi":"10.1093/cid/ciae628","DOIUrl":"https://doi.org/10.1093/cid/ciae628","url":null,"abstract":"Background Endocarditis occurs in approximately 10-15% of patients with Staphylococcus aureus bacteremia. Short time to positivity (TTP) in blood culture flasks has been linked to endocarditis in smaller studies. This study evaluated the association between TTP and endocarditis in S. aureus bacteremia in a large cohort. Methods Adult patients with ≥1 S. aureus positive blood culture treated at a tertiary level, 500-bed hospital in Stockholm, Sweden between 2011-2021 were retrospectively identified. The primary outcome was the presence of infective endocarditis. Results A total of 1703 episodes of S. aureus bacteremia (23/1703 MRSA) in 1610 patients were included. Median age was 75 years (interquartile range [IQR] 63-84) and median Charlson comorbidity index was 2 (IQR 1-3). Echocardiography was performed in 1102/1703 (65%). Thirty-day mortality was 406/1703 (24%) and endocarditis was found in 154/1703 (9%). Median TTP was shorter in patients with endocarditis (9 [IQR 7-12] hours) compared to patients without endocarditis (13 [IQR 10-18] hours, p&amp;lt;0.001). The risk of endocarditis decreased with 11% per hour (OR 0.89 [95% CI 0.54-0.92] p&amp;lt;0.001) in a univariate analysis using TTP as a continuous variable. In multivariate analysis TTP&amp;lt;13 hours (the median) was independently associated with endocarditis (OR 3.59, [95% CI 2.35-5.3] p&amp;lt;0.001). The negative predictive value of TTP&amp;gt;13 hours for endocarditis was 96% (95% CI 95-97). Conclusions Short TTP was associated with endocarditis. The negative predictive value of &amp;gt;95% suggests that TTP&amp;gt;13 hours can be used to risk stratify patients with S. aureus bacteremia.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"14 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142867254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Accuracy of Chest X-ray Computer-Aided Detection Software for Detection of Prevalent and Incident Tuberculosis in Household Contacts.","authors":"Liana Macpherson, Sandra V Kik, Matteo Quartagno, Francisco Lakay, Marche Jaftha, Nombuso Yende, Shireen Galant, Saalikha Aziz, Remy Daroowala, Richard Court, Arshad Taliep, Keboile Serole, Rene T Goliath, Nashreen Omar Davies, Amanda Jackson, Emily Douglass, Bianca Sossen, Sandra Mukasa, Friedrich Thienemann, Taeksun Song, Morten Ruhwald, Robert J Wilkinson, Anna K Coussens, Hanif Esmail","doi":"10.1093/cid/ciae528","DOIUrl":"https://doi.org/10.1093/cid/ciae528","url":null,"abstract":"<p><strong>Background: </strong>World Health Organization (WHO) tuberculosis (TB) screening guidelines recommend computer-aided detection (CAD) software for chest radiograph (CXR) interpretation. However, studies evaluating their diagnostic and prognostic accuracy are limited.</p><p><strong>Methods: </strong>We conducted a prospective cohort study of household contacts of rifampicin-resistant TB in South Africa. Participants underwent baseline CXR and sputum investigation (routine [single spontaneous] and enhanced [additionally 2-3 induced]) for prevalent TB and follow-up for incident TB. Three CXR-CAD software products (CAD4TBv7.0, qXRv3.0.0, and Lunit INSIGHT v3.1.4.111) were compared. We evaluated their performance to detect routine and enhanced prevalent and incident TB, comparing performance with blood tests (Xpert MTB host-response, erythrocyte sedimentation rate, C-reactive protein, QuantiFERON) in a subgroup.</p><p><strong>Results: </strong>483 participants were followed up for 4.6 years (median). There were 23 prevalent (7 routinely diagnosed) and 38 incident TB cases. The AUC ROCs (95% CIs) to identify prevalent TB for CAD4TBv7.0, qXRv3.0.0, and Lunit INSIGHT v3.1.4.111 were .87 (.77-.96), .88 (.79-.97), and .91 (.83-.99), respectively. More than 30% with scores above recommended CAD thresholds who were bacteriologically negative on routine baseline sputum were subsequently diagnosed by enhanced sputum investigation or during follow-up. The AUC performance of baseline CAD to identify incident cases ranged between .60 and .65. Diagnostic performance of CAD for prevalent TB was superior to blood testing.</p><p><strong>Conclusions: </strong>Our findings suggest that the potential of CAD-CXR screening for TB is not maximized as a high proportion of those above current thresholds, but with a negative routine confirmatory sputum, have true TB disease that may benefit intervention.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management, outcomes and predictors of mortality of Cryptococcus infection in patients without HIV: a multicentre study in 46 hospitals from Australia and New Zealand.","authors":"Julien Coussement, Christopher H Heath, Matthew B Roberts, Rebekah J Lane, Tim Spelman, Olivia C Smibert, Anthony Longhitano, C Orla Morrissey, Blake Nield, Monica Tripathy, Joshua S Davis, Karina J Kennedy, Sarah A Lynar, Lucy C Crawford, Simeon J Crawford, Benjamin J Smith, Andrew P Gador-Whyte, Rose Haywood, Andrew A Mahony, Julia C Howard, Genevieve B Walls, Gabrielle M O'Kane, Matthew T Broom, Caitlin L Keighley, Olivia Bupha-Intr, Louise Cooley, Jennifer A O'Hern, Justin D Jackson, Arthur J Morris, Caroline Bartolo, Adrian R Tramontana, Katherine C Grimwade, Victor Au Yeung, Roy Chean, Emily Woolnough, Benjamin W Teh, Monica A Slavin, Sharon C-A Chen","doi":"10.1093/cid/ciae630","DOIUrl":"https://doi.org/10.1093/cid/ciae630","url":null,"abstract":"<p><strong>Background: </strong>Limited data exist regarding outcomes of cryptococcosis in patients without HIV with few studies having compared outcomes of Cryptococcus gattii, versus C. neoformans, infection.</p><p><strong>Methods: </strong>We conducted a retrospective study in 46 Australian and New Zealand hospitals to determine the outcomes of cryptococcosis in patients without HIV diagnosed between 2015 and 2019, and compared outcomes of C. gattii versus C. neoformans infections. Multivariable analysis identified predictors of mortality within one year.</p><p><strong>Results: </strong>Of 426 patients, one-year all-cause mortality was 21%. C. gattii infection was associated with a lower mortality than C. neoformans (adjusted odds ratio [OR]: 0.47, 95% confidence interval [CI]: 0.23-0.95), whilst severe neurological symptoms at presentation was the strongest predictor of death (adjusted OR: 8.46, 95% CI: 2.99-23.98). Almost all (99.5%) patients with central nervous system (CNS) infection received induction antifungal therapy versus 27.7% of isolated pulmonary cryptococcosis. The commonest regimen in CNS disease was liposomal amphotericin B with flucytosine (93.8%, mean duration 31 ± 13 days). Among patients with CNS cryptococcosis, C. gattii infection was associated with higher risk of immune reconstitution inflammatory response (C-IRIS) than C. neoformans (21% versus 3%, p<0.001). Nineteen patients received amphotericin B-based re-induction therapy for suspected relapse but none had microbiological relapse. Serum cryptococcal antigen positivity and lung imaging abnormalities resolved slowly (resolution at one year in 25% and 34% of patients, respectively).</p><p><strong>Conclusion: </strong>Compared with C. neoformans, C. gattii infection demonstrated lower mortality but higher C-IRIS risk in CNS infection. Severe neurological symptoms were the strongest predictor of mortality.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Anti-CD4 Autoantibodies on Immune Reconstitution in People With Advanced Human Immunodeficiency Virus","authors":"Brian P Epling, Andrea Lisco, Maura Manion, Elizabeth Laidlaw, Frances Galindo, Megan Anderson, Gregg Roby, Virginia Sheikh, Stephen A Migueles, April Poole, Ainhoa Perez-Diez, Xiangdong Liu, V Koneti Rao, Peter D Burbelo, Irini Sereti","doi":"10.1093/cid/ciae562","DOIUrl":"https://doi.org/10.1093/cid/ciae562","url":null,"abstract":"Background Despite suppressive antiretroviral therapy (ART), 15%–30% of people with human immunodeficiency virus (HIV) experience a limited recovery of CD4 T cells. Although autoantibodies against the CD4 receptor have previously been identified in people with HIV (PWH), little is known about their longitudinal impact on CD4 T-cell reconstitution. Methods Anti-CD4 autoantibodies were evaluated by the fluid-phase luciferase immunoprecipitation systems immunoassay in ART-naive people with advanced HIV (CD4 count ≤100 cells/µL), PWH with CD4 count &amp;gt;200 cells/µL, long-term nonprogressors, people with idiopathic CD4 lymphopenia, people with autoimmune lymphoproliferative syndrome, and healthy volunteers without HIV. In the participants with advanced HIV, we assessed the association of anti-CD4 autoantibodies at ART initiation with CD4 recovery over a median follow-up of 192 weeks. Results Anti-CD4 autoantibodies were identified in 29% (61/210) of ART-naive participants with advanced HIV but were absent in people without HIV. Female PWH showed a 4-fold higher prevalence (P &amp;lt; .001) of anti-CD4 autoantibodies compared to males. After ART initiation, people with advanced HIV with anti-CD4 autoantibodies exhibited an overall slower rate of CD4 reconstitution (5.8 vs 6.6 cells/µL/month, P = .007) and lower week 192 CD4 count (268 vs 355 cells/µL, P = .037). Incidental, clinically indicated immunosuppressive therapy in these participants was associated with an improved rate of CD4 reconstitution (P = .0019) and higher week 192 CD4 count (551 vs 268 cells/µL, P = .019). Conclusions People with advanced HIV harboring anti-CD4 autoantibodies at ART initiation demonstrated a slower rate and extent of CD4 reconstitution after 4 years. Incidental immunosuppressive therapy was associated with increased CD4 counts in these participants.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"30 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142841171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between Acute Severe Acute Respiratory Syndrome Coronavirus 2 Viral Clearance and Long Coronavirus 2019 (Long COVID) Symptoms: A Cohort Study","authors":"Carly Herbert, Annukka A R Antar, John Broach, Colton Wright, Pamela Stamegna, Katherine Luzuriaga, Nathaniel Hafer, David D McManus, Yukari C Manabe, Apurv Soni","doi":"10.1093/cid/ciae539","DOIUrl":"https://doi.org/10.1093/cid/ciae539","url":null,"abstract":"Background The relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral dynamics during acute infection and the development of long coronavirus disease 2019 (COVID-19), or “long COVID,” is largely unknown. Methods Between October 2021 and February 2022, 7361 people not known to have COVID-19 self-collected nasal swab samples for SARS-CoV-2 reverse-transcription polymerase chain reaction testing every 24–48 hours for 10–14 days. Participants whose first known SARS-CoV-2 infection was detected were surveyed for long COVID in August 2023. Their slopes of viral clearance were modeled using linear mixed effects models with random slopes and intercepts, and the relative risk (RR) of long COVID based on viral slopes was calculated using a log binomial model, adjusted for age, symptoms, and variant. Sex-based interaction terms were also evaluated for significance. Results A total of 172 participants were eligible for analyses, and 59 (34.3%) reported long COVID. The risk of long COVID with 3–4 symptoms (adjusted RR, 2.44 [95% confidence interval, .88–6.82]) and ≥5 symptoms (4.97 [1.90–13.0]) increased with each unit increase in slope of viral clearance. While the probability of long COVID increased with slowed viral clearance among women, the same relationship was not observed among men (interaction term: P = .02). Acute SARS-CoV-2 symptoms of abdominal pain (adjusted RR, 5.41 [95% confidence interval, 2.44–12.0]), nausea (3.01 [1.31–6.89]), and body aches (2.58 [1.26–5.30]) were most strongly associated with long COVID. Conclusions We observed that slower viral clearance rates during acute COVID-19 were associated with increased risk and more symptoms of long COVID . Early viral-host dynamics appear to be mechanistically linked to the development of long COVID.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"48 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142841172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}