Clinical Infectious Diseases最新文献

{"title":"Virus-specific T-cell therapy for prophylaxis and treatment of cytomegalovirus infections after transplantation: a scoping review.","authors":"J S T Fung,R C Wright,D K Bharaj,A Alghamdi,D Hesson,J S Delisle,L Schweitzer,R K Avery,S Belga","doi":"10.1093/cid/ciaf232","DOIUrl":"https://doi.org/10.1093/cid/ciaf232","url":null,"abstract":"BACKGROUNDCytomegalovirus (CMV) infection is a leading complication following hematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT). Virus-specific T-cells (VST) have been used for the prophylaxis and treatment of CMV infections. We conducted a scoping review to catalogue and characterize the existing literature.METHODSSystematic searches were performed in collaboration with an expert librarian. Inclusion criterion was the use of CMV-VST for prophylaxis or treatment in HSCT and SOT patients. Major exclusion criteria were case reports and series with fewer than 5 cases. Databases were queried from inception to May 31, 2024. Of the 2587 identified abstracts, full text review was performed on 92 articles, and 67 studies underwent final data extraction.RESULTSMost studies were in the HSCT population. The CMV infection rate was 28% (IQR 14-44) when CMV-VSTs were used as prophylaxis. Response rates for non-refractory and/or resistant (R/R) infections and R/R infections in HSCT patients were 98% (IQR 70-100) and 70% (IQR 56-88), respectively. Four studies included SOT patients with R/R infections, demonstrating a response rate of 15-64%. Variables including donor/recipient serostatus and antiviral use were heterogeneously reported, and various definitions of CMV infection and response were used. CMV-VSTs were well-tolerated with minimal adverse events reported.CONCLUSIONCMV-VSTs are more commonly used in HSCT patients with limited data in SOT patients and differential reporting of key variables preclude extrapolation. A standardized registry should be considered for future studies with additional focus on the optimal dosing, timing, and interaction with concurrent antivirals.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"2 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915102","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":"Respiratory Syncytial Virus Co-Detection With Other Respiratory Viruses Is Not Significantly Associated With Worse Clinical Outcomes Among Children Aged <2 Years: New Vaccine Surveillance Network, 2016–2020","authors":"Justin Z Amarin, Ariana P Toepfer, Andrew J Spieker, Haya Hayek, Tess Stopczynski, Yasmeen Z Qwaider, Laura S Stewart, James D Chappell, Mary Allen Staat, Elizabeth P Schlaudecker, Geoffrey A Weinberg, Peter G Szilagyi, Janet A Englund, Eileen J Klein, Marian G Michaels, John V Williams, Rangaraj Selvarangan, Christopher J Harrison, Leila C Sahni, Vasanthi Avadhanula, Meredith L McMorrow, Heidi L Moline, Natasha B Halasa","doi":"10.1093/cid/ciaf194","DOIUrl":"https://doi.org/10.1093/cid/ciaf194","url":null,"abstract":"Background Risk factors for severe respiratory syncytial virus (RSV) illness include early infancy, premature birth, and underlying medical conditions. However, the clinical significance of respiratory viral co-detection is unclear. We compared the clinical outcomes of young children with RSV-only detection and those with RSV viral co-detection. Methods We conducted active, population-based surveillance of children with medically attended fever or respiratory symptoms at 7 US medical centers (1 December 2016–31 March 2020). Demographic and clinical data were collected through parental interviews and chart abstractions. Nasal swabs, with or without throat swabs, were systematically tested for RSV and 6 other common respiratory virus groups. We compared clinical outcomes, including hospitalization, and among those hospitalized, length of stay, intensive care unit admission, supplemental oxygen use, and intubation, between children aged &amp;lt;2 years with RSV-only detection and those with RSV co-detection. Results We enrolled 18 008 children aged &amp;lt;2 years. Of 17 841 (99.1%) tested for RSV, 5099 (28.6%) were positive. RSV was singly detected in 3927 children (77.0%) and co-detected in 1172 (23.0%). RSV co-detection with parainfluenza virus or adenovirus was associated with significantly lower odds of hospitalization (adjusted odds ratio, 0.56; 95% confidence interval [CI]: .33–.95; P = .031) and supplemental oxygen use (adjusted odds ratio, 0.66; 95% CI: .46–.95; P = .026), respectively, than RSV-only detection. For all other comparisons, we did not identify a significant association between RSV co-detection and worse clinical outcomes. Conclusions Co-detection of RSV with another respiratory virus was not significantly associated with worse clinical outcomes compared with RSV-only detection.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"290 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143927281","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":"HIV RNA testing to monitor oral PrEP use does not add clinical value: a real-world cohort study—United States, 2019-2023","authors":"Weiming Zhu, Kevin Delaney, Ya-lin A Huang, Rupa R Patel, Athena P Kourtis, Karen W Hoover","doi":"10.1093/cid/ciaf230","DOIUrl":"https://doi.org/10.1093/cid/ciaf230","url":null,"abstract":"Background The 2021 update of the CDC clinical guidelines for HIV preexposure prophylaxis (PrEP) recommended both antigen/antibody (Ag/Ab) and RNA testing at PrEP initiation and routine follow-up. We assessed real-world utilization and performance of HIV tests among oral PrEP users. Methods An oral PrEP user cohort was constructed using the HealthVerity database that included linked diagnoses, laboratory tests, and prescriptions from December 2018 to August 2023. Data was stratified by guideline pre- (2019−2021) and post-update (2022−2023) periods. For each period, we assessed the agreement between same-day HIV Ag/Ab and RNA results and calculated the false positive rate (FPR) and positive predictive values (PPV) of HIV Ag/Ab and RNA tests compared with adjudicated HIV status. Results The HIV RNA testing rate for follow-up increased from 16 per 100 person-years (PY) to 123 per 100 PYs after the guideline update. The positivity rate of HIV RNA tests decreased from 1.39% to 0.22%. Overall agreement between Ag/Ab and RNA results remained high. The FPRs of HIV Ag/Ab and RNA testing remained similar, but the PPV of HIV RNA testing for PrEP follow-up decreased from 100% to 67%. We estimated that 8,226 to 9,900 RNA tests would be needed for one HIV diagnosis earlier than would be detected with Ag/Ab testing alone. Discussion HIV RNA testing did not provide additional value to Ag/Ab testing during routine follow-up of oral PrEP users. Considering the cost and logistical complexity of HIV RNA testing, its use as a routine test during follow-up of oral PrEP users warrants reconsideration.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"15 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143910426","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":"State-of-the-Art Review: Modern Approach to Nocardiosis—Diagnosis, Management, and Uncertainties","authors":"Zachary A Yetmar, Paige K Marty, Josh Clement, Cyndee Miranda, Nancy L Wengenack, Elena Beam","doi":"10.1093/cid/ciae643","DOIUrl":"https://doi.org/10.1093/cid/ciae643","url":null,"abstract":"Nocardiosis is an uncommon yet potentially devastating infection. Nocardia tends to affect individuals with chronic lung disease or immunocompromising conditions, 2 groups increasing in number. Incidence of nocardiosis is likely to increase as well, and it is vital to have an approach to this complex disease. Here, we aim to review the presentation, diagnosis, and management of Nocardia in the modern era. We will also highlight areas of uncertainty in our understanding of nocardiosis and propose a general approach to nocardiosis therapy, accounting for response and tolerance of Nocardia treatment.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"20 1","pages":"e53-e64"},"PeriodicalIF":11.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893329","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":"Acute Unilateral Vision Loss in a Young Woman.","authors":"Megan Lane,Prishanya Pillai,Amira Abbas,Benjamin Osborne,Amanda Blair Spence,Princy Kumar","doi":"10.1093/cid/ciae484","DOIUrl":"https://doi.org/10.1093/cid/ciae484","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"36 1","pages":"901-903"},"PeriodicalIF":11.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897337","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":"A Sexually Active Man With an Erythematous Rash.","authors":"Shauna H Gunaratne,Jason Zucker","doi":"10.1093/cid/ciae502","DOIUrl":"https://doi.org/10.1093/cid/ciae502","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"72 1","pages":"921-923"},"PeriodicalIF":11.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897341","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":"Real-Time Genomic Surveillance for Enhanced Healthcare Outbreak Detection and Control: Clinical and Economic Impact.","authors":"Alexander J Sundermann,Praveen Kumar,Marissa P Griffith,Kady D Waggle,Vatsala Rangachar Srinivasa,Nathan Raabe,Emma G Mills,Hunter Coyle,Deena Ereifej,Hannah M Creager,Ashley Ayres,Daria Van Tyne,Lora Lee Pless,Graham M Snyder,Mark Roberts,Lee H Harrison","doi":"10.1093/cid/ciaf216","DOIUrl":"https://doi.org/10.1093/cid/ciaf216","url":null,"abstract":"BACKGROUNDCurrent methods are insufficient alone for outbreak detection in hospitals. Real-time genomic surveillance offers the potential to detect otherwise unidentified outbreaks. We initiated and evaluated the Enhanced Detection System for Healthcare-associated Transmission (EDS-HAT), a real-time genomic surveillance program for outbreak detection and mitigation.METHODSThis study was conducted at UPMC Presbyterian Hospital from November 2021 to October 2023. Whole genome sequencing (WGS) was performed weekly on healthcare-associated clinical bacterial isolates to identify otherwise undetected outbreaks. IP&C interventions were implemented in real-time based on identified transmission. A clinical and economic impact analysis was conducted to estimate infections avoided and net cost savings.RESULTSThere were 3,921 bacterial isolates from patient healthcare-associated infections that underwent WGS, of which 476 (12.1%) clustered into 172 outbreaks (size 2-16 patients). Of the outbreak isolates, 292 (61.3%) had an identified epidemiological link. Among the outbreaks with interventions, 95.6% showed no further transmission on the intervened transmission route. The impact analysis estimated that, over the two-year period, 62 infections and 4.8 deaths were avoided, with gross cost savings of $1,011,146, and net savings of $695,706, which translates to a 3.2-fold return on investment. Probabilistic sensitivity analysis showed EDS-HAT was cost-saving and more effective in 98% of simulations.CONCLUSIONReal-time genomic surveillance enabled the rapid detection and control of outbreaks in our hospital and resulted in patient and economic benefits. This study demonstrates the feasibility and effectiveness of integrating genomic surveillance into routine infection prevention practice, offering a paradigm shift in healthcare outbreak detection and control.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"135 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893086","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":"Responsible use of doxycycline for STI prevention includes both recognizing its benefits and planning for antimicrobial resistance monitoring.","authors":"Troy Grennan,Mark W Hull","doi":"10.1093/cid/ciaf220","DOIUrl":"https://doi.org/10.1093/cid/ciaf220","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"141 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893083","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":"Evidence for selection of doxycycline resistance in Staphylococcus aureus in DoxyPrEP study.","authors":"Sheeba Manoharan-Basil,Thibaut Vanbaelen,Chris Kenyon","doi":"10.1093/cid/ciaf219","DOIUrl":"https://doi.org/10.1093/cid/ciaf219","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"45 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893084","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":"Transmitted Human Immunodeficiency Virus Type 1 (HIV-1) Drug Resistance Among Newly Diagnosed Individuals in 31 Provincial-Level Administrative Divisions in China in 2023: A Cross-sectional Survey","authors":"Jingjing Hao, Xiu Liu, Dong Wang, Hongping Hu, Fangyuan Li, Yantong Li, Jing Hu, Chang Song, Yuhua Ruan, Yi Feng, Zheng Wang, Yiming Shao, Lingjie Liao, Hui Xing","doi":"10.1093/cid/ciaf159","DOIUrl":"https://doi.org/10.1093/cid/ciaf159","url":null,"abstract":"Background Transmitted drug resistance (TDR) may compromise the effect of antiretroviral therapy (ART), highlighting the necessity for continuous monitoring. Methods The study was conducted across 31 provincial-level administrative divisions of China. Demographic information and blood samples were collected from participants at diagnosis of human immunodeficiency virus (HIV) infection between April and June 2023. TDR and molecular transmission networks were analyzed based on partial pol sequences via the Stanford HIV drug resistance database and HIV-TRACE, respectively. Logistic regression was utilized to identify factors associated with TDR. Results HIV drug resistance genotyping was successfully performed on plasma samples from 6654 individuals. The overall TDR prevalence was 11.4% (95% confidence interval [CI], 10.6%–12.2%). Resistance to nonnucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs), protease inhibitors (PIs), and integrase strand transfer inhibitors (INSTIs) was 7.9%, 0.8%, 2.4%, and 1.0%, respectively. TDR to efavirenz/nevirapine (EFV/NVP) was 6.5%. According to the surveillance drug resistance mutation list, the prevalence of TDR to total, NNRTIs, NRTIs, PIs, and INSTIs was 8.2%, 6.4%, 1.0%, 0.7%, and 0.4%. Multivariable analysis linked TDR to non-Han ethnicity (adjusted odds ratio [AOR], 1.45 [95% CI, 1.17–1.79]), unknown transmission routes (AOR, 2.56 [95% CI, 1.33–4.90]), and CD4 ≥500 cells/μL (AOR, 1.29 [95% CI, 1.05–1.58]). Higher education (high school or more) reduced TDR odds (AOR, 0.77 vs primary education). Conclusions TDR among people with newly diagnosed HIV in China exceeds 10%, with EFV/NVP TDR &amp;gt;5%. Timely monitoring of TDR and adjustment of ART regimens are essential to mitigate the impact of drug resistance on treatment efficacy.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"22 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884281","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}