Clinical Infectious Diseases最新文献

{"title":"Epidemiology and Prognostic Factors Associated With Mold-Positive Blood Cultures: 10-Year Data From a French Prospective Surveillance Program (2012-2022).","authors":"Thiziri Tala-Ighil, Dea Garcia-Hermoso, Frédéric Dalle, Sophie Cassaing, Juliette Guitard, Karine Boukris-Sitbon, Thomas Obadia, Olivier Lortholary, Valérie Letscher-Bru, Marie-Pierre Ledoux, Taïeb Chouaki, Anne Pauline Bellanger, Célia Rouges, Marie Elisabeth Bougnoux, Maxime Moniot, Marc Pihet, Vincent Dubée, Frédéric Gabriel, Florent Morio, Lilia Hasseine, Christine Bonnal, Maud Gits-Muselli, Estelle Perraud-Cateau, Caroline Mahinc, Muriel Nicolas, Elisabeth Chachaty, Camille Cordier, Laurence Lachaud, Laura Courtellemont, Benoït Henry, Cécile Angebault, Gilles Gargala, Adélaïde Chesnay, Marie Liesse Pacreau, Laure Kamus, Nicole Desbois-Nogard, Magalie Demar, Loïc Epelboin, Alexandre Alanio, Eric Dannaoui, Fanny Lanternier","doi":"10.1093/cid/ciae594","DOIUrl":"https://doi.org/10.1093/cid/ciae594","url":null,"abstract":"<p><strong>Background: </strong>While invasive fusariosis and lomentosporiosis are known to be associated with fungemia, overall data on mold-related fungemia are limited, hampering early management. This study aimed to describe the epidemiology of mold-positive blood cultures.</p><p><strong>Methods: </strong>Epidemiological and clinical data on mold-positive blood cultures from 2012 to 2022 were obtained from the RESSIF database. Pseudofungemia was excluded using modified Duthie and Denning criteria. Univariable and multivariable Firth logistical regression was used to study factors associated with 90-day mortality.</p><p><strong>Results: </strong>Fusarium spp accounted for 67.5% of the 80 events, involving predominantly Fusarium fujikuroi spp complex (FFSC), Neocosmospora spp, and Fusarium oxysporum spp complex (FOSC). Lomentospora prolificans was the second most frequent (10%), followed by Trichoderma spp, Aspergillus spp, and Mucorales (5% each).Most patients had a history of hematological malignancy (HM) (70%). Forty-three percent had undergone allogeneic hematopoietic stem cell transplantation. Cutaneous and pulmonary lesions were common (43% each). Median time to blood culture positivity was 72 hours.HM and neutropenia were commonly reported in patients with FFSC, Neocosmospora spp, and L. prolificans fungemia. Pulmonary lesions were frequent in cases of L. prolificans fungemia. Patients with gastrointestinal conditions were frequently diagnosed with FOSC molds. HM (75%), particularly acute myeloblastic leukemia, was frequent in patients with Aspergillus spp fungemia. All patients with Trichoderma spp fungemia were exposed to corticosteroids.Day 90 mortality was 53%. Independent predictive factors of day 90 mortality included L. prolificans (odds ratio [OR], 33.3), Aspergillus spp fungemia (OR, 14.2), and corticosteroid exposure (OR, 7.85).</p><p><strong>Conclusions: </strong>Underlying conditions and clinical presentation vary between genera and could be considered to guide early management.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945637","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":"Analysis of Repeat Hepatitis C Viremia After Sustained Virologic Response in a Large Cohort of U.S. Veterans.","authors":"Alexander Matelski, Bruce Gregoire, Lauren A Beste, Cara D Varley, Elliott Lowy, Emily J Cartwright, Timothy R Morgan, David B Ross, Karine Rozenberg-Ben-Dror, Marissa M Maier","doi":"10.1093/cid/ciaf008","DOIUrl":"https://doi.org/10.1093/cid/ciaf008","url":null,"abstract":"<p><strong>Background: </strong>Chronic hepatitis C virus (HCV) infection affects >1% of the U.S. population, higher among U.S. Veterans. Direct-acting antiviral (DAA) medications are effective for viral cure, termed sustained virologic response (SVR), but repeat viremia after SVR is recognized. Prior work has been limited by use of electronic medical record data. We aim to better understand repeat viremia in the DAA era through detailed chart review.</p><p><strong>Methods: </strong>We identified 1,129 individuals from Veteran's Health Administration (VHA) who achieved SVR using DAA therapy but subsequently had detectable serum HCV nucleic acid. A random subset of 110 were chart reviewed and assigned one of four categories using laboratory, diagnosis, and chart review data: definite reinfection (25.5%), probable reinfection (25.5%), false positive (11.8%), and presumed late relapse (37.3%). We conducted between-group analysis of variance to identify demographic, behavioral, and laboratory features specific to each.</p><p><strong>Results: </strong>In our medical record cohort (n=1,129), substance use and unstable housing were common and median time to repeat viremia was 1.9 years. In our chart review cohort (n=110), younger age (18-34) and substance use were more frequent in definite or probable reinfection. Presumed relapse had comparatively more comorbid hepatocellular carcinoma (HCC) (20%, p<0.05) and more than half occurred prior to 1 year. The unique category of false positive has not previously been reported.</p><p><strong>Conclusions: </strong>This study deepens understanding of HCV reinfection and relapse and highlights important features including the HCV and opioid syndemic, contribution of laboratory error, possibility of a viral reservoir in HCC, and clinical engagement implications for those with ongoing risk.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945165","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":"Confounding could explain better sero-response of doxycycline/benzathine versus benzathine penicillin for syphilis.","authors":"Chris Kenyon","doi":"10.1093/cid/ciae659","DOIUrl":"https://doi.org/10.1093/cid/ciae659","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945166","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":"Safety of Triple-Dose Rifampin in Tuberculosis Treatment: A Systematic Review and Meta-Analysis.","authors":"Omri A Arbiv, Thomas Holmes, Marie JeongMin Kim, Marie Yan, Kamila Romanowski, Sarah K Brode, William J Burman, Dick Menzies, James C Johnston","doi":"10.1093/cid/ciaf004","DOIUrl":"https://doi.org/10.1093/cid/ciaf004","url":null,"abstract":"<p><strong>Background: </strong>There is growing interest in using high-dose rifampin for tuberculosis treatment. Recent studies suggest that triple-dose rifampin (TDR; ≥30 mg/kg/day) may be unsafe. We updated a systematic review to investigate the safety and efficacy of TDR.</p><p><strong>Methods: </strong>We searched Embase, MEDLINE, Cochrane Central Registry of Controlled Trials, Cochrane Database for Systematic Reviews and clinicaltrials.gov for randomized-controlled trials from January 1, 1965 to February 10, 2024 comparing standard-dose rifampin (SDR) to TDR and/or double-dose rifampin (DDR) in human tuberculosis treatment. The primary outcome was pooled incidence rate ratio (IRR) of severe adverse events (SevAE) between participants receiving TDR and SDR. Pooled relative risk (RR) of death was a key secondary outcome. Meta-analysis was performed by the inverse variance method. Heterogeneity was assessed by I2 and bias assessed by Cochrane Risk of Bias 2. The protocol was prospectively registered (osf.io/kfn5a).</p><p><strong>Results: </strong>Of the 11315 articles identified, 17 met inclusion criteria, enrolling 2313 SDR participants (17 studies), 2238 receiving DDR (12 studies), and 1199 receiving TDR (11 studies). Six studies had a high risk of bias. There was an increase in pooled SevAE among participants receiving TDR compared to SDR (IRR 1.48, 95% CI 1.12-1.96, I2 23%), driven by an increase in hepatic events (IRR 1.96, 95% CI 1.21-3.18). Death did not differ between participants receiving TDR and SDR (RR 1.19, 95% CI 0.71-1.99). One limitation is that only two included studies were blinded.</p><p><strong>Conclusions: </strong>Regimens using TDR were associated with an increase in SevAE, raising concerns regarding safety of TDR in humans.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945814","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":"The Application of Suppressive Antibiotic Therapy for Implant-Related Infection.","authors":"Xiang-Dong Wu, Yuhao Liu, Xing Wang","doi":"10.1093/cid/ciaf002","DOIUrl":"https://doi.org/10.1093/cid/ciaf002","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945816","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":"Safety and efficacy of three alternative regimens against relapsing Plasmodium vivax malaria in glucose 6-phosphate dehydrogenase deficient patients in the Brazilian Amazon (ALTPRIM)","authors":"Laila Barbosa, José Brito-Sousa, Cristiana Nascimento, Ana Pacheco, Márcia Alexandre, Aline Alencar, Marly Melo, Aretha Omena, Ingrid Souza, Emanuelle Silva, Michael Queiroz, Vitória Siqueira, Cristina Rabelo, Djane Baía-da-Silva, Débora Silva, Yasmin Rocha, Antônio Barbosa, Ramon Castro, Anne Almeida, Marcelo Brito, Adriana Lopes, Antônio Balieiro, Mônica Costa, Thais Amaral, Cristiane Valle, Alexia Vieira, Jhon Gonzaga, Dhélio Pereira, Maria Alecrim, Wuelton Monteiro, Marcus Lacerda, Gisely Melo","doi":"10.1093/cid/ciaf007","DOIUrl":"https://doi.org/10.1093/cid/ciaf007","url":null,"abstract":"Background Daily primaquine-induced hemolysis is a common cause of complications during Plasmodium vivax malaria treatment in individuals with glucose 6-phosphate dehydrogenase deficiency (G6PDd). Alternative regimens balancing safety and efficacy are needed. Methods G6PDd participants with P. vivax malaria from two sites in Brazilian Amazon between 2018 and 2022 were randomly allocated to three study arms, which received chloroquine (CQ) from day 1 to day 3 plus: (arm-1) seven-day course of primaquine (PQ) (0.5mg/kg/day), beginning at day 5; (arm-2) weekly PQ over eight weeks (0.75mg/kg/week) or; (arm-3) weekly CQ over 12 weeks (5mg/kg/week). A normal G6PD participants group was also enrolled in parallel using CQ for three days plus PQ for seven days. Primary focus was the safety profile, and the secondary was the number of patients free from the first recurrence until day 180. Results Fifty-four G6PDd participants were enrolled. Two participants in arm-1, but the arm was halted due to safety concerns. Weekly PQ group presented higher hemoglobin falls in D3 after the first dose (ΔHb = -1.61) than weekly CQ (ΔHb = -0.99), but efficacy was superior over the six-month follow-up. Conclusions Postponing the beginning of daily PQ to day 5, when less oxidative stress related to malaria itself would, in theory, decrease hemolytic effects of the drug in G6PDd patients, did not show to be safe. Weekly CQ avoiding the first relapse was not able to stop further relapses. Weekly PQ, as already demonstrated in Southeast Asia, was equally safe and efficacious in patients from Latin America.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"118 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142939647","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":"Predictors of Cryptococcus gattii clinical presentation and outcome: An international study","authors":"Eleni Galanis, Laura MacDougall, Caren Rose, Sharon C-A Chen, Hanna N Oltean, Paul R Cieslak, Emilio DeBess, Mei Chong, Tania C Sorrell, John W Baddley, Linda Hoang, Shawn R Lockhart, Peter G Pappas, Peter Phillips","doi":"10.1093/cid/ciae640","DOIUrl":"https://doi.org/10.1093/cid/ciae640","url":null,"abstract":"Background Infection by Cryptococcus gattii can lead to pulmonary or central nervous system (CNS) disease, or both. Whether site of infection and disease severity are associated with C. gattii species and lineages or with certain underlying medical conditions, or both is unclear. We conducted a retrospective cohort study to identify factors associated with site of infection and mortality among C. gattii cases. Methods We extracted data on 258 C. gattii cases from Australia, Canada and the United States reported from 1999 to 2011. We conducted unadjusted and multivariable logistic regression analyses to evaluate factors associated with site of infection and C. gattii mortality among hospitalized cases (N=218). Results Hospitalized C. gattii cases with CNS and other extrapulmonary disease were younger, more likely to reside in Australia and be infected with VGI lineage but less likely to have comorbidities and die as compared to pulmonary cases. The odds of having CNS and/or other extrapulmonary disease were 9 times higher in cases with VGI infection (aOR=9.21, 95%CI=3.28-25.89). Age &amp;gt;70 years (aOR=6.69, 95%CI=2.44-18.30), chronic lung disease (aOR=2.62, 95%CI=1.05-6.51) and an immunocompromised status (aOR=2.08, 95%CI=1.05-6.51) were associated with higher odds of C. gattii mortality. Conclusions Among hospitalized cases, C. gattii species and lineage are associated with site of infection but not with the risk of death, whereas older age and comorbidities increase the risk of death.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"9 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935956","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":"Influenza vaccine effectiveness against medically attended outpatient illness, United States, 2023-24 season.","authors":"Jessie R Chung, Ashley M Price, Richard K Zimmerman, Krissy Moehling Geffel, Stacey L House, Tara Curley, Karen J Wernli, C Hallie Phillips, Emily T Martin, Ivana A Vaughn, Vel Murugan, Matthew Scotch, Elie A Saade, Kiran A Faryar, Manjusha Gaglani, Jason D Ramm, Olivia L Williams, Emmanuel B Walter, Marie Kirby, Lisa M Keong, Rebecca Kondor, Sascha R Ellington, Brendan Flannery","doi":"10.1093/cid/ciae658","DOIUrl":"https://doi.org/10.1093/cid/ciae658","url":null,"abstract":"<p><strong>Background: </strong>The 2023-24 U.S. influenza season was characterized by a predominance of A(H1N1)pdm09 virus circulation with co-circulation of A(H3N2) and B/Victoria viruses. We estimated vaccine effectiveness (VE) in the United States against mild-to-moderate medically attended influenza illness in the 2023-24 season.</p><p><strong>Methods: </strong>We enrolled outpatients aged ≥8 months with acute respiratory illness in 7 states. Respiratory specimens were tested for influenza type/subtype by reverse-transcriptase polymerase chain reaction (RT-PCR). Influenza VE was estimated with a test-negative design comparing odds of testing positive for influenza among vaccinated versus unvaccinated participants. We estimated VE by virus sub-type/lineage and A(H1N1)pdm09 genetic subclades.</p><p><strong>Results: </strong>Among 6,589 enrolled patients, 1,770 (27%) tested positive for influenza including 796 A(H1N1)pdm09, 563 B/Victoria, and 323 A(H3N2). Vaccine effectiveness against any influenza illness was 41% (95% Confidence Interval [CI]: 32 to 49): 28% (95% CI: 13 to 40) against influenza A(H1N1)pdm09, 68% (95% CI: 59 to 76) against B/Victoria, and 30% (95% CI: 9 to 47) against A(H3N2). Statistically significant protection against any influenza was found for all age groups except adults aged 50-64 years. Lack of protection in this age group was specific to influenza A-associated illness. We observed differences in VE by birth cohort and A(H1N1)pdm09 virus genetic subclade.</p><p><strong>Conclusions: </strong>Vaccination reduced outpatient medically attended influenza overall by 41% and provided protection overall against circulating influenza A and B viruses. Serologic studies would help inform differences observed by age groups.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977738","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":"Development of a reference standard to assign bacterial versus viral infection etiology using an all-inclusive methodology for comparison of novel diagnostic tool performance.","authors":"Coburn Allen, J Kate Deanehan, Yaniv Dotan, Matthew A Eisenberg, Andrew M Fine, Jonathan Isenberg, Ann Kane, Dani Kirshner, Todd W Lyons, Yasmin Maor, Ami Neuberger, Daniel G Ostermayer, Sharona Paz, Oded Scheuerman, Shahaf Shiber, Victoria A Statler, Michal Stein, Renata Yakubov, Shirly Yanai, Roy Navon, Lior Kellerman, Tanya M Gottlieb, Eran Eden","doi":"10.1093/cid/ciae656","DOIUrl":"https://doi.org/10.1093/cid/ciae656","url":null,"abstract":"<p><strong>Background: </strong>Diagnostic test evaluation requires a reference standard. We describe an approach for creating a reference standard for acute infection using unrestricted adjudication and apply it to compare biomarker tools.</p><p><strong>Methods: </strong>Adults and children with suspected acute infection enrolled in three prospective studies at emergency departments and urgent cares were included. Adjudicators, blinded to C-reactive protein, procalcitonin, and MeMed BV (MMBV), labeled each case (bacterial/viral/non-infectious/indeterminate). Initial adjudication involved 3 adjudicators. Reference standard cohorts were defined: Microbiologically confirmed (3/3 adjudicators concur with high confidence and a concordant microbiological finding), unanimous (3/3 adjudicators concur with high confidence), suspected (3/3 adjudicators concur with high/moderate confidence or 2/3 adjudicators concur with high confidence) and all-inclusive (remaining unlabeled cases were reviewed by up to 7 additional adjudicators until reaching a leading label).</p><p><strong>Results: </strong>Among 1016 patients, 156 difficult-to-diagnose cases required over 3 adjudicators. The area under the receiver operating characteristic curve in the microbiologically confirmed (n=427), unanimous (n=565), suspected (n=860) and all-inclusive (n=1016) cohorts for MMBV were 0.98 (95% confidence interval 0.94-1.00), 0.98 (0.95-1.00), 0.95 (0.92-0.98) and 0.90 (0.87-0.93), respectively, and for procalcitonin were 0.69 (0.57-0.81), 0.77 (0.68-0.86), 0.74 (0.68-0.80) and 0.70 (0.65-0.75), respectively. A delta in performance between MMBV and procalcitonin was maintained across the different cohorts.</p><p><strong>Conclusion: </strong>Creating a reference standard that includes difficult-to-diagnose cases demands an approach to addressing diagnostic uncertainty in acute infections. Tool performance depends on the reference standard applied and decreases as the difficulty to diagnose increases, highlighting the importance of using the same reference standard when comparing tools.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920739","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":"Clinical characterisation and outcomes of human clade IIb mpox virus disease - a European multicentre observational cohort study (MOSAIC).","authors":"Elise Pesonel, Cédric Laouénan, Laetitia Guiraud, Josephine Bourner, Isabelle Hoffmann, Diana Molino, Coralie Tardivon, Delphine Bachelet, France Mentré, Alain Amstutz, Laura Merson, Amanda Rojek, Minerva Cervantes Gonzalez, Andrea Antinori, Antonella Castagna, Silvia Nozza, Valérie Pourcher, Agnès Libois, Jake Dunning, Evelina Tacconelli, Maya Hites, Fernando De La Calle Prieto, Peter Horby, Yazdan Yazdanpanah, Alexandra Calmy, F-Xavier Lescure, Piero Olliaro","doi":"10.1093/cid/ciae657","DOIUrl":"https://doi.org/10.1093/cid/ciae657","url":null,"abstract":"<p><strong>Background: </strong>The global mpox outbreak which started in May 2022 was caused by a novel clade IIb variant of the mpox virus (MPXV). It differed from the traditional Western and Central Africa disease in transmission patterns and clinical presentation.</p><p><strong>Methods: </strong>To address the need for detailed clinical and virologic data, we conducted an observational cohort study (MOSAIC) during May 2022-July 2023 in individuals with confirmed MPXV infection enrolled in six European Countries. Case-management decisions were left to the attending physician. Participants were monitored for up to six months for clinical signs/symptoms and clinical and virologic outcomes through hospital visits, phone interviews, and self-administered questionnaires. Outcomes included time-to-lesion resolution, clinical status, and virus clearance.</p><p><strong>Results: </strong>The 518 participants not receiving any specific treatment (\"untreated\") were diagnosed a median 5 days from symptom onset; 90% were managed as outpatients. Lesions were mostly cutaneous (88%) as and peri-genital (74%). By Day 14 from the first PCR-positive sample, 39% had resolved lesions. Time-to 95% unculturable virus was longest in cutaneous lesions (52 days). A putative systemic antiviral was available for 57 participants, 44% as in-patients, 34% and 58% had resolved lesions by D14 from the first PCR-positive sample and from treatment start, respectively. Time-to 95% unculturable virus was 60 days in skin and oropharynx. No death or recrudescence occurred by Day 180.</p><p><strong>Conclusion: </strong>MOSAIC provides comprehensive insights into the clinical and virologic characteristics of mpox caused by the clade IIb variant. The study forms the basis of clinical characterisation for ongoing mpox outbreaks.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920626","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}