Current Opinion in Infectious Diseases最新文献

{"title":"Update on syphilis diagnostics.","authors":"Stephanie Sweitzer, Joseph A Duncan, Arlene C Seña","doi":"10.1097/QCO.0000000000001073","DOIUrl":"10.1097/QCO.0000000000001073","url":null,"abstract":"<p><strong>Purpose of review: </strong>Syphilis is rising globally, with resultant increases in morbidity and mortality that disproportionately impact underserved populations. Appropriate screening and testing for syphilis with accurate, reliable, affordable, and timely assays is crucial for combating this epidemic. This review provides a brief overview of laboratory methods for syphilis diagnosis, with a focus on recent updates in diagnostics and directions for future research.</p><p><strong>Recent findings: </strong>Syphilis can be complex and time-consuming to diagnose and stage appropriately. The historic use of darkfield microscopy for diagnosis has been eclipsed by algorithms that include both nontreponemal and treponemal antibody tests for screening and confirmation of active Treponema pallidum infection. Newer diagnostic modalities include nucleic acid amplification assays (NAATs) and point-of-care testing (POCT), which hold promise for increasing identification of active syphilis but have notable limitations. More work is needed to develop accurate, reliable, affordable, and expeditious tests to optimize syphilis diagnosis.</p><p><strong>Summary: </strong>Algorithms utilizing a combination of serological treponemal and nontreponemal assays remain standard of care for the diagnosis of syphilis, but recently developed NAATs and POCT assays present opportunities to increase syphilis detection. Further research is warranted to improve upon these testing modalities and explore other markers that could aid in syphilis diagnosis.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"44-53"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11695141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prostate cancer in people with HIV.","authors":"Keith Sigel, Ryan Yu, Elizabeth Chiao, Ashish Deshmukh, Michael S Leapman","doi":"10.1097/QCO.0000000000001076","DOIUrl":"10.1097/QCO.0000000000001076","url":null,"abstract":"<p><strong>Purpose of review: </strong>Prostate cancer burden has been rising among people with HIV (PWH), yet it remains understudied in the context of HIV infection. The objective of this review article is to summarize contemporary information on the burden, risk, and outcomes of prostate cancer for people living with HIV.</p><p><strong>Recent findings: </strong>Despite a lower apparent incidence of prostate cancer in early studies for PWH compared to uninfected persons, this malignancy is now likely to be the most common tumor for US PWH. Tumor characteristics and stage appear to have limited differences by HIV status. The optimal approach to early detection of prostate cancer remains controversial, and there are little HIV-specific data surrounding screening. Prostate cancer outcomes may have been worse for PWH in the early antiretroviral era but may have improved in more recent years.</p><p><strong>Summary: </strong>Prostate cancer is an increasingly common clinical issue for PWH. Lower than expected incidence rates in the early ART-era may be increasing, and oncologic outcomes may also be improving. Treatment tolerability is still a key question for this patient group. Given the clinical and biological complexity of chronic HIV infection, strategies for both early detection and treatment will need continued evaluation specifically in the setting of HIV.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"10-17"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11695140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does climate change threaten delivery of HIV care in resource-limited settings?","authors":"Kingsley Stephen Orievulu, Matylda Buczkowska, Collins C Iwuji","doi":"10.1097/QCO.0000000000001079","DOIUrl":"10.1097/QCO.0000000000001079","url":null,"abstract":"<p><strong>Purpose of review: </strong>Extreme weather events (EWEs) pose a challenge to achieving UNAIDS goal of eliminating HIV as a public health threat by 2030. This review summarizes recent findings describing the disruption of HIV services by EWEs and discusses strategies for a resilient HIV care programme in resource-limited settings.</p><p><strong>Recent findings: </strong>EWEs impact each component of the continuum of care - HIV testing, linkage to treatment, viral suppression and other HIV prevention services. EWEs disrupt healthcare provision either through impacting the ability of the healthcare system to deliver care because of infrastructure damage and increased workload or by limiting people's ability to seek healthcare because of access challenges and forced displacements. This culminates in disengagement from care, poor treatment adherence and increase in HIV disease progression with more vulnerable groups such as women and young people being more adversely impacted.</p><p><strong>Summary: </strong>Most people affected by or at risk of HIV reside in resource-poor settings which are the region with the least capacity to adapt to climate change. Few recent studies with very limited geographical coverage show that EWEs affect the delivery of HIV care in this setting. Climate adaptation and mitigation policies are required to protect health in resource-limited settings.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"18-25"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When is it a sexually transmitted infection? Intimate contact transmission of pathogens not traditionally defined as STIs.","authors":"Angelo Roberto Raccagni, Antonella Castagna, Silvia Nozza","doi":"10.1097/QCO.0000000000001072","DOIUrl":"https://doi.org/10.1097/QCO.0000000000001072","url":null,"abstract":"<p><strong>Purpose of review: </strong>Several microorganisms, which are not traditionally considered sexually transmitted infections (STIs), are capable of sexual transmission and have the potential to cause global outbreaks. The aim of this review is to describe pathogens which are not traditionally defined as STIs, to grant insight on current and potential outbreaks and call for clinical vigilance among members of key populations.</p><p><strong>Recent findings: </strong>Recent findings emphasize that several pathogens, not traditionally classified as STIs, can be sexually transmissible. These include the mpox virus, enteric infections such as Shigella spp., dermatophytes such as Trichophyton mentagrophytes, ectoparasites and atypical bacterial genito-urinary infections such as Neisseria meningitidis. The internationally reported outbreaks and the reports on potential sexual transmission of these pathogens underlines the emerging risks, the need for a broader STI definition and the importance of vigilant public health control strategies.</p><p><strong>Summary: </strong>These findings suggest that clinical practice should broaden STI testing and awareness to include pathogens not traditionally considered sexually transmissible, particularly among key populations. Clinicians must be vigilant for atypical presentations, ensuring comprehensive sexual healthcare and diagnostic testing. Development of targeted preventive efforts and continuous surveillance to detect and manage emerging sexually transmissible infections is paramount.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":"38 1","pages":"65-70"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Climate change and extreme weather events and linkages with HIV outcomes: recent advances and ways forward.","authors":"Carmen H Logie, Andie MacNeil","doi":"10.1097/QCO.0000000000001081","DOIUrl":"10.1097/QCO.0000000000001081","url":null,"abstract":"<p><strong>Purpose of review: </strong>Discuss the recent evidence on climate change and related extreme weather events (EWE) and linkages with HIV prevention and care outcomes.</p><p><strong>Recent findings: </strong>We identified 22 studies exploring HIV prevention and care in the context of EWE. HIV prevention studies examined sexual practices that increase HIV exposure (e.g., condomless sex, transactional sex), HIV testing, and HIV recent infections and prevalence. HIV care-related outcomes among people with HIV included clinical outcomes (e.g., viral load), antiretroviral therapy adherence and access, HIV care engagement and retention, and mental and physical wellbeing. Pathways from EWE to HIV prevention and care included: structural impacts (e.g., health infrastructure damage); resource insecurities (e.g., food insecurity-related ART adherence barriers); migration and displacement (e.g., reduced access to HIV services); and intrapersonal and interpersonal impacts (e.g., mental health challenges, reduced social support).</p><p><strong>Summary: </strong>Studies recommended multilevel strategies for HIV care in the context of EWE, including at the structural-level (e.g. food security programs), health institution-level (e.g., long-lasting ART), community-level (e.g. collective water management), and individual-level (e.g., coping skills). Climate-informed HIV prevention research is needed. Integration of EWE emergency and disaster preparedness and HIV services offers new opportunities for optimizing HIV prevention and care.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"26-36"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11676615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial introductions.","authors":"","doi":"10.1097/QCO.0000000000001083","DOIUrl":"https://doi.org/10.1097/QCO.0000000000001083","url":null,"abstract":"","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":"38 1","pages":"v-vi"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progress towards effective vaccines for Chlamydia trachomatis.","authors":"Amanda L Collar, Kathryn M Frietze","doi":"10.1097/QCO.0000000000001075","DOIUrl":"10.1097/QCO.0000000000001075","url":null,"abstract":"<p><strong>Purpose of review: </strong>Effective vaccines to prevent sexually transmitted Chlamydia trachomatis (Ct) infection have eluded researchers for decades. However, recent studies of a promising vaccine in human trials, and emerging understanding of the complexity of the natural immune response to infection have provided hope for the eventual approval of a vaccine. This review highlights recent progress toward developing effective vaccines for Ct.</p><p><strong>Recent findings: </strong>In 2019, the first-in-human Ct vaccine, CTH522, Phase I/IIB trial was reported. Recent studies of this vaccine and its derivatives have further established CTH522 as the lead vaccine against sexually transmitted Ct. A variety of vaccines have entered the preclinical development pipeline, with researchers reporting efforts to target non-MOMP antigens, include novel adjuvants in vaccine formulations, and use alternative routes of administration to increase efficacy.</p><p><strong>Summary: </strong>While the approval of a vaccine for Ct is closer than ever, the need for careful consideration of future implementation is especially important for the successful clinical translation of Ct vaccines into humans.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":"38 1","pages":"54-59"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11698491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mpox: emergence following smallpox eradication, ongoing outbreaks and strategies for prevention.","authors":"Amy E Bryant, Stanford T Shulman","doi":"10.1097/QCO.0000000000001100","DOIUrl":"https://doi.org/10.1097/QCO.0000000000001100","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review focuses on the temporal relationship between the discontinuation of the global smallpox eradication effort with the rise of mpox in Africa and worldwide. It also discusses the global 2022 clade II mpox epidemic and the current 2024 clade I mpox outbreak. Newer findings on viral evolution and pathogenesis, plus current and future strategies for disease prevention, are reviewed.</p><p><strong>Recent findings: </strong>The temporal association between the incidence of mpox and the World Health Organization's Global Smallpox Eradication Program (GSEP) is presented. The 2022 global mpox epidemic is discussed. Recent data show that clade IIb monkeypox virus (MPXV)-2022 has novel genetic features supporting a greater propensity for mutations that may be responsible for enhanced human-to-human transmissibility, increased disease severity and accelerated viral evolution. In 2023, another outbreak of mpox began in Africa, this time due to the potentially more virulent MPXV clade Ib strains. This outbreak remains ongoing in Africa, and clade Ib mpox cases have recently been reported elsewhere including the United States and Great Britain. The World Health Organization has deemed mpox to be a global public health emergency. Two smallpox vaccines are approved for mpox prevention in the United States; a third smallpox vaccine and an improved diagnostic test have recently received WHO Emergency Use authorization. Newer mRNA-based vaccines for evolving orthopoxvirus infections are discussed.</p><p><strong>Summary: </strong>Vaccination to prevent smallpox provides immunologic cross-protection against infection with other members of genus Orthopoxvirus, including mpox. Discontinuation of the global smallpox eradication program in the 1980s and the subsequent waning of herd immunity contributed to the 2022 multinational epidemic of human clade IIb mpox infections. A second multinational outbreak with clade Ib MPXV is ongoing. Vaccination against smallpox remains the gold standard for mpox prevention, however newer multiepitope mRNA-based vaccines are in development and hold promise for prevention of mpox and other orthopoxvirus outbreaks.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chimeric antigen receptor-T-cell therapies going viral: latent and incidental viral infections.","authors":"Eleftheria Kampouri, Gemma Reynolds, Benjamin W Teh, Joshua A Hill","doi":"10.1097/QCO.0000000000001066","DOIUrl":"10.1097/QCO.0000000000001066","url":null,"abstract":"<p><strong>Purpose of review: </strong>Infections are the leading cause of non-relapse mortality following chimeric antigen receptor (CAR)-T-cell therapy, with viral infections being frequent both in the early and late phases post-infusion. We review the epidemiology of viral infections and discuss critical approaches to prevention and management strategies in this setting.</p><p><strong>Recent findings: </strong>Herpesviruses dominate the early period. herpes simplex virus and varicella zoster virus infections are rare due to widespread antiviral prophylaxis, but cytomegalovirus (CMV) reactivation is increasingly observed, particularly in high-risk groups including B cell maturation antigen (BCMA)-CAR-T-cell therapy recipients and patients receiving corticosteroids. While CMV end-organ disease is rare, CMV is associated with increased mortality, emphasizing the need to evaluate the broader impact of CMV on long-term hematological, infection, and survival outcomes. Human herpesvirus-6 (HHV-6) has also emerged as a concern, with its diagnosis complicated by overlapping symptoms with neurotoxicity, underscoring the importance of considering viral encephalitis in differential diagnoses. Respiratory viruses are the most common late infections with a higher incidence after BCMA CAR-T-cell therapy. Vaccination remains a critical preventive measure against respiratory viruses but may be less immunogenic following CAR-T-cell therapy. The optimal timing, type of vaccine, and dosing schedule require further investigation.</p><p><strong>Summary: </strong>A better understanding of viral epidemiology and preventive trials are needed to improve infection prevention practices and outcomes following CAR-T-cell therapies.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"526-535"},"PeriodicalIF":3.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When antimicrobial stewardship begins with microbiological test requests: the case of asymptomatic bacteriuria.","authors":"Hannah Imlay, Alistair Thorpe, Valerie M Vaughn","doi":"10.1097/QCO.0000000000001057","DOIUrl":"10.1097/QCO.0000000000001057","url":null,"abstract":"<p><strong>Purpose of review: </strong>We aim to review the rationale, methods, and experiences with diagnostic stewardship targeted at urinary tract infection (UTI) and related urinary syndromes.</p><p><strong>Recent findings: </strong>In the last 18 months, several articles have demonstrated the impact of diagnostic stewardship interventions at limiting inappropriate diagnosis of UTIs or inappropriate antibiotic-prescribing, targeting the urinary tract. Antimicrobial stewardship programs may create and implement interventions at the point of urine test ordering, urine test resulting, or at the point of prescribing antibiotics after results have returned. Specific design and implementation of stewardship interventions depends on context. To maximize their impact, interventions should be accompanied by education and garner buy-in from providers.</p><p><strong>Summary: </strong>Diagnostic stewardship can decrease unnecessary antibiotics and inappropriate diagnosis of UTI with multifaceted interventions most likely to be effective. Remaining questions include how to reduce ASB treatment in new populations, such as those with immune compromise, and persistent unknowns regarding UTI diagnosis and diagnostics.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"565-572"},"PeriodicalIF":3.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}