Infectious Disease Reports最新文献

{"title":"Bone Marrow Infection by <i>Pneumocystis jirovecii</i> in a Patient with AIDS: A Case Report and Literature Review.","authors":"Diego Alejandro Cubides-Diaz, Valentina Negrette-Lazaro, Viviana Poveda-Hurtado, Juan Pablo López-Salazar, Carlos Mauricio Calderón-Vargas, Carlos Arturo Álvarez-Moreno","doi":"10.3390/idr17030047","DOIUrl":"10.3390/idr17030047","url":null,"abstract":"<p><strong>Background: </strong><i>Pneumocystis jirovecii</i> primarily causes pneumonia in immunosuppressed individuals, particularly those living with advanced HIV/AIDS. Extrapulmonary dissemination is uncommon, with bone marrow involvement described in only a handful of cases globally. Bone marrow infection occurs in the setting of severe immunosuppression, poses diagnostic challenges, and carries a high mortality rate.</p><p><strong>Methods: </strong>We describe the case of a 34-year-old man newly diagnosed with HIV/AIDS, presenting with severe immunosuppression and <i>Pneumocystis jirovecii</i> pneumonia. The patient initially improved with cotrimoxazole and corticosteroids, but was readmitted shortly after discharge with abdominal pain, diarrhea, and worsening pancytopenia. A bone marrow biopsy revealed <i>Pneumocystis jirovecii</i> cysts, confirming disseminated infection. Concomitant Kaposi sarcoma involving the skin and gastrointestinal tract was also diagnosed. Despite antimicrobial therapy, the patient's condition worsened, leading to multisystem organ failure and death two months later.</p><p><strong>Conclusions: </strong>This case highlights a rare presentation of disseminated <i>Pneumocystis jirovecii</i> infection with bone marrow involvement in a patient with advanced HIV/AIDS. Although infrequent, this complication should be considered in individuals with <i>Pneumocystis jirovecii</i> pneumonia who develop persistent cytopenias and systemic symptoms. Diagnosis depends on histopathologic confirmation, which may lead to under-recognition. Early suspicion and individualized management are essential, though the optimal treatment approach for extrapulmonary infection remains undefined.</p>","PeriodicalId":13579,"journal":{"name":"Infectious Disease Reports","volume":"17 3","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology and Genetic Characterization of Distinct Ebola Sudan Outbreaks in Uganda.","authors":"Francesco Branda, Massimo Ciccozzi, Fabio Scarpa","doi":"10.3390/idr17030044","DOIUrl":"10.3390/idr17030044","url":null,"abstract":"<p><p><b>Background</b>. Sudan virus (SUDV) has caused multiple outbreaks in Uganda over the past two decades, leading to significant morbidity and mortality. The recent outbreaks in 2022 and 2025 highlight the ongoing threat posed by SUDV and the challenges in its containment. This study aims to characterize the epidemiological patterns and phylogenomic evolution of SUDV outbreaks in Uganda, identifying key factors influencing transmission and disease severity. <b>Methods</b>. We conducted a retrospective observational study analyzing epidemiological and genomic data from SUDV outbreaks in Uganda between 2000 and 2025. Epidemiological data were collected from official sources, including the Ugandan Ministry of Health and the World Health Organization, supplemented with reports from public health organizations. Genomic sequences of SUDV were analyzed to investigate viral evolution and identify genetic variations associated with pathogenicity and transmissibility. <b>Results</b>. The 2022 outbreak involved 164 confirmed cases and a case fatality rate (CFR) of 33.5%, with significant geographic variation in case distribution. The 2025 outbreak, still ongoing, was first detected in Kampala, with evidence of both nosocomial and community transmission. Phylogenomic analysis revealed the presence of two main genetic groups, representing Sudan and Uganda, respectively. The genetic variability of the Ugandan cluster is higher than that observed in Sudan, suggesting a greater expansion potential, which aligns with the current outbreak. Epidemiological findings indicate that human mobility, weaknesses in the health system, and delays in detection contribute to the amplification of the outbreak. <b>Conclusions</b>. Our findings underscore the importance of integrated genomic and epidemiological surveillance in understanding SUDV transmission dynamics. The recurrent emergence of SUDV highlights the need for improved outbreak preparedness, rapid response mechanisms, and international collaboration. Strengthening real-time surveillance and enhancing healthcare system resilience are critical to mitigating the impact of future outbreaks.</p>","PeriodicalId":13579,"journal":{"name":"Infectious Disease Reports","volume":"17 3","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Rickettsia parkeri</i> Rickettsiosis Resembling Sweet Syndrome: A Differential Diagnosis for Critical Discussion.","authors":"Lucas S Blanton, Sarah E Muir, Nicole L Mendell, David H Walker","doi":"10.3390/idr17030045","DOIUrl":"10.3390/idr17030045","url":null,"abstract":"<p><p><b>Introduction:</b> Spotted fever group (SFG) rickettsioses are tick-transmitted infections caused by Gram-negative, obligately intracellular bacteria in the genus <i>Rickettsia</i>. They present as an acute undifferentiated febrile illness, and they are often accompanied by rash and/or eschar. Although the rash of SFG rickettsioses usually consists of macules and papules, some, like in <i>Rickettsia parkeri</i> rickettsiosis, can also manifest with papulovesicular or pustular lesions. <b>Case:</b> We herein present a case of SFG rickettsiosis, due to <i>R. parkeri</i>, that masqueraded as Sweet syndrome (the prototype neutrophilic dermatosis) after the initial results of a shave biopsy. Further investigation of the biopsy specimen by immunohistochemical and PCR analysis would eventually confirm SFG rickettsiosis, with <i>R. parkeri</i> being detected by real-time PCR. <b>Discussion:</b><i>Rickettsia parkeri</i> is transmitted by the Gulf Coast tick (<i>Amblyomma maculatum</i>) and is an increasingly recognized cause of SFG rickettsiosis in the United States. <i>Rickettsia parkeri</i> should be considered in those with an acute undifferentiated febrile illness with lesions that are pustular or papulovesicular, as prompt recognition and empirical administration of doxycycline results in the rapid resolution of symptoms.</p>","PeriodicalId":13579,"journal":{"name":"Infectious Disease Reports","volume":"17 3","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of COVID-19 Symptom Rebound After Treatment with Remdesivir.","authors":"Kalpana Gupta, William J O'Brien, Judith Strymish, Anna Chen, Katherine Linsenmeyer, Rebecca Madjarov, Michael E Charness","doi":"10.3390/idr17030043","DOIUrl":"10.3390/idr17030043","url":null,"abstract":"<p><strong>Background/objectives: </strong>Recent in vitro data suggest that remdesivir might be less likely than nirmatrelvir-ritonavir to be associated with COVID-19 rebound. We compared the incidence of symptom rebound in our remdesivir-treated cohort with rates reported in the literature for nirmatrelvir-ritonavir.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of VA Boston Healthcare System patients who were nursing home residents or inpatients treated with remdesivir for mild to moderate COVID-19 that met clinical criteria for nirmatrelvir-ritonavir treatment between 05/2022 and 10/2024. Electronic health records were reviewed for evidence of symptom rebound in daily clinical evaluations and outside hospital care notes for 15-20 days after the diagnosis of COVID-19. Rates for nirmatrelvir-ritonavir were identified via a literature review.</p><p><strong>Results: </strong>Among 194 patients treated with remdesivir, 39 were excluded due to concurrent antiviral use, hypoxia, or ICU-level care. The average age of the remaining 155 patients was 75.1 ± 11.9 years; 147 patients (95%) were male. Evidence of symptom rebound was found in 1 of 155 (0.6%) remdesivir-treated patients, which is a rate lower than that reported in all 12 studies of nirmatrelvir-ritonavir symptom rebound during the Omicron era.</p><p><strong>Conclusions: </strong>Our finding of low rates of COVID-19 symptom rebound after treatment with remdesivir are consistent with the hypothesis that rebound may be less frequent after treatment with remdesivir than with nirmatrelvir-ritonavir.</p>","PeriodicalId":13579,"journal":{"name":"Infectious Disease Reports","volume":"17 3","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Humoral and Cell-Mediated Immunity Against SARS-CoV-2 in Healthcare Personnel Who Received Multiple mRNA Vaccines: A 4-Year Observational Study.","authors":"Hideaki Kato, Kaori Sano, Kei Miyakawa, Takayuki Kurosawa, Kazuo Horikawa, Yayoi Kimura, Atsushi Goto, Akihide Ryo","doi":"10.3390/idr17030042","DOIUrl":"10.3390/idr17030042","url":null,"abstract":"<p><p><b>Background/Objectives:</b> The long-term effects of multiple updated vaccinations against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) have not been clarified. Humoral or cellular immunity dynamics in healthcare workers for four years were analyzed. <b>Methods:</b> Blood samples were collected at five time points from April 2021 to January 2024. Humoral immunity was analyzed using the 50% neutralizing titer (NT₅₀) against the original Omicron XBB and Omicron BA.2.86 strains and cellular immunity were analyzed using the ELISpot interferon-gamma releasing assay. NT₅₀s and the spot-forming count (SFC) of the ELISpot assay were compared in the SARS-CoV-2 Omicron XBB-, Omicron-infected, and uninfected subjects. <b>Results</b>: 32 healthcare workers (median age, 47 years) who received 3-7 vaccine doses were enrolled. The NT₅₀s against the original strain decreased after the second vaccination but were maintained after the third vaccine dose. NT₅₀s against the Omicron XBB and BA.2.86 strains were detected before the Omicron vaccine was introduced and increased following the updated vaccination. The NT₅₀s against the Omicron XBB and BA.2.86 strains were elevated after natural infection by the Omicron strain, albeit without differences compared with the findings in uninfected subjects. Multivariate regression analysis revealed no confounder that affected the antibody titer against the BA.2.86 strain at the fifth blood sampling. The median number of SFCs ranged from 78 to 208 after the first two doses. <b>Conclusions</b>: Multiple vaccinations induced the production of antibodies with divergent activity against emerging mutant strains and enhanced protective effects against the original strain. This finding supported the importance of updated vaccination.</p>","PeriodicalId":13579,"journal":{"name":"Infectious Disease Reports","volume":"17 3","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Factors Determining Serologic Response to Treatment of Early Syphilis in Adult Men.","authors":"Justyna Czarny, Damian Kadylak, Małgorzata Sokołowska-Wojdyło, Roman J Nowicki","doi":"10.3390/idr17030041","DOIUrl":"10.3390/idr17030041","url":null,"abstract":"<p><p><b>Background:</b> Syphilis is an infectious systemic disease that remains a public health threat, with an increasing incidence worldwide. Despite the availability of diagnostic tests and effective treatments, achieving a serological cure remains challenging for some patients. <b>Methods:</b> A retrospective cohort study of 130 male patients with early syphilis who attended the Department of Dermatology Venereology and Allergology in Gdansk was carried out between 2021 and 2024. This study assessed the rates of proper serological response and seroreversion of the VDRL test during the posttreatment follow-up period and analyzed selected factors influencing the achievement of these points. <b>Results:</b> The treatment outcomes were favorable; 96.15% of the patients achieved a proper serological response at a median of 1.54 months and seroreversion of the VDRL test within 18 months (median time = 7 months). A significantly greater proper serological response was observed in the primary and secondary syphilis patients than in the early latent syphilis patients (<i>p</i> = 0.005). A proper serological response was associated with age over 30 years (risk ratio (<i>RR</i>) = 1.381, <i>p</i> = 0.008) and VDRL baseline titers (≥1:32) (RR = 1.484, <i>p</i> = 0.005). The patients in the secondary or latent stage of early syphilis had a lower risk of seroreversion than those in the primary stage did (RR = 0.590, <i>p</i> = 0.030; <i>RR</i> = 0.560, <i>p</i> = 0.019, respectively). High titers at baseline (≥1:32) were also associated with a 30.8% reduced risk of seroreversion compared with lower titers (<i>RR</i> = 0.692, <i>p</i> = 0.038). <b>Conclusions</b>: These results suggest that age, syphilis stage, and titer level are significant predictors of the response rate. Based on these results, it is recommended that serological follow-up be concentrated within the first three months posttreatment, as this period accounts for the majority of treatment responses.</p>","PeriodicalId":13579,"journal":{"name":"Infectious Disease Reports","volume":"17 3","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Condyloma Acuminata with Tirbanibulin 1% Ointment in People Living with HIV: A Case Series with Literature Review.","authors":"Fabio Artosi, Terenzio Cosio, Lorenzo Ansaldo, Alessandro Cavasio, Loredana Sarmati, Luca Bianchi, Elena Campione","doi":"10.3390/idr17030040","DOIUrl":"10.3390/idr17030040","url":null,"abstract":"<p><strong>Background: </strong>Condyloma acuminata (CA) are dysplastic lesions caused by human papillomavirus (HPV) infection. Condylomata acuminata are common in Human Immunodeficiency Virus- (HIV) infected individuals and have been linked to HIV transmission. Current therapeutic options for CA encompass laser, cryotherapy, imiquimod, sinecatechins, podophyllotoxin, and trichloroacetate. These topical therapies have limitations caused by significant local skin reactions, high recurrence rates, prolonged application times, and, in some cases, a supposed lower efficacy in people living with Human Immunodeficiency Virus (PLWH). Previous studies evaluated the effect in the CA treatment of tirbanibulin 1% ointment since it is a synthetic antiproliferative drug approved for the topical treatment of actinic keratoses, acting in two distinct ways: it inhibits microtubule polymerization and Src kinase signaling. Human papilloma virus can up-regulate the kinases Src and Yes, so the tirbanibulin efficient treatment of CA may be due to the suppression of Src kinase signaling.</p><p><strong>Methods: </strong>Here, we present for the first time a retrospective case series of three PLWHIV affected by CA.</p><p><strong>Case: </strong>The patients experienced variable outcomes, with complete resolution of smaller condylomas for 2 out of 3 patients. Adverse events were local and of mild to moderate severity, lasting one week or less.</p><p><strong>Conclusions: </strong>While in need of larger studies, it is possible to hypothesize tirbanibulin 1% ointment as a therapeutic alternative for people living with HIV, especially for condylomas smaller than 1 cm in size.</p>","PeriodicalId":13579,"journal":{"name":"Infectious Disease Reports","volume":"17 3","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Challenges in Extrapulmonary Tuberculosis: A Single-Center Experience in a High-Resource Setting at a German Tertiary Care Center.","authors":"Jonas Wilmink, Richard Vollenberg, Ioana D Olaru, Julia Fischer, Jonel Trebicka, Phil-Robin Tepasse","doi":"10.3390/idr17030039","DOIUrl":"10.3390/idr17030039","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Extrapulmonary tuberculosis accounts for a significant portion of tuberculosis cases, presenting unique diagnostic challenges due to its heterogeneous manifestations and paucibacillary nature. This study aims to fill this gap by evaluating the diagnostic outcomes and correlations between different specimen types and test results. <b>Methods</b>: A retrospective analysis of electronic medical records of patients diagnosed with TB between January 2013 and December 2023 was carried out. The data extracted included patient demographics, comorbidities, TB classification, specimen types, microbiological test results, and time intervals to diagnosis. Statistical analysis was applied to compare the variables between pulmonary and extrapulmonary/disseminated TB groups. <b>Results</b>: Most patients were male (62.4%) and born outside of Germany (74.2%). Comorbidities, such as diabetes, cardiac disease, immunosuppressed status, and HIV, were common. Among the 194 patients, 98 had pulmonary TB, and 96 had extrapulmonary/disseminated TB. A comparison of pulmonary vs. extrapulmonary TB showed that extrapulmonary TB patients had a longer diagnostic delay (<i>p</i> = 0.013), more symptoms (<i>p</i> = 0.001), and more complications (42.7% vs. 16.3%, <i>p</i> < 0.001). Diagnostic challenges were evident, with multiple invasive procedures required in 43.5% of the extrapulmonary TB cases. <b>Conclusions</b>: This study highlights the complex clinical presentation of tuberculosis, particularly in patients with extrapulmonary and disseminated forms, who experience delayed diagnosis and more complications. These challenges in diagnosing extrapulmonary TB emphasize the need for improved diagnostic strategies and early identification, especially in high-risk populations.</p>","PeriodicalId":13579,"journal":{"name":"Infectious Disease Reports","volume":"17 3","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Outcomes of Patients with Cirrhosis Who Develop Infective Endocarditis.","authors":"Erika M Dorff, Kyle Crooker, Torrance Teng, Tess Hickey, Max HoddWells, Ashwini Sarathy, Sean Muniz, Jennifer Lor, Amy Chang, Devika Singh, Jean Dejace, Elly Riser, Bradley J Tompkins, Andrew J Hale","doi":"10.3390/idr17020037","DOIUrl":"https://doi.org/10.3390/idr17020037","url":null,"abstract":"<p><p><b>Background:</b> Infective endocarditis (IE) is an increasingly common infection that results in significant morbidity and mortality. An important but under-analyzed subpopulation of patients with IE are those with concomitant cirrhosis. This study compared the characteristics and outcomes of patients with and without cirrhosis who were hospitalized with IE. <b>Methods:</b> The authors conducted a retrospective cohort study in adult patients with IE admitted at a single center from 2010 to 2020, comparing outcomes between those with and without cirrhosis at the time of admission. <b>Results:</b> A total of 22 patients with a history of cirrhosis and 356 patients without a history of cirrhosis were included. Over a quarter (27.3%) of those with cirrhosis experienced a decompensation event within two years of their admission for IE. Clinical features, microbiology, and direct complications from IE were largely similar between groups. There was no significant difference in IE-related mortality rates between groups, although, in an overall survival analysis, the group with cirrhosis did have a higher risk of all-cause mortality at 2 years (HR = 2.85; <i>p</i> = 0.012). <b>Conclusions:</b> This study highlights that IE in patients with cirrhosis may contribute to or trigger decompensation events. Further research is warranted to better understand morbidity outcomes in patients with cirrhosis who develop IE.</p>","PeriodicalId":13579,"journal":{"name":"Infectious Disease Reports","volume":"17 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12027125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved Sixty-Day Mortality in Candidemia with Antifungal Treatment Within 72 Hours of Fever Onset: A Single-Center Retrospective Study in Rural Japan.","authors":"Koji Hayashi, Chizuru Hashimoto, Kohei Ueda, Yuka Nakaya, Asuka Suzuki, Maho Hayashi, Mamiko Sato, Yasutaka Kobayashi","doi":"10.3390/idr17020036","DOIUrl":"https://doi.org/10.3390/idr17020036","url":null,"abstract":"<p><p><b>Introduction:</b> Prognostic factor investigations for candidemia have been conducted in large-scale facilities, leading to significant evidence, including early administration of echinocandin antifungal agents and removal of central venous catheters (CVCs). In departments that provide aggressive chemotherapy or transplantation, candidiasis markers are regularly evaluated, and preemptive treatments may be initiated. However, in resource-limited facilities, candidemia detection largely relies on vital signs like fever and blood cultures. This study assessed whether evidence from large-scale facilities applies to such settings. Additionally, while prior studies indicate that early antifungal treatment is based on positive blood cultures, no established criteria exist for early administration based on fever as an indicator. <b>Methods:</b> This study analyzed cases of candidemia from blood cultures at Fukui General Hospital (2014-2024). Patients aged 18 or older with at least one positive blood culture for <i>Candida</i> species and clinical signs of infection were included, while contamination cases were excluded. The patients were categorized into survival and death groups based on 60-day survival from fever onset. The variables collected included age, gender, duration from admission to fever onset, time from fever onset to blood culture collection and antifungal treatment initiation, antifungal treatment within 72 h, serum albumin levels, history of cancer, diabetes, empiric echinocandin treatment, CVC insertion, duration of CVC insertion until fever onset, use of total parenteral nutrition, broad-spectrum antibiotic use, and sequential organ failure assessment (SOFA) score. Fever was defined as a body temperature of 38.0 °C or higher, guiding blood culture collection. <b>Results:</b> Of 30 candidemia cases, 29 were analyzed. Survival was significantly associated with younger age (average 73.3 ± 13.3 vs. 83.1 ± 9.1 years, <i>p</i> = 0.038) and antifungal treatment within 72 h of fever onset (9 vs. 3, <i>p</i> = 0.025). CVC use was of marginal significance (8 vs. 13, <i>p</i> = 0.108). There was a significant difference in the duration (in days) of CVC insertion until fever onset (median [IQR]: 15.5 [11.75-19.5] vs. 30.0 [19.0-39.0], <i>p</i> = 0.027). Logistic regression identified early antifungal treatment (OR = 0.065, <i>p</i> = 0.035) and CVC use (OR = 21.8, <i>p</i> = 0.024) as independent predictors of mortality. <b>Conclusions:</b> Early antifungal treatment within 72 h of fever onset and CVC use were independent predictors of mortality in candidemia. The importance of early antifungal treatment was reaffirmed even in smaller facilities. The impact of CVC insertion on 60-day survival cannot be readily generalized due to the limited sample size. Further research is needed to clarify the impact of fever-based antifungal initiation and CVC use on 60-day survival.</p>","PeriodicalId":13579,"journal":{"name":"Infectious Disease Reports","volume":"17 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12027375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}