Infection最新文献

{"title":"Impact of adherence to quality indicators and effects of targeted treatment with cefazolin or flucloxacillin on in-hospital mortality in patients with methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections: a retrospective observational study.","authors":"Sven Kalbitz, Kathrin Marx, Nils Kellner, Annette Glas, Maike Fedders, Christoph Lübbert","doi":"10.1007/s15010-025-02473-4","DOIUrl":"https://doi.org/10.1007/s15010-025-02473-4","url":null,"abstract":"<p><strong>Purpose: </strong>To analyze the associations between adherence to quality indicators (QIs) in the treatment of bloodstream infections caused by methicillin-susceptible Staphylococcus (S.) aureus (MSSA) and in-hospital mortality.</p><p><strong>Methods: </strong>A retrospective observational study was conducted in patients admitted between 2019 and 2023 to Hospital St. Georg in Leipzig, Germany, with at least one positive blood culture for S. aureus. Ten QIs were categorized into four groups based on blood culture results, echocardiography, antibiotic treatment, and other parameters such as infectious disease (ID) specialist consultation. Propensity score (PS) matching was used to compare in-hospital mortality between MSSA patients treated with flucloxacillin and those treated with cefazolin. Multivariate Cox regression analysis was performed to determine risk factors associated with in-hospital mortality.</p><p><strong>Results: </strong>Of the 637 patients with S. aureus bloodstream infections, 495 patients with MSSA infection (77.8%) were included in the study. After the introduction of mandatory ID consultation in 2020, the median QI score increased to 9 out of a maximum of 10 points and was significantly higher in surviving cases than in fatal cases in subsequent years. There was a non-significant decrease in in-hospital mortality from 2019 (28.8%) to 2023 (22.7%) (p = 0.432). Based on PS matching, cefazolin had a favorable hazard ratio of 0.44 (95% CI 0.28-0.71; p < 0.001) for in-hospital mortality. The results of multivariate Cox regression analysis showed a significantly higher survival rate in patients who received QI-based management, including transesophageal echocardiography and antibiotic therapy initiated within 24 h.</p><p><strong>Conclusions: </strong>ID consultation is associated with better adherence to quality improvement measures. Targeted MSSA therapy with cefazolin, early initiation of antibiotic therapy, and adherence to antimicrobial treatment protocols increased survival rates in our study setting.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High risk of drug-resistant tuberculosis in IGRA-negative contacts: should preventive treatment be considered?","authors":"Thomas Theo Brehm, Niklas Köhler, Hans-Peter Grobbel, Jürgen Welling, Anna Maria Mandalakas, Vinicius Fava, Erwin Schurr, Christoph Lange","doi":"10.1007/s15010-024-02470-z","DOIUrl":"https://doi.org/10.1007/s15010-024-02470-z","url":null,"abstract":"<p><strong>Purpose: </strong>Deciding whether to provide preventive treatment to contacts of individuals with multidrug-resistant (MDR) tuberculosis is complex.</p><p><strong>Methods: </strong>We present the diagnostic pathways, clinical course and outcome of tuberculosis treatment in eight siblings from a single family. Tuberculosis disease was diagnosed by Mycobacterium tuberculosis culture and molecular detection of M. tuberculosis-specific DNA from bronchopulmonary specimens using GeneXpert^® MTB/RIF. M. tuberculosis infection was diagnosed by an interferon-gamma release assay (IGRA; QuantiFERON^®-TB Gold Plus). Whole exome sequencing for genetic predisposition to mycobacterial infection was performed in one patient.</p><p><strong>Results: </strong>Six of eight siblings aged 16-20 years from a migrant family of Somali origin were diagnosed with pulmonary MDR tuberculosis over a 12-month period. The remaining male siblings, aged 11 and 14 years, were asymptomatic during contact investigation. Chest radiographs, computed tomography (CT) scans, sputum cultures and nucleic acid amplification tests were negative, and the IGRA did not detect M. tuberculosis infection. A repeat CT scan eight months later was unremarkable, and repeated sputum cultures remained negative. In the absence of sufficient evidence of M. tuberculosis infection, no preventive treatment was offered. At month seven of consistent clinical observation, both children were diagnosed with pulmonary tuberculosis; the older with advanced disease and subsequent post-tuberculosis lung disease. Whole exome sequencing revealed no Mendelian variant associated with susceptibility to mycobacterial infection.</p><p><strong>Conclusion: </strong>When significant risk of tuberculosis transmission exists, close contacts of MDR tuberculosis patients should be offered preventive treatment with levofloxacin despite a negative IGRA test result.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting work ability impairment in post COVID-19 patients: a machine learning model based on clinical parameters.","authors":"Tarek Jebrini, Michael Ruzicka, Felix Völk, Gerardo Jesus Ibarra Fonseca, Anna Pernpruner, Christopher Benesch, Elisabeth Valdinoci, Max von Baum, Martin Weigl, Marion Subklewe, Michael von Bergwelt-Baildon, Julia Roider, Julia Mayerle, Bernhard Heindl, Kristina Adorjan, Hans Christian Stubbe","doi":"10.1007/s15010-024-02459-8","DOIUrl":"https://doi.org/10.1007/s15010-024-02459-8","url":null,"abstract":"<p><p>The Post COVID-19 condition (PCC) is a complex disease affecting health and everyday functioning. This is well reflected by a patient's inability to work (ITW). In this study, we aimed to investigate factors associated with ITW (1) and to design a machine learning-based model for predicting ITW (2) twelve months after baseline. We selected patients from the post COVID care study (PCC-study) with data on their ability to work. To identify factors associated with ITW, we compared PCC patients with and without ITW. For constructing a predictive model, we selected nine clinical parameters: hospitalization during the acute SARS-CoV-2 infection, WHO severity of acute infection, presence of somatic comorbidities, presence of psychiatric comorbidities, age, height, weight, Karnofsky index, and symptoms. The model was trained to predict ITW twelve months after baseline using TensorFlow Decision Forests. Its performance was investigated using cross-validation and an independent testing dataset. In total, 259 PCC patients were included in this analysis. We observed that ITW was associated with dyslipidemia, worse patient reported outcomes (FSS, WHOQOL-BREF, PHQ-9), a higher rate of preexisting psychiatric conditions, and a more extensive medical work-up. The predictive model exhibited a mean AUC of 0.83 (95% CI: 0.78; 0.88) in the 10-fold cross-validation. In the testing dataset, the AUC was 0.76 (95% CI: 0.58; 0.93). In conclusion, we identified several factors associated with ITW. The predictive model performed very well. It could guide management decisions and help setting mid- to long-term treatment goals by aiding the identification of patients at risk of extended ITW.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeted sputum sequencing for rapid and broad drug resistance of Mycobacterium tuberculosis.","authors":"Horng-Yunn Dou, Tsi-Shu Huang, Han-Chieh Wu, Chih-Hao Hsu, Feng-Jui Chen, Yu-Chieh Liao","doi":"10.1007/s15010-024-02463-y","DOIUrl":"https://doi.org/10.1007/s15010-024-02463-y","url":null,"abstract":"<p><strong>Purpose: </strong>Rapid detection of drug resistance in Mycobacterium tuberculosis (Mtb) from clinical samples facilitates the timely provision of optimal treatment regimens for tuberculosis (TB) patients.</p><p><strong>Methods: </strong>In November, 2023, the WHO released its second catalogue of resistance-conferring mutations in Mtb. Utilizing this information, we developed a single 17-plex PCR assay covering 16 key resistance genes and modified thermo-protection buffer to amplify 30 kbp DNA directly from sputum samples for nanopore sequencing. We implemented our protocol using rapid barcoding for sequencing with both a Flongle and a MinION flow cell.</p><p><strong>Results: </strong>The single multiplex PCR assay was successfully validated on clinical sputum samples using the thermo-protection buffer. The protocol was applied to both Flongle and MinION flow cells, analyzing 12 and 40 samples, respectively. Data analysis suggested that optimal performance could be achieved by processing 6 and 12 samples with similar microscope staining scores on these two platforms. This approach facilitated rapid antimicrobial resistance (AMR) predictions directly from sputum on the day of collection or the following day, with a cost of less than $35 per sample. Compared to AMR predictions based on whole-genome sequencing (WGS) using Mykrobe and TBProfiler, our amplicon-based analysis tool, ARapidTb, demonstrated superior resistance detection capabilities. When analyzing publicly available nanopore WGS datasets for 442 isolates, ARapidTb achieved agreement rates of 95.8% and 98.0%, outperforming Mykrobe (89.4% and 98.3%) and TBProfiler (75.6% and 89.8%).</p><p><strong>Conclusions: </strong>Our study significantly reduces the time required for drug resistance detection, enabling quicker initiation of appropriate treatments and potentially improving patient outcomes and TB management.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can nCD64 and mCD169 biomarkers improve the diagnosis of viral and bacterial respiratory syndromes in the emergency department? A prospective cohort pilot study.","authors":"Sergio Venturini, Massimo Crapis, Agnese Zanus-Fortes, Daniele Orso, Francesco Cugini, Giovanni Del Fabro, Igor Bramuzzo, Astrid Callegari, Tommaso Pellis, Vincenzo Sagnelli, Anna Marangone, Elisa Pontoni, Domenico Arcidiacono, Laura De Santi, Barbra Ziraldo, Giada Valentini, Veronica Santin, Ingrid Reffo, Paolo Doretto, Chiara Pratesi, Eliana Pivetta, Kathreena Vattamattahil, Rita De Rosa, Manuela Avolio, Rosamaria Tedeschi, Giancarlo Basaglia, Tiziana Bove, Carlo Tascini","doi":"10.1007/s15010-024-02468-7","DOIUrl":"https://doi.org/10.1007/s15010-024-02468-7","url":null,"abstract":"<p><strong>Purpose: </strong>Differentiating infectious from non-infectious respiratory syndromes is critical in emergency settings. This study aimed to assess whether nCD64 and mCD169 exhibit specific distributions in patients with respiratory infections (viral, bacterial, or co-infections) and to evaluate their diagnostic accuracy compared to non-infectious conditions.</p><p><strong>Methods: </strong>A prospective cohort study enrolled 443 consecutive emergency department patients with respiratory syndromes, categorized into four groups: no infection group (NOIG), bacterial infection group (BIG), viral infection group (VIG), and co-infection group (COING). Multinomial logistic regression was used to evaluate nCD64 and mCD169's association with diagnostic groups and estimate their predictive accuracy.</p><p><strong>Results: </strong>290 patients were included in VIG, 53 in BIG, 46 in COING, and 54 in NOIG. nCD64 was associated with bacterial infections and co-infections (p = 2.73 × 10^- 16 and p = 8.83 × 10^- 11, respectively), but not viral infections. mCD169 was associated with viral infections and co-infections (p = < 2 × 10^- 16 and p = 2.45 × 10^- 13, respectively), but not bacterial infections. The sensitivity and specificity of nCD64 for detecting bacterial infections were 0.75 and 0.84 (AUC = 0.83), respectively, while for mCD169 they were 0.87 and 0.91 (AUC = 0.92), respectively, for diagnosing viral infections. A diagnostic algorithm incorporating fever, nasopharyngeal swabs for the main respiratory virus, C-reactive protein, procalcitonin, and mCD169 reached an accuracy of 0.79 (95% CI 0.72-0.85) in distinguishing among the different groups.</p><p><strong>Conclusions: </strong>nCD64 and MCD169 seem valuable for distinguishing between bacterial and viral respiratory infections. Integrating these biomarkers into diagnostic algorithms could enhance diagnostic accuracy aiding patient management in emergency settings.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and microbiological features of Fusobacterium species bacteraemia: a multi-centre UK-based retrospective descriptive study.","authors":"David Hettle, Ameeka Thompson, Esther Akpan, Georgina Beckley, O Martin Williams","doi":"10.1007/s15010-024-02462-z","DOIUrl":"https://doi.org/10.1007/s15010-024-02462-z","url":null,"abstract":"","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the 2023 ISCVID and ESC Duke clinical criteria for the diagnosis of infective endocarditis among patients with positive blood cultures for new typical microorganisms.","authors":"Nicolas Fourré, Virgile Zimmermann, Laurence Senn, Pierre Monney, Georgios Tzimas, Florian Tagini, Piergiorgio Tozzi, Matthias Kirsch, Benoit Guery, Matthaios Papadimitriou-Olivgeris","doi":"10.1007/s15010-024-02460-1","DOIUrl":"https://doi.org/10.1007/s15010-024-02460-1","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the performance of the Duke clinical criteria of the European Society of Cardiology (ESC; 2015 and 2023 versions) and the 2023 International Society for Cardiovascular Infectious Diseases (ISCVID) in diagnosing infective endocarditis (IE) among patients with bacteraemia/candidaemia by pathogens introduced for the first time as typical microorganisms by ISCVID.</p><p><strong>Methods: </strong>Retrospective study.</p><p><strong>Setting: </strong>This study included adult patients with bacteraemia/candidaemia by such pathogens (coagulase negative staphylococci, Abiotrophia spp., Gemella spp., and Granulicatella spp., Cutibacterium. acnes, Corynebacterium striatum, C. jeikeium, Pseudomonas aeruginosa, Serratia marcescens, non-tuberculous mycobacteria, and Candida spp.) hospitalized at Lausanne University Hospital. Episodes were classified as IE by two expert clinicians.</p><p><strong>Results: </strong>Among 463 episodes with bacteraemia/candidaemia by such pathogens, IE was diagnosed in 63 episodes (14%). IE prevalence was 17% among episodes with bacteraemia by Staphylococcus lugdunensis or Abiotrophia spp. No case of IE was identified among Granulicatella spp. and Gemella spp. bacteraemias. Among 113 episodes with intracardiac prosthetic material, IE prevalence was 51% in episodes with bacteraemia by S. epidermidis. Sensitivity for the 2015 Duke-ESC, 2023 Duke-ISCVID, and the 2023 Duke-ESC clinical criteria was calculated at 5%, 57%, and 8%, respectively. More episodes were classified as possible IE by the 2023 Duke-ISCVID (30%) compared to 2015 Duke-ESC (13%) and 2023 Duke-ESC (16%) clinical criteria.</p><p><strong>Conclusion: </strong>The 2023 ISCVID version demonstrated superior sensitivity compared to both 2015 and 2023 Duke-ESC in diagnosing IE caused by new typical microorganisms, compared to the other criteria, albeit an increase in cases being classified as possible IE.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Klebsiella pneumoniae species complex bloodstream infection in adult patients: changing epidemiology and determinants of poor outcomes.","authors":"Adam G Stewart, Patrick N A Harris, Felicity Edwards, Behzad Kiani, David L Paterson, Kevin B Laupland","doi":"10.1007/s15010-024-02457-w","DOIUrl":"https://doi.org/10.1007/s15010-024-02457-w","url":null,"abstract":"<p><strong>Purpose: </strong>Klebsiella pneumoniae is a common cause of hospital- and community-acquired infection and can readily acquire multiple antimicrobial resistance determinants leading to poor health outcomes. We define the contemporary burden of disease, risk factors for antimicrobial resistance, and poor health outcomes for patients with K. pneumoniae bloodstream infection (Kp-BSI).</p><p><strong>Methods: </strong>All blood cultures with growth of K. pneumoniae species complex among residents of Queensland, Australia (population ≈ 5 million) who received care through a public hospital were identified over a 20-year period. Clinical, microbiological and outcome information was obtained from state-wide databases.</p><p><strong>Results: </strong>A total of 6, 988 patients (7, 496 episodes) with incident Kp-BSI were identified. Incidence rate more than doubled from 5.8 cases to 12.2 cases per 100,000 population over the study period (4.5% rise per year). 258 (3.4%) episodes involved isolates resistant to third-generation cephalosporins (3GC-R). 3GC-R Kp-BSI crude incidence rate increased almost 10% each year. The proportion of hospital-onset episodes reduced from 49.1 to 35.0%. Of all Kp-BSI episodes, 864 (11.5%) died within 30-days. A lower respiratory tract source was associated with a high risk of death (aHR 1.68, 95% CI 1.30-2.16) while a urinary tract source a lower risk (aHR 0.48, 95% CI 0.35-0.66). 3GC-R Kp-BSI was not related to death (aHR 1.08, 95% CI 0.76-1.50).</p><p><strong>Conclusion: </strong>A rising burden of both Kp-BSI and 3GC-R blood isolates in a previous low-prevalence setting is concerning. A significant rise in community-onset Kp-BSI over the 20-year period was noteworthy and requires further evaluation. 3GC-R status was not associated with mortality.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathophysiology and clinical outcomes of pancytopenia in disseminated histoplasmosis: a scoping review.","authors":"Bassey E Ekeng, David E Elem, Anthony N Kokelu, Asukwo Onukak, Walter O Egbara, Ofonime O Benjamin, Aje N Ogar, Stella T Chukwuma, Love E Okafor, Kingsley A Essien, Deborah U Ekpenyong, Felix Bongomin","doi":"10.1007/s15010-024-02431-6","DOIUrl":"https://doi.org/10.1007/s15010-024-02431-6","url":null,"abstract":"<p><strong>Purpose: </strong>Pancytopenia in the setting of disseminated histoplasmosis is sparsely described in the literature. We investigated the underlying mechanisms of pancytopenia in disseminated histoplasmosis and highlighted clinical outcomes.</p><p><strong>Methods: </strong>We conducted a scoping review of cases and series on disseminated histoplasmosis presenting with pancytopenia published between 2001 and 2024. PubMed database was used for the search. The search terms were (disseminated histoplasmosis) AND (pancytopenia OR haemophagocytic syndrome OR lymphohistiocytosis).</p><p><strong>Results: </strong>We identified 72 cases. Forty-four (61.1%) cases were from the Americas, 18 (25.5%) from Asia, 8 (11.1%) from Europe, and 1(1.4%) each from Africa and Australia. Of the 72 cases, five cases (6.9%) were reported in children. The mean age was 41.9 ± 16.7 years with a range of 3 months to 78 years. Seven cases (9.7%) were immunocompetent, 27 (37.5%) had an underlying HIV infection and 45 (62.5%) were complicated with haemophagocytic lymphohistiocytosis syndrome. Histoplasma antigen assay (n = 29, 40.2%) was the major diagnostic method followed by bone marrow biopsy (n = 28, 38.9%). Fifty-three cases (73.6%) recovered, 15 (20.8%) died and outcomes were not stated in 4 cases (5.65%). The relationship between haemophagocytic lymphohistiocytosis and fatal outcomes was not statistically significant (P = 0.5). Likewise, HIV infection was not significantly associated with fatal outcomes (P = 0.6). Fatal outcomes were predominantly due to difficulty or delayed diagnosis of disseminated histoplasmosis and/or haemophagocytic lymphohistiocytosis (n = 5, 6.9%), multiple organ failure (n = 4, 5.6%) and late presentation (n = 2, 2.8%).</p><p><strong>Conclusion: </strong>Pancytopenia in disseminated histoplasmosis is associated with poor outcomes. Such a hematologic finding should arouse the index of suspicion in the attending clinician for an invasive mycosis like disseminated histoplasmosis to avert fatal outcomes. Besides haemophagocytic lymphohistiocytosis, other factors associated with pancytopenia in disseminated histoplasmosis were the cooccurrence of viral and bacterial infections.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proportion of confirmed Lyme neuroborreliosis cases among adult patients with suspected early European Lyme neuroborreliosis.","authors":"Katarina Ogrinc, Petra Bogovič, Tereza Rojko, Vera Maraspin, Eva Ružić-Sabljić, Andrej Kastrin, Klemen Strle, Gary P Wormser, Franc Strle","doi":"10.1007/s15010-024-02461-0","DOIUrl":"10.1007/s15010-024-02461-0","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the frequency of confirmed Lyme neuroborreliosis (LNB) cases in adult patients with three different clinical presentations consistent with early LNB.</p><p><strong>Methods: </strong>Data were obtained through routine health care at the UMC Ljubljana, Slovenia from 2005 to 2022, using clinical pathways. The patients were classified into three groups: (i) radicular pain of new onset (N = 332); or (ii) involvement of cranial nerve(s) but without radicular pain (N = 997); or (iii) erythema migrans (EM) skin lesion(s) in conjunction with symptoms suggestive of nervous system involvement but without either cranial nerve palsy or radicular pain (N = 240). The diagnosis of LNB considered the following variables: the presence of: (1) neurologic symptoms consistent with LNB (with no other obvious explanation); (2) cerebrospinal fluid (CSF) pleocytosis (> 5 × 10⁶ leukocytes/L); and (3) demonstration of intrathecal synthesis of borrelial antibodies, and/or cultivation of borrelia from CSF, and/or the presence of EM. Patients fulfilling only the first two criteria were interpreted as having possible LNB, while those who satisfied all three criteria were regarded as having confirmed LNB.</p><p><strong>Results: </strong>Of 1569 adult patients, 348 (22.2%) had confirmed LNB and 70 (4.5%) others had possible LNB. The proportion of confirmed LNB cases was the highest for patients with radicular pain (217/332, 65.4%), followed by the group with EM and neurologic symptoms (47/240, 19.6%), and those with cranial neuritis (84/997, 8.4%).</p><p><strong>Conclusion: </strong>Only 22% of patients evaluated had confirmed LNB. The proportion of confirmed LNB cases correlated with clinical presentation and was highest among patients with recent onset of radicular pain.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}