Infection最新文献

{"title":"Activation of the MAPK network provides a survival advantage during the course of COVID-19-induced sepsis: a real-world evidence analysis of a multicenter COVID-19 Sepsis Cohort.","authors":"Andrea Witowski, Lars Palmowski, Tim Rahmel, Hartmuth Nowak, Stefan F Ehrentraut, Christian Putensen, Thilo von Groote, Alexander Zarbock, Nina Babel, Moritz Anft, Barbara Sitek, Thilo Bracht, Malte Bayer, Maike Weber, Christina Weisheit, Stephanie Pfänder, Martin Eisenacher, Michael Adamzik, Rump Katharina, Björn Koos, Dominik Ziehe","doi":"10.1007/s15010-024-02325-7","DOIUrl":"10.1007/s15010-024-02325-7","url":null,"abstract":"<p><strong>Purpose: </strong>There is evidence that lower activity of the RAF/MEK/ERK network is associated with positive outcomes in mild and moderate courses of COVID-19. The effect of this cascade in COVID-19 sepsis is still undetermined. Therefore, we tested the hypothesis that activity of the RAF/MEK/ERK network in COVID-19-induced sepsis is associated with an impact on 30-day survival.</p><p><strong>Methods: </strong>We used biomaterial from 81 prospectively recruited patients from the multicentric CovidDataNet.NRW-study cohort (German clinical trial registry: DRKS00026184) with their collected medical history, vital signs, laboratory parameters, microbiological findings and patient outcome. ERK activity was measured by evaluating ERK phosphorylation using a Proximity Ligation Assay.</p><p><strong>Results: </strong>An increased ERK activity at 4 days after diagnosis of COVID-19-induced sepsis was associated with a more than threefold increased chance of survival in an adjusted Cox regression model. ERK activity was independent of other confounders such as Charlson Comorbidity Index or SOFA score (HR 0.28, 95% CI 0.10-0.84, p = 0.02).</p><p><strong>Conclusion: </strong>High activity of the RAF/MEK/ERK network during the course of COVID-19 sepsis is a protective factor and may indicate recovery of the immune system. Further studies are needed to confirm these results.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"107-115"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141418799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and microbiological features of positive blood culture episodes caused by non-fermenting gram-negative bacilli other than Pseudomonas and Acinetobacter species (2020-2023).","authors":"Roberto Casale, Matteo Boattini, Sara Comini, Paulo Bastos, Silvia Corcione, Francesco Giuseppe De Rosa, Gabriele Bianco, Cristina Costa","doi":"10.1007/s15010-024-02342-6","DOIUrl":"10.1007/s15010-024-02342-6","url":null,"abstract":"<p><strong>Introduction: </strong>Non-fermenting Gram-negative bacilli (NFGNB) other than Pseudomonas aeruginosa and Acinetobacter baumannii complex are pathogens of interest due to their ability to cause health-care associated infections and display complex drug resistance phenotypes. However, their clinical and microbiological landscape is still poorly characterized.</p><p><strong>Methods: </strong>Observational retrospective study including all hospitalized patients presenting with a positive positive blood culture (BC) episode caused by less common NFGNB over a four-year period (January 2020-December 2023). Clinical-microbiological features and factors associated with mortality were investigated.</p><p><strong>Results: </strong>Sixty-six less common NFGNB isolates other than Pseudomonas and Acinetobacter species causing 63 positive BC episodes were recovered from 60 patients. Positive BC episodes were predominantly sustained by Stenotrophomonas maltophilia (49.2%) followed by Achromobacter species (15.9%) that exhibited the most complex resistance phenotype. Positive BC episodes had bloodstream infection criteria in 95.2% of cases (60 out 63), being intravascular device (30.2%) and respiratory tract (19.1%) the main sources of infection. Fourteen-day, 30-day, and in-hospital mortality rates were 6.4%, 9.5%, and 15.9%, respectively. The longer time from admission to the positive BC episode, older age, diabetes, admission due to sepsis, and higher Charlson Comorbidity Index were identified as the main predictors of in-hospital mortality.</p><p><strong>Conclusions: </strong>Positive BC episodes sustained by NFGNB other than Pseudomonas and Acinetobacter species were predominantly sustained by Stenotrophomonas maltophilia and Achromobacter species, having bloodstream infection criteria in the vast majority of cases. Factors that have emerged to be associated with mortality highlighted how these species may have more room in prolonged hospitalisation and at the end of life for patients with chronic organ diseases.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"183-196"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141579593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frequency and clinical significance of Herpes simplex virus type 1/2 reactivation in adult patients with mild to moderately severe community-acquired pneumonia: a multicentre cohort study.","authors":"Christina Bahrs, Christian Schönherr, Marcus Panning, Norman Rose, Theo Dähne, Stefan Hagel, Sebastian Weis, Jan Rupp, Gernot Rohde, Martin Witzenrath, Mathias W Pletz","doi":"10.1007/s15010-024-02351-5","DOIUrl":"10.1007/s15010-024-02351-5","url":null,"abstract":"<p><strong>Purpose: </strong>This study assessed the frequency, clinical significance, and risk factors for Herpes simplex virus (HSV) reactivation in immunocompetent patients with community-acquired pneumonia (CAP).</p><p><strong>Methods: </strong>The study included adult CAP-patients who were enrolled in the CAPNETZ study between 2007 and 2017 and had a residual sputum sample available for analysis. In addition to routine diagnostics, sputum and blood samples were tested for HSV-1/2 using PCR. Demographics, comorbidities, and CRB-65 score were compared between HSV-positive and negative patients using Fisher exact or Mann Whitney test. Logistic regression analyses investigated the influence of HSV reactivation on a modified hospital recovery scale (HRS) until day 7, divided into 3 categories (no oxygen therapy, oxygen therapy, ICU admission or death).</p><p><strong>Results: </strong>Among 245 patients, HSV-1 and HSV-2 were detected in 30 patients (12.2%, 95%CI 8.7-16.9) and 0 patients, respectively. All HSV-positive patients were hospitalized, had a CRB-65 severity score of 0-2 and survived the first 28 day. In the HSV-positive group, patients had a non-significantly higher median age (70.5 versus 66 years) and a higher rate of oncological comorbidities (16.7% versus 8.8%) compared to the HSV-negative group. Distribution of co-pathogens and outcome parameters did not significantly differ between both groups. In a multivariate logistic regression model, age (AOR 1.029, p = 0.012) and CRB-65 score (AOR 1.709, p = 0.048), but not HSV-1 as single or co-pathogen were independently associated with higher HRS.</p><p><strong>Conclusion: </strong>Our study suggests that HSV-1 reactivation is common in CAP but might not be associated with specific risk factors or a complicated disease course.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"449-455"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trimethoprim-sulfamethoxazole dosing and outcomes of pulmonary nocardiosis.","authors":"Zachary A Yetmar, Ryan B Khodadadi, Supavit Chesdachai, Jack W McHugh, Josh Clement, Douglas W Challener, Nancy L Wengenack, Wendelyn Bosch, Maria Teresa Seville, Elena Beam","doi":"10.1007/s15010-024-02323-9","DOIUrl":"10.1007/s15010-024-02323-9","url":null,"abstract":"<p><strong>Background: </strong>Nocardia often causes pulmonary infection among those with chronic pulmonary disease or immunocompromising conditions. Trimethoprim-sulfamethoxazole (TMP-SMX) is recommended as first-line treatment, though little data exists regarding outcomes of different dosing regimens.</p><p><strong>Methods: </strong>We performed a multicenter retrospective cohort study of adult patients with non-disseminated pulmonary nocardiosis initially treated with TMP-SMX monotherapy. Patients' initial TMP-SMX dosing was categorized as high- (> 10 mg/kg/day), intermediate- (5-10 mg/kg/day) or low-dose (< 5 mg/kg/day). Outcomes included one-year mortality, post-treatment recurrence, and dose adjustment or early discontinuation of TMP-SMX. SMX serum concentrations and their effect on management were also assessed. Inverse probability of treatment weighting was applied to Cox regression analyses.</p><p><strong>Results: </strong>Ninety-one patients were included with 24 (26.4%), 37 (40.7%), and 30 (33.0%) treated with high-, intermediate-, and low-dose TMP-SMX, respectively. Patients who initially received low-dose (HR 0.07, 95% CI 0.01-0.68) and intermediate-dose TMP-SMX (HR 0.27, 95% CI 0.07-1.04) had lower risk of one-year mortality than the high-dose group. Risk of recurrence was similar between groups. Nineteen patients had peak SMX serum concentrations measured which resulted in 7 (36.8%) dose changes and was not associated with one-year mortality or recurrence. However, 66.7% of the high-dose group required TMP-SMX dose adjustment/discontinuation compared to 24.3% of the intermediate-dose and 26.7% of the low-dose groups (p = 0.001).</p><p><strong>Conclusions: </strong>Low- and intermediate-dose TMP-SMX for non-disseminated pulmonary nocardiosis were not associated with poor outcomes compared to high-dose therapy, which had a higher rate of dose adjustment/early discontinuation. Historically used high-dose TMP-SMX may not be necessary for management of isolated pulmonary nocardiosis.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"83-94"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients with immune mediated inflammatory diseases are insufficiently protected against vaccine-preventable infections.","authors":"Natasja van de Pol, C Janneke van der Woude, Marijn Vis, Martijn B A van Doorn, Saskia L Schrauwen, Fatos Cetinözman-Teunissen, Rachel L West, Annemarie C de Vries","doi":"10.1007/s15010-024-02373-z","DOIUrl":"10.1007/s15010-024-02373-z","url":null,"abstract":"<p><strong>Background: </strong>Patients with Immune Mediated Inflammatory Diseases (IMIDs) using immunosuppressive therapy are at increased risk of infections, including vaccine-preventable infections. In this study, we aimed to evaluate whether patients with IMIDs on systemic immunosuppressive therapy are vaccinated according to current guidelines.</p><p><strong>Methods: </strong>A survey was sent out, between August 2022 and March 2023, to all patients with IMIDs that visited the departments of dermatology, rheumatology and gastroenterology at an academic and regional hospital in Rotterdam, the Netherlands. Patient-reported vaccination status was compared to the Dutch guidelines on vaccinations in patients with chronic inflammatory diseases.</p><p><strong>Results: </strong>A total of 1,905/5,987 patients responded to the survey (response rate 32%). After exclusion of patients without systemic immunosuppressive medication, the study population comprised 1,390 patients, median age 56 years (IQR 42-66) and 41% male. Most patients (92%) had been vaccinated according to the Dutch National Immunization Program. Before starting immunosuppressive therapy, 2% of the patients who were still considered at risk according to the Dutch guideline were vaccinated for measles, and 4% for diphtheria/tetanus/polio (DT-IPV). Additionally, 62% of patients received an annual influenza vaccine, 16% received a five-yearly pneumococcal vaccine, and 91% were fully vaccinated against COVID-19.</p><p><strong>Conclusion: </strong>Patients with IMIDs on immunosuppressive therapy are not vaccinated in accordance with the guidelines. Implementation strategies to improve the vaccination rates for patients with IMIDs should specifically focus on vaccinating against measles and diphtheria/tetanus/polio, and periodic vaccination against pneumococcal and influenza infections.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"317-327"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of childhood bone and joint disease during the COVID-19 pandemic in New Zealand.","authors":"Sarah Hunter, Elsie Brown, Haemish Crawford, Cameron Grant","doi":"10.1007/s15010-024-02356-0","DOIUrl":"10.1007/s15010-024-02356-0","url":null,"abstract":"<p><strong>Purpose: </strong>It is unknown whether social distancing impacts frequency of presentation and severity of childhood bone and joint infection (BJI). In New Zealand, the COVID-19 disease elimination strategy involved strict social isolation policies spanning March 2020-September 2022. Examination of this period may provide insight around risk factors for BJI.</p><p><strong>Methods: </strong>A retrospective review of all patients < 16 years with presumed acute haematogenous osteomyelitis (AHO) or septic arthritis (SA) treated in the Auckland region was performed between 2018 and 2023. Frequency and severity of presentations has been examined before, during, and after periods of social restriction. Severe cases included those with intensive care admission, recurrent infection, or multiple surgeries. Pre-hospital experience, length of stay, and disease outcomes have also been assessed.</p><p><strong>Results: </strong>A total of 563 cases met inclusion criteria. Compared to the pre-pandemic period, monthly case averages reduced between April 2020 to September 2022 (10.1 vs. 7.9 cases/month, p = 0.008). Separating cases by causative microbiology shows a statistically significant drop in culture negative and Kingella kingae mediated BJI cases (4.2 vs. 2.9 cases/month, p = 0.006) but not for cases secondary to Staphylococcus aureus and Streptococcus pyogenes (4.2 vs. 3.9 cases/month, p = 0.6). The frequency of severe disease reduced during this period (5.6 vs. 4.1 cases/month, p = 0.01) together with lower rates of recurrent infection (9% vs. 4%, p = 0.03).</p><p><strong>Conclusion: </strong>The COVID-19 management strategy in New Zealand utilised strict social isolation, mask wearing, and hand hygiene measures to control disease spread between 2020 and 2022. These measures coincided with reduction in frequency and severity of presentations for childhood BJI.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"253-258"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141878678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management and outcome of cutaneous diphtheria in adolescent refugees in Germany, June 2022 - October 2023.","authors":"Alicia Zink, Juliana Hofer, Christian Schneider, Franziska Kessler, Hannes Klenze, Dietrich Klauwer, Klaudia Maleki, Andreas Müller, Sarah Goretzki, Shubei Wang, Robin Kobbe, Andrea Vanegas Ramirez, Sebastian Bode, Ales Janda, Roland Fressle, Jonathan Remppis, Philipp Henneke, Siegbert Rieg, Anja Berger, Andreas Sing, Markus Hufnagel, Benedikt D Spielberger","doi":"10.1007/s15010-024-02374-y","DOIUrl":"10.1007/s15010-024-02374-y","url":null,"abstract":"<p><strong>Objectives: </strong>From September 2022 an increase in Corynebacterium diphtheriae (C. diphtheriae) infections was reported in Europe. Our study focuses on 31 adolescent and young adult refugees with cutaneous C. diphtheriae infections detected in Germany. We examined treatment regimens and outcomes to provide targeted insights into the management of this infection.</p><p><strong>Methods: </strong>We distributed a standardized survey, focused on children and adolescents presenting to paediatric clinics through the German Paediatric Infectious Diseases Society (DGPI) and additional professional contacts in Germany. Data were extracted from routine medical documentation and reported anonymously.</p><p><strong>Results: </strong>A total of 31 individuals with cutaneous C. diphtheriae infection were reported by 9 centres. Two of these showed diphtheria toxin (DT) related systemic symptoms and four exhibited systemic inflammation requiring complex management. The remaining 25 cases, with exclusively cutaneous manifestations, were afebrile. Treatment with topical antiseptics and systemic antibiotics, mainly aminopenicillin/beta-lactamase inhibitors (BLI) (35%) or clindamycin (25%), achieved eradication in all but two cases treated with aminopenicillin/BLI. Treatment duration varied between 5 and 17 days.</p><p><strong>Conclusions: </strong>In refugees presenting with chronic skin wounds, C. diphtheriae should be included into the differential diagnosis. Fever seems to be a valuable marker to differentiate severe cases with potentially DT-mediated sequelae from exclusively cutaneous diphtheria (CD). For afebrile CD, topical antiseptics and oral antibiotic therapy with clindamycin for 7 days, followed by clinical surveillance appears to be a safe treatment regimen. Patients with CD who present with fever or pharyngitis should be thoroughly investigated including blood and pharyngeal swab cultures.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"329-337"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Splenic abscess and infective endocarditis.","authors":"Monique Boukobza, Lionel Rebibo, Emila Ilic-Habensus, Bernard Iung, Xavier Duval, Jean-Pierre Laissy","doi":"10.1007/s15010-024-02322-w","DOIUrl":"10.1007/s15010-024-02322-w","url":null,"abstract":"<p><strong>Objective: </strong>To determine the background, bacteriological, clinical and radiological findings, associated lesions, treatment and outcome of splenic abscesses (SAs) in infective endocarditis (IE).</p><p><strong>Methods: </strong>Retrospective study (2005-2021) of 474 patients with definite IE. The diagnosis of SA was made in 36 (7.6%) patients (31, 86.1%, males, mean age = 51.3) on abdominal CT.</p><p><strong>Results: </strong>The main implicated organisms were Streptococcus spp (36.1%), Enterococcus faecalis (27.7%), Staphyloccus spp (19.4%). Rare agents were present in 10 patients (27.8%). Pre-existing conditions included a prosthetic valve (19.4%), previous IE (13.9%), intravenous drug use (8.4%), diabetes (25%) alcohol abuse (13.9%), liver disease (5.5%). Vegetations ≥ 15 mm were present in 36.1%. Common presentations were abdominal pain (19.4%) and left-sided pleural effusion (16.5%). SA were more often small (50%; 7 multiple) than large (36.1%; 1 multiple) or microabscesses (13.9%, 3 multiple). Associated complications were extrasplenic abscesses (brain, 11.1%; lung, 5.5%; liver, 2.8%), infectious aneurysms (16.7%: 3 intracranial, 1 splenic, 1 hepatic, 1 popliteal), emboli (brain, 52.8%; spleen, 44.4%, 5 evolving to SA; kidney, 22.2%; aorta, 2.8%), osteoarticular infections (25%). Twenty-eight (77.8%) patients only received antimicrobials, 7 (19.4%) underwent splenectomy, after cardiac surgery in 5. One had percutaneous drainage. The outcome was uneventful (follow-up 3 months-14 years; mean: 17.2 months).</p><p><strong>Conclusion: </strong>In SA-IE patients, the prevalence of vegetation size, Enterococcus faecalis, rare germs, diabetes, osteo-arthritic involvement and cancer was higher than in non-SA patients. Some SAs developed from splenic infarcts. IE-patients with evidence of splenic emboli should be evaluated for a possible abcedation. Cardiac surgery before splenectomy was safe.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"71-82"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446090","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":"Acute hepatitis E virus infection presenting as meningo-encephalitis.","authors":"Moritz Hafkesbrink, M Schemmerer, J J Wenzel, S Isenmann","doi":"10.1007/s15010-024-02361-3","DOIUrl":"10.1007/s15010-024-02361-3","url":null,"abstract":"<p><strong>Background: </strong>Acute hepatitis E infection (HEV), with its high incidence in Europe, should be considered as a differential diagnosis of acute viral hepatitis and can in some cases manifest with pronounced neurological symptoms.</p><p><strong>Clinical case: </strong>We report on a 33-year-old female patient with severe arthralgia, myalgia, headache and psychomotor deterioration. Laboratory analyses showed elevated transaminases without signs of cholestasis. Acute hepatitis E virus infection was detected in serum. She reported fatigue and dysesthesias not responsive to analgesics. Cerebrospinal fluid (CSF) analysis revealed an inflammatory syndrome. HEV RNA was detected in the CSF. The infection remained mild, but dysesthesias persisted. Eight weeks after the first admission, the symptoms worsened again. Complete and sustained remission was achieved following intravenous corticosteroid treatment.</p><p><strong>Conclusion: </strong>In patients with acute neurological symptoms and liver enzyme elevation, HEV infection should be considered. Neurologic symptoms such as fatigue, arthralgia, myalgia and dysesthesia along with psychomotor retardation should prompt CSF analysis.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"475-479"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141982234","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 accuracy of hematological parameters in the diagnosis of neonatal sepsis: a network meta-analysis.","authors":"Rong Huang, Tai-Liang Lu, Ri-Hui Liu","doi":"10.1007/s15010-024-02354-2","DOIUrl":"10.1007/s15010-024-02354-2","url":null,"abstract":"<p><strong>Background: </strong>Currently, there are hundreds of hematological parameters used for rapid diagnosis of neonatal sepsis, but there is no network meta-analysis to compare the diagnostic efficacy of these parameters.</p><p><strong>Methods: </strong>We searched for literature on the diagnostic neonatal sepsis and selected 20 of the most common parameters to compare their diagnostic efficacy. We used Bayesian network meta-analysis, Frequentist network meta-analysis, and individual traditional diagnostic meta-analysis to analyze the data and verify the stability of the results. Based on the above analysis, we ranked the diagnostic efficacy of 20 parameters and searched for the optimal indicator. We also conducted subgroup analysis based on different designs. GRADE was used to evaluate the quality of evidence.</p><p><strong>Results: </strong>311 articles were included in the analysis, of which 206 articles were included in the network meta-analysis. Bayesian models fond the top three of the advantage index were P-SEP, SAA, and CD64. In Individual model, P-SEP, SAA, and CD64 had the best sensitivity; ABC, SAA, and P-SEP had the best specificity. Frequentist model showed that CD64, P-SEP, and IL-10 ranked in the top three for sensitivity, while P-SEP, ABC, and I/M in specificity. Overall, P-SEP, SAA, CD64, and PCT have good sensitivity and specificity among all the three methods. The results of subgroup analysis were consistent with the overall analysis. All evidence was mostly of moderate or low quality.</p><p><strong>Conclusions: </strong>P-SEP, SAA, CD64, and PCT have good diagnostic efficacy for neonatal sepsis. However, further studies are required to confirm these findings.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"231-239"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141878677","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}