Open Forum Infectious Diseases最新文献

{"title":"Effectiveness of Ampicillin-Sulbactam Versus Ceftriaxone for the Initial Treatment of Community-Acquired Pneumonia in Older Adults: A Target Trial Emulation Study.","authors":"Shungo Yamamoto, Akihiro Shiroshita, Yuki Kataoka, Hidehiro Someko","doi":"10.1093/ofid/ofaf133","DOIUrl":"10.1093/ofid/ofaf133","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines for community-acquired pneumonia (CAP) include ampicillin-sulbactam as an initial treatment option, though they do not mandate routine coverage of anaerobic organisms. This study aimed to compare the effectiveness of ampicillin-sulbactam with that of ceftriaxone as initial treatment for CAP in older adults.</p><p><strong>Methods: </strong>This study was conducted using the target trial emulation framework, using a nationwide Japanese database (May 2010-June 2023). The study included patients aged ≥65 years, admitted to Diagnosis Procedure Combination hospitals for CAP, who received either ampicillin-sulbactam or ceftriaxone as the initial treatment. The exposure group received ampicillin-sulbactam, while the control group received ceftriaxone, both on the day of hospitalization. The primary outcome was in-hospital mortality; the secondary outcome was the development of <i>Clostridioides difficile</i> infection during hospitalization.</p><p><strong>Results: </strong>The study included 26 633 older patients hospitalized with CAP, with 14 906 receiving ampicillin-sulbactam and 11 727 receiving ceftriaxone as initial treatment. After inverse probability of treatment weighting, the ampicillin-sulbactam group was associated with a higher in-hospital mortality rate than the ceftriaxone group (10.5% vs 9.0%, respectively; adjusted risk difference, 1.5% [95% confidence interval, .7%-2.4%]; adjusted odds ratio, 1.19 [1.08-1.31]). The incidence of <i>C difficile</i> infection was numerically higher in the ampicillin-sulbactam group (0.6% vs 0.4%; adjusted risk difference, 0.2% [95% confidence interval, .0%-.4%]; adjusted odds ratio, 1.45 [.99-2.11]). These results were consistent among patients with risk factors for aspiration.</p><p><strong>Conclusions: </strong>In older patients with CAP, initial treatment with ampicillin-sulbactam was associated with higher mortality compared to treatment with ceftriaxone.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 3","pages":"ofaf133"},"PeriodicalIF":3.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limitations of the MTB/RIF Assay: An Xpert Review of 4 Clinical Cases.","authors":"Allison L Haas, Angela Ma, Jonathan Pham, Punam Verma, Uma Malhotra, E Chandler Church, Masahiro Narita, Vincent Escuyer, Salika M Shakir","doi":"10.1093/ofid/ofaf132","DOIUrl":"10.1093/ofid/ofaf132","url":null,"abstract":"<p><p>Current U.S. Centers for Disease Control and Prevention tuberculosis (TB) guidelines recommend molecular testing for initial diagnosis of TB and detection of rifampin resistance to expedite initiation of proper treatment. The Cepheid Xpert MTB/RIF assay can detect members of the <i>Mycobacterium tuberculosis</i> complex and rifampin resistance by evaluating for mutations in the <i>rpoB</i> gene. However, false-positive and false-negative detection of <i>M tuberculosis</i> and rifampin resistance results can lead to incorrect treatment of patients, including overuse of second-line anti-TB drugs, and may result in patient harm and increased healthcare cost. We present a series of 4 cases to demonstrate the limitations of the Xpert MTB/RIF assay in the diagnosis of TB, emphasizing the importance of follow-up confirmatory testing and laboratory oversight in reporting accurate results.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 4","pages":"ofaf132"},"PeriodicalIF":3.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Clinical Picture Caused by <i>Fasciola gigantica</i>: Analysis of 3250 Patients Along the 1995-2019 Countrywide Spread in Vietnam.","authors":"Nguyen Van De, Pham Ngoc Minh, Thanh Hoa Le, Do Trung Dung, Tran Thanh Duong, Bui Van Tuan, Le Thanh Dong, Nguyen Van Vinh Chau, Pablo F Cuervo, M Dolores Bargues, M Adela Valero, Albis Francesco Gabrielli, Antonio Montresor, Santiago Mas-Coma","doi":"10.1093/ofid/ofaf116","DOIUrl":"10.1093/ofid/ofaf116","url":null,"abstract":"<p><strong>Background: </strong><i>Fasciola gigantica</i> is the causal agent of human fascioliasis, which is emerging in southern Asia and increasingly reported in Africa. Unfortunately, knowledge of the clinical picture by <i>F gigantica</i> is insufficient, because of the sporadic individual case reports, or few case series of short number of patients from areas where the 2 genetically pure fasciolid species geographically overlap and specific causality was not verified.</p><p><strong>Methods: </strong>The clinical picture is assessed from patients examined in well-equipped hospitals of big cities in Vietnam. Records of 3250 <i>Fasciola</i>-infected patients were registered in individual cards and a database for their complete analysis was constructed. Case profile was based on typical symptoms, blood eosinophilia, serological test, imaging techniques, Kato-Katz test, and ex juvantibus confirmation. Anamnesis furnished information about place of residence, professional activities, and infection source.</p><p><strong>Results: </strong>Symptoms, signs, and manifestations, including neurological, meningeal, neuropsychic, and ocular disorders, are analyzed according to frequency, sex, and age groups. Early patient diagnosis and treatment facilitated by radio broadcasting underlie differences between serological positivity, coprological positivity, and liver lesions and explain the absence of severe long-term complications and posttreatment sequelae.</p><p><strong>Conclusions: </strong>This is the first sufficiently wide study of the clinical picture caused by <i>F gigantica</i>. The assessment has been made in a population without previous contact with fascioliasis and shows that <i>F gigantica</i> (and <i>F gigantica</i>-like hybrids) do not cause clinical pictures different from those caused by <i>Fasciola hepatica.</i> This clinical picture will be useful for physicians and health officers in endemic areas of Asia and Africa.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 3","pages":"ofaf116"},"PeriodicalIF":3.8,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Activity of Rezafungin Against Echinocandin Non-wild type <i>Candida glabrata</i> Clinical Isolates From a Global Surveillance Program.","authors":"Mariana Castanheira, Lalitagauri M Deshpande, John H Kimbrough, Marisa Winkler","doi":"10.1093/ofid/ofae702","DOIUrl":"10.1093/ofid/ofae702","url":null,"abstract":"<p><p>Among 1463 <i>Candida glabrata</i> isolates collected in 39 US hospitals, 91 (6.2%) were non-wild type to ≥1 echinocandins (ECH-NWT) when tested by the Clinical and Laboratory Standards Institute (CLSI) reference broth microdilution method and interpretative criteria. Rezafungin breakpoints established by the US Food and Drug Administration (FDA) were also applied. ECH-NWT isolates were noted in all US census divisions, and 71 (79.0% of ECH-NWT) carried FKS hot spot (HS) alterations. S663P in FKS2 HS1 (31 isolates) was the most common alteration, followed by substitutions/deletions in position F659 in FKS2 HS1 (14 isolates) and S629P in FKS1 HS1 (9 isolates). Six isolates had substitutions in the HSs of FKS1 and FKS2, and 8 other alterations were noted in the 11 remaining isolates. When CLSI/FDA breakpoints were applied, rezafungin was active against 97.5%/95.3% and 59.3%/23.9% of the overall <i>C glabrata</i> and ECH-NWT isolates, respectively. Anidulafungin, caspofungin, and micafungin inhibited 93.9%/13.2%, 95.7%/33.0%, and 95.6%/29.7% of the overall <i>C glabrata</i>/ECH-NWT isolates. Isolates that did not harbor FKS HS substitutions were more susceptible to echinocandins when compared with isolates with substitutions (47.4%-100% and 4.2%-49.3%; lowest for anidulafungin and highest for rezafungin per the CLSI breakpoint). Isolates harboring the FKS2 HS1 S663P alterations were more resistant to echinocandins-3.2% susceptible (anidulafungin) to 35.5% (rezafungin CLSI breakpoint)-when compared with other single alterations. Rezafungin dosing and pharmacokinetic/pharmacodynamic characteristics allow for coverage of higher minimum inhibitory concentration values, making this agent an attractive option for some isolates that carry FKS alterations and still demonstrate rezafungin-susceptible minimum inhibitory concentration values.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 3","pages":"ofae702"},"PeriodicalIF":3.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Amikacin Liposome Inhalation Suspension and Amikacin Resistance Development in Patients With Refractory <i>Mycobacterium avium</i> Complex Pulmonary Disease.","authors":"Yu Kurahara, Shiomi Yoshida, Asami Osugi, Yuya Tanaka, Takehiko Kobayashi, Toshiharu Mitsuhashi, Yohei Kawasaki, Satoshi Mitarai, Kazunari Tsuyuguchi","doi":"10.1093/ofid/ofaf118","DOIUrl":"10.1093/ofid/ofaf118","url":null,"abstract":"<p><strong>Background: </strong>Amikacin liposome inhalation suspension (ALIS) is key for treating refractory <i>Mycobacterium avium</i> complex pulmonary disease (MAC-PD). However, microbiological efficacy by subtype remains unknown. The frequency and mechanism of amikacin (AMK) resistance during ALIS administration are also unclear.</p><p><strong>Methods: </strong>We retrospectively analyzed data from refractory MAC-PD patients who received ALIS for at least 6 months as an adjunct to guideline-based therapy at the NHO Kinki Chuo Chest Medical Center. We investigated the efficacy of ALIS and analyzed gene expression and the frequency of AMK resistance.</p><p><strong>Results: </strong>We enrolled 44 patients (median age, 72.0 years): 19 (43.2%) with the noncavitary nodular bronchiectatic (NC-NB) subtype and 25 (56.8%) with the cavitary subtype. Overall, sputum culture conversion was 56.8% (25/44): 84.2% (16/19) in the NC-NB subtype and 36.0% (9/25) in the cavitary subtype (<i>P</i> = .001). During intermittent dosing, conversion occurred in 50.0% (9/18). In patients with C-reactive protein (CRP) ≥1 mg/dL, cavitary subtype, and clarithromycin (CLM) resistance, the risk ratio for persistently positive cultures was 10.81 (95% CI, 1.66-70.40) compared with those with CRP <1 mg/dL, NC-NB subtype, and CLM susceptibility. Of all participants, 15.9% (7/44) had isolates with AMK resistance (minimum inhibitory concentration ≥128 µg/mL), and of these 71.4% (5/7) had <i>rrs</i> mutations.</p><p><strong>Conclusions: </strong>Regimens that included ALIS achieved higher culture conversion in NC-NB than cavitary MAC-PD cases. High CRP levels, cavitary disease, and CLM resistance predicted persistent culture positivity. AMK resistance acquired during ALIS administration may limit treatment options for refractory MAC-PD.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 3","pages":"ofaf118"},"PeriodicalIF":3.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Early and Delayed Treatment With Remdesivir on Mortality in Patients Hospitalized With COVID-19.","authors":"Steve R Makkar, Kristen Hansen, Nathan Hotaling, Andrew Toler, Hythem Sidky","doi":"10.1093/ofid/ofae740","DOIUrl":"10.1093/ofid/ofae740","url":null,"abstract":"<p><strong>Background: </strong>We applied a target trial emulation framework to estimate the association between early and delayed initiation of remdesivir (RDV) with mortality in hospitalized adults between May 1, 2020, and July 31, 2024, with varying coronavirus disease 2019 (COVID-19) clinical severity.</p><p><strong>Methods: </strong>Using electronic health records in the National COVID Cohort Collaborative (N3C) database, we emulated a sequence of randomized target trials initiated on each of the first 7 days of hospitalization. We identified 373 226 eligible person-trial hospitalizations, of which 53 959 were initiators and 319 267 were noninitiators of RDV treatment. Patients were divided into clinical severity subgroups based on baseline oxygenation, which included no supplemental oxygen (NSO), noninvasive supplemental oxygen (NISO), or invasive ventilation (IV). In each trial, initiators were matched with replacement to noninitiators receiving the same oxygenation type. Trials beginning on days 1-3 and days 4-7 of hospitalization were pooled separately to evaluate the effects of early and delayed initiation of RDV, respectively. Cox proportional hazards regression was used to estimate the marginal hazard ratio for mortality between initiators and noninitiators within each treatment delay.</p><p><strong>Results: </strong>Across trials, 53 449 initiators were matched to 26 600 unique noninitiators. Early, but not delayed, RDV treatment was associated with a reduction in 60-day mortality in the NSO (hazard ratio [HR], 0.89; 95% CI, 0.84-0.95) and NISO subgroups (HR, 0.91; 95% CI, 0.84-0.99), but not in those receiving IV. Results were consistent across sensitivity analyses.</p><p><strong>Conclusions: </strong>Early treatment with RDV is associated with reduced mortality risk in hospitalized COVID-19 patients either not on supplemental oxygen or receiving noninvasive supplemental oxygen.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 2","pages":"ofae740"},"PeriodicalIF":3.8,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of Algorithms to Detect Acute and Disseminated Lyme Disease in U.S. Administrative Claims Data.","authors":"Sheryl A Kluberg, Noelle M Cocoros, June O'Neill, Thomas G Boyce, Maria E Sundaram, Anna Schotthoefer, Robert T Greenlee, Djeneba Audrey Djibo, Cheryl N McMahill-Walraven, John Aucott, Jennifer C Moïsi, Luis Jodar, Sarah J Willis, James H Stark","doi":"10.1093/ofid/ofaf109","DOIUrl":"10.1093/ofid/ofaf109","url":null,"abstract":"<p><strong>Background: </strong>Lyme disease (LD) is the most common vector-borne disease in the United States, though traditional LD surveillance underestimates the burden of disease. We validated algorithms for early localized and disseminated LD, with and without LD-specific diagnosis codes, in states with high incidence and their neighboring states with low LD incidence.</p><p><strong>Methods: </strong>We identified cohorts of potential incident LD cases in administrative insurance claims data, October 2015-October 2023, in 1 national and 1 regional insurer. Three algorithms were studied: a primary algorithm of an LD-specific diagnosis code and indicated antibiotic and 2 secondary algorithms for disseminated LD requiring a non-LD-specific musculoskeletal or neurologic diagnosis code, an antibiotic, and an LD diagnostic test. We included individuals from high LD-incidence states and neighboring low LD-incidence states. We validated the algorithms using medical records for a sample of potential cases, classifying them according to modified surveillance case definitions. We calculated positive predictive values (PPVs) for each algorithm.</p><p><strong>Results: </strong>Overall, we identified 9483 potential LD cases in claims data and reviewed 841 medical records. The PPVs for the primary algorithm were 90.7% and 81.3% in high-incidence and neighboring states, respectively, when suspect, probable, and confirmed cases were included; they were 76.6% and 28.0% when only confirmed and probable were included. For confirmed and possible cases, the secondary musculoskeletal algorithm PPVs were 12.9% and 4.1%, and the secondary neurologic algorithm PPVs were 6.2% and 1.8% in high-incidence and neighboring states, respectively.</p><p><strong>Conclusions: </strong>This study found that claims-based algorithms requiring diagnosis codes for LD or for related symptoms, in addition to other criteria, can identify cohorts of true LD cases. These algorithms, adjusted for PPV, can be used to estimate LD incidence in the United States.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 4","pages":"ofaf109"},"PeriodicalIF":3.8,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analyzing the Donor Dilemma: Outcomes of Kidney Transplant Recipients From Donors With Positive Blood Cultures Obtained at Organ Procurement.","authors":"Petros A Svoronos, R Alfonso Hernandez Acosta, Prakhar Vijayvargiya, Pradeep Vaitla, James Wynn, Christopher Anderson, Jason Parham, Elena Beam, M Rizwan Sohail, Zerelda Esquer Garrigos","doi":"10.1093/ofid/ofae694","DOIUrl":"10.1093/ofid/ofae694","url":null,"abstract":"<p><p>Based on expert consensus, the American Society of Transplantation recommends 7-14 days of preventive antibiotic therapy for solid organ transplant recipients from donors with positive blood cultures. We evaluated management and outcomes of kidney transplant recipients from these donors.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 2","pages":"ofae694"},"PeriodicalIF":3.8,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-Year Effectiveness of Bictegravir/Emtricitabine/Tenofovir Alafenamide as a Switch Strategy in the Real World.","authors":"Alejandro de Gea-Grela, Rafael Micán, Rosa de Miguel, Lucía Serrano, Cristina Marcelo, María Luisa Montes, Luis Ramos-Ruperto, Carmen Busca, María Del Mar Arcos-Rueda, Rocío Montejano, Jose Ramon Arribas, Juan Gonzalez-García, José Ignacio Bernardino, Luz Martín-Carbonero","doi":"10.1093/ofid/ofaf087","DOIUrl":"10.1093/ofid/ofaf087","url":null,"abstract":"<p><strong>Background: </strong>We previously described the effectiveness of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) as a switch strategy in real life in people with HIV (PWH) at 48 weeks. We did not find that previous nucleoside reverse transcriptase inhibitor (NRTI) resistance-associated mutations (RAMs) had an impact on efficacy. Herein we report response rates after 3 years of follow-up.</p><p><strong>Methods: </strong>This retrospective review comprised PWH who were treatment experienced and switched to B/F/TAF in a single-center cohort. HIV RNA <50 copies/mL was analyzed at 96 and 144 weeks in an intention-to-treat analysis (missing = failure) and per-protocol analysis; patients with missing data or changes for reasons other than virologic failure were excluded.</p><p><strong>Results: </strong>An overall 506 PWH were included: 16.2% were women, the median age was 52.3 years, the median time of HIV infection was 18.9 years, and 13.6% had documented preexisting NRTI RAMs. At 96 weeks of follow-up in the intention-to-treat and per-protocol analyses, HIV RNA <50 copies/mL was seen in 73.1% and 95.4%, respectively. At 144 weeks, these figures were 68.2% and 94%. There were no statistically significant differences between patients with and without previous NRTI RAMs. A total of 140 patients were excluded for the per-protocol analysis at week 144: 46 were lost to follow-up, 32 discontinued treatment due to toxicity, 34 simplified to dual antiretroviral therapy, 7 switched for other reasons, and 20 patients died (no death was B/F/TAF related).</p><p><strong>Conclusions: </strong>Through 3 years of follow-up, switching to B/F/TAF maintained high rates of virologic suppression in long-term PWH. These results were seen even in patients with preexisting NRTI RAMs.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 3","pages":"ofaf087"},"PeriodicalIF":3.8,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicodemographic and Radiological Features of Infective Ring-Enhancing Brain Lesions: A 4-Year Retrospective Study at a Tertiary Referral Center.","authors":"Edwin Chong Yu Sng, Ling Ling Chan, Edwin Philip Conceicao, Min Jia Wong, Dorothy Hui Lin Ng, Hwee Kuan Lee, Candice Yuen Yue Chan","doi":"10.1093/ofid/ofaf095","DOIUrl":"10.1093/ofid/ofaf095","url":null,"abstract":"<p><strong>Background: </strong>The diagnostic evaluation of ring-enhancing brain lesions (REBLs) is challenging, especially in immunocompromised patients. We conducted a retrospective study to describe the clinicodemographic and radiological features among patients presenting with REBLs to a tertiary referral center.</p><p><strong>Methods: </strong>Radiological reports of all patients who underwent brain computed tomography or magnetic resonance (MR) imaging between 1 November 2013 and 31 October 2017 were filtered for terms indicative of REBLs. Infectious diseases physicians reviewed the medical records to confirm the diagnosis.</p><p><strong>Results: </strong>Over the 4-year study period, there were 42 patients with infective REBLs and 249 with neoplastic REBLs. Pyogenic brain abscesses (PBAs) (20 of 42 [47.6%]) were the most common cause of infective REBLs, followed by tuberculous brain abscesses (TBAs) (9 of 42 [21.4%]) and <i>Nocardia</i> brain abscesses (NBAs) (6 of 42 [14.3%]). The patients were predominantly male, with a mean age of 55.2 years. Fewer than half were febrile at presentation. Cerebrospinal fluid investigations established the microbiological diagnosis in fewer than half of those who underwent lumbar puncture or extraventricular drain insertion. Conversely, brain biopsy yielded the microbiological diagnosis in almost all patients (16 of 17) who underwent the operation. Median white blood cell counts and C-reactive protein were higher in those with PBAs or NBAs than in those with TBAs. All with PBAs and NBAs who underwent MR imaging had diffusion-weighted imaging-hyperintense lesions, compared with only about half of those with TBAs.</p><p><strong>Conclusions: </strong>Our study has revealed important distinguishing features between infective REBLs and neoplastic REBLs and between PBAs, TBAs, and NBAs.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 3","pages":"ofaf095"},"PeriodicalIF":3.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}