Lancet Infectious Diseases最新文献

{"title":"Prevalence, clinical management, and outcomes of adults hospitalised with endemic arbovirus illness in southeast Europe (MERMAIDS-ARBO): a prospective observational study","authors":"Louise Sigfrid, Xin Hui S Chan, Louella M R Kasbergen, Lauren Hookham, Jia Wei, Siyu Chen, James L Lee, Reina S Sikkema, Erwin de Bruin, Victor M Corman, Chantal Reusken, Katherine Loens, Corneliu Petru Popescu, Mihaela Lupse, Violeta Briciu, Pellumb Pipero, Arjan Harxhi, Edmond Puca, Albina Ponosheci Biçaku, Maja Travar, Marion P G Koopmans","doi":"10.1016/s1473-3099(24)00655-8","DOIUrl":"https://doi.org/10.1016/s1473-3099(24)00655-8","url":null,"abstract":"<h3>Background</h3>Arboviruses have expanded into new regions in Europe, yet data indicate gaps in disease notifications and a risk of further spread. We aimed to report on prevalence, clinical management, and outcomes of endemic arbovirus infections in southeast Europe.<h3>Methods</h3>In this prospective observational study (MERMAIDS-ARBO), we enrolled adults (age ≥18 years) hospitalised with an arbovirus-compatible disease syndrome within 21 days of symptom onset across 21 hospitals in seven countries in southeast Europe over four arbovirus seasons (May 1–Oct 31, during 2016–19). We obtained data from case report forms completed by site investigators on admission and discharge. Participants were excluded if they had non-infectious CNS disorders, symptoms of another confirmed cause, an identified focal source of infection, or symptoms caused by recurrence of a pre-existing condition. The primary outcome was the proportion of participants with confirmed or probable acute infections with West Nile virus (WNV), tick-borne encephalitis virus (TBEV), Crimean–Congo haemorrhagic fever virus (CCHFV), or Toscana virus (TOSV), per reference laboratory criteria. Secondary outcomes were the proportions of patients treated with antivirals, antibiotics, or corticosteroids; the proportion of patients requiring intensive care; hospital length of stay; and mortality.<h3>Findings</h3>Of 2896 adults screened for eligibility, 929 were recruited and 913 met protocol-defined eligibility criteria (median age 43·1 years [IQR 29·5–59·7]; 550 [60%] men, 361 [40%] women, and two [<1%] with missing data). 530 (58%) participants presented with suspected meningitis, encephalitis, or both, and 318 (35%) with fever plus myalgia, fever plus arthralgia, or both. 820 (90%) reported no international travel within 21 days before symptom onset. 727 (80%) were administered antibiotics, 379 (42%) corticosteroids, and 222 (24%) antivirals. The median length of hospital stay was 9 days (IQR 6–14), and 113 (12%) required intensive care. Of 847 participants with a reference laboratory sample who met full eligibility criteria for analysis, 110 (13%) were diagnosed with 114 confirmed or probable acute arbovirus infections (four had coinfections or cross-reactivity): one (<1%) with CCHFV, 16 (2%) with TBEV, 44 (5%) with TOSV, and 53 (6%) with WNV. There was one death (<1%) of an individual with WNV. Of the 110 participants, 49 (45%) had a local clinician-attributed arbovirus discharge diagnosis.<h3>Interpretation</h3>Our data highlight the need to strengthen arbovirus surveillance systems for the early detection of emerging and re-emerging outbreaks, including investments to increase awareness of arbovirus infections among clinicians, to improve access to specialist diagnostics, and to develop effective and accessible vaccines and treatments to protect populations and health systems in southeast Europe.<h3>Funding</h3>European Commission and Versatile Emerging infectious disease Obs","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"21 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143463161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Penicillin treatment failure probably explains repeat episode of neurosyphilis – Authors' reply","authors":"Louiselle LeBlanc, Jacques Pépin","doi":"10.1016/s1473-3099(25)00081-7","DOIUrl":"https://doi.org/10.1016/s1473-3099(25)00081-7","url":null,"abstract":"No Abstract","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"29 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143452231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mycoplasma pneumoniae infections: changing the clinical approach to an evolving disease","authors":"Marco Bongiovanni","doi":"10.1016/s1473-3099(25)00008-8","DOIUrl":"https://doi.org/10.1016/s1473-3099(25)00008-8","url":null,"abstract":"No Abstract","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"20 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143452229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Penicillin treatment failure probably explains repeat episode of neurosyphilis","authors":"Chris Kenyon, Thibaut Vanbaelen","doi":"10.1016/s1473-3099(25)00080-5","DOIUrl":"https://doi.org/10.1016/s1473-3099(25)00080-5","url":null,"abstract":"No Abstract","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"66 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143452234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mycoplasma pneumoniae infection in adult inpatients during the 2023–24 outbreak in France (MYCADO): a national, retrospective, observational study","authors":"Ariane Gavaud, Matthieu Holub, Antoine Asquier-Khati, Karine Faure, Sophie Leautez-Nainville, Gwenael Le Moal, François Goehringer, David Luque Paz, Bérangère Arnould, Victor Gerber, Guillaume Martin-Blondel, Charles Declerck, Sandrine Gazaignes, Sophie Blanchi, Paul Loubet, Natacha Mrozek, Thomas Perpoint, Melanie Cresta, Morgane Mailhe, Alexandre Bleibtreu, Theophile Cocherie","doi":"10.1016/s1473-3099(24)00805-3","DOIUrl":"https://doi.org/10.1016/s1473-3099(24)00805-3","url":null,"abstract":"<h3>Background</h3>An epidemic of <em>Mycoplasma pneumoniae</em> infection has been observed in France since September, 2023. We aimed to describe the characteristics of adults hospitalised for <em>M pneumoniae</em> infection and identify factors associated with severe outcomes of infection.<h3>Methods</h3>MYCADO is a retrospective observational study including adults hospitalised for 24 h or more in 76 hospitals in France for a <em>M pneumoniae</em> infection between Sept 1, 2023, and Feb 29, 2024. Clinical, laboratory, and imaging data were collected from medical records. We identified factors associated with severe outcomes of infection, defined as a composite of intensive care unit (ICU) admission or in-hospital death, using multivariable logistic regression.<h3>Findings</h3>1309 patients with <em>M pneumoniae</em> infection were included: 718 (54·9%) were men and 591 (45·1%) were women; median age was 43 years (IQR 31–63); 288 (22·0%) had chronic respiratory failure; 423 (32·3%) had cardiovascular comorbidities; and 105 (8·0%) had immunosuppression. The most common symptoms were cough (1098 [83·9%]), fever (1023 [78·2%]), dyspnoea (948 [72·4%]), fatigue (550 [42·0%]), expectorations (473 [36·1%]), headache (211 [16·1%]), arthromyalgia (253 [19·3%]), ear, nose, and throat symptoms (202 [15·4%]), diarrhoea (138 [10·5%]), and vomiting (132 [10·1%]). 156 (11·9%) of 1309 patients had extra-respiratory manifestations, including 36 (2·8%) with erythema multiforme, 19 (1·5%) with meningoencephalitis, 44 (3·4%) with autoimmune haemolytic anaemia, and 17 (1·3%) with myocarditis. The median hospital stay was 8 days (IQR 6–11). 424 (32·4%) patients had a severe outcome of infection, including 415 (31·7%) who were admitted to the ICU and 28 (2·1%) who died in hospital. Those more likely to present with severe outcomes of infection were patients with hypertension, obesity, chronic liver failure, extra-respiratory manifestations, pulmonary alveolar consolidation or bilateral involvement on CT scan, as well as elevated inflammatory markers, lymphopenia or neutrophilic polynucleosis, and those who did not versus did receive any antibiotic active against <em>M pneumoniae</em> before admission.<h3>Interpretation</h3>This national, observational study highlighted unexpected, atypical radiological presentations, a high proportion of transfers to the ICU, and an association between severity and delayed administration of effective antibiotics. This should remind clinicians that no radiological presentation can rule out <em>M pneumoniae</em> infection, and encourage them to reassess patients early after prescribing a β-lactam, or even to discuss prescribing macrolides as first-line treatment in the context of an epidemic.<h3>Funding</h3>None.<h3>Translation</h3>For the French translation of the abstract see Supplementary Materials section.","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"17 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143462976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DoxyPEP: thinking towards implementation","authors":"Jaime Garcia-Iglesias, Chase Ledin, John Gilmore, Manik Kohli, Eddy Smith, Benjamin Weil, Laia Ventura Garcia","doi":"10.1016/s1473-3099(25)00077-5","DOIUrl":"https://doi.org/10.1016/s1473-3099(25)00077-5","url":null,"abstract":"No Abstract","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"31 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whipple's disease: from in-vitro data to bedside practice via trial results","authors":"Xavier Puéchal","doi":"10.1016/s1473-3099(25)00016-7","DOIUrl":"https://doi.org/10.1016/s1473-3099(25)00016-7","url":null,"abstract":"No Abstract","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"35 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143435666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral treatment of Whipple's disease with doxycycline and hydroxychloroquine versus intravenous therapy with ceftriaxone followed by oral trimethoprim–sulfamethoxazole in Germany: a phase 2/3, prospective, open-label, randomised, controlled, non-inferiority trial","authors":"Verena Moos, Justina Krüger, Kristina Allers, Annette Moter, Judith Kikhney, Anja A Kühl, Christoph Loddenkemper, Andrea Stroux, Katina Schinnerling, Thomas Schneider","doi":"10.1016/s1473-3099(24)00797-7","DOIUrl":"https://doi.org/10.1016/s1473-3099(24)00797-7","url":null,"abstract":"&lt;h3&gt;Background&lt;/h3&gt;Previous studies have shown that intravenous ceftriaxone or meropenem for 14 days, followed by oral trimethoprim–sulfamethoxazole for 1 year, cures 98% of people with Whipple's disease. However, intravenous therapy requires hospitalisation and carries risks for treatment-associated complications. The aim of this study was to investigate whether oral-only treatment for Whipple's disease is non-inferior to intravenous therapy.&lt;h3&gt;Methods&lt;/h3&gt;This phase 2/3, prospective, open-label, randomised, controlled, non-inferiority trial enrolled individuals aged 18 years or older with confirmed Whipple's disease from across Germany who had received treatment for less than 1 month at Charité–Universitätsmedizin Berlin. Participants were randomly assigned (1:1) with block randomisation to receive either intravenous ceftriaxone (2 g once per day) for 14 days, followed by oral trimethoprim–sulfamethoxazole (960 mg twice per day) for 12 months, or oral doxycycline (100 mg twice per day) plus hydroxychloroquine (200 mg twice per day) for 12 months. Ten participants who had already received intravenous ceftriaxone were non-randomly assigned to the intravenous treatment group. Participants in the oral-only treatment group were PCR-positive for &lt;em&gt;Tropheryma whipplei&lt;/em&gt; in cerebrospinal fluid received trimethoprim–sulfamethoxazole (960 mg five times per day) until clearance. The primary outcome was complete clinical remission without recurrence during the observation period of 24 months, assessed in the intention-to-treat (ITT) population. The prespecified non-inferiority margin was –18%. Safety was a secondary endpoint, assessed in the ITT population. The study was registered with the EU Clinical Trials Register, EudraCT 2008–003951–54, and is completed.&lt;h3&gt;Findings&lt;/h3&gt;Between May 26, 2010, and Oct 30, 2018, we screened 310 individuals and enrolled 64 participants in the study. After exclusion of four individuals whose diagnosis was not confirmed, 31 participants were assigned to the intravenous treatment group and 29 to the oral-only treatment group. By ITT, 25 (81%) of 31 participants in the intravenous treatment group and 28 (97%) of 29 participants in the oral-only treatment group had complete clinical remission without recurrence. The risk difference was 15·9 percentage points (95% CI –1·2 to 33·1), with the lower bound of the 95% CI above our non-inferiority margin of –18%. A post-hoc per-protocol analysis confirmed the non-inferiority of oral-only treatment. No participant relapsed, but two participants in the intravenous treatment group died from nosocomial infections. Serious adverse events occurred in 13 (42%) of 31 participants in the intravenous treatment group and eight (28%) of 29 participants in the oral-only treatment group, but this difference was not statistically significant (p=0·244).&lt;h3&gt;Interpretation&lt;/h3&gt;Oral-only treatment of Whipple's disease was safe and non-inferior to sequential intravenous–oral treatment. Oral treat","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"88 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143435668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Europe needs a sustainably funded influenza research and response network","authors":"Florian Krammer, Wendy S Barclay, Martin Beer, Ian H Brown, Rebecca Jane Cox, Menno D de Jong, Ervin Fodor, Ron A M Fouchier, Gülsah Gabriel, Adolfo García-Sastre, Raquel Guiomar, Peter Horby, Marion Koopmans, Nicola S Lewis, Stefania Maggi, Isabella Monne, Nadia Naffakh, Hanna Nohynek, Albert Osterhaus, Katarina Prosenc, Charlotte Thålin","doi":"10.1016/s1473-3099(25)00068-4","DOIUrl":"https://doi.org/10.1016/s1473-3099(25)00068-4","url":null,"abstract":"No Abstract","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"23 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143435667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trump administration dismantles USAID","authors":"Talha Burki","doi":"10.1016/s1473-3099(25)00106-9","DOIUrl":"https://doi.org/10.1016/s1473-3099(25)00106-9","url":null,"abstract":"No Abstract","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"29 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143417445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}