Showing papers in "Infectious diseases in 2019"
TL;DR: The current knowledge on mechanisms supporting H. pylori resistance to gastric environment and to therapy is highlighted and several molecular bases for this phenomenon described.
Abstract: Helicobacter pylori is a human-specific pathogen with a strict tropism for the gastric mucosa. This bacterium infects around half of the world population and is the main responsible for gastritis, peptic ulcer and, in some cases, for the pathogenesis of gastric cancer. Nevertheless, disease development in infected subjects depends not only on the bacterium, but also on the host genetic predisposition and on environmental factors. The fascinating question of how the bacterium can survive in the gastric environment has stimulated research in this field. It is now clear that H. pylori is able to colonize and adhere to the gastric epithelium through several mechanisms, including the breakdown of urea with production of the cell-toxic ammonia. The resulting raise in pH neutralizes acidity of the stomach, thereby allowing the bacterium to safely cross the mucus layer to the epithelial surface. Current challenges regard understanding the mechanisms of antibiotic resistance and how to overcome it. Lately, an increasing H. pylori resistance rate to antibiotics has been reported and several molecular bases for this phenomenon described. In this review, we highlight the current knowledge on mechanisms supporting H. pylori resistance to gastric environment and to therapy.
64 citations
TL;DR: The present review summarizes the literature data regarding extracellular and cell-associated virulence factors of S. maltophilia and considers the basic characteristics of biofilm formation.
Abstract: Stenotrophomonas maltophilia is an increasingly prevalent opportunistic pathogen responsible for a wide range of nosocomial infections in intensive care unit patients, life-threatening diseases in immunocompromised haematology-oncology patients and chronic pulmonary infections in individuals with cystic fibrosis. Therapy of these infections is problematic due to the remarkable intrinsic antimicrobial resistance of the species and to acquired resistance to multiple antimicrobial agents. As this organism is a low-grade pathogen, the pathogenesis of S. maltophilia infections involves numerous virulence factors as well as the ability of bacterial cells to form biofilms on abiotic surfaces and host tissues. The present review summarizes the literature data regarding extracellular and cell-associated virulence factors of S. maltophilia (some of which have still not been studied in detail) and considers the basic characteristics of biofilm formation. Many virulence features such as extracellular enzymes, bacterial motility and biofilm formation are finely controlled by quorum sensing (QS) that enable the bacteria to express these virulence factors in a coordinated, cell-density-dependent manner and overwhelm the host defence mechanisms. Manipulating the QS regulatory system is a promising approach for development of new strategies for control of S. maltophilia infections.
64 citations
TL;DR: A review of social and behavioral factors contributing to the current resurgence of syphilis and recommendations for reducing syphilis incidence through medical and public health prevention strategies are offered.
Abstract: In the last decade, there has been a marked resurgence of syphilis in the United States despite the availability of effective treatments and previously reliable prevention strategies. The majority of cases are among the population of men who have sex with men (MSM); however, there has also been a recent increase among premenopausal women, coinciding with a concerning rise of congenital cases. The resurgence of syphilis can be largely attributed to changing social and behavioral factors, especially among young MSM. The biological association of syphilis with human immunodeficiency virus (HIV) transmission and acquisition is particularly alarming because of the increased individual and healthcare burden. In addition, some individual actions and public health efforts that are meant to reduce the risk of acquiring HIV may actually lead to risk compensation that facilitates the transmission of syphilis. Untreated syphilis is associated with detrimental health outcomes; therefore, both effective prevention strategies and treatment of this systemic disease have important short-term and long-term public health implications. This article offers a review of social and behavioral factors contributing to the current resurgence and recommendations for reducing syphilis incidence through medical and public health prevention strategies.
55 citations
TL;DR: The mortality from viral pneumonia was high in adult patients and old age, viral-bacterial co-infection, underlying malignancy, and initial shock were independent predictors of mortality.
Abstract: Background: With the advancement of diagnostic methods, a viral infection is increasingly recognized in adult patients with pneumonia and the outcomes can be fatal especially in high-risk patients....
46 citations
TL;DR: The need for comprehensive HPV education on college campuses is highlighted and insights to priority populations that may be appropriate focuses of efforts to increase HPV knowledge and vaccination rates are offered.
Abstract: Despite the existence of a safe and effective vaccine, human papillomavirus (HPV) remains prevalent in the United States, with late adolescence and early adulthood being periods of increased risk. ...
43 citations
TL;DR: The presence of L. adecarboxylata is reported in a patient initially admitted to the authors' hospital for a lung transplant, who had diarrhoea, urinary tract infection and pneumonia caused by L.adecar boxylata.
Abstract: Leclercia adecarboxylata is a Gram-negative bacterium belonging to the family Enterobacteriaceae. It has been described as an emerging human pathogen with the potential to cause severe infection in immunocompromised patients. The aim of this study was to describe a clinical case of infection with L. adecarboxylata and give a review of previous reports on infection. We report the presence of L. adecarboxylata in a patient initially admitted to our hospital for a lung transplant. She had diarrhoea, urinary tract infection and pneumonia caused by L. adecarboxylata. The isolate was resistant to trimethoprim-sulfamethoxazole and susceptible to 15 other antibiotics tested. The literature search for previous reports of infection with L. adecarboxylata resulted in 61 publications describing 74 cases. Bacteremia and wound infections were most often described, and only a few cases were fatal. L. adecarboxylata was most often found as a monomicrobial infection in immunocompromised patients, and as part of a polymicrobial infection in immunocompetent patients. The previously described isolates showed a high susceptibility to antibiotics, and treatment was efficient in most cases. Due to similarities in metabolic products, L. adecarboxylata might have been mistaken as Escherichia spp., but with new identification methods such as MALDI-TOF MS, it is possible to obtain a certain identification.
39 citations
TL;DR: Lactate predicts risk of death in all patients, although patients with sepsis have a higher mortality for any given lactate level, and serum lactate, including normal values, is associated with long-term mortality.
Abstract: Objective:To measure the relationship between lactate and mortality in hospital inpatients. Main outcomes of interest were 3-day, 30-day, and 1-year all-cause mortality.Design:Retrospective cohort ...
38 citations
TL;DR: The aetiology of brain abscess is usually polymicrobial, most frequently involving a variety of aerobic and obligate anaerobic bacteria as mentioned in this paper, and the authors in this paper report on the results of a recent study.
Abstract: To the editor,The aetiology of brain abscess is usually polymicrobial, most frequently involving a variety of aerobic and obligate anaerobic bacteria. In this journal, a Helsinki group reported on ...
30 citations
TL;DR: Infection tripled the cost of a total joint arthroplasty, and thecost of two-stage revisions were triple that of debridement, antibiotics and implant retention treatment.
Abstract: Background: In Europe few studies have analyzed the costs of treating aseptic revisions and prosthetic joint infections with either debridement, antibiotics and implant retention or two-stage revis...
28 citations
TL;DR: Isolates from ‘classical’ biofilm-related infections, but also from superficial skin infections, are especially proficient in forming biofilms, and there is, however, no obvious relation ofBiofilm-forming capacity of isolates and the clinical outcome of the infection, and more studies are needed.
Abstract: Background: Biofilms are involved in many Staphylococcus aureus infections, but relation of biofilm formation and the infection types or the clinical outcomes remain unclear.Methods: We measured biofilm formation, with a microtiter plate assay, of a collection of methicillin-sensitive clinical isolates from 159 invasive S. aureus infections, encompassing all cases occurring within a hospital catchment area during two years, and from additional 49 non-invasive skin infections from the same region. Results were related to available clinical and microbiological documentation.Results: Isolates from medical device infections (intravenous line-associated and prosthetic joint infections), as well as isolates from superficial skin infections, were particularly proficient in forming biofilms. No increased biofilm-forming capacity was seen in isolates from endocarditis, osteomyelitis, or other infections. There was also a correlation of biofilm formation with the agr type of the isolates. Thicker biofilms w...
28 citations
TL;DR: To the EditorA recent report in the present journal drew attention to lymphopenia in influenza infection and noted that a high rate of complications occurred in neu...
Abstract: To the EditorA recent report in the present journal drew attention to lymphopenia in influenza infection [1]. Besides the authors’ main observation that a high rate of complications occurred in neu...
TL;DR: It is important to increase knowledge about pathogenesis, diagnosis and treatment of brucellosis in order to manage and control this infection, especially in endemic regions.
Abstract: Brucellosis, caused by the intracellular pathogens Brucella, is one of the major zoonotic infections. Considering the economic burden, its prevalence has been a health concern especially in endemic regions. Brucella is able to survive and replicate within host cells by expressing different virulence factors and using various strategies to avoid the host's immune response. This leads to progression of the disease from an acute phase to chronic brucellosis. Exploration of genetic variations has confirmed the expected influence of gene polymorphisms on susceptibility and resistance to brucellosis of humans. Since there is no approved human vaccine and treatment is uncertain with risk of relapse, it is important to increase knowledge about pathogenesis, diagnosis and treatment of brucellosis in order to manage and control this infection, especially in endemic regions.
TL;DR: PCT has a moderate ability to distinguish bacterial respiratory infection in patients with AECOPD and can reduce unnecessary administration of antibiotics without increasing adverse outcomes, however, for patients requiring admission in the ICU, PCT may have a poor diagnostic value, and the PCT-guided algorithm may not effectively and safely reduce the antibiotic exposure.
Abstract: Background: The value of procalcitonin (PCT) in the diagnosis of bacterial infections and for determining antibiotic usage among patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is currently unclear. Methods: We systematically reviewed the literature and selected studies that evaluated PCT as a biomarker for predicting bacterial infection and compared PCT-based protocols to determine its application in the initiation or discontinuation of antibiotics. Guidance for systematic reviews from Cochrane and the GRADE were followed to perform this study. Data were pooled and analyzed by using a random-effects or a fixed-effects model based on the heterogeneity. Results: The pooled sensitivity and specificity of PCT in diagnosing respiratory bacterial infections were 0.60 and 0.76, respectively, with the area under the summary receiver operating characteristic curve of 0.77. Subgroup analysis showed that the sensitivity and specificity of PCT for patients in ICU were 0.48 and 0.69, respectively. PCT-based protocols decreased antibiotic prescription (relative risk = 0.66, 95% CI: 0.62-0.71) and total antibiotic exposure (mean difference = -2.60, 95% CI: -4.48-0.72), without affecting clinical outcomes such as treatment failure, length of hospitalization and rates of re-exacerbation or overall mortality. Conclusions: PCT has a moderate ability to distinguish bacterial respiratory infection in patients with AECOPD. PCT-guided algorithm can reduce unnecessary administration of antibiotics without increasing adverse outcomes. However, for patients requiring admission in the ICU, PCT may have a poor diagnostic value, and the PCT-guided algorithm may not effectively and safely reduce the antibiotic exposure.
TL;DR: Adding an oropharynx sample to a nasopharyngeal sample increased the diagnostic yield of respiratory viruses.
Abstract: Background: Along with the current development of molecular diagnostic methods of respiratory viruses, the bedside patient sampling techniques need to be evaluated. We here asked the question wheth...
TL;DR: Assessment of the prevalence of Enterococcus faecalis infections among patients with hospital-acquired surgical wound sepsis and bacteremia in surgical wards and identify the antimicrobial susceptibility found MDR in all isolates and high-level resistance to gentamicin, erythromycin, and vancomycin were reported in E Faecalis isolates.
Abstract: Background:The study aimed to assess the prevalence of Enterococcus faecalis infections among patients with hospital-acquired surgical wound sepsis and bacteremia in surgical wards and identify the...
TL;DR: Risk factors for community-acquired ESBL-producing E coli urinary tract in the pediatric patient population were antibiotic usage within the previous 3 months and Middle Eastern ethnic background.
Abstract: Background: We noted a recent increase in cases of urinary tract infection due to community-acquired ESBL-producing Escherichia coli in children treated at our institution. Risk factors of ...
TL;DR: Differences in data sources and variations in definitions limit the utility of continuum of care as a comparative tool, however, countries from all three regions reported people who inject drugs (PWID) as hard-to-reach population across all HIV continuum stages.
Abstract: Background/objectives: Inadequate HIV care for hard-to-reach populations may result in failing the UNAIDS 90–90–90 goal. Therefore, we aimed to review the HIV continuum of care and hard-to-reach po...
TL;DR: Medical treatment alone or with limited surgery could be successful therapeutic strategies for complicated S. aureus SC septic arthritis in selected patients.
Abstract: Background: Aggressive surgery such as en bloc joint resection is favored for treating uncommon sternoclavicular (SC) septic arthritis, based on expert opinion and small case series. We analyzed th...
TL;DR: The evidence of HBOT in NSTI is poor and biased and there is a strong need for randomized controlled trials (RCTs) to shed light on a potential life-saving treatment.
Abstract: Background: Necrotizing soft tissue infection (NSTI) is a rare and potentially life-threatening disease. Rapid surgical intervention, antibiotics and intensive care are the mainstay of treatment. Hyperbaric oxygen therapy (HBOT) is used as adjuvant therapy in some centres but there is a lack of research-based evidence of efficacy. Methods: Following the PRISMA guideline we conducted a systematic review on the efficacy of HBOT on NSTI with mortality as primary outcome. Through January 2019 major databases were searched and relevant literature assessed. The criteria for study inclusion were research of any design and any period of time comparing HBOT vs. non-HBOT in a population of NSTI-patients. Studies were analysed using the modified Delphi method and risk of bias in non-randomized studies - of interventions tool. Relative risk (RR) on mortality was calculated for each study individually. Results: A number of 1733 studies were identified through database search. Ultimately, 21 studies were included of which 19 were case series with a control group. The majority of the studies performed poor in quality assessment and all featured a high to critical risk of bias. The association of HBOT on mortality was generally reported as positive, however, the results should be considered with great scepticism. Conclusions: The evidence of HBOT in NSTI is poor and biased. There is a strong need for randomized controlled trials (RCTs) to shed light on a potential life-saving treatment.
TL;DR: Education and training activities devoted to operators involved in the disease management, and to general population, may significantly contribute to strengthen the system and improve botulism surveillance systems.
Abstract: Foodborne botulism is a life-threatening disease caused by the ingestion of food containing preformed botulinum neurotoxins, the most potent natural poisons known to humans. On the basis of the new challenges in management of the diseases as well as considering the potential use of botulinum toxins as biological weapons, foodborne botulism is still considered a public health emergency. Each suspected case should be immediately notified to public health authorities with the aim of preparing a prompt response. With the aim of improving botulism surveillance systems, health authorities as well as governmental organizations should enhance national and international cooperation. Education and training activities devoted to operators involved in the disease management, and to general population, may significantly contribute to strengthen the system.
TL;DR: There was not a significant shift to non-albicans species as the cause of candidemia in Southern Finland during the 10-year study period, and there was no statistically significant association between 30-day mortality and an early start of an effective antifungal treatment.
Abstract: Background: Candidemia is a life-threatening infection with high mortality. Our aim was to evaluate the Candida species distribution, antifungal susceptibilities and risk factors associated with 30...
TL;DR: In general, non-vector-borne DENV transmission routes such as needlestick injuries, organ transplantation or blood transfusion are rare but possible; recently, the authors published an article...
Abstract: Sir,In general, non-vector-borne DENV transmission routes such as needlestick injuries, organ transplantation or blood transfusion are rare but possible; recently your journal published an article ...
TL;DR: It is indicated that a high initial load of S. aureus DNA in blood is associated with sepsis, mortality and persistent immune dysregulation in S.aureus bacteraemia patients, and further studies are needed to define the role of bacterial DNA load monitoring in the management of the disease.
Abstract: Background: Staphylococcus aureus bacteraemia is a disease with varying presentation, ranging from uncomplicated to life-threatening infections. In S. aureus bacteraemia, a high load of bacterial DNA in blood has been linked to mortality. We hypothesized that a high DNA load would also be linked to the presence of sepsis, and to high C-reactive protein (CRP) and lymphopaenia, indicating inflammation and immunosuppression.Methods: Twenty-seven patients with culture-proven S. aureus bacteraemia, 13 (48%) with sepsis and six (22%) non-survivors, were enrolled in a prospective study. Blood samples were collected on days 0, 1–2, 3–4, 6–8, 13–15 and 26–30, and subjected to droplet digital PCR targeting the nuc gene to determine the nuc DNA load.Results: nuc DNA was detected on days 0–2 in 22 patients (81%), and on days 6–8 in three patients (all non-survivors). The nuc DNA load on days 1–2 was significantly elevated in patients with sepsis (median 2.69 versus 1.32 log10 copies/mL; p = .014) and in non-s...
TL;DR: After 12 months, HIV-infected patients with NAFLD switching from a PI/r to raltegravir showed a significantly greater decrease in the hepatic steatosis degreee in comparison with those with unchanged cART and treated only with lifestyle modification.
Abstract: Background: The ritonavir-boosted protease inhibitor (PI/r) use has been associated with several metabolic abnormalities, and the non-alcoholic fatty liver disease (NAFLD) is becoming a ver...
TL;DR: The magnitude of multi-drug resistance and the level of extended spectrum beta lactamase producing Non-Fermenting Gram-Negative Bacilli were high and both in the community and in hospital setting are essential.
Abstract: Background:Emergence of resistance to multiple antimicrobial agents in Non-Fermenting Gram-Negative Bacilli is a major problem to public health, as it limits drug treatment options against infectio...
TL;DR: Viral infections and IR interact in a bi-directional manner after hematopoietic stem cell transplantation and close follow-up of both IR and viral loads is warranted.
Abstract: Background: Viral infections are a major cause of morbidity and mortality after hematopoietic stem cell transplantation (HSCT). Although immune suppression plays a central role, the literat...
TL;DR: Chronic obstructive pulmonary disease was not independently associated with 30-d mortality in patients with community acquired pneumonia, and factors related to mortality were age, premorbid condition, severity of pneumonia as determined by CURB-65 score, and pleural effusion and multi-lobular infiltrate on chest X-ray.
Abstract: Background: It is still a matter of debate whether the outcome of community acquired pneumonia is more severe in patients with chronic obstructive pulmonary disease. We aimed to determine whether c...
TL;DR: Mortality in patients with influenza pneumonia was higher than the expected mortality in community-acquired pneumonia, although generally considered benign, influenza is a deadly infection in ICU patients in Reunion Island.
Abstract: Background: In Reunion Island, influenza is not considered a serious illness despite significant mortality in intensive care unit (ICU). We assess the post-pandemic mortality of influenza by comparing it to other community-acquired pneumonia in our ICU. Methods: Retrospective, descriptive, and single-centre cohort study. The main aim was to determine the standardized mortality ratio (SMR) for influenza based on the quartiles of the SAPSII score in the reference population of 954 patients hospitalized for community-acquired pneumonia. Another aim was to analyze the risk factors for mortality in influenza patients. Results: 127 consecutive patients were hospitalized in our ICU with a positive influenza PCR, from January 2013 to December 2017. The mortality rate of these patients was 31% (CI 95%: 23-39%). In patients hospitalized for community-acquired pneumonia, the SMR of patients with influenza was 1.24 (CI 95%: 0.89-1.70). At admission, thirty-nine patients (31%) had superinfections, in 17 caused by methicillin-susceptible Staphylococcus aureus. Need for renal replacement therapy (RR 2.53 [1.29-4.93]) or ECMO (RR 2.35 [1.16-4.74]) were associated with mortality. Twenty-four patients underwent ECMO, 17 with VV-ECMO. Conclusions: Mortality in patients with influenza pneumonia was higher than the expected mortality in community-acquired pneumonia. Although generally considered benign, influenza is a deadly infection in ICU patients in Reunion Island.
TL;DR: BK-virus associated nephropathy (BKVAN) and BKV associated haemorrhagic cystitis (HC) are complications of BKv infection/reactivation in renal and allogeneic haematopoietic stem cell transplantation patients, respectively.
Abstract: BK-virus (BKV) associated nephropathy (BKVAN) and BKV associated haemorrhagic cystitis (HC) are complications of BKV infection/reactivation in renal and allogeneic haematopoietic stem cell transpla ...
TL;DR: A high prevalence of bacterial vaginosis and vaginal candidiasis is revealed and suggests that health care providers should increase awareness and communication to improve vaginal hygiene practices and suggest that young women and women with low levels of education were at increased risk for vaginal/cervical infections.
Abstract: Background:Lower reproductive tract infections in women are important causes of morbidity but can also lead to complications and sequelae. This study aimed to establish the prevalence and risk fact...