Fungal infections are relatively common among patients with systemic lupus erythematosus (SLE), and patients may be infected simultaneously or sequentially with multiple fungal species. Physicians need to select appro...Fungal infections are relatively common among patients with systemic lupus erythematosus (SLE), and patients may be infected simultaneously or sequentially with multiple fungal species. Physicians need to select appropriate antifungal agents and therapeutic regimens based on the type and severity of the infection. Herein, we report a young SLE patient who developed concurrent pulmonary infection with Pneumocystis jirovecii and Trichosporon coremiiforme. The patient presented with a variety of imaging manifestations,with specific features evolving as the disease progressed.展开更多
Febrile infants are at greater risk of invasive bacterial infections (IBI),which include bacterial meningitis and bacteremia.Although bacterial meningitis is uncommon,^([1-2])it remains a concern for clinicians treati...Febrile infants are at greater risk of invasive bacterial infections (IBI),which include bacterial meningitis and bacteremia.Although bacterial meningitis is uncommon,^([1-2])it remains a concern for clinicians treating infants younger than 90 d.Guidelines for investigating fever without a source(meaning without an apparent source of infection,or of nonobvious origin) are numerous around the world but remain conflicting,particularly on whether to perform a lumbar puncture for cerebrospinal fluid (CSF) analysis in infants older than 22 d and hence at lower risk than younger infants.展开更多
BACKGROUND: Inappropriate antibiotic treatment for patients with viral infections has led to a surge in antimicrobial resistance, increasing mortality and healthcare costs. Viral and bacterial infections are often dif...BACKGROUND: Inappropriate antibiotic treatment for patients with viral infections has led to a surge in antimicrobial resistance, increasing mortality and healthcare costs. Viral and bacterial infections are often difficult to distinguish. Myxovirus resistance protein A(MxA), an essential antiviral factor induced by interferon after viral infection, holds promise for distinguishing between viral and bacterial infections. This study aimed to determine the ability of Mx A to distinguish viral from bacterial infections.METHODS: We quantified MxA in 121 infected patients via dry immunofluorescence chromatography. The Kruskal-Wallis test and receiver operating characteristic(ROC) curve analysis were used to determine the diagnostic value of Mx A, either alone or in combination with C-reactive protein(CRP) or procalcitonin(PCT), in patients with viral, bacterial, or co-infections.RESULTS: The value of MxA(ng/mL) was significantly higher in patients with viral infections than in those with bacterial and co-infections(82.3 [24.5–182.9] vs. 16.4 [10.8–26.5], P<0.0001)(82.3 [24.5–182.9] vs. 28.5 [10.2–106.8], P=0.0237). The area under the curve(AUC) of the ROC curve for distinguishing between viral and bacterial infections was 0.799(95% confidence interval [95% CI] 0.696–0.903), with a sensitivity of 68.9%(95% CI 54.3%–80.5%) and specificity of 90.0%(95% CI 74.4%–96.5%) at the threshold of 50.3 ng/mL. Combining the MxA level with the CRP or PCT level improved its ability. MxA expression was low in cytomegalovirus(15.8 [9.6–47.6] ng/mL) and Epstein-Barr virus(12.9 [8.5–21.0] ng/mL) infections.CONCLUSION: Our study showed the diagnostic efficacy of Mx A in distinguishing between viral and bacterial infections, with further enhancement when it was combined with CRP or PCT. Moreover, EpsteinBarr virus and human cytomegalovirus infections did not elicit elevated Mx A expression.展开更多
The appearance of HBV DNA in the liver and serum of 15 patients with hepatitisB conifected with HDV was observed and compared with that of 13 HDV-negative cases.Itwas found that HBsAg titer was lower than or equal to ...The appearance of HBV DNA in the liver and serum of 15 patients with hepatitisB conifected with HDV was observed and compared with that of 13 HDV-negative cases.Itwas found that HBsAg titer was lower than or equal to 1:4 in 8 HDV-positive patients,inwhom it was temporally negative in 5,and negative during the,two-day hospitalization in 1.No similar result could be observed in the HDV-negative cases.The detection rate of HBVDNA in both the HDV positive and negative groups was 20.0％ (3/15) and 25％ (3.12) in se-rum,and 46.7％ (7/15) and 61.5％ (8/13) in the liver rcspectively.There was no signif-icant statistical difference between the 2 groups.The HBV DNA grains detected with in situ hybridization,with biotinylated HBV DNAprobe were demonstrated in the sparse type of distribution in 3 cases and lightly stained in 2.Itis believed that HBV DNA replication activity might be suppressed by HDV.However activeHRV DNA replication was also present in some HDV-positive patients and HBV DNA was posi-tive in both the liver and serum in 3 such patients.It was concluded that the difference of the detection rate of HBV DNA in HDV-positivepatients might be related to the different stages of HDV infection.展开更多
Rickettsia felis is an exclusively cytozoic Gram-negative prokaryote with cat fleas as the major vectors.[1]As early as 1918,Rickettsia felis was detected in cat fleas in Europe and named Rickettsia ctenocephali.[2]Sy...Rickettsia felis is an exclusively cytozoic Gram-negative prokaryote with cat fleas as the major vectors.[1]As early as 1918,Rickettsia felis was detected in cat fleas in Europe and named Rickettsia ctenocephali.[2]Symptoms of fever,malaise,headache,maculopapular rash and eschar are observed in patients with Rickettsia felis infection.展开更多
BACKGROUND:Streptococcus pneumoniae(S.pneumoniae)is a common pathogen that causes bacterial pneumonia.However,with increasing bacterial resistance,there is an urgent need to develop new drugs to treat S.pneumoniae inf...BACKGROUND:Streptococcus pneumoniae(S.pneumoniae)is a common pathogen that causes bacterial pneumonia.However,with increasing bacterial resistance,there is an urgent need to develop new drugs to treat S.pneumoniae infections.Nanodefensin with a 14-carbon saturated fatty acid(ND-C14)is a novel nanoantimicrobial peptide designed by modifying myristic acid at the C-terminus of humanα-defensin 5(HD5)via an amide bond.However,it is unclear whether ND-C14 is effective against lung infections caused by S.pneumoniae.METHODS:In vitro,three groups were established,including the control group,and the HD5 and ND-C14 treatment groups.A virtual colony-count assay was used to evaluate the antibacterial activity of HD5 and ND-C14 against S.pneumoniae.The morphological changes of S.pneumoniae treated with HD5 or ND-C14 were observed by scanning electron microscopy.In vivo,mice were divided into sham,vehicle,and ND-C14 treatment groups.Mice in the sham group were treated with 25μL of phosphate-buffered saline(PBS).Mice in the vehicle and ND-C14 treatment groups were treated with intratracheal instillation of 25μL of bacterial suspension with 2×108 CFU/mL(total bacterial count:5×10^(6) CFU),and then the mice were given 25μL PBS or intratracheally injected with 25μL of ND-C14(including 20μg or 50μg),respectively.Survival rates were evaluated in the vehicle and ND-C14 treatment groups.Bacterial burden in the blood and bronchoalveolar lavage fluid were counted.The lung histology of the mice was assessed.A propidium iodide uptake assay was used to clarify the destructive eff ect of ND-C14 against S.pneumoniae.RESULTS:Compared with HD5,ND-C14 had a better bactericidal eff ect against S.pneumoniae because of its stronger ability to destroy the membrane structure of S.pneumoniae in vitro.In vivo,ND-C14 significantly delayed the death time and improved the survival rate of mice infected with S.pneumoniae.ND-C14 reduced bacterial burden and lung tissue injury.Moreover,ND-C14 had a membrane permeation eff ect on S.pneumoniae,and its destructive ability increased with increasing ND-C14 concentration.CONCLUSION:The ND-C14 may improve bactericidal eff ects on S.pneumoniae both in vitro and in vivo.展开更多
Latent tuberculosis infection(LTBI)has become a major source of active tuberculosis(ATB).Although the tuberculin skin test and interferon-gamma release assay can be used to diagnose LTBI,these methods can only differe...Latent tuberculosis infection(LTBI)has become a major source of active tuberculosis(ATB).Although the tuberculin skin test and interferon-gamma release assay can be used to diagnose LTBI,these methods can only differentiate infected individuals from healthy ones but cannot discriminate between LTBI and ATB.Thus,the diagnosis of LTBI faces many challenges,such as the lack of effective biomarkers from Mycobacterium tuberculosis(MTB)for distinguishing LTBI,the low diagnostic efficacy of biomarkers derived from the human host,and the absence of a gold standard to differentiate between LTBI and ATB.Sputum culture,as the gold standard for diagnosing tuberculosis,is time-consuming and cannot distinguish between ATB and LTBI.In this article,we review the pathogenesis of MTB and the immune mechanisms of the host in LTBI,including the innate and adaptive immune responses,multiple immune evasion mechanisms of MTB,and epigenetic regulation.Based on this knowledge,we summarize the current status and challenges in diagnosing LTBI and present the application of machine learning(ML)in LTBI diagnosis,as well as the advantages and limitations of ML in this context.Finally,we discuss the future development directions of ML applied to LTBI diagnosis.展开更多
目的系统评价儿科体外膜肺氧合(ECMO)支持患者院内感染的流行病学特征。方法采用主题词与自由词相结合的方式,系统检索中国知网、万方医学数据库、中国生物医学文献数据库、维普数据库、Pubmed、Embase、web of science数据库,搜集关于...目的系统评价儿科体外膜肺氧合(ECMO)支持患者院内感染的流行病学特征。方法采用主题词与自由词相结合的方式,系统检索中国知网、万方医学数据库、中国生物医学文献数据库、维普数据库、Pubmed、Embase、web of science数据库,搜集关于儿科ECMO支持患者院内感染的观察性研究,检索时限均为建库到2023年12月。由2名研究者独立进行文献筛选、提取资料、评价纳入研究的偏倚风险后,使用Stata 18.0软件进行meta分析。结果共纳入16项研究,包括3353例儿科ECMO支持患者,其中发生院内感染患者712例。随机效应模型meta分析结果显示,院内感染发生率为28.55%[95%CI(22.26%,35.28%)]。病原学分布中以革兰阴性菌为主(约占68.68%),其中前3位为:鲍曼不动杆菌(26.93%)、肺炎克雷伯菌(11.90%)、铜绿假单胞菌(9.39%)。结论当前证据显示,儿科ECMO支持患者院内感染率较高,且可能受地域影响。受研究质量影响,上述结论尚待更高质量研究验证。展开更多
文摘Fungal infections are relatively common among patients with systemic lupus erythematosus (SLE), and patients may be infected simultaneously or sequentially with multiple fungal species. Physicians need to select appropriate antifungal agents and therapeutic regimens based on the type and severity of the infection. Herein, we report a young SLE patient who developed concurrent pulmonary infection with Pneumocystis jirovecii and Trichosporon coremiiforme. The patient presented with a variety of imaging manifestations,with specific features evolving as the disease progressed.
基金the financial contribution of the Groupe de Recherche En Médecine d’Urgence du CHUL (GREMUC)which is the local emergency department research group。
文摘Febrile infants are at greater risk of invasive bacterial infections (IBI),which include bacterial meningitis and bacteremia.Although bacterial meningitis is uncommon,^([1-2])it remains a concern for clinicians treating infants younger than 90 d.Guidelines for investigating fever without a source(meaning without an apparent source of infection,or of nonobvious origin) are numerous around the world but remain conflicting,particularly on whether to perform a lumbar puncture for cerebrospinal fluid (CSF) analysis in infants older than 22 d and hence at lower risk than younger infants.
基金supported by the National Natural Science Foundation of China (82272196 and 82272220)。
文摘BACKGROUND: Inappropriate antibiotic treatment for patients with viral infections has led to a surge in antimicrobial resistance, increasing mortality and healthcare costs. Viral and bacterial infections are often difficult to distinguish. Myxovirus resistance protein A(MxA), an essential antiviral factor induced by interferon after viral infection, holds promise for distinguishing between viral and bacterial infections. This study aimed to determine the ability of Mx A to distinguish viral from bacterial infections.METHODS: We quantified MxA in 121 infected patients via dry immunofluorescence chromatography. The Kruskal-Wallis test and receiver operating characteristic(ROC) curve analysis were used to determine the diagnostic value of Mx A, either alone or in combination with C-reactive protein(CRP) or procalcitonin(PCT), in patients with viral, bacterial, or co-infections.RESULTS: The value of MxA(ng/mL) was significantly higher in patients with viral infections than in those with bacterial and co-infections(82.3 [24.5–182.9] vs. 16.4 [10.8–26.5], P<0.0001)(82.3 [24.5–182.9] vs. 28.5 [10.2–106.8], P=0.0237). The area under the curve(AUC) of the ROC curve for distinguishing between viral and bacterial infections was 0.799(95% confidence interval [95% CI] 0.696–0.903), with a sensitivity of 68.9%(95% CI 54.3%–80.5%) and specificity of 90.0%(95% CI 74.4%–96.5%) at the threshold of 50.3 ng/mL. Combining the MxA level with the CRP or PCT level improved its ability. MxA expression was low in cytomegalovirus(15.8 [9.6–47.6] ng/mL) and Epstein-Barr virus(12.9 [8.5–21.0] ng/mL) infections.CONCLUSION: Our study showed the diagnostic efficacy of Mx A in distinguishing between viral and bacterial infections, with further enhancement when it was combined with CRP or PCT. Moreover, EpsteinBarr virus and human cytomegalovirus infections did not elicit elevated Mx A expression.
文摘The appearance of HBV DNA in the liver and serum of 15 patients with hepatitisB conifected with HDV was observed and compared with that of 13 HDV-negative cases.Itwas found that HBsAg titer was lower than or equal to 1:4 in 8 HDV-positive patients,inwhom it was temporally negative in 5,and negative during the,two-day hospitalization in 1.No similar result could be observed in the HDV-negative cases.The detection rate of HBVDNA in both the HDV positive and negative groups was 20.0％ (3/15) and 25％ (3.12) in se-rum,and 46.7％ (7/15) and 61.5％ (8/13) in the liver rcspectively.There was no signif-icant statistical difference between the 2 groups.The HBV DNA grains detected with in situ hybridization,with biotinylated HBV DNAprobe were demonstrated in the sparse type of distribution in 3 cases and lightly stained in 2.Itis believed that HBV DNA replication activity might be suppressed by HDV.However activeHRV DNA replication was also present in some HDV-positive patients and HBV DNA was posi-tive in both the liver and serum in 3 such patients.It was concluded that the difference of the detection rate of HBV DNA in HDV-positivepatients might be related to the different stages of HDV infection.
文摘Rickettsia felis is an exclusively cytozoic Gram-negative prokaryote with cat fleas as the major vectors.[1]As early as 1918,Rickettsia felis was detected in cat fleas in Europe and named Rickettsia ctenocephali.[2]Symptoms of fever,malaise,headache,maculopapular rash and eschar are observed in patients with Rickettsia felis infection.
基金supported by the National Natural Science Foundation of China(82072148)Zhejiang Provincial Basic Public Welfare Research Program of Zhejiang Province(LGF21H150002)+1 种基金Zhejiang Medicine and Health Science and Technology Project(2022RC245&2023KY255)Ningbo Municipal Natural Science Foundation(2023J134).
文摘BACKGROUND:Streptococcus pneumoniae(S.pneumoniae)is a common pathogen that causes bacterial pneumonia.However,with increasing bacterial resistance,there is an urgent need to develop new drugs to treat S.pneumoniae infections.Nanodefensin with a 14-carbon saturated fatty acid(ND-C14)is a novel nanoantimicrobial peptide designed by modifying myristic acid at the C-terminus of humanα-defensin 5(HD5)via an amide bond.However,it is unclear whether ND-C14 is effective against lung infections caused by S.pneumoniae.METHODS:In vitro,three groups were established,including the control group,and the HD5 and ND-C14 treatment groups.A virtual colony-count assay was used to evaluate the antibacterial activity of HD5 and ND-C14 against S.pneumoniae.The morphological changes of S.pneumoniae treated with HD5 or ND-C14 were observed by scanning electron microscopy.In vivo,mice were divided into sham,vehicle,and ND-C14 treatment groups.Mice in the sham group were treated with 25μL of phosphate-buffered saline(PBS).Mice in the vehicle and ND-C14 treatment groups were treated with intratracheal instillation of 25μL of bacterial suspension with 2×108 CFU/mL(total bacterial count:5×10^(6) CFU),and then the mice were given 25μL PBS or intratracheally injected with 25μL of ND-C14(including 20μg or 50μg),respectively.Survival rates were evaluated in the vehicle and ND-C14 treatment groups.Bacterial burden in the blood and bronchoalveolar lavage fluid were counted.The lung histology of the mice was assessed.A propidium iodide uptake assay was used to clarify the destructive eff ect of ND-C14 against S.pneumoniae.RESULTS:Compared with HD5,ND-C14 had a better bactericidal eff ect against S.pneumoniae because of its stronger ability to destroy the membrane structure of S.pneumoniae in vitro.In vivo,ND-C14 significantly delayed the death time and improved the survival rate of mice infected with S.pneumoniae.ND-C14 reduced bacterial burden and lung tissue injury.Moreover,ND-C14 had a membrane permeation eff ect on S.pneumoniae,and its destructive ability increased with increasing ND-C14 concentration.CONCLUSION:The ND-C14 may improve bactericidal eff ects on S.pneumoniae both in vitro and in vivo.
文摘Latent tuberculosis infection(LTBI)has become a major source of active tuberculosis(ATB).Although the tuberculin skin test and interferon-gamma release assay can be used to diagnose LTBI,these methods can only differentiate infected individuals from healthy ones but cannot discriminate between LTBI and ATB.Thus,the diagnosis of LTBI faces many challenges,such as the lack of effective biomarkers from Mycobacterium tuberculosis(MTB)for distinguishing LTBI,the low diagnostic efficacy of biomarkers derived from the human host,and the absence of a gold standard to differentiate between LTBI and ATB.Sputum culture,as the gold standard for diagnosing tuberculosis,is time-consuming and cannot distinguish between ATB and LTBI.In this article,we review the pathogenesis of MTB and the immune mechanisms of the host in LTBI,including the innate and adaptive immune responses,multiple immune evasion mechanisms of MTB,and epigenetic regulation.Based on this knowledge,we summarize the current status and challenges in diagnosing LTBI and present the application of machine learning(ML)in LTBI diagnosis,as well as the advantages and limitations of ML in this context.Finally,we discuss the future development directions of ML applied to LTBI diagnosis.
文摘目的系统评价儿科体外膜肺氧合(ECMO)支持患者院内感染的流行病学特征。方法采用主题词与自由词相结合的方式,系统检索中国知网、万方医学数据库、中国生物医学文献数据库、维普数据库、Pubmed、Embase、web of science数据库,搜集关于儿科ECMO支持患者院内感染的观察性研究,检索时限均为建库到2023年12月。由2名研究者独立进行文献筛选、提取资料、评价纳入研究的偏倚风险后,使用Stata 18.0软件进行meta分析。结果共纳入16项研究,包括3353例儿科ECMO支持患者,其中发生院内感染患者712例。随机效应模型meta分析结果显示,院内感染发生率为28.55%[95%CI(22.26%,35.28%)]。病原学分布中以革兰阴性菌为主(约占68.68%),其中前3位为:鲍曼不动杆菌(26.93%)、肺炎克雷伯菌(11.90%)、铜绿假单胞菌(9.39%)。结论当前证据显示,儿科ECMO支持患者院内感染率较高,且可能受地域影响。受研究质量影响,上述结论尚待更高质量研究验证。
