Concurrent Infection Research Articles

Contribution of Pseudomonas aeruginosa − mediated club cell necroptosis to the bias of type 17 inflammation and steroid insensitivity in asthma

IntroductionOpportunistic pathogen infection is one of the important inducements for asthma exacerbation. Pseudomonas aeruginosa (PA) is a kind of dominant pathogenic bacteria in the respiratory tract that is associated with severe asthma, but the underlying mechanisms still remains unclear. ObjectivesTo examine the role of PA infection in the bias of the inflammatory endotype in asthma and its effect on the sensitivity to steroid therapy. MethodsAn adjusted HDM (House Dust Mite) −induced asthma model with PA inoculation in the airway was utilized to mimic the process of opportunistic PA infection in asthma, focusing on the interaction between bacteria and epithelium. Dexamethasone administration in vivo was used to test the sensitivity to steroid therapy. ResultsIt was uncovered that PA could promote the loss of club cells in the necroptosis pattern through cellular CYP450 activation, leading to an imbalance of inflammatory response and steroid insensitivity. Club cell loss results in the activation of cellular E-cadherin/β-catenin axis in the rest of club cells for goblet metaplasia and mucus hypersecretion, as well as epithelial damage and GR downregulation for steroid resistance. For clinical applications, the necroptosis inhibitor Nec-1 can effectively relieve the pathological symptoms of asthma in vivo. Meanwhile, CCSP administration in the airway can regulate the pulmonary inflammation and restore the steroid sensitivity in asthma. ConclusionThese experiments provide a novel mechanism of concurrent PA infection in asthma through club cell necroptosis and the pathological consequences. Nec-1 treatment and CCSP supplementation may be possible therapeutic strategies for asthma treatment.

Hepatitis Delta Virus Testing, Prevalence, and Liver-Related Outcomes Among U.S. Veterans with Chronic Hepatitis B

Background and AimsHepatitis delta virus (HDV) infection in patients with chronic hepatitis B (CHB) is associated with worse liver-related outcomes. We aim to comprehensively evaluate HDV testing, diagnosis, and liver-related outcomes among a national cohort of U.S. Veterans with CHB. MethodsU.S. Veterans with CHB from 2010 to 2023 were evaluated to determine trends in HDV testing (anti-HDV antibody, HDV RNA) and proportion positive among those tested. HDV positive patients were 1:2 propensity score matched to CHB patients who were HDV negative to evaluate incidence (per 100,000 person-years) of cirrhosis, hepatic decompensation, or hepatocellular carcinoma using competing risks Nelson-Aalen methods for estimating cumulative hazards. ResultsAmong 27,548 CHB patients identified, 16.1% completed HDV testing, among whom 3.25% (n=144) were positive. After excluding patients with cirrhosis or HCC at baseline, 71 patients with HDV (median follow-up 5.3 years, IQR 2.5-7.6) were propensity score matched to 140 CHB patients without HDV (median follow-up 4.5 years, IQR 2.6-8.1). Compared to CHB patients without HDV, those with concurrent HDV had significantly greater incidence of cirrhosis (4.39 vs. 1.30 per 100,000 person-years, p < 0.01) and hepatic decompensation (2.18 vs. 0.41 per 100,000 person-years, p=0.01). ConclusionAmong a national cohort of U.S. Veterans with CHB, low rates of HDV testing were observed. This is concerning given that patients with concurrent HDV infection had >3 times and >5 times greater risks of cirrhosis and hepatic decompensation, respectively, compared to CHB patients without HDV, highlighting the importance of timely HDV diagnosis and treatment.

Clinical characteristics and outcome analysis of pulmonary nocardiosis in southern China: a two-center retrospective study

BackgroundPulmonary nocardiosis (PN) is a rare and opportunistic infection. This study aimed to analyze clinical, radiological, and microbiological features, treatment and outcome of PN in southern china.MethodsClinical, laboratory, imaging, treatment and outcome data of PN patients at two tertiary hospitals from January 1, 2018, to January 1, 2024 were collected. Factors associated with clinical outcomes were determined by multivariate logistic regression analysis.Results67 PN patients including 53 with clinical improvement and 14 with treatment failure were enrolled. Bronchiectasis was the most common respiratory disease in patients with PN (31.3%). The major symptoms of PN were cough (89.6%) and sputum (79.1%). Lung nodules, bronchiectasis, consolidation, pleural involvement, mass, cavity, and lymph node enlargement were the frequent computed tomography findings of PN. Among the Nocardia species detected, N. farcinica was the most common pathogen. Neutrophil-to-lymphocyte ratio (OR = 1.052, p = 0.010), concurrent bacterial infection (OR = 7.706, p = 0.016), and the use of carbapenems (OR = 9.345, p = 0.023) were independently associated with poor prognosis in patients with PN.ConclusionsThis study provides important insights into the clinical features of PN in southern china. neutrophil-to-lymphocyte ratio, concurrent bacterial infection, and the use of carbapenems were independently associated with poor prognosis in patients with PN.

Simultaneous Periprosthetic Joint Infection and Infective Endocarditis: Prevalence, Risk Factors, and Clinical Presentation

BackgroundInfective endocarditis (IE) and periprosthetic joint infections (PJI) occur due to hematogenous bacterial spread, theoretically increasing the risk for concurrent infections. There is a scarcity of literature investigating this specific association. We aimed to assess the prevalence, comorbidities, and clinical presentation of patients who have simultaneous PJI and IE. MethodsWe retrospectively identified 655 patients (321 men, 334 women; 382 total hip arthroplasty, 273 total knee arthroplasty) who developed a PJI from July 1, 2015, to December 31, 2020, at one institution. There were two groups created: patients diagnosed with PJI with IE (PJI + IE) and PJI patients who did not have IE (PJI). We analyzed clinical outcomes and comorbidities. ResultsThere were nine patients who had PJI with IE (1.4% of PJI patients). The C-reactive protein (170.9 versus 78, P = 0.026), Elixhauser comorbidity score (P = 0.002), length of hospital stay (LOS) (10.9 versus 5.7 days, P = 0.043), and the two-year post-discharge mortality rate (55.6 versus 9.0%, P = 0.0007) were significantly greater in the PJI+IE group. Comorbidities such as iron deficiency anemia (P = 0.03), coagulopathy (P = 0.02), complicated diabetes mellitus (P = 0.02), electrolyte disorders (P = 0.01), neurological disease (P = 0.004), paralysis (P = 0.04), renal failure (P = 0.0001), and valvular disease (P = 0.0008) occurred more frequently in the PJI + IE group. Modified Duke’s criteria were met for possible or definite IE in 8 of the 9 patients (88.9%). ConclusionConcurrent PJIs and IE, although rare, are a potentially devastating disease state with increased LOS and two-year mortality rates. This emphasizes the need for appropriate IE workups in patients who have a PJI. The modified Duke’s criteria is effective in establishing a diagnosis for IE in this scenario.

A double whammy of bullous pyoderma gangrenosum and deep vein thrombosis following COVID-19 infection

Bullous pyoderma gangrenosum (PG) is a rare variant presenting with hemorrhagic bulla and is usually associated with hematological malignancies. COVID-19 infection has various clinical manifestations, with one-fourth of patients developing deep vein thrombosis (DVT). There are a few reports of PG following COVID-19 infection or vaccination. We report a case of bullous PG, and skin lesions worsened due to concurrent DVT and COVID-19 infection, prolonging its healing time and physical disability.

Interaction of High- and Low-Risk Human Papillomavirus Genotypes is Associated with a Reduced Risk of Developing Cervical Cancer.

Cervical cancer is among the most common types of cancer in women and is associated with human papillomavirus (HPV) infection. The association between cervical cancer and high-risk HPV infection has been well documented. However, the effect of simultaneous infection with high- and low-risk HPV or low-risk HPV alone on the risk of developing cervical malignancy remains unanswered in guidelines. We investigated the association of high and low-risk HPVs (HR or LR) genotypes with cervical carcinoma risk and pathological and cytological information in cases recruited from a population-based cohort study of 790 patients. Correlation matrix and t-test were used for analysis. The percentage of HR+LR and HR-HPV16/18 were 9.30% and 11.20% in class II, 7.15% and 7.10% in class IV, and 7.15% and 5.80% in As-CUS smears. Interestingly, concurrent infection with HR-HPV and LR-HPV types led to a significant reduction in the risk of developing malignancy compared to the high-risk group (OR=0.3 (0.098-0.925), pvalue=0.04). The percentage of individuals with cervical malignancy was 10.2% and 28.2% within the co-infected and the HR-HPV participants. Our findings suggest that simultaneous infection with high- and low-risk HPV may reduce the risk of cervical malignancy.

Assessment of Complications and Length of Hospital Stay Associated With Surgical Emergencies in Patients With Concurrent COVID-19 Infection.

The delivery of surgical services was profoundly affected by the COVID-19 pandemic, resulting in the postponement of elective surgeries and a shift in focus to essential emergency procedures. Our study aimed to assess the impact of concurrent COVID-19 infection on complications, hospital stay, and recovery following emergency surgery. A retrospective matched cohort study was conducted between July 2020 and February 2022 at a tertiary care hospital in India. Data from 48 patients with COVID-19 infection in the immediate preoperative period was compared with 48 matched controls not infected with the virus. The data collected included patient demographics, surgical procedures, duration of hospital stay, and postoperative complications. Patients with concurrent COVID-19 infection had notably longer mean hospital stays (13.44 days) than the controls (6.63 days) (P = 0.002). An elevated proportion of COVID-19-positive patients experienced discharge delays (36 out of 48, 75%), compared to just six of the 48 non-COVID-19 patients (12.5%) (P ≤ 0.001). Postoperative findings in the COVID-positive cohort revealed elevated rates of pulmonary complications (5/48, 10.4%), higher rates of postoperative ICU admissions (8/48, 16.7%), and persistently elevated D-dimer levels extending beyond postoperative day seven (18/48, 37.5%). This suggests that emergency surgery in patients with COVID-19 is linked to significantly lengthier hospital stays, increased discharge delays, and a greater prevalence of adverse events in the postoperative period when compared to controls. These findings underscore the need for enhanced perioperative strategies and preparedness for potential future pandemics.

Clinical and laboratory characteristics of asymptomatic and symptomatic neurosyphilis in HIV-infected patients: A retrospective study in China.

There are high rates of human immunodeficiency virus (HIV) and Treponema pallidum coinfection, HIV can increase the incidence and disability rate of neurosyphilis. However, there is a lack of data about the risk factors associated with the development of symptomatic neurosyphilis (SNS). We retrospectively reviewed the medical records of inpatients with concurrent syphilis and HIV infection who underwent a lumbar puncture and completed cerebrospinal fluid (CSF) examination. Sixty inpatients were consecutively enrolled from Beijing Ditan Hospital between January 2015 and March 2023. The clinical and laboratory features were evaluated between the SNS and asymptomatic neurosyphilis (ANS) groups. All patients were male, 25% (15/60) patients were diagnosed with ANS, and 75% (45/60) patients were diagnosed with SNS. Meningovascular neurosyphilis was the most prevalent clinical form in this study. Age, CD4 cell count, highly active antiretroviral therapy use, and serum HIV viral load showed no statistically significant differences between the 2 groups. The SNS group lacked early detection of syphilis (P < .001) and did not get previous adequate therapy for syphilis (P < .001) than the ANS group, as well as a higher initial serum toluidine red unheated serum test (TRUST) titer, current serum TRUST titer, CSF white blood cell count (WBC), protein concentration, and CSF TRUST titer (P = .014, P = .042, P = .01, P = .007, and P = .007, respectively). In multivariable logistic regression, high CSF WBC count (odds ratio = 1.08; P = .032) and previous treatment of syphilis (odds ratio = 0.01; P = .049) related to the SNS. Lack of antisyphilis treatment in the early stage of syphilis and a higher CSF WBC count are related risk factors for SNS in HIV-infected patients. Meningovascular neurosyphilis should get more attention in young patients with cryptogenic stroke.

WITHDRAWN: A successful management of concurrent infection with cranial Nocardia gipuzkoensis and pulmonary Klebsiella pneumoniae: A case report

BackgroundSuccessful management of concurrent infection with cranial N. gipuzkoensis and pulmonary Klebsiella pneumoniae has never been described. Case presentationA 71-year-old female was given referral to our hospital due to intracal space occupying lesion for over 20 days. Initial chief complaints implied cranial and pulmonary inflammation. Subsequently, drainage of brain lesion was obtained and identified as Nocardia gipuzkoensis infection through microbial culture and metagenomic next-generation sequencing (mNGS). Sputum culture determined as Klebsiella pneumoniae infection. Combined with results of antimicrobial susceptibility tests and allergic history, the patient was improved after being treated with two-week Meropenem (2g/8h iv) combined Vancomycin (1g/12h iv), and reached neurological recovery followed with oral administration of Linezolid (0.6g/12h po) and Levofloxacin (0.5g/24h po) for over 6 weeks. ConclusionA successful administration of concurrent infections was reported. It might provide supporting evidence for shortening the intravenous administration of nocardiosis.

Molecular Survey of Tick-Borne Haemoparasites of Dogs by Multiplex Polymerase Chain Reaction from Punjab, India.

Tick-transmitted parasites as Babesia gibsoni, Babesia vogeli, Ehrlichia canis, and Hepatozoon canis are major health concern for dogs. Owing to prevalence and infection severity, there is need of sensitive, specific, and affordable test for their simultaneous detection. Prevalence of B. gibsoni, B. vogeli, E. canis, and H. canis infections was assessed on 719 blood samples by microscopy and multiplex PCR assay targeting 18S rRNA (B. gibsoni & H. canis), ITS1 & 5.8S rRNA (B. vogeli) and VirB9 gene (E. canis). An internal control (canine-actin) was also included to increase the accuracy of assay and effect of associated risk factors with disease prevalence was also studied. Microscopic prevalence of B. gibsoni, B. vogeli, E. canis and H. canis was 5.0%, 0.1%, 1.4% and 1.0%, respectively, whereas with multiplex PCR assay, the corresponding values were 8.9%, 1.1%, 2.6% and 5.1% besides concurrent infections of B. gibsoni & H. canis (0.4%), B. gibsoni & E. canis (0.4%), E. canis & H. canis (0.3%) and B. gibsoni & B. vogeli (0.1%). Analytical sensitivity of developed assay was 0.1pg (B. gibsoni & H. canis), 0.01pg (B. vogeli), and 1.0pg (E. canis). A ″fair″ (B. vogeli & H. canis) to ″substantial″ (B. gibsoni & E. canis) agreement between two tests was observed with data as statistically significant. Breed, sex and location were significantly associated with B. gibsoni infection. The developed multiplex PCR assay offers a potential solution to detect these pathogens simultaneously, aiding in timely diagnosis and effective disease management in suspected dogs.

Identification of concurrent infection with Jaagsiekte sheep retrovirus and maedi-visna virus in China.

Ovine pulmonary adenomatosis (OPA) and maedi-visna disease (MVD) are chronic and progressive infectious diseases in sheep caused by Jaagsiekte sheep retrovirus (JSRV) and maedi-visna virus (MVV), respectively. To investigate the pathological changes and conduct viral gene analysis of OPA and MVD co-occurrence in Inner Mongolia, China. Using gross pathology, histopathology, immunohistochemistry, ultrastructural pathology, PCR, and sequence analysis, we investigated the concurrent infection of JSRV and MVV in 319 Dorper rams slaughtered in a private slaughterhouse in Inner Mongolia, in 2022. Of the 319 rams included, 3 showed concurrent JSRV and MVV infection. Gross lung pathology showed diffuse enlargement, consolidation, and greyish-white miliary nodules on the lung surface; the trachea was filled with a white foamy fluid; hilar and mediastinal lymph nodes were significantly enlarged. Histopathology results revealed typical OPA and MVD lesions in the lung tissue. Immunohistochemical results were positive for JSRV envelope protein (Env) in the tumor cells and MVV CA in alveolar macrophages. Transmission electron microscopy showed several virions and autophagosomes in the lung tissue, severely damaged mitochondria, and the induced mitophagy. Nucleotide sequences obtained for JSRV env and MVV gag showed the highest homology with the Inner Mongolian strains of JSRV env (JQ837489) and MVV gag (MW248464). Our study confirmed that OPA and MVD co-occurrence and identified the pathological changes in Inner Mongolia, China, thereby providing references for the identification of concurrent JSRV and MVV infections.

Single-stage management of Charcot neuroarthropathy and osteomyelitis in diabetic patients

Objective: Describe our experience treating Charcot neuroarthropathy (CN) coexisting with concurrent bone infection in a single step, treated with external fixation, and report the mid-term radiographic and functional outcomes. Methods: Retrospective case series of patients diagnosed with CN and osteomyelitis treated with a single-step approach consisting of necrotic bone debridement and fusion extended over the affected joints using a circular external fixator with a minimum of 18 months of follow-up. Results: Six patients were evaluated, and three patients achieved excellent results and were able to walk outside their homes. One of them required a below-the-knee amputation due to persistent infection. Two patients had good results according to the Pinzur proposed evaluation scheme. All patients agreed that they would choose the reconstruction process for their deformity over an infrapatellar amputation. Conclusion: We believe the results from our case series apply to the previously published literature on this therapeutic modality. Level of evidence IV; Case series.

Comprehensive assessment of vaginal infections using a single swab

BackgroundThe decision to use a particular test to diagnose patients presenting with symptoms of vaginitis and/or STI is based primarily on the prevailing standards of care in the clinic at...

Dual nematode infection in Brassica nigra affects shoot metabolome and aphid survival in distinct contrast to single-species infection.

Previous studies showed that aphid performance was compromised on Brassica nigra infected by root-lesion nematodes (Pratylenchus penetrans, Pp), but less, or positively influenced by root-knot nematode (Meloidogyne spp., Mi) infection. These experiments were on single-nematode infections, while naturally, roots are infected with several nematode species simultaneously. We performed greenhouse assays to assess the effects of single (Mi, Pp) and concurrent (MP)-nematode infections on aphid performance. Using targeted and untargeted profiling of leaf and phloem metabolomes, we examined how single- and concurrent-nematode infections affect shoot metabolomes, and elucidated the possible consequences on aphid performance. We found that the metabolic response towards double-infection is different from single-species infections. Moreover, Mi- and Pp-infections triggered discrete changes in B. nigra leaf and phloem metabolic profiles. Both Pp and MP-infections reduced aphid survival, suggesting that the biological effect could primarily be dominated by Pp-induced changes. This concurred with increased indole glucosinolates and hydroxycinnamic acid levels in the leaves, in particular the putative involvement of salicylic acid-2-O-β-D-glucoside. This study provides evidence that concurrent infection by different nematode species, as is common in natural environments, is associated with distinct changes in aboveground plant metabolomes, which are linked to differences in the survival of an aboveground herbivore.

Preneutropenic Fever in Patients With Hematological Malignancies: A Novel Target for Antimicrobial Stewardship.

Many patients with hematological malignancy develop fever after chemotherapy/conditioning but before chemotherapy-induced neutropenia (preneutropenic fever [PNF]). The proportion of PNF with an infectious etiology is not well established. We conducted a single-center, prospective observational substudy of PNF (neutrophils >0.5 cells/μL, ≥38.0°C) in adults receiving acute myeloid leukemia (AML) chemotherapy, or allogeneic hematopoietic cell transplant (allo-HCT) conditioning enrolled in a neutropenic fever randomized controlled trial between 1 January and 31 October 2018. Eligible patients had anticipated neutropenia ≥10 days and exclusions included concurrent infection and/or neutropenia prior to chemotherapy or conditioning. PNF rates and infections encountered were described. Associations between noninfectious etiologies and fever were explored. Antimicrobial therapy prescription across preneutropenic and neutropenic periods was examined. Of 62 consecutive patients included (43 allo-HCT, 19 AML), 27 had PNF (44%) and 5 (19%) had an infective cause. Among allo-HCT, PNF occurred in 14 of 17 (82%) who received thymoglobulin; only 1 of 14 (7%) had infection. During AML chemotherapy, 18 of 19 received cytarabine, of which 8 of 18 (44%) had PNF and 3 of 8 (38%) had infection. Most patients with PNF had antimicrobial therapy continued into the neutropenic period (19/27 [70%]). Those with PNF were more likely to be escalated to broader antimicrobial therapy at onset/during neutropenic fever (5/24 [21%] vs 2/30 [7%]). Rates of PNF were high, and documented infection low, leading to prolonged and escalating antimicrobial therapy. In the absence of infection, early cessation of empiric therapy after PNF is recommended as an important stewardship intervention.

Reassessing the Risk of Severe Parvovirus B19 Infection in the Immunocompetent Population: A Call for Vigilance in the Wake of Resurgence.

Despite Parvovirus B19 (B19V) generally causing mild or asymptomatic infections, and only certain high-risk groups such as hematological or immunocompromised patients and pregnant women tending to develop complications, several factors challenge the assumption of a "benign" clinical course in immunocompetent adults and adolescents. A significant proportion of the population may harbor undiagnosed health conditions or genetic predispositions that could render them more susceptible to severe B19V complications. These could include mild hematological disorders, immune dysregulation not resulting in overt immunodeficiency, or underlying cardiac conditions. Concurrent infections with other pathogens, even seemingly minor ones, could synergistically increase the severity of B19V infection, leading to more pronounced clinical manifestations. While not definitively proven, the possibility of emerging B19V strains with increased virulence or altered tissue tropism cannot be entirely discounted. Additionally, the period of pandemic-related restrictions likely led to reduced B19V circulation, potentially resulting in a cohort of young adults with limited natural immunity, making them more vulnerable to infection. Potential clinical consequences include atypical and severe presentations, even in individuals without known risk factors. The traditional focus on B19V primarily as a pediatric concern might lead to underdiagnosis or delayed diagnosis in adults, potentially hindering timely intervention and management. A surge in B19V-related complications, even if individually mild, could collectively strain healthcare resources, particularly in settings with limited capacity or pre-existing pressures. Possible recommendations are to heighten clinical awareness with a high index of suspicion for B19V infection in adults and adolescents presenting with compatible symptoms, even in the absence of classic risk factors. Additionally, expanding testing criteria and enhancing public health surveillance efforts would be prudent.

Mycobacterium marseillense bloodstream infection combined with skin fungal infection: a case report and literature review

BackgroundNon-tuberculous mycobacteria (NTM) are present widely in the natural environment and can invade the human body through the respiratory tract, gastrointestinal tract, and skin. Immunocompromised patients are particularly prone to infection, which primarily affects multiple organs, including the lungs, lymph nodes, and skin. However, cases of NTM bloodstream infections are rare. Here, we report a rare case of Mycobacterium marseillense bloodstream infection with concurrent skin fungal infection in a patient after kidney transplantation. Related literature was reviewed to enhance the understanding of this rare condition.Case presentationA 58-year-old male with a history of long-term steroid and immunosuppressant use after kidney transplantation presented with limb swelling that worsened over the past two months. Physical examination revealed redness and swelling of the skin in all four limbs, with a non-healing wound on the lower left limb. Skin tissue analysis by metagenomic next-generation sequencing (mNGS) and fungal culture indicated infection with Trichophyton rubrum. Blood culture results suggested infection with Mycobacterium marseillense. After receiving anti-NTM treatment, the patient’s symptoms significantly improved, and he is currently undergoing treatment.ConclusionMycobacterium marseillense is a NTM. Gram staining suffered from misdetection, and the acid-fast staining result was positive. This bacterium was identified by mass spectrometry and mNGS analyses. Antimicrobial susceptibility tests for NTM were performed using the broth microdilution method. The results of the susceptibility test showed that Mycobacterium marseillense was sensitive to clarithromycin, an intermediary between moxifloxacin and linezolid. Bacterial clearance requires a combination of drugs and an adequate course of treatment. NTM bloodstream infections are relatively rare, and early identification and proactive intervention are key to their successful management.

Investigation of non-communicable diseases prevalence, patterns, and patient outcomes in hospitalized populations: a prospective observational study in three tertiary hospitals

BackgroundNon-communicable diseases (NCDs) pose a significant global health challenge, constituting over 80% of mortality and morbidity. This burden is particularly pronounced in low- and middle-income countries (LMICs), including Ethiopia. Despite this, there’s limited research on this issue in Africa. This study aims to investigate the prevalence, patterns, and outcomes of NCDs in hospitalized populations across three tertiary hospitals in Ethiopia.MethodsA hospital-based cohort study (August 2022 - January 2023) included patients aged 14 and older diagnosed with cardiovascular diseases (CVDs), diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), asthma, or cancer at three Ethiopian hospitals. Data on demographics, socio-economic factors, clinical characteristics, and outcomes were collected through medical records and interviews. Logistic regression identified factors independently associated with in-hospital mortality, with p ≤ 0.05 considered statistically significant.ResultsIn the study across three tertiary hospitals involving 2,237 patients, we uncovered the impact of NCDs. About 23.4% of patients struggled with NCDs, with cardiovascular diseases (53.3%), cancer (29.6%), diabetes (6.1%), and respiratory diseases (6.5%) being the most prevalent. Notably, among those affected, women comprised a slight majority (55.1%), with the average patient age being 47.2 years. Unfortunately, 15.3% of patients with NCDs faced in-hospital mortality. Our analysis revealed predictors of mortality, including cancer diagnosis (adjusted odds ratio [AOR]:1.6, 95% CI: 1.2–1.8, p = 0.01), medication adherence ( AOR: 0.36, 95% CI: 0.21–0.64, p < 0.001), concurrent infections (AOR: 0.36, 95% CI: 0.16–0.86, p < 0.001), chronic kidney diseases (CKD) (AOR: 0.35, 95% CI: 0.14–0.85, p = 0.02), and complications during hospitalization (AOR: 6.36, 95% CI: 3.45–11.71, p < 0.001).ConclusionOur study reveals a substantial prevalence of NCDs among hospitalized patients, affecting approximately one in four individuals, primarily with CVDs and cancer. Alarmingly, a significant proportion of these patients did not survive their hospitalization, emphasizing the urgent need for targeted interventions to enhance outcomes in this population.

A challenging coexistence: community-acquired methicillin-resistant Staphylococcus aureus and Mycobacterium tuberculosis

BackgroundCommunity-acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) usually emerges after a viral infection and causes severe disease in immunocompetent individuals. Concurrent infection with tuberculosis (TB) is generally very rare in immunocompetent patients. Our case is the first report of the coexistence of CA-MRSA and TB in an immunocompetent patient.Case presentationA 24-year-old male patient of African origin, who has been living in Turkey for a year, was admitted to our hospital 3 months ago with fever, cough, and sputum complaints, which developed following symptoms of influenza infection. More intense bilateral infiltration and cavitary appearance were observed on the left in the chest radiography of the patient who did not respond to amoxicillin and gemifloxacin treatments. The patient’s sputum culture showed MRSA growth, and his sputum acid-resistant bacteria (ARB) was reported as three positive. Vancomycin, isoniazid, rifampicin, pyrazinamide, and ethambutol treatments were started. Subsequently, Mycobacterium Tuberculosis growth was also detected in the mycobacteria culture. Vancomycin treatment was completed in 14 days. There was no growth in the control sputum culture. When the patient, who gave clinical and laboratory response, was admitted with increased shortness of breath complaint two months after discharge, it was observed that minimal spontaneous pneumothorax developed in the left lung, and it was decided to follow up without intervention. In the second month of tuberculosis treatment, sputum ARB and mycobacteria culture became negative, and the patient was switched to dual antituberculosis treatment (isoniazid, rifampicin), and his treatment is still ongoing.ConclusionsMixed infections should be considered in case of non-response to treatment in patients with pneumonia. Mixed infections should also be followed closely as they may be more complicated.

Concurrent Ascaris infection modulates host immunity resulting in impaired control of Salmonella infection in pigs.

Ascaris is one of the most widespread helminth infections, leading to chronic morbidity in humans and considerable economic losses in pig farming. In addition, pigs are an important reservoir for the zoonotic salmonellosis, where pigs can serve as asymptomatic carriers. Here, we investigated the impact of an ongoing Ascaris infection on the immune response to Salmonella in pigs. We observed higher bacterial burdens in experimentally coinfected pigs compared to pigs infected with Salmonella alone. The impaired control of Salmonella in the coinfected pigs was associated with repressed interferon gamma responses in the small intestine and with the alternative activation of gut macrophages evident in elevated CD206 expression. Ascaris single and coinfection were associated with a rise of CD4-CD8α+FoxP3+ Treg in the lymph nodes draining the small intestine and liver. In addition, macrophages from coinfected pigs showed enhanced susceptibility to Salmonella infection in vitro and the Salmonella-induced monocytosis and tumor necrosis factor alpha production by myeloid cells was repressed in pigs coinfected with Ascaris. Hence, our data indicate that acute Ascaris infection modulates different immune effector functions with important consequences for the control of tissue-invasive coinfecting pathogens.IMPORTANCEIn experimentally infected pigs, we show that an ongoing infection with the parasitic worm Ascaris suum modulates host immunity, and coinfected pigs have higher Salmonella burdens compared to pigs infected with Salmonella alone. Both infections are widespread in pig production and the prevalence of Salmonella is high in endemic regions of human Ascariasis, indicating that this is a clinically meaningful coinfection. We observed the type 2/regulatory immune response to be induced during an Ascaris infection correlates with increased susceptibility of pigs to the concurrent bacterial infection.