Diagnosis Of Infection Research Articles

The Impact of Rapid Molecular Diagnostics for Influenza on Antibiotic Stewardship in the Emergency Department—An Observational Retrospective Study

Objective: The clinical diagnosis of respiratory tract infections (RTIs) may result in unnecessary antibiotic treatment due to clinical exams’ low sensitivity and specificity to differentiate viral from bacterial infections and costly diagnostic work-ups. Unnecessary antibiotic consumption drives antibiotic resistance. We explored whether a rapid influenza-specific polymerase chain reaction (PCR) assay reduced antibiotic use in an emergency room before the COVID-19 pandemic. Methods: We conducted an observational retrospective study of patients with RTI symptoms treated in the ER of the University Hospital Basel from September 2014 to June 2015. We evaluated the impact of rapid diagnostic results, such as an influenza-specific PCR, blood sample results, and radiological imaging, on antibiotic prescription rates. Patient-related confounding factors were included since a patient’s clinical condition affects doctors’ clinical decision-making. Results: We included 607 patients with RTIs, tested with PCR for influenza A or B. Logistic regression showed that the odds ratio (OR) of being treated with antibiotics was significantly reduced by more than two-thirds in patients with a positive influenza PCR result (OR = 0.37; 95% CI, 0.22–0.59; p < 0.001). Increasing C-reactive protein (CRP) levels by tenfold (OR = 5.14; 95% CI, 3.34–8.12; p < 0.001) or suspected chest infection on a radiograph (OR = 5.81; 95% CI, 3.23–10.89; p < 0.001) increased the OR of antibiotic treatment by fivefold. The highest OR for antibiotic prescription was due to increased procalcitonin level by tenfold (OR = 10.13; 95% CI, 4.79–23.4; p < 0.001). Conclusions: Our study provides real-world evidence from a pre-COVID-19 ER setting of diagnostic tools used for RTI evaluation and their impact on antibiotic prescriptions. Rapid influenza-specific PCR results may affect the prescription rate of antibiotics but should be seen as part of a comprehensive diagnostic approach to guide clinical decision-making.

Factors affecting decisions to use antibiotic-sparing treatment approaches in women with uncomplicated urinary tract infections: a scoping review protocol.

This scoping review will explore the evidence on factors influencing the decisions to use antibiotic-sparing treatments in women with uncomplicated urinary tract infection. Overuse and misuse of antibiotics are the main drivers of antimicrobial resistance. Antibiotic-sparing treatments, such as symptomatic treatment with analgesics and delayed prescriptions, have considerable potential to reduce antibiotic consumption, but the majority of patients still receive antibiotics without delay. The reasons for the poor implementation of these alternative approaches are unknown. A better understanding of the factors influencing treatment decisions is needed. This review will consider the experiences and attitudes of health care professionals and women, in outpatient settings in high-income countries, regarding the use of antibiotic-sparing treatments for the diagnosis or suspected diagnosis of uncomplicated urinary tract infections (ie, healthy women aged 18-64years who are not pregnant, immunosuppressed, and have no functional or structural urinary tract abnormalities). This review will follow the JBI methodology for scoping reviews. MEDLINE (Ovid), Embase, and the Cochrane Library will be searched to identify peer-reviewed articles: original research (quantitative or qualitative studies, experimental or observational), reviews, case reports, and case series. Gray literature will also be searched for. Sources in any language from 2000 to 2024 will be included. Three reviewers will screen the sources and extract data using a tool developed by the reviewers. The analysis will use counts and descriptive qualitative content analysis. The results will be presented in visual, tabular, and narrative formats. https://osf.io/t8y5e/.

Current trends and evidence on post-TEVAR aorto-pulmonary and -bronchial fistula: a narrative review.

Aorto-bronchial or aorto-pulmonary fistulas (ABPF) are a rare but life-threatening complication following thoracic endovascular aortic repair (TEVAR). This narrative review aims to provide an overview of the current trends and available evidence on ABPF following TEVAR, evaluating risk factors, diagnostic approaches, and possible preventive and therapeutic strategies. Relevant publications on post-TEVAR ABPF were selected through a literature search on PubMed. Studies providing data on post-TEVAR ABPF concerning pathogenesis, clinical presentation, diagnostic tools, surgical approaches, and outcomes were included. The literature search obtained 169 articles. After selection, 37 studies, published between 2000 and 2024, remained for analysis. The primary symptom of ABPF is typically hemoptysis, which may be recurrent or persistent. The diagnostic pathway for ABPF encompasses medical history, clinical evaluation, blood tests, sputum and blood cultures. CTA is the first-line imaging modality in suspected ABPF, while bronchoscopy is reserved for hemodynamically stable patients. Moreover, 18-fluoro-deoxyglucose positron emission tomography (PET-CT) can aid in the diagnosis of graft infection. Post-TEVAR ABPF are associated with multiple risk factors, mainly patient-specific clinical conditions (i.e. chronic inflammatory conditions, underlying mediastinal oncologic pathologies, and infectious diseases) and anatomical characteristics, mainly large aortic aneurysms, severe aortic tortuosity, and an extensive peri-aortic hematoma. Strategies to minimize the risk of ABPF formation include appropriate device oversizing, long sealing zones, limited extent of aortic coverage, selective hematoma evacuation, and strict adherence to sterility and antibiotic prophylaxis. Radical surgical interventions have shown superior outcomes compared to endovascular approaches, which may be adopted as initial step to stabilize the patient in a staged treatment. Post-TEVAR ABPF is a rare and life-threatening condition. Literature is scarce and a deeper understanding of risk factors, diagnostic pathways, and therapeutic strategies is essential for the prevention and management of ABPF secondary to TEVAR.

P0490 Diagnosis and treatement of latent tuberculosis infection in patients with chronic Inflammatory Bowel Disease candidates for anti-TNFα therapy in a tuberculosis endemic country

Abstract Background The increasing use of anti-TNFα agents in the management of IBD raises concerns about the increased risk of latent TB reactivation, justifying the need for effective screening recommendations. Our study focuses on IBD patients candidates for anti-TNF therapy aiming to determine the prevalence of latent TB infection, examine factors influencing QantiFERON® outcomes, and describe therapeutic modalities for latent TB in this population. Methods This was a descriptive retrospective study of 87 patients followed up in the gastroenterology department of the Mohammed V Military Training Hospital in Rabat for IBD who were candidates for anti-TNF alpha biotherapy between 2021 and 2024. Results The prevalence of latent tuberculosis TBL identified in patients with chronic inflammatory bowel disease candidates for anti-TNFα therapy in our study was 24.1%, detected by the Quantiferon Gold IT® test. Factors influencing the results of the test found mainly include the various risk factors for tuberculosis in our context of intermediate endemicity, and the use of immunosuppressants, which is associated with a negative test. As the intradermal tuberculin test could not be carried out in Morocco due to a stock shortage, the comparison of the performance of the two tests was not possible. Despite an initially negative Quantiferon Gold IT® test, 4 cases of active tuberculosis were recorded after initiation of anti-TNF treatment. Conclusion The IGRA Quantiferon Gold IT® test is considered a valuable tool for detecting latent tuberculosis in IBD patients who are candidates for anti-TNF treatment. However, its use and interpretation in an endemic country and in vaccinated subjects should be the subject of larger-scale studies aimed at proposing appropriate recommendations based on the risk of latent tuberculosis.

P1356 Comparison of different diagnostic test for detection of CMV colitis in hospitalized patients with ulcerative colitis: an interim analysis

Abstract Background Cytomegalovirus (CMV) colitis is a serious concern worsening the prognosis of patients with ulcerative colitis (UC) as an independent risk factor for hospitalization and surgery. European guidelines indicate that immunohistochemistry [IHC], tissue polymerase chain reaction [PCR], or possibly both, are essential for confirming active CMV colitis in IBD and should be considered as standard tests. The aim of our study is to evaluate the diagnostic performance of different tests used for diagnosis of CMV infection in comparison with the gold standard in hospitalized patients for UC flare. Methods We prospectively included consecutive UC patients hospitalized for a UC flare since March 2024. UC activity was assessed according to the Truelove&Witts score together with CMV-DNA PCR on blood, stool, tissue and IHC on colonic biopsies were all performed within 5 days from admission. Demographic data, history of medications, lab test at admission were collected for every patient. Patients were treated for UC according to guidelines; in case of CMV positivity on IHC or tissue CMV PCR > 250 cp/mg (qPCR) they received either ganciclovir or vanganciclovir if useful according to investigators. We registered clinical remission and need of surgery within 30-days from hospitalization. Results In this interim analysis we collected data on 51 patients. Of these, 70.6% were admitted with severe UC according to the Truelove&Witts score, with a median endoscopic Mayo score of 3, and 49% of the patients were steroid-refractory at hospital admission. 63% of patients achieved clinical remission 30 days after admission, whereas 37% did not show signs of response, including 4 patients who needed surgery within this time frame. In our cohort 16/51patients (31.4%) were diagnosed with CMV colitis according to IHC or qPCR > 250 cp/mg, while only 3/51 patients (5.8%) confirmed the diagnosis according to IHC criteria. Only 8 patients received antiviral treatment; in the remaining 8 cases antiviral treatment was not indicated due to lack of presumed clinical benefit. Blood positive CMV-DNA was found in 8 patients; among them 5 were confirmed with CMV colitis. Only 3 patients tested positive for stool CMV-DNA, however all of them received a subsequent confirmation of CMV colitis. Conclusion Concordance between diagnostic criteria (qPCR vs IHC criteria) was low confirming the unreliability of currently accepted diagnostic test. Preliminary data about alternative sources of CMV DNA testing looks promising and more reliable. Further data are needed to attain definite conclusions.

P0810 Anti TNF Treatment is Associated with Reduced Risk of Diabetes in Patients With Inflammatory Bowel Disease

Abstract Background Inflammatory bowel disease (IBD) is a state of excess inflammatory cytokines, including tumor necrosis α (TNF). Studies in human and animal models showed that TNF has an important role in pathophysiology of insulin resistance (1). While there is some evidence of a link between IBD and diabetes mellitus (DM) and that anti-TNF therapy is associated with better glucose levels in patients with IBD and DM (2), the potential for prevention of onset or impact of other advanced therapies has not been described. Methods We used the TriNetX global federated network to identify patients with IBD ≥18 years diagnosed with IBD between 2019 and 2024, and who were treated with advanced therapy within 2 years of that diagnosis. Patients who were diagnosed with DM prior or within 3 months of IBD diagnosis or treatment were excluded. The primary endpoint was a diagnosis of DM or a HgbA1C>6.5%. Patients were divided into two different cohorts: 1) patients treated with anti-TNF, and 2) patients treated with vedolizumab, IL23 inhibitors or JAK inhibitors, and never with anti-TNF. Patients were compared using a 1:1 propensity matching by race, gender, age, sociodemographic comorbidities, BMI, hypertension, long term use of steroids, ischemic heart disease, IBD subtype and past total or partial colectomy. A diagnosis of psoriasis was used as positive control outcome, and a diagnosis of upper respiratory tract infections (URTI) was used as negative control outcome. Results 43,372 patients with a new diagnosis of IBD were identified: 30,583 treated with anti TNF and 12,789 treated with other advanced therapies. Following propensity scored matching, 12,762 patients were in each balanced cohort. After a follow up of 3 years, patients treated with anti TNF had a 72.5% lower risk for subsequent diabetes (0.3% vs. 1.04% HR 0.275, 95% CI 0.174 -0.437, p<0.001), a higher risk of psoriasis (HR 1.35, 95% CI 1.074 - 1.694, p<0.001) but no significant difference of URTI (Figure 1). Conclusion Patients with IBD treated with anti-TNF have a significantly lower risk of developing diabetes compared to patients treated with other advanced therapies. The mechanisms and protective effect of anti-TNF therapy warrants further investigation.

Robust Diagnosis of Acute Bacterial and Viral Infections via Host Gene Expression Rank-Based Ensemble Machine Learning Algorithm: A Multi-Cohort Model Development and Validation Study.

The accurate and prompt diagnosis of infections is essential for improving patient outcomes and preventing bacterial drug resistance. Host gene expression profiling as an approach to infection diagnosis holds great potential in assisting early and accurate diagnosis of infection. To improve the precision of infection diagnosis, we developed InfectDiagno, a rank-based ensemble machine learning algorithm for infection diagnosis via host gene expression patterns. Eleven data sets were used as training data sets for the method development, and the InfectDiagno algorithm was optimized by multi-cohort training samples. Nine data sets were used as independent validation data sets for the method. We further validated the diagnostic capacity of InfectDiagno in a prospective clinical cohort. After selecting 100 feature genes based on their gene expression ranks for infection prediction, we trained a classifier using both a noninfected-vs-infected area under the receiver-operating characteristic curve (area under the curve [AUC] 0.95 [95% CI, 0.93-0.97]) and a bacterial-vs-viral AUC 0.95 (95% CI, 0.93-0.97). We then used the noninfected/infected classifier together with the bacterial/viral classifier to build a discriminating infection diagnosis model. The sensitivity was 0.931 and 0.872, and specificity 0.963 and 0.929, for bacterial and viral infections, respectively. We then applied InfectDiagno to a prospective clinical cohort (n = 517), and found it classified 95% of the samples correctly. Our study shows that the InfectDiagno algorithm is a powerful and robust tool to accurately identify infection in a real-world patient population, which has the potential to profoundly improve clinical care in the field of infection diagnosis.

Helicobacter pylori in children: modern aspects of diagnosis and treatment in the light of the latest international recommendations

Despite the development of modern medical science, the problem of Helicobacter pylori and Helicobacter pylori-associated diseases has remained relevant in recent decades. Current research is focused on studying the role of Helicobacter pylori in the etiology and pathogenesis of various diseases and the search for optimal schemes of eradication therapy. The issues of diagnosis and treatment of Helicobacter pylori infection in childhood are the most controversial at the present stage. Therefore, the purpose of our work was to review and evaluate new approaches to the diagnosis and treatment of Helicobacter pylori, which are published in the Updated joint ESPGHAN/NASPGHAN guidelines for management of Helicobacter pylori infection in children and adolescents (2023). The unsatisfactory results of classical eradication therapy schemes, growing antibiotic resistance, and the ever-changing prevalence of Helicobacter pylori infection in children are the factors that formed the basis of the decision to update the guidelines of the European and North American Societies for Paediatric Gastroenterology, Hepatology and Nutrition. The change in views and positions in line with the evidence-based medicine set out in the Maastricht VI Consensus was the basis for the revision of the recommendations for children, which were formulated and published in the Journal of Pediatric Gastroenterology and Nutrition in May 2024. The updated consensus contains recommendations that are supported by scientific evidence and those remained unchanged, including: gastric or duodenal ulcer is still a clear and unambiguous indication for Helicobacter pylori eradication, children with functional illnesses should not be screened for Helicobacter pylori. The experts also reviewed a number of provisions and made changes to the diagnosis and treatment of Helicobacter pylori, namely testing for Helicobacter pylori is not recommended when determining the causes of chronic immune thrombocytopenic purpura and in the initial examination of patients with iron deficiency anaemia and short stature; invasive testing for Helicobacter pylori in inflammatory bowel diseases, celiac disease and eosinophilic esophagitis is not indicated as well. When prescribing treatment, sensitivity to antibacterial drugs should be considered, and if it cannot be determined, regimens with clarithromycin to be avoided. The review of the updated guidelines is aimed at familiarising practitioners with the principles of quality practice at the European level and improving the efficiency of diagnosis and treatment of Helicobacter pylori in children, taking into account regional opportunities.

Racial/ethnic differences in post-acute sequelae of SARS-CoV-2 in children and adolescents in the United States

Racial/ethnic differences are associated with the symptoms and conditions of post-acute sequelae SARS-CoV-2 infection (PASC) in adults. These differences may exist among children and warrant further exploration. We conducted a retrospective cohort study with difference-in-differences analyzes to assess these differences in children and adolescents under the age of 21. The study utilized data from the RECOVER Initiative in the United States, which aims to learn about the long-term effects of COVID-19. The cohort included 225,723 patients with SARS-CoV-2 infection or COVID-19 diagnosis between March 2020 and October 2022. The study compared minority racial/ethnic groups to Non-Hispanic White (NHW) individuals, stratified by severity during the acute phase of COVID-19. Within the severe group, Asian American/Pacific Islanders (AAPI) had a higher prevalence of fever/chills and respiratory signs and symptoms, Hispanic patients showed greater hair loss prevalence in severe COVID-19 cases, while Non-Hispanic Black (NHB) patients had fewer skin symptoms in comparison to NHW patients. Within the non-severe group, AAPI patients had increased POTS/dysautonomia and respiratory symptoms, and NHB patients showed more cognitive symptoms than NHW patients. In conclusion, racial/ethnic differences related to COVID-19 exist among PASC symptoms and conditions in pediatrics, and these differences are associated with the severity of illness during acute COVID-19.

Inherited metabolic diseases are a potent risk factor for cytomegalovirus infection in pediatric living donor liver transplantation

BackgroundCytomegalovirus (CMV) is a major infectious complication in solid-organ transplant recipients, particularly in the context of pediatric liver transplantation. CMV serostatus is a well-established risk factor for postoperative CMV infection, with CMV seronegative recipients who receive organs from seropositive donors (D+/R−) being at the highest risk. Our previous research indicated a higher incidence of CMV infection in recipients with inherited metabolic diseases (IMDs) compared with those with biliary atresia (BA). This study aimed to determine whether IMDs constitute an independent risk factor for postoperative CMV infection.MethodsWe retrospectively analyzed data from 45 IMD and 230 BA recipients. We collected information on the occurrence and timing of episodes of CMV infections, methylprednisolone (mPSL) pulse therapy, patient characteristics, and peri- and postoperative data.ResultsMultivariable analysis identified mPSL pulse therapy (Odds Ratio (OR): 4.43), CMV serostatus (D+/R−) (OR: 6.03), and underlying IMDs (OR: 3.28) as independent risk factors for CMV infection. Further stratified analysis, which considered the timing of CMV infection diagnosis relative to mPSL pulse therapy, confirmed that CMV serostatus with (D+/R−) (OR: 5.61) and underlying IMDs (OR: 2.83) remained independent predictors of CMV infection, even when excluding the influence of mPSL pulse therapy.ConclusionsThis study demonstrates that IMDs are a potent independent risk factor for CMV infection following pediatric liver transplantation.Clinical trial numberNot applicable.

Performance evaluation of the LIOFeron®TB/LTBI IGRA for screening of paediatric LTBI and tuberculosis

Purpose: High-accuracy diagnostic screening tests for Mycobacterium tuberculosis (MTB) infection are required, primarily to detect patients with latent infections (LTBIs) in order to avoid their progression to active tuberculosis disease. The performance of the novel IGRA LIOFeron®TB/LTBI was evaluated in children. The originality of this test is the new MTB antigen contained (l-alanine dehydrogenase), identified as a tool to differentiate active TB from LTBI infection. Methods: From March 2022 to November 2023, a population of 90 children was enrolled and grouped into healthy, active TB or LTBI individuals, based on diagnostic guidelines. The blood of all these participants was tested with LIOFeron®TB/LTBI assay in comparison to diagnosis, as gold standard, and to the current used IGRA QuantiFERON®-TB Gold Plus. Results: The two assays demonstrated an excellent concordance of their results with patients’ diagnosis of MTB infection. The performance of LIOFeron®TB/LTBI assay in terms of accuracy of MTB infection diagnosis was high at ROC analysis (AUC = 0.997), and the test showed 100% sensitivity in LTBI detection. The QuantiFERON®-TB Gold Plus sensitivity for LTBI detection was 85.7%. Conclusions: Based on the obtained results, the LIOFeron®TB/LTBI assay appears to be a promising test for TB and LTBI screening among paediatric patients.What is known:• The detection of LTBI in children, exposed to MTB infections, followed by appropriate treatment, has a pivotal role in reducing tuberculosis burden.• IGRA tests are easy-to-use methods for helping large TB screening in paediatrics.What is new:• The LIOFeron®TB/LTBI performance evaluation showed 100% of sensitivity in the detection of LTBI patients.• The LIOFeron®TB/LTBI assay might be useful for the detection of LTBI and active tuberculosis paediatric patients.

A case of mucormycosis caused by Rhizopus microsporus in a renal transplant patient.

A 54-year-old man who had been on the kidney donor register for 32years received a kidney from a 9-year-old boy who had died of fulminant myocarditis. The post-operative course was poor, and hemodialysis was still needed after surgery. A kidney biopsy one hour after surgery showed a neutrophil-predominant inflammatory cell infiltrate localized to the peritubular capillaries (PTC) and acute tubular necrosis of the proximal tubule. Rhizopus species was detected in a perirenal white exudate taken 29days postoperatively, and the transplanted kidney was removed on postoperative day 45. The removed kidney showed fungal collection formation localized in the arteries and endotheliitis and embolization of the arteries. Renal damage caused by mucormycosis due to Rhizopus microspores was diagnosed. Mucormycosis is a fungal infection with a strong vascular affinity that develops along the vascular wall but does not extend beyond it. The infection leads to arterial infarction and organ failure. This report presents a rare case in which mucormycosis, which had been nested within the peritubular capillaries of the donor kidney, proliferated under immunosuppressive treatment but did so only in the artery, leading to infarction of the kidney. Neutrophilic collections within the PTC on one hour biopsy may be helpful in the early diagnosis of fungal infections.

Subcutaneous Infection With Snow Leopard Sign on 18F-FDG PET/CT Mimicking Subcutaneous Panniculitis-Like T-Cell Lymphoma.

A 37-year-old man presented with a 2-month history of fever of unknown origin and erythema rashes on the trunk and limbs. 18F-FDG PET/CT revealed increased 18F-FDG uptake in subcutaneous panniculitis, forming a snow leopard sign, along with enlarged lymph nodes, which suggested subcutaneous panniculitis-like T-cell lymphoma. However, skin biopsy indicated subcutaneous infection, and bone marrow biopsy revealed no abnormal lymphocytes. After anti-infection treatment, symptoms improved, leading to a final diagnosis of systemic infection. This case demonstrates how extensive subcutaneous infections on PET/CT could be misinterpreted as subcutaneous panniculitis-like T-cell lymphoma.

Clinical and radiological characteristics and 1-year self-reported outcomes from patients with encephalitis and coronavirus disease 2019

IntroductionSevere acute respiratory syndrome coronavirus infection is responsible for multisystemic disease and has high transmissibility. It culminated in a pandemic, challenging scientific knowledge and care capacity. Neurological symptoms are highly prevalent, and cases of encephalitis have been described, in both peri- and postinfectious periods. However, pathogenesis and prognosis are unclear. Thus, we aim to describe the clinical findings in cases of encephalitis in patients infected with severe acute respiratory syndrome coronavirus, together with a 1-year follow-up of self-perception of recovery and remaining neuropsychiatric symptoms.MethodsThis is a retrospective observational study in which patients with cerebrospinal fluid collection and a recent diagnosis of severe acute respiratory syndrome coronavirus infection were screened for encephalitis through analysis of medical records. We describe their clinical and paraclinical findings using descriptive statistics, together with their long-term outcome, through a self-assessment questionnaire.ResultsAmong the 135 patients screened, 11 patients were included. Most of them were admitted for neurological symptoms (73%), and in 63% of cases, those symptoms occurred within the first 7 days of systemic symptoms. Most patients had minor pulmonary involvement assessed on chest computed tomography. On cerebrospinal fluid analysis, the most relevant finding was hyperproteinorrachia. Three patients (27%) had positive changes on magnetic resonance studies. In the outcome analysis, most patients (77%) reported gait difficulties and 66% reported memory and concentration problems.ConclusionEncephalitis associated with severe acute respiratory syndrome coronavirus 2 infection is rare but responsible for chronic sequelae in cognitive and motor aspects. The pathophysiology seems to be associated with both the immune-mediated and inflammatory processes, and the low frequency of paraclinical findings demands a high clinical suspicion.

Comparative performance of microscopy, rapid diagnostic tests, and multiplex real-time PCR for detection of malaria parasites among pregnant women in northwest Ethiopia

BackgroundLow malaria parasitaemia is a diagnostic challenge in pregnancy, leading to false negative microscopy and rapid diagnostic test (RDT) results. However, these submicroscopic or subpatent infections could cause adverse pregnancy outcomes. Thus, evaluating the diagnostic performance of microscopy, RDT, and multiplex qPCR in pregnancy is vital for informed decisions.MethodsA total of 835 peripheral blood and 372 placental blood samples were collected from 835 pregnant women attending first antenatal care or admitted for delivery at selected health facilities in northwest Ethiopia between November 2021 and July 2022. In multiplex qPCR, all microscopy and/or RDT positive samples were extracted and amplified individually, whereas all samples negative by both RDT and microscopy were extracted after pooling ten samples together and tested for Plasmodium genus. The diagnostic performance of microscopy, RDT, and multiplex qPCR in pregnancy was compared and evaluated against each other.ResultsUsing multiplex qPCR as a reference test, microscopy had a sensitivity of 73.8% (95% confidence interval (CI): 65.9–80.7) and 62.2% (95% CI: 46.5–76.2) to detect Plasmodium parasites in peripheral and placental blood samples, respectively, with a 100% (95% CI: 98.9–100) specificity in both samples. Similarly, the RDT had a sensitivity of 67.6% (95% CI: 59.3–75.1) and a specificity of 96.5% (95% CI: 94.9–97.8) for Plasmodium infection diagnosis in peripheral blood and a sensitivity of 62.2% (95% CI: 46.5–76.2) and a specificity of 98.8% (95% CI: 96.9–99.7) in placental blood samples. Considering microscopy as a reference test, multiplex qPCR showed a sensitivity of 100% (95% CI: 96.6–100) and a specificity of 94.8% (95% CI: 93.0–96.3) to diagnose Plasmodium infections in both peripheral and placental blood samples. Pooled multiplex qPCR detected 34 peripheral and 12 placental blood Plasmodium infections from microscopy and RDT negative samples. The pooled assay obviated about half of the reactions and its testing costs. Microscopy showed almost perfect agreement (κ = 0.823) with multiplex qPCR for detecting malaria parasites in pregnancy, whereas the RDT showed a substantial agreement (κ = 0.684).ConclusionMultiplex qPCR had a better performance for Plasmodium infection diagnosis in pregnancy compared to microscopy and RDT. Pooled multiplex qPCR could be a sensitive and resource-efficient strategy for epidemiological surveillance of Plasmodium infections in pregnancy.

Potentials of Presepsin as a Novel Sepsis Biomarker in Critically Ill Adults: Correlation Analysis with the Current Diagnostic Markers.

Background: Sepsis is a major cause of patient death in intensive care units (ICUs). Rapid diagnosis of sepsis assists in optimizing treatments and improves outcomes. Several biomarkers are employed to aid in the diagnosis, prognostication, severity grading, and sub-type discrimination of severe septic infections (SSIs), including current diagnostic parameters, hemostatic measures, and specific organ dysfunction markers. Methods: This study involved 129 critically ill adults categorized into three groups: sepsis (Se = 48), pneumonia (Pn = 48), and Se/Pn (33). Concentrations of five plasma markers (IL-6, IL-8, TREM1, uPAR, and presepsin) were compared with 13 well-established measures of SSI in critically ill patients. These measures were heart rate (HR), white blood count (WBC), C-reactive protein (CRP), procalcitonin (PCT), lactate plasma concentrations, and measures of hemostasis status (platelets count (PLT), fibrinogen, prothrombin time (PT), activated partial thromboplastin time (APTT), international normalization ratio (INR) and D-dimer). Plasma bilirubin and creatinine served as indicators of liver and kidney dysfunction, respectively. Results: Promising roles for these biomarkers were found. The best results were for presepsin, which scored 10/13, followed by IL-6 and IL-8 (each scored 7/13), and the worst were for TREM-1 and uPAR (scored 3/13). Presepsin, IL-6, and IL-8 discriminated between the SSI sub-types, whilst only presepsin correlated with bilirubin and creatinine. uPAR was positive for kidney dysfunction, and TREM-1 was the only indicator of artificial ventilation (AV). Conclusions: Presepsin is an important potential biomarker in SSIs. However, further work is needed to define this marker's diagnostic and prognostic cutoff values.

Diagnosis and management of congenital Cytomegalovirus: Critical Appraisal of Clinical Practice Guidelines.

To review the currently available Clinical Practice Guidelines regarding the diagnosis and management of Cytomegalovirus (CMV) infection in pregnancy. Medline, Turning Research into Practice (TRIP), Web of Science databases and scientific societies' websites were searched electronically up to April 2024. We included national and international Clinical Practice Guidelines regarding diagnosis, treatment and follow-up of CMV infection in pregnancy, published in English language. Quality assessment of the included guidelines was performed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. Ten Clinical Practice Guidelines and two expert consensus statements were included. The review showed agreement among national and international guidelines about the diagnostic criteria for primary maternal CMV infection and about the gold standard for confirmation of fetal infection. Regarding treatment, only two societies recommended routine administration of Valaciclovir in case of primary infection in the clinical practing setting. Fetal surveillance including ultrasound and magnetic resonance imaging (MRI) in case of confirmed infection was found to be heterogeneous among the recommendations. Although consensus was obtained regarding the diagnostic criteria for primary CMV infection in pregnancy, there was heterogeneity among Clinical Practice Guidelines with regards to other aspects of clinical management of CMV in pregnancy. In addition, some topics where not addressed in the current guidelines, including the treatment of non-confirmed fetal infection and the management of non-primary maternal infection. Recommendations regarding prevention of congenital CMV are rapidly evolving based on the new available evidence.

Intention to use mobile phone-based TB screening among HIV patients in Debre Tabor Town public health facilities, Northwest Ethiopia: a cross-sectional study

BackgroundTo ensure fair access to TB screening, early diagnosis of TB infections, and timely starting of appropriate treatment, mobile technology tools provide convenience and feasibility for communities with limited infrastructure. This study aimed to assess the intention to use mobile-based TB screening among HIV patients in Debre Tabor Town Public health facilities, in Ethiopia.MethodA facility-based cross-sectional study was conducted among 423 HIV patients. Data was collected from May 23 to July 11, 2022, through the use of an interviewer-administered questionnaire. Epi-data 4.6 was utilized for data entry, and analysis was performed using Stata 14. Binary logistic regression analysis was employed to assess factors associated with the outcome variable. A P-value of less than 0.05 was considered statistically significant.ResultAround 70.7% of HIV patients indicated their intention to use mobile phone-based TB screening services. being employed, (AOR = 2.93; 95% CI: 1.35–6.34), experience reading received text messages (AOR = 2.81; 95% CI: 1.05–7.49), perceived usefulness (AOR = 7.29; 95% CI: 4.00 -13.31), perceived ease of use (AOR = 2.15; 95% CI: 1.17–3.95) clients having clinical follow-ups at the hospital (AOR = 3.03; 95% CI: 1.63–5.62) are significantly associated with intention to use mobile phone-based TB screening.ConclusionIn conclusion, approximately 70.7% of HIV clients intend to use mobile phone-based TB screening services, which is higher compared to previous studies. Factors such as employment status, experience reading received text messages, perceived usefulness, perceived ease of use, and having clinical follow-ups at a hospital were found to be significantly associated with the intention to use mobile phone-based TB screening. Healthcare providers, mobile health developers, and policymakers should take into account these factors when developing and deploying mobile phone-based TB screening initiatives.

Evaluating the clinical utility of Aspergillus, Mucorales, and Nocardia bronchoalveolar PCRs for the diagnosis of invasive pulmonary infections in patients with hematological malignancies.

Invasive pulmonary infections are a significant cause of morbidity and mortality in patients with hematological malignancies and hematopoietic stem cell transplantation (HCT) recipients. A delay in identifying a causative agent may result in late initiation of appropriate treatment and adverse clinical outcomes. We examine the diagnostic utility of PCR-based assays in evaluating invasive pulmonary infections from bronchoalveolar lavage (BAL). Patients with hematological malignancies and HCT recipients who underwent bronchoscopy with BAL from January 2020 to January 2024 for unexplained pulmonary infiltrates and had ≥1 PCR targeting Aspergillus, Mucorales, or Nocardia (Eurofins-Viracor, KS) were reviewed. Testing for microbiology and pathology except BAL PCRs to identify the etiology of pulmonary infiltrate was defined as standard-of-care. Invasive fungal diseases were defined as per European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium (EORTC/MSGERC) 2020 guidelines. Pulmonary nocardiosis was defined by a combination of clinical, radiographic, and microbiologic criteria. Of 134 patients, 77 were HCT recipients, and 70% were on antifungal agents. Thirty-two were diagnosed with infection with one of the three target pathogens, including 20 with probable or proven invasive pulmonary aspergillosis (IPA), seven with mucormycosis, and three with nocardiosis. For IPA, 19 were diagnosed by standard-of-care, and one (5%) was solely diagnosed by Aspergillus PCR. Mucorales PCR was positive in three of seven cases of proven mucormycosis, but the cultures were negative in all. All three nocardiosis cases were detected by PCR and culture. In our cohort, PCR targeting Mucorales and Nocardia can improve the early detection of invasive pulmonary infection, whereas Aspergillus PCR has a low added value when done in conjunction with standard-of-care, including BAL galactomannan.IMPORTANCEInvasive pulmonary infections are a significant cause of morbidity and mortality in immunocompromised patients. Timely diagnosis of invasive pulmonary infection reduces the time to targeted treatment initiation and improves clinical outcomes. The recent European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium (EORTC/MSGERC) update included the addition of serum or bronchoalveolar lavage (BAL) PCR as a method to determine probable Aspergillus disease. This reflects an increased utilization of PCR-based assays in the diagnosis of fungal diseases. Although PCR assays for Aspergillus diagnosis have been well characterized in the literature, their additive clinical utility in conjunction with BAL galactomannan index measurements remains unclear. Moreover, only a few reports characterize the analytic and clinical performance of Mucorales and Nocardia PCR.

Whole-Cell Thermal Sensor for the Detection of P. falciparum-Infected Erythrocytes: Imprinted Polymers as Synthetic Receptors for the Detection of Malaria.

Malaria is a major public healthcare concern worldwide, representing a leading cause of death in specific regions. The gold standard for diagnosis is microscopic analysis, but this requires a laboratory setting, trained staff, and infrastructure and is therefore typically slow and dependent on the experience of the technician. This study introduces, for the first time, a biomimetic sensing platform for the direct detection of the disease. The heart of the sensor consists of a synthetic receptor created by surface imprinting Plasmodium falciparum-infected erythrocytes in a polymeric matrix. This receptor layer is coupled to a low-cost and fast thermal transducer platform, allowing for real time detection of the infection. The artificial receptor is a composite of poly(dimethylsiloxane) and graphene oxide that, in combination with the thermal readout, exhibited a limit of detection below 0.5% parasitemia in erythrocyte samples. This value is relevant for the diagnosis of infection in patients with low parasitemia levels. This study proves that biomimetic sensors could be further explored for the development of point-of-care technologies for the management of the disease.