Incidence Of Chronic Infection Research Articles

Experience of the Center for cystic fibrosis in the Omsk Region

Cystic fibrosis is an autosomal recessive disease caused by pathogenic variants in the nucleotide sequence of the cystic fibrosis transmembrane conductance regulator (CFTR) gene. As the disease affects multiple organs, an integrated approach to the treatment is essential. The most effective model of providing medical care to patients with cystic fibrosis is the organization of specialized centers.Aim. To assess the effectiveness of specialized medical care for patients with cystic fibrosis in the Children’s Center for Cystic Fibrosis from 2011 to 2023.Methods. A comparative analysis of the Center’s activities was carried out using the National Register of Cystic Fibrosis Patients for 2011 and the medical records of patients registered for follow-up in 2023.Results. The average age of the children followed at the Center increased from 7.1 to 10.4 years (Mann – Whitney; p = 0.004). In 2023, cystic fibrosis was diagnosed primarily through newborn screening (Fisher; p = 0.000). The most common clinical picture was the mixed form of cystic fibrosis. 100% of pathological alleles were identified, the frequency of the F508del allele was 57.8 – 58.9%. A predominance of “severe” genotypes was noted. The incidence of chronic infection with P. aeruginosa decreased significantly (Fisher; p = 0.002) due to the optimization of antibacterial treatment regimens, strict adherence to the sanitary and epidemiological regulations, and the use of hospitalreplacement technologies. CFTR modulators have been used in patient care since 2021. The greatest clinical efficacy was observed with the use of elexacaftor/tezacaftor/ivacaftor + ivacaftor. By the 180th day of use in children, forced expiratory volume in 1 second improved from 63.3% to 84.2% (Wilcoxon; p = 0.001), and sweat chlorides decreased by 33 mmol/l (Wilcoxon; p = 0.0001). The results of the Center’s work in 2011 – 2023 are a consequence of improved approaches to specialized medical care for cystic fibrosis.Conclusion. The creation of a multidisciplinary team for the treatment of patients with cystic fibrosis can significantly increase the level of care and improve the quality of life of patients.

Pathogenesis, Immunology and Management of Dermatophytosis.

Dermatophytic infections of the skin and appendages are a common occurrence. The pathogenesis involves complex interplay of agent (dermatophytes), host (inherent host defense and host immune response) and the environment. Infection management has become an important public health issue, due to increased incidence of recurrent, recalcitrant or extensive infections. Recent years have seen a significant rise in incidence of chronic infections which have been difficult to treat. In this review, we review the literature on management of dermatophytoses and bridge the gap in therapeutic recommendations.

A longitudinal study of lung bacterial pathogens in patients with primary ciliary dyskinesia

In patients with primary ciliary dyskinesia (PCD), impaired mucociliary clearance leads to an accumulation of secretions in the airways and susceptibility to repeated bacterial infections. The primary aim of this study was to investigate the bacterial flora in non-chronic and chronic infections in the lower airways of patients with PCD. We retrospectively reviewed the presence of bacteria from patients with PCD during an 11-year period and genotyped 35 Pseudomonas aeruginosa isolates from 12 patients with chronic infection using pulsed-field gel electrophoresis. We identified 5450 evaluable cultures from 107 patients with PCD (median age 17 years, range 0–74 years) (median age at diagnosis 7.8 years, range 0–63 years). Haemophilus influenzae was the most frequent microorganism. Other common pathogens were P. aeruginosa, Streptococcus pneumoniae, Moraxella catarrhalis and Staphylococcus aureus. The number of patients colonized with P. aeruginosa at least once varied from 11 to 44 patients (15–47%) annually, and 42 patients (39%) met the criteria for chronic infection at least once. Pseudomonas aeruginosa was more frequently isolated in teenagers and adults than children (p 0.02) and the prevalence was significantly lower in patients with preschool (<6 years) PCD diagnosis (p 0.04). Ten out of 12 patients (83%) were chronically infected with a unique clone-type of P. aeruginosa. No sharing of clone-types or patient-to-patient transmission was observed. In conclusion, PCD patients were infected by a unique set of bacteria acquired in an age-dependent sequence. Pseudomonas aeruginosa frequently colonizes the lower respiratory tract and the incidence of chronic infection was higher than previously reported.

Hepatitis C virus-induced hepatocellular carcinoma in sub-Saharan Africa

In sub-Saharan Africa, as in other geographical regions, the incidence and, to a lesser extent, the characteristics of hepatitis C virus (HCV)-induced hepatocellular carcinoma differ from those of the tumor caused by hepatitis B virus. HCV is a less common and less well-documented cause of hepatocellular carcinoma in the African subcontinent than it is in resource-rich regions. Perhaps surprisingly, sub-Saharan Black Africans have the highest estimated regional prevalence of chronic HCV infection globally. The infection is more common in urban than in rural dwellers. Little information is available on the age at which HCV infection is acquired in sub-Saharan Black Africans, but the incidence of chronic infection is age-related, being highest (12%) in those over the age of 40 years. No significant difference in sex distribution is evident. The documented incidence of chronic HCV infection in Black patients with hepatocellular carcinoma in the sub-continent ranges from 1.7% in the Central African Republic to 40.3% in Somalia, but varies between 10 and 20% in the majority of the countries. Patients with hepatocellular carcinoma are, on average, 20 years older than those with hepatitis B virusinduced tumors. The sex difference between the patients just fails to reach statistical significance. As with hepatocellular carcinoma in other populations, much remains to be learnt about the mechanisms involved in the pathogenesis of HCV-induced hepatocellular carcinoma in sub-Saharan Black Africans.

Características de los pacientes con infección crónica por el virus de la hepatitis B. Análisis de una serie de 474 pacientes

ObjectiveTo determine the clinical, laboratory, serological and histologic characteristics of chronic hepatitis B virus carriers in our environment. Material and methodsA retrospective cohort study was performed that included chronic AgHBs carriers aged more than 13 years attending our service since January 2000. ResultsA total of 474 patients were included. At diagnosis, 55.49% were men, with a mean age of 41.05±13.93 years. Alanine aminotransferase (ALT) levels were within the normal range in 57.17% of the patients, and 87.76% were AgHBe(−). Hepatitis C and D virus coinfection was found in 3.62% and 1.86%, respectively. Liver biopsy was performed in 31.22%; varying grades of inflammation-fibrosis were found in 63.51% and cirrhosis was found in 12.84%. Compared with AgHBe(−) patients, those who were AgHBe(+) were younger and had greater disease activity. This difference was statistically significant. Patients in the immunotolerant phase were the least numerous (5.26%), while AgHBe(−) patients with chronic HBV infection were the most numerous (48.32%). Patients in the immunoreactive phase showed greater histological involvement (16.67% cirrhosis). A familial history of chronic HBV was found in 21.52%. The percentage of non-Spanish patients increased in the last few years and accounted for 18.78%. ConclusionChronic HBV infection in our environment occurs mainly in middle-aged persons. GPT values are normal in more than 50%, most are AgHBe(−), and approximately half are inactive carriers. The incidence of chronic infection has increased in the non-Spanish population in recent years.

Acute Hematogenous Osteomyelitis in Children

We reviewed the cases of 60 children with acute osteomyelitis with an average follow-up of 34 months. All patients were treated initially with high-dose intravenous (i.v.) antibiotics. Eight patients did not respond to this treatment within 48 h and had surgical drainage. The remaining 52 patients were divided into two subgroups: (a) 35 patients received i.v. antibiotics for an average of 21 days; (b) 17 patients received i.v. antibiotics for an average of 8 days followed by 4 weeks of oral therapy with monitoring of serum bactericidal levels. The incidence of chronic infection (12% for the operatively treated group and 4% for the nonoperatively treated group) depended more on the time interval between the presentation of symptoms and the onset of treatment than it did on the route of antibiotic administration.

Use of a new chemically modified intravenous IgG preparation in severe primary humoral immunodeficiency: Clinical efficacy and attempts to individualize dosage

Sixteen patients with severe primary humoral immunodeficiency diseases were treated intravenously for 12 months with a β-propiolactone stabilized preparation of IgG (Intraglobin) as part of a phase II study of safety and efficacy. In order to evaluate the metabolism of IgG in these patients and to determine whether increased doses of IgG would lead to a decrease in the rate of infections, the study was divided into two periods. All patients were infused with a standard dose of 100 mg/kg/month for 6 months and the peak and trough serum IgG concentrations were determined. The half-life of the IgG was determined in each patient after the fourth month and this value was used to calculate the dose necessary to raise the trough serum IgG concentration to a minimum of 200 mg/dl. The patients received this individualized dose in the final 6 months and the half-life determination was repeated at the conclusion of the study. Only 3 of 10 patients who received a higher dose in the second period had a substantial increase in trough serum IgG concentrations, but the failure to achieve higher concentrations was not due to a shortening of the half-life. The Intraglobin was well tolerated with no patient unable to complete the study due to side-effects. Ten percent of the infusions were associated with minor, self-limited reactions, with 16 of the 19 reactions occurring in the first 6 months. There were no life-threatening infections during the 12-month period. A total of 105 episodes of infections were recorded, but only a cummulative total of 51 days of normal school or work activity were lost by the 16 patients during the 12 months of the trial period. Most infectious episodes were due to chronic bronchitis, sinusitis, and otitis. There was no reduction in the number of infections in the second, higher dose period of the study; however, as there was little increase in serum IgG concentration, more data are required before it will be possible to determine if the incidence of chronic infections can be reduced by a further increase in the serum IgG concentration.