Significant Risk Factor For Infection Research Articles

P0227 Uncontrolled clinical activity and anti-TNF plus thiopurine combination therapy are predictive factors of 1-year infection risk following acute severe ulcerative colitis: AOCC and ANZIBDC collaboration study

Abstract Background Information on infectious complications following acute severe ulcerative colitis (ASUC) is limited. The aim of this study was to determine rates of infections following ASUC treatment and the associated risk factors, using data from the Asian Organization for Crohn’s and Colitis (AOCC) and the Australia New Zealand IBD Consortium (ANZIBDC). Methods We collected medical records of patients diagnosed with ASUC according to Truelove and Witts criteria from January 2015 to December 2022 across the AOCC and ANZIBDC. We analyzed the incidence, prognosis, and associated risk factors for infection within one year after treatment and discharge for ASUC. Results A total of 676 ASUC patients (mean age 37±17.08, male 379, 56%) were enrolled, with 329 from AOCC (China, Japan, Korea, Taiwan) and 347 from ANZIBDC. Infections occurring within 1 year following ASUC treatment were identified in 65 patients (9.6%), with no difference between the AOCC and ANZIBDC groups. The most common infections included Clostridioides difficile (C. diff) infection (17/65, 26%), CMV colitis (14/65, 21%), and pneumonia (7/65, 10%). The infection group experienced a poorer prognosis, including a higher overall readmission rage (39.3% vs. 92.2%, P < 0.001) and UC-related readmission rate (16.3% vs. 31.3%, P = 0.004), as well as increased mortality during the 1-year follow-up period (1.1% vs. 13.8%, P < 0.001) compared with the non-infection group. Infections occurred more frequently in patients with clinical activity than in those with clinical remission following ASUC treatment (17.2% vs. 6.9%, P < 0.001). In an analysis adjusted for age, gender, and region (AOCC vs. ANZIBDC), significant risk factors for infection after ASUC included combination therapy with an anti-TNF agent and thiopurine at discharge (adjusted hazard ratio [aHR] 3.714, 95% confidence interval [CI] 1.122–8.979, P = 0.03) and clinical activity during the follow-up period (aHR 3.080, 95% CI 1.690–5.614, P < 0.001). Conclusion Infections were common within 1 year following ASUC treatment and associated with high readmission rates and increased risk of mortality. Combination therapy with an anti-TNF agent plus thiopurine at discharge and persistent disease activity were significant risk factors for the development of infection following ASUC treatment. These findings highlight the need for vigilant infection monitoring and inflammation control to improve ASUC outcomes.

Exploring How Adipose Tissue, Obesity, and Gender Influence the Immune Response to Vaccines: A Comprehensive Narrative Review.

Vaccines represent an essential tool for the prevention of infectious diseases. Upon administration, a complex interaction occurs between the vaccine formulation and the recipient's immune system, ultimately resulting in protection against disease. Significant variability exists in individual and population responses to vaccination, and these differences remain the focus of the ongoing research. Notably, well-documented factors, such as age, gender, and genetic predisposition, influence immune responses. In contrast, the effects of overweight and obesity have not been as thoroughly investigated. The evidence indicates that a high body mass index (BMI) constitutes a significant risk factor for infections in general, with adipose tissue playing a crucial role in modulating the immune response. Furthermore, suboptimal levels of vaccine seroconversion have been observed among individuals with obesity. This review provides a plausible examination of the immunity and protection conferred by various vaccines in individuals with an overweight status, offering a comprehensive analysis of the mechanisms to enhance vaccination efficiency.

Incidence and Risk of Infections in Patients With Radiographic Axial Spondyloarthritis Receiving Biologic Therapies: A Prospective Observational Study Using the KOBIO Registry.

This study aimed to assess the occurrence of infection and risk factors among patients with radiographic axial spondyloarthritis (r-axSpA) treated with biologics in a real-world setting. This prospective observational cohort study included patients with r-axSpA from the Korean College of Rheumatology Biologics (KOBIO) registry who initiated or switched to a biologic agent between December 2012 and December 2023. The primary outcome was the first occurrence of any infection, ranging from mild to severe, classified by organ system. The infection rates per 1000 person-years (PY), with 95% CI, were calculated using the Poisson distribution method. Cox proportional hazard regression models-adjusted for confounders-estimated hazard ratios for infection risk, considering only the first infection event. This analysis included 2129 patients with a total of 7107.67 PY of follow-up. The predominant infections observed were of the upper and lower respiratory tract (25.89/1000 PY), followed by herpes zoster (HZ; 6.13/1000 PY). Multivariate Cox regression analysis revealed significant risk factors for infection, including advanced age, ischemic heart disease (IHD), diabetes mellitus (DM) with complications, chronic kidney disease (CKD), and peripheral arthritis. In contrast, male sex was identified as a protective factor against the development of infections. The infection rate was 39.39 events/1000 PY, with respiratory tract infections being most common, followed by HZ. Significant risk factors for the occurrence of infection in patients with r-axSpA treated with biologics included advanced age, female sex, IHD, DM with complications, CKD, and peripheral arthritis. These findings emphasize infection risk assessment, particularly in high-risk patients, to optimize the safety of biologic therapy in r-axSpA.

Prevalence of gastrointestinal and blood parasites in horses of Nakhon Si Thammarat province, Thailand.

The global prevalence of gastrointestinal (GI) and blood parasite infections in horses is a significant concern due to their substantial impact on morbidity, mortality, and economic losses in the horse industry. In Thailand, limited research has been conducted on these parasites in horse populations, and data from southern Thailand are lacking. Consequently, this study aimed to estimate the prevalence of GI and blood parasites in horses in Nakhon Si Thammarat province, Thailand. In total, 79 fecal and blood samples were collected from horses across 11 farms in Nakhon Si Thammarat province. The fecal examination was conducted using simple flotation, formalin-ethyl acetate sedimentation, and a modified McMaster technique. Conventional polymerase chain reaction (PCR) was used to identify blood and strongyle parasites. The influence of sex, age, and body condition score on the prevalence of GI parasites was also analyzed. Six GI parasites were detected: four nematodes (Oxyuris equi, Parascaris equorum, strongyles, and Strongyloides westeri), one trematode (Gastrodiscus aegyptiacus), and one protozoan (Eimeria leuckarti). The overall prevalence of GI parasites was 74.7%, with single strongyle infections accounting for the highest proportion at 50.6%, followed by co-infections of strongyles and G. aegyptiacus at 10.1%. All 11 pooled strongyle samples were positive for cyathostomins and Strongylus vulgaris using conventional PCR with specific primers. Sex was significantly associated with the overall prevalence of GI parasites, whereas both sex and age were significant risk factors for infection by strongyle parasites. Theileria equi was the only blood parasite species detected in the surveyed horses, with a prevalence of 1.3% (n = 1/79). This study is the first to estimate the prevalence of GI and blood parasites in horses from Nakhon Si Thammarat province, Thailand. These findings highlight the importance of implementing control measures against GI parasites and are pivotal for developing effective infection prevention strategies.

Infection following mini-open rotator cuff repair: a single surgeon experience

Surgical technique has been shown to influence risk of surgical site infection following rotator cuff repair (RCR). Few studies have reported the rate of infection associated with mini-open RCR. The goal of this study was to report the postoperative infection rate and risk factors for infection among patients undergoing RCR performed by a single surgeon using a modified mini-open technique. Our hypothesis was that the rate of infection after mini-open RCR would be lower than previously reported for this surgical approach. We retrospectively reviewed an institutional shoulder surgery database to identify patients who underwent mini-open RCR performed by 1 surgeon at an academic tertiary care institution between 2003 and 2020. Patient records were reviewed to determine which individuals returned within 3months postoperatively with a superficial or deep surgical site infection requiring operative management. Patient demographics, preoperative clinical characteristics, intraoperative variables, microbiological findings, infection management, and clinical course after infection were recorded. Backward elimination multivariate regression was used to assess for significant risk factors for infection. Of the 925 patients identified, 823 (89%) had at least 3months of follow-up and were included for further analysis. A majority of the patients undergoing RCR were men (57%). The mean age was 58.4±9.9years, and the mean body mass index was 29.3±5.9kg/m2. Fourteen cases (1.7%) of postoperative surgical site infection were identified in 13 patients. Ten infections (1.2%) were superficial and 4 (0.49%) were deep. The most commonly identified organisms were Staphylococcus aureus and Cutibacterium acnes. Male sex (odds ratio [OR] 4.3, 95% CI 1.2-15.3) and diabetes mellitus (OR 3.9, 95% CI 1.2-12.6) were found to be associated with greater odds of infection. The RCR construct was found to be intact in all 10 patients with superficial infections and 2 of the 4 patients with deep infections. All infections were successfully treated with 1 round of surgical débridement and wound irrigation, and with 6 or fewer weeks of intravenous antibiotic therapy. All patients with postoperative infections recovered with no sequelae at a median final follow-up of 63.5months (range, 3-215months). This single-surgeon series of a large patient cohort undergoing mini-open RCR over an 18-year period demonstrated a low overall infection rate of 1.7%. Only 4 infections were deep, which suggests that deep infection after mini-open RCR is uncommon and approximates infection rates seen with arthroscopic techniques.

Depression as a Prognostic Factor in Lower Extremity Amputation for Diabetic Foot: Insights From a Prospective Study on Wound Healing, Infections, and Early Mortality

This study addresses the challenges faced by diabetic patients undergoing lower extremity amputation due to diabetic foot, particularly focusing on the implications for wound healing and early mortality. The wounds at the amputation stump may necessitate multiple surgical interventions. The aim is to identify prognostic factors associated with these outcomes, shedding light on the complexities surrounding the postamputation phase. A prospective study was conducted on 39 diabetic patients who underwent lower extremity amputation due to diabetic foot between 2021 and 2022. Comprehensive preoperative data, encompassing parameters such as blood count, erythrocyte sedimentation rate, C-reactive protein, procalcitonin, hemoglobin A1c, albumin, protein, transferrin, ferritin levels, age, gender, body mass index, smoking habits, dialysis, revascularization, duration of surgery, and the use of tourniquet during the procedure were meticulously recorded. Additionally, cognitive performance and depression status were assessed preoperatively using the Mini-Mental State Examination (MMSE) and Beck Depression Inventory (BDI), respectively. A follow-up period of 3 months postsurgery allowed for the comparison of patients who developed infections at the amputation stump with those who did not, as well as the distinction between patients who survived and those who succumbed to mortality. The study revealed that the use of a tourniquet during surgery significantly increased the risk of infection (p = .027), and higher BDI scores were associated with increased risks of both infection (AUC = 0.814) and mortality (AUC = 0.769), with cut-off scores of 24.0 and 23.5 predicting these outcomes with high sensitivity and specificity, respectively. Additionally, lower MMSE scores were associated with increased short-term postoperative mortality. There were no statistically significant differences between the groups in parameters such as complete blood count, ESR, CRP, procalcitonin, HbA1c, albumin, total protein, transferrin, ferritin levels, age, gender, BMI, smoking, dialysis, revascularization, and surgery duration. This investigation highlights the significance of considering tourniquet usage during amputation, preoperative depression status, and cognitive function in patients who undergo amputation due to diabetic foot. The use of a tourniquet during surgery is a significant risk factor for infection, and elevated BDI scores are strong predictors of both infection and mortality in patients undergoing amputations. The findings underscore the importance of a multidisciplinary neuropsychiatric evaluation preoperatively to enhance patient care and outcomes.

Gastric bezoars secondary to mixed infection with Sarcina ventriculi and G + bacilli: a case report

Sarcina ventriculi is a bacterium with a specific histological morphology and infection can present with symptoms such as abdominal pain, nausea, vomiting and occasionally fatal complications. Delayed gastric emptying is regarded as the most significant risk factor for infection. Its pathogenicity is currently unknown and treatment options are inconsistent. Here we report a case of gastric bezoars secondary to a mixed infection of Sarcina ventriculi and G + bacilli, which is diagnosed by a pathological biopsy.

Efficacy and Postoperative Infection following Super Mini Percutaneous Nephrolithotomy vs Flexible Ureteroscopy for Diabetic Nephrolithiasis: A Comparative Analysis and Risk Factors for Postoperative Infectious Complications.

Objective: To compare the efficacy and postoperative infection rate of super mini percutaneous nephrolithotomy (SMP) and flexible ureteroscopic lithotripsy (FURL) in patients with diabetic nephrolithiasis and to explore the risk factors associated with postoperative infection following these two procedures. Methods: The medical history and surgery details of 252 patients with diabetic nephrolithiasis who underwent lithotripsy in our hospital between January 2018 and May 2023, including 144 SMP and 108 FURL, were reviewed and compared. Perioperative outcomes were compared between the two groups. Logistic regression was performed to identify the significant risk factors for infection after each procedure. Results: SMP achieved a higher stone-free rate (SFR) on postoperative day 1 and postoperative day 30 compared with FURL (p < 0.05). The mean operative time was shorter in SMP (p < 0.01). FURL was associated with less hemoglobin drop (p < 0.01) and shorter length of stay (p < 0.01). The incident rate of systemic inflammatory response syndrome (SIRS) was higher after SMP (p = 0.019), while the incident rate of urinary tract infection (UTI) was higher after FURL (p = 0.021). Overall postoperative infection and sepsis rates were similar between the two procedures. Logistic regression analysis revealed that gender odds ratio [OR]: 0.225, 95% confidence interval [CI]: 0.079-0.639), HbA1c (OR: 3.516, 95% CI: 1.841-6.716), and operation time (OR: 1.037, 95% CI: 1.008-1.066) were independent risk factors for infection after FURL, while operation time (OR: 1.063, 95% CI: 1.022-1.106) and HbA1c (OR: 7.443, 95% CI: 2.956-18.742) significantly predicted SMP-associated infections. Conclusion: In diabetic patients, SMP demonstrated higher SFR and shorter operation time, whereas FURL was associated with less bleeding and shorter hospitalization. SMP had a higher incident rate of SIRS and FURL had a higher incident rate of UTI. Elevated HbA1c and prolonged operative duration increased infection risk after both procedures, while female gender was an additional risk factor for FURL-related infections.

Prevalence, Risk Factors, and Impact of Bacterial or Fungal Infections in Acute Liver Failure Patients from India.

We evaluated the prevalence, risk factors, and impact of bacterial/fungal infections in acute liver failure (ALF) patients. We analyzed clinical, biochemical, and microbiological data of ALF patients with and without bacterial/fungal infections admitted at an institute over the last 5 years. We enrolled 143 patients, 50% males, median age 25years, with acute viral hepatitis (32.2%), drug-induced injury (18.2%), and tropical illness (14%) as aetiologies of ALF. 110 patients (76.9%) developed bacterial/fungal infections [Bacterial infection: MDR: 70%, PDR: 7%, ESBL: 40%, CRE: 30%, CRAB: 26.6%, MDR-EF: 13.3% and fungal infection: 19 (17.3%)]. On univariable analysis, SIRS (33.6% vs.3%), ICU admission (78.2% vs. 45.5%), mechanical ventilation (88.2% vs. 51.5%), inotropes (39.1% vs. 6.1%), invasive catheters (91.8% vs. 39.4%), and prolonged catheterization (6days vs. 0days) were significant risk factors for infections (p < 0.05, each). In contrast, SIRS and catheterization independently predicted infection on multivariable regression. Organ failures [3 (2-4) vs. 1 (0-2)], grade-III-IV HE (67.3% vs. 33.3%), circulatory failure (39.1% vs. 6.1%), coagulopathy (INR > 2.5: 58.2% vs. 33.3%), renal injury (28.2% vs. 6.1%) (p < 0.05), MELD (32.9 ± 8.2 vs. 26.7 ± 8.3) and CPIS [3(2-4) vs. 2(0-2)] were higher in infected vs. non-infected patients (p < 0.001). 30-day survival was significantly lower in infected vs. non-infected patients (17.3% vs. 75.8%, p < 0.001), while no patient survived with fungal infections. Refractory septic shock was the commonest cause of mortality in patients. Infections due to MDR organisms are high, fungal infections are fatal, and refractory septic shock is the dominant reason for mortality, implying bacterial and fungal infections as the major killer in ALF patients.

The Incidence of and Risk Factors for Breast Infections After Tissue Expander Placement

Abstract Goals/Purpose Breast tissue expansion has a reported infection rate ranging from 2.4-25% in the literature when used for post mastectomy breast reconstruction. Expander infections may prolong the reconstructive timeframe, increase costs, portend poorer aesthetic outcomes, and decrease patient satisfaction. Medical treatments are often attempted to salvage implants prior to surgical treatment including irrigation, implant replacement, or explantation. The purposes of this study include 1) to ascertain the incidence of breast infections in patients with breast tissue expanders at our institution, 2) explore the success of medical treatments in precluding explantation, 3) identify modifiable risk factors associated with any post-expander breast infection, and 4) identify modifiable risk factors associated with post-expander breast infections requiring subsequent explantation. Methods/Technique A single-center, single-surgeon, 4-year retrospective review was performed. Patient demographics, medical comorbidities, and surgical techniques were extracted. Clinical infection was defined by clinical evidence of cellulitis or abscess in a breast with a tissue expander present, regardless of the presence or absence of systemic symptoms. Preservation of the tissue expander following treatment of clinical infection with either antibiotics or surgical intervention was considered salvage, whereas removal of the expander with pocket closure was considered explantation. The incidence of infection and explantation were calculated separately. Chi-squared analysis was used to identify risk factors for both infection and explantation separately. A generalized estimated equations model was used to account for patients who had one infected breast and how that might affect the risk of infection in the other breast or in either breast following future implant or expander placement. It was also used to identify odds ratios for infection and explantation related to the risk factors identified previously. Results/Complications A total of 349 breasts with tissue expanders in 163 patients were included in the study cohort. There was a 17.1% incidence of infection in the cohort and a 12.9% incidence of explantation secondary to infection. Of the infected breasts, 24.6% were managed with antibiotics alone. Significant risk factors for infection were prior chest radiation (p=0.021; OR 3.73, CI95% 1.22-11.34) and use of immune modulating drugs (p=0.012; 2.81, CI95% 1.25-6.30). Significant risk factors for explantation were age (p=0.030), tissue expander volume (p=0.038), and subpectoral placement (p=0.012). For each 5-year increase in age, odds ratio for explantation was 1.44 (CI95% 1.04-2.01). For every 50-cc increase in tissue expander volume, odds ratio for explantation was 1.28 (CI95% 1.02–1.55). Subpectoral placement carried an odds ratio of 11.5 (CI95% 1.7-77.3) compared to prepectoral placement or placement of a tissue expander under autologous tissue transfer (latissimus or free tissue transfer). Conclusion The incidence of breast tissue expander related infections at our institution was within the ranges previously published. A quarter of the breasts with infections were able to successfully avoid explantation with prompt initiation of antibiotic therapy. A history of chest radiation prior to mastectomy and the use of immune modulating drugs were noted to be significant risk factors for developing infections in breasts with tissue expanders. Explantation was more common with increases in age and tissue expander volumes. Surprisingly, subpectoral placement portended a significantly higher risk of explantation as compared to prepectoral tissue expander placement or when placed under a flap. BMI, a history of smoking, intent of mastectomy (prophylactic vs curative), adjuvant radiation, and use of acellular dermal matrix were not significantly related to either infection or explantation in this cohort.

New perspectives for fascioliasis in Upper Egypt's new endemic region: Sociodemographic characteristics and phylogenetic analysis of Fasciola in humans, animals, and lymnaeid vectors.

Fascioliasis is a significant vector-borne disease that has emerged in numerous tropical and subtropical countries causing severe health problems. Egypt is one of the fascioliasis endemic regions; however, the current situation in Upper Egypt is understudied, with only sporadic human cases or outbreaks. This study aims to highlight the sociodemographic characteristics of human fascioliasis in a newly emerged endemic area in Upper Egypt, along with risk factors analysis and the molecular characteristics of the fasciolid population in humans, animals, and lymnaeid snails. The study reported Fasciola infection in patients and their close relatives by analyzing the risk of human infection. Morphological and molecular characterization was performed on lymnaeid snails. Multigene sequencing was also used to characterize fasciolids from human cases, cattle, and pooled snail samples. The study identified asymptomatic Fasciola infection among family members and identified the presence of peridomestic animals as a significant risk factor for infection. This is the first genetic evidence that Radix auricularia exists as the snail intermediate host in Egypt. This study revealed that Assiut Governorate in Upper Egypt is a high-risk area for human fascioliasis that requires additional control measures. Fasciola hepatica was the main causative agent infecting humans and snail vectors in this newly emerged endemic area. In addition, this is the first report of R. auricularia as the snail intermediate host transmitting fascioliasis in Upper Egypt. Further research is required to clarify the widespread distribution of Fasciola in Egypt's various animal hosts. This provides insight into the mode of transmission, epidemiological criteria, and genetic diversity of fasciolid populations in Upper Egypt.\.

Early cytopenias and infections after standard of care idecabtagene vicleucel in relapsed or refractory multiple myeloma

AbstractIdecabtagene vicleucel (ide-cel) was FDA-approved in March 2021 for the treatment of relapsed/refractory multiple myeloma after 4 lines of therapy. On the KarMMa trial, grade ≥ 3 cytopenias and infections were common. We sought to characterize cytopenias and infections within 100 days after ide-cel in the standard-of-care (SOC) setting. This multi-center retrospective study included 52 patients who received SOC ide-cel; 47 reached day-90 follow-up. Data were censored at day 100. Grade ≥ 3 cytopenia was present among 65% of patients at day 30 and 40% of patients at day 90. Granulocyte colony stimulating factor (G-CSF) was administered to 88%, packed red blood cell transfusions to 63%, platelet transfusions to 42%, thrombopoietin (TPO) agonists to 21%, intravenous immunoglobulin to 13%, and CD34+ stem cell boosts to 8%. At day 100, 19% and 13% of patients had ongoing use of TPO agonists and G-CSF, respectively. Infections occurred in 54% of patients and were grade ≥ 3 in 23%. Earlier infections in the first 30 days were typically bacterial (68%) and severe (50%). Later infections between days 31 and 100 were 50% bacterial and 42% viral; only 13% were grade ≥ 3. On univariate analysis, high pre-CAR-T marrow myeloma burden (≥ 50%), circulating plasma cells at pre-lymphodepletion (LD), and grade ≥ 3 anemia at pre-LD were associated with grade ≥ 3 cytopenia at both days 30 and 90. Longer time from last bridging treatment to LD was the only significant risk factor for infection.

Clinical Manifestation of Infectious Keratitis in Ocular Graft Versus Host Disease

Purpose: We evaluated the clinical manifestations of, and risk factors for, infectious keratitis in patients with ocular graft-versus-host disease (GVHD).Methods: A total of 11 patients who developed infectious keratitis after a diagnosis of ocular GVHD between January 2015 and December 2020, and 36 who did not (the control group), were included in this retrospective study. We recorded sex, age, any underlying disease, any other organ affected by systemic GVHD, systemic immunosuppressant use, follow-up duration, clinical manifestations, the severity of ocular GVHD prior to infection, the size of the epithelial defect, the depth of infiltration, hypopyon status, and the results of microbiological tests. Systemic and ocular indices (including systemic GVHD status) were compared using the chi-squared test. Risk factors for infection were identified.Results: Of the corneal indices, the presence of corneal filaments, the extent of corneal neovascularization, and the number of corneal epithelial defects were significantly higher in the infected group (p = 0.023, p = 0.004, and p = 0.001, respectively). GVHD severity was also significantly higher in that group (p &lt; 0.001). The presence of corneal filaments, corneal neovascularization, and corneal epithelial defects prior to infection correlated significantly with the risk of infection (p = 0.046, p = 0.010, and p = 0.003, respectively). Multivariate analysis identified corneal epithelial defects as a significant risk factor for infection (p = 0.029).Conclusions: In patients with ocular GVHD, corneal epithelial defects, corneal neovascularization, and corneal filaments prior to infection were associated with the development of infection. In particular, corneal epithelial defects before infection was a significant risk factor for infection.

Prevalence and risk factors of urogenital schistosomiasis among under-fives in Mtama District in the Lindi region of Tanzania.

IntroductionDespite the ongoing intervention for schistosomiasis control among school-age children in the Lindi region of Tanzania, urogenital schistosomiasis continues to be a public health problem, presumably because other at-risk populations are not covered in praziquantel deworming campaigns. Evidence shows that under-fives become infected in their early life hence the need to understand the disease profile and the risk factors for exposure to infection so as to plan effective control strategies in this group. This study examined the prevalence and risk factors of urogenital schistosomiasis among under-fives in the Mtama district, Lindi region of Tanzania.Methodology/Principal findingsA quantitative community-based cross-sectional study was carried out among 770 participants (385 under-fives and their 385 parents/guardians) in the Mtama district to investigate the burden and the risk factors associated with S. haematobium infection. A single urine specimen was collected from the under-fives and tested for macro and microhaematuria, presence of S. haematobium ova, and intensity of infection. A structured questionnaire gathered on risk factors for S. haematobium exposure in under-fives from their parents/guardians. Data analysis was performed using descriptive statistics, chi-square test, and logistic regression.Prevalence of S. haematobium ova was 16.9%, and that of macro and microhaematuria was 6% and 17.9%, respectively. Of the 65 positive under-fives, 49 (75.4%) 95% CI 65.4–86.3 had a light infection intensity, and 16 (24.6%) 95% CI 13.7–35.5 had a heavy infection intensity. Among the assessed risk factors, the parents/guardians habit of visiting water bodies for domestic routines (AOR: 1.44, 95% CI: 1.13–1.74), especially the river (AOR: 6.00, 95% CI: 1.20–35.12), was found to be a significant risk factor for infection of S. haematobium in under-fives.Conclusion/SignificanceA moderate prevalence of S. haematobium was found among the under-fives conceivably with adverse health events. The infected under-fives could be a source of continuity for transmission in the community. An intervention that covers this group is necessary and should be complemented with regular screening, health education campaigns, and an adequate supply of safe water.

Risk Stratification of SARS-CoV-2 Breakthrough Infections Based on an Outbreak at a Student Festive Event.

In early 2022, the Coronavirus disease 2019 (COVID-19) remains a global challenge. COVID-19 is caused by an increasing number of variants of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Here, we report an outbreak of SARS-CoV-2 breakthrough infections related to a student festive event with 100 mostly vaccinated guests, which took place in Northern Bavaria, Germany, in October 2021. The data were obtained by retrospective guest interviews. In total, 95 students participated in the study, with 94 being fully vaccinated and 24 reporting infection by the delta variant. Correlation analyses among 15 examined variables revealed that time spent at the event, conversation with the supposed index person, and a homologous viral vector vaccination regime were significant risk factors for infection. Non-significant observations related to higher rates of infection included time since last vaccination, shared use of drinking vessels, and number of individual person-to-person contacts at the event. Our data suggest that a high rate of breakthrough infections with the delta variant occurs if no preventive measures are practiced. To limit infection risk, high-quality testing of participants should be considered a mandatory measure at gatherings, irrespective of the participants’ vaccination status.

Complications After Implantation of Subcutaneous Central Venous Ports: Focus on Infection and Catheter Pinch-off

Objective The objective of this study was to determine the causes of postoperative complications associated with subcutaneous central venous ports. Summary of Background Data Central venous ports were subcutaneously implanted in 523 patients between January 2005 and December 2013. Methods The purpose of port implantation was administration of chemotherapy in 439 patients and home central venous nutrition in 84 patients. The underlying disease was malignant in 481 patients and benign in 42. Results The median follow-up was 12 months (range, 1–99 months), and postoperative complications developed in 69 patients (13%). Infection occurred in 40 patients (7.6%) and catheter pinch-off in 11 patients (3%). Significant risk factors for infection were nutritional port placement (P &amp;lt; 0.001) and use of a femoral vein approach (P = 0.001). A left subclavian approach was a significant risk factor for catheter pinch-off (P = 0.003). Conclusions Postoperative complications, mainly infections and catheter pinch-off, developed in 13% of the patients. As for measures against complications, a femoral vein approach should be avoided to prevent infection. Moreover, because ports for parenteral nutrition require multiple punctures, methods to reduce the number of punctures and techniques for disinfection and management should be reevaluated. To prevent catheter pinch-off, an internal jugular vein approach should be used instead of a left subclavian approach.

Detection, Molecular Identification and Transmission of the Intestinal Protozoa Blastocystis sp. in Guinea from a Large-Scale Epidemiological Study Conducted in the Conakry Area.

Blastocystis sp. is a single-celled parasite estimated to colonize the digestive tract of 1 to 2 billion people worldwide. Although it represents the most frequent intestinal protozoa in human stools, it remains still under-investigated in countries with a high risk of infection due to poor sanitary and hygiene conditions, such as in Africa. Therefore, the present study was carried out to determine the prevalence and subtype (ST) distribution of Blastocystis sp. in the Guinean population. For this purpose, fecal samples were collected from 500 individuals presenting or not digestive disorders in two hospitals of Conakry. Search for the parasite in stools was performed by real-time PCR targeting the small subunit rDNA gene followed by sequencing of the PCR products for subtyping of the isolates. A total of 390 participants (78.0%) was positive for Blastocystis sp. Five STs were identified in the Guinean cohort (ST1, ST2, ST3, ST4 and ST14) with varying frequency, ST3 being predominant. Among them, ST4 was found in only two patients confirming its global rarity in Africa whereas infections by ST14 were likely the result of zoonotic transmission from bovid. No significant association was detected between Blastocystis sp. colonization or ST distribution and the symptomatic status of Guinean subjects or the presence of digestive symptoms. In contrast, drilling water consumption represented a significant risk factor for infection by Blastocystis sp. Predominance of ST3 coupled with its low intra-ST diversity strongly suggested large-scale human-to-human transmission of this ST within this cohort. In parallel, the highest intra-ST diversity of ST1 and ST2 was likely correlated with various potential sources of infection in addition to anthroponotic transmission. These findings highlighted the active circulation of the parasite in Guinea as reported in some low-income African countries and the necessity to implement prevention and control measures in order to limit the circulation of this parasite in this endemic geographical area.

Curvularia Sinusitis in Leukemic Patients

Abstract Curvularia species are dematiaceous filamentous fungi that can cause a variety of infections in both immunocompetent and immunocompromised hosts. We present 2 cases of severely immunosuppressed patients with acute invasive fungal sinusitis due to Curvularia species. Both patients had a history of hematologic malignancy with refractory disease and prolonged neutropenia. They presented with facial and sinus pain, which prompted maxillofacial computed tomography that showed acute sinusitis. Subsequently, they underwent nasal endoscopy with a biopsy that revealed a definitive diagnosis of invasive fungal sinusitis. Dematiaceous fungi are responsible for most fungal sinusitis cases, with Curvularia being one of the most common species isolated. Generally, invasive fungal rhinosinusitis may follow a relatively innocuous and nonspecific course. In addition, fungal infections may complicate chronic allergic sinusitis. Computed tomography scan is the first imaging modality of choice, and magnetic resonance imaging has a role in prognostication in acute invasive fungal rhinosinusitis. Endoscopic sinus surgery with biopsy yields a definitive diagnosis and is therapeutic. Management typically includes a combination of surgery and antifungal agents. Severe neutropenia is a significant risk factor for infection and is associated with poor outcomes. Aggressive surgical debridement, combined with antifungal therapy, should be emphasized in leukemic patients despite their prolonged neutropenia and bleeding tendency.

Infections in systemic lupus erythematosus: A study of incidence and risk factors in 100 patients from western India

Aim: The present study was conducted to evaluate the incidence and characteristics of infections in patients of systemic lupus erythematosus (SLE) and determine the risk factors for infection.Materials and Methods: This is a prospective, observational study carried out at a single-center, tertiary care hospital. The study included all adult SLE patients diagnosed as per the revised American College of Rheumatology (ACR) criteria from January 2015 to October 2019. Episodes of infection and pathogens isolated were recorded.Results: A total of 100 patients with SLE were evaluated (94 females and 6 males). Forty-seven (47%) patients suffered from 54 episodes of infection. Urinary tract infections were most common (31.48%), followed by skin and mucous membrane (27.78%). Escherichia coli (E. coli) was the most common organism isolated in 9 (16.8%) cases. Tuberculosis was seen in 6 (11.1%) patients. Forty-three (79.6%) patients had a SLE disease activity index score of more than 5 at the time of infection. Significant risk factors for infection included use of prednisolone, prednisolone dose higher than 10 mg, use of cyclophosphamide within the preceding 3 months of infections, use of other immunosuppressive agents, and leukopenia. Renal lupus and presence of comorbidities did not have a significant association with occurrence of infections. The relative risk of infections in SLE patients was 4.7 compared to non SLE controls.Conclusion: Patients of SLE are at increased risk for various infections. Management of SLE needs vigilance for infection and judicious use of immunosuppressive drugs.

Impact of Chronic Obstructive Pulmonary Disease on Infectious Complications and Mortality in Patients With Aneurysmal Subarachnoid Hemorrhage.

Background and Purpose: Chronic obstructive pulmonary disease (COPD) has been associated with several complications and mortality in acutely ill patients. For patients with aneurysmal subarachnoid hemorrhage (aSAH), the association between COPD and clinical outcomes remains unclear.Methods: In this retrospective cohort study, we analyzed consecutive aSAH patients admitted to the West China Hospital between 2014 and 2019. Propensity score matching analysis and cox regression models was used to assess the association between COPD and mortality. The primary outcome was long-term mortality.Results: Using a clinical database from a large university medical center, 2,925 patients with aSAH were identified, of whom 219 (7.5%) also had COPD. Patients were followed-up for a median of 3.8 years, and during follow-up 633 patients (21.6%) died. Long-term mortality was higher in patients with COPD compared to patients without COPD in the Cox regression models [adjusted hazard ratio (HR) 1.52, 95% confidence interval (CI) 1.14–2.02]. Propensity score matching analysis also showed similar associations between COPD and mortality in hospital, at 1 year, at 2 years, and at long-term. Similarly, patients with COPD had significantly higher incidence of infections, such as pneumonia [odds ratio (OR) 3.24, 95% CI 2.30–4.56], urinary tract infection (OR 1.81, 95% CI 1.20–2.73), bloodstream infection (OR 3.83, 95% CI 1.84–7.99), and hospital infection (OR 3.24, 95% CI 2.28–4.61).Conclusions: Among aSAH patients, COPD is associated with increased mortality. COPD represents a significant risk factor for infections. Given that these are preventable complications, our findings are of clinical relevance.