Source Of Infection Research Articles

O01 Epidemiology and clinical characteristics of patients with carbapenem-resistant Enterobacterales infections: experience from a large tertiary care centre in a developing country

Abstract Background Carbapenem-resistant (CR) Enterobacterales (CREs) are a significant source of healthcare-associated infections. These bacteria are difficult to treat and have a high mortality rate due to high rates of antibiotic resistance. These pathogens are also linked to major outbreaks in healthcare institutions, especially those with limited resources in infection prevention and control. Objectives To describe the epidemiology and clinical characteristics of patients with carbapenem-resistant Enterobacteriaceae in a referral hospital in a developing country. Methods This was a retrospective cross-sectional study that included 218 patients admitted to An-Najah National University Hospital between 1 January 2021, and 31 May 2022. The target population was all patients with CRE infection or colonization in the hospital setting. Results Of the 218 patients, 135 had CR Klebsiella pneumoniae (61.9%) and 83 had CR Escherichia coli (38.1%). Of these, 135 were male (61.9%) and 83 were female (38.1%), with a median age of 51 years (IQR 24–64). Malignancy was a common comorbidity in 36.7% of the patients. Approximately 18.3% of CRE patients were obtained from patients upon admission to the emergency department, the largest percentage among departments. Most CRE pathogens were isolated from rectal swabs, accounting for 61.3%. Among the 218 patients, colistin was the most widely used antimicrobial agent (13.3%). CR E. coli showed resistance to amikacin in 23.8% of the pathogens tested and 85.7% for trimethoprim/sulfamethoxazole compared with CR K. pneumoniae, for which the resistance to trimethoprim/sulfamethoxazole was 74.1%, while for amikacin it was 64.2%. Regarding meropenem MIC, 85.7% of CR E. coli were greater than 16 mg/L compared with 84% of CR K. pneumoniae isolates. Conclusions This study found that CREs are frequently reported in this tertiary care setting, implying the presence of selective pressure and transmission associated with healthcare setting. The antibiotics tested showed a variety of resistance rates, with CR K. pneumoniae being more prevalent than CR E. coli and exhibiting an extremely high resistance pattern to the available therapeutic options.

Antemortem detection of Mycobacterium bovis in nasal swabs from African rhinoceros

Mycobacterium bovis (M. bovis) infection has been identified in black (Diceros bicornis) and white (Ceratotherium simum) rhinoceros populations in Kruger National Park, South Africa. However, it is unknown whether M. bovis infected rhinoceros, like humans and cattle, can shed mycobacteria in respiratory secretions. Limited studies have suggested that rhinoceros with subclinical M. bovis infection may present minimal risk for transmission. However, recent advances that have improved detection of Mycobacterium tuberculosis complex (MTBC) members in paucibacillary samples warranted further investigation of rhinoceros secretions. In this pilot study, nasal swab samples from 75 rhinoceros with defined infection status based on M. bovis antigen-specific interferon gamma release assay (IGRA) results were analysed by GeneXpert MTB/RIF Ultra, BACTEC MGIT and TiKa–MGIT culture. Following culture, speciation was done using targeted PCRs followed by Sanger sequencing for mycobacterial species identification, and a region of difference (RD) 4 PCR. Using these techniques, MTBC was detected in secretions from 14/64 IGRA positive rhinoceros, with viable M. bovis having been isolated in 11 cases, but not in any IGRA negative rhinoceros (n = 11). This finding suggests the possibility that MTBC/M. bovis-infected rhinoceros may be a source of infection for other susceptible animals sharing the environment.

Nurses’ attıtudes to the cleanıng of pulse oxımeter probes

Purpose: This study aims to determine nurses'attitudes toward cleaning pulse oximetry probes inTurkey.Materials and Methods: This research was carriedout descriptively between January and May 2023.This study was conducted with 319 nurses with 93%power. The questionnaire consists of 12 questionsabout the participants' demographic characteristicsand attitudes toward cleaning the saturation devices.Results: All nurses (n=319) stated that saturationdevices should be cleaned. It was found that 91.5%(n=292) of the nurses stated that saturation deviceswere a source of infection for healthcare workers,and 95.3% (n=304) stated that they were one of the causes of hospital infections. It was stated that 27.0%of the nurses (n=86) performed saturation cleaningseveral times a month, and 51.1% (n=163) stated thatthe substances they used to clean the saturationdevices were insufficient.Conclusions: It is seen that the nurses highly agreethat the saturation devices should be cleaned and thatit is a source of infection for patients and staff.However, despite this, it is seen that the frequency ofcleaning the saturation device is low, and there arequite different cleaning frequencies from each other.

Diagnostic value of microRNAs in active tuberculosis based on quantitative and enrichment analyses

BackgroundTuberculosis (TB) infection remains a crucial global health challenge, with active tuberculosis (ATB) representing main infection source. MicroRNA (miRNA) has emerged as a potential diagnostic tool in this context. This study aims to identify candidate miRNAs for ATB diagnosis and explore their possible mechanisms. MethodsDifferentially expressed miRNAs in ATB were summarized in qualitative analysis. The diagnostic values of miRNAs for ATB subtypes were assessed by overall sensitivity, specificity, and area under the curve. Additionally, we conducted enrichment analysis on miRNAs and target genes. ResultsOver 100 differentially expressed miRNAs were identified, with miR-29 family being the most extensively studied. The miR-29 family demonstrated sensitivity, specificity, and area under the curve of 80 %, 80 % and 0.86 respectively for active pulmonary TB (PTB). The differentially expressed miR-29-target genes in PTB were enriched in immune-related pathways. ConclusionsThe miR-29 family exhibits good diagnostic value for active PTB and shows association with immune process.

The importance of the bacterial spectrum in the clinical diagnostics and management of patients with spontaneous pyogenic spondylodiscitis and isolated spinal epidural empyema: a 20-year cohort study at a single spine center

BackgroundPersonalized clinical management of spondylodiscitis (SD) and isolated spinal epidural empyema (ISEE) is challenging due to limited evidence of microbiologic findings and their clinical impact during the clinical course of the disease. We aimed to characterize clinico-microbiological and imaging phenotypes of SD and ISEE to provide useful insights that could improve outcomes and potentially modify guidelines.MethodsWe performed chart review and collected data on the following parameters: bacterial antibiogram-resistogram, type of primary spinal infection, location of spinal infection, source of infection, method of detection, clinical complications (sepsis, septic embolism, and endocarditis), length of hospital and intensive care unit (ICU) stay, relapse rate, and disease-related mortality in patients with proven pyogenic SD and ISEE treated surgically in a university hospital in Germany between 2002 and 2022.ResultsWe included data from 187 patients (125 SD, 66.8% and 62 ISEE, 33.2%). Gram-positive bacteria (GPB) were overall more frequently detected than gram-negative bacteria (GNB) (GPB: 162, 86.6% vs. GNB: 25, 13.4%, p < 0.001). Infective endocarditis was caused only by GPB (GPB: 23, 16.5% vs. GNB: 0, 0.0%, p = 0.046). Methicillin-susceptible Staphylococcus aureus was the most frequently isolated strain (MSSA: n = 100, 53.5%), occurred more frequently in the cervical spine compared to other bacteria (OB) (MSSA: 41, 41.0% vs. OB: 18, 20.7%, p = 0.004) and was most frequently detected in patients with skin infection as the primary source of infection (MSSA: 26, 40.6% vs. OB: 11, 16.7%, p = 0.002). Streptococcus spp. and Enterococcus spp. (SE: n = 31, 16.6%) were more often regarded as the cause of endocarditis (SE: 8, 27.6% vs. OB: 15, 11.4%, p = 0.037) and were less frequently detected in intraoperative specimens (SE: 19, 61.3% vs. OB: 138, 88.5%, p < 0.001). Enterobacterales (E: n = 20, 10.7%) were identified more frequently in urinary tract infections (E: 9, 50.0% vs. OB: 4, 3.6%, p < 0.001). Coagulase-negative Staphylococci (CoNS: n = 20, 10.7%) were characterized by a lower prevalence of sepsis (CoNS: 4, 20.0% vs. OB: 90, 53.9%, p = 0.004) and were more frequently detected in intraoperative specimens (CoNS: 20, 100. 0% vs. OB: 137, 82.0%, p = 0.048). Moreover, CoNS-associated cases showed a shorter length of ICU stay (CoNS: 2 [1–18] days vs. OB: 6 [1–53] days, median [interquartile range], p = 0.037), and occurred more frequently due to foreign body-associated infections (CoNS: 8, 61.5% vs. OB: 15, 12.8%, p = 0.008). The presence of methicillin-resistant Staphylococcus aureus (MRSA) prolonged hospital stay by 56 [24–58] days and ICU stay by 16 [1–44] days, whereas patients with Pseudomonas aeruginosa spent only 20 [18–29] days in the hospital and no day in the ICU 0 [0–5] days.ConclusionsOur retrospective cohort study identified distinct bacterial-specific manifestations in pyogenic SD and ISEE regarding clinical course, neuroanatomic targets, method of pathogen detection, and sources of infection. The clinico-microbiological patterns varied depending on the specific pathogens.

Transition to Oral Antibiotic Therapy for Hospitalized Adults With Gram-Negative Bloodstream Infections

Management of gram-negative bloodstream infections (GN-BSIs) with oral antibiotics is highly variable. To examine the transition from intravenous (IV) to oral antibiotics, including selection, timing, and associated clinical and microbial characteristics, among hospitalized patients with GN-BSIs. A retrospective cohort study was conducted of 4581 hospitalized adults with GN-BSIs at 24 US hospitals between January 1 and December 31, 2019. Patients were excluded if they died within 72 hours. Patients were excluded from the oral therapy group if transition occurred after day 7. Statistical analysis was conducted from July 2022 to October 2023. Administration of antibiotics for GN-BSIs. Baseline characteristics and clinical parameters reflecting severity of illness were evaluated in groups receiving oral and IV therapy. The prevalence of transition from IV to oral antibiotics by day 7, median day of transition, sources of infection, and oral antibiotic selection were assessed. Of a total of 4581 episodes with GN-BSIs (median age, 67 years [IQR, 55-77 years]; 2389 men [52.2%]), 1969 patients (43.0%) receiving IV antibiotics were transitioned to oral antibiotics by day 7. Patients maintained on IV therapy were more likely than those transitioned to oral therapy to be immunosuppressed (833 of 2612 [31.9%] vs 485 of 1969 [24.6%]; P < .001), require intensive care unit admission (1033 of 2612 [39.5%] vs 334 of 1969 [17.0%]; P < .001), have fever or hypotension as of day 5 (423 of 2612 [16.2%] vs 49 of 1969 [2.5%]; P < .001), require kidney replacement therapy (280 of 2612 [10.7%] vs 63 of 1969 [3.2%]; P < .001), and less likely to have source control within 7 days (1852 of 2612 [70.9%] vs 1577 of 1969 [80.1%]; P < .001). Transitioning patients from IV to oral therapy by day 7 was highly variable across hospitals, ranging from 25.8% (66 of 256) to 65.9% (27 of 41). A total of 4109 patients (89.7%) achieved clinical stability within 5 days. For the 3429 episodes (74.9%) with successful source control by day 7, the median day of source control was day 2 (IQR, 1-3 days) for the oral group and day 2 (IQR, 1-4 days) for the IV group (P < .001). Common infection sources among patients administered oral therapy were the urinary tract (1277 of 1969 [64.9%]), hepatobiliary (239 of 1969 [12.1%]), and intra-abdominal (194 of 1969 [9.9%]). The median day of oral transition was 5 (IQR, 4-6 days). Total duration of antibiotic treatment was significantly shorter among the oral group than the IV group (median, 11 days [IQR, 9-14 days] vs median, 13 days [IQR, 8-16 days]; P < .001]. Fluoroquinolones (62.2% [1224 of 1969]), followed by β-lactams (28.3% [558 of 1969]) and trimethoprim-sulfamethoxazole (11.5% [227 of 1969]), were the most commonly prescribed oral antibiotics. In this cohort study of 4581 episodes of GN-BSIs, transition to oral antibiotic therapy by day 7 occurred in fewer than half of episodes, principally with fluoroquinolones, although this practice varied significantly between hospitals. There may have been additional opportunities for earlier and more frequent oral antibiotic transitions because most patients demonstrated clinical stability by day 5.

Using interprofessional collaboration to reduce reported rates of central-line-associated bloodstream infection in an intensive care setting.

Using a multicomponent approach that included blood-culture stewardship, evaluation for secondary sources of bloodstream infection, improved documentation, and prompt central-line removal, an interprofessional team improved patient care and reduced central-line-associated bloodstream infection rates in collaboration with the primary team on the surgical intensive care unit.

Perceived risk of infection, ethical challenges and motivational factors among frontline nurses in Covid-19 pandemic: prerequisites and lessons for future pandemic

BackgroundInfection risk was significant for front-line nurses during the Covid-19 outbreak. The pandemic presented several ethical difficulties and sapped nurses’ drive to labor harder for longer periods. This study evaluates registered nurses’ perceptions of Covid-19 infection risk, ethical dilemmas, and motivating factors.Materials and methodsDuring March and April 2022, 400 registered nurses from a newly established tertiary care hospital participated in this cross-sectional exploratory survey. The risk assessment scale, motivation to work scale, and ethical dilemma scale were used to assess the perceived risk of infection, motivational factors and ethical challenges experienced by the nurses. Appropriate descriptive and inferential statistics were applied to compute the results.Results76.4% of nurses feared working as a nurse put them at higher risk of infection. Besides the fear of contracting infection, nurses believed they were the source of infection to family members (70.8%) and people around (67.5%). 63.3% of nurses agree that they do not have the right to refuse treatment and every patient has the right to receive optimal care, regardless of age, gender, and medical conditions. Professional obligation to treat patients (72.3%) and sound professional knowledge and experience (83.5%) are important motivating factors to work during the pandemic. Multilinear regression analysis revealed that professional education (95% CI, 3.845 − 0.694, p = 0.005), Covid-19 positive status (95% CI,0.455-2.756, p = 0.006), and post-Covid-19 hospitalization (95% CI, 1.395–6.978, p = 0.003) and duration of hospitalization (95% CI, 0.754-0.058, p = 0.022) are independent predictors of higher perceived risk of infection among nurses.ConclusionsDuring the pandemic, nurses were afraid to work and faced personal and family risks of contracting the virus. Despite these challenges, they still feel a strong sense of commitment and dedication to providing the best possible care. Nurse administrators need to create a supportive environment that follows ethical principles and meets the needs of nurses to boost their motivation and encourage them to continue working for longer periods.

Biofouling on titanium implants: a novel formulation of poloxamer and peroxide for in situ removal of pellicle and multi-species oral biofilm.

Eradicating biofouling from implant surfaces is essential in treating peri-implant infections, as it directly addresses the microbial source for infection and inflammation around dental implants. This controlled laboratory study examines the effectiveness of the four commercially available debridement solutions '(EDTA (Prefgel®), NaOCl (Perisolv®), H2O2 (Sigma-Aldrich) and Chlorhexidine (GUM® Paroex®))' in removing the acquired pellicle, preventing pellicle re-formation and removing of a multi-species oral biofilm growing on a titanium implant surface, and compare the results with the effect of a novel formulation of a peroxide-activated 'Poloxamer gel (Nubone® Clean)'. Evaluation of pellicle removal and re-formation was conducted using scanning electron microscope (SEM), energy-dispersive X-ray spectroscopy and X-ray photoelectron spectroscopy to assess the surface morphology, elemental composition and chemical surface composition. Hydrophilicity was assessed through contact angle measurements. The multi-species biofilm model included Streptococcus oralis, Fusobacterium nucleatum and Aggregatibacter actinomycetemcomitans, reflecting the natural oral microbiome's complexity. Biofilm biomass was quantified using safranin staining, biofilm viability was evaluated using confocal laser scanning microscopy, and SEM was used for morphological analyses of the biofilm. Results indicated that while no single agent completely eradicated the biofilm, the 'Poloxamer gel' activated with 'H2O2' exhibited promising results. It minimized re-contamination of the pellicle by significantly lowering the contact angle, indicating enhanced hydrophilicity. This combination also showed a notable reduction in carbon contaminants, suggesting the effective removal of organic residues from the titanium surface, in addition to effectively reducing viable bacterial counts. In conclusion, the 'Poloxamer gel + H2O2' combination emerged as a promising chemical decontamination strategy for peri-implant diseases. It underlines the importance of tailoring treatment methods to the unique microbial challenges in peri-implant diseases and the necessity of combining chemical decontaminating strategies with established mechanical cleaning procedures for optimal management of peri-implant diseases.

Retrospective Analysis of Hospital Acquired Infection and Antibiotic Resistance in Coronary Care Unit (CCU), Adult, and Pediatric Cardiology Wards.

Antibiotics resistance is an paramount threat affecting the whole world but nowhere situation is as gloomy as in India. No study till date regarding epidemiology of hospital acquired infections in coronary care units(CCU) and cardiology wards from India. From Indian perspective it is the first observational study to analyse microbiological profile and antibiotic resistance in CCU. The purpose of this observational study is to explore the epidemiology and importance of infections in CCU patients. After ethics committee approval, the records of all patients who were admitted in coronary care units, adult and pediatric cardiology wards surgery between January 2020 and December 2021 were reviewed retrospectively. The type of organism,source of infection ,age wise distribution and seasonal variability among patients who developed hospital acquired infection (HAI) were determined. 271 patients developed microbiologically documented HAI during from January 2020 to December 2021. Maximum number of organisms(78/271 28.78%) are isolated from urinary samples ,followed by blood stream(60/271 22.14%) and Endotracheal tube (54/271 19.92%). Acinetobacter baumanii (53/271, 19.5%) being the most common isolate among all the samples taken . Acinetobacter was the most frequent pathogens isolated in patients with LRTI and blood stream infection while E. coli was from urinary tract infection . In the adult population, infection with E. coli(24.6%) is the most common followed by Klebsiella pneumoniae (12.8%) and Acinetobacter baumanii (10.1%). In the pediatric population Acinetobacter baumanii (38.6%%) is the most common followed by Klebsiella pneumoniae (20.5%) and Methicillin Resistant Staphylococcus aureus, MRSA (6.8%). Commonly used antibiotics eg ciprofloxacin,ceftazidime and amikacin were found to be resistant against the top three isolates. Urinary tract was the most common site of infection and Gram-negative bacilli, the most common pathogens in adult as well as pediatric population. Antibiotic resistance was maximum with commonly isolated microorganisms.

Development of yellow rust in grain crops and wild cereal grasses and damage to winter wheat varieties

Factors that determine the degree of development of wheat brown rust are the influence of temperature (the growth limits of uredospores are from 2 to 32 °C with an optimum of 15-20 °C) and the effect of a drop of liquid for at least 4-6 hours. Under favorable conditions, the causative agent of brown rust can reduce the yield of wheat by up to 45%, and in the case of epiphytotic development at the germination stage by 80-100%, and damage to the grain can reach 50%. In the North Kazakhstan, Kostanay and Akmola regions, epiphytotic brown rust of wheat was found in cereals, including triticale. For successful breeding, it is important to find new resistance genes in the host plant.Yellow rust of wheat is a disease that affects more than 20 species of cultivated and wild cereals, including wheat, rye, barley, wheatgrass, Aegilops and others. As a result, the development of stripe rust disease was detected in four wild and cultivated grain crops. It has been established that the sources of infection are wild species of grain crops.

Cryptococcus neoformans and cryptococcosis: a contribution made by Prof. Dr. Mahendra Pal

Mycotic infections are reported to occur in both sexes, all age groups, in all seasons, and in urban and rural areas of the world. The people with weakened immune systems are more likely to get an infection due to fungi, which are widely prevalent in our environment. Cryptococcosis primarily caused by Cryptococcus neoformans is a life-threatening enigmatic mycosis of global importance. It is estimated that 1000000 cases of cryptococcal meningitis complicating HIV/AIDS are reported every year worldwide. Disease has been encountered in humans as well as in a variety of animals including cats and dogs. The source of infection is exogenous, as the fungus occurs as a saprophyte in nature. Currently, the pigeon excreta serve as the chief saprobic reservoir of C. neoformans. Human as well as animals may acquire the infection from the environment where the fungus grows luxuriantly. The respiratory tract is recognized as the principal mode of entry of the organism. The pathogen can also enter through the fungal contaminated objects via traumatized skin. Clinical spectrum of disease is varied, as manifested with several forms, such as pulmonary, meningeal, visceral, osseous, and cutaneous. The laboratory help is imperative to confirm an unequivocal diagnosis of cryptococcosis. The pathogen can be easily isolated from the clinical specimens of the patients on Pal sunflower seed medium. Modified Pal sunflower seed can be employed to undertake the sexual compatibility studies of Cr. neoformans. Several drugs including amphotericin B, fluconazole, and itraconazole have been recommended for the treatment of disease. The immediate attention to the skin injury and use of face mask when dealing with avian droppings can help in the prevention of infection.

Exogenous endophthalmitis caused by Citrobacter Koseri

Aims/Purpose: To present a case of exogenous endophthalmitis caused by Citrobacter Koseri.Methods: We present a 66‐year‐old man that works in an animal laboratory exercising their care, who came to the emergency department due to sudden loss of vision in his left eye. Using indirect ophthalmoscopy, we observed a dense hemovitreous that prevented visualization of the posterior structures. An ocular ultrasound was performed in which suggestive signs of retinal detachment are intuited, so we decided to perform an exploratory vitrectomy. During exploratory vitrectomy via pars plana, a dense fibrinoid vitreous was observed, with a tear at XIIh of more than 1 h in diameter. The vitrectomy was completed successfully after suturing the sclerotomies.Results: The postoperative period evolved adequately, but 3 days later, the patient presented to the emergency room with pain and severe ocular inflammation. On physical examination, he presented intense conjunctival hyperemia, signs of corneal melting, and increased ocular tone. Endophthalmitis was diagnosed and treatment was started with reinforced intravitreal and eye drops antibiotics and anti‐inflammatories. 24 h later, the patient went back with an extrusion of the lens that was sent to microbiological study. On physical examination, we observed corneal melting that produced complete corneal perforation with extrusion of purulent and vitreous material and an urgent evisceration was performed. Two days later, the microbiological samples confirmed the Citrobacter Koseri microorganism.Conclusions: Cases of exogenous endophthalmitis caused by Citrobacter are limited in the literature. In this case, exposed suture material and the epidemiological history of the patient were suspected as the source of infection. Despite early diagnosis and intensive treatment, the clinical course of Citrobacter endophthalmitis is very aggressive and has a poor visual prognosis. In our case it ended with evisceration.

Investigation of aspergillosis outbreak in young ducklings: Unraveling the role of hatcheries in Aspergillus fumigatus transmission.

Aspergillosis is a disease that affects several species of birds and causes substantial losses in the poultry business. The purpose of the investigation was to identify the pathogen responsible for a respiratory outbreak among juvenile ducklings. An epidemic of Aspergillosis infected a total of 800 Muscovy ducks that were being reared in El-Beheira Governorate. Tissue samples were obtained to isolate suspected fungi from diseased birds and the hatchery environment. In addition, identification and molecular characterization were performed on the obtained fungal isolates. Affected birds displayed acute respiratory manifestations such as difficulty breathing, gasping for air, nasal discharge, and a mortality rate of up to 28.1%. Postmortem examination revealed bronchitis, tracheitis, congested lungs, air sacculitis, severe multifocal granulomatous pneumonia, a congested, enlarged liver, and a congested kidney with nephritis. Mycological examination revealed seven Aspergillus (A.) spp. isolates from ducklings and six from hatcheries. Isolate colonial morphology and microscopical examination were as follows: A. fumigatus, A. niger, Syncephalastrum racemosum, and four untypable isolates. These isolates were further identified by polymerase chain reaction (PCR), and the internal transcribed spacers (ITSs) gene was detected. Four representative isolates were submitted for sequencing and further phylogenetic analysis. The source of duckling infection might be linked to the hatchery environment due to the observed similarity of isolates from both affected birds and the hatchery, as evidenced by phylogenetic analysis. Our findings demonstrated the significance of appropriate hatchery control in preventing infection in young ducklings. Furthermore, the use of molecular identification techniques would be helpful for tracing the source of infection and rapid diagnosis of Aspergillus in the field.

Prevention of infections of various genesis in children’s patients: approaches and methods in modern conditions

Infections in childhood pose a significant danger to young patients, since their immune response may not always be effective. Unfortunately, modern ecology, as well as various genetic factors can negatively affect children’s immunity, as a result of which the resistance of the body of pediatric patients may be insufficient, which can lead not only to severe complications, but also to death. It is for this reason that at the present stage the issue of prevention of infections of various genesis in children’s patients is acute, since, as is known, it is easier to prevent the disease than to treat it. It is important for medical workers, as well as adults caring for children, to observe infection prevention measures, since the body of children should not suffer from the consequences of certain infectious diseases. It is very important to vaccinate children’s patients in a timely manner, as well as to carry out other preventive measures, such as proper nutrition, lack of contact with sources of infections and compliance with hygiene rules. If these measures are implemented, the child’s body will be able to form an adequate immune response, get stronger without additional stress, which will create favorable conditions for the further development of the child’s body.

Molecular prevalence and subtype distribution of Blastocystis spp. among children who have diarrheia or are asymptomatic in Wenzhou, Zhejiang Province, China.

Blastocystis sp., a significant zoonotic parasite with a global distribution, was the focus of this study, which aimed to investigate its prevalence and genetic diversity among diarrheic and asymptomatic children in Wenzhou, China. We collected 1,032 fecal samples from Yuying Children's Hospital, Wenzhou, China, comprising 684 from children with diarrhea and 348 from asymptomatic children. Genomic DNA extracted from these samples was used to detect Blastocystis spp. by PCR, targeting the small subunit ribosomal RNA gene. Subsequently, a phylogenetic tree was constructed, applying the maximum likelihood method. Blastocystis spp. were detected in 67 (6.5%) of the fecal samples. The prevalence rate of Blastocystis spp. in diarrheic children (8.8%; 60/684) was significantly higher than that in asymptomatic children (2.0%; 7/348) (χ 2=17.3, p<0.001). Sequence analysis of the SSU rRNA gene identified five known Blastocystis spp. subtypes, ST1 (n=12), ST2 (n=5), ST3 (n=35), ST4 (n=12), and ST7 (n=3). ST1 and ST3 were present in both diarrheic and asymptomatic children, while ST2, ST4, and ST7 were exclusive to diarrheic children. Intra-subtype genetic polymorphisms were identified, comprising four variations in ST1 (ST1-1 to ST1-4), five in ST3 (ST3-1 to ST3-5), two in ST4 (ST4-1 and ST4-2), and two in ST7 (ST7-1 and ST7-2). Notably, ST1-2 to ST1-4, ST3-3 to ST3-5, and ST7-1 and ST7-2 represent newly identified variations. The composition and genetic characteristics of subtypes among children in this region suggest various sources of infection, including human-to-human and animal-to-human transmission.

ПРИЧИНЫ РАЗНОНАПРАВЛЕННОЙ РЕНТГЕНОЛОГИЧЕСКОЙ ДИНАМИКИ ПРИ ЛЕЧЕНИИ ТУБЕРКУЛЕЗА ОРГАНОВ ДЫХАНИЯ У ДЕТЕЙ И ПОДРОСТКОВ

Chest CT monitoring of children with TB is the principal method of evaluation of treatment effectiveness. Multidirectional CT dynamics at any stage of treatment requires a well-informed decision concerning further treatment tactics. Objective: To analyze possible causes and clinical significance of multidirectional dynamic changes in the lungs during treatment for pulmonary TB in children and adolescents. Materials and methods. A retrospective study: we analyzed inpatient case records and CT files of 49 patients aged 2–17 years with active pulmonary TB, who demonstrated multidirectional dynamic changes in the lungs during the main treatment course according to chest CT data. Non-contrast-enhanced CT with lung and abdominal windows at no more than 1.3 mm slice thickness was used. The dynamic changes were assessed using various radiological patterns and compared with clinical and laboratory data; the administered chemotherapy regimen was assessed considering drug susceptibility data from both patient and infection source. Results. Multidirectional CT dynamics was detected at various stages of TB treatment. The retrospective analysis showed that in 31% of cases it witnessed treatment failure and required treatment correction, in 47% of cases it demonstrated natural course of TB, in 9% of cases it was associated with concomitant pathology. We failed to determine the cause of multidirectional CT dynamics in 4% of cases, in these cases further treatment options were targeted to chemotherapy correction. Conclusion. Multidirectional CT dynamics during treatment for pulmonary TB in children and adolescents does not always mean treatment failure, other possible causes should be also considered.

ПЕРЕНОСИМОСТЬ ПРОТИВОТУБЕРКУЛЕЗНОЙ ТЕРАПИИ У ДЕТЕЙ

Objective: to evaluate tolerability of different chemotherapy regimens in children with pulmonary TB and input of second-line drugs to the development of adverse drug reactions (ADR). Materials and methods. The study enrolled 92 children aged 2–12 years (a median of 6 years of age) with newly diagnosed active pulmonary TB, who received treatment in 2019–2022. The initial drug combination was based on drug susceptibility of both infection source and patient (chemotherapy regimens 1/3, 2 and 4/5); the number of TB drugs and chemotherapy duration was determined by severity of TB process. The patients were divided into groups based on the chemotherapy regimen: group 1 included 29 patients only administered first-line drugs (1/3), 16 patients of group 2 received chemotherapy regimen 2, and 47 patients of group 3 received 4/5 chemotherapy regimen. Results. ADR were observed in 61 of 92 children (66,3%); satisfactory tolerability was observed in 31 children (33.7%). ADR occurred most frequently in patients of group 3 (85.1%) compared to group 2 (68.8%) and group 1 (34.5%) (χ2 = 20.624, p &lt; 0.001). ADR, which required withdrawal of the offending drug, were more frequent among children, who received chemotherapy regimen 4/5 or 2 (55.3% and 50.0% respectively) compared to children, who received chemotherapy regimen 1/3 (10.3%) (χ2 = 15,372, p = 0,001). Allergic reactions were reliably more frequent under chemotherapy regimen 4/5 compared to chemotherapy regimen 1/3 (31.9% and 6.9% respectively) (χ2 = 6,464, p &lt; 0,012). Clinical and laboratory manifestations of allergic reactions were identical and did not depend on the chemotherapy regimen. Toxic reactions were reliably more frequent under chemotherapy regimen 4/5 compared to 1/3 (48.9% and 20.8% respectively) (χ2 = 6.064, p = 0.014). The range of toxic reactions increased under administration of second-line drugs and demonstrated more clinical and laboratory manifestations under chemotherapy regimen 4/5. Intractable ADR most frequently occurred under administration of amikacin/capreomycin (41.7%), protionamide (30.0%), levofloxacin/moxifloxacin (17.0%), or cycloserine (11.6%). Conclusion. The frequency of ADR to TB treatment in children depends on the administered drugs. The least incidence of adverse reactions was observed in patients, who received first ling drugs (chemotherapy regimen 1/3). Toxic reactions prevailed over allergic ones. The range of toxic reactions increased in patients, who received second-line drugs.

Seropositivity and Trends of Transfusion Section Transmitted Infections among Blood Donors: Five Years Cross-sectional Study on 20,392 Blood Donors in a Tertiary Care Hospital of Ahmedabad, Gujarat, India

Introduction: Blood transfusion is a lifesaving intervention. However, it can also be a source of Transfusion-transmissible Infections (TTIs), posing a potential threat to the recipient. Testing for TTIs before blood transfusion is crucial for the safety of recipients. However, donations occurring during the window period, the prevalence of asymptomatic carriers, viral strains with high genetic variability, and technical errors are responsible for TTIs and remain one of the greatest obstacles in transfusion medicine to deal with. All blood donors are to be screened against five major infections-Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Syphilis, and Malaria. Aim: To study the seroprevalence and trends of TTI among healthy blood donors at the Blood Centre of Ahmedabad, Gujarat, India. Materials and Methods: A cross-sectional study was carried out by reviewing blood donors’ records over a period of five years from January 1, 2018, to December 31, 2022, at the Blood Centre, Department of Pathology, of Sheth L.G. General Hospital, Maninagar, Ahmedabad, Gujarat, India. The data collected for each seropositive donor included the results of TTI testing, the age group of donors, the type of donation, the frequency of donation, and co-infection. The results were expressed in numbers and percentages. Results: Among a total of 20,392 healthy blood donors during the five-year period, the total number of seropositive cases (n) was 243 (1.19%). TTI seropositive donors in years 2018, 2019, 2020, 2021, and 2022 were 60 (1.29%), 50 (1.16%), 39 (1.22%), 45 (1.14%), and 49 (1.16%), respectively. A maximum of 118 (48.56%) seropositive donors were recorded in age group of 18-29 years. Individual seropositive donors during the fiveyear period for HIV, HBV, HCV, syphilis, and malaria were 19 (0.09%), 155 (0.76%), 28 (0.14%), 41 (0.20%), and 00 (0.00%), respectively. Voluntary Blood Donors (VBD) 10,933 (53.61%) exceeded Replacement Donors (RD) 9,459 (46.39%), and repeat blood donors 14,462 (70.92%) surpassed first-time donors 5,930 (29.08%). The seroprevalence of TTI among replacement, voluntary, first-time, and repeat blood donors was 2.41%, 0.14%, 2.06% and 0.84% respectively. Out of 243 seroreactive donors, two donors (0.82%) showed dual reactivity for TTI during the five-year period. Conclusion: Implementation of strict donor selection criteria, utilisation of sensitive screening modalities, promoting public awareness, and dispelling myths regarding the merits of voluntary blood donation, judicious use of blood products, and mass immunisation for Hepatitis B infection are essential interventions needed to curb TTI to a significant extent.

Study on genetic characteristics of Cryptosporidium isolates and first report of C. parvum IIdA24G2 subtype in dairy cattle in China.

Cryptosporidium is an important gastrointestinal parasite that can cause mild to severe diarrhea in various vertebrates, including humans and domestic animals. Infection is prevalent in dairy cattle, particularly calves, resulting in diarrhea and increased mortality with significant production losses. However, the prevalence and identity of Cryptosporidium spp. in cattle in Heilongjiang Province is still poorly known. Our study aimed to investigate the prevalence and species and subtype distribution of Cryptosporidium in cattle in the region. In addition, we evaluated the zoonotic potential of Cryptosporidium isolates and assessed possible transmission routes and health effects of this organism. We collected 909 fecal samples from five different farms in Heilongjiang Province between August and September 2022. The samples underwent Cryptosporidium detection by nested PCR and small subunit (SSU) rRNA gene sequence analysis. Four Cryptosporidium species were identified, including C. parvum, C. bovis, C. ryanae, and C. andersoni, with an overall prevalence of 4.4% (40/909). Based on sequence analysis of the 60 kDa glycoprotein gene of C. parvum and C. bovis, three subtypes of C. parvum were identified, namely two previously known subtypes (IIdA19G1 and IIdA20G1), and one novel subtype (IIdA24G2). Two distinct subtype families were identified in C. bovis (XXVId and XXVIe). The high diversity of Cryptosporidium in dairy cattle and the emergence of a novel subtype of C. parvum in Heilongjiang Province suggest that dairy cattle may serve as a significant source of zoonotic cryptosporidiosis infection in this region.