Clinical Infectious Diseases

In a cohort of predominantly unimmunized infants, clinical disease was not different for infection with pertactin-deficient or pertactin-producing B. pertussis. Molecular analyses demonstrated remarkable strain diversity of PFGE types as well as multiple mechanisms and molecular sites of pertactin inactivation.

This is the first known study in the U.S. demonstrating that prenatal Tdap vaccination prevents pertussis in infants. This strategy was 85% more effective than postpartum vaccination at preventing pertussis in infants <8 weeks of age, receipt between 27-36 gestation was optimal.

This study demonstrates that prenatal Tdap vaccination reduces severity of disease in infants who are infected with pertussis; prenatal Tdap vaccination was 58% (95% CI: 15%-80%) effective in preventing hospitalization and lowered risk of ICU admission among infants with pertussis.

HIV-infected persons are at increased cardiovascular disease (CVD) risk. Current prediction equations fail to adequately predict CVD risk and should be recalibrated or modified to improve accuracy among U.S. HIV-infected adults. Among those at highest CVD risk, less than half report statin and/or aspirin use.

Corticosteroids could be a viable adjuvant therapy for critically ill pulmonary tuberculosis patients with acute respiratory failure because this treatment seemed to reduce the 90-day mortality in our study group.

In START, immediate cART initiation reduced risk of infection-related cancer by 74% and infection-unrelated cancer by 51%. Adjustment for potential mediators, such as HIV RNA, appeared to attenuate HRs of immediate/deferred cART for infection-unrelated cancer more than infection-related cancer. cART benefit in reducing cancer risk may be mediated by mechanisms beyond HIV suppression.

Authors investigated the effect of subclinical CMV and EBV replication on CD4+ and CD8+ T-cell dynamics when antiretroviral therapy (ART) is started during early infection. Findings suggest that active CMV infection in the setting of treated HIV may represent an attractive potential target for therapeutic intervention.

Dichotomisation of ICU patients into high- and low-risk groups for invasive candidiasis is problematic. Categorisation into high, intermediate, and low risk groups should allow better targeting of early antifungal strategies and more efficient utilisation of newer diagnostic tests.

Neurosyphilis (NS) is rare and diagnosis is difficult. The aim of our study is to describe the clinical symptoms of NS today and to assess a new diagnostic test for NS, a polymerase chain reaction assay in the cerebral spinal fluid, as the actual gold standard, cerebrospinal fluid-Venereal Disease Research Laboratory, is not enough sensitive.

We compared vaccination of TM and ADEM cases with vaccination in matched persons in the study population. Vaccines were not associated with TM. The odds ratio for ADEM and Tdap vaccine was elevated, with a possible excess risk of 1/million doses.

Expression of C-reactive protein and serum amyloid A acute-phase reactants was significantly increased in early Lyme disease, but not in the later stages of active infection. Post-treatment Lyme disease syndrome was associated with elevated C-reactive protein, suggesting ongoing enhanced inflammation.

Viral hepatitis is the most significant contributor to HCC in NYC. Improvement in viral hepatitis screening and treatment, as well as in HCC screening, is needed.

In young people with perinatal HIV in England, cognitive impairment was relatively mild, and similar to HIV-negative affected controls, but lower than general population data. CDC stage C, worse depression, and black African ethnicity (likely associated with socio-economic status), predicted lower scores.

Risk of developing Kaposi sarcoma after starting combination antiretroviral therapy is substantial in human immunodeficiency virus–infected children of sub-Saharan African (SSA) origin, whether they live in Africa or Europe, but low in children of non-SSA origin in Europe and in Asia.

Pharmaceutical companies' decline in investing in antimicrobials and the rise of resistance has led to multiple reports on future antibiotic development. The consensus is that a constellation of economic incentives are needed to support all phases of antibacterial drug development.

Our finding that 17.1% of rectal specimens were positive for GC, CT, or both infections suggests that routine testing and timely repeat rectal GC and CT testing should be prioritized among men who reported receptive rectal sex.

In high-income countries providers are ethically justified in discussing breastfeeding as a reasonable, though inferior, option for mothers living with HIV as the duty of non-maleficence must be weighed against the providers' obligation to respect patient autonomy.

Galactomannan, beta-D-glucan, and polymerase-chain-reaction-based assays to detect invasive fungal disease in pediatric cancer or hematopoietic stem-cell transplantation patients demonstrated high negative predictive values for galactomannan, but overall, variable and generally poor sensitivity, specificity and positive predictive values for all biomarkers.

Women who were notified for chlamydial infection by a sex partner and who tested positive for Chlamydia trachomatis were about four times more likely to have cervico-vaginal microbiotas dominated by Lactobacillus iners or diverse anaerobic bacteria than by L. crispatus.

This article highlights the portfolio of the most cost-effective HIV prevention strategies for different levels of spending on HIV prevention. Our findings suggest that relative to the status quo, PrEP and Test-and-Treat are highly cost-effective.

Examining untreated leprosy patients and household contacts over 5-7 years, looking at new cases, anti-PGL-I positivity, and presence of Mycobacterium leprae DNA in nasal swab, biopsy and in blood by qPCR; evidenced M. leprae human-to-human transmission through the aerosol route.

Laboratories should individually optimize procedures for BC collection, processing, analysis, and result reporting. Implementation of rapid BC diagnostics should be done with clinical decision support systems that maximize clinical benefits.

We provided evidence of improved clinical symptoms, reduced viral loads and prolonged survival time of confirmed Ebola virus disease patients treated with favipiravir through a retrospective clinical cases study. It's worth performing further randomized controlled trial for favipiravir monotherapy.

In this post-hoc analysis of the Phase 3 ION trials evaluating HCV therapy with ledipasvir/sofosbuvir±ribavirin, current opioid substitution therapy and ongoing drug use during therapy did not impact treatment completion, adherence, sustained virologic response, and safety.

Human immunodeficiency virus type 1–infected individuals who switched from a virologically effective regimen comprising a boosted protease inhibitor (PI) plus 2 nucleoside reverse transcriptase inhibitors (NRTIs) to raltegravir plus 2 NRTIs had similar clinical and immunovirologic outcomes to individuals who continued PI.

Six HIV care metrics (baseline and time-updated HIV-1 RNA, viremia copy-years, time-updated CD4, time-updated VACS Index, and VACS Index score-years) predicted AMI and mortality among HIV infected individuals. Time-updated VACS Index provided the best prediction for both AMI and mortality.

Invasive wound mucormycosis is associated with a very poor prognosis in critically ill burn patients. The detection of circulating Mucorales DNA can reduce the time to diagnosis by 10 (5-11 days) days relative to standard techniques and may allow earlier initiation of treatment and a possibly better outcome.

Several new treatment options are available for patients with chronic hepatitis C virus infection. The present study shows that sofosbuvir and ledipasvir given for eight weeks is safe and effective under real-world conditions. Well-selected HIV-HCV-coinfected patients respond equally well to this combination treatment.

Early after starting combination antiretroviral therapy low CD4 cell count is the dominant risk factor for developing Kaposi sarcoma. In contrast, detectable HIV-1 RNA viral load becomes an increasingly important risk factor several years after treatment start, independently of immunodeficiency.

In a cohort of Ebola virus–infected patients from Monrovia, Liberia, we found that patients were 20% more likely to survive when Plasmodium species parasitemia was detected, even after controlling for Ebola viral load and age.

Among persons currently infected with hepatitis C virus, fibrosis-4 scores indicated that 23% had advanced fibrosis or cirrhosis at first diagnosis. Of those infected, 54% were in care and 51% with advanced fibrosis or cirrhosis were evaluated for treatment.

Despite increasing use of antiretrovirals, no clear reduction in end-stage liver disease events was observed in American human immunodeficiency virus–viral hepatitis–coinfected patients over 15 years. Direct-acting antivirals for hepatitis C and tenofovir-based regimens for hepatitis B should be prioritized.

A four-hour classroom course on dengue emphasizing case studies and practical aspects of clinical management was effective in changing key physician practices in the management of patients hospitalized with dengue in Puerto Rico.

HCV-infected non-immigrants had more behavioural comorbidities and all-cause hospitalizations versus immigrants. Liver-related hospitalization was similar between cohorts with lower rates in immigrants after age, sex, and comorbidity-adjustment. Immigrants were older with more HCC, possibly reflecting long delays between arrival and HCV diagnosis

Our case-control study findings suggest that, during 2010–2011, seasonal influenza vaccination reduced the risk of influenza-associated hospitalizations by >50% among adults aged ≥50 years. Even in those aged ≥75 years, vaccination was significantly effective in preventing influenza hospitalizations.

Universal surgical mask usage by both patients and providers reduced the incidence of respiratory viral infections in patients following hematopoietic stem cell transplant, especially parainfluenza 3, in this single-site prospective study.

The growth benefits of cotrimoxazole during early antiretroviral therapy are not well characterized. We found that cotrimoxazole during the first 24 months of antiretroviral therapy in Asian children was associated with larger increases in weight for age compared with non-cotrimoxazole use.

A high level of soluble human leucocyte antigen (HLA)-G is associated with the risk of developing the clinical forms of human African trypanosomiasis (HAT) after infection. HLA-G could help as a potential biomarker of risk in HAT control and elimination.

In this retrospective cohort study of children treated for multidrug-resistant tuberculosis in Peru, we report a treatment success rate of 77.2%. We found that baseline severe disease and baseline weight-for-age z score ≤−1 independently predicted death or treatment failure.

A novel macrolide, solithromycin, was noninferior to moxifloxacin in the primary outcome of early clinical response in this registration trial evaluating adult patients with community-acquired bacterial pneumonia. Clinical success at 5–10 days posttherapy and systemic adverse events were comparable.

Cardiovascular disease (CVD) was responsible for an increasing share of deaths to human immunodeficiency virus-infected individuals in New York City. CVD mortality rates among virally suppressed individuals were attenuated compared with unsuppressed individuals, but remained elevated compared with the general population.

Multiplex molecular diagnostic panels represent a paradigm shift for both clinical microbiology and infectious diseases. This review summarizes the advantages and limitations of current US Food and Drug Administration–approved tests for respiratory viruses, diarrheal illness, and meningitis/encephalitis.

Health-related quality of life, work productivity, and other patient-reported outcomes are reported by patients with hepatitis C virus (HCV) genotypes 2 and 3 during treatment with sofosbuvir and ribavirin or sofosbuvir/velpatasvir without ribavirin, and after clearance of HCV infection.

The updated World Health Organization ranking of antimicrobials according to their importance in human medicine supports the better management of antimicrobial resistance from nonhuman sectors. Highest-priority antimicrobials are quinolones, third- and fourth-generation cephalosporins, macrolides and ketolides, and glycopeptides.

Early findings from IMPAACT P1060 played an important role in recommendations for lopinavir/ritonavir (LPV/r) in first-line antiretroviral regimens for children <3 years of age. In long-term follow-up, we confirmed the superiority of LPV/r-based antiretroviral therapy over nevirapine-based regimens.

Virological failure in HIV-infected adolescents and young adults occurred most frequently during the transition period from pediatric to adult care. We identified several characteristics associated with virological outcomes.

This study investigates the nonspecific immunological effects of diphtheria-tetanus-pertussis and measles vaccination of healthy African infants. The results indicate sex-differential effects on both innate and adaptive immunity, providing the first mechanistic insights into how these vaccines alter infectious disease susceptibility.

In the 2014–2015 influenza season, when circulating viruses were antigenically drifted from vaccine viruses, relatively high influenza vaccine effectiveness was estimated in hospitalized adults, suggesting that the 2014–2015 vaccine may have been more effective in preventing severe illness.

Vaccine program evaluation includes assessment of vaccine uptake and effectiveness. Often examined separately, we propose a design to estimate rotavirus vaccination coverage using control participants from a rotavirus vaccine effectiveness test-negative case-control study and examine rotavirus vaccination coverage in Quebec, Canada.