Clinical Infectious Diseases

We reported computed tomographic (CT) imaging findings of 3 patients with coronavirus disease 2019 (COVID-19) pneumonia with initially negative results before CT examination and finally confirmed positive for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by real-time reverse-transcription polymerase chain reaction assay.

We analyzed age- and sex-specific morbidity and mortality data from SARS-COV-2 pandemic in China and Republic of Korea (ROK). Data from China exhibit a Gaussian distribution with peak morbidity in the 50-59 years cohort, while the ROK data have a bimodal distribution with highest morbidity in the 20-29 years cohort.

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HIV-2 infection is endemic in some countries in West Africa. Due to the lower prevalence in industrialized countries, there is limited experience and knowledge on management of HIV-2 infected individuals in Europe. Compared to HIV-1, there are differential characteristics of HIV-2 regarding diagnostic procedures, clinical course and, most importantly, antiretroviral therapy. We integrated the published literature on HIV-2 (studies and reports on epidemiology, diagnostics, clinical course, treatment) as well as expert experience in diagnosing and clinical care of HIV-2 infected to provide recommendations for a present standard of medical care of HIV- infected in Western European countries, including an overview of strategies for diagnosis, monitoring and treatment, with suggestions for effective drug combinations for first- and second line treatment, post-exposure prophylaxis and prevention of mother-to-child transmission as well as listings of mutations related to HIV-2 drug resistance- and CCR5/CRCX4 co-receptor tropism...

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INTRODUCTION: Programmatic treatment outcome data for people living with HIV-2 in West Africa, where the virus is most prevalent, are scarce. METHODS: HIV-2-infected adults initiating or receiving ART through the Senegalese national AIDS program were invited to participate in this prospective, longitudinal observational cohort study. We analyzed HIV-2 viral loads, CD4 counts, antiretroviral drug resistance, loss to follow up, and mortality. We also examined changes in treatment guidelines over time and assessed progress toward UNAIDS' 90-90-90 targets for HIV-2...

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BACKGROUND: To retrospectively analyze the evolution of clinical features and thin-section CT imaging of novel coronavirus pneumonia (COVID-19) in 17 discharged patients. METHODS: Serial thin-section CT scans of 17 discharged patients with COVID-19 were obtained during recovery. Longitudinal changes of clinical parameters and CT pattern were documented in all patients during 4 weeks since admission. CT score was used to evaluate the extent of the disease. RESULTS: There was a marked improvement of fever, lymphocytes count, C-reactive protein and erythrocyte sedimentation rate within the first two weeks since admission...

BACKGROUND: The outcomes of patients with severe pulmonary blastomycosis requiring mechanical ventilation (MV) is not well understood in the modern era. Limited historical case series have reported 50-90% mortality in patients with Acute Respiratory Distress Syndrome (ARDS) caused by blastomycosis. The objective of this large retrospective cohort study was to describe the risk factors and outcomes of patients with severe pulmonary blastomycosis. METHODS: We performed a retrospective cohort analysis utilizing the Nationwide Inpatient Sample (NIS) from 2006-2014...

INTRODUCTION: Several observational studies have shown decreases in measured influenza vaccine effectiveness (mVE) during influenza seasons. One study found decreases of 6%-11% per month during the 2011-12 to 2014-15 seasons. These findings could indicate waning immunity but could also occur if vaccine effectiveness is stable and vaccine provides partial protection in all vaccinees ("leaky") rather than complete protection in a subset of vaccinees. Since it is not known whether influenza vaccine is leaky, we simulated the 2011-12 to 2014-15 influenza seasons to estimate the potential contribution of leaky vaccine effect to the observed decline in mVE...

Response-adaptive randomization (RAR) has recently gained popularity in clinical trials. The intent is noble: minimize the number of participants randomized to inferior treatments and increase the amount of information about better treatments. Unfortunately, RAR causes many problems, including: 1) bias from temporal trends, 2) inefficiency in treatment effect estimation, 3) volatility in sample size distributions that can cause a nontrivial proportion of trials to assign more patients to an inferior arm, 4) difficulty of validly analyzing results, and 5) the potential for selection bias and other issues inherent from being unblinded to ongoing results...

99DOTS is a cellphone-based strategy for monitoring tuberculosis medication adherence. In a sample of 597 Indian tuberculosis patients, we compared 99DOTS' adherence assessments against results of urine isoniazid tests collected during unannounced home visits. 99DOTS had suboptimal accuracy for measuring adherence, partly due to poor patient engagement with 99DOTS.

BACKGROUND: Demonstration of intrathecal production of Borrelia-specific antibodies (ITAb) is considered the most specific diagnostic marker of Lyme neuroborreliosis (LNB). Limitations include delayed detectabilty in early infection and continued presence long after successful treatment. Markers of active inflammation - increased CSF leukocytes, protein and CXCL13 - provide nonspecific markers of active infection. To assess the utility of CSF CXCL13, we measured its concentration in 132 patients with a broad spectrum of neuroinflammatory disorders, including LNB...

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BACKGROUND: Coronavirus disease 2019 (COVID-19) has become a public health emergency. The widely used reverse transcription PCR (RT-PCR) method has limitations for clinical diagnosis and treatment. METHODS: A total of 323 samples from 76 COVID-19 confirmed patients were analyzed by droplet digital PCR (ddPCR) and RT-PCR based two target genes (ORF1ab and N). Nasal swabs, throat swabs, sputum, blood, and urine were collected. Clinical and imaging data were obtained for clinical staging...

Community-acquired bacterial pneumonia (CABP) remains a significant cause of morbidity and mortality worldwide. Antimicrobial resistance, including in pathogens that cause CABP, continues to spread at an alarming rate. Because of these factors, the development of new antibiotic classes is urgently needed. Lefamulin, previously known as BC-3781, is a semisynthetic pleuromutilin antibiotic that was approved by the Federal Drug Administration for the treatment of CABP in adults. Available in both oral and intravenous (IV) formulations, lefamulin has potent in vitro activity against both typical and atypical CABP pathogens...

BACKGROUND: The novel coronavirus SARS-CoV-2 is a newly emerging virus. The antibody response in infected patient remains largely unknown, and the clinical values of antibody testing have not been fully demonstrated. METHODS: A total of 173 patients with SARS-CoV-2 infection were enrolled. Their serial plasma samples (n=535) collected during the hospitalization were tested for total antibodies (Ab), IgM and IgG against SARS-CoV-2. The dynamics of antibodies with the disease progress was analyzed...

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BACKGROUND: Diagnosis of schistosomiasis remains elusive soon after infection. We evaluated several diagnostic methods in a cluster of travelers simultaneously exposed to freshwater in South Africa. METHODS: Eosinophil count, schistosome antibody tests, stool and urine microscopy, and serum Dra1 PCR assays were performed at week 4-5 (w4-5, early symptomatic phase), week 7-8 (w7-8, praziquantel treatment), and week 12-14 (w12-14, post-treatment). Sequencing was done on serum of 3 patients to identify the species...

BACKGROUND: The Standardized Antimicrobial Administration Ratio (SAAR) is a risk-adjusted metric of antimicrobial use (AU) developed by the CDC in 2015 as a tool for hospital antimicrobial stewardship programs (ASPs) to track and compare AU to a national benchmark. In 2018, CDC updated the SAAR by expanding the locations and antimicrobial categories for which SAARs can be calculated and by modeling adult and pediatric locations separately. METHODS: We identified eligible patient care locations and defined SAAR antimicrobial categories...