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Infect. Dis. Rep., Volume 16, Issue 1 (February 2024) – 10 articles

Cover Story (view full-size image): Cytomegalovirus (CMV) infections are challenging in immunocompromised patients. Until recently, anti-CMV drugs such as (val)ganciclovir (GCV), foscarnet (FOS) and cidofovir (CDV) were all viral DNA polymerase inhibitors. However, these drugs may induce cross-resistance and cause serious side-effects. In 2017, letermovir (LMV) was approved for the prophylaxis of CMV infection in CMV-seropositive adults who received an allogeneic hematopoietic stem cell transplant. Maribavir (MBV) was approved in 2021 for the treatment of adult transplant patients with refractory/resistant CMV disease. LMV targets the CMV terminase complex and prevents viral DNA cleavage and its packaging into capsids. MBV inhibits the pUL97 kinase and interferes with virion maturation. This review provides an update on these novel antiviral drugs for the prevention and treatment of CMV infections in transplant recipients. View this paper
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14 pages, 577 KiB  
Article
Respiratory Syncytial Virus (RSV) and Intention to Recommend RSV Vaccination: A Cross-Sectional Survey of Cardiologists and Cardiac Nurses in Southern Italy
by Domenico Ponticelli, Lorenzo Losa, Ippazio Cosimo Antonazzo, Anna Zampella, Fabio Di Marino, Gaetano Mottola, Mara Noemi Fede, Fortuna Gallucci, Roberto Magliuolo, Antonio Rainone, Antonella Arcari, Carmine Del Giudice and Pietro Ferrara
Infect. Dis. Rep. 2024, 16(1), 128-141; https://doi.org/10.3390/idr16010010 - 15 Feb 2024
Viewed by 1019
Abstract
As respiratory syncytial virus (RSV) vaccine distribution gains traction in Europe and Italy, healthcare workers (HCWs) can strategize about vaccine promotion to increase uptake among patients at risk of RSV consequences, such cardiac patients. This cross-sectional survey investigated the knowledge about and attitude [...] Read more.
As respiratory syncytial virus (RSV) vaccine distribution gains traction in Europe and Italy, healthcare workers (HCWs) can strategize about vaccine promotion to increase uptake among patients at risk of RSV consequences, such cardiac patients. This cross-sectional survey investigated the knowledge about and attitude towards RSV and RSV vaccines, and the intention to recommend vaccination within a cardiological hospital in Italy. To explore factors associated with the outcomes of interest, multivariate logistic regression analyses were conducted. Of 197 invited HCWs, 78.2% returned the survey. The knowledge about market authorisation for new RSV vaccines for older adults (present in 46.9% of respondents) was significantly associated with the HCWs’ age, education, and previous update on vaccinations. HCWs with a higher educational level and those with a positive attitude towards RSV vaccines safety reported a higher attitude towards the importance of vaccinating people at risk. The willingness of recommending RSV vaccination to patients (70.5% of respondents) was more likely in HCWs who were knowledgeable about market authorisation for RSV vaccines and in physicians. This tempestive research sheds light on current factors influencing the strategies of cardiac HCWs regarding RSV vaccination. The results suggest the need for training events on the protective role of RSV vaccination in cardiac patients. Full article
(This article belongs to the Special Issue Global Burden of Respiratory Syncytial Virus)
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12 pages, 2400 KiB  
Article
Impact of the COVID-19 Pandemic Surveillance of Visceral Leishmaniasis in Brazil: An Ecological Study
by Josefa Rayane Santos Silveira, Shirley Verônica Melo Almeida Lima, Allan Dantas dos Santos, Luana Silva Siqueira, Guilherme Reis de Santana Santos, Álvaro Francisco Lopes de Sousa, Layze Braz de Oliveira, Isabel Amélia Costa Mendes and Caíque Jordan Nunes Ribeiro
Infect. Dis. Rep. 2024, 16(1), 116-127; https://doi.org/10.3390/idr16010009 - 09 Feb 2024
Viewed by 711
Abstract
The aim of the study was to assess the impact of the COVID-19 pandemic on the notification of new VL cases in Brazil in 2020. It is an ecological and time-series study (2015–2020) with spatial analysis techniques, whose units of analysis were the [...] Read more.
The aim of the study was to assess the impact of the COVID-19 pandemic on the notification of new VL cases in Brazil in 2020. It is an ecological and time-series study (2015–2020) with spatial analysis techniques, whose units of analysis were the 5570 Brazilian municipalities. The study population consisted of all new cases of VL recorded between 2015 and 2020. The P-score was calculated to estimate the percentage variation in new VL cases. Global and local univariate Moran’s Indices and retrospective space–time scan statistics were used in spatial and space–time analyses, respectively. It was expected that there would be 3627 new cases of VL in Brazil in 2020, but 1932 cases were reported (−46.73%). All Brazilian regions presented a negative percentage variation in the registration of new VL cases, with the Southeast (−54.70%), North (−49.97%), and Northeast (−44.22%) standing out. There was spatial dependence of the disease nationwide in both periods, before and during the first year of the COVID-19 pandemic. There was a significant reduction in the incidence of new VL cases in Brazil during the first year of the COVID-19 pandemic. These findings reinforce the need for better preparedness of the health system, especially in situations of new epidemics. Full article
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11 pages, 1489 KiB  
Article
A Simple Risk Formula for the Prediction of COVID-19 Hospital Mortality
by Jiří Plášek, Jozef Dodulík, Petr Gai, Barbora Hrstková, Jan Škrha, Jr., Lukáš Zlatohlávek, Renata Vlasáková, Peter Danko, Petr Ondráček, Eva Čubová, Bronislav Čapek, Marie Kollárová, Tomáš Fürst and Jan Václavík
Infect. Dis. Rep. 2024, 16(1), 105-115; https://doi.org/10.3390/idr16010008 - 29 Jan 2024
Viewed by 677
Abstract
SARS-CoV-2 respiratory infection is associated with significant morbidity and mortality in hospitalized patients. We aimed to assess the risk factors for hospital mortality in non-vaccinated patients during the 2021 spring wave in the Czech Republic. A total of 991 patients hospitalized between January [...] Read more.
SARS-CoV-2 respiratory infection is associated with significant morbidity and mortality in hospitalized patients. We aimed to assess the risk factors for hospital mortality in non-vaccinated patients during the 2021 spring wave in the Czech Republic. A total of 991 patients hospitalized between January 2021 and March 2021 with a PCR-confirmed SARS-CoV-2 acute respiratory infection in two university hospitals and five rural hospitals were included in this analysis. After excluding patients with unknown outcomes, 790 patients entered the final analyses. Out of 790 patients included in the analysis, 282/790 (35.7%) patients died in the hospital; 162/790 (20.5) were male and 120/790 (15.2%) were female. There were 141/790 (18%) patients with mild, 461/790 (58.3%) with moderate, and 187/790 (23.7%) with severe courses of the disease based mainly on the oxygenation status. The best-performing multivariate regression model contains only two predictors—age and the patient’s state; both predictors were rendered significant (p < 0.0001). Both age and disease state are very significant predictors of hospital mortality. An increase in age by 10 years raises the risk of hospital mortality by a factor of 2.5, and a unit increase in the oxygenation status raises the risk of hospital mortality by a factor of 20. Full article
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12 pages, 502 KiB  
Review
The Subcutaneous Administration of Beta-Lactams: A Case Report and Literary Review—To Do Small Things in a Great Way
by Gabriele Maria Leanza, Beatrice Liguoro, Simone Giuliano, Chiara Moreal, Luca Montanari, Jacopo Angelini, Tommaso Cai, Rita Murri and Carlo Tascini
Infect. Dis. Rep. 2024, 16(1), 93-104; https://doi.org/10.3390/idr16010007 - 29 Jan 2024
Viewed by 600
Abstract
The subcutaneous (s.c.) route is a commonly used method for delivering various drugs, although its application in the administration of antibiotics is relatively uncommon. In this case, we report a successful treatment of nosocomial pneumonia using piperacillin/tazobactam via continuous subcutaneous administration. Furthermore, this [...] Read more.
The subcutaneous (s.c.) route is a commonly used method for delivering various drugs, although its application in the administration of antibiotics is relatively uncommon. In this case, we report a successful treatment of nosocomial pneumonia using piperacillin/tazobactam via continuous subcutaneous administration. Furthermore, this article provides an overview of the current literature regarding the s.c. administration of beta-lactam antibiotics. Based on our analysis, we identified only 15 studies that described the s.c. use of beta-lactam antibiotics in human subjects. Among these studies, cephalosporins were the most extensively investigated antibiotic class, with 10 available studies. According to the study findings, all three antibiotic classes (cephalosporins, penicillins, and carbapenems) demonstrated a similar pharmacokinetic profile when administered via the subcutaneous route. The subcutaneous route appears to be associated with a lower peak serum concentration (Cmax) but a comparable minimum blood concentration (Cmin) and an extended half-life (t1/2) when compared to conventional routes of antibiotic administration. Further research is necessary to determine whether subcutaneously administered beta-lactam antibiotics in human subjects achieve pharmacodynamic targets and demonstrate clinical efficacy. Full article
(This article belongs to the Section Bacterial Diseases)
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10 pages, 547 KiB  
Brief Report
Characterization of Lophomonas spp. Infection in a Population of Critical Care Patients
by Francisco das Neves Coelho, João Borralho, Teresa Baptista-Fernandes, Cristina Toscano and Maria Eduarda Carmo
Infect. Dis. Rep. 2024, 16(1), 83-92; https://doi.org/10.3390/idr16010006 - 26 Jan 2024
Viewed by 1915
Abstract
Lophomonas are flagellated protozoa that have been increasingly associated with upper and lower airway infection in humans. The prevalence and characterization of this disease in the critically ill remains poorly understood. We present a series of eleven ICU patients with confirmed Lophomonas spp. [...] Read more.
Lophomonas are flagellated protozoa that have been increasingly associated with upper and lower airway infection in humans. The prevalence and characterization of this disease in the critically ill remains poorly understood. We present a series of eleven ICU patients with confirmed Lophomonas spp. identification in respiratory samples. Full article
(This article belongs to the Section Parasitological Diseases)
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18 pages, 1628 KiB  
Review
Management of Cytomegalovirus Infections in the Era of the Novel Antiviral Players, Letermovir and Maribavir
by Jocelyne Piret and Guy Boivin
Infect. Dis. Rep. 2024, 16(1), 65-82; https://doi.org/10.3390/idr16010005 - 18 Jan 2024
Viewed by 1104
Abstract
Cytomegalovirus (CMV) infections may increase morbidity and mortality in immunocompromised patients. Until recently, standard antiviral drugs against CMV were limited to viral DNA polymerase inhibitors (val)ganciclovir, foscarnet and cidofovir with a risk for cross-resistance. These drugs may also cause serious side effects. This [...] Read more.
Cytomegalovirus (CMV) infections may increase morbidity and mortality in immunocompromised patients. Until recently, standard antiviral drugs against CMV were limited to viral DNA polymerase inhibitors (val)ganciclovir, foscarnet and cidofovir with a risk for cross-resistance. These drugs may also cause serious side effects. This narrative review provides an update on new antiviral agents that were approved for the prevention and treatment of CMV infections in transplant recipients. Letermovir was approved in 2017 for CMV prophylaxis in CMV-seropositive adults who received an allogeneic hematopoietic stem cell transplant. Maribavir followed four years later, with an indication in the treatment of adult and pediatric transplant patients with refractory/resistant CMV disease. The target of letermovir is the CMV terminase complex (constituted of pUL56, pUL89 and pUL51 subunits). Letermovir prevents the cleavage of viral DNA and its packaging into capsids. Maribavir is a pUL97 kinase inhibitor, which interferes with the assembly of capsids and the egress of virions from the nucleus. Both drugs have activity against most CMV strains resistant to standard drugs and exhibit favorable safety profiles. However, high-level resistance mutations may arise more rapidly in the UL56 gene under letermovir than low-grade resistance mutations. Some mutations emerging in the UL97 gene under maribavir can be cross-resistant with ganciclovir. Thus, letermovir and maribavir now extend the drug arsenal available for the management of CMV infections and their respective niches are currently defined. Full article
(This article belongs to the Special Issue Prevention, Diagnosis and Treatment of Infectious Diseases)
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30 pages, 2948 KiB  
Article
An Epidemic Model with Infection Age and Vaccination Age Structure
by Glenn Webb and Xinyue Evelyn Zhao
Infect. Dis. Rep. 2024, 16(1), 35-64; https://doi.org/10.3390/idr16010004 - 10 Jan 2024
Viewed by 905
Abstract
A model of epidemic dynamics is developed that incorporates continuous variables for infection age and vaccination age. The model analyzes pre-symptomatic and symptomatic periods of an infected individual in terms of infection age. This property is shown to be of major importance in [...] Read more.
A model of epidemic dynamics is developed that incorporates continuous variables for infection age and vaccination age. The model analyzes pre-symptomatic and symptomatic periods of an infected individual in terms of infection age. This property is shown to be of major importance in the severity of the epidemic, when the infectious period of an infected individual precedes the symptomatic period. The model also analyzes the efficacy of vaccination in terms of vaccination age. The immunity to infection of vaccinated individuals varies with vaccination age and is also of major significance in the severity of the epidemic. Application of the model to the 2003 SARS epidemic in Taiwan and the COVID-19 epidemic in New York provides insights into the dynamics of these diseases. It is shown that the SARS outbreak was effectively contained due to the complete overlap of infectious and symptomatic periods, allowing for the timely isolation of affected individuals. In contrast, the pre-symptomatic spread of COVID-19 in New York led to a rapid, uncontrolled epidemic. These findings underscore the critical importance of the pre-symptomatic infectious period and the vaccination strategies in influencing the dynamics of an epidemic. Full article
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9 pages, 707 KiB  
Brief Report
Effect of Different Approaches to Antimicrobial Therapy with Cefmetazole and Meropenem on the Time to Defervescence in Non-Severe Extended-Spectrum β-Lactamase-Producing Escherichia coli Bacteremia
by Takanobu Hoshi, Satoshi Fujii, Kei Watanabe, Yuta Fukumura, Koji Miyazaki, Madoka Takahashi, Sakae Taniguchi, Shingo Kimura, Arisa Saito, Naoki Wada, Masaji Saijo, Kazunori Yamada, Kuninori Iwayama, Marie Itaya and Hideki Sato
Infect. Dis. Rep. 2024, 16(1), 26-34; https://doi.org/10.3390/idr16010003 - 27 Dec 2023
Viewed by 792
Abstract
Carbapenems are antimicrobial agents commonly used to treat extended-spectrum β-lactamase (ESBL)-producing bacteria. Although cefmetazole (CMZ) is considered effective for ESBL-producing Escherichia coli (ESBL-EC) bacteremia, previous studies showed its limitations, including the influence of the initial antimicrobial agent. Here, we examined the effects of [...] Read more.
Carbapenems are antimicrobial agents commonly used to treat extended-spectrum β-lactamase (ESBL)-producing bacteria. Although cefmetazole (CMZ) is considered effective for ESBL-producing Escherichia coli (ESBL-EC) bacteremia, previous studies showed its limitations, including the influence of the initial antimicrobial agent. Here, we examined the effects of different approaches to antimicrobial therapy with CMZ and meropenem (MEPM) on the time to defervescence in ESBL-EC bacteremia. Notably, the influence of previous antimicrobial agents was excluded. Inpatients with ESBL-EC detected in blood cultures between April 2018 and March 2023 were included and assigned to CMZ (n = 14), MEPM (n = 8), de-escalation to CMZ (dCMZ; n = 9), or escalation to MEPM (eMEPM; n = 11) groups. The median time to defervescence was 3.5, 1.0, 2.0, and 4.0 days in the CMZ, MEPM, dCMZ, and eMEPM groups, respectively, with no significant differences. Cox proportional hazards analysis showed a significant difference in the hazard ratio (95% confidence interval) of 0.378 (0.145–0.984) for the time to defervescence with CMZ versus MEPM (p = 0.046). The extent of a delayed time to defervescence is greater with early CMZ administration than with MEPM administration in patients with non-severe ESBL-EC bacteremia. Full article
(This article belongs to the Section Antimicrobial Stewardship)
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13 pages, 983 KiB  
Article
Urea/Creatinine Ratio’s Correlation with Creatine Kinase Normalization in Pediatric COVID-19 Patients with Myositis: Evaluating Prognostic and Predictive Value
by Francesco Pizzo, Andrea Marino, Alessandra Di Nora, Serena Spampinato, Giovanni Cacciaguerra, Giuseppe Costanza, Federica Scarlata, Arturo Biasco, Maria Chiara Consentino, Riccardo Lubrano, Bruno Cacopardo, Giuseppe Nunnari, Martino Ruggieri and Piero Pavone
Infect. Dis. Rep. 2024, 16(1), 13-25; https://doi.org/10.3390/idr16010002 - 25 Dec 2023
Viewed by 829
Abstract
Coronavirus disease 2019 (COVID-19) has been chiefly linked with substantial respiratory complications. However, emerging studies have brought attention to the occurrence of severe muscle inflammation (myositis) related to COVID-19, potentially leading to multi-organ failure and increased mortality. Myositis is generally characterized by heightened [...] Read more.
Coronavirus disease 2019 (COVID-19) has been chiefly linked with substantial respiratory complications. However, emerging studies have brought attention to the occurrence of severe muscle inflammation (myositis) related to COVID-19, potentially leading to multi-organ failure and increased mortality. Myositis is generally characterized by heightened serum creatine kinase (CK) levels. Acute myositis is characterized by an infiltration of viruses into calf muscle fibers, which may cause a subsequent inflammatory response leading to calf muscle pain. Symptomatic and supportive management, along with explanation and reassurance, is all that is required in managing this condition. While the association between myositis and severe outcomes has been recognized in adults, it remains less understood in the pediatric population. The current retrospective study, conducted at Policlinico San Marco University Hospital in Catania, aimed to analyze clinical and laboratory factors associated with myositis in pediatric patients with SARS-CoV-2 infection. Between January 2022 and January 2023, ten pediatric patients diagnosed with myositis and SARS-CoV-2 infection were evaluated. The study highlighted clinical manifestations such as fever, calf muscle pain, and abnormal gait. Lab results showed elevated CK levels among other findings. All patients underwent treatment, with the majority recovering without complications. A notable correlation was observed between CK levels, blood urea nitrogen (BUN), and the urea/creatinine ratio (UCR). The study also discusses potential pathophysiological mechanisms behind SARS-CoV-2’s impact on skeletal muscles, emphasizing an indirect inflammatory response. Our findings underscore that while myositis in children with SARS-CoV-2 infection appears to follow a benign and self-limiting trajectory, it is crucial to monitor specific markers for early intervention and management. Further research is warranted to elucidate the underlying mechanisms and improve clinical outcomes. Full article
(This article belongs to the Section Viral Infections)
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12 pages, 2882 KiB  
Article
Trends and Spatiotemporal Patterns of Avian Influenza Outbreaks in Italy: A Data-Driven Approach
by Francesco Branda, Sandra Mazzoli, Massimo Pierini and Massimo Ciccozzi
Infect. Dis. Rep. 2024, 16(1), 1-12; https://doi.org/10.3390/idr16010001 - 19 Dec 2023
Cited by 1 | Viewed by 1067
Abstract
In recent years, the unprecedented spread of the Avian Influenza Viruses (AIVs) among birds and mammals has caused devastation in animal populations, including poultry, wild birds, and some mammals, damaging farmers’ livelihoods and the food trade. Given the urgency of the situation, it [...] Read more.
In recent years, the unprecedented spread of the Avian Influenza Viruses (AIVs) among birds and mammals has caused devastation in animal populations, including poultry, wild birds, and some mammals, damaging farmers’ livelihoods and the food trade. Given the urgency of the situation, it is particularly important that scientists and the public can access research results and data as soon as possible. The main aim of this study is to present a global open-access dataset of Avian Influenza outbreaks to enable researchers and policymakers (i) to rapidly detect, and respond to animal outbreaks as the first line of defense; (ii) to conduct epidemiological and virological investigations around animal outbreaks and human infections; and (iii) to communicate the risk. We show the potential use of this dataset to the research community by analyzing the most updated information on past and current Highly Pathogenic Avian Influenza (HPAI) outbreaks in domestic poultry and wild birds over the period from October 2021 to July 2023 in Italy. In addition, we applied indices borrowed from Economics (such as Homogeneity, Specialization, and Location Index) to the wild birds dataset to show their possible usage in epidemiology. Full article
(This article belongs to the Section Infection Prevention and Control)
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