Journal of Clinical Medicine

Editorial

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5 pages, 175 KiB

Open AccessEditorial

Clinical Aspects of Infectious Diseases

by Yasir Waheed

J. Clin. Med. 2024, 13(16), 4853; https://doi.org/10.3390/jcm13164853 - 16 Aug 2024

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Abstract

Infectious diseases are illnesses caused by harmful pathogens, including viruses, bacteria, fungi, and parasites [...] Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

Research

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11 pages, 672 KiB

Open AccessArticle

Measles—Clinical and Biological Manifestations in Adult Patients, Including a Focus on the Hepatic Involvement: Results from a Single-Center Observational Cohort Study from Romania

by Victoria Bîrluțiu and Rares-Mircea Bîrluțiu

J. Clin. Med. 2024, 13(18), 5535; https://doi.org/10.3390/jcm13185535 - 18 Sep 2024

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Abstract

Background: Hepatic involvement in measles, particularly among adolescents and adults, has been recognized since 1960. This involvement typically manifests during the eruptive phase of the disease and is primarily characterized by hepatocellular dysfunction, with jaundice being a less common occurrence. Studies have [...] Read more.

Background: Hepatic involvement in measles, particularly among adolescents and adults, has been recognized since 1960. This involvement typically manifests during the eruptive phase of the disease and is primarily characterized by hepatocellular dysfunction, with jaundice being a less common occurrence. Studies have reported hepatic involvement in 80–86% of measles cases among young adults associated with severe forms of the disease with intra-infectious hepatitis. Recent data from Romania indicated 20,035 confirmed measles cases between January and June 2024, including 17 fatalities and significant hepatic alterations. These findings underscore the need for the further investigation of the hepatic manifestations of measles. The primary objective of our study was to evaluate the clinical and baseline characteristics of the enrolled patients with a brief assessment of liver impairment. Methods: In light of these observations, we conducted a retrospective analysis between 1 November 2023 and 15 June 2024 in patients aged >16 years who were confirmed, by the detection of measles IgM in serum samples, to have acute measles infection and hospitalization. Results: During the study period, 71 hospitalized patients were diagnosed with measles, of whom 37 were female (52.1%), with ages ranging from 16 to 64 years (mean age 34.21 years). Most cases (77.5%) exhibited moderate clinical forms of measles, while 22.5% had severe forms. Respiratory failure requiring oxygen therapy was uncommon (25.4% of severe pneumonia cases). Although a Pearson chi-square test indicated no significant association between the presence of pneumonia and clinical form (p = 0.066), the likelihood ratio test suggested a potential link (p = 0.018). Hepatic involvement was common with elevated AST (87.3%) and ALT (76%) levels. Jaundice was observed in 12.7% of patients. GGT changes were noted in 35.2% of cases, with significant correlations between GGT levels and disease severity (p = 0.001). Analysis of various symptoms revealed significant associations between nausea, dyspnea, and severe clinical forms. Anorexia, diarrhea, and nausea were the most frequently reported symptoms. Thrombocytopenia was observed in 11 patients, with no significant correlation with disease severity. Comorbidities, such as COPD, were significantly associated with disease severity (p = 0.010). Conclusions: Our findings highlight that, while cytolytic hepatic damage is a typical response to measles infection, cholestatic involvement may serve as an indicator of more severe disease progression. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

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14 pages, 1758 KiB

Open AccessArticle

Maternal–Fetal Transfer of Anti-SARS-CoV-2 Antibodies in Amniotic Fluid: Insights from Maternal Vaccination and COVID-19 Infection

by Inshirah Sgayer, Marwan Odeh, Meital Gal-Tanamy, Mona Shehadeh, Hagai Rechnitzer, Yousef Haddad, Rudi Hamoudi, Nisreen Kinaani Mousa, Vivian Abu Uksa Dakwar, Maya Frank Wolf, Tzipora C. Falik Zaccai and Lior Lowenstein

J. Clin. Med. 2024, 13(17), 5023; https://doi.org/10.3390/jcm13175023 - 25 Aug 2024

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Abstract

Objectives: As the COVID-19 pandemic wanes, understanding maternal–fetal antibody transfer remains crucial for optimizing vaccination strategies. This study evaluates anti-SARS-CoV-2 antibody levels in amniotic fluid following maternal BNT162b2 mRNA vaccination and/or COVID-19 infection during early pregnancy, focusing on the first and second [...] Read more.

Objectives: As the COVID-19 pandemic wanes, understanding maternal–fetal antibody transfer remains crucial for optimizing vaccination strategies. This study evaluates anti-SARS-CoV-2 antibody levels in amniotic fluid following maternal BNT162b2 mRNA vaccination and/or COVID-19 infection during early pregnancy, focusing on the first and second trimesters. Methods: A retrospective cohort study was conducted at a tertiary university-affiliated hospital, involving 149 pregnant women who underwent amniocentesis. Anti-SARS-CoV-2 spike IgG levels were measured in amniotic fluid samples. Participants were categorized based on vaccination and infection status: vaccine-only, infection-only, vaccine + infection, and no vaccine/infection. Correlations between antibody levels and the time since vaccination or infection were analyzed. Results: The vaccine + infection group had a higher proportion of positive antibody levels compared to the vaccine-only group (63.6% vs. 35.9%, p = 0.029). Median SARS-CoV-2 IgG levels were significantly higher in the vaccine + infection group (283.0 AU/mL) than in the vaccine-only group (64.1 AU/mL, p = 0.006). Women who received three vaccine doses had higher antibody levels and more positive antibody rates compared to those with one or two doses. A significant negative correlation was found between antibody levels and the interval since the last vaccine dose or infection. Conclusions: Our results indicate the presence of anti-SARS-CoV-2 antibodies in the amniotic fluid, reflecting antibody transfer during early pregnancy. However, a noticeable decrease in immunity was observed, as indicated by declining amniotic fluid antibody levels over time. Further studies are needed to determine the optimal timing and number of boosters required to protect against new variants of SARS-CoV-2. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

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15 pages, 923 KiB

Open AccessArticle

Infections with Klebsiella pneumoniae in Children Undergoing Anticancer Therapy or Hematopoietic Cell Transplantation: A Multicenter Nationwide Study

by Alicja Sękowska, Krzysztof Czyżewski, Kamila Jaremek, Patrycja Zalas-Więcek, Olga Zając-Spychała, Jacek Wachowiak, Anna Szmydki-Baran, Łukasz Hutnik, Agnieszka Gietka, Olga Gryniewicz-Kwiatkowska, Bożenna Dembowska-Bagińska, Katarzyna Semczuk, Katarzyna Dzierżanowska-Fangrat, Wojciech Czogała, Walentyna Balwierz, Iwona Żak, Renata Tomaszewska, Tomasz Szczepański, Ewa Bień, Ninela Irga-Jaworska, Katarzyna Machnik, Justyna Urbańska-Rakus, Sonia Pająk, Marcin Płonowski, Maryna Krawczuk-Rybak, Aleksandra Królak, Tomasz Ociepa, Tomasz Urasiński, Paweł Wawryków, Jarosław Peregud-Pogorzelski, Tomasz Brzeski, Katarzyna Mycko, Hanna Mańko-Glińska, Wanda Badowska, Agnieszka Urbanek-Dądela, Grażyna Karolczyk, Weronika Stolpa, Katarzyna Skowron-Kandzia, Agnieszka Mizia-Malarz, Filip Pierlejewski, Wojciech Młynarski, Jakub Musiał, Radosław Chaber, Joanna Zawitkowska, Agnieszka Zaucha-Prażmo, Katarzyna Drabko, Jolanta Goździk, Jowita Frączkiewicz, Małgorzata Salamonowicz-Bodzioch, Krzysztof Kałwak and Jan Styczyński Show full author list Hide full author list

J. Clin. Med. 2024, 13(14), 4078; https://doi.org/10.3390/jcm13144078 - 12 Jul 2024

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Abstract

Background: Klebsiella pneumoniae is a nosocomial pathogen that causes severe infections in immunocompromised patients. The aim of the study was to conduct a microbiological and clinical analysis of K. pneumoniae infections in children with malignancies or undergoing hematopoietic cell transplantation in Poland. [...] Read more.

Background: Klebsiella pneumoniae is a nosocomial pathogen that causes severe infections in immunocompromised patients. The aim of the study was to conduct a microbiological and clinical analysis of K. pneumoniae infections in children with malignancies or undergoing hematopoietic cell transplantation in Poland. Methods: We conducted a retrospective, multicenter study including children and adolescents under 19 years old treated between 2012 and 2021. We analyzed patients’ characteristics, microbiological data, and the outcomes of antibiotic therapy. Results: A total of 9121 newly diagnosed children were treated for malignancy and 1697 pediatric patients underwent hematopoietic cell transplantation. K. pneumoniae infections were diagnosed in 527 patients. Their overall incidence was 4.86% in pediatric hematology and oncology patients and 4.95% in patients who underwent hematopoietic cell transplantation. The incidence of infection was higher in patients with acute leukemia than with solid tumors (7.8% vs. 4.1%; OR = 2.0; 95% CI = 1.6–2.4; p < 0.0001). The most frequent source of infection was in the urinary tract at 55.2%. More than 57% of K. pneumoniae strains were extended-spectrum β-lactamase-positive and almost 34% were multidrug-resistant. Infections with K. pneumoniae contributed to death in 3.22% of patients. Conclusions: K. pneumoniae is one of the most critical pathogens in children suffering from malignancies or undergoing hematopoietic cell transplantation. The incidence of multidrug-resistant K. pneumoniae strains is increasing and contributing to poor clinical outcome. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

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11 pages, 1179 KiB

Open AccessArticle

The Diagnostic Accuracy of Procalcitonin and Its Combination with Other Biomarkers for Candidemia in Critically Ill Patients

by Stelios Kokkoris, Epameinondas Angelopoulos, Aikaterini Gkoufa, Foteini Christodouli, Theodora Ntaidou, Evangelia Theodorou, Georgia Dimopoulou, Ioannis Vasileiadis, Panagiotis Kremmydas and Christina Routsi

J. Clin. Med. 2024, 13(12), 3557; https://doi.org/10.3390/jcm13123557 - 18 Jun 2024

Cited by 1 | Viewed by 1070

Abstract

Background: The aim of this study was to investigate the usefulness of serum procalcitonin (PCT), C-reactive protein (CRP), neutrophil to lymphocyte count ratio (NLR), and their combination, in distinguishing candidemia from bacteremia in intensive care unit (ICU) patients. Methods: This is a retrospective [...] Read more.

Background: The aim of this study was to investigate the usefulness of serum procalcitonin (PCT), C-reactive protein (CRP), neutrophil to lymphocyte count ratio (NLR), and their combination, in distinguishing candidemia from bacteremia in intensive care unit (ICU) patients. Methods: This is a retrospective study in ICU patients with documented bloodstream infections (BSIs) and with both serum PCT and CRP measurements on the day of the positive blood sample. Illness severity was assessed by sequential organ failure assessment (SOFA) score on both admission and BSI day. Demographic, clinical, and laboratory data, including PCT and CRP levels and NLR on the day of the BSI, were recorded. Results: A total of 63 patients were included in the analysis, of whom 32 had bacteremia and 31 had candidemia. PCT, CRP, and NLR values were all significantly lower in candidemia compared with bacteremia (0.29 (0.14–0.69) vs. 1.73 (0.5–6.9) ng/mL, p < 0.001, 6.3 (2.4–11.8) vs. 19 (10.7–24.8) mg/dl, p < 0.001 and 6 (3.7–8.6) vs. 9.8 (5.3–16.3), p = 0.001, respectively). PCT was an independent risk factor for candidemia diagnosis (OR 0.153, 95%CI: 0.04–0.58, p = 0.006). A multivariable model consisting of the above three variables had better predictive ability (AUC-ROC = 0.88, p < 0.001), for candidemia diagnosis, as compared to that of PCT, CRP, and NLR, whose AUC-ROCs were all lower (0.81, p < 0.001, 0.78, p < 0.001, and 0.68, p = 0.015, respectively). Conclusions: A combination of routinely available laboratory tests, such as PCT, CRP, and NLR, could prove useful for the early identification of ICU patients with candidemia. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

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10 pages, 1364 KiB

Open AccessArticle

Hospitalizations for Acute Otitis and Sinusitis in Patients Living with HIV: A Retrospective Analysis of a Tertiary Center in Romania

by Vlad Ștefan Pleșca, Victor Daniel Miron, Adrian Gabriel Marinescu, Anca Cristina Drăgănescu, Anca Doina Pleșca, Oana Săndulescu, Cătălina Voiosu, Răzvan Hainăroșie and Anca Streinu-Cercel

J. Clin. Med. 2024, 13(11), 3346; https://doi.org/10.3390/jcm13113346 - 6 Jun 2024

Cited by 1 | Viewed by 825

Abstract

Background/Objectives: Acute or chronic ear, nose and throat (ENT) conditions in people living with HIV can lead to hospitalization and affect their quality of life. The aim of our study was to determine the frequency and characteristics of hospitalizations for acute sinusitis (AS) [...] Read more.

Background/Objectives: Acute or chronic ear, nose and throat (ENT) conditions in people living with HIV can lead to hospitalization and affect their quality of life. The aim of our study was to determine the frequency and characteristics of hospitalizations for acute sinusitis (AS) and acute otitis (AO) in people living with HIV. Methods: We performed a retrospective analysis over the course of six years (from January 2018 to December 2023), assessing all hospitalizations for AS and/or AO occurring in patients living with HIV, at the largest infectious diseases hospital in Romania. Results: We identified a total of 179 cases, among which 149 cases (83.2%) were attributed to AS and 41 cases (22.9%) were due to AO. Among cases of AS, maxillary sinuses were most frequently involved (n = 140/149, 94.0%), and among cases of AO, acute congestive otitis media (n = 14, 34.1%) and acute purulent otitis media (n = 13, 31.7%) were the most common forms. The underlying HIV infection was classified as stage C3 in 57.5% of cases. In 19.6% of cases, it was possible to identify either the trigger or the etiological agent, and the most frequent bacterial pathogens were Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae and Pseudomonas aeruginosa. Conclusions: In conclusion, this study highlights that hospitalizations due to acute sinus and ear involvement are not isolated events in people living with HIV. A prospective follow-up is needed to gain a deeper and more dynamic understanding of how ENT health is affected in people with HIV infection. Furthermore, promoting prevention through vaccination may reduce to a certain extent the burden of ENT infections in this population. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

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16 pages, 1638 KiB

Open AccessFeature PaperArticle

The German Multicenter Registry for ME/CFS (MECFS-R)

by Hannah Hieber, Rafael Pricoco, Katrin Gerrer, Cornelia Heindrich, Katharina Wiehler, Lorenz L. Mihatsch, Matthias Haegele, Daniela Schindler, Quirin Donath, Catharina Christa, Annika Grabbe, Alissa Kircher, Ariane Leone, Yvonne Mueller, Hannah Zietemann, Helma Freitag, Franziska Sotzny, Cordula Warlitz, Silvia Stojanov, Daniel B. R. Hattesohl, Anna Hausruckinger, Kirstin Mittelstrass, Carmen Scheibenbogen and Uta Behrends Show full author list Hide full author list

J. Clin. Med. 2024, 13(11), 3168; https://doi.org/10.3390/jcm13113168 - 28 May 2024

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Abstract

Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating multisystemic disease characterized by a complex, incompletely understood etiology. Methods: To facilitate future clinical and translational research, a multicenter German ME/CFS registry (MECFS-R) was established to collect comprehensive, longitudinal, clinical, epidemiological, and laboratory data [...] Read more.

Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating multisystemic disease characterized by a complex, incompletely understood etiology. Methods: To facilitate future clinical and translational research, a multicenter German ME/CFS registry (MECFS-R) was established to collect comprehensive, longitudinal, clinical, epidemiological, and laboratory data from adults, adolescents, and children in a web-based multilayer-secured database. Results: Here, we present the research protocol and first results of a pilot cohort of 174 ME/CFS patients diagnosed at two specialized tertiary fatigue centers, including 130 (74.7%) adults (mean age 38.4; SD 12.6) and 43 (25.3%) pediatric patients (mean age 15.5; SD 4.2). A viral trigger was identified in 160/174 (92.0%) cases, with SARS-CoV-2 in almost half of them. Patients exhibited severe functional and social impairment, as reflected by a median Bell Score of 30.0 (IQR 30.0 to 40.0) and a poor health-related quality of life assessed with the Short Form-36 health survey, resulting in a mean score of 40.4 (SD 20.6) for physical function and 59.1 (SD 18.8) for mental health. Conclusions: The MECFS-R provides important clinical information on ME/CFS to research and healthcare institutions. Paired with a multicenter biobank, it facilitates research on pathogenesis, diagnostic markers, and treatment options. Trial registration: ClinicalTrials.gov NCT05778006. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

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13 pages, 717 KiB

Open AccessArticle

The Diagnostic Accuracy of Procalcitonin, Soluble Urokinase-Type Plasminogen Activator Receptors, and C-Reactive Protein in Diagnosing Urinary Tract Infections in the Emergency Department—A Diagnostic Accuracy Study

by Mathias Amdi Hertz, Isik Somuncu Johansen, Flemming S. Rosenvinge, Claus Lohman Brasen, Eline Sandvig Andersen, Anne Heltborg, Thor Aage Skovsted, Eva Rabing Brix Petersen, Mariana Bichuette Cartuliares, Stig Lønberg Nielsen, Christian Backer Mogensen and Helene Skjøt-Arkil

J. Clin. Med. 2024, 13(6), 1776; https://doi.org/10.3390/jcm13061776 - 20 Mar 2024

Cited by 1 | Viewed by 1349

Abstract

Background: Urinary tract infections (UTIs) are a leading bacterial infection in the emergency department (ED). Diagnosing UTIs in the ED can be challenging due to the heterogeneous presentation; therefore, fast and precise tests are needed. We aimed to evaluate the diagnostic precision [...] Read more.

Background: Urinary tract infections (UTIs) are a leading bacterial infection in the emergency department (ED). Diagnosing UTIs in the ED can be challenging due to the heterogeneous presentation; therefore, fast and precise tests are needed. We aimed to evaluate the diagnostic precision of procalcitonin (PCT), soluble urokinase plasminogen activator receptors (suPARs), and C-reactive protein (CRP) in diagnosing UTIs, grading the severity of UTIs, and ruling out bacteremia. Methods: We recruited adults admitted to three Danish EDs with suspected UTIs. PCT, suPAR, and CRP were used in index tests, while blood cultures, expert panel diagnosis, and severity grading were used in the reference tests. Logistic regression and area under the receiver operator characteristic curves (AUROCs) were utilized to evaluate the models and determine the optimal cut-offs. Results: We enrolled 229 patients. PCT diagnosed UTI with an AUROC of 0.612, detected severe disease with an AUROC of 0.712, and ruled out bacteremia with an AUROC of 0.777. SuPAR had AUROCs of 0.480, 0.638, and 0.605, while CRP had AUROCs of 0.599, 0.778, and 0.646. Conclusions: The diagnostic performance of PCT, suPAR, or CRP for UTIs or to rule out severe disease was poor. However, PCT can safely rule out bacteremia in clinically relevant numbers in ED patients suspected of UTI. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

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20 pages, 1597 KiB

Open AccessArticle

Intraspinal and Intracranial Neurotuberculosis, Clinical and Imaging Characteristics and Outcomes in Hospitalized Patients: A Cohort Study (2000–2022)

by Ana Luisa Corona-Nakamura, Martha Judith Arias-Merino, María Guadalupe Miranda-Novales, David Nava-Jiménez, Juan Antonio Delgado-Vázquez, Rafael Bustos-Mora, Aldo Guadalupe Cisneros-Aréchiga, José Francisco Aguayo-Villaseñor, Martha Rocio Hernández-Preciado and Mario Alberto Mireles-Ramírez

J. Clin. Med. 2023, 12(13), 4533; https://doi.org/10.3390/jcm12134533 - 6 Jul 2023

Cited by 1 | Viewed by 1660

Abstract

Neurotuberculosis (neuroTB) is a devastating disease, and is difficult to diagnose. The aim of this study was to analyze the clinical and imaging characteristics, and outcomes of a retrospective cohort (2000–2022) of hospitalized patients diagnosed with intraspinal and intracranial neuroTB. This work was [...] Read more.

Neurotuberculosis (neuroTB) is a devastating disease, and is difficult to diagnose. The aim of this study was to analyze the clinical and imaging characteristics, and outcomes of a retrospective cohort (2000–2022) of hospitalized patients diagnosed with intraspinal and intracranial neuroTB. This work was designed through clinical, laboratory and imaging findings. Variables included: demographic data, history of tuberculosis, neurological complications, comorbidities and outcomes. Morbi-mortality risk factors were identified by univariate analysis. The cohort included: 103 patients with intraspinal and 82 with intracranial neuroTB. During the study period, in-hospital mortality of 3% for intraspinal and 29.6% for intracranial neuroTB was estimated. Motor deficit was found in all patients with intraspinal neuroTB. Risk factors for the unfavorable outcome of patients with intraspinal neuroTB were: age ≥ 40 years, diabetes mellitus (DM), diagnostic delay, kyphosis and spondylodiscitis ≥ 3 levels of involvement. Among the patients with intracranial neuroTB, 79/82 (96.3%) had meningitis and 22 patients had HIV infection (10 of them died). Risk factors for mortality from intracranial neuroTB were: HIV infection, hydrocephalus, stroke, lymphopenia and disseminated and gastrointestinal TB. Patients with intraspinal neuroTB had a significant number of destroyed vertebrae that determined their neurological deficit status. The mortality burden in intracranial neuroTB was conditioned by HIV infection and renal transplantation patients. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

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Review

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11 pages, 719 KiB

Open AccessReview

Adrenomedullin as a New Prosperous Biomarker in Infections: Current and Future Perspectives

by Gabriela Trojan, Anna Moniuszko-Malinowska, Anna Grzeszczuk and Piotr Czupryna

J. Clin. Med. 2024, 13(20), 6142; https://doi.org/10.3390/jcm13206142 - 15 Oct 2024

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Abstract

Adrenomedullin has emerged as a promising biomarker in the field of viral diseases. Numerous studies have demonstrated its potential in assessing disease severity, predicting clinical outcomes, and monitoring treatment response. Adrenomedullin (AM) is a multifaceted peptide implicated in vasodilation, hormone secretion, antimicrobial defense, [...] Read more.

Adrenomedullin has emerged as a promising biomarker in the field of viral diseases. Numerous studies have demonstrated its potential in assessing disease severity, predicting clinical outcomes, and monitoring treatment response. Adrenomedullin (AM) is a multifaceted peptide implicated in vasodilation, hormone secretion, antimicrobial defense, cellular growth, angiogenesis, and, importantly, chronic pain. AM and related peptides interface with cytoskeletal proteins within neuronal contexts, influencing microtubule dynamics. AM has primarily been utilized in diagnosing diseases of bacterial origin, including sepsis. Nevertheless, there are reports suggesting its utility in diseases of viral origin, and this is the focus of the present study. Furthermore, adrenomedullin has been shown to be elevated in various viral infections, suggesting its role in immune response modulation. Furthermore, AM may contribute to neuronal dysfunction through mechanisms involving immune and inflammatory responses, apoptosis, and disruptions in calcium homeostasis. This review aims to consolidate current knowledge regarding AM and its potential implications in viral diseases, elucidating its diverse roles in neurological pathophysiology. This review highlights the growing importance of adrenomedullin as a biomarker in viral diseases and the need for further functional studies to understand the underlying mechanisms involved. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

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34 pages, 494 KiB

Open AccessReview

Ten Issues for Updating in Community-Acquired Pneumonia: An Expert Review

by Francisco Javier Candel, Miguel Salavert, Miren Basaras, Marcio Borges, Rafael Cantón, Emilia Cercenado, Catian Cilloniz, Ángel Estella, Juan M. García-Lechuz, José Garnacho Montero, Federico Gordo, Agustín Julián-Jiménez, Francisco Javier Martín-Sánchez, Emilio Maseda, Mayra Matesanz, Rosario Menéndez, Manuel Mirón-Rubio, Raúl Ortiz de Lejarazu, Eva Polverino, Pilar Retamar-Gentil, Luis Alberto Ruiz-Iturriaga, Susana Sancho and Leyre Serrano Show full author list Hide full author list

J. Clin. Med. 2023, 12(21), 6864; https://doi.org/10.3390/jcm12216864 - 30 Oct 2023

Cited by 1 | Viewed by 7013

Abstract

Community-acquired pneumonia represents the third-highest cause of mortality in industrialized countries and the first due to infection. Although guidelines for the approach to this infection model are widely implemented in international health schemes, information continually emerges that generates controversy or requires updating its [...] Read more.

Community-acquired pneumonia represents the third-highest cause of mortality in industrialized countries and the first due to infection. Although guidelines for the approach to this infection model are widely implemented in international health schemes, information continually emerges that generates controversy or requires updating its management. This paper reviews the most important issues in the approach to this process, such as an aetiologic update using new molecular platforms or imaging techniques, including the diagnostic stewardship in different clinical settings. It also reviews both the Intensive Care Unit admission criteria and those of clinical stability to discharge. An update in antibiotic, in oxygen, or steroidal therapy is presented. It also analyzes the management out-of-hospital in CAP requiring hospitalization, the main factors for readmission, and an approach to therapeutic failure or rescue. Finally, the main strategies for prevention and vaccination in both immunocompetent and immunocompromised hosts are reviewed. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

30 pages, 891 KiB

Open AccessReview

Ten Issues to Update in Nosocomial or Hospital-Acquired Pneumonia: An Expert Review

by Francisco Javier Candel, Miguel Salavert, Angel Estella, Miquel Ferrer, Ricard Ferrer, Julio Javier Gamazo, Carolina García-Vidal, Juan González del Castillo, Víctor José González-Ramallo, Federico Gordo, Manuel Mirón-Rubio, Javier Pérez-Pallarés, Cristina Pitart, José Luís del Pozo, Paula Ramírez, Pedro Rascado, Soledad Reyes, Patricia Ruiz-Garbajosa, Borja Suberviola, Pablo Vidal and Rafael Zaragoza Show full author list Hide full author list

J. Clin. Med. 2023, 12(20), 6526; https://doi.org/10.3390/jcm12206526 - 14 Oct 2023

Cited by 6 | Viewed by 7430

Abstract

Nosocomial pneumonia, or hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP) are important health problems worldwide, with both being associated with substantial morbidity and mortality. HAP is currently the main cause of death from nosocomial infection in critically ill patients. Although guidelines for the [...] Read more.

Nosocomial pneumonia, or hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP) are important health problems worldwide, with both being associated with substantial morbidity and mortality. HAP is currently the main cause of death from nosocomial infection in critically ill patients. Although guidelines for the approach to this infection model are widely implemented in international health systems and clinical teams, information continually emerges that generates debate or requires updating in its management. This scientific manuscript, written by a multidisciplinary team of specialists, reviews the most important issues in the approach to this important infectious respiratory syndrome, and it updates various topics, such as a renewed etiological perspective for updating the use of new molecular platforms or imaging techniques, including the microbiological diagnostic stewardship in different clinical settings and using appropriate rapid techniques on invasive respiratory specimens. It also reviews both Intensive Care Unit admission criteria and those of clinical stability to discharge, as well as those of therapeutic failure and rescue treatment options. An update on antibiotic therapy in the context of bacterial multiresistance, in aerosol inhaled treatment options, oxygen therapy, or ventilatory support, is presented. It also analyzes the out-of-hospital management of nosocomial pneumonia requiring complete antibiotic therapy externally on an outpatient basis, as well as the main factors for readmission and an approach to management in the emergency department. Finally, the main strategies for prevention and prophylactic measures, many of them still controversial, on fragile and vulnerable hosts are reviewed. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

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17 pages, 983 KiB

Open AccessReview

Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods

by Małgorzata Satora, Arkadiusz Grunwald, Bartłomiej Zaremba, Karolina Frankowska, Klaudia Żak, Rafał Tarkowski and Krzysztof Kułak

J. Clin. Med. 2023, 12(16), 5376; https://doi.org/10.3390/jcm12165376 - 18 Aug 2023

Cited by 13 | Viewed by 7524

Abstract

Vulvovaginal candidiasis (VVC) is a common condition associated with discomfort in affected women. Due to the presence of different forms of the disease, diverse treatment regimens are developed; the newest ones include oteseconazole and ibrexafungerp. Here, we focus on the most up-to-date recommendations [...] Read more.

Vulvovaginal candidiasis (VVC) is a common condition associated with discomfort in affected women. Due to the presence of different forms of the disease, diverse treatment regimens are developed; the newest ones include oteseconazole and ibrexafungerp. Here, we focus on the most up-to-date recommendations regarding VVC treatment, as well as novel treatment options. Topical and oral azoles are the drugs of choice in uncomplicated mycosis. The efficacy of probiotics and substances such as TOL-463 and chlorhexidine is indicated as satisfactory; however, there are no relevant guidelines. Although the majority of researchers agree that the treatment of non-albicans VVC should be long-lasting, the recommendations are inconsistent. Another clinical problem is the treatment of VVC with azole intolerance or resistance, for which literature proposes the use of several drugs including oteseconazole, ibrexafungerp, and voriconazole. The treatment schedules for recurrent VVC include mainly fluconazole; however, alternative options such as immunotherapeutic vaccine (NDV-3A) or designed antimicrobial peptides (dAMPs) were also described. We also focused on VVC affecting pregnant women, which is a substantial challenge in clinical practice, also due to the heterogeneous relevant guidelines. Thus far, few precise recommendations are available in the literature. Future studies should focus on atypical VVC forms to elucidate the inconsistent findings. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

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32 pages, 7502 KiB

Open AccessReview

Interleukins (Cytokines) as Biomarkers in Colorectal Cancer: Progression, Detection, and Monitoring

by Sajida Maryam, Katarzyna Krukiewicz, Ihtisham Ul Haq, Awal Ayaz Khan, Galal Yahya and Simona Cavalu

J. Clin. Med. 2023, 12(9), 3127; https://doi.org/10.3390/jcm12093127 - 25 Apr 2023

Cited by 11 | Viewed by 4623

Abstract

Cancer is the primary cause of death in economically developed countries and the second leading cause in developing countries. Colorectal cancer (CRC) is the third most common cause of cancer-related deaths worldwide. Risk factors for CRC include obesity, a diet low in fruits [...] Read more.

Cancer is the primary cause of death in economically developed countries and the second leading cause in developing countries. Colorectal cancer (CRC) is the third most common cause of cancer-related deaths worldwide. Risk factors for CRC include obesity, a diet low in fruits and vegetables, physical inactivity, and smoking. CRC has a poor prognosis, and there is a critical need for new diagnostic and prognostic biomarkers to reduce related deaths. Recently, studies have focused more on molecular testing to guide targeted treatments for CRC patients. The most crucial feature of activated immune cells is the production and release of growth factors and cytokines that modulate the inflammatory conditions in tumor tissues. The cytokine network is valuable for the prognosis and pathogenesis of colorectal cancer as they can aid in the cost-effective and non-invasive detection of cancer. A large number of interleukins (IL) released by the immune system at various stages of CRC can act as “biomarkers”. They play diverse functions in colorectal cancer, and include IL-4, IL-6, IL-8, IL-11, IL-17A, IL-22, IL-23, IL-33, TNF, TGF-β, and vascular endothelial growth factor (VEGF), which are pro-tumorigenic genes. However, there are an inadequate number of studies in this area considering its correlation with cytokine profiles that are clinically useful in diagnosing cancer. A better understanding of cytokine levels to establish diagnostic pathways entails an understanding of cytokine interactions and the regulation of their various biochemical signaling pathways in healthy individuals. This review provides a comprehensive summary of some interleukins as immunological biomarkers of CRC. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

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12 pages, 1951 KiB

Open AccessSystematic Review

Corticosteroid Treatment for Leptospirosis: A Systematic Review and Meta-Analysis

by Pavlo Petakh, Valentyn Oksenych and Oleksandr Kamyshnyi

J. Clin. Med. 2024, 13(15), 4310; https://doi.org/10.3390/jcm13154310 - 24 Jul 2024

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Abstract

Background: Leptospirosis, a zoonotic disease prevalent in tropical regions, often leads to severe complications such as Weil’s disease and acute respiratory distress syndrome (ARDS). This pioneering meta-analysis investigated the role of corticosteroids in treating severe leptospirosis, addressing a critical gap in the current [...] Read more.

Background: Leptospirosis, a zoonotic disease prevalent in tropical regions, often leads to severe complications such as Weil’s disease and acute respiratory distress syndrome (ARDS). This pioneering meta-analysis investigated the role of corticosteroids in treating severe leptospirosis, addressing a critical gap in the current clinical knowledge. Methods: We systematically reviewed studies from PubMed and Scopus, focusing on randomized controlled trials and observational cohort studies involving adult patients diagnosed with leptospirosis. Five studies comprising 279 participants met the inclusion criteria. Results: Although some studies suggest potential benefits, particularly for pulmonary complications, the evidence remains inconclusive due to the limited number of studies and their methodological limitations. Notably, while four of the five reviewed studies indicated a possible positive role of corticosteroids, the single randomized controlled trial showed no significant benefit, highlighting the need for more robust research. Conclusions: While the current evidence provides a basis for potential benefits, it is not sufficient to make definitive clinical recommendations. Further research is essential to clarify the role of corticosteroids in the treatment of severe leptospirosis, with the aim of improving patient outcomes and guiding clinical practices effectively. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

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9 pages, 1048 KiB

Open AccessBrief Report

Impact of Povidone Application to Nares in Addition to Chlorhexidine Bath in Critically Ill Patients on Nosocomial Bacteremia and Central Line Blood Stream Infection

by Raquel Nahra, Shahrzad Darvish, Snehal Gandhi, Suzanne Gould, Diane Floyd, Kathy Devine, Henry Fraimow, John E. Dibato and Jean-Sebastien Rachoin

J. Clin. Med. 2024, 13(9), 2647; https://doi.org/10.3390/jcm13092647 - 30 Apr 2024

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Abstract

Nosocomial Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia results in a significant increase in morbidity and mortality in hospitalized patients. We aimed to analyze the impact of applying 10% povidone iodine (PI) twice daily to both nares in addition to chlorhexidine (CHG) bathing on nosocomial [...] Read more.

Nosocomial Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia results in a significant increase in morbidity and mortality in hospitalized patients. We aimed to analyze the impact of applying 10% povidone iodine (PI) twice daily to both nares in addition to chlorhexidine (CHG) bathing on nosocomial (MRSA) bacteremia in critically ill patients. A quality improvement study was completed with pre and post-design. The study period was from January 2018 until February 2020 and February 2021 and June 2021. The control period (from January 2018 to May 2019) consisted of CHG bathing alone, and in the intervention period, we added 10% PI to the nares of critically ill patients. Our primary outcome is rates of nosocomial MRSA bacteremia, and our secondary outcome is central line associated blood stream infection (CLABSI) and potential cost savings. There were no significant differences in rates of MRSA bacteremia in critically ill patients. Nosocomial MRSA bacteremia was significantly lower during the intervention period on medical/surgical areas (MSA). CLABSIs were significantly lower during the intervention period in critically ill patients. There were no Staphylococcus aureus CLABSIs in critical care area (CCA)during the intervention period. The intervention showed potential significant cost savings. The application of 10% povidone iodine twice a day in addition to CHG bathing resulted in a significant decrease in CLABSIs in critically ill patients and a reduction in nosocomial MRSA in the non-intervention areas. Further trials are needed to tease out individual patients who will benefit from the intervention. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

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6 pages, 185 KiB

Open AccessCase Report

Encephalitis in the Course of HHV-7 Infection in an Infant

by Justyna Moppert, Eliza Łężyk-Ciemniak and Małgorzata Pawłowska

J. Clin. Med. 2024, 13(2), 418; https://doi.org/10.3390/jcm13020418 - 12 Jan 2024

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Abstract

Most cases of acute infections caused by human herpesvirus 7 (HHV-7) are asymptomatic or very mild. Clinical symptoms disappear spontaneously; however, the infection becomes latent and persists for life with periodic asymptomatic reactivation. Little is known about the virus’s ability to cross the [...] Read more.

Most cases of acute infections caused by human herpesvirus 7 (HHV-7) are asymptomatic or very mild. Clinical symptoms disappear spontaneously; however, the infection becomes latent and persists for life with periodic asymptomatic reactivation. Little is known about the virus’s ability to cross the blood–brain barrier. Our case of an immunocompetent infant indicates that HHV-7 infection should be considered a cause of neuroinfection, not only in immunocompromised patients but also in the youngest immunocompetent patients. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

11 pages, 15626 KiB

Open AccessCase Report

Complicated Clinical Course of a Patient with Multivisceral Cystic Echinococcosis Requiring Extensive Surgical and Medical Treatment

by Gabriela Loredana Popa, Alexandru Cosmin Popa, Bogdan Mastalier, Carmen Michaela Crețu and Mircea Ioan Popa

J. Clin. Med. 2023, 12(17), 5596; https://doi.org/10.3390/jcm12175596 - 27 Aug 2023

Cited by 2 | Viewed by 1554

Abstract

Cystic echinococcosis is an often-overlooked condition that otherwise negatively impacts both the individual and the community, prompting major public health concerns. Early diagnosis and treatment, as well as collaboration between specialties including surgery and parasitology, are essential for avoiding complications and disease relapse. [...] Read more.

Cystic echinococcosis is an often-overlooked condition that otherwise negatively impacts both the individual and the community, prompting major public health concerns. Early diagnosis and treatment, as well as collaboration between specialties including surgery and parasitology, are essential for avoiding complications and disease relapse. To better illustrate this, we present the case of an elderly person with a rare localization of the disease at the muscular level. The patient underwent numerous surgical interventions, and received multiple courses of antiparasitic treatment over the course of 40 years as a result of the multivisceral dissemination of the parasite. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

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