A reliable estimation of Candida bloodstream infection prevalence is increasingly important to track changes in Candida species distribution and define burden of ongoing candidemia. A systematic review and meta-analysis were conducted to estimate candidemia prevalence and identify patterns of Candida species in South-eastern Asia. Systematic electronic-databases literature search was performed on published studies recorded candidemia prevalence in South-Eastern Asia. Using meta-analysis of proportions, the overall pooled prevalences of candidemia by Candida (C.) albicans, C. tropicalis, C. parapsilosis and C. glabrata were calculated as 28.4% (95% CI 24.9-31.8), 29.2% (95% CI 24.7-33.7), 19.1% (95% CI 14.8-23.4) and 14.0% (95% CI 10.4-17.5), respectively. Based on publication year and country, subgroup analyses were conducted on Candida species to determine heterogeneity source. The findings may not precisely reflect true candidemia prevalence in different countries. Therefore, it highlights continuous need to conduct prevalence studies, assess and monitor growing burden, control effect of potential risk factors and implement regional surveillance programs to prevent further rise.
Viral reproductive tract infections (VRTIs) are a significant global health concern with severe consequences, including infertility, chronic pelvic pain, and increased risk of HIV transmission. Complex interplay between pathogens and the host immune system plays a critical role in the pathogenesis and treatment of VRTIs. This review aims to provide a comprehensive overview of the multifaceted roles of the immune system in both contributing to and combating VRTIs. The review will also address the consequent perturbations in immune homeostasis and the implications for disease manifestation and progression. The interrelation between systemic immunity and local immune responses is discussed, providing insights into the challenges and breakthroughs in managing these infections. By providing a comprehensive overview of the mechanisms, implications, and therapeutic strategies associated with viral reproductive tract infections and immune dysfunction, this review also informs future research and clinical practice in this important area of reproductive health.
Objective: To assess the effectiveness of COVID-19 vaccination in patients with rheumatic diseases undergoing biologic (bDMARDs) or targeted-synthetic disease-modifying anti-rheumatic drugs (tsDMARDs).
Methods: This cross-sectional study was conducted at ten rheumatology clinics in Turkey between May 1, 2021, and October 30, 2022. Patients with rheumatic diseases on bDMARD or tsDMARD therapy who received at least two doses of an mRNA or inactivated SARS-CoV-2 vaccine were included. After vaccination, COVID-19 infection rates, adverse events, and rheumatic disease flares were recorded. Data were collected via face-to-face or telephone interviews.
Results: A total of 963 participants were included in the final analysis; 44% were male, and the median age was 49 years. The most frequently observed rheumatic diseases were ankylosing spondylitis and rheumatoid arthritis, accounting for 37.2% and 32.6% of cases, respectively. Adalimumab (19.2%) and infliximab (17.8%) were the most commonly used bDMARDs. Of the participants, 634 (65.9%) received an inactivated vaccine (CoronaVac) and 329 (34.1%) an mRNA vaccine (BioNTech). A total of 502 (52.1%) patients received a booster dose. Following the first, second, and third vaccine doses, adverse event rates were 19.9%, 15.9%, and 26.7%, respectively. Forty-two (4.4%) patients experienced a disease flare within six months after their first vaccination dose. COVID-19 infection occurred in 79 participants (8.2%) after two vaccine doses; most cases were symptomatic but did not require hospitalization. The COVID-19 infection rate was lower in participants who received a booster dose than those who did not (3.4% vs. 8.2%, P<0.001).
Conclusions: Our study indicates that both mRNA and inactivated SARS-CoV-2 vaccines are effective in preventing severe COVID-19 outcomes, with an acceptable rate of adverse events and disease flares among patients with rheumatic diseases on bDMARD or tsDMARD therapy.
Objective: To identify the risk factors for acquiring scrub typhus infection among all age group.
Methods: A case-control study was carried out from June to December 2019 in collaboration with the Department of Health Services, Kerala. 136 Of serologically confirmed scrub typhus reported during 2018 were included and 270 age and sex-matched healthy controls were selected randomly from different locations in the same area where the cases were reported. The risk factors identified were compared between cases and controls, using univariate and multivariable logistic regression analysis to identify the risk factors for scrub typhus infection.
Results: Some key factors like house type with individuals residing in houses with concrete roofs are associated with a higher risk of scrub typhus infection compared to tiled roofs (aOR 0.14, 95% CI 0.36-0.56, P=0.005). Housewives exhibit a significantly higher risk (aOR 3.97, 95% CI 2.15-8.94, P=0.038) of scrub typhus infection. Environmental factors, including the presence of rats (aOR 3.48, 95% CI 1.19-6.53, P=0.023), the presence of domestic animals (aOR 2.98, 95% CI 1.67-5.19, P<0.001), wet agricultural fields around the house (aOR 3.64, 95% CI 1.50-6.54, P<0.001), and hygiene practices like not changing clothes after work (aOR 2.64, 95% CI 1.37-4.68, P=0.024), and disposing of the wastes in their own yard (aOR 4.79, 95% CI 3.78-9.55, P=0.043) are identified as significant high-risk factors for scrub typhus infection.
Conclusions: These findings will be very useful to create awareness among the public and to undertake a detailed control strategy for scrub typhus.
Rationale: Primary immunodeficiency disorders can be fatal especially in infants. Prompt recognition with a comprehensive medical history, genetic evaluation, and appropriate treatment can be lifesaving in a few subtypes.
Patient concerns: A 4-month-old male infant presented with axillary swelling, fever, and ulcerative lesions. Despite care at multiple facilities, symptoms persisted, raising concern for an underlying immunodeficiency. The patient's sibling had similar symptoms and died at six months, suggesting a genetic predisposition.
Diagnosis: Mendelian susceptibility to mycobacterial disease, IFNGR2 deficiency.
Interventions: The patient was treated with tailored anti-tubercular therapy and azithromycin prophylaxis.
Outcomes: Following treatment, the patient’s symptoms have resolved. At 20 months, he is thriving with normal development.
Lessons: This case highlights the importance of a thorough medical history and genetic testing in infants with recurrent or unusual infections. Early diagnosis of mendelian susceptibility to mycobacterial disease can lead to effective treatment and better outcomes.