We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log 10 increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV—CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences—is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence.
Background Hemotropic mycoplasmas, previously classified in the genus Eperythrozoon, have been reported as causing human infections in Brazil, China, Japan and Spain. Methods In 2017, we detected DNA from “Candidatus Mycoplasma haemohominis” in the blood of a Melanesian patient from New Caledonia presenting with febrile splenomegaly,weight loss, life-threatening autoimmune haemolytic anemia and hemophagocytosis. The full genome of the bacterium was sequenced from a blood isolate. Subsequently, we tested retrospectively (2011-2017) and prospectively (2018-2019) patients who had been hospitalized with a similar clinico-biological picture. In addition, as these patients had been in contact with frugivorous bats (authorized under conditions for hunting and eating in New Caledonia) we investigated the role of these animals and their biting flies by testing them for hemotropic mycoplasmas. Results Fifteen patients were found to be infected by this hemotropic mycoplasma. Among them, four (27%) died following splenectomy performed for spontaneous spleen rupture, or to cure refractory autoimmune haemolytic anemia. The bacterium was cultivated from the patient's blood. The full genome of the Neocaledonian “Candidatus M. haemohominis” strain differed from that of a recently identified Japanese strain. Forty-six percent of 40 tested Pteropus bats and 100% of collected bat flies Cyclopodia horsfieldi (Nycteribiidae, Diptera) were positive. Human,bat and dipteran strains were highly similar. Conclusions The bacterium being widely distributed in bats, “Candidatus M. haemohominis” should be regarded as a potential cause of severe infections in humans.
Calcaneal osteomyelitis is characterized by frequent relapse with delayed wound healing. Clinicians should take into account the impact of older age, as well as co-morbidities such as diabetes mellitus or the presence of neuropathy, during the routine management of patients with this difficult-to-treat bone infection.
Since the mid-1980s, Klebsiella pneumoniae hypermucoviscous isolates have emerged in Taiwan and other Asian countries. We reported the first autochthonous European liver abscess due to an ST57 isolate, which belongs to virulent clonal complex CC23-K1. This case highlights the emergence in France and Europe of hypermucoviscous virulent K. pneumoniae isolates.
BackgroundIn 2017, New Caledonia experienced an outbreak of severe dengue causing high hospital burden (4,379 cases, 416 hospital admissions, 15 deaths). We decided to build a local operational model predictive of dengue severity, which was needed to ease the healthcare circuit.MethodsWe retrospectively analyzed clinical and biological parameters associated with severe dengue in the cohort of patients hospitalized at the Territorial Hospital between January and July 2017 with confirmed dengue, in order to elaborate a comprehensive patient’s score. Patients were compared in univariate and multivariate analyses. Predictive models for severity were built using a descending step-wise method.ResultsOut of 383 included patients, 130 (34%) developed severe dengue and 13 (3.4%) died. Major risk factors identified in univariate analysis were: age, comorbidities, presence of at least one alert sign, platelets count <30×109/L, prothrombin time <60%, AST and/or ALT >10N, and previous dengue infection. Severity was not influenced by the infecting dengue serotype nor by previous Zika infection. Two models to predict dengue severity were built according to sex. Best models for females and males had respectively a median Area Under the Curve = 0.80 and 0.88, a sensitivity = 84.5% and 84.5%, a specificity = 78.6% and 95.5%, a positive predictive value = 63.3% and 92.9%, a negative predictive value = 92.8% and 91.3%. Models were secondarily validated on 130 patients hospitalized for dengue in 2018.ConclusionWe built robust and efficient models to calculate a bedside score able to predict dengue severity in our setting. We propose the spreadsheet for dengue severity score calculations to health practitioners facing dengue outbreaks of enhanced severity in order to improve patients’ medical management and hospitalization flow.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.