泌尿生殖道支原体感染及耐药性研究

目的 了解解脲脲支原体(Uu)和人支原体(Mh)感染状况及耐药性,为临床合理用药提供可靠依据.方法 对2042例疑为非淋菌性尿道(宫颈)炎患者的泌尿生殖道标本进行支原体培养及耐药性检测.结果 支原体培养阳性881例(43.1%),单纯Uu感染650例(31.8%),单纯Mh感染74例(3.6%),Uu、Mh合并感染157例(7.6%);不同性别及不同年龄段人群支原体阳性率比较,差异有统计学意义(P<0.01),18种常用抗菌药物中,交沙霉素、多西环素和克拉霉素耐药率最低(3.6%、4.1%、4.2%),对氧氟沙星、氟罗沙星和甲砜霉素的耐药率较高(38.2%、18.3%、14.6%).结论 支原体感染呈明显上升趋势,支原体对常用抗菌药物存在不同程度的耐药性,加强对支原体的耐药性监测,对指导临床治疗有重要意义.     

TORCH Infections. Toxoplasmosis,Other (syphilis,varicella-zoster,parvovirus B19), Rubella,Cytomegalovirus (CMV), and Herpes infections

Perinatal infections account for 2% to 3% of all congenital anomalies. TORCH, which includes Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes infections, are some of the most common infections associated with congenital anomalies. Most of the TORCH infections cause mild maternal morbidity, but have serious fetal consequences, and treatment of maternal infection frequently has no impact on fetal outcome. Therefore, recognition of maternal disease and fetal monitoring once disease is recognized are important for all clinicians. Knowledge of these diseases will help the clinician appropriately counsel mothers on preventive measures to avoid these infections, and will aid in counseling parents on the potential for adverse fetal outcomes when these infections are present.     

Transfusion-Associated Infections with Cytomegalovirus and Other Human Herpesviruses

Of all human herpesviruses, human cytomegalovirus (HCMV) is the most significant cause of transfusion-associated (TA) morbidity and mortality. The problem of TA HCMV infection differs from that of other transfusion-transmitted infections in that only certain groups of patients require HCMV-free blood or blood components, i.e. seronegative pregnant women, premature infants of low birth weight who are born to seronegative mothers, seronegative recipients of allogeneic bone marrow transplants from seronegative donors, seronegative AIDS patients, and seronegative immunosuppressed patients in general. HCMV is strictly cell-associated, and transmission appears to be due to reactivation of latent virus in white blood cells. TA HCMV infec-tion in risk groups can be minimized by selection of HCMV-seronegative donors. Since transmission of HCMV from seropositive donors by blood components containing fewer than 10 7 leukocytes per unit is unlikely, leukodepletion of transfusion products by filtration is an effective alternative to the use of seronegative blood products. Other human herpesviruses causing TA infections are Epstein-Barr virus (EBV) and the human herpesviruses 6 and 7 (HHV-6, HHV-7), whereas transmissions of herpes simplex viruses (HSV-1, HSV-2) and varicella-zoster virus (VZV) by blood transfusion - if occurring at all - are extremely rare events. Frequency and clinical significance of TA infections with the human herpesvirus 8 (HHV-8) have not yet been fully elucidated. Despite the low seroprevalence of HHV-8 in Germany, its oncogenic potential merits attention, and strategies to prevent transmission and spread of HHV-8 by blood and blood products should be discussed. Copyright 2000 S. Karger GmbH, Freiburg     

The "Other" Veneral Diseases: Herpes Simplex, Trichomoniasis and Candidiasis

Although the term venereal disease has been synonymous with gonorrhea and syphilis, the Center for Disease Control now states that the new cases of herpes simplex type - 2, trichomoniasis and candidiasis are rapidly approaching and, in certain instances, have surpassed the annual cases of syphilis and gonorrhea. Trichomoniasis and candidiasis are at times unbearable to millions of women. In relation to genital herpes, the circumstances are much more serious. It is rapdily approaching epidemic proportions, it has no cure, and it can be detrimental to the unsuspecting pregnant woman. It is imperative that, as health professionals, we broaden our teaching efforts to include these “other” venereal diseases and help our students to do what they can within the total framework of their own knowledge and behavior to avoid and treat venereal infections. Traditionally the term “venereal disease” has been thought of as being synonymous with only gonorrhea and syphilis because of their high incidence rates. The Center for Disease Control estimates that there are 3 million new cases of trichomoniasis and 300,000 to I million cases of herpes genitalis, compared to one million cases of gonorrhea and about 20,000 cases of syphilis each year. These incidence rates certainly indicate a need for our educational programs to include trichomoniasis and herpes simplex, as well as the traditional coverage of gonorrhea and syphilis, in our health education classes. But what are these other common, sexually transmitted diseases? What are their causes, symptoms and complications, and most important, how can they be prevented or at least treated?     

女性生殖道不同亚型人乳头状瘤病毒混合感染及分型研究

目的 探讨女性生殖道不同亚型人乳头状瘤病毒(HPV)混合感染情况及分型的临床意义.方法 导流杂交方法确诊为HPV多重感染的女性患者132例,分析不同年龄组的不同HPV亚型检出情况,评价HPV分型在宫颈病变中价值.结果 女性生殖道中21种HPV亚型均有被检出,共检到383株HPV亚型;高危型以16、58、52、33、18型为主,低危型主要以11型和6型为主;HPV亚型混合感染患者以21～40岁年龄段最多;多种感染类型以2种HPV亚型感染(54.5%)最常见,3种HPV亚型感染(25.0%)次之;多重感染类型与不同宫颈疾病(宫颈炎、宫颈湿疣、CIN Ⅰ、Ⅱ、Ⅲ及宫颈癌)之间并不存在必然联系(χ2=23.927,P>0.05).结论 女性患者不同HPV亚型的混合感染以HPV16型和HPV11型为主,2种HPV亚型感染最为常见;预防和治疗宫颈疾病中,多种HPV亚型混合感染应引起重视.     

濮阳市泌尿生殖道感染患者支原体耐药监测

目的了解濮阳市泌尿生殖道感染患者支原体对9种抗生素的耐药情况。方法采用法国生物梅里埃公司提供的IST2试剂盒检测支原体耐药谱。结果1170例患者中检出支原体402例,阳性率为34.4%,其中解脲支原体(UU)阳性295例占25.2%。解脲(UU)+人型(MH)支原体混合感染90例占7.7%,MH阳性17例占1.5%。对支原体耐药性最高的是环丙沙星、氧氟沙星,其次是红霉素、阿奇霉素、克拉霉素。结论支原体在体外显示对多种抗生素耐药,特别是UU+MH感染时多重耐药率更高。本市治疗支原体感染者,应根据药敏情况进行合理选用抗生素,以降低耐药率,减少耐药菌株的发生。     

Prevalence of HIV,Syphilis, and Other Sexually Transmitted Infections among MSM from Three Cities in Panama

Respondent-driven sampling (RDS) was used to conduct a biobehavioral survey among men who have sex with men (MSM) in three cities in the Republic of Panama. We estimated the prevalence of HIV, syphilis, and other sexually transmitted infections (STIs), sociodemographic characteristics, and sexual risk behaviors. Among 603 MSM recruited, RDS-adjusted seroprevalences (95 % confidence intervals) were: HIV—David 6.6 % (2.2–11.4 %), Panama 29.4 % (19.7–39.7 %), and Colon 32.6 % (18.0–47.8 %); active syphilis—David 16.0 % (8.9–24.2 %), Panama 24.7 % (16.7–32.9 %), Colon 31.6 % (14.8–47.5 %); resolved HBV infection—David 10.0 % (4.8–16.8 %), Panama 29.4 % (20.0–38.3 %), and Colon 40.6 % (21.9–54.4 %); herpes simplex virus type 2—David 38.4 % (27.9–48.9 %), Panama 62.6 % (52.8–71.0 %), and Colon 72.9 % (57.4–85.8 %). At least a third of MSM in each city self-identified as heterosexual or bisexual. HIV prevalence is concentrated among MSM. Preventive interventions should focus on increasing HIV and syphilis testing, and increasing promotion of condom awareness and use.     

神经妥乐平联合抗病毒药治疗带状疱疹的临床研究

目的研究神经妥乐平治疗带状疱疹及其神经疼痛的有效性及安全性. 方法设立开放、随机、对照实验,观察抗病毒药物 伐昔洛韦联合神经妥乐平和单用抗病毒药物治疗带状疱疹及其伴发神经痛的疗效比较. 结果阿昔洛韦联合神经妥乐平疗效明显优于对照组,使病程缩短、病情减轻显著、后遗神经痛发生率低. 结论治疗带状疱疹合用神经妥乐平可明显提高疗效、缩短病程、显著缓解带状疱疹神经痛,降低带状疱疹后遗神经痛的发病率,安全有效.     

Fungemia and Other Fungal Infections Associated with Use of Saccharomyces boulardii Probiotic Supplements

Because of widespread use of probiotics, their safety must be guaranteed. We assessed use of Saccharomyces boulardii probiotic yeast from medical records for patients who had Saccharomyces fungemia or other clinical Saccharomyces culture findings. We evaluated all Saccharomyces sp. findings at 5 university hospitals in Finland during 2009–2018. We found 46 patients who had Saccharomyces fungemia; at least 20 (43%) were using S. boulardii probiotic. Compared with a control group that had bacteremia or candidemia, the odds ratio for use of an S. boulardii probiotic was 14 (95% CI 4–44). Of 1,153 nonblood culture findings, the history for 125 patients was checked; at least 24 (19%) were using the probiotic (odds ratio 10, 95% CI 3–32). This study adds to published fungemia cases linked to use of S. boulardii probiotic and sheds light on the scale of nonblood Saccharomyces culture findings that are also linked to use of this probiotic.     

Mycoplasma genitalium and Other Reproductive Tract Infections in Pregnant Women,Papua New Guinea, 2015–2017

Much about the range of pathogens, frequency of coinfection, and clinical effects of reproductive tract infections (RTIs) among pregnant women remains unknown. We report on RTIs (Mycoplasma genitalium, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Treponema pallidum subspecies pallidum, bacterial vaginosis, and vulvovaginal candidiasis) and other reproductive health indicators in 699 pregnant women in Papua New Guinea during 2015–2017. We found M. genitalium, an emerging pathogen in Papua New Guinea, in 12.5% of participants. These infections showed no evidence of macrolide resistance. In total, 74.1% of pregnant women had >1 RTI; most of these infections were treatable. We detected sexually transmitted infections (excluding syphilis) in 37.7% of women. Our findings showed that syndromic management of infections is greatly inadequate. In total, 98.4% of women had never used barrier contraception. These findings will inform efforts to improve reproductive healthcare in Papua New Guinea.     

Differentiation of Acute Q Fever from Other Infections in Patients Presenting to Hospitals,the Netherlands

Differentiating acute Q fever from infections caused by other pathogens is essential. We conducted a retrospective case–control study to evaluate differences in clinical signs, symptoms, and outcomes for 82 patients with acute Q fever and 52 control patients who had pneumonia, fever and lower respiratory tract symptoms, or fever and hepatitis, but had negative serologic results for Q fever. Patients with acute Q fever were younger and had higher C-reactive protein levels but lower leukocyte counts. However, a large overlap was found. In patients with an indication for prophylaxis, chronic Q fever did not develop after patients received prophylaxis but did develop in 50% of patients who did not receive prophylaxis. Differentiating acute Q fever from other respiratory infections, fever, or hepatitis is not possible without serologic testing or PCR. If risk factors for chronic Q fever are present, prophylactic treatment is advised.     

Gender Abuse,Depressive Symptoms,and HIV and Other Sexually Transmitted Infections Among Male-to-Female Transgender Persons: A Three-Year Prospective Study

Objectives. We examined gender abuse and depressive symptoms as risk factors for HIV and other sexually transmitted infections (HIV/STI) among male-to-female transgender persons (MTFs).Methods. We conducted a 3-year prospective study of factors associated with incident HIV, syphilis, hepatitis B, chlamydia, and gonorrhea among 230 MTFs from the New York Metropolitan Area. Statistical techniques included Cox proportional hazards analysis with time varying covariates.Results. Among younger MTFs (aged 19–30 years), gender abuse predicted depressive symptoms (Center for Epidemiologic Studies Depression score ≥ 20), and gender abuse combined with depressive symptoms predicted both high-risk sexual behavior (unprotected receptive anal intercourse) and incident HIV/STI. These associations were independent of socioeconomic status, ethnicity, sexual orientation, hormone therapy, and sexual reassignment surgery.Conclusions. Gender abuse is a fundamental distal risk factor for HIV/STI among younger MTFs. Interventions for younger MTFs are needed to reduce the psychological impact of gender abuse and limit the effects of this abuse on high-risk sexual behavior. Age differences in the impact of gender abuse on HIV/STI suggest the efficacy of peer-based interventions in which older MTFs teach their younger counterparts how to cope with this abuse.Extremely high rates of HIV have been detected among male-to-female transgender persons (MTFs). Community-based studies using nonprobability sampling have observed an HIV prevalence of 22% to 35%, with yearly incidence rates ranging from 3.5% to 7.8%.1–9 Established risk factors for HIV in this population include ethnicity (African Americans and Hispanics compared with Whites) and sexual orientation (those attracted to men only compared with other categories of sexual attraction).1,4The dominant behavioral mode by which MTFs contract HIV and transmit the virus to others, including the general population,10 is unprotected receptive anal intercourse (URAI) with committed, casual, or commercial partners.11 MTFs report frequencies of high-risk sexual behavior (including URAI) with noncommercial and commercial sex partners that are much higher than those for the general population12 and higher than for sexual minorities.13A potentially significant proximal risk factor, which may combine with URAI to cause HIV in this population, is depressed affect. MTFs report levels of depressive symptomatology that are much higher than in the general population,14,15 and some previous studies suggest that depressive symptoms are intertwined with high-risk sexual behavior.16–20A more fundamental distal risk factor, which may cause depressive symptoms and ultimately high-risk sexual behavior and HIV among MTFs, is abuse associated with an atypical presentation of gender. Because they transgress basic gender norms, many MTFs are taunted or beaten by family members, neighbors, coworkers, strangers, or the police,21 and a recent study showed that this abuse is linked to depressive symptomatology.22 For some MTFs, gender abuse may be highly traumatizing and intertwined with depressed affect, which may erode prevention consciousness and the use of condoms to prevent HIV in particular.23–27We present the findings of a community-based prospective study designed to evaluate social, psychological, and behavioral risk factors for incident HIV and other sexually transmitted infections (HIV/STI) among MTFs. We tested 3 interrelated hypotheses, reflecting the literature reviewed here: (1) gender abuse is associated with depressive symptoms as measured by the Center for Epidemiologic Studies Depression scale (CES-D); (2) gender abuse is associated with URAI with committed, casual, and commercial partners, with the effects partially mediated by depressive symptoms; and (3) gender abuse is associated with incident HIV/STI, with the effects partially mediated by depressive symptoms and URAI.Psychological or physical abuse associated with an atypical presentation of gender (gender abuse) is the result of a binary gender system in which all individuals are expected to conform to a single gender role (male or female) consistent with their sexual anatomy at birth.23 Although it is subjectively experienced, this abuse is ultimately the product of social forces beyond the perceptions of individuals28; following the Institute of Medicine’s conceptualization,29 we posited that it was a distal social risk factor for HIV/STI in this population. We conceptualized depressive symptoms as a proximal psychological risk factor for URAI. We included URAI as a behavioral risk factor that directly causes HIV/STI. We hypothesized that gender abuse and depressive symptoms affect HIV/STI via their effects on URAI.We further hypothesized that these associations are modified by age. Some studies suggest that younger MTFs are particularly vulnerable to gender abuse and victimization.30–33 Other studies suggest that older MTFs, after years of coping to this adversity, develop attitudes and skills to better cope with it.29,34 Age differences in vulnerability to gender abuse were demonstrated in a recent retrospective study by our research team: gender abuse was strongly associated with depressive symptomatology during adolescence and early adulthood, but the strength of this association declined markedly during later stages of life.22 Building on this finding, we examined age differences in the effects of gender abuse on depressive symptom longitudinally in this study, with further predictions of age differences in the effects of gender abuse on URAI and HIV/STI.An analysis of HIV among MTFs must also recognize the fact that this is a diverse population with regard to socioeconomic status (SES) and stage of gender transition,29 both of which could confound observed associations between gender abuse and HIV/STI. Because of this potential confounding, we included indicators of SES (education and income) and variation along a spectrum of gender transition (hormone therapy, preoperational transsexual identity, and sexual reassignment surgery) in the analysis.     

甲苯达唑驱治鞭虫及其它肠线虫感染的疗效观察

目的：观察相同剂量不同疗程的甲苯达唑对鞭虫感染驱虫效果。方法：将420例以鞭虫感染为主的肠线虫病患分成3组,其中2组甲苯达唑总剂量800mg,2天（A组）、4天（B组）分服,另一组阿苯达唑总剂量600mg,2天分服为对照;于服药前和服药后2周和4周分别改良加藤厚涂片法粪检考核疗效。结果：治华2周,甲苯达唑4天疗法组鞭虫卵阴转率（97．20％）高于2天疗法组（88．04％）（P＜0．05）,但治后4周虫卵阴转率相同;阿苯达唑2天疗法组（72．45％－76．14％）较前2组低（P＜0．001和P＜0．01）。虫卵减少率3组均高于95％,3组鞭虫卵未阴虫治后平均EPG较治前均呈减少趋势,蛔虫卵治后4周的阴转率为91．67％－96．43％,3组间无差异。3个组的药物副反应均轻微短暂。结论：甲苯达唑800mg2天、4天疗法驱治鞭虫的疗效均达91％以上,明显优于阿苯达唑。     

Effects of Nonpharmaceutical COVID-19 Interventions on Pediatric Hospitalizations for Other Respiratory Virus Infections,Hong Kong

To determine the effects of nonpharmaceutical interventions (NPIs) for coronavirus disease on pediatric hospitalizations for infection with respiratory viruses other than severe acute respiratory syndrome coronavirus 2, we analyzed hospital data for 2017–2021. Compared with 2017–2019, age-specific hospitalization rates associated with respiratory viruses greatly decreased in 2020, when NPIs were in place. Also when NPIs were in place, rates of hospitalization decreased among children of all ages for infection with influenza A and B viruses, respiratory syncytial virus, adenovirus, parainfluenza viruses, human metapneumovirus, and rhinovirus/enterovirus. Regression models adjusted for age and seasonality indicated that hospitalization rates for acute febrile illness/respiratory symptoms of any cause were reduced by 76% and by 85%–99% for hospitalization for infection with these viruses. NPIs in Hong Kong were clearly associated with reduced pediatric hospitalizations for respiratory viruses; implementing NPIs and reopening schools were associated with only a small increase in hospitalizations for rhinovirus/enterovirus infections.