In recent years, the incidence of Clostridium difficile infection (CDI) has been in increase worldwide. Effective surveillance is the key to control the incidence and spread of CDI. The content of CDI surveillance mainly includes case definition, standardized diagnosis, CDI case source definition, CDI incidence and suggestions for CDI prevention and control. This review summarizes the pivotal components of effective CDI surveillance, and provides some practical prevention and control suggestions for the standardized surveillance and prevention and control of CDI in hospitals in China.
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Although early detection is critical, diagnosing vitreoretinal lymphoma (VRL) remains difficult. We sought to assess the potential diagnostic value of spectral-domain optical coherence tomography (SD-OCT) in VRL.We reviewed the clinical records and pre-treatment SD-OCT images of biopsy-confirmed VRL and uveitis patients, with primary involvement of the sub-retinal pigment epithelium (RPE) and the outer retina, including acute syphilitic posterior placoid chorioretinitis (ASPPC), chronic stage sympathetic ophthalmitis (SO), and idiopathic multifocal choroiditis (MFC).We included 45 eyes of 45 VRL patients and 40 eyes of 40 uveitis patients (17 ASPPC eyes, eight chronic SO eyes, and 15 MFC eyes). On SD-OCT, lymphoma cell infiltration was observed in various retinal layers, most commonly in the sub-RPE (80%) and sub-retinal space (62%). Highly sensitive features for VRL as compared to uveitis included vitreous cells (93%), focal hyper-reflective sub-retinal infiltration (51%), and diffuse RPE elevations (56%). The features strongly specific for VRL included preretinal deposits (92.5%), intra-retinal infiltration (except the incomplete vertical hyper-reflective type, 100%), banded hyper-reflective sub-retinal infiltration (90%), and confluent RPE detachments (100%). We identified an approach to VRL diagnosis based on these SD-OCT findings: (1) two highly sensitive features plus one strongly specific feature; or (2) one highly sensitive feature plus two strongly specific features, demonstrated a sensitivity of 80% and specificity of 95% for VRL.The SD-OCT may enable the detection of detailed lymphoma infiltration characteristics and provide significant supplemental value for VRL diagnosis, particularly when combining highly sensitive and specific VRL-associated SD-OCT features.
Clostridium difficile (C.difficile) is an exclusively anaerobic, spore-forming, and Gram-positive pathogen that is the most common cause of nosocomial diarrhea and is becoming increasingly prevalent in the community. Because C. difficile is strictly anaerobic, spores that can survive for months in the external environment contribute to the persistence and diffusion of C. difficile within the healthcare environment and community. Antimicrobial therapy disrupts the natural intestinal flora, allowing spores to develop into propagules that colonize the colon and produce toxins, thus leading to antibiotic-associated diarrhea and pseudomembranous enteritis. However, there is no licensed vaccine to prevent Clostridium difficile infection (CDI). In this study, a multi-epitope vaccine was designed using modern computer methods. Two target proteins, CdeC, affecting spore germination, and fliD, affecting propagule colonization, were chosen to construct the vaccine so that it could simultaneously induce the immune response against two different forms (spore and propagule) of C. difficile. We obtained the protein sequences from the National Center for Biotechnology Information (NCBI) database. After the layers of filtration, 5 cytotoxic T-cell lymphocyte (CTL) epitopes, 5 helper T lymphocyte (HTL) epitopes, and 7 B-cell linear epitopes were finally selected for vaccine construction. Then, to enhance the immunogenicity of the designed vaccine, an adjuvant was added to construct the vaccine. The Prabi and RaptorX servers were used to predict the vaccine's two- and three-dimensional (3D) structures, respectively. Additionally, we refined and validated the structures of the vaccine construct. Molecular docking and molecular dynamics (MD) simulation were performed to check the interaction model of the vaccine-Toll-like receptor (TLR) complexes, vaccine-major histocompatibility complex (MHC) complexes, and vaccine-B-cell receptor (BCR) complex. Furthermore, immune stimulation, population coverage, and in silico molecular cloning were also conducted. The foregoing findings suggest that the final formulated vaccine is promising against the pathogen, but more researchers are needed to verify it.
Uveitis is a disease presenting with varied clinical symptoms and potentially devastates visual function. Here, we report a patient with uveitis exhibiting a rare appearance of preretinal deposits (PDs).A 49-year-old female showed vitreous opacity and perivascular white PDs involving veins and arteries. The interferon-gamma release assay was strongly positive and chest computed tomography showed signs of calcified nodules; other tests were unremarkable. The patient was diagnosed with uveitis and tubercular infection. The patient was given systemic anti-tubercular therapy and steroids, which were subsequently combined with immunosuppressants. The shrinkage of HRD was more sensitively observed with OCT than on photographs during follow-up visits. The right eye was relieved subsequently, but the left eye showed vitreous opacity and responded poorly to the treatment. Three months after the dexamethasone intravitreal implant, the perivascular deposits in the left eye disappeared and the vitreous opacity was relieved.PDs can appear as spotted deposits in the posterior pole and segmental deposits in the periphery in patients with uveitis, which mainly involves the vitreous cavity and is easily confused with retinal vasculitis. OCT can more sensitively observe the response than other examinations.
Abstract Purpose It is generally believed that Carbapenem-resistant Enterobacteriaceae (CRE) colonization is primarily responsible for subsequent systemic infection in humans. In China, the specific situation of CRE colonization and subsequent systemic infection in hospitalized patients necessitates further exploration. Methods We retrospectively analyzed data of intestinal CRE colonization inpatients at Xiangya Hospital, Central South University, regarding demography, clinical and pathogenic characteristics, treatment, and outcome. A risk prediction model for subsequent CRE infection was established and externally validated. Results In total, 839 intestinal CRE colonization samples from inpatients were included. Finally, 317 cases of intestinal CRE colonization were enrolled, 25.9% of whom developed systemic infections. The subsequent CRE infection rates of CRKP and CREC were 27.0% and 32.3%, respectively. The incidence of subsequent CRE infection in the respiratory medicine department, hematology department, and intensive care unit (ICU) was 26.7%, 21.8%, and 45.0%, respectively. Taking probiotics and the combined oral and intravenous administration of antibiotics were the protective factors for the subsequent infection of intestinal CRE colonization, while liver disease, agranulocytosis ≥ 7 days, hypoproteinemia, invasive respiratory assisted ventilation, history of surgery/trauma in the past 3 months, and use of antifungal drugs were the independent risk factors. Conclusions CRE infection after intestinal CRE colonization in inpatients can significantly prolong the length of hospital stay and increase total medical costs. The CRE infection group exhibited poor efficacy and high mortality. Thus, the established risk prediction model for intestinal infection after CRE colonization in hospitalized patients has a good prediction efficacy for high-risk departments.
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