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Argentine hemorrhagic fever (AHF) is a severe hemorrhagic fever caused by a New World arenavirus, Junin virus (JUNV), which was discovered in 1958 (1). The virus reservoir consists of rodents [...]

T-cell–based diagnostic tools identify pathogen exposure but lack differentiation between recent and historical exposures in acute infectious diseases. Here, T-cell receptor (TCR) RNA sequencing was performed on HLA-DR+/CD38+CD8+ T-cell subsets of hospitalized coronavirus disease 2019 (COVID-19) patients (n = 30) and healthy controls (n = 30; 10 of whom had previously been exposed to severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]). CDR3α and CDR3β TCR regions were clustered separately before epitope specificity annotation using a database of SARS-CoV-2–associated CDR3α and CDR3β sequences corresponding to >1000 SARS-CoV-2 epitopes. The depth of the SARS-CoV-2–associated CDR3α/β sequences differentiated COVID-19 patients from the healthy controls with a receiver operating characteristic area under the curve of 0.84 ± 0.10. Hence, annotating TCR sequences of activated CD8+ T cells can be used to diagnose an acute viral infection and discriminate it from historical exposure. In essence, this work presents a new paradigm for applying the T-cell repertoire to accomplish TCR-based diagnostics. [ABSTRACT FROM AUTHOR]

Objective To review the effectiveness of antibiotic stewardship interventions in hospitals in low- and middle-income countries. Methods We searched MEDLINE[R], Embase[R], Cochrane Central Register of Controlled-Trials and regional indexes for studies of interventions to improve appropriate prescribing and use of antibiotics for hospitalized patients in low- and middle-income countries. We included controlled trials, controlled before-and-after studies and interrupted time-series studies published up to December 2017. We report prescribing, clinical and microbiological outcomes using a narrative approach. Findings We screened 7342 original titles and abstracts, assessed 241 full-text articles and included 27 studies from 2 low-income and 11 middle-income countries. We found a medium (11 studies) or high risk (13 studies) of bias. Generally, all types of interventions (structural, persuasive and enabling) and intervention bundles were reported to improve prescribing and clinical outcomes. However, the studied interventions and reported outcomes varied widely. The most frequent intervention was procalcitonin-guided antibiotic treatment (8 of 27 studies, all randomized controlled trials). The intervention was associated with a relative risk for patients receiving antibiotics ranging between 0.40 and 0.87. Conclusion The majority of studies reported a positive effect of hospital antibiotic stewardship interventions. However, we cannot draw general conclusions about the effectiveness of such interventions in low- and middle-income countries because of low study quality, heterogeneity of interventions and outcomes, and under-representation of certain settings. To strengthen the evidence base, action needs to be taken to address these shortcomings. Objectif Etudier l'efficacite des interventions visant un usage plus rationnel des antibiotiques dans les hopitaux de pays a revenu faible et intermediaire. Methodes Nous avons consulte MEDLINE[R], Embase[R], le registre central Cochrane des essais controles ainsi que des index regionaux afin de rechercher des etudes portant sur des interventions menees pour ameliorer la prescription et l'usage des antibiotiques pour les patients hospitalises, dans des pays a revenu faible et intermediaire. Nous avons inclus des essais controles, des etudes controlees avant/ apres et des etudes en series temporelles interrompues, publies jusqu'a decembre 2017. Nous evoquons ici, en adoptant uneapproche narrative, les resultats obtenus en termes de prescription et aux niveaux clinique et microbiologique. Resultats Nous avons selectionne 7342 resumes et titres originaux, evalue 241 articles dans leur version integrale et inclus 27 etudes, pour 2 pays a faible revenu et 11 pays a revenu intermediaire. Nous avons identifie un risque de biais moyen (11 etudes) ou eleve (13 etudes). En regle generale, ces publications indiquent que tous les types utilisation rationnelle des antibiotiques en milieu hospitalier, d'interventions (structurelles, persuasives et capacitantes) ainsi que toutes les interventions combinees ont permis d'ameliorer les resultats en termes de prescription et au niveau clinique. Cependant, les interventions etudiees et les resultats publies sont extremement varies. L'intervention la plus frequente a consiste a guider les antibiotherapies en utilisant la procalcitonine (8 etudes sur 27; toutes correspondent a des essais controles randomises). Pour les patients, cette intervention a ete associee a un risque relatif de prescription d'antibiotiques compris entre 0,40 et 0,87. Conclusion La majorite des etudes font etat d'un effet positif des interventions visant a promouvoir l'usage rationnel des antibiotiques en milieu hospitalier. Neanmoins, nous ne pouvons pas tirer de conclusions generales sur l'efficacite de ces interventions dans les pays a revenu faible ou intermediaire, compte tenu de la mauvaise qualite des etudes, de l'heterogeneite des interventions et des resultats ainsi que de la sous-representation de certains contextes. Pour consolider les donnees disponibles, des actions doivent etre entreprises afin de combler ces lacunes. Objetivo Revisar la eficacia de las Intervenciones de administracion de antibioticos en hospitales de paises con ingresos medios y bajos. Metodos Se realizaron busquedas en MEDLINE [R], Embase [R], en el Registro Central de Ensayos Controlados Cochrane y en indices regionales en relacion a estudios de intervenciones para mejorar la prescripcion y el uso adecuado de antibioticos para pacientes hospitalizados en paises con ingresos medios y bajos. Incluimos ensayos controlados, estudios controlados de tipo antes y despues y estudios de series de tiempo interrumpido publicados hasta diciembre de 2017. Informamos acerca de los resultados de prescripcion, clinicos y microbiologicos usando un enfoque narrativo. Resultados Revisamos 7342 titulos orlginalesy resumenes,evaluamos 241 articulos de texto completos, incluidos 27 estudios de 2 paises con ingresos bajos y 11 con ingresos medios. Encontramos riesgo medio de sesgo (11 estudios) o riesgo alto (13 estudios). Por lo general, se informo de que todos los tipos de intervenciones (estructurales, persuasivas y permisivas) y conjuntos de intervenciones mejoran los resultados de prescripcion y los resultados clinicos. Sin embargo, las Intervenciones estudiadas y los resultados sobre los que se informo varian considerablemente. La Intervencion mas frecuente fue el tratamiento antibiotico guiado de procalcltonlna (8 de 27 estudios, todos ellos ensayos controlados aleatorlzados). La intervencion se asocio aun riesgo relativo para pacientes que recibian antibioticos que oscilan entre 0,40 y 0,87. Conclusion La mayoria de los estudios informaron sobre un efecto positivo de las intervenciones hospitalarias con administracion de antibioticos. Sin embargo, no podemos extraer conclusiones generales acerca de la efectividad de tales Intervenciones en paises con ingresos medios y bajos debido a la baja calidad del estudio, a la heterogeneidad de las intervenciones y los resultados y a la baja representacion de ciertas regiones. Para fortalecer la base de las evidencias, es necesario tomar medidas para abordar estas deficiencias., Introduction Antibiotic resistance is a problem of global importance. (1) Representative data on the extent of the problem in low-and middle-income countries are relatively scarce, but high levels of resistance [...]

Objective To assess the antibiotic prescribing practices of doctors working in the Lao People's Democratic Republic and their knowledge of local antibiotic resistance patterns. Methods Doctors attending morning meetings in 25 public hospitals in four provinces were asked to complete a knowledge, attitude and practice survey. The questionnaire contained 43 multiple choice questions that the doctor answered at the time of the meeting. Findings The response rate was 83.4% (386/463).Two hundred and seventy doctors (59.8%) declared that they had insufficient information about antibiotics. Only 14.0% (54/386) recognized the possibility of cephalosporin cross-resistance in methicillin-resistant Staphylococcus aureus. Most participants had no information about local antibiotic resistance for Salmonella Typhi (211/385, 54.8%) and hospital-acquired pneumonia (253/384, 65.9%). Unnecessary antibiotic prescriptions were considered as harmless by 115 participants and 148 considered locally-available generic antibiotics to be of poor quality. Nearly three- quarters (280/386) of participants agreed that it was difficult to select the correct antibiotics. Most participants (373/386) welcomed educational programmes on antibiotic prescribing and 65.0% (249/383) preferred local over international antibiotic guidelines. Conclusion Doctors in the Lao People's Democratic Republic seem to favour antibiotic prescribing interventions. Health authorities should consider a capacity building programme that incorporates antibiotic prescribing and hospital infection control. Objectif Evaluer les pratiques de prescription d'antibiotiques des medecins travaillant en Republique democratique populaire lao et leur connaissance des profils locaux de resistance aux antibiotiques. Methodes Les medecins participant aux reunions matinales dans 25 hopitaux publiques dans 4 provinces ont ete invites a repondre a une enquete sur leurs connaissances, leur attitude et leur pratique. Le questionnaire contenait 43 questions a choix multiples auxquelles les medecins repondaient au moment de la reunion. Resultats Le taux de reponse etait de 83,4% (386/463). Deux cent soixante-dix medecins (59,8%) ont declare ne pas avoir suffisamment d'informations sur les antibiotiques. Seuls 14,0% des medecins (54/386) ont admis la possibilite d'une resistance croisee pour la cephalosporine chez la bacterie Staphylococcus aureus resistante a la methicilline. La plupart des participants n'avaient aucune information sur la resistance locale aux antibiotiques pour la bacterie Salmonella Typhi (211/385, 54,8%) et la pneumonie nocosomiale (253/384,65,9%). Les prescriptions inutiles d'antibiotiques etaient considerees comme inoffensives par 115 participants et 148 participants consideraient que les antibiotiques generiques disponibles localement etaient de mauvaise qualite. Pres de trois-tiers des participants (280/386) convenaient qu'il etait difficile de selectionner les antibiotiques appropries. La plupart des participants (373/386) ont bien accueilli les programmes de formation relatifs a la prescription des antibiotiques et 65,0% (249/383) preferaient recevoir des recommandations locales pour les antibiotiques plutot que des recommandations internationales. Conclusion Les medecins en Republique democratique populaire lao semblaient soutenir les interventions en matiere de prescription d'antibiotiques. Les autorites de sante devraient envisager l'etablissement d'un programme de renforcement des capacites qui integre la prescription des antibiotiques et le controle des infections a l'hopital. Objetivo Evaluar las practicas de prescripcion de antibioticos de los medicos que prestan servicio en la Republica Democratica Popular Lao y sus conocimientos de los patrones de resistencia a antibioticos locales. Metodos Se solicito a los medicos que asistian a reuniones por la manana en 25 hospitales publicos de cuatro provincias que completaran una encuesta sobre conocimientos, actitudes y practicas. El cuestionario contenia 43 preguntas de opcion multiple que los medicos contestaron en la reunion. Resultados La tasa de respuesta fue del 83,4 % (386/463). 270 medicos (59,8 %) declararon que no disponian de informacion suficiente acerca de los antibioticos. Solo el 14,0 % (54/386) reconocio la posibilidad de resistencia cruzada con cefalosporlna del Staphylococcus aureus resistente a la meticilina. La mayoria de los participantes no tenia informacion sobre la resistencia antlbiotlca local para la Salmonela typhi (211/385, 54,8 %) y la neumonia adquirida en el hospital (253/384, 65,9 %). 115 participantes consideraron Inofensivas las prescripciones innecesarias de antibioticos y 148 consideraron que los antibioticos genericos disponibles localmente eran de mala calidad. Casi tres cuartas partes (280/386) de los participantes convinieron en que era dificil elegir los antibioticos correctos. La mayoria de los participantes (373/386) acogieron bien los programas educativos sobre la prescripcion de antibioticos y el 65,0 % (249/383) prefirio pautas locales para el uso de antibioticos frente a las internacionales. Conclusion Los medicos en la Republica Democratica Popular Lao parecen favorecer las intervenciones de prescripcion de antibioticos. Las autoridades sanitarias deberian considerar un programa de capacitacion que incorpore la prescripcion de antibioticos y el control de las Infecciones hospitalarias., Introduction Antimicrobial resistance is caused by pathogens changing in ways that render medicines ineffective against the infections they were previously used to treat, and is considered a global public health [...]

Melioidosis, an infectious disease caused by Burkholderia pseudomallei, is endemic to Southeast Asia and tropical Australia (1,2). B. pseudomallei is a gram-negative bacterium that causes lung or soft tissue infections [...]