Volume 31, Issue 4, 2023
Editorial
Did the updated Duke criteria missed Erysipelothrix rhusiopathiae from the list of typical microorganisms causing infective endocarditis?
Volpicelli Lorenzo,
Oliva Alessandra,
Venditti Mario
Infectious endocarditis is a severe condition still characterized by a high morbidity and mortality rate. An early diagnosis may positively impact the outcome, so we need our diagnostic tools to match with the ever-changing epidemiologic and microbiologic landscape of infectious diseases.
We read with great interest the update to the Modified Duke Criteria for the diagnosis of Infectious Endocarditis recently proposed by the International Society for Cardiovascular Infectious Diseases and decided to propose the addition of Erysipelothrix rhusiopathiae to the list of typical microorganisms causing Endocarditis. This pathogen is widespread distributed in the world, has a zoonotic origin, harbors virulence factors and a multidrug resistance phenotype. Moreover, its retrieval from blood seems to have an important correlation with the presence of Endocarditis.
The inclusion of E. rhusiopathiae in the list of typical microorganisms may represent a further refinement of the Modified Duke Criteria, which represent a fundamental tool in the management of patients with suspected endocarditis.
Review
Synergistic fight against future pandemics: Lessons from previous pandemics
Okesanya Olalekan John,
Olatunji Gbolahan,
Manirambona Emery,
Oluebube Mba Mercy,
Rasheed Abdu-Samad Adebayo,
Olaleke Noah Olabode,
Ogunlayi Aderonke Cecilia,
Ogaya Jerico B,
Oladipo Elijah Kolawole,
Igbalajobi Olumuyiwa Ayokunle,
Oso Tolutope Adebimpe,
Lucero-Prisno Don Eliseo
The history of pandemics spans centuries and has had a profound impact on human health, societies, and economies. Pandemics have caused fear, panic, and significant morbidity and mortality rates throughout history. From the Athenian Plague in 430 BC to the ongoing COVID-19 pandemic, infectious diseases have posed a continuous threat to global health systems. The transition from hunter-gatherer societies to agrarian communities, increased trade and interaction between humans and animals, urbanization, travel rates, and the impact of a growing human population have all contributed to the emergence and spread of infectious diseases. Climate change and changes in land use further affect the transmission of pathogens and the distribution of disease-carrying vectors. Lessons from previous pandemics include the importance of early diagnosis and response, global cooperation and collaboration, strengthened healthcare systems, preparedness planning, public health education and communication, research and development, and adaptability and flexibility in response strategies. These lessons emphasize the significance of timely identification, swift action, sharing information and resources, investing in healthcare infrastructure, preparedness planning, effective communication, research advancements, and the ability to adapt measures as pandemics evolve. In addition, the COVID-19 pandemic has reinforced the need for a collaborative and coordinated global response to future pandemics. Governments, international bodies, healthcare organizations, and individuals could learn from the lessons of the past and apply them effectively to combat and mitigate the impact of future outbreaks. By prioritizing all the recommendations stated, the world can synergistically protect public health and minimize the devastating consequences of pandemics.
Outcomes of COVID-19 amongst patients with ongoing use of inhaled corticosteroids - a systematic review & meta-analysis
Mahmood Syed Nazeer,
Shah Viraj,
Patel Urvish,
Nawaz Muhammad Umair,
Akula Narayana Varalakshmi,
Balan Irina,
Manivannan Divya,
Pleshkova Yelena,
Negit Shayaan,
Desai Prarthana,
Jaiswal Richa,
Gurram Namratha,
Patel Neel,
Tirupathi Raghvendra,
Koritala Thoyaja
Background. WHO quoted the numbers for the Coronavirus disease 2019 (COVID-19) pandemic as of August 2021 were 200 million cases with over 4 million deaths globally. COVID-19 is associated with several respiratory pathologies. Inhaled corticosteroids (ICS) are used to improve lung function by reducing inflammation, edema, mucus secretion, and inhibiting various cytokine activities. However, there is limited data on the effect of ICS usage in patients with COVID-19. In this study, we aim to evaluate the association between the use of ICS and the outcomes in COVID-19 patients compared to standard COVID-19 treatment.
Methods. We followed PRISMA guidelines and MOOSE protocol for conducting the systematic review and meta-analysis comparing ICS and standard COVID-19 therapy. A search on PubMed is conducted yielding 270 articles of which 6 manuscripts are finalized for inclusion in the study. Patients with COVID-19 are identified from the studies based on confirmed positive RT-PCR tests. Hospitalization, ICU admission, and mortality are selected as the outcomes of our study. Using RevMan 5.3, we performed random-effects models to estimate the pooled effect size (pooled odds ratio), 95% confidence interval (95% CI), and heterogeneity (I2). Forest plots are obtained and p <0.05 is considered statistically significant.
Results. Our study involves the comparison of ICS vs Non-ICS for mortality (N= 207,842 vs 166,217), ICU hospitalization (N= 1,084 vs 9,425), and the risk of hospitalization (N= 1,273 vs 1,676).Of the six studies, five reported mortality. We found a higher mortality rate in patients with asthma (60.88%, 107/160) and chronic obstructive pulmonary disease (COPD) (68.46%, 382/558) among ICS users. The overall mortality is 7.49% (107/1428). We found that ICS use was associated with higher odds of mortality (OR=1.45 95%CI: 1.10-1.91; p=0.009, I2= 68%) amongst COVID-19 patients. In subgroup analysis, higher odds of mortality among COPD patients using ICS was noted [pooled OR: 1.52 (1.24-1.86); p<0.0001; I2=0%]. However, no significant association between ICS and mortality was observed among asthma patients.
Conclusion. ICS is associated with increased mortality and risk for hospitalization in patients with COVID-19 as compared to standard non-steroid-based COVID-19 therapy. It is crucial for healthcare providers to carefully evaluate the potential risks and benefits of ICS usage in the context of COVID-19 management to optimize patient outcomes and safety.
The role of long-acting antibiotics in the clinical practice: a narrative review
Micheli Giulia,
Chiuchiarelli Marta,
Taccari Francesco,
Fantoni Massimo
Introduction. The increasing emergence of bacterial strains with new resistance determinants has become a threat to current antibiotic therapies in recent years. This has prompted research for innovative options with improved efficacy and safety profiles: long-acting glycopeptides, such as dalbavancin and oritavancin, are currently approved for the treatment of acute bacterial skin and skin structure infections (ABSSSI). Their efficacy, microbiological profile, and ease of administration may provide an answer to this challenge, as well as reducing length of stay and hospital costs. This narrative review aims to explore the current evidence on the real-word use of dalbavancin and oritavancin, in labelled and off-label indications in clinical practice.
Methods. A PubMed library database search with no time limits was performed using the following terms: long-acting antibiotics, dalbavancin, oritavancin.
Discussion. Registration studies confirmed non-inferiority of long-acting glycopeptides to standard of care in ABSSSI (dalbavancin DISCOVER 1 and 2: 79.7% clinical success in the dalbavancin group and 79.8% in the vancomycin-linezolid group; oritavancin SOLO I: 82,3% clinical success in the oritavancin group versus 78,9% for the vancomycin group; SOLO II: 80,1% clinical success versus 82,9%). Large cohorts have confirmed similar success rates in ABSSSI treatment in real-world practice. Evidence for off-label indications is still rather scarce but promising, especially in bone and joint infections therapy for both dalbavancin and oritavancin, and infective endocarditis for dalbavancin. Moreover, these drugs may have their place in non-adherent patients, in setting of addition or difficult access to healthcare. Another potential use of these drugs is in patients with oral intake impairment or reduced gastro-intestinal absorption. However, the low penetration in cerebrospinal fluid of dalbavancin and the unfavourable outcomes in the only case report of oritavancin treatment in human meningitis despite encouraging animal models would seem to make these molecules unsuitable for central nervous system infection therapy. Most of the available evidence is based on small retrospective cohorts, so robust prospective studies investigating off-label indications are needed.
Worldwide prevalence of extended-spectrum β-lactamases-producing uropathogenic Escherichia coli isolates among kidney transplant patients: a systematic review and meta-analysis
Mostaghimi Talieh,
Shirafkan Hoda,
Nasrollahian Sina,
Fayyazi Amirhossein,
Hatami Maryam,
Rajabnia Mehdi,
Pournajaf Abazar,
Halaji Mehrdad
A significant proportion of urinary tract infections (UTIs), typically affecting kidney transplant patients (KTPs), is attributed to the presence of extended-spectrum β-lactamases (ESBLs) and multi-drug resistance (MDR) in Escherichia coli strains.
For this reason, the current meta-analysis was conducted to summarize the frequency of ESBL-producing UPEC among KTPs.
A systematic search was conducted to identify studies in the Web of Science, PubMed, Embase, and Scopus electronic databases between 2000 and 2021. Finally, 16 articles were selected for data extraction, and meta-analysis was performed using the metaprop command in the STATA (version 11) software.
From those studies, the pooled prevalence of ESBL-producing uropathogenic E. coli (UPEC) isolates was 40%. The subcategory analysis results based on continent indicated that Asian countries had the highest rate of ESBL-producing isolates with 45%, followed by 40%, 28%, and 16% in Europe, South America and North America, respectively.
Uncomfortably, a high level of UPEC isolates in the current investigation was ESBL-producing isolates. These isolates pose a serious threat to public health because they can contribute to the spread of antimicrobial resistance in the local population and hasten the ineffectiveness of the majority of commonly prescribed antibiotics for the treatment of UTI in KTPs and other patients
Interaction of the viral infectious agents in the development and exacerbation of the multiple sclerosis
Mahdavi Sina,
Asghari Ozma Mahdi,
Azadi Arezou,
Sadeghi Javid,
Bannazadeh Baghi Hossein,
Ahangar Oskouee Mahin
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system (CNS). The underlying cause of MS is still unknown. Multiple risk factors have been suggested that involve a combination of genetic, environmental, and infectious factors that contribute along with a weakened immune system. There is growing evidence supporting the potential role of viral infections in the development of the disease. Viruses like human immunodeficiency virus (HIV), John Cunningham virus (JCV), Varicella-Zoster virus (VZV), human herpesvirus 6 (HHV-6), Epstein-Barr virus (EBV), and human endogenous retroviruses (HERVs) have been proposed in the pathogenesis of MS. Their pathogenetic mechanisms are not well known, but several possibilities have been discussed. The present study highlights the proposed potential molecular and genetic mechanisms underlying this viral interaction and its implications for the development of MS.
Central nervous system and neuropsychiatric disturbances in people living with HIV
Corti Nicolò,
Bonfanti Paolo
CNS/NP disturbances are common in PLWH and still represent one of the major concerns in the modern HIV era. With an increasingly aging population, the spectrum of these manifestations depends on several factors, such as HIV direct activity in the CNS, the type of antiretroviral therapy, comorbidities and age-associated decline in neurocognition. When selecting an appropriate ARV regimen for PLWH, it is important to discuss the perception and impact of CNS/NP disturbances in the patient’s quality of life. The rapidly evolving progress in antiretroviral development encourages the possibility of having minimally toxic molecules with even better CNS tolerability profiles in the future.
Different studies have shown how in both ARV-naïve and virologically suppressed adults, BIC-based regimen is associated with significantly lower bothersome CNS/NP symptoms when compared to DTG-based regimen.
In conclusion, BIC-based regimen is an interesting option for all types of PLWH, especially among ARV-experienced patients with previous exposure to either EFV or DTG (or both) that may suffer from bothersome CNS/NP disturbances associated with antiretroviral therapy.
Pharmacological outlook of Lenacapavir: a novel first-in-class Long-Acting HIV-1 Capsid Inhibitor
Di Perri Giovanni
The evolution of antiretroviral therapy is now addressed to develop regimens consisting of two instead of three drugs and it is also increasingly oriented to develop long-acting parenteral formulations in order to increase treatment adherence and to reduce the multifaceted individual burden associated to daily intake of drugs. This new way was first paved by the dual association consisting of the INSTI Cabotegravir and the NNRTI Rilpivirine, whose formulations allow for a single administration every two months. In 2022 a new drug with a novel mechanism of action and a longer persistence of effective drug concentrations was made available in many countries for the treatment of drug-resistant HIV infection in association to other antiretrovirals. Lenacapavir is a first in class capsid inhibitor that exerts its inhibitory effect on HIV replication by binding to a structural protein of the capsid. This unprecedented mechanism of action actually differs from those of all prior antiretrovirals as Lenacapavir interferes with multiple stages rather than with a single enzyme. Such binding determines a series of inhibitory effects on sequential steps of the HIV life cycle and the net result is that of an impressive intrinsic antiretroviral potency, as testified both by in vitro studies and the 10-day monotherapy clinical study with single injections. The antiretroviral activity of Lenacapavir is unaffected by any mutation conferring resistance to older antiretrovirals. Lenacapavir is slowly released from the site of injection and this requires an initial coverage by its oral formulation (half-life: 10-12 days) in order to provide adequate pharmacokinetic exposure in the first days of treatment. The subcutaneous administration of Lenacapavir (half-life: 8-12 weeks) is then scheduled every 6 months. Lenacapavir is metabolized by CYP3A and UGT1A1, it is a substrate of Pgp and a moderate inhibitor of CYP3A. While co-administration with strong inducers of these enzymatic entities is contraindicated or it is not recommended in case of weaker inducers, few are the potential interactions of Lenacapavir as perpetrator (by its moderate inhibitory effect on CYP and weak inhibition of Pgp). In most such cases no preventive dosage adjustments are recommended and clinical monitoring only is advised. Lenacapavir overall characteristics thus meet the major clinical-pharmacologic expectations of this new era of antiretroviral development. A safe and truly potent antiviral drug, with a low metabolic interactive potential and a frequency of administration with the potential to be successfully employed beyond the current therapeutic indications.
The current state of knowledge on dracunculiasis: a narrative review of a rare neglected disease
Simonetti Omar,
Zerbato Verena,
Maurel Cristina,
Cosimi Lavinia,
Babich Stella,
Cavalli Fabio,
Di Bella Stefano,
Pavia Davide,
Pesaresi Cristiano,
Luzzati Roberto
Dracunculiasis (Guinea Worm Disease) is a chronic disease that is primarily found in the arid and poor areas of our planet where water supply systems consist of open wells. This parasitic disease is transmitted to humans not only through the consumption of water contaminated with crustaceans harbouring larvae of Dracunculus medinensis, but also through the ingestion of paratenic (frogs) or transport hosts (fish). The natural progression of the disease is caused by adult worms invading connective tissues, leading to blistering and ulceration of the extremities, approximately one year after infection. In 1986, the Guinea Worm Eradication Program (GWEP) was launched and since then, the incidence of the disease has been reduced by over 99%. Indeed, the most recent global report from 2022 shows only 13 cases of human dracunculiasis worldwide, the lowest annual incidence ever reported. The new found knowledge of potential animal reservoirs and the recent discovery of possible edible paratenic hosts could pose challenges to the future eradication of this debilitating disease. Therefore, attempts to eradicate this parasitosis should not be postponed. Intensive research is needed in this neglected area of medicine, now that the goal is within reach.
Longitudinal evaluation of two different COVID-19 vaccination strategies in individuals with and without previous SARS-CoV-2 infection.
Scapaticci Margherita,
Bartolini Andrea,
Vignoli Monica,
Orecchioni Chiara,
Paradiso Michela,
Riga Monica,
Marzo Chiara,
Corda Carolina,
Costantini Silvia,
Arnetoli Federica,
Deleonardi Gaia,
Mancini Rita
Background. We tested the antibody response to SARS-CoV-2 vaccination in individuals with and without previous infection that received different vaccination strategies.
Methods. We recruited 203 volunteers. Individuals who have had SARS-CoV-2 infection during the six months preceding vaccination received one dose (group 1), the others received two (group 2). After 3 months, 98 subjects received a booster dose. Anti-Sars-CoV-2 Spike RBD IgG were tested in all subjects before vaccination (T0), and at 15 (T15), 90 (T90), 180 (T180) and 360 (T360) days after second or single dose; additionally, in group 2, IgG were tested 10 days after the vaccination (T10).
Results. The difference of IgG concentration between the groups was statistically significant (p<0.05) at T0, T15 and T90, but not at T180 (p=0.713) and T360 (p=0.069). At T0 and T90 the antibody titre was higher in group 1, but it dropped in all volunteers 90 days after vaccination. Most of infections after vaccination occurred between T90 and T180.
Conclusions. Antibody titre is significantly associated with a previous SARS-CoV-2 infection. Probability of contracting the infection increases after three months from primary vaccination, even among who had a previous infection, confirming the efficacy of vaccination as a preventive measure against SARS-CoV-2 infections and the need of booster administrations.
Original article
Etiological characterization of acute undifferentiated febrile illness in Apartadó and Villeta municipalities, Colombia, during COVID-19 pandemic
Silva-Ramos Carlos Ramiro,
Gil-Mora Juliana ,
Serna-Rivera Cristian C. ,
Martínez Díaz Heidy-C. ,
Restrepo-López Nicaela ,
Agudelo-Flórez Piedad ,
Arboleda Margarita ,
Diaz Francisco J. ,
Faccini-Martínez Álvaro A.,
Hidalgo Marylin,
Melby Peter C. ,
Aguilar Patricia V. ,
Cabada Miguel M. ,
Tobón-Castaño Alberto ,
Rodas Juan David
Background: Acute undifferentiated febrile illness (AUFI) is one of the leading causes of illness in tropical regions. Although malaria is the most important cause, other pathogens such as Dengue (DENV), Leptospira and recently, Coronavirus Disease 2019 (COVID-19) have gained importance. In Colombia, few studies aimed to identify the etiology of AUFI. Most of them performed in Apartadó and Villeta municipalities, identifying the active circulation of several pathogens. Thus, we conducted a cross-sectional study in these municipalities to characterize the etiologies of AUFI during COVID-19 pandemic.
Methods: An active surveillance was conducted between September and December 2021 in local hospitals of Apartadó and Villeta municipalities. Febrile patients were enrolled after voluntarily agreeing to participate in the study. Ten different etiologies were evaluated through direct, serological, molecular and rapid diagnostic methods.
Results: In Apartadó a confirmed etiology was found in 60% of subjects, DENV (25%) being the most frequent, followed by leptospirosis (16.7%), malaria (10%), COVID-19 (8.3%), spotted fever group (SFG) rickettsiosis (6.7%) and Chikungunya (1.7%). In Villeta, a specific etiology was confirmed in 55.4% of patients, of which SFG rickettsiosis (39.3%) was the most frequent, followed by leptospirosis (21.4%), DENV (3.6%) and malaria (1.8%). No cases due to Mayaro, Yellow Fever, Oropouche and Venezuelan Equine Encephalitis viruses were detected.
Conclusion: We confirm the relevance of dengue fever, leptospirosis, SFG rickettsiosis, COVID-19 and malaria as causes of AUFI in the municipality of Apartadó, and highlight the great importance of SFG rickettsiosis as the main cause of AUFI in the municipality of Villeta.
The frequency of IgG anti-varicella and anti-rubella antibodies in female students of Shiraz University of Medical Sciences, Iran
Hashemi Seyed MohammadAli,
Alipour Amir Hossein,
Khatab Zinab,
Maleki Saghar,
Nekooei Fatemeh,
Dashtizadeh Fatemeh,
Daryabor Gholam Reza,
Kalantar Kurosh,
Salimi Vahid,
Sarvari Jamal
Background: As infection with rubella and varicella-zoster viruses (VZV) can lead to congenital syndrome and its dangerous complications, assessing immunity to these congenital infections can represent the biological risk assessment related to their exposure in high-risk groups. Therefore, we aimed to evaluate the frequency of IgG anti-varicella/rubella antibodies (Abs) in female students at Shiraz University of Medical Sciences (SUMS), Iran.
Patients and Methods: In this study, a total of 434 female students were included. Sera were isolated from blood samples and stored at -20°C for later analysis. A questionnaire form was documented and contained demographic data as well as the history of vaccinations. Enrolled students were divided into recipients of either one or two doses of the measles/rubella (MR) vaccine. Serum samples were analyzed for rubella and VZV IgG Abs using commercial IgG immunoassays.
Results: The students were 21.6±4.25 years old on average. Out of the 434 enrolled students, 292 (67.3%) and 287 (66.1%) students were positive for anti-varicella and anti-rubella IgG-Abs, respectively. The frequency of anti-rubella IgG Ab was significantly higher in those who received one dose of MR vaccine (P<0.001). In addition, 205 (47.2%) and 59 (13.6%) students were double-positive (anti-varicella/rubella IgG Abs) and double-negative, respectively.
Conclusion: Our results indicated that an additional dose of rubella vaccine may be required for those who received two doses of the vaccine. In addition, we recommend the inclusion of the VZV vaccine in Iran's routine vaccination program. Further studies are recommended to verify these results.
Impact of Nested Multiplex Polymerase Chain Reaction Assay in the management of pediatric patients with acute respiratory tract infections: a single center experience
Sherif Basma,
Hamza Heba M.,
Abdelwahab Hoda Ezz Elarab
Purpose: Acute lower respiratory infection (ALRI) remains a global public health problem among children. Distinguishing the etiology of ALRI is challenging and rapid pathogen identification is critical for optimizing the diagnosis and treatment of infectious diseases. Multiplex polymerase chain reaction (PCR) is sensitive, simple, and rapid. Our objective was to evaluate the diagnostic yield and prognostic significance of the FilmArray test for identification of pathogens in pediatric patients with ALRI at a tertiary care center.
Methods: A prospective observational cross-sectional study involved 230 pediatric patients presented with acute lower respiratory tract (LRT) symptoms, for whom conventional bacterial culture and FilmArray testing was ordered to aid in the proper diagnosis of the implicated respiratory pathogens.
Results: FilmArray Respiratory panel (FARP) was positive in 201 patients (87.4%). The most common detected pathogens were Respiratory syncytial virus (RSV), Human Rhinovirus/Enterovirus, Parainfluenza, Influenza A, and Klebsiella pneumoniae; 45 (19.6%), 38 (16.5%), 11 (4.8%), 8 (3.5%) and 6 (2.6%) respectively. FilmArray enabled a change in antimicrobial therapy in 168 (73%) of the patients.
Conclusions: FilmArray enables to improve etiological diagnosis of ALRI and optimize the antimicrobial use of drugs in critical care pediatric patients. Clinical correlation is essential to interpret multiple pathogens and resistance genes.
Disinfectant caps in vitro effectiveness
Rimoldi Sara Giordana,
La Cava Leyla,
Palladino Chiara,
Piacenza Mariagrazia,
Vimercati Stefania,
Cristina Pagani,
Salari Federica,
Curreli Daniele,
Gismondo Maria Rita,
Foschi Antonella,
Giustivi Davide,
Diotto Veronica,
Bizzi Emanuele,
Calloni Maria,
Casella Francesco,
Martini Elena,
Donadoni Mattia,
Cogliati Chiara,
Gidaro Antonio
Background: Catheter-related bloodstream infections (CRBSIs) are a major cause of morbidity and mortality among hospitalized patients. Different studies suggest that the use of disinfectant caps (DCs) significantly reduces the rate of CRBSIs. The first purpose of this study is to analyze, through an in-vitro-model, the antiseptic effect of DCs produced by two manufacturers; the second aim is to assess potential differences in terms of effectiveness between the two manufacturers’ products.
Methods: A know concentration of thirteen different microorganisms was incubated with the sponge drenched in antimicrobial fluid inside DCs and cultured through several assays to investigate the disinfectant effectiveness of some commercially available caps. Disinfectant properties were evaluated under two different conditions: baseline (DCs placed on the needle-free connectors (NFCs) and stress test (DCs directly applied to the catheter hub).
Results: Both manufacturers overcame the basal tests (fourteen different assays). Regarding stress tests: the only significant bacterial load was found for Serratia marcescens (104 CFU/mL in ICU Medical™), both at 90 and 180 minutes after incubation; due to the low load, MDR Acinetobacter baumannii was not considered significant (<103 CFU/mL in BD PureHub™).
Conclusions: Our results confirm what was reported in BD PureHub™ datasheet and add data not previously shown by ICU Medical™. Moreover, no difference was observed between the two manufacturers products: the use of both DCs on NFCs was able to reclaim the catheter lumen. These findings support the routine use of DCs with NFCs, as part of a structured bundle of interventions, to reduce the incidence of CRBSIs.
Case report
Splenic infarction: an uncommon yet significant complication in COVID-19 patients - a case series report and literature review
Pitliya Aakanksha,
Patel Mizba Basheer,
Batra Vanshika,
Agrawal Bhavika,
Kancherla Neeraj,
Yadav Kumari Priya,
Kumar Deepak,
Pitliya Anmol
Splenic infarction is a rare complication observed in some patients affected by coronavirus disease 19 (COVID-19), with poorly understood clinical features and prognosis. We analyzed the histopathological reports and clinical data from six adult patients admitted to a tertiary care center between 10 October 2020, and 10 January 2021, diagnosed with COVID-19 and splenic infarct. Confirmed COVID-19 diagnosis was established through a nasopharyngeal swab while uncertain diagnoses, children, and non-hospitalized patients were excluded. Splenic infarct was confirmed by abdominal CT scan. The findings indicated a direct impact of the virus on the spleen, evident through a decline in lymphocyte counts. These results emphasize the significance of comprehending the potential complications and pathological changes associated with COVID-19, particularly concerning splenic involvement. The literature review employed a specific keyword search strategy focusing on COVID-19 and splenic infarction case reports. The review highlighted the association between COVID-19 and an increased risk of thromboembolism, emphasizing the importance of monitoring and managing clotting issues. It also underscored the need to consider splenic infarction as a potential complication in COVID-19 patients with abdominal pain. The study highlighted the diverse nature of splenic infarction in COVID-19 patients, necessitating a multidisciplinary management approach and calls for further research to elucidate underlying mechanisms and optimize treatment strategies.
Brain abscesses caused by Listeria monocytogenes in a patient with myasthenia gravis - Case report and systematic review
Carneiro Bruno Hassunuma,
de Melo Thayane Guimarães,
da Silva Alessandra Filpo Ferreira,
Lopes Júlia Tavares,
Ducci Renata Dal-Prá,
Carraro Junior Hipólito,
Ducroquet Marcelo Abreu,
França João Cesar Beenke
Background: Listeriosis is a known cause of community acquired bacterial meningitis/meningoencephalitis. It occurs more frequently in neonates, older people and immunocompromised hosts. Rarely, brain abscesses can complicate the course of infection, which poses a difficulty in the management and elevates morbidity and mortality. Myasthenia gravis is an autoimmune disease that often requires immunosuppressive treatment, which increases the risk for invasive infections.
Case description: A 75-year-old myasthenic patient, treated with prednisone and pyridostigmine, was diagnosed with invasive listeriosis. He presented with muscle weakness, dyspnea, hemiparesis and altered mental status. Brain imaging revealed multiple abscesses and blood cultures were positive for Listeria monocytogenes. Despite combination antibiotic therapy, he died 6 weeks after admission.
Systematic review: Ninety-six cases of brain abscesses from 1968 to 2023 were reviewed; the majority of the patients were men, 54 years-old on average, and had at least one risk factor for invasive listeriosis. The mortality exceeded 22%. Blood cultures and CSF/abscess cultures were positive in only 79.2% and 54.6%, respectively. The most common therapeutic approach was a combination regimen that included amoxicillin or ampicillin. Only 8 patients underwent surgery, of which one died.
Conclusion: This case highlights the importance of L. monocytogenes as a cause of brain abscesses in populations at risk, including myasthenic patients. The challenge of diagnosing and treating this condition is aggravated by the paucity of literature and the high mortality rate.
Clinical utility of intrabronchial antifungal instillation in a complicated case of chronic pulmonary aspergillosis: case report and systematic review of literature
Sharma Sreyas,
Kumar Rohit,
Ish Pranav,
AJ Mahendran,
Gupta Neeraj Kumar,
Gupta Nitesh,
Madan Manu
Chronic pulmonary aspergillosis (CPA) is a progressive, debilitating clinical condition associated with significant morbidity. Surgery is the mainstay of treatment for life-threatening hemoptysis in symptomatic patients with simple aspergillomas. However, in patients with chronic cavitary pulmonary aspergillosis, surgical removal of aspergillomas is fraught with difficulty due to debilitating nature of the illness. Here we present a case showcasing the utility of intrabronchial voriconazole instillation in controlling hemoptysis in a patient unfit for surgery followed by systematic review of literature involving 11 clinical studies after screening a total of 5572 studies from PubMed and Google Scholar database. Data gathered from these studies addresses the concerns regarding the efficacy, safety of the procedure as well as draws attention regarding several lacunae in our existing knowledge. A 53-year-old male with chronic pulmonary aspergillosis who had recurrent episodes of hemoptysis despite bronchial artery embolization and was unfit for surgery due to limited lung reserve, patient underwent single session of intrabronchial voriconazole instillation which resulted in dramatic symptomatic and radiological improvement. Intrabronchial antifungal instillation may be a safe and effective option for hemoptysis control in patients with chronic pulmonary aspergillosis.
Enterococcal meningitis associated with Strongyloides infection: a case report and literature review
Cosimi Lavinia,
Di Bella Stefano,
Luzzati Roberto,
Simeth Catrin Theresia,
Pinamonti Maurizio,
Cominotto Franco,
Sisto Ugo Giulio
Strongyloides stercoralis is an intestinal nematode endemic throughout tropical and subtropical areas, with a life cycle consisting of free-living and parasitic components. Unlike other soil-transmitted nematodes, it is capable of self-infection, which can cause chronic disease that lasts for decades, or cause overwhelming hyperinfection in people taking corticosteroids or other immunosuppressive drugs or who have impaired Th2 cell-mediated immunity, particularly those infected with human T-lymphotropic virus 1.
During hyperinfection, a large numbers of larvae have access to the bloodstream, lungs, central nervous system, and other organs. Bacteremia and polymicrobial meningitis can occur due to disruption of the intestinal mucosa and the presence of bacteria on the surface of foreign larvae.
Enterococcal meningitis for instance may occur concurrently with strongyloidiasis as a consequence of haematogenous dissemination. We present a clinical case of a 45-year-old, man from Bangladesh, in which co-infection occurred. The patient was not immunocompromized and had no apparent risk factors, which represents the unusual aspect of this case report.
A literature review on enterococcal meningitis and Strongyloides coinfection in adult patients was performed encountering 21 cases. Cases have been reviewed and discussed. Clinicians may suspect S. stercoralis co-infection when identifying an enterococcal meningitis in adult patients coming from endemic areas.
The Infections in the History of Medicine
Historical account of clinical observations on leprosy and related manifestations in the Comacchio area, Italy, in the XIX century
Vicentini Maria Beatrice,
Contini Carlo
Known before Christ and in ancient Egypt, leprosy was believed to be a mysterious disease of supernatural origin. It covered the body with lumps and sores, dulled the senses, produced altered facial features and mutilation of the limbs. By the 6th century AD, the disease had certainly made its appearance in Western Europe and continued to occur in the following centuries. It was also thought to be attributable to poverty and poor sanitation. Leprosy was not considered an infectious disease until 1873, when physician G. H. A. Hansen first identified Mycobacterium leprae, calling it Hansen's bacillus, and the disease was named Hansen's disease.
This paper analyses clinical reports on leprosy observed in Northern Italy, in the Comacchio area near Ferrara (Po Delta), in the 19th century, taking into consideration documents and manuscripts of the time.
The scholars who made the greatest contribution to the description of the disease in and around Comacchio area were Antonio Campana, Andrea Verga, Alessandro Colla, Clodoveo Biagi, Ottone Schrön, Giacomo Sangalli, Raffaele Cavalieri, and local physicians Cristoforo Belloli, and Francesco Ballotta.
Observations on the manifestations of the disease and attempts to cure it, including milk diet, are reported. In particular, this morbid form, which was not found in neighboring territories, was called “Mal di formica” because of its benignity at onset, its slowness and its slow progress. Tubercular Leprosy or Mal di fegato, a form of incurable leprosy was nothing more than the leprosy or elephantiasis described by the Greeks and Hebrews. The people most affected were women, who accounted for two-thirds of the sick. According to some authors, the causes of leprosy could be attributed to overuse of certain rotten or salted fish. Campana was the first to think that a lazaret should be erected for the sick.
Erratum
ERRATUM
Multifaceted realities of scrub typhus: a case series from southern India
Ravikumar Diviya Bharathi,
Sivasubramanian Barath Prashanth,
Shanmugam Sruthi Nandhaa,
Krishnaswamy Vanitha,
Rabaan Ali,
Al-Tawfig Jaffar A.,
Tirupathi Raghavendra
Erratum for
Multifaceted realities of scrub typhus: a case series from southern India
Diviya Bharathi Ravikumar , Barath Prashanth Sivasubramanian , Sruthi Nandhaa Shanmugam , Vanitha Krishnaswamy , Ali Rabaan, Jaffar A. Al-Tawfiq, Raghavendra Tirupathi
