Volume 30, Issue 3, 2022
Editorial
Growing shreds of evidence for monkeypox to be a sexually transmitted infection
Amer Fatma A.,
Hammad Noha M.,
Wegdan Ahmed Ashraf,
ElBadawy Nissreen E.,
Pagliano Pasquale,
Rodríguez-Morales Alfonso J.,
Not available
Review
A comparative overview of SARS CoV 2 and its variants of concern
Ahmad Aqeel,
Fawaz Mohammed Ali Mullah ,
Aisha Arafeen
In December 2019, the severe acute respiratory syndrome 2 (SARS-CoV-2) coronavirus outbreak began in Wuhan, China, and quickly spread to practically every corner of the globe, killing millions of people. SARS-CoV-2 produced numerous variants, five of which have been identified as variants of concern (VOC) by the World Health Organization (WHO) (Alpha, Beta, Gamma, Delta, and Omicron). We conducted a comparative epidemiological analysis of SARS-CoV-2 and its VOC in this paper. We compared the effects of various spike (S) protein mutations in SARS-CoV-2 and its VOC on transmissibility, illness severity, hospitalization risk, fatality rate, immunological evasion, and vaccine efficacy in this review. We also looked into the clinical characteristics of patients infected with SARS-CoV-2 and its VOC.
MIS-C related to SARS-CoV-2 infection: a narrative review of presentation, differential diagnosis, and management
Gadiwala Salika,
Mistry Ayushi,
Patel Sejal,
Chaithanya Avanthika,
Pathak Stuti,
Satnarine Travis,
Bekina-Sreenivasan Daria,
Bakarr Abdul Akim,
Das Bibhuti Bhusan,
Chandra Raj,
Patel Saurabhkumar,
Areti Sathya
Multisystem Inflammatory Syndrome in Children (MIS-C), a rare condition, has been reported approximately 2-4 weeks after the onset of COVID-19 in children and adolescents, causing inflammation in multiple systems, including cardiovascular and respiratory, digestive, and central nervous systems. This condition is also known as hyperinflammatory shock, Kawasaki-like disease, and Pediatric Inflammatory Multisystem Syndrome (PIMS). The signs and symptoms include but are not limited to fever, rash, peripheral edema, gastrointestinal symptoms, conjunctivitis, and shock. Thirty-eight studies met our criteria, with a total of 5822 patients. The most affected population was between 5-18 years of age. We noted that MIS-C presented with a wide range of signs and symptoms that overlap with Kawasaki Disease, including high fever, sore throat, malaise, tachypnea, tachycardia, conjunctival injection, mucosal edema, cardiac involvement, and gastrointestinal symptoms. It causes an increase in IL-17A, IL-6, and arterial damage, a distinct difference from Kawasaki disease. The laboratory findings in MIS-C showed an increase in inflammatory markers like CRP, ESR, ferritin, leukocytes, and TNF-α. WHO stated that 23% of affected children with MIS-C had underlying conditions like chronic lung diseases, cardiovascular disease, and immunosuppression. In most affected children, aspirin and IVIG were successful, which resulted in a decrease in the inflammatory markers. We find that MIS-C is a rare, but potentially fatal pediatric complication, after COVID-19 infection. The aim of this article is to study the emerging relationship between COVID-19 and MIS-C in children and adolescents affected by this condition, to discuss the immunological mechanisms, and explore potential therapies.
Acute hepatitis (Non Hepa A-E) of unknown origin among pediatrics
Faezi Nasim Asadi,
Mehramouz Bahareh,
Taghizadeh Sepehr,
Pagliano Pasquale,
Kafil Hossein Samadi,
Several clusters and individual cases of acute hepatitis have been reported in the US, Europe and recently in Asia and Central America since October 2021. A laboratory investigation of the common viral hepatitis agents (HAV, HBV, HCV, HDV and HEV) yielded negative results prompting the use of the term “acute non HepA-E hepatitis” to describe this condition. As of 24 June of 2022, WHO have reported 920 probable cases of severe acute hepatitis of unknown origin among pediatrics in 33 countries in five WHO regions. Since the previous reports on 27 May 2022, 270 new probable cases have been increased, including from four new countries, some of whom were also found to be positive for SARS-CoV-2. All the patients showed symptoms such as vomiting, diarrhea, jaundice, and abdominal pain. The patients’ liver enzymes were remarkably increased. No connection with SARS-CoV-2 or its vaccine has been found so far. However, the suspected cause is adenovirus, including its genomic variations, because its pathogenesis and laboratory investigations have been positively linked. Until further evidence emerges, hygiene precautions could be helpful to prevent its spread.
Pre-Exposure Prophylaxis for viral infections other than HIV
Soriano Vicente,
Treviño Ana,
de Mendoza Carmen,
Moreno-Torres Víctor,
Pintos Ilduara,
Barreiro Pablo,
Corral Octavio
The battle against human viral infections has historically relied on two medical strategies, namely vaccines to protect from contagion and antivirals to treat infected patients. In the absence of vaccines, antivirals have occasionally been used as peri-exposure prophylaxis, given either before (pre-exposure prophylaxis) or right after (post-exposure prophylaxis). In an unprecedented way, the use of antiretrovirals as chemoprophylaxis has triumphed in the HIV field. Indeed, oral antiretrovirals given either daily or at demand to HIV-uninfected individuals engaged in high-risk behaviors protect from contagion. More recently, the advent of long-acting formulations has allowed HIV protection following intramuscular injections every three months. Can we envision a similar prophylactic strategy for other human viral infections?
The advent of such ‘chemical vaccines’ would fill an unmet need when classical vaccines do not exist, cannot be recommended, immune responses are suboptimal, escape mutants emerge or immunity wanes. In this review, we discuss the opportunities for antiviral chemoprophylaxis for viral hepatitis B and C, retroviruses HTLV-1 and HIV-2, and respiratory viruses influenza and SARS-CoV-2, among others.
Human monkeypox disease (MPX)
Farahat Ramadan Abdelmoez,
Sah Ranjit,
El-Sakka Amro A.,
Benmelouka Amira Yasmine,
Kundu Mrinmoy,
Labieb Fatma,
Shaheen Rahma Sameh,
Abdelaal Abdelaziz,
Abdelazeem Basel,
Bonilla-Aldana D. Katterine,
Franco- Carlos,
Henao-Martinez Andres F.,
Garout MohammedA.,
León-Figueroa Darwin A.,
Pachar Monica,
Suárez José Antonio,
Ramirez Juan David,
Paniz-Mondolfi Alberto,
Rabaan Ali A.,
Al-Tawfiq Jaffar A.,
Nishiura Hiroshi,
Ortiz-Martínez Yeimer,
Garcia-Robledo Juan Esteban,
Cimerman Sergio,
Barbosa Alexandre Naime,
Pagliano Pasquale,
Zambrano-Sanchez Gabriela,
Cardona-Ospina Jaime A. ,
Bížová Beatrice,
Rodriguez-Morales Alfonso J.
Monkeypox is a rare viral infection, endemic in many central and western African countries. The last international outbreak of monkeypox reported outside Africa occurred back in 2003. However, monkeypox has reemerged at a global scale with numerous confirmed cases across the globe in 2022. The rapid spread of cases through different countries has raised serious concerns among public health officials worldwide prompting accelerated investigations aimed to identify the origins and cause of the rapid expansion of cases. The current situation is reminiscent of the very early stages of the still ongoing COVID-19 pandemic. Overlapping features between these, two seemingly alike viral entities include the possibility for airborne transmission and the currently unexplained and rapid spread across borders. Early recognition of cases and timely intervention of potential transmission chains are necessary to contain further outbreaks. Measures should include rapid and accurate diagnosis of cases meeting case definitions, active surveillance efforts, and appropriate containment of confirmed cases. Governments and health policymakers must apply lessons learned from previous outbreaks and start taking active steps toward limiting the recent global spread of monkeypox. Herein, we discuss the status of the current monkeypox outbreaks worldwide, the epidemiological and public health situation at a global scale and what can be done to keep at bay its further expansion and future global implications.
Determinants of public health and interventions to address HIV infection among men who have sex with men in Miami-Dade County, Florida, USA
Gonzales-Zamora Jose A.,
Ponce-Rosas Linda,
Martinez Richard
Human immunodeficiency virus (HIV) among men who have sex with men (MSM) has been recognized as a public health problem in Miami-Dade County, Florida, USA. This was found to be a significant problem in our need assessment as evidenced by the HIV incidence rate of 28.4 per 100,000 population, which is higher than the average incidence reported for the state of Florida. MSM account for the mostly affected group, reaching 59% of all the new cases. A review of the HIV determinants was conducted using an ecological framework. At the individual level, sexual abuse, alcohol, and drug consumption were identified as determinants of HIV infection in this population. Family rejection was recognized as a determinant at the interpersonal level. Connection to the gay community can function as a protective factor but it can also be possible predictor of HIV infection. Among structural factors, poverty was found to be positively associated with HIV prevalence. Additionally, we highlighted the importance of sexual health education and especially pre-exposure prophylaxis (PrEP) as protective factors. By using systems thinking tools, we designed a causal loop diagram that illustrates visually the recognized determinants of public health. Finally, we presented several studies that evaluate evidence-based interventions to improve the uptake and retention in care of PrEP in MSM. We also described existing interventions implemented in Miami-Dade County, and reported studies that may contribute to the development of new HIV preventive strategies in the future.
Original article
Comparison of clinical characteristics and outcome in RT-PCR positive and false-negative RT-PCR for COVID-19: A Retrospective analysis
Meena Durga Shankar,
Kumar Bharat,
Kachhwaha Arjun,
Kumar Deepak,
Khichar Satyendra,
Bohra Gopal Krishana,
Sharma Ankur,
Kothari Nikhil,
Garg Pawan,
Sureka Binit,
Banerjee Mithu,
Garg Mahendra Kumar,
Misra Sanjeev
Cases with SARS-CoV-2 RT-PCR negative pneumonia are an understudied group with uncertainty remaining regarding their treatment approach. We aimed to compare the clinical and radiological characteristics of RT-PCR positive and clinically diagnosed RT-PCR negative COVID-19. This was a single-centre retrospective study conducted at a tertiary care hospital in Western India. All patients (age ≥18 years) with suspicion of COVID-19 with SARI (severe acute respiratory infections) who were subjected to RT-PCR testing (nasal/oropharyngeal swab) were included. Based on RT-PCR results, patients were categorized and compared for demographic, clinical, and biochemical characteristics and outcomes. Out of 500 patients, 339 (67.8%) found RT-PCR positive. Except for the radiological findings, both groups differ in clinical presentation, disease severity (inflammatory markers), and outcome. RT-PCR-positive patients had raised ferritin, NLR (Neutrophil-Lymphocyte ratio), LDH, and high mortality compared to the swab-negative group. In-hospital mortality was also significantly high in RT-PCR positive group (HR=1.9, 95% CI = 1.4-2.5, p=0.001). On multivariate analysis, NLR, ferritin, and d-dimer were the independent predictors of mortality in RT-PCR-positive (p=0.038, 0.054, and 0.023). At the same time, raised TLC (total leukocyte count) and procalcitonin were the risk factors for poor outcomes in RT-PCR-negative patients (p=0.041 and 0.038). We found significantly raised ferritin, NLR, and LDH levels and increased mortality in RT-PCR positive patients compared to RT-PCR negative. Incorporating clinical features, radiological, and biochemical parameters could be prudent while managing the RT-PCR-negative patients.
Home management of COVID-19 symptomatic patients: a safety study on COVID committed home medical teams
Venturini Sergio,
Orso Daniele,
Cugini Francesco,
Martin Francesco,
Boccato Cecilia,
De Santi Laura,
Pontoni Elisa,
Tomasella Silvia,
Nicotra Fabrizio,
Grembiale Alessandro,
Tonizzo Maurizio,
Grazioli Silvia,
Fossati Sara,
Callegari Astrid,
del Fabro Giovanni,
Massimo
To reduce the overburden in the hospital, during the COVID-19 pandemic, some "COVID Committed Home Medical Teams" (CCHTs) were created in Italy. These units consist of a small pool of general practitioners who aim to evaluate all patients with COVID-19 who require a medical examination directly at home. After the first visit (which can end with patient hospitalisation or home management), CCHTs periodically monitor the patients' clinical conditions and vital signs (usually a revaluation every 24-48 hours, except for a sudden worsening). However, this strategy - which reduces the pressure on hospitals - has never been evaluated for patient safety. Our study aims to determine whether a home-based monitoring and treatment strategy for non-severe COVID-19 patients was safe as direct hospital admission by the emergency department. We conducted a retrospective observational study about 1,182 patients admitted to the hospital for COVID-19 between September 2020 and April 2021, confronting in-hospital and 30-day mortality in both CCHT-referred (n=275) and directly admitted by emergency department (n=907). Patients assessed by the CCHT had lower in-hospital and 30-day mortality (18% vs 28%, p = 0.001; and 20% vs 30%, p = 0.002); but, in the propensity score matching comparison, there was no characteristic between the two groups turned out significantly different. CCHT did not correlate with in-hospital or 30-day mortality. CCHT is a safe strategy to reduce hospital overburden for COVID-19 during pandemic surges.
Impact of SARS-CoV-2 infection on tuberculosis outcome and follow-up in Italy during the first COVID-19 pandemic wave: a nationwide online survey
Canetti Diana,
Antonello Roberta Maria,
Saderi Laura,
Giro Mara,
Goletti Delia,
Sarmati Loredana,
Rodari Paola,
Bocchino Marialuisa,
Schirò Miriam,
Riccardi Niccolò,
Sotgiu Giovanni
Background: SARS-CoV-2 pandemic affected tuberculosis (TB) management. This Italian nationwide survey assessed COVID-19 impact on TB care and outcomes.
Materials and methods: Twenty-one hospitals or referral centres fulfilled an online survey. Primary objective was to describe clinical features, outcomes and retention in care in subjects with latent TB infection (LTBI) or disease over the first wave of COVID-19 pandemic. Secondary objectives were the assessment of risk factors, co-morbidities, diagnostics, radiological findings, and outcomes of COVID-19 in the study population.
Results: 254 patients with LTBI or active TB were included. In co-infected (SARS-CoV-2, LTBI/TB) patients, recovery occurred in 29/32 (90.6%) cases, death in one case. High retention in care was preserved.
Conclusion: in our cohort, outcomes did not seem to be adversely conditioned by incident COVID-19.
Are SARS-CoV-2 rapid antigen tests useful for the control of latest variants spreading?
Marascio Nadia,
Quirino Angela,
Scarlata Giuseppe Guido Maria,
Barreca Giorgio Settimo,
Giancotti Aida,
Lamberti Angelo Giuseppe,
Gallo Luigia,
Foti Fabio,
Laurendi Domenico Luca,
Dattola Daniela,
Marsico Antonino,
La Rocca Antonia,
Matera Giovanni
Reverse Transcription Polymerase Chain Reaction (RT-PCR) conducted on nasopharyngeal swabs is the gold standard in the diagnosis of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). In Italy, recent guidelines indicate that rapid antigen tests (RATs) can be used for the isolation of positive patients or for the interruption of quarantine, but they are often less sensitive to detect positive subjects. Indeed, the performance of these RATs depends on the timing and the population on which they are evaluated. Herein, we evaluated the performance of BIOCREDIT COVID-19 Ag and Fluorecare® SARS-CoV-2 Spike Protein Test during a population screening in the Calabria Region, Southern Italy. We report that both antigen test shows low sensitivity in contrast to the high sensitivity declared by manufacturer (90% and 92%, respectively) and that the area under the curve (AUC) was good for Fluorecare® SARS-CoV-2 Spike Protein Test but very poor for BIOCREDIT COVID-19 Ag. We suggest that these RATs should be re-evaluated in the current pandemic era.
Deoxycholate amphotericin for management of mucormycosis: a retrospective cohort study from South India
Gupta Nitin,
Srinivas Sourabh,
Harikumar Anagha,
Devaraja K,
Nallapati Vishnu Teja,
Saravu Kavitha
Introduction: Liposomal amphotericin use is limited in developing countries due to its extremely high cost and availability. Therefore, the study aimed to evaluate deoxycholate amphotericin B's utility and adverse effect profile in patients with mucormycosis.
Methodology: This retrospective cohort study from 2019 to 2021 included patients with proven mucormycosis who received deoxycholate amphotericin B for more than or equal to five days and had at least three creatinine values on treatment. Baseline demographic details, risk factors and treatment details of all the patients were recorded. In addition, the details of treatment-related adverse effects and outcomes were ascertained.
Results: Of the 57 included patients, a history of diabetes, COVID-19 and steroid use was present in 49 (86%), 43 (75.4%) and 33 (57.9%) patients, respectively. Isolated rhino-orbital mucormycosis was the most common presentation (n=49, 86%). The median time of follow-up was 48 (30.5-90) days. A total of 8 (14%) patients died during the hospital stay. The median duration of amphotericin treatment was 21 (14-40) days. Thirty-nine patients (68.4%) developed hypokalaemia on treatment, while 27 (47.4%) patients developed hypomagnesaemia. A total of 34 (59.6%) patients developed AKI on treatment. The median day of development of AKI was 6 (4-10) days. The median baseline, highest and final creatinine values were 0.78 (0.59-0.94) mg/dl, 1.27 (0.89-2.16) mg/dl and 0.93 (0.74-1.59) mg/dl respectively. The median percentage change from baseline to highest value and last follow-up value was 45% (0.43%-161%) and 25% (-4.8%-90.1%) respectively. The final creatinine was less than 150% of the baseline in 36 (61.3%) patients.
Conclusion: Deoxycholate amphotericin is an acceptable alternative for treating mucormycosis in resource-constrained settings.
Adherence to antiretroviral therapy thought package-refill among HIV+ persons at “D. Cotugno” hospital, Naples, Italy
Fusco Francesco Maria,
Sangiovanni Nadia,
Papa Nunzia,
Cuomo Nunzia,
Tambaro Orsola,
Iodice Valentina,
Bruner Vincenzo,
Carleo Maria Aurora,
Rizzo Viviana,
Palmiero Giulia,
Di Lorenzo Mariana,
Spatarella Micaela,
Viglietti Rosaria,
Sangiovanni Vincenzo,
Esposito Vincenzo
Background: A gold-standard for the measurement of adherence to antiretroviral therapy (ART) is lacking. Aim of this study is to verify the feasibility of a package-refill-based measurement of ART at “D. Cotugno” hospital, Naples, Italy, and the factors associated to adherence.
Methods: In the period January 2018-August 2020, we calculated the package-refill as the ratio between ART-packages actually withdrawn, and the ART packages needed to regularly take ART. Adherence was associated, trough a univariate e multivariate logistic regression, to demographical, behavioural and clinical factors.
Results: 1140 HIV+ subjects were included. At univariate logistic regression inadequate package-refill-based adherence is associated with HIV-RNA higher than 50 copies/mmL (OR 3.77-IC95% 2.76-5.13) and with HIV-RNA higher than 200 copies/mmL (OR 3.98-IC95% 2.69-5.90). Being not-Italian and Injective-drug-user are associated with low adherence, having HIV/AIDS for more than 8 years is associated with better adherence.
Conclusions: Package-refill is a suitable method for measuring adherence and is associated with the condition of viral failure.
Influenza-associated severe acute respiratory infections among children under five years old in Morocco, September 2017 to March 2019
Regragui Zakia,
Bimouhen Abderrahman,
E lFalaki Fatima,
Ihazmad Hassan,
Benkerroum Samira,
Triki Soumia,
Cherkaoui Imad,
Mahraoui Chafiq,
Filali-Maltouf Abdelkarim,
Medraoui Leila,
Oumzil Hicham
The main aim of this research is to investigate the trend of influenza infection among children under 5 years with severe acute respiratory infections (SARI) as well as those who suffer from a high burden of disease.
This research is based on a survey conducted from September 2017 to March 2019. During this period nasopharyngeal swabs were collected in a group of 942 children under 5 years with SARI, admitted in pediatric services of 8 sentinel hospitals.
The virological surveillance of influenza was carried out at the National influenza Center, located in the National Institute of Hygiene, using a Reverse transcription polymerase chain reaction (qRt-PCR) monoplex assay developed by the Centers for Disease Control and Prevention (CDC; Atlanta, GA).
The median age of participants was 11 months, and 40% of them were female. A total of 112 samples were reported positive yielding a frequency of 11.88% (112/942). Among all the influenza confirmed cases, 68.75% (77/112), 15.17% (17/112), 16.04% (18/112) were subtyped as influenza AH1N1pdm09, AH3N2 and influenza B respectively. Meanwhile, the proportion of patients admitted at the intensive care unit was 5,35% (6/112). Out of which 83.33% (5/6) were AH1N1pdm09 and it was reported that just 1.78% (2/112) of the positive cases were vaccinated.
The study confirms that influenza affects greatly children with SARI. Thus, the need for influenza vaccines is highly recommended for children under 5 years. Moreover, our findings highlight that influenza virus is not the only cause of SARI among this group of children. Accordingly, special attention should be paid to the non-flu respiratory viruses.
Case report
Treatment with cefiderocol in K. pneumoniae KPC nosocomial external ventricular drainage meningitis: A brief report
Colombo Francesco,
Waheed Ali,
Panese Sandro,
Scarparo Claudio,
Solinas Maria,
Parisi Saverio Giuseppe,
Geremia Nicholas
We report the case of successful use of cefiderocol (FDC) in a Carbapenemase Producing K. pneumoniae (CPKP) post-surgical meningitis in a 44-year-old man treated with antimicrobial therapy and external ventricular drainage (EVD). The patient was known for being colonised by CPKP; for this reason, therapy with ceftazidime/avibactam (CZA) plus fosfomycin and linezolid was started. After an initial response a CZA resistant CPKP strain was isolated from CSF culture, so the antibiotic therapy was modified to FDC with trimethoprim/sulfamethoxazole for 14 days, and EVD was replaced. A complete recovery was obtained. This is the first case report describing FDC administration in CPKP meningitis.
Actinomycosis mimicking malignancy: a report of three cases diagnosed with fine-needle aspiration cytology
Cretella Pasquale,
Italia Maria Carola,
Serio Bianca,
Zeppa Pio,
Caputo Alessandro
We describe three cases of actinomycosis of the head and neck area, clinically suspected to be malignancies, diagnosed by fine-needle aspiration (FNAC). The patients presented with painless, slowly growing masses in the cervicofacial area. Ultrasonography identified the masses as enlarged lymph nodes which were subsequently biopsied by FNAC. Cytological features were similar in all cases, with a background of granulocytes and scattered lymphocytes and histiocytes. At high magnification colonies of branching, filamentous and beaded bacteria were detected. In the Diff-Quik–stained smears, these filamentous colonies showed an evident yellowish color with the typical feature of the “sulfur granules” consistent with the Splendore-Hoeppli phenomenon. A diagnosis of actinomycosis was made and confirmed in all cases by the subsequent microbiological tests. The patients were treated with high-dose penicillin, which caused the masses to progressively shrink. The lymph nodal localization of cervico-facial actinomycosis may be a diagnostic challenge, because in that area, lymphadenopathies may occur both in benign and malignant conditions. FNAC is a safe, fast, and reliable method to perform an accurate diagnosis of actinomycosis avoiding the surgical excision for histological evaluation.
The Infections in the History of Medicine
The Manchurian pandemic of pneumonic plague (1910-1911)
Michaleas Spyros N.,
Laios Konstantinos,
Karamanou Marianna,
Sipsas Nikolaos V.,
Androutsos Georges
China’s winter of 1910-1911 was one of its most difficult. A deadly airborne pneumonic plague, believed to have originated from tarbagan marmots, broke out in October 1910 in a northeastern Chinese province commonly known by the exonym Manchuria. The disease had a near 100 percent mortality rate, affecting mainly the lower socio-economic classes and eventually killing more than 60,000 people over six months. By April 1911, the epidemic was suppressed, in large part due to the efforts of a Western-educated Chinese physician, Wu Lian-Teh. Similar to the recent COVID-19 pandemic, the Great Manchurian Plague outbreak highlighted the importance of personal protective equipment, such as face masks, and a quick and efficient international medical response.
