Volume 28, Issue 4, 2020
Editorial
The shortcomings of tocilizumab in COVID-19
Tirupathi Raghavendra,
Bharathidasan Kavya,
Areti Swetha,
Kaur Jagdeep,
Salim Sohail,
Al-Tawfiq Jaffar A.
Not available
Review
Risk Factors for COVID-19
Rashedi Jalil,
Mahdavi Poor Behroz,
Asgharzadeh Vahid,
Pourostadi Mahya,
Samadi Kafil Hossein,
Vegari Ali,
Tayebi-khosroshahi Hamid,
Asgharzadeh Mohammad
SARS-CoV-2 in bats was transmitted to humans at a live and wet animal market in China through the intermediate host, creating COVID-19. Viral, environmental and host factors play roles in virus infection and disease. The virus has high transmissibility and is rapidly transmitted to people through close contact and droplets from coughing, sneezing and talking loudly, as well as through contact with contaminated objects. As crowding is an environmental risk factor for contamination, its transmission is high among patients and staff in hospital and also in elderly-care centers. It is more common in the elderly, in men, and subjects with diabetes mellitus, hypertension, cardiovascular disease, and malignancy.
After SARS-CoV-2, will H5N6 and other influenza viruses follow the pandemic path?
Bonilla-Aldana D. Katterine,
Aguirre-Florez Mateo,
Villamizar-Peña Rhuvi,
Gutiérrez-Ocampo Estefanía,
Henao-Martínez Juan F.,
Cvetkovic-Vega Aleksandar,
Dhama Kuldeep,
Rabaan Ali A.,
Sah Ranjit,
Rodriguez-Morales Alfonso J.,
Schlagenhauf Patricia,
Paniz-Mondolfi Alberto
While the world is focused on attending, controlling, and mitigating the current pandemic of COVID-19, caused by the SARS-CoV-2, other viral threats are possibly emerging and reemerging especially in Asia, posing a risk for the spread in that region and beyond. A predictable threat is the avian influenza virus, especially H5N6, which has recently led to significant outbreaks in China and the Philippines, deserving more attention and control. In the current review, we assess the history of this highly pathogenic reemerging virus, as well as the contemporary implications of poultry outbreaks occurring in some Asian countries. We also look at outbreaks due to other strains not only in Asia but also across Europe and Africa, according to recent reports from the World Organization of Animal Health (OIE).
Viral dynamics in the Upper Respiratory Tract (URT) of SARS-CoV-2
Tirupathi Raghavendra,
Ramparas Tasha Renu,
Wadhwa Gautham,
Areti Swetha,
Kaur Jagdeep,
Salim Sohail,
Rabaan Ali A.,
Al-Tawfiq Jaffar A.
To date, research on viral shedding (VS), live virus isolation and infection status remains ongoing as scientists and clinicians attempt to better understand the coronavirus disease of 2019 (COVID-19) pandemic. Viral RNA detection at different stages of the disease, quantitative changes and patterns of viral persistence and clearance all provide context for the pathogenesis and transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Given the highly infectious nature of SARS-CoV-2 and its impact on the global population and economy, clinicians continue to seek the best methods for controlling its spread, and data on public health preventative measures continue to emerge. In this paper we review the available evidence on the viral dynamics of SARS-CoV-2 in the URT to determine a timeline for infection based on molecular and viral culture findings and to assess the significance of persistently positive results.
Elevated cardiac troponin I as a predictor of outcomes in COVID-19 hospitalizations: a meta-analysis
Malik Preeti,
Patel Urvish,
Patel Nidhi H.,
Somi Shamima,
Singh Jagmeet
Globally, coronavirus is causing more social, economic and healthcare disruption than expected. The emerging literature has reported the complications of coronavirus, and the mortality and risk factors involved, including cardiac injury and multisystem organ failure. In this meta-analysis, we aim to evaluate the association of elevated troponin I levels with outcomes in COVID-19 hospitalized patients. Observational studies describing troponin I levels and outcomes of COVID-19 hospitalized patients from 1 December 2019 to 15 August 2020 were identified. Data were extracted following PRISMA guidelines with a consensus of two independent reviewers. Adverse outcomes were defined as admission to intensive care units (ICUs), oxygen saturation <90%, invasive mechanical ventilation (IMV), and in-hospital mortality. The odds ratio (OR) and 95% confidence interval (95% CI) were obtained and forest plots were created using random-effects models. Ten studies with 3982 confirmed COVID-19 patients were included. In patients with poor outcomes, the prevalence of elevated troponin I levels was 51% (690/1341). In meta-analysis, patients with elevated troponin I levels had higher odds of poor outcomes compared to better outcomes with pooled OR of 7.92 (95% CI: 3.70–16.97; p<0.00001) with 70% heterogeneity (p=0.0005). Our meta-analysis suggests that COVID-19 patients with elevated troponin I levels had a higher risk of poor outcomes. Hence, evaluating the troponin I levels might be helpful in preventing risk of cardiac complications and other organ dysfunction.
Involvement of the exocrine pancreas during COVID-19 infection and possible pathogenetic hypothesis: a concise review
Zippi Maddalena,
Hong Wandong,
Traversa Giampiero,
Maccioni Francesca,
De Biase Dario,
Gallo Claudio,
Fiorino Sirio
The gastrointestinal system may be affected by COVID-19 infection with an incidence variable from 3% up to 79%. Several works show that the pancreas, both in its exocrine and endocrine function, can be affected by this viral infection, although this organ has been poorly analyzed in this current epidemic context. This mini-review aims to provide a summary of available studies on exocrine pancreas involvement during COVID-19 infection. A search through MEDLINE/PubMed was conducted on the topic in hand. With regard to exocrine function, some studies highlight the presence of an associated hyperenzymemia (hyperamylasemia, hyperlipasemia), while others describe isolated and rare cases of acute pancreatitis. More attention should be paid to pancreatic impairment in subjects with COVID-19, as this may prove to be one of the elements aggravating its clinical course. Indeed, acute pancreatitis, especially when presenting in severe forms with hyperstimulation of the pro-inflammatory response, may represent a crucial factor in the progression of COVID-19, entailing both an increase in hospitalization days and in mortality rate.
The role of laboratory medicine in managing biological risk: proposal for a simple and easy-to-follow protocol for occupational accidents at risk of bloodborne infection
Scapaticci Margherita,
Bartolini Andrea,
Da Rin Giorgio
Bloodborne pathogens represent a major hazard for healthcare workers (HCWs) and exposure prevention still represents the primary strategy to reduce the risk of occupational bloodborne pathogen infections, such as hepatitis B (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Each healthcare organization should have simple and easy-to-apply operating procedures (OPs), quickly accessible to their personnel, including educational programmes, written protocols for prompt reporting and procedures for correct evaluation, counselling, treatment and follow-up of occupational exposure. From a careful review of literature data and international recommendations, in this study we summarize the recommendations to follow in the event of occupational exposure to HIV, HBV and HCV, also providing tables and a flowchart, that are simple to apply and could be a guide, especially in moments of apprehension caused by the occurrence of an occupational accident due to biohazard, in which important decisions must be taken and appropriate assessments carried out in the shortest possible time. Obviously, for this purpose, the people to be involved in the various processes must appear clearly in each OP, and the forms to be filled in must be easily and promptly accessible at all times.
Tenofovir alafenamide revisited
Di Perri Giovanni
Two Tenofovir pro-drugs are available for the treatment of HIV and HBV infection. Tenofovir Alafenamide (TAF) was clinically developed as a safer alternative to the older Tenofovir Disoproxil Fumarate (TDF) as the latter was consistently found to be associated to proximal renal tubule dysfunction and decrease in bone mineral density (BMD). As compared to TDF, the pharmacological properties of TAF are such that a more active drug is delivered into target cells while much less is measurable in general circulation. This translates into an antiretroviral action comparable to TDF with a significantly lower impact on proximal renal tubular function and bone structural integrity. The lipid-lowering effects of TDF as well as its lesser tendency to be associated to undesired body weight increase have raised some doubts about the substitution of TDF with TAF. Both issues, whose genesis is multifactorial, are strictly linked to the hypothesis of increased cardiovascular risk that might follow the switch from TDF to TAF. However, the long-term impact of decreasing renal function on cardiovascular risk must also be considered, especially in aging patients. It is thus a matter of balance: while the action on modifiable behavioural variables may well reduce lipid levels and body weight, the permanent dysfunctional pressure exerted by TDF on the proximal renal tubule could cause irreversible damage to both kidneys and bones. Therefore, all things considered, avoidance of TDF, particularly when aging patients are concerned, appears the preferable approach.
Original article
Monocyte absolute count as a preliminary tool to distinguish between SARS-CoV-2 and influenza A/B infections in patients requiring hospitalization
Curtolo Ambrogio,
Oliva Alessandra,
Volpicelli Lorenzo,
Ceccarelli Giancarlo,
D’Ettorre Gabriella,
Borrazzo Cristian,
Mastroianni Claudio Maria,
Venditti Mario
Since the most frequent symptoms of novel coronavirus 2019 disease (COVID-19) are common in influenza A/B (FLU), predictive models to distinguish between COVID-19 and FLU using standardized non-specific laboratory indicators are needed. The aim of our study was to evaluate whether a recently dynamic nomogram, established in the Chinese population and based on age, lymphocyte percentage and monocyte absolute count, might apply to a different context. We collected data from 299 patients (243 with COVID-19 and 56 with FLU) at Policlinico Umberto I, Sapienza University of Rome. The nomogram included age, lymphocyte percentage and monocyte absolute count to differentiate COVID-19 from FLU. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated for all associations. Multivariate logistic regression models were used to adjust for potential confounding. A p-value of less than 0.05 was considered statistically significant. Patients with COVID-19 had higher age, lymphocyte percentage and monocyte absolute count than patients with FLU. Although univariate analysis confirmed that age, lymphocyte percentage and monocyte absolute count were associated with COVID-19, only at multivariate analysis was monocyte count statistically significant as a predictive factor of COVID-19. Using receiver operating characteristic (ROC) curves, we found that a monocyte count >0.35x103/mL showed an AUC of 0.680 (sensitivity 0.992, specificity 0.368). A dynamic nomogram including age, lymphocyte percentage and monocyte absolute count cannot be applied to our context, probably due to differences in demographic characteristics between Italian and Chinese populations. However, our data showed that monocyte absolute count is highly predictive of COVID-19, suggesting its potential role above all in settings where prompt PCR nasopharyngeal testing is lacking.
Discharge ward during the SARS-CoV-2 pandemic: an effective way to increase patient turnover when human resources are scarce
Castelnuovo Filippo,
Marchese Valentina,
Cristini Graziella,
Crosato Cerena,
Pennati Francesca,
Izzo Ilaria,
Paraninfo Giuseppe,
Van Hauwermeiren Evelyn,
Castelli Francesco
During the SARS-CoV-2 pandemic, the province of Brescia (Italy) had a significant number of COVID-19 cases, which led to a subversion of the ordinary structure of the university hospital ASST Spedali Civili, driven by the need to hospitalize as many patients as possible in a narrow period of time. At the peak of the epidemic, a rapid hospitalization discharge area, the Discharge Ward (DW), was set up with the aim of facilitating the rapid turnover of patients in the wards where the most severe patients had to be hospitalized. The organization and activities carried out are described in the results of this reproducible experience during epidemic events.
The positive impact of social media on the level of COVID-19 awareness in Saudi Arabia: a web-based cross-sectional survey
Alnasser Ali Hassan A.,
Al-Tawfiq Jaffar A.,
Al Kalif Mohammed Sheker H.,
Alobaysi Azzam Mohammed A.,
Al Mubarak Murtada Hussain M.,
Alturki Hamad Nasser H.,
Alharbi Abdulsalam Awadh A.,
Albahrani Rahmah Sahib S.,
Alatef Sultan Salem Ali S.,
Al Hamad Anwar Ramadan N.
In late December 2019, the COVID-19 pandemic started to spread from Hubei province in China. Currently there are many affected countries worldwide, including Saudi Arabia. This study aimed to assess the use of social media as a source for COVID-19 awareness in Saudi Arabia. An online survey was conducted between 9 and 13 May 2020 and a total of 3,204 subjects participated in the survey. We used snowball sampling techniques through an online structured questionnaire. The data were cleaned, coded and analysed using the Statistical Package for the Social Sciences SPSS version 25.0. A chi-square test was used to find the associations between variables. Of all participants, 75.4% had a high level of awareness of the COVID-19 pandemic. Saudi participants above 18 years old and medical practitioners showed a high level of awareness. All participants from all regions of Saudi Arabia showed a high level of awareness except for those from the northern region. The most common source of information was the official government social media, and 44.1% reported the use of Twitter. Our findings show that social media have a positive impact on the circulation of information about the COVID-19 pandemic in Saudi Arabia.
Outbreak of catheter-related Burkholderia cepacia sepsis acquired from contaminated ultrasonography gel: the importance of strengthening hospital infection control measures in low resourced settings
Viderman Dmitriy,
Khudaibergenova Makhira,
Kemaikin Vadim,
Zhumadilov Agzam,
Poddighe Dimitri
This article reports the largest nosocomial outbreak of B. cepacia-related HAIs and the epidemiological investigations leading to identification of ultrasound gel as a direct means of infection transmission. Multiple environmental sampling was conducted to identify the source and route of infection. The samples were collected from all sources considered to be potential reservoirs of B. cepacia. Standard methods for pathogen isolation and antibiotic sensitivity testing were used. In all, 61 patients developed B. cepacia-related sepsis and this agent was isolated only from ultrasonography gel. All patients required the placement of a central venous line to receive the chemotherapy for the underlying hematologic disease. The hospital outbreak persisted after identification of the source of infection and it took more than four months to be completely eradicated after the first cases. B. cepacia is a serious threat for hospitalized patients needing invasive procedures, including the central line placement for chemotherapy, regardless of the need of any intensive care. Implementation of protocols for active surveillance of HAIs should also target this opportunistic agent and include periodic sterility control of commonly used medical materials, including ultrasonography gel and equipment.
Susceptibility and Serotypes of Streptococcus pneumoniae isolates in invasive pneumococcal disease: a study from Kerala, South India
Arjun Rajalakshmi,
Ratheesh Raveendran Sarala,
Mohan Viji,
Uduman Sayenna,
Jalaludeen Sherook,
Prabhakaran Abhilash,
Sasidharan Aswathy,
Niyas Vettakkara Kandy Muhammed
Invasive pneumococcal disease (IPD) is a major burden causing significant mortality and morbidity. This study was conducted to ascertain the magnitude of the problem of drug resistance, the pneumococcal serotypes that are prevalent in our area, and whether current pneumococcal vaccines are able to cover the prevalent serotypes adequately. A retrospective study was done by reviewing the microbiology registry of our hospital. Details of patients whose blood, cerebrospinal fluid (CSF) or any other sterile fluid grew S. pneumoniae between the period January 1, 2016 and December 31, 2019 were collected. Identification and susceptibility testing were done by Vitek2 as per CLSI 2008 guidelines. Serotyping was attempted for 39 isolates. Fifty-five pneumococcal isolates in blood and CSF were identified over four years from 51 patients, of whom nine belonged to the paediatric age group. Among 55 isolates, 50 were isolated from blood, four had growth of pneumococci in both blood and CSF, and one had growth in CSF alone. Overall non-susceptibility to penicillin was noted in 11 isolates, and 10 isolates were non-susceptible to ceftriaxone. Common serotypes isolated were 9V, 19F, 23F and 6 B. The most common clinical presentation was pneumonia followed by sepsis and meningitis. Five of the 51 patients succumbed to the illness. Penicillin susceptibility among pneumococcal isolates in IPD was 80% and susceptibility to ceftriaxone was 82%. This observation reiterates the view that vancomycin must be added to the empiric therapy of suspected IPD. Most of the identified serotypes are covered by current pneumococcal vaccines, highlighting the pivotal role of pneumococcal vaccine in prevention of IPD.
Comparison of efficacy and safety of two fixed-dose combination regimens for tuberculosis in the Chinese population
Sun Yaoyao,
Cao Bonan,
Rao Wenwang,
Li Xinwei,
Yu Baozhu,
Zhang Tiejuan,
Zhang Ping,
Yu Qiong,
Zhou Lin
To date, there have been few studies on the dosage of fixed-dose combination (FDC) for the treatment of tuberculosis (TB) in the Chinese population. The aim of this study was to evaluate the efficacy and safety of two FDC regimens in two provinces with a high tuberculosis burden. A total of 2,353 newly diagnosed active pulmonary TB patients were recruited from Shandong Province (n=1,223) and Jilin Province (n=1,130). Participants received FDC treatment for six months (intensive phase and continuation phase). The difference in the two regimens was the dosage of FDC in the continuation phase. For Shandong Province, the cure rate was 96.4% (370/384). In all, 1,172 patients successfully completed the treatment, the success rate being 95.8% (1,172/1,223). For Jilin Province, the cure rate was 92.5% (345/373): 1,109 patients successfully completed the treatment and the treatment success rate was 98.1% (1,109/1,130). Significant differences were observed in the cure rate (χ2=5.382, p=0.020) and the treatment success rate (χ2=10.581, p=0.001) between the two provinces. The integral analysis showed that both regimens had similar efficacy, but the regimen of Jilin Province was inferior to that of Shandong Province in terms of safety.
Serosurvey of HBV surface antigen and anti-HBV surface antibody among HIV-infected patients in Fars province, southern Iran
Rastegarian Mohammad,
Zeighami Ali,
Shahriarirad Reza,
Erfani Amirhossein,
Arefkhah Nasir,
Ghorbani Fariba,
Sarkari Bahador,
Sarvari Jamal
HBV infection is a major public health issue that can lead to liver cirrhosis and hepatocellular carcinoma. The current study evaluated the prevalence of HBsAg and anti-HBsAb among HIV/AIDS patients in Shiraz, southern Iran. The subjects in this study comprised 251 participants previously confirmed for HIV infection registered at the Shiraz HIV/AIDS center in southern Iran. Peripheral whole blood (5 ml) was obtained from each participant and evaluated for HBsAg and anti-HBs antibodies, utilizing commercial ELISA kits. The 251 participants consisted of 158 (63.5%) males and 91 (36.5%) females. HBsAg and anti-HBsAb were detected in 16 (6.4%) and 117 (46.6%) cases, respectively, while five cases (2%) were positive for both viral markers. No statistically significant association was observed between patients’ age, sex, or CD4+ cell count and seropositivity to HBsAg or anti-HBsAb. The findings of the study revealed a relatively high seroprevalence of HBsAg and anti-HBsAb among HIV patients, highlighting the importance of preventive and therapeutic programs in such patients.
Analysis of genetic and viral determinants of HBsAg levels in patients with chronic HBV infection
Vergori Alessandra,
Rossetti Barbara,
Vicenti Ilaria,
Meini Genny,
Lentini Gianluca,
Valoriani Beatrice,
Caudai Cinzia,
Morandi Matteo,
Cusi Maria Grazia,
Zazzi Maurizio,
De Luca Andrea
Single nucleotide polymorphisms (SNPs) in the interleukin 28B (IL28B) gene can influence the course of treated and untreated HBV infection. However, the correlation between different IL28B-SNPs and HBVDNA and quantitative HBsAg (qHBsAg) in chronic HBV infection remains to be fully elucidated. Patients with chronic HBV infection were analysed for qHBsAg, HBVDNA, HBV genotype and six IL28B-SNPs (rs12980275, rs8105790, rs8099917, rs7248668, rs12979860, rs10853728). Seventy patients were recruited: 80% Caucasian, 56% genotype D, 44% treated with nucleos(t)ide analogues, 11% cirrhotic, 37% inactive carriers (IC). Median (IQR) qHBsAg and HBVDNA were 3.2 log10 IU/ml (2.2-3.9) and 2.2 log10 IU/ml (0.3-3.3), respectively. Lower levels of qHBsAg were associated in the whole study population with rs12979860 CC vs. CT (p=0.05), rs12980275 AA vs. AG (p=0.04), rs8105790 TT vs. CT (p=0.05) and genotype D vs. A+E (p=0.01). rs8105790 TT was present in 81% of IC vs. 46% non-IC (p=0.005). These data were also confirmed in the untreated patients’ subgroup. In multivariate analysis, IL28B-SNP haplogroups were associated with lower qHBsAg: CC/AA at rs12979860/rs12980275 (-0.70 log IU/mL, 95% CI -1.26;-0.14; p=0.01), CC/TT at rs12979860/rs8105790 (-0.78 log IU/mL, 95% CI -1.33;-0.23; p=0.006) and AA/TT at rs12980275/rs8105790 (-0.71 log IU/mL, 95% CI -1.27;-0.17; p=0.01) both in the whole population and in the untreated subgroup. Specific IL28-SNP haplogroups might be associated with lower qHBsAg.
Beyond Italian guidelines in the management of HIV-positive patient
Andreoni Massimo,
Antinori Andrea,
Castagna Antonella,
D’Arminio Monforte Antonella,
Di Perri Giovanni,
Galli Massimo,
Gori Andrea,
Mussini Cristina,
Perno Carlo Federico
Although AIDS/HIV infection and related deaths have significantly decreased in Italy in recent years, new problems have made it more challenging to manage the disease. To overcome the new hurdles, the Italian National Plan of Interventions against HIV and AIDS was recently issued by the National Health Authorities, and the Italian Guidelines (GL) for diagnosis, therapy and management of HIV-1 infection were subsequently drafted by the Italian Society of Infectious and Tropical Diseases (SIMIT). Although the GLs provide clear recommendations, they are open to personal interpretation depending on the experience and/or background of individual healthcare professionals. To minimize the interpretative variability, eight residential meetings were organized in Italy in 2019 to promote a multidisciplinary approach and discuss specific HIV-associated conditions, such as cardiovascular or neuro-psychological comorbidities, advanced stage of infection, and high CD4 cell counts. To undertake this educational program, the GLs were simplified into key steps by creating ad hoc decisional algorithms, and an innovative multimedia technology was used during the meetings to collect and summarize individual opinions up to the final statements. For HIV patients with cardiovascular diseases, “CV risk factor identification” and “change of patients’ lifestyle” were the most commonly shared approaches by all healthcare professionals, regardless of individual attitudes. Among HIV individuals with neurocognitive and psychological comorbidities, “more neurocognitive tests”, “better customization of antiretroviral therapy (ART)”, and “assessment of psychological symptoms” were the most frequently identified options to carry out. Advanced HIV infection and low CD4 cell count being a particularly serious condition burdened by high mortality, almost all specialists oriented their opinion toward a prompt and scrupulous clinical evaluation to be performed just before and immediately after the start of ART. Finally, the most pursued recommendations in patients with acute HIV infection and high CD4 cell count were the achievement of a “prompt diagnosis” and “start of well-shaped ART”, as the most appropriate means to keep the viral load as low as possible. Undoubtedly, despite negligible discrepancies in individual interpretation among specialists, this nationwide educational program was able to capture local differences, but to guarantee at the same time a constant alignment of individual specialists towards the Italian clinical practice GLs. Different priorities in the daily management of the four HIV-1 subpopulations highlighted during the meetings reflect the presence of different regional health policies nationwide, in turn generating different healthcare offers. This program offered state-of-the-art management of four widely represented subpopulations of HIV-1 patients.
Difference in clinical presentation between the first and second phases of Kyasanur Forest disease: an experience from a teaching hospital in South India
Gupta Nitin,
Varma Muralidhar,
Saravu Kavitha
Kyasanur forest disease (KFD) is a biphasic tick-borne disease which occurs during the post-monsoon season. The patient may visit the hospital in either of the phases, and it is essential to differentiate between the two phases as the management considerations in both phases are different. This is a retrospective review of patients diagnosed with KFD who were treated by the Infectious Disease Department between September 2019 and May 2020. A total of 14 cases (16 admissions) were diagnosed during the study period by reverse-transcriptase polymerase chain reaction assay. Of these, nine cases came to our hospital during the first phase and seven (including two-readmissions) came to our hospital during the second phase. The manifestations in the first phase included high-grade fever (100%), myalgia (67%), conjunctival suffusion (33%), palatal eruptions (78%), gastrointestinal manifestations (67%), leucopenia (100%), thrombocytopenia (89%), elevated transaminases (89%), elevated creatine phosphokinase (100%) and activated partial thromboplastin time (APTT) (100%). Manifestations in the second phase were fever (57%), headache (100%), blurring of vision (29%), neck signs (71%), leukocytosis (71%), thrombocytopenia (14%), elevated transaminases (40%) and APTT (20%). The clinical symptomatology and laboratory manifestations are different in each of the two phases and can be easily identified by primary care physicians.
Toxoplasma gondii infection during pregnancy: a ten-year observation in the province of Trento, Italy
Piffer Silvano,
Lauriola Anna Lina,
Pradal Ugo,
Collini Lucia,
Dell’Anna Laura,
Pavanello Lucia
The study analysed the trend of toxoplasmosis infection in pregnancy by using antenatal serological screening and the incidence of the congenital condition in newborns in the province of Trento, Italy. Data from pregnant women who gave birth at local maternity units between 2009 and 2018 were obtained. The serological test results were collected from birth attendance certificates (BACs), the main - and mandatory - source of information used to monitor pregnancies, births and neonatal health in Italy. The BAC used in the province of Trento acquires the results of serological tests for a vast range of infections in pregnancy. The data collected from the BACs were integrated with those provided by the Hospital Information System (HIS), which was also used to collect data on the trimester in which the seroconversion occurred. A total of 45,492 pregnant women were analysed, of whom 24% were foreigners. The average coverage of serological screening in pregnancy was 99.7%. Mean overall prevalence of Toxoplasma gondii infection was 21.7% (95% CI: 21.3-22.1): in Italians the prevalence was 17.9% (95% CI: 17.5-18.30) and in foreign nationals 32.7% (95% CI: 32.26-33.13). The mean annual seroconversion rate was 3.5‰ (95% CI: 3.0-4.2) of susceptible women and 2.7‰ (95% CI: 2.2-3.4) of all pregnant women who were screened. The seroconversion rate was higher amongst foreign women (3.2‰, 95% CI: 3.0-3.6) than Italian women (2.4‰, 95% CI: 2.1-2.8). In all, 91.0% of seroconverted women were treated during pregnancy in accordance with the anti-toxoplasma protocol. Five cases of congenital infection were identified (2 amongst Italians and 3 amongst foreign women), amounting to an overall transmission rate of 4.0% (2.3% in Italians and 8.8% in foreigners). Transmission risk ranged from 0.0% in the first trimester to 19% in the third. The incidence of congenital toxoplasmosis, over the entire study period, was 0.12‰ live births (0.11‰ in Italians and 0.16‰ in foreigners). Data collection on infections in pregnancy through BAC allows area-based assessment. Although the quality of the data recorded in the BAC can be considered satisfactory, it was also necessary to access other information sources. The screening coverage was very high. The prevalence of toxoplasmosis infection was found to be higher in foreign mothers than in Italians, as well as seroconversion. The extent of serological screening and the high treatment rate helped to keep the risk of infection transmission to the foetus low and to achieve a very low rate of congenital infection.
Case report
Concomitant renal and splenic infarction as a complication of COVID-19: a case report and literature review
Ramanathan Maya,
Chueng Teresa A.,
Fernandez Edgar,
Gonzales-Zamora Jose
The prothrombotic state contributes to diverse and devastating prognoses of severe COVID-19. We describe a unique COVID-19 case with concomitant splenic and renal infarcts. Based on this, clinicians should have a low threshold to suspect a diagnosis of deep vein thrombosis/pulmonary embolism (DVT/PE), especially in the abdominal visceral region if a patient comes in several days after a COVID-19 diagnosis with abdominal pain. Whether or not empiric full dose anticoagulation is needed in patients without definite diagnosis of thromboembolism is still controversial. Further studies need to be done; meanwhile, we advocate the use of regular dose thromboprophylaxis in all hospitalized patients and therapeutic anticoagulation only when there is a confirmed diagnosis of thromboembolism.
Glecaprevir/pibrentasvir ultra-short treatment to cure HCV infection: case report and literature review
Volpicelli Lorenzo,
Biliotti Elisa,
Milito Cinzia,
Cruciata Alessia,
Spaziante Martina,
Rivano Capparuccia Marco,
Taliani Gloria,
Mezzaroma Ivano
Shortening therapy duration with direct-acting antiviral agents (DAAs) is desirable to pursue the WHO target of HCV eradication by 2030. We report two cases of HCV-infected women who achieved sustained virologic response after an ultra-short treatment with glecaprevir/pibrentasvir (G/P), discontinued due to cutaneous adverse events, and analyze similar cases reported in the literature. Female gender seems to be a prevailing characteristic in this group of patients. G/P, due to its pangenotypic and strong antiviral activity, may represent a candidate for a shortened DAA regimen in non-cirrhotic treatment-naive subjects.
The Infections in the History of Medicine
Control measures of a 400-year-old plague epidemic: an example of past efficiency at controlling disease and similarities with current epidemics
Vicentini Chiara Beatrice,
Contini Carlo
The plague caused by the bacterium Yersinia pestis, provides one of the best historical examples of pandemic infection. It can therefore be considered the first "globalized” disease, thanks also to the crowds that favoured the rebalancing of infectious agents between Europe and the Middle East.
In this paper we analyse all the official documents of the time, highlighting the most effective prevention measures implemented in the city of Ferrara during the Italian plague. Historical mortality data for the 1630 Italian plague in northern Italy are first analysed. In contrast to the high rates recorded throughout the area from Milan to Florence, the mortality rate in Ferrara remained normal over the period. From the city’s documents it emerged that the authorities, from the 16th century onwards, had already understood that the spread of the contagion could also occur through domestic animals, although rats are never mentioned. The strength of Ferrara's response to the "plague emergency" stems from an efficient and emergency-ready health control system, financed and supported by the "permanent surveillance team of the city and the Pontifical Legation of Ferrara - Azienda Sanitaria Pubblica" even in times of great economic difficulty for the State. Among the various measures that the city of Ferrara adopted to deal with the plague the following should be mentioned: guards at the city gates, lazarettos, safety of doctors, self-isolation and treatment of every suspicious case as if it were a real case of plague, measures to support the poorer classes of the population, veterinary and hygiene standards for the city and for housing, management of Catholic religious functions and the precepts of the Legation of Ferrara, which was under papal control, closure of churches to avoid mass gatherings, and limitations of all kinds of social and economic relations within and outside the population. The broad regimen, laid down in the 16th century, contains extremely modern health rules which are very much in line with those recommended by the WHO and the health authorities of each individual state in the current COVID-19 pandemic, even starting with hand-washing. The fight against epidemics of the past, especially the history of the plague in the 17th century, anticipates very important and valid concepts, and represents a wake-up call for the recent epidemics of emerging pathogens
From inoculation to vaccination: the fight against smallpox in Siena in the 18th and 19th centuries
Orsini Davide,
Martini Mariano
Smallpox is a contagious viral disease. In the fight against smallpox, stimulation of the immune system by means of inoculation of human smallpox and subsequent vaccination constituted a very important step forward in the history of medicine. First reported in ancient Greece and in the Egypt of the Pharaohs, smallpox reappeared in the middle of the 16th century, becoming the leading endemic disease in the following century and periodically causing hundreds of thousands of deaths. In the 18th and 19th centuries, Europe was afflicted by numerous epidemics. While their consequences in large urban centres are well known, we know little about the diffusion, morbidity and mortality of the disease in rural areas. To shed light on this issue, we scrutinised the main initial experiences of the use of inoculation in Siena and the scientific, healthcare, social and political consequences that stemmed from them.
Letters to the editor
Usefulness and limitations of implementing rapid tests for the diagnosis of COVID-19 in Latin America
García-Díaz Génesis,
Montalvo-Varela Eduardo,
Cano-Pérez Eder,
da-Silva- Francisco-Junior Ronaldo,
Rodriguez-Morales Alfonso J.
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