Volume 29, Issue 1, 2021
Review
COVID-19-associated coagulopathy: a concise review on pathogenesis and clinical implications
Memar Montazerin Sahar,
Najafi Homa,
Shojaei Fahimehalsadat,
Chi Gerald,
Goudarzi Sogand,
Sharfaei Sadaf,
Kahe Farima,
Hassanzadeh Shakiba
In this review, we summarize the possible mechanisms of COVID-19-associated coagulopathy and compare its features to other similar conditions. The recent COVID-19 pandemic has caused enormous mortality and morbidity worldwide. It is important to note that COVID-19-associated thrombotic events play a huge role in the morbidity of this disease. Interestingly, it has been observed that this complication may occur despite prophylactic anticoagulant therapy. Recent studies on COVID-19-associated coagulopathy revealed that the COVID-19–associated hypercoagulability is more frequently observed among those with a severe course of the disease. Various mechanisms have been suggested as explanations for this condition and possible underlying etiologies.
Airborne transmission of SARS-CoV-2 is the dominant route of transmission: droplets and aerosols
Rabaan Ali A.,
Al-Ahmed Shamsah H.,
Al-Malkey Maysaa K.,
Alsubki Roua A.,
Ezzikouri Sayeh,
Al-Hababi Fadel Hassan,
Sah Ranjit,
AlMutair Abbas,
Alhumaid Saad,
Al-Tawfiq Jaffar A.,
Al-Omari Awad,
Alhumaid Saad,
Al-Tawfiq Jaffar A.,
Al-Omari Awad,
Al-Qaaneh Ayman M. ,
Al-Qahtani Manaf Al-Qahtani,
Tirupathi Raghavendra,
Al Hamad Mohammad A. ,
Al-baghli Nadira A. ,
Sulaiman Tarek ,
Alsubait Arwa ,
Mehta Rachana ,
Abass Elfadil ,
Alawi Maha ,
Alshahrani Fatimah Alshahrani,
Shrestha Dhan Bahadur ,
Karobari Mohmed Isaqali ,
Pecho-Silva Samuel ,
Arteaga-Livias Kovy,
Bonilla Aldana D. Katterine ,
Rodriguez-Morales Alfonso J.
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a pandemic worldwide. On a daily basis the number of deaths associated with COVID-19 is rapidly increasing. The main transmission route of SARS-CoV-2 is through the air (airborne transmission). This review details the airborne transmission of SARS-CoV-2, the aerodynamics, and different modes of transmission (e.g. droplets, droplet nuclei, and aerosol particles). SARS-CoV-2 can be transmitted by an infected person during activities such as expiration, coughing, sneezing, and talking. During such activities and some medical procedures, aerosols and droplets contaminated with SARS-CoV-2 particles are formed. Depending on their sizes and the environmental conditions, such particles stay viable in the air for varying time periods and can cause infection in a susceptible host. Very few studies have been conducted to establish the mechanism or the aerodynamics of virus-loaded particles and droplets in causing infection. In this review we discuss the various forms in which SARS-CoV-2 virus particles can be transmitted in air and cause infections.
COVID-19 pandemic: from origins to outcomes. A comprehensive review of viral pathogenesis, clinical manifestations, diagnostic evaluation, and management
Ochani Rohan Kumar,
Asad Ameema,
Yasmin Farah,
Shaikh Shehryar,
Khalid Hiba,
Batra Simran,
Sohail Muhammad Rizwan,
Mahmood Syed Faisal,
Ochani Rajkumar,
Hussham Arshad Mohammad,
Kumar Arjan,
Surani Salim
Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), the causative pathogen for the COVID-19, first emerged in Wuhan, China, in December 2019 and by March 2020, it was declared a pandemic. COVID-19 pandemic has overburdened healthcare systems in most countries and has led to massive economic losses. SARS-CoV-2 transmission typically occurs by respiratory droplets. The average incubation period is 6.4 days and presenting symptoms typically include fever, cough, dyspnea, myalgia or fatigue. While the majority of patients tend to have a mild illness, a minority of patients develop severe hypoxia requiring hospitalization and mechanical ventilation. Management is mostly supportive. However, several direct anti-viral agents, and immunomodulatory therapy with steroids and various cytokine blockers seem promising in early results. However, an effective vaccine has been established, which will help curb the pandemic.
Original article
Alopecia and severity of COVID-19: a cross-sectional study in Peru
Salazar Arenas Miguel Ángel,
Muñoz del Carpio-Toia Agueda,
Aybar Galdos Johan,
Rodriguez-Morales Alfonso J.
The aim of this study was to determine the relationship between COVID-19 severity and androgenic alopecia in patients hospitalized in the Surgery Service of Honorio Delgado Espinoza Hospital in Arequipa, Peru. A cross-sectional study was performed in male patients with a diagnosis of COVID-19. Alopecia, clinical characteristics, treatment, and evolution were collected. In all, 98 patients were included; median age was 55 years old (range 18-89), 32.7% with comorbidities, and 45.9% with androgenic alopecia. The severity of COVID-19 infection was moderate to severe in 13.2% of patients without alopecia, and in 88.9% of patients with alopecia (p<0.001). In the logistic regression model analysis, patients with alopecia had a higher risk of presenting moderate to severe symptoms due to SARS-CoV-2 infection (OR: 80.2; 95% CI 16.2-397.7). In conclusion, the severity of infection was statistically significant in patients over 60 years old and those with alopecia.
Role of neutrophil-to-lymphocyte, lymphocyte-to-monocyte and platelet-to-lymphocyte ratios as predictors of disease severity in COVID-19 patients
Kalabin Aleksandr,
Mani Vishnu Raj Kumar,
Valdivieso Sebastian Cristobal,
Donaldson Brian
Direct viral damage and uncontrolled inflammation contribute to disease severity in SARS-CoV-2 infection. The aim of this study was to investigate the prognostic significance of neutrophil-to-lymphocyte [NLR], lymphocyte-to-monocyte [LMR] and platelet-to-lymphocyte [PLR] ratios in COVID-19 patients. All 184 COVID-19 patients hospitalized in our institution between March – April 2020 were retrospectively analyzed. The patients were grouped into intubated and non-intubated, and subgrouped into survived and deceased. An unpaired Student’s t-test was used for continuous variables, and the Pearson Chi-square (χ²) test for categorical. Univariate and multivariate logistic regression models were developed to assess the independent relationship between NLR, LMR and PLR and unfavorable outcomes. Non-parametric correlations were calculated using Spearman’s Rho correlation coefficient. The mean age of the patients was 64.7; mean BMI was 29.10; 73 (39.67%) were female and 111 male (60.33%). No statistical difference between groups was identified with regard to NLR (mean 8.29, standard deviation [SD] 7.86). On multivariate regression analysis, only PLR and LMR were shown to influence the ratio and it was positively correlated with PLR, lactate and C-reactive protein [CRP]. LMR for non-intubated survived [NI-S] (mean 2.29, SD 1.31) and non-intubated deceased [NI-D] (mean 1.79, SD 0.81) groups were statistically significant (p=0.03). LMR was influenced only by NLR on regression analysis. A positive correlation of LMR with body mass index [BMI] was ascertained. No statistical significance was found between groups for PLR (mean 269.85, SD 207.98) and the ratio was influenced by age and NLR on regression analysis, and positively correlated with NLR. To conclude, previously reported findings of a prognostic role of NLR, LMR and PLR in COVID-19 were not validated in our cohort and we would caution against using the ratios in question as independent markers for disease severity.
Psychological distress during the initial stage of the COVID-19 pandemic in an Italian population living with HIV: an online survey
Delle Donne Valentina,
Ciccarelli Nicoletta,
Massaroni Valentina,
Lombardi Francesca,
Lamonica Silvia,
Borghetti Alberto,
Fabbiani Massimiliano,
Cauda Roberto,
Di Giambenedetto Simona
The aim of this study was to explore the psychological impact of the initial stage of the 2019 coronavirus (COVID-19) pandemic on people living with HIV (PLWH), a population at increased risk of psychological distress. PLWH participated in an online survey exploring demographic and clinical data, physical symptoms, contact history, knowledge and concerns, precautionary measures and additional information about COVID-19 during the first phase of the pandemic in Italy. The Impact of Event Scale-Revised (IES-R) (identifying the COVID-19 pandemic as a specific traumatic life event) and the Depression, Anxiety and Stress Scale (DASS-21) also formed part of the survey. Out of 98 participants, 45% revealed from mild to severe psychological impact from COVID-19 according to IES-R. A lower percentage, instead, complained of significant levels of depression (14%), anxiety (11%) or stress (6%) according to DASS-21. Higher education, being unemployed, number of perceived COVID-19 physical symptoms, concerns about risk of contracting COVID-19 and the pandemic situation in Italy, and needing additional information to prevent COVID-19 infection were positively associated to a higher risk of negative psychological impact. Moreover, among the participants, female gender, age, fewer years from HIV diagnosis and not being aware of their own viremia were associated to a higher risk of negative psychological outcomes. Almost half of our PLWH sample experienced significant levels of distress related to the COVID-19 pandemic. Women, elderly patients and those with recent HIV diagnosis appear to be the more psychologically fragile subgroups. Our findings could help identify patients most in need of psychological interventions to improve the wellbeing of PLWH.
Clinical profile and treatment outcomes of patients with brucellosis: a hospital-based cohort study from Southern India
Pericherla Sindhu,
Gupta Nitin,
Saravu Kavitha
The clinical epidemiology of patients with brucellosis in India has not been well described. The aim of this study was therefore to delineate the demographic and clinical characteristics, complications and treatment outcomes of patients diagnosed with brucellosis. A prospective cohort study was conducted from January 2015 to June 2017. All patients above the age of 18 years with a confirmed diagnosis of brucellosis were enrolled and followed up for six months to study the outcomes of treatment. Of the 94 patients enrolled, 77% were male. A total of 38% of the patients had a history of animal contact, and 24% had a history of consumption of unpasteurized dairy products. Acute brucellosis was found in 65% of the patients, and sub-acute presentation was seen in the rest. Fever (94%) and arthralgia (54%) were the most predominant symptoms. The most common focal complication was osteoarticular involvement (34%). Except for three patients, all those who were available for follow-up showed a complete response to therapy. In conclusion, brucellosis should be suspected in patients with fever and osteoarticular involvement in endemic areas. Early identification and prompt initiation of treatment are associated with high cure rates.
Diagnostic and infection control strategies for Clostridioides difficile infections in a setting of high antimicrobial resistance prevalence
Bertolino Lorenzo,
Patauner Fabian,
Gagliardi Massimo,
D’Amico Fabiana,
Crivaro Valeria,
Bernardo Mariano,
Scherillo Isabella,
Bellitti Filomena,
Cusano Caterina,
Greco Rita,
Panetta Vittorio,
Durante Adriana,
Di Caterino Alfonsina,
Frieri Angelo,
Cioffi Grazia,
Nappo Maria,
Corrado Mariano,
Lanzieri Michele,
Sabatini Paola,
Bettelli Roberto,
dello Russo Rita,
Taddeo Maria Luisa,
Petrone Rosalba,
Di Sevo Maria Giovanna,
Iannuzzo Mariateresa,
Iervolino Mario,
Buonocore Raffaella,
D’Agostino Federica,
Gambardella Michele,
De Martino Antonio,
Spagnuolo Silvano,
Savarese Marina,
Sole Sabina,
Russo Carmela,
Agozzino Erminia,
Galdiero Massimiliano,
Martino Rosa,
Calemma Rosa,
Sciambra Antonio,
Aprea Cristina,
Colaccio Diego,
Di Guida Pasquale,
Venditti Michele,
Montella Emma,
Guerriero Francesco,
Perrotta Rita,
Di Filippo Umberto,
Pizza Angelo,
Di Fronzo Antonietta,
Lombardi Anna,
Capuano Luigi,
De Stefano Andrea,
Mastropietro Angela,
Mastro Matilde,
Loffreda Romolo,
Maccarone Luigi,
Di Tora Amelia,
Oto Savino,
Tammaro Carminantonio,
Mondelli Antonio Claudio,
Ruocco Maria,
Ferraro Biagio,
Petrosino Alfonso,
Presta SilviaS.A.,
Durante Mangoni Emanuele
Clostridioides difficile (CD) is a major nosocomial pathogen and the leading cause of antibiotic-associated diarrhoea. In light of the strong association between antimicrobial use and CD infections (CDI), it may be hypothesised that areas at higher prevalence of antimicrobial resistance, like the region of Campania in southern Italy, could also have a higher rate of CDI. In this multicentre, region-based, prospective study, we analysed such issues, exploiting CDI incidence data collected from local hospitals. In 2016, the Italian National Centre for Disease Control supported a project involving three Italian regions: Friuli Venezia Giulia, Lazio and Campania. In Campania, a network of 49 hospitals willing to participate in the project was created. The project consisted of two phases: a survey on practice patterns concerning CDI and an epidemiological surveillance study. We identified a stringent need to improve awareness about CDI among the regional health-care community, as a widespread lack of surveillance programmes for CDI control was observed (existing in only 40% of participating facilities). Moreover, almost half of the participating hospitals (n=16, 43%) had no standardised procedures or protocols to control and prevent CDI. In the second phase of the study, we collected data of CDI cases during a six-month surveillance programme. In all, 87 CDI cases were observed, for a total of 903,334 patient bed-days and 122,988 admissions. According to the above data, CDI incidence was 0.96 cases/10000 patient bed-days, much lower than expected based on prior studies conducted elsewhere. The results of our study suggest CDI remains a rather neglected clinical issue in Campania. Despite a high burden of antimicrobial resistance and antimicrobial use in our geographic setting, we observed a very low incidence of CDI. Such a low incidence could be explained by underdiagnosis, but could also be related to actual diet, the lower patient age or the specific genetic background. However, further studies are warranted to either confirm or rebut the above hypotheses.
Rapid identification of non-tuberculous mycobacteria with MALDI-TOF mass spectrometry
Oliva Ester,
Arosio Marco,
Mazzola Ester,
Mascheroni Miriam,
Cerro Annarosa,
Cuntrò Marina,
Vailati Francesca,
Cavallini Marco,
Farina Claudio
Rapid and accurate identification of non-tuberculous mycobacteria (NTM) is important for a prompt start to antibiotic therapy. The aim of this study was to obtain accurate identification of NTM quickly by analyzing the performance of the MALDI-TOF mass spectrometry (MS) system VITEK® MS in identifying various NTM species from solid medium and MGIT 960 liquid medium. The study was performed in two phases: preliminary and perspective. Overall, 41/42 species and 33/34 species were correctly identified from the MGIT medium in the preliminary and perspective phases, respectively. The VITEK® MS system includes in its database part of the mycobacteria from the Mycobacterium fortuitum complex but is unable to discriminate among the various species belonging to the complex. Although the VITEK® MS system does not have the protein spectrum of Mycobacterium chimaera, it is not able to distinguish between Mycobacterium chimaera and Mycobacterium intracellulare. Since the VITEK® MS includes the separate protein spectrum of both M. chelonae and M. abscessus, it can discriminate between the two microorganisms. Thanks to these studies we show that the VITEK® MS system is a reliable method for identification of NTMs directly from MGIT liquid medium, instead of the use of solid media.
A study of group B streptococcus in pregnant women in Lebanon: prevalence, risk factors, vaginal flora and antimicrobial susceptibility
Alfouzan Wadha,
Gaddar Nahed,
Dhar Rita,
Rabaan Ali A.
Guidelines recommend universal screening of all pregnant women at 35-37 weeks of gestation for group B streptococcus (GBS) colonization and reserve a risk-factor-based approach for women who have no prenatal cultures. This study determines the prevalence of GBS among pregnant women in Lebanon and assesses the association between risk factors and vaginal flora in this patient population and antibiotic resistance pattern of the GBS isolates. Vaginal samples from women between 35-37 weeks of gestation were obtained and cultured on 5% sheep blood agar (BA), colistin nalidixic acid agar, Strep B Select chromogenic agar and Lim enrichment broth. Also, vaginal flora was evaluated on Gram-stained smears. Colonies on BA suggestive of GBS were identified by Gram staining, catalase test and agglutination in group B antiserum. Antimicrobial susceptibility to different antibiotics was tested on BA. Risk factors were obtained. The prevalence of vaginal GBS colonization was 18.4% (31/168). Evaluation of Gram-stained vaginal smears revealed an inverse relationship between the presence of lactobacilli and GBS colonization (p=0.029). Resistance of GBS to erythromycin and clindamycin was found to be 25.8% and 12.9%, respectively. Demographic and obstetric data did not reveal statistically significant differences in GBS colonization rates between age groups (p=0.498) or level of education (p=0.696) among these women. Prevalence of GBS remains high in this region with no identifiable risk factors for its acquisition. Furthermore, increase in resistance to erythromycin and clindamycin should prompt susceptibility testing of all GBS isolates. The resistance profile of these strains represents an emerging public health concern that needs further surveillance.
Prevalence of respiratory viruses by Multiplex PCR: a four-and-a-half year retrospective study in an Italian general hospital
Leli Christian,
Di Matteo Luigi,
Gotta Franca,
Vay Daria,
Piceghello Andrea,
Cornaglia Elisa,
Cavallo Valeria,
Busso Simone,
Carrabba Laura,
Mazzeo Roberta,
Rocchetti Andrea
Viruses are frequent causal agents of acute respiratory infections and the most common are influenza virus, respiratory syncytial virus (RSV), human parainfluenza virus (HPIV), human metapneumovirus (HMPV), rhinovirus (RV), adenovirus (AdV) and the four endemic human coronaviruses (HCoV) -229E, -NL63, -OC43, -HKU1. Multiplex real-time PCR platforms are becoming increasingly common in laboratories mostly in relation to the increased diagnostic sensitivity and reduced turnaround time. The aim of our study was to determine the prevalence of respiratory viruses in a population of patients within the S.S. Antonio e Biagio e Cesare Arrigo General Hospital catchment area of Alessandria, Italy, from January 2016 to June 2020. Therefore, we retrospectively analyzed the results of multiplex real-time PCR performed on nasopharyngeal swabs collected from consecutive patients with symptoms of respiratory infection. A total of 572 patients were included in the study subdivided as follows: pediatric 197/572 (34.4%), adults 200/572 (35%) and elderly 175/572 (30.6%). Among all samples, 235/572 (41.1%) were positive for a respiratory virus, of whom 189/235 (80.4%) were monomicrobial. The prevalence was: 15.5% (89/572) of rhinovirus/enterovirus (RV/EV); 9.4% (54/572) of RSV; 8.9% (51/572) of influenza virus; 5.4% (31/572) of AdV; 3.1% (18/572) of HCoV; 2.8% (16/572) of HPIV; and 2.3% (13/572) of HMPV. RV/EV were the pathogens most frequently involved in coinfections (34.7%, 16/46), followed by AdV (19.6%, 9/46) and influenza virus (19.6%, 9/46). Samples collected from the pediatric group were more frequently positive. The prevalence of positive pediatric samples compared to adults and elderly, respectively was: 28.4% (56/197) for RV/EV vs 10.5% (21/200) vs 6.9% (12/175), p<0.0001; 18.8% (37/197) for RSV vs 2% (4/200) vs 7.4% (13/175), p<0.0001; 13.7% (27/197) for AdV vs 1% (2/200) vs 1.1% (2/175), p<0.0001; and 6.6% (13/197) for HPIV vs 0.5% (1/200) vs 1.1% (2/175), (p<0.0001).
With regard to seasonality, a significantly higher prevalence of influenza virus (p<0.0001) and RSV (p=0.029) was found during winter, with peaks in January-February. AdV peaked during winter 2018-2019 (p=0.004), while HCoV were detected with a significantly higher prevalence during winter 2019-2020 (p=0.037). With regard to HPIV, a significant peak from summer to fall 2018 was observed (p=0.016). Most viral respiratory infections have seasonal patterns and the prevalence of respiratory viruses varies according to the method, geographic area and population considered. Knowledge of local epidemiology is therefore crucial for implementation of prevention and treatment strategies.
Prophylactic letermovir decreases cytomegalovirus reactivation after stem cell transplantation: a single-center real-world evidence study
Serio Bianca,
Giudice Valentina,
Guariglia Roberto,
Fontana Raffaele,
Pezzullo Luca,
Martorelli Maria Carmen,
Ferrara Idalucia,
Mettivier Laura,
D’Addona Matteo,
Vaccaro Emilia,
Langella Maddalena,
Selleri Carmine
Cytomegalovirus (CMV) reactivation is a major cause of morbidity and mortality after organ or hematopoietic stem cell transplantation (HSCT). Letermovir (LTV) is a novel antiviral agent approved for CMV prophylaxis after allogeneic transplantation. In this single-center real-world study, we evidenced the efficacy and safety of LTV for CMV prophylaxis in allogeneic HSCT recipients. A total of 133 consecutive patients who underwent autologous or allogeneic HSCT were included in the study, and a subgroup of 13 allogeneic HSCT recipients received CMV prophylaxis with LTV 240 mg/daily from day +7 to +100 (allo-LTV cohort). All patients in the allo-LTV cohort were at moderate or high risk of reactivation based on donor/recipient serology status, and 62% also received haploidentical HSCT and cyclophosphamide which further increased the CMV reactivation risk. CMV infection rate was also compared to that observed in allogeneic HSCT patients without CMV prophylaxis and autologous recipients who have the lowest reported CMV infection incidence and were used as a control cohort. In our experience, patients receiving LTV showed a significant decline in CMV reactivation incidence to similar rates described in autologous HSCT recipients (7.7% of allogeneic LTV-treated vs 68% of allogeneic recipients without prophylaxis vs 15% of autologous patients; p< 0.0001). The only patient in the allo-LTV cohort with CMV reactivation was a 25-year-old female with a diagnosis of very high-risk acute lymphoblastic leukemia who received a haploidentical HSCT after ex vivo T cell depletion. CMV reactivation occurred beyond LTV course, at +187 days from transplantation. In addition, we confirmed efficacy and safety of valganciclovir 450 mg/daily as pre-emptive therapy or for treatment of CMV disease in allogeneic and autologous HSCT recipients who experienced CMV reactivation even after LTV prophylaxis. However, further clinical trials in larger populations and longer follow-up are required to confirm our preliminary results.
Case report
The importance of anamnesis in differential diagnosis: a case of SARS-CoV-2 and dengue virus co-infection
Giacomelli Andrea,
Pagani Gabriele,
Covizzi Alice,
Antinori Spinello,
Cattaneo Dario,
Gervasoni Cristina
Dengue fever should be included in the differential diagnosis of febrile illness even if another infection such as COVID-19 has been found in returning travellers from tropical and sub-tropical area where dengue virus circulates epidemically. We describe a 40-year-old man diagnosed with laboratory-confirmed COVID-19 and dengue fever during the COVID-19 outbreak in Milan, Italy.
A case series of vestibular symptoms in positive or suspected COVID-19 patients
Malayala Srikrishna Varun,
Mohan Gisha,
Vasireddy Deepa,
Atluri Paavani
Respiratory symptoms are the most common presentation of an acute COVID-19 infection, but thromboembolic phenomena, encephalopathy and other neurological symptoms have been reported.
With these case series, we present multiple presentations of COVID-19 induced vestibular symptoms namely dizziness, vertigo and nystagmus. The patients reported in this case series are from different parts of the world, belong to different age groups and had manifested these symptoms in different periods of the pandemic.
The pathophysiology of vestibular neuritis induced by COVID-19 is similar to any other viral infection. Whether in the inpatient or outpatient settings, COVID-19 should be considered in the differential diagnosis for patients presenting with these symptoms, irrespective of the presence of respiratory symptoms or hypoxia.
Clinical use of BCG and its complications: a case series
Colomba Claudia,
Rubino Raffaella,
Mantia Gabriele,
Guida Marascia Federica,
Abbott Michelle,
Gizzi Andrea,
Anastasia Antonio,
Palermo Gabriele,
Tolomeo Manlio,
Cascio Antonio
Bacillus Calmette-Guérin (BCG), a live, attenuated strain of Mycobacterium bovis, is the essential constituent of the vaccine against tuberculosis and the gold-standard adjuvant treatment for urothelial cancer of the bladder. Being a live, attenuated strain with a potential pathogenic action, bacilli can cause several complications, both locally near the inoculation site and remotely through blood dissemination. BCG-related disease can represent a side effect of anti-TB vaccination in patient with congenital or acquired immunodeficiency or a complication of the therapeutic schedule in oncologic patients. Herein we report five cases of BCG-related disease which occurred at the Infectious Diseases Department of the University Hospital of Palermo during a five-year period from January 2014 to December 2019.
Multidrug-resistant Gram-negative post-neurosurgical meningitis and the role of intraventricular colistin: a case series
Iaria Chiara,
Giammalva Giuseppe Roberto,
Spicola Daria,
Fimognari Anna Maria,
Imburgia Claudia,
Di Lorenzo Francesco,
Ficalora Antonio,
Sanfilippo Adriana,
Mazzarese Vincenzo,
Scafidi Antonio,
Cimò Francesco,
Capodicasa Antonio,
Marsala Grazia Laura,
Saporito Antonella,
Di Bernardo Francesca,
Iacopino Domenico Gerardo,
Fiorenza Vito
The aim of this study was to report the clinical experience of intraventricular colistin for the treatment of multi-resistant Gram-negative post-surgical meningitis in a tertiary hospital. Post-neurosurgical meningitis (PNM) is one of the life-threatening complications of neurosurgical procedures, and is frequently sustained by Acinetobacter baumannii and Klebsiella pneumoniae. Here we describe our experience of five cases of PNM caused by gram-negative multi-drug resistant (MDR) bacteria, treated with intraventricular (IVT) colistin, admitted to the Neurosurgery Unit of A.R.N.A.S. Civico of Palermo, Italy, from January 2016 to June 2020. In four patients the cerebrospinal fluid (CSF) culture was positive for A. baumannii, while in one patient it was positive for K. pneumoniae. IVT colistin therapy was administered for a median time of 18 days (range 7-29). The median time to CSF negativization was seven days (range 5-29). IVT colistin administration was associated with intravenous administration of meropenem and colistin in all patients. As regards clinical outcome, four patients were successfully treated and were subsequently discharged, while one patient died following respiratory complications and subsequent brain death. IVT colistin administration is an effective therapy for MDR post-neurosurgical meningitis and its administration is also prescribed by guidelines. However, IVT therapy for Gram-negative ventriculitis is mostly understudied. Our paper adds evidence for such treatment that can actually be considered life-saving.
A case of Corynebacterium striatum endocarditis successfully treated with an early switch to oral antimicrobial therapy
Biscarini Simona,
Colaneri Marta,
Mariani Bianca,
Chiara Teresa,
Bruno Raffaele,
Seminari Elena
Patients with Corynebacterium striatum endocarditis are usually managed with long-term intravenous antibiotic therapy and hospitalization. Here we describe a case of a 76-year-old woman with hepatitis C virus (HCV) related cirrhosis who developed endocarditis due to Corynebacterium striatum associated with severe aortic regurgitation. To our knowledge, this is the first case to be successfully treated with an early switch to oral linezolid after three weeks of vancomycin. We performed a literature review using the PubMed database and found 27 cases which showed the enhanced virulence of this pathogen especially for long-term hospitalized patients with a frequent need of surgical treatment (44.4%) and long course of parenteral antimicrobial therapy, with vancomycin as drug of choice. There are no studies confirming the possibility of using oral treatment in non-diphtheritic Corynebacteria infective endocarditis. This case report provides us with the evidence that once the patient is in a stable condition, the efficacy and safety of linezolid might be similar to vancomycin administration. New trials and prospective studies are needed to confirm the opportunity of an early switch to oral therapy in this specific setting.
The Infections in the History of Medicine
The plague which hit the city of Bologna in the year 1630
Sabbatani Sergio,
Fiorino Sirio,
Manfredi Roberto
In the year 1630, similarly to other cities of Northern Italy, Bologna was affected by a plague epidemic. It occurred after the arrival of Lansquenet troops, engaged by the Emperor Frederick II in the siege of Mantua city. The human losses have been calculated by the historian demographer Bellettini in the terms of around 15,000 people, so that the number of inhabitants in Bologna declined from 62,000 to 47,000 units in the time span of 7-8 months. Initially, during the winter and the early Spring, although the plague epidemic had been known after that it involved many cities close to Bologna (i.e. Turin, Milan, Venice, Genoa and Verona), the population tried to keep the epidemic hidden, being afraid that commerce echanges could be affected by this event. Later, starting from the month of May, under the guidance of cardinal Bernardino Spada, cooperating with the numerous religious orders and in particular that of the Camillians, the city reacted, launching an organization effort which significantly aided in the containment of the plague epidemic. A number of Lazarettoes were organized outside of the city walls and relevant sums supported the clean operation of over 3,000 houses. The city Senate sustained the poor population with a sum of 700,000 lire and grain donations. Even though the balance was heavy in terms of loss of human lives, it resulted not so dramatic, compared with that paid by other Italian cities. From a cultural point of view, according to the belief of the scientific, the miasmatic theories were still considered satisfactory, although in the common practice people who could leave the city escaped from Bologna, in order to avoid the contagion.
We can argue that the impact of the epidemic was reduced by means of the organizational approach with strict isolation measures for sick persons, the closing of the city walls in the urban areas more affected by the plague, and finally a sanctionatory and punitive approach for individuals, who disregarded the applied rules.
The Greek physician and politician Ioannis Kapodistrias (1776–1831) and the plague of 1828 in Greece
Tsoucalas Gregory,
Michaleas Spyros N.,
Karamanou Marianna
Count Ioannis Antonios Kapodistrias was an important political figure of the 19th century. He was a pioneer in the fight against epidemics and used his medical experience in Italy to protect Greeks from the 1828 plague. As a renowned diplomat and leader, Kapodistrias helped forge the federal state structure of Switzerland and formed the first organized administrative state in the Hellenic peninsula.
Letters to the editor
Finnish sauna and COVID-19
Kunutsor Setor K.,
Lavie Carl J.,
Laukkanen Jari A.
Not available
Determinants of SARS-COV-2 seroconversion in a cohort of recovered patients
Ciccullo Arturo,
Tosato Matteo,
Borghetti Alberto,
Moschese Davide,
Fantoni Massimo,
Di Giambenedetto Simona,
Landi Francesco,
Not available
COVID-19 vaccine: Challenges in developing countries and India’s initiatives
Chakraborty Chiranjib,
Ranjan Sharma Ashish,
Bhattacharya Manojit,
Lee Sang-Soo,
Agoramoorthy Govindasamy
Not available
