Volume 30, Issue 2, 2022
Review
Pathological involvement of placenta in COVID-19: a systematic review
Motwani Rohini,
Deshmukh Vishwajit,
Kumar Ashutosh,
Kumari Chiman,
Raza Khursheed,
Krishna Hare
The mammalian placenta, which is responsible for bonding between the mother and the fetus, is one of the first organs to develop. Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection has caused a great threat to public health and affected almost all the organs including the placenta. Owing to limited available data on vertical transmission and pathological changes in the placenta of SARS-CoV-2 positive patients, we aim to review and summarize histopathological and ultrastructural changes in the placental tissue following SARS-CoV-2 infection. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guidelines were used for review writing. Multiple studies have reported significant pathological changes in the placental tissue of SARS-CoV-2 positive mothers. On the other hand, some studies have demonstrated either no or very little involvement of the placental tissue. The most common pathological changes reported are fetal and maternal vascular malformation, villitis of unknown etiology, thrombus formation in the intervillous space and sub-chorionic space, and chorangiosis. Reports on vertical transmission are less in number. The observations of this review present a strong base for the pathological involvement of the placenta in SARS-CoV-2 infected mothers. However, a smaller number of original studies have been done until now, and most of them have small sample sizes and lack matched control groups, which are the big limitations for drawing an effective conclusion at this stage. Antenatal care can be improved by a better understanding of the correlation between maternal SARS-CoV-2 infection and placental pathology in COVID-19.
Healthcare workers epidemic biological risks - recommendations based on the experience with COVID-19 and Ebolavirus
Edgar Mia,
Selvaraj Saranya A.,
Lee Karen E.,
Caraballo-Arias Yohama,
Harrell Mason,
Rodriguez-Morales Alfonso J.
Infectious disease outbreaks frequently cause illness and death among Healthcare Workers (HCWs). We compare strategies from recent, past and ongoing outbreak measures used to protect HCWs, including those facing additional challenges such as racial disparities, violence and stigmatization. Outbreaks and pandemics superimposed on countries with preexisting crises have also affected emergency response to these viral outbreaks. Strategies to protect HCWs include adherence to recommended infection prevention and control measures; new technology such as rapid point-of-care tests and remote monitoring; adopting national public health preparedness plans to ensure the supply and allocation of PPE, staff, and testing supplies; occupational health and mental health support services. Lessons learned from recent pandemics should be used by Infection Prevention and Control and Occupational Health staff to refine preparedness plans to protect HCWs better.
Postbiotics as the key mediators of the gut microbiota-host interactions
Ozma Mahdi Asghari,
Abbasi Amin,
Akrami Sousan,
Lahouty Masoud,
Shahbazi Nayyer,
Ganbarov Khudaverdi,
Pagliano Pasquale,
Sabahi Sahar,
Köse Şükran,
Yousefi Mehdi,
Dao Sounkalo,
Asgharzadeh Mohammad,
Hosseini Hedayat,
Samadi Kafil Hossein
The priority of the Sustainable Development Goals for 2022 is to reduce all causes related to mortality. In this regard, microbial bioactive compounds with characteristics such as optimal compatibility and close interaction with the host immune system are considered a novel therapeutic approach. The fermentation process is one of the most well-known pathways involved in the natural synthesis of a diverse range of postbiotics. However, some postbiotics are a type of probiotic response behavior to environmental stimuli that usually play well-known biological roles. Also, postbiotics with unique structure and function are key mediators between intestinal microbiota and host cellular processes/metabolic pathways that play a significant role in maintaining homeostasis. By further understanding the nature of parent microbial cells, factors affecting their metabolic pathways, and the development of compatible extraction and identification methods, it is possible to achieve certain formulations of postbiotics with special efficiencies, which in turn will significantly improve the performance of health systems (especially in developing countries) toward a wide range of acute/chronic diseases. The present review aims to describe the fundamental role of postbiotics as the key mediators of the microbiota-host interactions. Besides, it presents the available current evidence regarding the interaction between postbiotics and host cells through potential cell receptors, stimulation/improvement of immune system function, and the enhancement of the composition and function of the human microbiome.
Further insights into to the role of statins against active tuberculosis: systematic review and meta-analysis
Meregildo-Rodriguez Edinson Dante,
Chunga-Chévez Eleodoro Vladimir,
Robles-Arce Luis Gianmarco,
Vásquez-Tirado Gustavo Adolfo
Objectives: Tuberculosis is a major cause of global morbidity and mortality. Statins could be associated with a lower risk of some infectious diseases, including tuberculosis. Statins could reduce the risk of latent tuberculosis infection and active tuberculosis, acting as an adjuvant in treating tuberculosis. This study aimed to determine if statins reduce the risk of active tuberculosis.
Methods: We systematically analyzed 8 databases from inception to December 2021. We included articles without language restriction if they met our inclusion and exclusion criteria and the PECO strategy (Population: adults without active pulmonary tuberculosis; Exposure: treatment with any statin; Comparator: no use of statins; Outcome: active tuberculosis). Odds Ratios (ORs) with 95% confidence intervals (CIs) were pooled using random-effects models regardless of heterogeneity quantified by Cochran's Q and I2 statistics. We performed subgroup analyses according to the participants’ diabetic status and follow-up length (≤10 years or >10 years).
Results: Twelve articles reporting observational studies involving 3.038.043 participants, including at least 32.668 cases of active tuberculosis. Eight reported retrospective cohort studies, three nested case-control study, and one was a case control study.
According to our meta-analysis, statins may reduce the risk of active tuberculosis, in the general population (OR 0.66; 95% CI, 0.54-0.81), in non-diabetic (OR 0.66; 95% CI, 0.54-0.80) and in diabetic patients (OR 0.65; 95% CI, 0.49-0.87). This protective effect did not differ according to the participants’ diabetic status nor follow-up length (test for subgroup differences I2 = 0). We found significant clinical and methodological heterogeneity. Similarly, the forest plot, and the I2 and Chi2 statistics suggested considerable statistical heterogeneity (I2 = 95%, p <0.05, respectively). Of the 12 included studies, 9 were at low risk of bias and 3 were at high risk of bias. Similarly, according to the funnel plot, it is very likely that there are important publication biases.
Conclusion: Statin use may significantly reduce the risk of tuberculosis in the general population, diabetic and non-diabetic patients. Nevertheless, caution should be exercised when interpreting these conclusions, due to the quality of the evidence, the heterogeneity of the studies, the presence of bias, and the difficulty in extrapolating these results to populations of other races and ethnicities.
Recent breakthroughs in the treatment of chronic hepatitis Delta
Brancaccio Giuseppina,
Gaeta Laura,
Vitale Alessandro,
Gaeta Giovanni B.
Hepatitis Delta virus (HDV) is responsible for the most aggressive form of chronic hepatitis, which may evolve towards cirrhosis, hepatocellular carcinoma and death within few years. During the last 30 years the only available therapy was interferon or peg-IFN, which was characterized by poor tolerability and modest results. The detailed knowledge of the HDV replication cycle and its interaction with HBV allowed the introduction of new drugs which are currently in phase II or III of experimentation. Basically, bulevirtide, to date the only one approved by EMA, inhibits the entry of the virus into the hepatocytes and hence its intrahepatic spread; lonafarnib inhibits the pharnesylation process of the L-HDAg, which is critical for the assembly of the HDV virion; the nucleic acid polymers (NAPs) mainly block the production/release of HBsAg. The available clinical trials with these compounds showed an excellent anti-viral activity against HDV.
Original article
Real-life use of remdesivir-containing regimens in COVID-19: a retrospective case-control study.
Cogliati Dezza Francesco,
Oliva Alessandra,
Mauro Vera,
Romani Francesco Eugenio,
Aronica Raissa,
Savelloni Giulia,
Casali Elena,
Valeri Serena,
Cancelli Francesca,
Mastroianni Claudio Maria
Background. Remdesivir (REM) has shown potent antiviral activity in vitro and efficacy in animal models of COVID-19; nevertheless, clinical trials and real-life reports have shown conflicting data on its effectiveness. Aims of the study were to evaluate the impact of remdesivir on I) Intensive Care Unit (ICU) admission, II) need for orotracheal intubation (OTI) and III) in-hospital mortality. Furthermore, we estimated the kinetics of laboratory parameters and assessed the risk factors for in-hospital mortality in the remdesivir population.
Methods. We conducted a retrospective, single-center, case-control (1:1) study including hospitalized patients with confirmed SARS-CoV-2 infection. Cases were patients treated with remdesivir for 5 days, controls were patients not receiving remdesivir.
Results. A total of 192 patients (96 cases and 96 controls) were included in the study. Patients receiving remdesivir had a lower rate of ICU admission and need for OTI than controls, whereas no difference between cases and controls were observed as for mortality rate. However, at multivariable analysis remdesivir was not associated with ICU admission neither with OTI. Instead, presence of haematological malignancies, lower duration of symptoms, higher severity of infection and low lymphocytes count at admission were independently associated with in-hospital mortality. In patients treated with remdesivir a low albumin value and duration of lymphopenia were significantly associated with mortality.
Conclusions. Our real-life study showed that therapy with remdesivir did not have impact on either ICU admission, need for OTI or in-hospital mortality.
Impact of COVID-19 severity on health-related quality of life among Saudi adult patients
Alnasser Ali Hassan A.,
Al-Tawfiq Jaffar A.,
Al Kalif Mohammed Sheker H.,
Alburaih Jasem Ahmad H.,
Al Hamad Lubna Abdulaziz A.,
Abadi Akilah Abdulkarim A.,
Alghanim Dhia Abdulwahid A.,
Hamzi Alhassan Ahmed S.,
Al-Huraiz Duaa Hussain M.,
Al-Haguri Bian Abdo Mohammed,
Alawami Ebtihal Ali A.,
Khlitit Hawra Abdulwahed I.,
Almutawah Sukainah YousifI.,
AlEid Ibtihal Faisal S.,
Al-Kalaif Zahra Shaker H.
COVID-19 patients may experience varying degrees of symptom severity, significantly impacting the health-related quality of life. As a result, the current study examines the impact of symptom severity on health-related quality of life among Saudi adult COVID-19 patients. In this cross-sectional study 310 adult COVID-19 patients were recruited through a snowball technique in Saudi Arabia. We used a questionnaire (SF-12 RAND tool questionnaire) that included three parts: sociodemographic factors, perception of degree severity of COVID-19 symptoms, and health-related quality of life (HRQoL). Out of 310 COVID-19 adult patients, 200 (64.5%) were female, 110 (35.5%) were between 30-49 years old. The mean scores of the HRQoL, physical components summary (PCS), and mental components summary (MCS) were 58.11±17.02, 71.32±23.72, and 44.91±17.94, respectively. Patients with very severe symptoms had the lowest HRQoL mean rank (120.39, P=0.023). There was a strong positive correlation between HRQoL and PCS (0.852) and HRQoL and MCS (0.730). However, PCS and MCS had a weak positive correlation (0.292). The severity of COVID-19 symptoms had a significant impact on HRQoL. Thus, it is essential to enhance the uptake of vaccines to decrease the risk of infections and avoid impact on quality of life.
Development of a nomogram to assess the impact of the myocardial injury on the prognosis of COVID-19 patients
Jin Mengdi,
Li Zhijun,
Li Xinwei,
Xie Mengtong,
Li Weizhen,
Ai Lizhe,
Sun Yaoyao,
Cheng Xiaodan,
Sheng Yan,
Zhang Jinnan,
Jiang Nan,
Yu Qiong
Coronavirus disease 2019 (COVID-19) has been spreading worldwide. Many COVID-19 patients were accompanied by myocardial injury during the course of the disease. To evaluate the association of cardiac injury with clinical outcomes in COVID-19 patients, we recruited 261 COVID-19 cases admitted to Tongji Hospital of Huazhong University of Science and Technology in this study. Compared with patients without myocardial injury, those with myocardial injury were older, with shorter hospital stays and lower survival rates. They also had higher levels of inflammatory biomarkers (Interleukin-6,8,10 and C-reactive protein), coagulation biomarkers, liver and kidney function markers. Kaplan-Meier analysis demonstrated that patients with myocardial injury had a higher mortality rate. The multivariate Cox regression model and the nomogram revealed that myocardial injury, co-morbidity, and abnormal procalcitonin (PCT) levels were independent risk factors of the mortality of COVID-19 patients. The linear correlation analysis and the ROC curve suggested a predictive value of the neutrophil-lymphocyte ratio (NLR) in cardiac injury. Summarily, myocardial injury in COVID-19 patients is associated with a higher mortality risk. Attention should be paid to monitoring myocardial injury in patients with significantly elevated myocardial markers and NLR at admission.
BCGitis after Bacille Calmette-Guerin intravesical administration from two referral centers: clinical characteristics and risk factors
De Benedetto Ilaria,
Barco Ambra,
Rossi Marianna,
Lapadula Giuseppe,
Lupia Tommaso,
Bonfanti Paolo,
Bonora Stefano,
Di Perri Giovanni,
Calcagno Andrea
Bacillus Calmette-Guerin (BCG) is commonly and safely used as intravesical instillation to treat bladder cancer. Adverse effects are widely described in case report and series with a broad range of clinical presentations known as “BCGitis”. Moreover, microbiological identification is often inconclusive leading to diagnostic uncertainty and no standardisation of definitions is available. We retrospectively collected all cases of BCGitis (n=19) after BCG intravesical administration occurred in 2 major Italian hospitals in the last 10 years. Median age was 71.8 years and among comorbidities hypertension affected 60% of patients. The delay in the onset of symptoms was < one week and an inverse correlation was observed between the number of instillations and the time to the onset of symptoms. Moreover, a febrile presentation was the commonest clinical symptom (85%) and an interstitial or micronodular pattern at chest X-ray or CT scan was found positive in about 70% and 90% of cases, respectively. Larger cohorts are needed in order to inform clinically relevant algorythms for this uncommon disease.
The prevalence of gonococcal and non-gonococcal infections in women referred to obstetrics and gynecology clinics
Kazemian Hossein,
Karami Zarandi Morteza,
Zargoush Zeinab,
Ghafourian Sobhan,
Sadeghifard Nourkhoda ,
Jalilian Anahita ,
Shafieian Mahnaz ,
Pakzad Iraj ,
Bacterial vaginosis is a condition caused by changes in the vaginal microbial ecosystem and increases the risk of preterm delivery, premature rupture of membranes, endometritis, and weight loss of the baby. This study aimed to evaluate the frequency of gonococcal and non-gonococcal genital infections in women referred to clinics in Ilam, Iran. Two swab samples were taken from each patient using a sterile swab, one swab was placed in a THB medium for the culture of Streptococcus agalactiae and the other in PBS buffer for PCR. PCR method was conducted for the identification of the other bacterial agents such as Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum, and also S. agalactiae. Sampling was performed on 169 women with symptomatic vaginosis. The frequency of S. agalactiae by culture and PCR methods was 4.7% (8 samples) and 13.6% (23 samples) respectively. Also, 6.5% (11 samples), 3.5% (6 samples), 4.1% (7 samples), 1.2% (2 samples), and 0% of the samples were positive for N. gonorrhoeae, M. genitalium, M. hominis, U. urealyticum and C. trachomatis by PCR method. Except for a significant association between S. agalactiae colonization and abortion, there was no significant correlation between the prevalence of these bacteria and the patient's age, age of marriage, number of deliveries, and number of abortions. Overall, the prevalence of gonococcal and non-gonococcal infection in women referred to clinics in Ilam is similar to the other parts of Iran.
Screening of group B Streptococcus infection in pregnancy and neonatal outcomes in the province of Trento, Italy
Piffer Silvano,
Rizzello Roberto,
Pedron Mariangela,
Dellanna Laura,
Lauriola Anna Lina
The study analyzes the trend of group B streptococcal (GBS) infection in pregnancy in the province of Trento, Italy, where a universal screening of GBS infection in pregnancy has been active for some time. Data from pregnant women who gave birth at local maternity units between 2015-2019 were obtained from birth attendance certificates (BAC), the main - and mandatory - source of information for monitoring pregnancies, births and neonatal health in Italy. The BAC used in the province of Trento acquires the results of a vast range of infections in pregnancy. The data collected from the BAC were integrated with those provided by the Hospital Information System (SIO). The occurrence of neonatal GBS infection was investigated on 2019 birth cohort, using the hospital discharge archive as an ancillary information source. Between 2015-2019, 20,905 pregnant women received care at maternity units of the province of Trento, Italy, of whom 25.5% were foreigners. The average coverage of GBS testing in pregnancy was 91.8% (95% CI 91.25-92.35) without significant variations from one year to the next.Test coverage varies in relation to maternity units and some socio-demographic characteristics of mothers. The average proportion of GBS positive cases over the study period was 21.0% (95% CI 20.7-21.3), a value that does not show statistically significant changes from one year to the next. The proportion of positive cases appears uneven among the subgroups of pregnant women considered, even if the differences are not statistically significant. In the 2019 birth cohort, newborns to GBS-positive mothers had an excess of stillbirths, of those born with Apgar at 5 minutes <7 and hospitalized at birth. However, these excesses were not statistically significant. Intravenous Antibiotic Prophylaxis (IAP) was performed in 86.8% of births from GBS positive mothers who had an indication for IAP. IAP was inadequate in 7.4% of the GBS positive mothers. Postnatal evaluation of 783 live births to GBS positive mothers identified 3 cases of early neonatal GBS infection. The incidence of neonatal GBS infection over the whole series of live births is 0.71/1,000 (95% CI 0.56-0.86), 0.68/1000 (CI 95% 0.55-0.79) in Italians and 1.07/1000 (95% CI 0.45-1.65) in foreigners. Data collection on infections in pregnancy through BAC allows area-based assessment. The quality of the data recorded in the BAC can be considered satisfactory but it was necessary to access to other information sources. The local availability of various information sources should allow periodic audits and closer monitoring of neonatal GBS infection
Higher viral load of Epstein-Barr virus in gastric cancer compared with non-cancerous gastroduodenal tissues
Zebardast Arghavan,
Pazhoohan Maryam,
Yazdani Cherati Azadeh,
Salehi Maryam,
Saber Amoli Saghar,
Yahyapour Yousef,
Ranaee Mohammad,
Shokri Shirvani Javad,
Sadeghi Farzin
Introduction: Epstein-Barr Virus (EBV)-associated gastric cancer is a distinct molecular subtype of gastrointestinal carcinomas as defined by the Cancer Genome Atlas. Methods: In the present study 237 samples from Iranian patients diagnosed with gastric cancer and gastroduodenal disease were retrospectively examined for EBV infection by quantitative Real-Time PCR. Results: Of the 237 samples tested, EBV DNA was detected in 37 samples (15.6%), in 13 of the 81 gastric cancer cases (16%), and 24 of the 156 non-cancerous samples (15.4%). The EBV infection rate was found higher in patients with gastric ulcer (35%) and duodenal ulcer (21.9%) compared to patients with gastric cancer (16%) and gastritis (19.6%). The EBV-encoded small RNA (EBER) copy number in the gastric cancer group (mean = 2.14×10-1 with range of 2.14×10-2 to 4.10×10-1 copies/cell) was higher than gastroduodenal diseases group (mean = 1.39×10-2 with range 1.11×10-3 to 2.35×10-2 copies/cell), and this difference was statistically significant (P >0.001) Conclusion: The higher number of copies of EBV- EBER in the gastric cancer group compared to the non-cancer group confirmed the possible role of EBV in inducing cancer.
Predictors of lethality in severe leptospirosis in Transcarpathian region of Ukraine
Petakh Pavlo,
Nykyforuk Andriy
Leptospirosis is one of the most widespread zoonoses in the Transcarpathian region, with an average lethality of 12.5%. To determine the predictors of lethality, a retrospective study of 97 medical records of patients with leptospirosis in the period from 2009 to 2018 was conducted. Quantitative variables in the presence of normal distribution were compared using a paired Student's t-test, and in the case of an abnormal distribution, the Mann-Whitney U test was used. The criterion χ2 was used for qualitative variables. Multivariate analysis was used for the calculation of the Odds ratio. The following factors that are associated with death from leptospirosis have been identified: total bilirubin greater than 300 mcmol/L (OR, 4.25; 95% confidence interval [CI], 1.57-11.53), platelets less than 50 x (109/L) (OR, 3.95; 95% confidence interval [CI], 1.45-10.73), creatinine above 200 mcmol/L (OR, 1.95; 95% confidence interval [CI], 1.47-2.60) and jaundice (OR, 1.39; 95% confidence interval [CI], 1.21-1.60). Detection of these predictors will help to quickly identify a patient at risk of severe course of the disease and death, which will allow deciding on the use of early intensive care.
Case report
Thoracic aorta graft infection by avibactam-resistant KPC-producing K. pneumoniae treated with meropenem/vaborbactam: a case report and literature review
Belati Alessandra,
Novara Roberta,
Bavaro Davide Fiore,
Procopio Andrea,
Fico Cecilia,
Diella Lucia,
Romanelli Federica,
Stolfa Stefania,
Mosca Adriana,
Di Gennaro Francesco,
Saracino Annalisa
Meropenem/vaborbactam (M/V) is a new carbapenem-carbapenemase inhibitor combination drug active against extensively drug resistant Gram-negative pathogens. Studies about its efficacy and place in therapy are limited in “real-life” and no data are available for deep site infections, like vascular graft infections.
We present a case of a patient successfully treated with M/V for a thoracic aorta graft infection, placed for a traumatic penetrating aortic ulcer, due to an extensively KPC-producing Klebsiella pneumoniae resistant to ceftazidime/avibactam.
Furthermore, we conducted a systematic literature review concerning vascular graft infections caused by carbapenem-resistant Klebsiella pneumoniae and the papers published until now about the use of M/V for the treatment of ceftazidime/avibactam-resistant K. pneumoniae.
Meropenem/vaborbactam is a promising antibiotic for difficult-to-treat Gram-negative bacteria with limited therapeutic options. Only few reports have been published and more studies are needed to assess which is the best place in therapy of M/V.
Uncommon lymphocutaneous cellulitis after insect bite: a case report of primary cutaneous nocardiosis and literature review
Lovecchio Antonio,
Bazzacco Giulia,
Di Bella Stefano,
Di Meo Nicola,
Luzzati Roberto
Nocardia is a genus of aerobic actinomycetes that are usually responsible for opportunistic infection in immunocompromised patients. Less frequently nocardiosis can interest immunocompetent population, causing especially primary cutaneous infections. Cutaneous involvement by Nocardia spp. may occur mostly as one of four clinical manifestations: superficial cellulitis or abscess, mycetoma, lymphocutaneous (also defined “sporotrichoid”) infection and secondary cutaneous involvement from systemic disease. Infections usually present after minor local injury, especially in traumatic outdoor activities (e.g. gardeners, farmers, road accidents), with subsequent environmental contamination of the wound. In sporadic cases cutaneous infection follows an insect bite. Microbiological diagnosis is often difficult to obtain and N. brasiliensis is the species isolated in most cases (80%). We present the case of a 45-year-old female with fever and a painful and necrotizing lesion on her right leg with secondary ascending lesions occurred on the homolateral knee and consensual groin lymphadenopathy after insect sting (maybe a spider bite). Cultures on skin biopsy identified Nocardia brasiliensis. Infection was completely healed after 5 months of targeted antibiotic therapy. In addition, we performed a literature review of all cutaneous nocardiosis cases in immunocompetent individuals, finding that only in 22 cases the infection presented after insect bite; in most of these cases lymphocutaneous manifestation was seen and N. brasiliensis was the nocardia species isolated. Our case, along with others in literature, reveals that the real burden of soft-tissues nocardiosis seems low but probably many cases might go undiagnosed because of difficulties in microbiology diagnosis. Primary cutaneous nocardiosis should be included in the diagnostic pathway in cases of cellulitis following insect bite or sting, especially when localized to extremities.
A case of ceftriaxone-induced liver injury and literature review
Guarino Matteo,
Perna Benedetta,
Pastorelli Alessandra,
Bertolazzi Paolo,
Caio Giacomo,
Maritati Martina,
De Giorgio Roberto,
Contini Carlo
Background: Liver injury evoked by drugs spans various clinical manifestations ranging from mild biochemical abnormalities to acute liver failure. Ceftriaxone is a third-generation cephalosporin often used in clinical practice for its long half-life, high tissue penetration rate, wide spectrum and good safety profile. Ceftriaxone, as other cephalosporins have little hepatotoxicity; however, few cases of toxic hepatitis induced by this antibiotic have been reported.
Case Presentation: We describe a case of acute, drug-induced liver injury (‘hepatitis’) in a 77 years-old female patient treated with ceftriaxone for pneumonia. After 48hours from antibiotic administration, clinical condition worsened with a clinical and laboratory profile compatible with an acute non cholestatic liver injury. Ceftriaxone administration was immediately stopped and the patient was treated with hydro-electrolyte replacement, high-flow oxygen, vitamin K infusion, steroids and proton-pump inhibitors with a progressive clinical improvement.
Conclusions: Even if rare, a ceftriaxone-induced hepatotoxicity (confirmed by RUCAM score), should be considered when all other possible causes have been excluded.
Rhino-orbito-cerebral mucormycosis in an acute lymphoblastic leukemia pediatric patient. Case report and review of literature
Abril Rincón Cindy Carolina,
Silva-Ramos Carlos Ramiro,
Amuruz Arancibia Joel,
Prada-Avella Ma. Camila,
Suárez Amaranto
Mucormycosis is a disease caused by opportunistic fungi of the order Mucorales that generally affects immunocompromised patients or those with underlying disease. It has a high mortality rate and is the third most common invasive fungal infection. The following is a case report of a 12-year-old pediatric patient diagnosed with B-cell acute lymphoblastic leukemia, who presented an aggressive infectious disease two months after beginning chemotherapy, which began in the right frontal and maxillary sinuses, with subsequent progression and extension, progressively deteriorating the patient’s clinical status. Culture and biopsy of the affected areas were performed, confirming by histopathology and isolation a rhino-orbito-cerebral mucormycosis due to Actinomucor elegans. The patient was treated with specific antifungal therapy as an inpatient and left the service after obtaining negative cultures, continuing with outpatient antifungal treatment.
Recrudescence of Plasmodium falciparum malaria 5 years after treatment in an HIV migrant: a case report with a peculiar presentation
Forniti Arianna,
Riccardi Niccolò,
Sponga Pietro,
Buono Chiara,
Iapoce Riccardo,
Suardi Lorenzo Roberto,
Tiseo Giusy,
Falcone Marco,
Menichetti Francesco
In the last two decades, several cases of delayed-onset malaria in migrants from endemic areas were reported. The decrease of acquired immunity over time, often enhanced by immune suppression, represents a possible underlying mechanism for recrudescence. Here we describe a case of Plasmodium falciparum malaria occurring five years after exposure in a patient infected with human immunodeficiency virus, originating from Ivory Coast. Peculiarly, bilateral subsegmental pulmonary embolism in the absence of deep venous thrombosis was also detected, requiring anticoagulant therapy. Treatment with dihydroartemisinin/piperaquine was followed by clearance of trophozoites and the patient was discharged home.
The Infections in the History of Medicine
Epidemiological evolution and historical anti-malarial control initiatives in Colombia, 1848-2019
Padilla-Rodríguez Julio Cesar,
Olivera Mario J.,
Padilla-Herrera María Cristina
The evolution of epidemiological transmission and the control measures implemented in Colombia have been the result of complex global and regional economic and political processes that occurred at different historical moments, since the dawn of the country's republican life. The development of economic activities for the production, exploitation and export of agricultural products, minerals and raw materials demanded in the international market, favored the necessary conditions for the emergence, expansion, resurgence and persistence of the endemic epidemic of malaria in the different stages studied. A common and fundamental element in the different defined historical moments was the importance given to malaria as an economic problem due to the negative externalities it imposed on the labor force. In addition, due to the role it played as a barrier that limited the exploitation of natural resources and raw materials of interest; as well as the impact that it caused to the flow and commercial exchange.
The previous situation was framed with the growth, consolidation and geostrategic expansion of the United States, as the main commercial partner of the region, and its interest in the exploitation of resources and raw materials, cheap labor, the need to create new markets, which coincided with the goals of modernization and economic strengthening of Colombia. Taking into account different relevant milestones that occurred in the 1848-2019 period, the following stages were defined: 1) Epidemiological emergence and re-emergence of tropical fevers in places of economic exploitation, 1848-1899; 2) Emergence of a new paradigm, control in enclaves of economic interest, ports and cities, 1900-1949; 3) Control to eradication, intensified control-eradication, prevention and control, 1950-1999 and 4) Prevention, control and elimination of malaria, 2000-2019.
Historically, antimalarial control initiatives in the country have been directed, restricted and prioritized in places of political and economic importance. The technical-scientific intervention measures implemented in the different stages studied have been uncritically replicated without adapting to the epidemiological scenarios existing in the country. Finally, the antimalarial control measures implemented in Colombia have been imported and adopted from international health initiatives as a result of commitments and obligations acquired in the global commercial context.
Letters to the editor
Cutaneous complications of COVID-19 vaccines
dos Santos Vitorino Modesto,
Sugai Taciana Arruda Modesto,
Modesto Laura Campos,
Modesto Julia Campos
Not available
