Volume 30, Issue 4, 2022
Review
Corticosteroids use for COVID-19: an overview of systematic reviews
Cruciani Mario,
Pati Ilaria,
Masiello Francesca,
Pupella Simonetta,
De Angelis Vincenzo
Purpose. A reappraisal of the validity of the conclusions of systematic reviews (SRs) and meta-analyses related to corticosteroids use for the treatment of COVID-19.
Material and Methods. An overview of SRs (umbrella review). The methodological quality of the SRs was assessed using tha AMSTAR-2 checklist; quality of the evidence was appraised following the GRADE approach.
Results: 35 SRs were included in this overview. Data were from 307 overlapping reports, based on 121 individual primary studies (25 randomized clinical trials (RCTs), 96 non-RCTs). In critically ill patients the use of steroids significantly reduced mortality compared to standard of care in 80% of the SRs, more often with moderate/high level of certainty; however, in patients not requiring oxygen supplementation the use of steroids increased the overall mortality in 2/3 of the comparisons. Clinical progression of diseases (need for mechanical ventilation, or for intensive care admission) was more commonly observed among controls compared to steroids recipients (in 9 out of 14 comparisons; certainty of evidence from very-low to moderate). The occurrence of adverse events was similar among steroids recipients and controls. Other outcomes (i.e., viral clearance, length of hospital stay) or issue related to optimal dose and type of steroids were addressed in a minority of SRs, with a high level of uncertainty, so that no definitive conclusions can be drawn.
Conclusions. There is moderate certainty of evidence that corticosteroids reduce mortality and progression of disease in critically ill COVID-19 patients compared to standard of care, without increasing the occurrence of adverse events.
The emergence of SARS-COV-2 Omicron subvariants: current situation and future trends
Farahat Ramadan Abdelmoez,
Abdelaal Abdelaziz,
Umar Tungki Pratama,
El-Sakka Amro A.,
Benmelouka Amira Yasmine,
Albakri Khaled,
Ali Iftikhar,
Al-Ahdal Tareq,
Abdelazeem Basel,
Sah Ranjit,
Rodriguez-Morales Alfonso J.
The SARS-CoV-2 Omicron variant (B.1.1.529) has been the most recent variant of concern (VOC) established by the World Health Organization (WHO). Because of its greater infectivity and immune evasion, this variant quickly became the dominant type of circulating SARS-CoV-2 worldwide. Our literature review thoroughly explains the current state of Omicron emergence, particularly by comparing different omicron subvariants, including BA.2, BA.1, and BA.3. Such elaboration would be based on structural variations, mutations, clinical manifestation, transmissibility, pathogenicity, and vaccination effectiveness. The most notable difference between the three subvariants is the insufficiency of deletion (Δ69-70) in the spike protein, which results in a lower detection rate of the spike (S) gene target known as (S) gene target failure (SGTF). Furthermore, BA.2 had a stronger affinity to the human Angiotensin-converting Enzyme (hACE2) receptor than other Omicron sub-lineages. Regarding the number of mutations, BA.1.1 has the most (40), followed by BA.1, BA.3, and BA.3 with 39, 34, and 31 mutations, respectively. In addition, BA.2 and BA.3 have greater transmissibility than other sub-lineages (BA.1 and BA.1.1). These characteristics are primarily responsible for Omicron's vast geographical spread and high contagiousness rates, particularly BA.2 sub-lineages.
Clinical impact of COVID-19 on tuberculosis
Sanduzzi Zamparelli Stefano,
Mormile Mauro,
Sanduzzi Zamparelli Alessandro,
Guarino Amedeo,
Parrella Roberto,
Bocchino Marialuisa
During COVID 19 pandemic, a lot of diseases suffered from a limited access to health care services, owing to the use of resources, both technical and financial, mainly directed towards such a dramatic outbreak. Among these, tuberculosis (TB) has been one of the most penalized, with a huge delay both in diagnosis and in start of treatment, with a consequential dramatic increase in morbidity and mortality.
COVID 19 and tuberculosis share similar common pathogenetic pathways, and both diseases affect primarily the lungs.
About the impact of TB on COVID 19 severity and mortality, data are unclear and literature reports are often conflicting. Certainly, considering the management of coinfected patients, there are pharmacokinetic interactions between several drugs used for the therapy of SARS-CoV-2 infection and the treatment of TB.
Periodontal disease as a non-traditional risk factor for acute coronary syndrome: a systematic review and meta-analysis
Meregildo-Rodriguez Edinson Dante,
Robles-Arce Luis Gianmarco,
Chunga-Chévez Eleodoro Vladimir,
Asmat-Rubio Martha Genara,
Zavaleta-Alaya Petterson,
Vásquez-Tirado Gustavo Adolfo
Objectives: Previous observational studies have suggested an association between periodontal disease (PD) and cardiovascular and cerebrovascular diseases. Nonetheless, evidence linking PD with coronary heart disease (CHD) and acute coronary syndrome (ACS) is still contradictory. We aim to systematically review the role of PD as a risk factor for ACS (myocardial infarction and unstable angina).
Methods: The protocol was registered in PROSPERO (CRD42021286278) and we followed the recommendations of the PRISMA and AMSTAR 2 guidelines. We systematically searched for 7 databases and electronic thesis repositories from inception to February 2022. We included articles without language restriction following the PECO strategy (population: “adult participants”; exposure: “periodontal disease”; comparator: “no periodontal disease”; outcome: “acute coronary syndrome” OR “acute myocardial infarction” OR “unstable angina”). Odds ratios (OR) with 95% confidence intervals (95% CI) were pooled using random effects and heterogeneity was quantified by Cochran’s Q and Higgins’ I2 statistics. Subgroup analyses were carried out according to the participants’ sex, type of diagnosis of PD, type of study, and continent of origin of studies.
Results: We included 46 papers (17 cohort, 25 case-control, and 4 cross-sectional studies) that met the inclusion criteria. This meta-analysis includes a total of 6,806,286 participants and at least 68,932 ACS events, mainly myocardial infarction (MI). In accordance with our results, PD is associated with a higher risk of ACS (OR 1.35; 95% CI 1.25–1.45). However, clinical and methodological heterogeneity was significant (I2 = 86%, p < 0.05). In the sensitivity analysis, the exclusion of some studies with "extreme" results (outliers) did not significantly affect the overall estimate or heterogeneity. In subgroup analysis, we found no statistically significant differences between men and women according to subgroup difference tests (I2 = 0%, p = 0.67). Conversely, there were differences according to the type of diagnosis of PD (clinical or self-reported diagnosis), type of study (cohort, case-control, or cross-sectional study), and the continent of origin (North America, South America, Asia, or Europe) of the studies (I² = 79%–96%, p < 0.10). Of the 46 studies, only 4 had a high risk of bias. Additionally, the funnel plot suggested publication bias.
Conclusion: PD may be an important non-traditional risk factor for ACS. Although, this meta-analysis brings together more studies, and therefore more evidence, than any other previous similar study, its results should be interpreted with caution due to the great heterogeneity and the potential presence of bias.
Role of tigecycline in the treatment of urinary tract infections: a systematic review of published case reports
Charles Reema,
Adhikari Shreya Das,
Mittal Ankit,
Chaudhuri Souvik,
Gupta Mukund,
Khot Wasim,
Schito Marco,
Gupta Nitin
Introduction: The emergence of multi-drug resistance has forced clinicians to occasionally use drugs that are not approved to treat urinary tract infections (UTIs). This systematic review aimed to evaluate the utility of tigecycline in patients with UTIs.
Methodology: A systematic review of case studies was used to retrieve articles between 1.1.1999 to 1.1.2021 from two databases, PubMed and Embase. The title-abstract screening was done for 198 articles, out of which 69 articles were included for full-text screening. A total of 18 articles with 27 cases were included for final analysis.
Results: Of the 27 cases, there were 13 cases with complicated UTI and five had catheter-associated UTI. The most common organisms were Klebsiella pneumoniae (n=11), Acinetobacter baumannii (n=9), and Escherichia coli (n=6). Tigecycline was used as monotherapy in 19 patients and as a combination therapy in 8 patients. The median duration of tigecycline was 13 (10-15) days. A favourable clinical or microbiological response at varying intervals was seen in 24/27 (88.9%). Within three months of a favourable response, recurrence of symptoms was seen in four patients.
Conclusion: In a small analysis of published case reports, tigecycline appeared to be a relatively effective treatment in patients with UTIs, caused by multidrug-resistant organisms. Where tigecycline is the only susceptible drug, it can be used for treatment. Further research, such as randomized controlled trials, is needed to fully assess the drug’s efficacy in this context.
Antibiotic therapy for pan-drug-resistant infections
Asghari Ozma Mahdi,
Abbasi Amin,
Asgharzadeh Mohammad,
Pagliano Pasquale,
Guarino Amedeo,
Köse Şükran,
Samadi Kafil Hossein
Antibiotic resistance occurs when microorganisms resist the drugs used against the infection caused by them and neutralize their effects over time using various mechanisms. These mechanisms include preventing drug absorption, changing drug targets, drug inactivating, and using efflux pumps, which ultimately cause drug resistance, which is named pan-drug-resistant (PDR) infection if it is resistant to all antimicrobial agents. This type of drug resistance causes many problems in society and faces the health system with difficulties; therefore their treatment is crucial and encourages doctors to develop new drugs to treat them. PDR Gram-negative bacteria, including Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, and Escherichia coli are among the most significant resistant bacteria to many antimicrobial agents, and only a limited range of antibiotics, especially synergistically are effective on them. For the therapy of PDR A. baumannii, tigecycline in combination with colestimethate, imipenem, amikacin, and ampicillin-sulbactam are the most effective treatments. The utilization of β-lactamase inhibitors such as ceftolozane-tazobactam, ceftazidime-avibactam, or imipenem-cilastatin-relebactam has the most efficacy against PDR P. aeruginosa. The PDR K. pneumoniae has been treated in the last decades with tigecycline and colistin, but currently, nitrofurantoin, fosfomycin, and pivmecillinam seem to be the most effective agent for the therapy of PDR E. coli. While these drugs impressively struggle with PDR pathogens, due to the daily increase in antibiotic resistance in microorganisms worldwide, there is still an urgent need for the expansion of novel medicines and methods of combating resistance.
Why do we miss isolated male genital tuberculosis diagnosis?
Retal Youssef,
Kharbach Youssef,
Khallouk Abdelhak
Tuberculosis remains a worldwide health problem. It can affect the entire genitourinary tract. Tuberculosis of male genital tract still presents a diagnostic dilemma because of its varied presentations and the unavailability of sensitive and specific investigations.
“Urogenital tuberculosis” is the most common term used in the literature. Male genital tuberculosis (MGTB) is usually reviewed together with urinary tract tuberculosis because often both sites are involved simultaneously; however, this is not always the case and current terminology may need to be modified. Until now, little importance has been given to isolated MGTB diagnosis. The current methods used for diagnosis are not adequate and the optimal strategy warrants further studies with a special attention on the evaluation of sperm investigations.
In this review, we aim to establish a summary on the type of tuberculosis affecting only the male genital tract. We recommend that the diagnosis of MGTB should be made taking into consideration the epidemiological data, the clinical presentation, and performance of latest molecular or immunological tools from urine, sperm, blood, other fluids or tissue specimens.
Original article
Pre-existing chronic kidney disease (CDK) was not associated with a severe clinical outcome of hospitalized COVID-19: results of a case-control study in Southern Italy
Calò Federica,
Russo Antonio,
Palamone Mariagrazia,
Maggi Paolo,
Allegorico Enrico,
Gentile Ivan,
Sangiovanni Vincenzo,
Russomando Annamaria,
Gentile Valeria,
Calabria Giosuele,
Pisapia Raffaella,
Salomone Megna Angelo,
Masullo Alfonso,
Iodice Valentina,
Russo Grazia,
Parrella Roberto,
dell’Aquila Giuseppina,
Gambardella Michele,
Ponticiello Antonio,
Pisaturo Mariantonietta,
Coppola Nicola
The presence of co-morbidities is associated with a poor outcome in patients with COVID-19. The aim of the present study was to investigate the outcomes of patients with SARS-CoV-2 infection and chronic kidney disease (CKD) in order to assess its impact on mortality and severity of disease. We performed a multicenter, observational, 1:2 matched case-control study involving seventeen COVID-19 Units in southern Italy. All the adults hospitalized for SARS-CoV-2 infection and with pre-existing CKD were included (Cases). For each Case, two patients without CKD pair matched for gender, age (+5 years), and number of co-morbidities (excluding CKD) were enrolled (Controls). Of the 2,005 patients with SARS-CoV-2 infection followed during the study period, 146 patients with CKD and 292 patients without were enrolled in the case and control groups, respectively. Between the Case and Control groups, there were no statistically significant differences in the prevalence of moderate (17.1% vs. 17.8%, p=0.27) or severe (18.8% and 13.7%, p=0.27) clinical presentation of COVID-19 or deaths (20.9% vs. 28.1%, p=0.27).
In the Case group, the patients dead during hospitalization were statistically higher in the 89 patients with CKD stage 4-5 compared to 45 patients with stages 1-3 CKD (30.3% vs 13.3%, p=0.03). Our data suggests that only CKD stage 4-5 on admission was associated with an increased risk of in-hospital death.
Efficacy and safety of oral antivirals in individuals aged 80 years or older with mild-to-moderate COVID-19: preliminary report from an Italian Prescriber Center
Bruno Giuseppe,
Perelli Serena,
Giotta Massimo,
Bartolomeo Nicola,
DeVita Giuseppina,
Buccoliero Giovanni Battista
Introduction: Molnupiravir and Nirmatrelvir/ritonavir(r), have demonstrated to prevent the progression to severe COVID-19 in high-risk individuals. Real life data are lacking in the elderly.
Methods: All consecutive individuals aged ≥80 years with confirmed COVID-19 and mild-to-moderate illness who received an oral antiviral prescription between 11th January and 31st May 2022 were included in this retrospective single-centre study. The aim was to assess safety and effectiveness of oral antivirals in individuals ≥80 years with mild to moderate COVID-19.
Results: A total of 168 subjects ≥80 years were included. Molnupiravir was prescribed in 147 (87.5%) subjects whereas Nirmatrelvir/r in 21 (12.5%); 16 (9.5%) experienced at least one adverse event. Overall, 21 (12.5%) hospitalizations and five deaths were reported at 28 days. At multivariate analysis male sex (OR = 4.196, 95% CI = 1.479-11.908; p=0.007), a moderate illness at time of prescription (OR=10.946, 95% CI =2.857-41.395; p=0.0005) and a greater number of days from the onset of symptoms to the therapy (OR=2.066, 95% CI = 1.285-3.322; p=0.0027) were associated with hospitalization and/or death.
Conclusion: In this real-life setting, including older individuals’ hospitalizations and mortality at 28 days remained low thanks to the prompt initiation of oral antiviral therapy. The use of oral antivirals can play a significant role in reducing healthcare costs and ensuring benefits among the elderly population.
COVID-19 chest CT and laboratory features of B.1.617.2 (Delta variant) vs B.1.1.7 (Alpha variant) surge: a single center case-control study
Viceconte Giulio,
Ponsiglione Andrea,
Buonomo Antonio Riccardo,
Camera Luigi,
Scotto Riccardo,
De Giorgi Marco,
Pinto Lorenzo,
Pinchera Biagio,
Villari Riccardo,
Foggia Maria,
Gerundo Gerardo,
Abete Pasquale,
Brunetti Arturo,
Gentile Ivan
Purpose: To assess clinical, laboratory and radiological differences between Delta and Alpha SARS-CoV-2 variants.
Materials and methods: Twenty SARS-CoV-2 patients admitted from 30th of August to 30th of October 2021 (period with estimated highest prevalence of Delta variant circulation in Italy) were enrolled. Patients were matched in a 1:1 ratio with same gender and same age +/- 2 years controls admitted from 1st of September 2020 to 30th of January 2021 (predominant circulation of Alpha variant). Chest computed tomography (CT) were retrospectively evaluated. Main clinical parameters, radiological and laboratory findings were compared between two groups.
Results: Patients with probable Delta variant had significantly higher CT severity scores, lower PaO2/FiO2 ratio and higher C-reactive protein and lactate dehydrogenase levels at admission. On multivariate analysis, probable Delta variant infection was associated with higher CT severity score. Ground glass opacities and crazy paving patterns were more frequently noticed than consolidation, with the latter being more frequent in Delta cohort, even though not significantly. According to prevalent imaging pattern, the consolidation one was significantly associated with pregnancy (p =0.008).
Conclusions: Patients admitted during predominance of Delta variant circulation had a more severe lung involvement compared to patients in infected when Alpha variant was predominant. Despite imaging pattern seems to be not influenced by viral variant and other clinical variables, the consolidative pattern was observed more frequently in pregnancy.
Detection of human adenovirus among Iranian pediatric hospitalized patients suspected of COVID-19: epidemiology and comparison of clinical features
Mohammadi Mohsen,
Bid-Hendi Shadi,
Baghershiroodi Mahnaz,
Chehrazi Mohammad,
Yahyapour Yousef,
Gouranourimi Azin,
Sadeghi Farzin
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children typically results in similar symptoms with other viral respiratory agents including human adenoviruses (HAdVs). Mixed HAdV and SARS-CoV-2 infection (co-infection) in children might result in enhanced or reduced disease severity compared with single infections. The present study aims to investigate the rate of SARS-CoV2 and HAdV infection and also their coinfection and compare the two infections regarding their laboratory and clinical characteristics at hospital admission. A total of 360 combined oropharyngeal and nasopharyngeal swab samples from hospitalized children were examined by real-time PCR for the existence of the SARS-CoV-2 and HAdVs. The symptoms, the clinical characteristics and laboratory findings were retrieved and compared in SARS-CoV-2 and HAdVs positive cases. Of the total 360 suspected COVID-19 hospitalized children, 45 (12.5%) and 19 (5.3%) specimens were PCR-positive for SARS-CoV-2 and HAdV respectively. SARS-CoV-2 and HAdV co-infection was detected in 4 cases (1.1%). Regarding symptoms at hospital admission, fever in SARS-CoV-2 positive group was significantly higher than that in HAdV positive group [34 (85%) vs. 7 (46.7%), p = 0.012]. However, percentages of cases with sore throat, headache, fatigue, lymphadenopathy and conjunctivitis in HAdV positive group were significantly higher than those in SARS-CoV-2 positive group. SARS-CoV-2 and HAdV co-infected children showed mild respiratory symptoms. The present study revealed that SARS-CoV-2 positive children often appear to have a milder clinical course than children with respiratory HAdV infection and children co-infected with SARSCoV-2 and HAdV had less-severe disease on presentation.
Prognostic evaluation of Acinetobacter baumannii ventilator-associated pneumonia in COVID-19
De Benedetto Ilaria,
Lupia Tommaso,
Shbaklo Nour,
Bianchi Alessandro,
Concialdi Erika,
Penna Maurizio,
Corcione Silvia,
DeRosa Francesco Giuseppe
Background. Since the emergence of the pandemic of SARS-CoV-2, a high reported incidence of VAP in COVID-19 sustained by carbapenem resistant Acinetobacter baumannii (CRAB) has been observed, but data are scarce to date.
Materials and methods. We retrospectively collected COVID-19 patients who developed CRAB-VAP - defined according to Center for Diseases Control (CDC) 2020 criteria and European Society of Clinical Microbiology and Infectious Diseases (ESCMID) or Infectious Diseases Society of America (IDSA) guidelines - to describe characteristics and outcome.
Results. Among 21 patients with CRAB-VAP in COVID-19, median age was 66 years (IQR 41-80). Median time of VAP-onset was 7 days (IQR 0-28 days) from ICU - admission and 76.2% had septic shock. Treatment regimens were all colistin-based, in 28% (n= 6) including ampicillin/sulbactam and rifampicin. In three cases, cefiderocol was started as rescue. Survival rate at 28-days was 35% (n= 7).
Conclusion. Non-fermenting Gram-negative bacteria are an emerging aetiology of VAP in COVID-19 patients. This underscores the urgent need for proper microbiological identification to address therapies and infection control protocols.
Pseudomonas infection reduction in the ICU: a successful multidisciplinary quality improvement project
Khedr Anwar,
Mathew Bijoy M.,
Mushtaq Hisham,
Nelson Courtney A.,
Poehler Jessica L.,
Jama Abbas B.,
Borge Jeanine M.,
von Lehe Jennifer L.,
Gomez Urena Eric O.,
Khan Syed Anjum
Pseudomonas aeruginosa infection causes high morbidity and mortality, especially in immunocompromised patients. Pseudomonas can develop multidrug resistance. As a result, it can cause serious outbreaks in hospital and intensive care unit (ICU) settings, increasing both length of stay and costs. In the second quarter of 2020, in a community hospital’s 15-bed ICU, the P. aeruginosa-positive sputum culture rate was unacceptably high, with a trend of increasing prevalence over the previous 3 quarters. We performed a multidisciplinary quality improvement (QI) initiative to decrease the P. aeruginosa-positive rate in our ICU. We used the Define, Measure, Analyze, Improve, and Control model of Lean Six Sigma for our QI initiative to decrease the P. aeruginosa-positive sputum culture rate by 50% over the following year without affecting the baseline environmental services cleaning time. A Plan-Do-Study-Act approach was used for key interventions, which included use of sterile water for nasogastric and orogastric tubes, adherence to procedure for inline tubing and canister exchanges, replacement of faucet aerators, addition of hopper covers, and periodic water testing. We analyzed and compared positive sputum culture rates quarterly from pre-intervention to post-intervention. The initial P. aeruginosa-positive culture rate of 10.98 infections per 1,000 patient-days in a baseline sample of 820 patients decreased to 3.44 and 2.72 per 1,000 patient-days in the following 2 post-intervention measurements. Environmental services cleaning time remained stable at 34 minutes. Multiple steps involving all stakeholders were implemented to maintain this progress. A combination of multidisciplinary efforts and QI methods was able to prevent a possible ICU P. aeruginosa outbreak.
The utility of point of care testing of procalcitonin in paediatric acute assessment
Munro Alasdair P.S.,
Hungwe Charles,
Patel Pratisksha,
Ward Nick,
Struthers Simon,
Saeed Kordo
Objective: Febrile illnesses are a common cause of presentation in acute pediatrics, with biomarkers frequently used to help differentiate mild infections from serious bacterial infections (SBI). We aimed to see if a point of care test for procalcitonin could help to reduce antibiotic use and avoid unnecessary admission.
Patients and Methods: A point of care procalcitonin machine which produces results within 20 minutes was introduced to two pediatric assessment units across both sites of a secondary-care hospital trust, alongside guidance for when tested would be appropriate. We performed a prospective, observational, pilot service evaluation, of all children tested during the study period of November 2018 to March 2019. We collected data at the time of testing, including the indication for testing and plan prior to testing, then retrospectively collected outcome data for children tested including diagnosis, treatment and whether the child was admitted to hospital.
Results: 68 tests were performed over 5 months. There are differing denominators due to missing data. Children were predominantly male (40/68, 58.8%) and pre-school age (median age 2.9y, Q1-Q3 1.3-6.7). Severity of illness was low, with 7/54 (11.5%) triggering sepsis tools. The primary indication for testing was febrile illness with no source of infection and some concerning features (31/59, 52.5%). Following testing, 35/67 (52.5%) of patients were admitted and 31/67 (47.1%) had IV antibiotics. A low procalcitonin (<0.5ng/L) was observed in 46/67 (69.1%) of patients, however 21/46 (45.7%) of these children were admitted and 16/46 (34.8%) were given IV antibiotics. Procalcitonin performed poorly at detecting SBIs in this cohort (result >0.5ng/L for 1/5 SBIs).
Conclusion: There was no clear impact of point of care procalcitonin on admission or antibiotic prescribing in this small pilot study. Clinicians often tested for reasons outside the recommended scenarios and often treated “low risk” patients, as determined by low procalcitonin, with antibiotics. These effects may be due to low familiarity with procalcitonin as a biomarker.
Seroprevalence of Strongyloides infection among steroid recipients in a tertiary care centre in North India
Ramprasad Aishwarya,
Kodan Parul,
Jonnalagadda Kirtana,
Bir Raunak,
Verma Nishant,
Sahni Kanika,
Vikram Naval K.,
Soneja Manish,
Mirdha Bijay Ranjan,
Wig Naveet
Background: Strongyloides stercoralis (S. stercoralis), a unique parasite, can cause mortal disease even years after the exposure. Iatrogenic use of steroids can complicate asymptomatic infections to a life-threatening hyperinfection and/or disseminated infection. Data regarding seroprevalence of strongyloidiasis remains scarce and this knowledge gap needs due attention in many endemic countries including India.
Aim: The present study is aimed at assessing the seroprevalence of Strongyloides infection and the need for routine screening among individuals receiving steroid therapy.
Methodology: Eighty patients receiving steroid therapy and thirty healthy volunteers who had not received any immunosuppressive drugs and/or anthelminthic therapy in last six months were enrolled as cases and controls respectively and they were screened by Strongyloides IgG ELISA.
Results: Among the 80 patients on steroids, the mean cumulative prednisolone equivalent dose received was 8.2 g ( 11.2g) for a mean duration of 184 days, 16 patients (20%, 95% CI 11.9-30) had a positive Strongyloides IgG serology. Only 4 controls (4/30, 13.3%, CI 3.8-30.7) tested positive (p=0.4).
Conclusions: Our study demonstrated a Strongyloides seroprevalence of 20% in the study population emphasizing the need for screening for Strongyloides infection prior to immunosuppressive therapy in order to prevent hyperinfection or possible dissemination
Mapping Dengue in children in a Colombian Caribbean Region: clinical and epidemiological analysis of more than 3500 cases
Ricardo-Rivera Sandra Milena,
Aldana-Carrasco Leidy Marcela,
Lozada-Martinez Ivan David,
Bolaño-Romero Maria Paz,
Acevedo-Lopez Nicole,
Sajona-Leguia Walter Antonio,
Bula-García Daniela Lucía,
Fady Zaghab-Zgieb Feraz,
Peralta Farak Juan Carlos,
López Ordóñez Juliana,
Dengue continues to be a global public health problem due to its impact in terms of morbidity and mortality and economic burden on health systems, with severe effects mainly on children. Among the objectives of sustainable development is the control of infectious diseases; therefore, it is necessary to evaluate the impact of existing programs on the prevention and management of infectious diseases. The aim of this study was to analyze the epidemiological, clinical, and geospatial behavior of dengue in children in a region of the Colombian Caribbean. A retrospective cross-sectional study was carried out. The data provided by the Municipal Health Secretariat were taken and the cases of dengue and severe dengue in children aged 0 to 17 years reported in Sincelejo, Colombia, were extracted. The sociodemographic and clinical characteristics presented were analyzed and descriptive statistics were performed with tables and graphs of frequency and accumulated percentages. To locate the areas with the highest incidence of cases during the year, a geospatial location of the cases was carried out with the QGIS v.3.8 program. In 2019, there were 3611 cases of dengue fever in children aged 0 to 17 years. There were 1394 (38.6%) cases with warning signs, and 41 (1.1%) cases of severe dengue fever. Cases of severe dengue fever occurred more frequently in women. The incidence rate found was 3927 and 45.1 cases per 100,000 population, for dengue and severe dengue in children, respectively. The age ranges with the highest number of cases were children aged 4 to 9 years with 1778 cases. The clinical presentation was varied, with the most frequent symptoms, in all groups, being fever in 100% of cases, myalgias ≥71%, and arthralgias ≥64%. Only 9% (n=315) of the cases, corresponded to cases in the rural area. A very high incidence of cases of dengue and dengue with alarm signs in children was evidenced in the Colombian Caribbean region, mainly in the urban area, despite the existence of public health programs and strategies to control the burden of diseases transmitted by arbovirus vectors.
Case report
Clinical presentation of Monkeypox among people living with HIV in South Florida: a case series
Wong Lena,
Gonzales- Zamora Jose A.,
Beauchamps Laura,
Henry Zachary,
Lichtenberger Paola
Introduction: Monkeypox, historically a zoonotic disease caused by monkeypox virus, is a new global health emergency. Since May 2022, dozens of non-endemic countries have seen new cases with rapid spread. Generally a self-limited disease, there are vulnerable populations, in which severe or deadly illness can occur. There is limited data on immunocompromised patients in this outbreak, particularly on people living with HIV, who are disproportionately affected.
Methods: We reported seven cases of monkeypox in people living with HIV in South Florida, USA. Relevant demographic, epidemiologic and clinical data were described.
Results: All the patients were men, identified as gay or bisexual, and were on combination antiretroviral therapy (cART) for HIV. Six of the seven had CD4 counts more than 200 cells/mm3 (one unknown level), and one of the seven had detectable HIV viral load. Six had sexual or intimate contact with asymptomatic partners prior to development of symptoms. Two were hospitalized, one for proctitis and one for an increasing number of lesions. Six had disseminated lesions and one had localized perianal lesions and all had 5-25 total number of lesions. Five received tecovirimat with resolution of lesions in 2-14 days and all were doing well at the time of the present report. Close contacts received the Jynneos vaccine which was well tolerated.
Conclusions: Our case series described monkeypox in people living with HIV and have noted atypical symptoms (lack of fever and more notable anogenital lesions) and relatively mild course as described in HIV seronegative patients. We stress the importance of early detection and isolation as well as vaccination to contacts, which has been well tolerated. In our case series, we are unable to estimate the effectiveness of tecovirimat given the limited number of patients, but all our patients had lesions that resolved within two weeks of rash onset and had no side effects reported.
The Infections in the History of Medicine
The history of Gin and Tonic; the infectious disease specialist long drink. When gin and tonic was not ordered but prescribed
Winston Churchill statement promoting Gin and Tonic as a life saver during British Empire extension hides many truths. As a matter of fact, the modern cocktail is thought to be born in India where it was widely distributed by Royal Navy for its anti-malarial properties. The aim of the present work is to review and unveil the history of Gin and Tonic through the centuries. As a matter of facts, primitive Gin and Tonic protective effects were well understood by physicians far before the advent of the “germ theory” and its fortunate invention is one of the most fascinating approaches in the history of preventive medicine. Indeed, quinine, a compound with protective effects on the replicative cycle of Plasmodium spp was discovered in 18th Century and since 19th it become the main compound of tonic beverages such as Schweppe's ones. Interestingly, it was administered to British expatriates’ seamen and soldiers in order to prevent febrile paroxysms. Soon after, British military doctors demonstrated that the addition of lime or lemon peels to tonics was effective in preventing scurvy. While, addition of alcoholic beverages and gin contributed to make more enjoyable the bitter and unpleasant taste of this beverages. Results: The spectacular voyage of Gin and Tonic teaches us that a popular recreational drink of our Century was a powerful prophylaxis which certainly helped British colonial expansion.
