Acute Bacterial Pneumonia Research Articles

The ER-Golgi transport of influenza virus through NS1-Sec13 association during virus replication.

Influenza A virus is a respiratory virus that can cause complications such as acute bronchitis and secondary bacterial pneumonia. Drug therapies and vaccines are available against influenza, albeit limited by drug resistance and the non-universal vaccine administration. Hence there is a need for host-targeted therapies against influenza to provide an effective alternative therapeutic target. Sec13 was identified as a novel host interactor of influenza. Endoplasmic reticulum-to-Golgi transport is an important pathway of influenza virus replication and viral export. Specifically, Sec13 has a functional role in influenza replication and virulence.

Epidemiological Profile of Acute Typical Bacterial Pneumonia at The National Reference University Hospital Center of N’Djamena: Risk Factors and Antibiotic Resistance

Acute bacterial pneumonias are non-tuberculous bacterial infections of the lung. They constitute a common pathology in children and adults. The objective of this study was to promote microbiological diagnosis for optimal treatment in terms of antibiotic therapy. This is a prospective observational and analytical study running from June 2022 to February 2023 based on cytobacteriological examinations of sputum from patients of all genders and ages admitted to the pulmonology and infectious diseases department of the National Reference University Hospital Center (CHURN) from N’Djamena. The isolation, identification and antibiogram of the bacteria responsible for acute pneumonia were carried out according to standard clinical microbiology techniques. Of the 207 patients receiving sputum cytobacteriological screening, 121 bacterial agents were isolated, representing a prevalence of bacterial pneumonia of 58.45%. The most isolated bacterial strains were Staphylococcus (45.25%) followed by Streptococcus pneumoniae (34%) and Escherichia coli (10%). Significant differences were observed in terms of predominance of participation of men in the survey compared to women, the origin of patients from N’Djamena and Provinces, schooled and non-schooled patients and Gram-positive and Gram-negative bacteria with the probabilities of 0.01, 0.001, 0.01 and 0.001 respectively. The average age of the patients was 40.9 years with a sex ratio of 1.9. The antecedents associated with pneumonia were HIV infection, respiratory diseases, diabetes, smoking, alcoholism and cough with the proportions of 8.7%, 7.7%, 4.8%, 11.1% and 72.5 % respectively. The sensitivity of isolated bacterial strains gradually decreases from aminopenicillins to 3rd generation cephalosporin. The proportions of resistance were completely variable. Among Staphylococcus, resistance was very remarkable with erythromycin (68%), oxacillin (64.51%), ciprofloxacin (60%) and 96.15% of Staphylococcus were sensitive to fusidic acid. Oxacillin and amoxicillin clavulanic acid were almost inactive. Resistance of Escherichia coli remains high with amoxicillin clavulanic acid (66.7%) and ceftazidime (83.3%). Pseudomonas aeruginosa was 100% susceptible to ceftazidime. This study not only revealed the high prevalence of bacterial pneumonia and high resistance of the antibiotics tested. The importance of the sensitivity test allows the adaptation of antibiotic therapy to microbiological results.

Lung microbiome on admission in critically ill patients with acute bacterial and viral pneumonia

Composition of pulmonary microbiome of patients with severe pneumonia is poorly known. The aim of this work was to analyse the lung microbiome of patients admitted to the intensive care unit (ICU) with severe community acquired pneumonia (CAP) between 2019 and 2021 in comparison with a control group of 6 patients undergoing digestive surgery. As a second objective, the diagnostic capabilities of metagenomics was also studied in a small group of selected patients. The lung microbiome of patients with viral (5 with Influenza A and 8 with SARS-CoV-2) pneumonia at admission showed a similar diversity as the control group (p = 0.140 and p = 0.213 respectively). Contrarily, the group of 12 patients with pneumococcal pneumonia showed a significant lower Simpson´s index (p = 0.002). In the control group (n = 6) Proteobacteria (36.6%), Firmicutes (24.2%) and Actinobacteria (23.0%) were the predominant phyla. In SARS-CoV-2 patients (n = 8), there was a predominance of Proteobacteria (mean 41.6%) (Moraxella and Pelomonas at the genus level), Actinobacteria (24.6%) (Microbacterium) and Firmicutes (22.8%) mainly Streptococcus, Staphylococcus and Veillonella. In patients with Influenza A pneumonia (n = 5) there was a predominance of Firmicutes (35.1%) mainly Streptococcus followed by Proteobacteria (29.2%) (Moraxella, Acinetobacter and Pelomonas). In the group of pneumococcal pneumonia (n = 12) two phyla predominated: Firmicutes (53.1%) (Streptococcus) and Proteobacteria (36.5%) (Haemophilus). In the 7 patients with non-pneumococcal bacterial pneumonia Haemophilus influenzae (n = 2), Legionella pneumophila (n = 2), Klebsiella pneumoniae, Streptococcus pyogenes and Leptospira were detected by metagenomics, confirming the diagnosis done using conventional microbiological techniques. The diversity of the respiratory microbiome in patients with severe viral pneumonia at ICU admission was similar to that of the control group. Contrarily, patients with pneumococcal pneumonia showed a lower grade of diversity. At initial stages of SARS-CoV-2 infection, no important alterations in the pulmonary microbiome were observed. The analysis of bacterial microbiome showed promising results as a diagnostic tool.

Outcomes of therapeutic plasma exchange in severe autoimmune hemolytic anemia hospitalizations: An analysis of the National Inpatient Sample.

Autoimmune hemolytic anemia (AIHA) is characterized by humoral and/or cellular immune-mediated hemolysis of red blood cells. The role of therapeutic plasma exchange (TPE) in AIHA is unclear. We queried the National Inpatient Sample (NIS) for 2002-2019 to identify hospitalizations with the primary diagnosis of AIHA. We included hospitalizations with the highest severity subclass identified by All Patient Refined Disease Related Group (APR-DRG). We used multivariate regression analysis to compare in-hospital mortality and other relevant in-hospital outcomes between hospitalizations that received TPE and those that did not. We identified 255 weighted hospitalizations in the TPE group and 4973 in the control group. Those in the control group were older (median age 67 vs. 48 years, p < .001) and had a higher prevalence of most comorbidities. The TPE group had higher odds of all-cause in-hospital mortality (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.19-2.11). They also had higher rates of many secondary outcomes, including requiring mechanical ventilation, developing circulatory shock, acute stroke, urinary tract infections, intracranial hemorrhage, acute kidney injury, and requiring new hemodialysis. No significant differences were noted in the rates of acute myocardial infarctions, bacterial pneumonia, sepsis/septicemia, thromboembolic events, and other bleeding events. Furthermore, the TPE group had a higher median length of hospital stay (19 vs. 9 days, p < .001). Hospitalizations with severe AIHA that received TPE had higher rates of adverse in-hospital outcomes.

#4753 TELEDIALYSIS: THE FIRST NORTHEAST ITALY EXPERIENCE OF TELEHEALTH IN PERITONEAL DIALYIS PATIENTS

Abstract Background and Aims During Covid19 epidemic, International Society of Peritoneal Dialysis recommend “ People on PD should stay at home. Hospital visits should be minimized for only urgent indications. Consultations should otherwise be conducted by telehealth”. In 2021 in Italy Government enforce plan to develop Telehealth and to create a new Nephrology home model to provide better oversight of care with remote monitoring.Telehealth has been used to manage patients with chronic kidney disease (CKD) and demonstrated equal outcomes in CKD care by either in-person or virtual visits. Telehealth also help facilitate patient education about home dialysis modalities and self-care, especially in peritoneal dialysis setting (PD). We report the first experience in the Northeast of Italy with Teledialysis, a combination of PD technique and new technology devices that we used together to overcome clinical, social and psychological barriers to PD. Method In our pilot study, we enrolled 12 consecutive Automated Peritoneal Dialysis (APD) patients from our Nephrology program in “San Bassiano Hospital”, Bassano del Grappa, Vi, Italy. Teledialysis was perform with the combination of two systems: 1- A Web platform Sharesource (Baxter Renal care ®) that with a mod-M added to APD device supports remote patient management through secure communication with can allows details of the home dialysis treatment and provide to the clinician the ability to act on that assessment by updating the patient device setting to the cycler. 2-Totem eVISUS System (TesiSquare®) that is a plug and play system consisting of two units: a) a transportable remote station at the patient's home (Totem) equipped with high performance camera, touchscreen monitor, speaker microphone hand free and computers, internet routers for fixed and mobile phone, wireless access point and remote control to answer calls remotely and b) a Control Station (in our Hospital) that by a simple use of a mouse form our healthcare personnel can connect to one or more patients at the same time and check the Totem Camera. (Figure 1) Figure 1:The Teledialysis System: 1) Sharesource for remote control; 2) Totem at home access point with remote control. 3) Central station in the hospital for virtual evaluation. We control day by day PD sessions by sharesource and we provide virtual support to our patients for medications of catheter exit-site and catheter exit-site monitoring and instructions for PD training; we also perform clinical evaluation status, we check PD effluent color and we aid patients and care givers for PD session management. Results During an observation period of 11 months we enrolled 12 consecutive patients (4m/8F) with an average age of 73 yrs; cognitive impairment, diabetes, hypertension, chronic heart failure and peripheral vascular disease (PVD) were common comorbidities (see Figure 2). Figure 2:Characteristcs of the patients. We perform 60 teledialysis sessions with an average duration of 26’ minutes. We don’t detect any exit Site Infection (ESI), Tunnel infection or Peritonits in our population; none of our patients require urgently hospital or emergency room admission. Only once we suggest access to our department for fever and dyspnea and the patient require a one week hospitalization for acute bacterial pneumonia. (Table 1) Conclusion Our preliminary results shown that Teledialysis is a safe, reliable, flexible and effective system and is easy to use for our patients; we assert that technology really can help nephrologist to improve PD program and aid patients to overcome barriers to select PD and avoid fear of the failure. Teledialysis promote a real integration between Hospital and our territory by a new care pathway.

Microenvironment-Activated Nanozyme-Armed Bacteriophages Efficiently Combat Bacterial Infection.

Bacterial infection is one of the greatest challenges to public health, requiring new therapeutic methods. Herein, an innovative nanozyme-armed phage (phage@palladium (Pd)) system is fabricated for combating bacterial infection. The proposed phage@Pd preserves the function of the phages to achieve precise recognition and adhesion to the host Escherichia coli. In aid of the phages, the ultrasmall Pd nanozymes equipped with conspicuous pH-dependent peroxidase-like activity can generate toxic hydroxyl radical around the bacteria in acidic and hydrogen-peroxide-overexpressed infection microenvironment while remaining inert in physiological conditions, thus realizing the noteworthy elimination of bacteria at infected sites, and in the meantime ensuring the biological safety of phage@Pd in healthy tissues. In addition, the filamentous structure of phage@Pd can also enhance its bactericidal efficiency toward nonhost bacteria by randomly entangling on them, indicating possible broad-spectrum germicidal efficacy. Notably, phage@Pd can not only eradicate planktonic bacteria, but also kill the bacteria inside the biofilm in vitro. For both in vivo models of acute bacterial pneumonia or subcutaneous abscess, phage@Pd shows significant activity in eliminating infection and promoting tissue recovery. These results demonstrate that the phage@Pd nanohybrid is a safe and effective antimicrobial agent, providing a new insight into development of advanced antibacterial materials.

TO THE TREATMENT OF ACUTE BACTERIAL DESTRUCTIVE PNEUMONIA IN CHILDREN

The basis of this study was the results of treatment of 176 sick children with acute bacterial destructive pneumonia. In the treatment of this pathology, a new approach to the treatment of inflammatory infiltrates of the lung was used, based on the optimal choice of an antibiotic administered percutaneously-intrapulmonary to the lesion, which prevented the transition of the disease to a purulent-destructive stage. And also tested a differentiated method of drainage treatment of severe pleural complications of acute bacterial destructive pneumonia (ABDP) in children.

A Novel Design Eco-friendly Microwave-assisted Cu–N@CQDs Sensor for the Quantification of Eravacycline via Spectrofluorimetric Method; Application to Greenness Assessments, Dosage Form and Biological Samples

Community-acquired pneumonia is one of the most common infectious diseases and a substantial cause of mortality and morbidity worldwide. Therefore eravacycline (ERV) was approved by the FDA in 2018 for the treatment of acute bacterial skin infections, GIT infections, and community-acquired bacterial pneumonia caused by susceptible bacteria. Hence, a green highly sensitive, cost-effective, fast, and selective fluorimetric approach was developed for the estimation of ERV in milk, dosage form, content uniformity, and human plasma. The selective method is based on the utilization of plum juice and copper sulphate for the synthesis of green copper and nitrogen carbon dots (Cu–N@CDs) with high quantum yield. The quantum dots' fluorescence was enhanced after the addition of ERV. The calibration range was found to be in the range 1.0 – 80.0 ng mL−1 with LOQ equal to 0.14 ng mL−1 and LOD was found to be 0.05 ng mL−1. The creative method is simple to deploy in clinical labs and therapeutic drug health monitoring system. The current approach has been bioanalytically validated using US-FDA and validated ICH criteria. High-resolution transmission electron microscopy (HR-TEM), X-ray photon spectroscopy (XPS), Zeta potential measurements, fluorescence, UV–VIS, and FTIR spectroscopy have all been used to fully characterize the Cu–N@CQDs. The Cu–N@CQDs were effectively applied in human plasma and milk samples with a high percentage of recovery ranging from 97.00 to 98.80%.

Lung epithelial cell-derived C3 protects against pneumonia-induced lung injury.

The complement component C3 is a fundamental plasma protein for host defense, produced largely by the liver. However, recent work has demonstrated the critical importance of tissue-specific C3 expression in cell survival. Here, we analyzed the effects of local versus peripheral sources of C3 expression in a model of acute bacterial pneumonia induced by Pseudomonas aeruginosa. Whereas mice with global C3 deficiency had severe pneumonia-induced lung injury, those deficient only in liver-derived C3 remained protected, comparable to wild-type mice. Human lung transcriptome analysis showed that secretory epithelial cells, such as club cells, express high levels of C3 mRNA. Mice with tamoxifen-induced C3 gene ablation from club cells in the lung had worse pulmonary injury compared with similarly treated controls, despite maintaining normal circulating C3 levels. Last, in both the mouse pneumonia model and cultured primary human airway epithelial cells, we showed that stress-induced death associated with C3 deficiency parallels that seen in Factor B deficiency rather than C3a receptor deficiency. Moreover, C3-mediated reduction in epithelial cell death requires alternative pathway component Factor B.Thus, our findings suggest that a pathway reliant on locally derived C3 and Factor B protects the lung mucosal barrier.

LB2302. Ceftobiprole Compared to Daptomycin With or Without Optional Aztreonam for the Treatment of Complicated Staphylococcus aureus (SAB): Results of a Phase 3, Randomized, Double-Blind Trial (ERADICATE)

Abstract Background SAB is common, serious, and potentially lethal. Antibiotic options are limited, especially for MRSA. Ceftobiprole is an advanced-generation cephalosporin with bactericidal activity against Gram-positive (including MRSA) and Gram-negative pathogens, with efficacy and safety demonstrated in previous Phase 3 studies in acute bacterial skin infections and pneumonia. The present study evaluated ceftobiprole in patients with complicated SAB. Methods ERADICATE was a randomized (1:1), double-blind, multicenter, Phase 3, non-inferiority trial comparing ceftobiprole (BPR) vs daptomycin (DAP) ± optional aztreonam, for up to 42 days of treatment, in patients with complicated SAB (NCT03138733). The primary efficacy endpoint was overall clinical success 70 days post-randomization, adjudicated by a blinded independent Data Review Committee. Success required survival, no new SAB complications, symptom improvement, SAB clearance, and no receipt of other potentially effective antibiotics. The non-inferiority margin for the difference in success rates was -15% (BPR-DAP, 95% CI, 2-sided, lower bound). Safety was assessed through adverse events (AE) and laboratory data. Results Of 390 patients randomized, 387 (189 BPR, 198 DAP) were in the modified intent-to-treat (mITT) population who received study medication and had a positive baseline blood culture for S. aureus (94 MRSA). Median treatment duration was 21 days for both groups. Key baseline characteristics were balanced (Fig. 1). In the BPR group 69.8% experienced success, compared to 68.7% for DAP (adjusted difference 2.0%, 95% CI -7.1% to 11.1%, Fig. 2). There were no significant differences in mortality, microbiological eradication, or in key subgroup analyses (Fig. 3). The proportion of patients experiencing ≥1 AE was 63% for BPR and 59% for DAP. Treatment-related severe or serious AEs were infrequent. Gastrointestinal AEs, mostly mild nausea, were more frequent with BPR, consistent with data from previous Phase 3 studies. Conclusion Ceftobiprole is non-inferior to daptomycin for overall success in patients with complicated SAB. All-cause mortality, microbiological eradication rates and new SAB complications were similar between treatment groups. Both treatments were well tolerated. Disclosures Thomas L. Holland, MD, Aridis: Advisor/Consultant|Basilea Pharmaceutica: Advisor/Consultant|Karius: Advisor/Consultant|Lysovant: Advisor/Consultant Sara E. Cosgrove, MD, Basilea: Advisor/Consultant|Debiopharma: Advisor/Consultant Sarah B. Doernberg, MD, MAS, Basilea: Advisor/Consultant|Genentech: Advisor/Consultant|Gilead: Grant/Research Support|Johnson and Johnson: Advisor/Consultant|NIH: Grant/Research Support|Regeneron: Grant/Research Support Maziar Assadi Gehr, MD, Basilea Pharmaceutica: full time employee of Basilea Pharmaceutica International Ltd Marc Engelhardt, MD, Basilea Pharmaceutica: full time employee of Basilea Pharmaceutica International Ltd Kamal Hamed, MD, Basilea Pharmaceutica: previous full time employee of Basilea Pharmaceutica International Ltd|Lysovant: full time employee of Lysovant Daniel Ionescu, MD, Basilea Pharmaceutica: full time employee of Basilea Pharmaceutica International Ltd Mark Jones, PhD, Basilea Pharmaceutica: full time employee of Basilea Pharmaceutica International Ltd Mikael Sauley, MSc, Basilea Pharmaceutica: full time employee of Basilea Pharmaceutica International Ltd Jennifer Smart, PhD, Basilea Pharmaceutica: full time employee of Basilea Pharmaceutica International Ltd Harald Seifert, MD, Basilea Pharmaceutica: Advisor/Consultant|Debiopharm: Advisor/Consultant|Eumedica: Advisor/Consultant|Gilead: Advisor/Consultant|MSD: Advisor/Consultant|Shionogi: Advisor/Consultant Timothy C. Jenkins, MD, Basilea: Clinical outcomes adjudication committee Vance G. Fowler, Jr, MD, MHS, Armata Valanbio Akagera Aridis Roche: Advisor/Consultant|BASILEA: Grant/Research Support|Basilea Novartis Debiopharm Genentech: Advisor/Consultant|MedImmune Bayer Janssen Contrafect Regeneron Destiny Amphliphi Integrated Bioth: Advisor/Consultant|NIH MedImmune Allergan Theravance Novartis Merck Contrafect Karius Genentech Regeneron Janssen: Grant/Research Support.

The added value of molecular-based diagnostics in the African forensic medical setting.

Sudden unexpected infant death (SUDI) is reported to be an extraordinarily high burden in sub-Saharan Africa, with the incidence rate in South Africa among the highest in the world. It is common for the cause of many such infant deaths to remain unexplained even after a full medico-legal death investigation, and then to be categorised as a sudden unexplained infant death (SUID). Fortunately, advances in molecular-based diagnostics allow researchers to identify numerous underlying inherited cardiac arrhythmogenic disorders in many SUDI cases, with a predominance of variants identified in the SCN5A gene. Such cardiac arrhythmogenic-related sudden deaths generally present with no structural alterations of the heart that are macroscopically identifiable at autopsy, therefore highlighting the importance of post mortem genetic testing. We report on a significant genetic finding that was made on a SUDI case in which the cause was ascribed to an acute bacterial pneumonia but it was still subjected to post mortem genetic testing of the SCN5A gene. The literature shows that many SUDI cases diagnosed with inherited cardiac arrhythmogenic disorders have demonstrated a viral prodrome within days of their death. It is therefore not uncommon for these cardiac disorders in infants to be mistaken for flu, viral upper respiratory tract infection or pneumonia, and without the incorporation of post mortem genetic testing, any other contributory causes of these deaths are often disregarded. This study highlights the need for research reporting on the genetics of inherited cardiac disorders in Africa.

Nanoparticle-modified microrobots for in vivo antibiotic delivery to treat acute bacterial pneumonia.

Bioinspired microrobots capable of actively moving in biological fluids have attracted considerable attention for biomedical applications because of their unique dynamic features that are otherwise difficult to achieve by their static counterparts. Here we use click chemistry to attach antibiotic-loaded neutrophil membrane-coated polymeric nanoparticles to natural microalgae, thus creating hybrid microrobots for the active delivery of antibiotics in the lungs in vivo. The microrobots show fast speed (>110 µm s-1) in simulated lung fluid and uniform distribution into deep lung tissues, low clearance by alveolar macrophages and superb tissue retention time (>2 days) after intratracheal administration to test animals. In a mouse model of acute Pseudomonas aeruginosa pneumonia, the microrobots effectively reduce bacterial burden and substantially lessen animal mortality, with negligible toxicity. Overall, these findings highlight the attractive functions of algae-nanoparticle hybrid microrobots for the active in vivo delivery of therapeutics to the lungs in intensive care unit settings.

Ceftaroline: Systematic Review of Clinical Uses and Emerging Drug Resistance.

To assess the success rates of off-label uses of ceftaroline for infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and evaluate emerging ceftaroline resistance. We queried PubMed/MEDLINE, with the search term "Ceftaroline." Articles were restricted to the English language and year of publication (January 1, 2009-January 31, 2022). Clinical trials, observational studies, and case reports that reported efficacy, safety, pharmacokinetics, use in MRSA infections other than acute bacterial skin infection and community-acquired pneumonia, and ceftaroline resistance were selected. The search pooled 103 publications and all abstracts were reviewed. Forty-six articles that reported efficacy, safety, pharmacokinetics, or off-label use in multiple patients and 7 articles on ceftaroline resistance are used in this review. Ceftaroline has been approved for treatment of acute skin/soft tissue infection and community-acquired pneumonia. Ceftaroline's efficacy in off-label infections ranged from 66.7% to 87.3% depending on the types of infection. There were 14 documented cases of ceftaroline resistance associated with PBP2a changes. Case series and observational studies have documented success with ceftaroline alone or in combination with vancomycin or daptomycin for treatment of MRSA bone and joint, endovascular, diabetic foot infections, and bacteremia from other causes. Despite the lack of randomized controlled trials, ceftaroline is used as salvage therapy for different MRSA infections. The data from case series and observational studies are promising but ceftaroline should be used judiciously as ceftaroline-resistant MRSA begin to emerge.

A CASE OF PNEUMONIC TULAREMIA MIMICKING COVID-19

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Tularemia is a zoonotic infection caused by Francisella tularensis, an anaerobic and fastidious gram-negative bacterium. It is transmitted from direct inhalational exposure and bites from infected ticks, rabbits, rodents, birds, or domestic animals. About 200 cases of human tularemia are reported each year in the United States. We report an unusual case of tularemia without any known exposure with a recent Coronavirus disease-19 (COVID-19) infection with an overlap of symptoms of COVID-19 pneumonia. CASE PRESENTATION: A healthy 22 years old male with an uncomplicated COVID-19 infection a month ago presented with fever, nausea, vomiting for a week and a resolving inguinal rash with no recent travel, sick contacts, occupational or animal exposures. On admission, he was febrile up to 103.4, tachycardiac and tachypneic with coarse breath sounds in bilateral lungs, right cervical adenopathy without any rash or erythema on the skin. His initial labs were WBC 16.6 k/mcl, platelets 154 k/mcl, elevated inflammatory markers (ESR 64mm/hr, CRP 164mg/ml), mild transaminitis (AST/ALT 43/89 uL), negative COVID-19 PCR, initial troponin of 1.6 which peaked to 3.6 and a procalcitonin 12.6. An electrocardiogram showed sinus tachycardia, a chest x-ray and computed tomography (CT) of the chest showed bilateral basilar heterogenous opacities, echocardiography showed regional wall motion abnormalities with preserved ejection fraction and right internal jugular vein thrombosis on the upper extremity doppler ultrasound. On hospital day 2, he developed acute hypoxic respiratory failure and septic shock requiring mechanical ventilation. Initial differential diagnosis was concerning for acute viral illness, viral myocarditis, murine typhus, bacterial pneumonia, and COVID-19 inflammatory syndrome. A complete viral and autoimmune workup was negative except for a positive Francisella tularemia antibody. He completed 10 days of oral doxycycline and was discharged home on room air on three months of rivaroxaban. DISCUSSION: Pneumonic tularemia presents with initial non-specific symptoms followed by fever, chest pain, productive cough with nodular infiltrates with pleural effusion on imaging, it can be challenging to diagnose with overlapping symptoms with COVID-19. In our case, the initial history and imaging findings could have been consistent with viral myocarditis and post COVID-19 hypoxia.Yet, the ability to wean off oxygen and the rapid improvement in symptoms with initial treatment without steroids was more consistent with some other viral or bacterial etiology of disease. CONCLUSIONS: COVID-19 is associated with superimposed bacterial and fungal infections. Limited data is available on the covid-19 inflammatory syndrome with superimposed zoonotic infections. However, clinicians must be vigilant of other febrile illnesses and alternative diagnoses whose symptoms overlap with COVID-19. REFERENCE #1: Patel HM. Murine typhus mistaken for COVID-19 in a young man. BMJ Case Rep. 2020;13(11):e239471. Published 2020 Nov 3. doi:10.1136/bcr-2020-239471 REFERENCE #2: Siberry GK. Keeping Your Diagnostic Mind Open During the COVID-19 Pandemic. Pediatr Infect Dis J. 2020 Dec;39(12):e444. doi: 10.1097/INF.0000000000002951. PMID: 33214407. REFERENCE #3: Gurcan S. Epidemiology of tularemia. Balkan Med J. 2014;31(1):3-10. doi:10.5152/balkanmedj.2014.13117 DISCLOSURES: No relevant relationships by Christopher Dayton, source=Web Response No relevant relationships by Mahnoor Mir, source=Web Response

Clinical Characteristics and Outcome of Patients with Suspected COVID-19 in Emergency Department (RESILIENCY Study II).

Objectives: COVID-19 may show no peculiar signs and symptoms that may differentiate it from other infective or non-infective etiologies; thus, early recognition and prompt management are crucial to improve survival. The aim of this study was to describe clinical, laboratory, and radiological characteristics and outcomes of hospitalized COVID-19 patients compared to those with other infective or non-infective etiologies. Methods: We performed a prospective study from March 2020 to February 2021. All patients hospitalized for suspected or confirmed COVID-19 were prospectively recruited. All patients were evaluated according to a predefined protocol for diagnosis of suspected SARS-CoV-2 infection. The primary endpoint was evaluation of clinical, laboratory, and radiological characteristics associated or not with COVID-19 etiology at time of hospitalization in an emergency department. Results: A total of 1036 patients were included in the study: 717 (69%) patients with confirmed COVID-19 and 319 (31%) without COVID-19, hospitalized for other causes. The main causes of hospitalization among non-COVID-19 patients were acute heart failure (44%) and bacterial pneumonia (45.8%). Overall, 30-day mortality was 9% among the COVID-19 group and 35% in the non-COVID-19 group. Multivariate analysis showed variables (fever > 3 days, dry cough, acute dyspnea, lymphocytes < 1000 × 103/µL, and ferritin > 250 ng/mL) independently associated with COVID-19 etiology. A decision tree was elaborated to early detect COVID-19 patients in the emergency department. Finally, Kaplan–Meier curves on 30-day survival in COVID-19 patients during the first wave (March–May 2020, n = 289 patients) and the second wave (October–February 2021, n = 428 patients) showed differences between the two study periods (p = 0.021). Conclusions: Patients with confirmed diagnosis of COVID-19 may show peculiar characteristics at time of hospitalization that could help physicians to distinguish from other infective or non-infective etiologies. Finally, a different 30-day mortality rate was observed during different periods of the pandemic.

Main approaches to treatment of hypoxia in acute respiratory distress syndrome, bacterial and viral pneumonia (part II)

The paper summarizes data on modern approaches to the diagnosis, prevention and treatment of severe acute parenchymal respiratory failure of various origins, including ARDS due to bacterial viral pneumonia. The work is based on the data of modern well-organized studies, analysis of international clinical guidelines with a high degree of evidence, as well as the results of our own long-term experimental studies and clinical observations of the treatment of patients with ARDS of various origins, including viral pneumonia of 2009, 2016, 2020. Scientifically grounded algorithms for prevention, differential diagnosis and personalized therapy of severe acute respiratory failure using innovative medical technologies and a wide range of respiratory and adjuvant treatment methods have been formulated. The authors tried to adapt as much as possible the existing current recommendations for the daily clinical practice of anesthesiologists and resuscitators.

Main approaches to treatment of hypoxia in acute respiratory distress syndrome, bacterial and viral pneumonia (part III)

The paper summarizes data on modern approaches to the diagnosis, prevention and treatment of severe acute parenchymal respiratory failure of various origins, including ARDS due to bacterial viral pneumonia. The work is based on the data of modern well-organized studies, analysis of international clinical guidelines with a high degree of evidence, as well as the results of our own long-term experimental studies and clinical observations of the treatment of patients with ARDS of various origins, including viral pneumonia of 2009, 2016, 2020. Scientifically grounded algorithms for prevention, differential diagnosis and personalized therapy of severe acute respiratory failure using innovative medical technologies and a wide range of respiratory and adjuvant treatment methods have been formulated. The authors tried to adapt as much as possible the existing current recommendations for the daily clinical practice of anesthesiologists and resuscitators.

Main approaches to treatment of hypoxia in acute respiratory distress syndrome, bacterial and viral pneumonia (part I)

The paper summarizes data on modern approaches to the diagnosis, prevention and treatment of severe acute parenchymal respiratory failure of various origins, including ARDS due to bacterial viral pneumonia. The work is based on the data of modern well-organized studies, analysis of international clinical guidelines with a high degree of evidence, as well as the results of our own long-term experimental studies and clinical observations of the treatment of patients with ARDS of various origins, including viral pneumonia of 2009, 2016, 2020. Scientifically grounded algorithms for prevention, differential diagnosis and personalized therapy of severe acute respiratory failure using innovative medical technologies and a wide range of respiratory and adjuvant treatment methods have been formulated. The authors tried to adapt as much as possible the existing current recommendations for the daily clinical practice of anesthesiologists and resuscitators.

A Twin Disease Mouse Model to Assess Atherosclerosis Progression Following Lung Infection in ApoE Deficient Mice

Inflammation is a risk factor for atherosclerosis progression and plaque instability. Previous studies have demonstrated that hospitalisation for pneumonia is associated with increased short- and long-term risk of cardiovascular disease. Herein, we describe a clinically relevant twin disease murine model to study the impact of inflammation from acute bacterial pneumonia on atherosclerosis.

Prospective validation study of prognostic biomarkers to predict adverse outcomes in patients with COVID-19: a study protocol

IntroductionAccurate triage is an important first step to effectively manage the clinical treatment of severe cases in a pandemic outbreak. In the current COVID-19 global pandemic, there is a lack...