Infection Risk Assessment Research Articles

POST-HOC STRATIFICATION OF THE RISK OF INFECTION IN EXTRACTED PATIENTS

Abstract Introduction Infection represents one of the most widespread and feared complications of CIED implantation procedures. Most of the time this could even evolve into endocarditis on electrocatheters or septic shock, to the point that the only life-saving therapy becomes the transvenous extraction of electrocatheters. For this reason, the problem often arises of preventing these infectious conditions by carrying out an infectious risk assessment before the implant so as not to incur these complications over time. This study aims to stratify post-hoc the infectious risk of patients extracted in our center to validate the introduction and use of scores for the pre-implantation assessment of infectious risk. Methodology We evaluated 163 patients who underwent transvenous extraction of leads, of which 130 due to pocket infection/endocarditis on leads or sepsis. In these patients, a post-hoc assessment of the risk of infection was made according to the UPCM score, a score created by the University of Pittsburgh. A score value greater than or equal to 7 identifies patients who are more likely to develop an infection over time. This score takes into account risk factors such as: early reoperation, type of device implanted (CRTD vs ICD/PM), presence of more than 2 catheters in place, replacement or revision of the device, use of temporary pacing, intake of corticosteroids or anticoagulants oral, renal function, fever within 24 hours before implantation, presence of diabetes or heart failure, male gender. We then paid particular attention to patients who had undergone an upgrade procedure or to those who had undergone an extraction procedure twice. Results Of the 130 patients in our center who underwent extraction for infection, 112 had a score greater than or equal to 7; On the other hand, 18 were those with a score lower than 7. The average value was found to be 22.9. Conclusions The identification of a score that can be evaluated before the CIED implantation procedure can be an excellent aid in identifying fragile patients who could suffer from infection in the long or short term. By doing this, further alternatives to the transvenous implant could be evaluated, such as the implantation of a leadless pacemaker or subcutaneous ICD in non-PM dependent patients eligible for this.

TLR9 gene polymorphism confers risk to Helicobacter pylori infection in Jiangsu, China and its inspiration for precision nursing car.

The number of studies which investigate the association between TLR9 gene polymorphism and Helicobacter pylori (H.pylori) infection is low and their results are not consistent. To get a better understanding of the association between TLR9 gene polymorphism and H.pylori infection, providing basis and risk assessment for precision nursing for hospital nurses. A total of 630 normal physical examination subjects were collected including 240 H.pylori (+) and 390 H.pylori (-) subjects. PCR-RFLP was applied to investigate the present polymorphism. At the same time, the meta-analysis was performed between TLR9 gene polymorphism and H.pylori infection risk. Three genotypes (TT, TC, and CC) were observed for TLR9 gene rs187084 polymorphism. CC genotype and C allele were responsible for the significant associations (all P< 0.05). Meta-analysis found no significant associations were found by any genetic models (all P> 0.05). TLR9 polymorphism has a crucial role in H.pylori infection risk and CC genotype confers increased risk to H.pylori infection in the Southern Chinese population. After understanding the influence of TLR9 gene polymorphism on H.pylori infection, nurses can improve the risk assessment of Helicobacter pylori infection and provide health education more personally.

Prevention and Risk Assessment of Cardiac Device Infections in Clinical Practice.

The implantation of cardiac electronic devices (CIEDs), including pacemakers and defibrillators, has become increasingly prevalent in recent years and has been accompanied by a significant rise in cardiac device infections (CDIs), which pose a substantial clinical and economic burden. CDIs are associated with hospitalizations and prolonged antibiotic therapy and often necessitate device removal, leading to increased morbidity, mortality, and healthcare costs worldwide. Approximately 1-2% of CIED implants are associated with infections, making this a critical issue to address. In this contemporary review, we discuss the burden of CDIs with their risk factors, healthcare costs, prevention strategies, and clinical management.

Integrated assessment of bioaerosol dispersion patterns and infection risk in a typical urban environment: Implications for urban biosecurity management

Exposure to bioaerosols in high-density urban environments will pose a severe threat to human life and health and present significant challenges to the sustainability and resilience of cities. In this study, the aerodynamic dispersion patterns of bioaerosols at two release locations (open and dense areas) under both thermal conditions in Zhongguancun, Beijing, are investigated. By coupling a dose-response model and an improved cellular automaton, the infection risk within exposed populations was assessed, and emergency evacuation strategies for distinct populations in high-risk areas were devised. This study reveals that bioaerosol distribution is notably influenced by factors such as thermal conditions, release locations and pedestrian height. Bioaerosol concentration above the release source decreases with increasing pedestrian height at two release locations. Under the same exposure time, the infection probability of different groups in this area declines with pedestrian height increases, with adult males having the highest and elderly females having the lowest probability. Thermal conditions and building layout near the release source were second only to exposure time in influencing infection probability and evacuation path. Proximity to the release source indicates a high infection probability but a short evacuation distance to safe areas, while downstream areas exhibit lower infection probability but require longer evacuation distances. The layout of buildings near the release source has the most significant effect on evacuation time. Evacuation for high-risk populations should be prioritized upstream or either side of the mainstream. This study aims to mitigate potential biological threats, address challenges in enhancing urban biosecurity management, and enable sustainable urban development.

Quantifying Exhaled Particles in Healthy Humans During Various Respiratory Activities Under Realistic Conditions.

Background: Quantitatively collecting and characterizing exhaled aerosols is vital for infection risk assessment, but the entire droplet size spectrum has often been neglected. We analyzed particle number and size distribution of healthy participants in various respiratory activities, considering inter-individual variability, and deployed a simplified far-field model to inform on infection risks. Methods: Participants repeated the same respiratory activities on two visits. Particles were collected using an airtight extraction helmet supplied with High Efficiency Particulate Air (HEPA) filtered air. The sampling volume flow was transported to two particle counters covering the small and large particle spectrum. The applied simple mass balance model included respiratory activity, viral load, room size, and air exchange rates. Results: Thirty participants completed the study. The major fraction of the number-based size distribution was <5 μm in all respiratory activities. In contrast, the major fraction of the volume-based size distribution was 2-12 μm in tidal breathing, but >60 μm in all other activities. Aerosol volume flow was lowest in tidal breathing, 10-fold higher in quiet/normal speaking, deep breathing, coughing, and 100-fold higher in loud speaking/singing. Intra-individual reproducibility was high. Between participants, aerosol volume flow varied by two orders of magnitude in droplets <80 μm, and three orders of magnitude in droplets >80 μm. Simple model calculations not accounting for potential particle size-dependent differences in viral load and infection-related differences were used to model airborne pathogen concentrations. Conclusions: Quantitative analysis of exhaled aerosols for the entire droplet size spectrum as well as the variability in aerosol emission between individuals provides information that can support infection research. Clinical Trial Registration number: NCT04771585.

Transmission dynamics of Zika virus with multiple infection routes and a case study in Brazil

The Zika virus (ZIKV) is a serious global public health crisis. A major control challenge is its multiple transmission modes. This paper aims to simulate the transmission patterns of ZIKV using a dynamic process-based epidemiological model written in ordinary differential equations, which incorporates the human-to-mosquito infection by bites and sewage, mosquito-to-human infection by bites, and human-to-human infection by sex. Mathematical analyses are carried out to calculate the basic reproduction number and backward bifurcation, and prove the existence and stability of the equilibria. The model is validated with infection data by applying it to the 2015–2016 ZIKV epidemic in Brazil. The results indicate that the reproduction number is estimated to be 2.13, in which the contributions by mosquito bite, sex and sewage account for 85.7%, 3.5% and 10.8%, respectively. This number and the morbidity rate are most sensitive to parameters related to mosquito ecology, rather than asymptomatic or human-to-human transmission. Multiple transmission routes and suitable temperature exacerbate ZIKV infection in Brazil, and the vast majority of human infection cases were prevented by the intervention implemented. These findings may provide new insights to improve the risk assessment of ZIKV infection.

Evaluating the Demand for Nucleic Acid Testing in Different Scenarios of COVID-19 Transmission: A Simulation Study.

The 2019 novel coronavirus (COVID-19) has been recognized as the most severe human infectious disease pandemic in the past century. To enhance our ability to control potential infectious diseases in the future, this study simulated the influence of nucleic acid testing on the transmission of COVID-19 across varied scenarios. Additionally, it assessed the demand for nucleic acid testing under different circumstances, aiming to furnish a decision-making foundation for the implementation of nucleic acid screening measures, the provision of emergency materials, and the allocation of human resources. Considering the transmission dynamics of COVID-19 and the preventive measures implemented by countries, we explored three distinct levels of epidemic intensity: community transmission, outbreak, and sporadic cases. Integrating the theory of scenario analysis, we formulated six hypothetical epidemic scenarios, each corresponding to possible occurrences during different phases of the pandemic. We developed an improved SEIR model, validated its accuracy using real-world data, and conducted a comprehensive analysis and prediction of COVID-19 infections under these six scenarios. Simultaneously, we assessed the testing resource requirements associated with each scenario. We compared the predicted number of infections simulated by the modified SEIR model with the actual reported cases in Israel to validate the model. The root mean square error (RMSE) was 350.09, and the R-squared (R2) was 0.99, indicating a well-fitted model. Scenario4 demonstrated the most effective prevention and control outcomes. Strengthening non-pharmaceutical interventions and increasing nucleic acid testing frequency, even under low testing capacity, resulted in a delayed epidemic peak by 78days. The proportion of undetected cases decreased from 77.83% to 31.21%, and the overall testing demand significantly decreased, meeting maximum demand even with low testing capacity. The initiation of testing influenced case detection probability. Under high testing capacity, increasing testing frequency elevated the detection rate from 36.40% to 77.83%. Nucleic acid screening proved effective in reducing the demand for testing resources under diverse epidemic prevention and control strategies. While effective interventions and nucleic acid screening measures substantially diminished the demand for testing-related resources, varying degrees of insufficient testing capacity may still persist. The nucleic acid detection strategy proves effective in promptly identifying and isolating infected individuals, thereby mitigating the infection peak and extending the time to peak. In situations with constrained testing capacity, implementing more stringent measures can notably decrease the number of infections and alleviate resource demands. The improved SEIR model demonstrates proficiency in predicting both reported and unreported cases, offering valuable insights for future infection risk assessments. Rapid evaluations of testing requirements across diverse scenarios can aptly address resource limitations in specific regions, offering substantial evidence for the formulation of future infectious disease testing strategies.

Review of advanced practice nurse role in infection throughout the hematopoietic stem cell transplant journey.

Prolonged periods of immunosuppression during hematopoietic stem cell transplant (HSCT) can result in serious infectious complications and contribute to transplant-related morbidity and mortality. Adherence to standardized pre and postinfection screening guidelines, prescribed medications, and early identification of infectious symptoms through comprehensive patient and family education are crucial to minimizing infectious complications. Advanced practice nurses (APNs) are key members of the multidisciplinary care team in the HSCT specialty, maintaining a specialized skillset and scope of practice which includes a holistic based, preventative medicine and risk mitigation approach. This review sought to describe the role of the APN in HSCT care and to further examine existing APN led models of care which focus on infection prevention and education throughout the HSCT treatment journey. No studies specifically examined the APN role in infectious diseases risk assessment, screening, and management throughout the HSCT journey were identified throughout our review, however, there was considerable evidence to demonstrate the benefits of APN led care in the oncology and solid organ transplantation specialty which led to improvements in continuity of care, overall patient outcomes, and multidisciplinary team collaboration. The key themes identified in our review, were the role of the APN in the delivery of comprehensive patient and family education, the role of the APN in supporting, mentoring, and educating junior medical and nursing teams, the collaboration between the APN and the multidisciplinary care team, and the role of the APN in prompt recognition, triage, and management of treatment related complications, such as infection.

Assessment of antibiotic-resistant infection risks associated with reclaimed wastewater irrigation in intensive tomato cultivation

Agricultural irrigation using reclaimed urban wastewater (RWW) represents a sustainable practice to meet the ever-increasing water stress in modern societies. However, the occurrence of residual antibiotics and antibiotic resistant bacteria (ARB) in RWW is an important human health concern. This study applied for the first time a novel Simple-Death dose-response model to the field data of Escherichia coli and Pseudomonas spp. collected from three greenhouses for cultivation of tomatoes irrigated with RWW. The model estimates the risk of infection by enteropathogenic E. coli associated with consumption of tomatoes and the risk of eye-infection caused by Pseudomonas aeruginosa in cultivation soil through hand-to-eye contacts. The fraction of antibiotic resistant (AR)-E. coli measured in irrigation water and AR-Pseudomonas spp. in soil was incorporated in the model to estimate the survival of ARB and antibiotic susceptible bacteria in the presence of trace level of antibiotics in human body. The results showed that the risk of E. coli infection through consumption of tomatoes irrigated with RWW is within the WHO and USEPA recommended risk threshold (<10−4); Pseudomonas aeruginosa eye-infection risk is at or below the acceptable risk level. The presence of residual antibiotic in human body reduced the overall risk probabilities of infections but selectively enhanced the survival of ARB in comparison to their susceptible counterparts, which resulted in antibiotic untreatable infection. Therefore, the outcomes of this study call for a new risk threshold for antibiotic untreatable infections and highlight the key importance of adopting work safety measures for better human health protection.

Prevalence of Borrelia burgdorferi and Anaplasma phagocytophilum in Ixodes ricinus collected from dogs in eastern Poland

Abstract Introduction Ixodes ricinus ticks are an important vector and reservoir of pathogenic microorganisms causing dangerous infectious diseases in humans and animals. The presence of ticks in urban greenery is a particularly important public health concern due to the potential for humans and companion animals to be exposed to tick-borne diseases there. The study assessed the prevalence of Borrelia burgdorferi and Anaplasma phagocytophilum infection in I. ricinus ticks feeding on dogs. Material and Methods The study consisted in analyses of I. ricinus ticks collected in 2018–2020 from owned and stray dogs in the north-eastern part of Lubelskie province (eastern Poland). An AmpliSens PCR kit was used for qualitative detection and differentiation of tick-borne infections. Results Infections of B. burgdorferi and A. phagocytophilum were detected in 10.9% and 12.9% of the examined ticks, respectively. One tick (0.7%) was co-infected by both pathogens. Infection with B. burgdorferi was significantly more highly prevalent in ticks collected from the owned dogs than from the strays (18.7% and 2.8%, respectively), whereas the prevalence of A. phagocytophilum was similar in both groups (12.0% and 13.9%, respectively). Conclusion The co-infection observed in the study suggests the possibility of simultaneous infection by both pathogens from a single tick bite. The presence of pathogens in ticks collected from dogs is a factor in assessing infection risk not only to companion animals but also to their owners, who are in close contact with their dogs and visit the same green areas recreationally.

Risk factors of COVID-19 disease confirmed cases in Solok District

According to West Sumatra corona virus data, Solok Regency has the highest prevalence of positive confirmed cases of COVID-19 in West Sumatra, and one of the areas where the prevalence has increased significantly. Analysis of risk factors for COVID-19 cases in Solok Regency in 2021. We conducted a cross-sectional study analysis of secondary data from March to December 2020 with a mass randomized trial using the polymerase chain reaction (PCR) test in Solok Regency. Descriptive statistical analysis was used with secondary data relevant, and a logistic regression model was used to assess infection risk factors. A total of the 770 participants, 47.4% were women and 66% were aged 50-64 years. A total of 624 participants tested (81.03%) were identified as asymptomatic PCR SARS-CoV infection without symptoms, with 88% of participants with co-morbidities and 66% of participants without travel history. Based on the results obtained a significant relationship between history of comorbidities (p-value=0.00; AOR=0.16; 95% CI=0.08-0.32), clinical symptoms (p-value=0.00; AOR=0.04; 95% CI=0.03-0.08), and travel history (p-value=0.00, AOR=1.80, 95% CI=1.25-2.61). The majority of cases that were confirmed positive for COVID-19 based on the PCR test showed no symptoms, with co-morbidities and travel history. Confirmed positive cases of COVID-19 are associated with co-morbidities, symptoms and travel history.

Risk assessment and pathogen profile of surgical site infections in traumatic brain injury patients undergoing emergency craniotomy: A retrospective study.

Emergency craniotomy in patients with traumatic brain injury poses a significant risk for surgical site infections (SSIs). Understanding the risk factors and pathogenic characteristics of SSIs in this context is crucial for improving outcomes. This comprehensive retrospective analysis spanned from February 2020 to February 2023 at our institution. We included 25 patients with SSIs post-emergency craniotomy and a control group of 50 patients without SSIs. Data on various potential risk factors were collected, including demographic information, preoperative conditions, and intraoperative details. The BACT/ALERT3D Automated Bacterial Culture and Detection System was utilized for rapid bacterial pathogen identification. Statistical analyses included univariate and multivariate logistic regression to identify significant risk factors for SSIs. The study identified Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus as the most prevalent pathogens in SSIs. Significant risk factors for SSIs included the lack of preoperative antibiotic use, postoperative drainage tube placement, diabetes mellitus, and the incorporation of invasive procedures, all of which showed a significant association with SSIs in the univariate analysis. The multivariate analysis further highlighted the protective effect of preoperative antibiotics and the increased risks associated with anaemia, diabetes mellitus, postoperative drainage tube placement, and the incorporation of invasive procedures. Our research underscores the critical role of factors like insufficient preoperative antibiotics, postoperative drainage, invasive techniques, anaemia, and diabetes mellitus in elevating the risk of surgical site infections in traumatic brain injury patients undergoing emergency craniotomy. Enhanced focus on these areas is essential for improving surgical outcomes.

Infection risk assessment due to contaminant leakage in biological laboratories in different scenarios - the case of COVID-19 virus

Biosafety laboratories are specialized in handling dangerous microorganisms, but there are cases where contaminants are leaked due to improper handling and other reasons. Therefore, an in-depth understanding of the pattern of infection after a laboratory spill can help laboratory personnel get out of danger as soon as possible and avoid the occurrence of infection events. In this paper, we take the COVID-19 virus outbreak in recent years as an example to explore the probability of infection of laboratory personnel under different circumstances. The study used computational fluid dynamics (CFD) to predict the change of contaminant concentration over time in a typical laboratory, and then analyzed the relationship between contaminant concentration and infection probability by using a metrological response model, and calculated the infection probability of indoor personnel over time in the presence or absence of obstacles in the laboratory and the different locations of contaminant leakage, respectively. The results showed that the probability of personnel infection remained basically stable after 8 min of contaminant leakage; at the same time, the probability of infection was higher when the contaminant source was located below the exhaust vent than in other locations; and the probability of illness was lower in laboratories with obstacles than in laboratories without obstacles under the same conditions. This finding is helpful for laboratory layout design.

Airborne Transmission of SARS-CoV-2: The Contrast between Indoors and Outdoors

COVID-19 is an airborne disease, with the vast majority of infections occurring indoors. In comparison, little transmission occurs outdoors. Here, we investigate the airborne transmission pathways that differentiate the indoors from outdoors and conclude that profound differences exist, which help to explain why SARS-CoV-2 transmission is much more prevalent indoors. Near- and far-field transmission pathways are discussed along with factors that affect infection risk, with aerosol concentration, air entrainment, thermal plumes, and occupancy duration all identified as being influential. In particular, we present the fundamental equations that underpin the Wells–Riley model and show the mathematical relationship between inhaled virus particles and quanta of infection. A simple model is also presented for assessing infection risk in spaces with incomplete air mixing. Transmission risk is assessed in terms of aerosol concentration using simple 1D equations, followed by a description of thermal plume–ceiling interactions. With respect to this, we present new experimental results using Schlieren visualisation and computational fluid dynamics (CFD) based on the Eulerian–Lagrangian approach. Pathways of airborne infection are discussed, with the key differences identified between indoors and outdoors. In particular, the contribution of thermal and exhalation plumes is evaluated, and the presence of a near-field/far-field feedback loop is postulated, which is absent outdoors.

A study on contaminant leakage from Airborne Infection Isolation room during medical staff entry; Implementation of walking motion on hypothetical human model in CFD simulation

The recent outbreak of respiratory infectious diseases such as Middle East Respiratory Syndrome (MERS) and Coronavirus Disease-19 (COVID-19) highlights the critical role of Air Infection Isolation (AII) rooms in preventing the spread of disease. However, the risk of contaminant leakage from the AII room during medical staff interactions remains a significant challenge. This study advances our understanding by employing Computational Fluid Dynamics (CFD) simulations with a novel approach. While CFD simulations mitigate some limitations of field experiments, such as measurement resolution and variable changes, their accuracy is often limited by the oversimplification of models, particularly in representing human models and movement. Unlike prior studies, we incorporate minimal simplification, featuring a human model with Personal Protective Equipment (PPE) and realistic walking motions. This study explores four distinct scenarios with varied human movements, offering a comprehensive analysis of airflow and contaminant dispersion in AII rooms. The results indicated significant differences in airflow patterns and contaminant distribution when realistic walking motion was implemented in the human model, as opposed to simplified movement models. The contaminant leakage from the AII room ranged from 20.6 % to 28.6 %, suggesting that prior studies may underestimate infection risks due to oversimplified human models and motions. These findings underscore the importance of implementing realistic human models and motions in CFD simulations for accurate infection risk assessment in AII rooms. Additionally, our study opens pathways for future research to explore more complex human interactions in clinical settings, enhancing infection control strategies.

Concentration and risk assessment of Cryptosporidium infection associated with exposure to the Njoro River, Njoro Sub-County, Nakuru, Kenya

BackgroundCryptosporidium is a gastrointestinal pathogen. The oocysts are transmitted through the environment, and drinking contaminated water is one particular route. There is heavy pollution of Cryptosporidium in Njoro River, the main source of drinking water for humans and animals around the watershed. However, there is no information on the parasite concentration and estimated health risk exposed to these populations. This study determined the level of contamination and risk of infection by Cryptosporidium parasites in Njoro River. Water samples were collected monthly from three ecological sites along Njoro River for twelve months. Cryptosporidium oocysts were concentrated from these water samples using calcium carbonate flocculation method, examined and counted using epifluorescent microscopy. Quantitative microbial risk assessment was applied to estimate the health risk of Cryptosporidium infection in Njoro River using a beta-Poisson dose–response model.ResultsThe concentration of Cryptosporidium parasites in Njoro River is 0.936 ± 0.73 oocysts/litre. However, this concentration fluctuates with ecological site of the river; highest concentration occurs at downstream (1.325 ± 0.73), followed by midstream (0.917 ± 0.74) and least at upstream (0.567 ± 0.54). Concentration of Cryptosporidium in the river is higher during wet than dry seasons, with the difference in mean concentrations between the two seasons being significant (t(34) = − 6.101, p < 0.01). There was a negative correlation between Cryptosporidium concentration, temperature and pH, while a strong positive correlation existed between Cryptosporidium concentration and turbidity. The daily probability of infection by Cryptosporidium in Njoro River watershed is 0.25, while the annual risk is 0.99.ConclusionsNjoro River is heavily polluted with Cryptosporidium parasites. This exposes both the humans and animals that drink water from this river to a high risk of cryptosporidiosis, a potentially fatal infection particularly in immunocompromised individuals.

Assessment of COVID-19 infection Risk, thermal Comfort, and energy efficiency in negative pressure isolation wards with varied ventilation modes

Negative pressure isolation wards (NPIWs) play a crucial role in providing care to COVID-19 patients during a pandemic. However, the exhalation of patients releases aerosols containing pathogens, posing a potential infection risk for healthcare workers (HCWs). While robust ventilation systems within NPIWs can help mitigate this risk, they may also lead to increased energy consumption and reduced thermal comfort for patients. Therefore, it is imperative to strike a delicate balance between HCW safety, patient comfort, and energy efficiency when optimizing airflow within NPIWs. This study introduces TARGETING, a novel index designed to assess the efficiency of aerosols removal of ventilation systems in NPIWs. The primary goal of TARGETING is to enhance the precision of ventilation systems, consequently reducing the required air changes per hour (ACH) and minimizing energy consumption. The research delves into the impact of various supply air parameters, including ACH and temperature, as well as different ventilation modes. Through a comprehensive evaluation utilizing an array of metrics such as the Air Diffusion Performance Index (ADPI), Predicted Mean Vote (PMV), TARGETING, infection risk assessment, and energy consumption estimation measured by cooling load (Lcool), this study employs an Analytic Hierarchy Process to assess the aforementioned indices. The findings highlight that air curtain ventilation (ACV) emerges as the most favorable choice, delivering comprehensive benefits, including an infection risk of less than 0.03%, an ADPI score of 90.2%, a PMV close to zero, TARGETING at 1.3, and energy savings ranging from 35.1% to 57.3%.

Analysis of Infection Transmission Patterns and Infection Risk Assessment for Building Occupants Using Crowd Simulation

Analysis of Infection Transmission Patterns and Infection Risk Assessment for Building Occupants Using Crowd Simulation

The Assessment of Infection Risk in Patients with Vitiligo Undergoing Dialysis for End-Stage Renal Disease: A Retrospective Cohort Study.

Vitiligo is an autoimmune condition that causes patchy skin depigmentation. Although the mechanism by which vitiligo induces immunocompromise is unclear, other related autoimmune diseases are known to predispose those affected to infection. Individuals with vitiligo exhibit epidermal barrier disruption, which could potentially increase their susceptibility to systemic infections; patients with renal disease also show a predisposition to infection. Nevertheless, there is little research addressing the risk of infection in dialysis patients with vitiligo in comparison to those without it. A retrospective analysis was performed on patients with end-stage renal disease (ESRD) in the United States Renal Data System who started dialysis between 2004 and 2019 to determine if ESRD patients with vitiligo are at an increased risk of bacteremia, cellulitis, conjunctivitis, herpes zoster, or septicemia. Multivariable logistic regression modeling indicated that female sex, black compared to white race, Hispanic ethnicity, hepatitis C infection, and tobacco use were associated with an enhanced risk of vitiligo, whereas increasing age and catheter, versus arteriovenous fistula, and access type were associated with a decreased risk. After controlling for demographics and clinical covariates, vitiligo was found to be significantly associated with an increased risk of bacteremia, cellulitis, and herpes zoster but not with conjunctivitis and septicemia.

Purpura fulminans – meningococcal infection or postsplenectomy sepsis

The article presents two clinical cases with description of peculiarities of septic infection occurred after splenectomy and due to congenital splenic hypoplasia.Decreased immune defense resulted from splenectomy leads to severe infections with a high risk of death. The most severe sequela is overwhelming postsplenectomy infection (OPSI-syndrome) which is characterized by high mortality rate (50-70%) within 12-24 hours from the onset of the first symptoms. The main risk factors of postsplenectomy sepsis are a condition which became an indication for splenectomy, the immune status of the patient, age and the time period after splenectomyStreptococcus pneumoniae, Haemophilus infuenzae type b, Neisseria meningitidis are commonly identified etiological factors of OPSI-syndrome. The diagnosis could be delayed due to nonspecific flu-like prodromal symptoms of the OPSI-syndrome. Delay in the diagnosis and treatment of sepsis may increase the risk of death.One of the syndromes associated with post-splenectomy sepsis is fulminant purpura (purpura fulminans), which requires differential diagnosis with meningococcal infection. However, half of the cases of fulminant pneumococcal purpura occur in patients with asplenia or hyposplenia. In the first clinical case, a preliminary diagnosis of generalized meningococcal infection was made on admission, but the diagnosis of pneumococcal infection could not be excluded in asplenic patient and was subsequently confirmed by laboratory tests.Given the high risk of fulminant postsplenectomy sepsis, and the difficulties of timely diagnosis, the preventive strategy of infections after splenectomy falls into three major categories- vaccination, antibiotic prophylaxis, and patient (patient’s parents) education.Improving healthcare workers’ knowledge is required to ensure prompt diagnosis of hyposplenism, adequate risk assessment of postplenectomy infection and prevention of OPSI-syndrome.