Atypical Bacterial Infections Research Articles

Effect of Ureaplasma/Mycoplasma genital tract infection on preterm labor.

Genitourinary tract infections in pregnant women are one of the causes of abnormal pregnancy development including miscarriages, premature labor or premature rupture of membranes (PPROM). Atypical bacteria responsible for reproductive tract infections include Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum. Identification of pathogens and appropriately selected therapy can improve obstetric outcomes in patients with symptoms of threatened miscarriage or threatened preterm labor. The purpose of our study is to analyze the impact of reproductive tract infections with ureaplasma and mycoplasma bacteria during pregnancy. In the presented study, we retrospectively analyzed the cases of 201 pregnant patients hospitalized in the Obstetrics and Gynecology Department of Poznan Regional Hospital in 2019-2022, who had a swab taken from external os area of the cervix for atypical bacteria - Ureaplasma and Mycoplasma. Only patients with symptoms of threatened miscarriage or threatened preterm labor were included in the study group. Microbiological tests were performed in the hospital laboratory with the Mycoplasma IST 3 test from Biomerieux. We found a higher incidence of preterm labor in patients with symptoms of threatened preterm labor and a genital tract infection with Ureaplasma/Mycoplasma bacteria, compared to patients not infected with Mycoplasma/Ureaplasma - 31.1% vs 20% (p = 0.098). This observation in the case of Ureaplasma/Mycoplasma monoinfection group applied to 6 patients. - 75% of the group. Pregnant patients who had co-infection with other types of bacteria (48 patients in total) gave birth before 37 weeks of pregnancy in 27.1% of cases. We obtained a significant difference (p = 0.007) when comparing groups with positive and negative cultures for Ureaplasma/Mycoplasma by the presence of monoinfection/coinfection and the week of pregnancy in which delivery occurred. We also noted the effect of atypical bacterial infection for PPROM - this complication preceded preterm delivery in 40% of ureaplasma-positive patients, compared to 20% of PPROM without infection. We found a similar rate of preterm labor and pregnancy loss in Ureaplasma/Mycoplasma-positive patients who received antibiotic therapy (35.7%) compared to a group of pregnant women who did not receive treatment (31.6%). Infection of the genital tract with atypical bacteria Ureaplasma and Mycoplasma has a negative impact on the course of pregnancy. Identification of the type of microorganisms in cervical canal secretions of pregnant patients with symptoms of threatened miscarriage or preterm labor seems crucial. The impact of antibiotic therapy though, requires further analysis.

To Compare Serum Procalcitonin And CRP As Markers Of Neonatal Sepsis

Objective: This study compares serum Procalcitonin (PCT) levels with CRP as predictive markers for neonatal sepsis. Method: It was a Quasi-experimental study performed in the neonatal intensive care unit (NICU) of Holy Family Hospital, Rawalpindi, for six months from July 2021 to January 2022 after the approval of the ethical board. The study included neonates admitted to the neonatal intensive care unit of Holy Family Hospital with a diagnosis of neonatal sepsis. Parents are permitted via written informed consent. A predesigned proforma was used to record clinical examinations, histories, and outcomes, which included hospital stay duration, complications, neonatal discharge, or mortality. Results: Seventy neonates meeting the study's inclusion criteria were enrolled. The average age in the study was 6.44 ± 5.24 days, with 40 (57.1%) males and 30 (42.9%) females. The CRP test demonstrated a sensitivity of 85.42%, specificity of 81.82%, positive predictive value (PPV) of 91.11%, negative predictive value (NPV) of 72.00%, and diagnostic accuracy of 84.29% in predicting neonatal sepsis. The PCT test displayed sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 87.76%, 90.48%, 95.56%, 76.00%, and 88.57%, respectively. Conclusion: This study underscores Procalcitonin as a superior and early predictor compared to CRP in forecasting neonatal sepsis. Procalcitonin emerges as a particular marker for bacterial infections when contrasted with other inflammation indicators such as CRP, white blood cells, or lactate. Notably, Procalcitonin levels remain unaffected in viral or atypical bacterial infections. Keywords: Serum, Predictor, Neonatal, Sepsis.

Clinical and bacteriological profile of community acquired pneumonia in hospitalized children

Community-acquired pneumonia (CAP) is the leading cause of mortality and morbidity with important clinical impact across the World. India accounts for 23 per cent of global pneumonia burden with case fatality rates between 14 and 30 per cent. Pneumonia is basically classified into typical and atypical pneumonia. Emerging evidence indicates that dual typical and atypical bacterial infections function synergistically in many cases and together likely enhance the severity of CAP. However, the optimal management of CAP in children is still not well defined and the diagnosis is challenging when based solely on clinical observations since the common symptoms of CAP, especially at an early stage, are similar to those of ordinary respiratory tract infections. So RT-PCR is a rapid and precise molecular technique is used for rapid detection of bacteria causing community acquired pneumonia. A total of 268 samples were tested for the respective bacterial pathogens, among the tested the most common pathogen was Haemophilus influenzae (18.3%, 49/268) followed by S. pneumoniae (14.6%,39/268), M. catarhallis (9.3%,25/268),M. pneumoniae (9%, 24/268), B. parapertusis (3.4%,9/268), B. pertusis (1.5%, 4/268), C. pneumoniae (1.5%, 4/268), C. burnetti (1.1%, 3/268)and L. pneumophila (0.74%, 2/268). H. influenza and S. pneumoniae were the most commonly detected organisms among the community acquired pneumonia patients.

A horse or a zebra? Unusual manifestations of common cutaneous infections in primary immunodeficiency pediatric patients.

Patients with primary immunodeficiency disorders (PIDs) often suffer from recurrent infections because of their inappropriate immune response to both common and less common pathogens. These patients may present with unique and severe cutaneous infectious manifestations that are not common in healthy individuals and may be more challenging to diagnose and treat. To describe a cohort of patients with PIDs with atypical presentations of skin infections, who posed a diagnostic and/or therapeutic challenge. This is a retrospective study of pediatric patients with PID with atypical presentations of infections, who were treated at the immunodeficiency specialty clinic and the pediatric dermatology clinic at the Sheba Medical Center between September 2012 and August 2022. Epidemiologic data, PID diagnosis, infectious etiology, presentation, course, and treatment were recorded. Eight children with a diagnosis of PID were included, five of whom were boys. The average age at PID diagnosis was 1.7 (±SD 3.2) years. The average age of cutaneous infection was 6.9 (±SD 5.9) years. Three patients were born to consanguineous parents. The PIDs included the following: common variable immunodeficiency, severe combined immunodeficiency, DOCK8 deficiency, ataxia telangiectasia, CARD11 deficiency, MALT1 deficiency, chronic granulomatous disease, and a combined cellular and humoral immunodeficiency syndrome of unknown etiology. The infections included the following: ulcerative-hemorrhagic varicella-zoster virus (two cases) atypical fungal and bacterial infections, resistant Norwegian scabies, giant perianal verrucae (two cases), and diffuse molluscum contagiosum. In this case series, we present unusual manifestations of infectious skin diseases in pediatric patients with PID. In some of the cases, recognition of the infectious process prompted life-saving treatment. Increasing familiarity with these dermatological manifestations, as well as keeping a high index of suspicion, is important to enabling early diagnosis of cutaneous infections in PIDs and initiation of prompt suitable treatment.

Macrophage Activation Syndrome in Adult Onset Still’s Disease: A Life Threatening Complication

Adult onset Still’s disease (AOSD), a multi-systemic inflammatory disorder, is a rare disorder but an important differential to be considered in patients of Pyrexia of Unknown Origin, especially if patient presents with polyarthritis. Macrophage activation syndrome (MAS), a subset of Secondary Hemophagocytic Lymphohistiocytosis (HLH), considered as the most life threatening complication of AOSD, mostly develops around the onset of disease. Hence, in a previously undiagnosed case of AOSD, recognizing MAS as a presenting feature complicating underlying AOSD is essential for increased patient survival, as in our case.
 
 
 A 39 year old diabetic female presented with high grade fever with chills and multiple joint pains symmetrically involving proximal shoulder, knees and distal joints (involving MCP, PIP and DIP joints of hand) associated with swelling and early morning stiffness, relieved on activity, since past 6 months. No history of oral ulcers, rash, jaundice, weight loss, loss of appetite, foreign travel or close animal contact.
 
 On examination, Pallor was present, Blood Pressure was 120/70 mm Hg, pulse rate was 102/min and temperature was 100 F. On per abdomen, mild hepatomegaly was present and other system examination was unremarkable.
 
 Routine laboratory findings on day of presentation have been summarised (Table 1.1). Ultrasound Abdomen revealed hepatomegaly and Chest X-ray showed signs of old infective foci. Peripheral smear for Malarial parasite, Ns1Ag and dengue serology, Widal test and Montoux test were negative. Blood cultures and urine cultures were sterile. X-Ray of joints were normal. USG of B/L Knee joints showed mild joint effusion bilaterally with no internal echoes (non tappable). Trans-thoracic echo and Trans-esophageal echo were normal. CT chest, neck and abdomen showed old tubercular changes in lung. Tests for atypical bacterial infections which was normal (RK 39, Chickungunya, Brucella, Leptospirosis and Scrub typhus). Fever did not respond to Broad Spectrum Antibiotics, Antimalarials or Antitubercular therapy and patient continued to have persistent fever spikes.
 
 Autoimmune profile showed ANA and RA Factor negative but markers of inflammation were raised: CRP- 521, ESR -148, IL-6 – 84.0, Procalcitonin-6.9 and S.Ferritin >2000. During the work up for Anemia, Microcytic hypochromic anemia was found with Elevated NAP SCORE-165. Incidentally, her triglycerides were found to be elevated (356) and a reduced fibrinogen. With these results, we planned for a bone marrow aspirate and biopsy which showed increased myeloid preponderance (32:1), increased histiocytes and evidence of hemophagocytosis.
 
 The 2004 diagnostic criteria of HLH was fulfilled. After ruling out almost all infectious and malignant causes of secondary HLH, we searched for a rheumatologic cause. Thus diagnosis of AOSD (after fulfilling Yamaguchi’s criteria) with MAS (a subset of 2’ HLH) was made. Patient had dramatic improvement after receiving steroids with her fever episodes and joint pains settling completely thereafter.
 
 
 Prompt recognition of life threatening complications like MAS which pose diagnostic difficulty due to overlapping features in a patient of AOSD, should be done at the earliest to improve patient prognosis and survival. Serum Ferritin levels can be considered a useful marker to assess the disease activity and to predict MAS occurrence in such patients.

Clinical analysis of hospital acquired mycoplasma pneumoniae infection after cardiac surgery: a case series.

Mycoplasma pneumoniae (MP) is a common pathogen of community-acquired respiratory infections. The clinical characteristics hospital-acquired MP infections are rarely reported in the literature. Our ward is mainly responsible for the management of patients during the perioperative period of cardiac surgery. Several patients had fever during the improvement of their condition after cardiac surgery, and the effect of upgrading antibiotics and increasing the antibacterial spectrum was not good. Using inpatient data of Guangdong Provincial People's Hospital, we conducted a retrospective case series study of hospital-acquired MP infection after cardiac surgery from January 2015 to December 2020 to investigate the clinical characteristics. Clinical data was extracted from patients with a confirmed diagnosis of MP infection after >48 hours of hospitalization. All analyses for this study were descriptive. Data were expressed as mean ± standard deviation (SD), median with range or number with percentage as appropriate. We totally included 22 patients. The time of onset of hospital-acquired MP infection after surgery was 23.32±12.57 days, and the duration of antibiotic use before the onset of infection was 4-40 days. Both fever and sore throat were the main symptoms of nosocomial MP infection, and the rash was the most common physical sign. Laboratory tests were normal for peripheral blood leukocyte count and procalcitonin in most patients (17 cases), while the lymphocyte count was decreased in 10 cases. A single serum anti-MP antibody titer ≥1:160 combined with clinical manifestations and imaging helped confirm nosocomial MP infection, although a double serum anti-MP antibody (four-fold change in titer) wasn't seen. With quinolone therapy, such as levofloxacin, all the patients' temperature gradually returned to normal and were discharged uneventfully. Patients after cardiac surgery should be aware of the presence of hospital-acquired MP infection when they develop new fever accompanied by atypical bacterial infection signs such as sore throat and rash during treatment. In such cases, changes in MP antibody titers need to be monitored and anti-MP therapy is required.

Management of Psychiatric Disorders with HIV and Dermatological Disorders.

Management of Psychiatric Disorders with HIV and Dermatological Disorders.

Atypical bacterial infections of the central nervous system transmitted by ticks: An unknown threat

Infections of the central nervous system caused by atypical bacteria are becoming more common. Borrelia burgdorferi and Rickettsia conorii are microorganisms transmitted by ticks; infection with these bacteria result in a wide spectrum of manifestations on imaging. In areas where these tick-borne microorganisms are endemic, including Spain, these infections must be included in the differential diagnosis of patients with a variety of systemic and neurologic symptoms. The clinical presentation of these infections is nonspecific, and CT is normally the initial imaging technique, although MRI is more sensitive to early changes. On MRI, these infections can manifest as small lesions in the deep supratentorial white matter that are hyperintense on T2-weighted/FLAIR sequences. It is fundamental to know the imaging characteristics of the different atypical bacterial infections and their differential diagnoses. Good history taking combined with complementary tests (blood tests and CSF analysis) and the neuroimaging findings can help reach the right diagnosis and enable appropriate treatment, thereby preventing possible neurological sequelae.

Infecciones bacterianas atípicas del sistema nervioso central transmitidas por garrapatas: una amenaza desconocida

Infections of the central nervous system caused by atypical bacteria are becoming more common. Borrelia burgdorferi and Rickettsia conorii are microorganisms transmitted by ticks; infection with these bacteria result in a wide spectrum of manifestations on imaging. In areas where these tick-borne microorganisms are endemic, including Spain, these infections must be included in the differential diagnosis of patients with a variety of systemic and neurologic symptoms. The clinical presentation of these infections is nonspecific, and CT is normally the initial imaging technique, although MRI is more sensitive to early changes. On MRI, these infections can manifest as small lesions in the deep supratentorial white matter that are hyperintense on T2-weighted/FLAIR sequences. It is fundamental to know the imaging characteristics of the different atypical bacterial infections and their differential diagnoses. Good history taking combined with complementary tests (blood tests and CSF analysis) and the neuroimaging findings can help reach the right diagnosis and enable appropriate treatment, thereby preventing possible neurological sequelae.

Prevalence and Atopy Association of Mycoplasma Pneumoniae and Chlamydia Pneumoniae Infections in Infants with Recurrent Wheezing

The most common cause in the etiology of wheezing is respiratory tract infections. Viruses (in especially RSV), Chlamydia Pneumoniae and Mycoplasma Pneumoniae bacteria can cause transient airway hypersensitivity and wheezing by causing tissue damage and inflammation when they reach the lower respiratory tract. The association has been demonstrated and discussed between these two atypical bacteria and asthma. By setting major and minor parameters for predicting asthma risk, the asthma predictive index (API) was developed in children with excessive wheezing. This study was planned to examine the relationship of atopy and atypical bacterial infections in infants with persistent wheezing. Thirty-two females and fifty-eight males children under 2 years of age were included in the study. Fifty-six cases (62.2%) were positive for API and thirty-four cases (37.8%) were negative. The presence of infection was investigated by enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) method. It was found that both infections were substantially more serious in the second year than in the first year of life. However no statistically meaningful outcome was obtained, when comparing the presence of both pathogens and API positivity. Regardless of the API, the existence of bacterial agents was found to be statistically meaningful, especially in the range of 1-2 years, when subgroup analysis was performed in children with wheezing under the age of 2 years. It is appropriate to keep in mind the existence of these two bacteria in wheezy children. In the second year of life, both infection agents also showed a statistically significant increase and found that these patients could develop persistent wheezing.

Molecular Detection of Bacterial Agents of Atypical Pneumonia: Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila in Suez Canal region

Background: Atypical bacterial infections played an important role in community-acquired pneumonia (CAP). It is difficult to detect atypical pathogens by conventional microbiological diagnostic methods. Atypical bacteria do not respond to beta-lactam antibiotics. The use of multiplex polymerase chain reaction (PCR) methods enables rapid and simultaneous detection of many pathogens in a single analysis. Aim: detecting the prevalence of atypical bacterial pathogens as etiologic agents of atypical pneumonia, in the Suez Canal region. Materials and Methods: This cross-sectional descriptive study was conducted throughout 18 months, from October 2018 to April 2020. It included 84 Egyptians suffered from CA atypical pneumonic patients of all age groups from Suez-Canal region, Egypt. Sputum samples were collected for identification of Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophilia by using multiplex PCR. Results: Among the 84 atypical pneumonia patients, L. pneumophila were detected in 12 (14%) patients. M. pneumoniae and C. pneumoniae were not detected in our samples. Compared with L. pneumophila -negative cases, L. pneumophila -positive cases were more prevalent in middle aged males, smokers, COPD, diabetic and asthmatic patients (P values = 0.048). Persistent cough, elevated levels of C-reactive protein (C-RP), bilateral pulmonary infiltration are significant clues for predicting L. pneumophila pneumonia. Conclusions: L. pneumophila incidence is not low in our geographical region in atypical pneumonia patients. Clinicians should consider atypical bacterial pathogens while prescribing antimicrobial management plan. Keywords: Atypical pneumonia, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella pneumophilia, multiplex-PCR.

Adult Onset Still Disease

Abstract Introduction. Adult Onset Still Disease (AOSD) is a systemic inflammatory disease, of unknown etiology, affecting young adults. It is, at least in part, a diagnosis of exclusion. Characterized by high fever with spikes, with or without complete defervescence outside of said spikes, arthritis, and evanescent rash. Also, sore throat, hepatomegaly, splenomegaly, serositis, lymphadenopathy might be present. Fatal risk is mainly attributed to Macrophage Activation Syndrome. Biologically its main trait is a marked inflammatory syndrome with unusually elevated ferritin levels. Case presentation. 31 year old male, known with a history of alopecia areata, treated with Diprophos, last dose one month prior to admission, with fever, odynophagia, sore throat, diffuse myalgia, debuted twelve days before. On blood samples, at admission and during his hospital stay, marked inflammatory signs are present (elevated ESR up to 100mm/h, C-reactive protein up to 37.4mg/dl and marked ferritin of 6240 ng/ml) accompanied by leukocytosis with neutrophilia, lymphopenia, low grade normochromic, normocytic anemia, thrombocytosis, slightly elevated liver function tests, cholestasis (GGT 502 U/L, ALKP 255 U/L) with normal bilirubin, D-dimers over 3000 with lowering values to 1344, spontaneous INR at 1.57. Normal values for rheumatoid factor, no antinuclear antibodies present, negative serology for hepatitis B, C, HIV, atypical bacterial infections (Chlamydia, Coxiella, Mycoplasma) Epstein-Barr Virus, syphilis, vasculitis markers (pANCA, cANCA) and anti-double stranded DNA, all coupled with 5 different hemocultures and 3 different urocultures all negative. Repeated ENT evaluation was within normal, chest X-Ray, echocardiography and CT scans of neck, thorax and abdomen reported back no significant abnormalities. Thus, by applying Yamaguchi criteria, after a complex evaluation of the case, the diagnosis is AOSD, and during his stay at the Internal Medicine department of Col ea Clinical Hospital, despite antiinflammatory, antithermic, antibiotic and corticosteroid treatment, the patient remains symptomatic, with high fever (up to 38.8 degrees Celsius) with chills and diffuse myalgias. At the indication of a rheumatologist, inside a specialty clinic, pulse-therapy with Methylprednisolone is initiated (500mgs a day for 5 days) with fever remission for more than 72 hours. The corticosteroid treatment is continued at home, with the patient self-monitoring for symptoms. Two months after corticoid therapy was initiated, the patient is almost without any symptoms (alopecia areata still present partially) and the inflammatory syndrome is greatly diminished. Conclusion. We present the case of a 31 year old male, with AOSD, defined by Yamaguchi criteria, with persistent symptomatology, mainly as high fever, without response to usual treatment, with the exception of pulse-therapy with Methylprednisolone. The diagnosis proved to be difficult, in part being one of exclusion, but also the clinical presentation, so unspecific, might easily lead to a different diagnosis.

ДИФФЕРЕНЦИРОВАННАЯ ТРАНСФОРМАЦИЯ ФЕНОТИПА СУБПОПУЛЯЦИЙ НЕЙТРОФИЛЬНЫХ ГРАНУЛОЦИТОВ ПРИ ВИРУСНО-ВИРУСНЫХ И ГНОЙНЫХ БАКТЕРИАЛЬНЫХ ИНФЕКЦИЯХ У ИММУНОКОМПРОМЕТИРОВАННЫХ ДЕТЕЙ

Children with clinical signs of immunocompromise have impaired functioning of the immune system. At the same time, the state of subpopulations of multifunctional neutrophil granulocytes (NG), which provide antiviral and antibacterial protection, in such patients has been poorly studied. Objective of the study: to assess the features of the transformation of the phenotype of the three most significant subpopulations of NG, their association with impaired phagocytic and microbicidal activity in immunocompromised children with atypical viral-viral co-infections and bacterial infections, and to clarify their differential diagnostic significance. Materials and methods of research: the phenotypes of NG subpopulations expressing CD64, CD32, CD16, CD11b receptors, phagocytic and microbicidal activity of NG were studied in the peripheral blood of 43 immunocompromised children of both sexes aged of 5–9 years old suffering from recurrent ARVI, atypical chronic mono – or mixed herpes virus infections (HVI) and purulent bacterial infection. 3 study groups were formed: 1st – repeated ARVI/HVI mono, 2nd – repeated ARVI/HVI mixed, 3rd – minor purulent infection (MPI) and a comparison group (20 apparently healthy children). Results: different differentiated transformation of the phenotype of functionally significant subpopulations of NG associated with impaired functional activity of NG as well as with the incidence of viral co-infections (repeated ARVI and recurrent HVI mixed) and the severity of clinical manifestations of MPI has been identified in the studied groups. Conclusion. Еvaluation of the features of transformation of phenotype of NG subpopulations, their effector functions in immunocompromised children with atypical viral-viral co-infections and purulent bacterial infections, will allow in the future to optimize the methods of target immunotherapy aimed at remodulating the negatively transformed phenotype of NG subpopulations, correcting their dysfunctions and, thereby, significantly increase the clinical effectiveness of therapeutic and preventive measures.

High burden of infections in Indian patients with Idiopathic Inflammatory Myopathy: validation of observations from the MyoCite dataset.

To determine the prevalence, profile and predictors of infections in an Indian cohort with idiopathic inflammatory myopathies (IIM). We reviewed the records of a retrospective cohort with IIM enrolled from consecutive patients being followed up in the clinic, and these constituted the observation cohort. A newly diagnosed inception cohort with IIM were followed prospectively as the validation cohort for confirmation of observations and comparison with the observation cohort. Among the 68 patients in the observation cohort (average age 33.4 years, female:male 4.2:1), 37 (54.4%) experienced 54 infections between them; of these 54 infections, 21 (38.8%) were major and recurrent infections and they occurred in 11 patients (16.17%) over 3.08 years. Tuberculosis was the most common infection (12, 22.2%), with a predominance of extrapulmonary forms. Serum protein [odds ratio (OR) 0.44], platelets (0.44) at disease onset and daily steroid dose (1.04) predicted major infections on multivariate analysis. A higher daily dose of steroids at first infection correlated with number of recurrent infections. The infection-free 1-year survival was 73.8%.Of the 70 patients in the validation cohort (average age 35.7 years, female:male 3.7:1), 3 had myositis attributed to an infection. A similar proportion of the cohort experienced infections (22, 33.3%) with similar number of major (10, 45.4%) and recurrent (4, 18%) infections being recorded. The most common infection was community-acquired pneumonia, followed by tuberculosis, with serum albumin (OR 0.25) at disease onset being the only predictor. The one-year infection-free survival rate was 64.7%. Those who had a major infection had increased mortality at 1 year, with a survival rate of 60%, compared with 89.09% in those without.In both cohorts, a daily prednisone dose >6.25 mg predisposed to major infections. Major and recurrent infections are common in Indian IIM patients and confer higher risk for future infections and lower survival. Respiratory and atypical bacterial infections such as tuberculosis occur throughout the disease course.

COVID-19 and Cushing's syndrome: recommendations for a special population with endogenous glucocorticoid excess

COVID-19 and Cushing's syndrome: recommendations for a special population with endogenous glucocorticoid excess

Efficacy of Maggot Debridement Therapy on Refractory Atypical Diabetic Foot Ulcers: An Open-Label Study.

Atypical or refractory diabetic foot ulcers (DFUs) are still a major health problem. Maggot debridement therapy (MDT) by larva of Lucilia sericata is an ancient and a modern option for wound healing. It works by debridement, stimulation of wound healing, and disinfection. In this study, we aimed to evaluate the efficacy of MDT for healing atypical and refractory DFUs. Patients with atypical DFUs were selected and further evaluated for some predefined differential diagnoses like atypical fungal, parasitic, or bacterial infections, malignancy, trauma, and so on. Multiple MDT sessions were carried out. Ulcer size was measured before every MDT session. Complete wound healing, time to heal, and adverse effects were recorded as well. Forty-two DFU patients (26 men, 16 women) with 42 nonhealing atypical ulcers participated in this study. Complete wound healing was achieved in 35 patients (83.3%) by MDT. Complete debridement and then healing of the wounds happened in less than 1.79 ± 0.8 months. Four ulcers persisted, and 3 (7.1%) were eventually amputated. MDT may be considered as an effective treatment for atypical DFUs, which are unresponsive to conventional therapies.

2595. Murine Models for the Host Response to Typical and Atypical Pneumonia

BackgroundThe etiology of pneumonia is difficult to diagnose, with typical bacterial, atypical bacterial, and viral infections being the most common. However, diagnostics that discriminate these infectious etiologies are limited. We, therefore, focused on the host response to identify possible diagnostic markers and better understand these infections. However, atypical bacterial pneumonia is challenging to identify in humans precisely because of this diagnostic difficulty. Therefore, we utilized murine models to define host response differences between typical bacterial, atypical bacterial, and viral pneumonia.MethodsMice were intranasally inoculated with S. pneumoniae (n = 38), M. pneumoniae (n = 27), H1N1 pr8 (n = 19), or saline as a control (n = 42). RNA was extracted from peripheral blood collected at 24, 48, 72, 120, or 168 hours and subjected to microarray analysis. Diagnostic signatures were generated using lasso logistic regression and accuracy was assessed using nested leave-one-out cross-validation with feature selection repeated within each iteration. Differentially expressed genes were used to perform gene set enrichment analysis. These murine-derived signatures were externally validated in silico in 487 human subjects found across 5 publicly available data sets.ResultsWe generated pathogen-specific murine disease signatures that performed with 91–100% accuracy. Pathway analysis revealed that animals with pneumococcal pneumonia had a robust immune response by 48 hours that continued to 72 hours post-infection. In contrast, animals infected with M. pneumoniae did not show evidence of a strong immune response until 72-hours post-infection. Additionally, the immune response to M. pneumoniae bared greater similarity to the viral response than it did to the host pneumococcal response. H1N1-infected mice showed an anti-viral response at 120 hours that resolved by 168 hours post-infection. The AUC values resulting from independent human validation of our murine signatures ranged from 89 to 98%.ConclusionThere are discrete host responses to typical bacterial, atypical bacterial, and viral etiologies of pneumonia in mice. These signatures validate well in humans, highlighting the conserved nature of the host response to these pathogen classes. DisclosuresEphraim L. Tsalik, MD MHS PhD, Immunexpress: Consultant; Predigen, Inc.: Officer or Board Member, Research Grant.

Application of a nucleic acid-based multiplex kit to identify viral and atypical bacterial aetiology of lower respiratory tract infection in hospitalized children.

Lower respiratory tract infections (LRTIs), particularly those acquired in hospitals, are an important cause of childhood morbidity and mortality. Understanding the aetiology and epidemiology of LRTIs is necessary for clinical management, reduction of antibiotic usage, vaccine development and prevention of nosocomial infection. In this study, we aimed to detect 13 viruses and atypical bacteria in nasopharyngeal secretion specimens from hospitalized children with LRTIs. From January 2014 to December 2016, nasopharyngeal secretion specimens were prospectively collected from 3232 children aged between 1 and 72 months. Nucleic acid was extracted and analysed using the SureX13 respiratory pathogen multiplex kit as per the manufacturer's instructions. A total of 2874 (88.9 %) children tested positive for viral and/or atypical bacterial infections, and 965 (29.9 %) were co-infected with multiple pathogens. The most frequently detected respiratory tract pathogens (RTPs) were rhinovirus, respiratory syncytial virus, parainfluenza virus and adenoviruses. The rates of RTP and co-infection positivity in the toddler group were significantly higher than those in the infant and preschool groups. The SureX13 respiratory pathogen multiplex kit has the ability to effectively detect a range of RTPs in hospitalized paediatric patients with LRTIs.

Clinical characteristics and outcomes of patients with severe acute respiratory infections (SARI): results from the Egyptian surveillance study 2010\u20132014

BackgroundRespiratory viral and atypical bacterial infections data in Egyptian patients are sparse. This study describes the clinical features and outcomes of patients with severe acute respiratory infections (SARI) in hospitalized patients in Egypt.MethodsSARI surveillance was implemented at Cairo University Hospital (CUH) during the period 2010–2014. All hospitalized patients meeting the WHO case definition for SARI were enrolled. Nasopharyngeal/oropharyngeal (NP/OP) swabs were collected and samples were tested using RT-PCR for influenza A, B, respiratory syncytial virus (RSV), human metapneumovirus (hMPV), parainfluenza virus (PIV 1,2,3,4), adenovirus, bocavirus, coronavirus, enterovirus, rhinovirus, and atypical bacteria. Data were analyzed to calculate positivity rates for viral pathogens and determine which pathogens related to severe outcomes or resulted in death.ResultsOverall, 1,075/3,207 (33.5%) cases had a viral etiology, with a mean age of 5.74 (±13.87) years. The highest rates were reported for RSV (485 cases, 45.2%), PIV (125, 11.6%), and adenovirus (105, 9.8%). Children had a higher viral rate (981, 91.2%) compared to 94 (8.8%) cases in adults. Patients with identified viruses had significantly lower rates for ICU admission, hospital stay, mechanical ventilation, and overall mortality than those without identified viruses. No infections were independently associated with severe outcomes.ConclusionsViral pathogens were encountered in one-third of hospitalized adult and pediatric Egyptian patients with SARI, while atypical bacteria had a minor role. Highest rates of viral infections were reported for RSV, PIV, and adenovirus. Viral infections had neither negative impacts on clinical features nor outcomes of patients with SARI in our locality.

Clinical characteristics and outcomes of patients with severe acute respiratory infections (SARI): results from the Egyptian surveillance study 2010–2014

Background: Respiratory viral and atypical bacterial infections data in Egyptian patients are sparse. This study describes the clinical features and outcomes of patients with severe acute respiratory infections (SARI) in hospitalized patients in Egypt. Methods: SARI surveillance was implemented at Cairo University Hospital (CUH) during the period 2010–2014. All hospitalized patients meeting the WHO case definition for SARI were enrolled. Nasopharyngeal/oropharyngeal (NP/ OP) swabs were collected and samples were tested using RT-PCR for influenza A, B, respiratory syncytial virus (RSV), human metapneumovirus (hMPV), parainfluenza virus (PIV 1,2,3,4), adenovirus, bocavirus, coronavirus, enterovirus, rhinovirus, and atypical bacteria. Data were analyzed to calculate positivity rates for viral pathogens and determine which pathogens related to severe outcomes or resulted in death. Results: Overall, 1,075/3,207 (33.5%) cases had a viral etiology, with a mean age of 5.74 (±13.87) years. The highest rates were reported for RSV (485 cases, 45.2%), PIV (125, 11.6%), and adenovirus (105, 9.8%). Children had a higher viral rate (981, 91.2%) compared to 94 (8.8%) cases in adults. Patients with identified viruses had significantly lower rates for ICU admission, hospital stay, mechanical ventilation, and overall mortality than those without identified viruses. No infections were independently associated with severe outcomes. Conclusions: Viral pathogens were encountered in one-third of hospitalized adult and pediatric Egyptian patients with SARI, while atypical bacteria had a minor role. Highest rates of viral infections were reported for RSV, PIV, and adenovirus. Viral infections had neither negative impacts on clinical features nor outcomes of patients with SARI in our locality.