Center For Infectious Diseases Research Articles

Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series

ObjectiveTo characterise the clinical features of monkeypox infection in humans.DesignDescriptive case series.SettingA regional high consequences infectious disease centre with associated primary and secondary care referrals, and affiliated sexual health centres...

Should we stay aware of monkeypox maxillofacial lesions?

AbstractMonkeypox is an endemic infectious disease commonly observed only in Central Africa; however in the last month, WHO considered it an international outbreak, with several cases described in a short span. Oral surgeons are exposed to patients at risk for monkeypox and some of the most prevalent lesions could be observed first in the maxillofacial region. The knowledge of the common signs and symptoms of the monkeypox and associated diseases is fundamental to the report and referral to infectious diseases centers for definitive treatment and public health control. This letter to the editor summarizes the associated diseases and common maxillofacial lesions observed in monkeypox infection.

Herpes Simplex Virus Type 1 and Varicella-Zoster Virus Coinfection in an Immunocompromised Male Patient

Department of Internal Medicine University of South Florida Morsani College of Medicine Tampa, FL [email protected] Division of Infectious Diseases University of South Florida Morsani College of Medicine Infectious Disease Fellowship Program Tampa, FL Division of Infectious Diseases and Tropical Medicine Internal Medicine Department Moffitt Cancer Center Tampa, FL The authors have no funding or conflicts of interest to disclose. Blake Brown, N.S., and J.G. performed the infectious disease consultation for this patient. Blake Brown reviewed the literature and drafted the manuscript. N.S. and J.G. were responsible for revision of the manuscript; all authors approved this version for submission.

Azithromycin treatment failure and macrolide resistance in Mycoplasma genitalium infections in Sofia, Bulgaria.

Mycoplasmagenitalium is an established cause of sexually transmitted infections in men and women. Current guidelines recommend azithromycin and moxifloxacin as first- and second-line treatment, respectively. However, azithromycin treatment failure has been increasingly reported. The aim of this study was to determine the efficacy of azithromycin and alternative antibiotic regimens in a prospective cohort of M.genitalium-positive patients, and macrolide resistance mutations associated with azithromycin failure.

Paracoccidioidomycosis in people living with HIV/AIDS: A historical retrospective cohort study in a national reference center for infectious diseases, Rio de Janeiro, Brazil.

Paracoccidioidomycosis (PCM) is one of the main endemic systemic mycoses in Latin America, usually occurring in rural areas. When PCM occurs simultaneously with underlying immunosuppressive conditions, it can present as an opportunistic disease. Between 2000 and 2017, literature reported around 200 PCM cases in people living with HIV/AIDS (PLWHA). To address research gaps on this co-infection and to study its possible temporal changes in the last decade, we performed an active co-infection case search on the HIV/AIDS and PCM cohorts from a Brazilian reference center database from 1989 to 2019. We found 20 PLWHA among 684 PCM patients (2.92%), predominantly male (70.0%) and urban workers (80.0%). The median age of patients was higher in the 2010-2019 decade (p = 0.006). The occurrence of PCM in PLWHA was lower when compared with other fungal diseases. Although 50.0% of the patients had already been diagnosed with HIV infection and presented CD4+ T cell counts greater than 200/mm3 at the time of PCM diagnosis, the suspicion of immunosuppression in the context of atypical and more severe clinical forms of PCM revealed the diagnosis of HIV infection in 35.0% of the patients. Two (10.0%) patients had an evolution compatible with immune reconstitution inflammatory syndrome (IRIS) after starting antiretroviral therapy (ART).We highlight the importance of considering a PCM diagnosis in PLWHA to prevent a late-onset treatment and progression to severe manifestations and unfavorable outcomes. In addition, HIV investigation is recommended in PCM patients, especially those with atypical and more severe clinical presentations.

Clinical features, microbiology, and vancomycin regimens in sepsis patients: A retrospective study conducted at a single infectious diseases center

Despite increasing antibiotic resistance, vancomycin remains the first choice to treat severe infections due to drug-resistant gram-positive bacteria. This study aimed to summarise the clinical, microbiological, and vancomycin treatment outcomes in bacteremia patients. From July to December 2019, a retrospective cohort analysis was conducted on patients with bacteremia treated with vancomycin at a tertiary hospital in Hanoi, Vietnam. Patients without vancomycin concentrations were excluded from the study. Patients had a median age of 54 years (IQR, 41.8 - 63.3), with a male/female ratio of 1.86. Renal complication was markedly different; Clcr < 60, 60 - 130, and > 130 mL/min was 29%, 60%, and 11%, respectively. The median Charlson score was 3.0 (2-4.3), the qSOFA score was 1 (1-2), and the NEWS score was 76%, with a median of 6 (5-8). Twenty-one cases had positive blood culture where85.7% were gram-positive. 93% of patients with sepsis were treated with vancomycin as the first antimicrobial, of which 72% used vancomycin in combination with other antibiotics. Renal complications occurred in 12% of all patients, with grades R, I, and F accounting for 4%, 5%, and 3%, respectively. The median duration of treatment was 12 days (IQR, 7-17), with a success rate of 82 % and a failure rate of 18%, respectively. Conclusions: In most patients with bacteremia, microbiological tests reveal no detectable bacteria. When sepsis is suspected, a vancomycin regimen should be initiated.

Prevention of Sexually Transmitted Infectious Diseases (STI), HIV AIDS Based Onottawa Charter Health Promotion Strategy in Wakatobi District, Southeast Sulawesi

Targeting to end the AIDS Epidemic by 2030, the government of Wakatobi Regency, Southeast Sulawesi undertakes HIV prevention efforts with Health promotion strategies based on the Ottawa Charter so that individuals and communities can adopt healthy behaviors by not behaving at risk. This study aimed to examine the prevention of STIs and HIV AIDS based on the Ottawa Charter in Wakatobi in 2022. Using Quasi qualitative data collection techniques using observation, in-depth interviews, and documentation. Informants, namely 1 key informant: Head of the Wakatobi District Health Office, 1 Supporting Informant is the Wakatobi KPAD, and 3 regular informants, namely the Head of Division and Head of the Prevention and Control of Infectious Diseases and Public Health Center officers in Wakatobi Regency. Based on the study results, shows that prevention efforts based on the Ottawa strategy have been implemented but have not been maximized. There are several dimensions: health-oriented policies, a supportive environment, Reorientation of Health Services, individual skills strategies, and Community Movements. Although not many activities have been carried out related to independent programs in HIV prevention and control, the Health Office and KPAD have included plans to approach existing risk groups so that they can realize positive behaviors for health. Based on the results of the study, HIV AIDS Prevention Efforts in Wakatobi Regency based on the Ottawa Charter still need to be improved and strengthened by the local government, especially the Health Service and KPAD. Several programs are still in the planning stages within the dimensions of the Ottawa Charter.

Incidences of Infectious Events in a Renal Transplant Cohort of the German Center of Infectious Diseases (DZIF).

BackgroundInfectious complications are a major cause of morbidity and mortality after kidney transplantation.MethodsIn this transplant cohort study at the German Center of Infectious Diseases (DZIF), we evaluated all infections occurring during the first year after renal transplantation. We assessed microbial etiology, incidence rates, and temporal occurrence of these infections.ResultsOf 804 renal transplant recipients (65.2% male, 51 ± 14 years), 439 (54.6%) had 972 infections within the first year after transplantation. Almost half of these infections (47.8%) occurred within the first 3 months. Bacteria were responsible for 66.4% (645/972) of all infections, followed by viral (28.9% [281/972]) and fungal (4.7% [46/972]) pathogens. The urinary tract was the most common site of infection (42.4%). Enterococcus was the most frequently isolated bacterium (20.9%), followed by E. coli (17.6%) and Klebsiella (12.5%). E. coli was the leading pathogen in recipients <50 years of age, whereas Enterococcus predominated in older recipients. Resistant bacteria were responsible for at least 1 infection in 9.5% (76/804) of all recipients. Viral infections occurred in 201 recipients (25.0%). Of these, herpes viruses predominated (140/281 [49.8%]), and cytomegalovirus had the highest incidence rate (12.3%). In the 46 fungal infections, Candida albicans (40.8%) was the most commonly isolated. Other fungal opportunistic pathogens, including Aspergillus fumigatus and Pneumocystis, were rare.ConclusionsRenal allograft recipients in Germany experience a high burden of infectious complications in the first year after transplantation. Bacteria were the predominating pathogen, followed by opportunistic infections such as cytomegalovirus. Microbial etiology varied between age groups, and resistant bacteria were identified in 10% of recipients.

Duffy blood system and G6PD genetic variants in vivax malaria patients from Manaus, Amazonas, Brazil

BackgroundOver a third of the world’s population is at risk of Plasmodium vivax-induced malaria. The unique aspect of the parasite’s biology and interactions with the human host make it harder to control and eliminate the disease. Glucose-6-phosphate dehydrogenase (G6PD) deficiency and Duffy-negative blood groups are two red blood cell (RBC) variations that can confer protection against malaria.MethodsMolecular genotyping of G6PD and Duffy variants was performed in 225 unrelated patients (97 with uncomplicated and 128 with severe vivax malaria) recruited at a Reference Centre for Infectious Diseases in Manaus. G6PD and Duffy variants characterizations were performed using Real Time PCR (qPCR) and PCR–RFLP, respectively.ResultsThe Duffy blood group system showed a phenotypic distribution Fy(a + b−) of 70 (31.1%), Fy(a + b +) 96 (42.7%), Fy(a−b +) 56 (24.9%) and Fy(a−b−) 1 (0.44%.) The genotype FY*A/FY*B was predominant in both uncomplicated (45.3%) and severe malaria (39.2%). Only one Duffy phenotype Fy(a-b) was found and this involved uncomplicated vivax malaria. The G6PD c.202G > A variant was found in 11 (4.88%) females and 18 (8.0%) males, while c.376A > G was found in 20 females (8.88%) and 23 (10.22%) male patients. When combined GATA mutated and c.202G > A and c.376A > G mutated, was observed at a lower frequency in uncomplicated (3.7%) in comparison to severe malaria (37.9%). The phenotype Fy(a−b +) (p = 0.022) with FY*B/FY*B (p = 0.015) genotype correlated with higher parasitaemia.ConclusionsA high prevalence of G6PD c202G > A and c.376A > G and Duffy variants is observed in Manaus, an endemic area for vivax malaria. In addition, this study reports for the first time the Duffy null phenotype Fy(a-b-) in the population of the Amazonas state. Moreover, it is understood that the relationship between G6PD and Duffy variants can modify clinical symptoms in malaria caused by P. vivax and this deserves to be further investigated and explored among this population.

The Influence of Sex, Gender, and Age on COVID-19 Data in the Piedmont Region (Northwest Italy): The Virus Prefers Men.

Several important sex and gender differences in the clinical manifestation of diseases have been known for a long time but are still underestimated. The infectious Coronavirus 2019 disease pandemic has provided evidence of the importance of a sex and gender-based approach; it mainly affected men with worse symptomatology due to a different immune system, which is stronger in women, and to the Angiotensin-converting enzyme 2 and Transmembrane protease serine 2 roles which are differently expressed among the sexes. Additionally, women are more inclined to maintain social distance and smoke less. Analysis of data on the infectious Coronavirus 2019 disease testing from people admitted to the Amedeo di Savoia Hospital, a regional referral center for infectious diseases, has been applied to the whole of 2020 data (254,640 records). A high percentage of data in the dataset was not suitable due to a lack of information or entering errors. Among the suitable samples, records have been analyzed for positive/negative outcomes, matching records for unique subjects (N = 123,542), to evaluate individual recurrence of testing. Data are presented in age and sex-disaggregated ways. Analyses of the suitable sample also concerned the relation between testing and hospital admission motivation and symptoms. Our analysis indicated that a sex and gender-based approach is mandatory for patients and the National Health System’s sustainability.

A study of the effectiveness of nucleos(t)ide analogues in the treatment of HBeAg- positive chronic hepatitis B with normal alanine aminotransferase and high level of HBV DNA

Objective: To investigate the effectiveness of nucleos(t)ide analogues in the treatment of HBeAg-positive chronic hepatitis B with normal alanine aminotransferase and high level of HBV DNA. Methods: Treatment-naïve chronic hepatitis B patients who were followed up at the Center of Infectious Diseases, West China Hospital of Sichuan University from January 2019 to January 2020 were selected as subjects. Demographic characteristics, the results of laboratory examination before treatment and one year after treatment were retrospectively collected. Patients were divided into tenofovir dipivoxil (TDF) and propofol fumurate tenofovir (TAF) treatment group according to different types of medication. The changes of serum HBV DNA level, HBeAg serological conversion and HBsAg quantitative level were analyzed and compared between the two groups. Results: A total of 38 cases were enrolled. Among them, there were 16 and 22 cases in the TDF and TAF group, respectively. There was no statistically significant difference in demographic characteristics, baseline HBV DNA levels and HBsAg quantitative levels between the two groups. Virological response was achieved in 60.5% (23/38) of patients after one year of antiviral therapy. Serum HBV DNA levels below the lower limit of detection [68.2% (15/22) vs. 50.0% (8/16), P=0.258] and higher HBeAg seroconversion rate [18.2%] (4/22) vs. 6.3% (1/16), P=0.374] was obtained in TAF than TDF group; however, there was no statistically significant differences between the two. Serum HBsAg quantitative level was significantly reduced with TDF and TAF treatment. In addition, alanine aminotransferase elevation was reduced in TAF than TDF treated group. Multivariate logistic regression analysis showed that patient age was an independent predictor of a virological response to antiviral therapy. Conclusion: HBeAg-positive CHB patients with normal alanine aminotransferase, and high HBV DNA level can obtain better curative effect after TDF and TAF treatment.

MRNA-1273 and Ad26.COV2.S vaccines protect against the B.1.621 variant of SARS-CoV-2

BackgroundSince the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2019, viral variants with greater transmissibility or immune-evasion properties have arisen, which could jeopardize recently deployed vaccine- and antibody-based countermeasures.MethodsHere, we evaluated in mice and hamsters the efficacy of a pre-clinical version of the Moderna mRNA vaccine (mRNA-1273) and the Johnson & Johnson recombinant adenoviral-vectored vaccine (Ad26.COV2.S) against the B.1.621 (Mu) variant of SARS-CoV-2, which contains spike mutations T95I, Y144S, Y145N, R346K, E484K, N501Y, D614G, P681H, and D950N.FindingsImmunization of 129S2 and K18-human ACE2 transgenic mice with the mRNA-1273 vaccine protected against weight loss, lung infection, and lung pathology after challenge with the B.1.621 or WA1/2020 N501Y/D614G SARS-CoV-2 strain. Similarly, immunization of 129S2 mice and Syrian hamsters with a high dose of Ad26.COV2.S reduced lung infection after B.1.621 virus challenge.ConclusionsThus, immunity induced by the mRNA-1273 or Ad26.COV2.S vaccine can protect against the B.1.621 variant of SARS-CoV-2 in multiple animal models.FundingThis study was supported by the NIH (R01 AI157155 and U01 AI151810), NIAID Centers of Excellence for Influenza Research and Response [CEIRR] contracts 75N93021C00014 and 75N93021C00016, and the Collaborative Influenza Vaccine Innovation Centers [CIVIC] contract 75N93019C00051. It was also supported, in part, by the National Institutes of Allergy and Infectious Diseases Center for Research on Influenza Pathogenesis (HHSN272201400008C) and the Japan Program for Infectious Diseases Research and Infrastructure (JP21wm0125002) from the Japan Agency for Medical Research and Development (AMED).

The Beneficial Effect of the COVID-19 Vaccine Booster Dose among Healthcare Workers in an Infectious Diseases Center.

Introduction: Healthcare workers in Poland received a booster dose of the BNT162b2 mRNA vaccine (Pfizer-BioNTech, Manufacturer: Pfizer, Inc., and BioNTech; Moguncja, Germany) at the beginning of October 2021. Here, we report on the preliminary results of an ongoing clinical study into the antibody response to SARS-CoV-2 of healthcare workers previously exposed to the virus, with or without evidence of past infection, in the Hospital for Infectious Diseases in Warsaw before and after the vaccine booster dose. Methods: Blood samples were collected on the day the vaccine booster dose was administered and again 14 days later. The levels of SARS-CoV-2 IgG antibodies (against the n-protein, indicative of disease) and S-RBD (indicative of a response to vaccination) were measured. Results: One hundred and ten health care workers from the Hospital for Infectious Diseases were included in the study. The percentage of subjects with a positive test for anti-n-protein IgG antibodies at both time points remained unchanged (16, 14%), while a statistically significant increase in the percentage of subjects producing high levels of S-RBD antibodies (i.e., >433 BAU/mL) was observed (from 23, 21% to 109, 99%; p = 0.00001). Conclusions: The results of the study indicate that the booster dose of the vaccine significantly increases the percentage of people with high levels of S-RBD antibodies, regardless of previous contact with the virus, which may indicate greater protection against both the disease and a severe course of COVID-19.

95 years of protecting and improving the health of children (devoted to the 95th anniversary of Pediatric Research and Clinical Center for Infectious Diseases)

95 years of protecting and improving the health of children (devoted to the 95th anniversary of Pediatric Research and Clinical Center for Infectious Diseases)

COVID-19 management in a UK Tertiary Centre with High Consequence Infectious Diseases Centre: Nutritional status, intervention and outcome

Coronavirus disease 2019 (COVID-19) has rapidly spread across the globe. Elderly individuals and patients with comorbidities such as obesity, diabetes, and hypertension have been shown to have a higher risk of hospitalization, severe disease, and mortality.1 To date, little data has been published on the timely identification and correction of undernutrition in patients hospitalised with COVID-19.

World Tuberculosis Day 2022: aligning COVID-19 and tuberculosis innovations to save lives and to end tuberculosis

World Tuberculosis Day 2022: aligning COVID-19 and tuberculosis innovations to save lives and to end tuberculosis

Pulmonary tularemia in a person taking immunosuppressive drugs: a literature review and a clinical case report

Ieva Radavičiūtė 1, Gintarė Žilinskaitė 1, Birutė Zablockienė 2, 3 1 Vilnius University Faculty of Medicine, Vilnius, Lithuania 2 Vilnius University Faculty of Medicine, Institute of Clinical Medicine, Clinic of Infectious diseases and Dermatovenerology, Vilnius, Lithuania 3 Vilnius University Hospital Santaros Klinikos, Center of Infectious Diseases, Vilnius, Lithuania Abstract Introduction: Aerobic Gram negative bacterium – Francisella tularensis may cause a rare zoonotic disease tularemia. The reservoir of infection are various animals and arthropods. The infection can be transmitted through the respiratory tract, skin, mucous membranes, gastrointestinal tract or by insect bites. Consequently the clinical forms of tularemia are ulcerative glands, lymphadenopathy, ocular hemorrhage, oral and pharyngeal tularemia, gastrointestinal, respiratory and typhoidal tularemia. One of the most severe forms of the disease is pulmonary tularemia, which has a high mortality rate and is particularly dangerous in patients taking immunosuppressive drugs. Clinical case: This article presents a clinical case of a patient treated for rheumatoid arthritis with a TNF-alpha inhibitor (Infliximab). He contacted a doctor in the spring of 2020 due to a dry cough. In September of 2020 a diagnosis of tularemia was confirmed after various diagnostic tests. Antibacterial treatment was effective, but the patient was recommended not to resume biologic therapy with TNF-alpha inhibitors in the setting of tularemia. Conclusion: Tularemia is a rare but easily contagious infectious disease that often takes time to diagnose. In this clinical case, tularemia was more severe in an immunosuppressed patient who developed severe lesions such as lung lesions and lymphadenopathy than in a normal tularemia case patient. For such patients it is particularly important to recognize tularemia, perform laboratory tests to diagnose the zoonosis, and decide on further treatment with immunosuppressive therapy. Keywords: Immunodeficiency; biological therapy; pneumonia, tularemia.

Changing Patterns in Epidemiology of Brucellosis in the South of Iran (2015-2020): Based on Cochrane-Armitage Trend Test.

Background:Brucellosis is known in Iran as an endemic disease; however, its incidence is not the same in all provinces and is higher in some areas.Objective:The present study was designed to determine the epidemiological status and trend of brucellosis in the period from 2015 to 2020 in the south of Fars province, Southern Iran.Methods:This is a cross-sectional analytical study. This study included all patients with brucellosis in the period from 2015 to 2020 whose information had been registered in the Infectious Diseases Center of Larestan city. To collect the data, we used a checklist that included information such as age, gender, number of cases by year and month, occupation, and nationality of the patients with brucellosis. The rate of brucellosis incidence during these years was analyzed using the Cochran-Armitage trend test. P-value less than 0.05 was considered significant.Results:The average annual incidence of the disease was 8.94 per 100 000 population. It has decreased from 26.83 (per 100 000 people) in 2015 to 1.83 (per 100 000 people) in 2020. The results of Cochrane-Armitage process test showed that the reduction in the incidence of the disease from 2015 to 2020 was significant (PTrend = 0.001). The trend of the disease by month also showed that the majority of cases occurred between December and February, with the highest incidence of the disease in February (9.93 per 100 000 people) and the lowest in May (1.1 per 100 000 people) (P = 0.001).Conclusion:Although the results of the present study indicated a decrease in the incidence of the disease in the southern region of Fars province, due to the fact that the disease is common between humans and livestock, there is the possibility of scattered and irregular epidemics in each period.

The Use of Hyperbaric Oxygen Therapy to Treat Necrosis and Open Wounds due to Ionizing Radiation

Radiation is invaluable for the treatment of tumors but causes detrimental effects on surrounding healthy tissue because ionizing radiation is nonspecific to its target. Wounds may develop from radiation therapy for cancers growing close to or on the skin, like melanoma. Clinically approved approaches are needed to regenerate tissue and close wounds after ionizing radiation treatment. Surgical intervention is commonly performed for wound closure post-radiation, but it has a high chance of developing infection. Hyperbaric Oxygen Therapy (HBOT) is a treatment currently being used for patients with ulcers, burns, infections, crush injuries, and more, but requires further research to confirm its reliability on radiation induced wounds. HBOT, unlike surgical intervention post-radiation, mitigates infection and the disfiguring of skin. This case study was on a patient who underwent HBOT for a wound developed from radiation after a successful treatment of melanoma. The patient suffered from sequela necrosis and open wound from the radiation that measured 3cm by 2cm with 30% slough. They were presented to the Ocala Infectious Disease and Wound Center and were prescribed 40 sessions of continuous 90-minute HBOTs at 2.0 ATA (atmospheres absolute) for a duration of 10 weeks. The size of their wound and percent slough was measured on a weekly basis to determine the effects of HBOT. A successful treatment of HBOT would be represented by a decrease in wound size and decrease in percent slough. Thus, HBOT may offer a safer and reliable alternative to radiation induced wound closure.

Quantitative Electroencephalography Indicators in Children with Acute Purulent Meningitis.

The aim of the present work was to assess the state of brain bioelectrical activity in children during the acute period of bacterial purulent meningitis, with quantitative mathematical analysis of the changes found. The studies included 31 children on days 1 and 6 from onset of illness: 16 children (8.9 ± 2.4 years) admitted to the Pediatric Scientific Clinical Center for Infectious Diseases with laboratory confirmation of diagnoses of purulent meningitis (due to Neisseria meningitidis) (n = 11) or Streptomyces pneumoniae (n = 2) or unidentified pathogen (n = 3)), along with 15 healthy children. Electroencephalogram (EEG) traces were recorded from all these children in the state of calm waking using a Neuron-Spectrum 4/VP 16-channel electroencephalograph. Clinical assessment of the EEG included analysis of background rhythms, zonal differences, and detection of pathological types of activity. Quantitative analysis consisted of the mean power (μV2) and amplitude (μV) of the α, θ, and δ rhythms, along with mean power ratios – α/θ and α/δ. Visual analysis of the EEG in 100% of children in the acute period of purulent meningitis showed diffuse slowing with detection of δ and θ waves. Focal changes in the form of sharp waves were seen in 18.8% of cases (three patients). No cases displayed periodic activity. Meningitis patients showed significant reductions in the α/δ (p = 0.001) and α/θ (p = 0.048) spectral ratios. ROC analysis showed that the α/θ value was <0.18 and the α/δ value was <0.02 (sensitivity 100% and specificity 80%, AUROC 0.9), which may be evidence of the likely development of cerebral edema. Thus, pediatric patients with acute purulent meningitis showed significant impairments to the normal α/θ and α/δ rhythm power ratios on the EEG, which is presumptively explained by suppression of the functional activity of the thalamus and thalamocortical pathways, as well as the reticular formation of the brain.