Concurrent Bacterial Infection Research Articles

SURVEY ON THE MOST COMMON DISEASES CIRCULATING AMONG PIGEONS IN THE EASTERN PROVINCE, SAUDI ARABIA

Molecular and microbiological approaches were used to investigate the common circulating pathogens in pigeon flocks. Sixty-nine flocks were investigated for viral, bacterial and parasitic infection evidence, including the histories, clinical signs and lesions. We reported that the seroprevalences of Newcastle disease viruses (NDVs), Mycoplasma gallisepticum (MG) and Mycoplasma synoviae (MS) were 50.57%, 7.25% and 8.69%. respectively; no avian influenza virus (AIV)‒specific antibodies were detected. NDVs and pigeon paramyxoviruses (PPVs) were detected in 40.57% and 15.9%, respectively, of the pigeons. Multiple diseases were the predominant finding, with 60.87% of diseased flocks harboring multifactorial infections of viral, bacterial and parasitic pathogens. Concurrent viral and bacterial infections were reported in 15.94%, and viral and parasitic coinfections were found in 20.29%. Mixed infections of NDV with bacterial and parasitic diseases were detected in 21.74%. Bacterial and mycotic pathogens were detected in 22/69 (31.88%) and 5/69 (7.25%), respectively. Salmonella spp. were only detected in 3/69 (4.35%) of diseased flocks. Parasitic diseases were the most prevalent infections, either as a single infection or concurrently with others. Parasites including Cestoda spp., Ascaris spp., Eimeria spp., Trichomonas gallinae and external parasites(Menopon gallinae, Pseudolynchia canariensis) were reported in 12/69 (17.39%), 10/69 (10.49%), 10/69 (10.49%), 18/69 (26.1%) and 3/69 (4.35%), respectively. We concluded that pigeon flocks harbor many pathogens that may threaten the health of animals and humans; they are serious amplifiers and reservoir hosts of disease and, ultimately, may be serious biological hazards to the intensive poultry production sector and community. Pigeon vaccines should be developed. Strict biosecurity measures should be applied to protect pigeons and commercial poultry flocks. Key words: Pigeon, diseases, PCR, isolation and identification, Saudi Arabia

#5688 CLINICAL PROFILE AND OUTCOMES OF DENGUE-INDUCED ACUTE KIDNEY INJURY (DAKI): A TERTIARY CENTRE EXPERIENCE FROM SOUTH INDIA

Abstract Background and Aims Dengue is currently the most relevant viral infection transmitted by a mosquito bite that represents a major threat to public health worldwide. While Dengue-Associated Acute Kidney injury (DAKI) is a lethal complication, it remains as one of the least studied complications. Method This is a retrospective observational study amongst adult hospitalized Dengue patients admitted at a tertiary care hospital between January 2019 and December 2019. We estimated the prevalence of Acute Kidney Injury (AKI) using KDIGO AKIN (Acute Kidney Injury Network) criteria. Outcomes were analyzed during the time of discharge. Results Out of the 1550 hospitalized patients, majority of the patients were males – 1005 (64.9%). Most common age group was between 20 to 40 years. 85 (5.48%) of the total study patients developed DAKI. Older age groups were found to be more at risk for concurrent bacterial infections and higher mortality rate. Most patients had stage 1 AKI (70.1%). Overall mortality in patients with AKI was 20.3% and 80.5% in those requiring dialysis. The incidence of DAKI risk was increased by as much as 4.5-fold in the presence of hemoconcentration (or hematocrit > 46.5%). Older age, Male sex, co-existing viral hepatitis, Dengue Hemorrhagic Fever, Dengue Shock Syndrome, Rhabdomyolysis, Multiple Organ Dysfunction Syndrome were found to be independent risk factors for DAKI. Presence of DAKI was associated with higher mortality and longer hospital stay. Conclusion In our study population, we found a low prevalence of AKI but Mortality was high in patients requiring ICU care and dialysis. Prompt recognition and identification of the at-risk population and administration of appropriate supportive treatment should be aimed to reduce the morbidity and mortality associated with this common and very important tropical disease.

Fasciola hepaticaFh15 promote survival in a mouse septic shock model and downregulates inflammatory cytokines

Abstract Parasitic helminths and helminth-derived molecules, possess an inherent anti-inflammatory capacity. Fasciola hepatica has been reported to decrease in vivo particular Th1 immune responses caused by concurrent bacterial infections. Studies have shown that some Fasciola hepatica’s excretory-secretory products has the capacity to reduce phagocytic activity, affect cell recruitment, and induce activation of alternative activated macrophages. We hypothesized that recombinant F. hepatica FABP (Fh15) may be an excellent target for the development of new anti-inflammatory drugs against sepsis. For this, we developed a mouse model of septic shock to determine the capacity of Fh15 to suppress the cytokine storm and prevent the mortality rate of mice exposed to lethal doses of LPS. BALB/c mice were allotted into two experimental groups of 5 animals each, which received an IP injection with 12mg/kg body wt. of LPS from E. coli 0111: B4. One hour after LPS injection one group received a single IP injection with 100 μg Fh15 and the other group received two injections of 100 μg Fh15 two hours apart. Control groups received IP injection with LPS, Fh15 or PBS alone. Animals were monitored for mortality for 72 hrs. Blood samples were collected from all animals at baseline and by the time they were about to die or survived the LPS lethal challenge. As expected, all animals from LPS-control group succumbed between 12 to 24h following the LPS challenge. In contrast, between 40 to 100% of animals that received the Fh15 treatment survived to the LPS challenge. This notable increase in the survival rate was found associated to significant suppression in the production of pro-inflammatory cytokines such as IL-12, TNF-a and IFN-g, which were measured in serum by BioPlex.

Concurrent infections of Streptococcus iniae and Aeromonas veronii in farmed Giant snakehead (Channa micropeltes).

The giant snakehead, Channa micropeltes, is an increasingly important economic freshwater fish in Thailand and other regions of Asia. Presently, giant snakehead are cultured under intensive aquaculture conditions, leading to high stress and conditions favouring disease. In this study, we reported a disease outbreak in farmed giant snakehead with a cumulative mortality of 52.5%, continuing for 2 months. The affected fish exhibited signs of lethargy, anorexia and haemorrhage of the skin and eyes. Further bacterial isolations revealed two different types of colonies on tryptic soy agar: small white, punctate colonies of gram-positive cocci and cream-coloured, round and convex colonies of rod-shaped gram-negative bacteria. Additional biochemical and species-specific PCR analysis based on 16S rRNA confirmed the isolates as Streptococcus iniae and Aeromonas veronii. Multilocus sequence analysis (MLSA) placed the S.iniae isolate into a large clade of strains from clinically infected fish worldwide. Gross necropsy findings showed liver congestion, pericarditis and white nodules in the kidney and liver. Histologically, the affected fish showed focal to multifocal granulomas with inflammatory cell infiltration in kidney and liver, enlarged blood vessels with mild congestion within the meninges of the brain and severe necrotizing and suppurative pericarditis with myocardial infarction. Antibiotic susceptibility tests revealed that S.iniae was sensitive to amoxicillin, erythromycin, enrofloxacin, oxytetracycline, doxycycline and resistant to sulfamethoxazole-trimethoprim, while the A.veronii was susceptible to erythromycin, enrofloxacin, oxytetracycline, doxycycline, sulfamethoxazole-trimethoprim and resistant to amoxicillin. Conclusively, our findings highlighted the natural concurrent bacterial infections in cultured giant snakehead, which support the implementation of appropriate treatment and control strategies.

Methicillin-resistant Staphylococcus aureus Bacteremia With Splenic Abscess Masked by Epstein-Barr Virus-associated Hemophagocytic Lymphohistiocytosis.

To the Editors: Splenic abscess, often associated with bacteremia, is a rare, potentially life-threatening disease that is sometimes reported in immunocompromised patients. It is characterized by prolonged fever and leukocytosis.1 Epstein–Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) is also a potentially life-threatening hyperinflammatory disease triggered by EBV infection and characterized by high-grade fever and cytopenia.2 We present a case of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia with splenic abscess masked by EBV-HLH. A previously healthy 7-year-old girl, with no family history of immunodeficiency or hematologic diseases, developed a fever, cough and rhinorrhea. She was treated for suspected bacterial pneumonia with clarithromycin followed by tosufloxacin. On day 4, blood examination showed bicytopenia (WBC 1690/μL, neutrophils 598/μL, platelets 92 × 103/μL) and a negative blood culture. On day 7, although the cough and rhinorrhea improved, the high-grade fever continued, and cracked lips, cervical lymphadenopathy and scattered erythema appeared. Blood examination showed hypercytokinemia (platelets 52 × 103/μL, C-reactive protein 13.63 mg/dL, fibrinogen 155 mg/dL, triglyceride 219 mg/dL, lactate dehydrogenase 5727 U/L). She was suspected to have HLH or Kawasaki disease and was referred to our hospital. We stopped antibiotic treatment and administered intravenous immunoglobulin 2 g/kg and prednisolone 2 mg/kg. Both ferritin (26,566 ng/dL) and soluble interleukin-2 receptor (4998/mL) were elevated, and along with fever, bicytopenia, and later-recognized splenomegaly, 5 of the 8 HLH 2004 diagnostic criteria were met.3 We did not perform bone marrow aspiration due to the invasiveness. Additionally, EBV-VCA IgM and EBV-VCA IgG were positive, and anti-EBNA was negative. The initial EBV infection was considered to be a trigger of the HLH. On day 8, bicytopenia and coagulopathy had improved, but C-reactive protein was further elevated. The blood culture and urine culture of day 7 were positive for gram-positive cocci, later identified as MRSA. On day 10, abdominal contrast-enhanced CT showed splenomegaly and multiple spleen abscesses (Fig. 1A–C). We administered intravenous vancomycin for 7 weeks (Figure, Supplemental Digital Content 1, https://links.lww.com/INF/E923). Repeated cardiac ultrasound showed no evidence of infective endocarditis. Since then, no relapse was documented.FIGURE 1.: Abdominal contrast-enhanced computed tomography on day 10. Splenomegaly, scattered nodular low-density areas (arrows) and multiple wedge-shaped low-density lesions (arrowheads) in the spleen (A, B, and C).No report has described bacteremia or splenic abscess after only 7 days following the onset of EBV-HLH. HLH causes severe neutropenia, which contributes to an immunosuppressed state.4 Splenic abscesses, sometimes with bacteremia, often occur in an immunosuppressed state.1,5 In our case, no etiology other than HLH, suggestive of immunodeficiency leading to a splenic abscess, was identified. HLH induces persistent high-grade fever and leukocytopenia.2,3 Furthermore, a study that reviewed 6 immunocompromised patients diagnosed with splenic abscesses reported that the five patients were febrile because of their splenic abscess and that none had leukocytosis.5 High-grade fever is the common characteristic of HLH and bacterial infection. Leukocytosis, one of the characteristics of bacterial infection, can be masked by leukopenia due to HLH, as in our case. In conclusion, a severe bacterial infection such as bacteremia with a splenic abscess may develop shortly after EBV-HLH. HLH induces persistent high-grade fever and leukocytopenia, and thus a diagnosis of concurrent bacterial infection may be challenging. Blood cultures and abdominal contrast-enhanced CT should be performed.

Molecular Prevalence and Risk Factors of Campylobacter Infection in Puppies in the Nairobi Metropolitan Region, Kenya.

Campylobacter species are widely distributed pathogens; however, data on its epidemiology in puppies remain scanty, especially in Kenya. A cross-sectional study was conducted in the Nairobi Metropolitan Region to determine molecular prevalence and associated risk factors of Campylobacter species infection in puppies. A total of 260 rectal swabs were collected from puppies from breeding kennels, shelters, and the University of Nairobi Veterinary Teaching and Referral Hospital. The samples were subjected to polymerase chain reaction (PCR) assays for identification of Campylobacter species. Data on potential risk factors associated with puppy exposure were collected using a semistructured questionnaire. Multivariable mixed effects logistic regression analyses were performed with kennels as random effects. Campylobacter species were detected in 64 of the 260 sampled puppies yielding an overall prevalence of 24.6%. Multivariable results showed that puppies from shelters, puppies from kennels that are washed daily, puppies with a recent history of vomiting, and those treated with antibiotics in the past month were significantly associated with the presence of Campylobacter species. Being a kenneled puppy and having had concurrent bacterial infections were identified as protective factors. This study provides molecular evidence of puppy exposure to Campylobacter species which could have impact on puppy health and highlights the need to develop awareness and management strategies to potentially reduce the risk of transmitting this pathogen among puppies, to humans, and other animals.

Yeasts of the Malassezia Genus – Recent Findings

Abstract The genus Malassezia is a medically important genus of yeasts that can colonize the skin of humans and other warm-blooded animals. The genus currently comprises 18 species of which four new species were identified recently. The most widely known species, M. pachydermatis, occurs in animals but was detected also in humans, namely at life endangering septicaemias and in prematurely born children. Proliferation of Malassezia occurs most frequently as a result of disturbances in the normal homeostasis of host immunity on the one hand and virulence of these yeasts on the other hand. The successful management of the disease depends on the therapeutic control of overgrowth of the yeasts and any concurrent bacterial infection by local or systemic anti microbial treatment, as well as, on identification and potential correction of the predisposing factors.

Role of Antifungal Prophylaxis in Invasive Fungal Infection in Children with Acute Lymphoblastic Leukemia—A Retrospective Cross-Sectional Study

AbstractIntroduction Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. Its outcome in India is not as good as that in the western world. One of the important reasons for lesser survival rates is opportunistic infections, including invasive fungal infections (IFIs). Antifungal prophylaxis (AFP) in ALL children is routinely not followed. However, owing to its incidence in high-risk ALL, this study is focused on the use of AFP in those children.Objectives This retrospective study investigated the role of AFP in newly diagnosed children with high-risk ALL on intensive blocks of therapy on regimens B and C of the United Kingdom Acute Lymphoblastic Leukemia 2003 protocol.Materials and Methods The study was conducted in a tertiary care center from 1st December 2013 to 31st December 2019 and included children with ALL from 1 to 18 years of age. Routine AFP with voriconazole was commenced for high-risk ALL children from 1st July 2017 onward in our center. We analyzed data of all IFIs in children before and after AFP with National Cancer Institute high-risk status who had been started on regimen B induction and regimen B or C consolidation and intensification phases.Results A total of 55 children with high-risk ALL were included in the study. The median age was 4 years, with the majority being between the age of 1 and 10 years (38 out of 55; 65%) and predominantly male (36 out of 55; 69%). Total incidence of IFI in our cohort was 51% (28 out of 55). A significant number of children (16 out of 22 [70%]) who were not on prophylaxis developed IFI versus children (12 out of 33 [28%]) on prophylaxis (p = 0.008). The most common organisms isolated were Candida parapsilosis and Candida tropicalis. Children not receiving AFP were found to be 4.7 times (95% confidence interval: 1.44–15.13) more likely to get IFI than the ones receiving AFP. The presence of concurrent bacterial infection increases the risk of IFI (p = 0.04).Conclusion The incidence of IFI was high in high-risk ALL children who were not on AFP. The introduction of routine AFP reduced the incidence of IFI.

Emerging fish pathogens Lactococcus petauri and L. garvieae in Nile tilapia (Oreochromis niloticus) farmed in Brazil

Lactococcosis in fish has been associated with Lactococcus garvieae and the recently described L. petauri. However, the relevance of these emerging fish pathogens to Nile tilapia still requires thorough understanding. This study investigated lactococcosis outbreaks in Nile tilapia on Brazilian farms and characterized the isolates through multilocus sequence typing (MLST), virulence to Nile tilapia, and antimicrobial susceptibility. Lactococcosis outbreaks were monitored from 2019 to 2022 throughout Brazil. The outbreaks occurred mainly during warmer months, and co-infections were observed in four farms, whereas concurrent bacterial infections were identified in all farms. Since the sequence of the 16S rRNA was not capable of differentiating between L. petauri and L. garvieae, Lactococcus spp. isolates were identified at the species level using the gyrB gene sequence. In total, 30 isolates were classified as L. petauri and two as L. garvieae. According to the MLST, all L. petauri isolates were grouped in the sequence type (ST) 24, except for one isolate which belonged to the newly described ST47. A new ST was also described for the L. garvieae isolates identified, ST46. The L. petauri ST24 and ST47 were characterized as singletons, whereas L. garvieae ST46 was grouped with ST16 and ST17 and formed CC17. For the challenge trial, an L. petauri ST24 isolate was chosen considering that this MLST lineage was the most frequently observed. Fish were challenged by intraperitoneal injection and different bacterial doses were used (106 to 102 CFU per fish). The infection in the challenged fish progressed very rapidly, and within 48 h post-challenge clinical signs and the first mortalities were observed. The pathogenicity of L. petauri to Nile tilapia was confirmed. The estimated LD50 was 5.74 × 103 CFU 15 days post-challenge. Provisional epidemiological cutoff values were determined for L. petauri for six antimicrobial agents from different drug classes. All isolates were characterized as wild type (WT) for neomycin and oxytetracycline, whereas 96.67% of the isolates were characterized as WT for amoxicillin, erythromycin, and florfenicol, and 83.33% were WT for norfloxacin. The L. petauri ST24 was observed in different regions of the country, illustrating a rapid expansion of this bacterial lineage.

The Occurrence of Thrombosis during Intensive Chemotherapy Treatment for Acute Myeloid Leukemia Patients Does Not Impact on Long-Term Survival

Introduction A thrombotic event is seen in 10% of newly diagnosed acute myeloid leukemia (AML) patients and has been shown to be associated with disseminated intravascular coagulation (Libourel et al. Blood. 2016). As of yet, the association of developing thrombosis during intensive chemotherapy with AML risk models such as the Medical Research Council (MRC) cytogenetics-based assessment and the European LeukemiaNet (ELN) 2017 molecular based risk model has not been rigorously evaluated. In addition, there is a paucity of data pertaining to the long-term prognostic impact of thrombosis in AML patients. Aiming to investigate these prognostic facets of thrombosis in AML, we performed an analysis of patients with AML diagnosed with thrombosis during treatment with intensive chemotherapy. Methods For this analysis, we collected data on baseline clinical, laboratory, cytogenetic and molecular characteristics of patients with newly diagnosed AML who were treated with intensive chemotherapy and were diagnosed with venous thrombosis. These data were compared with intensively treated patients who did not experience thrombosis to assess for clinical parameters associated with a higher likelihood of developing thrombosis, and to determine whether overall survival was affected by thrombosis. Results The analyzed cohort consisted of 335 newly diagnosed AML patients diagnosed and treated between 2007 through 2021 at the Sheba Medical Center. Median patient age at diagnosis was 55 years. At the time of data analysis 162 patients were alive (48%). Two hundred and eighty-three patients were classified as de novo AML (85%) and the remainder were categorized as secondary disease (15%). Ninety patients harbored the FLT3-ITD mutation (28%) and 117 patients harbored NPM1 mutations (39%). Of evaluable patients, 7 were found to have biallelic CEBPA mutations (8%). In terms of MRC cytogenetic risk, 35 patients (11%) were classified as favorable risk, 219 (66%) patients as intermediate risk, 58 patients (17%) as adverse risk and 21 patients had technically insufficient cytogenetic studies. Using the ELN 2017 risk stratification model, 132 patients (40%) had favorable risk disease, 122 patients (36%) intermediate risk, and 80 patients (24%) adverse risk disease. Venous thrombosis was seen in 33 patients (9.9%) with 28 patients diagnosed with central catheter related thrombosis and 5 patients with lower extremity deep vein thrombosis. In 23 patients (70%) thrombosis occurred during the initial induction chemotherapy phase, in 5 patients (15%) during the first consolidation treatment phase, in 3 patients (9%) during the second consolidation treatment phase, and in 2 patients (6%) during admission for salvage chemotherapy. Following diagnosis of thrombosis, the central catheter was taken out in 9 patients (28%), and 3 patients (8.8%) experienced a recurrence of thrombosis. At the time of thrombosis diagnosis, 14 patients (42%) were found to have a concurrent blood stream bacterial infection. Nineteen patients (58%) were started on anticoagulation following the diagnosis of thrombosis. In univariate analysis, patient age, initial levels of white blood cells, hemoglobin, platelets, creatinine, uric acid, lactate dehydrogenase, INR, albumin, and liver function tests were not significantly different between patients who developed thrombosis and those who did not. Disease type (de novo versus secondary), FLT3-ITD and NPM1 mutational status, achievement of remission, and ELN 2017 risk category also not did not differ to a significant degree between groups. However, MRC intermediate risk group patients were significantly more likely to experience thrombosis compared to favorable risk and adverse risk patients (12.8% versus 5.7% and 1.7%, respectively; p=0.049). Overall survival was not significantly impacted by the diagnosis of thrombosis with an estimated median overall survival of 3.7 years seen in patients without thrombosis compared with 2.2 years in patients with thrombosis (p=0.47). Leukemia-free survival was also comparable between groups (2.4 years versus 1 year; p=0.15). Conclusion Venous thrombosis is seen mostly during the initial induction phase of AML patients receiving intensive therapy with a tight association with the MRC intermediate risk category, however long-term survival and leukemia related outcomes are not significantly impacted by the diagnosis of thrombosis.

The interplay of infectious diseases consultation and antimicrobial stewardship in candidemia outcomes: A retrospective cohort study from 2016 to 2019.

To evaluate the need for mandatory infectious diseases consultation (IDC) for candidemia in the setting of antimicrobial stewardship guidance. Retrospective cohort study from January 2016 to December 2019. Academic quaternary-care referral center. All episodes of candidemia in adults (n = 92), excluding concurrent bacterial infection or death or hospice care within 48 hours. Primary outcome was all-cause 30-day mortality. Secondary outcomes included guideline-adherence and treatment choice. Guideline-adherence was assessed with the EQUAL Candida score. Of 186 episodes of candidemia, 92 episodes in 88 patients were included. Central venous catheters (CVCs) were present in 66 episodes (71.7%) and were the most common infection source (N = 38, 41.3%). The most frequently isolated species was Candida glabrata (40 of 94, 42.6%). IDC was performed in 84 (91.3%) of 92 candidemia episodes. Mortality rates were 20.8% (16 of 77) in the IDC group versus 25% (2 of 8) in the no-IDC group (P = .67). Other comparisons were numerically different but not significant: repeat blood culture (98.8% vs 87.5%; P = .17), echocardiography (70.2% vs 50%; P = .26), CVC removal (91.7% vs 83.3%; P = .45), and initial echinocandin treatment (67.9% vs 50%; P = .44). IDC resulted in more ophthalmology examinations (67.9% vs 12.5%; P = .0035). All patients received antifungal therapy. Antimicrobial stewardship recommendations were performed in 19 episodes (20.7%). The median EQUAL Candida score with CVC was higher with IDC (16 vs 11; P = .001) but not in episodes without CVC (12 vs 11.5; P = .81). In the setting of an active antimicrobial stewardship program and high consultation rates, mandatory IDC may not be warranted for candidemia.

Impact of Respiratory Viral Panel Results on Piperacillin-Tazobactam Use in a Medical Intensive Care Unit: A Single-Center Retrospective Study

PurposeIn critically ill patients with acute respiratory infection, antibiotic stewardship can be challenging given the acuity and complexities of such patients, and the associated high mortality. This study determined the impact of respiratory viral panel (RVP) testing on piperacillin-tazobactam (PT) use in patients admitted to a medical intensive care unit (MICU). MethodsThis retrospective chart review used data from adults admitted to a MICU between January 1, 2017, and January 31, 2018, and with findings from at least one RVP available. FindingsRVP testing was performed on samples from 90 patients admitted to the MICU. RVP was positive in 41% (37/90) of patients, and 53.3% (48/90) received PT during their MICU stay. PT was discontinued in 25.5% (23/90) of patients, 16.2% (6/37) with a positive RVP and 32.1% (17/53) with a negative RVP. Overall mortality was significantly lower in the positive RVP group versus the negative RVP group (odds ratio = 0.28; P = 0.001). In a multivariate Cox proportional hazards model (adjusted for acute kidney injury and culture positivity), the risk for PT discontinuation was significantly less in patients with a positive RVP compared to those with a negative RVP (primary outcome). Overall mortality rate and median length of stay were significantly lower in patients with a positive RVP compared to those in patients with a negative RVP (secondary outcomes). The 30-day hospital readmission rate and the risk for AKI were not significantly different between those with positive versus negative RVP. ImplicationsReasons for these observations are currently unclear, but deserve further exploration in future studies. It is hypothesized that the treating providers were concerned about the presence of concurrent bacterial infections along with the diagnosed viral infections given that the patients were critically ill. This suggests that RVP results did not impact PT-prescribing practices in the MICU, and thus that the routine use of RVP solely for guiding antimicrobial-stewardship practices may not be effective.

Elevated Fasting Blood Glucose Levels Are Associated with Worse Clinical Outcomes in COVID-19 Patients Than in Pneumonia Patients with Bacterial Infections.

Aims: We investigate how fasting blood glucose (FBG) levels affect the clinical severity in coronavirus disease 2019 (COVID-19) patients, pneumonia patients with sole bacterial infection, and pneumonia patients with concurrent bacterial and fungal infections. Methods: We enrolled 2761 COVID-19 patients, 1686 pneumonia patients with bacterial infections, and 2035 pneumonia patients with concurrent infections. We used multivariate logistic regression analysis to assess the associations between FBG levels and clinical severity. Results: FBG levels in COVID-19 patients were significantly higher than in other pneumonia patients during hospitalisation and at discharge (all p < 0.05). Among COVID-19 patients, the odds ratios of acute respiratory distress syndrome (ARDS), respiratory failure (RF), acute hepatitis/liver failure (AH/LF), length of stay, and intensive care unit (ICU) admission were 12.80 (95% CI, 4.80–37.96), 5.72 (2.95–11.06), 2.60 (1.20–5.32), 1.42 (1.26–1.59), and 5.16 (3.26–8.17) times higher in the FBG ≥7.0 mmol/L group than in FBG < 6.1 mmol/L group, respectively. The odds ratios of RF, AH/LF, length of stay, and ICU admission were increased to a lesser extent in pneumonia patients with sole bacterial infection (3.70 [2.21–6.29]; 1.56 [1.17–2.07]; 0.98 [0.88–1.11]; 2.06 [1.26–3.36], respectively). The odds ratios of ARDS, RF, AH/LF, length of stay, and ICU admission were increased to a lesser extent in pneumonia patients with concurrent infections (3.04 [0.36–6.41]; 2.31 [1.76–3.05]; 1.21 [0.97–1.52]; 1.02 [0.93–1.13]; 1.72 [1.19–2.50], respectively). Among COVID-19 patients, the incidence rate of ICU admission on day 21 in the FBG ≥ 7.0 mmol/L group was six times higher than in the FBG < 6.1 mmol/L group (12.30% vs. 2.21%, p < 0.001). Among other pneumonia patients, the incidence rate of ICU admission on day 21 was only two times higher. Conclusions: Elevated FBG levels at admission predict subsequent clinical severity in all pneumonia patients regardless of the underlying pathogens, but COVID-19 patients are more sensitive to FBG levels, and suffer more severe clinical complications than other pneumonia patients.

Adenoviral infection in 5 red-tailed hawks and a broad-winged hawk.

Adenoviral infections among raptors are best described in falcons and are characterized most commonly by necrotizing hepatitis and splenitis; only one case has been reported in a hawk. Five red-tailed hawks (Buteo jamaicensis) and a broad-winged hawk (Buteo platypterus) had an adenoviral infection based on history, histopathology, negative-stain electron microscopy, and PCR. All birds had acute onset of illness resulting in death; 3 had evidence of a concurrent bacterial infection. Microscopically, all 6 birds had solitary, pale eosinophilic-to-amphophilic, intranuclear inclusion bodies within presumed hematopoietic cells in bone marrow and macrophages in spleen. Five of the 6 birds had similar inclusions within hepatocytes and Kupffer cells. All but one bird had severe bone marrow necrosis. There was moderate splenic necrosis (3 of 6) and mild-to-marked hepatic necrosis (4 of 6). Negative-stain electron microscopy demonstrated adenoviral particles in bone marrow (5 of 6), liver (1 of 5), and/or spleen (1 of 5). PCR was positive for adenovirus in bone marrow (3 of 5), liver (1 of 3), spleen (4 of 6), and/or intestinal contents (2 of 3). Viral DNA polymerase gene sequences clustered within the Siadenovirus genus. There was 99% nucleotide identity to one another and 90% nucleotide identity with the closest related adenovirus (Harris hawk, EU715130). Our case series expands on the limited knowledge of adenoviral infections in hawks. The splenic and hepatic necrosis, and particularly the hitherto unreported bone marrow necrosis, suggest that adenoviral infection is clinically relevant and potentially fatal in hawks.

Multisite Clinical Utilization of Antibiotics among Hospitalized Patients with COVID‐19

IntroductionSevere acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has infected over 212,000,000 individuals worldwide with a mortality rate of 2.1% as of August 2021. A concerning trend in the treatment of COVID‐19 has emerged wherein hospitalized patients are administered broad spectrum antibiotics to stave off secondary bacterial infection. However, the clinical justification for the use of broad‐spectrum antibiotics for viral respiratory infection remains tenuous. Over administration of these therapies contributes to the growing frequency of antimicrobial resistance, which prior to the pandemic contributed to nearly 700,000 death per year.ObjectiveTo describe the clinical utilization and efficacy of broad‐spectrum antibiotics among hospitalized patients with SARS‐CoV‐2 within 3 hospital systems in the American southwest.MethodsA multisite retrospective chart review of patients admitted to inpatient care due SARS‐CoV‐2 infection from March 1st, 2020 through January 31st, 2021 was conducted. ed data included patient demographics, laboratory culture results, administered antibiotics, and patient outcomes. Analysis was conducted using descriptive statistics, the Pearson chi‐square for categorical data, and the Mann‐Whitney U test for continuous data.ResultsA total of 489 patients with confirmed SARS‐CoV‐2 infection via nasopharyngeal sample were included in the analysis with 19.2% (94/489) diagnosed with a concurrent bacterial infection. Patients with concurrent bacterial infections were more likely to require critical care (50.0% vs 20.7%; p<0.001) and expire (28.7% vs 14.4%; p<0.001) while hospitalized. Though the rates of secondary bacterial infection were low, 83.4% of all patients were administered at least one broad spectrum antibiotic, with the most common being Azithromycin (60%; 297/489) followed by Ceftriaxone (46.6%; 228/489). Antibiotics were not preferentially administered to patients with concurrent bacterial infection (p=0.1619), nor did it show clinical efficacy for reducing mortality among the entire sample (p=0.190) or those with secondary infection (p=0.191).ConclusionThe COVID‐19 pandemic has contributed to non‐specific over administration of broad‐spectrum antibiotics, which failed to improve the rate of patient mortality even when afflicted with secondary infection. Over‐administration of these drugs will continue to exacerbate the growing rates of antimicrobial resistance. Clinicians are recommended to apply early empirical approaches when selecting to employ antibiotic therapies.

The Impact of Secondary Bacterial Infections in COVID‐19 Patients on Mortality and the Immune Response in the State of Arizona

The literature on COVID‐19 has focused primarily on urban centers and suggest an increased risk of mortality in COVID‐19 patients coinfected with bacteria compared to those solely infected with COVID‐19. In patients screened or admitted to suburban and rural hospitals in Arizona, mortality increased with co‐infection. The impact of bacterial coinfections on the immune response was studied by comparing white blood cell (WBC) and lymphocyte counts as well as the relationship between duration of steroid use and mortality in coinfected COVID‐19 patients investigated.MethodsA chart review of 677 SARS‐CoV‐2 patients was conducted at during December 2020 to March 2021. Patients solely infected with COVID‐19 (COVID‐19 patients) were compared to patients with concurrent bacterial or fungal infections (coinfected patients). Parameters included admission duration, ICU duration, mortality, WBC, lymphocytes, and duration of steroid use. WBC and lymphocytes were compared amongst COVID‐19 and coinfected patients that survived or that expired during their hospital stay. COVID‐19 positive patients not admitted to hospital were used as controls.ResultsThe admitted and ICU duration of coinfected patients was significantly (p < 0.05) higher (12.93 vs 10.92 days) than COVID‐19 patients (6.39 vs 4.38 days), as was mortality rate (22.5% vs 9.8%). WBC was higher (9.4x103) in coinfected patients than COVID‐19 alone (7.9x103). Lymphocytes were lower (2.03x103) in coinfected patients compared to COVID‐19 alone (2.41x103). A significant difference in WBC was seen between expired COVID‐19 patients (10.1x103), expired coinfected patients (10.01x103) and COVID‐19 non‐admitted patients (6.44x103). Lymphocytes were lower in surviving coinfected patients (I.96x103) and expired COVID‐19 patients (I.61x103) than COVID‐19 non‐admitted patients (7.33x 103). Expired coinfected patients were treated with steroids for a longer average duration (9.22 days) when compared to expired COVID‐19 (6.77 days).ConclusionThe presence of other bacterial infections increased hospitalization and mortality rate of patients admitted to a suburban hospital with COVID‐19 infection. Patients with co‐infections needed longer steroid treatment, had higher WBCs but lower lymphocytes. Thus, co‐infection presents significant challenges for treatment of patients with a diagnosis of COVID‐19.

Omphalitis and Concurrent Serious Bacterial Infection.

Describe the clinical presentation, prevalence of concurrent serious bacterial infection (SBI), and outcomes among infants with omphalitis. Within the Pediatric Emergency Medicine Collaborative Research Committee, 28 sites reviewed records of infants ≤90 days of age with omphalitis seen in the emergency department from January 1, 2008, to December 31, 2017. Demographic, clinical, laboratory, treatment, and outcome data were summarized. Among 566 infants (median age 16 days), 537 (95%) were well-appearing, 64 (11%) had fever at home or in the emergency department, and 143 (25%) had reported fussiness or poor feeding. Blood, urine, and cerebrospinal fluid cultures were collected in 472 (83%), 326 (58%), and 222 (39%) infants, respectively. Pathogens grew in 1.1% (95% confidence interval [CI], 0.3%-2.5%) of blood, 0.9% (95% CI, 0.2%-2.7%) of urine, and 0.9% (95% CI, 0.1%-3.2%) of cerebrospinal fluid cultures. Cultures from the site of infection were obtained in 320 (57%) infants, with 85% (95% CI, 80%-88%) growing a pathogen, most commonly methicillin-sensitive Staphylococcus aureus (62%), followed by methicillin-resistant Staphylococcus aureus (11%) and Escherichia coli (10%). Four hundred ninety-eight (88%) were hospitalized, 81 (16%) to an ICU. Twelve (2.1% [95% CI, 1.1%-3.7%]) had sepsis or shock, and 2 (0.4% [95% CI, 0.0%-1.3%]) had severe cellulitis or necrotizing soft tissue infection. There was 1 death. Serious complications occurred only in infants aged <28 days. In this multicenter cohort, mild, localized disease was typical of omphalitis. SBI and adverse outcomes were uncommon. Depending on age, routine testing for SBI is likely unnecessary in most afebrile, well-appearing infants with omphalitis.

Histopathology and transcriptome analysis reveals the gills injury and immunotoxicity in gibel carp following acute deltamethrin exposure

More and more evidences proved that deltamethrin (Del) exposure induced adverse effects and damaged immune function to the aquatic animals in the parasite killing process with increasing insecticide application. However, little is currently known of the negative effect on mucosal immunity, especially in gills tissue. Therefore, this study was aimed to reveal the tissue injury and immunotoxicity in the gill of gibel carp following acute deltamethrin exposure. The LC50 of deltamethrin on gibel carp at 96 h was determined to be 6.194 μg/L, and then juvenile gibel carp (Carassius auratus gibelio) (8.8 ± 1.0 g) were exposed to four Del exposure groups (0.61, 1.22, 2.44, and 4.88 μg/L) for 12 h and 24 h. We measured the lysozyme (LYZ) contents and myeloperoxidase (MPO) activities and found that with increased concentration of Del exposure, the LYZ contents were found to increase in the 1.22 μg/L Del group initially significantly and then gradually significantly decrease in the 4.88 μg/L Del group. And the activities of MPO were significantly lifted in a dose-dependent manner. The histological analysis showed that Del exposure caused serious desquamation and necrosis in the surface of epithelial cells, accompanied by interlamellar cellular mass degenerative. In addition, the mucous cells were significantly decreased in the high Del concentration group (2.44 μg/L and 4.88 μg/L Del group) by AB-PAS staining. Additionally, totally 2857 DEGs (including 1624 up-regulated and 1233 down-regulated genes) were identified between the control group and 4.88 μg/L Del exposure group using transcriptional analysis. Among these, some genes involved in innate immune molecules, complement activation, apoptosis-related molecules, cytokine, and adaptive immune molecules, were also down-regulated. Importantly, we found immune system process and tumor necrosis factor receptor (superfamily) binding pathways were downregulated based on the GO and KEGG enrichment analysis. Meanwhile, we detected the expression of pro-inflammatory cytokines (TNF-α, IFN-γ, IL-1β, and IL-8), anti-inflammatory cytokines (TGF-β), LYZ, IgM, and Hsp70 in the gills tissue at 12 h and 24 h after Del exposure, which were consistent with our sequencing results. Collectively, these results demonstrated that the gills injury and immunotoxicity were induced by Del exposure and provided novel insight for explaining to some extent why Del-exposure fish are more susceptible to concurrent or secondary viral or bacterial infections.

Amoebiasis in Pregnancy: A Review and Update of the Literature

Amoebiasis in Pregnancy: A Review and Update of the Literature

Cancer has an Independent Association with Death in Hospitalized Patients with COVID-19: A Single-center Study in Iran

Background: COVID-19 could cause severe complications in those with pre-existing conditions such as cancer. Here, we aimed to assess the outcome of COVID-19 in hospitalized patients with a history of cancer. Methods: In this retrospective cohort study, we extracted medical records of patients with any cancer history among hospitalized patients with COVID-19. Our patients were admitted between February 20th and July 15th, 2020. The primary outcome was death, and the secondary outcomes were overall survival, COVID-19-specific mortality, admission to intensive care unit (ICU), and hospital stay. A group of individuals without cancer history was selected from the COVID-19 cohort and matched for age, gender, and pre-existing conditions. We utilized univariate and multivariate logistic regression to analyze the association between studied variables and primary outcomes. Results: We identified 46 patients with cancer and COVID-19. The median age was 63, and 54.3% were male. According to the univariate logistic regression analysis, death was 5.3 (CI95%: 1.75-15.85) times more probable in cancer patients than controls (p=0.003). The multivariate analysis adjusted for having cancer and sex, age, and having any comorbidity showing this figure was 5.5 (CI95%:1.8-16.8) (p=0.003). The 30- and 90-day COVID-19 specific mortality was 30% (CI95%:17-43) and 33% (CI95%: 20-46), respectively. Conclusion: Patients with COVID-19 with a history of cancer have a considerably higher risk of death irrespective of age, gender, and other pre-existing conditions. Patients with advanced cancers and concurrent bacterial infections need the most vigorous care.