Department Of Infectious Diseases Research Articles

Severe Malaria and Risk Factors for Death in the Infectious Diseases Department of the University Hospital of Fann in Dakar, Senegal

Aim: The aim of this study was to describe the epidemiological, clinical, paraclinical and outcome aspects of severe malaria and to determine the risk factors for death.
 Methodology: This was a retrospective descriptive and analytical study of patients treated for severe malaria at the infectious and tropical diseases department of the University Hospital center of Fann between January 1, 2019 and December 31, 2021. Multivariate logistic regression was used to identify risk factors for death 
 Results: During our study, 138 patients were hospitalized for severe malaria over a period of 3 years, with a peak in the months of october and november. They were mostly from urban areas (68.11%). The average consultation time was 6.7 days ± 7.1 days. There was a clear male predominance, with a sex ratio of 3.18. The average age of patients was 33.96 ± 17 years. The main signs of clinical severity were coma (44.2%), prostration (36.95%) and jaundice (61.5%). Biological signs included anaemia (14.49%) and renal failure (9.42%). Severe malaria was associated with SARS Cov 2 infection in 4 patients. All patients were treated with injectable artesunate. The average length of hospitalization was 6 ± 6 days. Case fatality was 10.7. In multivariate analysis, coma (ORa =12.29 IC95%: 2.0 - 73.22 P=0.006) and severe anaemia (ORa=27.16 IC95%: 3.4 - 217.18 P=0.006) were risk factors associated with death.
 Conclusion: Early recognition of the signs of seriousness and their early management thanks to improved technical facilities in intensive care units can improve the prognosis of patients.

Ramsay Hunt syndrome and concurrent varicella-zoster virus meningitis in Denmark: A nationwide cohort study.

Ramsay Hunt syndrome (RHS) is a manifestation of reactivated varicella-zoster virus (VZV) from the geniculate ganglion. Data on clinical features and outcomes of patients with RHS and concurrent VZV meningitis (henceforth RHS meningitis) are limited. Thus, we conducted a nationwide population-based cohort study of all adults hospitalized for RHS meningitis at the departments of infectious diseases in Denmark from 2015 to 2020. Patients with VZV meningitis without cranial nerve palsies were included for comparison. In total, 37 patients with RHS meningitis (mean annual incidence: 1.6/1 000 000 adults) and 162 with VZV meningitis without cranial nerve palsies were included. In RHS meningitis, the median age was 52 years (interquartile range: 35-64), and in addition to peripheral facial nerve palsy (100%), dizziness (46%), and hearing loss (35%) were common symptoms. The triad of headache, neck stiffness, and photophobia/hyperacusis was less common in RHS meningitis than in VZV meningitis without cranial nerve palsies (0/27 [0%] vs. 24/143 [17%]; p = 0.02). At 30 days after discharge, 18/36 (50%) patients with RHS meningitis had persistent peripheral facial nerve palsy, with no statistically significant difference between those treated with and without adjuvant glucocorticoids (6/16 [38%] vs. 12/20 [60%]; p = 0.18). Additional sequelae of RHS meningitis included dizziness (29%), neuralgia (14%), tinnitus/hyperacusis (11%), hearing loss (9%), headache (9%), fatigue (6%), and concentration difficulties (3%). In conclusion, clinical features and outcomes of RHS meningitis were primarily related to cranial neuropathies.

Inpatient covid-19-related comorbidities and ct-semiotics

Introduction. In the Russian Federation, registration of individual COVID-19 cases started at the end of January 2020 that markedly increased in the second half of March. At the moment, the situation with COVID-19 is unstable. As of 2023, COVID-19 incidence in descending order is as follows: USA (104 958 987 people), India (44 684 775 people) and France (39 582 057 people). Russia ranked 10th regarding total COVID-19 incidence (22 137 084 people, including 395 727 fatalities). The infection is able to “overlap” with the underlying pathology, thereby worsening patient’s condition up to death. Lung multislice computed tomography (MSCT) is recommended for all patients with COVID-19. If unavailable, a chest X-ray is performed. The aim of the study was to identify the most frequent comorbid diseases and changes on radiological scan in patients with COVID-19.Materials and methods. The study was carried out at the Infectious Disease Department No. 1, Regional Public Health Institution “Clinical Hospital No. 1” Smolensk. For this, there were analyzed 69 hospital patient records with basic diagnosis — coronavirus infection. The data of anamnesis and additional instrumental investigations were taken into account.
 Results. 69 patients aged between 18 and 91 years were included in the study. Respiratory failure was not observed in 75.81% of cases. A group of patients (66.67%) with comorbidities of organs and systems was identified, among which most common were: arterial hypertension (95.65%), coronary heart disease (78.26%), diabetes mellitus (30.43%), grade 1–2 obesity (17.39%), chronic hepatitis (17.39%). Diseases of the gastrointestinal tract and respiratory system were less prevalent. The rate of reported complications is as follows: bilateral polysegmental pneumonia — 72.46%; unilateral polysegmental pneumonia — 2.8%; pleurisy — 4.35%; unilateral hydrothorax — 1.45%. Each of the inpatients underwent radiological examination during hospitalisation. X-ray examination accounted for a smaller proportion (39.13%) and multispiral chest computed tomography (MSCT) — for a bigger percentage (60.87%). Chest MSCT at the beginning of inpatient treatment visualized CT-2 stage (64.29%) in the vast majority, less — CT-1 (26.19%), least frequently — CT-3 (7.14%) and CT-4 (2.38%). Before patient discharge, an average of 12.16% improvement in the radiological picture was found in patients with initial CT-1 stage, 14% — in CT-2, 12% and 26% — in CT-3 and CT-4, respectively.Conclusion. The moderate disease course without respiratory depression prevailed among the patients. Co-morbidities were found mainly in the anamnesis of persons over 50 years old. The most frequent clinical complication of coronavirus infection was bilateral pneumonia. After patient’s hospitalization, clinical and instrumental picture gradually improved, which was confirmed by radiological data.

A Rare Presentation of Pancytopenia - Amiodarone-Induced Bone Marrow Granuloma

Introduction: Amiodarone is a widely used antiarrhythmic medication associated with a various range of side effects, such as thyroiditis, pneumonitis, and hepatitis. Additionally, although extremely rare, amiodarone has been reported to induce bone marrow granuloma, leading to hematologic disorders. This abstract illustrates the case of amiodarone-induced bone marrow granuloma resulting from unopposed intake of the medication. Case presentation: A 67-year-old male with a known history of iron deficiency and Vitamin B12 deficiency was referred to the hematology/oncology clinic from his primary care clinic due to persistent pancytopenia despite receiving iron and vitamin supplements. Three months before this presentation, the patient underwent EGD and colonoscopy, which did not reveal any gastrointestinal neoplasm. He denied experiencing other symptoms, such as fever, chill, nausea, or vomiting. Both his vital signs and physical examinations were unremarkable. Routine lab results showed pancytopenia, with a hemoglobin level of 11.2, MCV of 71, WBC of 2.6, and platelet of 128. The peripheral blood smear did not demonstrate any blasts or atypical leukocytes. Flow cytometry was negative for abnormal cellular populations. However, the bone marrow biopsy revealed a hypercellular marrow with numerous scattered non-necrotizing granulomas without blasts or atypical cells. A broad range of diagnoses was considered encompassing sarcoidosis, malignancy, infective diseases, and drug reactions. Chest, abdomen, and pelvis CT showed no evidence of malignancy or sarcoidosis. The patient was referred to the infectious disease department to exclude undiagnosed infectious causes. An extensive work-up ensued, including tick-borne diseases, fungal infections, tuberculosis, hepatitis, CMV, and HIV, all of which yielded negative results. The patient's medication list was reviewed to evaluate any potential medication-related adverse effects. Notably, it revealed that the patient had been self-administering amiodarone 200mg once daily for the past 18 months without appropriate cardiology supervision, which was prescribed to manage frequent premature ventricular complexes (PVCs). This situation occurred as a result of the cardiologist leaving the area, which led to a disruption in the follow-up care. Consequently, the patient was presumably diagnosed with amiodarone-induced bone marrow granuloma and was referred to cardiology for further management of amiodarone and PVC. Management: Amiodarone was discontinued and was switched to sotalol by cardiology. Simultaneously, the patient continued to follow hematology/oncology for regular follow-up of CBC. Following the cessation of amiodarone, the patient's pancytopenia gradually improved over time. Discussion: Amiodarone-induced bone marrow granuloma is an extremely rare adverse effect, and its incidence remains unknown due to limited information. However, several case reports documented a similar side effect associated with amiodarone. Typically, bone marrow biopsy reveals noncaseating granuloma, and patients may exhibit various forms of cytopenia. Patients with this condition have shown improvement in cytopenia after the discontinuation of amiodarone. Also, it was observed that granuloma of the bone marrow partially or completely resolves following the discontinuation. However, considering the wide array of potential causes of bone marrow granuloma, including infectious diseases, malignancy, or inflammatory diseases, physicians must thoroughly investigate and exclude other plausible causes before making the diagnosis. Nevertheless, it is crucial for physicians to include amiodarone as the differential diagnosis of pancytopenia as it can be easily reversed by the discontinuation of amiodarone.

541. The Effect of Early Remdesivir Administration in COVID-19 Disease Progression

Abstract Background Since the global outbreak of SARS-CoV-2, antiviral drugs have played a major role in the treatment of COVID-19 by reducing complications and mortality. Remdesivir is an effective therapeutic option for hospitalized patients with risk for clinical progression with COVID-19 who cannot receive nirmatrelvir/ritonavir mainly because of kidney & liver disease or issues with drug- interactions. Remdesivir can be administered for as long as 7 days after symptom onset according to treatment recommendations, but antiviral treatment work best when given as early as possible. In this study we investigated the impact of timing of remdesivir administration on clinical outcome. Methods Retrospective clinical data from consecutive PCR-confirmed SARS-CoV-2 patients who received remdesivir and were hospitalized at the department of infectious diseases, Clinic Favoriten (Vienna) from the 1st of July 2021 until the 31st of April 2022 were analyzed. We divided patients into two groups of early (0-3 days since symptom onset) and late (≥ 4) remdesivir administration. The primary outcome was in hospital disease progression measured according to the WHO COVID-19 Clinical Progression Scale (≥1 point). In a multivariable logistic regression adjusted for age, sex, SARS-CoV2 variant, and COVID-19 vaccination status, clinical outcomes were assessed. Results 219 patients who received remdesivir could be included in the analysis. The ratio between early and late group was 67.6% to 32.4%. After adjusting for age, sex, vaccination status, and viral variant, patients who received remdesivir more than 4 days after symptom onset tended to have a higher probability of clinical deterioration (OR 2,13 95% CI 0,98 to 4,64, p= 0,056) including a higher probability for high-flow oxygen therapy (OR 2,52 95% CI 1,40 to 4,52, p= 0,002) or being admitted to ICU (OR 4,34 95% CI 1,38 to 13,67, p= 0,012). There was no significant difference in mortality.Table 1.Demographic and Clinical Characteristics of the PatientsTable 2.Clinical outcomes adjusted to age, sex, virus variant and vaccination status Conclusion Our data show that the risk for complications of COVID19 including a need for high-flow oxygen therapy and ICU admission is elevated when remdesivir is administered after day 4 in hospitalized patients. This may indicate that patients at increased risk for severe disease who cannot take oral options should receive antiviral therapy with remdesivir as early as possible. Disclosures Moritz Platzer, MD, Gilead: Grant/Research Support

1869. Knowledge about and Perceptions of Latent Tuberculosis Infection (LTBI) among Physicians and Advanced Practice Providers at Tufts Medical Center

Abstract Background Mycobacterium Tuberculosis (TB) is a leading cause of infectious disease mortality worldwide. Most active TB cases result from reactivation of latent tuberculosis infection (LTBI). A large reservoir of latent TB is a major public health problem worldwide and in the United States. A better understanding of provider perspectives on LTBI could improve a sub-optimal LTBI care cascade. Methods A 13-question survey was fielded to attending physicians, fellows, and advanced practice providers working in the infectious disease, pulmonary/critical care, and general medicine departments at Tufts Medical Center (TMC), an academic tertiary care center in Boston, Massachusetts. Results The response rate of the survey was 33% (62/186). Only 17 (30.9%) providers were able to correctly identify all indications for screening. When asked how they decide who to treat, 26.8% (15/56) of providers selected that they would refer their patient to another specialist. Overall, provider confidence in LTBI management decreased along the care cascade (Figure 1). Infectious disease providers expressed more confidence in management than general medicine and pulmonary/critical care providers. The two most observed issues/barriers to care for patients were language, reported by 39 (76.5%) providers, and lack of knowledge or understanding about TB, reported by 39 (76.5%) providers. The two most selected interventions to improve LTBI care at TMC were use of in-person language interpreters, chosen by 37 (71.2%) providers, and information pamphlets available in patients’ preferred languages, chosen by 36 (69.2%) providers. Providers were asked “On a scale of 1-5, (“1” = not at all, and “5” = perfectly) “How confident are you in your ability to do the following” for the listed management tasks. Conclusion Results suggest that providers believe the largest barriers to patient LTBI treatment completion are due to a lack of patient comprehension about their infection. Improving patient understanding could be accomplished through in-person interpreters, information pamphlets about LTBI in patients’ preferred languages, and forming community partnerships to improve awareness and understanding of the risks of LTBI. Additionally, ensuring that providers feel confident in their ability to manage LTBI, are updated on screening guidelines, and have referral resources when needed, could help close the gaps in the LTBI care cascade. Disclosures All Authors: No reported disclosures

574. Daily Antibiotic Utilization Prescription Audit in the Infectious disease (ID) and Non-ID Department in Hospitalized Patients: A Prospective Case-Control study in a Teritiary care hospital

Abstract Background Antimicrobial prescription audits were often carried out to reduce the overuse of antibiotics. Usually, audits were performed over periodical intervals. Daily antibiotics audits were time consuming and labour intensive. Though it"s practically impossible, we tried. However, we conducted this audit over a three-month period as daily audit and the cases were regularly followed. It is the prospective case-control study of antibiotic utilizations from prescriptions on ID and non-ID department. Methods This Prospective Case-Control study was conducted in tertiary care hospital in India for a period of 3months (Jan-mar2023). Data regarding demographics, antibiotic therapy, diagnosis, rational antibiotic usage (indications mentioned or not), type of therapy (surgical prophylaxis, definitive and empirical therapy) and 48hrs review of antibiotic prescriptions (escalation, de-escalation, continuation and dis-continuation therapy) of both groups were collected by Pharm-D interns from the medical records and analysed using SPSS version 26.0. Results During the study period, 899 subjects’ medical records were audited for antibiotic usage from the prescriptions. The comparative data were shown in table-1. Conclusion 1/3rd of the cases acquired ID opinion which is significantly less than the non-ID department. Predominantly ID opinion is acquired when culture shows positive results. In most cases, the indications were mentioned only by the ID and not by the non-ID team. Discontinuation (28.1%) and de-escalations (18.7%) done by the ID was found to be significantly higher than non-ID. Based on this, we conclude that ID opinion play a crucial role in selection of antibiotics, both in terms of definitive and empirical choices. This study has certain limitations where, outcomes will be followed further. Disclosures All Authors: No reported disclosures

Effects of sputum bacillary load and age on GeneXpert and traditional methods in pulmonary tuberculosis: a 4-year retrospective comparative study

BackgroundThe purpose of this study was to evaluate the diagnostic value of the GeneXpert® MTB/RIF (Xpert®), Auramine O staining method, and Lowenstein-Jensen medium for bacteriologically confirmed pulmonary tuberculosis and explore the effects of the sputum bacillary load (SBL) and qRT‒PCR threshold cycle (Ct) value on the detection methods.MethodsWe retrospectively analysed the results in the Department of Infectious Disease for 49 months. The χ2 test was used to compare the performances of each method, receiver operating characteristic curve analysis was used to determine the optimal cut-off values, and the factors associated with a false-negative result from Xpert® were analysed by logistic regression.ResultsSimultaneous analysis of 980 sputum specimens showed that the positive detection rate of Xpert® did not increase with increasing SBL, and there were differences between the three when SBL ≤ 1 + (all P < 0.05). There was a good negative correlation between the Ct value and the SBL (P < 0.0001). Age was an independent risk factor for false-negative Xpert® results (P = 0.029), and when Ct < 16, the diagnostic sensitivity and specificity were both 100.00%. The optimal cut-off Ct values for resegmentation based on the drug resistance classification were < 18.6, 18.6–34.1, and > 34.1 cycles.ConclusionsXpert® was not affected by SBL but it was by age, and it is more advantageous when SBL ≤ 1 + . The results regarding rifampicin resistance were reliable, and the novel Ct segmentation was a practical and more clinically meaningful classification method for diagnosing rifampicin resistance. These findings will help improve physicians’ ability to accurately diagnose TB.

Characteristics of hematological parameters on admission in COVID-19 Omicron variant infected in Chinese population: a large-scale retrospective study

BackgroundThe Omicron variant of SARS-CoV-2, currently the most prevalent strain, has rapidly spread in Jingzhou, China, due to changes in the country’s epidemic prevention policy, resulting in an unprecedented increase in cases. Previous studies reported hematological parameters’ predictive value in COVID-19 severity and prognosis, but their relevance for early diagnosis in patients infected by the Omicron variant, particularly in high-risk pneumonia cases, remains unclear. Our study aimed to evaluate these parameters as early warning indicators for Omicron-infected patients in fever clinics and those with pulmonary infections (PI).MethodsA total of 2,021 COVID-19 patients admitted to the fever clinic and infectious disease department of Jingzhou Hospital Affiliated to Yangtze University from November 1, 2022, to December 31, 2022, were retrospectively recruited. Demographic and hematological parameters were obtained from the electronic medical records of eligible patients. These hematological parameters were analyzed by receiver operating characteristic (ROC) curves to determine whether they can be used for early diagnosis of COVID-19 patients in fever clinics and the presence of PI in COVID-19 patients.ResultsStatistical differences in hematological parameters were observed between COVID-19 patients with fever and PI and control groups (P < 0.01). The ROC curve further demonstrated that lymphocyte (LYM) counts, neutrophil (NEU) counts, monocyte-to-lymphocyte ratios (MLR), platelet-to-lymphocyte ratios (PLR), white blood cell counts (WBC), and mean corpuscular hemoglobin concentration (MCHC) were the top 6 indicators in diagnosing Omicron infection with fever, with area under the curve (AUC) values of 0.738, 0.718, 0.713, 0.702, 0.700, and 0.687, respectively (P < 0.01). Furthermore, the mean platelet volume (MPV) with an AUC of 0.764, red blood cell count (RBC) with 0.753, hematocrit (HCT) with 0.698, MLR with 0.694, mean corpuscular hemoglobin (MCH) with 0.676, and systemic inflammation response indexes (SIRI) with 0.673 were the top 6 indicators for the diagnosis of COVID-19 patients with PI (P < 0.01).ConclusionsLYM, NEU, MLR, PLR, WBC, and MCHC can serve as potential prescreening indicators for Omicron infection in fever clinics. Additionally, MPV, RBC, HCT, MLR, MCH, and SIRI can predict the presence of PI in COVID-19 patients infected by the Omicron variant.

80 years of protecting children's health (to the anniversary of the formation and development of the Department of Children's Infectious Diseases named after Professor S. D. Nosov of the Ivanovo State Medical Academy)

The article presents the history of the development of the Department of Children's Infectious Diseases named after Professor S.D. Nosov of the Ivanovo State Medical Academy. The department was created in 1943 on the basis of the 2nd infectious diseases building of the First City Clinical Hospital in Ivanovo. For 80 years, the staff of the department has preserved and continued the scientific and pedagogical traditions in training qualified personnel for Russian healthcare and preserving the health of children.

Clinical and laboratory aspects of the new coronavirus infection in newborns and infants

Purpose: to identify clinical and laboratory aspects of a new coronavirus infection in newborns and infants. Materials and methods: a retrospective analysis of 131 observations of newborns and infants infected with SARS-CoV-2 treated in children's infectious diseases departments of Izhevsk was carried out. Results. The course of coronavirus infection in newborns and infants who became ill on an outpatient basis and were hospitalized did not have significant specific clinical and laboratory features and was similar to the symptoms of major respiratory infections. Among the hospitalized, 80.9% of children had a mild severity of coronavirus infection, the rest of the children had a moderate course. The clinical picture was dominated by cough (86.3%), nasal congestion (74%) and fever (71.8%). Significant clinical differences were obtained in newborns in the form of predominance of nasal obstruction, and in infants in the predominance of fever and dry cough. Pneumonia was diagnosed in 19.1% in the form of a mild, mainly bilateral lesion.

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

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

In memory of Alexander Markusovich Bronshtein

On August 11, 2023, at the age of 79 years, Alexander Markusovich Bronstein, Doctor of Medical Sciences, Professor of the Department of Infectious Diseases and Epidemiology of the Faculty of Medicine of the Russian National Research Medical University named after N.I. Pirogov, who worked on the editorial board of our magazine for more than a quarter of a century.

Viral lumbosacral radiculitis (Elsberg syndrome) in Denmark

PurposeTo describe clinical features and outcomes of viral lumbosacral radiculitis (Elsberg syndrome).MethodsNationwide population-based cohort study of all adults hospitalised for viral lumbosacral radiculitis at departments of infectious diseases in Denmark from 2015 to 2020.ResultsTwenty-eight patients with viral lumbosacral radiculitis were included (mean annual incidence: 1.2/1,000,000 adults). The median age was 35 years (IQR 27–43), and 22/28 (79%) were female. All patients had urinary retention, with 17/28 (61%) needing a catheter. On admission, at least one sign or symptom of meningitis (headache, neck stiffness, photophobia/hyperacusis) was present in 18/22 (82%). Concurrent genital herpetic lesions were present in 11/24 (46%). The median cerebrospinal fluid leukocyte count was 153 cells/µL (IQR 31–514). Magnetic resonance imaging showed radiculitis/myelitis in 5/19 (26%). The microbiological diagnosis was herpes simplex virus type 2 in 19/28 (68%), varicella-zoster virus in 2/28 (7%), and unidentified in 7/28 (25%). Aciclovir/valaciclovir was administered in 27/28 (96%). At 30 days after discharge, 3/27 (11%) had persistent urinary retention with need of catheter. At 180 days after discharge, moderate disabilities (Glasgow Outcome Scale score of 4) were observed in 5/25 (20%).ConclusionsUrinary retention resolved within weeks in most patients with viral lumbosacral radiculitis, but moderate disabilities according to the Glasgow Outcome Scale were common at the end of follow-up.

Quality of Life of People Living with HIV on Antiretroviral Therapy: A Cross-Sectional Study in Monastir, Tunisia.

Despite the benefits of an efficient antiretroviral therapy (ART), HIV/AIDS epidemic still represents the most seriousaffection worldwide that negatively impacts people's quality of life (QoL). As no studies exist on QoL in Tunisia, the aim of the present work was i: to assess, based on WHOQOL-HIV BREF tool, the perception of QoL of people living with HIV (PLHIV) receiving ART and ii: to investigate the relationship between socio-demographic features, disease-related variables and QoL domains' mean scores. This cross-sectional study was conducted at the department of infectious diseases of F. Bourguiba Teaching Hospital in Monastir, Tunisia. One hundred and five participants receiving ART were involved. QoL assessment was based on the WHOQOL-HIV Bref including six domains with 29 items with scores ranged from the lowest (4) to the highest (20). Results were reported as frequencies and means (±SD). The Student's t-test for independent samples and the one-way ANOVA were performed to assess differences in QoL mean scores. Linear regression analysis was used to investigate predictors of QoL. The confidence interval was set at 95%. Clients' mean age was 39.20±10.18 years old with a male to female sex ratio of 3.12. Low mean scores were seen with the environment (12.34±2.90), social relations (12.58±3.94) and psychological domains (12.76±3.31), and moderate mean scores were noted for the physical (14.11±3.52), the spiritual (14.05±3.78) and the level of independence (13.98±3.57) domains. Regression analysis showed that health status and feeling healthy were related to all QoL domains and that profession, marital status and the presence of a confident person were related to environment and spiritual domains. QoL of PLHIV on ART is affected. Concrete measures and strategies should be undertaken by healthcare stakeholders to improve QoL determinants.

A Predictive Model for Identifying Low Medication Adherence Among Patients with Cirrhosis.

This study aims to identify the novel risk predictors of low medication adherence of cirrhosis patients in a large cohort and construct an applicable predictive model to provide clinicians with a simple and precise personalized prediction tool. Patients with cirrhosis were recruited from the inpatient populations at the Department of Infectious Diseases of Tangdu Hospital. Patients who did not meet the inclusion criteria were excluded. The primary outcome was medication adherence, which was analyzed by the medication possession ratio (MPR). Potential predictive factors, including demographics, the severity of cirrhosis, knowledge of disease and medical treatment, social support, self-care agency and pill burdens, were collected by questionnaires. Predictive factors were selected by univariable and multivariable logistic regression analysis. Then, a nomogram was constructed. The decision curve analysis (DCA), clinical application curve analysis, ROC curve analysis, Brier score and mean squared error (MSE) score were utilized to assess the performance of the model. In addition, the bootstrapping method was used for internal validation. Among the enrolled patients (460), most had good or moderate (344, 74.78%) medical adherence. The main risk factors for non-adherence include young age (≤50 years), low education level, low income, short duration of disease (<10 years), low Child-Plush class, poor knowledge of disease and medical treatment, poor social support, low self-care agency and high pill burden. The nomogram comprised these factors showed good calibration and good discrimination (AUC = 0.938, 95% CI = 0.918-0.956; Brier score = 0.14). In addition, the MSE value was 0.03, indicating no overfitting. This study identified predictive factors regarding low medication adherence among patients with cirrhosis, and a predictive nomogram was constructed. This model could help clinicians identify patients with a high risk of low medication adherence and intervention measures can be taken in time.

CORRELATION BETWEEN INTRAHEPATIC cccDNA AND SERUM HBV pgRNA IN TREATMENT-NAÏVE CHRONIC HEPATITIS B PATIENTS

Objectives: To evaluate the correlation between intrahepatic covalently closed circular DNA (cccDNA) and serum HBV pregenomic Ribo nucleic acid (pgRNA) in treatment-naïve chronic hepatitis B (CHB) patients. Methods: A total of 105 treatment-naïve CHB patients from the Department of Infectious Diseases, Military Hospital 103, Vietnam Military Medical University, were enrolled from 2017 to 2020. Real-time RT-PCR methods were used to quantify serum HBV pgRNA and intrahepatic cccDNA. Clinical and histopathological assessments were also performed. The patients were categorized into two groups: HBeAg-positive CHB (n = 59) and HBeAg-negative CHB (n = 46). Statistical analyses were conducted using Medcalc 20.019. Results: In treatment-naïve patients, the average concentration of cccDNA and HBV RNA were 1.61 ± 0.40 log10 copies/cell and 4.88 ± 1.65 log10 copies/mL, respectively. A positive linear correlation was observed between HBV pgRNA and cccDNA, especially in the overall group and the HBeAg-negative subgroup, as well as in patients with HAI score ≥ 9 and Fibrosis score ≥ 3 (r = 0.49, r = 0.56, and r = 0.57; p &lt; 0.01, respectively). Conclusion: The study findings indicate a positive linear correlation between intrahepatic cccDNA and serum HBV pgRNA in CHB patients. HBV pgRNA can serve as a reliable marker in the management of CHB patients.

Association of HLA-DRB1*11 and HLA-DRB1*12 gene polymorphism with COVID-19 in Burkina Faso

BackgroundThe clinical manifestations of coronavirus disease (COVID-19) can vary widely, ranging from asymptomatic to severe, and may be influenced by the host genetic background. The aim of the present study was to determine the frequencies of HLA-DRB1*11 and HLA-DRB1*12 allele polymorphisms and their associations with COVID-19.MethodsIn this cross-sectional study, 198 subjects were enrolled, including 150 COVID-19 positive cases and 48 subjects who tested negative for COVID-19. Participants were recruited from the emergency, intensive care, and infectious diseases departments of the Bogodogo Centre University Hospital (CHU-B) or the routine laboratory of Centre de Recherche Biomoléculaire Pietro Annigoni (CERBA). Genomic DNA was extracted from nasopharyngeal swabs samples and multiplex PCR-SSP was used to detect the HLA-DRB1*11 and HLA-DRB1*12 alleles. The study was approved by CERS (№ 2021-02-033).ResultsThe positive cases were categorized into 38 asymptomatic (CC+), 60 symptomatic (NC+), and 52 severe cases (SC+). Females were more frequent in the overall study population (53.0%, 105/198) as well as in the negative group’s CC- (68.75%, 33/48) and SC+ (57.69%, 30/52 negative groups, whereas males were more frequent in the CC+ (63.16%, 24/38) and NC+ (53.33%, 32/60) groups. The highest mean age was observed in the SC + group. A frequency of 19.19% (38/198) and 14.65% (29/198) was found for the HLA-DRB1*11 and HLA-DRB1*12 alleles, respectively. Individuals carrying the HLA-DRB1*11 allele had an approximately sixfold higher risk of asymptomatic SARS-CoV-2 infection (OR = 5.72 [1.683–19.442], p = 0.005) based on the association analysis.ConclusionsAltogether, the present study reports high frequency of HLA-DRB1*11 and HLA-DRB1*12 alleles within a population from Ouagadougou, Burkina Faso. The results suggest that individuals carrying the HLA-DRB1*11 allele are more susceptible to COVID-19 infection but may not display symptoms.

Steroid use in measles: A retrospective cohort study during the 2017 outbreak in tertiary referral center, Rome and Latina, Italy

IntroductionSince early January 2017, a new measles outbreak in Italy has been observed. The aim of the study was to compare features between adults and children measles cases and evaluate the effect of steroid treatment on the above parameters. MethodsA retrospective multicenter, descriptive study was performed. We analyzed all patients admitted to the Department of Public Health and Infectious Diseases, Sapienza University, Rome and Latina, from January 2017 to December 2017 and discharged with diagnosis of measles. ResultsWe identified 113 patients discharged with the diagnosis of measles infection cases of which 59 adults and 54 children (≤16 years). In adult population 32 patients (54 %) were males, with a median age of 30.5 years old and all unvaccinated (100 %). Keratoconjunctivitis 30 (50 %) was the most frequent complication. In pediatric population 27 (50 %) patients were males, with a median age of 3 years old. Information on measles vaccination status was available for only 21 (38.8 %) of cases. Keratoconjunctivitis 40 (74 %) was the most frequent complication. Analyzing the differences between adult and pediatric patients we found that children were significantly more likely to have keratoconjunctivitis and diarrhea as complications than adults in which the rate of thrombocytopenia and hepatitis was highest. Thirty-nine adult subjects (66 %) have been treated with systemic corticosteroids. ConclusionsPediatric patients differ from adults in complications and liver involvement. Regarding steroids use, although there is no clear indication of steroid use during measles, there is no evidence of a worse outcome in our cases series.

Benign recurrent lymphocytic meningitis (Mollaret's meningitis) in Denmark: a nationwide cohort study.

Data on clinical features and outcomes of benign recurrent lymphocytic meningitis (BRLM) are limited. This was a nationwide population-based cohort study of all adults hospitalized for BRLM associated with herpes simplex virus type 2 (HSV-2) at the departments of infectious diseases in Denmark from 2015 to 2020. Patients with single-episode HSV-2 meningitis were included for comparison. Forty-seven patients with BRLM (mean annual incidence 1.2/1,000,000 adults) and 118 with single-episode HSV-2 meningitis were included. The progression risk from HSV-2 meningitis to BRLM was 22% (95% confidence interval [CI] 15%-30%). The proportion of patients with the triad of headache, neck stiffness and photophobia/hyperacusis was similar between BRLM and single-episode HSV-2 meningitis (16/43 [37%] vs. 46/103 [45%]; p = 0.41), whilst the median cerebrospinal fluid leukocyte count was lower in BRLM (221 cells vs. 398 cells; p = 0.02). Unfavourable functional outcomes (Glasgow Outcome Scale score of 1-4) were less frequent in BRLM at all post-discharge follow-up visits. During the study period, 10 (21%) patients with BRLM were hospitalized for an additional recurrence (annual rate 6%, 95% CI 3%-12%). The hazard ratio for an additional recurrence was 3.93 (95% CI 1.02-15.3) for patients with three or more previous episodes of meningitis. Clinical features of BRLM were similar to those of single-episode HSV-2 meningitis, whilst post-discharge outcomes were more favourable. Patients with three or more previous episodes of meningitis had higher risk of an additional recurrence.