Department Of Infectious Diseases Research Articles

P11 A case of Mycobacterium marinum infection in a patient with rheumatoid arthritis recently initiated on adalimumab

P11 A case of <i>Mycobacterium marinum</i> infection in a patient with rheumatoid arthritis recently initiated on adalimumab

Uncovering a Rarely Diagnosed Disease: Severe Leptospirosis with Multiorgan Failure in Slovakia

Leptospirosis is a zoonotic disease caused by bacteria from the genus Leptospira. The infection occurs mainly in developing countries in the tropical zone and countries with lower hygiene standards. The highest incidence is observed especially in environments associated with the presence of rodents, mainly rats, which are a potential source of infection. The clinical manifestations and severity of leptospirosis are highly variable. This case report describes the a 53-year-old patient (male) without comorbidities, who was admitted to an infectious disease department in the east of Slovakia for jaundice, general fatigue, weakness, and fever (health difficulties for approximately 7 days at home). The clinical laboratory picture of the patient was dominated by significant hyperbilirubinemia, acute renal failure, hepatopathy, severe thrombocytopenia, and involvement of the lung parenchyma in the sense of bilateral interstitial pneumonia on chest X-ray. A double combination of antibiotics (ceftriaxone and clarithromycin) were added to the treatment. During hospitalization, a diagnosis of leptospirosis was suspected based on medical history and the results of laboratory tests and was subsequently confirmed serologically. The antibiotic regimen was de-escalated to cephalosporin (ceftriaxone) monotherapy with adequate laboratory and clinical effects (on the 4th day). The patient was discharged after a total of 18 days in good clinical condition.

Lipid profile after switching from TDF (tenofovir disoproxil)-containing to TAF (tenofovir alafenamide)-containing regimen in virologically suppressed people living with HIV

Background. Tenofovir disoproxil fumarate (TDF) or its prodrug tenofovir alafenamide fumarate (TAF) are currently being recommended in treatment of HIV infection. Distinct pharmacological properties of these two forms of a this drug make TAF treatment less nephrotoxic and lead to better impact on bone density. Nevertheless, there is a rising concern about possible metabolic adverse effects of TAF. The purpose of this study was to evaluate the effects on the lipid profile among ART (antiretroviral therapy)-experienced patients switching from TDF‑containing to TAF‑containing regimen in the first year after the switch. Methods. Demographic and clinical data of HIV‑positive ART‑experienced patients treated in infectious diseases department was retrospectively collected. Changes of lipid profile with regards to baseline BMI, age and time of ART duration were analyzed. Results. In the group of 36 patients there was a significant increase in total cholesterol levels (+18.43 mg/dl, SD = 23.86 mg/dl, p &lt; 0.0001) and LDL levels (+13.75 mg/dl SD = 23.05 mg/dl, p = 0.001) in first 12 months after switching from TDF‑containing to TAF‑containing regimen. There were no statistically significant changes in both HDL and TG levels observed. Analysis of total cholesterol and LDL levels in certain subpopulations revealed a significant increase within first year after the switch in patients younger than 40 years old and in those whose BMI was within normal range. Conclusions. Presented data suggests that switching from TDF to TAF in ART‑experienced patients may be associated with worsening lipid parameters. Early detection and management of dyslipidemias among HIV‑positive patients are needed.

Are Selected Cytokines and Epstein-Barr Virus DNA Load Predictors of Hepatological Complications of Epstein-Barr Virus Infection in Children?

The aim of the study was to evaluate tumour necrosis factor-α (TNF-α), interleukin-6 (IL-6), soluble intracellular adhesion molecules 1 (s-ICAM-1) and Epstein-Barr virus (EBV) DNA load levels as predictors of hepatological complications of EBV infection in children. The study group consisted of 54 children aged one to eighteen years, who were hospitalised from 1 December 2018 to 31 December 2020 in the Department of Paediatrics, Infectious Diseases and Hepatology and who had hepatological complications in the course of serologically and molecularly confirmed EBV infection. It was shown that IL-6, TNF-α, and s-ICAM-1 concentrations were the highest in patients with hepatitis and biliary pole damage. Higher EBV DNA viremia positively correlated with increased C-reactive protein (CRP) and TNF-α levels and increased leukocyte, lymphocyte, and monocyte counts. Increases in lymphocyte counts and TNF-α concentrations were observed along with increases in gamma-glutamyl transpeptidase (GGTP) activity. Increased concentrations of IL-6, TNF-α, and s-ICAM-1 may indicate the risk of hepatitis with concomitant biliary pole damage during EBV infection.

Risk factors that are associated with adrenal insufficiency among patients with fever of unknown origin

ABSTRACT Background Adrenal insufficiency is one of the causes of fever of unknown origin (FUO). The purpose of this study is to find out risk factors that are associated with adrenal insufficiency in FUO patients. Methods This study was conducted retrospectively in a tertiary hospital with 846 beds in South Korea. All adult inpatients (age ≥19 years) who have requested a consult with the department of infectious disease for FUO between 1 July 20191 July 2019 and 30 June 202030 June 2020 were included in the study. Among them, those who underwent an adrenocorticotropic hormone (ACTH) stimulation test and had a fever of 37.8°C or higher within 48 hours of the ACTH stimulation test were finally included in the study subjects. Results A total of 202 FUO patients were enrolled and 61 (30.1%) were finally diagnosed with adrenal insufficiency. In a multivariate analysis, use of immunosuppressant within 3 months (OR 6.06, 95% CI 1.82–20.13, P = 0.003), use of corticosteroid within 3 months (OR 8.23, 95% CI 1.35–50.17, P = 0.022), sodium ≥ 136.7 (OR 3.43, 95% CI 1.49–7.88, P = 0.004), and calcium ≥ 8.4 (OR 0.31, 95% CI 0.14–0.71, P = 0.005) were proven to be factors associated with adrenal insufficiency in FUO patients. Conclusion In conclusion, 30.1% of FUO patients were diagnosed with adrenal insufficiency. The risk factors that are associated with adrenal insufficiency in FUO patients were immunosuppressive prescription or systemic steroid prescription within 3 months, or with sodium ≥ 136.7 or calcium < 8.4.

Detection of Cutibacterium (Propionibacterium) acnes in orthopaedic surgery: serious problem or contamination?

PurposeBone and joint infections are an important and increasing problem. Whether intraoperatively detected bacteria should be considered relevant or not is often difficult to assess.This retrospective cohort study analyzes the relevance of C. acnes cultured from deep intraoperative specimens.MethodsAll deep tissue samples collected intraoperatively between 2015 and 2020 from a quartiary care provider were evaluated for detection of C. acnes and its therapeutical consequences. Infection rates were determined according to a standardized definition and protocol and analyzed in dependence of patient’s demographic data (age and gender), operative parameters (type of surgery, body region/location of surgery, and impression of the surgeon), and initiated therapy.ResultsIn 270 cases of more than 8500 samples, C. acnes was detected. In 30%, the detection was considered an infection. The number of samples taken and tested positive for C. acnes correlated significantly with its classification as a cause of infection. If more than one sample of the patient was positive, the detection was significantly more likely to be treated as infection (p < 0.001).In 76% of cases, a consultation to the infectious diseases (ID) department took place regarding the classification of the pathogen detection and the therapy to be carried out.Almost all of the tested isolates demonstrated the wild-type susceptibility for penicillin and clindamycin.ConclusionIntraoperative detection of skin-colonizing bacteria such as C. acnes is not always synonymous with infection. In particular, if other examination results contradict an infection (pathological sample without evidence of an infectious event, detection of malignant cells, etc.), the situation must be considered in a very differentiated manner. Interdisciplinary boards, for example, are suitable for this purpose. Care should be taken to obtain a sufficiently large number of tissue samples for microbiological examination to be able to better classify the result.

What do medical students and graduated physicians think about infectious disease specialists?

ObjectivesThis study evaluated the social representation and stereotypes on infectious disease (ID) specialists among medical students and physicians in France after the COVID-19 pandemic. MethodsA survey applying the hierarchical evocation model assessed the social representations (SRs) of ID specialists. ResultsAll in all, 372 answers were analyzed. The positive elements related to the personal and professional qualities of ID specialists (‘intellectual prestige”, “open-mindedness”), in contrast with negative stereotypes related to their perceived daily life and practice characteristics (“hospital-based”, “intense”, “overspecialized”). Variables such as “I would not have chosen (or I won’t choose) ID after the national ranking exam” and “I know someone who is an ID specialist” were associated with worse SR scores (p < 0.001 and p = 0.022 respectively). ConclusionsThese findings provide insights into the attractiveness of ID as a specialty. Rounds in ID departments may enhance the interest of the specialty as a possible residency choice.

Научная работа сотрудников кафедры эпидемиологии и инфекционных болезней Оренбургского государственного медицинского университета в период пандемии COVID-19

The main results of the scientific work of the staff of the Department of Epidemiology and Infectious Diseases of the Orenburg State Medical University during the COVID-19 pandemic are presented, namely: the diagnosis of a new coronavirus infection, clinical features in children and adults (including those with combined pathology – HIV- infection, pulmonary tuberculosis), the epidemiological situation in the Orenburg region in the first months of the pandemic. Considerable material has been presented on the study of the features of the formation of immunity in COVID-19. Based on the literature data, an assessment was made of the prospects for vaccination against COVID-19. Valuable scientific material has been accumulated, reflected in more than 30 scientific publications, which is of significant practical importance in the diagnosis, treatment and management of patients with COVID-19. Keywords: COVID-19, immunity, incidence, diagnosis, clinical picture, new coronavirus infection.

Do Hematocrit Levels Differentiate between Complicated and Uncomplicated Dengue Fever?

Objective: To compare mean hematocrit levels in patients with uncomplicated and complicated Dengue Fever and evaluate the role of hematocrit in differentiating uncomplicated and complicated Dengue Fever.&#x0D; Study Designs: Prospective longitudinal study.&#x0D; Place and Duration of Study: Department of Infectious Diseases, Holy Family Hospital, Rawalpindi Pakistan, from Oct 2019 to Sep 2020.&#x0D; Methodology: Around 240 dengue patients were enrolled. Hematocrit level at presentation was measured using an automated haematology analyzer. The patients were then followed for the development of complications (Dengue hemorrhagic fever and Dengue shock syndrome).&#x0D; Results: Of 240 patients, 183(76.2%) were male, and 57(23.8%) were female. Dengue Fever was present in 96(40%) patients, whereas 144(60%) patients developed complications (Dengue Hemorrhagic Fever and Dengue Shock Syndrome). The mean hematocrit level at presentation significantly differed among the groups (p=0.012). Following the ROC curve analysis, for the cut-off value of 42.6% of hematocrit Group II had a sensitivity of 56.25% and a specificity of 62.5% at an Area under the curve of 0.589.&#x0D; Conclusion: The mean hematocrit levels were significantly higher in patients with complicated versus uncomplicated Dengue Fever. Hematocrit could not be projected as a predictor of Dengue Fever severity.

Amyloid A in Serum and Ascetic Fluid as a Marker of Spontaneous Bacterial Peritonitis

Abstract Background Esophageal varices (EV) are a major complication of cirrhosis secondary to the development of clinically significant portal hypertension EV can lead to life-threatening bleeding, further decompensation and death among patients with cirrhosis. Aim of the Work The aim of this study is to assess the role of the clinical usefulness of the Amyloid A (serum and ascetic fluid) in patients with ascites (liver cirrhosis) and as a diagnostic marker for Spontaneous Bacterial Peritonitis. Patients and Methods This prospective study was conducted on 240 cirrhotic patients selected randomly presented for screening for esophageal varices at Hepatology, Gastroenterology and Infectious Diseases Department, Benha University Hospital Hospitals and at Kafr El- Shiekh Liver Research center Results The cause of cirrhosis was HCV in 205 patients (85.42%), HBV in 14 patients (5.83%), BHF in 47 patients (19.58%) with, AIH in 6 patients (2.5%) and other diseases in 21 patients (8.75%). the prevalence of oesophageal varices and its staging were 55 patients (22.9%) had no oesophageal varices, 44 patients (18.3%) had esophageal varices grade I-II (Small EVs) and 141 patients (58.8%) had oesophageal varices grade III-IV (Large EVs). According to Child-Pugh (CP) Score, 129 (53.75%) patients were Child A, 72 (30%) patients were Child B and 39 (22.9%) patients were Child C. ALBI ranged from -3.2 - (-0.42) with mean value −1.94 ± - 0.74. 67 (27.9%) patients were ALBI 1, 100 (41.7%) patients were ALBI 2 and 73 (30.4%) patients were ALBI 3. 50 (20.83%) patients were ALBI-PLT 2, 30 (12.5%) patients were ALBI-PLT 3, 88 (36.67%) patients were ALBI-PLT 4, 72 (30.0%) patients were ALBI-PLT 5. There was a significant difference among cirrhotic patients regarding EVs as regard to hemoglobin, platelets, APRI, albumin, total bilirubin, ALBI, ALBI-PLT, INR, Child-Pugh (CP) score, platelet count/spleen diameter ratio, spleen size and ascites (P &amp;lt; 0.001). Regarding the presence of EV, ALBI, ALBI-PLT, Child-Pugh (CP) Score and platelet count/spleen diameter ratio, are good predictors for the presence of oesophageal varices. ALBI at cut-off &amp;gt;-2.6 can predict oesophageal varices with sensitivity 83.77, specificity 53.06, PPV 87.4, NPV 45.6, AUC 0.711 and P-value &amp;lt;0.001, ALBI- PLT at cut-off &amp;gt;2 can predict oesophageal varices with sensitivity 96.48, specificity 87.76, PPV 96.9, NPV 97.7, AUC 0.982 and P-value &amp;lt;0.001. Regarding differentiation between Small EVs and large EVs, This study showed that ALBI, ALBI-PLT, Child-Pugh (CP) Scores, platelet count/spleen diameter ratio, spleen size and APRI could be used in prediction of the size of EVs, ALBI at cut-off &amp;gt;-2.03 can predict the size with sensitivity 95.28, specificity 93.75, PPV 96.8, NPV 90.9, AUC 0.971 and Pvalue &amp;lt;0.001. Conclusion Combined ALBI grade and platelet count (ALBI-PLT score), albumin-bilirubin ratio (ALBI), could be used as a serum non-invasive marker of the presence of oesophageal varices which may help in reducing unnecessary endoscopies and a good selection of patients who need an endoscopy to decrease intervention and burden on endoscopy units.

Utility of clinical metagenomics in diagnosing malignancies in a cohort of patients with Epstein-Barr virus positivity.

Differentiation between benign and malignant diseases in EBV-positive patients poses a significant challenge due to the lack of efficient diagnostic tools. Metagenomic Next-Generation Sequencing (mNGS) is commonly used to identify pathogens of patients with fevers of unknown-origin (FUO). Recent studies have extended the application of Next-Generation Sequencing (NGS) in identifying tumors in body fluids and cerebrospinal fluids. In light of these, we conducted this study to develop and apply metagenomic methods to validate their role in identifying EBV-associated malignant disease. We enrolled 29 patients with positive EBV results in the cohort of FUO in the Department of Infectious Diseases of Huashan Hospital affiliated with Fudan University from 2018 to 2019. Upon enrollment, these patients were grouped for benign diseases, CAEBV, and malignant diseases according to their final diagnosis, and CNV analysis was retrospectively performed in 2022 using samples from 2018 to 2019. Among the 29 patients. 16 of them were diagnosed with benign diseases, 3 patients were diagnosed with CAEBV and 10 patients were with malignant diseases. 29 blood samples from 29 patients were tested for mNGS. Among all 10 patients with malignant diagnosis, CNV analysis suggested neoplasms in 9 patients. Of all 19 patients with benign or CAEBV diagnosis, 2 patients showed abnormal CNV results. The sensitivity and specificity of CNV analysis for the identification for tumors were 90% and 89.5%, separately. The application of mNGS could assist in the identification of microbial infection and malignancies in EBV-related diseases. Our results demonstrate that CNV detection through mNGS is faster compared to conventional oncology tests. Moreover, the convenient collection of peripheral blood samples adds to the advantages of this approach.

COVID-19 and post-covid syndrome in patients with rheumatoid arthritis

Objective: to study the course of COVID -19 and post-covid syndrome (PCS) in patients with rheumatoid arthritis (RA).Material and methods. The study included 32 adult patients with a confirmed diagnosis of RA, who met ACR/EULAR criteria. All patients had COVID-19. Material for analysis was obtained by means of a questionnaire developed at the V.A. Nasonova Research Institute of Rheumatology, which patients completed during their interview with the researcher.Results and discussion. The study group consisted mainly of women (n=29, 90%). The mean age of the patients was 50.75±16.48 years. Among the clinical manifestations of COVID-19, weakness/fatigue (90.6%; p&lt;0.0001), fever (71.9%; p=0.0005) and anosmia (62.5%; p=0.045) were significantly more common. Almost half of the patients had dysgeusia (59.4%), increased arthralgia (53.1%), dyspnea on exertion (50%), and cough (46.9%). A significant positive association was found between increased arthralgia during COVID-19 and RA activity (r=0.72; p&lt;0.05). Hospitalisation was required in 37.5% of patients with COVID-19. In 12.5% of cases, COVID-19 progressed with complications. Patients with higher RA activity were more likely to have an increase in arthralgia as a symptom of infection. PCS was registered in 47.8% of patients who underwent COVID-19. Retrospective evaluation of patients with PCS revealed a higher rate of hospitalisation in infectious disease departments and a more severe course of COVID-19. Subsequently, repeated cases of COVID-19 were more common in this group.Conclusion. Risk assessment of PCS development is necessary to appropriately distribute the burden on the health care system and to develop a strategy for prevention, timely diagnosis, and treatment of this syndrome in patients with rheumatic diseases. To achieve this goal, new studies in a larger cohort of patients with RA and rheumatic diseases in general are needed.

Short-term prognostic predictive value of the neutrophil/lymphocyte ratio combined with prognostic nutritional index in hepatitis B virus-related acute-on-chronic liver failure

Objective: To explore the prognostic predictive value of neutrophil/lymphocyte ratio (NLR) combined with prognostic nutritional index (PNI) in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods: Clinical data from 149 HBV-ACLF patients admitted to the infectious diseases Department of the General Hospital of Ningxia Medical University were retrospectively analyzed. Demographic data of the enrolled patients and the initial clinical-related data after admission were collected. Patients were divided into survival (93 cases) and death groups (56 cases) according to their prognostic condition 90 days after discharge. Demographic and clinical differences were compared between the two groups data. Receiver operating characteristic (ROC) curves were plotted to determine the optimal cutoff values for NLR and PNI in predicting the 90-day mortality rate of HBV-ACLF patients. The COX regression model was used to conduct univariate and multivariate analyses to investigate the correlation between NLR and PNI and the prognosis of HBV-ACLF patients. Kaplan-Meier survival analysis was used to explore the effects of NLR and PNI on the survival of HBV-ACLF patients. Results: The death group NLR was higher than that of the survival group, while the PNI was lower than that of the survival group, with a statistically significant difference. The area under the receiver operating characteristic curve (0.842, 95% CI: 0.779-0.906) showed patients with adverse prognosis assessed by NLR combined with PNI had a superior prognosis than that of the Model for End-Stage Liver Disease (MELD) and its combined serum sodium (MELD-Na) and Child-Turcotte-Pugh (CTP) scores. COX regression analysis showed that NLR≥3.03 and MELD score were independent risk factors affecting the prognosis of HBV-ACLF patients. PNI > 36.13 was a protective factor for evaluating the prognosis of HBV-ACLF patients. Conclusion: NLR combined with PNI can enhance the prognostic predictive value of HBV-ACLF.

Mucocutaneous Manifestations Among HIV-Infected Patients in Madagascar: Cross-Sectional Study.

More than 90% of HIV-infected patients present with at least one mucocutaneous manifestation during the course of their disease. Insufficient data are available regarding dermatologic findings among HIV-infected patients in Madagascar. This study aimed at evaluating the spectrum of mucocutaneous manifestations and their relationship with CD4 cell counts in HIV-infected patients in Madagascar. A cross-sectional study on HIV-positive patients attending the Department of Infectious Diseases in the University Hospital of Antananarivo in Madagascar was conducted from January 2013 to March 2020. HIV-positive patients older than 18 years and receiving antiretroviral therapy as well as those awaiting antiretroviral therapy commencement were included. Among 328 patients enrolled in this study, 167 (51%) presented with at least one type of mucocutaneous lesion. Oral candidiasis was the most common presentation, followed by seborrheic dermatitis and Kaposi sarcoma. Decreases in CD4 cell counts were substantially correlated with oral candidiasis, syphilis, and condyloma acuminatum. According to our findings, oral candidiasis, syphilis, and condyloma acuminatum may serve as clinical indicators for predicting the immune status of patients. As HIV infection progressed and immune function declined, an increase in cutaneous manifestations was observed.

COVID-19 IN NEWBORNS: OWN EXPERIENCE ON THE EXAMPLE OF CLINICAL CASES

Introduction. Currently, there is controversial information regarding the epidemiologic characteristics and severity of COVID-19 in pregnant women and newborns. Most researchers report the same severity of disease in pregnant and non-pregnant women, and a milder course of disease in the neonatal period, with the possibility of critical illness in some infants. Ideas about the possibility of transmission of SARS-CoV-2 to a newborn have changed. Since intrauterine transmission of the novel coronavirus is currently considered rare, COVID-19 in newborns is usually associated with postnatal transmission of the virus.The aim of the work was to analyze the epidemiologic and clinical features of the COVID-19 in newborns based on the analysis of clinical cases.Material and methods. On 2020, at the beginning of the COVID-19 pandemic, 11 newborns were admitted to the infectious diseases departments of Chernivtsi Regional Children's Clinical Hospital, 9 children were referred from home by a family physician, and 2 children were transferred from maternity care facilities. Diagnosis was confirmed by PCR-RT detection of SARS-CoV-2 RNA in nasal/oropharyngeal swabs.The research was conducted in accordance with the principles of bioethics, the conclusion of the Commission on Biomedical Ethics of the Bukovinian State Medical University on the observance of moral and legal rules for conducting medical-scientific research, Protocol No. 6 dated March 16, 2023.The research was carried out within the framework of scientific and research activity of the Department of Pediatrics and Infectious Diseases of Children of the Bukovinian State Medical University "Modern epidemiological, clinical-paraclinical and diagnostic features of the most common inflammatory infectious and non-infectious diseases in children", state registration number: 0122U002208.Results. The analysis of the epidemiologic data allowed to identify an intrafamilial source of infection in all identified cases (in one case the source of infection could not be identified), in most cases it was the mother, in one case the source of infection was the father and the grandmother. In most families there are older siblings who could serve as a potential additional source of infection, but respiratory symptoms in siblings were identified in one third of the families.In the late neonatal period, cases of horizontal virus transmission were characterized by mild symptoms of upper respiratory tract infection as acute nasopharyngitis, one case - as a mixture with secretory diarrhea. COVID-19 in another child was accompanied by acute gastroenteritis and moderate dehydration. The clinical picture of coronavirus infection in the remaining third of cases was characterized by lower respiratory tract infection as acute tracheobronchitis, acute obstructive bronchitis and bronchiolitis.Two infants were transferred from the maternity hospital after delivery because of COVID-19 maternal symptoms and SARS-CoV-2 RNA detection in the infants' nasal/oropharyngeal swabs on the first day of life. These children were asymptomatic with no clinical or laboratory evidence of an infectious-inflammatory process during observation.Conclusions. The presence of an exclusively family source of infection can be considered an epidemiological feature of COVID-19 in the neonatal period. In the case of horizontal transmission of the SARS-CoV-2 virus in newborns, the disease COVID-19 in most cases proceeds as mild upper respiratory tract infection, less often – as lower respiratory tract infection and/or secretory diarrhea. In the case of maternal COVID-19 disease before childbirth the vertical and/or antenatal infection mode and the subsequent asymptomatic neonatal COVID-19 cannot be denied.

The “Electronic Pediatrician (EPed®)” – A clinically tested prototype software for computer-assisted pathophysiologic diagnosis and treatment of ill children

BackgroundKnowledge-based systems (KBS) are software applications based on a knowledge base and an inference engine. Various experimental KBS for computer-assisted medical diagnosis (CAMD) and treatment were started to be used since 70 s (VisualDx, GIDEON, DXPlain, CADUCEUS, Internist-I, Mycin etc). ObjectivesThis article briefly presents and tests the “Electronic Pediatrician (EPed)”, a prototype medical user-interface-based stand-alone KBS software created by the author (in Romanian language) that offers both a computer-assisted pathophysiologic diagnosis and treatment of ill children. EPed currently covers the most frequent (and mainly infectious) respiratory, digestive, renal and central nervous system pediatric diseases treated in the Department of Pediatric Infectious Diseases (DPID) of the County Emergency Hospital of Târgoviște town (Dâmbovița County, Romania). MethodsEPed uses a new type of pathophysiologically-based diagnosis algorithm, which combines the relative incidences of diseases and the degree of covering any clinical picture of any patient. EPed was tested by a retrospective study in which the author has chosen 34 clinical child cases diagnosed and treated in DPID in the period of pandemics. The diagnoses predicted by EPed for each tested patient in part was compared to the diagnoses established by the clinician for each patient, so that to test the diagnostic accuracy of EPed. ResultsThe real diagnoses of the 34 children tested were found to occupy an average list-index of 12 (varying from 1 to 57) in the lists of EPed-predicted diagnoses for each case in part (based on the clinical and paraclinical signs inputs), which is considered an acceptable result for a demo version. ConclusionsThe diagnostic accuracy of EPed was acceptable and is perfectible in the future by using other formulas of scoring which combine the relative incidences of diseases and the degree of covering the clinical picture of a patient. EPed is the first pathophysiologically-based KBS focused on general pediatrics (mainly on pediatric infectious diseases) written in Romanian.

Clinical features and antimicrobial resistance of invasive non-typhoid Salmonella infection in children at Xiamen

Objective: To investigate the clinical characteristics, serogroups and antimicrobial resistance of invasive non-typhoid Salmonella infection in children at Xiamen. Methods: Retrospective cohort study. The clinical manifestations, treatment, prognosis, serogroups and antimicrobial resistance of 29 hospitalized children with invasive non-typhoid Salmonella infection confirmed by blood, cerebrospinal fluid, bone marrow and other sterile body fluids or deep pus culture at the Department of Infectious Diseases, the Department of Orthopedics and the Department of General Surgery in Xiamen Children's Hospital from January 2016 to December 2021 were analyzed. According to the clinical diagnosis criteria, the patients were divided into sepsis group and non-sepsis group (bacteremia and local suppurative infection). The inflammatory markers, serogroups distribution and drug resistance were compared between the two groups. Comparison between groups using Mann-Whitney U test and χ2 test. Results: Among the 29 cases, there were 17 males and 12 females, with an onset age of 14 (9, 25) months, and 10 cases (34%) of patients were younger than 1 year old, 15 cases (52%) under 1 to 3 years old, and 4 cases (14%) greater than or equal 3 years old. The onset time of 25 cases (86%) was from April to September. The diseases included 19 cases (66%) septicemia (2 of which were combined with suppurative meningitis), 10 cases (34%) non-sepsis group, including 7 cases bacteremia and 3 cases local suppurative infection (2 cases of osteomyelitis, 1 case of appendicitis with peritonitis). The clinical manifestations were fever in 29 cases (100%), diarrhea and abdominal pain in 18 cases (62%), cough and runny nose in 10 cases (34%). Eighteen cases (62%) were cured and 11 cases (38%) were improved by effective antibiotics treatment. C-reactive protein in sepsis group was significantly higher than that in non-sepsis group (25.2 (16.1, 56.4) vs. 3.4 (0.5, 7.5) mg/L, Z=-3.81, P<0.001).The serogroups of C, B and E were the most prevalent among non-typhoid Salmonella isolates, accounting for 10 cases (34%), 9 cases (31%) and 7 cases (24%) respectively. Antibacterial drug sensitivity test showed that the sensitivity rates of imipenem, ertapenem and piperaciratazobactam were all 100% (31/31), those of ceftazidime, ceftriaxone, and cefepime were 94% (29/31), 94% (29/31) and 97% (30/31) respectively. The drug resistance rates of ampicillin, ampicillin-sulbactam and trimethoprim-sulfamethoxazole were 51% (16/31), 48% (15/31) and 48% (15/31) respectively, those of cefazolin, cefotetan, tobramycin, gentamicin and amikacinwere all 100% (31/31). There were no significant differences in the drug resistance rates of ceftazidime, ceftriaxone, aztreonam, ampicillin-sulbactam, ampicillin, trimethoprim-sulfamethoxazole and ciprofloxacin between the sepsis group and the non-sepsis group (χ2=0.31,0.31,0.00,0.02,0.02,0.02,0.26, all P>0.05). Conclusions: Invasive non-typhoid Salmonella infection in children at Xiamen mainly occurred in infants younger than 3 years old.The main clinical manifestations are fever, abdominal pain and diarrhea. C-reactive protein can be served as the laboratory indicators for indicating sepsis. The third generation of cephalosporins is recommended as the first choice for treatment.

First person – James Glover

ABSTRACT First Person is a series of interviews with the first authors of a selection of papers published in Journal of Cell Science, helping researchers promote themselves alongside their papers. James Glover is co-first author on ‘ UMAD1 contributes to ESCRT-III dynamic subunit turnover during cytokinetic abscission’, published in JCS. James is a PhD student in the lab of Juan Martin-Serrano at the Department of Infectious Diseases, King's College London, UK, investigating cell division using advanced microscopy techniques.

Bezoar in the gastrointestinal tract: a rare case of diagnosis in the practice of a gynecologist and surgeon

Purpose. To present a clinical case of bezoar in a girl of 13 years old, with differential diagnosis of infectious, surgical and gynecological pathology.Materials and methods. The mother of a 13-year-old girl turned 26. On 10.2022, for consultation with complaints of abdominal pain, nausea, vomiting, loose stools. According to the mother, despite repeated visits to doctors, the child could not be diagnosed. Because of this, initially there was hospitalization in the infectious diseases department, re-hospitalization in the surgical department and then in the gynecological department. On 29.10.2022, the girl was operated on in a gynecological hospital, together with a pediatric surgeon.Results. During the surgical intervention, about 400.0 serous effusion was found in the abdominal cavity. During the revision of the organs of the female reproductive system, two paraovaril cysts up to 1 cm were found on both sides, removed. When revising the appendicular process, no pathology was revealed. When revising the intestine, a dense consistency of bezoar was found measuring 8 × 6 cm. The wall of the small intestine was opened over the bezoar, evacuation of a foreign body, layer-by-layer suturing. In the postoperative period, the patient received antibacterial, infusion and symptomatic therapy. The postoperative wound healed initially, without signs of inflammation. After discharge, a psychologist’s consultation is recommended.Conclusion. Bezoars are a rare type of pathology. Their diagnosis is difficult due to the absence of early specific clinical symptoms. This case from practice indicates that bezoar can simulate various pathologies of the abdominal cavity. Particular attention should be paid to pathological behavioral reactions, to consult children and adolescents with a psychologist and a neurologist. Unfortunately, the diagnosis is made when patients are admitted to the hospital with the phenomena of an “acute” abdomen, for surgical intervention.

Investigation of the Frequency of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium in Men Living with HIV in Terms of Sociodemographic Characteristics and Behavioral Risk Factors

The aim of this study was to investigate the frequency of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium in men living with HIV in terms of sociodemographic characteristics and behavioral risk factors. In this cross-sectional, single center study, all HIV-infected male patients, aged ≥ 18 years, including those being followed-up (n= 142) and the new admissions (n= 16) at Hacettepe University, Department of Infectious Diseases between March 1st, 2017 and May 1st, 2018 were included. After obtaining the informed consent form; age, follow-up days in STI-clinic, marital status, education, employment status; STI-related sign and symptoms, prior STI diagnosis, multiple sexual partners during the last year, exchanging sex for money, sexual orientation, drug use, condom use with regular and casual partner and also risk factors regarding partners were inquired as behavioural risk factors. A sample of first-voided urine of each participant was tested for the presence of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium by using nucleic acid amplification test (NAAT) (BD-MAX system, BD Diagnostics, USA) and BD MAX Mycoplasma-Ureaplasma-OSR for BioGX, (BD Diagnostics, The Netherlands). All participants living with HIV, men who have sex with men (MSM) and heterosexual men were grouped as STI-positive and STI-negative and compared. For all statistical analysis, SPSS 24 software was used. During the period of 14 months; the data was determined as follows: median follow-up time was 1138 (IQR= 159.5- 1494.5) days, median age was 35 (IQR= 28-42) years, 73.3% were single, 68.3% were at least college graduates or had higher educational attainment, 78.1% were currently employed. Of the participants, 26.9% reported STI-related sign and symptoms, 50.0% at least one STI episode in the past. Nine (5.6%) M.genitalium, five (3.1%) N.gonorrhoeae, and four (2.5%) C.trachomatis were detected in the urine samples of 17 (10.7%) individuals. N.gonorrhoeae and C.trachomatis were detected simultaneously in only one patient's urine sample. STI-positive patients (n= 17) were determined to be younger compared to STI-negative group [(p= 0.02; 27 years (IQR= 24-37) vs 35 years (IQR= 28-42)], had prominent STI-related signs and symptoms (p< 0.001) and had more multiple sexual partners (p= 0.03). The median CD4+ T lymphocyte count were relatively lower (p= 0.03) in STI-positive patients and plasma HIV RNA level was higher compared to the STI-negative participants (p= 0.05). STI-positive MSM group were younger [p= 0.01; 26 years (IQR= 23.5-29) vs 33 years, (IQR= 28-40)], STI-related signs and symptoms were more prominent (p= 0.02), the frequency of exchanging sex for money/drugs among their partners (p= 0.03) was higher compared to their STI-negative counterparts. Among STI-positive heterosexual patients, the presence of STI-related signs and symptoms (p= 0.04), drug use among their partners (p= 0.04) and plasma HIV RNA level (p<0.01) were significantly higher. STI was identified as an important health problem in this series of men living with HIV, 63.0% of whom had MSM and had a relatively high education level and socioeconomic status. Young age, having multiple partners, drug use, exchanging sex for money/drugs were prominent among the participants and their partners. Public health studies should focus on preventing STIs in young people living with HIV who have behavioral risk factors.