Department Of Infectious Diseases Research Articles

Biochemical profile and resistance phenotype of isolates responsible for bacteremia in 111 HIV-infected patients hospitalized at the National Reference University Hospital of N'Djamena from 2020 to 2023

Introduction: Surveillance of antibiotic resistant bacteria provides important information to optimize care for people living with HIV (PLHIV). The objective of this work was to determine the prevalence of bacteremia in PLHIV and to describe the biochemical profile and resistance of bacteria to antibiotics commonly prescribed for the care of patients and followed in the cohort in the infectious disease departments (SMI) of the National Reference University Hospital (CHU-RN) of N'Djamena. Material and methods: This was a descriptive, analytical and etiological diagnostic study carried out on isolates responsible for bacteremia in PLHIV, from 01/01/2020 to 03/31/2023. The isolation, the identification of the bacteria and the antibiogram were carried out by standard methods of clinical microbiology. Results: The study included 111 PLHIV, 51 of who were positive on blood culture (54%). The average age of PLHIV was 45.5 years with the extremes ranging from 15 and 76 years. The age group most affected by bacteremia was that of 55 years and over. A significant difference was observed in terms of the predominance of women over men (P = 0.02). The most identified bacteria were Staphylococcus aureus (56.86%) and Escherichia coli (16.68%). The most determined resistance phenotypes were multi-resistant bacteria (BMR) and extended-spectrum beta-lactamases (ESBL) with the proportions of 29.41% and 23.52% respectively. Conclusion: The results of this study raise the need for continuous monitoring of antibacterial resistance and to apply the recommendations for the proper use of antibiotics among PLHIV in Chad.

Technology assisted physical activity among hospitalised medical patients a cluster randomised clinical trial

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Bispebjeg University Hospital (public hospital) Danish Physiotherapy Foundation. Background To investigate whether patients, with independent basic mobility, admitted to medical wards, by simple feedback on physical activity (the integration of accelerometer measurements and tablet feedback) can be nudged to increase the level of activity during hospitalization. The aim is to investigate if medical patients with intact basic mobility, can increase the level of physical activity by simple feedback from a new technology solution. Methods Design: A cluster randomised clinical trial. Primary outcome: time spend out of bed (min/day). Power calculation: 320 patients. All included patients had their physical activity level measured. The intervention group received feedback by an app on a tablet. The patients participated for a minimum of 24 hours and up to 7 days. Inclusion of patients from the Department of Carardiology, Geriatric Department and Department of Pulmonary and Infectious disease. Primary efficacy measure: Time out of bed (min). Results 354 patients were included. Difference between those who received feedback (intervention) and those without feedback (control) was 23.6 min/day more out of bed (95%CI 13.75 – 33.50); P = <.0001. Conclusion Patients admitted to medical wards, with independent basic mobility, were on average 23.6 minutes more physically active per day (21%) when they received feedback about their physical activity. Implication This technological solution with feedback can be a tool to nudge the patients with independent basic mobility to stay physically active during hospitalization. The solution may also allocate resources for those patients who have a greater need for help and support for mobilization.

Working conditions for healthcare workers at a Swedish university hospital infectious disease department during the COVID-19 pandemic: barriers and facilitators to maintaining employee wellbeing.

Healthcare workers (HCWs) at infectious disease departments have held the frontline during the COVID-19 pandemic. This study aimed to identify barriers and facilitators to maintaining the employees' wellbeing that may be used to increase preparedness for future pandemics within ID Departments. In September 2020, a web-based survey on demographics and work environment was distributed to all HCWs at the Infectious Disease Department at Sahlgrenska University Hospital. Results were compared with a pre-COVID-19 survey from October 2019. A quantitative analysis of the overall effects of the pandemic on the working conditions of HCWs was conducted; in addition, a qualitative content analysis of open-ended responses was performed. In total, 222 and 149 HCWs completed the pre-COVID-19 and COVID-19 surveys (84 and 54% response rate), respectively. Overall, we found significant changes regarding increased workload, lack of emotional support in stressful work situations, and inability to recover after shifts. These factors correlated both with younger age and concern of becoming infected. The open-ended answers (n = 103, 69%) revealed five generic categories (Workload; Organizational support; Worry and ethical stress; Capability; and Cooperation and unity) with a total of 14 identified factors representing plausible individual and organizational-level barriers or facilitators to sustained employee wellbeing. Younger HCWs as well as those expressing worries about contracting the infection were found to be particularly affected during the COVID-19 pandemic and these groups may require additional support in future outbreaks. Factors both increasing and decreasing the pandemic-induced negative health consequences for HCWs were identified; this knowledge may be utilized in the future.

A retrospective analysis of clinical features of patients hospitalized with SARS-CoV-2 Omicron variants BA.1 and BA.2

The causative agent of the ongoing Corona virus disease 2019 (COVID-19) pandemic, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has acquired a considerable amount of mutations, leading to changes in clinical manifestations and increased transmission. Recent studies based on animal disease models and data from the general population were reporting a higher pathogenicity of the BA.2 sublineage compared to BA.1. The aim of this study was to provide real world data on patients with the SARS-CoV-2 Omicron BA.1 and BA.2 subvariants treated at our center, highlighting similarities and differences in the clinical disease course. We retrospectively collected and analyzed the data of adult patients admitted with confirmed SARS-CoV-2 infection at the Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria. Patient characteristics including age, underlying diseases, vaccination status and outcome were compared between patients with the BA.1 and BA.2 subvariants. Between January 2022 and May 2022 we included 168 patients infected with Omicron BA.1 and 100 patients with BA.2. Patients admitted with BA.2 were significantly older, more often fully immunized and required less dexamethasone than patients with BA.1. No substantial differences were identified between patients infected with BA.1 and BA.2 regarding BMI, laboratory findings, need for supplemental oxygen, mortality and other evaluated comorbidities excepting active malignancies. The significantly larger percentage of fully immunized patients admitted with BA.2 is pointing to an increased transmissibility of this subvariant, while the comparable outcome of a somewhat older and sicker patient population might be indicative of reduced virulence.

Clinical Case of a Patient With Aortic Periprosthetic Infection

Sepsis is the body’s unregulated response to infection and if not properly managed it can lead to septic shock, multiple organ failure and death. The aim of this article is to present a case of aortic periprosthetic infection, diagnosed in the Infectious Diseases Department of the Hospital no. 3 from Craiova, Romania. Abdominal aortic aneurysm is a serious medical condition, with a high risk of death due to the rupture of the arterial wall. The early antimicrobial treatment decreased the inflammatory markers level Although antibiotic therapy was initiated early, due to multiple associated pathologies, the patient died.

Evaluation of the neutrophil-leukocyte index in patients with cardiac disorders and new coronavirus infection

Background: The neutrophil-leukocyte index (NLI) is an independent predictor of an unfavorable outcome in stable ischemic heart disease, as well as of mortality in patients with acute coronary syndromes and uncontrolled heart failure. A number of studies have shown the informative value of NLI for the prediction of severe course of COVID-19. NLI variability in COVID-19 with comorbid baseline physical diseases and cardiovascular disorders in particular, has not been studied.
 Aim: To evaluate the clinical value of NLI in hospitalized patients with COVID-19 depending on their concomitant cardiac disorders.
 Materials and methods: In this retrospective quantitative study we have analyzed the data from medical files of the patients with the diagnosis of new coronavirus infection confirmed by polymerase chain reaction, treated in a specialized in-patient department of infectious diseases in 2020 to 2022. Previously diagnosed cardiac disorders were defined as any past history of these disorders. The results of instrumental and laboratory work-up were assessed before treatment.
 Results: The analysis included 226 patients with median age of 50.0 (Q1Q3: 42.063.0) years, with 81.4% (n = 184) of them being men. Ninety four (41.6%) patients had no previously diagnosed cardiovascular disorders. Arterial hypertension by the time of admittance was present in 132 (58.4%), ischemic heart disease, in 77 (34.1%), atherosclerotic and/or post-infarct cardiosclerosis, in 82 (36.3%), and chronic heart failure, in 77 (34.1%) of the patients.
 In the total study group (n = 226) the median NLI was 2.6 (1.574.47). The larger was the volume of the lung involvement (assessed by computed tomography at admittance), the higher was NLI (p = 0.009, Kruskal-Wallis test). There was an association between the NLI value and the degree of respiratory failure (p 0.001, Kruskal-Wallis test). Median NLI in the patients with cardiac disorders (irrespective of their nosology) was significantly higher than that in the patients without any history of cardiovascular problems: 3.30 (2.095.42) versus 1.95 (1.423.62) (p 0.001, Mann-Whitney U-test). We found significant difference in the NLI values for each type of cardiac disorders, compared to that in the patients without history of cardiovascular disorders, including for the patients with arterial hypertension (p 0.001, Kruskal-Wallis test), ischemic heart disease (p 0.001, Mann-Whitney U-test), atherosclerotic cardiosclerosis (p = 0.001, Mann-Whitney U-test), and chronic heart failure (p = 0.040, Kruskal-Wallis test).
 Conclusion: We have confirmed the contribution of cardiovascular disorders to the course of COVID-19 and the clinical value of NLI as a convenient laboratory marker of the severity of infectious disease.

Application and evaluation of Flipped Teaching based on Video Conference in standardized training for internal medicine residents.

In view of the importance of infectious diseases in public health, Shanghai Municipal Health Commission designated a hospital ("Designated Hospital") to carry out infectious diseases training for internal medicine residents in those hospitals ("Dispatching Hospitals") that didn't have an infectious disease ward or could not meet the training standards of infectious diseases. I aimed to explore Flipped Teaching with Video Conference as the carrier in infectious diseases training for internal medicine residents, to make up for the lack of actual training time of the Department of Infectious Diseases for those residents caused by subjective or objective reasons, and to ensure the smooth implementation and quality assurance of infectious diseases training for those residents. Vertical management mode was adopted, management and lecture teams were established, and training program and teaching implementation were formulated. Flipped Teaching based on Video Conference was carried out for internal medicine residents of Dispatching Hospitals who planned to participate in infectious diseases training of the Designated Hospital in April. The quantitative analysis was applied to this teaching evaluation, and the evaluation indexes were included into statistical analysis to evaluate the effect of the teaching model. All 19-member internal medicine residents participated in the Flipped Teaching based on Video Conference from April 1 to 4, of which 12 residents were scheduled to participate in infectious diseases training from March 1 to April 30, and 7 residents were scheduled to participate in infectious diseases training from April 1 to May 31 in the Designated Hospital. A management team of 6 internal medicine residents was built, and a lecture team was composed of 12 internal medicine residents who were scheduled to receive infectious diseases training in the Designated Hospital from March 1 to April 30. According to the training requirements in the Department of Infectious Diseases, 12 contents were selected to be taught, and implementation rate of the teaching plan was over 90%. A total of 197 feedback questionnaires were collected. The feedback that the teaching quality was "good" and "very good" accounted for more than 96%, and the attendance rate of the whole teaching process reached more than 94%. Six internal medicine residents put forward 18 "Improvement suggestions", accounting for 9.1%; and 11 internal medicine residents gave 110 suggestions of "Praise highlights", accounting for 55.8%. The overall evaluation feedback of Flipped Teaching was good, P<0.001. Flipped Teaching based on Video Conference was generally effective in delivering lectures and learning for internal medicine residents participating in the infectious diseases training, and it could be used as a supplementary training method for standardized training of internal medicine residents to make up for the shortage of actual training period in a certain stage.

Process and Specification for Collecting Nasal and Throat Swab Specimens from Hospitalized Patients with Novel Coronavirus Infection in the Department of Infectious Diseases

The rapid spread of the novel coronavirus around the world has caused a large number of cases of novel coronavirus pneumonia that are rare in human history. The detection of the novel coronavirus is the key link to preventing and controlling the epidemic of the novel coronavirus, so the establishment of nasal and throat swab specimen collection process, mastery of the relevant rules and regulations for the collection of novel coronavirus pneumonia, standardization of nasal and throat swab specimen collection operating procedures, and standardized patient management are the keys to controlling the spread of coronavirus pneumonia. Literatures about novel coronavirus 2019 were searched by the Web of Science database. A total of 556 English literatures were collected.Using VOSviewer software to extract keywords, and conducting the cluster analysis and knowledge mapping. This study describes in detail the basic methods, standard procedures and basic steps for collecting nasal and throat swab specimens from patients infected with novel coronavirus infection，as well as the precautions and common problems of throat swab specimen collection in novel coronavirus infection samples. Finally, the main ways and prospects for the prevention of respiratory infectious diseases are proposed. This study is of great significance for the prevention and control of the rapid spread of novel coronavirus pneumonia.

Atypical Cutaneous Viral Infections Reveal an Inborn Error of Immunity in 8 Patients.

Unusual viral skin infections might be the first clinical manifestation in children with an inborn error of immunity (IEI). We performed a prospective study from 1 October 2017 to 30 September 2021, at the Department of Pediatric Infectious Diseases and Clinical Immunity of Ibn Rochd University Hospital-Casablanca. During this period, on 591 patients newly diagnosed with a probable IEI, eight of them (1.3%), from six independent families, had isolated or syndromic unusual viral skin infections, which were either profuse, chronic or recurrent infections, and resistant to any treatment. The median age of disease onset was nine years old and all patients were born from a first-degree consanguineous marriage. By combining clinical, immunological and genetic investigations, we identified GATA2 deficiency in one patient with recalcitrant profuse verrucous lesions and monocytopenia (1/8) and STK4 deficiency in two families with HPV lesions, either flat or common warts, and lymphopenia (2/8), as previously reported. We also identified COPA deficiency in twin sisters with chronic profuse Molluscum contagiosum lesions, pulmonary diseases and microcytic hypochromic anemia (2/8). Finally, we also found one patient with chronic profuse MC lesions and hyper IgE syndrome, (1/8) and two patients with either recalcitrant profuse verrucous lesions or recurrent post-herpetic erythema multiforme and a combined immunodeficiency (2/8) with no genetic defect identified yet. Raising clinicians awareness that infectious skin diseases might be the consequence of an inborn error of immunity would allow for optimized diagnosis, prevention and treatment of patients and their families.

Severe Neonatal Skin Infection: Clinical Case

Background. Pyoderma is the most common skin infectious disease of early age, it is a group of dermatoses characterized by purulent-inflammatory damage to the skin, dermal appendages, and subcutaneous fat. The diagnosis is based on medical history and physical examination. The main treatment methods are antibacterial therapy (local or systemic) and antiseptic skin toilet. Some forms of deep pyoderma require surgical interventions.Clinical case description. Girl A., 14 days of life, was admitted to the neonatal department of infectious disease with complaints of the mass in the left shoulder joint area. Historical information: 27 years old mother was not observed in any maternity welfare centre; chorioamnionitis was revealed at admission to the obstetric hospital. She received broad-spectrum antibacterial therapy perinatally. A girl from spontaneous vaginal delivery born on the 39th week with body weight of 2700 g, body length of 50 cm, and APGAR score of 8/9, she was breastfed. The condition on admission was severe. There were multiple indurated rash elements (pustules with turbid fluid) on the skin of the chest, limbs, and back. Skin desquamation was noted. There was hyperemia area up to 3.5 × 1.5 cm in the left shoulder joint area, with soft-elastic consistency, fluctuation symptom was positive. Complete blood count has shown: leukocytosis and neutrophilosis. Methicillin-resistant Staphylococcus aureus (MRSA) was revealed in blood via PCR method, in hemoculture, and in throat and nose cultures. C-reactive protein level was increased. Abscess culture — MRSA. Screening by immunological assay was performed to exclude primary immunodeficiency. Abscess incision and drainage were performed; 5 mL of thick yellow-green pus was obtained. Combination therapy with broad-spectrum antibiotic was carried out.Conclusion. There was positive dynamics on the administered therapy: the child condition was satisfactory, skin cleared of infectious rash, abscess was sanitized, laboratory parameters normalized, the child had no fever.

ЮБИЛЕЙ УЧИТЕЛЯ И ДРУГА (К 70-ЛЕТИЮ СО ДНЯ РОЖДЕНИЯ ВЛАДИМИРА МАКСИМОВИЧА ЦЫРКУНОВА)

The article describes the main stages of the professional path of a talented scientist and teacher, a well-known infectious disease physician, hepatologist and long-term head of the Department of Infectious Diseases of Grodno State Medical University, Honored Scientist of the Republic of Belarus, Doctor of Medical Sciences, Professor Vladimir Maksimovich Tsyrkunov.

Cohort profile: a longitudinal study of HIV infection in the central nervous system with focus on cerebrospinal fluid – the Gothenburg HIV CSF Study Cohort

PurposeIn order to enable long-term follow-up of the natural course of HIV infection in the central nervous system, a longitudinal cohort study with repeated cerebrospinal fluid (CSF) analyses at intervals...

COMPARISON OF CLINICAL, LABORATORY FINDINGS AND COMPLICATIONS IN BACTERIEMIC AND NONBACTERIEMIC BRUCELLOSIS: A SINGLE CENTER EXPERIENCE

Objective: Brucellosis is a systemic zoonosis that affects various organs or body systems and can mimic many diseases. Symptoms can range from acute febrile illness to chronic clinical manifestations with severe complications. In our study, we investigated the relationship between bacteremia and clinical and laboratory findings, and complications in patients with brucellosis.&#x0D; Material and Methods: Two hundred and twenty-three patients diagnosed with brucellosis between 2005 and 2020 in the department of infectious diseases and clinical microbiology of a tertiary care university hospital were included in the study. Rose Bengal test, Brucella standard tube agglutination test and culture (blood and/or bone marrow culture) were used for the diagnosis of brucellosis. The patients were divided into two groups according to their bacteremia status. Patients with positive culture were identified as bacteremia, and patients with negative culture were identified as non-bacteriemic.&#x0D; &#x0D; Results: A total of 223 patients were included in the study, of which 142 (63.7%) were male. While weight loss, fever and hematological complications were higher in bacteremia cases (p=0.001, p

Retrospective analysis of a cohort of HIV-infected patients on antiretroviral therapy in Abidjan (2003 to 2017)

Background: Antiretroviral therapy (ART) has been successful in improving clinical outcomes for HIV-positive patients, but efforts are needed to improve life expectancy and quality of life. This study aimed to analyze a long-term ART cohort and assess patients' life expectancy. Methods: A retrospective cohort study was conducted at the infectious and tropical diseases department of the University Teaching Hospital of Treichville from 2003 to 2017. Data analysis was done using VBA access and XLSTAT 2018 excel software. Patients on post-exposure chemoprophylaxis and prevention of mother-to-child transmission were excluded. Results: Out of 19,567 patient records, 49.60% were included, 72.43% were in 1st line, and 50.10% were over 50 years old, mostly female 58.49%, 98.4% HIV1. 74.31% had a CD4/mm3 (Nadir) count &lt;350. The patients were essentially on the 2IN+INN regimen (72.31%), TDF + XTC + EFV (20.57%). The average duration under treatment 6.15 [0-13.67] ±3.94 years, the average duration under a line of treatment 4.33 [0-14.04] ±2.96 years. Life expectancy was 10.37 years. It is higher in patients on 2IN+IPr (12.21 years) versus 10.12 years in patients on 2IN+INN. The comparison of duration on a line according to the CD4 counts and the line of treatment did not show a significant difference p&gt;0.05. Conclusions: The study concluded that ART significantly improved the life expectancy of patients, adherence could be improved to further enhance the benefits of ART. The use of new combinations of ART may reduce events related to non-compliance.

A clinical case of viral-bacterial pneumonia caused by SARS-COV-2 and &lt;i&gt;Klebsiella pneumoniae&lt;/i&gt;, complicated by a generalized infection with developed septicemia

Patient A.I., 58 years old, on September 6, 2022 was hospitalized within several hours in the infectious diseases department of the Novocheboksarskaya City Hospital of the Ministry of Health of Chuvashia. The patient in serious condition was admitted being accompanied by ambulance team, according to his son, from the night of 09/05/2022 until the afternoon of 09/06/2022 the patient complained of hectic temperature, diffuse pain in the abdominal cavity. In addition, the patient noted cough, feeling of air lack. As a result, an ambulance was called in. At admission, computed tomography revealed signs of bilateral viral interstitial pneumonia, with a lesion area of 51% and areas of consolidation. The diagnosis of COVID-19 was confirmed by PCR in a nasopharyngeal swab. History: Dyscirculatory encephalopathy of degrees 12, arterial hypertension, chronic indurative pancreatitis. Objective examination: on admission the body temperature was 38.8C. SaO2 56%. Blood pressure 93/50 mm Hg. Art. Deep palpation revealed diffuse soreness and tension in the muscles of the anterior abdominal wall. The assessment of the condition on the NEWS2 scale comprised 11 points. Treatment was started, but a sudden death occurred. A clinical diagnosis was made: a new coronavirus infection COVID-19, virus verified. Competing disease: Acute parapancreatitis. Abscess of the mesentery of the small intestine. Complications of the underlying disease: Bilateral viral interstitial pneumonia. Acute respiratory distress syndrome. Septicemia (SOFA 2 points, procalcitonin = 2 ng/ml). Post-mortem sectional examination revealed signs of viral-bacterial pneumonia. In the brain pericellular and perivascular edema, heart prominent edema of the interstitium, muscle fibers fragmented, kidneys necronephrosis, pancreas periductal, interlobular and intralobular sclerosis of the pancreas, between the islets of neutrophilic infiltrates. Hyperplasia was noted in the lymphoid and hematopoietic tissue, vasculitis, signs of interstitial inflammation in the parenchymal organs were determined. According to the results of microbiological examination of lung tissue, abundant growth of Klebsiella pneumoniae was found. Conclusion. The cause of death of the patient A.I. 58 years old was a novel coronavirus infection COVID-19, which caused bilateral viral pneumonia, in parallel with bacterial microflora, complicated by acute respiratory failure. There was also a generalized spread of infection with developed septicemia and multiple organ failure (pulmonary, cerebral, renal).

Factors Associated with Outcome in Patients Managed for Invasive Fungal Infections at the Infectious Diseases Department of a Tertiary Care Hospital

Objective: To look for the factors associated with outcomes in patients managed for invasive fungal infections at the Infectious Diseases Department of a Tertiary Care Hospital&#x0D; Study Design: Comparative cross-sectional study&#x0D; Place and Duration of Study: Department of Infectious Diseases, Pak Emirates Military Hospital, Rawalpindi Pakistan,from Apr 2021 to Sep 2022.&#x0D; Methodology: A total of 90 patients with a different types of invasive fungal infections diagnosed by consultant infectious diseases were recruited. First, they were given standard treatment for fungal infection; they were diagnosed as per guidelines.Then, they were followed up for one month to look for an outcome. &#x0D; Results: Out of 90 patients with invasive fungal infections included in the study, 62(68.8%) had a good outcome, while 28(31.2%) had a poor outcome. The mean age of the patients recruited in our study was 39.54±6.27 years. Of all the participants, 65(72.2%) patients were male, while 25(27.8%) were female. Statistical analysis revealed that poorly controlled diabetes, COVID-19 infection and HIV positive were statistically significantly associated with poor outcomes in our study participants (p-value&lt;0.05).&#x0D; Conclusion: The Considerable number of patients with invasive fungal infections had a poor outcome in our study. The presence of poorly controlled diabetes, COVID-19 infection and being HIV positive were the factors associated with poor outcomes in our study participants.

A prospective long-term evaluation of the ocular findings of children followed with the diagnosis of multisystem inflammatory syndrome (long-term evaluation of ocular findings following MIS-C).

The most frequently reported ocular finding in the acute phase of the multisystem inflammatory syndrome in children (MIS-C), is conjunctivitis. More rarely, punctuate epitheliopathy, anterior uveitis and optic disc oedema can be seen. We aimed to investigate the acute and long-term ocular effects of MIS-C. Cases aged 1 month to 18 years who were diagnosed with MIS-C between January 2022 and June 2022 in the Department of Pediatric Infectious Diseases in our hospital were included in the study. Ophthalmological examinations were performed immediately after diagnosis, at one month, three months, and six months. Males consisted of 64.7% of the 34 cases included in the study and the mean age was 8.68 ± 4.32 years (min-max:2-17). In the first examination, conjunctivitis was observed in 6 (17.6%), punctuate epitheliopathy in 4 (11.7%), and subconjunctival haemorrhage in 3 (8.8%) patients. Two patients (5.8%) had optic disc oedema. No pathological anterior or posterior segment findings were observed in the sixth-month examination. The relationship between subconjunctival haemorrhage and intensive care hospitalisation was statistically significant (p = 0.014). Also, all patients with subconjunctival haemorrhage were clinically classified as severe MIS-C (p = 0.002). Although pathological ocular findings were observed in the acute phase of the disease, all of them were found to be improved at the sixth-month follow-up. The most striking finding of our study is that cases with subconjunctival haemorrhage were clinically more severe, and all patients needed intensive care. This study may be informative in establishing ocular follow-up protocols that are expected to be carried out in the acute period and in the follow-up of these patients.

Coexisting cytomegalovirus colitis in an immunocompetent patient with Clostridioides difficile colitis: A case report

Clostridioides difficile (C. difficile) colitis is one of the most common infections in hospitalized patients, characterized by fever and diarrhea. It usually improves after appropriate antibiotic treatment; if not, comorbidities should be considered. Cytomegalovirus (CMV) colitis is a possible co-existing diagnosis in patients with C. difficile infection with poor treatment response. However, compared with immunocompromised patients, CMV colitis in immunocompetent patients is not well studied. We present an unusual case of co-existing CMV colitis in an immunocompetent patient with C. difficile infection. An 80-year-old female patient was referred to the infectious disease department due to diarrhea, abdominal discomfort, and fever for 1 wk during her hospitalization for surgery. C. difficile toxin B polymerase chain reaction on stool samples was positive. After C. difficile infection was diagnosed, oral vancomycin treatment was administered. Her symptoms including diarrhea, fever and abdominal discomfort improved for ten days. Unfortunately, the symptoms worsened again with bloody diarrhea and fever. Therefore, a sigmoidoscopy was performed for evaluation, showing a longitudinal ulcer on the sigmoid colon. Endoscopic biopsy confirmed CMV colitis, and the clinical symptoms improved after using ganciclovir. Co-existing CMV colitis should be considered in patients with aggravated C. difficile infection on appropriate treatment, even in immunocompetent hosts.

Measurement of lactate in pleural fluid rapidly identify infection and guide therapy

Background Measurements of pleural fluid biomarkers for rapid identification of complicated parapneumonic effusion (CPPE) are crucial for optimal management. Previous studies for biomarker evaluation were however based on pleura culture, not modern DNA technique. Lactate has not been thoroughly studied earlier as a potential biomarker in this regard. Objectives To evaluate whether the routine biomarkers pH, glucose, lactate dehydrogenase (LDH) measured in pleural fluid in a microbiological well characterised cohort could differentiate simple parapneumonic effusion (SPPE) from CPPE and if pleural fluid lactate could be of additional use in this discrimination. Methods Pleural fluid prospectively collected from adult patients (n = 112) with PPE admitted to the Departments of Infectious Diseases (DIDs) at four Stockholm County hospitals were characterised microbiologically with bacterial culture and 16S rDNA sequencing, and biochemically with pH, glucose, LDH and lactate. Results Forty and seventy two patients were categorised as SPPE/CPPE. The median values between SPPE/CPPE differed significantly for all biomarkers with varying overlap. Receiver operating characteristics (ROC) curves showed the area under the curve (AUC) for pH 0.905 (CI 0.847–0.963), glucose 0.861 (CI 0.79–0.932), LDH 0.917 (CI 0.860–0.974) and lactate 0.927 (CI 0.877–0.977), corresponding to best cut-off levels and sensitivity/specificity for pH of 7.255, 0.819/0.9, glucose 5.35 mmol/L, 0.847/0.775, LDH 9.8 µcat/L, 0.905/0.825 and lactate 4.9 mmol/L, 0.875/0.85. Conclusions To distinguish between SPPE/CPPE, pH and LDH performed well, but optimal cut-off values differed from earlier established recommendations. Pleura lactate had the largest AUC of the investigated biomarkers and may be used in the analyses of PPE-staging.

Why Product Information Should not be Set in Stone: Lessons from a Decade of Linezolid Therapeutic Drug Monitoring: An Opinion Paper.

*Department of Clinical Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, Australia; and †Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy. Correspondence: Deborah J. E Marriott, MD, Department of Clinical Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, NSW 2068, Australia (e-mail: [email protected]). Conflicts of Interest and Source of Funding: None declared