Early Infection Group Research Articles

New insights into swine dysentery: faecal shedding, macro and microscopic lesions and biomarkers in early and acute stages of Brachyspira hyodysenteriae infection

BackgroundSwine dysentery (SD) is a severe mucohaemorrhagic colitis in pigs caused classically by Brachyspira hyodysenteriae. Although several aspects of B. hyodysenteriae infection dynamic are already described, further research in the early stage of this infection is required. In this study, 7-week-old pigs were orally challenged with B. hyodysenteriae to obtain information about faecal shedding, macro and microscopic intestinal lesions and serum acute phase proteins in pigs at the onset of B. hyodysenteriae shedding (early infection group, n = 8), in pigs with mucohaemorrhagic diarrhoea (acute infection group, n = 8) and in non-infected controls (n = 16).ResultsFirst B. hyodysenteriae detection by q-PCR and first loose stools with blood and mucus occurred both at 8 days post-inoculation. The lapse between a positive q-PCR and observation of mucohaemorrhagic diarrhoea ranged from 0 to 3 days, except in a single pig in which this period lasted 5 days. Macroscopic lesions were observed in the large intestine from both infected groups although more frequent and severe in acute infection group. Microscopic observation of the apex mucosa revealed that in early infection only higher ulceration values were observed compared to healthy controls. In contrast, the acute infection group exhibited higher ulceration, neutrophils infiltration and increased mucosal thickness compared to the other two groups. Among the serum biomarkers tested, only haptoglobin, C-reactive protein, and creatine kinase showed a significant increase in pigs in the acute infection period compared to controls, whereas haptoglobin was the only factor with a significant increase at the early infection compared to non-infected animals.ConclusionsThis study provides new insights about SD and remarks the complex and limited options to perform an early detection of infected animals beyond PCR diagnosis.

Early Versus Late Periprosthetic Joint Infection After Total Knee Arthroplasty: Do Patient Differences Exist?

BackgroundPeriprosthetic joint infection (PJI) is a devastating complication following total knee arthroplasty (TKA). Little evidence exists comparing those with early versus late PJI. The purpose of the study was to determine comorbidity profile differences between patients developing early and late PJI. MethodsThere were 72,659 patients undergoing primary TKA from 2009 to 2021, who were identified from a commercial claims and encounters database. Subjects diagnosed with PJI were categorized as either ‘early’ (within 90 days of index procedure) or ‘late’ (> 2 years after index arthroplasty). Non-infected patients within these periods served as control groups following 4:1 propensity score matching on other extraneous variables. Logistic regression analyses were performed comparing comorbidities between groups. ResultsPatients were significantly younger in the late compared to the early infection group (58.1 versus 62.4 years, P < .001). When compared to those with early PJI, patients who had chronic kidney disease (13.3 versus 4.1%; OR [odds ratio] 5.17, P = .002), malignancy (20.4 versus 10.5%; OR 2.53, P = .009), uncomplicated diabetes (40.8 versus 30.6%; OR 2.00, P = .01), rheumatoid arthritis (9.2 versus 3.3%; OR 2.66, P = .046), and hypertension (88.8 versus 81.6%; OR 2.17, P = .04), were all significant predictors of developing a late PJI. ConclusionsWhen compared to patients diagnosed with early PJI following primary TKA, the presence of chronic kidney disease, malignancy, uncomplicated diabetes, rheumatoid arthritis, and hypertension, were independent risk factors for the development of late PJI. Younger patients who have these comorbidities may be targets for preoperative optimization interventions that minimize the risk of PJI.

Clinical, Hematological, and Biochemical Alterations Associated With Early and Late Infection of Lumpy Skin Disease in Cattle in Egypt

This study aimed to investigate clinical, hematological, and biochemical alterations associated with early (during the first week.) and late (after one month) of lumpy skin disease (LSD) infection in cattle infected during an outbreak of LSD in Egypt. Animals which were clinically examined directly after the clinical onset of LSD showed, firm elevated skin nodules that were distributed all over the body, fever (more than 40℃) associated with anorexia, general weakness, reduced milk yield, enlargement of superficial lymph nodes, and edema in the brisket and/or limbs. Examination of the affected animals one month after the disease onset revealed marked weight loss, shrunk of skin nodules and formation of sit fast. There were significant increases in body temperature, pulse and respiratory rate in all animals infected with LSD with significant decrease of ruminal movement compared to control group. DNA extracted from skin samples collected from LSD infected animals showed bands at the expected size (172 base pairs) by partial amplification of viral attachment protein using PCR. Reduced RBCS count, Hb content, HCT, and MCHC values with a significant increase in MCV in all LSD infected cows compared to the control group, while leukogram analysis revealed leucopenia and lymphopenia during the 1st week. Post-infection, however, one month post-infection revealed granulocytic leukocytosis. In addition, all LSD infected cows showed inflammatory thrombocytopenia. Animals during early LSD infection showed significant reduction in total protein, albumin, glucose and TAC and significant increase in ALT, AST, ALP, LDH, CPK, C-troponin-1, total and direct bilirubin, creatinine, K and MDA levels compared to the control group. While animals during late infection showed significant decrease in glucose, ALT, AST, LDH, CPK, C-troponin-1, direct bilirubin, K and MDA levels and significant increase in total protein, albumin and TAC compared to the early infection group. It can be concluded that, LSD infection in cattle revealed critical alterations in some hematological and serum biochemical parameters during both early and late stages of infection with negative impact on different organ functions including skin, muscle, liver, kidney and heart.

Effect of Hospital-associated SARS-CoV-2 Infections in Cardiac Surgery: A Multicenter Study

BackgroundThe effect of hospital-associated SARS-CoV-2 infections in cardiac surgery patients remains poorly investigated, and current data are limited to small case series with conflicting results. MethodsA multicenter European collaboration was organized to analyze the outcomes of patients who tested positive with hospital-associated SARS-CoV-2 infection after cardiac surgery. The study investigators hypothesized that early infection could be associated with worse postoperative outcomes; hence 2 groups were considered: (1) an early hospital-associated SARS-CoV-2 infection group comprising patients who had a positive molecular test result ≤7 days after surgery, with or without symptoms; and (2) a late hospital-associated SARS-CoV-2 infection group comprising patients whose test positivity occurred >7 days after surgery, with or without symptoms. The primary outcome was 30-day mortality. Secondary outcomes included all-cause mortality or morbidity at early follow-up and SARS-CoV-2–related hospital readmission. ResultsA total of 87 patients were included in the study. Of those, 30 were in the early group and 57 in the late group. Overall, 30-day mortality was 8%, and in-hospital mortality was 11.5%. The reintubation rate was 11.4%. Early infection was significantly associated with higher mortality (adjusted OR, 26.6; 95% CI, 2, 352.6; P < .01) when compared with the late group. At 6-month follow-up, survival probability was also significantly higher in the late infection group: 91% (95% CI, 83%, 98%) vs 75% (95% CI, 61%, 93%) in the early infection group (P = .036). Two patients experienced COVID-19–related rehospitalization. ConclusionsIn this multicenter analysis, hospital-associated SARS-CoV-2 infection resulted in higher than expected postoperative mortality after cardiac surgery, especially in the early infection group.

Effects of intrauterine infection in different periods on the placenta and endometrial blood vessel formation of pregnant mice and the growth and development of fetal rats

Objective: To investigate the effects of intrauterine infection in different periods on the placenta and endometrial blood vessel formation of pregnant rats and the growth and development of fetal rats.Methods: According to the random number table method, 32 pregnant rats were divided into the early infection group, the mid-term infection group, the late infection group and the control group, with 8 rats in each group. On the 3rd, 9th and 15th day of pregnancy, lipopolysaccharide was injected intraperitoneally to construct intrauterine infection models. The pregnant rats in the control group were intraperitoneally injected with the same dose of 0.9% sodium chloride solution. On the 18th day of pregnancy, the inflammatory factors [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)], the blood vessel density of placenta and endometrium in the placental tissues of pregnant rats, dead fetus + absorbed fetus, the inflammatory factors IL-6, TNF-α and oxidation reaction indicators [malondialdehyde (MDA) and myeloperoxidase (MPO)] in the fetal rat lung and brain tissues were detected.Results: The changing trend of IL-6 and TNF-α levels in the placental tissues of pregnant rats with intrauterine infection in different periods was: the control group &lt; the late infection group &lt; the mid-term infection group &lt; the early infection group, the differences were statistically significant (p &lt;.05). The changing trend of fetal rat weight, placental weight and placental coefficient in the intrauterine infection groups in different periods was: the control group &gt; the late infection group &gt; the mid-term infection group &gt; the early infection group, the differences were statistically significant (p &lt; .05). The blood vessel density of placenta and endometrium, the mean number of fetuses, brain coefficient and lung coefficient in the late infection group were significantly increased in comparison with the early infection group and the mid-term infection group. The total number and the ratio of dead fetus + absorbed fetus, the levels of IL-6, TNF-α, MDA and MPO in brain and lung tissues were significantly reduced, and the differences were statistically significant (p &lt; .05). The blood vessel density of placenta and endometrium, brain coefficient and lung coefficient of pregnant rats in the mid-term infection group were significantly increased in comparison with the early infection group, and the differences were statistically significant (p &lt; .05). There was no statistically significant difference in the other indicators between the two groups (p &gt; .05).Conclusions: Intrauterine infection in different periods can inhibit placental and endometrial angiogenesis, and affect the survival rate of fetal rats and the growth and development of brain and lung. The reason may be related to the aggravation of fetal inflammatory responses and oxidative stress. The earlier the intrauterine infection occurs, the severer the adverse effects on the fetal rats will be.

Anti-phospholipids antibodies and immune complexes in COVID-19 patients: a putative role in disease course for anti-annexin-V antibodies

IntroductionBesides distinctive respiratory and digestive hallmarks, COVID-19 has been recently associated with a high prevalence of pro-inflammatory and hypercoagulable states known as “COVID-19 Associated Coagulopathy” (CAC), corresponding to a worsening in patients’ conditions, whose causes are still to be elucidated. A link between anti-phospholipid antibodies (aPLs) and viral infections has long been suggested. APLs are assessed for anti-phospholipid syndrome (APS) diagnosis, characterized by thrombocytopenia, thrombosis, and coagulopathy. Furthermore, circulating immune complexes (CICs), arisen upon inflammatory responses and related immune dysregulation, can lead to endothelial cell damage and thrombotic complications.MethodWe performed an extended panel including IgG/IgM anti-cardiolipin, IgG/IgM anti-β2-glycoprotein-1, coupled with IgG/IgM anti-prothrombin, IgG/IgM anti-annexin-V on two COVID-19 patient groups (early and late infection time), and a negative control group. IgG CIC analysis followed to evaluate inflammatory status, through a possible complement system activation.ResultsOur results showed low positive case percentage in IgG/IgM anti-cardiolipin and IgG/IgM anti-β2-glycoprotein-1 assays (4.54%, 6.25%, and 4.55%; in early infection group, late infection group, and control group, respectively); few positive cases in IgG/IgM anti-prothrombin and IgG/IgM anti-annexin-V immunoassays; and no IgG CIC positivity in any patient.ConclusionsIn conclusion, our data show a low aPL prevalence, likely excluding an involvement in the pathogenesis of CAC. Interestingly, IgG/IgM anti-prothrombin and anti-annexin-V positive cases, detected in late infection group, suggest that aPLs could temporarily increase or could trigger a “COVID-19-induced-APS-like-syndrome” in predisposed patients.Key Points•To our knowledge, anti-prothrombin (aPT) antibodies, anti-annexin-V antibodies and CICs in COVID-19 patients have not been reported in the scientific literature.•Lack of uniformity and the low percentage of aCL/aβ2GP1 positivity preclude a putative role in CAC pathogenesis.•IgG/IgM anti-prothrombin and IgG/IgM anti-annexin-V data show that distribution of positive case number increases in late infection patients, significantly in anti-annexin-V results, suggesting a possible role for these anti-phospholipid antibodies in disease course.•aPLs can arise transiently in some patients with critical illness and SARS-CoV-2 infection (disappearing in a few weeks), as well as in other genetically predisposed patients; they could trigger a “COVID-19-induced-APS-like-syndrome”.

Evaluation of a new simultaneous anti-SARS-CoV-2 IgA, IgM and IgG screening automated assay based on native inactivated virus

In addition to molecular testing, there is evolving interest for anti-SARS-CoV-2 antibodies serologic assays. Majority of them focus on IgM/IgG despite IgA important role in mucosal immunity.A simultaneous anti-SARS-CoV-2 IgA/IgG/IgM immunoassay, performed on an automated instrument by ELISA kit coated with native inactivated SARS-CoV-2, was detected on two control groups (negative swab healthcare workers; pre-pandemic healthy or with other viral infections individuals) and on two COVID-19 patient groups (early and late infection).Specificities were 100% in all groups, indicating no cross-reactivity with other infectious or pre-pandemic sera. Sensitivities were 94% in early infection group and 97% in total positive patient group, reaching 100% in late infection group.To our knowledge, this is the first technique based on native SARS-CoV-2. It is able to identify more positive samples than kits using recombinant antigens, therefore virus native epitopes as well as simultaneous anti-SARS-CoV-2 IgA/IgM/IgG detection could help to contain COVID-19 spreading.

Exosomal MicroRNAs Associate With Neuropsychological Performance in Individuals With HIV Infection on Antiretroviral Therapy.

Neurocognitive dysfunction remains prevalent among people living with HIV (PLWH), even after viral suppression on combination antiretroviral therapy (cART). We investigated associations between neuropsychological performance (NP) and patterns of circulating exosomal microRNA (exo-miRNA) expression in PLWH on cART. A cross-sectional examination of plasma exo-miRNA among PLWH on cART with systemic viral suppression and volunteers without HIV infection. Thirty-one PLWH who started cART during early infection (n = 19) or chronic infection (n = 12) participated in phlebotomy and an 11-test neuropsychological battery after >1 year on treatment. NP higher- or lower-performing participants were categorized based on normalized neuropsychological scores. Total RNA was extracted from purified exosomes of 31 PLWH and 5 volunteers without HIV and subject to small RNA sequencing. Differential expression of exo-miRNAs was examined and biological functions were predicted. Eleven exo-miRNAs were up-regulated in NP lower-performing (n = 18) relative to higher-performing PLWH (n = 13). A high proportion of the differentiating exo-miRNA target the axon guidance KEGG pathway and neurotrophin tyrosine receptor kinase signaling Gene Ontology pathway. Differential expression analysis of exo-miRNAs between NP lower- (n = 7) and higher-performing (n = 12) PLWH within the early infection group alone confirmed largely consistent findings. Plasma exo-miRNA content differed between NP higher- and lower-performing PLWH. Several differentially expressed exo-miRNAs were predicted to be involved in inflammation and neurodegeneration pathways. Exo-miRNA in plasma may indicate cross-talk between the circulation and central nervous system and thus may be clinically relevant for neurocognitive dysfunction in PLWH.

The treatment of early and delayed infection of intramedullary nails of lower limb

Objective To explore the treatment methods and prognosis of early infection and delayed infection after intra-medullary nail fixation. Methods Data of 22 cases of postoperative infections after intramedullary nail from January 2013 to Au-gust 2017 were retrospectively analyzed. There were 18 males and 4 females aged from 20 to 72 years old, with an average age of 46.8 years. 14 cases were tibias and 8 cases were femurs. In the early infection group, 6 cases showed swelling, heat and pain in the affected area with drainage and pus. In the late infection group, 12 cases showed sinus formation and 4 cases showed no sinus tract. According to whether the infection occurred within six weeks, it was divided into early infection and delayed infection groups. Of 6 patients in early infection group, there was 1 case of septic shock which underwent removal of intramedullary nails, debridement and antibiotic bone cement stick implantation. 5 cases were retained intramedullary nail and underwent local debride-ment treatment. Late infection occurred in 16 patients. One patient with tibia infection was given partial dressing to heal the frac-ture. Then the intramedullary nail was removed and intramedullary debridement was performed. Two patients with poor general condition, the intramedullary nails were removed and debridement was performed. Calcium sulphate cement was implanted and fixed with external fixation. The remaining 13 cases were treated with debridement and antibiotic cement stick implantation. We compared the differences between early and late infections of internal fixation, infection control, fracture healing, and secondary fracture fixation. Results Of the 6 patients with early infection, 1 patient with septic shock removed intramedullary nails to con-trol infection. After infection controlled, the fracture was treated with intramedullary nailing. Of the 5 patients with retained intra-medullary nails, 2 patients’ infection were controlled and 3 were uncontrolled. After removal of the intramedullary nails the infec-tion was control. The success rate of retaining intramedullary nails was 33.3% (2/6). Late infection occurred in 16 cases and infec-tion was all controlled. The fractures healed in 22 patients. The fracture healing time of 6 patients with early infection was 2-6 months, with an average of 3.67±2.08 months. The fracture healing time of 16 patients with late infection was 2-4 months (average 3.2±0.79) months. Conclusion Patients with early bone infections after femoral and tibial intramedullary nail surgery may at-tempt debridement therapy with retained intramedullary nails, but the failure rate is high. If the intramedullary nail fails to remain, follow the treatment of patients with delayed bone infection. For patients with delayed bone infection, because the fracture has not yet healed, thorough debridement is used after the removal of internal fixation, then calcium sulfate or antibiotic bone cement stick should be implanted and fixed with external fixation. For the second phase, we may choose plate, intramedullary nail or external fixation to fix the fractures according to the soft tissue condition. All of the fixation methods could provide good fracture healing. Key words: Femur; Tibia; Infection; Fracture fixation, intramedullary

FACTORS ASSOCIATED WITH THE DEVELOPMENT OF EARLY INFECTION AFTER SURGICAL TREATMENT OF FRACTURES.

ABSTRACTObjective:Infection after the internal fixation of fractures is a major complication. Early infection is particularly challenging, because it occurs when the fracture is not yet united. The objective of this study is to identify possible factors related to the development of early infection in patients treated with internal fixation for fractures. Method:This retrospective observational study analyzed 24 patients with long bone fractures who underwent internal fixation and developed infections in the post-operatory period. The infections were classified as early (diagnosis in the first two weeks after surgery) or late (diagnosis after 2 weeks). Results:Of the 24 patients studied, 11 (46%) developed early infections and 13 (54%) were diagnosed with late infections. The early infection group was significantly younger (37.8 versus 53.1 [p = 0.05]) and underwent more surgeries prior to internal fixation (1.2 versus 0.2 [p < 0.00]). Conclusion:Risk factors for the development of early infection in the postoperative period should be considered when treating patients with internal fracture fixation in order to diagnose this condition as early as possible. Level of Evidence IV; Case series.

Characterizing infections in prosthetic breast reconstruction: A validity assessment of national health databases

Current guidelines in the United States require reporting only the 30-day postoperative outcomes to standardized databases, including the National Surgical Quality Improvement Program (NSQIP). Thus, many breast implant-related complications go unreported in standard databases. We sought to characterize late periprosthetic infections following implant-based breast reconstruction. We conducted a retrospective analysis of all women who underwent expander/implant reconstruction from 2005 to 2014 at two institutions. All periprosthetic infections were identified and divided into early and late cohorts (≤30 days or >30 days). Infection was defined as any episode where antibiotics were initiated or a prosthetic device was explanted because of clinical evidence of the infection. In the 1820 patients (2980 breasts) identified, 421 periprosthetic infections occurred (14%). Of these, 173 (41%) were early and 248 (59%) were late (mean time to infection=66.4±101.9 days). Patients with late infections were more likely to be current smokers or have diabetes than patients with early infections (p<0.034 for both). Infections caused by gram-negative bacteria and antimicrobial-resistant strains of Staphylococcus were more common in the early infection group (p<0.001 for both). Implant loss due to infection was more common in the late infection group (p=0.037). Late periprosthetic infections following implant-based breast reconstruction are underestimated in national outcome databases and have unique risk factors and microbiology compared to early infections. A system-level change in reevaluating and redefining a timeline for tracking and treating implant infections is necessary, given the substantial morbidity associated with, and frequency of, late periprosthetic infections.

Clinical Predictors of Port Infections within the First 30 Days of Placement

PurposeTo identify risk factors for port infections within 30 days of placement. Material and MethodsA retrospective chart review of port placements from 2002–2009 was conducted. Patients who had port removals secondary to infection within the first 30 days of placement were included. This group of patients was compared with a control group of patients with ports with no evidence of infection. For every one patient with a port infection, two control subjects were chosen of the same gender and new port placement during the same month as the corresponding patient with an infected port. ResultsFrom 2002–2009, 4,404 ports were placed. Of the 4,404 patients, 33 (0.7%) were found to have a port infection within 30 days of placement. Compared with the control group, the early infection group had a higher prevalence of leukopenia (21.2% vs 6.1%, P = .039) and thrombocytopenia (33% vs 12%, P = .0158). There was also a higher prevalence of an inpatient hospital stay during port placement and high international normalized ratio in the early infection group. ConclusionsLow preoperative white blood cell and platelet counts were risk factors for early infection. Abnormal coagulation profiles and inpatient access of ports after placement could be additional risk factors.