Immune-compromised Patients Research Articles

Growing emergence of drug-resistant Pseudomonas aeruginosa and attenuation of its virulence using quorum sensing inhibitors: A critical review.

A perilous increase in the number of bacterial infections has led to developing throngs of antibiotics for increasing the quality and expectancy of life. Pseudomonas aeruginosa is becoming resistant to all known conventional antimicrobial agents thereby posing a deadly threat to the human population. Nowadays, targeting virulence traits of infectious agents is an alternative approach to antimicrobials that is gaining much popularity to fight antimicrobial resistance. Quorum sensing (QS) involves interspecies communication via a chemical signaling pathway. Under this mechanism, cells work in a concerted manner, communicate with each other with the help of signaling molecules called auto-inducers (AI). The virulence of these strains is driven by genes, whose expression is regulated by AI, which in turn acts as transcriptional activators. Moreover, the problem of antibiotic-resistance in case of infections caused by P. aeruginosa becomes more alarming among immune-compromised patients, where the infectious agents easily take over the cellular machinery of the host while hidden in the QS mediated biofilms. Inhibition of the QS circuit of P. aeruginosa by targeting various signaling pathways such as LasR, RhlR, Pqs, and QScR transcriptional proteins will help in blocking downstream signal transducers which could result in reducing the bacterial virulence. The anti-virulence agent does not pose an immediate selective pressure on growing bacterium and thus reduces the pathogenicity without harming the target species. Here, we review exclusively, the growing emergence of multi-drug resistant (MDR) P. aeruginosa and the critical literature survey of QS inhibitors with their potential application of blocking P. aeruginosa infections.

The 47th Annual Meeting of the European Society for Blood and Marrow Transplantation: Nurses Group – Oral Session (NO001 – NO010)

Background: Italy was one of the first European Countries to deal with the Coronavirus Disease 2019 (COVID-19) outbreak, since its appearance in China. The virus spread from northern regions to central and southern ones with different intensity. Drastic emergency restrictions were introduced including quarantine and self-isolation measures. Initially, these were limited to Northern Italy then extended nationwide. The Italian Health System is organized on a regional basis with different funding, resources, institutional pathways. Health Care Professionals (HCPs) working in clinically demanding areas such as Emergency Departments and Intensive Care Units are at high risk of developing physical/mental health outcomes related to Coronavirus pandemic, such as stress, anxiety, depression, sleep disorders and burn-out symptoms (Luo et al., 2020). Nurses in Hematopoietic Stem Cell Transplant (HSCT) Units are caring for complex immune-compromised patients, being hospitalized for long period without seeing relatives. However, it is not known if nurses working in HSCT settings experience similar problems during the pandemic. The aim of the study was to investigate physical and psychological issues among nurses working in Italian HSCT Units during COVID-19 spread. Methods: A cross-sectional study was conducted between June and August 2020 through an online questionnaire sent to nurses working in Italian HSCT centers registered with GITMO (Gruppo Italiano per il Trapianto Midollo Osseo). Data were collected immediately after the lockdown period (during phase 2, consisting of a progressive reduction of lockdown measures) in order to:-investigate the prevalence of sleep disorders and burnout symptoms with validated tools: Pittsburgh Sleep Quality Index (PSQI) and Maslach Burnout Inventory (MBI), respectively.-explore significant correlations with other variables such as geographical areas (Northern Italy-NIT vs Central Sothern Italy-CSIT) according with COVID-19 incidence, its spread. Statistical analysis was performed using the Matrix Laboratory (MATLAB) Statistical toolbox version 2008 (MathWorks, Natick, MA, USA). Results: Three hundred and eight nurses working in 61 Italian HSCT Units responded to the survey: 214 nurses from NIT and 94 nurses from CSIT. Nurses responding from CSIT were older (mean 47, p = 0.0001) and male (74.5%, p < 0.0001). More nurses from NIT did not have children compared to those from CIST (49.5% vs 30.9%, p = 0.0023). Symptoms like stress, anxiety and depression were more frequently reported by CSIT than NIT nurses (NIT 27.7% vs 12.6%, p = 0.0013). MBI results: NIT and CSIT nurses reported low level of emotional exhaustion (median score: 14.0 vs 12.0 respectively) and depersonalization (3.0 vs 4.0);medium level of personal accomplishment (36.0 vs 34.5) were reported without significant differences between groups. Worst sleep quality was detected on nurse working in CSIT centers than NIT (global PSQI score 7.6 vs 6.5;p = 0.008) with the main differences in sleep duration (p = 0.006), sleep disturbance (p = 0.03), need of medication (p < 0.001). Conclusions: Despite cited differences on disease incidence and spread of infection, COVID-19 pandemic did not appear to have an impact on nurses' sleep quality or symptoms of burnout. Greater sleep disorders of nurses working in CSIT centers suggests that other factors influencing this issue.

Introspecting Scope of Ultra-Diluted Homeopathic Preparations in Human SARS-CoV-2 Infection: A Perspective Review

AbstractCoronavirus disease 2019 (COVID-19) is a zoonotic disease caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). Its symptoms range from mild fever, cough, pharyngitis to severe acute respiratory syndrome. Since its first outbreak in Wuhan province of China, the disease has spread worldwide and emerged as pandemic. The infection is mainly spread by droplets and through contacts. Initially SARS-CoV-2 was thought to cause viral pneumonia only, but now it is evident that the virus can spread through the bloodstream and can cause systemic lesions as well. Though most of the time patients recovered spontaneously for immune-compromised patients, it is detrimental. Lack of effective therapy in conventional medicine has made host immune response as the only option to focus on this battle against COVID-19. First-world countries such as the USA, Italy, England and Spain have witnessed a massive number of deaths, and India is not an exception to that. The whole world is searching for effective treatment in the form of antiviral drugs, vaccines and hydroxychloroquine, but none has proven effective. Homeopathy has always put a mark during epidemics and in recent past during the elimination of leptospirosis in Cuba (2009–2014), homeopathy was very effective. In this scenario, we think homeopathy has a decisive role to play to fight this pandemic as it can enhance the host immune response and reduce the severity of the infection to a great extent. In this review, we will discuss the scopes of homeopathic medicines in the treatment of coronavirus disease.

Anticipating Third Wave of Covid-19 in India. How Much Prepared We Are?

The second wave of Covid -19 in India has made us witness as to how negligence from the part of everyone of us, be it people, Government or policy makers of healthcare system might bring the unwanted disaster in the form of Covid Tsunami. This has made us to see never ending queues of patients , relatives standing for hours for the want of hospital beds, oxygen, essential medicines and lastly but unfortunate for their turn for the cremations of loved ones . But now we can see the number of active cases are declining across the country. Amidst this positive observation in regard of second wave ,there is speculation erupting about the Covid third wave. We can appreciate a similarity in the way that the noble corona virus behave with the Spanish flu that had shaken the world in 1918. It had resulted in three waves with second wave was most deadly and long lasting than the other two waves. During the first wave where the infection was mostly of mild severity we had seen the disease affecting the elderly and immune-compromised patients more. In contrast to this, second wave resulting from mutant strains affected the younger population more and it was of larger severity with high mortality rate. Scientists and experts are now anticipating the third wave , taking the lesson from the Spanish flu and we must be better prepare for it. In order to prepare ourselves from a expected third wave of Covid-19, we shouldn’t repeat mistakes that we made during previos waves. We should refrain ourselves from dismantling our enhanced healthcare facilities, there should not be any sorts of shortage of oxygen , hospital beds, and drug that we have already witnessed. We must have an aggressive containment measure comprising of a really strong and pro-active surveillance system. This can be achieved by increasing the capacity of the existing surveillance system by identifying active cases early. We must ensure that we should follow “social vaccine” of proper masking, avoid indoor gatherings, and proper sanitization. Our vaccination programme needs a boost. We should vaccinate a large section of people before any third wave hits us. The more we vaccinate, the better prepared we are. As medical professionals, it must be ensured that proper scientific protocol must be implemented while handling Covid-19 cases. And last but not the least efforts must be made to fill up vacancies seen in our public health system, especially for frontline healthcare workers. As it is anticipated that the young children are more vulnerable to the forthcoming third wave, efforts are to be sought in order to start vaccination of the younger children in our country. Trials for which has already been started in India and across the world. Till the time vaccine is made available, the resources are to be mobilized to build up healthcare facilities catering the vulnerable age group in this third wave such as building up of more paediatric wards, paediatric ICU’s , training of healthcare personals in handling the emergencies for expected third wave .In addition to these efforts , more and more paediatric covid care centers must be set up at various parts of the country. Equally important is making arrangements for rehabilitation centers for the orphans. Countries like US, Singapore and UAE have already started vaccinating the children in age group between 12 to 15 years with Pfizer-BioNTech Covid vaccine. It’s a high time that the government in India must consider for allowing “expedited approval pathway” to the companies like Pfizer for their Covid-19 vaccine for children. All these combined efforts from everyone may ensure that the country and world may remain well equipped against these subsequent waves of this deadly virus and pave the path of the triumph in the near future.

MO261LUPUS NEPHRITIS AND COVID-19 INFECTION

Background and AimsCovid-19 infection poses a serious challenge for immune-compromised patients with autoimmune systemic diseases. This is likely due to a combination of immune dysfunction, immunosuppressive therapy and excess co-morbidities.The aim of this study is to describe clinical characteristics of patients with lupus nephritis (LN) and Coronavirus disease 2019 (COVID-19), and to identify baseline variables associated with a severe infection requiring hospitalization.MethodA telephone survey investigating the impact of COVID-19 on patients with biopsy - proven LN was administered. Data extraction included diagnosis, disease activity status, demographics, occupational exposure, adherence to social distancing advise, therapy, comorbidities, and laboratory tests. Covid-19 was classified as definite diagnosis of Covid-19 disease (presence of symptomatic Covid-19 infection, confirmed by a nasopharyngeal SARS-CoV-2 polymerase chain reaction test). Comparisons between patients with or without hospitalization were performed.Results114 patients (median age 34,9 ± 12,4 years) with LN were included in the study. All were on different doses glucocorticoids, 82 were taking hydroxychloroquine and 30 took immunosuppressants. 31 patients (26 women, 5 men) developed symptomatic COVID-19 infection - they have at least one symptom (chest pain, fever, asthenia, chills, cough, sore throat, dyspnea, headache, arthralgia, myalgia, odynophagia, diarrhea, conjunctivitis, hypo-, ageusia, hypo-, anosmia) of COVID-19 and were PCR test positive. These 31 patients prior to their COVID-19 illness were treated with methylprednisolone, 16 - with cyclophosphamide, 8 - with azathioprine, 3 – with hydroxychloroquine. Six patients (4 men, 2 women) required hospitalization - these were more frequently older and with comorbidities (cardio-respiratory illness, hypertension and other) and active LN (3 –class IV LN, 2-class V LN, 1 class III LN and 1 Class II LN, according the 2003 ISN/RPS classification). Adherence to therapy and to social distancing advise was high. The median time from onset of symptoms to hospital admission was 6 (3-11) days. The median length of stay was 12 days (8-20) days. No deaths occurred.ConclusionCovid-19 is more frequent in the subgroup of LN patients without therapy with hydroxychloroquine, which might play some protective role against the most harmful manifestations of Covid-19. Male sex, previous lung disease, serum creatinine level, proteinuria, glucocorticoids use > 5 mg/day, were associated to hospitalization of patients with LN.

Direct and Indirect Impact of COVID-19 for Patients with Immune-Mediated Inflammatory Diseases: A Retrospective Cohort Study

Importance: Since the beginning of the Coronavirus Disease-19 (COVID-19) pandemic, Severe Acute Respiratory Syndrome-CoV-2 (SARS-CoV-2) infection has been a serious challenge for immune-compromised patients with immune-mediated inflammatory diseases (IMIDs). Objective: Our aim was to investigate the impact of COVID-19 in terms of risks of infection, hospitalization and mortality in a cohort of patients with rheumatoid arthritis (RA), psoriasis (PSO) or inflammatory bowel disease (IBD). Furthermore, we studied the impact of SARS-CoV-2 infection on the prescribed drug regimen in these patients. Methods: Through the record linkage between health information systems, a cohort of patients, ≥18 years old, assisted in the Lazio region and who had suffered from immune-mediated inflammatory diseases (RA, PSO, IBD) between 2007 and 2019, was identified. The risk of infection, hospitalization or mortality for COVID-19, was assessed by logistic regression models, and reported in an Odds Ratio (ORs; CI 95%), adjusting for sex, age and the Charlson Comorbidity Index. We also estimated these risks separately by IMID and in the subgroup of prevalent biologic drug users. We investigated deferral of biological treatments in the study population by comparing the prevalence of weekly use of biologicals (2019–2020) before and during the pandemic periods. Findings: Within the 65,230 patients with IMIDs, the cumulative incidence for COVID-19 was 303/10,000 ab. In this cohort of patients, we observed a significantly higher risk of SARS-CoV-2 infection than the general population: OR = 1.17 (95% CI 1.12–1.22). The risk was higher even considering separately each disease and in the subgroup of prevalent biologic drug users. This last subgroup of patients showed a higher risk of death related to COVID-19 (OR 1.89; 95% CI 1.04–3.33) than the general population. However, no differences in terms of risks of hospitalization or death related to COVID-19 were recorded in patients with the IMIDs. Comparing the 2019–2020 prevalence of weekly biological drug treatments in prevalent biologic drug users, we found a decrease (−19.6%) during the lockdown, probably due to pandemic restrictions. Conclusions and Relevance: Patients with IMIDs seem to have a higher risk of SARS-CoV2 infection. However, other than for patients with prevalent biologic drug treatment, no significant differences in terms of hospitalization and mortality were reported compared to the general populations; further investigation is warranted on account of unmeasured confounding. In addition, during the lockdown period, the COVID-19 emergency highlighted a lower use of biologic drugs; this phenomenon requires strict pharmacological monitoring as it could be a proxy of forthcoming long-term clinical progression.

POS1184 AUTOIMMUNE SYSTEMIC DISEASES AND COVID-19 INFECTION

Background:Covid-19 infection poses a serious challenge for immune-compromised patients. This is likely due to a combination of immune dysfunction, immunosuppressive therapy and excess co-morbidities. Little is known about the impact of Coronavirus disease 2019 (COVID-19) in patients with inflammatory autoimmune systemic diseases.Objectives:The aim of this study is to describe clinical characteristics of patients with autoimmune systemic diseases and COVID-19, and to identify baseline variables associated with a severe infection requiring hospitalization.Methods:A telephone survey investigating the impact of COVID-19 on patients with systemic lupus erythematosus (SLE), systemic sclerosis (SSc), inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis), idiopathic inflammatory myopathies (IIM), ANCA-associated vasculitis (AAV) was administered. Data extraction included diagnosis, disease activity status, demographics, disease duration, occupational exposure, adherence to social distancing advise, therapy, comorbidities, and laboratory tests. Covid-19 was classified as definite diagnosis of Covid-19 disease: presence of symptomatic Covid-19 infection, confirmed by a nasopharyngeal SARS-CoV-2 polymerase chain reaction test. Comparisons between patients with or without hospitalization were performed.Results:512 patients (median age 53,4 ± 14,3 years) with autoimmune systemic diseases (234 IA, 182 SLE, 42 SSc, 31 IIM, 23 AAV) were included in the study. 89 patients (58 woman, 31 men) developed at least one symptom (fever, asthenia, chills, cough, sore throat, dyspnea, chest pain, headaches, arthralgias, myalgias, odynophagia, diarrhea, conjunctivitis, hypo-, ageusia, hypo-, anosmia) of COVID-19 and were PCR test positive. Of patients with COVID – 19 infection 54 patients were treated with methylprednisolone, 36 – with methotrexate, 34 – with hydroxychloroquine, 26- with biologics, 10 - with azathioprine, 6 - with cyclophosphamide prior to their COVID-19 illness.Conclusion:Covid-19 is more frequent in the subgroup of patients without therapy with modifying anti-rheumatic drugs, which might play some protective role against the most harmful manifestations of Covid-19. 21 patients required hospitalization - these were more frequently men, older and with comorbidities (cardio-respiratory illness, renal diseases, diabetes mellitus). Male sex, previous coronary and lung disease, serum creatinine level, proteinuria, glucocorticoids use &gt; 5 mg/day, were associated to hospitalization. Patients with inflammatory arthritis do not seen to be at higher risk for infection or a severe course of COVID-19.

Investigation of Antifungal Properties of Synthetic Dimethyl-4-Bromo-1-(Substituted Benzoyl) Pyrrolo[1,2-a] Quinoline-2,3-Dicarboxylates Analogues: Molecular Docking Studies and Conceptual DFT-Based Chemical Reactivity Descriptors and Pharmacokinetics Evaluation.

Candida albicans, an opportunistic fungal pathogen, frequently colonizes immune-compromised patients and causes mild to severe systemic reactions. Only few antifungal drugs are currently in use for therapeutic treatment. However, evolution of a drug-resistant C. albicans fungal pathogen is of major concern in the treatment of patients, hence the clinical need for novel drug design and development. In this study, in vitro screening of novel putative pyrrolo[1,2-a]quinoline derivatives as the lead drug targets and in silico prediction of the binding potential of these lead molecules against C. albicans pathogenic proteins, such as secreted aspartic protease 3 (SAP3; 2H6T), surface protein β-glucanase (3N9K) and sterol 14-alpha demethylase (5TZ1), were carried out by molecular docking analyses. Further, biological activity-based QSAR and theoretical pharmacokinetic analysis were analyzed. Here, in vitro screening of novel analogue derivatives as drug targets against C. albicans showed inhibitory potential in the concentration of 0.4 µg for BQ-06, 07 and 08, 0.8 µg for BQ-01, 03, and 05, 1.6 µg for BQ-04 and 12.5 µg for BQ-02 in comparison to the standard antifungal drug fluconazole in the concentration of 30 µg. Further, in silico analysis of BQ-01, 03, 05 and 07 analogues docked on chimeric 2H6T, 3N9K and 5TZ1 revealed that these analogues show potential binding affinity, which is different from the therapeutic antifungal drug fluconazole. In addition, these molecules possess good drug-like properties based on the determination of conceptual Density Functional Theory (DFT)-based descriptors, QSAR and pharmacokinetics. Thus, the study offers significant insight into employing pyrrolo[1,2-a]quinoline analogues as novel antifungal agents against C. albicans that warrants further investigation.

Long-term surveillance for hepatitis E virus in an Italian two-site farrow-to-finish swine farm.

In humans, hepatitis E virus (HEV) is responsible for an acute enterically transmitted hepatitis, which can become chronic in immune-compromised patients. Genotypes 3 and 4 (HEV-3 and HEV-4) are zoonotic, and domestic pigs and wild boar are the main reservoirs. The occurrence of autochthonous cases in Europe, which have been increasing over the last 10years, has been associated with food-borne zoonotic transmission of HEV-3, mainly linked to consumption of undercooked or raw pork products (sausages containing liver) and wild boar meat. Zoonotic HEV-3 strains are widespread on pig farms, but little information is available on the dynamic of HEV-3 infection within farms, among pigs. The aims of this study were to evaluate the prevalence of the infection among pigs of different ages along the production chain by the zoonotic HEVs, and to evaluate how long the virus may persist in the farm environment. The presence of HEV-RNA was investigated by real-time reverse transcription PCR (RT-PCR) in 281 test faecal pools over 19months (2017-2019) on a two-site farrow-to-finish farm (about 1,000 sows), in Northern Italy. A total of 67/281 test faecal pools (23.8%) resulted positive for the presence of HEV-RNA (site 1: 59/221, 26.7%; site 2: 8/60, 13.3%). Nucleotide sequencing revealed a unique HEV-3 viral variant circulating during 19months of surveillance. The same HEV-3 strain was detected in the same farm on 2012, indicating the persistence of the same virus over 7years, and highlighting the role of the environment as a continuous source of infection on pig farms. The results confirmed the circulation of the zoonotic genotype HEV-3 in pigs before slaughtering.

Knowledge, barriers and facilitators regarding COVID-19 vaccine and vaccination programme among the general population: A cross-sectional survey from one thousand two hundred and forty-nine participants

Background and aimsThe success of the COVID-19 vaccination program is dependent on people's knowledge and attitude regarding the vaccination program. Higher vaccine acceptance can be ensured by strengthening the facilitators and limiting the barriers being observed among the general population. Material and methodsIndexed study is a cross-sectional web-based survey using a pre-validated questionnaire to assess knowledge, barriers and facilitators of COVID-19 vaccine and vaccination programme administered on adults across India using a Google online survey platform. ResultsA total of 1294 responses (age: 38.02 ± 13.34 years) were collected. Most of the participants had limited knowledge regarding the eligibility of vaccines in vulnerable population groups such as people with allergies (57.89%) and immune-compromised patients (62.98%), pregnant and lactating women (41.89%) and patients with chronic illness (34.78%). Older participants (>45 years) were more willing to take the COVID-19 vaccine (p < 0.001) as they believed the vaccine is not harmful and considered it as societal responsibility. Younger participants (<45 years) and those residing in urban settings raised concerns on the availability of the vaccine and authenticity of the vaccine (p < 0.001). ConclusionThere is a scope for improvement in people's knowledge regarding COVID-19 vaccine and the vaccination programme by addressing the barriers and facilitators which can improve the participants' turnover at vaccination centres.

Anncaliia algerae

Anncaliia algerae belongs to the microsporidia, a group of obligate intracellular pathogens originally classified as early branching 'primitive' protozoa but now understood to be related to the Cryptomycota as a basal branch in the fungal kingdom. A. algerae has emerged as a rare opportunistic human pathogen in immune compromised patients such as those taking immune suppressive medications for arthritis, hematologic malignancy, or organ transplantation. It was originally identified as a pathogen of mosquitoes and is probably transmitted to humans by food or water through ingestion, inhalation, or contamination of ocular tissue or wounds with environmental spores. A. algerae infection primarily causes myositis; however, vocal cord, skin, corneal (in immune competent hosts), and disseminated infections have been reported. Human infection has also been reported with other members of the Anncaliia genus: Anncaliia vesicularum in a HIV patient, and Anncaliia connori in an infant with thymic dysplasia.

Effect of Biofield Treatment on Blood, Hepatic, and Cardiac Biomarkers in Vitamin D3 Deficiency Diet (VDD) Induced Sprague Dawley Rats

A novel proprietary formulation was designed that consist of minerals (magnesium, zinc, copper, calcium, selenium, and iron), vitamins (ascorbic acid, pyridoxine HCl, alpha tocopherol, cyanocobalamin, and cholecalciferol), Panax ginseng extract, β-carotene, and cannabidiol isolate. The study objective was to evaluate the impact of Consciousness Energy Healing Treatment (the Trivedi Effect®) on a novel test formulation in male Sprague Dawley (SD) rats, fed with vitamin D3 deficiency diet (VDD) for immunomodulatory activity. The test formulation was divided into two parts. One part was denoted as the untreated test formulation without any Biofield Energy Treatment, while the other part was defined as the Biofield Energy Treated sample, which received the Biofield Energy Healing Treatment by renowned Biofield Energy Healer, Mr. Mahendra Kumar Trivedi. The level of total leukocytes count (TLC) were significantly increased by 23.1% and 17.44% in the Biofield Energy Treated test formulation (G5) and Biofield Energy Treated test formulation from day -15 (G7) groups, respectively compared with the disease control group (G2) induced by VDD. Moreover, the level of neutrophils was significantly increased by 71.68%, 92.92% (p≤0.01), 42.48%, and 49.56% in the G5, G7, Biofield Energy Treatment per se plus Biofield Energy Treated test formulation from day -15 (G8), and Biofield Energy Treatment per se animals plus untreated test formulation (G9) groups, respectively compared with the G2 group. Monocyte level was also increased by 23.53%, 17.65%, and 29.41% in the G5, Biofield Energy Treatment per se to animals from day -15 (G6), and G9 groups, respectively compared to the G2 group. Hepatic biomarker like alkaline phosphatase (ALP) was significantly reduced by 14.98% and 23.07% (p≤0.05) in the G7 and G9 groups, respectively as compared to the G2 group. Besides, cardiac biomarker like creatine kinase myocardium band (CK-MB) was also significantly (p≤0.05) reduced by 20.99% in the G6 group compared with the G2. Altogether, results suggested that the Biofield Treated test formulation and Biofield Energy Treatment per se significantly increased immune-related parameters, which might be beneficial for the management of immune-compromised patients as well as to boost-up the immunity in healthy peoples. The results showed a significant slowdown of disease progression and all other disease-related complications/symptoms in the preventive Biofield Energy Treatment group per se and the Biofield Energy Treated Test formulation groups (viz. G6, G7, G8, and G9) as compared to the disease control group.

Within-Host and Between-Host Evolution in SARS-CoV-2-New Variant's Source.

Some of the newly emerging corona viral variants show high numbers of mutations. This is unexpected for a virus with a low mutation rate due to an inherent proof-reading system. Could such a variant arise under very special conditions occurring in a host where the virus replicates and mutates in a rather unlimited fashion, such as in immune compromised patients? The virus was shown to replicate in an immunosuppressed cancer patient for more than 105 days and might be a source of new variants. These patients are asymptomatic and the virus may therefore escape detection and attention and be high-risk. Similarly, HIV-infected individuals may be immunocompromised and support coronavirus replication with increased mutation rates. The patients may promote “within-host evolution”. Some of the viruses present in such a highly mutagenic swarm or quasispecies within one patient may become founders and cause a pandemic by further “between-host evolution”. B.1.1.7 with 23 mutations may be such a case. Immunosuppressed patients can be identified and treated by the synthetic antibody cocktails as passive immunization and kept under control. Immunosuppressed patients can be easily identified and supervised by healthcare workers—once they become aware of the risk—to avoid new variants with pandemic potential.

Increasing burden of necrotizing otitis externa: our experience of 38 cases

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Necrotizing otitis externa is an infection affecting immune-compromised and elderly diabetic patients resulting in complications with significant morbidity and mortality. We present our experience with this disease, along with the investigative tools and treatment modalities that benefitted most. The objective being to analyze the course of the disease and the benefit of having an institutional protocol for its management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a retrospective observational study on patients diagnosed with necrotizing otitis externa between 2013-2019.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Out of 38 patients 36 were diabetics, the commonest clinical presentation included otalgia in 37 patients, granulations in 35, facial nerve palsy in 14 and &lt;em&gt;Pseudomonas aeruginosa&lt;/em&gt; was isolated in 19 patients. They were managed with multidrug combination antibiotic therapy, topical dressing and drops with 27 showing improvement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;We recommend a diagnostic triad for NOE comprising of otalgia in an elderly diabetic patient with granulations in the external auditory canal. It is best managed by controlling diabetes, appropriate antibiotic combination, topical dressing, and sometimes surgical debridement.&lt;/p&gt;

Surgical multidisciplinary approach of orbital complications of sinonasal inflammatory disorders.

SUMMARYOrbital infection complicating sinonasal inflammatory disorders may lead to serious sequelae, including blindness and death, if untreated. Communication between the otorhinolaryngologist, neuroradiologist, ophtalmologist, neurosurgeon and maxillo-facial surgeon is critical and time-sensitive for a successful treatment. The large majority of pre-septal cellulitis cases resolves after broad-spectrum antibiotic therapy. Also orbital cellulitis has been found responsive to pharmacological approach in most cases. The management of the subperiosteal abscess (SPA) is more controversial. An aggressive surgical approach is always recommended also in case of cavernous sinus thrombosis. In cases of surgical indication, debate is still open on the timing and the approach (endoscopic or external). The surgeon should be prepared to convert an endoscopic approach to an external one if needed and this should be included in the informed consent. Decompression of one or more orbital walls may be necessary if orbital pressure remains elevated. Immediate surgery is indicated in children with large SPA or orbital abscesses (OA), or in immune-compromised patients. Moreover, any worsening in the ophthalmological function must be carefully considered as a landmark in candidacy to surgery.

Presentation and outcomes of chronic rhinosinusitis following liver and kidney transplant.

ObjectiveThis study aims to describe presenting characteristics of patients diagnosed with non-invasive chronic rhinosinusitis (CRS) following liver or kidney transplant and determine factors associated with disease-related complications, selection of endoscopic sinus surgery (ESS), and disease resolution in this population.Study designRetrospective chart review.SettingAn academic tertiary care center (Mayo Clinic, Rochester, Minnesota).Subjects and methodsLiver and kidney transplant recipients evaluated by Mayo Clinic otolaryngologists for CRS between 1998 and 2018 were identified. Univariate and multivariate logistic regression analyses were used to determine patient factors and treatment modalities associated with developing complications, selection of ESS, and disease resolution.ResultsFifty-seven patients met inclusion criteria. No patients developed intraorbital or intracranial complications of their CRS. Multivariate modeling demonstrated that the presence of polyps (P = 0.036) was associated with undergoing ESS within one year of presentation. A higher Lund–Mackay (LM) computed tomography score (P = 0.023) and older age (P = 0.018) were significantly associated with decreased disease resolution. No other factors were significantly associated with the use of endoscopic sinus surgery within one year of otolaryngology presentation or resolution of CRS in this cohort.ConclusionThe risk of developing CRS-related intraorbital or intracranial complications in this immunecompromised patient cohort may be lower than originally thought. For liver- and kidney-recipients stable on immunosuppressive medication for many years, prognostic factors for CRS may mirror those for immunocompetent patients.

Medical Image of the Month: Pulmonary Aspergillus Overlap Syndrome Presenting with ABPA, Multiple Bilateral Aspergillomas

No abstract available. Article truncated after 150 words. Introduction. Aspergillus is a ubiquitous fungal organism that causes a variety of pulmonary manifestations, both in immune-competent and immune-compromised patients. It can vary from simple colonization, Aspergilloma, ABPA to Chronic Pulmonary Aspergillosis (CPA) and Invasive Pulmonary Aspergillosis (IPA) (1). ABPA is the most frequently recognized manifestation of allergic aspergillosis, caused by the immunological reactions mounted against Asp. fumigatus. Aspergillomas are rounded conglomerates of fungal hyphae, fibrin, mucus and cellular debris that arise in pulmonary cavities, as a late manifestation of CPA. Chronic pulmonary aspergillosis (CPA) is a long-term aspergillus infection of the lung. The most common form of CPA is chronic cavitary pulmonary aspergillosis (CCPA), which untreated may progress to chronic fibrosing pulmonary aspergillosis. Aspergillus overlap syndrome is defined as the occurrence of more than one form of aspergillus disease (e.g., ABPA with Aspergilloma, ABPA progressing to IPA etc.) in a single individual. Case Report. A 58-year-old woman, resident of …

Is lymphangitic streaking associated with different pathogens?

Little is known regarding the differences in microbiology associated with cellulitis or abscess with or without lymphangitic streaking. The objective of our study is to assess whether there are differences in the pathogens identified from wound cultures of patients with paronychia with and without associated lymphangitis. Retrospective cross-sectional study at a tertiary pediatric emergency department over 25years. We opted to assess patients with paronychia of the finger, assuming that these cases will have a greater variety of causative pathogens compared to other cases of cellulitis and soft tissue abscess that are associated with nail biting. Case identification was conducted using a computerized text-screening search that was refined by manual chart review. We included patients from 1month to 20years of age who underwent an incision and drainage (I&D) of a paronychia and had a culture obtained. The presence or absence of lymphangitis was determined from the clinical narrative in the medical record. We excluded patients treated with antibiotics prior to I&D as well as immune-compromised patients. We used descriptive statistics for prevalence and χ2 tests for categorical variables. Two hundred sixty-six patients met inclusion criteria. The median age was 9.7years [IQR 4.7, 15.4] and 45.1% were female. Twenty-two patients (8.3%) had lymphangitic streaking associated with their paronychia. Patients with lymphangitis streaking were similar to those without lymphangitis in terms of age and sex (p=0.52 and p=0.82, respectively). Overall, the predominant bacteria was MSSA (40%) followed by MRSA (26%). No significant differences were found between the pathogens in the 22 patients with associated lymphangitis compared to the 244 patients without. Staphylococcus aureus represent the majority of pathogens in paronychia, although streptococcal species and gram-negative bacteria were also common. Among patients with paronychia of the finger, there seems to be no association between pathogen type and presence of lymphangitic streaking.

P0703 / #615: NORWEGIAN SCABIES IN INFANT, PRESENTATION OF A CASE.

Aims & Objectives: Scabies is a parasitic disease caused by infestation with Sarcoptes scabiei var hominis. Is one of the most frequent pruritic dermatological disease in the world. Afecting more tan 300 million people a year. The norwegian scabies is an atypical form of scabies, affecting immune-compromised patients, with hyperkeratotic lesions and is highly contagious. Clinical case: A female infant 3 month old, both parents and a brother with diagnosis of scabies a year ago. She was born healthy, 40 days old start with maculae and papules spread throughout the body, ambulatory management is given with ivermectin and benzylbenzoate with partial improvement. Evolve erythematous-squamous, hyperkeratotic plaques with relapse and with major hyperkeratotic lesions. Right foot abscess is observed and admitted to hospitalization, without response to antibiotic treatment, presents septic shock and intravascular coagulation with evolution to multiorgan failure and death.Methods: It is a description of case report Results: The diagnosis of norwegian scabies was made by clinical and biopsy. The worst risk factor for this patient was age, making her more prone to septic shock and multi-organ failure. Conclusions: Conclusion: The Norwegian scabies is a complicated pathology in diagnosis and management, mainly at this age by the immune system.

Seroprevalence of Toxoplasma Gondii among Cancer patient in Qena Governate

Background: Toxoplasmosis is one of the most important cosmopolitan life-threatening diseases in immune-compromised patients. It is caused by an intracellular protozoon: Toxoplasma gondii(T. gondii), this parasite can cause pneumonia, encephalitis or disseminated disease in immune-deficient patients. Objectives:This study aimed to evaluate the prevalence of toxoplasmosis in Egyptian cancer patients and to correlate the prevalence with type of malignancy and the different cancer treatment modalities. Patients and Methods: This study conducted on 100 cancer patients (21 male and 79 female) who attended the Oncology Outpatient Clinic of Qena University Hospital and diagnosed by cancer , receiving chemotherapy or both chemotherapyand radiotherapy, and their ages ranging from 20 year to 76 years from January 2019 until December2020. Results: The high incidence of Toxoplasmosis was among cancer breast patient. The mean of Ig M titre is 0.849 with minimum level is 0.15 and maximum level is 10.43. There were 70 cancer patients undergoing chemotherapy, 6 of them were positive for toxoplasmaIg M(8.7%) , but 30 of whom received chemotherapy and radiotherapy, 11 of whom were infected (36.7%) according to the IgM level. Conclusion: Patients with a positive result are at risk of reactivation of the infection, while patients with a negative result should be informed to prevent primary infection.