Sequelae Of Infection Research Articles

P-1281. A Novel Substance Use Disorder-Focused Infectious Diseases Consultation Service: Our Experience with Xylazine-Related Ulcers

Abstract Background Xylazine is a non-opioid analgesic that has become a prevalent additive in the illicit drug supply due to its low cost and synergistic effect with opioids. It is associated with soft tissue ulcers that become necrotic and can lead to infection, amputation, and death. Our hospital created a novel Infectious Diseases (ID) consultation service to help manage xylazine-related ulcers and other infectious sequelae of substance use disorder (SUD). Herein we describe characteristics of patients with SUD who presented to our hospital with xylazine-related soft tissue ulcers. Methods Using data extracted from our electronic health record, we generated a database of patients seen on our ID-SUD service between October 10, 2023 and January 1, 2024. We identified patients ≥ 18 years with documented SUD and conducted a retrospective chart review to identify patients with ulcers. Ulcers were defined based on documentation within the physical examination of a provider’s note or under the photographic media section. Patient demographics and clinical characteristics were collected and described using simple counts and frequencies. Results We identified 193 patients with SUD seen by the ID consult team during the study period. 73 patients (38%) had skin ulcers. The ulcer group was younger with a median age of 40, more likely to be white (78%) or Hispanic (18%), more likely to have tested positive for fentanyl (96%), more likely to inject (99%), and more likely to leave the hospital against medical advice (38%) compared to the non-ulcer patients, as shown in Table 1. Of patients with ulcers, 39 (53%) had ulcers >10cm in size, 55 (75%) had multiple ulcers, 10 (14%) had fever on admission, 17 (23%) developed bacteremia during hospitalization, and 72 (99%) received antibiotics during hospitalization, as shown in Table 2. Conclusion Xylazine-related skin ulcers have become common in patients with SUD, in particular intravenous opioid use. In our adult population in a large city with high rates of SUD, we demonstrated that many patients develop multiple large ulcers. Additionally, many patients with ulcers had evidence of systemic infection with fever, leukocytosis, and/or bacteremia. We anticipate an improvement in clinical outcomes as more is learned about pathophysiology and treatment of xylazine-related ulcers. Disclosures All Authors: No reported disclosures

Outcomes of a Population-Based Congenital Cytomegalovirus Screening Program

Detection of congenital cytomegalovirus (cCMV) infection has previously relied on targeted screening programs or clinical recognition; however, these approaches miss most cCMV-infected newborns and fail to identify those infants who are asymptomatic at birth but at risk for late-onset sensorineural hearing loss. To determine the feasibility of using routinely collected newborn dried blood spots (DBS) in a population-based cCMV screen to identify infants at risk for hearing loss and describe outcomes of infants screened. This diagnostic study of a population-based screening program in Ontario, Canada, took place from July 29, 2019, to July 31, 2023. All newborns with a DBS sample collected as part of routine care were screened using polymerase chain reaction (PCR) analysis for cCMV as a risk factor for hearing loss. Infants with positive DBS PCR results for cCMV were referred for confirmation of infection by urine PCR (the gold standard), as well as complete medical and audiologic assessments for sequelae of cCMV infection. Infants with possible or confirmed symptomatic cCMV were referred to pediatric infectious disease specialists for evaluation for potential treatment with valganciclovir. Detection of cCMV by polymerase chain reaction assay on a newborn DBS. Number of infants with positive screening results successfully retrieved and confirmed to have cCMV and the timeliness of retrieval and symptomatic evaluation. Of 565 987 infants born in the screening period, 551 034 (97.4%) received cCMV screening on the DBS (45.7% female, 54.3% male). Of these infants, 689 (0.13%) screened positive for cCMV; 601 (87.2%) had cCMV infection confirmed and a complete assessment of sequelae of their congenital infection. Ninety-six infants with completed assessments (16.0%) were deemed to have cCMV symptoms, and 63 of these (65.6%) began valganciclovir treatment. Sensorineural hearing loss was confirmed in 34 of 96 infants (35.4%). This program found acceptable and feasible implementation of a population-based screening program using routinely collected DBS samples, suggesting that it may serve as a template for jurisdictions considering universal cCMV screening. The program had a much lower than expected prevalence of cCMV-positive screens but still identified many children who would otherwise not have been diagnosed and who would benefit from ongoing audiologic surveillance.

Neck Abscess as a Rare Sequela of Pediatric Varicella-Zoster Infection: A Case Report

Neck Abscess as a Rare Sequela of Pediatric Varicella-Zoster Infection: A Case Report

Chlamydia trachomatis impairs T cell priming by inducing dendritic cell death.

The lack of effective adaptive immunity against Chlamydia trachomatis leads to chronic or repeated infection and serious disease sequelae. Dendritic cells (DCs) are professional antigen-presenting cells that are crucial for the activation of T cells during C. trachomatis infection. cDC1s and cDC2s are the two main DC subsets responsible for T cell priming, but little is known about how C. trachomatis affects their ability to prime T cells. Using a mouse model of infection, we found that C. trachomatis uptake reduced the viability of cDC1s and cDC2s both in vitro and in vivo, with cDC1s experiencing more death. DC death was mainly due to apoptosis and is alleviated in Casp3/7 or Bak1/Bax knockout DCs. In addition, we observed that C. trachomatis-specific CD8+ T cells were preferentially activated by cDC1s. Reduction in DC viability by C. trachomatis impaired the ability of infected DCs to activate T cells upon co-culture, although in the case of CD8+ T cell priming, controlling for viability was insufficient to fully rescue the defect. RNA sequencing of DCs from infected mice showed upregulation of cell death pathways, supporting our observations of DC death caused by C. trachomatis. Finally, we validated our findings with human DCs in vitro, observing C. trachomatis-induced cell death. These results indicate that C. trachomatis may evade the adaptive immune system by directly inducing cell death in DCs.

Nutritional and psychological sequelae of COVID-19 infection in maintenance hemodialysis patients.

The risk of infection with COVID-19 in hemodialysis (HD) patients is higher compared to the general population. Additionally, HD patients are at higher risk of developing post-COVID-19 infection sequelae. However, this has not been thoroughly investigated. Therefore, we aimed to study the impact of COVID-19 on nutritional status and psychological health in HD patients 6 months following recovery. We recruited HD patients who were proven to be infected with COVID-19 and received treatment at two HD units in two institutions between April 2022 and December 2022. Additionally, we enrolled a group of age- and sex-matched HD patients who had not previously been infected with COVID-19 or received vaccination. Nutritional status was assessed using malnutrition inflammation score (MIS), while psychological health was assessed using online questionnaires. The Patient Health Questionnaire 9 (PHQ 9) was employed to assess symptoms of depression, the Generalized Anxiety Disorder 7 (GAD 7) was used to identify anxiety disorders, the Patient Health Questionnaire 15 (PHQ 15) was utilized to measure somatic symptoms, and the Insomnia Severity Index (ISI) was used to measure insomnia. A total of 60 subjects (30 patients and 30 controls) were assessed in the study. We found statistically significant differences between patients and controls regarding the MIS (median score (interquartile range (IQR)); 11 (9-12) and 5.5 (5-7), respectively), PHQ 15 (median score (IQR); 17.5 (15-19) and 9 (6-11), respectively), PHQ 9 (median score (IQR); 17 (13-19) and 5 (7-8), respectively), GAD 7 (median score (IQR); 14 (11-16) and 6 (4-8), respectively), and ISI (median score (IQR); 20 (15-22) and 8 (7-11), respectively), with p<0.001 for all scores. COVID-19 has long-term effects on the psychosocial health of HD patients and may lead to a higher incidence of malnutrition 6 months post recovery.

Association of chronic kidney disease with acute clinical outcomes and hospitalization costs of cancer resection.

Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) have been noted to face increased cancer incidence. Yet, the impact of concomitant renal dysfunction on acute outcomes following elective surgery for cancer remains to be elucidated. All adult hospitalizations entailing elective resection for lung, esophageal, gastric, pancreatic, hepatic, or colon cancer were identified in the 2016-2020 National Inpatient Sample. Based on stage of renal dysfunction, CKD patients were sub-classified as CKD1-3, CKD4-5, or ESRD (others: Non-CKD). Multivariable regression models were developed to assess the association of comorbid CKD/ESRD with in-hospital mortality, perioperative complications, and resource utilization. Of ~515,145 patients, 32,195 (6.2%) had CKD (5.1% CKD1-3, 0.7% CKD4-5, 0.5% ESRD). The incidence of CKD among patients undergoing cancer resection increased from 5.3% in 2016 to 7.3% in 2020 (P<0.001). Following risk adjustment, CKD1-3 and CKD4-5 remained linked with similar likelihood of mortality and hospitalization costs, but greater need for blood transfusion (CKD1-3 AOR 1.21, CI 1.09-1.35; CKD4-5 AOR 1.73 CI 1.38-2.18). CKD4-5 was also associated with greater odds of infection (AOR 1.88, CI 1.34-2.62) and respiratory sequelae (AOR 1.36, CI 1.05-1.77). Further, ESRD was linked with greater odds of in-hospital mortality (AOR 2.74, CI 1.69-4.45), infection (AOR 2.31, CI 1.62-3.30) and respiratory complications (AOR 1.72, CI 1.31-2.26), as well as greater resource utilization, relative to Non-CKD. Comorbid renal dysfunction was linked with inferior clinical and financial outcomes following elective cancer resection. Future work is needed to develop optimal management strategies and recovery pathways for this complex cohort.

Autoantibodies Targeting G-Protein-Coupled Receptors and RAS-Related Molecules in Post-Acute COVID Vaccination Syndrome: A Retrospective Case Series Study.

Background/Objectives: While post-acute COVID-19 syndrome is well known and extensively studied, the post-acute COVID vaccination syndrome (PACVS) is a more recent nosological entity that is poorly defined at the immunopathological level, although it shares many symptoms with the sequelae of viral infections. Methods: This single-center retrospective study reports a case series of 17 subjects vaccinated with mRNA or adenoviral vector vaccines who were healthy before vaccination and had never been infected with SARS-CoV-2 but who presented with symptoms similar to PACVS for a median time of 20 months (min 4, max 32). The medical records of all patients referred to our outpatient clinic over a one-year period were retrospectively analyzed. Results: In this group, serological tests showed that, in addition to positivity for anti-spike protein antibodies, a high percentage of subjects were positive for antibodies against G protein-coupled receptors and molecules involved in the response to SARS-CoV-2. In a panel of 16 autoantibodies tested, a few were positively associated with some of the symptoms reported by patients: anti-ATR1 with lymphadenopathy and/or tonsillitis; anti-ACE2 with skin symptoms such as ecchymosis, skin oedema, and rash; anti-MAS1 with widespread burning sensation; and anti-STAB1 with skin oedema and rash. Anti-ADRA2A were negatively associated with memory loss and/or mental fog. ACE2 correlated with the serum levels of anti-S antibodies, supporting the hypothesis of an anti-idiotype mechanism in the immunopathogenesis of PACVS. Conclusions: This exploratory analysis suggests that the levels of autoantibodies directed against ACE2, and probably also MAS1 and STAB1, may serve as biomarkers for PACVS.

The Link between Malaria and Hematological Disorders: Epidemiological Trends and Blood Cell Alterations

This work delves into the intricate dynamics between malaria and hematological disorders, with a particular focus on elucidating the interplay between epidemiological trends and blood cell alterations. By meticulously dissecting the existing literature, this study aims to elucidate the mechanisms through which malaria influences blood cell alterations and contributes to the development of various hematological complications. This review underscores the urgent need for a multidisciplinary approach that integrates epidemiology, hematology, and pathology to better understand this complex relationship. Furthermore, it systematically unravels the diverse hematological disorders that arise as sequelae of malaria infection, providing a comprehensive understanding of the epidemiological dimensions and consequences of these complications. Building upon this foundation, this study investigates the molecular connection between hemoglobinopathies and malaria susceptibility, exploring the protective effects conferred by certain genetic variants against severe malaria. Drawing upon existing epidemiological data and cutting-edge molecular analyses, this paper highlights novel avenues for malaria management and intervention strategies. The conclusions and future perspectives presented in this paper emphasize the imperative of an integrated approach that synthesizes epidemiological knowledge with molecular insights, ultimately advancing our ability to mitigate the burdens imposed by malaria and its associated hematological morbidities. By bridging the fields of epidemiology and hematology, this research contributes to the broader understanding of malaria pathogenesis and paves the way for enhanced diagnostic, therapeutic, and preventive measures in the fight against this global health threat. Keyword: Malaria, Hematology Disorders, Epidemiological Trends and Blood Cell Alterations

Generalized Fatigue: Why Post-Polio Syndrome Should Be Included as A Differential Diagnosis.

Dear Editor, Post-Polio Syndrome (PPS) is a neurological condition that manifests in the form of non-specific symptoms such as fatigue, sleep dysfunction, muscle and bone pains, at least 15 years after the initial infection with polio virus. Multiple mechanisms have been suggested to describe the pathogenesis of PPS, with some studies attributing it to accommodative changes in the muscle fibers, with replacement of type II fibers by type I fibers and muscle hypertrophy. It has also been postulated that the virus may persist unknowingly or be reactivated. Additionally, inflammatory and autoimmune causes have also been hypothesized.1 Among the symptoms, fatigue, muscle weakness with atrophy and motor dysfunction are the most common ones to be reported in PPS, associated with significant morbidity in patients. 2 Owing to the non availability of diagnostic tests for this condition, PPS remains a diagnosis of exclusion with factors such as a confirmation of previous polio infection and subsequent resolution characterized by neurologic stability for more than 15 years, abrupt onset of neurologic symptoms with persistence for one year, and exclusion of other possible attributable medical conditions established as essential parts of its diagnostic criteria. 3 The management of the condition is mainly based on physical therapy, and previous researches based on the use of drugs such as pyridostigmine, steroids, and IV immunoglobulins have shown limited efficacy in the improvement of the prognosis and condition of PPS patients.2 As of today, Pakistan remains among the three countries where the transmission of polio virus is prevalent, with the majority of outcomes in the past twenty years attributed to areas in the northern transmission zone bordering eastern Afghanistan, such as Khyber Pakhtunkhwa and Federally Administered Tribal Areas, and those in the southern transmission zone including southern Punjab, northern Sindh and Karachi.4 According to the Pakistan Polio Eradication Programme, 354 cases of polio virus have been reported in Pakistan from 2015-2024, with the highest number of infections occurring in Khyber Pakhtunkhwa. This is in contrast to the 20,000 cases reported in the early 1990s prior to immunization efforts.5 Statistically, 15-20 million people across the globe still suffer from the sequelae of infection with the virus.1 Additionally, it has been postulated that about 25 to 40 percent of such survivors of poliomyelitis will experience PPS at some point in their lifetime. ---Continue

Compromised CD8+ T cell immunity in the aged brain increases severity of neurotropic coronavirus infection and postinfectious cognitive impairment.

Advanced age increases the risk of severe disease from SARS-CoV-2 infection, as well as incidence of long COVID and SARS-CoV-2 reinfection. We hypothesized that perturbations in the aged antiviral CD8+ T cell response predisposes elderly individuals to severe coronavirus infection, re-infection, and postinfectious cognitive sequelae. Using MHV-A59 as a murine model of respiratory coronavirus, we found that aging increased CNS infection and lethality to MHV infection. This was coupled with increased CD8+ T cells within the aged CNS but reduced antigen specificity. Aged animals also displayed a decreased proportion of CD103+ resident memory cells (TRM), which correlated with increased severity of secondary viral challenge. Using a reciprocal adoptive transfer paradigm, data show that not only were fewer aged CD8+ T cells retained within the adult brain post-infection, but also that adult CD8+ cells expressed lower levels of TRM marker CD103 when in the aged microenvironment. Furthermore, aged animals demonstrated spatial learning impairment following MHV infection, which worsened in both aged and adult animals following secondary viral challenge. Spatial learning impairment was accompanied by increased TUNEL positivity in hippocampal neurons, suggestive of neuronal apoptosis. Additionally, primary cell coculture showed that activated CD8+ T cells induced TUNEL positivity in neurons, independent of antigen-specificity. Altogether, these results show that non-antigen specific CD8+ T cells are recruited to the aged brain and cause broad neuronal death without establishing a TRM phenotype that confers lasting protection against a secondary infection.

Examining Brain Structures and Cognitive Functions in Patients with Recovered COVID-19 Infection: A Multicenter Study Using 7T MRI.

Emerging evidence suggests that severe acute respiratory syndrome, COVID-19, negatively impacts brain health, with clinical magnetic resonance imaging (MRI) showing a wide range of neurologic manifestations but no consistent pattern. Compared with 3 Tesla (3T) MRI, 7 Tesla (7T) MRI can detect more subtle injuries, including hippocampal subfield volume differences and additional standard biomarkers such as white matter lesions. 7T MRI could help with the interpretation of the various persistent post-acute and distal onset sequelae of COVID-19 infection. To investigate the differences in white matter hyperintensity (WMH), hippocampal subfields volumes, and cognition between patients hospitalized with COVID-19 and non-hospitalized participants in a multi-site/multi-national cohort. Original investigation of patients hospitalized with COVID-19 between 5/2020 and 10/2022 in 3 USA and 1 UK medical centers with follow-up at hospital discharge. A total of 179 participants without a history of dementia completed cognitive, mood and other assessments and MRI scans. COVID-19 severity, as measured by hospitalization vs no hospitalization. 7T MRI scans were acquired. All WMH and hippocampal subfield volumes were corrected for intracranial volumes to account for subject variability. Cognition was assessed using a comprehensive battery of tests. Pearson correlations and unpaired t-tests were performed to assess correlations and differences between hospitalized and non-hospitalized groups. We found similar WMH volume (4112 vs 3144mm³, p=0.2131), smaller hippocampal volume (11856 vs 12227mm³, p=0.0497) and lower cognitive and memory performance, especially the MoCA score (24.9 vs 26.4 pts, p=0.0084), duration completing trail making test B (97.6 vs 79.4 seconds, p=0.0285), Craft immediate recall (12.6 vs 16.4 pts, p<0.0001), Craft delay recall (12.0 vs 15.6 pts, p=0.0001), and Benson figure copy (15.2 vs 16.1 pts, p=0.0078) in 52 patients hospitalized for COVID-19 (19[37%] female; mean[SD] age, 61.1[7.4] years) compared with 111 age-matched non-hospitalized participants (66[59%] female; mean[SD] age, 61.5[8.4] years). Our results indicate that hospitalized COVID-19 cases show lower hippocampal volume when compared to non-hospitalized participants. We also show that WMH and hippocampal volumes correlate with worse cognitive scores in hospitalized patients compared with non-hospitalized participants, potentially indicating recent lesions and atrophy. Question: Do white matter hyperintensity burden, hippocampal whole and subfield volumes, and cognition differ between patients hospitalized with COVID-19 versus participants without hospitalization?Findings: We found no significant difference in white matter hyperintensity volume, but hippocampal volume was reduced, and cognitive and memory performance were worse in those hospitalized for COVID-19 compared with age-matched non-hospitalized group (either mild COVID-19 or no COVID-19 reported). In the hospitalized group, increased white matter hyperintensity and reduced hippocampal volumes are significantly higher correlated with worse cognitive and memory scores.Meaning: Adults hospitalized for COVID-19 had lower hippocampal volumes and worse cognitive performance than adults with COVID-19 that did not lead to hospitalization or without reported COVID-19 infection.

Dopamine receptor autoantibody signaling in infectious sequelae differentiates movement versus neuropsychiatric disorders.

Despite growing recognition, neuropsychiatric diseases associated with infections are a major unsolved problem worldwide. Group A streptococcal (GAS) infections can cause autoimmune sequelae characterized by movement disorders, such as Sydenham chorea, and neuropsychiatric disorders. The molecular mechanisms underlying these diseases are not fully understood. Our previous work demonstrates that autoantibodies (AAbs) can target dopaminergic neurons and increase dopamine D2 receptor (D2R) signaling. However, AAb influence on dopamine D1 receptor (D1R) activity is underexplored. We found evidence that suggests GAS-induced cross-reactive AAbs promote autoimmune encephalitis of the basal ganglia, a region of high dopamine receptor density. Here, we report a mechanism whereby neuropsychiatric syndromes are distinguished from movement disorders by differences in D1R and D2R AAb titers, signaling, receiver operating characteristic curves, and immunoreactivity with D1R and D2R autoreactive epitopes. D1R AAb signaling was observed through patient serum AAbs and novel patient-derived monoclonal antibodies (mAbs), which induced both D1R G protein- and β-arrestin-transduced signals. Furthermore, patient AAbs and mAbs enhanced D1R signaling mechanisms mediated by the neurotransmitter dopamine. Our findings suggest that AAb-mediated D1R signaling may contribute to the pathogenesis of neuropsychiatric sequelae and inform new options for diagnosis and treatment of GAS sequelae and related disorders.

Rheumatic manifestations and sequela of acute parvovirus B19 infection in hospitalized adult population.

Parvovirus B19 infection has been associated with various clinical entities including musculoskeletal manifestations and the development of different autoimmune diseases. The aim of our study is to examine the musculoskeletal manifestations associated with acute parvovirus B19 infection and the possible development of chronic autoimmune rheumatic diseases. Retrospective cohort study that included adult hospitalized patients diagnosed with an acute parvovirus B19 infection between 1 January 2021 and 1 February 2024. Subjects were followed-up for 6-12 months after hospitalization aiming to identify patients who developed chronic autoimmune rheumatic diseases. The study included 23 patients diagnosed with acute parvovirus B19 infection. Patients were predominantly females (16, 69.6%) with mean age at diagnosis of 39.3 ± 13.11 years. Most patients were Jewish (15, 65.2%). The two most common acute symptoms were fever (82.6%) and myalgia (56.5%). Polyarthritis was present only in three patients (13%) and all of them had wrists involvement. Anti-nuclear antibodies and rheumatoid factor were the most common autoantibodies present with equal prevalence each (13%). Five patients were treated with prednisone during the acute phase (21%), two (8.7%) of them needed drug escalation and were subsequently treated with hydroxychloroquine and methotrexate. One patient developed systemic lupus erythematosus during the first 6 months of follow-up. Musculoskeletal manifestations developing during acute parvovirus B19 are usually self-limited with only a small minority of patients developing chronic autoimmune diseases. It is crucial to differentiate self-limited manifestations related to acute parvovirus B19 from idiopathic autoimmune diseases aiming to avoid unnecessary immunosuppressive therapy.

SARS-CoV-2 Encephalitis versus Influenza Encephalitis: More Similarities than Differences.

From time to time, physicians face challenging diagnostic and therapeutic issues concerning the acute management of children with viral encephalitis. The aim of this article is to provide an updated narrative review on the similarities and differences between SARS-CoV-2 and influenza encephalitis. A PubMed search was performed with the function "Clinical Queries" using the key terms "SARS-CoV-2" OR "Influenza" AND "Encephalitis". The search strategy included metaanalyses, clinical trials, randomized controlled trials, reviews and observational studies. The search was restricted to the English literature and pediatric population. This article compares similarities and contrasts between SARS-CoV-2 and influenza-associated encephalitis. Encephalitis is an uncommon manifestation of both influenza and SARS-CoV-2. Both viruses are associated with fever and respiratory symptoms. However, SARS-CoV-2 patients may only have mild symptoms or be asymptomatic as silent carriers, rendering the disease spread difficult to control. Influenza patients usually have more severe symptomatology and are often bed bound for several days limiting its spread. Influenza is associated with seasonal and annual outbreaks, whereas SARS-CoV-2 has become endemic. Complications of encephalitis are rare in both viral infections but, when present, may carry serious morbidity and mortality. Many long-term sequelae of COVID- 19 infections (long COVID-19) have been described but not with influenza infections. Mortality associated with encephalitis appears higher with influenza than with SARS-CoV-2. Prophylaxis by immunization is available for both influenza and SARS-CoV-2. Specific efficacious antivirals are also available with oseltamivir for influenza and nirmatrelvir/ritonavir for SARS-CoV-2. Steroids are indicated with more severe SARS-CoV-2 but their role is not distinct in influenza disease. Encephalitis is a rare complication of influenza and SARS-CoV-2 infections. Both carry significant morbidity and mortality. Efficacious vaccines for prophylaxis and antivirals for treatment are available for both viruses.

A clinical odyssey: ulcerative colitis, renal failure, obstructive uropathy, and Streptococcus agalactiae meningoencephalitis

Streptococcus agalactiae infections are primarily attributed to pregnancy and neonates. However, adults with underlying immune-compromised states can also be affected. We report a rare instance of GBS meningoencephalitis in a 40-year-old male with chronic kidney disease. The patient presented to us with obstructive uropathy with urinary tract infection. He developed generalised seizures during in-hospital care. Cerebrospinal fluid examination confirmed Streptococcus agalactiae infection. The immunocompromised state of the patient probably contributed to his illness (GBS meningoencephalitis). Early diagnosis by a qualitative multiplexed nucleic acid based in vitro diagnostic test (BioFire ® FilmArray ®) and early treatment helped achieve a successful outcome with no post infection sequelae. This case report demonstrates the importance of early accurate aetiological diagnosis and appropriate treatment to achieve an optimal outcome.

Laboratory possibilities of prognosis of local complications in hip replacement

BACKGROUND: Endoprosthetics of large joints is a frequently performed operation in traumatology practice. The progression of local infectious sequela among postoperative patients is of major socio-economic importance since more than 30% of cases of inflammatory postoperative reactions are complicated by sepsis. In recent years, new criteria have been sought to assess the risks of infection in the field of surgical intervention, and prognostic scales have also been developed. AIM: The aim of the study was to evaluate the prognostic value of coagulological, biochemical and hematological indicators of the risk of hemorrhagic complications in patients after hip replacement. MATERIALS AND METHODS: The study included 85 patients who were in the clinic of Traumatology and Orthopedics of the I.I. Mechnikov for planned hip replacement. The average age of the patients was 64 ± 10 years. There were 46 women (54%), 39 men (46%). All patients underwent clinical and laboratory examination before surgery, the day after surgery and before discharge. All patients received rivaroxaban (10 mg 1 time/day) after surgery for the prevention of venous thromboembolic complications (46 patients) or apixaban (2.5 mg 2 times/day) (39 patients) during the entire period of stay in the clinic. Retrospectively, depending on the occurrence of complications, the patients were divided into 2 groups: group 1 — 78 patients (42 women and 36 men), whose postoperative period passed without complications, and group 2 — 7 patients (4 women and 3 men), who had hemorrhagic cases. Screening coagulogram (International Normalized Ratio, Activated partial thromboplastin time, fibrinogen) was performed on the STA Compact analyzer (Stago, France), biochemical parameters (alanine aminotransferase, aspartate aminotransferase, creatinine, total calcium, ionized calcium, serum iron, C-reactive protein) were determined on the COBAS Integra 400plus analyzer, hematological parameters on the DxH800 analyzer (Beckman Coulter, USA). RESULTS: A retrospective analysis revealed that a decrease in serum iron in male patients before surgery is a marker of the prognosis of hemorrhagic complications. Prognostic significant laboratory indicators of the development of hemorrhagic complications in patients in the early period after hip replacement include an increase in fibrinogen and C-reactive protein; a decrease in serum iron. During the recovery period, the concentration of C-reactive protein and the relative number of monocytes are the most significant for assessing the risk of complications. CONCLUSIONS: Among the laboratory indicators in the structure of the weight coefficients of the prognosis of complications in patients undergoing hip replacement, it is necessary to evaluate the concentration of serum iron before surgery, especially in men, in the early postoperative period — C-reactive protein, fibrinogen and serum iron and at discharge — C-reactive protein and the number of monocytes as additional criteria for the risk of complications.

Memory impairment after one year of the acute episode of Covid-19 infection

Abstract Introduction Memory impairment is one of the most frequently reported sequelae of COVID-19 infection. The aim of our study was to estimate the risk of memory disorders one year after the acute episode of COVID-19 infection in the Tunisian population of Monastir. Methods This is a cohort study conducted in Monastir University Hospital. The study included two groups: Exposed subjects were randomly selected among those with a positive diagnosis of COVID-19 between September 2021 and January 2022. The non exposed group was selectd among subjects with a negative COVID-19 diagnosis during the same period and who had no COVID infection during the following year. The Mac Nair scale was used to assess memory impairment after one year of follow up. Results Our study included 140 subjects diagnosed with Covid-19 and 139 subjects who had never been in contact with this virus. The incidence rate of memory impairment at one year post-Covid-19 infection was 17.9% (IC95% [11.5 - 24.2%]), whereas in the non exposed group it was 9.4% (IC95% [4.45% -14.5%]). Multivariate analysis revealed that the group exposed to Covid-19 had a significantly higher Mac-Nair Total score after one year of the acute episode of infection compared with the non exposed group (exp β = 1.25, IC95% [1.10; 1.42]). The other main predictors of memory impairment in the study population were age (exp β = 1.006, IC95% [1.001; 1.01]), diabetes (exp β = 1.67, IC95% [1.44; 1.95]), history of anxiety and depression ((exp β = 1.71, IC95% [1.35; 2.17]) and obesity (exp β = 1.25, IC95% [1.10; 1.42]), whereas vaccination with two or more doses prior to COVID-19 infection (exp β = 0.84, IC95% [0.74; 0.96]) and male gender (exp β = 0.65, IC95% [ 0.57; 0.73]) were found to be protective against these disorders. Conclusions Our study allowed us to estimate the risk of long-term memory disorders following Covid-19 infection. This could help better guide preventive measures to reduce the incidence of these disorders. Key messages • The incidence rate of memory impairment at one year post-Covid-19 infection was 17.9%. • The main other predictors of memory impairment were age, female gender, diabetes, history of anxiety and depression and obesity whereas vaccination prior to COVID-19 infection was a protective factor.

Post-dengue fatigue syndrome: A comprehensive review of an emerging clinical entity

Post-dengue fatigue syndrome (PDFS) is an emerging clinical entity characterised by persistent, debilitating fatigue and other symptoms following acute dengue infection. This review synthesises current evidence on the epidemiology, clinical features, pathophysiology and management of PDFS. Studies suggest that 20–25% of hospitalised dengue patients may develop PDFS, though population-based incidence is likely lower. Risk factors include older age, female sex and possibly host genetic factors. The hallmark symptom is profound fatigue, often accompanied by musculoskeletal pain, cognitive difficulties, sleep disturbances and mood changes. While some patients recover within weeks, others experience symptoms persisting for months or years. The pathophysiology of PDFS remains unclear but may involve persistent immune activation, hypothalamic-pituitary-adrenal axis dysfunction and autonomic nervous system disturbances. Diagnosis is based on the clinical history and exclusion of alternative causes. Management typically involves a multidisciplinary approach, including patient education, graded exercise therapy, cognitive behavioural therapy and symptomatic treatment. However, evidence for specific interventions is limited. Prognosis is variable, with some patients experiencing prolonged disability. Significant research gaps remain, including the need for standardised diagnostic criteria, biomarkers and controlled trials of potential therapies. As dengue’s global burden increases, further investigation of PDFS is crucial to improve recognition and develop evidence-based treatments for this impactful sequela of dengue infection.

Prevalence and associations of insomnia after COVID-19 infection.

Sleep disturbances in "long COVID" are common, but the associations between the severity of sleep problems and the severity of COVID infection are unclear. We evaluated the prevalence, persistence, comorbidities, and clinical effects of insomnia following recovery from acute COVID-19 infection in a COVID-specific clinic. Inpatients discharged after COVID infection and outpatients referred for persistent post-COVID symptoms were surveyed on insomnia severity (Insomnia Severity Index, ISI), other neuropsychological symptoms, cardiopulmonary symptoms and physiological functions (6 minute walk distance and others), and functional outcome and quality of life (QOL). Multivariable regression models evaluated the severity of ISI against independent variables. A total of 280 patients met criteria at the initial visit. The prevalence of significant insomnia at the initial visit was 50% and 42% at the subsequent visit (obtained in 78 of the 280 patients). Lower age, female sex, non-white race, and non-Hispanic ethnicity were significantly associated with worse initial ISI scores. More severe symptoms of anxiety and depression were strong correlates with worse ISI scores. Interval improvements in insomnia severity correlated with improvements in anxiety and post-traumatic stress disorder (PTSD) scores. Physiological sequelae of infection did not correlate with insomnia at any stage. Initial and persistent insomnia is common in long COVID. Treatment for insomnia with the use of evidence based approaches (such as cognitive behavioral therapy for insomnia) may best suit this particular post-COVID symptom.

Respiratory sequelae after COVID-19 infection in Thai healthy children.

The long-term respiratory sequelae of COVID-19 infection in children remain poorly understood and may differ across countries. This study aims to investigate the respiratory sequelae, including residual respiratory symptoms and pulmonary function in Thai children. The secondary aim is to identify factors associated with the respiratory sequelae. This is an observational study involving 56 healthy children, aged between 7 and 18 years, who were diagnosed with COVID-19 infection from July 2021 to February 2023. Clinical data relating to COVID-19 infection and persistent symptoms after the infection were assessed after the infection up to 6 months. Spirometry was performed to assess pulmonary function. Post-COVID-19 symptoms were identified in 14 patients (25%), with fatigue, cough, and dyspnea being common symptoms (28%-35%). A significant correlation was found between post COVID-19 symptoms and pneumonia (OR = 6.00, 95%CI [1.54,23.33], p = .01). Abnormal pulmonary function was identified in 10 patients (17.8%) with obstructive impairment being the most common. However, there was no significant association between clinical factors and pulmonary function impairment. Prolonged respiratory symptoms and abnormal pulmonary function following COVID-19 infection are not uncommon in children. The post-COVID-19 symptoms are possibly associated with COVID-19 pneumonia.