Department Of Infectious Diseases Research Articles

Viral lumbosacral radiculitis (Elsberg syndrome) in Denmark

PurposeTo describe clinical features and outcomes of viral lumbosacral radiculitis (Elsberg syndrome).MethodsNationwide population-based cohort study of all adults hospitalised for viral lumbosacral radiculitis at departments of infectious diseases in Denmark from 2015 to 2020.ResultsTwenty-eight patients with viral lumbosacral radiculitis were included (mean annual incidence: 1.2/1,000,000 adults). The median age was 35 years (IQR 27–43), and 22/28 (79%) were female. All patients had urinary retention, with 17/28 (61%) needing a catheter. On admission, at least one sign or symptom of meningitis (headache, neck stiffness, photophobia/hyperacusis) was present in 18/22 (82%). Concurrent genital herpetic lesions were present in 11/24 (46%). The median cerebrospinal fluid leukocyte count was 153 cells/µL (IQR 31–514). Magnetic resonance imaging showed radiculitis/myelitis in 5/19 (26%). The microbiological diagnosis was herpes simplex virus type 2 in 19/28 (68%), varicella-zoster virus in 2/28 (7%), and unidentified in 7/28 (25%). Aciclovir/valaciclovir was administered in 27/28 (96%). At 30 days after discharge, 3/27 (11%) had persistent urinary retention with need of catheter. At 180 days after discharge, moderate disabilities (Glasgow Outcome Scale score of 4) were observed in 5/25 (20%).ConclusionsUrinary retention resolved within weeks in most patients with viral lumbosacral radiculitis, but moderate disabilities according to the Glasgow Outcome Scale were common at the end of follow-up.

Quality of Life of People Living with HIV on Antiretroviral Therapy: A Cross-Sectional Study in Monastir, Tunisia.

Despite the benefits of an efficient antiretroviral therapy (ART), HIV/AIDS epidemic still represents the most seriousaffection worldwide that negatively impacts people's quality of life (QoL). As no studies exist on QoL in Tunisia, the aim of the present work was i: to assess, based on WHOQOL-HIV BREF tool, the perception of QoL of people living with HIV (PLHIV) receiving ART and ii: to investigate the relationship between socio-demographic features, disease-related variables and QoL domains' mean scores. This cross-sectional study was conducted at the department of infectious diseases of F. Bourguiba Teaching Hospital in Monastir, Tunisia. One hundred and five participants receiving ART were involved. QoL assessment was based on the WHOQOL-HIV Bref including six domains with 29 items with scores ranged from the lowest (4) to the highest (20). Results were reported as frequencies and means (±SD). The Student's t-test for independent samples and the one-way ANOVA were performed to assess differences in QoL mean scores. Linear regression analysis was used to investigate predictors of QoL. The confidence interval was set at 95%. Clients' mean age was 39.20±10.18 years old with a male to female sex ratio of 3.12. Low mean scores were seen with the environment (12.34±2.90), social relations (12.58±3.94) and psychological domains (12.76±3.31), and moderate mean scores were noted for the physical (14.11±3.52), the spiritual (14.05±3.78) and the level of independence (13.98±3.57) domains. Regression analysis showed that health status and feeling healthy were related to all QoL domains and that profession, marital status and the presence of a confident person were related to environment and spiritual domains. QoL of PLHIV on ART is affected. Concrete measures and strategies should be undertaken by healthcare stakeholders to improve QoL determinants.

A Predictive Model for Identifying Low Medication Adherence Among Patients with Cirrhosis.

This study aims to identify the novel risk predictors of low medication adherence of cirrhosis patients in a large cohort and construct an applicable predictive model to provide clinicians with a simple and precise personalized prediction tool. Patients with cirrhosis were recruited from the inpatient populations at the Department of Infectious Diseases of Tangdu Hospital. Patients who did not meet the inclusion criteria were excluded. The primary outcome was medication adherence, which was analyzed by the medication possession ratio (MPR). Potential predictive factors, including demographics, the severity of cirrhosis, knowledge of disease and medical treatment, social support, self-care agency and pill burdens, were collected by questionnaires. Predictive factors were selected by univariable and multivariable logistic regression analysis. Then, a nomogram was constructed. The decision curve analysis (DCA), clinical application curve analysis, ROC curve analysis, Brier score and mean squared error (MSE) score were utilized to assess the performance of the model. In addition, the bootstrapping method was used for internal validation. Among the enrolled patients (460), most had good or moderate (344, 74.78%) medical adherence. The main risk factors for non-adherence include young age (≤50 years), low education level, low income, short duration of disease (<10 years), low Child-Plush class, poor knowledge of disease and medical treatment, poor social support, low self-care agency and high pill burden. The nomogram comprised these factors showed good calibration and good discrimination (AUC = 0.938, 95% CI = 0.918-0.956; Brier score = 0.14). In addition, the MSE value was 0.03, indicating no overfitting. This study identified predictive factors regarding low medication adherence among patients with cirrhosis, and a predictive nomogram was constructed. This model could help clinicians identify patients with a high risk of low medication adherence and intervention measures can be taken in time.

CORRELATION BETWEEN INTRAHEPATIC cccDNA AND SERUM HBV pgRNA IN TREATMENT-NAÏVE CHRONIC HEPATITIS B PATIENTS

Objectives: To evaluate the correlation between intrahepatic covalently closed circular DNA (cccDNA) and serum HBV pregenomic Ribo nucleic acid (pgRNA) in treatment-naïve chronic hepatitis B (CHB) patients. Methods: A total of 105 treatment-naïve CHB patients from the Department of Infectious Diseases, Military Hospital 103, Vietnam Military Medical University, were enrolled from 2017 to 2020. Real-time RT-PCR methods were used to quantify serum HBV pgRNA and intrahepatic cccDNA. Clinical and histopathological assessments were also performed. The patients were categorized into two groups: HBeAg-positive CHB (n = 59) and HBeAg-negative CHB (n = 46). Statistical analyses were conducted using Medcalc 20.019. Results: In treatment-naïve patients, the average concentration of cccDNA and HBV RNA were 1.61 ± 0.40 log10 copies/cell and 4.88 ± 1.65 log10 copies/mL, respectively. A positive linear correlation was observed between HBV pgRNA and cccDNA, especially in the overall group and the HBeAg-negative subgroup, as well as in patients with HAI score ≥ 9 and Fibrosis score ≥ 3 (r = 0.49, r = 0.56, and r = 0.57; p &lt; 0.01, respectively). Conclusion: The study findings indicate a positive linear correlation between intrahepatic cccDNA and serum HBV pgRNA in CHB patients. HBV pgRNA can serve as a reliable marker in the management of CHB patients.

Association of HLA-DRB1*11 and HLA-DRB1*12 gene polymorphism with COVID-19 in Burkina Faso

BackgroundThe clinical manifestations of coronavirus disease (COVID-19) can vary widely, ranging from asymptomatic to severe, and may be influenced by the host genetic background. The aim of the present study was to determine the frequencies of HLA-DRB1*11 and HLA-DRB1*12 allele polymorphisms and their associations with COVID-19.MethodsIn this cross-sectional study, 198 subjects were enrolled, including 150 COVID-19 positive cases and 48 subjects who tested negative for COVID-19. Participants were recruited from the emergency, intensive care, and infectious diseases departments of the Bogodogo Centre University Hospital (CHU-B) or the routine laboratory of Centre de Recherche Biomoléculaire Pietro Annigoni (CERBA). Genomic DNA was extracted from nasopharyngeal swabs samples and multiplex PCR-SSP was used to detect the HLA-DRB1*11 and HLA-DRB1*12 alleles. The study was approved by CERS (№ 2021-02-033).ResultsThe positive cases were categorized into 38 asymptomatic (CC+), 60 symptomatic (NC+), and 52 severe cases (SC+). Females were more frequent in the overall study population (53.0%, 105/198) as well as in the negative group’s CC- (68.75%, 33/48) and SC+ (57.69%, 30/52 negative groups, whereas males were more frequent in the CC+ (63.16%, 24/38) and NC+ (53.33%, 32/60) groups. The highest mean age was observed in the SC + group. A frequency of 19.19% (38/198) and 14.65% (29/198) was found for the HLA-DRB1*11 and HLA-DRB1*12 alleles, respectively. Individuals carrying the HLA-DRB1*11 allele had an approximately sixfold higher risk of asymptomatic SARS-CoV-2 infection (OR = 5.72 [1.683–19.442], p = 0.005) based on the association analysis.ConclusionsAltogether, the present study reports high frequency of HLA-DRB1*11 and HLA-DRB1*12 alleles within a population from Ouagadougou, Burkina Faso. The results suggest that individuals carrying the HLA-DRB1*11 allele are more susceptible to COVID-19 infection but may not display symptoms.

Steroid use in measles: A retrospective cohort study during the 2017 outbreak in tertiary referral center, Rome and Latina, Italy

IntroductionSince early January 2017, a new measles outbreak in Italy has been observed. The aim of the study was to compare features between adults and children measles cases and evaluate the effect of steroid treatment on the above parameters. MethodsA retrospective multicenter, descriptive study was performed. We analyzed all patients admitted to the Department of Public Health and Infectious Diseases, Sapienza University, Rome and Latina, from January 2017 to December 2017 and discharged with diagnosis of measles. ResultsWe identified 113 patients discharged with the diagnosis of measles infection cases of which 59 adults and 54 children (≤16 years). In adult population 32 patients (54 %) were males, with a median age of 30.5 years old and all unvaccinated (100 %). Keratoconjunctivitis 30 (50 %) was the most frequent complication. In pediatric population 27 (50 %) patients were males, with a median age of 3 years old. Information on measles vaccination status was available for only 21 (38.8 %) of cases. Keratoconjunctivitis 40 (74 %) was the most frequent complication. Analyzing the differences between adult and pediatric patients we found that children were significantly more likely to have keratoconjunctivitis and diarrhea as complications than adults in which the rate of thrombocytopenia and hepatitis was highest. Thirty-nine adult subjects (66 %) have been treated with systemic corticosteroids. ConclusionsPediatric patients differ from adults in complications and liver involvement. Regarding steroids use, although there is no clear indication of steroid use during measles, there is no evidence of a worse outcome in our cases series.

Benign recurrent lymphocytic meningitis (Mollaret's meningitis) in Denmark: a nationwide cohort study.

Data on clinical features and outcomes of benign recurrent lymphocytic meningitis (BRLM) are limited. This was a nationwide population-based cohort study of all adults hospitalized for BRLM associated with herpes simplex virus type 2 (HSV-2) at the departments of infectious diseases in Denmark from 2015 to 2020. Patients with single-episode HSV-2 meningitis were included for comparison. Forty-seven patients with BRLM (mean annual incidence 1.2/1,000,000 adults) and 118 with single-episode HSV-2 meningitis were included. The progression risk from HSV-2 meningitis to BRLM was 22% (95% confidence interval [CI] 15%-30%). The proportion of patients with the triad of headache, neck stiffness and photophobia/hyperacusis was similar between BRLM and single-episode HSV-2 meningitis (16/43 [37%] vs. 46/103 [45%]; p = 0.41), whilst the median cerebrospinal fluid leukocyte count was lower in BRLM (221 cells vs. 398 cells; p = 0.02). Unfavourable functional outcomes (Glasgow Outcome Scale score of 1-4) were less frequent in BRLM at all post-discharge follow-up visits. During the study period, 10 (21%) patients with BRLM were hospitalized for an additional recurrence (annual rate 6%, 95% CI 3%-12%). The hazard ratio for an additional recurrence was 3.93 (95% CI 1.02-15.3) for patients with three or more previous episodes of meningitis. Clinical features of BRLM were similar to those of single-episode HSV-2 meningitis, whilst post-discharge outcomes were more favourable. Patients with three or more previous episodes of meningitis had higher risk of an additional recurrence.

Knowledge and Attitudes towards HIV and HCV among the Population Attending the Fast-Track Cities Mobile Unit in Brescia, Italy.

The Infectious and Tropical Diseases Department of the University of Brescia organized free rapid screening tests for HIV and HCV as part of the Fast-Track City commitment. A cross-sectional study was conducted, consisting of an anonymous multiple-choice questionnaire that was administered to individuals who underwent the screening or consultation. The study aimed to compare knowledge and attitudes towards HIV and HCV between age groups (18-40 vs. >40) and sexual orientations (heterosexual vs. LGBTQ+). Overall, 333 questionnaires were completed. Overall, only 107 (32%) of respondents knew how HIV is transmitted. Major differences were shown between different age groups, where people under the age of 40 had a significantly higher correct response rate than people over 40 (n = 101; 39% versus n = 6; 7.8%, p < 0.00001). Similarly, almost half of LGBTQI+ people (n = 28; 44.4%) gave the correct answer, versus 30% (n = 79) of heterosexuals (p = 0.0359). Only 9.6% of the population demonstrated high levels of knowledge for both HIV and HCV. Our study highlights that misconceptions about HIV and HCV should be addressed in prevention and education programs, whose target should also be specific populations.

Targeted Pharmaceutical Analysis of Antibiotic Use by Risk Criteria in Patients Hospitalized in the Infectious and Tropical Diseases Department at Treichville Teaching Hospital (Abidjan, Côte d'Ivoire)

Introduction: Most pharmacotherapeutic problems in hospitals are caused by anti-infectives. Audit of prescriptions by a clinical pharmacist is a control and prevention element for iatrogenic risks. Objective: The main aim of our study was to assess the use of antibiotics according to risk criteria in patients hospitalized in the infectious diseases Unit of the Treichville Teaching Hospital (Abidjan, Ivory Coast). Methods: This cross-sectional descriptive study conducted from August to December 2022 in the Infectious and Tropical Diseases department of the Treichville University Hospital aimed to analyze the use of antibiotics in patients with risk criteria. The tools for detecting pharmacotherapeutic problems allowed us to evaluate the frequency and nature of pharmaceutical interventions, highlighting the role of the pharmacist in patient management. Data were analyzed using SPSS version 20.0 software (IBM, USA). Results: A total of 88 patients were included in the study, with a majority of singles (54.5%) and a predominance of subjects under 45 years of age (87.6%) and HIV-positive (93.2%). Antibiotics were the most frequent treatment (75.1%), followed by beta-lactams (36.7%). The main drug interactions were precautions for use (53.6%) and contraindicated associations (45.6%), especially the combination of Ofloxacin with bivalent cations or didanosine. The main pharmaceutical interventions proposed were monitoring of biological parameters in at-risk patients (68.8%) and drug substitution (14.8%). All proposed pharmaceutical interventions were accepted by prescribers. Risk criteria associated with the use of antibiotics were significantly associated with the nature of proposed pharmaceutical interventions. Conclusion: In conclusion, the use of antibiotics in patients with risk criteria is common in the Infectious and Tropical Diseases department of the Treichville University Hospital. The results emphasize the importance of prescription audit by a clinical pharmacist in detecting pharmacotherapeutic problems and preventing iatrogenic risks. The proposed pharmaceutical interventions were accepted by prescribers and were tailored to the risk criteria associated with the use of antibiotics.

Characteristics, Management, and Outcomes of Bacterial Dermohypodermatitis at the Infectious and Tropical Diseases Department of Fann University Hospital, 2016-2020

Recent trends show a clear increase in cases of bacterial dermohypodermatitis (BDH) worldwide. According to some authors, this upsurge is linked to an increase in risk factors, particularly depigmentation. In Senegal, all data relating to BDH come from dermatology departments. The objective of this study was to describe the characteristics, management, and outcomes of dermohypodermatitis at the Infectious and Tropical Diseases Department (SMIT) of Fann hospital. This was a retrospective study conducted at the SMIT. The study population consisted of all patients hospitalized in the department for BDH from 2016 to 2020. We recorded 54 cases of BDH, representing a hospital frequency of 1.29%. The sex ratio (M/F) was 0.42. The median age was 46.5 years [17-85 years]. The most factor of BDH, was depigmentation (31.48%). BDH was localized to the lower limbs in 81.48%. Pain (96.30%), inflammatory swelling (92.59%), and erythematous placard (85.19%) were the main physical symptoms. Blood cultures were positive for Staphylococcus aureus, and Staphylococcus saprophyticus. Cytobacteriological examinations of fluid from ruptured phlyctens isolated Staphylococcus aureus, Klebsiella pneumoniae, Enterobacter spp, Escherichia Coli, and Acinetobacter Spp. Deep vein thrombosis (DVT) was found in 4 patients (13.79%). Complications were present in 18 patients (33.33%). We recorded 5 deaths, representing a lethality rate of 9.26%. Depigmentation has become a major risk factor. Women need to be educated about the harmful effects associated with this practice.

Tetanus, an infectious disease still topical in Lome (Togo)

Tetanus still remains a public health problem in Togo despite the existence of the Expanded Program on Immunization. A retrospective and descriptive cohort study was performed from January 1, 2008 to December 31, 2018 in the infectious and tropical diseases department of Sylvanus Olympio teaching hospital of Lome (Togo) on tetanus cases. We included 208 tetanus cases accounting for 6.5% of the whole hospitalizations in the infectious and tropical diseases department at this hospital. The median age of the patients was 23 [13-38 years] with male predominance (81.2%). The patients were workers (63.5%) and came mainly from urban areas (65.9%). Tetanus vaccination was only up to date in 9.3% of patients. Gateways were dominated by skin wounds (66.8%). Antitetanus serum was administered in 191 patients (91.8%) mainly through intrathecal route (189 patients (91.1%)). Complications were marked by superinfection of the wound (n=8), septic shock (n=3), acute respiratory failure and skin necrosis in 1 case respectively. The lethality was 27.4%. The morbidity of tetanus, in particular juvenile morbidity, remains high with significant lethality. It is therefore important to place particular emphasis on the vaccine booster component.

INFLUENCE OF OBESITY ON DIFFICULTY OF RUNNING CORONAVIRUS DISEASE (COVID-19) (clinical case)

Aim: To conduct a retrospective analysis of the influence of obesity on the severity of the course of COVID-19 based on the analysis of the chart of an inpatient who was treated in the infectious department of the Chernivtsi Regional Clinical Hospital.&#x0D; Materials and methods. "Medical card of an inpatient" of a patient who was undergoing inpatient treatment in the infectious department of the Chernivtsi Regional Clinical Hospital.&#x0D; Results. A 42-year-old obese patient (BMI 40.0 kg/m2) was admitted to the inpatient ward of the infectious disease department of the Chernivtsi Regional Clinical Hospital on the 5th day of her illness. In hospital conditions, oxygen therapy was immediately started (flow 3 l/min), antibiotic therapy (cefepime - 1 g 3 r/day), hormone therapy (dexamethasone - 8 mg 1 r/day) was prescribed. On the 26th day of intensive treatment, the patient's condition significantly worsened. The state of consciousness was disturbed to the level of sopor, and then came a coma. Hemodynamic instability was noted, which required medical support (dopamine). The patient underwent endotracheal intubation and mechanical ventilation. Despite all the measures applied, cardiac arrest occurred. The resuscitation measures that were carried out did not have the desired effect, and the death of the patient was confirmed.&#x0D; Conclusion. In patients with obesity (BMI &gt; 40), the course of COVID-19 is much more severe, compared to patients whose body weight is within acceptable norms. Also, excess body weight significantly increases the risk of complications in patients with COVID-19 caused by Sars-Cov2, and more often leads to a fatal outcome.

Features of COVID-19 in teenagers. Clinical cases

Coronavirus infection in childhood is a common disease and has a number of features of the clinical course. There remain quite a lot of problems related to the variety of clinical symptoms, the severity of the course and treatment tactics in different age categories. Purpose - to study the epidemiological and clinical features of the coronavirus disease COVID-19 in adolescents compared to the younger age group in order to predict the severity of the course and determine treatment tactics. Materials and methods. A single-center retrospective open cohort study of 188 patients under the age of 18 hospitalized in the infectious disease department of the Chernivtsi Regional Children’s Clinical Hospital with a confirmed respiratory infection caused by SARS-CоV-2 was conducted. This cohort of patients is divided into 2 clinical groups. The Group I consisted of children aged 12 to 18 years (43 children), the Group II included children aged 0 to 11 years (145 patients). Results. Epidemiologically, extrafamilial sources of infection prevail in adolescence in the range of 44.2% (n=19), which is explained by greater social activity compared to children from birth to 11 years of age. For the 1st observation group, symptoms of damage to the lower respiratory tract are more characteristic, in particular, cough 81.4% (n=23), shortness of breath 51.1% (n=22), hypoxemia 14.2% (n=6) and symptoms of associated with intoxication syndrome (general weakness, asthenia 97.6% (n=42), decreased appetite, refusal to eat 74.4% (n=32), myalgia 11.6% (n=5), headache 14,2% (n=6)). The severity of the course of the coronavirus infection in adolescence is due to the dominance of lower respiratory tract lesions with the development of pneumonia in 58.2% (n=25) of cases, which required longer and more intensive treatment. Conclusions. The share of adolescents hospitalized due to COVID-19 was 22.9% (n=43), among them with a severe degree of impairment of the general condition - 16.4% (n=7), which is due to the predominance of damage to the lower respiratory tract with the development of pneumonia in 58.2% (n=25) of cases. This cohort of patients is characterized by a longer intoxication syndrome, the epidemiological role of family contacts with regard to COVID-19 decreases, and the value of unidentified non-familial sources of infection increases - 44.2% (n=19). The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of parents or their guardians was obtained for conducting research. No conflict of interests was declared by the authors.

Retracted: Analysis of the Demand for Continuing Education of Nurses in the Department of Infectious Diseases and Its Influencing Factors.

[This retracts the article DOI: 10.1155/2022/3743588.].

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

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

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

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

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

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

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

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

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

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

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

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