Clinical Infectious Diseases Research Articles

1302. Impact of Insurance Coverage on the Route of Antibiotic Treatment for Forefoot Osteomyelitis

Abstract Background Recent studies suggest oral antibiotics can be a non-inferior alternative to intravenous antibiotics for treating bone and joint infections. In this study, we aimed to investigate whether insurance type affects the choice of antibiotic treatment routes and whether the route of antibiotic treatment influences the delivery of home health services. Methods We conducted a retrospective chart review of non-bacteremic patients who underwent amputations for forefoot osteomyelitis with residual signs of infection on proximal bone cultures and were discharged home from the hospital. Of 461 patients scheduled for hospital follow-up visits for bone and joint infections in our community practice infectious diseases clinic from January 2019 to December 2022, 40 met the inclusion criteria. Results were analyzed with multivariable logistic regression, selecting models with the lowest Akaike Information Criterion. Results The placement of PICC lines decreased significantly over time (OR 0.34, 95% CI: 0.14 - 0.71, p = 0.01), mirroring national trends favoring increased oral antibiotic use. After controlling for the year of treatment, we observed a trend towards patients with Medicaid insurance more frequently receiving IV antibiotics (OR 4.8, 95% CI: 1.0 - 29, p = 0.06). We found no evidence that the antibiotic administration route led to differences in the delivery of home health services at the time of discharge (p = 0.99). PICC Placement Percentage by Year and Insurance Percentage of PICC line Placement by year in patients with and without Medicaid Insurance during hospital encounter PICC Placement Frequency by Insurance and Home Nursing Frequency of PICC placement in patients during hospital encounters based on (A) if a patient has Medicaid insurance and (B) if home nursing is ordered at discharge Organisms Cultured by Year Frequency of organisms cultured on proximal bone cultures by year of study Conclusion Our findings suggest a trend towards patients with Medicaid insurance more frequently receiving IV antibiotics, despite the higher direct and indirect costs. It remains unclear whether this trend is due to differences in the severity of infections or microbiological resistance patterns. Future studies should assess the interaction of psychosocial and microbiological factors in influencing shared decisions regarding the route of antibiotic treatment outside of clinical trial settings. Organisms Cultured by Antibiotic Route, Insurance Type, and Home Nursing Orders Frequency of PICC line placement (A), Insurance coverage (B), and ordered for home nursing at discharge (C) by organisms cultured from proximal bone margins Disclosures All Authors: No reported disclosures

Viral Load Pattern of HIV Positive Children and Adolescents Attending a Paediatric Infectious Diseases Clinic in Owerri, Nigeria

Background: The Viral load (VL) test measures the number of copies of HIV RNA in one milliliter of blood and is the preferred antiretroviral therapy (ART) monitoring strategy. Viral suppression is defined as patients having ≤ 1000 copies of viral RNA/ml of blood.
 Methods/Materials: This study involved the retrospective review of viral load test result of patients aged 2-19years living with HIV/AIDS and enrolled in the treatment programme of the Paediatric infectious diseases clinic of the Federal University Teaching hospital Owerri.
 Results: 117 patients met the inclusion criteria and 103 were virally suppressed giving a suppression rate of 88%. Majority of those virally suppressed were in the 15-19 age group. A logistic regression analysis to ascertain the impact of age, gender, drug regimen, and duration on ARTs on the likelihood of viral suppression showed that age, gender, and drug regimen were not significant predictors of viral suppression (p > 0.05). However, duration on ARTs was a significant predictor (p < 0.01), with patients who had been on ARTs for greater than 24 months having higher odds of viral suppression (OR = 5.42, 95% CI = 1.84-15.93) compared to those who had been on ARTs for 0-6 months.
 Conclusion: Our study provides important insights into the viral load pattern of children and adolescents living with HIV/AIDS in Owerri. It highlights the importance of early initiation of ART, adherence to ART regimen, and routine viral load monitoring to achieve and maintain viral suppression.

Impact of a New Diagnostic Stewardship Team on Utilization and Interpretation of a Microbial Cell-Free DNA Detection Test

Abstract Background After commercial metagenomic next-generation sequencing of plasma microbial cell-free DNA (NGS-mcfDNA) became available at Children’s Healthcare of Atlanta (CHOA) in 2018 with an institutional requirement for Infectious Disease (ID) consultation and approval, we observed an initial period of test utilization without consistent ID involvement. Subsequently we assembled a Diagnostic Stewardship Team (DST) composed of a clinical microbiologist and 3 ID clinicians with expertise in diagnosis and management of infections in immunocompromised children and antimicrobial stewardship, to improve test utilization by clinicians and to optimally impact patient care. Methods We performed a retrospective medical record review as an IRB-deemed Quality Improvement project. NGS-mcfDNA results and their clinical impacts prior to the formation of the DST were assessed, using previously published standardized criteria as an initial framework (Hogan 2021)1. We shared our findings with Bone Marrow Transplant (BMT), Pediatric Intensive Care Unit (PICU), and ID clinicians, providing education on the potential benefits and limitations of NGS-mcfDNA testing. Stakeholder acceptability and engagement with the DST was prioritized, with emphasis on highlighting the benefits to clinicians of expertise in patient selection for testing and with interpretation of results which can be discordant with conventional microbiological tests. DST approval became required for all NGS-mcfDNA tests, with approval decision and discussion documented in the medical record, followed by documentation of test results, interpretation, and communications with treating and consulting clinicians. After one year of DST engagement, which began on June 1, 2021, we repeated our analysis of NGS-mcfDNA utilization and clinical impacts to evaluate the results of DST involvement. We classified time periods into pre-DST, February 28, 2018 - April 12, 2021, and post-DST, June 1, 2021 – May 31, 2022. Results The majority of NGS-mcfDNA tests sent in both the pre- and post-DST periods resulted in no or indeterminate clinical impact (65% pre-DST vs. 73% post-DST), while post-DST the percentage of positive clinical impacts increased (18% pre-DST vs. 25% post-DST), and the percentage of negative clinical impacts decreased (16% pre-DST vs. 2% post-DST), likely due to DST engagement. The number of tests per year increased by three-fold, while fewer patients had multiple NGS-mcfDNA tests sent. Awareness of the requirement for DST consultation and test approval lead to more selective NGS-mcfDNA test requests on the part of BMT clinicians, and the majority of positive clinical impacts from NGS-mcfDNA testing in BMT patients resulted from collaboration between BMT and ID in de-escalation of antimicrobials. An increased awareness of the potential benefits of NGS-mcfDNA testing for pre-treated and diagnostically challenging patients led to an increase in NGS-mcfDNA test requests from ID clinicians. Conclusion Implementation of a DST resulted in universal ID engagement with clinicians requesting NGS-mcfDNA tests and ID involvement in test interpretation. Discussion with experienced diagnostic stewards at the time of NGS-mcfDNA test consideration, with attention to the rationale for test request and consideration of potential test limitations prior to return of results, in addition to rigorous interpretation of results, can increase the positive clinical impacts and decrease the negative clinical impacts of NGS-mcfDNA tests. Reference 1. Hogan CA, Yang S, Garner OB, Green DA, Gomez CA, Dien Bard J, Pinsky BA, Banaei N. Clinical Impact of Metagenomic Next-Generation Sequencing of Plasma Cell-Free DNA for the Diagnosis of Infectious Diseases: A Multicenter Retrospective Cohort Study. Clin Infect Dis. 2021 Jan 27;72(2):239-245. doi: 10.1093/cid/ciaa035. PMID: 31942944. Characteristics of NGS-mcfDNA tests sent from CHOA NGS-mcfDNA tests in BMT patients post-DST (n=19 tests)

The nature of lesions of the central nervous system in infections, caused by <i>Varicella Zoster</i> virus

Varicella Zoster virus can cause damage to the nervous system, more often in the form of meningitis and meningoencephalitis.Purpose: to identify the nature of damage to the central nervous system during infections caused by the Varicella Zoster virus. Materials and methods. The article presents the literature data and the results of own observations of 47 patients treated at the Infectious Diseases Clinical Hospital of Yaroslavl in the period from 2015 to 2021. There were 20 children (42.6%) aged from 18 days to 12 years with chickenpox. There were 27 (57.4%) patients with Herpes Zoster, of which 20 (74.1%) were adults aged 24 to 82 years, 7 (25.9%) were children aged 4 to 14 years. Results. The main clinical and laboratory indicators were analyzed, the features of central nervous system lesions caused by the Varicella Zoster virus were revealed, and the medical and social significance of this problem was confirmed. Among the patients, patients with Herpes Zoster predominated — 27 (57.4%). Meningitis (45.0%), meningoencephalitis (30.0%) and encephalitis (25.0%) were recorded in children with chickenpox. In children with Herpes Zoster, meningoencephalitis predominated (71.4%), while in adults - meningitis (65.0%); there were no encephalitis. There were no deaths, 14.9% of patients were transferred to the neurological department, 85.1% were discharged as outpatients.

Black Box Warning: Large Language Models and the Future of Infectious Diseases Consultation.

Large language models (LLMs) are artificial intelligence systems trained by deep learning algorithms to process natural language and generate text responses to user prompts. Some approach physician performance on a range of medical challenges, leading some proponents to advocate for their potential use in clinical consultation and prompting some consternation about the future of cognitive specialties. However, LLMs currently have limitations that preclude safe clinical deployment in performing specialist consultations, including frequent confabulations, lack of contextual awareness crucial for nuanced diagnostic and treatment plans, inscrutable and unexplainable training data and methods, and propensity to recapitulate biases. Nonetheless, considering the rapid improvement in this technology, growing calls for clinical integration, and healthcare systems that chronically undervalue cognitive specialties, it is critical that infectious diseases clinicians engage with LLMs to enable informed advocacy for how they should-and shouldn't-be used to augment specialist care.

A Pilot Study Using a Standardized Method of Measuring Distress Demonstrates Higher Levels in Septic Revisions

BackgroundCombined Orthopaedic Infectious Disease Clinics facilitate care for prosthetic joint infection (PJI) patients similar to multidisciplinary care in cancer centers. The National Comprehensive Cancer Network developed a standardized distress thermometer (DT) to measure distress in cancer patients. We propose using this tool to assess distress in PJI patients. MethodsIn this pilot study, a retrospective review of patients treated in our combined clinic over 2 years was conducted. In addition to providing information surrounding their treatment, patients completed a questionnaire and DT, adapted with permission from the National Comprehensive Cancer Network. DT scores were compared to a chronologically collected matched aseptic control group. ResultsThere were 122 patients in the septic group and 40 patients in the aseptic group. On a scale of 0-10 (10, the highest level of distress), the septic group reported a mean DT score of 6.18 (±3.2), which was significantly higher than the aseptic mean score of 3.33 (±2.06) [P < .0001]. Over 75% of patients in the septic group reported a DT score ≥4, the cutoff used in most cancer centers to warrant additional support. Twenty-one percent of the septic group (26/122) reported extreme distress (defined as a score ≥10) compared to 0/40 of aseptic patients. ConclusionsPatients treated for PJI experience significantly higher levels of distress compared to aseptic revision patients. More attention is needed to measure and clinically address distress. Improved screening for distress would allow us to provide more comprehensive care and possibly improve compliance, outcomes, and resources available for the treatment of PJI patients.

Antibiotic prescribing practices and perceptions on antimicrobial resistance among healthcare practitioners in Russia

ObjectivesAntimicrobial resistance (AMR) is a growing global health threat. The misuse of antibiotics is the main factor contributing to the development of AMR. Healthcare practitioners (HCPs) play a crucial role in the use of antibiotics. There are limited data available on antibiotic prescribing patterns among physicians in Russia. The aim of this study was to explore antibiotic prescribing practices and perceptions of AMR among HCPs in the Russian Federation. Study designA cross-sectional, multi-centre study was used. MethodsA survey using an online questionnaire was conducted among HCPs. A qualitative study was conducted before the questionnaire was developed. The online questionnaire was distributed via email addresses obtained from the Consilium Medicum database, a specialised educational resource for healthcare professionals in Russia. ResultsIn total, 746 HCPs from 74 regions of the Russian Federation were included in the study. Physicians who participated in this study did not frequently prescribe antibiotic drugs: 40.6% of participants recommended antibiotics less than five times per week. Gynaecologists, paediatricians, family doctors, and surgeons were the least likely study participants to prescribe antibiotics, whereas clinical pharmacologists, otolaryngologists, urologists, and infectious disease specialists prescribed antibiotics more often. Amoxicillin and amoxicillin/clavulanic acid were the most frequently prescribed antimicrobials. The majority of HCPs in Russia who took part in this survey reported relying on national guidelines for information on antibiotic prescribing. Only 67.8% of study participants perceived AMR as a challenge for their practice. ConclusionsHealth authorities should regularly provide up-to-date reliable information on AMR in the region. Antimicrobial stewardship programmes are important for specialised medical professionals, such as urologists, gynaecologists, and otolaryngologists, since they are responsible for prescribing second-line antibiotics, which carries with it a greater responsibility.

A Membrane-Targeted Photosensitizer Prevents Drug Resistance and Induces Immune Response in Treating Candidiasis.

Candida albicans (C. albicans), a ubiquitous polymorphic fungus in humans, causes different types of candidiasis, including oral candidiasis (OC) and vulvovaginal candidiasis (VVC), which are physically and mentally concerning and financially costly. Thus, developing alternative antifungals that prevent drug resistance and induce immunity to eliminate Candida biofilms is crucial. Herein, a novel membrane-targeted aggregation-induced emission (AIE) photosensitizer (PS), TBTCP-QY, is developed for highly efficient photodynamic therapy (PDT) of candidiasis. TBTCP-QY has a high molar absorption coefficient and an excellent ability to generate 1 O2 and •OH, entering the interior of biofilms due to its high permeability. Furthermore, TBTCP-QY can efficiently inhibit biofilm formation by suppressing the expression of genes related to the adhesion (ALS3, EAP1, and HWP1), invasion (SAP1 and SAP2), and drug resistance (MDR1) of C. albicans, which is also advantageous for eliminating potential fungal resistance to treat clinical infectious diseases. TBTCP-QY-mediated PDT efficiently targets OC and VVC in vivo in a mouse model, induces immune response, relieves inflammation, and accelerates the healing of mucosal defects to combat infections caused by clinically isolated fluconazole-resistant strains. Moreover, TBTCP-QY demonstrates excellent biocompatibility, suggesting its potential applications in the clinical treatment of OC and VVC.

2020–2021 rhinovirus genetic diversity in Saint Petersburg

Introduction. Rhinoviruses represent one of the most common respiratory viruses and belong to the Picornoviridae family, genus Enterovirus, being divided into three types: A, B, C, which account for 169 types. Rhinoviruses predominate in autumn and spring periods, although they circulate throughout almost entire epidemic season. The rhinovirus genome is represented by a single-stranded 7.2 thousand base-long +RNA. According to the publications, the most common rhinovirus species is rhinovirus A (HRV-A), followed by rhinoviruses C (HRV-C) and finally rhinovirus B (HRV-B). The aim of our study was to define rhinovirus genetic diversity in Saint Petersburg . Materials and methods. The study was conducted at the Laboratory of Molecular Virology, Smorodintsev Research Institute of Influenza. Samples (smears from the nasopharynx and oropharynx) were delivered from the S.P. Botkin Clinical Infectious Diseases Hospital, St. Olga’s Children's City Hospital, N.F. Filatov Children's City Clinical Hospital No. 5. Outpatient samples were used as well. Samples received from December 2020 to October 2021 were analyzed. Detection of rhinoviruses was carried out by real-time PCR, typing — by Sanger sequencing, with primers developed by da Costa Souza L. et al. (2021). Results. According to total specimen testing, rhinoviruses comprise 3.2% total number of specimens tested. Of these, 71 rhinoviruses were typed, representing 17.03% total number of rhinovirus-positive specimens. The most common was HRV-A (55%), among which 21 types were found (the most common HRV-A46 is 13%, n = 5). HRV-B and HRV-C were found in equal numbers — 23% (n = 16) of each species out of total number of typed rhinoviruses. Among HRV-B, 8 types were found; the most common HRV-B06 comprised 33% (n = 5). Among HRV-C, 7 types were found (the most common types are HRV-C42, HRV-C32 and HRV-C15 — 19% each, n = 3). HRV-A was detected mainly in patients aged 18 to 65 years (57.5%, n = 23). HRV-B was detected only in adult patients (100%, n = 16). HRV-C was detected in children under 2 years of age (43.75%, n = 7) and adults aged 18–65 years (31.25%, n = 5). In some cases, HRV-A and HRV-C were associated with various respiratory tract syndromes such as acute nasopharyngitis, laryngotracheitis, obstructive bronchitis, and pneumonia. HRV-B was related to clinical manifestations of pneumonia in seven cases. Conclusion. Rhinovirus type A prevails in Saint Petersburg . Rhinoviruses can be associated with diverse respiratory tract syndromes.

Artificial Intelligence and Infectious Disease Imaging.

The mass production of the graphics processing unit and the coronavirus disease 2019 (COVID-19) pandemic have provided the means and the motivation, respectively, for rapid developments in artificial intelligence (AI) and medical imaging techniques. This has led to new opportunities to improve patient care but also new challenges that must be overcome before these techniques are put into practice. In particular, early AI models reported high performances but failed to perform as well on new data. However, these mistakes motivated further innovation focused on developing models that were not only accurate but also stable and generalizable to new data. The recent developments in AI in response to the COVID-19 pandemic will reap future dividends by facilitating, expediting, and informing other medical AI applications and educating the broad academic audience on the topic. Furthermore, AI research on imaging animal models of infectious diseases offers a unique problem space that can fill in evidence gaps that exist in clinical infectious disease research. Here, we aim to provide a focused assessment of the AI techniques leveraged in the infectious disease imaging research space, highlight the unique challenges, and discuss burgeoning solutions.

A case of West Nile fever in the Kursk region of Russia

Aim: to analyze the features of the clinical course of a case of West Nile fever (WNF) first detected in the Kursk region. Materials and methods. The article presents the first case of WNF detected in the Kursk region, confirmed by detection of pathogen RNA in the PCR test. Results. Patient Ch., 68 years old, was hospitalized to the intensive care unit of the Regional Clinical Infectious Diseases Hospital with severe intoxication, fever up to 39°C, positive meningeal symptoms of Kernig, Brudzinsky, severe neck stiffness. Upon admission, the analysis of peripheral blood showed leukocytosis up to 13.6×109, lymphopenia up to 5%, ESR acceleration up to 20 mm/h. Biochemical analysis revealed a significant increase in CRP, an increase in transaminase activity. In the cerebrospinal fluid, cytosis was noted up to 71 cells per mm3, an increase in protein up to 872 mg/l, the number of neutrophils up to 60%, lymphocytes - up to 40%, and the loss of a delicate plaque. The results of the study revealed high titers of Ig M and Ig G to the antigens of the virus, as well as the detection of WNF virus RNA in the blood and cerebrospinal fluid by PCR. Taking into account the data of the epidemiological anamnesis, clinical symptoms, positive results of ELISA and PCR of blood and cerebrospinal fluid for the causative agent of WNF, the diagnosis was made: West Nile fever with CNS damage, meningeal form (serous meningitis), severe course. Dyscirculatory encephalopathy of complex (dyscirculatory, dysmetabolic) genesis with scattered microsymptomatics. Conclusion. The described clinical case indicates that the WNF causative agent circulates in the Kursk region, which justifies the need for blood and cerebrospinal fluid testing in all patients with hyperthermia of unknown origin, combined with neurological symptoms for the WNF virus.

After the HIV/AIDS Congress 2022 (24-27 November 2022, Antalya): Gains, Challenges and Recommendations for the Future Response to HIV Infection in Türkiye

The National HIV/AIDS Congress, organized every year by the Turkey HIV/AIDS Platform, which was formed by the five physician associations operating in the field of HIV infection in Turkey, was held in Antalya on 24-27 November 2022. This congress, AIDS and Sexually Transmitted Diseases Association (AIDS and STD Association), HIV/AIDS Prevention and Education Association (HAKED), HIV Infection Association (HIVEND), Turkish Infectious Diseases and Clinical Microbiology Specialist Association (EKMUD) and Turkish Clinical Microbiology and Infectious Diseases (KLİMİK) Association. In addition, the Red Ribbon Association, Positive-iz Association, and Positive Living Association, three subject associations operating in the field, contributed. This report aims to summarize the data presented by the health professionals, health authorities, and non-governmental organizations working at the forefront of the response to the HIV/AIDS epidemic in our country, their shares and discussions during the congress, and to determine the needs by analyzing the current situation in our country in the light of these.

Clinical Features and Outcomes of the Association of Co-Infections in Children with Laboratory-Confirmed Influenza during the 2022-2023 Season: A Romanian Perspective.

The 2022-2023 influenza season in Romania was characterized by high pediatric hospitalization rates, predominated due to influenza A subtypes (H1N1) pdm09 and H3N2. The lowered population immunity to influenza after the SARS-CoV-2 pandemic and the subsequent stoppage of influenza circulation, particularly in children who had limited pre-pandemic exposures, influenced hospitalization among immunosuppressed children and patients with concurrent medical conditions who are at an increased risk for developing severe forms of influenza. This study focused on the characteristics of influenza issues among pediatric patients, as well as the relationship between different influenza virus types/subtypes and viral and bacterial co-infections, as well as illness severity in the 2022-2023 season after the SARS-CoV-2 pandemic. We conducted a retrospective clinical analysis on 301 cases of influenza in pediatric inpatients (age ≤ 18 years) who were hospitalized at the National Institute of Infectious Diseases "Prof. Dr. Matei Balș" IX Pediatric Infectious Diseases Clinical Section between October 2022 and February 2023. The study group's median age was 4.7 years, and the 1-4 year age group had the highest representation (57.8%). Moderate clinical forms were found in 61.7% of cases, whereas severe versions represented 18.2% of cases. Most of the complications were respiratory (acute interstitial pneumonia, 76.1%), hematological (72.1%, represented by intra-infectious and deficiency anemia, leukopenia, and thrombocytopenia), and 33.6% were digestive, such as diarrheal disease, liver cytolysis syndrome, and the acute dehydration syndrome associated with an electrolyte imbalance (71.4%). Severe complications were associated with a risk of unfavorable evolution: acute respiratory failure and neurological complications (convulsions, encephalitis). No deaths were reported. We noticed that the flu season of 2022-2023 was characterized by the association of co-infections (viral, bacterial, fungal, and parasitic), which evolved more severely, with prolonged hospitalization and more complications (p < 0.05), and the time of use of oxygen therapy was statistically significant (p < 0.05); the number of influenza vaccinations in this group was zero. In conclusion, co-infections with respiratory viruses increase the disease severity of the pediatric population to influenza, especially among young children who are more vulnerable to developing a serious illness. We recommend that all people above the age of six months should receive vaccinations against influenza to prevent the illness and its severe complications.

Management of nonfermenting gram-negative infections: a critique of the guidelines.

In the present narrative review, we discuss the characteristics and differences between the Infectious Diseases Society of America (IDSA) and European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines in terms on their recommendations/suggestions for the treatment of Pseudomonas aeruginosa and Acinetobacter baumannii infections. Treatment of severe infections caused by nonfermenting gram-negative bacteria (NF-GNB) is posing both novel hopes and novel challenges to physicians worldwide, and both the IDSA and the ESCMID have recently updated/released their guidelines or guidance documents, based on different philosophies and providing recommendations for the treatment of NF-GNB infections. In order to correctly exploit recent advances in the treatment of such infections, IDSA and ESCMID approaches should be viewed as complementary and evolving, and should not preclude further revision based on accumulating evidence on the use of novel β-lactams and β-lactam/β-lactamase inhibitor combinations. A joint consideration of both philosophies should leave the door opened for the wise use of novel agents, ultimately building precious experience on their use that could favorably influence future guidelines revisions.

Ураження серцево-судинної системи у дітей з COVID-19

Purpose - to assess the diagnostic and prognostic value of the E-selectin marker in relation to manifestations of damage to the cardiovascular system in children with COVID-19. Materials and methods. We conducted a cohort, observational, retrospective study involving 88 patients aged 1 month to 18 years with laboratory-confirmed COVID-19 by polymerase chain reaction. The children were hospitalized in Kyiv City Children’s Clinical Infectious Disease Hospital. We divided the examined cohort into two groups according to the course of the disease - the main group, which included 42 patients with a complicated course of COVID-19, and the control group - 46 patients with an uncomplicated course of the disease. In the study, we took into account the data of ECG, patient complaints and clinical symptoms. During the comprehensive examination of the patients on the first day of their stay in the hospital, the blood serum of the patients was collected for the purpose of its further examination for the level of E-selectin by enzyme immunoassay. Statistical, analytical methods and the method of empirical research were used in the research. To calculate the obtained results, we used the statistical program “Statistical software EZR v. 1.54”. Results. In patients of the control group, E-selectin was observed at the level of 12.02±1.7 ng/ml, while in the children of the main one, the indicator was higher, it was 15.04±1.9 ng/ml (p=0.034). According to the assessment of the prognostic value, we found that an increase in the level of E-selectin above 10 ng/ml is associated with a significant increase in the risk of the appearance of clinical symptoms of the cardiovascular system in children with COVID-19 (p&lt;0.05). We also noted a tendency for the marker to grow with objective changes on the ECG. Conclusions. We discovered the diagnostic and prognostic value of the E-selectin marker in children with COVID-19 regarding the manifestations of damage to the cardiovascular system in children with COVID-19. An increase in the level of E-selectin above 10 ng/ml is associated with a significant increase in the risk of the appearance of clinical symptoms of damage to the cardiovascular system (p&lt;0.05) and objective changes during instrumental examination (p&lt;0.1). The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. Written consent from patients was not required, as the study is retrospective and uses data from routine medical records. No conflict of interests was declared by the authors.

Infectious Diseases Telemedicine to the Arizona Department of Corrections During SARS-CoV-2 Pandemic. A Short Report.

The University of Arizona infectious diseases provides telemedicine clinics to the Arizona Department of Corrections (DOC) and Pima County Jail. Beginning in January 2020 there was a sharp drop in the number of monthly consultations following the public health emergency regarding the SARS-CoV-2 pandemic. Only since ending the emergency have the number of consults risen each month to pre-pandemic numbers. However, the nature of consult requests has changed. In this report we document the change from predominately human immunodeficiency virus (HIV) consults to a broader spectrum of infectious-related issues, most noteworthy being infective endocarditis, osteomyelitis, and chronic hepatitis B and C infection, the majority of cases due to intravenous drug injection. Although the DOC and jail underwent major upheavals intramurally due to the pandemic, medical outcomes with the diseases listed above, were excellent. The telemedicine infectious diseases clinics continued to provide timely, effective care for inmates.

Demographic characteristics of patients with anosmia consulting to the COVID-19 outpatient clinic

Background/Aim: Coronavirus disease 2019 (COVID-19) cases first emerged in Turkey in March 2020, spreading rapidly and peaking in April and May. This study aimed to assess individuals with loss of taste and smell who were admitted to our hospital with a COVID-19 diagnosis. Methods: Between March and June 2020, we retrospectively assessed 6966 patients who visited Kartal Dr. Lütfi Krdar City Hospital’s Infectious Diseases and Clinical Microbiology COVID-19 outpatient clinics; 137 patients with loss of taste and smell were included in the study. We enrolled 18-year-old patients who were admitted to the infection emergency outpatient clinics. Results: Out of the 6966 patients hospitalized with a pre-diagnosis of COVID-19 infection, 137 (0.19%) complained of poor taste and smell. Among these, 69 (50.4%) were female, and 68 (49.6%) were male. Of the 137 patients, 100 (73%) reported a loss of smell, while 94 (68.6%) reported a loss of taste. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR (reverse transcriptase-polymerase chain reaction) was positive in approximately one-third (n=2672, 38.4%) of the 6966 patients and roughly half (n=62, 48.4%) of the patients with loss of taste and smell. The most common symptoms observed in patients with anosmia were fever (n=123, 91%), cough (n=102, 75%), shortness of breath (n=411, 30%), sore throat (n=12, 9%), malaise (n=12, 9%), myalgia (n=11, 8%), nausea/vomiting (n=6, 5%), diarrhea (n=4, 3%), loss of smell (n=2, 2%), and loss of taste (n=2, 2%). Comorbidities included hypertension (n=4, 3%), diabetes mellitus (n=4, 2%), chronic obstructive pulmonary disease (n=2, 2%), and coronary artery disease (n=1, 1%). Conclusion: Patients admitted to our hospital during the initial wave of the pandemic experienced typical and prevalent symptoms such as fever, cough, shortness of breath, sore throat, and loss of taste and smell. Further large cohort studies are required to address the “tasteless” COVID-19 more fully.

Implementing a peer-supported, integrated strategy for substance use disorder care in an outpatient infectious disease clinic is associated with improved patient outcomes

Substance use disorder (SUD) and infectious disease (ID) care integration may lead to improvements in SUD and ID outcomes. We assessed implementation of integrating peer-supported SUD care in an outpatient ID setting. In this implementation study, we describe REcovery in Specialty care Through medication and OutREach (RESTORE), a low-threshold SUD program implemented in a Baltimore outpatient ID clinic. Key program components were clinician training and support in SUD care, prescription of SUD treatment medications, and peer-based psychosocial support provided by peer recovery specialists. We assessed clinician adoption of RESTORE and compared patient outcomes from baseline to 6 months. Between January 2019 and January 2022, the number of ID clinicians (N=61) who prescribed buprenorphine increased eightfold from 3 (5%) to 24 (39%). Of 258 ID patients referred to RESTORE, 182 (71%) engaged, 137 consented to study participation. Mean age in the study sample was 52.1 (SD=10.4), 63% were male, 84% were Black/African-American. Among 127 (93%) who completed 6-month follow-up, fewer participants reported illicit/non-prescribed opioid use in the past 30 days at follow-up (32%) compared to baseline (52%; p<0.001). Similar reductions were noted for cocaine use (47% to 34%; p=0.006), emergency department visits (23% to 9%; p=0.002), and inpatient hospitalizations (15% to 7%; p=0.025). SUD care integration into an outpatient ID care setting using a peer-supported implementation strategy was adopted by clinicians and improved clinical outcomes for patients. This strategy is a promising approach to treating people with infectious diseases and SUD.

Key Contributions by the Swiss Tropical and Public Health Institute Towards New and Better Drugs for Tropical Diseases.

Thanks to its expertise in clinical research, epidemiology, infectious diseases, microbiology, parasitology, public health, translational research and tropical medicine, coupled with deeply rooted partnerships with institutions in low- and middle-income countries (LMICs), the Swiss Tropical and Public Health Institute (Swiss TPH) has been a key contributor in many drug research and development consortia involving academia, pharma and product development partnerships. Our know-how of the maintenance of parasites and their life-cycles in the laboratory, plus our strong ties to research centres and disease control programme managers in LMICs with access to field sites and laboratories, have enabled systems for drug efficacy testing in vitro and in vivo, clinical research, and modelling to support the experimental approaches. Thus, Swiss TPH has made fundamental contributions towards the development of new drugs - and the better use of old drugs - for neglected tropical diseases and infectious diseases of poverty, such as Buruli ulcer, Chagas disease, food-borne trematodiasis (e.g. clonorchiasis, fascioliasis and opisthorchiasis), human African trypanosomiasis, leishmaniasis, malaria, schistosomiasis, soil-transmitted helminthiasis and tuberculosis. In this article, we show case the success stories of molecules to which Swiss TPH has made a substantial contribution regarding their use as anti-infective compounds with the ultimate aim to improve people's health and well-being.

The Value of NSE, S100, and E-Selectin Biomarkers for Predicting the Course and Severity of COVID-19 in Children

Objective — to investigate the relationship between the level of NSE, S100 and E-selectin biomarkers with the complicated course and symptoms of the nervous system in children with COVID-19. Materials and methods. We conducted a pilot, cohort, observational, retrospective study involving 88 children aged 1 month to 18 years with laboratory-confirmed COVID-19 by the PCR method, who underwent inpatient treatment at the Kyiv City Children’s Clinical Infectious Disease Hospital in 2021—2022. During the first day of hospital stay, blood serum was collected from patients and the level of NSE, S100 and E-selectin biomarkers was determined by enzyme immunoassay. Results and discussion. A complicated course was observed in 42 (47.7 %) patients. Symptoms from the nervous system were noted in 46 (52 %) patients. In patients with an uncomplicated course, the average level of NSE on the first day of inpatient treatment was (12.1 ± 1.2) μg/l, S100 — (164 ± 8.2) ng/l, E-selectin (12.02 ± 1.7) ng/ml. In patients with a complicated course, the average levels of biomarkers were, respectively: (16.9 ± 1.5) μg/L, (165.9 ± 6.9) ng/L, and (15.04 ± 1.9) ng/mL. An increase in the level of NSE above 15 μg/L and E-selectin above 25 ng/ml was associated with a significant increase in the risk of clinical symptoms from the nervous system and a complicated course in children with COVID-19 (p &lt; 0.05). The value of the S100 index above 150 ng/l was associated with an increased risk of clinical symptoms of nervous system damage (p &lt; 0.05) and a tendency to complications (p &lt; 0.1). The level of all biomarkers was also associated with an increase in the duration of inpatient treatment. Conclusions. Complicated course and onset of nervous system symptoms in children hospitalized with COVID-19 are associated with increased levels of the biomarkers NSE, S100, and E-selectin. Determina­tion of these biomarkers can be used in diagnostics to predict the course and severity of the disease in children undergoing inpatient treatment for COVID-19.