Negative Blood Research Articles

Experiences and Perceptions on Community Client-Led ART Delivery (CCLADS) Model of Antiretroviral (ART) Delivery: Patients' and Providers' Perspectives in South Western Uganda.

Community Client-Led ART Delivery groups (CCLADS) were introduced as part of the differentiated service delivery models in 2017 to better serve growing number of HIV patients and reduce unnecessary burden on the HIV care delivery system. However, there is limited evidence on the exact patients' and care providers' experiences and perceptions regarding the CCLADS model of ART delivery. We therefore aimed to explore the experiences and perceptions on CCLADS model from the patient and provider perspectives. A descriptive qualitative study was conducted at two ART clinics in Southwestern Uganda. We conducted in-depth interviews (IDI) to get a deeper understanding of the patient and providers' perspective regarding the model. Responses from participants were recorded using audio recorders and were translated and transcribed. We used thematic approach to analyze the data. A total of 20 in depth interviews were conducted, with providers, CCLAD leaders and Adults Living with HIV (ALHIV) to assess the experiences and perceptions to participation among People Living with HIV (PLHIV) enrolled in CCLADS and the care providers. Key themes included benefits, limitations, experiences and perceptions of CCLADS. Benefits to ALHIV included: Longer refills, reduced transport costs, receive drugs in time, peer advice; to providers: time saving, less tiresome and reduced congestion at facility. Barriers included: stigma, limited outreaches, failure to comply. Patients perceived the model positively (cost effective, improved quality care, no missed appointment where as others were negative (blood samples not taken like before). Experiences also included enough time, learnt some activities and good adherence. Participation in the CCLADS groups provides several benefits to the patient including reduced transport, longer refills and good adherence. Stigma remains a challenge to CCLADS participation, which requires innovative and collaborative strategies from Ministry of Health (MOH) and implementation partners to address in order to sustain CCLADS participation.

Role of Superantigens in Various Childhood Inflammatory Diseases.

Superantigens (Sags) are a part of some viral or bacterial proteins that stimulate T cells and antigen-presenting cells leading to systemic immune repose and inflammation. SAgs might have a possible role in various inflammatory childhood diseases (e.g., Kawasaki disease, atopic dermatitis, and chronic rhinosinusitis). Worldwide studies have been conducted to determine the role of staphylococcal SAgs (TSST-1) in various inflammatory diseases. The SAgs (TSST-1) not only induce sepsis and septic shock (even in negative blood culture for S. aureus), but may also have a significant role in various childhood inflammatory diseases (e.g., KD, OMS, Polyp, dermatitis, psoriasis). In proven Sags-induced inflammatory diseases, the inhibition of the cell-destructive process by SAgs suppressants might be helpful. In toxic shock or sepsis-like presentation and even in cases with negative blood cultures, immediate use of anti staphylococcal drugs is required. Occasionally, the clinical presentation of some human viruses (e.g., coronavirus and adenovirus) mimics KD. In addition, coinfection with adenovirus, coronavirus, and para-influenza virus type 3 has also been observed with KD. It has been observed that in developed KD, bacterial sags induced an increase in acute-phase reactants and in the number of white blood cells, and neutrophil counts. Multisystem inflammatory syndrome in children (MISC) and KS were observed during the recent COVID-19 pandemic. This study summarized the relationship between viral and bacterial SAgs and childhood inflammatory diseases.

LBODP100 A Rare Case Of Pembrolizumab Induced Graves’ Disease

Abstract Cancer immunotherapies have recently changed the therapeutic armamentarium of anti-cancer treatments, particularly for melanoma and cancers of the kidneys, lungs, and colon. Immune checkpoint inhibitors (ICPis) act on various immune checkpoints. Of them, anti-PD-1 antibodies (such as pembrolizumab) are monoclonal antibodies that act against programmed cell death 1 protein. However, by counteracting the regulators of adaptive immunity, this class of drugs may cause immune-related adverse events that involve multiple organs and endocrine glands, such as the thyroid gland. The symptoms of thyroid dysfunction usually present during the first weeks of ICPis therapy. In the current report, we present a case of a 50-year-old male who presented to the emergency department complaining of fever, chills, nausea, and vomiting for one week. The patient had a history of colon cancer with lymph node metastasis status post tumor resection and colostomy. He began Keytruda® (pembrolizumab) treatment after tumor resection, and the presenting symptoms appeared after receiving the first immunotherapy infusion. His medical history was significant for psoriasis and rheumatoid arthritis. The patient's history was unremarkable for thyroid diseases, and he did not receive thyroid medications with no previous exposure to intravenous contrast media, over-the-counter iodine preparations, or biotin. At the emergency department, the patient had a temperature of 101.4°F, a heart rate of 110 bpm, and blood pressure of 130/70 mm Hg. On examination, tenderness was indicated upon palpating the anterior part of the neck. The patient was treated with intravenous fluids, steroids, beta-blockers, and broad-spectrum antibiotics. A workup for sepsis was requested, and it revealed negative blood culture and urine culture results. His laboratory indices demonstrated a suppressed level of TSH (0. 01 mIU/mL) and elevated Free T4 (3.16 ng/dl). Still, his TSH level reported at the Oncology clinic before Keytruda administration was (0.9 mIU/mL), and Free T4 was (1.7 ng/dl). Thyroid ultrasound revealed a heterogeneous thyroid gland consistent with thyroiditis. Antibody testing showed positive thyroid antithyroglobulin antibodies and elevated thyroid-stimulating antibodies (TSI). A radioactive iodine uptake test was ordered, revealing increased contrast uptake. These findings suggested that the cause of thyroid dysfunction was Graves’ disease. The patient was started on Methimazole 20mg per day and discharged home after scheduling an outpatient follow-up appointment with the endocrinologist. This case is one of the rare cases of thyrotoxicosis attributable to Graves’ disease related to pembrolizumab therapy. To the best of our knowledge, two studies in the literature reported three cases of ICPi-induced thyrotoxicosis with thyroid antibody positivity following anti-PD-1 antibody therapy. Presentation: No date and time listed

Better Late than Never - Fever of Unknown Origin in a Patient with a Prosthetic Valve

Better Late than Never - Fever of Unknown Origin in a Patient with a Prosthetic Valve Abstract. A patient presents with worsening of his general condition, chills and dyspnoea on exertion. With a history of aortic valve replacement, infective endocarditis is suspected, but due to negative imaging by transesophageal echocardiography and negative blood cultures cannot be confirmed. Finally, Cutibacterium acnes prosthetic valve endocarditis is diagnosed after culture of C. acnes during an extended incubation period of blood cultures, the presence of embolic complications and a characteristic finding on PET-CT scan.

Granulicatella elegans infective endocarditis: A case report

Granulicatella elegans is a rare cause of infective endocarditis, accounting for 1–2% of all cases. It is well recognized that this pathogen can present in association with negative blood cultures. There are higher rates of both relapse and mortality compared with endocarditis caused by other bacteria. Microbiological diagnosis can be especially challenging because many conventional blood culture media lack pyridoxal, which can be found in automated blood culture broths like BACTEC™ or BACT/ALERT® and thus they may require ‘helper’ bacteria to be culture the organism. This current case report describes a 66-year-old male patient with a 10-year history of post-inflammatory combined aortic valve disease (moderate aortic stenosis and mild aortic regurgitation). He presented with a 3-month history of recurrent fever and general deterioration. Despite targeted, prolonged, combined antibiotic treatment with intravenous penicillin and gentamicin, surgery was eventually required. An aortic prosthetic valve implantation was performed with good results. In case of subacute endocarditis, especially when a causative organism proves difficult to detect, G. elegans should be considered. Identification is greatly enhanced by using polymerase chain reaction methods and this test should be considered in all cases of culture negative endocarditis.

Association of Dengue Disease with ABO RH Blood Group

Background: Dengue viral infection is a global public health issue. Several viral and other host factors are the contributed factors including the ABO blood group for transmission of dengue virus (DENV). ABO blood groups have been shown to involve in the intensity of DENV. This study aims to find the association ABO and Rh blood group with DENV infection. Methods: This cross-sectional study was conducted in tertiary care hospital. All DENV NS-1 positive patients were included irrespective of age and gender. The blood group of all DENV-infected patients was determined through ABO and Rh anti-sera (forward blooding grouping). Descriptive data were analyzed through SPSS and Microsoft Excel. Results: Among a total of 105 dengue-infected patients, male were 68 patients and female were 37 patients. The highest number of cases were found in the age group 21-30 years and 11-20 years. The predominant blood group was found A positive in dengue viral infected patients while AB negative blood group was found common in Rh negative blood groups. Conclusion: Blood group A positive and AB negative patients in Rh positive and Rh negative blood groups had more risk of dengue viral infection as compared to other blood groups. Further studies are necessary to find the severity of patients with different blood groups. Based on their differential distribution in the community and their correlation with mosquito performance, it can be deduced that the risk of contracting dengue infection differs with the ABO and Rh blood groups. Additional study is necessary to determine whether HLA, dengue serotype, and ABO are experimental/predictor factors, and whether certain blood subgroups are associated with a disproportionately higher risk of dengue virus infection. Keywords: Dengue viral infection, Serotype, Anti-A, Anti-B, Anti-D, ABO, Rh blood group

Implementation of a 24-hour empiric antibiotic duration for negative early-onset sepsis evaluations to reduce early antibiotic exposure in premature infants.

Antibiotic exposure increases the risk of morbidity and mortality in premature infants. Many centers use at least 48 hours of antibiotics in the evaluation of early-onset sepsis (EOS, <72 hours after birth), yet most important pathogens grow within 24 hours. We investigated the safety and efficacy of reducing empiric antibiotic duration to 24 hours. Quality improvement study. A tertiary-care neonatal intensive care unit. Inborn infants <35 weeks gestational age at birth (ie, preterm) admitted January 2019 through December 2020. In December 2019, we changed the recommended duration of empiric antibiotics for negative EOS evaluations from 48 hours to 24 hours. Patient characteristics before and after the intervention were similar. After the intervention, 71 preterm infants (57%) with negative EOS evaluations received ≤24 hours of antibiotics, an increase from 15 (10%) before the intervention. These 71 infants comprised 77% of infants with negative EOS blood cultures after excluding those treated as clinical sepsis (≥5 days of antibiotics). For all negative EOS blood cultures, the mean treatment duration decreased by 0.5 days from 3.9 days to 3.4 days. This finding equated to 2.4 fewer antibiotic days per 100 patient days for negative EOS blood cultures but similar antibiotic days per 30 patient days (7.2 days vs 7.5 days). This measure did not change over time. Subsequent sepsis evaluations <7 days after a negative EOS blood culture did not increase. Excluding contaminants, the median time to positivity was 13.2 hours (range, 8-23) in 8 positive blood cultures. Implementation of a 24-hour antibiotic course for negative EOS evaluations safely reduced antibiotic exposure in 77% of infants <35 weeks gestational age at birth in whom EOS was ruled out. All clinically significant pathogens grew within 24 hours.

Presepsin Levels in Positive and Negative Blood Cultures of Febrile Neutropenic Pediatric Patients with Malignancies in Dr. Soetomo General Hospital, Surabaya, Indonesia

This was observational research with cross sectional type of study conducted from January to October 2020 at Dr. Soetomo General Hospital, Surabaya. The subjects of the research were 30 children’s patients with febrile neutropenic episodes with malignancy based on the criteria of the American Society of Clinical Oncology and Infectious Disease Society of America, which were grouped into 2 groups based on blood culture results from secondary data. The control group was hemophilia patients without any complaint. The presepsin level was checked using ELISA. The differences in presepsin levels in positive and negative blood cultures and the control were analyzed using T2 free samples or Mann-Whitney U according to the data distribution. Median (min-max) presepsin levels in positive, negative and control cultures: 4.1(0.3 - 14) ng/mL, 2.95(0.2 - 13.8) ng/mL, 0.1(0.1 - 0.5)ng/mL. There is no significant difference in presepsin levels between positive and negative blood culture (p = 0.606). There is a significant difference between positive and negative culture presepsin levels towards controls (p = 0.001 and p = &lt;0.001). There is an increase in the level of presepsin in febrile neutropenic pediatric patients with malignancy, but this examination cannot differentiate between bacteremia and non-bacteremia infections.

Burden and mortality of sepsis and septic shock at a high-volume, single-center in Vietnam: a retrospective study

ABSTRACT Background Sepsis and septic shock have high mortality rates and often require a prolonged hospital stay. Patient outcomes may vary according to multiple factors. We aim to determine the prevalence of antimicrobial resistance and factors associated with mortality and hospital stay. Methods Clinical and microbiological data of patients with sepsis or septic shock were retrospectively collected for 15 months. Patients with negative blood cultures and patients that did not meet the SEPSIS 3 criteria were excluded. Results We included 48 septic shock and 28 septic patients (mean APACHE II 20.32 ± 5.61 and mean SOFA 9.41 ± 3.17), with a mean age of 60.5 ± 16.8 years and 56.6% males. WBCs, neutrophils, INR, and fibrinogen levels were significantly associated with mortality. 59.5% of the cultured bacteria were gram-negative (most common E. coli) and 27.8% were gram-positive (most common S. aureus), while 7.6% were other types of bacteria and 5.1% were fungi. Resistance patterns to gram-negative were varying, and resistance to piperacillin/tazobactam, carbapenems, and aminoglycosides were from 60% to 100% (A. baumanii), while they were highly sensitive to Colistin. E. coli was also resistant to ceftriaxone (77.8%) and sulbactam/cefoperazone (44.4%). Resistance rates for Gram-positives were high, from 86% to 100% for oxacillin, while for vancomycin, teicoplanin, and linezolid, they were often low but arrived up to 42.8%. According to our logistic regression analysis, patients over 65 year-old and those who received corticosteroids had a significantly increased risk of in-hospital mortality (OR: 4.0; OR: 4.8). Conclusion Sepsis still poses a significant threat to patients’ health, even when positive blood culture results allow the administration of specific antibiotic treatment.

The Role of C-reactive Protein Estimation in Determining the Duration of Antibiotic Therapy in Neonatal Sepsis.

Introduction: Septicemia is globally considered the most important cause of neonatal morbidity and fatality. Serum C-Reactive Protein (CRP) is an acute phase reactant, which is brought out in response to the inflammatory reaction. It is prophesied to drop down speedily after the coherent weeding out of microbial incitation due to the short half-life of CRP. CRP levels reflect the individual's association between microbial infection and defensive mechanisms. Methods: This hospital-based cross-sectional study included 150 admitted patients with suspected sepsis in the Department of Pediatrics, Rajendra Institute Medical Sciences (RIMS), Ranchi, India, over a study period of one year (2020 to 2021). CRP was estimated on the day of admission and repeated after 72 hours, on the fifth day, and on the seventh day for serial values of CRP, and the findings were compared by making three groups. Further, the research participants were designated to three different groups according to the CRP estimation levels.Results: Out of the 150 assumed neonatal septicemia patients, antibiotics were paused in 42 neonates (28%) within 72 hours. In group 2, 8% of neonates’ antibiotics were stopped in five days, and a total of 102 neonates (68%) could be discharged on the seventh day of antibiotic therapy as their CRPs became negative on the third day and seventh day consecutively, along with negative blood culture reports. In group 3, antibiotics of 48 neonates (32%) were continued beyond seven days.Conclusion: CRP has a skyscraping specificity and negative predictive values (NPV); thus, by estimating serial CRPs, the antibiotic therapy duration can be determined, which further helps determine the period of hospitalization.

C-Reactive Protein, Procalcitonin, and a Novel Pathogenesis and Therapeutic Target of Thrombocytopenia in Sepsis.

Objective The aim of the study is to analyze the clinical characteristics, pathogen distribution, and drug sensitivity information of adult sepsis, and to provide reference for empirical clinical use; to explore the relationship between C-reactive protein (CRP) and calcitonin (PCT) The clinical value in the diagnosis of adult sepsis. Methods We collected 455 cases of hospitalized patients with positive blood culture, including 352 cases with sepsis and 103 cases without sepsis; 1609 cases of hospitalized patients with suspected infection and negative blood culture, including 287 cases of sepsis, and 518 cases of non-infectious systemic inflammatory response syndrome (SIRS) and 804 cases of local infection. Age, gender, route of admission, admission status, CRP, PCT, and white blood cell (WBC) levels were collected from the patients. The differences between the factors were statistically analyzed, and the receiver operating characteristic curve (ROC curve) was plotted to obtain the optimal cut-off values of CRP and PCT and their area under the curve (AUC), and to compare the CRP, PCT and PCT, and the CRP + PCT tandem to diagnose sepsis sensitivity and specificity. Results (1) 387 pathogenic strains were isolated from blood cultures of patients with sepsis, 71.06% Gram-negative, 26.87% Gram-positive and 2.07% fungi. (2) Among Gram-positive bacteria, Staphylococcus aureus was 87.5% resistant to penicillin and sensitive to vancomycin, milantropine, and teicoplanin; among Gram-negative bacteria, Escherichia coli was resistant to piracillin The resistance rate was 73.1%, fully susceptible to viraemia (100%) and resistant to imipenem, amikacin, and lacillin/tazole. (3) Among patients with positive blood cultures, CRP and PCT levels were higher in patients with sepsis than in those without sepsis. Pairwise comparison of ROC curves showed that the diagnostic value of PCT was greater than that of CRP (P=0.016). Conclusion CRP and PCT have a good reference value for diagnosis of sepsis patients and determination of the degree of infection in septic patients, especially PCT is more valuable for diagnosis of sepsis.

Infective endocarditis in adults with congenital heart disease – 11 years data from Hungary

Abstract Background Despite recent preventive strategies and advances in antimicrobial and surgical treatment the incidence and mortality rate of infective endocarditis (IE) remains high in adult Congenital Heart Disease (ACHD) patients. Purpose The aim of our retrospective study was to assess the clinical and microbiological characteristics, inhospital and one year mortality rates of ACHD patients admitted with IE in our tertiary referral hospital between 2010 and 2020. Methods Definitive diagnosis of IE were in agreement with modified Duke's criteria. Inhospital baseline data and up to one year follow-up data were collected from the hospital records. ACHD patients were classified based on their lesion severity (ESC guideline classification). Survival data and mortality predictors were analysed by Kaplan-Meier estimator and by uni- and multivariate model. Results 60 cases had been treated with IE. Mean age was 37±11.3 years (18–69), and most of them (76.6%, n=46) were men. ACHD complexity was as following: simple 66.7% (n=40), moderate 20% (n=12) and severe 13.3% (n=8). The most common pre-existing congenital cardiac abnormality was bicuspidal aortic valve seen in 52% (n=31) of cases. Sixty four percent (n=37) of patients had previous heart surgery (n=16, artificial heart valve surgery). Majority of patients had a left sided valve endocarditis (85%, n=51). IE related hospital stay was mean 28±9 days. Infection route was presumed in 30% of patients (n=18), they had an invasive procedure within 6 months preceding the IE diagnosis. Besides common bacterinemia caused by Staphylococcus (33%, n=20) and Streptococcus (25%, n=15), 18% (n=11) of patients had a negative blood culture. IE affected 36 patients with a native valve, and all 16 with an artificial valve. Seventy seven percent of patients required surgical intervention, immediate or urgent surgery in 22 and elective in 24 patients. Overall inhospital mortality was 13%, the majority 5 out of 8 patients having an immediate/emergent surgical intervention. IE was complicated by acute heart failure in 17 (28%) and by stroke in 4 (6.7%) patients. During one year follow-up 21 patients (38%) remained with chronic heart failure, and 3 more died. There was no significant difference in mortality between ACHD complexity groups, and no significant predictors of mortality were found. Conclusion The most common ACHD lesion affected by IE was bicuspid aortic valve. Two-third of patients required surgical intervention, those with immediate/emergent surgery having a 22% early mortality rate. ACHD complexity was not related to early or late outcome in this population. Funding Acknowledgement Type of funding sources: None.

A CASE OF INCOMPATIBILITY DUE TO MATERNAL ANTI-C

Hemolytic disease of the fetus and newborn (HDN) is a condition in which the lifespan of an infant's red blood cells (RBCs) is shortened by the action of specific IgG antibody (ies) derived from the mother directed against Rhesus or other blood group antigens on fetal RBCs that are inherited from the father but are not expressed by the mother. The widespread use of Rh immune globulin has dramatically decreased the occurrence of anti D-HDN among D negative pregnant women, but has not eliminated the problem. No measures are available to prevent sensitization to other blood groups, most notably other Rhesus (C,c,E,e), Kell and Duffy antigens. In this article, a case of anti-c incompatibility is presented and the issue of risks involving Rh negative blood transfusion in aloimmunized patients with anti-c is discussed. Twin live babies named newborn1, sex female, and newborn2 were born from the 8th pregnancy of a 38 year-old brazilian mother from Pinhão-Paraná-Brazil through a normal vaginal route. Medical report of newborn1 during twenty days described levels of indirect bilirubin oscillating between 7 to 11 mg/dl and hemoglobin dropping from 13,9 to 10,1 g/dl without jaundice, phototherapy or transfusion registered. Thirty days postnatal, newborn1 had hemoglobin 7,7 g/dl and indirect bilirubin 11,3mg/dl and a blood transfusion was required. Antibody screen of the mother was positive and crossmatching with O negative blood was not compatible. Other tests, performed at Hemocentro Regional de Guarapuava-Paraná, identified mother's blood as A positive, phenotype C(+)c(-)E(-)e(+)K1(-), antibody screen detected anti-c antibodies with 1:256 titre. Baby's blood sample was identified as O positive, phenotype C(+)c(+)E(-)e(+)K1(-) with the direct anti-globulin test (DAT) positive (2+). After centrifugation with saline solution baby's sample after showed yellowed supernatant. A blood transfusion with 30 ml of O positive, c antigen negative blood, match compatible with the mother's serum, was transfused without reactions. At the hospital the mother revealed that these were her 8th and 9th children. Also, she said to be illiterate and that ignored her pregnancy until the 8th month and for it she simply did not have antenatal care. Unfortunately details about her other pregnancies could not be got. Anti-c is an important Rh antibody that may cause severe HDN, and in some cases may be as severe as anti-D HDN. In a series of 1022 cases of non Rh D aloimmunization Kenneth found that only anti-c was associated with severe HDN that ended in hydropic stillbirth or necessitated intrauterine blood transfusion[1]. This was not the case presented in the article. Nevertheless, an important aspect embedded issue along with anti-c that goes unnoticed by many refers to the matter of Rh negative blood available for transfusion, including aloimmunized anti-c patients. The stereotype held by Rh negative blood as universal blood not applies to anti-c. If ones take into account the high incidence of c antigen both in Rh positive and Rh negative blood among the population, we can suppose that people having anti c antibodies, like the mother in the article, are sitted on an authentic powder keg where a transfusional mistake, either for misinformation or any reason can bring unexpected results.

S3177 The (Icteric) Eye of the Storm: A Case of Weil’s Syndrome

Introduction: Leptospirosis is one of the most prevalent zoonotic diseases affecting humans residing in tropical areas. We herein describe a case of a patient with leptospirosis acquired in the Bronx, NY. Case Description/Methods: A 63 year-old man with no significant medical history was evaluated for muscle pain, fatigue, and diarrhea of 3 days duration. He was feverish to 102 F and icteric. Laboratory evaluation revealed hemoglobin of 7.5 g/dL, total white count of 18 k/uL, platelet count of 40 k/uL, INR 1.5, creatinine of 5 mg/dL, urea nitrogen 85 mg/dL, creatine kinase 4000 U/L, alkaline phosphatase 192 U/L, total bilirubin 39 mg/dL, direct bilirubin > 23 mg/dL, AST 96 U/L, ALT 113 U/L and albumin 2.5 g/dL. Initial laboratory evaluation was negative for common and atypical infections. Radiologic evaluation revealed unremarkable non-contrast MRCP and US abdomen. Upon further detailed history, the patient reported that his basement was recently flooded by a devastating hurricane. Despite negative parasite blood smear and IgM antibodies for leptospira, empiric treatment for leptospirosis with Ceftriaxone resulted in resolution of all symptoms and lab abnormalities. Repeated blood work on follow-up visits at 4 weeks was noted with positive IgM antibodies for leptospira (Figure). Discussion: Leptospirosis is caused by a poorly staining gram-negative spirochetal bacteria. Transmission to humans occurs through mucous membranes, open skin wounds or after drinking, eating, swimming, or wading in water contaminated by stool or urine of infected rodents. Outbreaks have been documented in non tropical, urban areas affected by hurricanes, heavy rains or floods. In approximately 90% of cases, the disease is anicteric. Phase 1 includes viral-like illness, conjunctival suppuration followed by transient improvement. Phase 2 includes myalgia, nausea, vomiting, abdominal pain, hepatomegaly, increased serum bilirubin and serum aminotransferases. 10% of cases manifest as Weil’s syndrome, characterized by jaundice in the first phase, followed by second phase manifesting with high fever, profound jaundice with severely elevated serum bilirubin levels (up to 30mg/dL, mostly direct) and elevated serum transaminases. Renal and liver involvement are predominant and can lead to severe morbidity and death. Blood cultures, urine cultures and specific anti Leptospira IgM serology can assist with diagnosis. Antibiotic treatments, primarily Penicillin, 3rd generation Cephalosporins and Doxycycline, can benefit if administered at an early stage.Figure 1.: Laboratory evaluation during hospital stay and 4 weeks after discharge. Abbreviation: ALP, alkaline phosphatase; TB, total bilirubin; DB, direct bilirubin; AST, Aspartate transaminase; ALT, Alanine transaminase.

AML-139 Early Onset of Therapy-Related Acute Myeloid Leukemia in a Patient Treated for a Hodgkin Lymphoma

Therapy-related acute myeloid leukemia (t-AML) is a known complication of certain types of therapies, such as cytotoxic, radiation, or immunosuppressants. At present, t-AML incidence is relatively low. However, this is expected to change in the near and medium future due to improved overall survival rates. t-AML can occur a few months to several years after the initial therapy, depending on the type and dosage of therapy and patient-specific variation. The prognosis is generally poor, with patients presenting complex karyotype and significant structural abnormalities. As such, the optimal treatment remains a challenge. We report the case of a patient treated for a Hodgkin lymphoma stage IIB in December 2019, who underwent 8 cycles of ABVD and radiotherapy 30 Gy with a negative PET scan in August 2020, diagnosed with acute monoblastic leukemia (M5a - FAB) in January 2021. A 53-year-old male, smoker, presented with fatigue and oliguria for the past month. Laboratory studies revealed leukocytosis (272×109/L), thrombocytopenia (83×109/L) and no anemia, with 90% blasts in peripheral blood smear. The metabolic profile revealed a tumoral lysis syndrome and an elevated lactate dehydrogenase of 1877 U/L. The bone marrow aspirate showed 98-99% blasts cells of monocytic lineage while the flow cytometry analysis indicated 95% monocytic cells, positive for CD64+, CD33++, CD56+, CD36+ slab, CD300e-, CD14-, HLA-DR+. Normal karyotype, negative FISH for del 17p - TP53, and negative for the tested genes on RT-PCR (FLT3, RUNX1-RUNX1T1, CBFb-MYH11, MLL-AF9, PML-RARA), NGS negative (blood specimen). The patient had been successfully treated with conventional chemotherapy and underwent bone marrow transplantation from an unrelated donor with 100% donor chimerism at one year. t-AML only rarely presents with normal karyotype and there is a lack of clearly defined prognostic factors. Optimal treatment is still very much a matter of debate, in part because of the poor prognosis of the condition, and the only treatment with curative intent remains allogeneic hematopoietic stem cell transplantation.

A FATAL CASE OF COMPLICATED SALMONELLA AORTITIS

A FATAL CASE OF COMPLICATED SALMONELLA AORTITIS

CASE REPORT: BIOPROSTHETIC VALVE ENDOCARDITIS CAUSING NON-ST-ELEVATION MYOCARDIAL INFARCTION

CASE REPORT: BIOPROSTHETIC VALVE ENDOCARDITIS CAUSING NON-ST-ELEVATION MYOCARDIAL INFARCTION

The Value of Perinatal Factors, Blood Biomarkers and Microbiological Colonization Screening in Predicting Neonatal Sepsis.

Background: Neonatal sepsis is one of the most important causes of elevated morbidity and mortality rates in neonatal intensive care units worldwide. While the clinical manifestations of neonatal sepsis tend to be nonspecific, its rapid development and life-threatening potential call for reliable markers for early detection. Methods: We conducted a retrospective single-center study including all neonates suspected of having developed neonatal sepsis from 2013 to 2016. Perinatal and clinical characteristics as well as microbiological and laboratory findings were evaluated. Neonatal sepsis was defined as either culture-proven sepsis (positive blood culture) or clinical sepsis (at least one symptom and elevated C-reactive protein (CRP) concentrations within 72 h with negative blood culture). We further differentiated between early-onset (EOS) and late-onset (LOS) sepsis. Results: Microbiological colonization screening by throat and rectal swabs frequently did not detect the organism that subsequently caused the sepsis. Depending on the age of the newborn with sepsis (EOS or LOS), associations between different anamnestic and clinical factors (prenatal or postnatal ones) were found. In particular, the central–peripheral temperature difference showed a strong association with LOS. Laboratory results useful for the early detection of neonatal sepsis included interleukin-6 (IL-6) and CRP concentrations. Conclusions: Elevated IL-6 >100 ng/L was a strong marker for neonatal sepsis. When choosing the antibiotics for treatment, data from microbiological colonization screening should be considered but not solely relied on. Some indicators of infection also depended on postnatal age.

TUBERCULOUS PLEURAL EFFUSION MASQUERADING AS DRUG-INDUCED LUPUS

TUBERCULOUS PLEURAL EFFUSION MASQUERADING AS DRUG-INDUCED LUPUS

CANDIDA ALBICANS AS A CAUSE OF PACEMAKER LEAD ENDOCARDITIS : A CASE REPORT AND REVIEW OF THE LITERATURE

CANDIDA ALBICANS AS A CAUSE OF PACEMAKER LEAD ENDOCARDITIS : A CASE REPORT AND REVIEW OF THE LITERATURE