Negative PCR Research Articles

S1980 Cocaine-Induced Pseudomembranous Colitis With Negative Clostridium difficile Infection

Introduction: Pseudomembranous colitis (PMC) is most commonly caused by Clostridium difficle (C.Diff). The incidence of C.Diff related PMC is 3-8% and increasing. Other than Clostridium difficile, ischemia, infections, medications, and inflammatory conditions can cause PMC. We report a case of pseudomembranous colitis-tested negative PCR for C. difficile. Case Description/Methods: A 52-year-old female with a past medical history of hypothyroidism, asthma, and polysubstance abuse (history of chronic heroin, cocaine, benzodiazepine, alcohol, and cigarette use) with Hx of chronic intermittent diarrhea due to opioid withdrawal presented to the emergency department with bloody watery diarrhea of 3-4 times in a day for 5 days. On initial evaluation, the patient's vital signs are stable. The abdomen is diffusely tender on physical examination with increased tenderness in the left lower quadrant. Labs showed WBC count of 15,900/μL, 90.2% neutrophils, AST of 80 U/L, ALT of 41 U/L, ALP of 97 U/L, total bilirubin of 0.5 mg/dL, lactic acid of 0.9 mmol/L and c-reactive protein of 11.9 mg/dL. The urine drug screen was positive for benzodiazepine, cocaine, opiate, and methadone. CT scan of the abdomen showed mild diffuse concentric colonic wall thickening representing colitis. The patient was empirically treated with IV ceftriaxone, IV metronidazole, and PO vancomycin. Stool for C. difficile PCR was negative 3 times on 3 different days. Stool culture was negative for Salmonella, Shigella, Campylobacter, or E. coli O157:H7. Fecal lactoferrin quantification was 320.72 μg/mL. The patient underwent sigmoidoscopy, which showed discontinuous areas of ulcerated mucosa covered with yellowish punctate membrane with stigmata of recent bleeding in the entire examined colon. Biopsy of the colon showed focal active colitis with superficial crypt erosion and focal adherent mucopurulent material negative for crypt abscesses and granulomas, consistent with pseudomembranous colitis. The patient was continually treated with supportive care including IV fluids and bowel rest. Her diet was advanced, and her diarrhea improved (Figure). Discussion: Other than C. difficile, we propose keeping other differentials of pseudomembranous colitis is essential. Other infections from S. aureus, E. coli, Shigella and Strongyloides may also cause PMC. Non-infectious causes of PMC include chemical endoscope cleaning agents, intestinal ischemia, drug abuse from cocaine, inflammatory bowel disease, and microscopic colitis to avoid over-usage of antibiotics and focus on targeted therapy.Figure 1.: Discontinuous areas of ulcerated mucosa covered with yellowish punctate membrane with stigmata of recent bleeding in the entire examined colon.

A CASE OF ANTISYNTHETASE SYNDROME: THE IMPORTANCE OF HISTORY IN DISTINGUISHING ETIOLOGY OF INTERSTITIAL LUNG DISEASE IN A COVID-19 WORLD

A CASE OF ANTISYNTHETASE SYNDROME: THE IMPORTANCE OF HISTORY IN DISTINGUISHING ETIOLOGY OF INTERSTITIAL LUNG DISEASE IN A COVID-19 WORLD

PROLONGED COLONIZATION AND COISOLATION OF SARS-COV-2 IN UNVACCINATED RECIPIENTS OF LUNG TRANSPLANTS

PROLONGED COLONIZATION AND COISOLATION OF SARS-COV-2 IN UNVACCINATED RECIPIENTS OF LUNG TRANSPLANTS

COVID-19 clearance among patients with cancer during the Delta and Omicron waves.

42 Background: COVID-19 presents a particular challenge in oncology, as in-person visits and treatments can be delayed during infection and patients are at risk for prolonged viral shedding. Our center uses two consecutive negative PCR tests for patients to return to clinic. As vaccination rates increase, we questioned the need for this strategy vs a time-based clearance approach. Methods: We identified cancer patients who tested positive for COVID-19 from 10/1/2021 to 3/31/2022 at a single tertiary care center and performed chart review under an IRB-approved protocol. Subgroups were compared using the Welch’s t-test and Welch’s ANOVA for 2 or > 2 groups, respectively. Results: 169 patients were identified. 153 had documented clearance defined as two consecutive negative PCR tests. The mean clearance time was 35.7 days (95% CI 32.3-39.0). There was a trend toward longer clearance time in patients with hematologic vs solid tumors (39.6 vs 33.2, p =.06) and a significant increase in patients treated with B cell depletion (58.0) vs chemo/targeted therapy (35.7, p =.01) or immunotherapy (29.0, p =.004). No significant difference was found by vaccination status or between the Delta and Omicron waves. If defined as one negative test, mean clearance time was 25.9 days (95% CI 23.6-28.1), and there was a significant difference in patients with hematologic vs solid tumors and in those treated with B cell depletion vs other therapies. However, 16.0% (27/169) of patients had a subsequent positive test after a first negative result, with increased incidence in patients with hematologic malignancy (26.2%, 16/61) and stem cell/adoptive cell transplant (46.2%, 6/13). Conclusions: COVID-19 is a significant barrier to oncologic care, and clearance times remain longer than reported for the general population. In this single center study, clearance time was > 1 month and further increased in patients with hematologic malignancy or on B cell depleting therapy. While adjusting clearance criteria to a single negative test or specific timeframe may be an attractive option to reduce delays, a large proportion of patients may have further positive PCR testing.[Table: see text]

The frequency of cardiovascular complications in patients suffering from COVID-19

Background: Pandemic caused by Corona virus infection has damaged the population throughout the universe. Cases of COVID-19 increased rapidly in whole world. COVID-19 has been associated with a number of cardiovascular co-morbidities including hypertension, ischemic heart disease, diabetes mellitus, dyslipidemia, atrial fibrillation and cardiac failure.
 Aims and objective: To determine the frequency of cardiovascular complications in patients with COVID-19.
 Material and methods: This observational cohort study was conducted in corona ward of DHQ Hospital, Gujrat from 1st January to 31st June 2021. Total 216 patients between 18-70 years of age, admitted who had COVID-19 confirmed by PCR after taking informed consent; patients already suffering from any cardiovascular, respiratory or other life threatening illness were excluded while hypertensive, diabetics and smoker were included in the study. Duration of admission was according to the severity of illness. Detailed history was taken from all patients followed by relevant examination. Investigations like ECG, echocardiographically and troponins were done to diagnose cardiovascular complications. All the patients were treated conservatively. Frequency of cardiovascular complications was noted. The patients who had clinical relief of symptoms, fever free, normal X-Ray chest and at least two consecutive negative PCR results for covid-19 were discharged. p value <0.05 was considered as significant.
 Results:� Out of two hundred sixteen patients, 30(14%) patients were diabetics and 21(10%) were hypertensive. Myocardial injury in 12% (myocarditis 4%, myocardial infarction 1%, raised troponins without myocarditis and ECG changes in 7% thromboembolism 1%, right ventricle dysfunction 5%, arrhythmias in 9%. Most of the patients had mild symptoms and recovered by conservative management. About 4-5% patients required invasive ventilatory support. Age, gender, diabetes, hypertension and previous cardiovascular co-morbidities increase the frequency of cardiovascular complications. Overall mortality was around 2%. p value was calculated as significant < 0.05.
 Conclusion: COVID-19 is known for cardiovascular complications in which acute myocardial injury, myocarditis, arrhythmias, thromboembolism, right ventricle dysfunction are common. These complications are more common in those having cardiovascular disease (CVD) or other co-morbidities

Guillain-Barré syndrome as an early complication of a new coronavirus infection SARS-CoV-2 (clinical case)

The new strain of coronavirus SARS CoV-2 can affect any organ and system of the body. The pathogenesis of these lesions is due to both direct damage to body cells by the virus and the development of immunopathological reactions that can lead to demyelinating diseases of the nervous system. The article presents a clinical case of the development of Guillain-Barré syndrome associated with coronavirus disease in a 71-year-old man who developed after infection with a new strain of SARS CoV-2 virus. The man was hospitalized on the seventh day of the disease with complaints of unproductive cough, weakness, fever in the range of 37.5-38.7°C, shortness of breath during exercise. The clinical diagnosis was confirmed by the presence of SARS CoV-2 RNA in the nasopharyngeal secretion. According to digital radiography, the presence of interstitial pneumonia was determined. Against the background of treatment, the condition gradually improved and on the 14th day after the onset of the disease, a negative PCR result (SARS CoV-2 (-) RNA) was obtained. However, on the 16th day of hospital stay (23-24th days of the disease) he was diagnosed with polyneuropathy (Guillain-Barré syndrome), severe tetraparesis. Despite the therapy, the condition gradually deteriorated due to the progression of polyneuropathy. On the 9th day after the onset of neurological symptoms (25th days of illness), on the background of severe neurological deficits, the signs of respiratory and cardiovascular insufficiency developed, which led to the death of the patient. It has been shown that the course of Guillain-Barré syndrome, which developed after infection with a new strain of SARS CoV-2 virus, in this case has a severe course and lethal outcome of the disease. It is necessary to look for clinical predictors that would predict the occurrence of neurological complications in patients with coronavirus disease.

A Multi-center Retrospective Analysis of Healthcare Workers after COVID-19: Epidemiological and Clinical Features

Objective: Concerns regarding the high-level risk of infection among healthcare workers (HCWs) increased after COVID19 was declared as a pandemic in March 2020. Inadequate infection control owing to a shortage of personal protective equipment or an inconvenient usage of infection control measures may play a significant role in transmission to/among healthcare personnel. The study aimed to determine the characteristics and outcomes of COVID-19 patients who are healthcare workers along with possible transmission routes of COVID-19 in four different healthcare facilities in Istanbul. 
 Methods: All hospital records were reviewed retrospectively. Demographic and clinical characteristics of HCWs were documented, and all infected HCWs were subjected to a phone-based mini-questionnaire and three-dimensional test (TDT). All statistical analyses were done using statistical packages SPSS Demo Ver 22 (SPSS Inc. Chicago, IL, USA). 
 Results: Clinical features of COVID-19 were similar to the general public’s characteristics. The most frequent symptoms were cough, fever, and headache. HCWs with the O blood group tend to have asymptomatic COVID-19 infection. Hospital workers other than medical professionals have a lack of convenience of infection control measures. The median duration of PCR negativity was 9 days. HCWs who had a sore throat at the beginning of COVID-19 have a longer PCR-positive duration. 
 Conclusion: Understanding the clinical features or characteristics of asymptomatic COVID-19 carriers may aid in the implementation of a feasible screening program for early detection. It is strongly advised that proper infection control precautions, education, and auditing of nonclinical staff be implemented. As a result, transmission among healthcare workers can be avoided.

OA22 A case report of Whipple's arthritis

Introduction/BackgroundWhipple’s disease is rare chronic systemic infection caused by the Tropheryma whipplei. Initially it was thought it can only affect the Gastrointestinal tract but later on it was discovered that it is multisystemic and can affect heart, brain, skin, eyes and lungs. The common presenting features are gastrointestinal tract symptoms like diarrhoea, vomiting, reduced appetite and weight loss. Other common extra intestinal features are joints pain, uveitis, and confusion and memory loss. Rarely, it can present with seizures and other neurological deficits. It predominantly affects the males as compared to females likely with defective T-Lymphocytes particularly TH1 population function.Description/MethodA 69 year old gentleman presented with unexplained weight loss, chronic diarrhoea, reduced appetite and abdominal bloating with travelling history in the past. Background history of epilepsy, hypercholesterolemia and osteoarthritis. Initial blood tests showed a normocytic anaemia along with lymphopenia. CT thorax and abdomen found indeterminate mesenteric lymphadenopathy. Upper GI endoscopy confirmed tiny proximal stomach tiny polyps, polypectomy was done along with multiple biopsies taken from duodenum. The duodenal biopsies histopathology report had shown an infiltration of PAS stain positive foamy macrophages with mixed inflammatory cells within the lamina propria along with broadening of villi. Furthermore, no micro-organisms were seen, including fungi and mycobacteria along with atypical cells. Histopathology is quite consistent with Whipple's disease however tissue biopsy for Whipple’s PCR was negative but serum Whipple’s PCR was detected. On infectious disease team advice he was started on ceftriaxone for two weeks later, switched to oral trimoxazole for 12 months resulted in complete symptoms resolution along with negative Whipple's PCR.Three months later, Rheumatology team was involved as he had developed palindromic migratory polyarthritis along with raised inflammatory markers, involving his right knee, right wrist, left elbow and then left wrist along with active joint inflammation. Blood investigations had shown weakly positive Rheumatoid factor with negative anti CCP and ANA. The plain films of various joints did not show any early inflammatory changes like periarticular osteopenia and erosions. Infectious disease team had suggested a repeat endoscopy reassuringly, he had negative serum and biopsies Whipple's PCR. After couple of weeks he developed a left knee pain with joint effusion which was aspirated with aseptic technique and the left knee synovial fluid came positive for Whipple’s PCR. On Infectious team recommendation he was commenced on hydroxychloroquine and doxycycline for another 12 months.Discussion/ResultsWhipple’s disease arthritis is easily misdiagnosed and approximately 1.58% of patients with unexplained seronegative inflammatory arthritis are positive for Tropheryma whipplei. Furthermore, the diagnosis of Whipple’s disease can be prolonged in patients with no gastrointestinal tract symptoms and in some cases gastrointestinal symptoms occur after extra intestinal features. In 41%to 61% cases of Whipple’s disease arthritis was reported which indicates Whipple's disease is significantly associated with arthritis and even more in Whipple's prodromal disease where the percentages of joint symptoms peak around 40%-80%. With the antibiotics the outcome of Whipple's disease can be fatal, it can be the worst when patients are misdiagnosed and on immunosuppressants.Giving a reference of retrospective single centre cohort study of seven patients was done. All 7 patients presented with symmetrical polyarthritis and 3 patients developed erosive arthritis. The most common joints were wrists, knuckles and knees involved, less commonly joints involvement were hips, elbows and shoulders. All patients were seronegative and out of 7, 6 patients were given disease modifying agents for considering seronegative rheumatoid arthritis but didn’t get good treatment response. All patients were treated with treated with ceftriaxone along with Co –Trimoxazole or Doxycycline/hydroxychloroquine. Both combinations were used as alternatives due to side effects or inefficacy and eventually lead to arthritis remission over the treatment course of 12 - 27 months. Interestingly, 2 out of 6 patients duodenal biopsies were positive for PAS staining and but all patients synovial fluid from one inflamed joint was positive for Whipple's PCR.The desirable investigations for suspected Whipple's arthritis are for suspected Whipple’s disease are PCR with samples of joint fluid, saliva and stools.In our case, Patient joints symptoms resolved with the course of antibiotics without progression of further joint involvement.Key learning points/ConclusionIn conclusion, Whipple’s disease can rarely present like seronegative arthritis with or without GI symptoms. For patients with seronegative inflammatory arthritis not responding to initial DMARDs therapy, Whipple’s arthritis should be excluded. The positive outcome about Whipple’s arthritis is that it is antimicrobial treatment responsive. In the suspected patients diagnostics test to rule out Whipple's arthritis is minimal invasive synovial fluid tap for Whipple's PCR, which can be performed in routine clinical practice.

Nonsense mutation in the novel PERCC1 gene as a genetic cause of congenital diarrhea and enteropathy

Congenital diarrheas and enteropathies (CODEs) constitute a heterogeneous group of individually rare disorders manifesting with infantile-onset chronic diarrhea. Genomic deletions in chromosome 16, encompassing a sequence termed the ‘intestine-critical region (ICR)’, were recently identified as the cause of an autosomal recessive congenital enteropathy. The regulatory sequence within the ICR is flanked by an unannotated open reading frame termed PERCC1, which plays a role in enteroendocrine cell (EEC) function. We investigated two unrelated children with idiopathic congenital diarrhea requiring home parenteral nutrition attending the Irish Intestinal Failure Program. Currently 12 and 19-years old, these Irish male patients presented with watery diarrhea and hypernatremic dehydration in infancy. Probands were phenotyped by comprehensive clinical investigations, including endoscopic biopsies and serum gastrin level measurements. Following negative exome sequencing, PCR and Sanger sequencing of the entire coding region and intron boundaries of PERCC1 were performed for each proband and their parents. In both patients, serum gastrin levels were low and failed to increase following a meal challenge. While no deletions involving the ICR were detected, targeted sequencing of the PERCC1 gene revealed a shared homozygous c.390C > G stop gain variant. We report clinical and molecular findings in two unrelated patients harboring a shared homozygous variant in PERCC1, comprising the first description of a point mutation in this gene in association with CODE. That both parenteral nutrition dependent children with unexplained diarrhea at our institution harbored a PERCC1 mutation underscores the importance of its inclusion in exome sequencing interpretation.

Kidney Transplantation in Patients With the History of SARS-CoV-2 Infection

Background. The aim of this study is to present the experience and results of kidney transplantation in patients with the history of SARS-CoV-2 infection.Methods. We retrospectively analyzed waitlisted patients who had a history of SARS-CoV-2 infection and offered a kidney transplant between March 2020 and December 2021.Results. Of the 97 waitlisted potential kidney transplant recipients who were offered a kidney, 13 (13.4%) had a history of SARS-CoV-2 infection. All patients were tested negative for SARS-CoV-2 at the time of the kidney offer. Successful transplantation was performed in 9 patients (5 male; average age was 40.8 years), with the average time between SARS-CoV-2 infection and transplantation of 8 months. Four of 13 patients with a history of SARS-CoV-2 infection were finally not transplanted, with 2 patients not eligible for transplantation due to significant post-COVID findings in routine pretransplant chest CT scans, and 2 patients were not transplanted because of poor donor organ quality.Conclusions. Kidney transplantation after SARS-CoV-2 infection is possible in a setting of full recovery from acute infection, negative PCR test, and no pneumonic infiltrates on chest CT scan. A growing number of waitlisted patients with a history of SARS-CoV-2 infection imposes the need for decision-making tools and guidelines for risk/benefit assessment in these patients.

Evaluating the Effectiveness of a Novel Systematic Screening Approach for Tuberculosis among Individuals Suspected or Recovered from COVID-19: Experiences from Niger and Guinea.

Evidence suggests that the COVID-19 pandemic negatively impacts tuberculosis (TB) activities. As TB and COVID-19 have similar symptoms, we assessed the effectiveness of integrated TB/COVID-19 screening in Guinea and Niger. From May to December 2020, TB screening was offered to symptomatic patients after a negative COVID-19 PCR test or after recovery from COVID-19 in Guinea. From December 2020 to March 2021, all presumptive COVID-19 patients with respiratory symptoms were tested simultaneously for COVID-19 and TB in Niger. We assessed the TB detection yield and used micro-costing to estimate the costs associated with both screening algorithms. A total of 863 individuals (758 in Guinea, and 105 in Niger), who were mostly male (60%) and with a median age of 34 (IQR: 26–45), were screened for TB. Reported symptoms were cough ≥2 weeks (49%), fever (45%), and weight loss (30%). Overall, 61 patients (7%) tested positive for COVID-19 (13 in Guinea, 48 in Niger) and 43 (4.9%) were diagnosed with TB disease (35 or 4.6% in Guinea, and 8 or 7.6% in Niger). The cost per person initiating TB treatment was USD $367 in Guinea and $566 in Niger. Overall, the yield of both approaches was high, and the cost was modest. Optimizing integrated COVID-19/TB screening may support maintaining TB detection during the ongoing pandemic.

Host-associated variability of the cdtABC operon, coding for the cytolethal distending toxin, in Campylobacter jejuni.

Campylobacter, a major cause of food-borne gastroenteritis worldwide, colonize the gastrointestinal tract of a wide range of animals, being birds the main reservoir. The mechanisms involved in the interaction of Campylobacter with the different hosts are poorly understood. The cytolethal distending toxin, encoded in the cdtABC operon, is considered a pivotal virulence factor during human infection. Differences in the prevalence of cdtABC genes in Campylobacter isolates from three distinct origins (wild birds, broiler chickens and humans) prompted us to further characterize their allelic variability. The sequence of cdtABC is highly conserved among broiler and human isolates. A high diversity of cdtABC alleles was found among wild bird isolates, including several alleles that do not produce any functional CDT. These results suggest that specific variants of the cdtABC operon might define the host range of specific Campylobacter jejuni isolates. Moreover, our data indicate that PCR methodology is inaccurate to characterize the prevalence of the cdt genes, since negative PCR detection can be the result of divergences in the sequence used for primer design rather than indicating the absence of a specific gene.

210.6: COVID-19 Positive Donor Organs in Transplantation

Introduction: Due to unknown transmission risks, donors with acute COVID-19 infection manifested by positive PCR test were ineligible for organ donation in the past. We report our experience with 6 donors with acute COVID-19 infection whose organs were used for transplantation. Methods: Retrospective review of outcomes of transplantation from COVID-19 positive donors. Results: Organs from six brain dead donors were utilized for transplantation. Donors were tested with COVID-19 PCR either on nasopharyngeal swabs or Brochoalveolar lavage specimens or both. Heart, liver and kidney were used for transplant from 1 donor, heart was utilized from 2 and liver from 3 of the donors. Three donors had discrepancy in results with a negative nasopharyngeal PCR, but positive BAL specimen. One donor had symptomatic COVID-19 infection (pneumonia) and all others were asymptomatic. Cycle threshold was >25. Recipients included 3 heart transplant, 3 liver transplant and 1 combined liver-kidney transplant. All recipients had completed full vaccination series, and three received additional post transplant pre-exposure prophylaxis with Tixagevimab/Cligavimab. Standard post transplant immunosuppression with steroids, CNI and antimetabolite was used. Two heart transplant recipients underwent post transplant treatment for AMR. There were no post transplant COVID infections with of median follow up of 40 days. All patients and grafts are doing well. Conclusion: Successful transplantation of organs from donors with COVID-19 infection is feasible. Appropriate donor and recipient selection and risk assessment is essential and long term follow up to rule out any transmittable risks of donor derived infection.

310.5: Torque teno virus Titre Changes Under Immunosuppression Reduction Protocol for BK Virus-Associated Nephropathy: A Single Centre Pilot Study

Introduction: In BK virus-associated nephropathy (BKVaN), balancing the risk of immunosuppression (IS) reduction with the potential benefits can be challenging. A common approach is to empirically stop antiproliferative agents in the first instance and reduce the dose of calcineurin inhibitors (CNIs) later. Torque Teno virus (TTV), a novel ubiquitous DNA virus, has emerged as a better predictor of IS burden in some studies. We examined the changes in BKV and TTV titres in response to IS reduction as part of BKVaN treatment. Method: 20 renal transplant patients with stored blood samples were included in the study cohort from a population transplanted between 2017-19, in remission from an episode of clinically significant BK viraemia. They received standard IS; tacrolimus, antiproliferative (mycophenolate mofetil/azathioprine) and weaning dose prednisolone. BKV and TTV titres, 30-day average tacrolimus concentration, the dose of antiproliferative and prednisolone were collected at 4-time points. These included the last negative BK PCR; the onset of viraemia; the peak BK titre and BK titre <500 copies/ml. TTV DNA was extracted from stored frozen plasma and PCR was performed with Thermofisher 7500 Fast platform and TTV R-GENE® kit. The relationships between the variables were assessed using a multivariable linear regression model. Data were collected from electronic patient records and analysed with R 4.0.3. Result: The log-transformed mean TTV titre at the 4 time points were 5.02 (2.07), 5.52 (1.74), 6.23 (2.14) and 4.56 (1.27) respectively. In the multivariable model, log-transformed BK virus titre increased by 0.25 for every 1 ng/mL increase in tacrolimus concentration (p 0.0008). However, every 1 log rise in TTV titre led to 0.57 (0.17) log copies increase in BKV titre (p 0.0009), once adjusted for tacrolimus concentration. The relationship between tacrolimus and BKV became statistically insignificant when TTV titre was added as a predictor variable. This implies that TTV titre is a more sensitive predictor of BK viral load than tacrolimus concentration. Although statistically significant, all changes in antiproliferative or prednisolone dose were unable to predict linear changes in BKV titres. 5 patients who lost their graft in the mean follow up of 2.8 years had significantly low TTV titres (p< 0.05) at baseline, indicating suboptimum IS burden. In this small cohort, there was no relationship between TTV titres and rejections (n=5) or de novo DSA (n=3). An ongoing adequately powered prospective study will address these questions more decisively.Conclusion: Our study demonstrates that TTV titres more accurately indicate the effect of IS/CNI changes on BK titre and demonstrates its potential as a sensitive assay to objectively guide IS modification compared to current empirical practice in the management of BKVaN. A randomised control trial is warranted comparing empirical practices to TTV titre guided adjustment of immunosuppressive medications.

34535 Pseudoherpetic transient acantholytic dermatosis

A 70-year-old woman with newly diagnosed AML awaiting induction chemotherapy presented with pruritic erythematous papulovesicles on her back, abdomen, and extremities. Vesicle fluid HSV and VZV PCR tests were negative, but the patient was diagnosed with presumed disseminated zoster and started on IV acyclovir. However, after 8 days of treatment the rash was not improved. Biopsy at that time revealed hyperkeratosis, focal intraepidermal split with necrotic epidermis, acantholysis, and features consistent with herpetic cytopathic changes including multinucleated keratinocytes and nuclear molding. Immunohistochemical stains for HSV and VZV were negative, and repeat lesional fluid PCR for HSV and VZV were also negative. The patient was diagnosed with pseudoherpetic transient acantholytic dermatosis (TAD) or Grover disease. The rash improved with use of triamcinolone 0.1% cream and ammonium lactate lotion. TAD classically presents with pruritic erythematous papules across the trunk and is thought to be brought on by UV radiation, sweat, heat, or persistent fevers. Histology shows focal acantholysis, dyskeratosis, and intraepidermal clefting. Variants that resemble other acantholytic diseases such as Darier disease, pemphigus vulgaris and Hailey-Hailey disease have been described. A rare variant, pseudoherpetic TAD (P-TAD), has been reported to mimic HSV/VZV infection with multinucleated and hypereosinophilic keratinocytes but lacks true cytopathic effect despite multinucleation; HSV/VZV immunohistochemistry is negative. Clinically, PHD features ungrouped vesicles distributed regionally rather than the grouped vesicles classically seen in herpetic infection. Clinicians should consider a diagnosis of P-TAD in patients with suspected herpetic infection with negative confirmatory PCR testing and lack of response to antivirals.

Knee And Ankle Swelling—Daily Walker

HISTORY: A 68-year-old woman who walks daily presented to sports medicine clinic with left ankle and knee pain and swelling. Her pain started three weeks prior to presentation in her left ankle followed by redness and swelling. Several days later her left knee became painful, swollen, and red. She was unable to participate in her daily walks, and the pain started to wake her from sleep. The pain was described as achy and stiff. She had tried treatment with Naproxen and Tylenol without relief. No known injuries or tick bites. She denied fevers, previous joint pain, rash, or rheumatologic history. Several days before the onset of her joint pain she was seen in the emergency department for diarrhea. PHYSICAL EXAM: She was afebrile with a nontoxic appearance with significant joint effusions of the left knee and ankle with erythema. Diffuse tenderness to palpation over both joints. Range of motion of the ankle and knee were limited by effusions and pain. Strength was 5/5 with knee flexion/ extension, ankle dorsiflexion/ plantar flexion. Ligamentous and meniscal exams were limited by pain. Her gait was antalgic. DIFFERENTIAL: 1. Lyme or tick related illness 2. Reactive arthritis 3. Rheumatic arthritis 4. Gout/ pseudogout 5. Septic arthritis TEST AND RESULTS: X-ray of her left ankle obtained prior to her appointment showed an effusion. Blood work was notable for: negative tick-borne Ab panel. Elevated ESR (81), and CRP (9.9). Uric acid within normal limits. CBC with mildly elevated WBCs. CMP unremarkable. HLA B27 Positive. CCP antibodies and RF negative. Left knee joint aspirate was obtained via ultrasound guidance, and notable for: negative tick-borne PCR and crystals. Uric acid within normal limits. Smear: 3+ polymorphonuclear white blood cells. Culture with no growth. Stool cultures returned positive for Salmonella Enteritidis FINAL/ WORKING DIAGNOSIS: Salmonella Enteritidis reactive arthritis. TREATMENT AND OUTCOMES: Patient was seen by rheumatology where 40 mg prednisone daily was started for treatment of reactive arthritis with improvement in her pain within days. She had a prolonged treatment course due to viral infections that required intermittent discontinuation of her prednisone treatment. At an appointment after prednisone was completed, she had resolution of the effusions, and was able to walk pain-free.

Developing digital contact tracing tailored to haulage in East Africa to support COVID-19 surveillance: a protocol

IntroductionAt the peak of Uganda’s first wave of SARS-CoV-2 in May 2020, one in three COVID-19 cases was linked to the haulage sector. This triggered a mandatory requirement for a...

Evaluation of Clinical Features and Treatment Results of Pediatric Patients With Pre-Diagnosis of COVID-19

Aim: The epidemiological characteristics and modes of transmission of coronavirus disease 2019 (COVID-19) in children are not yet fully understood. In this study, it was aimed to evaluate clinical, laboratory, and radiological findings and treatment approaches in patients with negative and positive PCR tests among those with suspected COVID-19 retrospectively. Material and Methods: This study was conducted with 317 patients under 18 years of age, who received outpatient or inpatient treatment with a pre-diagnosis of COVID-19. All patients were assessed for clinical course, disease severity, comorbidity, demographic characteristics, laboratory and radiodiagnostic tests, treatment characteristics, and outcomes. Results: The PCR test was positive in 133 (42%) and negative in 184 (58%) of the patients with suspected COVID-19. There was a history of contact in 78 (58.6%) and 51 (27.7%) of the PCR-positive and negative patients, respectively (p&amp;lt;0.001). While the PCR-negative group had a higher rate of hospitalization (p=0.020), hospital stay was longer in PCR-positive cases (p=0.037). The white blood cell count (p=0.001), platelet count (p=0.037), neutrophil count (p=0.015), and lactate level (p=0.025) were significantly lower in the PCR-positive group. Conclusion: Early detection and isolation of children with symptoms suggestive of COVID-19 are important to limit the spread of the disease. It can be challenging initially to clinically understand whether the case has COVID-19, especially in pediatric patients. PCR test is the gold standard in the diagnosis of COVID-19. Considering the prevalence, severity, and complications of the outbreak, it would be a proper approach to initially evaluate suspected patients as COVID-19 patients.

Seronegative immunity to SARS-CoV-2: a case study

BackgroundCOVID-19 presents with a variable clinical course from asymptomatic to severe respiratory distress with nearly 25% mortality in mechanically-ventilated patients. As such, there is uncertainty regarding how host factors modulate the disease course.Case PresentationThis report examines these factors in two geriatric patients with multiple comorbid conditions who were residents of the long-term care facility in West Virginia that was the epicenter of COVID-19 in the state. Each patient had substantial, unprotected exposure to SARS-CoV-2 with subsequent negative PCR and antibody testing.ConclusionsThese cases could represent an important step in understanding host factors that modulate the disease course and susceptibility of patients exposed to SARS-CoV-2, and illustrate the need for further research into host resistance relating to this pandemic.

Clinical Progression and Outcome of Hospitalized Patients Infected with SARS-CoV-2 Omicron Variant in Shanghai, China.

Background: Studies on the Omicron variant infection have generally been restricted to descriptions of its initial clinical and epidemiological characteristics. We investigated the timeline-related progression and clinical outcome in hospitalized individuals with the Omicron variant. Methods: We conducted a retrospective, single-centered study including 226 laboratory-confirmed cases with the Omicron variant between 6 April and 11 May 2022 in Shanghai, China. The final date of follow-up was 30 May 2022. Results: Among 226 enrolled patients, the median age was 52 years, and 118 (52.2%) were female. The duration from onset of symptoms to hospitalization was 3 days (interquartile range (IQR): 2–4 days) for symptomatic patients. Cough occurred in 168 patients (74.3%). The median interval to negative reverse-transcriptase PCR tests of nasopharynx swab was 10 days ((IQR): 8–13 days). No radiographic progressions were found in 196 patients on the 7th day after onset of symptoms. The median duration of fever in all participants was 5 days (IQR: 4–6 days). The median PCR conversion time of Paxlovid-treated patients was 8 days (IQR: 7–10 days) compared with that of a traditional Chinese herb medicine lianhuaqingwen (10 days, IQR: 8–13 days) (p = 0.00056). Booster vaccination can significantly decrease the severity of Omicron infection when compared with unvaccinated patients (p = 0.009). In multivariate logistic analysis, erythrocyte sedimentation rate (ESR) (OR = 1.05) was independently related to the severity of the infection. Conclusions: The majority of clinical symptoms of Omicron infection were not severe. Early and aggressive administration of Paxlovid can significantly reduce the PCR conversion time. Booster vaccination should also be highly recommended in the population over 14 years old.