Prevention Of Secondary Infection Research Articles

Eosinophilic pustular folliculitis after phlebectomy: a case report

Eosinophilic pustular folliculitis (EPF), also known as Ofuji disease, is a rare inflammatory condition in which eosinophils infiltrate the skin, primarily around hair follicles. Several variants of the condition exist, but all exhibit sterile erythematous folliculocentric papules with or without pustules and pruritus. Common areas affected are the seborrheic areas of the body. Although the exact pathophysiology is not fully understood, the condition is seen more commonly in people of Japanese heritage, infants, and immunosuppressed patients. Immunosuppressed manifestations are divided into human immunodeficiency virus (HIV)-associated and non-HIV–associated categories. The goals of management are identification and treatment of an underlying disorder if present, relief of pruritis, and prevention of secondary infection. Here, we present the case of an adult female patient who developed EPF after a phlebectomy.

The Outbreak of Foot and Mouth Disease Serotype Sat-2 Infection in Al-Muthanna Province of Iraq

Introduction: prevalent in the majority of developing nations. Case report: The present study reported a foot and mouth disease Sat-2 outbreak in Al-Muthanna province in southern Iraq in March 2023. Three male Holstein Friesian cows, aged between 1 and 1.5 years and weighing approximately 550 ± 15 kg each, were affected. Clinical examination revealed symptoms, including fever, severe lameness, anorexia, depression, frothy salivation, and vesicular lesions on the mouth and feet. Confirmation of the Sat-2 serotype was achieved through serological testing and genotyping of the virus, conducted by the FMD Institute, Ankara, Türkiye. The Sat-2 serotype was recognized by genotyping the virus and submitting SAT-2 VP1 sequences. The treatments for secondary infection prevention included Ceftifur (2.2 mg/kg) for 5 days, and flunixin meglumine (2.2 mg/kg) for 2 days. The other animals that were not exposed to infected animals were vaccinated against FMD. Rigorous biosecurity measures were implemented, involving thorough disinfection of the environment and quarantine of the infected animals. Direct contact between the farmer and other animals, particularly the sick ones, was completely avoided. After 2 weeks, all infected animals began to eat normally again, and clinical signs disappeared. Notably, other animals on the farm did not exhibit any signs of FMD. Conclusion: In conclusion, the findings of this study underscore the importance of biosecurity measures and vaccination in FMD prevention. Additionally, administering antibiotics and non-steroidal anti-inflammatory drugs for the prevention of secondary infections proves to be crucial.

A phase 1/2 clinical trial of invariant natural killer T cell therapy in moderate-severe acute respiratory distress syndrome

Invariant natural killer T (iNKT) cells, a unique T cell population, lend themselves for use as adoptive therapy due to diverse roles in orchestrating immune responses. Originally developed for use in cancer, agenT-797 is a donor-unrestricted allogeneic ex vivo expanded iNKT cell therapy. We conducted an open-label study in virally induced acute respiratory distress syndrome (ARDS) caused by the severe acute respiratory syndrome-2 virus (trial registration NCT04582201). Here we show that agenT-797 rescues exhausted T cells and rapidly activates both innate and adaptive immunity. In 21 ventilated patients including 5 individuals receiving veno-venous extracorporeal membrane oxygenation (VV-ECMO), there are no dose-limiting toxicities. We observe an anti-inflammatory systemic cytokine response and infused iNKT cells are persistent during follow-up, inducing only transient donor-specific antibodies. Clinical signals of associated survival and prevention of secondary infections are evident. Cellular therapy using off-the-shelf iNKT cells is safe, can be rapidly scaled and is associated with an anti-inflammatory response. The safety and therapeutic potential of iNKT cells across diseases including infections and cancer, warrants randomized-controlled trials.

Cellulose-based bioabsorbable and antibiotic coated surgical staple with bioinspired design for efficient wound closure

The quest to design a flawless wound closure system began long ago and is still underway. Introducing surgical staples is one of the most significant breakthroughs in this effort. In this work, we developed a biodegradable surgical staple to meet the optimal wound closure system criteria and other clinical requirements, such as radiography compatibility and secondary infection prevention. To meet these requirements, a naturally derived cellulose acetate (CA) fiber-reinforced poly-(l-lactic acid) (PLLA) composite was synthesized, and its physicochemical properties were determined using several characterizations such as Fourier-transform infrared spectroscopy (FTIR), Differential scanning calorimetry (DSC) and Universal testing machine (UTM), etc. Taking cues from the Mantis's foreleg, a novel staple design was implemented and verified using Finite Element Analysis (FEA). The CA + PLLA staples were fabricated using melt-casted/3D-printing processes. The staples exhibited excellent biodegradation in both wound and physiological microenvironments with sufficient puncturing strength and later closed the wound's edges mechanically. In addition, the CA + PLLA staples also exhibit metal-like ductility properties to withstand horizontal skin tensions during the healing process. Further, the staples are coated with an antibiotic to combat infections effectively to provide better healing.

In vivo characterization of the superior fitness of classical swine fever virus genotype 2.1 to genotype 3.4

Classical swine fever (CSF), caused by classical swine fever virus (CSFV), is a highly contagious disease in pigs. In Taiwan, the emerging genotype 2.1 (G2.1) CSFV caused sporadic outbreaks in 1994 and replaced the previous G3.4 CSFV in the field. The shift of CSFV genotypes to G2 CSFV was also observed in several CSFV-affected countries. The present study aimed to explore the mechanism of the genotype shift of CSFV. Two groups of specific pathogen-free (SPF) pigs were first inoculated with either G2.1 or G3.4 CSFV (single-inoculated group) and housed together with naïve SPF pigs (cohabitating group). The results showed that peak viremia, viral loads in blood and tissues, and viral shedding of G2.1 were consistently higher than those of G3.4 CSFV in single-inoculated and cohabitating pigs. The phenomenon of superinfection exclusion (SIE), characterized by the prevention of secondary infection by a primary infection, was readily observed in CSFV single-inoculated pigs. Interestingly, coinfection of both genotypes of CSFV was observed in 3 out of 4 cohabitating pigs, while only one pig was infected with G2.1 CSFV alone. These findings suggest that the genetic shift in CSFV in the field may be in part the consequence of SIE.

Modern approaches to the treatment of trophic ulcers of venous etiology: photodynamic therapy

Chronic venous insufficiency, being the outcome and complication of most diseases of the veins of the lower extremities, is the fundamental cause of the formation of trophic ulcers. Over the past decade, in solving the problem of treating venous trophic ulcers, certain successes have been achieved, both in theoretical and practical terms. The modern concept of curation of patients with trophic ulcers of venous origin involves a reasonable combination of the following methods of treatment: local, including compression, as well as medical, surgical, minimally invasive and additional methods (physiotherapy, photodynamic therapy, etc.). The main goal of the treatment is to eliminate the ulcer, after which measures are taken to correct the underlying cause (chronic venous insufficiency) and prevent relapse. However, the tactics of the most successful treatment of patients with trophic ulcers of venous etiology is still not defined and requires further improvement. In particular, the method of photodynamic therapy, which includes the usage of special drugs - photosensitizers, also deserves to be studied and expanded for clinical use. The mechanism of photodynamic action is based on the ability of photosensitizers to accumulate in microbial and pathological cells. Under local light exposure, the photosensitizer enters an excited state and charges oxygen, which is associated with erythrocyte hemoglobin. Thus, in cells under the influence, a photochemical reaction is triggered, which ensures the formation of singlet oxygen and its free radicals. Reactive oxygen species, in turn, have a damaging effect on pathogenic flora and necrotic tissues. The main advantages of the method are relative simplicity, no risk of developing antibiotic resistance, acceleration of reparative and regenerative processes, and prevention of secondary infection. Thus, photodynamic therapy allows non-invasive, safe and effective optimization of local treatment and preoperative preparation of patients with venous trophic ulcers.

Challenges in Antibiotics Prescriptions in Paediatrics: A National Survey Among Lebanese Paediatricians

Objectives: The aim of this study, the first of its kind in Lebanon, was to evaluate attitudes and practices of Lebanese paediatricians towards antibiotics prescriptions with a special focus on upper respiratory tract infections to identify challenges facing physicians. Materials and Methods: This was a cross-sectional study conducted among paediatricians registered in the Orders of Physicians. A 63-item questionnaire in English was sent by e-mail or by message to mobile phones of all paediatricians with subsequent reminders. Results: One hundred seventeen physicians agreed to participate in the study. A high proportion of Lebanese paediatricians replied correctly on avoiding antibiotics in cases of cough (86.3%), upper respiratory tract infections (74.4%), tympanic membrane dysfunction (64.1%) and prevention of secondary infection (63%). Eighty percent of physicians prescribed antibiotics for pharyngitis without requesting a throat culture. Most physicians admitted that antibiotic use is considerable in their community and that antibiotic resistance is a threat on the national and international level. Forty percent of paediatricians agreed and strongly agreed that giving advice to parents reduces their antibiotic demand. The same percentage disagreed that they might prescribe antibiotics to gain parents’ trust. Conclusion: National campaigns are required to increase parents’ educations and promote judicious antimicrobial use. Implementing national guidelines, ensuring continuing medical education for doctors and regulating over the counter sale of antibiotics are highly recommended

METHODS OF MEDICAL REHABILITATION OF THOSE WHO HAVE SUFFERED COMPLICATIONS OF COVID-19

The Covid-19 pandemic could reach several million people worldwide. Presumably, 5-15% of them will need medical rehabilitation after suffering from pneumonia and acute respiratory distress syndrome. The goals of medical rehabilitation at the preclinical stage are to achieve the correction of diseases that contribute to the development of Covid-19 complications (acute respiratory distress syndrome, from 15% to 33 %; acute respiratory failure, 8 %; acute heart failure, from 7% to 20 %; secondary infection, from 6% to 10 %; acute renal failure, from 14% to 53 %; septic shock, from 4% to 8 %; cardiomyopathy, in 33% of critical; disseminated intravascular coagulation, in 71 % of the dead; pregnancy complications are not excluded. Rare complications include mucormycosis and encephalitis. Encephalitis occurs only in about 0.215% of hospitalized patients, but among patients with severe disease, its frequency increases to 6.7%). Non-medicinal technologies have a number of advantages over medicines that have a side effect, and such as glucocorticoids and antibiotics lead to a deterioration in the prognosis of the underlying disease. Medical rehabilitation in the intensive care unit is aimed at reducing the risks of complications and increasing the functional reserves of the body, as well as reducing the area and degree of lung damage, preventing extrapulmonary complications, including secondary infection. The main goal of medical rehabilitation in a hospital setting is to reduce the severity of symptoms, resorption and repair in the lesion of lung tissue, reduce the development of fibrosis, provide bronchial drainage for prevention of secondary infection. In addition, the timely transfer of the patient to a specialized stage of medical rehabilitation makes it possible to increase the functional reserve of the respiratory muscles and exercise tolerance. The second specialized stage of medical rehabilitation can be carried out in the conditions of a sanatorium-resort organization. The goals of this stage are not only to reduce symptoms and increase tolerance to physical activity, but also to improve the quality of life, psychological rehabilitation, and restoration of working capacity.

Review on middle east respiratory syndrome corona virus in camel: Its public health importance and economic impact

Middle East respiratory syndrome corona virus (MERS-CoV) is a novel lineage C beta corona virus derived from bats which can cause acute viral respiratory disease in humans and in camels. According to a WHO report, MERS cases have been reported from 27 countries and there have been 2,428 confirmed cases, resulting in 838 deaths. MERS-CoV is transmitted to humans through close contact with dromedaries and it causes asymptomatic or mild-to-severe illness in the human population. MERS-CoV uses dipeptidyl peptidase-4 (DPP4) protein in Pipistrelluspipistrellus bats for cell entry. Dromedary camels are a host reservoir species for the MERS-CoV. It is suspected that nasal mucous, sputum, saliva, milk or uncooked meat of infected camels are the main sources of transmission. Several factors such as being male and comorbid pre-existing illnesses are associated with severe disease and high mortality rates in patients with MERS. Studies in Ethiopia, Burkina Faso and Morocco reported that the prevalence of MERS-CoV sero-positivity ranges between 85.1- 99.4%, 73.2-89.9% and 48.3-100%, respectively. The clinical presentation of infected patients often indicate the presence of hemoptysis, sore throat, fever, cough, shortness of breath, and other gastrointestinal symptoms such as diarrhea and vomiting. The average incubation period of MERS-CoV is 6-7 days. No vaccine or treatment is currently available for MERS-CoV. Supportive therapy necessitates respiration and circulatory support, preservation of renal and hepatic function, and prevention of secondary infections. This seminar paper is therefore, intended to highlight the public health and economic importance of the MERS-CoV.

Celulite por acidente acantotóxico e suas peculiaridades: um relato de caso

INTRODUCTION: Acantotoxic accidents caused by skates (fish) are routinely caught in Brazil. It is more common in the northern region, especially from June to August, due to the season of river beaches and greater contact with rivers, dams and freshwater lakes: natural habitat of those species. It has an intense and also late inflammatory character, being a poison composed of polypeptides with thermolabile properties. There is no antivenom for those cases in Brazil. The treatment is based on symptom control and prevention of secondary infection, with status for the late effects of the poison. OBJECTIVES: To review emergency management and medical follow-up of an acantotoxic accident case in a pediatric patient and report the singularities related to this variety of accidents. METHODS: A case report of a 9-year-old boy admitted to a pediatric emergency department of a Federal District School Hospital, with a history of freshwater stingray injury, a clinical presentation of cellulitis and a dragged course. RESULTS: Regarded evolution compared to usual cellulitis patterns, requiring the antibiotic change and late signs of a form of necrotic formation. CONCLUSION: The approach to cellulitis was redirected due to the etiological factor correlated to the acantotoxic accident, implying to broaden the spectrum for gram-negative and anaerobic bacteria. It was then allowed to resolve and prevent more serious complications, such as late necrosis.

Prospective feasibility study of indigo naturalis ointment for chemotherapy-induced oral mucositis

ObjectivesIndigo naturalis, a herbal medicine effective against ulcerative colitis, exhibits anti-inflammatory effects and induces interleukin-22-mediated antimicrobial peptide production. Anti-inflammatory activity and the prevention of secondary infection are essential for the...

Incontinentia pigmenti (Bloch–Sulzberger syndrome) – a diagnosis valid from birth

Incontinentia pigmenti (IP, dye incontinence), or Bloch–Sulzberger syndrome, is a rare genodermatosis (1 : 40,000 to 1:50,000 births), inherited through a dominant X-linked conjugate, caused by mutations in the IKBKG/NEMO gene located on Xq28, often with eosinophilia. In most cases, the disease affects the female sex. In male fetuses, it is usually lethal. Incontinentia pigmenti is a multi-system disease. Changes occur in tissues and organs derived from the ectoderm and neuroectoderm and may affect the skin and appendages, eyes, central nervous system, skeleton, and teeth. It is usually diagnosed neonatally or during infancy when a characteristic 4-stage evolution of skin lesions materializes – accompanied by abnormalities in other organs. Skin defects can occur in utero, in which case they are visible at birth. The only treatment is symptomatic and involves proper skin care and prevention of secondary infections. The patient should have interdisciplinary care (dermatologist, neurologist, ophthalmologist, dentist) for the early diagnosis and treatment of possible disorders within other organs. The low incidence of the syndrome may delay diagnosis. The aim of this study is to present the characteristic symptoms of the disease, help clinicians make the right diagnosis and to emphasize the legitimacy of multi-specialist care.

Longitudinal analysis of humoral immunity against SARS-CoV-2 Spike in convalescent individuals up to 8 months post-symptom onset

SummaryWith the recent approval of highly effective coronavirus disease 2019 (COVID-19) vaccines, functional and lasting immunity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently under investigation as antibody levels in plasma were shown to decline during convalescence. Since the absence of antibodies does not equate to absence of immune memory, we evaluate the presence of SARS-CoV-2-specific memory B cells in convalescent individuals. Here, we report a longitudinal assessment of humoral immune responses on 32 donors up to 8 months post-symptom onset. Our observations indicate that anti-Spike and anti-receptor binding domain (RBD) immunoglobulin M (IgM) in plasma decay rapidly, whereas the reduction of IgG is less prominent. Neutralizing activity also declines rapidly when compared to Fc-effector functions. Concomitantly, the frequencies of RBD-specific IgM+ B cells wane significantly when compared to RBD-specific IgG+ B cells, which remain stable. Our results add to the current understanding of immune memory following SARS-CoV-2 infection, which is critical for secondary infection prevention and vaccine efficacy.

Intrapleural Steroid Instillation for Critically Ill Patients With Covid-19 Severe Adult Respiratory Distress Syndrome.

Within a very short period, outbreaks of a novel coronavirus disease (COVID-19) have affected 183 countries worldwide. COVID-19 resolves acutely, but it has resulted in thousands of deaths, with an overall fatality rate of 2% to 5% (1). Among the fatal cases, over 50% of patients died from respiratory failure with massive alveolar damage due to virus-activated “cytokine storm syndrome” (2). Of these patients, 67% developed adult respiratory distress syndrome (ARDS), 29% developed acute kidney injury, 23% developed cardiac injury, and 29% experienced liver dysfunction (3). The intensive care unit (ICU) mortality rate among those who required invasive mechanical ventilation was 86% (4), and the mortality of patients who received extracorporeal membrane oxygenation was also extremely high (5). Until now, there have been no proven effective specific treatment strategies and so methylprednisolone may be the best option for COVID-19 patients who develop ARDS (6). Although interferon alfa-2b, antiviral therapy, antibiotics for the prevention of secondary infection, and methylprednisolone were all administered to attenuate lung inflammation, histological examination still revealed bilateral diffuse alveolar damage with hyaline membrane formation in an autopsy of a patient (7). According to the imaging changes and pathological findings associated with ARDS, a tubular and enlarged appearance of the pulmonary vessels with a sudden caliber reduction seen within ground glass opacity lesions showing partial consolidation and fibrosis should be expected in severe cases of COVID-19 (8, 9). Fortunately, corticosteroids have a greater anti-inflammatory effect when administered intrapleurally, rather than via the intravenous route, because the permeability of the damaged visceral pleural membrane increases during pulmonary edema and steroid treatment, with the characteristic of fat-solubility, further permits infiltration into the lung parenchyma. Glucocorticoids can easily pass through the visceral pleura and bind to steroid hormone receptors, thereby allowing them to reach the injured areas and avoiding the problems of a ventilation–perfusion mismatch and the need for a shunt via intratracheal instillation or intravenous instillation. Glucocorticoids can normalize the ion pump (Na-K pump) and increase the synthesis of Na+/K+-ATPase, thus contributing to reductions in lung edema and optimization of oxygenation because alveolar fluid clearance is impaired in the majority of patients with ARDS (10). In COVID-19 severe refractory ARDS, more aggressive management is required to reduce the inflammatory reaction and consequent lung injury. The results of our study provide more evidence supporting the efficacy of intrapleural steroid instillation (IPSI) in the treatment of ARDS with multiple organ failure (11). This alternative treatment resulted in significant improvement in oxygenation and survival benefits after 5 days of treatment. The dosing schedule of intrapleural methylprednisolone was initially 40 mg q6 h in both pleural cavities, but the dose was reduced on the basis of chest radiography appearance, inspired oxygen concentration demand, and positive end-expiratory pressure of the ventilator. Thoracic catheterization was easily performed because COVID-19 patients usually had significant pleural effusion. Although managing COVID-19 pneumonia is currently a major issue for ICU healthcare providers around the world, IPSI will greatly improve the ability to respond effectively to current needs. Our recommendation in this severe case of COVID-19 might help physicians implement suitable therapeutic strategies for similar severe patients and reduce mortality.

SECONDARY INFECTION IN CANCER PATIENTS OF THE MUSCULOSKELETAL SYSTEM

Infectious diseases complications remain one of the main problems of surgery. Infections are one of the causes of canser patients morbidity and mortality, along with tumor diseases. The frequency of postoperative wound complications varies between 3-34% depending on the type of surgery [5]. Cancer patients are more susceptible to the systematic immunosuppresive state, caused by malignant neoplasms and directly by antitumor therapy. It is obvious that the anticancer problem of treatment and prevention of secondary infections in these conditions becomes even more urgent than before. Objective: To analise infections complications (IC) caused by microorganisms depending on antitumor treatment in cancer patients. Materials and methods: The study included 41 (100%) cancer patients with infectious complications during antitumor treatment in the Azerbaijan Medical University (AMU) Cancer clinic for skin and soft tissue neoplasms. Most often, the pathological process was lokalized in the lower extremities in 19 (46%) patients; in the upper extremities in 14 (34,1%) patients: in the trunk in 8 (19,5%) patients. Of these 12 patients (29,2%) patients received treatment for posteopertive complicattions, 10 (24%) patients received treatment for complications – related to chemotherapy and 19 (46%) patients received treatmentrelated to radiation therapy. There were 28 (68%) men and 13 woman (36,5%) patients. The age of the patients ranged from 34 to 82 years among the studied patients with soft tissue tumors 24 (58%), skin tumors 17 (41,4%) patients .

Murine Myeloid Progenitors Attenuate Immune Dysfunction Induced by Hemorrhagic Shock.

SummaryHemorrhagic shock induces an aberrant immune response characterized by simultaneous induction of a proinflammatory state and impaired host defenses. The objective of this study was to evaluate the impact of conditionally immortalized neutrophil progenitors (NPs) on this aberrant immune response. We employed a mouse model of hemorrhagic shock, followed by the adoptive transfer of NPs and subsequent inoculation of Staphylococcus aureus to induce pneumonia. We observed that transplant of NPs decreases the proportion of host neutrophils that express programmed death ligand 1 and intercellular adhesion molecule 1 in the context of prior hemorrhage. Following hemorrhage, NP transplant decreased proinflammatory cytokines in the lungs, increased neutrophil migration into the airspaces, and enhanced bacterial clearance. Further, hemorrhagic shock improved NP engraftment in the bone marrow. These results suggest that NPs hold the potential for use as a cellular therapy in the treatment and prevention of secondary infection following hemorrhagic shock.

Photothermal sterilization cellulose patch with hollow gold nanoparticles

In this work, we prepared hollow gold nanospheres (HAuNS) with rough surfaces and strong light absorption in the NIR region. Based on as-made HAuNS materials, photothermal sterilization patches using filter paper was prepared. When 808 nm and 4 W/cm2 laser light was irradiated on the patch containing 50 ppm of HAuNS, the temperature of patch surface increased to 63 °C. The photothermal conversion efficiency of the patch was found to be 38.8% and is enhanced by the overlap between the heat emission of nearby particles in the patch. The prepared patch was placed into an Escherichia coli culture medium with irradiation of NIR (pulsed laser by manually on/off). E. coli in direct contact with patch could be killed by local heating on the patch surface. Approximately 99% of the bacteria was killed compared to control test. Therefore, this patch can be applied to wounds to block the entry of bacteria from the outside for the prevention of secondary infections and the acceleration of treatment with the photothermal effect caused by NIR irradiation.

Abstract 17113: Secondary Infections Are Common in Patients Hospitalized for COVID-19 and Are Associated With Severe Outcomes

Background: Secondary infections occur in 10-15% of critically ill sepsis patients. Anecdotal reports suggest secondary infections are common in coronavirus disease 2019 (COVID-19), however data are lacking. We examine the rate of secondary infections in hospitalized patients with COVID-19 and its impact on the cytokine surge and in-hospital outcomes. Methods: The Michigan Medicine Covid-19 Cohort (M2C2) is an ongoing prospective observational study in which detailed clinical, laboratory and outcome data were collected from chart review of consecutive adult patients hospitalized for COVID-19. Patients who were positive for SARS-CoV-2 infection but without respiratory symptoms were not included in this cohort. We define secondary infections as physician-diagnosed and treated bacterial or viral infections secondary to SARS-CoV-2. Results: Of 553 COVID-19 patients hospitalized at Michigan Medicine, 191 (34.5%) developed a secondary infection during hospitalization. The mean age of patients with a secondary infection was 60 years, 61.3% were male compared to 58.8 years, 53.5% male in patients with no secondary infection. Bacterial pneumonia, including ventilator-associated pneumonia, was the most prevalent secondary infection among hospitalized patients (78.5%). Other secondary infections included urosepsis (14.1%), bacteremia (16.8%), and 17.3% of patients developed other types of infections such as shingles and clostridium difficile. 25.8% of patients without secondary infections received antibiotics during their admission compared to 47.1% of patients with secondary infections. Multiple secondary infections (>1) occurred in 43 (8.2%) of patients. Patients with secondary infections were more likely to develop acute kidney injury (78.0% vs. 38.3%, p<0.0001), acute respiratory distress syndrome (78.0% vs. 22.3%, p<0.0001), and death (26.2% vs. 10.2%, p<0.0001) during their hospitalization compared to patients without secondary infections. Conclusions: Secondary infections are common in hospitalized patients with COVID-19 and are associated with life-threatening complications and high mortality. This study suggests that secondary infection prevention may be especially important in COVID-19 patients.

Interleukin-6 Blocking vs. JAK-STAT Inhibition for Prevention of Lung Injury in Patients with COVID-19.

The severe respiratory insufficiency observed during COVID-19 infection may not be directly related to a cytopathogenic effect induced by the virus itself, but to an exaggerated and inappropriate immune response. In an effort to reduce the severity of organ dysfunction, including respiratory insufficiency, monoclonal antibodies (Mabs) that block the interleukin-6 receptor, such as tocilizumab, sarilumab, and siltuximab, are under investigation for the treatment of COVID-19. However, blocking of just one of the many cytokines involved in the inflammatory reaction may not slow down the magnitude of the process. Since timing is important, the immune deficiency induced by IL6 blockade at the late immunodeficiency phase of sepsis that follows the initial inflammatory response may be detrimental. Finally, monitoring the degree and duration of IL6 blockade may be challenging because of the long half-life of Mabs (2–3 weeks). Pro- and anti-inflammatory cytokines act through a common JAK-STAT signaling pathway, which can be inhibited by JAK-STAT inhibitors. Ruxolitinib, a tyrosine kinase inhibitor selective for JAK1, 2, blocks many pro- and anti-inflammatory cytokines including IL6. Ruxolitinib has favorable pharmacodynamics and an acceptable safety profile. The short half-life (4–6 h) of the drug offers the opportunity for ideal monitoring of the degree and duration of cytokine blocking, simply by the adjusting dose and duration of therapy. From a theoretical point of view, the balanced control of cytokine blockade throughout the course of the septic process should be the cornerstone of modern management. According to this hypothesis, maximization of blocking should be attempted at the phase of hyper-inflammation for preventing severe organ damage, while pro-inflammatory blockade should be minimized at the late phase of immunoparalysis for prevention of secondary infections. Based on the above considerations, we consider that the efficacy and safety of this drug deserves testing in the context of a controlled randomized trial.

Boosting effect of cyclosporine on corticosteroids in the acute management of toxic epidermal necrolysis

<p class="abstract">Toxic epidermal necrolysis (TEN) is a life-threatening dermatological emergencies. It is a rare, acute mucocutaneous disorder that usually occur secondarily as an idiosyncratic reaction to certain drugs. Prompt identification and discontinuation of the causative drug is mandatory along with adequate supportive care like proper hydration, minimize the number of skin manipulation, prevention of secondary infections. Many immunosuppressive modalities have been tried with variable results. In this manuscript, we reported 12 consecutive cases of TEN presented to our hospital over a period of 2 years from 2017 to 2019. All the cases presented with varying percentage of skin blistering and mucosal involvement secondary to an offending drug. The incriminated drug was discontinued, supportive care was initiated along with combination therapy of cyclosporine and corticosteroids as immunosuppressants. The clinical presentation, etiological drugs and treatment protocol followed and its efficacy will be described in details.</p>