Secondary Infection Research Articles

SARS-CoV-2 Infection in School Settings, Okinawa Prefecture, Japan, 2021-2022.

During the COVID-19 pandemic, widespread school closures were implemented globally based on the assumption that transmission among children in the school environment is common. However, evidence regarding secondary infection rates by school type and level of contact is lacking. Our study estimated the frequency of SARS-CoV-2 infection in school settings by examining the positivity rate according to school type and level of contact by using data from a large-scale school-based PCR project conducted in Okinawa, Japan, during 2021-2022. Our results indicate that, despite detection of numerous positive cases, the average number of secondary infections remained relatively low at ≈0.5 cases across all types of schools. Considering the profound effects of prolonged closures on educational access, balancing public health benefits against potential long-term effects on children is crucial.

Nano-emulgel formulation of lemongrass extract (Cymbopogon citratus) as herbal–based topical drug for oral mucositis: A review

Background: Oral mucositis is a condition characterized by inflammation and ulceration of the oral mucosa, commonly affecting cancer patients undergoing chemotherapy or radiotherapy, with MRSA infection as a significant contributing factor. This condition impairs mucosal barrier function, increasing susceptibility to secondary infections, especially from MRSA, which thrives in the moist environment of the oral cavity. Secondary infections by MRSA exacerbate symptoms, delay healing, and complicate the clinical presentation of mucositis through the production of virulence factors like enterotoxins and exfoliative toxins. Purpose: Explaining the potential of lemongrass extract and its combination with nanoemulgel formulation as herbal intervention against oral mucositis. Method: A literature review of studies published within the past five years from sources like ResearchGate, ScienceDirect, PubMed, and Google Scholar. Result: Lemongrass extract comprises prominent amount of citral, emphasizing anti-inflammatory and antioxidant capabilities. Combination with nanoemulgel phase will provide stability and enhanced therapeutic capabilities of lemongrass extract into the targeted oral site. Conclusion: The formulation of lemongrass extract nanoemulgel equipped can be a futuristic solution as an over-the-counter drug for minimally invasive therapy of oral mucositis.

Life After Invasive Meningococcal Disease: Insights from Survivors and Their Caregivers.

Invasive meningococcal disease (IMD) has a low incidence but is a life-threatening illness that is preventable via vaccination. Even with treatment, up to 10-15% of cases are fatal, and many survivors may experience severe long-term sequelae. Building upon the acute-phase findings presented in the Part1 manuscript for this study, we describe the long-term physical, social, psychological, and economic burden of IMD on US survivors and their caregivers in this Part2 manuscript. This was a novel, non-interventional, mixed-methods study among US survivors and their caregivers using a bespoke survey and qualitative interviews. Ten adult survivors, one adolescent survivor, and three caregivers participated in this study. Survivors described extensive physical, neurological, and systemic sequelae, including difficulty walking (11/11), repeat secondary infections (9/11), and numbness (6/11), among others, which were echoed by caregivers. Survivors shared that IMD had negatively impacted their long-term quality of life, citing long-term impacts including emotional impacts (11/11), social impacts (10/11), memory (7/11) and attention (5/11) problems, and difficulty with functional (10/11), self-care (7/11), and physical (6/11) activities. Caregivers were also impacted, describing emotional trauma (3/3), sleep problems (2/3), and day-to-day challenges (2/3). Long-term financial challenges related to healthcare resource utilization were substantial, with specialized care and rehabilitation therapy expenses (11/11), insurance challenges (8/11), and high out-of-pocket costs (6/11) for survivors. Productivity losses were also commonly described by survivors (9/11); sequelae hindered ability to attend school (9/11) or work full time (8/11). Caregivers (2/3) described taking leave from their employment, affecting family income. The humanistic burden of IMD on survivors and their caregivers is substantial and persistent. A comprehensive approach, including preventative measures (e.g., vaccination) and long-term medical, psychological, and financial support for those affected, is needed to mitigate the burden of IMD. A video abstract is available with this article. Video abstract (MP4 1,17,430kb).

Scabies: a clinical update.

Scabies is the most common neglected tropical disease with cutaneous manifestations, disproportionately affecting socially disadvantaged populations living in overcrowded settings. Scabies infestation is characterised by a generalised intractable pruritus, and is often complicated by secondary bacterial infection, which can lead to a range of complications. Scabies is a clinical diagnosis and requires an adequate degree of suspicion. The use of dermoscopy may improve diagnostic accuracy. In Australia, the first-line treatment recommended for scabies is topical permethrin 5% cream, applied to the whole body and repeated in one week. Oral ivermectin is subsidised by the Pharmaceutical Benefits Scheme with streamlined authority for patients who have completed and failed treatment with topical therapy, have a contraindication to topical treatment or have crusted scabies. Early identification and prompt initiation of treatment is key to minimise the disease burden of scabies.

High SARS-CoV-2 secondary infection rates in households with children in Georgia, United States, Fall 2020—Winter 2021

BackgroundA wide range of household secondary infection rates has been reported, and the role of children in population transmission dynamics for SARS-CoV-2 remains ill-defined. We sought to better understand household infection early in the pandemic.MethodologyA cross-sectional study of 17 households in the Atlanta metropolitan area with at least one child and one case of COVID-19 in the prior 1–4 months were recruited between December 2020 and April 2021. Self-collected saliva samples were tested on a multiplexed platform to detect IgG antibodies that bind to SARS-CoV-2 antigens. Secondary infection rates (SIR) were calculated and compared.ResultsWe report results on 17 families, including 66 individuals. We found an average SIR of 0.58; children and adults were similarly infected (62% children vs. 75% adults) (p = 0.2). Two out of 17 households had a pediatric index per our definition. Number of pediatric infections per household (p = 0.18), isolation (p = 0.34), and mask wearing (p = 0.80) did not differ significantly among households with an SIR above the mean vs. those with SIR below the mean. Households with higher SIR also had a higher number of symptomatic cases (p < 0.001).DiscussionWe demonstrated high household SIRs at the early stages of the pandemic in late 2020 to early 2021 with similar impact on children and adults. The ease of collecting saliva and the detection of asymptomatic infections highlight the advantages of this strategy and potential for scale-up.

Paederus Dermatitis: Two Outbreaks of an Entomologic Disease in Austere Expeditionary Care.

Paederus dermatitis, also known as dermatitis linearis, is an acute cutaneous condition caused by contact with the potent vesicant toxin paederin, produced by endosymbiotic Pseudomonas-like bacteria within Paederus spp. beetles. Paederin is a protein synthesis inhibitor that halts cell division, leading to vesiculation and necrotic breakdown of the epidermis. The resultant damage facilitates secondary infection, especially in austere conditions. Between October 2022 and July 2023, several US special operations teams forward deployed to various countries in East Africa reported over 17 cases of painful, blistering skin eruptions consistent with Paederus dermatitis, 2 of which are summarized in this report. To confirm the best treatment approach, 1 team's medic reached back to a deployed infectious disease physician in the same Combatant Command as well as through the DoD ADVISOR line to a dermatologist in the United States. All cases were managed with irrigation, followed by a combination of topical steroid and antibacterial ointments, with resolution occurring after 3 to 7 days, whereas 38% of the cases in July 2023 developed secondary cellulitis by day 7, requiring oral antibiotic treatment. Strict preventative measures were implemented to limit exposure while carefully observing each case, as this was critical to optimize medical readiness of the team. Ultimately, we seek to highlight the identification of beetles specific to East Africa, seasonal prevalence, and the importance of preventative measures as they vary depending on specific beetle characteristics. Additionally, we reiterate classic presentation features that help avoid misdiagnosis for cases that occur outside of the typical epidemiologic criteria.

Acute appendicitis due to extrapulmonary tuberculosis

Introduction and ImportanceTuberculous appendicitis is very infrequent, estimated to occur in only 0.1% of all appendectomies. Appendicular tuberculosis can manifest as either a primary or secondary infection. Primary appendicular tuberculosis is even more uncommon and occurs in the absence of any detectable primary focus elsewhere in the body. Case presentationIn this report, we present a challenging case of primary tuberculous appendicitis that does not appear to have originated from the lungs. This case highlights the importance of considering tuberculosis in the differential diagnosis of appendicitis, especially in regions where tuberculosis is endemic or in patients with a history of tuberculosis exposure. Clinical DiscussionDiagnosing tuberculous appendicitis can be challenging due to its rarity and the non-specific nature of its symptoms, which often mimic those of more common conditions such as acute appendicitis and because of these non-specific symptoms, tuberculous appendicitis is mostly diagnosed only after surgical intervention. ConclusionThis case underscores the need for a high index of suspicion and thorough diagnostic evaluation in patients with atypical presentations of appendicitis specifically in patients with chronic complaints. Treatment typically involves a combination of surgical intervention to remove the affected appendix and a prolonged course of anti-tuberculous medication to eradicate the infection and prevent recurrence.

Budget impact analysis on the use of Sysmex PA-100 AST system as a point of care for uncomplicated urinary tract infections detection and treatment in Spanish females

Objective Efficient diagnostic methods, such as the Sysmex PA-100, provide rapid antimicrobial susceptibility test results directly from urine samples with high sensitivity and specificity, and improve treatment recommendations. Our study analyzes the economic impact of integrating the Sysmex PA-100 to assess its potential benefits and cost implications for uncomplicated urinary tract infection (uUTI) management in Spain. Methodology A budget impact model was developed using a decision tree framework to compare current UTI management practices with a new scenario incorporating the Sysmex PA-100. The clinical inputs were extracted from published literature. The model, representing adult females with uUTIs, assessed direct medical and indirect costs over three years, including diagnostic procedures, treatment costs, staff time costs, and productivity loss. The cost data was captured from two Spanish hospitals. Two scenario analyses were conducted in the model: scenario A included costs for antimicrobial resistance (AMR) emergence in patients receiving unnecessary empirical antibiotics, whereas scenario B assumed no AMR costs. Results In scenario A, 100% implementation of PA-100 within various Spanish healthcare settings over one year resulted in total cost savings of EUR 323,657,712 (EUR 119.10 per patient per year). The total overall cost savings attributable to the implementation of PA-100 over three years were EUR 970,973,137. In scenario B, the total annual savings were EUR 4,254,795 (EUR 1.57 per patient per year), and the 3-year savings were EUR 12,764,385. Conclusion The adoption of this point-of-care system results in overall cost savings, driven by reductions in direct and indirect costs related to UTI management. The model highlights potential savings over three years owing to appropriate rapid management (reduction in time to diagnosis and treatment, which leads to fewer complications and secondary infections) and reduced staff time and productivity loss costs. These findings support the potential benefits of adopting the Sysmex PA-100 to enhance UTI management and allocate healthcare resource utilization in Spain.

Streptococcus dysgalactiae subsp.-equisimilis as an emerging secondary pathogen in leprosy foot ulcers

Background and Objectives: Leprosy foot ulcers (LFU) tend to become chronic due to secondary bacterial infections, leading to subsequent disfigurement and disability. Treatment modality for infected plantar ulcers thus so far is majorly based on conventional approach of empirical antibacterial therapy. However, this approach tends to overlook unconventional pathogens which are likely to be present in the LFU. Materials and Methods: Twenty-six leprosy patients (17 males and 9 females) who had completed multidrug therapy (MDT) and those are suffering from foot ulcer were included. Using sterile cotton swabs, two wound swabs were collected, of these; one for bacterial culture and another for NGS (Next Generation Sequencing). Results: Out of 26 samples tested on conventional bacterial culture, Streptococcus spp. (50%) was predominant organism. On NGS, 09/26 (34.61%) showed Streptococcus-dysgalactiae-subsp.-equisimilis-GGS 12 as the most abundant single organism, along with some unknown and unclassified organisms; 03/26 (11.5%) were Arcanobacterium-haemolyticum-DSM-20595 alone and 02/26 (7.69%) were Streptococcus-pyogenes alone.Acombination of Arcanobacterium-haemolyticum-DSM-20595 and Streptococcus-dysgalactiae-subsp.-equisimilis-GGS 124 was found in nine (34.61%) specimens. Conclusion: Polymicrobial infection with conventional and unconventional pathogenic bacteria is another notable finding suggesting appropriate interventions. The study findings also reiterate the need for understanding the polymicrobial infec- tions and their role in the clinical progression of the LFU.

A predictive model for secondary central nervous system infection after craniotomy based on machine learning

To analyze the risk factors of secondary Central nervous system infections (CNSIs) after craniotomy, and to establish an individualized predictive model for CNSIs risk. The independent risk factors were screened by univariate and multivariate logistic regression analysis. Logistic regression, naive bayes, random forest, light GBM and adaboost algorithms were used to establish predictive models for secondary CNSIs after craniotomy. The predictive model based on the Adaboost algorithm demonstrated superior prediction performance compared to the other four models. Under 5-fold cross validation, the accuracy was 0.80, the precision was 0.69, the recall was 0.85, the F1-score was 0.76, the area under the ROC curve was 0.897,and the average precision was 0.880. The top 5 variables of importance in Adaboost model were operation time, indwelling time of lumbar drainage tube, indwelling lumbar drainage tube during operation, indwelling epidural drainage tube during operation, and GCS score. In addition, Adaboost model with the best prediction performance was used for clinical verification, and the prediction results were compared with the actual occurrence of CNSIs after surgery. The results showed that the accuracy of Adaboost model in predicting CNSIs was 60%, the accuracy of Adaboost model in predicting non-CNSIS was 92%, and the overall prediction accuracy was 76%.

Is the identification of caseating granuloma in the intestine indicative of tuberculosis? a rare case of Crohn’s disease

BackgroundCrohn’s disease (CD) is a chronic intestinal inflammatory disorder, the etiology of which remains unknown, and is characterized by symptoms such as chronic abdominal pain, diarrhea, obstruction, and perianal lesions. Histopathology is widely regarded as the preferred method for diagnosing CD, although the histological diagnosis may lack specificity. The identification of granulomas is commonly believed to be the most reliable diagnostic indicator for CD, surpassing all other clinical features in significance. Nevertheless, research indicates that the detection rate of granulomas in CD exhibits considerable variability. Furthermore, granulomas can manifest in various specific infections including tuberculosis and Yersinia, as well as in a range of diseases characterized by macrophage reactions such as sarcoidosis and drug-induced enteritis. Granulomas associated with CD typically do not exhibit necrosis. However, the formation of caseous granulomas may occur as a result of secondary infections related to anti-CD drug treatment or perforation of the intestinal wall.Case presentationIn this study, we present a case of a 28-year-old female patient diagnosed with CD exhibiting histologic granulomas, including both caseating and non-caseating forms, which demonstrated a positive response to medical treatment.ConclusionIn clinical practice, various forms of granulomas may indicate diverse underlying diseases, yet lack specificity. It is suggested that the presence of caseous granulomas should not be considered as a definitive exclusion criterion for the diagnosis when clinical, endoscopic, imaging and other histopathological features are consistent with CD. This study is the first report of caseous granulomas in CD without concomitant tuberculosis infection.

Lymphocystis viral disease impacts the diversity and functional profiles of the skin microbiome in gilthead seabream

Lymphocystis viral disease (LVD) is a highly transmissible disease known to affect multiple fishes worldwide. Although this disease is usually benign, mortalities can occur in cases where infection is severe or secondary infection with bacterial pathogens and parasites occur. However, little is known about the bacterial dynamics of fish with LVD or what bacterial pathogens may be responsible for secondary infections. Here we assessed the effects of LVD on the skin microbiome of gilthead seabream by comparing 30 symptomatic, asymptomatic and recovered (three weeks after infection) fish using 16S rRNA high-throughput sequencing. Our results show that LVD is associated with significant changes in microbiome structure and function. Importantly, fish pathogens like Tenacibaculum maritimum and some Vibrio species increased their abundance. Moreover, microbial metabolic activities of the commensal microbiota that may confer some protection to fish were suppressed in diseased fish. After reducing fish cage density to treat symptoms and three weeks of recovery, the abundance of pathogens was significantly reduced and microbiome functionality was recovered, although community structure remained significantly different. These results show that LVD can severely disrupt the bacterial communities of the skin of the gilthead seabream, leading to an increase in bacterial pathogens responsible for relevant diseases in gilthead seabream farms.

Collaboration in Contradiction: Self-Adaptive Synergistic ROS Generation and Scavenge Balancing Strategies Used for the Infected Wounds Treatment.

The rational utilization of ROS is key to treating infected wounds. Exogenous ROS can destroy bacterial structures, quickly kill bacteria, and inhibit secondary infections. However, excess ROS at the wound will cause a secondary inflammatory response. Acute infections exacerbate this damage by increasing endogenous ROS, complicating the maintenance of ROS homeostasis. Therefore, regulating the balance of ROS production and scavenging in wounds has emerged as a promising strategy for wound treatment. Conventional ROS balancing platforms are mostly based on the " all for one" strategy of functional superposition and lack self-adaptability and integration. To subvert this conventional strategy, this study proposes a "one for all" self-adaptive integrated photodynamic therapy (PDT)-antioxidant model to actively regulate the ROS balance. A gelatin-hyaluronic acid hydrogel embedded with Se-modified cerium dioxide nanoparticles (Gel-HA-Se@CeO2 NPs) is designed for treating infected wounds. The Se@CeO2 NPs serve both as nanoenzymes and photosensitizers(PS). As nanoenzymes, they exhibit catalase and superoxide dismutase activities, converting hydrogen peroxide and superoxide anions into oxygen. As a PS, it synergizes with oxygen under NIR irradiation to rapidly produce singlet oxygen. Additionally, Se modification enhances the PDT effects by disrupting bacterial antioxidant systems. In vitro and in vivo experiments revealed that the ROS balance platform polarizes M1-type macrophages to M2-type macrophages, altering the wound microenvironment from proinflammatory to prohealing. RNA sequencing revealed that this hydrogel accelerated the reconstruction of the vascular network of the wound by activating the PI3K/AKT pathway and increasing VEGF secretion.This strategy is believed to be beneficial not only for infected wounds but also for treating other conditions that involve the regulation of reactive oxygen species, such as tumors and bacterial infections.

MANEJO DO HERPES-VÍRUS FELINO: MEDICINA DE ABRIGO

Infection by feline herpesvirus type 1 (FHV-1) is one of the main respiratory diseases in cats, often associated with other pathogens. The virus, which has double-stranded DNA and is sensitive to disinfectants and adverse conditions, proliferates in high-density environments, such as shelters, where stress compromises the immunity of the felines. Transmission mainly occurs through contact with secretions from infected cats, leading to inflammation and cellular necrosis. Clinical symptoms vary depending on the viral load, route of exposure, and the cat's immune status. After an incubation period of 2 to 6 days, symptoms such as depression, sneezing, fever, and loss of appetite appear, followed by nasal and ocular discharge, which may progress to secondary bacterial infection. In severe cases, especially in young or debilitated cats, viral pneumonia may occur. Diagnosis of the feline respiratory complex (FRC) involves clinical and laboratory tests, such as PCR and X-rays, and screening of new cats is fundamental for controlling the infection. Clinical management focuses on stress reduction, hydration, nebulization, and nutritional support. Treatment includes antivirals to reduce viral replication, as well as antibiotics for secondary infections. Vaccination with live attenuated virus, starting at nine weeks of age, is crucial, although it does not provide full protection. Measures such as quarantine, isolation, and disinfection are essential to control the spread of FHV-1. Collaboration between shelters, veterinarians, and animal protection organizations is vital for implementing effective measures and ensuring the welfare of cats, recognizing the importance of early detection and proper management.

Enzyme-mediated multifunctional self-healing lysozyme hydrogel for synergistic treatment of chronic diabetic wounds

Self-healing hydrogels have attracted significant attention in chronic diabetic wound healing due to their potential to minimize the risk of secondary infections caused by joint movement or dressing rupture. Herein, a multifunctional self-healing hydrogel mediated utilizing an enzyme-triggered cascade reaction based on dynamic imine bonds was designed. The hydrogel employs three enzymes: lysozyme (LYZ), glucose oxidase (GOx), and catalase (CAT), as building blocks. GOx catalyzes the conversion of glucose and 1-thio-β-d-glucose (β-GlcSH) into hydrogen peroxide (H2O2), gluconic acid (GA), and hydrogen sulfide (H2S). Subsequently, CAT eliminates H2O2, protecting the imine bonds from oxidative damage. The acidic environment created by GA decreases the pH and regulates the crosslinking density of imine bonds, enhancing the self-healing capability and porosity of the hydrogel. This feature enables the sustained release of the drug rosuvastatin calcium (RCa) to promote endothelial cell migration and vascular regeneration. Combined with the antioxidative and anti-inflammatory effects of released H2S gas and the antibacterial properties of lysozyme, this hydrogel exhibits promising therapeutic efficacy for the synergistic treatment of chronic diabetic wounds.

Secondary Dengue Infection Elicits Earlier Elevations in IL-6 and IL-10 Levels.

This study investigates the kinetics of interleukine-6 (IL-6) and interleukine-10 (IL-10) levels in dengue virus (DENV) infections during the febrile stage. Viremic patients were categorized into two phases based on anti-DENV IgM presence. Among 259 patients, 71% were in Phase I and 29% in Phase II. Secondary infections, accounting for 38.2% of cases, exhibited earlier elevations of IL-6 and IL-10 than primary infections, suggesting that pre-existing immune memory primes faster cytokine release. Thrombocytopenia and elevated aspartate transaminase (AST) levels were associated with Phase II, secondary infections, and hospitalization. Elevated IL-6 and IL-10 levels correlated with low platelet counts, linking them to clinical manifestations. The key finding is that IL-6 and IL-10 levels rise earlier in secondary infections compared to primary infections, whereas elevated cytokine levels typically occur later in the febrile phase. This study highlights the importance of cytokine dynamics in DENV infections, particularly during the early stages. The observation of cytokine concentration changes, especially in viremic samples, provides insights into the progression of dengue disease. Further research with broader cytokine panels is warranted to validate and expand these findings.

Qualitative and optimal control analysis of a two-serotype dengue model with saturated incidence in co-infection

ABSTRACT The arboviral disease dengue is a life-threatening global public health problem due to its high prevalence rate, morbidity and mortality. Recent studies suggest that morbidity during secondary dengue infection is higher than during primary infection. To deepen our understanding, we have explored a two-serotype co-infected dengue model with bilinear incidence for primary infection and saturated incidence for secondary infection. In the model, we have also included four control measures: mosquito bite prevention control, treatment control, vaccine control and mosquito killing control. The existence and local stability of the disease free, serotype II free, serotype I free and endemic equilibrium points have been studied. The effect of inhibitory or awareness factors on disease dynamics has also been exhaustively examined. By using sensitivity analysis we have identified and quantified the most influential parameters to prevent as well as to control the dengue outbreak. To optimize our strategies, we have characterized the time-dependent optimal control to reduce dengue prevalence and the total implementation cost of the aforementioned controls. Efficiency analysis has been done to identify the best effective combination of the applied controls to reduce dengue infection. Mosquito bites with treatment control is the most effective combined strategy to control dengue infection.

Scabies in 604 Patients: A Glimpse into the Disease Burden and Its Associated Mortality in Hong Kong.

Scabies is a worldwide parasitic dermatosis with a significant health burden on the young and the elderly. Statistics about the prevalence of scabies in Hong Kong are not available. This is a retrospective study of patients from a regional hospital cluster in Hong Kong with microscopy-documented Sarcoptes scabiei infestations from January 2018 to December 2022. The condition was categorised into classical scabies and crusted scabies upon clinical presentation. Demographic data, comorbid diseases, mobility and residential status, seasonal variability, secondary bacterial infection, treatment and outcomes were described. These were compared between classic and crusted scabies. In total, 604 patients were identified, representing 51.65 per 100,000 discharged patients during the study period. The median age was 84 years and 54.5% were male. The majority (506 or 83.8%) came from residential care homes for the elderly. The mean time from admission to diagnosis was 8.8 days for community-acquired infestation. There were 564 and 40 cases of classic and crusted scabies, respectively. The two groups of patients were comparable in terms of residence in elderly homes, co-existing chronic illnesses, mobility, and time from admission to diagnosis. Forty-five (7.5%) patients had positive blood cultures temporally associated with scabies. Patients with crusted scabies were at higher risk for bacteraemia (7/40 versus 38/564, p = 0.022). Permethrin and benzyl benzoate were the most popular treatment regimens, with treatment failure observed in 59/397 (14.4%) and 18/173 (10.4%), respectively. There were 172 (28.5%) mortalities within 30 days of scabies diagnosis. Thus, the burden of scabies infestation is significant in Hong Kong. Hospitalised patients diagnosed with scabies are mainly senior citizens living in residential care homes for the elderly, suggesting reservoirs of S. scabiei in the community. Of concern, bacteraemic illnesses are common and significant mortality is temporarily associated with infestation. With a rising elderly population, there is a pressing need to understand and control scabies in Hong Kong. Our study did not find that common medical illness, besides immunosuppressive therapy, predisposed patients to crusted scabies. The crusted form of scabies was associated with a higher risk of bacteraemia. The current study provides a better perspective of the disease load of scabies in Hong Kong.

Secondary Bacterial Infections in Critically Ill COVID-19 Patients Admitted in the Intensive Care Unit of a Tertiary Hospital in Romania.

Background: The outbreak of the COVID-19 pandemic caught healthcare systems in many countries unprepared. Shortages of personnel, medicines, disinfectants, and intensive care unit (ICU) capacities, combined with inadvertent use of antibiotics and emergence of drug-resistant secondary infections, led to a surge in COVID-19-related mortality. Objective: We aimed to evaluate the prevalence of secondary bacterial infections and the associated antibiotic resistance in a temporary established ICU dedicated to COVID-19 patients. We also assessed the utility of clinical and routine laboratory data as predictors of secondary infections and mortality in these patients. Methods: We examined the medical records of 243 patients admitted to the COVID-19 Medical Support Unit of Târgu Mures, Romania, between 1 August 2020 and 31 January 2021. Results: Among the 243 patients admitted to the COVID-19 Medical Support Unit of Târgu Mures between 1 August 2020 and 31 January 2021, 59 (24.3%) presented secondary infections. Acinetobacter baumannii and Klebsiella pneumoniae were the most frequent isolates (31.1% and 18.9%, respectively), most of them multidrug resistant. Chronic obstructive pulmonary disease had a higher prevalence in patients who developed secondary infections (p = 0.012). Secondary infections were associated with longer stay in the ICU and with higher mortality (p = 0.006 and p = 0.038, respectively). Conclusions: Early identification of secondary infections and proper use of antibiotics are necessary to limit the spread of multidrug-resistant microorganisms in COVID-19 patients admitted in the ICU.

The Incidence and Characteristics of Oral Candidiasis in Patients Hospitalized for SARS-CoV-2 Infection During the Circulation of Alpha, Beta, and Delta Variants

Background: Oral candidiasis has been documented in patients with SARS-CoV-2 infection, with varying prevalence rates across geographic regions and patient demographics. This study aimed to ascertain the incidence, characteristics, and risk factors associated with the development of oral candidiasis in patients hospitalized for SARS-CoV-2 infection in a tertiary infectious diseases hospital in Romania. Methods: A retrospective analysis was conducted on adult patients hospitalized between March 2020 and December 2022 with moderate or severe forms of SARS-CoV-2 infection, for whom a culture of lingual scrapings for Candida spp. was performed. Results: A total of 294 patients were deemed eligible for inclusion in the analysis, with an incidence rate of oral candidiasis of 17.0%. The incidence of oral candidiasis was 4.2 times higher in patients with severe forms of SARS-CoV-2 infection compared to those with moderate forms. Patients with a diagnosis of COVID-19 and oral candidiasis were more likely to receive antibiotics (98.0% vs. 86.1%, p = 0.017) and corticosteroids (100% vs. 83.6%, p = 0.003) than those without oral candidiasis. These findings were associated with a 19% higher relative risk of developing oral candidiasis for patients who received corticosteroid therapy compared to those who did not, and a 13% higher relative risk for those who were administered antibiotics compared to those who were not. The presence of respiratory insufficiency increased the odds of oral candidiasis association 4.7-fold (88.0% vs. 61.1%, p < 0.001). Conclusions: Although the data have been analyzed retrospectively, we have shown that individuals with severe forms of COVID-19 exhibited an elevated risk of developing oral candidiasis. The administration of antibiotics and corticosteroids was identified as a positive predictor for the development of oral candidiasis. The data presented here suggest that a key aspect of the therapeutic management of patients with SARS-CoV-2 infection should include the implementation of preventive measures to minimize the risk of secondary fungal infections.