Superinfection In Patients Research Articles

Impact and Occurrence of Herpesvirus and Aspergillosis Superinfection in Patients with Severe COVID-19 Pneumonia

Background: Pulmonary superinfections with Herpesviridae and Aspergillus spp. are common in severe coronavirus disease 2019 (COVID-19) pneumonia but their epidemiology and impact remain poorly understood. Methods: We conducted a retrospective observational study of 61 mechanically ventilated COVID-19 patients at Deventer Hospital’s ICU (2020–2021) who underwent bronchoalveolar lavage (BL) due to clinical deterioration. We analyzed blood and respiratory samples, treatment, and clinical outcomes. Results: Among 61 mechanically ventilated COVID-19 patients who underwent BL, 34 (55.7%) had superinfections, with 18 having COVID-19-associated pulmonary aspergillosis (CAPA), 7 having herpes simplex virus (HSV) infection, and 9 having both. Patients with HSV had later diagnoses (median 14 vs. 8 days, p = 0.014), longer mechanical ventilation (median 47 vs. 18.5 days, p = 0.015), and longer ICU stays (median 74 vs. 24 days, p = 0.021) compared to CAPA patients. At baseline, laboratory parameters and treatment (dexamethasone or tocilizumab) showed no significant association with superinfections. Mortality did not differ significantly among groups. Conclusion: In mechanically ventilated COVID-19 patients undergoing bronchoalveolar lavage, HSV reactivation occurred later in the course of illness and was associated with longer mechanical ventilation and ICU stays compared to CAPA. Baseline parameters did not predict superinfections.

The Association of Super Infection with SARS-COV2 Virus Infection

The literature on the association of Co-infection and Super infection in patients with SARS-COV2 infection is reviewed in this paper. Co-infection is defined by the Centers for Disease Control and Prevention in the United States as an infection that occurs in the human body when the person is already afflicted with multiple diseases. Super infection is another phrase used by the Centers for Sickness Control and Prevention to describe a disease caused by the same virus but with a different strain each time. Over a lengthy period of time, it has been seen that a patient's viral respiratory infection develops to bacterial infection, which can be fatal. However, the association between the two remains a mystery for the researchers. In the case of COVID-19 viruses, comparable results have been obtained. The extensive spectrum of Co-infections and Super infections in Corona patients has been documented in a number of articles.

Effect of early dexamethasone on outcomes of COVID-19: A quasi-experimental study using propensity score matching

BackgroundThe RECOVERY trial demonstrated that the use of dexamethasone is associated with a 36% lower 28-day mortality in hospitalized patients with COVID-19 on invasive mechanical ventilation. Nevertheless, the optimal timing to start dexamethasone remains uncertain. MethodsWe conducted a quasi-experimental study at National Taiwan University Hospital (Taipei, Taiwan) using propensity score matching to simulate a randomized controlled trial to receive or not to receive early dexamethasone (6 mg/day) during the first 7 days following the onset of symptoms. Treatment was standard protocol-based, except for the timing to start dexamethasone, which was left to physicians’ decision. The primary outcome is 28-day mortality. Secondary outcomes include secondary infection within 60 days and fulfilling the criteria of de-isolation within 20 days. ResultsA total of 377 patients with COVID-19 were enrolled. Early dexamethasone did not decrease 28-day mortality in all patients (adjusted odds ratio [aOR], 1.03; 95% confidence interval [CI], 0.97–1.10) or in patients who required O2 for severe/critical disease at admission (aOR, 1.05; 95%CI, 0.94–1.18); but is associated with a 24% increase in superinfection in all patients (aOR, 1.24; 95% CI, 1.12–1.37) and a 23% increase in superinfection in patients of O2 for several/critical disease at admission (aOR, 1.23; 95% CI, 1.02–1.47). Moreover, early dexamethasone is associated with a 42% increase in likelihood of delayed clearance of SARS-CoV-2 virus (adjusted hazard ratio, 1.42; 95% CI, 1.01–1.98). ConclusionAn early start of dexamethasone (within 7 days after the onset of symptoms) could be harmful to hospitalized patients with COVID-19.

The Relationship of Comorbid Diseases and Empirical Antibiotic Usage with Superinfection in COVID-19 Patients.

To identify the microorganisms responsible for superinfections in patients admitted with COVID-19 and evaluate the impact of empirical antibiotic regimen and comorbid disease on superinfections comparing COVID-19 patients with and without secondary infection. A descriptive study. Place and Duration of the Study: Department of Microbiology, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkiye, from March to July 2020. This study was conducted with patients diagnosed with COVID-19 disease based on radiological or quantitative RT-PCR test results. Culture results, demographic characteristics, clinical variables, and therapeutic regimen were collected from medical records. Superinfection developed in 48 (26.96%) of 178 cultures (24 of 101 patients) followed up in the COVID-19 clinics. Infections were determined as 25 (52.08%) bloodstream, 11 (22.9%) urinary tract, 10 (20.8%) respiratory tract and 2 (4.16%) soft tissue infections, respectively. Secondary infectious agents were E.coli in 11 (22.9%), A.baumannii in 8 (16.7%), S.homminis in 7 (14.6%), S.epidermidis in 6 (12.5%), K.pneumoniae in 4 (8.3%), C.albicans in 2 (4.1%), and other bacterial and fungal agents in 10 (20.8%). The median range from admission to the hospital to detecting microorganism growth was the longest with piperacillin/tazobactam with moxifloxacin and azithromycin. Secondary microorganism detection was delayed, mostly due to the empirical use of moxifloxacin, azithromycin, and piperacillin/tazobactam. Demographic characteristics, comorbidity and antibiotic use of patients were not directly related to secondary infections. In addition, the empirical use of azithromycin and moxifloxacin with piperacillin/tazobactam appeared to delay the development of superinfection. Superinfection, COVID-19, Comorbidity.

Bacterial Co- or Superinfection in Patients Treated in Intensive Care Unit with COVID-19- and Influenza-Associated Pneumonia.

Viral pneumonia is frequently complicated by bacterial co- or superinfection (c/s) with adverse effects on patients' outcomes. However, the incidence of c/s and its impact on the outcomes of patients might be dependent on the type of viral pneumonia. We performed a retrospective observational study in patients with confirmed COVID-19 pneumonia (CP) or influenza pneumonia (IP) from 01/2009 to 04/2022, investigating the incidence of c/s using a competing risk model and its impact on mortality in these patients in a tertiary referral center using multivariate logistic regressions. Co-infection was defined as pulmonary pathogenic bacteria confirmed in tracheal aspirate or bronchoalveolar lavage within 48 h after hospitalization. Superinfection was defined as pulmonary pathogenic bacteria detected in tracheal aspirate or bronchoalveolar lavage 48 h after hospitalization. We examined 114 patients with CP and 76 patients with IP. Pulmonary bacterial co-infection was detected in 15 (13.2%), and superinfection was detected in 50 (43.9%) of CP patients. A total of 5 (6.6%) co-infections (p = 0.2269) and 28 (36.8%) superinfections (p = 0.3687) were detected in IP patients. The overall incidence of c/s did not differ between CP and IP patients, and c/s was not an independent predictor for mortality in a study cohort with a high disease severity. We found a significantly higher probability of superinfection for patients with CP compared to patients with IP (p = 0.0017).

The Dark Side of Nosocomial Infections in Critically Ill COVID-19 Patients.

Coronavirus disease 2019 (COVID-19) is a potentially serious acute respiratory infection caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Since the World Health Organization (WHO) declared COVID-19 a global pandemic, the virus has spread to more than 200 countries with more than 500 million cases and more than 6 million deaths reported globally. It has long been known that viral respiratory tract infections predispose patients to bacterial infections and that these co-infections often have an unfavourable clinical outcome. Moreover, nosocomial infections, also known as healthcare-associated infections (HAIs), are those infections that are absent at the time of admission and acquired after hospitalization. However, the impact of coinfections or secondary infections on the progression of COVID-19 disease and its lethal outcome is still debated. The aim of this review was to assess the literature on the incidence of bacterial co-infections and superinfections in patients with COVID-19. The review also highlights the importance of the rational use of antibiotics in patients with COVID-19 and the need to implement antimicrobial stewardship principles to prevent the transmission of drug-resistant organisms in healthcare settings. Finally, alternative antimicrobial agents to counter the emergence of multidrug-resistant bacteria causing healthcare-associated infections in COVID-19 patients will also be discussed.

Prevalence of and prognostic factors for Candida superinfection in oral lichen planus and lichenoid reactions: A retrospective cohort study.

Oral candidiasis occasionally occurs in patients with oral lichen planus (OLP) or lichenoid reaction (OLR). However, not all patients undergoing corticosteroid therapy develop Candida superinfection. Thus, the identification of prognostic risk factors may help to identify patients at risk of Candida superinfection. A retrospective cohort study was conducted to review patients with OLP/OLR who received steroid therapy at a single dental hospital between January 2016 and December 2021. The prevalence of Candida superinfection and prognostic factors were assessed. Eighty-two eligible patients with OLP/OLR were retrospectively reviewed. The overall prevalence of Candida superinfection during the study period was 35.37%; the median time-to-event between initiation of corticosteroid therapy and diagnosis of superinfection was 60 days (interquartile range; 34-296). The ulcerative type of OLP/OLR, number of topical steroid applications, poor oral hygiene, and oral dryness were significantly associated with superinfection (p < 0.05; Fisher's Exact test) and were identified as prognostic factors in univariable risk ratio regression. Multivariable risk ratio regression revealed the ulcerative type of OLP/OLR and number of topical steroid applications were significant prognostic factors for Candida superinfection in patients with OLP/OLR. Candida superinfection occurs in approximately one-third of patients with OLP/OLR undergoing corticosteroid therapy. Patients with OLP/OLR should be closely monitored in the first 2months (60 days; median time to infection) after steroid prescription. The ulcerative type of OLP/OLR and a higher number of topical steroid applications per day may represent prognostic factors to identify patients at risk of Candida superinfection.

Risk factors and outcomes of fungal superinfections in patients with severe COVID-19: an observational study from Pisa academic hospital.

Superinfections acquired during the hospital course represent common complications in COVID-19 patients. Several studies reported an increasing incidence of COVID-19 associated pulmonary aspergillosis (CAPA) and candidaemia. The aim of this study is to describe fungal superinfections in a large cohort of hospitalized patients with COVID-19 and identify factors independently associated with the risk of fungal superinfections. Observational study including patients with COVID-19 admitted to the tertiary-care, University Hospital of Pisa, Italy from April 2020 to May 2021. Patients with pneumonia and laboratory confirmed SARS-CoV-2 infection with a RT-PCR test on a nasopharyngeal swab, were eligible for the study. Patients who died within 24 hours from admission and those with missing data were excluded. Data about fungal superinfections were collected. To identify factors independently associated with the development of fungal superinfections, a multivariate regression analysis was performed. Among 983 patients with COVID-19, 52 (5.3%) fungal superinfections were detected. Fungal superinfections included: 24/52 (46%) CAPA, 27/52 (51.9%) episodes of candidaemia and 1 case of pulmonary pneumocystosis in a haematological patient. All patients with CAPA were cared for in intensive care unit (ICU). The majority of patients received liposomal amphotericin B as antifungal treatment (83.3%). In-hospital mortality was 41.7%. Among 27 episodes of candidaemia, 16 (59.3%) occurred in ICU while 11 (40.7%) in medical wards. In-hospital mortality was 14.8%. Overall, patients with fungal superinfections had a median age of 73 (IQRs 59-77) years and a median length of ICU stay of 40 (17-50) days. In-hospital mortality among all patients with superinfections was 28.8%. On multivariable analysis, ICU stay (OR 17.63, 95% CI 8.3-37.41, p<0.001), high-dose steroids (OR 13.48, 95% CI 6.68-27.26, p<0.001), and diabetes mellitus (OR 2.14, 95% CI 1.09-4.17, p=0.026) were factors independently associated with the risk of developing a fungal superinfection. Fungal superinfections may complicate the hospital course of COVID-19 patients, especially of those admitted to ICU. Surveillance with detection of galactomannan on bronchoalveolar lavage in patients with clinical deterioration should be performed. A rational use of steroids is essential to avoid the risk of developing a fungal superinfection.

The controversial bond between COVID-19 and bacterial superinfections

The issue of bacterial coinfection and superinfections in patients managed for the novel coronavirus disease (COVID-19) has been a matter of concern and debate since the beginning of the COVID-19 pandemic [1]. Incidence, type and etiology of co-infections and super-infections in patients hospitalized for COVID-19 have been reported in several studies, and most of published data have been summarized in two large systematic reviews [2, 3]. The prevalence of superinfections was highest in patients admitted to intensive care unit (ICU) reaching up to 41% [2, 3].

The Role of Bacterial and Fungal Superinfection in Critical COVID-19

The range of reported rates of bacterial and fungal superinfections in patients with a severe course of COVID-19 is wide, suggesting a lack of standardised reporting. The rates of bacterial and fungal superinfection were assessed using predefined criteria to differentiate between infection and contamination. Overall, 117 patients admitted to the Intensive Care Unit due to severe COVID-19 were included. Overall, 55% of patients developed a superinfection and 13.6% developed a fungal superinfection (5.9% candidemia and 7.7% CAPA). The rate of ventilator-associated pneumonia was 65.2%. If superinfection was detected, the length of hospital stay was significantly longer and the mortality was especially increased if candidemia was detected. An increased risk of superinfection was observed in patients with pre-existing diabetes mellitus or chronic heart failure. The presence of immunomodulating therapy did not seem to have an impact on the frequency of superinfections. Increased awareness of high superinfection rates, fungal infections in particular, in patients suffering from severe COVID-19 is necessary.

The Duration of Mechanical Ventilation is the Main Cause of Bacterial/Fungal Superinfection in Critically Ill Patients with COVID-19 at Altitude

Background. COVID-19 patients in intensive care units suffer from bacterial/fungal superinfections. However, the incidence and cause of such superinfections in high-altitude hospitals remain poorly investigated. Objectives. The aim of this study was to evaluate the frequency of bacterial/fungal superinfection in patients with COVID-19 hospitalized in the intensive care unit (ICU) of the Hospital Universitario San José de Bogotá, Colombia, located at an altitude of 2,651 meters above sea level (high altitude). The impact of corticosteroids on the development of infection was also evaluated. Methods. The cohort included 279 patients, of which 188 (67.4%) were male, 116 (42.3%) were treated with dexamethasone, and 48 (17.2%) were diagnosed with superinfection. A retrospective descriptive cohort study was performed to evaluate the association between bacterial/fungal superinfection frequency, corticosteroid treatment, mechanical ventilation, and mortality rate. Results. Our results showed that bacteremia was the most frequent diagnosis (n=20; 41.6%) of patients with superinfection, followed by pulmonary superinfection (n=17; 35.4%). The most frequently identified causative agents of superinfection were K. pneumoniae (n=23; 26.1%), C. albicans (n=10; 11.4%) and P. aeruginosa (n=8; 9.1%). Moreover, our results showed no association between corticosteroid treatment (or the use of empiric antibiotic treatment) and mortality. However, we found a significant association between bacterial/fungal superinfection and the number of days on mechanical ventilation. However, bacterial/fungal superinfection showed no impact on the mortality rate. Conclusions. We conclude that bacterial/fungal superinfection in ICU highland patients with SARS-CoV-2 treated at Hospital Universitario San José in Bogotá, Colombia, increases mainly in proportion to the time required for mechanical ventilation.

The hepatitis delta virus and chronic hepatitis D.

The hepatitis delta virus and chronic hepatitis D.

S2176 Co-Occurrence of Two Rare Diseases: CMV Colitis in a Patient With Clozapine-Included Ischemic Colitis

Introduction: CMV (Cytomegalovirus) colitis is a well-recognized disease in immunocompromised patients, however, there are case reports and series describing the disease in immunocompetent hosts. Given its rarity, its characteristics are yet to be well defined. We present a case of CMV colitis in an immunocompetent patient who likely had concomitant ischemic colitis from clozapine. Case Description/Methods: A 68-year-old female with PMH of Schizophrenia on Clozapine, chronic constipation presented to the emergency department with 1 day of bloody diarrhea and NBNB vomiting. On arrival, she was noted to be tachycardic and tachypneic with a physical exam revealing diffuse abdominal tenderness and hypoactive bowel sounds. Initial labs were notable with leukocytosis of 19 K/ul with bands. Serum lactate, renal function, and liver function tests were normal. Clozapine level was elevated at 1143 ng/dl. Computed Tomography Angiography of the abdomen showed severe colitis of the entire descending colon. Working diagnosis at that point was Infectious colitis, inflammatory colitic, and ischemic colitis. She completed 5 days of antibiotics despite negative Gastrointestinal panel PCR with some relief of symptoms. Colonoscopy planned on day 6 was postponed due to acute delirium, which required the initiation of a new anti-psychotic. Colonoscopy on day 28 showed a 10 cm area of non-bleeding ulcerated mucosa at the splenic flexure. Histopathology reports which became available 1 week later showed colonic mucosa with ulceration, granulation tissue, acute inflammation, and rare CMV-positive cells. HIV test which was then obtained was negative, and CMV DNA PCR was 52 IU/ml. She was subsequently started on Valgancyclovir and discharged without any acute events with a plan for a follow-up colonoscopic examination. Discussion: CMV is a common virus with positive serology in upwards of 2-thirds of the general population. However, it rarely manifests in immunocompetent hosts. CMV colitis in immunocompetent hosts has been described mostly as a superinfection in patients with primary gastrointestinal disorders. Destruction of colonic mucosa from the ischemic colitis caused by clozapine likely allowed for CMV to establish the infection in our patient. It is thought that the anticholinergic manifestation in the gastrointestinal tracts which causes constipation and luminal dilation leads to decreased capillary circulation. Treatment usually involves discontinuation of the drug and supportive care.

Update on Staphylococcus aureus bacteraemia.

To review recently published evidence relevant to Staphylococcus aureus bacteremia (SAB). Staphylococcus aureus is the most common pathogen causing co-infections and superinfections in patients with COVID-19. Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia ratios have sharply risen during the pandemic. SAB mortality is 18% at 1 month and 27% at 3 months but has gradually decreased over the last 30 years. Recurrences and reinfections are common (9%). Standardised items to define complicated SAB, and a new cut-off defining persisting bacteremia after 2 days with positive blood cultures have been proposed. Multiple antibiotic combinations have been trialled including vancomycin or daptomycin with β-lactams, fosfomycin, or clindamycin, without significant results. In the recently published guidelines, vancomycin remains the first line of treatment for MRSA bacteremia. For the management of methicillin-susceptible Staphylococcus aureus , cefazolin less frequently causes acute kidney injury than flucloxacillin, and when susceptibility is demonstrated, de-escalation to penicillin G is suggested. Our review confirms that Staphylococcus aureus represents a special aetiology among all causes of bloodstream infections. Pending results of platform and larger trials, its distinct epidemiology and determinants mandate careful integration of clinical variables and best available evidence to optimize patient outcomes.

Serum Cytomegalovirus Polymerase Chain Reaction Test Is a Valuable Negative Predictor of Infection in Acute Severe Ulcerative Colitis.

Diagnosis of cytomegalovirus (CMV) colitis in the setting of severe ulcerative colitis (UC) remains a clinical challenge. This study aimed to determine the utility of serum CMV polymerase chain reaction (PCR) as a non-invasive test for the diagnosis of CMV superinfection in patients hospitalized with UC. This retrospective study included consecutive admitted patients with UC who had serum testing for CMV completed as part of standard hospital procedure and CMV colitis diagnosed by expert pathologists. Two hundred and six patients with UC were included; 13 patients (6%) had histologically confirmed CMV colitis. Eleven of 13 patients with CMV colitis (84%) and 3 of 193 (1.5%) patients without CMV colitis had a positive serum PCR test (p < 0.0001). ROC analysis showed that a CMV PCR level of 259IU/mL had a sensitivity and specificity of 77% and 99%, respectively, for diagnosis of CMV colitis with an AUC of 0.9 (p < 0.0001). Serum CMV PCR level significantly correlated to the number of inclusion bodies on biopsy specimens with data available (n = 8) (r = 0.8, p = 0.02). CMV positivity did not predict the need for salvage therapy, admission or 1-year colectomy rates. Serum CMV PCR has an excellent negative predictive value and demonstrates a strong correlation with CMV positivity on histology. This work supports a rationale for serum CMV PCR testing on admission to assess the risk of CMV colitis in patients with severe UC.

Rapid Detection of Bacterial and Fungal Pathogens Using the T2MR versus Blood Culture in Patients with Severe COVID-19.

ABSTRACTA high rate of bacterial and fungal superinfections was reported in critically ill patients with COVID-19. However, diagnosis can be challenging. The aim of this study is to evaluate the sensitivity and the clinical utility of the point-of-care method T2 magnetic resonance (T2MR) with the gold standard: the blood culture. T2MR can potentially detect five different Candida species and six common bacteria (so-called “ESKAPE” pathogens including Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Acinet`obacter baumanii, Pseudomonas aeruginosa, and Enterococcus faecium). If superinfection was suspected in patients with COVID-19 admitted to the intensive care unit, blood culture and two panels of T2MR were performed. Eighty-five diagnostic bundles were performed in 60 patients in total. T2MR detected an ESKAPE pathogen in 9 out of 85 (10.6%) samples, compared to BC in 3 out of 85 (3.5%). A Candida species was detected in 7 of 85 (8.2%) samples of T2MR compared to 1 out of 85(1.2%) in blood culture. The mean time to positive test result in samples with concordant positive results was 4.5 h with T2MR and 52.5 h with blood culture. The additional use of T2MR enables a highly sensitive and rapid detection of ESKAPE and Candida pathogens.IMPORTANCE Coronavirus disease 2019 (COVID-19) has led to a high number of deaths since the beginning of the pandemic worldwide. One of the reasons is the high number of bacterial and fungal superinfections in patients suffering from critical disease. However, diagnosis is often challenging. In this study we could show that the additional use of the culture-independent method T2MR did not only show a much higher detection rate of bacterial and fungal pathogens but also a significantly shorter time until detection and therapy change compared to the gold standard: the blood culture. The implementation of T2MRin the care of patients with severe course of COVID-19 might lead to an earlier sufficient antimicrobial therapy and as a result lower mortality and less use of broad-spectrum unnecessary therapy reducing the risk of resistance development.

Secondary Infections in Patients with COVID-19 Pneumonia Treated with Tocilizumab Compared to Those Not Treated with Tocilizumab: A Retrospective Study at a Tertiary Hospital in Kenya.

IntroductionFrom the first case of SARS-Co-2 in Wuhan, China, to the virus being declared as a pandemic in March 2020, the world has witnessed morbidity and mortality on a global scale. Scientists have worked at a record pace to deliver a vaccine for the prevention of this deadly disease. Tocilizumab, an interleukin-6 (IL-6) blocker, received an emergency use authorization (EUA) by the Federal Drug Agency (FDA) in June 2021.MethodsThis retrospective observational cohort study was conducted at the Aga Khan University Hospital, Nairobi, from March 8, 2020, to December 31, 2020. All patients with PCR confirmed COVID-19 pneumonia were included. Data were obtained from the medical records, and the admission registry was used to identify the patients, and both their electronic and paper-based files were retrieved from the medical records. Patient demographic data, medical history, baseline comorbidities, clinical characteristics, and outcome data were collected to study the infectious complications of Tocilizumab in patients affected by COVID-19 pneumonia.ResultsA total of 913 patients who were diagnosed with COVID-19 were included. The overall superinfection infection rate among the COVID-19 patients was 6%. Superinfection in patients who received the Tocilizumab was 17.2% and in the non-Tocilizumab group was 4.8%. The superinfection rate among severe and critically ill patients was even higher at 41.8% and 69.9% (Tocilizumab group) and 2.1% and 11.8% (non-Tocilizumab group), respectively (p < 0.001). There was no difference in mortality observed between the groups (p = 0.846). Infection among HIV co-infection was very low at 2.3%.ConclusionContrary to some studies, a higher rate of infection was observed among the Tocilizumab group, and no difference in mortality was observed between Tocilizumab and the non-Tocilizumab group. Infection among patients with HIV remains low in this susceptible population.

Disease-specific gaps within fungal respiratory tract infections: clinical features, diagnosis, and management in critically ill patients

We aim to examine the most recent findings in the area of invasive pulmonary fungal infections to determine the appropriate/and or lack of prevention measures and treatment of upper fungal respiratory tract infections in the critically ill. This will be addressed by focusing on the pathogens and prognosis over different bedridden periods in ICU patients, the occurrence of invasive fungal respiratory superinfections in patients with severe coronavirus disease 2019 which has been recently noted following the SARS-CoV-2 pandemic. Relevant reports referenced within include randomized controlled trials, meta-analyses, observational studies, systematic reviews, and international guidelines, where applicable. Of note, it is clear there is a significant gap in our knowledge regarding whether bacterial and fungal infections in coronavirus disease 2019 are directly attributable to SARS-CoV-2 or a consequence of factors such as managing high numbers of critically unwell patients, and the prolonged duration of mechanical ventilation/ICU admission duration of stay. An optimal diagnostic algorithm incorporating fungal biomarkers and molecular tools for early and accurate diagnosis of Pneumocystis pneumonia, invasive aspergillosis, candidemia, and endemic mycoses continues to be limited clinically. There is a lack of standardized molecular approach to identify fungal pathogens directly in formalin-fixed paraffin-embedded tissues and suboptimal diagnostic approaches for mould blood cultures, tissue culture processing for Mucorales, and fungal respiratory cultures (i.e., the routine use of bronchoscopic examination in ICU patients with influenza-associated pulmonary aspergillosis) for fungal point-of-care testing to detect and identify new, emerging or underrecognized, rare, or uncommon fungal pathogens.

Exfoliative Cheilitis More than an Aesthetic Problem: Case Report

Exfoliative cheilitis (EC) is a rare and chronic inflammatory condition. It is characterized by a continuous peeling of the vermilion of the lips and abnormal production of keratin scales. Treatment is difficult due to its chronic nature and it is often refractory. The objective of this article is to describe the management of EC and its impact on quality of life through two clinical cases. Two patients with EC are reported: one 21 years old with allergic rhinitis and gastric reflux, the other 18 years old, with a history of anxiety symptoms, without medication or psychiatric control. They had chronic scaly and crusty areas on both lip vermilions. In one of the patients, a biopsy was prescribed and he was treated with antifungals and topical vitamin E. Both patients were prescribed hydration, balanced diet, the application of moisturizing lip balm with sunscreen and modification of parafunctional habits, behavioral aid. The treatment healed the condition and eased their daily life and improved personal perception. Nibbling and lip licking favor dryness and superinfection in patients with EC; for its part, hydration, topical vitamin E and behavioral aid, improved this condition.

Baseline procalcitonin as a predictor of bacterial infection and clinical outcomes in COVID-19: A case-control study.

PurposeCoronavirus disease-2019 (COVID-19) is associated with a wide spectrum of clinical symptoms including acute respiratory failure. Biomarkers that can predict outcomes in patients with COVID-19 can assist with patient management. The aim of this study is to evaluate whether procalcitonin (PCT) can predict clinical outcome and bacterial superinfection in patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).MethodsAdult patients diagnosed with SARS-CoV-2 by nasopharyngeal PCR who were admitted to a tertiary care center in Boston, MA with SARS-CoV-2 infection between March 17 and April 30, 2020 with a baseline PCT value were studied. Patients who were presumed positive for SARS-CoV-2, who lacked PCT levels, or who had a positive urinalysis with negative cultures were excluded. Demographics, clinical and laboratory data were extracted from the electronic medical records.Results324 patient charts were reviewed and grouped by clinical and microbiologic outcomes by day 28. Baseline PCT levels were significantly higher for patients who were treated for true bacteremia (p = 0.0005) and bacterial pneumonia (p = 0.00077) compared with the non-bacterial infection group. Baseline PCT positively correlated with the NIAID ordinal scale and survival over time. When compared to other inflammatory biomarkers, PCT showed superiority in predicting bacteremia.ConclusionsBaseline PCT levels are associated with outcome and bacterial superinfection in patients hospitalized with SARS-CoV-2.