Volume 28, Issue 3, 2020
Editorial
Possibility of SARS-CoV-2 transmission from the breast milk of COVID-19 affected women patients to their infants: worries and strategies to counter it
Patel Shailesh Kumar,
Pathak Mamta,
Rana Jigyasa,
Tiwari Ruchi,
Natesan Senthilkumar,
Dhama Jaideep,
Malik Yashpal Singh,
Rodriguez Alfonso J. ,
Dhama Kuldeep,
Pagliano Pasquale
Not available
Review
Chest computed tomography findings in hospitalized COVID-19 patients: a systematic review and meta-analysis
Muhammad Syed Zaki,
Ahmed Areeba,
Shahid Izza,
Khalid Abdullah,
Menezes Ritesh G.,
Sheikh Muhammad Usman,
Siddiqi TariqJamal,
Usman Muhammad Shariq,
Khosa Faisal
Most studies evaluating chest computed tomography (CT) features in coronavirus disease 2019 (COVID-19) have been small-sized and have presented varied findings. We aim to systematically review these studies and to conduct a meta-analysis of their results to provide a well-powered assessment of chest CT findings in patients with COVID-19. PubMed and EMBASE databases were systematically searched to identify published studies that evaluated chest CT findings in COVID-19 patients. Data regarding study characteristics and CT findings, including distribution of lesions, the lobe of lung involved, lesion densities, and radiological patterns, were extracted. Arcsine transformed proportions from individual studies were pooled using a random-effects model to derive pooled proportions (PPs) and 95% confidence intervals (Cis). A total of fifty-four studies (n=2693 confirmed COVID-19 patients) were included in the final review. Prevalence of different CT findings varied across studies; however, the most common findings were bilateral pulmonary involvement (PP: 74.1% [68.4%, 79.5%]; I2 = 85.76%), ground glass opacification (PP: 64.6% [57.6%, 71.4%]; I2 = 91.52%), involvement of the left lower lobe (PP: 71.2% [58.9%, 82.1%]; I2 = 90.91%), and subpleural distribution of lesions (PP: 57.2% [39.0%, 74.3%]; I2 = 93.08%). Multivariate meta-regression revealed a positive association between prevalence of air bronchograms and average age of the population (p=0.013). Bilateral ground glass opacification, a subpleural distribution of lesions, and involvement of the left lower lobe were the most notable chest CT findings in COVID-19 patients.
Natural selection versus creation: a review on the origin of SARS-COV-2
Barh Debmalya,
Silva Andrade Bruno,
Tiwari Sandeep,
Giovanetti Marta,
Góes-Neto Aristóteles,
Alcantara Luiz Carlos Junior,
Azevedo Vasco,
Ghosh Preetam
SARS-CoV-2 has created a global disaster by infecting millions of people and causing thousands of deaths across hundreds of countries. Currently, the infection is in its exponential phase in several countries and there is no sign of immediate relief from this deadly virus. At the same time, some “conspiracy theories” have arisen on the origin of this virus due to the lack of a “definite origin”. To understand if this controversy is also reflected in scientific publications, here, we reviewed the key articles published at initial stages of the COVID-19 pandemic (January 01, 2020 to April 30, 2020) related to the zoonotic origin of SARS-CoV-2 and the articles opposing the “conspiracy theories”. We also provide an overview on the current knowledge on SARS-CoV-2 Spike as well as the Coronavirus research domain. Furthermore, a few important points related to the “conspiracy theories” such as “laboratory engineering” or “bioweapon” aspects of SARS-CoV-2 are also reviewed. In this article, we have only considered the peer-reviewed publications that are indexed in PubMed and other official publications, and we have directly quoted the authors’ statements from their respective articles to avoid any controversy.
Epidemiology of Pseudomonas aeruginosa in cystic fibrosis patients in Iran: A systematic review and meta-analysis
Alavi Foumani Ali,
Yaghubi Kalurazi Tofigh,
Mohammadzadeh Rostami Farzaneh,
Sedigh Ebrahim-Saraie Hadi,
Nazari Ali,
Halaji Mehrdad
The present study aims to investigate the prevalence of Pseudomonas aeruginosa in Iranian Cystic Fibrosis (CF) patients. We conducted a systematic search on this topic in Web of Science, PubMed, Embase, Scopus, and Google Scholar electronic databases to the end of July 2019. Then, 14 articles with eligible criteria were selected for data extraction and analysis by Comprehensive Meta-Analysis Software. The pooled prevalence of P. aeruginosa was 40.6% (95% CI: 32.4%-49.4%) ranging from 32.4% to 49.4%. There was a significant heterogeneity among the studies (χ2 =21.02; p <0.001; I2 = 86.07%). The funnel plot for publication bias showed no evidence of asymmetry. Based on the results of Begg’s and Egger’s test no significant publication bias was observed. The study demonstrated a relative prevalence of P. aeruginosa among CF patients in Iran. Due to the rapid spread and infection severity of P. aeruginosa and other opportunistic pathogens, efforts are required to identify risk factors, reservoirs, transmission routes and source of infection.
Bacteriophage therapy: an overview and the position of Italian Society of Infectious and Tropical Diseases
Cesta Novella,
Di Luca Mariagrazia,
Corbellino Mario,
Tavio Marcello,
Galli Massimo,
Andreoni Massimo
In recent years, the increase of antibiotic resistance and the lack in the pipeline of novel antimicrobial molecules make bacterial infections difficult to treat. Among European countries, Italy is the one region with a higher number of deaths caused by antibiotic-resistant bacteria. Moreover, a major concern is represented by biofilm-related infections. The ability of bacteria to form biofilm in presence of implanted-medical devices represents a further challenge for the treatment of bacterial infections. Thus, the development of alternative strategies to fight multi-drug resistant bacteria embedded in biofilms is an urgent need. Nowadays, bacteriophage therapy represents one of the potential and promising treatment options to overcome antibiotic resistance phenomenon. Bacteriophages are viruses capable to infect and replicate within bacterial cell. They are widespread in soil and water and play a role in microbial physiology. Since their discovery at the beginning of the twentieth century bacteriophages were used with therapeutic purposes against bacterial infections. However, the advent of the antibiotic era spurred medical doctors to abandon phage therapy in return for the most promising antibiotic therapy. For historical reasons, only few countries in the world, including Georgia, Russia and Poland have carried on the use of phages for therapeutic purposes and have developed specialised research and treatment centres, where phage therapy is permitted and applied to cure infectious disease. Although the efficacy of bacteriophages for treatment of infections is widely documented, the introduction of phage therapy in common management of bacterial infections in European hospital is hindered by the lack of an appropriate legal and regulatory framework. Different strategies have been used to overcome this problem, like the “Magistral Phage” preparation in Belgium. Here, we provide a review of the fundamental concept on bacteriophage therapy and propose this treatment as a possible alternative choice when antibiotics and surgery are not enough to eradicate a bacterial infection. We believe that the introduction of phage therapy in Italy might improve the quality of life of patients suffering of chronic bacterial infections and fight antibiotic resistances problem. To reach this goal the support and the promotion of Italian government and the scientific authorities is essential. SIMIT, the Italian Society of Infectious and Tropical Diseases, proposes to support the creation of an Italian Task Force to improve knowledge on bacteriophage therapy, collect stronger evidence about their efficacy and develop appropriate protocols for phage administration.
Past and current advances in Marburg virus disease: a review
Asad Ameema,
Aamir Alifiya,
Qureshi Nazuk Eraj,
Bhimani Simran,
Jatoi Nadia Nazir,
Batra Simran,
Ochani Rohan Kumar,
Abbasi Muhammad Khalid,
Tariq Muhammad Ali,
Marburg Virus (MARV), along with the Ebola virus, belongs to the family of Filovirus and is cause of a lethal and severely affecting hemorrhagic fever. The Marburgvirus genus includes two viruses: MARV and Ravn. MARV has been recognized as one of utmost importance by the World Health Organization (WHO). The case fatality rate of the virus ranges from 24.0 to 88.0% which demonstrates its lethal nature and the need for its widespread information.
The first case of the Marburgvirus disease (MARD) was reported in 1967 when lab personnel working with African green monkeys got infected in Germany and Serbia simultaneously. Following the initial case, many more outbreaks occurred around the world such as Uganda, Angola, Congo, Kenya and even in the United States in 2008. It was soon found out that the MARV was a zoonotic virus and mainly contracted from animal-to-human contact and further transmitted via human-to-human contact. The Egyptian fruit bat (Rousettus aegyptiacus) is known to be one of the significant sources of the infection and tourists visiting caves inhabited by these bats or workers accessing mines, populated by the bats, are at an increased risk of contracting the illness.
The incubation period ranges from 2-21 days and the clinical outcome can be broken down into three phases: initial generalized phase (day 1-4), early organ phase (day 5 to 13) and either a late organ/convalescence phase (day 13 onwards).
Furthermore, the treatment of MARD is solely based on supportive care. Much has been investigated in over the past half-century of the initial infection but only a few treatment options show promising results. In addition, special precaution is advised whilst handling the patient or the biospecimens. Disease-modifying agents and inhibitors of viral replications show constructive outcomes.
It is crucial to identify the host of the virus and educate the populations that are greatly at risk of the disease. While much is being investigated to devise a vaccine, it is important to educate Health Care Workers (HCWs) and close contacts facing the illness. Stopping the transmission remains the best measure that can be taken.
Original article
Use of lung ultrasound in COVID-19: comparison with ultra-high-resolution computed tomography among 29 patients at “D. Cotugno” hospital, Naples, Italy
Iodice Valentina,
Pisaturo Mariantonietta,
Fusco Francesco Maria,
Tambaro Orsola,
Parrella Giovanni,
Di Flumeri Giusy,
Viglietti Rosaria,
Pisapia Raffaella,
Palmiero Giulia,
Bignardi Elio,
Coppola Michele,
Rescigno Carolina,
Sangiovanni Vincenzo
Ultra-High-Resolution Computed Tomography (U-HR-CT) is the reference imaging technique for pneumonia in the new coronavirus disease (COVID-19). Pulmonary Ultrasound (LUS) could be a valid diagnostic alternative for the imaging of COVID-19. Our study aimed to investigate the clinical performance of LUS in the initial evaluation of pneumonia in COVID-19 patients, compared to standard U-HR-CT.
Among 29 patients with confirmed COVID-19, all U-HR-CT hallmarks showed an excellent concordance with LUS findings according to Cohen coefficient. In our experience, LUS is a viable alternative to U-HR-CT, with the advantages of being radiation-free, flexible, cost-effective, and reasonably reducing nosocomial transmission risks because performed at bed-side.
Out-patient management of patients with COVID-19 on home isolation
Ayaz Caglayan Merve,
Telli Dizman Gulcin,
Metan Gokhan,
Alp Alpaslan,
Unal Serhat
The rapidly increased number of patients with COVID-19 resulted in the shortage of hospital beds. An outpatient follow-up plan was developed for COVID-19 patients with stable clinical condition and no concomitant diseases. The records of COVID-19 first admission clinic were retrospectively reviewed to identify the COVID-19 patients who were followed on home isolation as outpatients between March 17, 2020 and April 18, 2020 in Ankara, Turkey. Demographic and clinical characteristics of the patients, compliance with isolation rules, re-admission rates, and outcomes were investigated. A total of 41 patients with COVID-19 were followed on home isolation without hospitalization. The median age of the patients was 36 years. Twenty-four (58.5%) of 41 patients were female. Twenty-nine (70.7%) patients were healthcare workers. The most common symptoms at admission were cough, myalgia/arthralgia, and loss of smell and/or taste. Fourteen (34.1%) patients were asymptomatic on the first admission. Anti-viral treatment was given to 27 (65.8%) of 41 patients. Four of 41 patients were readmitted to the outpatient clinic and hospitalized. Three patients had worsening respiratory symptoms and pneumonia was detected in CT scans. One patient was hospitalized because of disseminated herpes zoster infection. Two patients who jeopardized the isolation rules were isolated and monitored at another hospital by provincial health directorate teams. If adequate conditions are provided, follow-up on home isolation seems to be a feasible method in carefully selected patients. However, these patients should be monitored closely by an experienced team during the isolation period.
The therapeutic potential of convalescent plasma therapy on treating critically-ill COVID-19 patients residing in respiratory care units in hospitals in Baghdad, Iraq
Rasheed AnwarM.,
Fatak Dhurgham F.,
Hashim Hashim A.,
Maulood Mohammed F.,
Kabah Khulood K.,
Almusawi Yaqoob A.,
Abdulamir Ahmed S.
The current COVID-19 pandemic needs unconventional therapies to tackle the resulted high morbidity and mortality. Convalescent plasma is one of the therapeutic approaches that might be of benefit. Forty nine early-stage critically-ill COVID-19 patients residing in Respiratory Care Units (RCU) of three hospitals in Baghdad, Iraq, were included: 21 received convalescent plasma while 28, namely control group, did not receive it. Recovery or death, length of stay in hospital, and improvement in the clinical course of the disease were monitored clinically along with laboratory monitoring through SARS-CoV-2 RNA detection via PCR, and SARS-CoV-2 IgG and IgM serological monitoring. Patients who received convalescent plasma showed reduced duration of infection in about 4 days and showed less death rate [1/21 versus 8/28 in control group]. In addition, all the patients who were given convalescent plasma showed high levels of SARS-CoV-2 IgG and IgM three days after plasma transfusion. Plasma from donors with high levels of SARS-CoV-2 IgG and donors with positive SRAS-CoV-2 IgM showed better therapeutic results than other donors. Convalescent plasma therapy is an effective therapy if donors with high level of SARS-Cov2 antibodies are selected and if recipients are at their early stage of critical illness, being no more than three days in RCUs.
Impact of trainee-driven Antimicrobial stewardship program in a high burden resource-limited setting
Banerjee Sayantan,
Gupta Nitin,
Ray Yogiraj,
Kodan Parul,
Khot Wasim Yunus,
Fazal Farhan,
Niyas Vettakkara Kandy Muhammed,
Soneja Manish,
Kishore Naval,
Biswas Ashutosh,
Kapil Arti,
Wig Naveet
Antimicrobial Stewardship Program (ASP) is one of the most critical interventions required to halt the growing global antimicrobial resistance. The study aimed to evaluate the effect of trainee driven ASP implementation with limited available resources on outcome variables. An ASP team comprising of infectious diseases trainees and consultants was constituted to conduct stewardship activities in the Department of Medicine, All India Institute of Medical Sciences, a tertiary care apex institute in north India. Prospective audit and feedback were conducted by the team, and the following outcome variables were recorded and analyzed: the practice of sending cultures, appropriateness of prescribed empiric antibiotics, gross antimicrobial consumption and mortality. ASP intervention led to an increase in blood culture positivity rates by two folds (p<0.001). The trend of empiric prescription choices gradually shifted over time towards the use of more effective antibiotics according to the local antibiogram. Redundant usage of antibiotics substantially reduced over time. There was no impact of the antimicrobial stewardship program on the all-cause mortality rate. ASP had a significant effect on the practice of sending cultures and appropriateness of antibiotic usage. In resource-limited settings, trainee-driven antimicrobial stewardship program can succeed in inculcating rational practices among fellow residents and practising physicians.
Molecular detection of Anaplasma spp. in domestics dogs from urban areas of Soledad, Atlantico, Colombia
Bonilla-Aldana D. Katterine,
Pomares-Cantillo Lourdes H.,
Beltrán-Sánchez Carlos A.,
Bettin-Martínez Alfonso C.,
Campo-Urbina Mirna L.,
Rodriguez-Morales Alfonso J.,
Pérez-Doria Alveiro
Tick-borne pathogens are etiological agents of some zoonotic diseases, causing important consequences in animal and human health. These are emerging around the world, especially in tropical countries including Colombia. Domestic dogs play an essential role in the epidemiology of several zoonotic tick-borne pathogens. We performed the detection of bacteria from Anaplasmataceae family and parasites from the Piroplasmida order, in 85 domestic dogs from Soledad municipality, Atlantico, Colombia. Peripheral blood smears, detection by duplex PCR assay (ss rRNA 16S, from bacteria and the ITS-1, of ribosomal DNA from parasites), and DNA sequencing by Sanger method were done. Taxonomic identification was made by phylogenetics analysis of the DNA sequences. The gene sequences analysis showed that 12.9% of the dogs were infected with Anaplasma spp. Infection was higher in young dogs (OR=4.72, 95%CI 1.267-17.584). Besides that, 3.5% of them showed inclusions (morulae) compatible with bacteria from the order Rickettsiales. A coinfection with Babesia spp. and a Rickettsiales bacterial pathogens was found. The frequency of Anaplasma spp. detected in domestic dogs in Soledad highlights the need to improve diagnosis and control measures, to prevent the risk of transmission of these pathogens among ticks, dogs and humans exposed in the area.
Sexually transmitted infections in male prison inmates. Prevalence, level of knowledge and risky behaviours
Ciccarese Giulia,
Drago Francesco,
Oddenino Giorgio,
Crosetto Sara,
Rebora Alfredo,
Parodi Aurora
Data on the prevalence of sexually transmitted infections (STIs) and risk factors among incarcerated people are few and data about STIs awareness among inmates are even lacking. This study aimed to assess prevalence of STIs, risky behaviours and STIs level of knowledge in male inmates of the Casa Circondariale-Genova Marassi, the main penitentiary in Genoa, Italy. Between January and June 2019, 662 inmate medical records were retrospectively examined to obtain clinical and laboratory data about STIs. To investigate the inmate level of knowledge of STIs and their risky behaviours, 111consenting participants answered, anonymously, a written questionnaire. One hundred and twenty-two patients had at least one infectious disease when entered the prison: HIV (1.8%), HBV (2.7%), HCV (12.5%) and syphilis (1.3%). When asked to select from a list of diseases which ones they thought to be sexually transmitted, only 12% of the inmates answered correctly; most of them ignored which body fluids are at risk for HIV transmission, which STIs can induce tumors and if any vaccination exists to prevent STIs. Substance abuse was common among inmates that frequently exchanged needles for injecting drugs. To reduce the STIs incidence, it is necessary to target high-risk populations: everyone entering a prison should be offered a systematic screening of all STIs, including those currently neglected. Since STIs knowledge among inmates is poor and risky behaviours are diffuse, informative interventions in prison may provide an opportunity to educate such a high-risk population.
Fungal profile and antifungal susceptibility pattern in patients with oral candidiasis
Sav Hafize,
Altinbas Rabiye,
Dursun Zehra Bestepe
Oral candidiasis is a common fungal infection, affecting the oral mucosa. The aim of this study was to investigate the epidemiology and antifungal susceptibility of Candida species isolated from the oral cavity of patients affected by oral candidiasis. Oral swabs were taken from 34 patients and were inoculated on to Sabouraud Dextrose Agar (SDA). The yeasts were preliminarily evaluated according to the growth (human serum) germ tube, chlamydospore formation, reproduction at 45°C and colony characteristics on SDA medium. The commercial method Phoenix (Becton Dickinson, USA) was used for identification. Clinical and Laboratory Standards Institute (CLSI) reference M27-A3 microdilution method was applied for fluconazole (FLC), voriconazole (VRC), amphotericin B (AMB), ketoconazole (KTC), nystatin (NYT) antifungal susceptibility testing. A total of 34 Candida species were isolated and these species were identified as follows: 14 (41.2%) Candida albicans, 8 (23.5%) Candida glabrata, 8 (23.5%) Candida parapsilosis, 4 (11.8) Candida tropicalis. The geometric mean (GM) of the Minimum Inhibitory Concentration (MIC) for FLC, NYT, VRC, AMB, and KTC was 13.09 μg/mL, 4.77 μg/mL, 0.23 μg/mL, 0.20 μg/mL, 0.08 μg/mL, respectively. The most commonly isolated species was C. albicans. KTZ showed the lowest MIC value. NYT MIC values for non-albicans species were higher than for C. albicans ones.
Results of comprehensive cardiovascular diagnostic work-up in HIV positive patients
Pontecorboli Giulia,
Lagi Filippo,
Bagli Mauro,
De Vito Elena,
Millotti Giovanni,
Botta Annarita,
Cappelli Francesco,
Mattesini Alessio,
Acquafresca Manlio,
Barletta Giuseppe,
Del Bene Riccarda,
Colagrande Stefano,
Marcucci Rossella,
Bartoloni Alessandro,
Di Mario Carlo,
Martinelli Canio Vito
Cardiovascular disease (CVD) in the HIV population accounts for a large proportion of morbidity and mortality and, with the increased life expectancy, the burden of CVD is expected to rise. Inflammation, immune dysfunction, side effects of HIV medications, high prevalence of other risk factors are the likely pathogenic mechanisms for accelerated atherosclerosis. We aimed to evaluate the diagnostic yield of a cardiovascular multimodality diagnostic work-up in a contemporary cohort of HIV-infected patients. From November 2017 to October 2019, HIV infected patients were screened in a cardiovascular diagnostic work-up program including clinical history, physical examination, arterial blood pressure measurement, 12-lead ECG, and Transthoracic Echocardiogram (TTE). Advanced non-invasive cardiovascular imaging tests, like Coronary Computed Tomography Angiography (CCTA), stress-echocardiography, Cardiac Magnetic Resonance (CMR), were performed in patients with suspicion of chronic coronary syndrome (CCS) or non-ischemic heart disease (NIHD). 117 HIV-infected consecutive patients underwent this cardiovascular diagnostic work-up and were included in our study. Fifty-two patients (45%) had evidence of CVD. Of them, 22 presented Coronary Artery Disease (CAD), whereas 47 cases showed NIHD. In 17 cases both conditions were present. Among patients with CAD, 8 showed critical coronary stenosis; among them, 5 were treated with percutaneous coronary intervention, 2 with Aorto-Coronary By-Pass Grafting (CABG), and one with medical therapy. Hypertension and diabetes were significantly associated with the development of CVD (respectively p<0.001 and p< 0.05), while current smoking (p<0.02) and hypertension (p<0.007) were positively associated to CAD. A comprehensive cardiovascular diagnostic work-up including advanced multimodality diagnostic imaging modalities led to early detection of CVD in nearly half of an HIV population with immediate interventions required in 6.8% of them, and aggressive prevention treatment started in the remaining HIV patients.
Seroepidemiology of seasonal influenza virus among unvaccinated pregnant women in Lagos, Nigeria
Anjorin Abdul Azeez Adeyemi,
Nwammadu Juliet Ebere
Nigeria is the most populous African nation in the world having a population of over 200 million with little or no data on maternal influenza and its co-morbidities. In most developing countries, there is paucity of data for prioritization of strategies for the prevention and control of influenza with possible co-morbidities common in pregnancy. We therefore investigated recent infection of seasonal influenza virus with co-infection of malaria parasitaemia and typhoid fever in pregnant women in Lagos State, Nigeria. A descriptive hospital-based cross-sectional study was designed according to the Consortium for the Standardization of Influenza Seroepidemiology (CONSISE) guideline in 6 public health institutions between July 2016 and October 2018. Enzyme Immunoassay (Demeditec, Germany) was used to detect IgM specific antibodies to influenza A (H1N1) and (H3N2). P-values were determined with Chi-square using GraphPad Prism, USA.
Demographic characteristics of the patients showed median age of 29 (mean 29.3; mode, 28; and range, 18-45) years. Out of 182 pregnant women screened, 103 (56.6%) were IgM seropositive for influenza A. Patients with underlying diseases accounted for 72%, approximately three-times higher compared to 28% without underlying disease. Co-infection was detected with malaria parasitaemia (54%), typhoid fever (50.5%), and malaria and typhoid fever (33%). The most commonly reported symptoms were fever, cold, dizziness, swollen legs, and cough. Age group 21-30 years was the most affected while patients from densely populated area had the highest seroprevalence. This study revealed that seasonal influenza circulates with co-morbidities in pregnant women in Lagos. This may exacerbate their immunosuppressed state and lead to complication in pregnancy. Apt treatment of influenza-like illness should be considered in such women. Furthermore, there is need for enhanced surveillance including monitoring of the potential transmissibility of influenza to the foetus and newborns. We therefore recommend sturdy advocacy on preventing exposure to influenza virus, its optimal early diagnosis, vaccination and disease management in pregnancy.
Case report
SARS-CoV-2 and Dengue virus Co-infection. A Case Report
Radisic Marcelo Victor,
Piro Maria Ayelén,
Mori Ignacio,
Rotryng Flavio,
Santamarina Joaquín Francisco
Coinfection of SARS-CoV-2 and dengue virus has not been previously reported. We report a confirmed case with favourable outcome, but whether the occurrence of simultaneous infections may alter the usual clinical course of each infection is still unknown.
Xpert MTB/RIF for diagnosis of tubercular liver abscess. A case series
Agarwala Roshan,
Dhooria Sahajal,
Khaire Niranjan S.,
Mishra Shubhra,
Verma Samman,
Shah Jimil,
Mandavdhare Harshal S.,
Kumari Savita,
Dutta Usha,
Sharma Vishal
Hepatic involvement is an infrequent manifestation of abdominal tuberculosis and could occur in form of granulomatous hepatitis, nodular involvement or abscess formation. Tubercular liver abscess (TLA) is uncommon, and diagnosing this entity is a challenge. Xpert MTB/RIF (Cepheid, Sunnyvale, CA, USA) assay has been widely used for diagnosing pulmonary tuberculosis (TB) and lymph nodal tuberculosis. Its utility in some forms of other extrapulmonary TB has also been studied. The role of Xpert MTB/RIF for diagnosis of tubercular liver abscess is not known. Here we present a series of four 4 cases of TLA, where the diagnosis was made on the basis of positive Xpert MTB/RIF assay tested on liver drained pus.
Non tuberculous mycobacteria related spondylodiscitis: a case report and systematic literature review
Smimmo Alessandro,
Perna Andrea,
Fantoni Massimo,
De Marco Davide,
Velluto Calogero,
Proietti Luca,
Sali Michela,
Tamburrelli Francesco Ciro
Purpose: Mycobacterium xenopi and Non Tuberculous Mycobacteria (NTM) are rare causes of spondylodiscitis (SD). The aim of this study was to highlight the relevance of considering these pathogens in differential diagnosis of slow growing SD, obtaining the correct diagnosis and evaluating the key points of management and therapy approach.
Methods: A case of surgically treated Mycobacterium xenopi SD is reported. A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. The research was conducted on MEDLINE, PubMed and Scopus using as search-terms “vertebral”, “spinal”, “infection”, “spondylodiscitis”, “discitis”, “osteomyelitis”, “atypical”, “nontuberculous”, “mycobacterium”.
Results: After the screening of 444 titles and abstracts, 113 papers were considered eligible for the full-text analysis. Seventy-seven studies that met inclusion criteria were finally included in the review. Overall, including our report, 91 patients affected by NTM SD were analyzed in this systematic review
Conclusion: This review highlights the rarity of spinal infections due to NTM and the difficulty of their management. A tailored approach with prolonged antibiotic therapy, eventually associated with surgery in selected cases were suggested for the treatment of NTM infections.
A case of crusted scabies with a delayed diagnosis and inadequate therapy
Bonazzetti Cecilia,
Pagani Gabriele,
Giacomelli Andrea,
Morena Valentina,
Bassoli Cinzia,
Corbellino Mario,
Bestetti Giovanna,
Galimberti Laura,
Grande Romualdo,
Antinori Spinello
Crusted scabies is an infrequent disease caused by Sarcoptes scabiei that usually affects patients with underlying medical conditions leading to immunosuppression.
Here, we present the case of an 81 years old man, diagnosed with crusted scabies who came to our attention after multiple misdiagnosis and incorrect and potentially detrimental treatment with steroids. He was admitted to our inpatients ward and treated with oral ivermectin plus local permethrin. The hospitalization was complicated by a secondary bacterial skin infection caused by methicillin-sensitive Staphylococcus aureus.
Crusted scabies is commonly misdiagnosed in elderly and immunosuppressed people due to its unusual occurrence and atypical clinical presentation. It should be considered in the differential diagnosis of skin lesions associated with pruritus in patients with underling medical conditions leading to immunosuppression. A prompt diagnosis and treatment are warranted due to the potential secondary infections and subsequent related morbidity and mortality.
The Infections in the History of Medicine
El Alamein: the battle in the battle. How infectious disease management changed the fate of one of the most important battle of the World War II.
Simonetti Omar,
Armocida Emanuele
El Alamein, on Egypt's Mediterranean coast, was the theater of war for one of the most important and decisive battles of the Second World War.
The Allied victory in November 1942 opened the end of the Western Desert Campaign. The battle revived the morale of the Allies, being the first big success against the Axis since Operation Crusader in late 1941. The German threat to Egypt, the Suez Canal and the Middle Eastern and Persian oil fields was eliminated and the doors for Mediterranean advance were opened.
Fighting in the desert under extreme human conditions exposed all the involved armies to health hazards going beyond those arising from common battle injuries.
The outcome of the battle was influenced by a gap in morbidity and mortality derived from different approaches in infectious disease management between armies. The attention of the British for medical research, pharmacological experimentation, hygiene strategies and prevention may have been as important as warfare strategies in deciding the fate of the battle. Examples of some of these advances include wound nursing, control of endemic diseases, surveillance of difficult hygienic conditions, prevention of faecal-oral transmission diseases.
During El Alamein Battle soldiers on both fronts where engaged in two wars: the first one, vertical, was against the enemy uniform; the second one, horizontal, was against invisible enemies called pathogens. Only surviving the horizontal war meant preserve enough units and morale in order to win El Alaman Battle.
The Early Report of Herpetic Whitlow by Bahā' al-Dawlah Razi in 15th Century CE
DA herpetic whitlow is a lesion (whitlow) on a finger or thumb caused by herpes simplex virus. It is a painful infection that typically affects the fingers or thumbs. Occasionally infection occurs on the toes or on the nail cuticle. Symptoms of herpetic whitlow include tenderness, swelling and reddening of the infected finger skin, fever and swollen lymph nodes. Although, it is believed that the first recorded observations were in 1909 CE by H. G. Adamson, in the medieval period, Bahā' al-Dawlah Nūrbakhshī Razi (1501 CE) described herpetic whitlow, under the title of Dā'khes in Khulāsat al-Tajārib (The Summary of Experience), his book on medicine. Some of Bahā' al-Dawlah's descriptions and his etiology of Dā'khes are based on humoral theories and cannot be concurred with current medical concepts, but more symptoms and clinical manifestations are consistent with current definitions. It seems the earliest description of herpetic whitlow in the medical history
Letters to the editor
Awake proning in Covid-19 pneumonia
Sen Manas Kamal,
Gupta Nitesh,
Ish Pranav,
Kumar Rohit,
Yadav Siddharth Raj
Not available
Stroke as a complication of Coronavirus disease 2019 (COVID-19)
Marín-Medina Daniel S.,
Orozco-Hernández Juan Pablo,
Martínez-Muñoz Manuel A.,
Sánchez-Duque Jorge Andrés
Not available
Granulocyte colony-stimulating factors (G-CSF) and Covid-19: a double-edged sword?
Tralongo Antonino C.,
Danova Marco
Not available
Comparison of HIV-DNA decay in naïve patients starting dolutegravir plus lamivudine or dolutegravir-based triple therapy.
Lombardi Francesca,
Belmonti Simone,
Borghetti Alberto,
Ciccullo Arturo,
Fabbiani Massimiliano,
Di Giambenedetto Simona
Not available
