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29 ud af 29 tidsskrifter valgt, søgeord (pneumoni) valgt, emner højest 180 dage gamle, sorteret efter nyeste først. Opdateret for 8 dage siden.542 emner vises.
Giovanni Maria Guarrera,
Journal of Medical Virology, Accepted Article.
Pneumocystis jirovecii pneumonia (PJP) can be challenging to diagnose, often requiring bronchoscopy. Since most patients suspected of PJP undergo imaging, we hypothesized that the findings of these studies could help estimate the probability of disease prior to invasive testing.
We created a cohort of patients who underwent bronchoscopy specifically to diagnose PJP and conducted a nested case-control study to compare the radiographic features between patients with (n = 72) and without (n = 288) pathologically proven PJP. We used multivariable logistic regression to identify radiographic features independently associated with PJP.
Chest x-ray findings poorly predicted the diagnosis of PJP. However, multivariable analysis of CT scan findings found that “increased interstitial markings” (OR 4.3; 95%CI 2.2–8.2), “ground glass opacities” (OR 3.3; 95%CI 1.2–9.1) and the radiologist’s impression of PJP being “possible” (OR 2.0; 95%CI 1.0–4.1) or “likely” (OR 9.3; 95%CI 3.4–25.3) were independently associated with the final diagnosis (c-statistic 0.75).
Where there is clinical suspicion of PJP, the use of CT scan can help determine the probability of PJP. Identifying patients at low risk of PJP may enable better use of non-invasive testing to avoid bronchoscopy while higher probability patients could be prioritized.
Frederic Lamoth, Emmanouil Glampedakis, Noémie Boillat-Blanco, Mauro Oddo, Jean-Luc Pagani
The devastating pandemia of the novel Coronavirus Disease 2019 (COVID-19) resulting from the emergence of SARS-CoV-2 is of particular concern because of the development of acute respiratory distress syndrome (ARDS), which is associated with high mortality rates. Besides the impact of viral pneumonia itself, the prognosis can be affected by other infectious complications, such as ventilator-associated bacterial pneumonia or fungal infections. Previous reports of a significant risk of invasive pulmonary aspergillosis (IPA) among patients with severe Influenza raises questions about a similar association with COVID-19 .
Marcello A. Orsi, Giancarlo Oliva and Michaela Cellina
Michaela Cellina, Marcello A. Orsi and Giancarlo Oliva
Raj Kalkeri, Scott Goebel and Guru Dutt Sharma
The ongoing pandemic COVID-19, caused by SARS-CoV-2, has already resulted in more than 3 million cases and more than 200,000 deaths globally. Significant clinical presentations of COVID-19 include respiratory symptoms and pneumonia. In a minority of patients, extrapulmonary organs (central nervous system, eyes, heart, and gut) are affected, with detection of viral RNA in bodily secretions (stool, tears, and saliva). Infection of such extrapulmonary organs may serve as a reservoir for SARS-CoV-2, representing a potential source of viral shedding after the cessation of respiratory symptoms in recovered patients or in asymptomatic individuals. It is extremely important to understand this phenomenon, as individuals with intermittent virus shedding could be falsely identified as reinfected and may benefit from ongoing antiviral treatment. The potential of SARS-CoV-2 infection to rapidly disseminate and infect extrapulmonary organs is likely mediated through the nonstructural and accessory proteins of SARS-CoV-2, which act as ligands for host cells, and through evasion of host immune responses. The focus of this perspective is the extrapulmonary tissues affected by SARS-CoV-2 and the potential implications of their involvement for disease pathogenesis and the development of medical countermeasures.
Surat Nunthavichitra, Suttiporn Prapaso, Viravarn Luvira, Sant Muangnoicharoen, Pornsawan Leaungwutiwong and Watcharapong Piyaphanee
We report a young Thai man from the Thai-Myanmar border suffering from 2 days of fever and myalgia without respiratory tract signs or symptoms. He reported no history of travel through an area with confirmed COVID-19 cases or contact with sick persons. After excluding malaria and dengue, which are common causative agents of acute undifferentiated febrile illness (AUFI) in Thailand, chest radiography was performed according to the patient triage protocol of our institute for AUFI during the COVID-19 outbreak. Chest radiography revealed findings compatible with pneumonia. Nasopharyngeal, throat, and sputum samples tested positive for SARS-CoV-2 by real-time reverse transcriptase–PCR. The preadmission diagnosis of COVID-19 in this patient enabled appropriate management and isolation to prevent nosocomial transmission. Fever and nonspecific symptoms and laboratory results in early COVID-19 may be difficult to distinguish from tropical infectious diseases, especially when respiratory signs and symptoms are absent. This fact necessitates vigilant awareness in clinical investigation, management, and infection control, especially in tropical resource-limited settings.
The impression I get from Michael Hurley, now 36 years, working and living, with his wife, in Las Vegas (NV, USA), is that he was just a regular, active 17-year-old. In May 2001, on a school trip to Spain, he developed bronchial symptoms: “I was coughing a lot, but at 17, I was not really in tune with my body, and we think we are invincible at that age”, he says. “It persisted and got worse and worse, but I never thought it was something major that I needed to seek medical attention for.” Back home (Indianapolis, IN, USA), at the end of July, after a visit to a physician, he was diagnosed with pneumonia (mainly annoying because “I had to quit smoking”), but Michael's health continued to deteriorate.
An antibiotic already available for patients with complicated urinary tract infections or complicated intra-abdominal infections has received approval to treat adults with hospital-acquired or ventilator-associated bacterial pneumonia who have limited or no treatment options.
Hao, M., He, Y., Zhang, H., Liao, X.-P., Liu, Y.-H., Sun, J., Du, H., Kreiswirth, B. N., Chen, L.
Combating plasmid-mediated carbapenem resistance is essential to control and prevent the dissemination of carbapenem-resistant Enterobacteriaceae (CRE). Here we conducted a proof-of-concept study to demonstrate CRISPR/Cas9-mediated resistance gene and plasmid curing can effectively re-sensitize CRE to carbapenems. A novel CRISPR/Cas9-mediated plasmid-curing system (pCasCure) was developed and electrotransferred into various clinical CRE isolates. The results showed that pCasCure can effectively cure blaKPC, blaNDM and blaOXA-48 in various Enterobacteriaceae species of Klebsiella pneumoniae, Escherichia coli, Enterobacter hormaechei, E. xiangfangensis and Serratia marcescens clinical isolates, with > 94% curing efficiency. In addition, we also demonstrated that pCasCure can efficiently eliminate several epidemic carbapenem-resistant plasmids, including the blaKPC-harboring IncFIIK-pKpQIL and IncN pKp58_N, blaOXA-48-harboring pOXA-48-like, blaNDM-harboring IncX3 plasmids, by targeting their replication and partitioning (parA in pKpQIL) genes. However, curing blaOXA-48 gene failed to eliminate its corresponding pOXA-48-like plasmid in a clinical K. pneumoniae isolate 49210, while further next generation sequencing revealed that it was due to IS1R mediated recombination outside the CRISPR/Cas9 cleavage site, resulting in blaOXA-48 truncation and therefor escaped plasmid curing. Nevertheless, the curing of carbapenemase genes or plasmids, including the truncation of blaOXA-48 in 49210, successfully restore their susceptibility to carbapenems, with > 8-fold reduction of minimum inhibitory concentration (MIC) values in all tested isolates. Taken together, our study confirmed the concept of using CRISPR/Cas9-mediated carbapenemase genes and plasmids curing to re-sensitize CRE to carbapenems. Further work is needed to integrate pCasCure in an optimal delivery system to make it applicable for clinical intervention.
Literacka, E., Izdebski, R., Urbanowicz, P., Zabicka, D., Klepacka, J., Sowa-Sierant, I., Zak, I., Garus-Jakubowska, A., Hryniewicz, W., Gniadkowski, M.
GES-type extended-spectrum β-lactamases (ESBLs), like GES-1, mutate by Gly170Asn/Ser substitutions into carbapenem-hydrolyzing variants, of which GES-5 is relatively more frequent (1, 2)....
The probability of hospitalization in patients suffering from community-acquired pneumonia (CAP) with an underlying comorbidity, such as a cardiac pathology, is 73-fold higher than that in CAP patients without a comorbidity. Although previous studies have investigated patients with cardiac events and pneumonia, they have not studied the burden of disease in depth at the population level. The objective of this study is to provide population-level data on patients ≥60 years old who were hospitalized with pneumonia with comorbid cardiovascular disease (CVD) in Spain over a period of 19 years (1997–2015).
This is a retrospective study based on a minimum basic data set (MBDS). The following variables were collected: age, sex, re-admission (yes/no), hospital stay (days), and other diagnoses. Hospitalization rate (per 100,000 inhabitants), mortality rate (per 100,000 inhabitants), and lethality rate (%) were obtained, and the 95% confidence interval of each rate was calculated. Analyses were stratified by age (categorized into 4-year intervals), sex, and year of admission. Differences were assessed for significance with the chi-squared test for proportions and the Poisson model for rates. Logistic regression was run with in-hospital survival as the dependent variable and sex, age, year of admission, and re-admission (yes/no) as the independent variables. The level of significance was p
The first SARS-CoV-2 cases in Europe were reported in January 2020. Recently, concern arose on unrecognized infections before this date. For a better understanding of the pandemic, we retrospectively analyzed patient samples for SARS-CoV-2 from the prospective CAPNETZ study cohort.
We used nasopharyngeal swab samples from a cohort of well characterized patients with community acquired pneumonia of the CAPNETZ study group, recruited from different geographic regions across Germany, Austria, the Netherlands, and Switzerland between 02nd December 2019 and 28th April 2020. Multiplex real-time RT-PCR for a broad range of respiratory pathogens and SARS-CoV-2 real-time RT-PCR were performed on all samples.
In our cohort, respiratory pathogens other than SARS-CoV-2 were detected in 21.5% (42/195) of patients with rhinovirus as the most frequently detected pathogen. The detection rate increased to 29.7% (58/195) when SARS-CoV-2 was included. No SARS-CoV-2 positive sample was detected before end of March 2020.
Respiratory viral pathogens accounted for a considerable number of positive results but no SARS-CoV-2 case was identified before the end of March 2020.
Helena Hui Wang, Esther Lau, Richard Horton
“I feel deeply the burden of the honour placed upon me in being chairman of this Medical Conference, which is unique in our history, powerful in its representation, and which gives China a strong position amongst nations seeking the welfare of the people”, wrote Wu Lien Teh in his first publication in The Lancet,1 on his inaugural address delivered at the International Plague Conference in Shenyang, China, in 1911. Wu was elected as the chair of the conference for his work in controlling the pneumonic plague epidemic outbreak in 1910–11 in northeastern China, which ultimately claimed about 60 000 lives.
Deng, W., Bao, L., Liu, J., Xiao, C., Liu, J., Xue, J., Lv, Q., Qi, F., Gao, H., Yu, P., Xu, Y., Qu, Y., Li, F., Xiang, Z., Yu, H., Gong, S., Liu, M., Wang, G., Wang, S., Song, Z., Liu, Y., Zhao, W., Han, Y., Zhao, L., Liu, X., Wei, Q., Qin, C.
Coronavirus disease 2019 (COVID-19), which is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic. It currently remains unclear whether convalescing patients have a risk of reinfection. We generated a rhesus macaque model of SARS-CoV-2 infection that was characterized by interstitial pneumonia and systemic viral dissemination mainly in the respiratory and gastrointestinal tracts. Rhesus macaques reinfected with the identical SARS-CoV-2 strain during the early recovery phase of the initial SARS-CoV-2 infection did not show detectable viral dissemination, clinical manifestations of viral disease, or histopathological changes. Comparing the humoral and cellular immunity between primary infection and rechallenge revealed notably enhanced neutralizing antibody and immune responses. Our results suggest that primary SARS-CoV-2 exposure protects against subsequent reinfection in rhesus macaques.
Carbapenem-resistant hypervirulent Klebsiella pneumoniae strains have recently come into existence worldwide; however, researchers in northeast China are not aware of their clinical features and molecular characteristics.
Here, the molecular and virulent characteristics of 44 carbapenem-resistant K. pneumoniae (CRKP) isolates collected from January 2015 to December 2017 were studied. Multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE) were carried out to define the clonal relatedness among the isolates. PCR and capsular serotyping of the virulence-associated genes, as well as biofilm formation and serum complement-mediated killing assays, were employed to determine the virulent potential. The genomic features and associated mobile genetic elements of JmsCRE57 were detected by whole genome sequencing.
The only positive isolate was JmsCRE57, which belonged to the ST375 serotype K2 that expressed uge, mrkD, fimH, kpn, aerobactin and rmpA virulence-associated genes and showed strong biofilm formation and serum sensitivity. Sequencing results showed that the JmsCRE57 genome mainly consisted of a circular chromosome, three antimicrobial resistant plasmids and a virulent plasmid. The antimicrobial resistant plasmid expressing blaKPC-2, blaCTX-M-15, aph(3″)-Ib, aph(6)-Id, qnrB1, aac(3)-IIa, aac(6′)-Ib-cr, blaOXA-1, blaTEM-1B, catB4, sul2, dfrA14 and blaSHV-99. The virulent plasmid belonged to the IncHI1B group, which is mainly composed of mucoid phenotype genes and siderophore-associated genes. The remaining CRKP strains that expressed uge, fimH, mrkD and kpn virulence-associated genes were not successfully typed.
Our results provide new insights on the epidemiology of carbapenem-resistant K2 hypervirulent K. pneumoniae ST375 and CRKP ST76 strains in northeast China, which may help control their future outbreaks.
Duaa W. Al-Sadeq, Gheyath K. Nasrallah
Infectious diseases impose a major health threat globally, leading to 15 million deaths annually (Fauci et al., 2005). Although the percentage of mortality due to infectious diseases has declined, numerous new infectious diseases have been identified and reported recently. The novel coronavirus disease (COVID-19), caused by the SARS-CoV-2 virus, was firstly identified in Wuhan, China, in late December 2019 as an outbreak of unusual viral pneumonia (Mousavizadeh and Ghasemi, 2020). Later, the World Health Organization (WHO) declared a public health emergency worldwide, and the total number of infected cases reached 4.4 million by May 2020 (WHO, 2020).
Strongyloidiasis is a gastrointestinal parasitic infection caused by percutaneous infection with Strongyloides stercoralis. Digestive symptoms such as diarrhea and abdominal pain are the main manifestation, but serious infections such as septicemia, purulent meningitis, and bacterial pneumonia may occur in individuals harboring human T-lymphotropic virus type 1 (HTLV-1) or who are immunocompromised. Although coinfection with Strongyloides stercoralis and HTLV-1 can lead to chronic strongyloidiasis and a disseminated form of the disease, there is a high rate of response to the anthelmintic ivermectin.
We report a case of strongyloidiasis infection syndrome that was difficult to differentiate from immune reconstitution inflammatory syndrome (IRIS) for various reasons. The patient had been treated with the corticosteroids tacrolimus (Tac) and mycophenolate mofetil (MMF) for systemic lupus erythematosus (SLE) with lupus nephritis and pancytopenia. When the steroid was reduced, she developed cytomegalovirus (CMV) enteritis, and her respiratory status rapidly deteriorated immediately after the withdrawal of Tac and MMF. It was difficult to distinguish immune reconstitution inflammatory syndrome from strongyloidiasis infection syndrome because stool cultures were negative and eosinophils were not increased. Bronchoscopy revealed viable Strongyloides, leading to a diagnosis of strongyloidiasis infection syndrome, but the patient died despite treatment.
Both corticosteroid therapy and HTLV-1 infection can be associated with a decrease of eosinophils, despite the presence of parasitic infection. In conclusion, even if multiple culture tests are negative, the risk of parasitic infection should be assessed in patients receiving immunosuppressants and steroids even in non-endemic areas.
Wang W, Liu X, Wu S, et al.
AbstractCorona Virus Disease 2019(COVID-19)-affected patients with severe immune abnormalities have a risk of cytokine release syndrome. The definition, prevention, and treatment of symptoms of cytokine release syndrome in critically ill patients with COVID-19 are important problems. This was a single-center case series of 11 COVID-19 patients with acute respiratory distress syndrome (ARDS) from The First Affiliated Hospital of Guangzhou Medical University in China from January 26, 2020 to February 18, 2020. The termination date of follow-up was February 19, 2020.In this single-center analysis of 11 critically ill patients with COVID-19, 8 patients were determined to have characteristics of cytokine release syndrome (CRS), including pulmonary inflammation, fever, and dysfunction of non-pulmonary organs; an increase of- Interleukin-6 (IL-6) in peripheral blood was the highest risk factor and an early indicator of CRS in COVID-19.
Naoki Kakuta, Ryuichi Nakano, Akiyo Nakano, Yuki Suzuki, Takashi Masui, Saori Horiuchi, Risako Kakuta, Kohsuke Tsubaki, Miho Ogawa, Hisakazu Yano
β-lactam antibiotics are currently the major antimicrobials utilized worldwide for the treatment of serious infections due to Enterobacteriaceae including Klebsiella pneumoniae. However, increasing use of β-lactam antibiotics has led to the emergence of extended-spectrum β-lactamase (ESBL)-producing strains. These enzymes have been increasingly identified worldwide in K. pneumoniae (Calbo and Garau, 2015). It is notable that infections caused by ESBL-producing strains are associated with increased morbidity, mortality, and healthcare-associated costs (Maragakis et al., 2008).
Brown A, Singh K, Cruz M, et al.
AbstractEnterococcus faecalis is a significant cause of hospital-acquired bacteremia. Herein, the discovery is reported that cardiac microlesions form during severe bacteremic E. faecalis infection in mice. The cardiac microlesions were identical in appearance to those formed by Streptococcus pneumoniae during invasive pneumococcal disease (IPD). However, E. faecalis does not encode the virulence determinants implicated in pneumococcal microlesion formation. Rather, disulfide bond forming protein DsbA was found to be required for E. faecalis virulence in a C. elegans model and was necessary for efficient cardiac microlesion formation. Furthermore, E. faecalis promoted cardiomyocyte apoptotic and necroptotic cell death at sites of microlesion formation. Additionally, loss of DsbA caused an increase in pro-inflammatory cytokines unlike the wild-type strain, which suppressed the immune response. In conclusion, we establish that E. faecalis is capable of forming cardiac microlesions and identify features of both the bacterium and the host response that are mechanistically involved.
Tseng H, Sy L, Ackerson B, et al.
AbstractBackgroundWe describe the clinical epidemiology and outcomes among a large cohort of older adults hospitalized with respiratory syncytial virus (RSV) infection in the US.MethodsHospitalized adults aged ≥60 years who tested positive for RSV between 01/01/2011-6/30/2015 were identified from Kaiser Permanente Southern California. Patient-level demographics, comorbidities, clinical presentation, utilization, complications, and mortality were evaluated.ResultsThere were 664 participants hospitalized with RSV (61% female, 64% aged ≥75 years). Baseline chronic diseases were prevalent (all >30%). Nearly two-thirds (66%) developed pneumonia, 80% of which were radiographically confirmed. Very severe tachypnea (≥26 breaths per minute) was common (56%). Approximately 21% required ventilator support and 18% were admitted to the intensive care unit. Mortality during hospitalization was 5.6% overall (4.6% in 60-74 year-olds and 6.1% in ≥75 year-olds). Cumulative mortality within 30 days, 3 months, 6 months, and 12 months of admission was 8.6%, 12.3%, 17.2%, and 25.8%, respectively.ConclusionRSV infection in hospitalized older adults often manifested as severe, life-threatening lower respiratory tract illness with high rates of pneumonia, requirement for ventilatory support, and short- and long-term mortality. Increased recognition of the substantial RSV disease burden in adults will be important in the evaluation and use of urgently needed interventions.
Jia-Wei Yang, Ling Yang, Rong-Guang Luo, Jin-Fu Xu
Corticosteroids are commonly used as adjuvant therapy for acute respiratory distress syndrome (ARDS) by many clinicians due to their perceived anti-inflammatory effects. However, for patients with severe viral pneumonia, the corticosteroid treatment is highly controversial.
Bart S, Nambiar S, Gopinath R, et al.
AbstractBackgroundWhile there are ongoing regulatory convergence efforts, differences remain in primary endpoints recommended for community-acquired bacterial pneumonia (CABP) trials. The US Food and Drug Administration recommends assessing CABP symptom resolution at an early time point (3-5 days after randomization). Other regulatory agencies recommend assessing overall clinical response at a later time point (5-10 days after therapy ends).MethodsWe analyzed participant-level data from six recent CABP trials submitted to the FDA (n=4,645 participants) to evaluate concordance between early and late endpoint outcomes. We used multivariate logistic regression to identify factors associated with discordance.ResultsEarly and late endpoint outcomes were concordant for 85.6% of participants. The proportions of early endpoint responders that ultimately failed and early endpoint non-responders that ultimately succeeded were similar (6.0% vs 8.4%, respectively). Early endpoint response was highly predictive of late endpoint success (positive predictive value 92.9%). Multivariate logistic regression identified early endpoint responders/late endpoint failures as less likely to be obese and more likely to be infected with Chlamydophila pneumoniae or Staphylococcus aureus, have received antibacterial drug therapy prior to randomization, and have severe chest pain at baseline. The most common investigator-provided reasons for failure among early endpoint responders/late endpoint failures were receipt of non-study antibacterial drug therapy and loss to follow-up.ConclusionEarly and late endpoint outcomes were highly concordant. These data may be useful in the continuing efforts to reach international regulatory convergence on CABP clinical trial design recommendations.
Community-acquired Bacterial Pneumonia (CABP)Acute Bacterial Skin and Skin Structure Infection (ABSSSI)U.S. Food and Drug Administration (FDA)antibiotic clinical developmentclinical trial endpointsnon-inferiority trials
Christoph M. Ernst, Julian R. Braxton, Carlos A. Rodriguez-Osorio, Anna P. Zagieboylo, Li Li, Alejandro Pironti, Abigail L. Manson, Anil V. Nair, Maura Benson, Kaelyn Cummins, Anne E. Clatworthy, Ashlee M. Earl, Lisa A. Cosimi, Deborah T. Hung
Nature Medicine, Published online: 25 June 2020; doi:10.1038/s41591-020-0974-5Author Correction: Adaptive evolution of virulence and persistence in carbapenem-resistant Klebsiella pneumoniae
Jordan S, Zakowski P, Tran H, et al.
AbstractBackgroundPreliminary data from SARS-CoV-2 pneumonia patients indicate that a cytokine storm may increase morbidity and mortality. Tocilizumab (anti-IL-6R) is FDA-approved for treatment of cytokine storm associated with chimeric antigen receptor T-cell therapy. Here we examined compassionate use of tocilizumab in patients with SARS-CoV-2 pneumonia.MethodsWe report on a single-center study of tocilizumab in hospitalized patients with SARS-CoV-2 pneumonia. All patients had confirmed SARS-CoV-2 pneumonia and oxygen saturations
Coronavirus disease (COVID-19) is rapidly spreading worldwide. Although 10–20% of patients with COVID-19 have severe symptoms, little is known about the risk factors related to the aggravation of COVID-19 symptoms from asymptomatic or mild to severe disease states.
This retrospective study included 211 patients who were asymptomatic or with mild presentations of COVID-19. We evaluated the differences in demographic and clinical data between the cured (discharged to home) and transferred (aggravated to severe-stage COVID-19) groups.
A multivariate logistic analysis showed that body temperature, chills, initial chest X-ray findings, and the presence of diabetes were significantly associated with predicting the progression to severe stage of COVID-19 (p 37.5 °C, findings of pneumonia in chest X-ray, or diabetes.
Yang D, Chu H, Hou Y, et al.
ABSTRACTClinical manifestations of COVID-19 vary from asymptomatic virus shedding, non-specific pharyngitis, to pneumonia with silent hypoxia and respiratory failure. Dendritic cells and macrophages are sentinel cells for innate and adaptive immunity that affect the pathogenesis of SARS and MERS. However, the interplay between SARS-CoV-2 and these cell types remains unknown. Herein, we investigated the infection and host response of monocyte-derived dendritic cells (moDCs) and macrophages (MDMs) infected by SARS-CoV-2. We demonstrated that moDCs and MDMs were permissive to SARS-CoV-2 infection and protein expression but did not support productive virus replication. Importantly, SARS-CoV-2 launched an attenuated interferon response in both cell types. Additionally, SARS-CoV-2 triggered significant pro-inflammatory cytokine/chemokine expression in MDMs but not in moDCs. Further investigations suggested that this attenuated immune response to SARS-CoV-2 in moDCs was associated with viral antagonism of STAT1 phosphorylation. These findings on pathogenesis may explain the mild and insidious course of COVID-19 till late deterioration.
Davide Fiore Bavaro, Mariacristina Poliseno, Arnaldo Scardapane, Alessandra Belati, Nicolò De Gennaro, Amato Antonio Stabile Ianora, Giacchino Angarano, Annalisa Saracino
Since the outbreak of COVID-19 pandemic, growing attention has been paid to the emerging association between severe forms of novel coronavirus pneumonia and
Faryal Khamis, Ibrahim Al-Zakwani, Sabria Al Hashmi, Samata Al Dowaiki, Maher Al Bahrani, Nenad Pandak, Huda Al Khalili, Ziad Memish
The novel coronavirus (“SARS-CoV-2”) pandemic continues to perpetuate globally with an estimated 7,930,989 cases and 433,783 (Wikipedia, 2020) deaths (as of June 15th, 2020) without available effective treatment or vaccine. Several randomized controlled clinical trials, in search of the cure, are in progress (Keith et al., 2020a; Keith et al., 2020b). The SARS-CoV-2 virus infects the respiratory epithelium of the lower airways, causing widespread damage via cytopathic effects, resulting in severe inflammation and pneumonitis.
Malek A, Khalil M, Hachem R, et al.
AbstractBackgroundCheckpoint inhibitor (CPI) immunotherapy has revolutionized cancer treatment. However, immune-related adverse events (irAEs) and the risk of infections are not well studied. To assess the infectious risk of CPIs, we evaluated the incidence of infections in lung cancer patients treated with CPIs plus conventional chemotherapy (CC) versus CC alone.MethodsWe performed a retrospective comparative study of patients with advanced non–small cell lung cancer who received CPIs combined with CC and those treated with CC alone at our institution during January 2016 to February 2019. We compared clinical characteristics, treatments, and outcomes including infection rate and mortality between the groups.ResultsWe identified 123 patients for the CPI group and 147 patients for the control (CC) group. Eighteen patients (15%) in the CPI group and 33 patients (22%) in the control group developed infections (P=0.1). Pneumonia was the most common infection encountered in both groups. Urinary tract infection (UTIs) was higher in CC group (40%) compared to CPI group (9%) (P=0.01). On multivariable analysis, chronic obstructive pulmonary disease (P=0.024), prior use of corticosteroids (P=0.021), and neutropenia (P
Fernandez Cruz, A., Ruiz-Antoran, B., Munoz Gomez, A., Sancho Lopez, A., Mills Sanchez, P., Centeno Soto, G. A., Blanco Alonso, S., Javaloyes Garachana, L., Galan Gomez, A., Valencia Alijo, A., Gomez Irusta, J., Payares-Herrera, C., Morras Torre, I., Sanchez Chica, E., Delgado Tellez de Cepeda, L., Callejas Diaz, A., Ramos Martinez, A., Munez Rubio, E., Avendano-Sola, C., on behalf of Puerta de Hierro COVID-19 Study Group
Background: Evidence to support the use of steroids in COVID-19 pneumonia is lacking. We aim to determine the impact of steroid use in COVID-19 pneumonia in-hospital mortality.Patients and Methods: We performed a single-center retrospective cohort study in a University hospital in Madrid, Spain, during March 2020. To determine the role of steroids in in-hospital mortality, patients admitted with SARS-CoV-2 pneumonia and treated with steroids were compared to patients not treated with steroids, adjusting by a propensity-score for steroid treatment. Survival times were compared using log-rank test. Different steroid regimens were compared, and adjusted with a second propensity score.Results: During the study period, 463 out of 848 hospitalized patients with COVID19 pneumonia fulfilled inclusion criteria. Among them, 396 (46.7%) patients were treated with steroids and 67 patients were not. Global mortality was 15.1%. Median time to steroid treatment from symptom onset was 10 days (IQR 8-13). In-hospital mortality was lower in patients treated with steroids than in controls (13.9% [55/396] versus 23.9% [16/67], HR 0.51 [0.27-0.96], p= 0.044). Steroid treatment reduced mortality by 41.8% relative to no steroid treatment (RRR 0,42 [0.048- 0.65). Initial treatment with 1 mg/kg/day of methylprednisolone versus steroid pulses was not associated with in-hospital mortality (13.5% [42/310] versus 15.1% [13/86], OR 0.880 [0.449-1.726], p=0.710).Conclusions: Our results show that survival of patients with SARS-CoV2 pneumonia is higher in patients treated with glucocorticoids than in those not treated. In-hospital mortality was not different between initial regimens of 1 mg/kg/day of methylprednisolone and glucocorticoid pulses.
Khalifa, H. O., Soliman, A. M., Saito, T., Kayama, S., Yu, L., Hisatsune, J., Sugai, M., Nariya, H., Ahmed, A. M., Shimamoto, T., Matsumoto, T., Shimamoto, T.
Carbapenem and colistin antibiotics are often the last resort treatment for severe infections caused by multidrug-resistant bacteria (1-3)....
The 2019 novel coronavirus (COVID-19) presents a major threat to public health and has rapidly spread worldwide since the outbreak in Wuhan, Hubei Province, China in 2019. To date, there have been few reports of the varying degrees of illness caused by the COVID-19.
A case of 68-year-old female with COVID-19 pneumonia who had constant pain in the right upper quadrant of her abdomen during her hospitalization that was finally diagnosed as acute cholecystitis. Ultrasound-guided percutaneous transhepatic gallbladder drainage (PTGD) was performed, and the real-time fluorescence polymerase chain reaction (RT-PCR) COVID-19 nucleic acid assay of the bile was found to be negative. PTGD, antibacterial and anti-virus combined with interferon inhalation treatment were successful.
The time course of chest CT findings is typical for COVID-19 pneumonia. PTGD is useful for acute cholecystitis in COVID-19 patients. Acute cholecystitis is likely to be caused by COVID-19 .
The novel coronavirus pneumonia (coronavirus disease 2019, COVID-19) has spread around the world. We aimed to recapitulate the clinical and CT imaging features of COVID-19 and their differences in three age groups.
The clinical and CT data of patients with COVID-19 (n = 307) that had been divided into three groups (Group 1:
Schmid-Siegert E, Richard S, Luraschi A, et al.
AbstractBackgroundThe human pathogen Pneumocystis jirovecii harbors six families of major surface glycoproteins (MSG) encoded by a single gene superfamily. MSGs are presumably responsible for antigenic variation and adhesion to host cells. The genomic organization suggests that a single member of family I is expressed at a time per cell, whereas members of the other families are simultaneously expressed.MethodsWe analyzed RNA sequences expressed in several clinical samples, using specific weighted profiles for reads sorting and single nucleotide variants calling to estimate the diversity of the expressed genes.ResultsA number of different isoforms of at least four MSG families were expressed simultaneously, including of family I for which confirmation was obtained in the wet laboratory.ConclusionThese observations suggest that every single P. jirovecii population is made of individual cells with distinct surface properties. Our results enhance our understanding of the unique antigenic variation system and cell surface structure of P. jirovecii.
Karmen-Tuohy, Savannah; Carlucci, Philip M.; Zervou, Fainareti N.; Zacharioudakis, Ioannis M.; Rebick, Gabriel; Klein, Elizabeth; Reich, Jenna; Jones, Simon; Rahimian, Joseph
SARS-CoV-2 infection continues to cause significant morbidity and mortality worldwide. Preliminary data on SARS-CoV-2 infection suggests that some immunocompromised hosts experience worse outcomes. We performed a retrospective matched cohort study to characterize outcomes in HIV-positive patients with SARS-CoV-2 infection.
Leveraging data collected from electronic medical records for all patients hospitalized at NYU Langone Health with COVID-19 between March 2, 2020 and April 23, 2020, we matched 21 HIV-positive patients to 42 non-HIV patients using a greedy nearest neighbor algorithm. Admission characteristics, laboratory results, and hospital outcomes were recorded and compared between the two groups.
While there was a trend toward increased rates of ICU admission, mechanical ventilation, and mortality in HIV-positive patients, these differences were not statistically significant. Rates for these outcomes in our cohort are similar to those previously published for all patients hospitalized with COVID-19. HIV-positive patients had significantly higher admission and peak CRP values. Other inflammatory markers did not differ significantly between groups, though HIV-positive patients tended to have higher peak values during their clinical course. Three HIV-positive patients had superimposed bacterial pneumonia with positive sputum cultures, and all three patients expired during hospitalization. There was no difference in frequency of thrombotic events or myocardial infarction between these groups.
This study provides evidence that HIV coinfection does not significantly impact presentation, hospital course, or outcomes of patients infected with SARS-CoV-2, when compared to matched non-HIV patients. A larger study is required to determine if the trends we observed apply to all HIV-positive patients.
Corresponding author: Joseph Rahimian, MD, NYU Grossman School of Medicine, Department of Medicine, 31 Washington Square West, Floor number 4, New York, NY 10011, Joseph.Rahimian@nyulangone.org
Conflicts of Interest: No authors have conflicts to declare
& These authors contributed equally and share first authorship
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Paccoud O, Tubach F, Baptiste A, et al.
AbstractBackgroundData from non-randomized studies have suggested that hydroxychloroquine could be an effective therapeutic agent against Covid-19.MethodsWe conducted an observational, retrospective cohort study involving hospitalized adult patients with confirmed, mild to severe Covid-19 in a French university hospital. Patients who received hydroxychloroquine (200mg tid dosage for 10 days) on a compassionate basis in addition to SOCwere compared to patients without contraindications to hydroxychloroquine who received SOCalone. A propensity score-weighted analysis was performed to control for confounders: age, sex, time between symptom onset and admission ≤ 7 days, Charlson comorbidity index, medical history of arterial hypertension, and obesity, NEWS2 score at admission, and pneumonia severity. The primary endpoint was time to unfavorable outcome, defined as: death, admission to an intensive care unit, or decision to withdraw or withhold life-sustaining treatments, whichever came first.ResultsData from 89 patients with laboratory-confirmed Covid-19 were analyzed, 84 of whom were considered in the primary analysis; 38 patients treated with hydroxychloroquine and 46 patients treated with SOCalone. At admission, the mean age of patients was 66 years, the median Charlson comorbidity index was 3, and the median NEWS2 severity score was 3. After propensity score weighting, treatment with hydroxycholoroquine was not associated with a significantly reduced risk of unfavorable outcome (HR 0.90 [0.38; 2.1], p = 0.81). Overall survival was not significantly different between the two groups (HR 0.89 [0.23; 3.47], p = 1)ConclusionIn hospitalized adults with Covid-19, no significant reduction of the risk of unfavorable outcomes was observed with hydroxychloroquine in comparison to standard of care. Unmeasured confounders may however have persisted despite careful propensity-weighted analysis and the study might be underpowered. Ongoing controlled trials in patients with varying degrees of initial severity on a larger scale will help determine whether there is a place for hydroxychloroquine in the treatment of Covid-19.
HIV/AIDS and LGBT rights activist and author. Born in Bridgeport, CT, USA, on June 25, 1935, he died of pneumonia on May 27, 2020, in New York, NY, USA, aged 84 years.
Especially in elderly and multimorbid patients, Coronavirus Disease 2019 (COVID-19) may result in severe pneumonia and secondary complications. Recent studies showed pneumothorax in rare cases, but tension pneumothorax has only been reported once.
A 47-year-old male was admitted to the emergency department with fever, dry cough and sore throat for the last 14 days as well as acute stenocardia and shortage of breath. Sputum testing (polymerase chain reaction, PCR) confirmed SARS-CoV-2 infection. Initial computed tomography (CT) showed bipulmonary groundglass opacities and consolidations with peripheral distribution. Hospitalization with supportive therapy (azithromycin) as well as non-invasive oxygenation led to a stabilization of the patient. After 5 days, sputum testing was negative and IgA/IgG antibody titres were positive for SARS-CoV-2. The patient was discharged after 7 days.
On the 11th day, the patient realized pronounced dyspnoea after coughing and presented to the emergency department again. CT showed a right-sided tension pneumothorax, which was relieved by a chest drain (Buelau) via mini open thoracotomy. Negative pressure therapy resulted in regression of the pneumothorax and the patient was discharged after 9 days of treatment.
Treating physicians should be aware that COVID-19 patients might develop severe secondary pulmonary complications such as acute tension pneumothorax.
Level of evidence
Y. Chen et al.
Pietro Minuz, Giancarlo Mansueto, Fulvia Mazzaferri, Cristiano Fava, Andrea Dalbeni, Maria Chiara Ambrosetti, Marcella Sibani, Evelina Tacconelli
Recently, thromboembolic events have been reported in 20/81 patients with severe SARS-CoV-2 pneumonia admitted to intensive care units (ICUs). About 90% of patients showed an increased coagulation activity, including high D-dimer concentrations, which demonstrated 85% sensitivity and 89% specificity for identifying high-risk groups for thromboembolic events . Moreover, the cytokine storm syndrome has been proposed to cause a hypercoagulable state in COVID-19 patients [2, 3].
Aitken S, Sahasrabhojane P, Kontoyiannis D, et al.
AbstractBackgroundStenotrophomonas maltophilia is increasingly common in patients with acute myeloid leukemia (AML). Relatively little is known about factors that drive S. maltophilia infection. We evaluated the utility of the microbiome and cumulative antibiotic use as predictors of S. maltophilia infection in AML patients receiving remission induction chemotherapy (RIC).MethodsWe performed a sub-analysis of a prospective, observational cohort of patients with AML receiving RIC between 9/2013 and 8/2015. Fecal and oral microbiome samples collected from the start of RIC until neutrophil recovery were assessed for the relative abundance of Stenotrophomonas via 16S rRNA gene quantitation. The primary outcome, microbiologically-proven S. maltophilia infection, was analyzed using a time-varying Cox proportional hazards model.ResultsOf 90 included patients, 8 (9%) developed S. maltophilia infection (pneumonia, n=6; skin/soft-tissue, n=2). 4/8 (50%) patients were bacteremic. 7/8 (88%) patients with S. maltophilia infection had detectable levels of Stenotrophomonas vs 22/82 (27%) without infection (p < 0.01). An oral Stenotrophomonas relative abundance of 36% predicted infection (sensitivity: 96%, specificity 93%). No association of S. maltophilia infection with fecal relative abundance was found. Cumulative meropenem exposure was associated with increased infection risk (hazard ratio [HR] 1.17, 95% CI 1.01 – 1.35, p = 0.03).ConclusionsHerein, we identify the oral microbiome as a potential source for S. maltophilia infection and highlight cumulative carbapenem use as a risk factor for S. maltophilia in leukemia patients. These data suggest that real-time molecular monitoring of the oral cavity might identify patients at high risk for S. maltophilia infection.
Dudoignon E, Caméléna F, Deniau B, et al.
Streptococcus pneumoniae infections can lead to severe morbidity and mortality, especially in patients with invasive pneumococcal disease (IPD). This study evaluated factors associated with pneumococcal disease, pneumococcal vaccine effectiveness, and risk factors for all-cause mortality in hospitalised adults with pneumococcal disease in Singapore.
Retrospective case-control study of patients tested for pneumococcal disease with streptococcal urinary antigen testing and at least one sterile site culture, during their admission to a tertiary hospital in Singapore from 2015 to 2017. Patients were defined as cases of IPD or non-IPD, or as controls, based on laboratory results and clinical diagnoses. Multivariable models were constructed to determine factors associated with IPD/non-IPD, and risk factors for mortality from pneumococcal disease. Vaccine effectiveness against IPD/non-IPD was estimated using a variation of the test-negative design.
We identified 496 pneumococcal disease cases, of whom 92 (18.5%) had IPD. The mean age of cases was 69.1 ± 15.4 years, and 65.5% were male. Compared with controls (N = 9181), IPD patients were younger (mean age 61.5 ± 16.3 years, vs 72.2 ± 16.1 years in controls; p
Mycoplasma pneumoniae (M. pneumoniae) is an important pathogen of community-acquired pneumonia (CAP) in children. The coinfection rate of M. pneumoniae pneumonia (MPP) can reach 52% in some areas, but the effects of coinfection with different pathogens have not been clearly recognized.
The cases of MPP hospitalized in Beijing Children’s Hospital from 1/1/2014 to 12/31/2016 were screened. MPP patients coinfected with Human adenovirus (HAdV) were categorized into the research group. Patients with single M. pneumoniae infection were categorized into the control group, matching the research group by age and admission time with a ratio of 1:3. Clinical manifestations, laboratory examinations, and disease severity were compared between these two groups.
A total of 2540 hospitalized MPP cases were screened in Beijing Children’s Hospital, among which thirty cases were enrolled in the research group and ninety cases were enrolled in the control group. The results indicated that patients in the research group had longer hospital stays, longer fever durations and a higher rate of dyspnea, as well as a larger proportion applications of oxygen therapy and noninvasive continuous positive airway pressure (NCPAP). No obvious differences were found in lab examinations within the two groups. Regarding disease severity, the proportions of extremely severe pneumonia and severe disease defined by the clinical score system were higher in the research group than in the control group.
Compared with single M. pneumoniae infection, MPP coinfected with HAdV in children was relatively more serious.
International Liver Congress (ILC) 2020
27.08.2020 - 29.08.2020
World Sepsis Day
Det 8. videnskabelige nationale møde om infektiøs endokarditis
International Congress for Tropical Medicine and Malaria (ICTMM) 2020
20.09.2020 - 24.09.2020
Meeting of the European Society for Immunodeficiencies (ESID) 2020
14.10.2020 - 17.10.2020
COVID-19 retningslinje (2020)
National handlingsplan for antibiotika til mennesker (2017)
Retningslinjer til sundhedsprofessionelle vedr. håndtering af infektion med zikavirus (2019)
Infections in Patients Colonized with Extended-Spectrum Beta-Lactamase-Producing Enterobacterales – a Retrospective Cohort Study
30.07.2020Clinical Infectious Diseases Advance Access
Effectiveness of Cloth Masks for Protection Against Severe Acute Respiratory Syndrome Coronavirus 2
22.07.2020Emerging Infectious Diseases Journal
Coronavirus Disease among Persons with Sickle Cell Disease, United States, March 20–May 21, 2020
22.07.2020Emerging Infectious Diseases Journal
COVID-19: the worst may be yet to come
First step in a new era for treatment of patients with vitiligo
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