Reinfection in COVID-19: A scoping review

Reinfections in COVID-19 are being reported all around the world and are a cause for concern, considering that a lot of our assumptions and modeling (including vaccination) related to the disease have relied on long-term immunity. We were one of the first groups to report a series of 4 healthcare workers to have been reinfected. This review article reports a scoping review of the available literature on reinfections, with a discussion of the implications of reinfections.

Nontuberculous mycobacterial infection of the musculoskeletal system in immunocompetent hosts

BACKGROUND

Nontuberculous mycobacteria (NTM) were considered saprophytic organisms for many years but now are recognized as human pathogens. Although humans are routinely exposed to NTM, the rate of clinical infection is low. Such infections usually occur in the elderly and in patients who are immunocompromised. However, there has been an increasing incidence in recent years of infections in immunocompetent hosts. NTM infections in immunocompetent individuals are secondary to direct inoculation either contamination from surgical procedures or penetrating injuries rather than hematogenous dissemination. Clinically and on histopathology, musculoskeletal infections caused by NTM resemble those caused by Mycobacterium tuberculosis but are mostly resistant to routine antituberculosis medicines.

MATERIALS AND METHODS

Six cases of NTM infection in immunocompetent hosts presenting to the department from 2004 to 2015 were included in study. Of which two cases (one patella and one humerus) of infection were following an open wound due to trauma while two cases (one hip and one shoulder) of infection were by inoculation following an intraarticular injection for arthrogram of the joint, one case was infection following arthroscopy of knee joint and one case (calcaneum) was infection following local injection for the treatment of plantar fasciitis. All patients underwent inaging and tissue diagnosis with samples being sent for culture, staining, and histopathology.

RESULTS

Clinical suspicion of NTM inoculation led to the correct diagnosis (four cases with culture positive and two cases with histopathological diagnosis). There treatment protocol for extrapulmonary NTM infection was radical surgical debridement and medical management based on drug sensitivity testing in culture positive cases. At a mean follow up of 3 years (range1-9 years) all patients had total remission and excellent results.

CONCLUSIONS

Whenever a case of chronic granulomatous infection is encountered that does not respond to standard anti-tuberculous treatment, with a history of open trauma, surgical intervention, or injection as shown in this study, a possible NTM infection should be considered and managed appropriately.

Musculoskeletal melioidosis: An under-diagnosed entity in developing countries

BACKGROUND

Melioidosis is a saprophytic infectious disease caused by Gram-negative soil-dwelling bacillus Burkholderia pseudomallei.

MATERIALS & METHODS

We report three cases of musculoskeletal melioidosis that are presented to our department from 2011 to 2013.

RESULTS

One of the patients died due to post-septicemic ARDS. The other two patients have recovered fully and are followed up for minimum of 6 months. There were no recurrences.

CONCLUSIONS

Though musculoskeletal infection due to melioidosis is not common in India, new cases are being reported from Karnataka, Goa and Southern Maharashtra. The need for diagnosing this entity is due to the fact that the septicemic form has a mortality rate that exceeds 90%, and though culture sensitivity report shows susceptibility to various antibiotics, the infection responds to only specific set of antibiotics i.e. intravenous ceftazidime and combination of trimethoprim and sulfamethoxazole.