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Kakoullis L, Economidou S, Mehrotra P, Panos G, Karampitsakos T, Stratakos G, Tzouvelekis A, Sampsonas F. Bronchoscopy-related outbreaks and pseudo-outbreaks: A systematic review. Infect Control Hosp Epidemiol 2024; 45:509-519. [PMID: 38099453 DOI: 10.1017/ice.2023.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
OBJECTIVE To identify and report the pathogens and sources of contamination associated with bronchoscopy-related outbreaks and pseudo-outbreaks. DESIGN Systematic review. SETTING Inpatient and outpatient outbreaks and pseudo-outbreaks after bronchoscopy. METHODS PubMed/Medline databases were searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, using the search terms "bronchoscopy," "outbreak," and "pseudo-outbreak" from inception until December 31, 2022. From eligible publications, data were extracted regarding the type of event, pathogen involved, and source of contamination. Pearson correlation was used to identify correlations between variables. RESULTS In total, 74 studies describing 23 outbreaks and 52 pseudo-outbreaks were included in this review. The major pathogens identified in these studies were Pseudomonas aeruginosa, Mycobacterium tuberculosis, nontuberculous mycobacteria (NTM), Klebsiella pneumoniae, Serratia marcescens, Stenotrophomonas maltophilia, Legionella pneumophila, and fungi. The primary sources of contamination were the use of contaminated water or contaminated topical anesthetics, dysfunction and contamination of bronchoscopes or automatic endoscope reprocessors, and inadequate disinfection of the bronchoscopes following procedures. Correlations were identified between primary bronchoscope defects and the identification of P. aeruginosa (r = 0.351; P = .002) and K. pneumoniae (r = 0.346; P = .002), and between the presence of a contaminated water source and NTM (r = 0.331; P = .004) or L. pneumophila (r = 0.280; P = .015). CONCLUSIONS Continued vigilance in bronchoscopy disinfection practices remains essential because outbreaks and pseudo-outbreaks continue to pose a significant risk to patient care, emphasizing the importance of stringent disinfection and quality control measures.
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Affiliation(s)
- Loukas Kakoullis
- Department of Medicine, Mount Auburn Hospital, Cambridge, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - Sofia Economidou
- Department of Medicine, Mount Auburn Hospital, Cambridge, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - Preeti Mehrotra
- Harvard Medical School, Boston, Massachusetts, United States
- Division of Infection Controland Hospital Epidemiology, Silverman Institute for Health Care Quality and Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - George Panos
- Department of Internal Medicine, Division of Infectious Diseases, University General Hospital of Patras, Patras, Greece
| | - Theodoros Karampitsakos
- Ubben Center and Laboratory for Pulmonary Fibrosis Research, University of South Florida, Tampa, Florida, United States
| | - Grigorios Stratakos
- Department of Respiratory Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Argyrios Tzouvelekis
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Fotios Sampsonas
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
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Kakoullis L, Vaz VR, Kaur D, Kakoulli S, Panos G, Chen LH, Behlau I. Powassan Virus Infections: A Systematic Review of Published Cases. Trop Med Infect Dis 2023; 8:508. [PMID: 38133440 PMCID: PMC10747444 DOI: 10.3390/tropicalmed8120508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Powassan virus is an emerging neurotropic arbovirus transmitted by the tick Ixodes scapularis. This systematic review was conducted to aggregate data on its clinical manifestations, diagnostic findings, and complications. METHODS PubMed was searched until August 2023 using the term "Powassan", to identify all published cases of Powassan virus infections, as per PRISMA guidelines. RESULTS Among the 380 abstracts identified, 45 studies describing 84 cases (70 adult, 14 pediatric) were included. Cases were reported from the USA and Canada. Complications included paralysis in 44.1% of adult and 42.6% of pediatric cases, cognitive deficits in 33.3% of adult and 25% of pediatric cases, while the mortality rate was 19.1% and 7.1% in the adult and pediatric populations, respectively. Correlation analysis revealed an association between mortality and age (r = 0.264, p = 0.029), development of paralysis (r = 0.252, p = 0.041), or respiratory distress or failure (r = 0.328, p = 0.006). Factors associated with persistent neurological deficits were development of ataxia (r = 0.383, p = 0.006), paralysis (r = 0.278, p = 0.048), speech disorder (r = 0.319, p = 0.022), and cranial nerve involvement (r = 0.322, p = 0.017). Other significant correlations included those between speech disorders and ataxia (r = 0.526, p < 0.001), and between paralysis and respiratory distress or failure (r = 0.349, p = 0.003). CONCLUSION Powassan virus infections have significant morbidity and mortality and should be suspected in cases of encephalitis and possible tick exposure. PROSPERO registration number: CRD42023395991.
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Affiliation(s)
- Loukas Kakoullis
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA 02138, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Victor Renault Vaz
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA 02138, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Divmehar Kaur
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA 02138, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Sonia Kakoulli
- Medical School, University of Groningen, 9712 Groningen, The Netherlands
| | - George Panos
- Division of Infectious Diseases, Department of Medicine, School of Health Sciences, University of Patras, 26504 Patras, Greece
| | - Lin H. Chen
- Harvard Medical School, Boston, MA 02115, USA
- Division of Infectious Diseases and Travel Medicine, Department of Medicine, Mount Auburn Hospital, Cambridge, MA 02138, USA
| | - Irmgard Behlau
- Harvard Medical School, Boston, MA 02115, USA
- Division of Infectious Diseases and Travel Medicine, Department of Medicine, Mount Auburn Hospital, Cambridge, MA 02138, USA
- Molecular Biology and Microbiology and Ophthalmology, Tufts Graduate School of Biomedical Sciences, Tufts University School of Medicine, Boston, MA 02111, USA
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Mulita F, Liolis E, Akinosoglou K, Tchabashvili L, Maroulis I, Kaplanis C, Vailas M, Panos G. Postoperative sepsis after colorectal surgery: a prospective single-center observational study and review of the literature. Prz Gastroenterol 2022; 17:47-51. [PMID: 35371356 PMCID: PMC8942007 DOI: 10.5114/pg.2021.106083] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/12/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Postoperative sepsis represents a significant problem in colorectal surgery patients. AIM To identify the etiology as well as the risk factors associated with the development of postoperative sepsis, based on prospective data of patients undergoing colorectal surgery at a single large-volume institution. MATERIAL AND METHODS Between November 2019 and February 2021, 141 patients underwent an elective operation for colorectal cancer at a tertiary hospital center. The following variables were recorded for each patient: age, gender, American Society of Anesthesiologists Classification (ASA class), duration of surgery, surgical approach, comorbidities (diabetes, cardiovascular disease, respiratory disease). Univariate analysis was performed using χ2 tests for categorical variables. RESULTS A total of 69 males and 72 females were enrolled. Postoperative sepsis was diagnosed in 18 (12.77%) cases, with anastomotic leakage being the most frequent cause (3.55%). There was no statistically significant difference in the presence of sepsis among patients when gender, surgical approach, duration of surgery, and respiratory disease were taken into account. Sixty-nine patients were > 65 years old, with sepsis being statistically significant in this group (p = 0.034). Furthermore, patients with ASA class ≤ 2 developed postoperative sepsis less frequently than patients with advanced ASA scores (p = 0.008). Diabetes and cardiovascular disease also reach statistical significance; sepsis was more frequent in this group of patients (p = 0.013 and p = 0.009, respectively). CONCLUSIONS Following colorectal cancer procedures, postoperative sepsis was significantly more common among patients over 65 years old, ASA score > 2, and also with associated comorbidities such as diabetes and cardiovascular disease.
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Affiliation(s)
- Francesk Mulita
- Department of General Surgery, General University Hospital, Patras, Greece
- Address for correspondence: Dr. Francesk Mulita, Department of General Surgery, General University Hospital, Patras, Greece, e-mail:
| | - Elias Liolis
- Department of Internal Medicine, Division of Oncology, General University Hospital, Patras, Greece
| | - Karolina Akinosoglou
- Department of Internal Medicine and Infectious Diseases, General University Hospital, Patras, Greece
| | - Levan Tchabashvili
- Department of General Surgery, General University Hospital, Patras, Greece
| | - Ioannis Maroulis
- Department of General Surgery, General University Hospital, Patras, Greece
| | | | - Michail Vailas
- Department of General Surgery, General University Hospital, Patras, Greece
| | - George Panos
- Department of Internal Medicine and Infectious Diseases, General University Hospital, Patras, Greece
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Abstract
ABSTRACT Paraneoplastic arthritides are a group of inflammatory rheumatic syndromes induced by an occult and manifest malignancy, characterized by a wide range of musculoskeletal signs and symptoms that masquerade other rheumatic diseases such as rheumatoid arthritis. Although the pathogenesis of paraneoplastic arthritides is unknown, immune-mediated mechanisms can induce a paraneoplastic syndrome, with a dominant feature the polyarthritis. Common entities of paraneoplastic arthritides include paraneoplastic polyarthritis, hypertrophic osteoarthropathy, remitting seronegative symmetrical synovitis with pitting edema, palmar fasciitis and polyarthritis, and polyarthritis and panniculitis associated with pancreatic carcinoma. The electronic databases PubMed and Scopus were scrutinized using the following terms: paraneoplastic arthritis, paraneoplastic polyarthritis, or paraneoplastic rheumatic diseases. Abstracts, full articles, and selected references were reviewed. The aim of the present narrative review article was to describe the clinical characteristics, diagnostic evaluation, and management of paraneoplastic arthritides, and highlight the challenges that health care providers may encounter, distinguishing those conditions from other autoimmune rheumatic disorders. Future studies are needed to give insight into the mechanisms associated with paraneoplastic arthritides, leading to the development of novel diagnostic biomarkers.
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Affiliation(s)
- Konstantinos Parperis
- From the Division of Rheumatology, Department of Internal Medicine, University of Arizona College of Medicine/Maricopa Integrated Health System, Phoenix, AZ; and University of Cyprus Medical School
| | | | - George Panos
- Department of Internal Medicine, University of Cyprus Medical School, Nicosia, Cyprus
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Papaioannou M, Neocleous A, Savva P, Miguel F, Panayides A, Antoniou Z, Neofytou M, Schiza EC, Neokleous K, Constantinou I, Panos G, Pattichis CS, Schizas CN. A Prototype of the National EHR system for Cyprus . Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:2159-2162. [PMID: 34891716 DOI: 10.1109/embc46164.2021.9630760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The aim of this paper is to present Cyprus' initiative for the design and the implementation of the prototype of the integrated electronic health record at a national level that will establish the foundations of the country's broader eHealth ecosystem. The latter, requires an interdisciplinary approach and scientific collaboration among various fields, including medicine, information and communication technologies, management, and finance, among others. The objective, is to design the system architecture, specify the requirements in terms of clinical content as well as the hardware infrastructure, but also implement European and national legislation with respect to privacy and security that govern sensitive medical data manipulation. The present study summarizes the outcomes of the 1st phase of this initiative, which comprises of the healthcare as well as the administrative requirements, user stories, data-flows and associated functionality. Moreover, leveraging the HL7 Fast Healthcare Interoperability Resources (FHIR) standard we highlight the concluded interoperability framework that allows genuine cross-system communication and defines third-party systems connectivity.Clinical Relevance- This work is strongly correlated with medicine since it describes the system requirements and the architecture of a national integrated electronic health records system.
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Mulita F, Tchabashvili L, Liolis E, Vailas M, Akinosoglou K, Maroulis I, Panos G. 413P Butyrylcholinesterase as a predictive marker for wound infection in elective colorectal cancer surgery. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Mulita F, Liolis E, Tchabashvili L, Vailas M, Akinosoglou K, Assimakopoulos S, Maroulis I, Panos G. 1630P The impact of the COVID-19 outbreak on surgical site infections in elective colorectal cancer surgery: One potential benefit of the pandemic? Ann Oncol 2021. [PMCID: PMC8454339 DOI: 10.1016/j.annonc.2021.08.1623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Panos G, Mulita F, Akinosoglou K, Liolis E, Kaplanis C, Tchabashvili L, Vailas M, Maroulis I. Risk of surgical site infections after colorectal surgery and the most frequent pathogens isolated: a prospective single-centre observational study. Med Glas (Zenica) 2021; 18:438-443. [PMID: 34080408 DOI: 10.17392/1348-21] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/05/2021] [Accepted: 03/18/2021] [Indexed: 02/07/2023]
Abstract
Aim To identify risk factors for developing surgical site infections (SSIs) based on a prospective study of patients undergoing colorectal surgery. Methods Between November 2019 and January 2021, 133 patients underwent elective operation for colorectal cancer in our institution. The following variables were recorded for each patient: age, gender, body mass index (BMI), American Society of Anesthesiologists Classification (ASA class), duration of surgery, wound classification, skin preparation regimens, surgical approach, comorbidities (hypertension, diabetes, cardiovascular disease, respiratory disease, chronic steroid use), and pathogens responsible for surgical site infection. Univariate analysis was performed using χ2 tests for categorical variables. Results A total of 65 males and 68 females were enrolled. Postoperative SSI was diagnosed in 29 (21.8%) cases. Fifty five patients were >70 years old, and SSIs were significantly more frequent in this group (p=0.033). There were 92 patients with BMI <30kg/m2 and 87 with ASA class ≤2; SSIs occurred significantly less frequently in these patients (p=0.021 and p=0.028, respectively). Open surgery was performed in 113 patients; 35 (out of 113; 31%) wound infections were classified as contaminated or dirty, and SSI occurred more often in these two groups (p=0.048 and p=0.037, respectively). Nineteen patients had diabetes and 36 used steroids continuously; SSI was significantly more frequent in these patients (p=0.021 and p=0.049, respectively). Conclusion Following colorectal cancer procedures SSIs were significantly more common among patients over 70 years old, BMI≥30kg/m2 , ASA score>2, with diabetes and chronic steroid use, undergoing open, dirty or contaminated surgery. Escherichia coli and Enterococcus spp. were the two most common pathogens isolated.
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Affiliation(s)
- George Panos
- Department of Internal Medicine and Infectious Diseases, University General Hospital, Patras, Greece
| | - Francesk Mulita
- Department of General Surgery, University General Hospital, Patras, Greece
| | - Karolina Akinosoglou
- Department of Internal Medicine and Infectious Diseases, University General Hospital, Patras, Greece
| | - Elias Liolis
- Department of Internal Medicine, Division of Oncology, University General Hospital, Patras, Greece
| | | | - Levan Tchabashvili
- Department of General Surgery, University General Hospital, Patras, Greece
| | - Michail Vailas
- Department of General Surgery, University General Hospital, Patras, Greece
| | - Ioannis Maroulis
- Department of General Surgery, University General Hospital, Patras, Greece
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Kakoullis L, Sampsonas F, Karamouzos V, Kyriakou G, Parperis K, Papachristodoulou E, Christophi C, Lykouras D, Kalogeropoulou C, Daoussis D, Panos G, Velissaris D, Karkoulias K, Spiropoulos K. The impact of osteoporosis and vertebral compression fractures on mortality and association with pulmonary function in COPD: A meta-analysis. Joint Bone Spine 2021; 89:105249. [PMID: 34265476 DOI: 10.1016/j.jbspin.2021.105249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/29/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Osteoporosis is highly prevalent among patients with chronic obstructive pulmonary disease (COPD) and most commonly presents as a vertebral compression fracture (VCF). Our objective was to quantify the effect of osteoporosis and VCFs on the mortality and pulmonary function tests (PFTs), such as forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), of patients with COPD. METHODS A PubMed/Medline search was conducted using the search terms "chronic obstructive pulmonary disease", "osteoporosis" and "vertebral compression fracture". Meta-analyses were conducted to evaluate the differences in mortality and PFTs between patients with COPD with and without osteoporosis or VCFs, according to PRISMA guidelines. PROSPERO registration: CRD42019120335. RESULTS Of the 896 abstracts identified, 27 studies describing 7662 patients with COPD of which 1883 (24.6%) had osteoporosis or VCFs, were included. Random effects model analysis demonstrated that patients with COPD and osteoporosis or VCFs had an increased OR for mortality of 2.40 (95% CI: 1.24; 4.64, I2=89%, P<0.01), decreased FEV1/FVC with a mean difference of -4.80% (95% CI: -6.69; -2.90, I2=83%, P<0.01) and decreased FEV1, with a mean difference of -4.91% (95% CI: -6.51; -3.31, I2=95%, P<0.01) and -0.41 L (95% CI: -0.59; -0.24, I2=97%, P<0.01), compared to control subjects. Apart from FEV1 (liters) in subgroup 1 (P=0.06), all subgroup analyses found significant differences between groups, as did sensitivity analysis of low risk of bias studies. CONCLUSION Osteoporosis and VCFs are associated with a significant reduction in survival and pulmonary function among patients with COPD.
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Affiliation(s)
- Loukas Kakoullis
- Department of Respiratory Medicine, University General Hospital of Patras, Patras, Greece.
| | - Fotios Sampsonas
- Department of Respiratory Medicine, University General Hospital of Patras, Patras, Greece
| | | | - George Kyriakou
- Department of Medicine, University of Patras School of Health Sciences, Patras, Greece
| | - Konstantinos Parperis
- Department of Internal Medicine, Division of Rheumatology, University of Cyprus Medical School, Nicosia, Cyprus
| | | | - Costas Christophi
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Dimosthenis Lykouras
- Department of Respiratory Medicine, University General Hospital of Patras, Patras, Greece
| | | | - Dimitrios Daoussis
- Department of Rheumatology, University of Patras Medical School, Patras, Greece
| | - George Panos
- Department of Internal Medicine, Division of Infectious Diseases, University General Hospital of Patras, Patras, Greece
| | - Dimitrios Velissaris
- Department of Internal Medicine, University General Hospital of Patras, Patras, Greece
| | - Kyriakos Karkoulias
- Department of Respiratory Medicine, University General Hospital of Patras, Patras, Greece
| | - Kostas Spiropoulos
- Department of Respiratory Medicine, University General Hospital of Patras, Patras, Greece
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Kakoullis L, Parperis K, Psarelis S, Papachristodoulou E, Panos G. AB0647 CATASTROPHIC ANTIPHOSPHOLIPID SYNDROME TRIGGERED BY CONCURRENT VZV AND HSV INFECTION. A CASE REPORT. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Catastrophic antiphospholipid syndrome (CAPS) is a severe autoimmune condition, characterized by multiorgan failure due to thromboses and/or hemorrhage. Concurrent HSV/VZV infection is an exceedingly rare event, occurring mostly in immunocompromised patients. Herein, we report the first case of CAPS triggered by concurrent HSV/VZV infection, manifesting with zosteriform rash and haemorrhages at multiple sites.Objectives:To describe a case of CAPS provoked by concurrent HSV/VZV infection, manifesting with zosteriform rash and haemorrhages at multiple sites.Methods:A 36-year-old male, with a history of antiphospholipid syndrome (APS) presented with a 5-day history of epigastric pain, associated with fever, hematuria, rash and swelling in bilateral ears. Past medical history was remarkable for APS, based on 4 episodes of DVT/PE and triple positive antiphospholipid antibodies, on chronic well-maintained warfarin anticoagulation. On examination, a purpuric rash was evident on the right side of the neck as well as on both ears, consistent with a C3 dermatomal distribution (Figure 1). Laboratory studies revealed anemia, thrombocytopenia and acute kidney injury.Figure 1.Results:A full-body CT scan demonstrated the presence of multifocal lymphadenopathy, alveolar infiltrates suggestive of diffuse alveolar haemorrhage, and haemorrhage in both kidneys and the left adrenal gland; anticoagulation was held, despite the INR being within the patient’s baseline therapeutic levels. He was admitted with a working diagnosis of CAPS and possible zoster infection. Appropriate immunologic workup was requested. He was prescribed intravenous acyclovir, antibiotics, pulse dose of glucocorticoids, and IVIG. Bronchoscopy with bronchoalveolar lavage revealed the presence of haemosiderin-laden macrophages. The rash regressed, and the patients’ condition improved. He was discharged with glucocorticoid tapering regimen, hydroxychloroquine, aspirin and warfarin.Antibody titers were taken prior to IVIG administration at presentation, and at 4 weeks. High VZV IgG titers found at presentation regressed over four times on follow-up. Furthermore, at 4 weeks the patient had developed IgM antibodies against both VZV and HSV. These findings confirmed a concurrent infection.Conclusion:This is the first report of coexisting HSV/VZV infection associated with CAPS. A literature review identified a total of 28 patients with coexisting HSV/VZV infection, whereas only one case of CAPS triggered by HSV was identified1. This case illustrates that concurrent infection can occur in the absence of immunosuppressive therapy in patients with APS, serving as a trigger for hemorrhagic CAPS. Simultaneous treatment with antiviral against herpesviruses, glucocorticoids and IVIG may mitigate the inflammatory cascade associated with CAPS.References:[1]Catoggio C, Alvarez-Uría A, Fernandez PL, Cervera R, Espinosa G. Catastrophic antiphospholipid syndrome triggered by fulminant disseminated herpes simplex infection in a patient with systemic lupus erythematosus. Lupus. 2012 Oct;21(12):1359-61.Disclosure of Interests:None declared.
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Kakoullis L, Papachristodoulou E, Chra P, Panos G. Mechanisms of Antibiotic Resistance in Important Gram-Positive and Gram-Negative Pathogens and Novel Antibiotic Solutions. Antibiotics (Basel) 2021; 10:415. [PMID: 33920199 PMCID: PMC8069106 DOI: 10.3390/antibiotics10040415] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 01/04/2023] Open
Abstract
Multidrug-resistant bacteria have on overwhelming impact on human health, as they cause over 670,000 infections and 33,000 deaths annually in the European Union alone. Of these, the vast majority of infections and deaths are caused by only a handful of species-multi-drug resistant Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus spp., Acinetobacter spp. and Klebsiella pneumoniae. These pathogens employ a multitude of antibiotic resistance mechanisms, such as the production of antibiotic deactivating enzymes, changes in antibiotic targets, or a reduction of intracellular antibiotic concentration, which render them insusceptible to multiple antibiotics. The purpose of this review is to summarize in a clinical manner the resistance mechanisms of each of these 6 pathogens, as well as the mechanisms of recently developed antibiotics designed to overcome them. Through a basic understanding of the mechanisms of antibiotic resistance, the clinician can better comprehend and predict resistance patterns even to antibiotics not reported on the antibiogram and can subsequently select the most appropriate antibiotic for the pathogen in question.
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Affiliation(s)
- Loukas Kakoullis
- Department of Respiratory Medicine, University General Hospital of Patras, 26504 Patras, Greece;
| | - Eleni Papachristodoulou
- Department of Medicine, School of Health Sciences, University of Patras, 26504 Patras, Greece;
| | - Paraskevi Chra
- Department of Microbiology, Evangelismos Hospital, 10676 Athens, Greece;
| | - George Panos
- Department of Internal Medicine, Division of Infectious Diseases, University General Hospital of Patras, 26504 Patras, Greece
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Kakoullis L, Eliades E, Papachristodoulou E, Parperis K, Chra P, Constantinidou A, Chatzittofis A, Sampsonas F, Panos G. Response to COVID-19 in Cyprus: Policy changes and epidemic trends. Int J Clin Pract 2021; 75:e13944. [PMID: 33338320 PMCID: PMC7883066 DOI: 10.1111/ijcp.13944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/14/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES In late July, Cyprus experienced the second epidemic wave of COVID-19. We present the steps taken by the government and evaluate their effect on epidemic trends. MATERIALS Cyprus Press and Information Office data were analysed. Using an R-based forecasting program, two models were created to predict cases up to 01/09/2020: Model 1, which utilised data up to 09/06/2020, when airports reopened to foreign travelers with COVID-19 screening; and Model 2, which utilised data until 24/06/2020, when screening for passengers from low-transmission countries was discontinued. RESULTS PIO data revealed no significant policy changes between 24/06/2020 and 31/07/2020. Prediction models were robust and accurate (Model 1, R2 = 0.999, P < .001; Model 2, R2 = 0.998, P < .001). By August 30th, recorded cases exceeded those predicted by Model 1 by 24.47% and by Model 2 by 20.95%, with P values <.001 for both cases. CONCLUSIONS The significant difference between recorded cases and those projected by Models 1 and 2 suggests that changes in epidemic trends may have been associated with policy changes after their respective dates. Discontinuation of major restrictions such as airport reopening, can destabilise the control of the epidemic, and may concomitantly necessitate a reevaluation of the current epidemic status. In the face of an evolving situation such as the COVID-19 pandemic, states are forced to balance the imposing of restrictions against their impact on the economy.
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Affiliation(s)
- Loukas Kakoullis
- Department of Respiratory MedicineUniversity of Patras General HospitalPatrasGreece
| | - Elias Eliades
- Department of Health SciencesUniversity of UlsterBelfastUK
| | | | - Konstantinos Parperis
- Department of Internal MedicineUniversity of Cyprus Medical SchoolNicosiaCyprus
- Department of Medicine, Division of RheumatologyUniversity of Arizona College of MedicinePhoenixAZUSA
| | - Paraskevi Chra
- Department of MicrobiologyEvangelismos HospitalAthensGreece
| | | | | | - Fotios Sampsonas
- Department of Respiratory MedicineUniversity of Patras General HospitalPatrasGreece
| | - George Panos
- Department of Internal MedicineUniversity of Cyprus Medical SchoolNicosiaCyprus
- Department of Internal Medicine, Section of Infectious DiseasesUniversity of Patras General HospitalPatrasGreece
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Quattrocchi A, Mamais I, Tsioutis C, Christaki E, Constantinou C, Koliou M, Pana ZD, Silvestros V, Theophanous F, Haralambous C, Stylianou A, Sotiriou S, Athanasiadou M, Kyprianou T, Demetriou A, Demetriou CA, Kolokotroni O, Gregoriou I, Paphitou N, Panos G, Kostrikis L, Karayiannis P, Petrikkos G, Agathangelou P, Mixides G, Siakallis G, Hadjihannas L, Palazis L, Vavlitou A, Matsentidou-Timiliotou C, Koukios D, Adamidi T, Frangopoulos F, Constantinou E, Nikolopoulos G. Extensive Testing and Public Health Interventions for the Control of COVID-19 in the Republic of Cyprus between March and May 2020. J Clin Med 2020; 9:E3598. [PMID: 33171651 PMCID: PMC7695263 DOI: 10.3390/jcm9113598] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/31/2020] [Accepted: 11/05/2020] [Indexed: 12/24/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has significantly affected the well-being of individuals worldwide. We herein describe the epidemiology of COVID-19 in the Republic of Cyprus during the first epidemic wave (9 March-3 May 2020). We analyzed surveillance data from laboratory-confirmed cases, including targeted testing and population screening. Statistical analyses included logistic regression. During the surveillance period, 64,136 tests (7322.3 per 100,000) were performed, 873 COVID-19 cases were diagnosed, and 20 deaths were reported (2.3%). Health-care workers (HCWs) represented 21.4% of cases. Overall, 19.1% of cases received hospital care and 3.7% required admission to Intensive Care Units. Male sex (adjusted Odds Ratio (aOR): 3.04; 95% Confidence Interval (CI): 1.97-4.69), increasing age (aOR: 1.56; 95%CI: 1.36-1.79), symptoms at diagnosis (aOR: 6.05; 95%CI: 3.18-11.50), and underlying health conditions (aOR: 2.08; 95%CI: 1.31-3.31) were associated with hospitalization. For recovered cases, the median time from first to last second negative test was 21 days. Overall, 119 primary cases reported 616 close contacts, yielding a pooled secondary attack rate of 12% (95%CI: 9.6-14.8%). Three population-based screening projects, and two projects targeting employees and HCWs, involving 25,496 people, revealed 60 positive individuals (0.2%). Early implementation of interventions with targeted and expanded testing facilitated prompt outbreak control on the island.
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Affiliation(s)
- Annalisa Quattrocchi
- Department of Primary Care and Population Health, University of Nicosia Medical School, 1700 Nicosia, Cyprus; (A.Q.); (C.A.D.); (O.K.)
| | - Ioannis Mamais
- School of Sciences, European University, 1516 Nicosia, Cyprus;
| | - Constantinos Tsioutis
- School of Medicine, European University, 1516 Nicosia, Cyprus; (C.T.); (Z.-D.P.); (G.P.)
| | - Eirini Christaki
- Medical School, University of Cyprus, 1678 Nicosia, Cyprus; (E.C.); (M.K.); (G.P.)
| | - Costas Constantinou
- Nicosia General Hospital, 1678 Nicosia, Cyprus; (C.C.); (L.H.); (L.P.); (A.V.); (T.A.); (F.F.)
| | - Maria Koliou
- Medical School, University of Cyprus, 1678 Nicosia, Cyprus; (E.C.); (M.K.); (G.P.)
| | - Zoi-Dorothea Pana
- School of Medicine, European University, 1516 Nicosia, Cyprus; (C.T.); (Z.-D.P.); (G.P.)
| | - Valentinos Silvestros
- Unit for Surveillance and Control of Communicable Diseases, Ministry of Health, 1448 Nicosia, Cyprus; (V.S.); (F.T.); (C.H.); (A.S.); (S.S.); (I.G.); (E.C.)
| | - Fani Theophanous
- Unit for Surveillance and Control of Communicable Diseases, Ministry of Health, 1448 Nicosia, Cyprus; (V.S.); (F.T.); (C.H.); (A.S.); (S.S.); (I.G.); (E.C.)
| | - Christos Haralambous
- Unit for Surveillance and Control of Communicable Diseases, Ministry of Health, 1448 Nicosia, Cyprus; (V.S.); (F.T.); (C.H.); (A.S.); (S.S.); (I.G.); (E.C.)
| | - Androulla Stylianou
- Unit for Surveillance and Control of Communicable Diseases, Ministry of Health, 1448 Nicosia, Cyprus; (V.S.); (F.T.); (C.H.); (A.S.); (S.S.); (I.G.); (E.C.)
| | - Sotiroula Sotiriou
- Unit for Surveillance and Control of Communicable Diseases, Ministry of Health, 1448 Nicosia, Cyprus; (V.S.); (F.T.); (C.H.); (A.S.); (S.S.); (I.G.); (E.C.)
| | - Maria Athanasiadou
- Health Monitoring Unit, Ministry of Health, 1448 Nicosia, Cyprus; (M.A.); (T.K.); (A.D.)
| | - Theopisti Kyprianou
- Health Monitoring Unit, Ministry of Health, 1448 Nicosia, Cyprus; (M.A.); (T.K.); (A.D.)
| | - Anna Demetriou
- Health Monitoring Unit, Ministry of Health, 1448 Nicosia, Cyprus; (M.A.); (T.K.); (A.D.)
| | - Christiana A. Demetriou
- Department of Primary Care and Population Health, University of Nicosia Medical School, 1700 Nicosia, Cyprus; (A.Q.); (C.A.D.); (O.K.)
| | - Ourania Kolokotroni
- Department of Primary Care and Population Health, University of Nicosia Medical School, 1700 Nicosia, Cyprus; (A.Q.); (C.A.D.); (O.K.)
| | - Ioanna Gregoriou
- Unit for Surveillance and Control of Communicable Diseases, Ministry of Health, 1448 Nicosia, Cyprus; (V.S.); (F.T.); (C.H.); (A.S.); (S.S.); (I.G.); (E.C.)
| | - Niki Paphitou
- American Medical Center, 1311 Nicosia, Cyprus; (N.P.); (G.M.)
| | - George Panos
- Medical School, University of Cyprus, 1678 Nicosia, Cyprus; (E.C.); (M.K.); (G.P.)
- Department of Internal Medicine, Division of Infectious Diseases, Patras University General Hospital, Medical School, University of Patras, 265 04 Patras, Greece
| | - Leontios Kostrikis
- Department of Biological Sciences, University of Cyprus, 1678 Nicosia, Cyprus;
| | - Peter Karayiannis
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, 1700 Nicosia, Cyprus; (P.K.); (G.S.)
| | - Georgios Petrikkos
- School of Medicine, European University, 1516 Nicosia, Cyprus; (C.T.); (Z.-D.P.); (G.P.)
| | | | - George Mixides
- American Medical Center, 1311 Nicosia, Cyprus; (N.P.); (G.M.)
| | - Georgios Siakallis
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, 1700 Nicosia, Cyprus; (P.K.); (G.S.)
- Larnaca General Hospital, 6301 Larnaca, Cyprus
| | - Linos Hadjihannas
- Nicosia General Hospital, 1678 Nicosia, Cyprus; (C.C.); (L.H.); (L.P.); (A.V.); (T.A.); (F.F.)
| | - Lakis Palazis
- Nicosia General Hospital, 1678 Nicosia, Cyprus; (C.C.); (L.H.); (L.P.); (A.V.); (T.A.); (F.F.)
| | - Anna Vavlitou
- Nicosia General Hospital, 1678 Nicosia, Cyprus; (C.C.); (L.H.); (L.P.); (A.V.); (T.A.); (F.F.)
| | | | - Dimitris Koukios
- Limassol General Hospital, 3304 Limassol, Cyprus; (C.M.-T.); (D.K.)
| | - Tonia Adamidi
- Nicosia General Hospital, 1678 Nicosia, Cyprus; (C.C.); (L.H.); (L.P.); (A.V.); (T.A.); (F.F.)
| | - Frangiskos Frangopoulos
- Nicosia General Hospital, 1678 Nicosia, Cyprus; (C.C.); (L.H.); (L.P.); (A.V.); (T.A.); (F.F.)
| | - Elizabeth Constantinou
- Unit for Surveillance and Control of Communicable Diseases, Ministry of Health, 1448 Nicosia, Cyprus; (V.S.); (F.T.); (C.H.); (A.S.); (S.S.); (I.G.); (E.C.)
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Kakoullis L, Parperis K, Papachristodoulou E, Panos G. Infection-induced myeloperoxidase specific antineutrophil cytoplasmic antibody (MPO-ANCA) associated vasculitis: A systematic review. Clin Immunol 2020; 220:108595. [PMID: 32961330 DOI: 10.1016/j.clim.2020.108595] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND We conducted a systematic review to identify cases of infection-induced anti-myeloperoxidase (MPO) antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). METHODS PubMed/Medline databases were searched from inception to July of 2020, according to PRISMA guidelines. RESULTS Among the 618 abstracts identified, 18 articles describing 23 patients (60.9% female, mean age 50.5 years) were included. Median time between infection and vasculitis development was 3 months. Five (21.7%) patients expired during follow-up. Vasculitis regressed after the resolution of infection in 12/23 (52.2%). ANCA titers decreased significantly on follow-up in 14/16 patients and in all survivors in which they were measured. Pathogens reported included Mycobacterium spp., Coccidioides spp., Rickettsia rickettsii, Staphylococcus spp., EBV, CMV and Dengue virus. CONCLUSIONS MPO-AAV can occur after infection and may regress after its resolution. Infection should be considered in cases of MPO-AAV, as immunosuppressive treatment can have catastrophic results if the infection is not adequately treated.
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Affiliation(s)
- Loukas Kakoullis
- Department of Respiratory Medicine, University of Patras General Hospital, Patras, Greece; Department of Internal Medicine, University of Cyprus Medical School, Nicosia, Cyprus
| | - Konstantinos Parperis
- Department of Medicine, Division of Rheumatology, University of Arizona College of Medicine, Phoenix, AZ, USA; Department of Internal Medicine, Division of Rheumatology, University of Cyprus Medical School, Nicosia, Cyprus
| | - Eleni Papachristodoulou
- Department of Internal Medicine, Division of Rheumatology, University of Cyprus Medical School, Nicosia, Cyprus
| | - George Panos
- Department of Internal Medicine, University of Cyprus Medical School, Nicosia, Cyprus; Department of Internal Medicine, Section of Infectious Diseases, University of Patras General Hospital, Patras, Greece.
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15
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Daoussis D, Kolonitsiou F, Militsopoulou M, Panos G, Paliogianni F, Panagiotopoulos E. First report of Mycobacterium celatum–induced arthritis. Rheumatology (Oxford) 2020; 59:1772-1773. [DOI: 10.1093/rheumatology/kez586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
| | | | | | | | | | - Elias Panagiotopoulos
- Department of Orthopedics, Patras University Hospital, University of Patras Medical School, Patras, Greece
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16
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Papachristodoulou E, Kakoullis L, Parperis K, Panos G. Long-term and herd immunity against SARS-CoV-2: implications from current and past knowledge. Pathog Dis 2020; 78:5854538. [PMID: 32510562 PMCID: PMC7314002 DOI: 10.1093/femspd/ftaa025] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/04/2020] [Indexed: 12/20/2022] Open
Abstract
Effective herd immunity against SARS-CoV-2 will be determined on many factors: the percentage of the immune population, the length and effectiveness of the immune response and the stability of the viral epitopes. The required percentage of immune individuals has been estimated to be 50–66% of the population which, given the current infection rates, will take long to be achieved. Furthermore, data from SARS-CoV suggest that the duration of immunity may not be sufficiently significant, while the immunity response against SARS-CoV-2 may not be efficiently effective in all patients, as relapses have already been reported. In addition, the development of mutant strains, which has already been documented, can cause the reemergence of the epidemic. In conclusion, the development of an effective vaccine is an urgent necessity, as long-term natural immunity to SARS-CoV-2 may not be sufficient for the control of the current and future outbreaks.
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Affiliation(s)
| | - Loukas Kakoullis
- Department of Internal Medicine, Nicosia General Hospital, Nicosia, Cyprus.,Department of Respiratory Medicine, University of Patras General Hospital, Patras, Greece
| | - Konstantinos Parperis
- Department of Internal Medicine, University of Cyprus Medical School, Nicosia, Cyprus.,Department of Medicine, Division of Rheumatology, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - George Panos
- Department of Internal Medicine, University of Cyprus Medical School, Nicosia, Cyprus.,Department of Internal Medicine, Section of Infectious Diseases, University of Patras General Hospital, Patras, Greece
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17
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Panos G, Kakoullis L, Louppides S, Emmanuil A. Behçet's disease presenting as recurrent oral aphthosis in a 9-year-old boy from Greece. BMJ Case Rep 2020; 13:e229527. [PMID: 32107255 PMCID: PMC7046425 DOI: 10.1136/bcr-2019-229527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2020] [Indexed: 11/03/2022] Open
Abstract
We report a case of Behçet's disease in a 9-year-old boy from Greece, presenting with a history of recurrent ulceration of the oral cavity. Following inspection of the oral cavity, which revealed lesions on both the upper and lower labial mucosa, as well as a large ulcer on the apex of the tongue, the diagnosis of Behçet's disease was immediately suspected. The diagnosis was confirmed using the International Criteria for Behçet's Disease. Nevertheless, as multiple diseases can cause recurrent oral aphthosis, an extensive differential diagnosis was made, and pertinent tests were undertaken to exclude other causes of oral ulceration. The approach to a patient with Behçet's disease, as well as its various clinical presentations and complications, is discussed.
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Affiliation(s)
- George Panos
- Infectious Diseases Section, University General Hospital of Patras, Patras, Achaia, Greece
- Internal Medicine, University Cyprus School of Medicine, Nicosia, Cyprus
| | - Loukas Kakoullis
- Internal Medicine, Nicosia General Hospital, University of Cyprus Medical School, Nicosia, Cyprus
- Respiratory Medicine, University General Hospital of Patras, Patras, Greece
| | - Stylianos Louppides
- Internal Medicine, Nicosia General Hospital, University of Cyprus Medical School, Nicosia, Cyprus
| | - Andreas Emmanuil
- Biochemical Laboratory, University General Hospital of Patras, Patras, Greece
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18
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Kakoullis L, Sampsonas F, Giannopoulou E, Kalogeropoulou C, Papachristodoulou E, Tsiamita M, Lykouras D, Velissaris D, Karkoulias K, Spiropoulos K, Panos G. Measles-associated pneumonia and hepatitis during the measles outbreak of 2018. Int J Clin Pract 2020; 74:e13430. [PMID: 31573732 DOI: 10.1111/ijcp.13430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/19/2019] [Accepted: 09/21/2019] [Indexed: 11/27/2022] Open
Abstract
Background Between 2017 and 2018, Greece experienced a measles outbreak, affecting >3000 patients, most of which were unvaccinated. Measles-associated pneumonia (MAP) is the most common serious compilation of the disease, but very few recent reports regarding its presentation are available. Materials and Methods Between January and May 2018, 11 adult patients presented to our department with acute measles virus infection, hypoxia and findings on chest X-ray. Clinical, laboratory and radiological data were collected and assessed. Nine out of eleven patients had hypoxic respiratory failure. Other complications included hepatitis, cholestasis and myositis, which were observed in the majority of patients. All patients received supplementary oxygen administration, whereas five patients required continuous positive airway pressure ventilation. Scoring of the radiological examinations performed was most notable for the presence of reticular opacities and consolidations. Statistical analysis demonstrated a significant association between PaO2/FiO2 values and the presence of reticular opacities, with PaO2/FiO2 decreasing as the mean value of the reticular opacities score increased (P = .02). Conclusion To our knowledge, this is the first report demonstrating an association between PaO2/FiO2 values and the presence of reticular opacities in patients with MAP. MAP should be suspected in any patient presenting with acute onset hypoxaemia and a reticular pattern on radiological examination, especially in outbreak settings. What is known Measles infections are on the rise in Europe, with epidemics affecting several European countries, resulting from suboptimal immunisation. The most common serious complication of measles is pneumonia, which is more common in adult patients and can cause significant morbidity. It is the most common cause of death due to measles. What is new In this report, we present 11 adults with measles-associated pneumonia, who presented with the combination of acute measles virus infection, hypoxia and findings on chest X-ray. To our knowledge, this is the first report demonstrating an association between the severity of hypoxaemia and the presence of reticular opacities on chest imaging studies.
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Affiliation(s)
- Loukas Kakoullis
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
- Department of Internal Medicine, Nicosia General Hospital, University of Cyprus, Nicosia, Cyprus
| | - Fotios Sampsonas
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Eleni Giannopoulou
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | | | - Eleni Papachristodoulou
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
- Department of Internal Medicine, Nicosia General Hospital, University of Cyprus, Nicosia, Cyprus
| | - Maria Tsiamita
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Dimosthenis Lykouras
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | | | - Kyriakos Karkoulias
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Kostas Spiropoulos
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - George Panos
- Department of Internal Medicine, Nicosia General Hospital, University of Cyprus, Nicosia, Cyprus
- Department of Internal Medicine, Section of Infectious Diseases, University Hospital of Patras, Patras, Greece
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19
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Kakoullis L, Hadjihannas L, Louppides S, Panos G. Aspiration of anchovy paste liquid from a multilobulated liver space-occupying lesion in a patient presenting with fever and weight loss: early stage amoebic liver abscess. BMJ Case Rep 2020; 13:13/1/e234107. [PMID: 31969419 DOI: 10.1136/bcr-2019-234107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Loukas Kakoullis
- Department of Internal Medicine, Nicosia General Hospital, University of Cyprus Medical School, Nicosia, Cyprus.,Department of Respiratory Medicine, University of Patras, Patras, Achaia, Greece
| | - Linos Hadjihannas
- Department of Internal Medicine, Nicosia General Hospital, University of Cyprus Medical School, Nicosia, Cyprus
| | - Stylianos Louppides
- Department of Internal Medicine, Nicosia General Hospital, University of Cyprus Medical School, Nicosia, Cyprus
| | - George Panos
- Department of Internal Medicine, Nicosia General Hospital, University of Cyprus Medical School, Nicosia, Cyprus .,Infectious Diseases Section, University General Hospital of Patras, Patras, Achaia, Greece
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20
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Louppides S, Kakoullis L, Parpas G, Panos G. Upper eyelid oedema in a patient with pharyngitis/exudative tonsillitis and malaise: Hoagland sign in infectious mononucleosis. BMJ Case Rep 2019; 12:12/12/e233719. [PMID: 31871012 DOI: 10.1136/bcr-2019-233719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Stylianos Louppides
- Internal Medicine, Nicosia General Hospital, University of Cyprus Medical School, Nicosia, Cyprus
| | - Loukas Kakoullis
- Internal Medicine, Nicosia General Hospital, University of Cyprus Medical School, Nicosia, Cyprus
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Achaia, Greece
| | - Giorgos Parpas
- Internal Medicine, Nicosia General Hospital, University of Cyprus Medical School, Nicosia, Cyprus
| | - George Panos
- Infectious Diseases Section, University General Hospital of Patras, Patras, Achaia, Greece
- Internal Medicine, University Cyprus School of Medicine, Nicosia, Cyprus
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21
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Papachristodoulou E, Kakoullis L, Louppides S, Panos G. Granulomatous infective spondylitis in a patient presenting with progressive difficulty in walking: the differential between tuberculosis and brucellosis. BMJ Case Rep 2019; 12:12/11/e232540. [PMID: 31767612 DOI: 10.1136/bcr-2019-232540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of infectious spondylitis in a 52-year-old woman who presented with progressive difficulty in walking. The patient had a 2-month long history of neurological symptoms, which progressed rapidly to paraplegia, following her admission. Imaging studies demonstrated the presence of vertebral lesions as well as additional tissue with inflammatory elements in the spinal canal, which caused a mass effect. In combination with the presence of increased cells and protein in the cerebrospinal fluid (CSF), the differential was steered towards causes of infectious spondylitis, primarily tuberculosis. However, brucellosis was also considered, as it is endemic in our area. Prompt surgical decompression produced biopsy samples, which confirmed the presence of granulomatous inflammation. The patient was started on an empiric regimen covering both for tuberculosis and brucellosis, and gradually regained full mobility in her lower limbs. The differential of infectious spondylitis is discussed, with an emphasis on the differentiation between tuberculosis and brucellosis.
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Affiliation(s)
| | - Loukas Kakoullis
- Respiratory Medicine, University of Patras School of Medicine, Patras, Greece.,Internal Medicine, Nicosia General Hospital, Leukosia, Cyprus
| | | | - George Panos
- Internal Medicine, Section of Infectious Diseases, University General Hospital of Patras, Patras, Greece .,Internal Medicine, University Cyprus School of Medicine, Nicosia, Cyprus
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22
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Kakoullis L, Papachristodoulou E, Chra P, Panos G. Shiga toxin-induced haemolytic uraemic syndrome and the role of antibiotics: a global overview. J Infect 2019; 79:75-94. [DOI: 10.1016/j.jinf.2019.05.018] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 05/21/2019] [Accepted: 05/25/2019] [Indexed: 11/17/2022]
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Abstract
Porphyrias are disorders caused by defects in the biosynthetic pathway of heme. Their manifestations can be divided into three distinct syndromes, each attributable to the accumulation of three distinct classes of molecules. The acute neurovisceral syndrome is caused by the accumulation of the neurotoxic porphyrin precursors, delta aminolevulinic acid, and porphobilinogen; the syndrome of immediate painful photosensitivity is caused by the lipid-soluble protoporphyrin IX and, the syndrome of delayed blistering photosensitivity, caused by the water-soluble porphyrins, uroporphyrin, and coproporphyrin. Porphyrias can manifest with one, or with a combination, of these syndromes, depending on whether one or more types of molecules are being accumulated. Iron plays a significant role in some of these conditions, as evidenced by improvements in both clinical manifestations and laboratory parameters, following iron depletion in porphyria cutanea tarda, or iron administration in some cases of X-linked erythropoietic protoporphyria. While the pathophysiology of a specific type of porphyrias, the protoporphyrias, appears to favor the administration of zinc, results so far have been conflicting, necessitating further studies in order to assess its potential benefit. The pathways involved in each disease, as well as insights into their pathobiological processes are presented, with an emphasis on the development of photosensitivity reactions.
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Affiliation(s)
- Loukas Kakoullis
- a Department of Internal Medicine , Nicosia General Hospital, University of Cyprus Medical School , Nicosia , Cyprus
| | - Stylianos Louppides
- a Department of Internal Medicine , Nicosia General Hospital, University of Cyprus Medical School , Nicosia , Cyprus
| | - Eleni Papachristodoulou
- a Department of Internal Medicine , Nicosia General Hospital, University of Cyprus Medical School , Nicosia , Cyprus
| | - George Panos
- a Department of Internal Medicine , Nicosia General Hospital, University of Cyprus Medical School , Nicosia , Cyprus.,b Department of Internal Medicine, Section of Infectious Diseases , Patras University General Hospital, University of Patras School of Medicine , Patras , Greece
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24
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Blum PH, Panos G, Smith RJ. Measurement of Hardness of Barley and Malt with the Brabender Hardness Tester. II. Modification during Malting. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/00960845.1960.12006905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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25
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Panos G. Prevalence studies of M. genitalium and other sexually transmitted pathogens in high risk individuals indicate the need for comprehensive investigation of STIs for accurate diagnosis and effective treatment. Germs 2018; 8:8-11. [PMID: 29564243 DOI: 10.18683/germs.2018.1127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Chra P, Papaparaskevas J, Papadogeorgaki E, Panos G, Leontsinidis M, Arsenis G, Tsakris A. Prevalence of Mycoplasma genitalium and other sexually-transmitted pathogens among high-risk individuals in Greece. Germs 2018; 8:12-20. [PMID: 29564244 DOI: 10.18683/germs.2018.1128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/12/2017] [Accepted: 12/05/2017] [Indexed: 11/08/2022]
Abstract
Background The aim of the present study was to determine the prevalence of Mycoplasma genitalium (MG) infection among individuals at high risk for sexually-transmitted diseases (STDs) at a major urban STD clinic in Athens, in view of the lack of data pertaining to this infection in Greece. Methods Urethral and cervical samples from 176 individuals consecutively attending the clinic and agreeing to participate were prospectively collected and tested for MG infection using conventional PCR and TaqMan Real-Time PCR. All individuals were also examined for alternative STD pathogens. Results A total of 161 individuals (91.5%) reported symptoms, while 15 individuals (8.5%) were asymptomatic. MG was detected in 5.7% (10/176) of the total population and in 5.6% (9/161) of those with symptoms, corresponding to 5.7% (5/87) of symptomatic men and 5.4% (4/74) of symptomatic women. Among symptomatic males, 3.4% (3/87) displayed MG mono-infection. The median age of MG infected individuals was 25 years (IQR 21.5-29.5 years). Individuals infected with MG were more likely to be coinfected with Ureaplasma spp. [OR=5.12, 95%CI, 1.27-20.57] (p=0.017). MG infection was also more common among individuals who had received antibiotics in the previous 15 days [OR=6.04, 95%CI, 1.37-26.64] (p=0.035). Conclusion MG was found to represent an important microbial pathogen among patients presenting with symptoms of urethritis or cervicitis in Greece. Consideration of MG as cause of STD seems crucial in diagnostic algorithms and treatment strategies.
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Affiliation(s)
- Paraskevi Chra
- MD, Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece, Department of Microbiology, "Andreas Syggros" Hospital of Cutaneous and Venereal Diseases, 16121 Athens, Greece
| | - Joseph Papaparaskevas
- MD, PhD, Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Eleni Papadogeorgaki
- MD, PhD, Department of Microbiology, "Andreas Syggros" Hospital of Cutaneous and Venereal Diseases, 16121 Athens, Greece
| | - George Panos
- BSc, MD, PhD, DTM&H(Lon), FRCP, Department of Internal Medicine, Division of Infectious Diseases, University of Patras School of Medicine, 26504 Patras, Greece, Department of Internal Medicine, University of Cyprus Medical School, University Avenue, 1678 Nicosia, Cyprus
| | - Michalis Leontsinidis
- BSc, PhD, Department of Public Health, University of Patras School of Medicine, 26504 Patras, Greece
| | - George Arsenis
- MD, PhD, Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Athanassios Tsakris
- MD, PhD, FRCPath, Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Panos G, Watson DC, Karydis I, Velissaris D, Andreou M, Karamouzos V, Sargianou M, Masdrakis A, Chra P, Roussos L. Differential diagnosis and treatment of acute cauda equina syndrome in the human immunodeficiency virus positive patient: a case report and review of the literature. J Med Case Rep 2016; 10:165. [PMID: 27268102 PMCID: PMC4895963 DOI: 10.1186/s13256-016-0902-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 04/17/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Acute cauda equina syndrome is an uncommon but significant neurologic presentation due to a variety of underlying diseases. Anatomical compression of nerve roots, usually by a lumbar disk hernia is a common cause in the general population, while inflammatory, neoplastic, and ischemic causes have also been recognized. Among human immunodeficiency virus (HIV) infected patients with acquired immunodeficiency syndrome, infectious causes are encountered more frequently, the most prevalent of which are: cytomegalovirus, herpes simplex virus 1/2, varicella zoster virus, and Mycobacterium tuberculosis infections. Studies of cauda equina syndrome in well-controlled HIV infection are lacking. We describe such a case of cauda equina syndrome in a well-controlled HIV-infected patient, along with a brief review of the literature regarding the syndrome's diagnosis and treatment in individuals with HIV infection. CASE PRESENTATION A 36-year-old Greek male, HIV-positive patient presented with perineal and left hemiscrotal numbness, lumbar pain, left-sided sciatica, and urinary incontinence. Magnetic resonance imaging of the patient's lumbar spine revealed intrathecal migration of a fragment from an intervertebral lumbar disk exerting pressure on the cauda equina. A cerebrospinal fluid examination, brain computed tomography scan, spine magnetic resonance imaging, and serological test results were negative for central nervous system infections. Our patient underwent emergency neurosurgical spinal decompression, which resolved most symptoms, except for mild urinary incontinence. CONCLUSIONS Noninfectious etiologies may also cause cauda equina syndrome in HIV-infected individuals, especially in well-controlled disease under antiretroviral therapy. Prompt recognition and treatment of the underlying cause is important to minimize residual symptoms. Targeted antimicrobial chemotherapy is used to treat infectious causes, while prompt surgical decompression is favored for anatomical causes of cauda equina syndrome in the HIV-infected patient.
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Affiliation(s)
- George Panos
- Special Infections Unit, 2nd Internal Medicine Clinic, 1st Ι.Κ.Α. Penteli General Hospital, Melissia, Athens, Greece. .,Department of Infectious Diseases, Patras University General Hospital, 26504, Rion, Patras, Greece.
| | - Dionysios C Watson
- Department of Infectious Diseases, Patras University General Hospital, 26504, Rion, Patras, Greece
| | - Ioannis Karydis
- Special Infections Unit, 2nd Internal Medicine Clinic, 1st Ι.Κ.Α. Penteli General Hospital, Melissia, Athens, Greece
| | - Dimitrios Velissaris
- Internal Medicine Department, University Hospital of Patras, 26504, Rion, Patras, Greece
| | - Marina Andreou
- Internal Medicine Department, University Hospital of Patras, 26504, Rion, Patras, Greece
| | - Vasilis Karamouzos
- Internal Medicine Department, University Hospital of Patras, 26504, Rion, Patras, Greece
| | - Maria Sargianou
- Department of Infectious Diseases, Patras University General Hospital, 26504, Rion, Patras, Greece
| | - Antonios Masdrakis
- Special Infections Unit, 2nd Internal Medicine Clinic, 1st Ι.Κ.Α. Penteli General Hospital, Melissia, Athens, Greece
| | - Paraskevi Chra
- Department of Microbiology, Benakio-Korgialenio Hospital, 1 Erythrou Staurou Street, 11526, Athens, Greece
| | - Lavrentios Roussos
- Neurosurgery Clinic, Κ.Α.Τ. Hospital, 2 Nikis Street, 14561, Kifissia, Athens, Greece
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Panos G, Velissaris D, Karamouzos V, Matzaroglou C, Tylianakis M. Long QT Syndrome Leading to Multiple Cardiac Arrests After Posaconazole Administration in an Immune-Compromised Patient with Sepsis: An Unusual Case Report. Am J Case Rep 2016; 17:295-300. [PMID: 27125217 PMCID: PMC4913753 DOI: 10.12659/ajcr.896946] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND We present the case of a septic patient with severe immunodeficiency, who developed QT interval prolongation followed by episodes of lethal cardiac arrhythmia. Cardiac events occurred after posaconazole administration, incriminating posaconazole use, alone or in combination with voriconazole, as the culpable agent. CASE REPORT A 26-year-old female patient underwent orthopedic surgery to remove ectopic calcifications in her left hip joint. On the first post-operative day she became septic due to a surgical wound infection. Despite being treated according to the therapeutic protocols for sepsis, no clinical improvement was noticed and further assessment revealed an underlying immunodeficiency. Considering the underlying immunodeficiency and to that point poor clinical response, an antifungal agent was added to the antibiotic regiment. Following discontinuation of multiple antifungal agents due to adverse effects, posaconazole was administered. Posaconazole oral intake was followed by episodes of bradycardia and QT interval prolongation. The patient suffered continuous incidents of cardiac arrest due to polymorphic ventricular tachycardia (torsades des pointes) that degenerated to lethal ventricular fibrillation. Posaconazole was immediately discontinued and a temporary pacemaker was installed. The patient finally recovered without any neurological deficit, and was discharged in a good clinical status. CONCLUSIONS Close cardiac monitoring is recommended in cases where posaconazole administration is combined with coexisting risk factors, as they may lead to severe ECG abnormalities and cardiac arrhythmias such as long QT interval syndrome and torsades de pointes. Posaconazole interactions with medications metabolized via the CYP3A4 pathway should be considered an additional risk factor for lethal cardiac incidents.
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Affiliation(s)
- George Panos
- Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | | | - Vasilios Karamouzos
- Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | | | - Minos Tylianakis
- Department of Orthopaedic Surgery, University Hospital of Patras, Patras, Greece
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Abstract
Background The rapid replication rate of HIV-1, coupled with a high mutation rate and recombination, is the underlying force driving its genetic diversity. In the infected individual, a population of highly related but nonidentical strains exists. At the population level, multiple subtypes often cocirculate, leading to the generation of intersubtype recombinant forms. As a result, the geographic distribution of subtypes and recombinant forms is complex and uneven. Genetic subtyping of HIV-1 isolates has been shown to be helpful for understanding the genetic evolution, the worldwide spread of the virus, and the evaluation of drug resistance. Materials and methods We determined the genetic heterogeneity of HIV-1 group M in southwestern Greece. Protease and partial reverse-transcriptase sequences were generated from 150 HIV-1-infected individuals attending the Division of Infectious Diseases of Patras University Hospital, Greece, from 2006 to 2012, and analyzed using online subtyping tools and phylogenetic methods. Results The majority of the infected individuals were male (77%). HIV-1 subtype A1 was responsible for 51.3% of infections, followed by subtypes B (34%), G (4%), F1 (2%), and the circulating recombinant forms 02_AG (2.7%), 14_BG (1.3%), 35_AD (1.3%), and 01_AE (0.7%). Additionally, we identified three cases with a recombinant B/CRF02_AG strain (2%) and one with a recombinant G/GRF_AG strain. Sexual transmission was responsible for 96.3% of cases. Heterosexual transmission was responsible for 70.2% of subtype-A1 infections, whereas subtype B was transmitted by men who have sex with men in 75.5% of cases. Protease substitutions I13V, E35D, M36I, R57K, H69K, and L89M, which serve as drug-resistance support mutations in subtype B, were present in the majority of subtype-A1 sequences of the population. Conclusion HIV-1 infection in southwestern Greece is sexually transmitted and highly heterogeneous. Subtype A1 has surpassed subtype B, and is the most prevalent strain. In the population studied, subtype A1 exhibited certain polymorphisms in the protease region, which may serve as drug-resistance support mutations in subtype B.
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Affiliation(s)
- Nikolaos Davanos
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Patras, Patras, Greece
| | - George Panos
- Division of Infectious Diseases, Department of Internal Medicine, University Hospital, University of Patras, Patras, Greece
| | - Charalambos A Gogos
- Division of Infectious Diseases, Department of Internal Medicine, University Hospital, University of Patras, Patras, Greece
| | - Athanasia Mouzaki
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Patras, Patras, Greece
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Pantazis N, Psichogiou M, Paparizos V, Gargalianos P, Chini M, Protopapas K, Sipsas NV, Panos G, Chrysos G, Sambatakou H, Katsarou O, Touloumi G. Treatment Modifications and Treatment-Limiting Toxicities or Side Effects: Risk Factors and Temporal Trends. AIDS Res Hum Retroviruses 2015; 31:707-17. [PMID: 25950848 DOI: 10.1089/aid.2015.0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Combined antiretroviral treatment (cART) modifications are often required due to treatment failure or side effects. We investigate cART regimens' durability, frequency of treatment-limiting adverse events, and potential risk factors and temporal trends. Data were derived from the Athens Multicenter AIDS Cohort Study (AMACS). Statistical analyses were based on survival techniques, allowing for multiple contributions per individual. Overall, 2,756 individuals, aged >15 years, initiated cART. cART regimens were grouped by their initiation date into four calendar periods (1995-1998, 1999-2002, 2003-2006, and 2007+). Median [95% confidence interval (CI)] time to first treatment modification was 2.11 (1.95-2.33) years; cumulative probabilities at 1 year were 31.6%, 29.0%, 33.1%, and 29.6% for the four periods, respectively. cART modifications were less frequent in more recent years (adjusted HR=0.96 per year; p<0.001). Longer treatment duration was associated with lower HIV-RNA, higher CD4 counts, and being previously ART naive. cART modifications due to treatment failure became less frequent in recent years (adjusted HR=0.91 per year; p<0.001). Estimated (95% CI) 1 year cumulative probabilities of treatment-limiting side effects were 16.4% (12.0-21.3%), 19.3% (15.6-23.3%), 24.9% (20.3-29.7%), and 21.1% (13.4-29.9%) for the four periods, respectively, with no significant temporal trends. Risk of side effects was lower in nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens or triple nucleoside reverse transcriptase inhibitor (NRTI)-based cART regimens. Treatment modifications have become less frequent in more recent years. This could be partly attributed to the lower risk for side effects of NNRTI-based cART regimens and mainly to the improved efficacy of newer drugs. However, the rate of drugs substitutions due to adverse events remains substantially high.
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Affiliation(s)
- Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece
| | - Mina Psichogiou
- First Department of Propaedeutic Medicine, University of Athens, Athens, Greece
| | - Vassilios Paparizos
- AIDS Unit, Clinic of Venereologic and Dermatologic Diseases, Athens Medical School, “Syngros” Hospital, Athens, Greece
| | - Panagiotis Gargalianos
- First Department of Internal Medicine and Infectious Diseases Unit, General Hospital of Athens “G. Gennimatas,” Athens, Greece
| | - Maria Chini
- Third Department of Internal Medicine–Infectious Diseases Unit, Red Cross General Hospital, Athens, Greece
| | - Konstantinos Protopapas
- Fourth Department of Internal Medicine, Athens Medical School, “Attikon” University General Hospital, Athens, Greece
| | - Nikolaos V. Sipsas
- Infectious Diseases Unit, Department of Pathophysiology, “Laikon” Athens General Hospital and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Panos
- Department of Internal Medicine and Infectious Diseases, Patras University General Hospital, Patras, Greece
| | - George Chrysos
- Infectious Diseases Unit, “Tzaneion” General Hospital of Piraeus, Athens, Greece
| | - Helen Sambatakou
- HIV Unit, Second Department of Internal Medicine, Athens Medical School, “Hippokration” University General Hospital, Athens, Greece
| | - Olga Katsarou
- Blood Centre, National Reference Centre for Congenital Bleeding Disorders, “Laikon” Athens General Hospital, Athens, Greece
| | - Giota Touloumi
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece
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Assimakopoulos SF, Stamouli V, Dimitropoulou D, Spiliopoulou A, Panos G, Anastassiou ED, Marangos M, Spiliopoulou I. Toxoplasma gondii meningoencephalitis without cerebral MRI findings in a patient with ulcerative colitis under immunosuppressive treatment. Infection 2015; 43:589-93. [PMID: 25623638 DOI: 10.1007/s15010-015-0730-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/14/2015] [Indexed: 12/25/2022]
Abstract
Toxoplasmosis is the most common opportunistic infection of the central nervous system in immunosupressed patients. It is usually presented as a space-occupying lesion detected by cerebral computerized tomography or magnetic resonance imaging. The diffuse form of the disease (diffuse toxoplasmic meningoencephalitis) lacks the characteristic cerebral radiologic findings rendering pre-mortem diagnosis much more difficult. Herein, we describe a case of toxoplasmic menincoencephalitis, without evidence of cerebral space-occupying lesions, in a patient with ulcerative colitis under combined therapy with systemic glucocorticoids and azathioprine. Diagnosis was based on microscopic examination of cerebrospinal fluid (CSF) for the parasite, whereas, RT-PCR for Toxoplasma gondii was negative. Taking into consideration the limitations of molecular methods, investigation of the etiology of meningeal involvement in patients under immunosuppressive therapy presenting positive serology of previous T. gondii infection, should include microscopic examination of CSF for parasite presence.
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Affiliation(s)
- S F Assimakopoulos
- Division of Infectious Diseases, Department of Internal Medicine, University General Hospital of Patras, 26504, Patras, Greece
| | - V Stamouli
- Department of Microbiology, University General Hospital of Patras, 26504, Patras, Greece
| | - D Dimitropoulou
- Division of Infectious Diseases, Department of Internal Medicine, University General Hospital of Patras, 26504, Patras, Greece
| | - A Spiliopoulou
- Department of Microbiology, University General Hospital of Patras, 26504, Patras, Greece
| | - G Panos
- Division of Infectious Diseases, Department of Internal Medicine, University General Hospital of Patras, 26504, Patras, Greece
| | - E D Anastassiou
- Department of Microbiology, University General Hospital of Patras, 26504, Patras, Greece.,Department of Microbiology, School of Medicine, University of Patras, 26504, Patras, Greece
| | - M Marangos
- Division of Infectious Diseases, Department of Internal Medicine, University General Hospital of Patras, 26504, Patras, Greece
| | - I Spiliopoulou
- Department of Microbiology, University General Hospital of Patras, 26504, Patras, Greece. .,Department of Microbiology, School of Medicine, University of Patras, 26504, Patras, Greece.
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Schiza EC, Panos G, David C, Petkov N, Schizas CN. Integrated Electronic Health Record Database Management System: A Proposal. Stud Health Technol Inform 2015; 213:187-190. [PMID: 26152988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
eHealth has attained significant importance as a new mechanism for health management and medical practice. However, the technological growth of eHealth is still limited by technical expertise needed to develop appropriate products. Researchers are constantly in a process of developing and testing new software for building and handling Clinical Medical Records, being renamed to Electronic Health Record (EHR) systems; EHRs take full advantage of the technological developments and at the same time provide increased diagnostic and treatment capabilities to doctors. A step to be considered for facilitating this aim is to involve more actively the doctor in building the fundamental steps for creating the EHR system and database. A global clinical patient record database management system can be electronically created by simulating real life medical practice health record taking and utilizing, analyzing the recorded parameters. This proposed approach demonstrates the effective implementation of a universal classic medical record in electronic form, a procedure by which, clinicians are led to utilize algorithms and intelligent systems for their differential diagnosis, final diagnosis and treatment strategies.
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Affiliation(s)
- Eirini C Schiza
- eHealth Lab, Department of Computer Science - University of Cyprus, Cyprus
| | - George Panos
- Department of Internal Medicine, School of Medicine, University of Patras, Greece
| | - Christiana David
- eHealth Lab, Department of Computer Science - University of Cyprus, Cyprus
| | - Nicolai Petkov
- Department of Intelligent Systems Group of Johann Bernoulli Institute of Mathematics and Computer Science, University of Groningen, The Netherlands
| | - Christos N Schizas
- eHealth Lab, Department of Computer Science - University of Cyprus, Cyprus
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Matzaroglou C, Georgiou CS, Panagopoulos A, Assimakopoulos K, Wilke HJ, Habermann B, Panos G, Kafchitsas K. Kümmell's Disease: Clarifying the Mechanisms and Patients' Inclusion Criteria. Open Orthop J 2014; 8:288-97. [PMID: 25246995 PMCID: PMC4168653 DOI: 10.2174/1874325001408010288] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 07/31/2014] [Accepted: 08/11/2014] [Indexed: 12/23/2022] Open
Abstract
The three major causes of vertebral body collapse include infection, malignant neoplasia, and trauma and it may be difficult to distinguish between them, particularly in the presence of severe osteoporosis. In 1891, however, Dr Hermann Kümmell, further added another possibility of vertebral body crush; the delayed posttraumatic collapse. As originally described, this rare clinical entity includes patients, who after a trivial trauma and an asymptomatic clinical course they develop a progressive vertebral body collapse and a painful kyphosis. Although more than a century has passed from its initial description, only few cases have been reported in the literature, whereas the main pathologic eliciting event is still under investigation. As a consequence, great controversy exists regarding the discrete features of the clinical course, its radiographic appearance and the histopathological findings. To explain the time lag between the initial trauma and the occurrence of the vertebral collapse, the hypothesis of ischemic necrosis was advanced. Equation of Kümmell's disease with vertebral osteonecrosis, however, has wrongly led many authors to report cases of Kümmell's disease, even in the absence of history of spinal trauma. On the other hand, high coincidence of vertebral osteonecrosis and the pathognomonic radiographic finding of intravertebral vacuum cleft, has further added to the confusion. In this review we present an overview of the literature on Kümmell's disease, focusing on the different proposed eliciting mechanisms. We also highlight controversial subjects on clinical course, diagnosis and treatment of this entity, in an attempt to further clarify patients' inclusion criteria.
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Affiliation(s)
| | | | | | | | - Hans J Wilke
- Institute for Orthopedic Research and Biomechanics, University of Ulm, Germany
| | - Bjoern Habermann
- Department of Orthopaedics and Traumatology, Johannes Gutenberg University, Mainz, Germany
| | - George Panos
- Department of Internal Medicine, University of Patras, Greece
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Panos G, Sargianou M, Watson D, Dimisianos N, Chra P, Andreou M, Sklavou C, Ellul J. Emerging virus coinfections of the CNS: HTLV I/II as a common denominator. BMC Infect Dis 2014. [PMCID: PMC4221047 DOI: 10.1186/1471-2334-14-s2-p94] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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35
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Panos G, Sargianou M, Papa A, Gogos C. Hantaviruses: seroprevalence and risk factors among humans in Achaia prefecture, Greece. BMC Infect Dis 2014. [PMCID: PMC4221041 DOI: 10.1186/1471-2334-14-s2-p91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Panos G, Watson DC. Effect of HIV-1 subtype and tropism on treatment with chemokine coreceptor entry inhibitors; overview of viral entry inhibition. Crit Rev Microbiol 2014; 41:473-87. [DOI: 10.3109/1040841x.2013.867829] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Al-Taiar H, Panos G. EPA-0912 – The link trainee scheme, a new way of supporting psychiatry trainees in oxford. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78237-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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38
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Papadopoulos A, Pantazis N, Panagopoulos P, Kourkounti S, Xylomenos G, Chini M, Petrikkos G, Sambatakou H, Ioannidou P, Kordosis T, Panos G, Touloumi G. Effects of first antiretroviral regimen on lipid levels in HIV (+) individuals. J Chemother 2013; 24:38-47. [DOI: 10.1179/1120009x12z.0000000008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Watson DC, Sargianou M, Papa A, Chra P, Starakis I, Panos G. Epidemiology of Hantavirus infections in humans: a comprehensive, global overview. Crit Rev Microbiol 2013; 40:261-72. [PMID: 23607444 DOI: 10.3109/1040841x.2013.783555] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Hantaviruses comprise an emerging global threat for public health, affecting about 30,000 humans annually. Infection may lead to Hantavirus pulmonary syndrome (HPS) in the Americas and hemorrhagic fever with renal syndrome (HFRS) in the Europe and Asia. Humans are spillover hosts, acquiring infection primarily through the inhalation of aerosolized excreta from infected rodents and insectivores. Risk factors for infection include involvement in outdoor activities, such as rural- and forest-related activities, peridomestic rodent presence, exposure to potentially infected dust and outdoor military training; prolonged, intimate contact with infected individuals promotes transmission of Andes virus, the only Hantavirus known to be transmitted from human-to-human. The total number of Hantavirus case reports is generally on the rise, as is the number of affected countries. Knowledge of the geographical distribution, regional incidence and associated risk factors of the disease are crucial for clinicians to suspect and diagnose infected individuals early on. Climatic, ecological and environmental changes are related to fluctuations in rodent populations, and subsequently to human epidemics. Thus, prevention may be enhanced by host-reservoir control and human exposure prophylaxis interventions, which likely have led to a dramatic reduction of human cases in China over the past decades; vaccination may also play a role in the future.
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Affiliation(s)
- Dionysios Christos Watson
- Division of Infectious Diseases, Department of Internal Medicine, Patras University General Hospital , Patras , Greece
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Starakis I, Panos G, Koutras A, Mazokopakis EE. Pathogens and chronic or long-term neurologic disorders. Cardiovasc Hematol Disord Drug Targets 2012; 11:40-52. [PMID: 21446901 DOI: 10.2174/187152911795945123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Revised: 02/18/2011] [Accepted: 02/20/2011] [Indexed: 11/22/2022]
Abstract
Infections of the central nervous system may provoke glial and autoimmune responses but a definitive linkage between these infections and the pathogenesis of chronic neurologic disorders is still elusive. There are controversial reports implicating infectious agents in the pathogenetic mechanisms of chronic or long-term neurologic disorders, such as multiple sclerosis, amyotrophic lateral sclerosis, Parkinson's disease, Alzheimer's disease and autistic spectrum disorders, but the specific role of bacterial or viral infections in the pathogenesis of these medical entities has not been fully elucidated. Up till now, the evidence is distant from definite, but certain cases may be attributed to infections in the millieu of multiple toxic events such as trauma, nutritional deficits, immune dysregulation and excitotoxicity in genetically vulnerable indiniduals. There is an ongoing debate concering the direct involvement of various infectious agents in the neurodegenerative and neurobehavioral diseases pathogenesis and/or their contribution to the deterioration of the disease or co-morbidity in these patients. These patients are exceptionally difficult to be treated by using single therapeutic modalities, because their disese is multifocal and treatment is aimed to control signs and symptoms rather than the true causes of the disease and its progressive course. Furthermore, even if these causative links were indetifiable, our therapeutic interventions would come too late due to the irreversible damages at the time of the initiation of treatment. Our aim is to comprehensively review all available data suggesting that infections could be common antecedent events of progressive neurologic degenerative or behavioural diseases.
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Affiliation(s)
- Ioannis Starakis
- Medicine Patras University Hospital, Internal Medicine Department, Infectious Diseases Section, Greece.
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Sargianou M, Watson DC, Chra P, Papa A, Starakis I, Gogos C, Panos G. Hantavirus infections for the clinician: From case presentation to diagnosis and treatment. Crit Rev Microbiol 2012; 38:317-29. [DOI: 10.3109/1040841x.2012.673553] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Sargianou M, Watson DC, Kampiotis D, Papa A, Economopoulou A, Gogos C, Panos G. Febrile disease in a Bulgarian emigrant with acute renal failure, thrombocytopenia, bilateral subconjunctival haemorrhage and hypoxemia. J Clin Virol 2012; 54:2-5. [DOI: 10.1016/j.jcv.2012.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 01/23/2012] [Indexed: 10/28/2022]
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Lewden C, Bouteloup V, De Wit S, Sabin C, Mocroft A, Wasmuth JC, van Sighem A, Kirk O, Obel N, Panos G, Ghosn J, Dabis F, Mary-Krause M, Leport C, Perez-Hoyos S, Sobrino-Vegas P, Stephan C, Castagna A, Antinori A, d'Arminio Monforte A, Torti C, Mussini C, Isern V, Calmy A, Teira R, Egger M, Grarup J, Chêne G. All-cause mortality in treated HIV-infected adults with CD4 ≥500/mm3 compared with the general population: evidence from a large European observational cohort collaboration. Int J Epidemiol 2011; 41:433-45. [PMID: 22493325 DOI: 10.1093/ije/dyr164] [Citation(s) in RCA: 192] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Using data from a large European collaborative study, we aimed to identify the circumstances in which treated HIV-infected individuals will experience similar mortality rates to those of the general population. METHODS Adults were eligible if they initiated combination anti-retroviral treatment (cART) between 1998 and 2008 and had one prior CD4 measurement within 6 months. Standardized mortality ratios (SMRs) and excess mortality rates compared with the general population were estimated using Poisson regression. Periods of follow-up were classified according to the current CD4 count. RESULTS Of the 80 642 individuals, 70% were men, 16% were injecting drug users (IDUs), the median age was 37 years, median CD4 count 225/mm(3) at cART initiation and median follow-up was 3.5 years. The overall mortality rate was 1.2/100 person-years (PY) (men: 1.3, women: 0.9), 4.2 times as high as that in the general population (SMR for men: 3.8, for women: 7.4). Among 35 316 individuals with a CD4 count ≥500/mm(3), the mortality rate was 0.37/100 PY (SMR 1.5); mortality rates were similar to those of the general population in non-IDU men [SMR 0.9, 95% confidence interval (95% CI) 0.7-1.3] and, after 3 years, in women (SMR 1.1, 95% CI 0.7-1.7). Mortality rates in IDUs remained elevated, though a trend to decrease with longer durations with high CD4 count was seen. A prior AIDS diagnosis was associated with higher mortality. CONCLUSIONS Mortality patterns in most non-IDU HIV-infected individuals with high CD4 counts on cART are similar to those in the general population. The persistent role of a prior AIDS diagnosis underlines the importance of early diagnosis of HIV infection.
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Affiliation(s)
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- INSERM, U897, ISPED, Université Bordeaux Segalen, Bordeaux, France.
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Starakis I, Panos G, Mazokopakis E. Dealing with the substance abuse epidemic and infective endocarditis: clinical, immunologic and pathogenetic aspects. Curr Vasc Pharmacol 2011; 10:247-56. [PMID: 22022774 DOI: 10.2174/157016112799304978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 08/30/2011] [Accepted: 09/07/2011] [Indexed: 11/22/2022]
Abstract
Although infective endocarditis (IE) is not the most frequent infection seen in intravenous (IV) drug abusers (IVDAs), health care providers should always regard it as a possible diagnosis in this population. Many researchers have tried to elucidate the clinical, epidemiologic, immunologic and pathogenetic aspects of this entity. Right-sided endocarditis accounts for almost 10% of all IE episodes and has been most commonly interrelated with IV use of illicit substances. On the other hand, recent reports have proposed that left-sided valve participation is seen more often now than in the past. While, our progress in medicine, new diagnostic criteria and especially modern imaging techniques have broadened our ability to recognize IE, there are still some gray areas regarding right-sided IE. Our aim is to comprehensively review the clinical features and complications and also the possible pathogenetic and immunologic mechanisms implicated in IE patients who are injecting illicit substances.
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Scourfield A, Waters L, Holmes P, Panos G, Randell P, Jackson A, Mandalia S, Gazzard B, Nelson M. Non-cirrhotic portal hypertension in HIV-infected individuals. Int J STD AIDS 2011; 22:324-8. [PMID: 21680667 DOI: 10.1258/ijsa.2010.010396] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Non-cirrhotic portal hypertension (NCPH) has been associated with didanosine (ddI) exposure. We aimed to determine the number of individuals with NCPH within our cohort and define their characteristics. We identified individuals within our cohort with NCPH and performed a retrospective case note review. Cumulative antiretroviral therapy (ART) use was calculated and a statistical analysis performed to compare exposure to the rest of the clinic cohort for the same time period. Where available, data was collated on FibroScan®, echocardiography and coagulation profile. Seventeen patients were identified. Upper gastrointestinal bleeding was the most common presenting feature. Liver biopsy showed mild portal or periportal fibrosis in 13 (81%) and four with features of nodular regenerative hyperplasia. There was significantly greater exposure to ddl in this group (59.5 months) compared to the rest of the HIV cohort (21.1 months) P = <0.001. Eleven subjects has a liver elastography performed, six (55%) had a result greater than 9.6 kPa (consistent with greater than F2 disease by Metavir scoring). Echocardiography was performed in seven patients: four met criteria for pulmonary hypertension. This is consistent with other cohorts demonstrating an association between the didanosine exposure and NCPH. Our data also suggest an increased risk of pulmonary hypertension.
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Affiliation(s)
- A Scourfield
- Department of HIV Medicine, Chelsea and Westminster Hospital, London, UK.
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Lagadinou ED, Marangos M, Liga M, Panos G, Tzouvara E, Dimitroulia E, Tiniakou M, Tsakris A, Zoumbos N, Spyridonidis A. Human herpesvirus 6-related pure red cell aplasia, secondary graft failure, and clinical severe immune suppression after allogeneic hematopoietic cell transplantation successfully treated with foscarnet. Transpl Infect Dis 2011; 12:437-40. [PMID: 20561301 DOI: 10.1111/j.1399-3062.2010.00515.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Human herpesvirus 6 (HHV-6) is frequently detected after allogeneic hematopoietic cell transplantation (allo-HCT); however, the clinical interpretation of HHV-6 viremia in a transplant patient is challenging as it may signify asymptomatic reactivation, chromosomal integration of the virus genome in the donor or recipient with no clinical significance, or severe HHV-6 disease. Here we present a case of HHV-6 disease after allo-HCT presenting as pure red cell aplasia, secondary graft failure, and severe immunosuppression causing multiple severe bacterial super-infections. Examination of pre-transplant patient and donor samples as well as serial determination of HHV-6 DNA copy numbers after transplantation were necessary to definitively interpret HHV-6 viremia as active HHV-6 infection with a causative role in pancytopenia and immune suppression. Foscarnet treatment resulted both in viral load decline and disappearance of HHV-6-related bone marrow suppression and predisposition to severe infections. Clinicians should be aware of the wide array of clinical manifestations and the diagnostic pitfalls of post-transplant HHV-6 disease. These issues are extremely challenging, as they may result either in dangerous underestimation of HHV-6 disease or in the institution of unnecessary antiviral therapy. Late bone marrow aplasia and late severe infections after allo-HCT without other obvious causes may be HHV-6 related.
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Affiliation(s)
- E D Lagadinou
- Department of Internal Medicine, Patras University Medical Center, Rio/Patras, Greece
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Panos G, Samonis G, Alexiou VG, Kavarnou GA, Charatsis G, Falagas ME. Mortality and morbidity of HIV infected patients receiving HAART: a cohort study. Curr HIV Res 2008; 6:257-60. [PMID: 18473789 DOI: 10.2174/157016208784324976] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
HAART has substantially decreased mortality and morbidity among HIV-infected patients. We retrospectively analyzed morbidity and mortality in a cohort of HIV-infected adult patients with prolonged and frequent follow up (1987-2006). The study was divided in pre-HAART and HAART period for comparative reasons. In total, 615 HIV-infected patients (54 females) were included in our study. 144 died during the pre-HAART period (51.4 deaths per 100 patients). During the HAART period only 38 patients died from a total of 335 patients receiving HAART (11.3 deaths per 100 patients); the follow up in this part of the cohort was 2139 persons-years and the death incidence 1.77 deaths/per 100 person-years. The subanalysis excluding patients who died within 3 months from admission showed that death incidence among patients that have been receiving HAART from the time of diagnosis (1.2 deaths per 100 person-years) was slightly lower, compared to the death incidence of patients treated for some time with non-HAART as well (1.58 deaths per 100 persons-years). After the availability of HAART in this unit, the proportion of non-AIDS related deaths increased significantly from 8% to 40% (p<0.001); infections remained the leading cause of death in both groups of patients. Tauhe most common non-AIDS related causes of deaths were cancer and coronary disease. Our data from the studied cohort adds to the relevant literature regarding the dramatic reduction of morbidity and mortality that occurred after the availability of HAART.
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Panos G, Holmes P, Valero S, Anderson M, Gazzard B, Nelson M. Transient elastography, liver stiffness values, and acute hepatopathy. Hepatology 2008; 47:2140; author reply 2141. [PMID: 18508302 DOI: 10.1002/hep.22314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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Theocharis G, Peppas G, Spanos A, Vlara L, Issaris E, Panos G, Falagas M. 168: Effect of Meteorological Variables on the Incidence of Upper and Lower Respiratory Tract Infections. Ann Emerg Med 2008. [DOI: 10.1016/j.annemergmed.2008.01.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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