The first case of human invasion by Clinostomum complanatum in the European part of Russia

The article presents a rare case of human invasion by the trematode Clinostomum complanatum in the European part of Russia. The diagnosis was established based on a parasitological study of flukes removed from the tonsils and pharynx of a 42-year-old woman, a resident of the Tambov region of Russia.

Understanding clinical outcomes and factors influencing mortality in intensive care unit patients with COVID-19-associated candidemia

BACKGROUND

During the COVID pandemic, research has shown an increase in candidemia cases following severe COVID infection and the identification of risk factors associated with candidemia. However, there is a lack of studies that specifically explore clinical outcomes and mortality rates related to candidemia after COVID infection.

OBJECTIVES

The aim of this international study was to evaluate the clinical outcomes and identify factors influencing mortality in patients who developed candidemia during their COVID infection.

PATIENTS/METHODS

This study included adult patients (18 years of age or older) admitted to the intensive care unit (ICU) and diagnosed with COVID-associated candidemia (CAC). The research was conducted through ID-IRI network and in collaboration with 34 medical centres across 18 countries retrospectively, spanning from the beginning of the COVID pandemic until December 2021.

RESULTS

A total of 293 patients diagnosed with CAC were included. The median age of the patients was 67, and 63% of them were male. The most common Candida species detected was C. albicans. The crude 30-day mortality rate was recorded at 62.4%. The logistic regression analysis identified several factors significantly impacting mortality, including age (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02-1.07, p < .0005), SOFA score (OR 1.307, 95% CI 1.17-1.45, p < .0005), invasive mechanical ventilation (OR 7.95, 95% CI 1.44-43.83, p < .017) and duration of mechanical ventilation (OR 0.98, 95% CI 0.96-0.99, p < .020).

CONCLUSIONS

By recognising these prognostic factors, medical professionals can customise their treatment approaches to offer more targeted care, leading to improved patient outcomes and higher survival rates for individuals with COVID-associated candidemia.

Salmonella Reading: A rare case of generalized salmonellosis in non-endemic region

Salmonella Reading is a rare serotype of Salmonella enterica and is associated with sporadic cases and rare outbreaks worldwide. This article describes a rare case of generalized S. Reading infection imported from Indonesia to Moscow, Russia. A 37-year-old man was admitted to the hospital with fever, weakness, and headache after returning from Indonesia. During his stay in Indonesia, he developed symptoms of a gastrointestinal infection, which resolved there. However, upon return to Moscow, his condition worsened due to high fever, and he was diagnosed with a generalized salmonellosis caused by S. Reading (positive blood and stool culture). This case highlights the importance of differential diagnosis in patients with fever. The health risks associated with traveling to exotic countries and the importance of preventive measures are emphasized. This is the first published case of S. Reading in Eastern Europe.

Classical fever of unknown origin in 21 countries with different economic development: an international ID-IRI study

Fever of unknown origin (FUO) is a serious challenge for physicians. The aim of the present study was to consider epidemiology and dynamics of FUO in countries with different economic development. The data of FUO patients hospitalized/followed between 1st July 2016 and 1st July 2021 were collected retrospectively and submitted from referral centers in 21 countries through ID-IRI clinical research platform. The countries were categorized into developing (low-income (LI) and lower middle-income (LMI) economies) and developed countries (upper middle-income (UMI) and high-income (HI) economies). This research included 788 patients. FUO diagnoses were as follows: infections (51.6%; n = 407), neoplasms (11.4%, n = 90), collagen vascular disorders (9.3%, n = 73), undiagnosed (20.1%, n = 158), miscellaneous diseases (7.7%, n = 60). The most common infections were tuberculosis (n = 45, 5.7%), brucellosis (n = 39, 4.9%), rickettsiosis (n = 23, 2.9%), HIV infection (n = 20, 2.5%), and typhoid fever (n = 13, 1.6%). Cardiovascular infections (n = 56, 7.1%) were the most common infectious syndromes. Only collagen vascular disorders were reported significantly more from developed countries (RR = 2.00, 95% CI: 1.19-3.38). FUO had similar characteristics in LI/LMI and UMI/HI countries including the portion of undiagnosed cases (OR, 95% CI; 0.87 (0.65-1.15)), death attributed to FUO (RR = 0.87, 95% CI: 0.65-1.15, p-value = 0.3355), and the mean duration until diagnosis (p = 0.9663). Various aspects of FUO cannot be determined by the economic development solely. Other development indices can be considered in future analyses. Physicians in different countries should be equally prepared for FUO patients.

1168. Crimean-Congo Hemorrhagic Fever Virus in Central, Eastern, and South-eastern Asia

Background

Crimean-Congo hemorrhagic fever (CCHF) is endemic in Africa and in areas below the 50th parallel of north (latitude 50°0' N) in Asia and Europe, but the epidemiology of CCHF needs to be better characterized in most regions.

Methods

We comprehensively searched scientific databases for studies on CCHF epidemiology in these regions. We used a One Health approach to describe disease burden through human cases, animal and human serology studies, and Crimean-Congo hemorrhagic fever virus (CCHFV) isolation from ticks. In addition, we leveraged a classification scheme tosort countries into five categories based on the level of evidence and the maturity of their CCHF surveillance systems.

Results

We identified 2,253 CCHF cases that occurred in the region during the period 1944–2021. Central Asian countries reported the majority of cases (1,966). China is the only country in Eastern and South-eastern Asia that reported CCHF cases (287). Six countries (China, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan) were assigned to level 1 or level 2, based on the maturity of their surveillance systems. Two countries (Mongolia and Myanmar) were assigned to level 3, due to conclusive evidence of CCHFV circulation in the absence of reported CCHF cases. Subsequently, 13 countries in Eastern and South-eastern Asia were categorized in levels 4 and 5, based on CCHFV vector prevalence.

Conclusion

This paper describes past and present status of the CCHF reporting systems to inform international and local public-health agencies to strengthen or establish CCHF surveillance systems and address shortcomings in the region.

Disclosures

All Authors: No reported disclosures.

Analyzing central-line associated bloodstream infection prevention bundles in 22 countries: The results of ID-IRI survey

BACKGROUND

Because central line-associated bloodstream infections (CLABSIs) are a significant complication of central venous access, it is critical to prevent CLABSIs through the use of central line bundles. The purpose of this study was to take a snapshot of central venous access bundles in various countries.

METHODS

The participants in intensive care units (ICUs) completed a questionnaire that included information about the health center, infection control procedures, and central line maintenance. The countries were divided into 2 groups: those with a low or low-middle income and those with an upper-middle or high income.

RESULTS

Forty-three participants from 22 countries (46 hospitals, 85 ICUs) responded to the survey. Eight (17.4%) hospitals had no surveillance system for CLABSI. Approximately 7.1 % (n = 6) ICUs had no CLABSI bundle. Twenty ICUs (23.5%) had no dedicated checklist. The percentage of using ultrasonography during catheter insertion, transparent semi-permeable dressings, needleless connectors and single-use sterile pre-filled ready to use 0.9% NaCl were significantly higher in countries with higher and middle-higher income (P < .05).

CONCLUSIONS

Our study demonstrated that there are significant differences in the central line bundles between low/low-middle income countries and upper-middle/high-income countries. Additional measures should be taken to address inequity in the management of vascular access in resource-limited countries.

Clinical characteristics of COVID-19 in patients with tuberculosis and factors associated with the disease severity

BACKGROUND

Data on patients with COVID-19 who have pulmonary tuberculosis (TB) are limited. In this study, we compared the clinical characteristics of patients with COVID-19/TB and patients with COVID-19 only. In addition, we analyzed the links between the severity of COVID-19 disease and the clinical characteristics of patients with COVID-19/TB.

METHODS

We conducted a retrospective, anonymized, cross-sectional study of 111 patients who met inclusion criteria for analysis (75 patients with COVID-19/TB and 36 patients with COVID-19).

RESULTS

Patients in both groups (COVID-19/TB vs COVID-19) mainly suffered from fever (72.0% vs 100%, p < 0.001), fatigue (76.0% vs 94.4%, p  =  0.018), chest pain (72.0% vs 36.1%, p < 0.001), followed by cough (60.0% vs 97.2%, p < 0.001) and dyspnea (44.0% vs 63.9%, p  =  0.05). In group COVID-19/TB the most frequently reported co-morbidities were chronic liver disease (17 [22.7%]), cardiovascular diseases (25 [33.3%]), and diseases of the nervous system (13 [17.3%]). Female gender, fever, dyspnea, pulmonary bilateral TB lesion, and three or more co-morbidities have a statistically significant positive effect on the severity of the disease among patients with COVID-19/TB.

CONCLUSION

It is important to perform rapid molecular testing and computed tomography to correctly distinguish COVID-19 and TB because of the similar clinical characteristics of both diseases. Bilateral pulmonary TB lesion and co-morbidity should be considered risk factors for severe COVID-19.

Factors leading to dissemination of cutaneous anthrax: an international ID-IRI study

Background

Although anthrax is a rare zoonotic infection, it still causes significant mortality and morbidity. In this multicenter study, which is the largest anthrax case series ever reported, we aimed to describe the factors leading to dissemination of cutaneous anthrax.

Methods

Adult patients with cutaneous anthrax from 16 referral centers were pooled. The study had a retrospective design, and included patients treated between January 1, 1990 and December 1, 2019. Probable, and confirmed cases based upon CDC anthrax 2018 case definition were included in the study. A descriptive statistical analysis was performed for all variables.

Results

A total of 141 cutaneous anthrax patients were included. Of these, 105 (74%) patients had probable and 36 (26%) had confirmed diagnosis. Anthrax meningitis and bacteremia occurred in three and six patients, respectively. Sequelae were observed in three patients: cicatricial ectropion followed by ocular anthrax (n = 2) and movement restriction on the left hand after surgical intervention (n = 1). One patient had gastrointestinal anthrax. The parameters related to poor outcome (p < 0.05) were fever, anorexia, hypoxia, malaise/fatigue, cellulitis, fasciitis, lymphadenopathy, leukocytosis, high CRP and creatinine levels, longer duration of antimicrobial therapy, and combined therapy. The last two were seemingly the consequences of dissemination rather than being the reasons. The fatality rate was 1.4%.

Conclusions

Rapid identification of anthrax is crucial for prompt and effective treatment. Systemic symptoms, disseminated local infection, and high inflammatory markers should alert the treating physicians for the dissemination of the disease.

SARS-CoV2-associated multisystem inflammatory syndrome in children: data from Khimki hospital

Purpose

Multisystem inflammatory syndrome in children (MIS-C) – the most severe status, associated with SARS-COV-2 infection. Clinical and laboratory characteristics of MIS-C, and treatment optimization are topical problems on current stage. Our aim to analyze main features of the MIS-C.

Methods & Materials

We evaluated 41 children (21M/18F) 1 - 16 yrs. (8,45±0,677 yrs.) hospitalized in Khimki Regional Hospital with MIS-C from June 2020 to April 2021. 7 children had background disease (allergy, nephroblastoma, ulcerative colitis, diabetes mellitus, urologic pathology). 5 children were mongoloid race (12%). Excessive weight had 27%, according to BMI; 17% had high growth to age. 58% had A(II) blood group, Rh(+)-positive were 74%.

Results

All children at the admission had fever more than 3 days. Anti-SARS-COV-2 IgM and IgG had 1 patient, IgG only - 25 (61%); 2 patients were positive SARS-Cov2 RNA in the oropharyngeal swab; 27% had family contact to СOVID-19. By severity 66% children were hospitalized to the ICU. Clinically skin and mucosal signs had 31 (76 %), gastro-intestinal symptoms – 22 (54%), pneumonia – 20 (49%), kidney injury –15 (40%), cardiovascular damage - 10 (24%), CNS –6 (15%). Simultaneous damage of 2 systems had 37% children, 3 – 46%, 4 - 12%, 5 – 1 patient, 6 – 1 patient. 5 cases developed acute kidney injury like hemolytic-uremic syndrome (HUS), as the main MIS-C performance.

Laboratory features: increased ESR (Мe 40,0 (IQR 30-50) мм/ч), elevated CRP (Мe 118,9 (IQR 71,5-129,4)), ferritin (Мe 471,0 (IQR 214,08-990,28)), D-dimer (Мe 2,81 (IQR 1,76 – 4,55)), LDH (Мe 594,0 (IQR 511,0-663,0)), CK (Мe 112,0 (IQR 61,35-288,7)), CK-MB (Мe 44,95 (IQR 33,0-80,1)), decreased albumin (Мe 27,4 (IQR 23,0-33,0)). In 76% patients were treated with methylprednisolone pulse, IVIG in 20%, standard doses of corticosteroids – 10%. All children discharged home with recovery.

Conclusion

MIS-C is the most severe form of COVID-19 in children. In Khimki Regional Hospital 41 patient were successfully treated. The main features are severe status (66%-ICU), 63% children had 3+ affected systems; the main symptoms are skin and mucosal damage, gastrointestinal signs and headache, high BMI. There were 5 patients with HUS, during SARS-Cov2 associated MIS-C.

Etiology of community-acquired and hospital-acquired pneumonia associated with COVID-19

Purpose

The COVID-19 pandemic is accompanied by a high incidence of community-acquired pneumonia (CAP). Patients with a new coronavirus infection have an increased risk of developing hospital-acquired pneumonia. Aim: to study the etiological structure of CAP during the epidemic spread of COVID-19, to assess the risks of joining the pathogens of pneumonia associated with the provision of medical care.

Methods & Materials

Biological material from 1085 hospitalized patients with CAP was conducted from August 2020 - June 2021 in Rostov-on-Don (Russia). Verification of respiratory viruses including SARS-CoV-2 RNA was performed by polymerase chain reaction in nasopharyngeal smears. Bacteriological analysis of sputum was performed via classical methods, identification of isolated pathogens was carried out using time-of-flight mass spectrometry on an Autoflex (Bruker Daltonics) with BioTyper 3.0 software.

Results

Cases of type 3 parainfluenza virus (7.8±0.9%), other types of coronaviruses (HKU-1, OC43, HL-63 and 229Е) (2.7±0.5%), respiratory syncytial virus (1.9±0.5%) were detected in patients with COVID-19. Fungi of the genus Candida (35.6±1.8%) and Staphylococcus aureus (9.1±1.1%) were prevailing in the microbiota structure. Should be noted that the number of Streptococcus pneumoniae cultures decreased from 5.5 % in August 2020 to 1.1 % in June 2021, possibly due to pneumococcal vaccination. Gramm-negative enterobacteria were presented predominantly by Klebsiella pneumoniae (3.5±0.7%), Escherichia coli (2.9±0.6%), and non-fermenting Gramm-negative bacteria – Pseudomonas aeruginosa (1.5±0.5%) and Acinetobacter baumannii (1.2±0.4%). In 30.6% of patients treated in the hospital there was a secondary infection probably associated with compromised immune system and the transmission of infection from the hospital environment. Secondary infection with Candida spp., non-fermenting Gramm-negative bacteria (A. baumannii, and P. aeruginosa) and K. pneumoniae, including those characterized by multiple drug-resistance, prevailed. The most frequently registered resistance to penicillins, cephalosporins of 3rd generation.

Conclusion

A feature of CAP in patients with laboratory-confirmed COVID-19 is a higher incidence of mixed infection of both viral and bacterial etiology. Patients with COVID-19 represent a high risk group for the development of mycotic lung lesions, possibly against the background of treatment with antibacterial drugs. There is a significant risk of the formation of nosocomial infections in patients.

MIP-1a and MIP-1b in serum as potential markers of the severe course COVID-19

Purpose

Studying the pathogenesis of COVID-19 is necessary to developing of perspective predictors of severe course of disease and unfavorable prognosis. The macrophage activation syndrome observed in severe form of COVID-19 can potentially be used as a marker of poor prognosis, which makes it relevant to measure the levels of macrophage inflammatory proteins MIP-1a and MIP-1b.

Methods & Materials

Study included 80 patients (43 men and 37 women) aged 24 -90 years (mean = 58.3 years) with laboratory confirmed COVID-19 admitted Infectious Diseases Hospital in Moscow during April - August 2020. Patients were divided into 2 groups: group 1 included patients with a moderate form (N = 30), group 2 (N = 50) included patients with a severe form of COVID-19. Serum levels of MIP-1a and MIP-1b were assessed by ELISA.

Results

An increase of the MIP-1a level was observed in 3 patients in group 1 (10%) and in 42 patients in group 2 (84%). At the same time, the average concentration of MIP-1a was 3.71 pg/ml and 156.79 pg/ml in groups 1 and 2, respectively (p < 0.01).

MIP-1b level above baseline was detected in 11 patients in group 1 (36.7%) and in 48 patients in group 2 (96%). The mean MIP-1b concentrations were 7.53 pg/ml and 152.62 pg/ml in groups 1 and 2, respectively. Similarly with MIP-1a, the difference in mean MIP-1b concentrations between the two groups was statistically significant (p < 0.01).

A statistically significant correlation between the concentrations of MIP-1a and MIP-1b was observed for whole study population, the Pearson's correlation coefficient (r) is 0.756 (p < 0.01). At the same time, there were no statistically significant differences related to gender and age. Taken together, these data suggest the potential of serum concentrations of MIP-1a and MIP-1b as markers of the disease severity.

Conclusion

COVID-19 is accompanied by an increase in the level of macrophage inflammatory proteins. The severe disease in most cases was associated with significant increase in the concentrations of MIP-1a and MIP-1b in the blood serum, which makes it possible to consider these proteins as potential markers of the severe COVID-19.

The COVID-19 vaccination acceptance/hesitancy rate and its determinants among healthcare workers of 91 Countries: A multicenter cross-sectional study

The aim of this study was to investigate the COVID-19 vaccination acceptance rate and its determinants among healthcare workers in a multicenter study. This was a cross-sectional multi-center survey conducted from February 5 to April 29, 2021. The questionnaire consisted of 26 items in 6 subscales. The English version of the questionnaire was translated into seven languages and distributed through Google Forms using snowball sampling; a colleague in each country was responsible for the forward and backward translation, and also the distribution of the questionnaire. A forward stepwise logistic regression was utilized to explore the variables and questionnaire factors tied to the intention to COVID-19 vaccination. 4630 participants from 91 countries completed the questionnaire. According to the United Nations Development Program 2020, 43.6 % of participants were from low Human Development Index (HDI) regions, 48.3 % high and very high, and 8.1 % from medium. The overall vaccination hesitancy rate was 37 %. Three out of six factors of the questionnaire were significantly related to intention to the vaccination. While 'Perceived benefits of the COVID-19 vaccination' (OR: 3.82, p-value<0.001) and 'Prosocial norms' (OR: 5.18, p-value<0.001) were associated with vaccination acceptance, 'The vaccine safety/cost concerns' with OR: 3.52, p-value<0.001 was tied to vaccination hesitancy. Medical doctors and pharmacists were more willing to take the vaccine in comparison to others. Importantly, HDI with OR: 12.28, 95 % CI: 6.10-24.72 was a strong positive determinant of COVID-19 vaccination acceptance. This study highlighted the vaccination hesitancy rate of 37 % in our sample among HCWs. Increasing awareness regarding vaccination benefits, confronting the misinformation, and strengthening the prosocial norms would be the primary domains for maximizing the vaccination coverage. The study also showed that the HDI is strongly associated with the vaccination acceptance/hesitancy, in a way that those living in low HDI contexts are more hesitant to receive the vaccine.

Factors influencing on hospitalization of COVID-19 patients with comorbidity

Purpose

During COVID-19 pandemic, the total number of patients is periodically growing, including the number of those requiring hospitalization.

The factors that increase the risk of hospitalization with COVID-19 remain poorly understood.

Aim

identification of factors influencing on the likelihood of hospitalization in COVID-19 patients with comorbidity.

Methods & Materials

A retrospective cohort study of 74314 COVID-19 patients with a comorbidity within March-November 2020 in Russia. Using multivariate logistic regression, significant factors influencing hospitalization were identified.

Results

As a result, a logistic function was obtained that included 16 factors out of 21, which was statistically significant. In accordance with R² Nigelkirk coefficient of determination, composition of the factors are 46.6%. Based on the regression coefficient values, the age of the patients, the sex of the patients, the severity of the disease, cardiovascular diseases, respiratory diseases, endocrine pathology, oncology and other diseases, fever, dyspnea and late address for medical care (after 5 day of disease) are factors that increase the likelihood of hospitalization. Rhinitis, loss of taste, belonging to contact with contact with COVID-19 patient, early seeking for medical care had an inverse relationship with the risk of hospitalization.

The chances of hospitalization of patients with oncology is increased 1.496 times (95% CI:1.159-1.932), with endocrine diseases - by 1.573 times (95% CI:1.238 -1.999), in patients with cardiovascular pathology - by 1.502 times (95% CI:1.185-1.903),), in patients with bronchopulmonary pathology - by 1.439 times (95% CI:1.133-1.828), with other comobidities - by 1.501 times (95% CI:1.184-1.904), in patients with moderate the course of the disease - by 8.353 times in comparison with patients with a mild course (95% CI:8,000-8.721), in patients with a severe course of the disease risk is increased by 68.291 times (95% CI:59.279-78.673), risk of hospitalization in men compared with women is increased 1.393 times (95% CI: 1.348-1.438), in patients with fever - 1.14 times (95% CI: 1.09-1.20), with dispnoea - 1.526 (95% CI: 1.495- 1.596).

The chances of hospitalization with an increase in age by 1 year increased 1.012 times (95% CI: 1.010-1.013).

Conclusion

These factors will help healthcare workers with the decisions regarding hospitalization of patients.

Clinical and epidemiological assessment of the epidemic process of covid-19 in hostels depending on the type of their planning arrangement

Purpose

During the COVID-19 pandemic, people living in dormitories became one of the most vulnerable groups of the population involved in the process of focal morbidity.

Aim

To analyze the clinical and epidemiological features of the manifestation of the epidemic process of COVID-19 in hostels, depending on the type of their planning arrangement.

Methods & Materials

A prospective analytical study of 350 foci of COVID-19 formed in hostels in Moscow in the period from 04.12.2020 to 06.23.2020 with 3,228 cases in total.

Results

The epidemic process in the corridor-type dormitories (СTВ) had an earlier development, the first foci of COVID-19 began to form as early as 04/12/2020, which was 7 days ahead of the formation of foci in block-type dormitories (BCD). The average growth rate in the corridor-type dormitories was 8.4%, which was 5.3 times higher than the corresponding indicator in block-type dormitories. The prevalence rate was 1.5 times higher in the corridor-type dormitories. From 04/12/2020 to 06/23/2020, the number of COVID-19 infected in the block-type dormitories was significantly less than in the corridor-type dormitories: there were 4 cases of infection per 100 guests of the block-type dormitories, while in the corridor-type dormitories there were 10 cases of COVID-19 per 100 residents. The prevalence rate of severe COVID-19 in block-type dormitories was 1.1%, while in corridor-type dormitories the studied coefficient was 11 times higher and averaged 11.6%.

Conclusion

The type of planning arrangement of collective housing organizations is a fundamental factor influencing on the course of epidemic process of COVID-19 in dormitories. The complex of necessary anti-epidemic measures aimed at localizing

Predictors of severe course of COVID-19 depending on comorbid background

Purpose

Methods & Materials

Results

Conclusion

Vector-borne and zoonotic infections and their relationships with regional and socioeconomic statuses: An ID-IRI survey in 24 countries of Europe, Africa and Asia

BACKGROUND

In this cross-sectional, international study, we aimed to analyze vector-borne and zoonotic infections (VBZI), which are significant global threats.

METHOD

VBZIs' data between May 20-28, 2018 was collected. The 24 Participatingcountries were classified as lower-middle, upper-middle, and high-income.

RESULTS

382 patients were included. 175(45.8%) were hospitalized, most commonly in Croatia, Egypt, and Romania(P = 0.001). There was a significant difference between distributions of VBZIs according to geographical regions(P < 0.001). Amebiasis, Ancylostomiasis, Blastocystosis, Cryptosporidiosis, Giardiasis, Toxoplasmosis were significantly more common in the Middle-East while Bartonellosis, Borreliosis, Cat Scratch Disease, Hantavirus syndrome, Rickettsiosis, Campylobacteriosis, Salmonellosis in Central/East/South-East Europe; Brucellosis and Echinococcosis in Central/West Asia; Campylobacteriosis, Chikungunya, Tick-borne encephalitis, Visceral Leishmaniasis, Salmonellosis, Toxoplasmosis in the North-Mediterranean; CCHF, Cutaneous Leishmaniasis, Dengue, Malaria, Taeniasis, Salmonellosis in Indian Subcontinent; Lassa Fever in West Africa. There were significant regional differences for viral hemorrhagic fevers(P < 0.001) and tick-borne infections(P < 0.001), and according to economic status for VBZIs(P < 0.001). The prevalences of VBZIs were significantly higher in lower-middle income countries(P = 0.001). The most similar regions were the Indian Subcontinent and the Middle-East, the Indian Subcontinent and the North-Mediterranean, and the Middle-East and North-Mediterranean regions.

CONCLUSIONS

Regional and socioeconomic heterogeneity still exists for VBZIs. Control and eradication of VBZIs require evidence-based surveillance data, and multidisciplinary efforts.

A living WHO guideline on drugs to prevent covid-19

CLINICAL QUESTION

What is the role of drugs in preventing covid-19? WHY DOES THIS MATTER?: There is widespread interest in whether drug interventions can be used for the prevention of covid-19, but there is uncertainty about which drugs, if any, are effective. The first version of this living guideline focuses on the evidence for hydroxychloroquine. Subsequent updates will cover other drugs being investigated for their role in the prevention of covid-19.

RECOMMENDATION

The guideline development panel made a strong recommendation against the use of hydroxychloroquine for individuals who do not have covid-19 (high certainty).

HOW THIS GUIDELINE WAS CREATED

This living guideline is from the World Health Organization (WHO) and provides up to date covid-19 guidance to inform policy and practice worldwide. Magic Evidence Ecosystem Foundation (MAGIC) provided methodological support. A living systematic review with network analysis informed the recommendations. An international guideline development panel of content experts, clinicians, patients, an ethicist and methodologists produced recommendations following standards for trustworthy guideline development using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

UNDERSTANDING THE NEW RECOMMENDATION

The linked systematic review and network meta-analysis (6 trials and 6059 participants) found that hydroxychloroquine had a small or no effect on mortality and admission to hospital (high certainty evidence). There was a small or no effect on laboratory confirmed SARS-CoV-2 infection (moderate certainty evidence) but probably increased adverse events leading to discontinuation (moderate certainty evidence). The panel judged that almost all people would not consider this drug worthwhile. In addition, the panel decided that contextual factors such as resources, feasibility, acceptability, and equity for countries and healthcare systems were unlikely to alter the recommendation. The panel considers that this drug is no longer a research priority and that resources should rather be oriented to evaluate other more promising drugs to prevent covid-19.

UPDATES

This is a living guideline. New recommendations will be published in this article and signposted by update notices to this guideline.

READERS NOTE

This is the first version of the living guideline for drugs to prevent covid-19. It complements the WHO living guideline on drugs to treat covid-19. When citing this article, please consider adding the update number and date of access for clarity.

Description of the rare localization of Dirofilaria repens in human in the right inguinal lymph node

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Rare localization of Dirofilaria repens in human.

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Description of dirofilariasis caused by D. repens in the inguinal lymph node.

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Difficulties in the diagnosis of D. repens in the inguinal lymph node.

D. repens is the causative agent of subcutaneous dirofilariasis in canine animals. In recent years, human invasion by this vector-borne helminthiasis has been recorded in many countries with temperate climate, but the localization of this helminth in the cavities of the human body is extremely rare. Cases of atypical localization of D. repens are described in the organs of the chest, cervical lymph node, in the spermatic cord and epididymis. It is usually requires differential diagnosis with neoplastic or metastatic processes. We report a case of the detection of Dirofilaria repens in the right inguinal lymph node in a 56-year-old woman. Helminth was identified by parasitological and molecular biological methods. A morphological study of cross sections of the nematode in histological preparations and molecular biological method, the polymerase chain reaction (PCR) of scrapings of histological material, were used in parallel.

A living WHO guideline on drugs for covid-19

Updates

This is the fourteenth version (thirteenth update) of the living guideline, replacing earlier versions (available as data supplements). New recommendations will be published as updates to this guideline.

Clinical question

What is the role of drugs in the treatment of patients with covid-19?

Context

The evidence base for therapeutics for covid-19 is evolving with numerous randomised controlled trials (RCTs) recently completed and underway. Emerging SARS-CoV-2 variants and subvariants are changing the role of therapeutics.

What is new?

The guideline development group (GDG) defined 1.5% as a new threshold for an important reduction in risk of hospitalisation in patients with non-severe covid-19. Combined with updated baseline risk estimates, this resulted in stratification into patients at low, moderate, and high risk for hospitalisation. New recommendations were added for moderate risk of hospitalisation for nirmatrelvir/ritonavir, and for moderate and low risk of hospitalisation for molnupiravir and remdesivir. New pharmacokinetic evidence was included for nirmatrelvir/ritonavir and molnupiravir, supporting existing recommendations for patients at high risk of hospitalisation. The recommendation for ivermectin in patients with non-severe illness was updated in light of additional trial evidence which reduced the high degree of uncertainty informing previous guidance. A new recommendation was made against the antiviral agent VV116 for patients with non-severe and with severe or critical illness outside of randomised clinical trials based on one RCT comparing the drug with nirmatrelvir/ritonavir. The structure of the guideline publication has also been changed; recommendations are now ordered by severity of covid-19.

About this guideline

This living guideline from the World Health Organization (WHO) incorporates new evidence to dynamically update recommendations for covid-19 therapeutics. The GDG typically evaluates a therapy when the WHO judges sufficient evidence is available to make a recommendation. While the GDG takes an individual patient perspective in making recommendations, it also considers resource implications, acceptability, feasibility, equity, and human rights. This guideline was developed according to standards and methods for trustworthy guidelines, making use of an innovative process to achieve efficiency in dynamic updating of recommendations. The methods are aligned with the WHO Handbook for Guideline Development and according to a pre-approved protocol (planning proposal) by the Guideline Review Committee (GRC). A box at the end of the article outlines key methodological aspects of the guideline process. MAGIC Evidence Ecosystem Foundation provides methodological support, including the coordination of living systematic reviews with network meta-analyses to inform the recommendations. The full version of the guideline is available online in MAGICapp and in PDF on the WHO website, with a summary version here in The BMJ. These formats should facilitate adaptation, which is strongly encouraged by WHO to contextualise recommendations in a healthcare system to maximise impact.

Future recommendations

Recommendations on anticoagulation are planned for the next update to this guideline. Updated data regarding systemic corticosteroids, azithromycin, favipiravir and umefenovir for non-severe illness, and convalescent plasma and statin therapy for severe or critical illness, are planned for review in upcoming guideline iterations.

Systematic Review and Meta-analysis of Postexposure Prophylaxis for Crimean-Congo Hemorrhagic Fever Virus among Healthcare Workers

We performed a systematic review and meta-analysis on the effectiveness of ribavirin use for the prevention of infection and death of healthcare workers exposed to patients with Crimean-Congo hemorrhagic fever virus (CCHFV) infection. Splashes with blood or bodily fluids (odds ratio [OR] 4.2), being a nurse or physician (OR 2.1), and treating patients who died from CCHFV infection (OR 3.8) were associated with healthcare workers acquiring CCHFV infection; 7% of the workers who received postexposure prophylaxis (PEP) with ribavirin and 89% of those who did not became infected. PEP with ribavirin reduced the odds of infection (OR 0.01, 95% CI 0–0.03), and ribavirin use <48 hours after symptom onset reduced the odds of death (OR 0.03, 95% CI 0–0.58). The odds of death increased 2.4-fold every day without ribavirin treatment. Ribavirin should be recommended as PEP and early treatment for workers at medium-to-high risk for CCHFV infection.

Infection prevention and control practice for Crimean-Congo hemorrhagic fever-A multi-center cross-sectional survey in Eurasia

Background

Crimean Congo Hemorrhagic Fever (CCHF) is a life threatening acute viral infection that presents significant risk of nosocomial transmission to healthcare workers.

Aim

Evaluation of CCHF infection prevention and control (IP&C) practices in healthcare facilities that routinely manage CCHF cases in Eurasia.

Methods

A cross-sectional CCHF IP&C survey was designed and distributed to CCHF centers in 10 endemic Eurasian countries in 2016.

Results

Twenty-three responses were received from centers in Turkey, Pakistan, Russia, Georgia, Kosovo, Bulgaria, Oman, Iran, India and Kazakhstan. All units had dedicated isolation rooms for CCHF, with cohorting of confirmed cases in 15/23 centers and cohorting of suspect and confirmed cases in 9/23 centers. There was adequate personal protective equipment (PPE) in 22/23 facilities, with 21/23 facilities reporting routine use of PPE for CCHF patients. Adequate staffing levels to provide care reported in 14/23 locations. All centers reported having a high risk CCHFV nosocomial exposure in last five years, with 5 centers reporting more than 5 exposures. Education was provided annually in most centers (13/23), with additional training requested in PPE use (11/23), PPE donning/doffing (12/23), environmental disinfection (12/23) and waste management (14/23).

Conclusions

Staff and patient safety must be improved and healthcare associated CCHF exposure and transmission eliminated. Improvements are recommended in isolation capacity in healthcare facilities, use of PPE and maintenance of adequate staffing levels. We recommend further audit of IP&C practice at individual units in endemic areas, as part of national quality assurance programs.