Risk factors matter: case report of <I>Y. pseudotuberculosis</I> in obese patient

Yersinia pseudotuberculosis is a Gram-negative bacillus that can occasionally cause zoonosis. Infections of this bacterium typically present as self-limiting ileitis, often accompanied by diarrhea, but, especially in the case of immunocompromised patients, can also lead to serious secondary complications which, if not treated properly, can progress with a poor prognosis. Here, we present a case of successfully treated bacteremia due to Y. pseudotuberculosis in a multipathological obese patient. The diagnosis was possible through blood culture, and this highlights the importance of the search for unconventional pathogens, especially in certain categories of patients whose risk factors are strongly indicative and suggestive.

Convalescent or standard plasma versus standard of care in the treatment of COVID-19 patients with respiratory impairment: short and long-term effects. A three-arm randomized controlled clinical trial

BACKGROUND

The efficacy of early treatment with convalescent plasma in patients with COVID-19 is debated. Nothing is known about the potential effect of other plasma components other than anti-SARS-CoV-2 antibodies.

METHODS

To determine whether convalescent or standard plasma would improve outcomes for adults in early phase of Covid19 respiratory impairment we designed this randomized, three-arms, clinical trial (PLACO COVID) blinded on interventional arms that was conducted from June 2020 to August 2021. It was a multicentric trial at 19 Italian hospitals. We enrolled 180 hospitalized adult patients with COVID-19 pneumonia within 5 days from the onset of respiratory distress. Patients were randomly assigned in a 1:1:1 ratio to standard of care (n = 60) or standard of care + three units of standard plasma (n = 60) or standard of care + three units of high-titre convalescent plasma (n = 60) administered on days 1, 3, 5 after randomization. Primary outcome was 30-days mortality. Secondary outcomes were: incidence of mechanical ventilation or death at day 30, 6-month mortality, proportion of days with mechanical ventilation on total length of hospital stay, IgG anti-SARS-CoV-2 seroconversion, viral clearance from plasma and respiratory tract samples, and variations in Sequential Organ Failure Assessment score. The trial was analysed according to the intention-to-treat principle.

RESULTS

180 patients (133/180 [73.9%] males, mean age 66.6 years [IQR 57-73]) were enrolled a median of 8 days from onset of symptoms. At enrollment, 88.9% of patients showed moderate/severe respiratory failure. 30-days mortality was 20% in Control arm, 23% in Convalescent (risk ratio [RR] 1.13; 95% confidence interval [CI], 0.61-2.13, P = 0.694) and 25% in Standard plasma (RR 1.23; 95%CI, 0.63-2.37, P = 0.544). Time to viral clearance from respiratory tract was 21 days for Convalescent, 28 for Standard plasma and 23 in Control arm but differences were not statistically significant. No differences for other secondary endpoints were seen in the three arms. Serious adverse events were reported in 1.7%, 3.3% and 5% of patients in Control, Standard and Convalescent plasma arms respectively.

CONCLUSIONS

Neither high-titer Convalescent nor Standard plasma improve outcomes of COVID-19 patients with acute respiratory failure. Trial Registration Clinicaltrials.gov Identifier: NCT04428021. First posted: 11/06/2020.

Evaluation with E-test of the meropenem/vaborbactam association in carbapenem-resistant and sensitive negative control strains isolates of samples processed at the Laboratory of the Rivoli Hospital

Background and aims: Meropenem (Mer) and vaborbactam (Vab) is a combination of a carbapenem and a new β-lactamase inhibitor used in adults to treat different types of infections caused by Gram-negative bacteria. This combination is chosen as an alternative in infections caused by Gram-negative bacteria when carbapenem-only therapies are unsatisfactory. Materials and methods: Based on this, we report our assessment of such meropenem/vaborbactam association through the E-test and the Microscan routine automated system. This evaluation was performed on 22 samples, carbapenem-resistant strains of Gram-negative bacteria isolated from different types of biological material. Five E. coli and 1 P. mirabilis were respectively susceptible to both carbapenems and Mer/Vab, 6 P. aeruginosa and 2 A. baumannii were respectively resistant to both carbapenems and Mer/Vab and out of 8 K. pneumoniae which were resistant to carbapenems only one was resistant to the Mer/Var combination. Results and conclusions: From the data obtained, it can be seen that resistance to carbapenems is 72%, and drops to 36% with the combined use of Mer/Vab. However, this combination cannot be used in the treatment of patients with diseases caused by P. aeruginosa and Acinetobacter spp., resistant to meropenem.

An unexpected case report of Ascaris lumbricoides in pregnant woman

Soil-transmitted helminths, primarily Ascaris, Trichuris and hookworm, infect more than 760 million people worldwide. Parasitic diseases represent a social and economic problem in developing countries. Herein, we present a case of ascariasis in a pregnant woman, who was treated with mebendazole for three days without teratogenic effects. It is emphasized the need not to underestimate helminth infections in developed countries and how rapid notification is needed in order to quickly establish a guided therapy especially in pregnant women.

An unusual case of Rhodotorula mucilaginosa fungaemia in a cancer patient

<em>Rhodotorula</em> is emerging as a relevant cause of nosocomial and opportunistic infections. Herein, we present a case of fungaemia due to <em>Rhodotorula</em> <em>mucilaginosa</em> in a cancer patient with lumbosacral stimulator for herniated disc with unfavourable outcome. The patient was hospitalized for twenty days during which he underwent various diagnostic tests before discovering the presence of colon cancer. At day 16 of hospitalization, a bloodstream infection due to <em>R. mucilaginosa</em> with an antimycogram profile resistant to fluconazole occurred. It is emphasized the need for the rapid and correct identification of <em>R. mucilaginosa</em> in order to set up as fast as possible a pathogen driven therapy, in particular in the immunocompromised subjects.