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Romeo C, Parisio G, Scali F, Tonni M, Santucci G, Maisano AM, Barbieri I, Boniotti MB, Stadejek T, Alborali GL. Complex interplay between PRRSV-1 genetic diversity, coinfections and antimicrobial use influences performance parameters in post-weaning pigs. Vet Microbiol 2023; 284:109830. [PMID: 37481996 DOI: 10.1016/j.vetmic.2023.109830] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 04/28/2023] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
Porcine reproductive and respiratory syndrome (PRRS) is one of the main diseases of pigs, leading to large economic losses in swine production worldwide. PRRSV high mutation rate and low cross-protection between strains make PRRS control challenging. Through a semi-longitudinal approach, we analysed the relationships among performance parameters, PRRSV-1 genetic diversity, coinfections and antimicrobial use (AMU) in pig nurseries. We collected data over the course of five years in five PRRS-positive nurseries belonging to an Italian multisite operation, for a total of 86 batches and over 200,000 weaners involved. The farm experienced a severe PRRS outbreak in the farrowing unit at the onset of the study, but despite adopting vaccination of all sows, batch-level losses in nurseries in the following years remained constantly high (mean±SE: 11.3 ± 0.5 %). Consistently with previous studies, our phylogenetic analysis of ORF 7 sequences highlighted the peculiarity of strains circulating in Italy. Greater genetic distances between the strain circulating in a weaners' batch and strains from the farrowing unit and the previous batch were associated with increased mortality (p < 0.0001). All the respiratory and enteric coinfections contributed to an increase in losses (all p < 0.026), with secondary infections by Streptococcus suis and enteric bacteria also inducing an increase in AMU (both p < 0.041). Our findings highlight that relying solely on sows' vaccination is insufficient to contain PRRS losses, and the implementation of rigorous biosecurity measures is pivotal to limit PRRSV circulation among pig flows and consequently minimise the risk of exposure to genetically diverse strains that would increase production costs.
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Affiliation(s)
- Claudia Romeo
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna - IZSLER, via Bianchi 9, 25124 Brescia, Italy
| | - Giovanni Parisio
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna - IZSLER, via Bianchi 9, 25124 Brescia, Italy.
| | - Federico Scali
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna - IZSLER, via Bianchi 9, 25124 Brescia, Italy
| | - Matteo Tonni
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna - IZSLER, via Bianchi 9, 25124 Brescia, Italy
| | - Giovanni Santucci
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna - IZSLER, via Bianchi 9, 25124 Brescia, Italy
| | - Antonio M Maisano
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna - IZSLER, via Bianchi 9, 25124 Brescia, Italy
| | - Ilaria Barbieri
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna - IZSLER, via Bianchi 9, 25124 Brescia, Italy
| | - M Beatrice Boniotti
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna - IZSLER, via Bianchi 9, 25124 Brescia, Italy
| | - Tomasz Stadejek
- Department of Pathology and Veterinary Diagnostics, Institute of Veterinary Medicine, Warsaw University of Life Sciences - SGGW, Nowoursynowska 159C, 02-776 Warsaw, Poland
| | - G Loris Alborali
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna - IZSLER, via Bianchi 9, 25124 Brescia, Italy
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Hernández-Solis A, Güemes-González AM, Ruiz-Gómez X, Álvarez-Maldonado P, Castañeda-Casimiro J, Flores-López A, Ramírez-Guerra MA, Muñoz-Miranda O, Madera-Sandoval RL, Arriaga-Pizano LA, Nieto-Patlán A, Estrada-Parra S, Pérez-Tapia SM, Serafín-López J, Chacón-Salinas R, Escobar-Gutiérrez A, Soria-Castro R, Ruiz-Sánchez BP, Wong-Baeza I. IL-6, IL-10, sFas, granulysin and indicators of intestinal permeability as early biomarkers for a fatal outcome in COVID-19. Immunobiology 2022; 227:152288. [PMID: 36209721 PMCID: PMC9527226 DOI: 10.1016/j.imbio.2022.152288] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/12/2022] [Accepted: 09/28/2022] [Indexed: 11/30/2022]
Abstract
The clinical presentation of coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), ranges between mild respiratory symptoms and a severe disease that shares many of the features of sepsis. Sepsis is a deregulated response to infection that causes life-threatening organ failure. During sepsis, the intestinal epithelial cells are affected, causing an increase in intestinal permeability and allowing microbial translocation from the intestine to the circulation, which exacerbates the inflammatory response. Here we studied patients with moderate, severe and critical COVID-19 by measuring a panel of molecules representative of the innate and adaptive immune responses to SARS-CoV-2, which also reflect the presence of systemic inflammation and the state of the intestinal barrier. We found that non-surviving COVID-19 patients had higher levels of low-affinity anti-RBD IgA antibodies than surviving patients, which may be a response to increased microbial translocation. We identified sFas and granulysin, in addition to IL-6 and IL-10, as possible early biomarkers with high sensitivity (>73 %) and specificity (>51 %) to discriminate between surviving and non-surviving COVID-19 patients. Finally, we found that the microbial metabolite d-lactate and the tight junction regulator zonulin were increased in the serum of patients with severe COVID-19 and in COVID-19 patients with secondary infections, suggesting that increased intestinal permeability may be a source of secondary infections in these patients. COVID-19 patients with secondary infections had higher disease severity and mortality than patients without these infections, indicating that intestinal permeability markers could provide complementary information to the serum cytokines for the early identification of COVID-19 patients with a high risk of a fatal outcome.
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Affiliation(s)
- Alejandro Hernández-Solis
- Servicio de Neumología, Hospital General de México "Dr. Eduardo Liceaga", Secretaría de Salud, Mexico City, Mexico; Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Azmavet M Güemes-González
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Ximena Ruiz-Gómez
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Pablo Álvarez-Maldonado
- Servicio de Neumología, Hospital General de México "Dr. Eduardo Liceaga", Secretaría de Salud, Mexico City, Mexico
| | - Jessica Castañeda-Casimiro
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico; Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Argelia Flores-López
- Servicio de Neumología, Hospital General de México "Dr. Eduardo Liceaga", Secretaría de Salud, Mexico City, Mexico
| | - Martha Alicia Ramírez-Guerra
- Servicio de Neumología, Hospital General de México "Dr. Eduardo Liceaga", Secretaría de Salud, Mexico City, Mexico
| | - Omar Muñoz-Miranda
- Servicio de Neumología, Hospital General de México "Dr. Eduardo Liceaga", Secretaría de Salud, Mexico City, Mexico
| | - Ruth L Madera-Sandoval
- Unidad de Investigación Médica en Inmunoquímica, Centro Medico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Lourdes A Arriaga-Pizano
- Unidad de Investigación Médica en Inmunoquímica, Centro Medico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Alejandro Nieto-Patlán
- Departamento de Genética, Hospital Infantil de México Federico Gómez, Mexico City, Mexico; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Texas Children's Hospital, Center for Human Immunobiology, Department of Allergy, Immunology and Rheumatology, Houston, TX, USA.
| | - Sergio Estrada-Parra
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Sonia Mayra Pérez-Tapia
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico; Unidad de Desarrollo e Investigación en Bioterapéuticos (UDIBI), Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional. Mexico City, Mexico; Laboratorio Nacional para Servicios Especializados de Investigación, Desarrollo e Innovación (l+D+i) para Farmoquímicos y Biotecnológicos, LANSEIDI-FarBiotec-CONACyT. Mexico City, Mexico
| | - Jeanet Serafín-López
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Rommel Chacón-Salinas
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Alejandro Escobar-Gutiérrez
- Coordinación de Investigaciones Inmunológicas, Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE), Secretaria de Salud, Mexico City, Mexico
| | - Rodolfo Soria-Castro
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Bibiana Patricia Ruiz-Sánchez
- Facultad de Medicina. Universidad Westhill, Mexico City, Mexico; Departamento de Bioquímica, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Isabel Wong-Baeza
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico.
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Ceballos ME, Nuñez C, Uribe J, Vera MM, Castro R, García P, Arriata G, Gándara V, Vargas C, Dominguez A, Cerón I, Born P, Espíndola E. Secondary respiratory early and late infections in mechanically ventilated patients with COVID-19. BMC Infect Dis 2022; 22:760. [PMID: 36175841 PMCID: PMC9521562 DOI: 10.1186/s12879-022-07743-2] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 09/08/2022] [Indexed: 12/15/2022] Open
Abstract
Background Patients with COVID-19 receiving mechanical ventilation may become aggravated with a secondary respiratory infection. The aim of this study was to describe secondary respiratory infections, their predictive factors, and outcomes in patients with COVID-19 requiring mechanical ventilation. Methods A cohort study was carried out in a single tertiary hospital in Santiago, Chile, from 1st June to 31st July 2020. All patients with COVID-19 admitted to the intensive care unit that required mechanical ventilation were included. Results A total of 175 patients were enrolled, of which 71 (40.6%) developed at least one secondary respiratory infection during follow-up. Early and late secondary infections were diagnosed in 1.7% and 31.4% respectively. Within late secondary infections, 88% were bacterial, 10% were fungal, and 2% were of viral origin. One-third of isolated bacteria were multidrug-resistant. Bivariate analysis showed that the history of corticosteroids used before admission and the use of dexamethasone during hospitalization were associated with a higher risk of secondary infections (p = 0.041 and p = 0.019 respectively). Multivariate analysis showed that for each additional day of mechanical ventilation, the risk of secondary infection increases 1.1 times (adOR = 1.07; 95% CI 1.02–1.13, p = 0.008) Conclusions Patients with COVID-19 admitted to the intensive care unit and requiring mechanical ventilation had a high rate of secondary infections during their hospital stay. The number of days on MV was a risk factor for acquiring secondary respiratory infections. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07743-2.
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Affiliation(s)
- María Elena Ceballos
- Infectious Disease Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 6th Floor, Santiago, Chile.
| | - Carolina Nuñez
- Infectious Disease Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 6th Floor, Santiago, Chile
| | - Javier Uribe
- Internal Medicine Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María Magdalena Vera
- Intensive Medicine Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ricardo Castro
- Intensive Medicine Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Patricia García
- Clinical Laboratory Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gabriel Arriata
- Clinical Laboratory Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Vicente Gándara
- School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camila Vargas
- School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Angélica Dominguez
- Department of Public Health, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Inés Cerón
- Infectious Disease Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 6th Floor, Santiago, Chile
| | - Pablo Born
- Intensive Medicine Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo Espíndola
- Intensive Medicine Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Xiong L, Zhang P, Wang C, Lei S, Chen W, Lv X, Zheng X. Effects of corticosteroids treatment in patients with Severe Fever with Thrombocytopenia Syndrome:A single-center retrospective cohort study. Int J Infect Dis 2022; 122:1026-1033. [PMID: 35803466 DOI: 10.1016/j.ijid.2022.07.001] [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: 05/10/2022] [Revised: 06/23/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To evaluate the effect and safety of corticosteroids(CS) treatment in patients with severe fever with thrombocytopenia syndrome(SFTS). METHODS Patients with and without CS were retrospectively compared by COX regression and 1:1 propensity score matching analysis to evaluate the effects of CS on mortality and secondary infections in patients with SFTS. RESULTS A total of 467 SFTS patients were enrolled in the cohort study, there were 52 fatal cases and 415 nonfatal cases,the overall fatality rate was 11.1%. The mortality were observed in 36/144 (25%) and 16/323 (5%) patients in the CS-treated and non-CS-treated groups,respectively (P<0.001).Multivariate cox regression analysis showed that the difference was not statistically significant for CS treatment in the fatality (P>0.05, aHR 1.003, 95%CI 0.49-2.06).Difference in survival time between CS-treated and non-CS-treated groups after propensity score matching had no statistically significant (Log-Rank test P=0.390),whereas there was a significant difference in secondary infections between the CS-treated and non-CS-treated groups (P=0.007). CONCLUSIONS Although the CS treatment had no influence on fatality in patients with SFTS, it increased the risk of secondary infections.Administration of CS in patients with SFTS should be carefully considered and take into account the balance between therapeutic efficacy and adverse effects.
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Affiliation(s)
- Leiqun Xiong
- Department of Transfusion, Zhongshan Hospital Xiamen Branch, Fudan University, Xiamen Clinical Research Center for Cancer Therapy, Xiamen, 361015, China
| | - Pingping Zhang
- Department of Transfusion, Zhongshan Hospital Xiamen Branch, Fudan University, Xiamen Clinical Research Center for Cancer Therapy, Xiamen, 361015, China
| | - Cuibi Wang
- Department of Transfusion, Zhongshan Hospital Xiamen Branch, Fudan University, Xiamen Clinical Research Center for Cancer Therapy, Xiamen, 361015, China
| | - Shen Lei
- Department of Transfusion, Zhongshan Hospital Xiamen Branch, Fudan University, Xiamen Clinical Research Center for Cancer Therapy, Xiamen, 361015, China
| | - Weiyuan Chen
- Department of Transfusion, Zhongshan Hospital Xiamen Branch, Fudan University, Xiamen Clinical Research Center for Cancer Therapy, Xiamen, 361015, China
| | - Xiaoying Lv
- Department of Transfusion, Zhongshan Hospital Xiamen Branch, Fudan University, Xiamen Clinical Research Center for Cancer Therapy, Xiamen, 361015, China.
| | - Xin Zheng
- Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.
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Murgia F, Fiamma M, Serra S, Olla S, Garau MC, Cocco E, Lorefice L, Muntoni S, Paffi P, Porru S, Abis M, Finco G, Bellizzi S, Massidda O, Carta F, Atzori L. The impact of secondary infections in COVID-19 critically ill patients. J Infect 2022; 84:e116-7. [PMID: 35314266 DOI: 10.1016/j.jinf.2022.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 11/19/2022]
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Das R, Kotra K, Singh P, Loh B, Leptihn S, Bajpai U. Alternative Treatment Strategies for Secondary Bacterial and Fungal Infections Associated with COVID-19. Infect Dis Ther 2022; 11:53-78. [PMID: 34807451 PMCID: PMC8607056 DOI: 10.1007/s40121-021-00559-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/23/2021] [Accepted: 10/21/2021] [Indexed: 01/08/2023] Open
Abstract
Antimicrobials are essential for combating infectious diseases. However, an increase in resistance to them is a major cause of concern. The empirical use of drugs in managing COVID-19 and the associated secondary infections have further exacerbated the problem of antimicrobial resistance. Hence, the situation mandates exploring and developing efficient alternatives for the treatment of bacterial and fungal infections in patients suffering from COVID-19 or other viral infections. In this review, we have described the alternatives to conventional antimicrobials that have shown promising results and are at various stages of development. An acceleration of efforts to investigate their potential as therapeutics can provide more treatment options for clinical management of drug-resistant secondary bacterial and fungal infections in the current pandemic and similar potential outbreaks in the future. The alternatives include bacteriophages and their lytic enzymes, anti-fungal enzymes, antimicrobial peptides, nanoparticles and small molecule inhibitors among others. What is required at this stage is to critically examine the challenges in developing the listed compounds and biomolecules as therapeutics and to establish guidelines for their safe and effective application within a suitable time frame. In this review, we have attempted to highlight the importance of rational use of antimicrobials in patients suffering from COVID-19 and boost the deployment of alternative therapeutics.
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Affiliation(s)
- Ritam Das
- Department of Life Science, Acharya Narendra Dev College, University of Delhi, New Delhi, 110019 India
| | - Komal Kotra
- Department of Zoology, Acharya Narendra Dev College, University of Delhi, New Delhi, 110019 India
| | - Pulkit Singh
- Department of Zoology, Acharya Narendra Dev College, University of Delhi, New Delhi, 110019 India
| | - Belinda Loh
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 314400 People’s Republic of China
| | - Sebastian Leptihn
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 314400 People’s Republic of China
| | - Urmi Bajpai
- Department of Biomedical Science, Acharya Narendra Dev College, University of Delhi, Govindpuri, Kalkaji, New Delhi, 110019 India
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Pushparaj K, Kuchi Bhotla H, Arumugam VA, Pappusamy M, Easwaran M, Liu WC, Issara U, Rengasamy KRR, Meyyazhagan A, Balasubramanian B. Mucormycosis (black fungus) ensuing COVID-19 and comorbidity meets - Magnifying global pandemic grieve and catastrophe begins. Sci Total Environ 2022; 805:150355. [PMID: 34818767 PMCID: PMC8443313 DOI: 10.1016/j.scitotenv.2021.150355] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/25/2021] [Accepted: 09/11/2021] [Indexed: 05/02/2023]
Abstract
Post COVID-19, mucormycosis occurred after the SARS-CoV-2 has rampaged the human population and is a scorching problem among the pandemic globally, particularly among Asian countries. Invasive mucormycosis has been extensively reported from mild to severe COVID-19 survivors. The robust predisposing factor seems to be uncontrolled diabetes mellitus, comorbidity and immunosuppression acquired through steroid therapy. The prime susceptive reason for the increase of mucormycosis cases is elevated iron levels in the serum of the COVID survivors. A panoramic understanding of the infection has been elucidated based on clinical manifestation, genetic and non- genetic mechanisms of steroid drug administration, biochemical pathways and immune modulated receptor associations. This review lime-lights and addresses the "What", "Why", "How" and "When" about the COVID-19 associated mucormycosis (CAM) in a comprehensive manner with a pure intention to bring about awareness to the common public as the cases are inevitably and exponentially increasing in India and global countries as well. The article also unearthed the pathogenesis of mucormycosis and its association with the COVID-19 sequela, the plausible routes of entry, diagnosis and counter remedies to keep the infection at bay. Cohorts of case reports were analysed to spotlight the link between the pandemic COVID-19 and the nightmare-mucormycosis.
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Affiliation(s)
- Karthika Pushparaj
- Department of Zoology, School of Biosciences, Avinashilingam Institute for Home Science and Higher Education for Women, Coimbatore 641 043, Tamil Nadu, India
| | - Haripriya Kuchi Bhotla
- Department of Life Science, CHRIST (Deemed to be University), Bengaluru, Karnataka 560076, India
| | - Vijaya Anand Arumugam
- Department of Human Genetics and Molecular Biology, Bharathiar University, Coimbatore 641 046, Tamil Nadu, India
| | - Manikantan Pappusamy
- Department of Life Science, CHRIST (Deemed to be University), Bengaluru, Karnataka 560076, India
| | - Murugesh Easwaran
- International Centre for Genetic Engineering and Biotechnology, New Delhi 110067, India
| | - Wen-Chao Liu
- Department of Animal Science, College of Coastal Agricultural Sciences, Guangdong Ocean University, Zhanjiang 524088, PR China
| | - Utthapon Issara
- Division of Food Science and Technology Management, Faculty of Science and Technology, Rajamangala University of Technology Thanyaburi, Pathum Thani 12110, Thailand
| | - Kannan R R Rengasamy
- Green Biotechnologies Research Centre of Excellence, University of Limpopo, Private Bag X1106, Polokwane, Sovenga 0727, South Africa
| | - Arun Meyyazhagan
- Department of Life Science, CHRIST (Deemed to be University), Bengaluru, Karnataka 560076, India.
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Jolles S, Smith BD, Vinh DC, Mallick R, Espinoza G, DeKoven M, Divino V. Risk factors for severe infections in secondary immunodeficiency: a retrospective US administrative claims study in patients with hematological malignancies. Leuk Lymphoma 2021; 63:64-73. [PMID: 34702119 DOI: 10.1080/10428194.2021.1992761] [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: 10/20/2022]
Abstract
Real-world data are lacking to identify patients with secondary immunodeficiency (SID) who may benefit most from anti-infective interventions. This retrospective analysis used the IQVIA PharMetrics® Plus database to assess baseline characteristics associated with risk of severe infections post-SID diagnosis in patients with hematological malignancies. In 4066 patients included, the mean number of any and severe infections per patient in the one-year pre-SID diagnosis period was 9.5 and 0.7, respectively. Post-SID diagnosis, the mean annualized number of any and severe infections was 19.1 and 1.5, respectively. Receiver operating characteristic curve analysis identified a threshold (cutoff) of three bacterial infections at baseline as optimally predictive of severe infections post-SID diagnosis. Multivariate analysis indicated that hospitalizations, infections (≥3), or antibiotic use pre-SID diagnosis were predictive of severe infections post-SID diagnosis. Evaluation of these risk factors could inform clinical decisions regarding which patients may benefit from prophylactic anti-infective treatment, including immunoglobulin replacement if warranted.
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Affiliation(s)
| | - B Douglas Smith
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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9
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Pascucci E, Pugliese A. Modelling Immune Memory Development. Bull Math Biol 2021; 83:118. [PMID: 34687362 DOI: 10.1007/s11538-021-00949-6] [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: 03/20/2021] [Accepted: 09/27/2021] [Indexed: 12/01/2022]
Abstract
The cellular adaptive immune response to influenza has been analyzed through several recent mathematical models. In particular, Zarnitsyna et al. (Front Immunol 7:1-9, 2016) show how central memory CD8+ T cells reach a plateau after repeated infections, and analyze their role in the immune response to further challenges. In this paper, we further investigate the theoretical features of that model by extracting from the infection dynamics a discrete map that describes the build-up of memory cells. Furthermore, we show how the model by Zarnitsyna et al. (Front Immunol 7:1-9, 2016) can be viewed as a fast-scale approximation of a model allowing for recruitment of target epithelial cells. Finally, we analyze which components of the model are essential to understand the progressive build-up of immune memory. This is performed through the analysis of simplified versions of the model that include some components only of immune response. The analysis performed may also provide a theoretical framework for understanding the conditions under which two-dose vaccination strategies can be helpful.
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Affiliation(s)
- Eleonora Pascucci
- Dipartimento di Matematica, Università degli Studi di Trento, Via Sommarive 14, 38123, Povo, TN, Italy
| | - Andrea Pugliese
- Dipartimento di Matematica, Università degli Studi di Trento, Via Sommarive 14, 38123, Povo, TN, Italy.
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10
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Daix T, Jeannet R, Hernandez Padilla AC, Vignon P, Feuillard J, François B. Immature granulocytes can help the diagnosis of pulmonary bacterial infections in patients with severe COVID-19 pneumonia. J Intensive Care 2021; 9:58. [PMID: 34544474 PMCID: PMC8451732 DOI: 10.1186/s40560-021-00575-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/06/2021] [Accepted: 09/15/2021] [Indexed: 11/10/2022] Open
Abstract
During COVID-19, immature granulocyte (IG) concentration is heterogeneous with higher concentrations than those found in bacterial sepsis. We investigated the relationship between IG levels at ICU admission and on days 7 (± 2) and 15 (± 2) and associated pulmonary bacterial infections in intensive care unit (ICU) patients hospitalized for an acute respiratory distress syndrome (ARDS) related to SARS-CoV-2. Patients with associated pulmonary bacterial infection had a peak of IGs. IG thresholds of 18% or 2 G/L allowed discriminating patients with ventilator associated pneumonia with 100% sensitivity and specificity. Our study supports that IGs could help identifying pulmonary bacterial infections in this population.
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Affiliation(s)
- Thomas Daix
- Inserm CIC 1435, Dupuytren Teaching Hospital, 87000, Limoges, France.,UMR 1092, Faculty of Medicine, University of Limoges, 87000, Limoges, France.,Réanimation Polyvalente, CHU Dupuytren, 2 Avenue Martin-Luther King, 87042, Limoges, France
| | - Robin Jeannet
- Inserm CIC 1435, Dupuytren Teaching Hospital, 87000, Limoges, France.,UMR CNRS 7276, INSERM 1262, Faculty of Medicine, University of Limoges, 87000, Limoges, France
| | - Ana Catalina Hernandez Padilla
- Inserm CIC 1435, Dupuytren Teaching Hospital, 87000, Limoges, France.,UMR 1092, Faculty of Medicine, University of Limoges, 87000, Limoges, France
| | - Philippe Vignon
- Inserm CIC 1435, Dupuytren Teaching Hospital, 87000, Limoges, France.,UMR 1092, Faculty of Medicine, University of Limoges, 87000, Limoges, France.,Réanimation Polyvalente, CHU Dupuytren, 2 Avenue Martin-Luther King, 87042, Limoges, France
| | - Jean Feuillard
- UMR CNRS 7276, INSERM 1262, Faculty of Medicine, University of Limoges, 87000, Limoges, France.,Hematology Laboratory, Dupuytren Teaching Hospital, 87000, Limoges, France
| | - Bruno François
- Inserm CIC 1435, Dupuytren Teaching Hospital, 87000, Limoges, France. .,UMR 1092, Faculty of Medicine, University of Limoges, 87000, Limoges, France. .,Réanimation Polyvalente, CHU Dupuytren, 2 Avenue Martin-Luther King, 87042, Limoges, France.
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11
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Yu X, Lu L, Shen J, Li J, Xiao W, Chen Y. RLIM: a recursive and latent infection model for the prediction of US COVID-19 infections and turning points. Nonlinear Dyn 2021; 106:1397-1410. [PMID: 34092919 PMCID: PMC8166369 DOI: 10.1007/s11071-021-06520-1] [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] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/04/2021] [Indexed: 06/12/2023]
Abstract
UNLABELLED Initially found in Hubei, Wuhan, and identified as a novel virus of the coronavirus family by the WHO, COVID-19 has spread worldwide at exponential speed, causing millions of deaths and public fear. Currently, the USA, India, Brazil, and other parts of the world are experiencing a secondary wave of COVID-19. However, the medical, mathematical, and pharmaceutical aspects of its transmission, incubation, and recovery processes are still unclear. The classical susceptible-infected-recovered model has limitations in describing the dynamic behavior of COVID-19. Hence, it is necessary to introduce a recursive, latent model to predict the number of future COVID-19 infection cases in the USA. In this article, a dynamic recursive and latent infection model (RLIM) based on the classical SEIR model is proposed to predict the number of COVID-19 infections. Given COVID-19 infection and recovery data for a certain period, the RLIM is able to fit current values and produce an optimal set of parameters with a minimum error rate according to actual reported numbers. With these optimal parameters assigned, the RLIM model then becomes able to produce predictions of infection numbers within a certain period. To locate the turning point of COVID-19 transmission, an initial value for the secondary infection rate is given to the RLIM algorithm for calculation. RLIM will then calculate the secondary infection rates of a continuous time series with an iterative search strategy to speed up the convergence of the prediction outcomes and minimize the maximum square errors. Compared with other forecast algorithms, RLIM is able to adapt the COVID-19 infection curve faster and more accurately and, more importantly, provides a way to identify the turning point in virus transmission by searching for the equilibrium between recoveries and new infections. Simulations of four US states show that with the secondary infection rate ω initially set to 0.5 within the selected latent period of 14 days, RLIM is able to minimize this value at 0.07 and reach an equilibrium condition. A successful forecast is generated using New York state's COVID-19 transmission, in which a turning point is predicted to emerge on January 31, 2021. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s11071-021-06520-1.
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Affiliation(s)
- Xiang Yu
- School of Electronics and Information, Shanghai Dianji University, Shanghai, 201306 China
| | - Lihua Lu
- School of Electronics and Information, Shanghai Dianji University, Shanghai, 201306 China
| | - Jianyi Shen
- School of Electronics and Information, Shanghai Dianji University, Shanghai, 201306 China
| | - Jiandun Li
- School of Electronics and Information, Shanghai Dianji University, Shanghai, 201306 China
| | - Wei Xiao
- School of Electronics and Information, Shanghai Dianji University, Shanghai, 201306 China
| | - Yangquan Chen
- Mechatronics, Embedded Systems and Automation Lab, University of California, Merced, CA USA
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12
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Krishna V, Morjaria J, Jalandari R, Omar F, Kaul S. Autoptic identification of disseminated mucormycosis in a young male presenting with cerebrovascular event, multi-organ dysfunction and COVID-19 infection. IDCases 2021; 25:e01172. [PMID: 34075329 PMCID: PMC8161734 DOI: 10.1016/j.idcr.2021.e01172] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 04/19/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 12/13/2022] Open
Abstract
Among the secondary fungal infections in Coronavirus-19 (COVID-19) infection, Aspergillosis has been reported more often than Mucormycosis. Disseminated mucormycosis is almost always a disease of severely immunosuppressed hosts. We report a young obese Asian male who was admitted with an acute anterior cerebral artery (ACA) territory infarct and severe COVID-19 pneumonitis to the intensive care unit (ICU). He had a complicated stay with recurrent episodes of vasoplegic shock and multi-organ dysfunction. At autopsy, he was confirmed to have disseminated mucormycosis. We believe this to be the first documented case of disseminated mucormycosis in an immunocompetent host with COVID-19 infection. The lack of sensitive non-invasive modalities and biomarkers to diagnose mucormycosis, along with the extremely high mortality in untreated cases, present a unique challenge to clinicians dealing with critically ill patients with COVID-19.
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Affiliation(s)
- Vidya Krishna
- Department of Infectious Diseases, Immunology and BMT, Great Ormond Street Hospital, London, United Kingdom
| | - Jaymin Morjaria
- Department of Respiratory Medicine, Royal Brompton and Harefield Hospital, Guy’s and St.Thomas Hospital NHS Foundation Trust, London, United Kingdom
| | - Rona Jalandari
- Department of Cardiology, Royal Brompton and Harefield Hospital, Guy’s and St.Thomas Hospital NHS Foundation Trust, London, United Kingdom
| | - Fatima Omar
- Department of Cardiology, Royal Brompton and Harefield Hospital, Guy’s and St.Thomas Hospital NHS Foundation Trust, London, United Kingdom
| | - Sundeep Kaul
- Department of Respiratory Medicine, Royal Brompton and Harefield Hospital, Guy’s and St.Thomas Hospital NHS Foundation Trust, London, United Kingdom
- Department of Intensive Care, Royal Brompton and Harefield Hospital, Guy’s and St.Thomas Hospital NHS Foundation Trust, London, United Kingdom
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13
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Khurana S, Singh P, Sharad N, Kiro VV, Rastogi N, Lathwal A, Malhotra R, Trikha A, Mathur P. Profile of co-infections & secondary infections in COVID-19 patients at a dedicated COVID-19 facility of a tertiary care Indian hospital: Implication on antimicrobial resistance. Indian J Med Microbiol 2021; 39:147-153. [PMID: 33966856 PMCID: PMC7667411 DOI: 10.1016/j.ijmmb.2020.10.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The COVID-19 pandemic has raised concerns over secondary infections because it has limited treatment options and empiric antimicrobial treatment poses serious risks of aggravating antimicrobial resistance (AMR). Studies have shown that COVID-19 patients are predisposed to develop secondary infections. This study was conducted to ascertain the prevalence and profiles of co- & secondary infections in patients at the COVID-19 facility in North India. METHODS We studied the profile of pathogens isolated from 290 clinical samples. Bacterial and fungal pathogens were identified, and antimicrobial susceptibility was determined by the Vitek2® system. Additionally, respiratory samples were tested for any viral/atypical bacterial co-infections and the presence of AMR genes by FilmArray test. The clinical and outcome data of these patients were also recorded for demographic and outcome measures analyses. RESULTS A total of 151 (13%) patients had secondary infections, and most got infected within the first 14 days of hospital admission. Patients aged >50 years developed severe symptoms (p = 0.0004) and/or had a fatal outcome (p = 0.0005). In-hospital mortality was 33%.K.pneumoniae (33.3%) was the predominant pathogen, followed by A. baumannii (27.1%). The overall resistance was up to 84%.Majority of the organisms were multidrug-resistant (MDR) harbouring MDR genes. CONCLUSION A high rate of secondary infections with resistant pathogens in COVID-19 patients highlights the importance of antimicrobial stewardship programs focussing on supporting the optimal selection of empiric treatment and rapid-de-escalation, based on culture reports.
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Affiliation(s)
- Surbhi Khurana
- Department of Laboratory Medicine (Microbiology), JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India.
| | - Parul Singh
- Department of Laboratory Medicine (Microbiology), JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India.
| | - Neha Sharad
- Department of Laboratory Medicine (Microbiology), JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India.
| | - Vandana V Kiro
- Department of Laboratory Medicine (Microbiology), JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India.
| | - Neha Rastogi
- Department of Infectious Diseases, All India Institute of Medical Sciences, New Delhi, India.
| | - Amit Lathwal
- Department of Hospital Administration, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India.
| | - Rajesh Malhotra
- Department of Orthopedics Chief, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India.
| | - Anjan Trikha
- Department of Anaesthesiology, Pain Medicine and Critical Care, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India.
| | - Purva Mathur
- Department of Laboratory Medicine (Microbiology), JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India.
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14
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García-Meniño I, Forcelledo L, Rosete Y, García-Prieto E, Escudero D, Fernández J. Spread of OXA-48-producing Klebsiella pneumoniae among COVID-19-infected patients: The storm after the storm. J Infect Public Health 2021; 14:50-52. [PMID: 33341484 PMCID: PMC7713590 DOI: 10.1016/j.jiph.2020.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/13/2020] [Accepted: 11/08/2020] [Indexed: 12/30/2022] Open
Abstract
The impact of secondary infections by multidrug-resistant bacteria in COVID-19- infected patients has yet to be evaluated. Here, we report the clinical and molecular features of an outbreak of seven patients carrying CTX-M-15- and OXA-48-producing Klebsiella pneumoniae belonging to ST326 during COVID-19 pandemic in an ICU in northern Spain. Those patients were admitted to beds close to each other, two of them developed ventilator-associated pneumonia (VAP), one exhibited primary bacteremia and the remaining four were considered to be colonized. None of them was colonized prior to admission to the ICU an all, except one of those who developed VAP, were discharged. Hydroxychloroquine and lopinavir/ritonavir were administered to all of them as COVID-19 therapy and additionally, three of them received tocilizumab and corticosteroids, respectively. Reusing of personal protective equipment due to its initial shortage, relaxation in infection control measures and negative-pressure air in ICU rooms recommended for the protection of health care workers (HCWs), could have contributed to this outbreak. Maximization of infection control measures is essential to avoid secondary infections by MDR bacteria in COVID-infected patients.
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Affiliation(s)
- Isidro García-Meniño
- Laboratorio de Referencia de Escherichia Coli (LREC), Departamento de Microbiología y Parasitología, Facultad de Veterinaria, Universidad de Santiago de Compostela (USC), Lugo, Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago, Spain
| | - Lorena Forcelledo
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain; Grupo de Microbiología Traslacional, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain
| | - Yaiza Rosete
- Servicio de Microbiología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Emilio García-Prieto
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain; Grupo de Investigación Traslacional en el Paciente Crítico, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Dolores Escudero
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain; Grupo de Microbiología Traslacional, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain
| | - Javier Fernández
- Grupo de Microbiología Traslacional, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain; Servicio de Microbiología, Hospital Universitario Central de Asturias, Oviedo, Spain; Research & Innovation, Artificial Intelligence and Statistical Department, iAST™, Oviedo, Spain.
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15
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Kumar G, Adams A, Hererra M, Rojas ER, Singh V, Sakhuja A, Meersman M, Dalton D, Kethireddy S, Nanchal R, Guddati AK. Predictors and outcomes of healthcare-associated infections in COVID-19 patients. Int J Infect Dis 2020; 104:287-292. [PMID: 33207271 PMCID: PMC7666872 DOI: 10.1016/j.ijid.2020.11.135] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [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: 09/13/2020] [Revised: 11/06/2020] [Accepted: 11/08/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction Healthcare-associated infections (HAI) after viral illnesses are important sources of morbidity and mortality. This has not been extensively studied in hospitalized COVID-19 patients. Methods This study included all COVID-19-positive adult patients (≥18 years) hospitalized between 01 March and 05 August 2020 at the current institution. The Centers for Disease Control and Prevention definition of HAI in the acute care setting was used. The outcomes that were studied were rates and types of infections and in-hospital mortality. Several multivariable logistic regression models were constructed to examine characteristics associated with development of HAI. Results Fifty-nine (3.7%) of 1565 patients developed 140 separate HAIs from 73 different organisms: 23 were Gram-positive, 39 were Gram-negative and 11 were fungal. Patients who developed HAI did not have higher odds of death (OR 0.85, 95% CI 0.40–1.81, p = 0.69). HAIs were associated with the use of tocilizumab (OR 5.04, 95% CI 2.4–10.6, p < 0.001), steroids (OR 3.8, 95% CI 1.4–10, p = 0.007), hydroxychloroquine (OR 3.0, 95% CI 1.0–8.8, p = 0.05), and acute kidney injury requiring hemodialysis (OR 3.7, 95% CI 1.1–12.8, p = 0.04). Conclusions HAI were common in hospitalized Covid-19 patients. Tocilizumab and steroids were associated with increased risk of HAIs.
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Affiliation(s)
- Gagan Kumar
- Department of Pulmonary & Critical Care, Northeast Georgia Health System, Gainesville, GA, USA.
| | - Alex Adams
- Department of Internal Medicine, Northeast Georgia Health System, Gainesville, GA, USA
| | - Martin Hererra
- Department of Internal Medicine, Northeast Georgia Health System, Gainesville, GA, USA
| | - Erine Raybon Rojas
- Department of Pulmonary & Critical Care, Northeast Georgia Health System, Gainesville, GA, USA
| | - Vartika Singh
- Department of Internal Medicine, Apex Hospital, Varanasi, India
| | - Ankit Sakhuja
- Division of Cardiovascular Critical Care, Department of Cardiovascular and Thoracic Surgery, West Virginia University, WV, USA
| | | | | | - Shravan Kethireddy
- Department of Pulmonary & Critical Care, Northeast Georgia Health System, Gainesville, GA, USA
| | - Rahul Nanchal
- Division of Pulmonary & Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Achuta Kumar Guddati
- Division of Hematology/Oncology, Georgia Cancer Center, Augusta University, Augusta, GA, USA
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16
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Ripa M, Galli L, Poli A, Oltolini C, Spagnuolo V, Mastrangelo A, Muccini C, Monti G, De Luca G, Landoni G, Dagna L, Clementi M, Rovere Querini P, Ciceri F, Tresoldi M, Lazzarin A, Zangrillo A, Scarpellini P, Castagna A. Secondary infections in patients hospitalized with COVID-19: incidence and predictive factors. Clin Microbiol Infect 2020; 27:451-457. [PMID: 33223114 PMCID: PMC7584496 DOI: 10.1016/j.cmi.2020.10.021] [Citation(s) in RCA: 195] [Impact Index Per Article: 48.8] [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: 06/24/2020] [Revised: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 01/08/2023]
Abstract
Objectives The aim of our study was to describe the incidence and predictive factors of secondary infections in patients with coronavirus disease 2019 (COVID-19). Methods This was a cohort study of patients hospitalized with COVID-19 at IRCCS San Raffaele Hospital between 25th February and 6th April 2020 (NCT04318366). We considered secondary bloodstream infections (BSIs) or possible lower respiratory tract infections (pLRTIs) occurring 48 hours after hospital admission until death or discharge. We calculated multivariable Fine–Gray models to assess factors associated with risk of secondary infections. Results Among 731 patients, a secondary infection was diagnosed in 68 patients (9.3%); 58/731 patients (7.9%) had at least one BSI and 22/731 patients (3.0%) at least one pLRTI. The overall 28-day cumulative incidence was 16.4% (95%CI 12.4–21.0%). Most of the BSIs were due to Gram-positive pathogens (76/106 isolates, 71.7%), specifically coagulase-negative staphylococci (53/76, 69.7%), while among Gram-negatives (23/106, 21.7%) Acinetobacter baumanii (7/23, 30.4%) and Escherichia coli (5/23, 21.7%) predominated. pLRTIs were caused mainly by Gram-negative pathogens (14/26, 53.8%). Eleven patients were diagnosed with putative invasive aspergillosis. At multivariable analysis, factors associated with secondary infections were low baseline lymphocyte count (≤0.7 versus >0.7 per 109/L, subdistribution hazard ratios (sdHRs) 1.93, 95%CI 1.11–3.35), baseline PaO2/FiO2 (per 100 points lower: sdHRs 1.56, 95%CI 1.21–2.04), and intensive-care unit (ICU) admission in the first 48 hours (sdHR 2.51, 95%CI 1.04–6.05). Conclusions Patients hospitalized with COVID-19 had a high incidence of secondary infections. At multivariable analysis, early need for ICU, respiratory failure, and severe lymphopenia were identified as risk factors for secondary infections.
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Affiliation(s)
- Marco Ripa
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Laura Galli
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Poli
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Oltolini
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Spagnuolo
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Giacomo Monti
- Anaesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Vita-Salute San Raffaele University, Milan, Italy; Anaesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- Vita-Salute San Raffaele University, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Clementi
- Vita-Salute San Raffaele University, Milan, Italy; Microbiology and Virology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Rovere Querini
- Vita-Salute San Raffaele University, Milan, Italy; Internal Medicine, Diabetes, and Endocrinology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- Vita-Salute San Raffaele University, Milan, Italy; Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- General Medicine and Advanced Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Adriano Lazzarin
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Vita-Salute San Raffaele University, Milan, Italy; Anaesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Scarpellini
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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17
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Kassem II. Refugees besieged: The lurking threat of COVID-19 in Syrian war refugee camps. Travel Med Infect Dis 2020; 38:101736. [PMID: 32380153 DOI: 10.1016/j.tmaid.2020.101736] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/30/2020] [Indexed: 11/22/2022]
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18
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Leijte GP, Rimmelé T, Kox M, Bruse N, Monard C, Gossez M, Monneret G, Pickkers P, Venet F. Monocytic HLA-DR expression kinetics in septic shock patients with different pathogens, sites of infection and adverse outcomes. Crit Care 2020; 24:110. [PMID: 32192532 PMCID: PMC7082984 DOI: 10.1186/s13054-020-2830-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/12/2020] [Indexed: 12/29/2022]
Abstract
Background Decreased monocytic (m)HLA-DR expression is the most studied biomarker of sepsis-induced immunosuppression. To date, little is known about the relationship between sepsis characteristics, such as the site of infection, causative pathogen, or severity of disease, and mHLA-DR expression kinetics. Methods We evaluated mHLA-DR expression kinetics in 241 septic shock patients with different primary sites of infection and pathogens. Furthermore, we used unsupervised clustering analysis to identify mHLA-DR trajectories and evaluated their association with outcome parameters. Results No differences in mHLA-DR expression kinetics were found between groups of patients with different sites of infection (abdominal vs. respiratory, p = 0.13; abdominal vs. urinary tract, p = 0.53) and between pathogen categories (Gram-positive vs. Gram-negative, p = 0.54; Gram-positive vs. negative cultures, p = 0.84). The mHLA-DR expression kinetics differed between survivors and non-survivors (p < 0.001), with an increase over time in survivors only. Furthermore, we identified three mHLA-DR trajectories (‘early improvers’, ‘delayed or non-improvers’ and ‘decliners’). The probability for adverse outcome (secondary infection or death) was higher in the delayed or non-improvers and decliners vs. the early improvers (delayed or non-improvers log-rank p = 0.03, adjusted hazard ratio 2.0 [95% CI 1.0–4.0], p = 0.057 and decliners log-rank p = 0.01, adjusted hazard ratio 2.8 [95% CI 1.1–7.1], p = 0.03). Conclusion Sites of primary infection or causative pathogens are not associated with mHLA-DR expression kinetics in septic shock patients. However, patients showing delayed or no improvement in or a declining mHLA-DR expression have a higher risk for adverse outcome compared with patients exhibiting a swift increase in mHLA-DR expression. Our study signifies that changes in mHLA-DR expression over time, and not absolute values or static measurements, are of clinical importance in septic shock patients.
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Affiliation(s)
- Guus P Leijte
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas Rimmelé
- Pathophysiology of Injury-Induced Immunosuppression, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, bioMérieux, Edouard Herriot Hospital, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.,Anesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Matthijs Kox
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Niklas Bruse
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Céline Monard
- Anesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Morgane Gossez
- Pathophysiology of Injury-Induced Immunosuppression, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, bioMérieux, Edouard Herriot Hospital, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.,Immunology Laboratory, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Guillaume Monneret
- Pathophysiology of Injury-Induced Immunosuppression, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, bioMérieux, Edouard Herriot Hospital, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.,Immunology Laboratory, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Fabienne Venet
- Pathophysiology of Injury-Induced Immunosuppression, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, bioMérieux, Edouard Herriot Hospital, 5 place d'Arsonval, 69437, Lyon Cedex 03, France. .,Immunology Laboratory, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France.
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Al-Salem WS, Solórzano C, Weedall GD, Dyer NA, Kelly-Hope L, Casas-Sánchez A, Alraey Y, Alyamani EJ, Halliday A, Balghonaim SM, Alsohibany KS, Alzeyadi Z, Alzahrani MH, Al-Shahrani AM, Assiri AM, Memish Z, Acosta-Serrano Á. Old World cutaneous leishmaniasis treatment response varies depending on parasite species, geographical location and development of secondary infection. Parasit Vectors 2019; 12:195. [PMID: 31046820 PMCID: PMC6498568 DOI: 10.1186/s13071-019-3453-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/20/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In the Kingdom of Saudi Arabia (KSA), Leishmania major and L. tropica are the main causative agents of Old World cutaneous leishmaniasis (CL). The national CL treatment regimen consists of topical 1% clotrimazole/2% fusidic acid cream followed by 1-2 courses of intralesional sodium stibogluconate (SSG); however, treatment efficacy is highly variable and the reasons for this are not well understood. In this study, we present a complete epidemiological map of CL and determined the efficacy of the standard CL treatment regime in several endemic regions of KSA. RESULTS Overall, three quarters of patients in all CL-endemic areas studied responded satisfactorily to the current treatment regime, with the remaining requiring only an extra course of SSG. The majority of unresponsive cases were infected with L. tropica. Furthermore, the development of secondary infections (SI) around or within the CL lesion significantly favoured the treatment response of L. major patients but had no effect on L. tropica cases. CONCLUSIONS The response of CL patients to a national treatment protocol appears to depend on several factors, including Leishmania parasite species, geographical location and occurrences of SI. Our findings suggest there is a need to implement alternative CL treatment protocols based on these parameters.
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Affiliation(s)
- Waleed S. Al-Salem
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
- Present Address: National Centre for Tropical Diseases, Saudi Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Carla Solórzano
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Gareth D. Weedall
- Faculty of Sciences, Liverpool John Moores University, Liverpool, UK
| | - Naomi A. Dyer
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Louise Kelly-Hope
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Aitor Casas-Sánchez
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Yasser Alraey
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Essam J. Alyamani
- National Center for Biotechnology, King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Alice Halliday
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | | | | | - Zeyad Alzeyadi
- Antimicrobial Research Centre, University of Leeds, Leeds, UK
| | | | | | | | - Ziad Memish
- Saudi Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Álvaro Acosta-Serrano
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
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