COVID-19-related multisystem inflammatory syndrome in adult: the first death in Brazil

The precise pathogenesis of COVID-19-related multisystem inflammatory syndrome remains largely elusive, despite its rarity. The syndrome symptoms often overlap with those of other infections, posing challenges for prompt diagnosis. A male patient, 34 years old, was admitted with suspicion of severe dengue, rapidly progressing to multiple organ dysfunction. Dengue tests resulted negative, and he passed away after four days. This case occurred approximately four weeks after the initial onset of COVID-19 and met all diagnostic criteria as defined by the Centers for Disease Control and Prevention. This report presents the first documented case of fatal multisystem inflammatory syndrome in adult (MIS-A) in Brazil. Recognizing the significance of suspecting this syndrome and promptly initiating treatment at an early stage are essential for minimizing damage and mortality

Understanding the potential impact of different drug properties on SARS-CoV-2 transmission and disease burden : a modelling analysis

Q1Q1Background The unprecedented public health impact of the COVID-19 pandemic has motivated a rapid search for potential therapeutics, with some key successes. However, the potential impact of different treatments, and consequently research and procurement priorities, have not been clear. Methods and Findings develop a mathematical model of SARS-CoV-2 transmission, COVID-19 disease and clinical care to explore the potential public-health impact of a range of different potential therapeutics, under a range of different scenarios varying: i) healthcare capacity, ii) epidemic trajectories; and iii) drug efficacy in the absence of supportive care. In each case, the outcome of interest was the number of COVID-19 deaths averted in scenarios with the therapeutic compared to scenarios without. We find the impact of drugs like dexamethasone (which are delivered to the most critically-ill in hospital and whose therapeutic benefit is expected to depend on the availability of supportive care such as oxygen and mechanical ventilation) is likely to be limited in settings where healthcare capacity is lowest or where uncontrolled epidemics result in hospitals being overwhelmed. As such, it may avert 22% of deaths in highincome countries but only 8% in low-income countries (assuming R=1.35). Therapeutics for different patient populations (those not in hospital, early in the course of infection) and types of benefit (reducing disease severity or infectiousness, preventing hospitalisation) could have much greater benefits, particularly in resource-poor settings facing large epidemics. Conclusions There is a global asymmetry in who is likely to benefit from advances in the treatment of COVID-19 to date, which have been focussed on hospitalised-patients and predicated on an assumption of adequate access to supportive care. Therapeutics that can feasibly be delivered to those earlier in the course of infection that reduce the need for healthcare or reduce infectiousness could have significant impact, and research into their efficacy and means of delivery should be a priorityRevista Internacional - Indexad

Understanding the relation between Zika virus infection during pregnancy and adverse fetal, infant and child outcomes: a protocol for a systematic review and individual participant data meta-analysis of longitudinal studies of pregnant women and their infants and children

IntroductionZika virus (ZIKV) infection during pregnancy is a known cause of microcephaly and other congenital and developmental anomalies. In the absence of a ZIKV vaccine or prophylactics, principal investigators (PIs) and international leaders in ZIKV research have formed the ZIKV Individual Participant Data (IPD) Consortium to identify, collect and synthesise IPD from longitudinal studies of pregnant women that measure ZIKV infection during pregnancy and fetal, infant or child outcomes.Methods and analysisWe will identify eligible studies through the ZIKV IPD Consortium membership and a systematic review and invite study PIs to participate in the IPD meta-analysis (IPD-MA). We will use the combined dataset to estimate the relative and absolute risk of congenital Zika syndrome (CZS), including microcephaly and late symptomatic congenital infections; identify and explore sources of heterogeneity in those estimates and develop and validate a risk prediction model to identify the pregnancies at the highest risk of CZS or adverse developmental outcomes. The variable accuracy of diagnostic assays and differences in exposure and outcome definitions means that included studies will have a higher level of systematic variability, a component of measurement error, than an IPD-MA of studies of an established pathogen. We will use expert testimony, existing internal and external diagnostic accuracy validation studies and laboratory external quality assessments to inform the distribution of measurement error in our models. We will apply both Bayesian and frequentist methods to directly account for these and other sources of uncertainty.Ethics and disseminationThe IPD-MA was deemed exempt from ethical review. We will convene a group of patient advocates to evaluate the ethical implications and utility of the risk stratification tool. Findings from these analyses will be shared via national and international conferences and through publication in open access, peer-reviewed journals.Trial registration numberPROSPERO International prospective register of systematic reviews (CRD42017068915).</jats:sec

Identification of temporal clusters and risk factors of bacteremia by nosocomial vancomycin-resistant enterococci

Background: This study aimed to evaluate a different methodology for addressing the evolution of nosocomial bacteremia by vancomycin-resistant enterococci (VRE) in a hospital setting.Methods: in this retrospective cohort study, data were collected from the date of first registration up to December 2008 from the electronic medical records of patients with VRE bacteremia in a school hospital.Results: Thirty cases of VRE bacteremia and 274 cases of vancomycin-susceptible enterococci (VSE) bacteremia were identified. the average age of the patients was 56 years. the rates of Enterococcus faecium and Enterococcus faecalis in the hospital's intensive care unit (ICU) and wards showed no statistically significant differences. the risk of acquiring VRE bacteremia was at least 3-fold higher in the ICU than in the wards. the risk of death was 2.73-fold higher in patients with VRE bacteremia compared with those with VSE bacteremia. Only one temporal cluster statistically significant of VRE bacteremia was found in the study period.Conclusions: the identification of temporal clusters can be an important tool to optimize health actions and thereby reduce the burden of operating costs. Copyright (C) 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.Med Coll Sao Jose do Rio Preto, Postgrad Dept, São Paulo, BrazilUnion Coll Great Lakes, Coll Med, Dept Med Sci, São Paulo, BrazilHosp Base, Dept Infect & Parasit Dis, São Paulo, BrazilMed Coll Sao Jose do Rio Preto, Virol Lab, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Infect Dis, Hosp Epidemiol Comm, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Infect Dis, Hosp Epidemiol Comm, São Paulo, BrazilWeb of Scienc

RELATO DO PRIMEIRO ÓBITO NO BRASIL POR SÍNDROME INFLAMATÓRIA MULTISSISTÊMICA EM ADULTO ASSOCIADA À COVID-19

O vírus SARS-CoV-2, responsável pela doença COVID-19, além da infecção aguda, pode causar um quadro inflamatório tardio e exacerbado, com manifestações extrapulmonares, primeiramente visto em crianças e adolescentes, denominado como Síndrome Inflamatória Multissistêmica Pediátrica. As evidências mostram que essa síndrome não se restringe a faixa etária pediátrica, mas em alguns casos, apesar de rara, já está presente entre indivíduos adultos. Suas implicações clínicas são significativas e, em casos graves, pode ser fatal. Além disso, os sintomas da síndrome muitas vezes se sobrepõem aos de outras infecções, como COVID-19 aguda grave e dengue, apresentando desafios para o diagnóstico imediato. Este caso ocorreu aproximadamente quatro semanas após o início dos sintomas da COVID-19 e atendeu a todos os critérios de diagnóstico definidos pelo Centro de Controle e Prevenção de Doenças. Trata-se de um paciente do sexo masculino, 34 anos, branco, sem comorbidades e sem uso de medicamentos. Hospitalizado com quadro de mal-estar, febre diária, vômitos, dor abdominal, mialgia difusa, confusão mental, prostração, inapetência, dificuldade de deambulação e lipotimia. Inicialmente, suspeitou-se que o paciente tinha dengue ou sepse, mas os testes subsequentes deram resultados negativos. À medida que a doença progredia, vários órgãos foram afetados, ocorrendo comprometimentos oculares (conjuntivite), cutâneo (rash cutâneo), renal (Insuficiência Renal Aguda e injúria renal) e cardíaco (comprometimento miocárdico) associado a choque, levando à morte. O óbito ocorreu trinta e três dias após o início dos sintomas da COVID-19. O caso foi investigado e notificado e após avaliação, o Ministério da Saúde, concluiu que tal evento preenche os critérios de definição de caso, sendo confirmada a Síndrome Inflamatória Multissistêmica em adultos associada à COVID-19, não havendo outro diagnóstico que melhor justifique o quadro clínico, decorrendo no primeiro óbito no Brasil. Com o advento da vacinação, que reduziu a incidência de COVID-19, é crucial aumentar a vigilância da Síndrome Inflamatória Multissistêmica para evitar que os casos sejam subdiagnosticados ou diagnosticados incorretamente. Reconhecer a importância de suspeitar dessa síndrome e iniciar o tratamento precocemente é essencial para minimizar danos e mortalidade

Yellow Fever Vaccine-Related Neurotropic Disease in Brazil Following Immunization with 17DD

The disease burden of yellow fever virus infection (YFV) is quite high in the tropics where vaccination coverage is low. To date, vaccination is the most effective control strategy to mitigate and eliminate the burden of YF disease. The licensed YF vaccines are safe and effective and serious adverse events are rare. Herein, we report three cases of neurological syndrome, compatible with meningoencephalitis following 17DD vaccination. In all cases, YFV-specific IgM antibodies were detected in the cerebrospinal fluid. Our observations confirm the development of YF vaccine-associated neurotropic disease, a rare serious adverse event, from which all three patients have fully recovered without any long-term sequelae. This report reinforces the need for awareness among health professionals to recognize and effectively manage such events in a timely manner

Clinical Characterization of Respiratory Syncytial Virus Infection in Adults: A Neglected Disease?

Lower respiratory tract infections (LRIs) are a significant cause of disability-adjusted life-years (DALYs) across all age groups, especially in children under 9 years of age, and adults over 75. The main causative agents are viruses, such as influenza and respiratory syncytial virus (RSV). Viral LRIs in adults have historically received less attention. This study investigated the incidence of RSV and influenza in adult patients admitted to a referral hospital, as well as the clinical profile of these infections. Molecular testing was conducted on nasopharyngeal samples taken from a respiratory surveillance cohort comprising adult (15–59 years) and elderly (60+ years) hospitalized patients who tested negative for SARS-CoV-2, to determine the prevalence for influenza and RSV. Influenza was found to be less frequent among the elderly. The main symptoms of RSV infections were cough, fever, dyspnea, malaise, and respiratory distress, while headache, nasal congestion, a sore throat, and myalgia were most frequent in influenza. Elderly patients with RSV were not found to have more severe illness than adults under age 60, underscoring the importance of providing the same care to adults with this viral infection