Bacterial meningoencephalitis secondary to disseminated strongyloidiasis in a pacient with COVID-19

Introduction. Strongyloidiasis in a parasitic diseases determined by the intestinal nematode Strongyloides stercoralis. In most cases, this disease is asymptomatic, but the immunocompromised patients can develop severe forms like hyper infestation and disseminated strongyloidiasis. There severe forms of the disease are associated with bacteremias with gastrointestinal microorganisms which can determine infectious complication anywhere in the body. Bacterial meningitis is the most common complication of this kind. Case presentation. We present you the case of a 78 years old patient who initially presented in another hospital for suddenly installed aphasia. He was clinical and paraclinical evaluated and the suspected diagnosis was acute meningoencephalitis, so he was transferred in our hospital. This is a case about a patient with an immunocompromised status determined by recent infection with SARS-CoV-2 who was hospitalized and received prolonged corticosteroid therapy. The clinical examination performed at the admission shows a patient with mediocre general status, partially cooperative, partially time-spatial oriented and to one’s own person, discreet neck stiffness, anxious-depressive mood, with acute respiratory failure. A coproparasitological examination is performed which reveals the presence of filariform larvae of Strongyloides stercoralis in the stool. Also, a parasitic PCR test from a stool sample is positive for Strongyloides stercoralis. These clinical and paraclinical findings corroborated with those found in the cerebrospinal fluid examination establish the diagnosis: acute bacterial meningoencephalitis secondary to disseminated strongyloidiasis. During the disease’s evolution, he is confirmed with a new infection with SARS-CoV-2. He receives antiviral treatment, antiparasitic treatment, antibiotic treatment and symptomatic treatment. The evolution of the disease is favorable. Conclusions. The immunocompromised status of the patient determined the evolution of the infestation with Strongyloides stercoralis to a severe form complicated with acute bacterial meningoencephalitis. The difficulty in establishing the diagnosis of strongyloidiasis is represented by the fact that Romania is a non-endemic country for the infection with this parasite

Servicii medicale integrate pentru pacienții coinfectați HIV/VHC din România ce provin din populațiile marginalizate – modelul Proiectului HepCare Europe implementat la Spitalul „Dr. Victor Babeș“ din București

Background. Proiectul HepCare Europe, cofinanţat de Comisia Europeană, a avut ca scop crearea şi implementarea unui model de management al VHC (screening, evaluare şi tratament) adresat pacienţilor ce provin din populaţiile vulnerabile. Ideea de bază a proiectului a fost creşterea accesului acestor pacienţi la servicii medicale integrate, prin implicarea cadrelor medicale din comunitate. Scopul acestui studiu a fost să evalueze caracteristicile socio-demografice şi clinice ale pacienţilor coinfectaţi HIV/VHC comparativ cu cei monoinfectaţi cu VHC înrolaţi în Proiectul HepCare Europe, în cadrul Spitalului Clinic de Boli Infecţioase şi Tropicale „Dr. Victor Babeş“ din Bucureşti. Metode. Studiu prospectiv efectuat la pacienţii cu anticorpi anti-VHC pozitivi (prin teste rapide orale), ce au fost evaluaţi la Spitalul „Dr. Victor Babeş“ din Bucureşti, România (SVB), în perioada aprilie 2016 – aprilie 2019. Caracteristicile socio-demografice şi clinice ale pacienţilor au fost comparate în funcţie de statusul de coinfectat HIV. Analiza statistică a datelor s-a realizat folosind programul SPSS versiunea 20.0. Rezultate. Screening-ul pentru hepatita cronică cu virus C s-a realizat la 525 de pacienţi, dintre care 230 (43,8%) au avut rezultat pozitiv. Majoritatea erau tineri, de sex masculin (85,2%) şi utilizatori de droguri injectabile (92,2%). 168 de pacienţi (73,0%) au fost evaluaţi la spital, din care 41,6% erau coinfectaţi HIV. Evaluarea gradului de fibroză hepatică s-a realizat pentru 82,1% dintre pacienţi, aproape o treime fiind identificaţi cu fibroză hepatică avansată (27,5%). ARN-VHC în plasmă a fost efectuat pentru jumătate din pacienţii luaţi în evidenţă, 80,9% din aceştia având încărcătură virală detectabilă. 24 de pacienţi au iniţiat tratamentul cu agenţi antivirali direcţi, din care 22 au obţinut răspuns viral susţinut, iar 2 au fost nonresponderi (utilizatori de droguri infectaţi cu genotip 3 ce nu au primit tratament cu regim pangenotipic). Infecţia HIV s-a asociat cu lipsa locuinţei (p < 0,0001), consumul de droguri injectabile (p = 0,001), consumul de etnobotanice în asociere cu opioidele (p < 0,0001), utilizarea de ace la comun (p < 0,0001) sau consumul de alcool (p < 0,0001). Valoarea mediană a limfocitelor CD4 la diagnostic a fost de 483/µl (IQR 290, 646), iar valoarea mediană a încărcăturii virale HIV în plasmă a fost de 2.74 log10copii/ml (IQR 1,27, 4,67). Încărcătura virală VHC în plasmă a fost semnificativ mai mare la pacienţii coinfectaţi HIV/VHC (p = 0,047). Concluzii. Coinfecţia HIV/VHC a fost frecventă la pacienţii ce provin din populaţiile vulnerabile. Infecţia HIV a fost asociată cu multipli factori de risc şi încărcătură virală VHC plasmatică mai ridicată. Barierele socio-economice şi accesul redus la tratamente pangenotipice cu agenţi antivirali direcţi (DAA) au limitat semnificativ iniţierea tratamentului la aceşti pacienţi. Acesta este primul studiu pilot din România despre managementul pacienţilor cu hepatită C care provin din populaţiile cheie

Increased risk of chikungunya infection in travellers to Thailand during ongoing outbreak in tourist areas : cases imported to Europe and the Middle East, early 2019

We report nine travellers with confirmed chikungunya virus infection, returning from tourist areas of Thailand to Sweden, Switzerland, the United Kingdom, Romania, Israel and France, diagnosed in January and February 2019. These sentinel tourists support the intensification of chikungunya virus circulation in Thailand and highlight the potential for importation to areas at risk of local transmission

Training in infectious diseases across Europe in 2021 - a survey on training delivery, content and assessment

Objectives: To define the status of infectious diseases (ID) as an approved specialty in Europe; to enumerate the number of specialists (in general and in relation to the overall population) and specialist trainees and describe the content, delivery and evaluation of postgraduate training in ID in different countries.Methods: Structured web-based questionnaire surveys in March 2021 of responsible national authorities, specialist societies and individual country representatives to the Section of Infectious Diseases of the European Union for Medical Specialties. Descriptive analysis of quantitative and qualitative responses.Results: In responses received from 33/35 (94.3%) countries, ID is recognized as a specialty in 24 and as a subspecialty of general internal medicine (GIM) in eight, but it is not recognized in Spain. The number of ID specialists per country varies from <5 per million inhabitants to 78 per million inhabitants. Median length of training is 5 years (interquartile range 4.0–6.0 years) with variable amounts of preceding and/or concurrent GIM. Only 21.2% of countries (7/33) provide the minimum recommended training of 6 months in microbiology and 30% cover competencies such as palliative care, team working and leadership, audit, and quality control. Training is monitored by personal logbook or e-portfolio in 75.8% (25/33) and assessed by final examinations in 69.7% (23/33) of countries, but yearly reviews with trainees only occur in 54.5% (18/33) of countries.Conclusions: There are substantial gaps in modernization of ID training in many countries to match current European training requirements. Joint training with clinical microbiology (CM) and in multidisciplinary team working should be extended. Training/monitoring trainers should find greater focus, together with regular feedback to trainees within many national training programmes.peer-reviewe

Risk factors for infections caused by carbapenem-resistant Enterobacterales: an international matched case-control-control study (EURECA)

Cases were patients with complicated urinary tract infection (cUTI), complicated intraabdominal (cIAI), pneumonia or bacteraemia from other sources (BSI-OS) due to CRE; control groups were patients with infection caused by carbapenem-susceptible Enterobacterales (CSE), and by non-infected patients, respectively. Matching criteria included type of infection for CSE group, ward and duration of hospital admission. Conditional logistic regression was used to identify risk factors. Findings Overall, 235 CRE case patients, 235 CSE controls and 705 non-infected controls were included. The CRE infections were cUTI (133, 56.7%), pneumonia (44, 18.7%), cIAI and BSI-OS (29, 12.3% each). Carbapenemase genes were found in 228 isolates: OXA-48/like, 112 (47.6%), KPC, 84 (35.7%), and metallo-beta-lactamases, 44 (18.7%); 13 produced two. The risk factors for CRE infection in both type of controls were (adjusted OR for CSE controls; 95% CI; p value) previous colonisation/infection by CRE (6.94; 2.74-15.53; <0.001), urinary catheter (1.78; 1.03-3.07; 0.038) and exposure to broad spectrum antibiotics, as categorical (2.20; 1.25-3.88; 0.006) and time-dependent (1.04 per day; 1.00-1.07; 0.014); chronic renal failure (2.81; 1.40-5.64; 0.004) and admission from home (0.44; 0.23-0.85; 0.014) were significant only for CSE controls. Subgroup analyses provided similar results. Interpretation The main risk factors for CRE infections in hospitals with high incidence included previous coloni-zation, urinary catheter and exposure to broad spectrum antibiotics

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

2015/16 seasonal vaccine effectiveness against hospitalisation with influenza a(H1N1)pdm09 and B among elderly people in Europe: Results from the I-MOVE+ project

We conducted a multicentre test-negative caseâ\u80\u93control study in 27 hospitals of 11 European countries to measure 2015/16 influenza vaccine effectiveness (IVE) against hospitalised influenza A(H1N1)pdm09 and B among people aged â\u89¥ 65 years. Patients swabbed within 7 days after onset of symptoms compatible with severe acute respiratory infection were included. Information on demographics, vaccination and underlying conditions was collected. Using logistic regression, we measured IVE adjusted for potential confounders. We included 355 influenza A(H1N1)pdm09 cases, 110 influenza B cases, and 1,274 controls. Adjusted IVE against influenza A(H1N1)pdm09 was 42% (95% confidence interval (CI): 22 to 57). It was 59% (95% CI: 23 to 78), 48% (95% CI: 5 to 71), 43% (95% CI: 8 to 65) and 39% (95% CI: 7 to 60) in patients with diabetes mellitus, cancer, lung and heart disease, respectively. Adjusted IVE against influenza B was 52% (95% CI: 24 to 70). It was 62% (95% CI: 5 to 85), 60% (95% CI: 18 to 80) and 36% (95% CI: -23 to 67) in patients with diabetes mellitus, lung and heart disease, respectively. 2015/16 IVE estimates against hospitalised influenza in elderly people was moderate against influenza A(H1N1)pdm09 and B, including among those with diabetes mellitus, cancer, lung or heart diseases

CLINICAL AND EVOLUTIVE ASPECTS OF COXIELLA BURNETII INFECTION

Introduction. Coxiella burnetii is the etiological agent of Q fever, a zoonosis that is still subject of „Query”. Formerly classified as a Rickettsia, C. burnetii is a highly infectious obligate intracellular bacteria, whose main animal reservoirs are cattle, sheep and goats. Commonly following transmission through inhalation of aerosols containing the pathogen spread during animal parturition, Q fever may present as a self-limited febrile illness, pneumonia or acute hepatitis. Nevertheless, the possibility of evolving towards a chronic form exists under certain circumstances, mainly involving previously affected heart valves or blood vessels. Diagnosis is usually serologically based and Doxycycline represents the most frequent choice of antibiotherapy. Objectives. The aim of this study is to analyse the clinical and laboratory settings that led to diagnosis of acute or chronic Q fever, the treatment regimens applied and consecutive outcome within the group of patients defined below. Materials and methods. The present paper represents an observational descriptive study performed on a group composed of 24 patients admitted in our hospital along 2018 and diagnosed with confirmed or probable acute or chronic Q fever. Both male and female subjects regardless of their age were included, under the condition of meeting the CDC case definition, by integrating the serological results into the clinical context. Results and conclusions. A suggestive epidemiological frame was rarely proven. Out of the 24 subjects with ages between 34 and 80 years old, of which only 2 were women, 22 had acute Q fever, manifested mostly as a combination of atypical pneumonia and hepatitis (9 cases, representing 41. Only 2 of the acute Q fever cases had a confirmed diagnosis. Frequent complaints were fever (all cases), chills, headaches and vomiting. Only 28% of the radiologically confirmed pneumonias were accompanied by dry cough, whilst only 21% of the hepatitis cases associated jaundice. Biologically, although leukocytosis was more weakly correlated with acute disease activity, all patients exhibited a moderate to high inflammatory response (through C reactive protein). Considering the latency of specific antibodies’ dosage results, the decision of initiating treatment was based on a clinical support. Antibiotherapy consisted of Doxycyclin, alone or in combinations meant to cover a larger spectrum, given the usually nonspecific symptoms and the initially low clinical suspicion for Q fever. Clinical evolution was favorable in all cases. Regarding the two patients with chronic Q fever, manifested as blood culture-negative endocarditis, of which only one was confirmed according to the CDC definition, both had presented valvular lesions before developing IE and had no history of acute infection with C. burnetii. In the first case, under empirical infective endocarditis agents (Ceftriaxone and Vancomycin), acute heart failure and necessity of surgical replacement of the affected valve occured, only afterwards being followed by the elevated phase I IgG level that brought diagnostic confirmation. Meanwhile, the second patient did receive a combination with Doxycycline, followed by favorable clinical evolution during admission

IMAGINI HIDROAERICE PULMONARE MULTIPLE – CAPCANE DE DIAGNOSTIC, PREZENTARE CAZURI CLINICE

Leziunile cavitare pulmonare pun probleme complexe de diagnostic diferenţial, spectrul etiologic incluzând: – Infecţii necrotizante (pneumonii, tuberculoză pulmonară, abcese cu paraziţi şi fungi) sau – Afecţiuni noninfecţioase (neoplasm pulmonar necrozat, infarct pulmonar infectat, vasculite, colagenoze cu cavităţi pulmonare prin mecanism imunologic, aspiraţie de corp străin intrabronşic, malformaţii congenitale pulmonare, pneumoconioze excavate etc). Prezentăm trei cazuri clinice cu imagini radiologice similare, respectiv multiple formaţiuni cavitare pulmonare, dar cu diagnostic şi etiologii diferite: sepsis cu Staphilococcus aureus MRSA, echinococoza cu localizări multiple şi tuberculoză pulmonară secundară, formă cazeos-cavitară. În toate cele trei cazuri, radiografia pulmonară standard a fost investigaţia de bază în diagnosticul afecţiunii pulmonare, însă diagnosticul de certitudine a necesitat efectuarea şi altor metode de investigaţie

Climate Change Is Increasing the Risk of the Reemergence of Malaria in Romania

The climatic modifications lead to global warming; favouring the risk of the appearance and development of diseases are considered until now tropical diseases. Another important factor is the workers’ immigration, the economic crisis favouring the passive transmission of new species of culicidae from different areas. Malaria is the disease with the widest distribution in the globe. Millions of people are infected every year in Africa, India, South-East Asia, Middle East, and Central and South America, with more than 41% of the global population under the risk of infestation with malaria. The increase of the number of local cases reported in 2007–2011 indicates that the conditions can favour the high local transmission in the affected areas. In the situation presented, the establishment of the level of risk concerning the reemergence of malaria in Romania becomes a priority