Case report of Usutu virus infection in an immunocompromised patient in Italy, 2022

Usutu virus (USUV) is an arthropod-borne flavivirus emerged in Africa in 1950s and in Eruope in 1990s causing a massive number of birds' deaths. The role of USUV as human pathogen has been only recently hypothesized and cases of USUV infection in humans remain limited and often related to immunocompromised subjects. Herein, we report a case of USUV meningoencephalitis infection in an immunocompromised patient with no history of previous flavivirus infection. The infection due to USUV evolved rapidly since hospital admission thus resulting fatal in few days after symptoms onset and, although not proven, a suspected bacteria co-infection has been hypothesized. Based on these findings, we suggested that when USUV meningoencephalitis is suspected in countries endemic, careful attention should be applied to neurological syndromes during summer months especially among immunocompromised patients

A proof-of-concept study on the genomic evolution of Sars-Cov-2 in molnupiravir-treated, paxlovid-treated and drug-naïve patients

Little is known about SARS-CoV-2 evolution under Molnupiravir and Paxlovid, the only antivirals approved for COVID-19 treatment. By investigating SARS-CoV-2 variability in 8 Molnupiravir-treated, 7 Paxlovid-treated and 5 drug-naive individuals at 4 time-points (Days 0-2-5-7), a higher genetic distance is found under Molnupiravir pressure compared to Paxlovid and no-drug pressure (nucleotide-substitutions/site mean & PLUSMN;Standard error: 18.7 x 10(-4) & PLUSMN; 2.1 x 10(-4) vs. 3.3 x 10(-4) & PLUSMN; 0.8 x 10(-4) vs. 3.1 x 10(-4) & PLUSMN; 0.8 x 10(-4), P = 0.0003), peaking between Day 2 and 5. Molnupiravir drives the emergence of more G-A and C-T transitions than other mutations (P = 0.031). SARS-CoV-2 selective evolution under Molnupiravir pressure does not differ from that under Paxlovid or no-drug pressure, except for orf8 (dN > dS, P = 0.001); few amino acid mutations are enriched at specific sites. No RNA-dependent RNA polymerase (RdRp) or main proteases (Mpro) mutations conferring resistance to Molnupiravir or Paxlovid are found. This proof-of-concept study defines the SARS-CoV-2 within-host evolution during antiviral treatment, confirming higher in vivo variability induced by Molnupiravir compared to Paxlovid and drug-naive, albeit not resulting in apparent mutation selection

Development and Validation of a Questionnaire to Explore Tuberculosis Knowledge in Foreign-Born Subjects From High Tuberculosis Incidence Countries.

Background: Italy is a low tuberculosis (TB) incidence country, and TB cases cluster especially among foreign-born subjects from high TB incidence countries. Several determinants of health contribute to active TB development in this population and TB control strategies should address all. TB knowledge represents only one of these determinants, and all alone does not increase person’s empowerment. However, TB knowledge could represent a contribution to TB control, when integrated into a framework of actions. To our knowledge, there are no validated questionnaires exploring TB knowledge among foreign-born subjects from high TB incidence countries who are living in a low TB incidence setting. Materials/Methods: the questionnaire’s item pool was compiled from literature reviews. The questionnaire collected demographic data, social determinants’ data and TB knowledge information. Questionnaire had to be performed face-to-face and answers were open-ended or multiple choice. Content validity was assessed by content validity index (CVI) and Delphi technique. Linguistic and cultural barriers were assessed undergoing a health literacy review and performing a focus group and two pilot tests. Reliability was assessed calculating Cronbach’s alpha coefficient. We computed the Kaiser-Meyer-Olkin test (KMO test) and the sphericity Bartlett’s test in order to perform principal component analysis (PCA). PCA was performed to assess validity. We enrolled and interviewed 96 adult foreign-born subjects from high TB incidence countries from November 2019 to December 2019 in four different facilities (a school, a refugee centre, an infectious diseases unit and an immigrant-health ambulatory) in Ferrara, Italy. Descritpive statistics was used to summarize dempgraphic data. Results: Seven TB experts evaluated the questionnaire with two Delphi technique rounds. Nineteen (50%) out of 38 items presented CVI <80% and were deleted. The focus group was conducted with four foreign-born subjects and two items were deleted and one item added. Eleven subjects underwent the first pilot test and 40 subjects the second one: no items were deleted. Cronbach’s alpha coefficient was 0.70 for TB knowledge items (four items). KMO test value was 0.68 and the sphericity Bartlett’s test was < 0.001. The questionnaire presented one factor (eigenvalue=1.99) [Figure1]. Table 1 and 2 show demographic data and social determinants of health of the population interviewed. Conclusions: We developed and validated a questionnaire as a reliable and valid tool for measuring TB knowledge among foreign-born subjects from high incidence TB countries, who are living in a low TB incidence setting. We hope this questionnaire could contribute to TB control

SARS-CoV-2 Infection: New Molecular, Phylogenetic, and Pathogenetic Insights. Efficacy of Current Vaccines and the Potential Risk of Variants

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly discovered coronavirus responsible for the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 has rapidly become a public health emergency of international concern. Although remarkable scientific achievements have been reached since the beginning of the pandemic, the knowledge behind this novel coronavirus, in terms of molecular and pathogenic characteristics and zoonotic potential, is still relatively limited. Today, there is a vaccine, or rather several vaccines, which, for the first time in the history of highly contagious infectious diseases that have plagued mankind, has been manufactured in just one year. Currently, four vaccines are licensed by regulatory agencies, and they use RNA or viral vector technologies. The positive effects of the vaccination campaign are being felt in many parts of the world, but the disappearance of this new infection is still far from being a reality, as it is also threatened by the presence of novel SARS-CoV-2 variants that could undermine the effectiveness of the vaccine, hampering the immunization control efforts. Indeed, the current findings indicate that SARS-CoV-2 is adapting to transmission in humans more efficiently, while further divergence from the initial archetype should be considered. In this review, we aimed to provide a collection of the current knowledge regarding the molecular, phylogenetic, and pathogenetic insights into SARS-CoV-2. The most recent findings obtained with respect to the impact of novel emerging SARS-CoV-2 variants as well as the development and implementation of vaccines are highlighted

Sarcopenic Obesity Phenotypes in Patients With HIV: Implications for Cardiovascular Prevention and Rehabilitation

Background: To describe prevalence, incidence and risk factors for sarcopenic obesity (SO) phenotypes in people living with HIV (PWH) and their association with subclinical cardiovascular disease (CVD). Methods: Observational, longitudinal study of PWH. A minimum of one criterion was necessary to diagnose sarcopenia: (i) weak hand grip (HG), (ii) low appendicular skeletal muscle index (ASMI), (iii) short physical performance battery (SPPB 10. Results: Among 2379 PWH 72% men, median age was 52 years, median HIV vintage 21 years, and median BMI 24 kg/m2. Two PWH had severe SO. The prevalence of SO1-SO4 was 19.7%, 3.6%, 20.8% and 0.8% respectively. Incidence of SO1-SO4 was 6.90, 1.2, 5.6 and 0.29 x 100 persons-year, respectively. SO1 was associated with risk of IMT ≥ 1, and SO3 with risk of CAC score >10. Conclusions: There was a large variability in incidence and prevalence of SO phenotypes. The presence of SO may have important implications for cardiovascular prevention and cardiac rehabilitation of PWH who suffered an event

First Human Case of Tick-Borne Encephalitis in Non-Endemic Region in Italy: A Case Report

Tick-borne encephalitis (TBE), a human viral infectious disease caused by the tick-borne encephalitis virus (TBEV), is emerging in Italy, especially in the north-eastern area. No human cases of autochthonous TBE have been reported in Italy’s central regions (such as Emilia-Romagna, Italy). However, here we describe the first human case of TBEV infection in this region, pointing to endemic transmission of TBEV, supporting the concept of circulation of TBEV and of the presence of a possible hot spot in the Serramazzoni region in the Emilian Apennines

Long-Term Suppressive Therapeutic-Drug-Monitoring-Guided Dalbavancin Therapy for Cardiovascular Prosthetic Infections

Dalbavancin represents a promising treatment for cardiovascular prosthetic infections due to its prolonged half-life, bactericidal activity, large spectrum of activity, and excellent biofilm penetration. However, the use of dalbavancin in this setting is limited, and only a few cases have performed therapeutic drug monitoring (TDM) analysis to optimize dosage in suppressive treatments longer than 4 weeks. Our retrospective case series reports the use of dalbavancin in a small cohort of patients with cardiovascular prosthetic infections (cardiac implantable electronic device infections (CEDIs), prosthetic valve endocarditis (PVE), prosthetic vascular graft infections (PVGIs)) treated with dalbavancin as sequential therapy. From May 2019 to May 2023, 14 patients were included: eight cases of PVE (57.1%), seven cases of PVGI (50%), three cases of CEDI (21.4%), and four cases with overlap of infection sites (28.6%). The main pathogen was Staphylococcus aureus (35.7%). Prosthesis replacement was obtained in four patients (28.6%). The median time between symptom onset and the end of treatment was 15 weeks (IQR 7–53), with a median duration of dalbavancin therapy of 8 weeks (IQR 1 to 45 weeks) and 3.5 doses per patient. Among patients managed with TDM-guided strategy, dalbavancin infusion intervals ranged from 4 to 9 weeks. The median length of follow-up was 65 weeks (IQR 23 to 144 weeks). Clinical success was achieved in 10 cases (76.9%); all clinical failures occurred in patients with the implant retained. Among patients monitored by TDM, clinical success was 87.5% vs. 60% in patients treated without TDM. Because of pharmacokinetic individual variability, dalbavancin TDM-guided administration could improve clinical outcomes by individualizing dosing and selecting dosing intervals. This case series seems to suggest a promising role of long-term suppressive dalbavancin treatment for difficult-to-treat cardiovascular prosthesis infection, also with limited surgical indications