Chagas disease and SARS-CoV-2 coinfection does not lead to worse in-hospital outcomes

Epidemiología; Microbiología; SARS-CoV-2Epidemiologia; Microbiologia; SARS-CoV-2Epidemiology; Microbiology; SARS-CoV-2Chagas disease (CD) continues to be a major public health burden in Latina America. Information on the interplay between COVID-19 and CD is lacking. Our aim was to assess clinical characteristics and in-hospital outcomes of patients with CD and COVID-19, and to compare it to non-CD patients. Consecutive patients with confirmed COVID-19 were included from March to September 2020. Genetic matching for sex, age, hypertension, diabetes mellitus and hospital was performed in a 4:1 ratio. Of the 7018 patients who had confirmed COVID-19, 31 patients with CD and 124 matched controls were included (median age 72 (64–80) years-old, 44.5% were male). At baseline, heart failure (25.8% vs. 9.7%) and atrial fibrillation (29.0% vs. 5.6%) were more frequent in CD patients than in the controls (p < 0.05). C-reactive protein levels were lower in CD patients compared with the controls (55.5 [35.7, 85.0] vs. 94.3 [50.7, 167.5] mg/dL). In-hospital management, outcomes and complications were similar between the groups. In this large Brazilian COVID-19 Registry, CD patients had a higher prevalence of atrial fibrillation and chronic heart failure compared with non-CD controls, with no differences in-hospital outcomes. The lower C-reactive protein levels in CD patients require further investigation.This study was supported in part by Minas Gerais State Agency for Research and Development (Fundação de Amparo à Pesquisa do Estado de Minas Gerais—FAPEMIG) [Grant Number APQ-00208-20], National Institute of Science and Technology for Health Technology Assessment (Instituto de Avaliação de Tecnologias em Saúde—IATS)/National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico—CNPq) [Grant Number 465518/2014-1], and CAPES Foundation (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior) [Grant Number 88887.507149/2020-00]

Cell-derived microvesicles in infective endocarditis: Role in diagnosis and potential for risk stratification at hospital admission

Objectives: To characterize the plasmatic profile of cell-derived microvesicles (MVs) at diagnosis and during the treatment of patients with infective endocarditis (IE). Methods: Blood samples from 57 patients with IE were obtained on 3 consecutive moments: upon admission (T0), at 2 weeks (T1), and at the end of treatment (T2), and were compared with 22 patients with other bacterial infections. MPs were measured by flow cytometry and labeled for specific cell markers of CD45 (leukocytes), CD66b (neutrophils), CD14 (monocytes), CD41a (platelets), CD51 (endothelial cells), CD3 (T lymphocyte) and CD235a (erythrocytes). Results: MVs from platelets (pltMVs), leukocytes (leukMVs), neutrophils (neutMVs), monocytes (monoMVs) and lymphocytes (lymphMVs) were significantly more elevated in the patients with IE, compared to the patients with other bacterial infections, despite comparable age, sex, blood counts and C-reactive protein levels. MVs values revealed a relatively stable pattern over time in IE, except for a significant increase in leukMVs and neutMVs in T1. LeukMVs (p = 0.011), neutMVs (p = 0.010), monoMVs (p = 0.016) and lymphMVs (p = 0.020), measured at admission, were significantly higher in IE patients that died during hospitalization in comparison with those that survived. In a multivariable analyses, the levels of neutMVs remained as an independent factor associated with mortality (odds ratio 2.203; 95% confidence interval 1.217 - 3.988; p = 0.009), adjustment for heart failure during the treatment. Conclusions: Plasma levels of pltMVs, leukMVs, neutMVs, monoMVs and lymphMVs were significantly more elevated in patients with IE than in patients with other bacterial infections at hospital admission. Furthermore, neutMVs at admission have been identified as an independent predictor of mortality in patients with IE. Thus, cell derived MPs may become an important tool in the differential diagnosis and mortality risk assessment early in the course of IE suspected cases

COVID-19 outcomes in people living with HIV: Peering through the waves

Objective: To evaluate clinical characteristics and outcomes of COVID-19 patients infected with HIV, and to compare with a paired sample without HIV infection. Methods: This is a substudy of a Brazilian multicentric cohort that comprised two periods (2020 and 2021). Data was obtained through the retrospective review of medical records. Primary outcomes were admission to the intensive care unit, invasive mechanical ventilation, and death. Patients with HIV and controls were matched for age, sex, number of comorbidities, and hospital of origin using the technique of propensity score matching (up to&nbsp;4:1). They were compared using the Chi-Square or Fisher's Exact tests for categorical variables and the Wilcoxon for numerical variables. Results: Throughout the study, 17,101&nbsp;COVID-19 patients were hospitalized, and 130&nbsp;(0.76%) of those were infected with HIV. The median age was&nbsp;54&nbsp;(IQR:&nbsp;43.0;64.0) years in&nbsp;2020 and 53&nbsp;(IQR:&nbsp;46.0;63.5) years in&nbsp;2021, with a predominance of females in both periods. People Living with HIV (PLHIV) and their controls showed similar prevalence for admission to the ICU and invasive mechanical ventilation requirement in the two periods, with no significant differences. In&nbsp;2020, in-hospital mortality was higher in the PLHIV compared to the controls (27.9%&nbsp;vs.&nbsp;17.7%; p&nbsp;=&nbsp;0.049), but there was no difference in mortality between groups in&nbsp;2021 (25.0%&nbsp;vs.&nbsp;25.1%; p &gt; 0.999). Conclusions: Our results reiterate that PLHIV were at higher risk of COVID-19 mortality in the early stages of the pandemic, however, this finding did not sustain in&nbsp;2021, when the mortality rate is similar to the control group

Analysis of immunization time, amplitude, and adverse events of seven different vaccines against SARS-CoV-2 across four different countries

BackgroundScarce information exists in relation to the comparison of seroconversion and adverse events following immunization (AEFI) with different SARS-CoV-2 vaccines. Our aim was to correlate the magnitude of the antibody response to vaccination with previous clinical conditions and AEFI.MethodsA multicentric comparative study where SARS-CoV-2 spike 1-2 IgG antibodies IgG titers were measured at baseline, 21-28 days after the first and second dose (when applicable) of the following vaccines: BNT162b2 mRNA, mRNA-1273, Gam-COVID-Vac, Coronavac, ChAdOx1-S, Ad5-nCoV and Ad26.COV2. Mixed model and Poisson generalized linear models were performed.ResultsWe recruited 1867 individuals [52 (SD 16.8) years old, 52% men]. All vaccines enhanced anti-S1 and anti-S2 IgG antibodies over time (p&lt;0.01). The highest increase after the first and second dose was observed in mRNA-1273 (p&lt;0.001). There was an effect of previous SARS-CoV-2 infection; and an interaction of age with previous SARS-CoV-2 infection, Gam-COVID-Vac and ChAdOx1-S (p&lt;0.01). There was a negative correlation of Severe or Systemic AEFI (AEs) of naïve SARS-CoV-2 subjects with age and sex (p&lt;0.001); a positive interaction between the delta of antibodies with Gam-COVID-Vac (p=0.002). Coronavac, Gam-COVID-Vac and ChAdOx1-S had less AEs compared to BNT162b (p&lt;0.01). mRNA-1273 had the highest number of AEFIs. The delta of the antibodies showed an association with AEFIs in previously infected individuals (p&lt;0.001).ConclusionsThe magnitude of seroconversion is predicted by age, vaccine type and SARS-CoV-2 exposure. AEs are correlated with age, sex, and vaccine type. The delta of the antibody response only correlates with AEs in patients previously exposed to SARS-CoV-2.Registration numberClinicalTrials.gov, identifier NCT05228912

Cytokine Signature in Infective Endocarditis

Submitted by Nuzia Santos ([email protected]) on 2016-02-22T18:40:28Z No. of bitstreams: 1 Cytokine Signature in Infective Endocarditis.pdf: 4520206 bytes, checksum: b19db1cac74d895dbecf1ec8e9e4e204 (MD5)Approved for entry into archive by Nuzia Santos ([email protected]) on 2016-02-22T18:51:07Z (GMT) No. of bitstreams: 1 Cytokine Signature in Infective Endocarditis.pdf: 4520206 bytes, checksum: b19db1cac74d895dbecf1ec8e9e4e204 (MD5)Made available in DSpace on 2016-02-22T18:51:07Z (GMT). No. of bitstreams: 1 Cytokine Signature in Infective Endocarditis.pdf: 4520206 bytes, checksum: b19db1cac74d895dbecf1ec8e9e4e204 (MD5) Previous issue date: 2015Universidade Federal de Minas Gerais. Faculdade de Medicina. Departamento de Clínica Médica. Programa de Pós-Graduação em Infectologia e Medicina Tropical. Belo Horizonte, MG, BrasilUniversidade Federal de Minas Gerais. Faculdade de Medicina. Departamento de Clínica Médica. Programa de Pós-Graduação em Infectologia e Medicina Tropical. Belo Horizonte, MG, BrasilFundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Laboratório de Biomarcadores de Diagnóstico e Monitoração. Belo Horizonte, MG, BrasilFundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Laboratório de Biomarcadores de Diagnóstico e Monitoração. Belo Horizonte, MG, BrasilUniversidade Federal de Minas Gerais. Faculdade de Medicina. Departamento de Clínica Médica. Programa de Pós-Graduação em Infectologia e Medicina Tropical. Belo Horizonte, MG, BrasilUniversidade Federal de Minas Gerais. Faculdade de Medicina. Departamento de Clínica Médica. Programa de Pós-Graduação em Infectologia e Medicina Tropical. Belo Horizonte, MG, BrasilUniversidade Federal de Minas Gerais. Faculdade de Medicina. Departamento de Clínica Médica. Programa de Pós-Graduação em Infectologia e Medicina Tropical. Belo Horizonte, MG, BrasilUniversidade Federal de Minas Gerais. Faculdade de Medicina. Departamento de Cirurgia. Belo Horizonte, MG, BrasilUniversidade Federal de Minas Gerais. Faculdade de Medicina. Departamento de Clínica Médica. Programa de Pós-Graduação em Infectologia e Medicina Tropical. Belo Horizonte, MG, BrasilUniversidade Federal de Minas Gerais. Faculdade de Medicina. Departamento de Clínica Médica. Programa de Pós-Graduação em Infectologia e Medicina Tropical. Belo Horizonte, MG, BrasilInfective endocarditis (IE) is a severe disease with high mortality rate. Cytokines participate in its pathogenesis and may contribute to early diagnosis improving the outcome. This study aimed to evaluate the cytokine profile in IE. Serum concentrations of interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12 and tumor necrosis factor (TNF)-α were measured by cytometric bead array (CBA) at diagnosis in 81 IE patients, and compared with 34 healthy subjects and 30 patients with non-IE infections, matched to the IE patients by age and gender. Mean age of the IE patients was 47±17 years (range, 15–80 years), and 40 (50%) were male. The IE patients had significantly higher serum concentrations of IL-1β, IL-6, IL-8, IL-10 and TNF-α as compared to the healthy individuals. The median levels of IL-1β, TNF-α and IL-12 were higher in the IE than in the non-IE infections group. TNF-α and IL-12 levels were higher in staphylococcal IE than in the non-staphylococcal IE subgroup. There was a higher proportion of both low IL-10 producers and high producers of IL-1β, TNF-α and IL-12 in the staphylococcal IE than in the non-staphylococcal IE subgroup. This study reinforces a relationship between the expression of proinflammatory cytokines, especially IL-1β, IL-12 and TNF-α, and the pathogenesis of IE. A lower production of IL-10 and impairment in cytokine network may reflect the severity of IE and may be useful for risk stratification

Outcomes of infective endocarditis in the current era: Early predictors of a poor prognosis

Background: The early identification of patients at risk of complications of infective endocarditis (IE) using parameters obtained as part of routine practice is essential for guiding clinical decision-making. This study aimed to identify a parameter at hospital admission that predicts the outcome, adding value to other well-known factors of a poor prognosis in IE. Methods: Two hundred and three patients with IE were included in this study. Clinical evaluation, echocardiography, blood cultures, and routine laboratory tests were performed at hospital admission. The endpoint was in-hospital mortality. Results: The mean age of the patients was 48.2 ± 16.6 years; 62% were male and 38% had rheumatic heart disease. During treatment, cardiac surgery was performed in 111 patients (55%), and the overall in-hospital mortality rate was 32%. In the multivariable analysis, the independent predictors of death were age (odds ratio (OR) 1.07, 95% confidence interval (CI) 1.02–1.13), C-reactive protein (CRP) at hospital admission (OR 1.12, 95% CI 1.04–1.21), length of the vegetation at diagnosis (OR 1.15, 95% CI 1.03–1.28), development of heart failure (OR 6.43, 95% CI 2.14–19.33), and embolic events during antimicrobial therapy (OR 12.14, 95% CI 2.11–71.89). Conclusions: An elevated CRP level at hospital admission and vegetation length at diagnosis were strong predictors of in-hospital mortality in IE, independent of other prognostic parameters, specifically taking into account patient characteristics and complications during therapy. Keywords: Infective endocarditis, C-reactive protein, Echocardiography, Mortalit

Radar graphics showing the proportion of subjects and the immunological biomarkers production in infective endocarditis (IE) etiological subgroups.

<p>The subgroups evaluated were: culture-negative IE (CN-IE), non-staphylococcal IE (non-S IE), and staphylococcal IE (S IE). Elevated proportion of high producers of IL-1β, TNF-α and IL-12 was observed only in the S IE subgroup. The prevalence of high producers of IL-10 was lower in the S IE subgroup as compared to the others subgroups.</p

Baseline characteristics of the patients with infective endocarditis.

<p>*Data presented as mean and standard deviation (mean ± SD) or absolute number (percentage) of patients.</p><p>Baseline characteristics of the patients with infective endocarditis.</p

Serum concentrations of inflammatory cytokines in the patients with infective endocarditis (IE) stratified according to the microorganisms.

<p>The groups evaluated were: culture-negative IE (CN-IE) (white circle), non-staphylococcal IE (non-S IE) (light gray circle), and staphylococcal IE (S IE) (dark gray circle). Significant differences at p<0.05 are highlighted by letter for difference of a group as compared to non-infective endocarditis indicated by ‘‘b”.</p

Comparison between cytokine levels and major symptoms at diagnosis of infective endocarditis and mortality.

<p>TNF-α, tumor necrosis factor-α.</p><p>*Median (interquartile range), pg/mL.</p><p>Comparison between cytokine levels and major symptoms at diagnosis of infective endocarditis and mortality.</p