[Singularities of COVID-19 in immunosuppressed persons]. / Singularités du Covid-19 chez les personnes immunosupprimées.

Immunosuppressed persons are a heterogeneous population that represents approximately 3 % of the adult population. They are more vulnerable to infectious agents, such as SARS-CoV-2. This is reflected by a reduced response to vaccination, a higher rate of progression towards a severe form of the disease, and recurrent or persistent infections associated with intra-host viral evolution. This review summarizes the evidence regarding vaccine efficacy, clinical and virological singularities, and the management in immunosuppressed patients.

Les personnes immunosupprimées (PI) constituent une population hétérogène représentant environ 3 % de la population adulte et sont plus vulnérables aux infections, telles que le Covid-19, face auquel elles présentent une réponse vaccinale diminuée, un taux plus élevé d'évolution vers une forme sévère de la maladie, et des infections persistantes associées à une excrétion virale prolongée et à une possible évolution virale intrahôte. Cet article résume l'évidence concernant l'efficacité vaccinale, les particularités clinico-virologiques et la prise en charge spécifique, dans la population des PI.

Challenges of antimicrobial stewardship among older adults.

Older adults hospitalized in internal medicine wards or long-term care facilities (LTCF) are progressively increasing. Older adults with multimorbidity are more susceptible to infections, as well as to more vulnerable to adverse effects (and interactions) of antibiotics, resulting in a need for effective and safer strategies for antimicrobial stewardship (ASM), both in hospitalization wards and long-term care facilities. Studies on antimicrobial stewardship in older patients are scarce and guidelines are required. Given the peculiarities of the optimization of antimicrobial prescription in individual older adults for common infections, tactics to overcome barriers need an update. The use of rapid diagnosis tests, biomarkers, de-escalation and switching from intravenous to oral/subcutaneous therapy strategies are examples of successful AMS interventions. AMS interventions are associated with reduced side effects, lower mortality, shorter hospital stays, and reduced costs. The proposed AMS framework in LTCF should focus on five domains: strategic vision, team, interventions, patient-centred care and awareness. Internists can partner with geriatrists, pharmacists and infectious disease specialists to address barriers and to improve patient care.

Skin manifestations in children with MIS-C and COVID-19: a narrative review.

This review aims to highlight the diverse skin manifestations in children and adolescents with COVID induced multisystem inflammatory syndrome in children (MIS-C). The symptoms of COVID-19 can vary greatly in severity between different age groups. Although most children infected with SARS-CoV-2 experience either no symptoms or only mild symptoms, some reported cases of severely affected children with a clinical presentation similar to incomplete Kawasaki disease have led to the definition of a new condition called MIS-C. MIS-C can involve multiple organs, including the skin, and may pose a life-threatening risk to affected children. Such cases highlight the need for continuous research into the possible skin manifestations associated with COVID-19 in pediatric populations to aid in early diagnosis and prompt treatment. We conducted a search of PubMed, Scopus, and ScienceDirect databases for studies published up until October 1, 2022. Three reviewers independently examined each study, and a fourth reviewer resolved any disagreements. A narrative review of all relevant papers was conducted. We present an overview of the clinical presentation, pathophysiology, diagnosis, and treatment of the various skin manifestations in children and adolescents with COVID-19 or MIS-C. The skin manifestations of COVID-19 and MIS-C can be diverse and are frequently overlooked. It is important to conduct further research to better understand the impact of this disease on children to provide appropriate care for these at-risk populations.

A case series of brain abscesses: an eleven-year retrospective single center study.

INTRODUCTION: We lack data on the epidemiology and management of brain abscesses in the Middle East. The aim of this study is to report a case series of brain abscesses admitted at a tertiary care center in Lebanon, between January 2008 and December 2018. METHODOLOGY: This retrospective study aimed at determining the demographic data, treatment, and correlations between different studied variables with prognosis of patients that received treatment. RESULTS: Forty-one patients (30 males) were included with a median age of 37 years (2-85). The analysis showed that the classic triad of fever, headache and neurologic deficit was only present in 12% of patients on admission. The source of infection was contiguous in 36.5%, post surgical in 32%, and distant in 17% of cases. Stereotactic biopsy was performed in 41.5% of patients, and craniotomy in 19.5%. A microorganism was isolated in 63% of patients (26 cases). The most used antibiotics were carbapenems (46%) and glycopeptides (66%). Eighty percent of patient (33) had a good outcome. A worse prognosis was significantly correlated with immunosuppression and multiple cerebral abscesses. CONCLUSIONS: Brain abscess remains a relatively rare condition.

Antibiotics in treatment of COVID-19 complications: a review of frequency, indications, and efficacy.

OBJECTIVES: To report available information in the literature regarding frequency, indications, types of antibiotic usage, duration, and their efficacy in Covid-19 infected patients. METHODS: The search was conducted on April 30 and May 7, 2020, using Ovid database and Google search. Patients' characteristics, clinical outcomes, as well as selected characteristics regarding antibiotic use (indication, class used, rates and types of bacterial secondary and co-infection, and duration of treatment) were analyzed. RESULTS: Nineteen clinical studies reporting data from 2834 patients were included. Mean rate of antibiotic use was 74.0 % of cases. Half the studies reported occurrence of a bacterial co-infection or complication (10 studies). Amongst the latter, at least 17.6 % of patients who received antibiotics had secondary infections. Pooled data of 4 studies show that half of patients receiving antibiotics were not severe nor critical. Detailed data on antibiotic use lack in most articles. CONCLUSIONS: The present review found a major use of antibiotics amongst Covid-19 hospitalized patients, mainly in an empirical setting. There is no proven efficacy of this practice. Further research to determine relevant indications for antibiotic use in Covid-19 patients is critical in view of the significant mortality associated with secondary infections in these patients, and the rising antimicrobial resistance.

Clostridioides difficile infections: Epidemiology, correlations and treatment in a Lebanese cohort with use of ATLAS scoring.

INTRODUCTION: The objectives of the present study were to investigate epidemiology, correlations, severity, and therapeutic response of Clostridioides difficile infections in a Lebanese tertiary care hospital. METHODOLOGY: In this retrospective cohort study, patients having at least one positive Clostridioides difficile test (antigen glutamate dehydrogenase/GDH with toxins, or PCR) were studied. RESULTS: Among 58 patients, 20 (34.5%) and 53 (91.4%) had positive antigen GDH and toxins, respectively. PCR was performed in 25 (43.1%) patients without any positive ribotype 027. Fifteen (25.9%) patients were immunocompromised, 35 (60.3%) patients received antibiotics prior to the infection and 34 (58.6%) on proton pump inhibitors. Fifty-four (93%) patients had a resolution of their symptoms after a mean period of 4.2 days of treatment. Twenty-two (38%) participants were treated with oral vancomycin, 11 (19%) with intravenous metronidazole and 23 (39.6%) with both antibiotics. Resolution of symptoms was significantly more rapid with monotherapy (p = 0.007) with no significant difference between vancomycin and metronidazole (p = 0.413). A positive correlation was found between ATLAS score and delay to symptoms resolution (r = 0.553; p < 0.001; N = 54), as well as between ATLAS score and prevalence of complications (p = 0.003). CONCLUSIONS: History of treatment with antibiotics, proton pump inhibitors, and hospital admission during the previous year were prevalent among our patient cohort. Rates of symptomatic resolution were similar with monotherapy and dual therapy.

Extended spectrum beta lactamase producing Escherichia coli tricuspid valve endocarditis.

Escherichia coli is a rare cause of endocarditis. This article reports an 82-year-old male with a mechanical aortic valve replacement who was admitted for fever and fatigue. He was diagnosed with a tricuspid valve endocarditis caused by an extended spectrum beta lactamase producing Escherichia coli following positive blood cultures and echocardiography. He received six weeks of imipenem / cilastatin and subsequently improved and was discharged with ambulatory follow ups with his infectious disease specialist.