Microbiological profile of bloodstream infections and antimicrobial resistance patterns at a tertiary referral hospital in Amazon, Brazil.

BACKGROUND: Bloodstream infections (BSI) are a global health issue, leading to high mortality and morbidity among hospitalized patients. METHODS: A retrospective, observational and descriptive study was conducted by reviewing blood culture records collected from patients with suspected BSI, between January 2017 and December 2019. RESULTS: The most frequent antimicrobial resistant (AMR) pathogens were methicillin-resistantStaphylococcus aureus(MRSA) (40%), methicillin-resistantS. epidermidis (MRSE) (9.5%), and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae (35.3%). CONCLUSIONS: Our findings underscore the importance of continued vigilance and advocate for the rational use of antimicrobial agents.

Difference in clinical features of SARS-CoV-2 in pediatric patients before and after emergence of P.1.

BACKGROUND: The P.1 variant is a Variant of Concern announced by the WHO. The present work aimed to characterize the clinical features of pediatric patients with SARS-CoV-2 before and after the emergence of P.1. METHODS: This is a cohort study. Data of symptomatic patients younger than 18 years diagnosed with COVID-19 by PCR tests registered in Painel COVID-19 Amazonas were analyzed. RESULTS: A total of 4080 symptomatic pediatric patients were identified in the database between March 2020 and July 2021, of which 1654 were categorized as pre-P.1 and 978 as P.1-dominant cases, based on the prevalence of P.1 of >90% in the North Region, Brazil. Lower case-fatality rate was observed in non-infants infected during the P.1-dominant period (0.9% vs. 2.2%). In general, patients infected during the P.1-dominant period had less fever (70.8% vs. 74.2%) and less lower respiratory tract symptoms (respiratory distress: 11.8% vs. 18.9%, dyspnea: 27.9% vs. 34.5%) yet higher prevalence of neurological symptoms, headache for example (42.8% vs. 5.9%). CONCLUSIONS: The prevalence of symptoms of COVID-19 can differ across different periods of variant dominance. Lower prevalence of fever during the P.1-dominant period may reduce the effectiveness of symptom-based screening in public premises where laboratory diagnostic tests are not available. IMPACT: The prevalence rate of symptoms of SARS-CoV-2 infection can differ among different variants. The present work documents the difference in the clinical features of SARS-CoV-2 in patients aged below 18 years before and after the emergence of P.1, the first study of its kind. Unlike previous studies that focus solely on hospitalized cases, the present work considers both mild and severe cases. While non-infants had a lower fatality rate, lower prevalence of fever associated with the emergence of P.1 may reduce the effectiveness of symptom-based screening in public premises where laboratory diagnostic tests are not available.

Microbiological profile of bloodstream infections and antimicrobial resistance patterns at a tertiary referral hospital in Amazon, Brazil

ABSTRACT Background: Bloodstream infections (BSI) are a global health issue, leading to high mortality and morbidity among hospitalized patients. Methods: A retrospective, observational and descriptive study was conducted by reviewing blood culture records collected from patients with suspected BSI, between January 2017 and December 2019. Results: The most frequent antimicrobial resistant (AMR) pathogens were methicillin-resistantStaphylococcus aureus(MRSA) (40%), methicillin-resistantS. epidermidis (MRSE) (9.5%), and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae (35.3%). Conclusions: Our findings underscore the importance of continued vigilance and advocate for the rational use of antimicrobial agents.

Decrease in compulsory notifications registered by the Brazilian National Hospital Epidemiological Surveillance Network during the COVID-19 pandemic: a descriptive study, 2017-2020. / Decréscimo nas notificações compulsórias registradas pela Rede Nacional de Vigilância Epidemiológica Hospitalar do Brasil durante a pandemia da COVID-19: um estudo descritivo, 2017-2020.

OBJECTIVE: To describe compulsorily notifiable diseases, health conditions and public health events (DAEs as per the Brazilian acronym) registered by the National Hospital Epidemiological Surveillance Network (RENAVEH as per the Brazilian acronym), before and during the COVID-19 pandemic. METHODS: This was a descriptive ecological study using records held on the Notifiable Health Conditions Information System (SINAN as per the Brazilian acronym) between Epidemiological Week (EW) 1 of 2017 (January 1st, 2017) and 52 of 2020 (December 26, 2020). RESULTS: Between 2017 and 2020, RENAVEH notified 1,258,455 DAE form records, with only 225,081 (17.9%) notifications in 2020, representing a decrease of 146,340 records compared to 2019. The temporal analysis showed a decrease per EW of more than 1,000 notified records with effect from EW 12. CONCLUSION: There was a decrease in compulsorily notifiable DAEs registered by RENAVEH in Brazil taking the period analyzed as a whole, in particular in 2020.

Decréscimo nas notificações compulsórias registradas pela Rede Nacional de Vigilância Epidemiológica Hospitalar do Brasil durante a pandemia da COVID-19: um estudo descritivo, 2017-2020 / Disminución de las notificaciones obligatorias registradas por la Red Nacional de Vigilancia Epidemiológica Hospitalaria de Brasil durante la pandemia de COVID-19: un estudio descriptivo, 2017-2020 / Decrease in compulsory notifications registered by the Brazilian National Hospital Epidemiological Surveillance Network during the COVID-19 pandemic: a descriptive study, 2017-2020

Objetivo: Descrever as notificações compulsórias de doenças, agravos e eventos de saúde pública (DAEs) registradas pela Rede Nacional de Vigilância Epidemiológica Hospitalar (Renaveh) do Brasil antes e durante a pandemia de COVID-19. Métodos: Estudo ecológico descritivo, com registros do Sistema de Informação de Agravos de Notificação (Sinan) no período correspondente às Semanas Epidemiológicas (SEs) 1 de 2017 (1º de janeiro de 2017) a 52 de 2020 (26 de dezembro de 2020). Resultados: No período de 2017 a 2020, a Renaveh notificou 1.258.455 fichas de DAEs, das quais apenas 225.081 (17,9%) foram notificadas em 2020, representando um decréscimo de 146.340 registros em relação às notificações de 2019. Na análise temporal por SE, houve decréscimo maior que mil registros nas notificações a partir da SE 12. Conclusão: Houve decréscimo nas notificações compulsórias de DAEs registradas pela Renaveh em todo o período analisado, com destaque para o ano de 2020.

Objetivo: Describir las notificaciones obligatorias de Enfermedades y Eventos de Salud Pública (DAEs), registradas por la Red Nacional de Vigilancia Epidemiológica Hospitalaria (RENAVEH), antes y durante la pandemia de COVID-19 e n Brasil. Métodos: Estudio ecológico descriptivo, con registros del Sistema de Información de Agravamientos de Notificación (Sinan) en el período de las Semanas Epidemiológicas (SEs) 1 de 2017 (1 de enero de 2017) a 52 de 2020 (26 de diciembre de 2020). Resultados: En el período 2017 a 2020, la RENAVEH notificó 1.258.455 registros de DAE, y solo se notificaron 225.081 (17,9%) registros en 2020, lo que representa una disminución de 146.340 registros con respecto a las notificaciones de 2019. En el análisis temporal por SE, hubo una disminución superior a mil registros en las notificaciones de la SE 12. Conclusión: Hubo una disminución en las notificaciones de DAEs registradas por la RENAVEH a lo largo del período analizado, con énfasis en el año 2020.

Objective: To describe compulsorily notifiable diseases, health conditions and public health events (DAEs as per the Brazilian acronym) registered by the National Hospital Epidemiological Surveillance Network (RENAVEH as per the Brazilian acronym), before and during the COVID-19 pandemic. Methods: This was a descriptive ecological study using records held on the Notifiable Health Conditions Information System (SINAN as per the Brazilian acronym) between Epidemiological Week (EW) 1 of 2017 (January 1st, 2017) and 52 of 2020 (December 26, 2020). Results: Between 2017 and 2020, RENAVEH notified 1,258,455 DAE form records, with only 225,081 (17.9%) notifications in 2020, representing a decrease of 146,340 records compared to 2019. The temporal analysis showed a decrease per EW of more than 1,000 notified records with effect from EW 12. Conclusion: There was a decrease in compulsorily notifiable DAEs registered by RENAVEH in Brazil taking the period analyzed as a whole, in particular in 2020.

Hemorrhagic and thrombotic manifestations in the central nervous system in COVID-19: A large observational study in the Brazilian Amazon with a complete autopsy series.

SARS-CoV-2 affects mainly the lungs, however, other manifestations, including neurological manifestations, have also been described during the disease. Some of the neurological findings have involved intracerebral or subarachnoid hemorrhage, strokes, and other thrombotic/hemorrhagic conditions. Nevertheless, the gross pathology of hemorrhagic lesions in the central nervous system has not been previously described in Brazilian autopsy cases. This study aimed to describe gross and microscopic central nervous system (CNS) pathology findings from the autopsies and correlate them with the clinical and laboratory characteristics of forty-five patients with COVID-19 from Manaus, Amazonas, Brazil. Forty-four patients were autopsied of which thirty-eight of these (86.36%) were positive by RT-PCR for COVID-19, and six (13.3%) were positive by the serological rapid test. Clinical and radiological findings were compatible with the infection. The patients were classified in two groups: presence (those who had hemorrhagic and/or thrombotic manifestations in the CNS) and absence (those who did not present hemorrhagic and/or thrombotic manifestations in the CNS). For risk assessment, relative risk and respective confidence intervals were estimated. Macroscopic or microscopic hemorrhages were found in twenty-three cases (52,27%). The postmortem gross examination of the brain revealed a broad spectrum of hemorrhages, from spots to large and confluent areas and, under microscopy, we observed mainly perivascular discharge. The association analyses showed that the use of corticosteroid, anticoagulant and antibiotic had no statistical significance with a risk of nervous system hemorrhagic manifestations. However, it is possible to infer a statistical tendency that indicates that individuals with diabetes had a higher risk for the same outcome (RR = 1.320, 95% CI = 0.7375 to 2.416, p = 0.3743), which was not observed in relation to other comorbidities. It is unknown whether the new variants of the virus can cause different clinical manifestations, such as those observed or indeed others. As a result, more studies are necessary to define clinical and radiologic monitoring protocols and strategic interventions for patients at risk of adverse and fatal events, such as the extensive hemorrhaging described here. It is imperative that clinicians must be aware of comorbidities and the drugs used to treat patients with COVID-19 to prevent CNS hemorrhagic and thrombotic events.

Immunologic biomarkers, morbidity and mortality among HIV patients hospitalised in a Tertiary Care Hospital in the Brazilian Amazon.

BACKGROUND: The irregular use of antiretroviral therapy (ART) and late diagnosis still account for a large part of HIV-associated mortality in people living with HIV (PLHIV). Herein, we describe HIV-associated morbidity among hospitalised HIV/AIDS patients with advanced immunosuppression and assess the comorbidities, laboratory parameters, and immunological markers associated with mortality. METHODS: The cross-sectional study was conducted at the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD) in Manaus, Brazil. In all, 83 participants aged between 12 and 70 years were enrolled by convenience within 72 h of their hospitalisation. Clinical and laboratory data were obtained from electronic medical records. We prospectively measured the cytokines Th1/Th2/Th17 and inflammatory cytokines IL-8, IL-1ß, and IL-12 using cytometric bead array, and the soluble CD14 using in-house enzyme-linked immunosorbent assay. RESULTS: The HIV/AIDS inpatients presented a scenario of respiratory syndromes as the most prevalent comorbidity. Almost all patients had CD4 T counts below 350 cells/mL and the mortality rate was 20.5%. Pulmonary tuberculosis, neurotoxoplasmosis and oropharyngeal-esophageal candidiasis were the most prevalent opportunistic infections. TB and weight loss were more prevalent in HIV/AIDS inpatients who died. The Mann Whitney analysis showed that those who died had higher platelet distribution width (PDW) on admission, which is suggestive for platelet activation. The Poisson multivariate analysis showed the prevalence of TB, digestive syndrome and increases in IL-8 and lactate dehydrogenase (LDH) associated to death. CONCLUSIONS: The advanced immunosuppression characterized by the opportunistic infections presented in these HIV/AIDS inpatients was the major factor of mortality. The role of platelet activation in worse outcomes of hospitalisation and the IL-8 associated with the context of advanced immunosuppression may be promising markers in the prediction of mortality in HIV/AIDS patients.

Guillain-Barré Syndrome Associated with SARS-CoV-2 Infection in a Pediatric Patient.

We report the case of a 15-year-old male patient presenting frontal headaches with retro-orbital pain accompanied by fever evolving to weakness and pain of the lower limbs, which ascended to upper limbs. A COVID-19 rapid test (IgG and IgM) and nasopharyngeal swab polymerase chain reaction (PCR) was positive for SARS-CoV-2. The blood tests, cerebral spinal fluid (CSF) analysis and CSF aerobic culture revealed no abnormalities. PCR testing of the CSF was negative for the most prevalent etiologies as well as for SARS-CoV-2. Electroneurography study was compatible with the acute motor axonal neuropathy variant of Guillain-Barré syndrome. No cases involving young patients have been presented to date. Therefore, this is the first reported pediatric case of SARS-CoV-2 infection associated with GBS. Evidence reveals that SARS-CoV-2 infection is not limited to the respiratory tract. Neurotropism could explain this important neurologic manifestation of COVID-19 in children.

We report the case of a 15-year-old male patient presenting frontal headaches with retro-orbital pain accompanied by fever evolving to weakness and pain of the lower limbs, which ascended to upper limbs. A COVID-19 rapid test and nasopharyngeal molecular test were positive for the SARS-CoV-2 virus. Neurological examination attested Guillain­Barré syndrome, a condition in which the immune system attacks the nerves and could be triggered by a bacterial or viral infection. The blood tests were normal and cerebral spinal fluid analysis was negative for the most common viruses related to GBS as well as for SARS-CoV-2. Although described in adults, no cases involving young patients have been presented to date. Therefore, this is the first reported case of GBS associated with SARS-CoV-2 in children.