Clinical presentation, antimicrobial resistance, and treatment outcomes of Aeromonas human infections: A 14-year retrospective study and comparative genomics of two isolates from fatal cases.

BACKGROUND: Aeromonas virulence may not be entirely dependent on the host immune status. Pathophysiologic determinants of disease progression and severity remain unclear. METHODS: One hundred five patients with Aeromonas infections and 112 isolates were identified, their clinical presentations and outcomes analyzed, and their antimicrobial resistance (AMR) patterns assessed. Two isolates (A and B) from fatal cases of Aeromonas dhakensis bacteremia were characterized using whole genome sequence analysis. Virulence factor- and AMR-encoding genes from these isolates were compared with a well-characterized diarrheal isolate A. dhakensis SSU, and environmental isolate A. hydrophila ATCC_7966T. RESULTS: Skin and soft tissue infections, traumatic wound infections, sepsis, burns, and intraabdominal infections were common. Diabetes, malignancy, and cirrhosis were frequent comorbidities. Male sex, age ≥ 65 years, hospitalization, burns, and intensive care were associated with complicated disease. High rates of AMR to carbapenems and piperacillin-tazobactam were found. Treatment failure was observed in 25.7% of cases. Septic shock and hospital-acquired infections were predictors of treatment failure. All four isolates harbored assorted broad-spectrum AMR genes including blaOXA, ampC, cphA, and efflux pumps. Only clinical isolates possessed both polar and lateral flagellar genes, genes for various surface adhesion proteins, type 3- and -6 secretion systems and their effectors, and toxin genes, including exotoxin A. Both isolates A and B were resistant to colistin and harbored the mobile colistin resistance-3 (mcr-3) gene. CONCLUSIONS: Empirical therapy tailored to local Aeromonas antibiograms may facilitate more favorable outcomes, while advanced diagnostic methods may aid in identifying correct Aeromonas spp. of significant clinical importance.

Neurocysticercosis: an update on diagnosis, treatment, and prevention.

Neurocysticercosis (NCC) is an important cause of neurological disease worldwide, including imported cases in nonendemic countries. PURPOSE OF REVIEW: The purpose of this review is to update information on diagnosis, management, and prevention of neurocysticercosis. RECENT FINDINGS: WHO and Infectious Diseases Society of America/American Society of Tropical Medicine and Hygiene guidelines emphasize the importance of corticosteroids and antiparasitic drugs for viable parenchymal disease and single enhancing lesions. Subarachnoid NCC is associated with a high fatality rate unless optimally treated. Advances in subarachnoid NCC include use of prolonged antiparasitic and anti-inflammatory courses and the increasing use of antigen-detection and quantitative PCR assays in diagnosis and follow-up. Emerging data support the safety and efficacy of minimally invasive surgery in ventricular cases. Calcified neurocysticercosis continues to be associated with a high burden of disease. Field studies are demonstrating the feasibility of eradication using a combination of mass chemotherapy for human tapeworms and vaccination/treatment of porcine cysticercosis. SUMMARY: NCC remains an important and challenging cause of neurological disease with significant morbidity despite advances in treatment and prevention.

Single-center investigation on central-line-associated bloodstream infections and blood-culture contamination during the early months of the coronavirus disease 2019 (COVID-19) pandemic.

In this retrospective cohort study, we assessed central-line-associated bloodstream infections (CLABSIs) and blood-culture contamination frequency during the first pandemic wave. Coronavirus disease 2019 (COVID-19) was significantly associated with CLABSI and blood-culture contamination. In the COVID-19 cohort, malignancy was associated with CLABSI. Black race, end-stage renal disease, and obesity were associated with blood-culture contamination.

Ischemic brain infarcts and vasculitis in histoplasmosis of the central nervous system: A case report and review of the literature.

Histoplasmosis is one of the most common endemic mycoses affecting immunocompromised individuals in the United States and Latin America. Involvement of the central nervous system carries higher mortality rates and worse prognosis, given its resemblance to stroke, vasculitis, and meningitis of other etiologies. The diagnosis is challenging, due to its subtle clinical presentation and the poor sensitivity of the cerebrospinal fluid culture. Herein the authors present a case of a middle-aged man with HIV, who presented with intermittent headaches exacerbated by an oculomotor nerve palsy, concerning for acute stroke. A diagnosis of central nervous system histoplasmosis was made, and his neurological deficits subsided after initiation of treatment. The stroke-like syndrome in this scenario may be secondary to granulomatous vasculitis of small caliber cerebral blood vessels. Histoplasmosis of the central nervous system remains a challenging diagnosis, which requires a high index of suspicion by the clinician for an early institution of therapy in order to improve outcomes.

Early Diagnosis of Latent Tuberculosis Reactivation due to Drug Interaction between Cobicistat and Intranasal Fluticasone.

BACKGROUND: Single-tablet antiretroviral therapy is currently the first-line choice for the treatment of HIV infection. Some therapeutic regimens contain the CYP3A4 inhibitor cobicistat, which can interact with drugs undergoing hepatic first-pass metabolism, leading to unintended adverse effects. CASE PRESENTATION: A 41-year-old man presented to the HIV clinic following a visit to the Emergency Department. His CD4+ count was 1,271 cells/µL, and viral load was undetectable in the previous month. The patient was on an antiretroviral therapy regimen containing cobicistat. He reported using a self-initiated over-the-counter fluticasone nasal spray for at least 2 weeks prior. He had a history of positive tuberculin skin test and a negative chest X-ray within the past year. He denied cough and was in no respiratory distress. A chest CT scan revealed a new thick-walled cavitary nodule in the right upper lobe. A CT-guided biopsy of the lesion yielded Mycobacterium tuberculosis. CONCLUSIONS: HIV-infected individuals have higher risk for tuberculosis reactivation regardless of their CD4+ count. Fluticasone's hepatic metabolism is bypassed in the presence of CYP3A4 inhibitors, which increases its systemic bioavailability and the risk for impaired immunity. The goal of this report is to increase awareness among physicians about the potential adverse outcomes from the interaction of these drugs.

Strongyloides stercoralis infection after the use of emergency corticosteroids: a case report on hyperinfection syndrome.

BACKGROUND: In clinical practice, identification of a case of severe asthma exacerbation prompts initiation of corticosteroids. However, not all that wheezes is asthma. CASE PRESENTATION: A 61-year-old man from the Peruvian Amazon presented with progressive dyspnea, abdominal pain, and cough for the past week. His medical history was remarkable for asthma since childhood; he was treated with beta-agonists, ipratropium, and orally administered corticosteroids. On evaluation, he was febrile and ill-appearing. His chest examination revealed diffuse wheezing and bilateral crackles. He was diagnosed as having community-acquired pneumonia and asthma exacerbation and was started on empiric antibiotics, nebulized beta-agonists, and orally administered corticosteroids. His clinical status continued deteriorating and he became critically ill despite broad-spectrum antibiotics and antifungals. Considering the epidemiological background of our patient, bronchoalveolar and fecal samples were obtained to investigate soil-transmitted helminths. Larvae of Strongyloides stercoralis were found in both specimens. Ivermectin was initiated and corticosteroids were discontinued. He experienced remarkable improvement of clinical condition over the next weeks. The literature on this topic was reviewed. CONCLUSION: Cases of severe asthma exacerbation warrant careful evaluation before the initiation of corticosteroids, especially in patients at risk for parasitic infections. A high index of suspicion is critical. Alternative etiologies of respiratory decompensation should be considered in patients who fail to improve with broad-spectrum antibiotics and antifungals.

Strongyloides stercoralis hyperinfection syndrome: a deeper understanding of a neglected disease.

Strongyloides stercoralis hyperinfection syndrome (SHS) is a life-threatening condition that warrants early detection and management. We describe the pathogenesis, organ-specific clinical manifestations, and risk factors associated to this condition. A comprehensive review of the literature was conducted in PubMed, LILACS, EBSCO and SciELO by using the keywords: "hyperinfection syndrome"; "Strongyloides stercoralis"; "disseminated strongyloidiasis"; "systemic strongyloidiasis", "pathogenesis" and "pathophysiology". Relevant articles on this topic were evaluated and included by consensus. Also, a secondary search of the literature was performed. Articles in English and Spanish language were included. SHS has been described in tropical and sub-tropical regions. However, there is growing evidence of cases detected in developed countries favored by increasing migration and the advance in immunosuppressive therapies for oncologic and inflammatory diseases. SHS is characterized by massive multiplication of larvae, typically in immunocompromised hosts. Clinical manifestations vary according to the organ involved and include diarrhea, intestinal bleeding, alveolar hemorrhages, heart failure, jaundice, bacteremia among others. Despite advances in the understanding of this condition, fatality rates are near 90%. Clinicians should consider SHS in the differential diagnosis of acutely ill patients with multiple organ damage and epidemiological risk factors. Adverse outcomes are common, especially with delayed anti-parasitic treatment.

Allele-specific differences in transcriptome, miRNome, and mitochondrial function in two hypertrophic cardiomyopathy mouse models.

Hypertrophic cardiomyopathy (HCM) stems from mutations in sarcomeric proteins that elicit distinct biophysical sequelae, which in turn may yield radically different intracellular signaling and molecular pathologic profiles. These signaling events remain largely unaddressed by clinical trials that have selected patients based on clinical HCM diagnosis, irrespective of genotype. In this study, we determined how two mouse models of HCM differ, with respect to cellular/mitochondrial function and molecular biosignatures, at an early stage of disease. We show that hearts from young R92W-TnT and R403Q-αMyHC mutation-bearing mice differ in their transcriptome, miRNome, intracellular redox environment, mitochondrial antioxidant defense mechanisms, and susceptibility to mitochondrial permeability transition pore opening. Pathway analysis of mRNA-sequencing data and microRNA profiles indicate that R92W-TnT mutants exhibit a biosignature consistent with activation of profibrotic TGF-ß signaling. Our results suggest that the oxidative environment and mitochondrial impairment in young R92W-TnT mice promote activation of TGF-ß signaling that foreshadows a pernicious phenotype in young individuals. Of the two mutations, R92W-TnT is more likely to benefit from anti-TGF-ß signaling effects conferred by angiotensin receptor blockers and may be responsive to mitochondrial antioxidant strategies in the early stage of disease. Molecular and functional profiling may therefore serve as aids to guide precision therapy for HCM.

Kato-Katz and Lumbreras rapid sedimentation test to evaluate helminth prevalence in the setting of a school-based deworming program.

The sensitivity of the Kato-Katz test is suboptimal for the evaluation of intestinal helminth prevalence. Moreover, during mass deworming, as helminth egg burden decreases, the sensitivity is likely to decrease. The Lumbreras rapid sedimentation (Lumbreras) is a low-cost non-quantitative test, but may provide useful information in low burden areas. We compared the prevalence of intestinal helminth infections assessed by the Kato-Katz and the Lumbreras rapid sedimentation test on 3 stool specimens from each of 1083 children. The sensitivities were compared using the McNemar paired test. Using the combined outcome of the 3 different stool tests as the standard, Kato-Katz had lower sensitivity than Lumbreras rapid sedimentation tests for Ascaris lumbricoides (85.1% vs. 95.1%, p = 0.03), Hymenolepis nana (77.7% vs. 97.9%, p < 0.01), Trichuris trichura (41.7% vs. 100%, p = 0.01), hookworm (0% vs. 100%, p = 0.01), and Strongyloides stercoralis (0% vs. 88%, p < 0.01). Kato-Katz demonstrated significantly lower sensitivity, missing most T. trichiura, hookworm, and S. stercoralis infections. The combination of Kato-Katz and Lumbreras rapid sedimentation tests enables the detection of more intestinal helminths infections in post-deworming low prevalence areas.

[Traditional treatments in an endemic area of american cutaneous Leishmaniasis in Peru]. / Tratamientos tradicionales utilizados en un área endémica de Leishmaniasis cutánea en el Perú.

In order to know the first-choice treatment by villagers of an endemic area of Cutaneous Leishmaniasis (CL) prior to medical attention in a health care center, a cross sectional study was realized in Pichupampa town. A census was made in order to collect demographic data and previous history of CL. 254 participants were surveyed. 41.7% (106/254) of the village had CL at least once in their lives and only half of them went to a health center to seek for primary care. 76/106 (71.7%) used some traditional treatment as their first choice and only 23.6% (25/106) subjects went to a health-care center without manipulation of their lesions. It's evident that a high percentage (71.7%) of people potentially infected by CL manipulate and treat their lesions with traditional treatments prior to professional health-care, actions that could interfere with the diagnosis and effectiveness of the program implemented by the Health Ministry.

Tratamientos tradicionales utilizados en un área endémica de leishmaniasis cutánea en el Perú / Traditional treatments in an endemic area of american cutaneous leishmaniasis in Peru

Con el objetivo de conocer el tratamiento utilizado por pobladores de un área endémica de leishmaniasis cutánea (LC) previo a su atención en un servicio de salud, se realizó un estudio de corte transversal en un poblado de Lima, Perú. Se censó a toda la población y se recolectaron datos demográficos y antecedentes de LC. De los 254 habitantes censados, 41,7% (106/254) refirieron haber tenido LC y de ellos solo la mitad acudieron a un centro de salud. 76/106 (71,7%) usaron algún tratamiento tradicional como primera medida y solo 23,6% (25/106) acudieron a un centro de salud sin manipular sus lesiones. Un alto porcentaje de personas potencialmente infectadas por LC manipulan y tratan sus lesiones con métodos tradicionales antes de acudir a un centro de salud, lo que podría interferir con el diagnóstico y efectividad del programa de tratamiento implementado por el Ministerio de Salud...

In order to know the first-choice treatment by villagers of an endemic area of Cutaneous Leishmaniasis (CL) prior to medical attention in a health care center, a cross sectional study was realized in Pichupampa town. A census was made in order to collect demographic data and previous history of CL. 254 participants were surveyed. 41.7% (106/254) of the village had CL at least once in their lives and only half of them went to a health center to seek for primary care. 76/106 (71.7%) used some traditional treatment as their first choice and only 23.6% (25/106) subjects went to a health-care center without manipulation of their lesions. ItÆs evident that a high percentage (71.7%) of people potentially infected by CL manipulate and treat their lesions with traditional treatments prior to professional health-care, actions that could interfere with the diagnosis and effectiveness of the program implemented by the Health Ministry...

Diferencia elevada de presión arterial interbraquial: Frecuencia y factores clínicos y demográficos / High difference of inter-arm blood pressure measurements: frequency and clinical and demographic factors

La diferencia elevada de presión arterial interbraquial (DEPAI) podría predecir eventos cardiovasculares adversos. Objetivos: Conocer la frecuencia de DEPAI y describir factores clínicos y demográficos relacionados. Material y métodos: Estudio descriptivo transversal. Muestra aleatoria de 211 pacientes de un hospital público de Lima. Se tomó la presión arterial tres veces, de forma simultánea en ambos brazos, con dos tensiómetros automáticos OMROM HEM-705CP propiamente calibrados, estando el paciente en posición sentada, con un reposo previo de cinco minutos. Se recolectaron datos demográficos y clínicos. Se estableció la DEPAI sistólica (≥10 mm Hg y ≥ 20 mm Hg) y diastólica (≥ 10 mm Hg). Se consideró las tres tomas y sólo las dos últimas. Se empleó las pruebas de Chi Cuadrado o Exacta de Fisher y el coeficiente de correlación puntual biserial para variables cualitativas y cuantitativas, respectivamente. Resultados: La edad promedio fue 48,92 ± 16,75 años. El 67,3% fue de sexo femenino. 23,08% de los participantes fueron obesos; 19,23%, hipertensos y 13,42%, fumadores. Según los punto de corte y cantidad de medidas consideradas, las frecuencias de DEPAI sistólica fueron 40,38%, 30,29%, 15,88% y12,98%; y las de DEPAI diastólica 13% y 10,1%. Hubo correlación entre DEPAI y HTA e IMC (p<0,05). Conclusiones: La frecuencia de DEPAI en un hospital de Lima es similar a la encontrada en otros medios. Este estudio encontró una asociación estadística de DEPAI con el IMC y HTA, pero se necesitan más estudios con poblaciones más grandes para conocer la relación de esta variable con predictores conocidos de morbilidad y mortalidad. (AU)

High difference of inter-arm blood pressure (HDIABP) measurements could predict adverse cardiovascular events. Objectives: To determine the frequency of HDIABP and to describe clinical and demographic factors related to it. Methods: Cross sectional study. A random sample of 211 patients from a public hospital in Lima was taken. Blood pressure was measured three times, simultaneously in both arms with two automated sphygmomanometers OMROM HEM705CP properly calibrated, with the patient seated with at least 5 minutes of previous resting. Clinical and demographic data were collected. Systolic HDIABP was defined as ≥ 10 mmHg and ≥ 20 mmHg, and diastolic HDIABP as ≥ 10 mmHg. Chi square test and Fisher´s exact test were used, as well as the correlation coefficient for qualitative and quantitative data. Results: Mean age was 48.92 ± 16.75 years; 67.3% were females; 23.08% were obese; 19.23% had blood hypertension and 13.42% were smokers. The frequencies of systolic and diastolic HDIABP were 40.38%, 30.29%, 15.88%, 12.98% and 13%, 10.1%. There was correlation between HDIABP and body mass index (p<0.05). Conclusions: The frequency of HDIABP found is similar than that reported elsewhere. We found and association between HDIABP and body mass index, but more studies are needed to determine a true association between these two variables. (AU)