Late peripheral facial paralysis after COVID-19: a rapid systematic review and two case reports.

Peripheral facial paralysis (PFP) has been shown to be a neurological manifestation of COVID-19. The current study presents two cases of PFP after COVID-19, along with a rapid review of known cases in the literature. Both case reports were conducted following CARE guidelines. We also performed a systematic review of PFP cases temporally related to COVID-19 using PubMed, Embase, and Cochrane Library databases on August 30, 2021, using a rapid review methodology. The two patients experienced PFP 102 and 110 days after COVID-19 symptom onset. SARS-CoV-2 RNA was detected in nasal samples through reverse-transcription real-time polymerase chain reaction (RT-qPCR) testing. Anosmia was the only other neurological manifestation. PFP was treated with steroids in both cases, with complete subsequent recovery. In the rapid review, we identified 764 articles and included 43 studies. From those, 128 patients with PFP were analyzed, of whom 42.1% (54/128) were male, 39.06% (50/128) female, and in 23 cases the gender was not reported. The age range was 18 to 59 (54.68%). The median time between COVID-19 and PFP was three days (ranging from the first symptom of COVID-19 to 40 days after the acute phase of infection). Late PFP associated with COVID-19 presents mild symptoms and improves with time, with no identified predictors. Late PFP should be added to the spectrum of neurological manifestations associated with the long-term effects of SARS-CoV-2 infection as a post COVID-19 condition.

Late peripheral facial paralysis after COVID-19: a rapid systematic review and two case reports

Peripheral facial paralysis (PFP) has been shown to be a neurological manifestation of COVID-19. The current study presents two cases of PFP after COVID-19, along with a rapid review of known cases in the literature. Both case reports were conducted following CARE guidelines. We also performed a systematic review of PFP cases temporally related to COVID-19 using PubMed, Embase, and Cochrane Library databases on August 30, 2021, using a rapid review methodology. The two patients experienced PFP 102 and 110 days after COVID-19 symptom onset. SARS-CoV-2 RNA was detected in nasal samples through reverse-transcription real-time polymerase chain reaction (RT-qPCR) testing. Anosmia was the only other neurological manifestation. PFP was treated with steroids in both cases, with complete subsequent recovery. In the rapid review, we identified 764 articles and included 43 studies. From those, 128 patients with PFP were analyzed, of whom 42.1% (54/128) were male, 39.06% (50/128) female, and in 23 cases the gender was not reported. The age range was 18 to 59 (54.68%). The median time between COVID-19 and PFP was three days (ranging from the first symptom of COVID-19 to 40 days after the acute phase of infection). Late PFP associated with COVID-19 presents mild symptoms and improves with time, with no identified predictors. Late PFP should be added to the spectrum of neurological manifestations associated with the long-term effects of SARS-CoV-2 infection as a post COVID-19 condition.

Risk Stratification and Factors Associated with Abandonment of Tuberculosis Treatment in a Secondary Referral Unit.

PURPOSE: To study the factors associated with the risk of discontinuing active tuberculosis treatment among patients in an outpatient referral unit and to analyze the association between patients' abandonment risk score and their odds of discontinuing the treatment. PATIENTS AND METHODS: In this cohort study, tuberculosis patients were prospectively followed up from June 2012 through July 2019 at a secondary tuberculosis referral unit in Mato Grosso do Sul, Brazil. At initial consultation, patients were interviewed using a standardized questionnaire and were assigned a score for the risk of treatment abandonment by the nurse. Univariate and multivariate analyses were performed using logistic regression. RESULTS: One hundred and forty-eight patients were included in the study, of which 65.0% (96/148) were male. Their mean age was 43.3 ± 14.8 years (range: 18-89 years). Smoking, drug use, repeated admissions, and a high abandonment risk score were the variables associated with the highest risk of discontinuing the treatment. The rate of tuberculosis and human immunodeficiency virus coinfection was 37.2%. The overall rate of global treatment abandonment was 10.8% (95% confidence interval [CI]: 6.1-16.2). Upon stratification of patients that abandoned by the risk score, 22.9% (8/35) of the ones that abandoned had a high risk, 10.9% (6/55) had an intermediate risk, and 3.5% (2/58) had a low risk of treatment abandonment. In multivariate analysis, the factors associated with abandoning the treatment were smoking [adjusted odds ratio (aOR) = 4.91 (95% CI: 1.08, 22.32)] and undergoing retreatment (aOR) = 3.66 (95% CI: 1.04, 12 88). CONCLUSION: Smoking and undergoing retreatment were independent risk factors for tuberculosis treatment abandonment in this center. Risk stratification can help prioritize the strengthening of treatment adherence among patients at higher risk of abandoning treatment in referral units.

Perfil microbiológico de bacteriemias e candidemias de origem comunitária em um hospital de Mato Grosso do Sul / Microbiological profile of bacteremies and candidemies of Community origin at the Mato Grosso do Sul hospital

Introdução: As infecções comunitárias, causadas por bactérias resistentes aos antibióticos, constituem um problema em potencial, contribuindo para o aumento da taxa de morbidade e mortalidade de pacientes hospitalizados. Objetivo: Descrever o perfil microbiológico das bacteriemia e candidemias de origem comunitária no Hospital Regional de Mato Grosso do Sul (HRMS) ao longo do ano de 2017. Método: Trata-se de um estudo transversal descritivo, através de buscas nos prontuários eletrônicos e registros do Laboratório de Microbiologia do HRMS. Foi utilizado o software BIOESTAT 5.0 para a análise estatística, com nível de significância de 5%. Resultados: Foram identificados 52 pacientes com bacteriemia de origem comunitária, correspondendo a 0, 5% de todas as hemoculturas realizadas e 4,21% das hemoculturas positivas no ano de 2017. Não houve diferença significativa entre gênero ou idade. Ao todo, 67,3% dos pacientes apresentavam comorbidades, principalmente cardíacas e diabetes mellitus e/ou obesidade. Infecções de corrente sanguínea foram em sua maioria primárias e causadas por bactérias gram-negativas. Os microrganismos resistentes corresponderam a 37,28% de todas as bactérias isoladas, dos quais 6 eram ESBL positivos. Não foram identificadas leveduras resistentes, exceto Candida krusei com resistência intrínseca à fluconazol. Conclusão: As infecções comunitárias foram principalmente causadas por bactérias gram-negativas, com prevalência de perfis com sensibilidade e acometeram pacientes acima de 60 anos, que estão mais sujeitos a complicações e evolução precoce a óbito, sobretudo os diabéticos e/ou obesos.

Introduction: Community infections, caused by antibiotic-resistant bacteria, are a potential problem, contributing to an increase in the morbidity and mortality rate of hospitalized patients. Objective: To describe the microbiological profile of bacteremia and candidemia of community origin at the Regional Hospital of Mato Grosso do Sul (HRMS) during the year 2017. Method: This is a cross-sectional descriptive study, through electronic records and records from the HRMS Microbiology Laboratory. BIOESTAT 5.0 software was used for statistical analysis, with a significance level of 5%. Results: We identified 52 patients with bacteremia of community origin, corresponding to 0.5% of all blood cultures performed and 4.21% of positive blood cultures in the year 2017. There was no significant difference between gender and age. Overall, 67.3% of the patients had comorbidities, mainly cardiac and diabetes mellitus and/or obesity. Bloodstream infections were mostly primary and caused by gram-negative bacteria. Resistant microorganisms corresponded to 37.28% of all bacteria isolated, of which 6 were ESBL positive. No resistant yeasts were identified except Candida krusei with intrinsic resistance to fluconazole. Conclusion: Community infections identified in the year 2017 were mainly caused by gram-negative bacteria, with prevalence of profiles with sensitivity and affected patients over 60 years, who are more subject to complications and early evolution to death, especially diabetics and / or obese.

Fatal Cronobacter sakazakii Sequence Type 494 Meningitis in a Newborn, Brazil.

We describe a case of infection with Cronobacter sakazakii sequence type 494 causing bacteremia and meningitis in a hospitalized late premature infant in Brazil. We conducted microbiological analyses on samples of powdered infant formula from the same batch as formula ingested by the infant but could not identify the source of contamination.

KPC-2-producing Klebsiella pneumoniae in a hospital in the Midwest region of Brazil.

The emergence of ß-lactamase-producing Enterobacteriaceae in the last few decades has become major challenge faced by hospitals. In this study, isolates of Klebsiella pneumoniae carbapenemase-2 (KPC-2)-producing K. pneumoniae from a tertiary hospital in Mato Grosso do Sul, Brazil, were characterized. Bacterial identification was performed by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF; Bruker Daltonics, Germany) mass spectrometry. The minimum inhibitory concentrations of carbapenems were determined using the agar dilution method as recommended by the Clinical Laboratory Standards Institute guidelines. Carbapenemase production was detected using the modified Hodge test (MHT) and polymerase chain reaction (PCR), followed by DNA sequencing. Of 360 (12.2%) K. pneumoniae isolates obtained between May 2009 and May 2010, 44 (12.2%) were carbapenem nonsusceptible. Of these 44 isolates, thirty-six K. pneumoniae isolates that were positive by MHT and PCR carried the bla KPC-2 gene. Thus, KPC-2producing Klebsiella pneumoniae has been present in a Brazilian hospital located in the Midwest region since at least 2009.

KPC-2-producing Klebsiella pneumoniae in a hospital in the Midwest region of Brazil

The emergence of β-lactamase-producing Enterobacteriaceae in the last few decades has become major challenge faced by hospitals. In this study, isolates of Klebsiella pneumoniae carbapenemase-2 (KPC-2)-producing K. pneumoniae from a tertiary hospital in Mato Grosso do Sul, Brazil, were characterized. Bacterial identification was performed by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF; Bruker Daltonics, Germany) mass spectrometry. The minimum inhibitory concentrations of carbapenems were determined using the agar dilution method as recommended by the Clinical Laboratory Standards Institute guidelines. Carbapenemase production was detected using the modified Hodge test (MHT) and polymerase chain reaction (PCR), followed by DNA sequencing. Of 360 (12.2%) K. pneumoniae isolates obtained between May 2009 and May 2010, 44 (12.2%) were carbapenem nonsusceptible. Of these 44 isolates, thirty-six K. pneumoniae isolates that were positive by MHT and PCR carried the blaKPC-2 gene. Thus, KPC-2producing Klebsiella pneumoniae has been present in a Brazilian hospital located in the Midwest region since at least 2009.