COVID-19 mortality is associated with low vitamin D levels in patients with risk factors and/or advanced age.

BACKGROUND & AIMS: Although conclusive evidence is yet lacking, it has been suggested that vitamin D deficiency (VD) may be associated with a more severe course of SARS-CoV-2 Infection (COVID-19). In this retrospective study we assessed the association of VD deficiency with mortality in a group of COVID-19 patients treated in a tertiary referral center. METHODS: Data of 257 Covid-19 patients hospitalized between 30th September 2020 and 2nd March 2021 have been collected retrospectively. The following parameters were collected: age, gender, serum level of 25-OH-Vitamin D3, outcome (survival/death), comorbidities (cancer, diabetes mellitus and chronic obstructive pulmonary disease). Serum VD measurement was done within 3 days of admission. RESULTS: VD levels were significantly lower in patients who did not survive, however, in this patients' group the average age was significantly higher than among those, who survived. After age-matching, in a subgroup of patients with risk factors and/or 60 years of age or older who survived had significantly higher VD level in their serum than those who deceased. Serum C-reactive protein, lactate-dehydrogenase and creatinin-kinase were significantly higher in the group in which the patients died, however these laboratory parameters did not correlate with the VD levels. CONCLUSION: We found that in COVID-19 infection, when old age as risk factor (60 years of age or older) was pooled with risk factors (cancer, diabetes and/or COPD), the VD levels were significantly lower in the patient group, in which the patients did not survive. We suggest further, prospective studies in similar subgroups to explore a possible causal relationship.

Complex oncologic therapy for loco-regionally advanced breast cancer associated with long-lasting SARS-CoV-2 PCR-positivity / Tartós SARS-CoV-2-PCR-pozitivitáshoz társuló, lokoregionálisan elorehaladott emlodaganat komplex onkológiai kezelése.

Összefoglaló. A COVID-19 mortalitását a súlyos társbetegségek, közöttük bizonyos daganatos betegségek is növelik. Immunszuppresszív hatásuk miatt felmerülhet a citotoxikus kezelések rizikónövelo hatása is. Ugyanakkor az onkológiai terápia megszakítása vagy halasztása, különösen az agresszívebb, kiterjedtebb és fiatalkorban jelentkezo daganatok esetében ronthatja a kórjóslatot. Egy 39 éves nobeteg esetét ismertetjük. A járvány során késlekedve felismert, lokoregionálisan kiterjedt emlodaganat miatt primer szisztémás kemoterápiában részesült. A kezelés 5. ciklusa során enyhe légúti tünetek kapcsán, az onkológiai ambulancián SARS-CoV-2-fertozése igazolódott. Kemoterápiás kezelését felfüggesztettük. A diagnózistól számított 3. napon tünetmentessé vált, ám SARS-CoV-2-PCR-pozitivitása még a 43. napon is fennállt. A 19. napon hormongátló kezelést indítottunk. Az 51. napon mastectomia és axillaris block dissectio történt. A 82. napon a megszakított kemoterápiát a hormongátló kezelés leállítását követoen G-CSF-profilaxis mellett újraindítottuk. A kezelés során fertozéses szövodményt nem észleltünk. Kemoterápia és mutét SARS-CoV-2-fertozött, tünetmentes daganatos betegnél szövodménymentesen végezheto elhúzódó virológiai pozitivitás esetén, felszabadító vizsgálat nélkül is. A daganatos betegek koronavírus-fertozése esetén az onkológiai protokolltól történo eltérés egyénre szabott optimalizálásával és a multidiszciplináris team szorosabb együttmuködésével az infektológiai és az onkológiai kockázat együttes alacsonyan tartása is megvalósítható. Orv Hetil. 2021; 162(16): 611-614. Summary. Mortality of COVID-19 is increased when certain co-morbidities, among others advanced malignancies are present. Deleterious effect of cytotoxic therapy, related to its immunosuppressive effect, may also be hypothesised. However, postponing or cancelling oncologic treatment, especially in younger patients with advanced and more aggressive tumors may worsen the prognosis. The case of a 39-year-old female patient is presented, who was diagnosed with loco-regionally advanced breast cancer during the pandemic. Primary systemic chemotherapy was started. The patient presented with acute respiratory tract symptoms during the fifth cycle and subsequently SARS-CoV-2 infection was diagnosed. Chemotherapy was cancelled. Symptoms resolved in three days after diagnosis. SARS-CoV-2 PCR remained positive up to day 43. Antihormonal therapy was introduced on day 19 and she underwent mastectomy with axillary lymph node dissection on day 51. Chemotherapy was reset postoperatively on day 82 with prophylactic G-CSF protection. No adverse event was observed throughout the treatment. Cytotoxic chemotherapy and surgery can be successfully delivered in breast cancer patients with prolonged asymptomatic SARS-CoV-2 PCR positivity, even without negative swab result. Individual optimisation of the therapy may require deviations from standard protocols. Closer multidisciplinary cooperation may contribute to the minimisation of both oncologic and infectious risks. Orv Hetil. 2021; 162(16): 611-614.

Streptococcus suis: An Underestimated Emerging Pathogen in Hungary?

Streptococcus suis (S. suis) is an emerging zoonotic pathogen, demonstrated as an etiological agent in human infections in increasing frequency, including diseases like purulent meningitis, sepsis, uveitis-endophtalmitis and arthritis. Due to the increased availability and utility of novel diagnostic technologies in clinical microbiology, more studies have been published on the epidemiology of S. suis, both in veterinary and human medicine; however, there are no comprehensive data available regarding human S. suis infections from East-Central European countries. As a part of our study, data were collected from the National Bacteriological Surveillance (NBS) system on patients who had at least one positive microbiological result for S. suis, corresponding to an 18-year study period (2002-2019). n = 74 S. suis strains were isolated from invasive human infections, corresponding to 34 patients. The number of affected patients was 1.89 ± 1.53/year (range: 0-5). Most isolates originated from blood culture (63.5%) and cerebrospinal fluid (18.9%) samples. Additionally, we present detailed documentation of three instructive cases from three regions of the country and with three distinctly different outcomes. Hungary has traditional agriculture, the significant portion of which includes the production and consumption of pork meat, with characteristic preparation and consumption customs and unfavorable epidemiological characteristics (alcohol consumption, prevalence of malignant diseases or diabetes), which have all been described as important predisposing factors for the development of serious infections. Clinicians and microbiologist need to be vigilant even in nonendemic areas, especially if the patients have a history of occupational hazards or having close contact with infected pigs.

[Special case of purulent meningitis caused by Streptococcus suis. Case report]. / Streptococcus suis okozta purulens meningitis különleges esete.

The authors describe the case of purulent meningitis of a male patient who has been diagnosed with the role of Streptococcus suis in the background of the infection. The bacterium is a colonizing agent in the upper respiratory, gastrointestinal tract, and genital organs of various animals (pigs, ruminants, cats, dogs, deer and horses). The pathogen is predominantly animal pathogenic, but human cases also occur with zoonotic origin. The disease occurs primarily in sepsis, meningitis, in both animal and human cases. The prevalence of the disease is very diverse in the continents, the highest is in Asia. There is a difference between the Asian and the European and American regions, which is affected by cultural and eating habits. The appearance of bacteria in our country is primarily due to an occupational disease, but also imported cases may occur, due to the emerging tourism. For the precise microbiological diagnosis of the pathogen, the existence of modern identification methods is indispensable. The authors want to draw attention to this bacterium that causes serious infections, so it is important to summarize and disclose the knowledge available in the literature. Orv Hetil. 2019; 160(1): 30-34.

[Empyema thoracis, hemorrhagic pericarditis and acalculous cholecystitis caused by Eikenella corrodens sepsis]. / Empyemát, haemorrhagiás pericarditist és acalculosus cholecystitist okozó Eikenella corrodens szepszis.

The authors present a case of a 29-year-old woman who was diagnosed with pneumonia in the left side complicated with pleural effusion and hemorrhagic pericarditis one month after she had undergone tonsillectomy. Eikenella corrodens was identified as pathogenic agent when the empyema was removed during thoracotomy. After the patient was given antibiotic treatment she was discharged from the hospital without any symptoms or complaints. However, one month after she had left the hospital she was readmitted to the surgical unit as an emergency because of acute abdominal complaints. On admission acalculous cholecystitis as well as hemorrhagic pericarditis requiring pericardiocentesis were also observed. A rare cause of sepsis, Eikenella corrodens was identified which resulted in a severe disorder including polyserositis. Pericardiocentesis was performed two times and the patient was given targeted antibiotics and non-steroidal anti-inflammatory drugs. She was also treated with antimycotics as she had developed mycosis. After one month the patient recovered and was discharged from the hospital. No further recurrence of symptoms or complaints was observed during follow up.

Genotypic and phenotypic characterisation of invasive Streptococcus pneumoniae isolates from Hungary, and coverage of the conjugate vaccines.

BACKGROUND AND AIMS: The 7-valent conjugate pneumococcal vaccine (Prevenar) was introduced as a recommended (but not yet obligatory) vaccine in Hungary in April 2009 and there was a sharp increase in the number of children vaccinated. Hence there is an urgent need for in-depth epidemiological data on invasive pneumococci before vaccination becomes widespread. Such a study has never been done before in Hungary. METHODS: 144 pneumococcal isolates, obtained from invasive infections or pneumonia, were collected from eight Hungarian diagnostic laboratories between 2000 and 2008. After confirmation of species identity, their susceptibilities to nine antibiotics were determined by Etest and agar dilution method. The serotypes and pulsed-field gel electrophoresis genotypes of the strains were also determined. RESULTS: In this cohort, most of the isolates were from patients at the extreme of life. Only 1.4% of the strains were resistant to penicillin, but nearly 40% were resistant to erythromycin (mainly due to erm(B) gene). Higher incidences of resistance were found in the very young and very old. The most prevalent serotypes in the cohort in descending order were 14, 6A, 6, 6B, 23F, 3, 19F and 11A. CONCLUSIONS: Results showed a similar but not identical profile to previously examined strains causing pulmonary infections in Hungary. The serotypes could be correlated to patient groups. Furthermore, there were examples of serotype switching in strains showing identical genotype but different serotype. The study also shows a good coverage by the conjugate vaccines over the invasive pneumococcal strains in Hungary based on the detected serotypes.

[Cost/benefit calculations of meticillin-resistant Staphylococcus aureus screening methods and their practical importance]. / A methicillinrezisztens Staphylococcus aureus -szurés költséghatékonysági vizsgálata és gyakorlati jelentosége.

Nosocomial infections are the main cause of extra charges in health care and they relate to patient safety, as well. About 30 percent of healthcare-associated infections can be prevented effectively with infection control and adequate screening methods. Currently, meticillin-resistant Staphylococcus aureus is the main nosocomial pathogen. Protective measures against this bacterium are well known, therefore it was selected for our present cost /benefit analysis. We have calculated the costs of the epidemic caused by methicillin-resistant Staphylococcus aureus at the Aladar Petz County Teaching Hospital, Gyor, in a two-year period, and also calculated the costs of the screening method. We compared our results with the published data. Screening methods are much less expensive than to cure the patient of a nosocomial infection. Thus, primary prevention has essential importance.

Molecular epidemiology of VIM-4 metallo-beta-lactamase-producing Pseudomonas sp. isolates in Hungary.

VIM metallo-beta-lactamase-producing serotype O11 or O12 Pseudomonas aeruginosa isolates infecting or colonizing 19 patients from seven hospitals in Hungary were characterized between October 2003 and November 2005. Macrorestriction analysis revealed the involvement of hospitals from three different towns in northwest Hungary in an outbreak caused by VIM-4-producing P. aeruginosa.

Rapid detection of methicillin resistance in teicoplanin-resistant coagulase-negative staphylococci by a penicillin-binding protein 2' latex agglutination method.

Thirty-five clinical isolates of coagulase-negative staphylococci with decreased glycopeptide sensitivity were examined by a penicillin-binding protein (PBP2') latex agglutination (LA) test and were compared to the detection of the mecA gene by PCR, and oxacillin susceptibility determined minimum inhibitory concentrations. The latex test demonstrated high sensitivity and specificity for detecting methicillin resistance in coagulase-negative staphylococci after PBP2' induction with oxacillin.

Antibiotic susceptibility and serotypes of Streptococcus pneumoniae isolates from Hungary.

OBJECTIVE: Hungary has reported one of the highest incidences of penicillin resistance in Streptococcus pneumoniae in Europe since the 1970s and is still cited accordingly. However, since the end of the 1990s the resistance of pneumococci in Hungary has not been investigated. In this study we assessed the current situation, particularly to establish whether the incidence of resistance is increasing and if this could be related to the spread of specific strain types. METHODS: Isolates of S. pneumoniae (n = 304) were collected by five diagnostic laboratories in Hungary in 2000-2002. Their identity was confirmed and their susceptibilities to 16 antibiotics were determined by the agar dilution method according to NCCLS guidelines. Representative strains were serotyped (n = 112). RESULTS AND CONCLUSIONS: We found significantly lower resistance rates for penicillin compared with the data previously reported from Hungary, but the intermediate resistance was high, at 37%. Macrolide resistance was a bigger problem ( approximately 40% for erythromycin), although there was full susceptibility to telithromycin. The strains with the highest MICs were isolated from carriers and young children. The fluoroquinolones were very effective, especially moxifloxacin and gatifloxacin. There was full susceptibility to vancomycin and linezolid. We found inconsistencies with previous reports in the survey of the resistance and identification of S. pneumoniae in the country. The serotype distribution of the isolates showed a much greater diversity than had previously been reported; however, there was correlation between serotype and resistance.