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1.
PLoS One ; 16(4): e0249668, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33819304

RESUMEN

OBJECTIVE: To understand the clinical characteristics of COVID-19 patients with clinically diagnosed bacterial co-infection (CDBC), and therefore contributing to their early identification and prognosis estimation. METHOD: 905 COVID-19 patients from 7 different centers were enrolled. The demography data, clinical manifestations, laboratory results, and treatments were collected accordingly for further analyses. RESULTS: Around 9.5% of the enrolled COVID-19 patients were diagnosed with CDBC. Older patients or patients with cardiovascular comorbidities have increased CDBC probability. Increased body temperature, longer fever duration, anhelation, gastrointestinal symptoms, illness severity, intensive care unit attending, ventilation treatment, glucocorticoid therapy, longer hospitalization time are correlated to CDBC. Among laboratory results, increased white blood cell counting (mainly neutrophil), lymphocytopenia, increased procalcitonin, erythrocyte sedimentation rate, C-reaction protein, D-dimer, blood urea nitrogen, lactate dehydrogenase, brain natriuretic peptide, myoglobin, blood sugar and decreased albumin are also observed, indicating multiple system functional damage. Radiology results suggested ground glass opacity mixed with high density effusion opacities and even pleural effusion. CONCLUSION: The aged COVID-19 patients with increased inflammatory indicators, worse lymphopenia and cardiovascular comorbidities are more likely to have clinically diagnosed bacterial co-infection. Moreover, they tend to have severer clinical manifestations and increased probability of multiple system functional damage.


Asunto(s)
Infecciones Bacterianas , Coinfección , Adulto , Anciano , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/epidemiología , Coinfección/diagnóstico , Coinfección/epidemiología , Comorbilidad , Diagnóstico Precoz , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Índice de Severidad de la Enfermedad
2.
Infez Med ; 29(1): 114-116, 2021 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-33664180

RESUMEN

Dengue fever should be included in the differential diagnosis of febrile illness even if another infection such as COVID-19 has been found in returning travellers from tropical and sub-tropical area where dengue virus circulates epidemically. We describe a 40-year-old man diagnosed with laboratory-confirmed COVID-19 and dengue fever during the COVID-19 outbreak in Milan, Italy.


Asunto(s)
/diagnóstico , Coinfección/diagnóstico , Dengue/diagnóstico , Anamnesis , Adulto , Coinfección/virología , Enfermedades Transmisibles Importadas/diagnóstico , Enfermedades Transmisibles Importadas/virología , Virus del Dengue , Diagnóstico Diferencial , Humanos , Masculino , Viaje
3.
World J Gastroenterol ; 27(9): 782-793, 2021 Mar 07.
Artículo en Inglés | MEDLINE | ID: mdl-33727770

RESUMEN

Coronavirus disease 2019 (COVID-19) has become a global pandemic and garnered international attention. The causative pathogen of COVID-19 is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel, highly contagious coronavirus. Numerous studies have reported that liver injury is quite common in patients with COVID-19. Hepatitis B has a worldwide distribution as well as in China. At present, hepatitis B virus (HBV) remains a leading cause of cirrhosis, liver failure, and hepatocellular carcinoma. Because both viruses challenge liver physiology, it raises questions as to how coinfection with HBV and SARS-CoV-2 affect disease progression and mortality. Is there an increased risk of COVID-19 in patients with HBV infection? In this review, we summarize the current reports of SARS-CoV-2 and HBV coinfection and elaborate the interaction of the two diseases. The emphasis was placed on evaluating the impact of HBV infection on disease severity and clinical outcomes in patients with COVID-19 and discussing the potential mechanism behind this effect.


Asunto(s)
/fisiopatología , Coinfección/fisiopatología , Hepatitis B Crónica/fisiopatología , /diagnóstico , /mortalidad , Coinfección/diagnóstico , Coinfección/inmunología , Coinfección/mortalidad , Progresión de la Enfermedad , Salud Global , Hepatitis B Crónica/diagnóstico , Hepatitis B Crónica/inmunología , Hepatitis B Crónica/mortalidad , Humanos , Pronóstico , Índice de Severidad de la Enfermedad
4.
BMC Infect Dis ; 21(1): 161, 2021 Feb 09.
Artículo en Inglés | MEDLINE | ID: mdl-33563205

RESUMEN

BACKGROUND: Although Respiratory syncytial virus (RSV) is one of the common pathogens in children with pertussis and viral coinfection, the clinical impact of RSV infection on pertussis remains unclear. We compared clinical characteristics and sought differences between infants with single Bordetella pertussis (B. pertussis) infection and those with RSV coinfection. METHODS: We enrolled 80 patients with pertussis who were hospitalized in Shenzhen Children's Hospital from January 2017 to December 2019. Respiratory tract samples were tested for B. pertussis with real-time polymerase chain reaction and respiratory viruses with immunofluorescence assay. Clinical data were obtained from hospital records and collected using a structured questionnaire. RESULTS: Thirty-seven of 80 patients had B. pertussis infection alone (pertussis group) and 43 had RSV-pertussis coinfection (coinfection group). No significant differences were found with regard to sex, body weight, preterm birth history, pertussis vaccination, symptoms, presence of pneumonia, or lymphocyte count between the 2 groups. Univariate analysis showed patients with RSV coinfection were older (median, 4.57 months vs 4.03 months, p = 0.048); more commonly treated with ß-lactam antibiotics (21% vs 5%, p = 0.044); had higher rates of wheezes (40% vs 14%, p = 0.009) and rales (35% vs 14%, p = 0.028) on chest auscultation, a higher rate of readmission (40% vs 11%, p = 0.004), and a longer hospital stay (median, 10 days vs 7 days, p = 0.002). In the further binary logistic regression analysis, patients with RSV coinfection had higher rates of wheezes (OR = 3.802; 95% CI: 1.106 to 13.072; p = 0.034) and readmission (OR = 5.835; 95% CI: 1.280 to 26.610; p = 0.023). CONCLUSIONS: RSV coinfection increases readmission rate in children hospitalized for pertussis. RSV infection should be suspected when wheezes are present on auscultation of the chest in these patients. Early detection of RSV may avoid unnecessary antibiotic use.


Asunto(s)
Infecciones por Virus Sincitial Respiratorio/diagnóstico , Tos Ferina/diagnóstico , Antibacterianos/uso terapéutico , Bordetella pertussis/genética , Bordetella pertussis/aislamiento & purificación , Coinfección/diagnóstico , Femenino , Hospitalización , Humanos , Lactante , Tiempo de Internación , Modelos Logísticos , Masculino , Readmisión del Paciente , ARN Viral/metabolismo , Reacción en Cadena en Tiempo Real de la Polimerasa , Infecciones por Virus Sincitial Respiratorio/complicaciones , Infecciones por Virus Sincitial Respiratorio/virología , Virus Sincitial Respiratorio Humano/genética , Virus Sincitial Respiratorio Humano/aislamiento & purificación , Estudios Retrospectivos , Tos Ferina/complicaciones , Tos Ferina/tratamiento farmacológico , Tos Ferina/microbiología
5.
West Afr J Med ; 38(2): 176-179, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33641155

RESUMEN

COVID-19 is a global pandemic, with attendant high morbidity and mortality. There is no previous documentation of its coinfection with Mycobacterium tuberculosis; the single most common cause of death from an infectious disease. Management and survival from this "cruel duel" in a low resource country will be daunting. We report the case of a middle-aged man who survived and the lessons learned from a COVID-19 treatment centre in the north-central of Nigeria. The patient presented with symptoms and clinical features of COVID-19 and Mycobacterium tuberculosis was confirmed with laboratory investigation. The patient commenced anti-tuberculous medications, received nutritional support and other supportive treatment for COVID-19 infection. He was discharged home to continue follow up at the medical outpatient and the DOTS clinic. Early recognition and prompt treatment are critical for a favourable clinical outcome.


Asunto(s)
Coinfección , Mycobacterium tuberculosis , Anciano , Coinfección/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Nigeria
6.
Sci Rep ; 11(1): 3934, 2021 02 16.
Artículo en Inglés | MEDLINE | ID: mdl-33594223

RESUMEN

Accumulating evidence supports the high prevalence of co-infections among Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) patients, and their potential to worsen the clinical outcome of COVID-19. However, there are few data on Southern Hemisphere populations, and most studies to date have investigated a narrow spectrum of viruses using targeted qRT-PCR. Here we assessed respiratory viral co-infections among SARS-CoV-2 patients in Australia, through respiratory virome characterization. Nasopharyngeal swabs of 92 SARS-CoV-2-positive cases were sequenced using pan-viral hybrid-capture and the Twist Respiratory Virus Panel. In total, 8% of cases were co-infected, with rhinovirus (6%) or influenzavirus (2%). Twist capture also achieved near-complete sequencing (> 90% coverage, > tenfold depth) of the SARS-CoV-2 genome in 95% of specimens with Ct < 30. Our results highlight the importance of assessing all pathogens in symptomatic patients, and the dual-functionality of Twist hybrid-capture, for SARS-CoV-2 whole-genome sequencing without amplicon generation and the simultaneous identification of viral co-infections with ease.


Asunto(s)
/diagnóstico , Coinfección/diagnóstico , Coinfección/virología , Análisis de Secuencia de ADN , /genética , Australia/epidemiología , Coinfección/epidemiología , Biología Computacional , Genoma Viral , Humanos , Sistemas de Lectura Abierta/genética , Reproducibilidad de los Resultados , Secuenciación Completa del Genoma
7.
BMC Infect Dis ; 21(1): 152, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33546631

RESUMEN

BACKGROUND: Knowledge on the etiology of LRTIs is essential for improvement of the clinical diagnosis and accurate treatment. Molecular detection methods were applied to identify a broad range of bacterial and viral pathogens in a large set of bronchial alveolar lavage (BAL) fluid samples. The patterns of detected pathogens were correlated to the clinical symptoms. METHODS: BAL fluid samples and clinical data were collected from 573 hospitalized children between 1 month and 14 years of age with LRTIs, enrolled from January to December 2018. Pathogens were detected using standardized clinical diagnostics, with a sensitive, high-throughput GeXP-based multiplex PCR and with multiplex qPCR. Data were analyzed to describe the correlation between the severity of respiratory tract disease and the pathogens identified. RESULTS: The pathogen detection rate with GeXP-based PCR and multiplex qPCR was significantly higher than by clinical routine diagnostics (76.09% VS 36.13%,χ2 = 8.191, P = 0.004). The most frequently detected pathogens in the BAL fluid were human adenovirus (HADV)(21.82%), Mycoplasma pneumoniae (20.24%), human rhinovirus (13.96%), Streptococcus pneumoniae (8.90%) and Haemophilus influenzae (8.90%). In 16.4% of the cases co-detection with two or three different pathogens was found. Viral detection rates declined with age, while atypical pathogen detection rates increased with age. Oxygen supply in the HADV and Influenza H1N1 infected patients was more frequent (49.43%) than in patients infected with other pathogens. CONCLUSION: Broad range detection of viral and bacterial pathogens using molecular methods is a promising and implementable approach to improve clinical diagnosis and accurate treatment of LRTI in children.


Asunto(s)
Líquido del Lavado Bronquioalveolar/microbiología , Líquido del Lavado Bronquioalveolar/virología , Infecciones del Sistema Respiratorio/diagnóstico , Adolescente , Bacterias/clasificación , Bacterias/genética , Bacterias/aislamiento & purificación , Niño , Niño Hospitalizado , Preescolar , Coinfección/diagnóstico , Coinfección/microbiología , Coinfección/virología , Pruebas Diagnósticas de Rutina , Femenino , Humanos , Lactante , Masculino , Reacción en Cadena de la Polimerasa , Infecciones del Sistema Respiratorio/microbiología , Infecciones del Sistema Respiratorio/virología , Virus/clasificación , Virus/genética , Virus/aislamiento & purificación
8.
Sci Rep ; 11(1): 3209, 2021 02 05.
Artículo en Inglés | MEDLINE | ID: mdl-33547380

RESUMEN

Viral co-infections occur in COVID-19 patients, potentially impacting disease progression and severity. However, there is currently no dedicated method to identify viral co-infections in patient RNA-seq data. We developed PACIFIC, a deep-learning algorithm that accurately detects SARS-CoV-2 and other common RNA respiratory viruses from RNA-seq data. Using in silico data, PACIFIC recovers the presence and relative concentrations of viruses with > 99% precision and recall. PACIFIC accurately detects SARS-CoV-2 and other viral infections in 63 independent in vitro cell culture and patient datasets. PACIFIC is an end-to-end tool that enables the systematic monitoring of viral infections in the current global pandemic.


Asunto(s)
/diagnóstico , Coinfección/diagnóstico , Aprendizaje Profundo , Infecciones por Virus ARN/diagnóstico , Virus ARN/aislamiento & purificación , /aislamiento & purificación , Coinfección/virología , Coronaviridae/aislamiento & purificación , Humanos , Metapneumovirus/clasificación , Metapneumovirus/aislamiento & purificación , Redes Neurales de la Computación , Orthomyxoviridae/clasificación , Orthomyxoviridae/aislamiento & purificación , Infecciones por Virus ARN/virología , Virus ARN/clasificación , RNA-Seq , Rhinovirus/clasificación , Rhinovirus/aislamiento & purificación , Sensibilidad y Especificidad
9.
BMC Infect Dis ; 21(1): 63, 2021 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-33435896

RESUMEN

BACKGROUND: Chest X-ray (CXR) interpretation remains a central component of the current World Health Organization recommendations as an adjuvant test in diagnosis of smear-negative tuberculosis (TB). With its low specificity, high maintenance and operational costs, utility of CXR in diagnosis of smear-negative TB in high HIV/TB burden settings in the Xpert MTB/RIF era remains unpredictable. We evaluated accuracy and additive value of CXR to Xpert MTB/RIF in the diagnosis of TB among HIV-positive smear-negative presumptive TB patients. METHODS: HIV co-infected presumptive TB patients were recruited from the Infectious Diseases Institute outpatient clinic and in-patient medical wards of Mulago Hospital, Uganda. CXR films were reviewed by two independent radiologists using a standardized evaluation form. CXR interpretation with regard to TB was either positive (consistent with TB) or negative (normal or unlikely TB). Sensitivity, specificity and predictive values of CXR and CXR combined with Xpert MTB/RIF for diagnosis of smear-negative TB in HIV-positive patients were calculated using sputum and/or blood mycobacterial culture as reference standard. RESULTS: Three hundred sixty-six HIV co-infected smear-negative participants (female, 63.4%; hospitalized, 68.3%) had technically interpretable CXR. Median (IQR) age was 32 (28-39) years and CD4 count 112 (23-308) cells/mm3. Overall, 22% (81/366) were positive for Mycobacterium tuberculosis (Mtb) on culture; 187/366 (51.1%) had CXR interpreted as consistent with TB, of which 55 (29.4%) had culture-confirmed TB. Sensitivity and specificity of CXR interpretation in diagnosis of culture-positive TB were 67.9% (95%CI 56.6-77.8) and 53.7% (95%CI 47.7-59.6) respectively, while Xpert MTB/RIF sensitivity and specificity were 65.4% (95%CI 54.0-75.7) and 95.8% (95%CI 92.8-97.8) respectively. Addition of CXR to Xpert MTB/RIF had overall sensitivity and specificity of 87.7% (95%CI 78.5-93.9) and 51.6% (95%CI 45.6-57.5) respectively; 86.2% (95%CI 75.3-93.5) and 48.1% (95%CI 40.7-55.6) among inpatients and 93.8% (95%CI 69.8-99.8) and 58.0% (95%CI 47.7-67.8) among outpatients respectively. CONCLUSION: In this high prevalence TB/HIV setting, CXR interpretation added sensitivity to Xpert MTB/RIF test at the expense of specificity in the diagnosis of culture-positive TB in HIV-positive individuals presenting with TB symptoms and negative smear. CXR interpretation may not add diagnostic value in settings where Xpert MTB/RIF is available as a TB diagnostic tool.


Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Coinfección/diagnóstico , VIH/aislamiento & purificación , Radiografías Pulmonares Masivas/métodos , Mycobacterium tuberculosis/genética , Técnicas de Amplificación de Ácido Nucleico/métodos , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/virología , Adulto , Recuento de Linfocito CD4 , Coinfección/epidemiología , Coinfección/virología , Exactitud de los Datos , Femenino , Recursos en Salud , Humanos , Masculino , Sensibilidad y Especificidad , Esputo/microbiología , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/microbiología , Uganda/epidemiología
10.
BMC Infect Dis ; 21(1): 68, 2021 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-33441085

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus that was first discovered in December 2019 in Wuhan, China. With the growing numbers of community spread cases worldwide, the World Health Organization (WHO) declared the COVID-19 outbreak as a pandemic on March 11, 2020. Like influenza viruses, SARS-CoV-2 is thought to be mainly transmitted by droplets and direct contact, and COVID-19 has a similar disease presentation to influenza. Here we present a case of influenza A and COVID-19 co-infection in a 60-year-old man with end-stage renal disease (ESRD) on hemodialysis. CASE PRESENTATION: A 60-year-old man with ESRD on hemodialysis presented for worsening cough, shortness of breath, and diarrhea. The patient first developed a mild fever (37.8 °C) during hemodialysis 3 days prior to presentation and has been experiencing worsening flu-like symptoms, including fever of up to 38.6 °C, non-productive cough, generalized abdominal pain, nausea, vomiting, and liquid green diarrhea. He lives alone at home with no known sick contacts and denies any recent travel or visits to healthcare facilities other than the local dialysis center. Rapid flu test was positive for influenza A. Procalcitonin was elevated at 5.21 ng/mL with a normal white blood cell (WBC) count. Computed tomography (CT) chest demonstrated multifocal areas of consolidation and extensive mediastinal and hilar adenopathy concerning for pneumonia. He was admitted to the biocontainment unit of Nebraska Medicine for concerns of possible COVID-19 and was started on oseltamivir for influenza and vancomycin/cefepime for the probable bacterial cause of his pneumonia and diarrhea. Gastrointestinal (GI) pathogen panel and Clostridioides difficile toxin assay were negative. On the second day of admission, initial nasopharyngeal swab came back positive for SARS-CoV-2 by real-time reverse-transcriptase polymerase chain reaction (RT-PCR). The patient received supportive care and resumed bedside hemodialysis in strict isolation, and eventually fully recovered from COVID-19. CONCLUSIONS: We presented a case of co-infection of influenza and SARS-CoV-2 in a hemodialysis patient. The possibility of SARS-CoV-2 co-infection should not be overlooked even when other viruses including influenza can explain the clinical symptoms, especially in high-risk patients.


Asunto(s)
/diagnóstico , Gripe Humana/diagnóstico , /diagnóstico por imagen , Coinfección/diagnóstico , Coinfección/diagnóstico por imagen , Coinfección/virología , Hospitalización , Humanos , Virus de la Influenza A/genética , Virus de la Influenza A/aislamiento & purificación , Virus de la Influenza A/fisiología , Gripe Humana/diagnóstico por imagen , Gripe Humana/virología , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Pandemias , Diálisis Renal , /aislamiento & purificación , Tomografía Computarizada por Rayos X
12.
Infection ; 49(2): 313-320, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33387261

RESUMEN

PURPOSE: This study aimed to determine the proportion of people living with HIV with anti-SARS-CoV-2 IgG antibodies in a sample from a large single HIV center in Munich, Germany, after the first phase of the coronavirus pandemic and to infer the prevalence of SARS-CoV-2 co-infection in people living with HIV. METHODS: Prospective sub-study of the ongoing ArcHIV cohort between May and July 2020. Anti-SARS-CoV-2 IgG antibodies were measured using the recomWell SARS-CoV-2 IgG ELISA (Mikrogen, Neuried, Germany); positive and borderline results were re-tested using the recomLine SARS-CoV-2 IgG immunoassay (Mikrogen, Neuried, Germany). Demographic and medical data were extracted from the electronic patient files. RESULTS: Overall, 500 people living with HIV were included in the study (83% male, median age 51 years). Three participants had been diagnosed with COVID-19 prior to study inclusion. Of those, nine were confirmed positive for SARS-CoV-2 IgG antibodies, resulting in an estimated seroprevalence (accounting for sensitivity and specificity of the test) of 1.5% (CI 95%: 0.69; 3.13) for the entire study sample, and 2.2% (CI 95%: 1.1; 3.9) for the subset of the Munich citizens. There were no marked differences for people living with HIV with and without SARS-CoV-2 co-infection. CONCLUSION: The seroprevalence of SARS-CoV-2 co-infection in people living with HIV as found in our study does not seem to exceed previous reports from general populations of 'hot-sport' areas; comparative data from the Munich population can be expected to be published soon. Our data also highlight, once more, the need to do confirmatory testing on positive samples to minimize the impact of false-positive results.


Asunto(s)
/epidemiología , Coinfección/epidemiología , Infecciones por VIH/epidemiología , Adulto , Anticuerpos Antivirales/sangre , Coinfección/diagnóstico , Estudios Transversales , Ensayo de Inmunoadsorción Enzimática , Femenino , Alemania/epidemiología , Infecciones por VIH/diagnóstico , Humanos , Inmunoglobulina G/sangre , Masculino , Persona de Mediana Edad , Estudios Prospectivos , /aislamiento & purificación , Sensibilidad y Especificidad , Estudios Seroepidemiológicos
13.
Rev Mal Respir ; 38(1): 58-73, 2021 Jan.
Artículo en Francés | MEDLINE | ID: mdl-33461842

RESUMEN

INTRODUCTION: The etiological diagnosis of bronchopulmonary infections cannot be assessed with clinical, radiological and epidemiological data alone. Viruses have been demonstrated to cause a large proportion of these infections, both in children and adults. BACKGROUND: The diagnosis of viral bronchopulmonary infections is based on the analysis of secretions, collected from the lower respiratory tract when possible, by techniques that detect either influenza and respiratory syncytial viruses, or a large panel of viruses that can be responsible for respiratory disease. The latter, called multiplex PCR assays, allow a syndromic approach to respiratory infection. Their high cost for the laboratory raises the question of their place in the management of patients in terms of antibiotic economy and isolation. In the absence of clear recommendations, the strategy and equipment are very unevenly distributed in France. OUTLOOK: Medico-economic analyses need to be performed in France to evaluate the place of these tests in the management of patients. The evaluation of the role of the different viruses often detected in co-infection, especially in children, also deserves the attention of virologists and clinicians. CONCLUSIONS: The availability of new diagnostic technologies, the recent emergence of SARS-CoV-2, together with the availability of new antiviral drugs are likely to impact future recommendations for the management of viral bronchopulmonary infections.


Asunto(s)
Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/virología , Virosis/diagnóstico , Antígenos Virales/análisis , Líquido del Lavado Bronquioalveolar/virología , Coinfección/diagnóstico , Técnica del Anticuerpo Fluorescente , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Nasofaringe/virología , Reacción en Cadena de la Polimerasa , Vigilancia de la Población , Manejo de Especímenes
15.
BMC Pregnancy Childbirth ; 21(1): 98, 2021 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-33516183

RESUMEN

BACKGROUND: This study estimated the prevalence of curable sexually transmitted and reproductive tract infections (STIs/RTIs) among pregnant women attending antenatal care (ANC) in rural Zambia, evaluated the effectiveness of syndromic management of STIs/RTIs versus reference-standard laboratory diagnoses, and identified determinants of curable STIs/RTIs during pregnancy. METHODS: A total of 1086 pregnant women were enrolled at ANC booking, socio-demographic information and biological samples were collected, and the provision of syndromic management based care was documented. The Piot-Fransen model was used to evaluate the effectiveness of syndromic management versus etiological testing, and univariate and multivariate logistic regression analyses were used to identify determinants of STIs/RTIs. RESULTS: Participants had a mean age of 25.6 years and a mean gestational age of 22.0 weeks. Of 1084 women, 700 had at least one STI/RTI (64.6%; 95% confidence interval [CI], 61.7, 67.4). Only 10.2% of infected women received any treatment for a curable STI/RTI (excluding syphilis). Treatment was given to 0 of 56 women with chlamydia (prevalence 5.2%; 95% CI, 4.0, 6.6), 14.7% of participants with gonorrhoea (prevalence 3.1%; 95% CI, 2.2, 4.4), 7.8% of trichomoniasis positives (prevalence 24.8%; 95% CI, 22.3, 27.5) and 7.5% of women with bacterial vaginosis (prevalence 48.7%; 95% CI, 45.2, 51.2). An estimated 7.1% (95% CI, 5.6, 8.7) of participants had syphilis and received treatment. Women < 20 years old were more likely (adjusted odds ratio [aOR] = 5.01; 95% CI: 1.23, 19.44) to have gonorrhoea compared to women ≥30. The odds of trichomoniasis infection were highest among primigravidae (aOR = 2.40; 95% CI: 1.69, 3.40), decreasing with each subsequent pregnancy. Women 20 to 29 years old were more likely to be diagnosed with bacterial vaginosis compared to women ≥30 (aOR = 1.58; 95% CI: 1.19, 2.10). Women aged 20 to 29 and ≥ 30 years had higher odds of infection with syphilis, aOR = 3.96; 95% CI: 1.40, 11.20 and aOR = 3.29; 95% CI: 1.11, 9.74 respectively, compared to women under 20. CONCLUSIONS: Curable STIs/RTIs were common and the majority of cases were undetected and untreated. Alternative approaches are urgently needed in the ANC setting in rural Zambia.


Asunto(s)
Coinfección/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Infecciones del Sistema Genital/epidemiología , Enfermedades de Transmisión Sexual/epidemiología , Adulto , Coinfección/diagnóstico , Coinfección/parasitología , Estudios Transversales , Femenino , Gonorrea/diagnóstico , Gonorrea/epidemiología , Humanos , Modelos Logísticos , Análisis Multivariante , Embarazo , Atención Prenatal , Prevalencia , Infecciones del Sistema Genital/diagnóstico , Infecciones del Sistema Genital/parasitología , Población Rural , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/parasitología , Factores Socioeconómicos , Sífilis/epidemiología , Tricomoniasis/epidemiología , Vaginosis Bacteriana/epidemiología , Vaginosis Bacteriana/parasitología , Adulto Joven , Zambia/epidemiología
16.
Rev Iberoam Micol ; 38(1): 16-18, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33500209

RESUMEN

BACKGROUND: Patients with severe viral pneumonia are likely to receive high-dose immunomodulatory drugs to prevent clinical worsening. Aspergillus species have been described as frequent secondary pneumonia agents in severely ill influenza patients receiving steroids. COVID-19 patients admitted to Intensive Care Unit (ICU) are receiving steroids as part of their treatment and they share clinical characteristics with other patients with severe viral pneumonias. COVID-19 patients receiving steroids should be considered a putative risk group of invasive aspergillosis. CASE REPORT: We are reporting a SARS-CoV-2/Aspergillus section Fumigati coinfection in an elderly intubated patient with a history of pulmonary embolism treated with corticosteroids. The diagnosis was made following the ad hoc definitions described for patients admitted to ICU with severe influenza, including clinical criteria (fever for 3 days refractory to the appropriate antibiotic therapy, dyspnea, pleural friction rub, worsening of respiratory status despite antibiotic therapy and need of ventilator support), a radiological criterion (pulmonary infiltrate) and a mycological criterion (several positive galactomannan tests on serum with ratio ≥0.5). In addition, Aspergillus section Fumigati DNA was found in serum and blood samples. These tests were positive 4 weeks after the patient was admitted to the ICU. The patient received voriconazole and after two month in ICU his respiratory status improved; he was discharged after 6 weeks of antifungal treatment. CONCLUSIONS: Severely ill COVID-19 patients would be considered a new aspergillosis risk group. Galactomannan and Aspergillus DNA detection would be useful methods for Aspergillus infection diagnosis as they allow avoiding the biosafety issues related to these patients.


Asunto(s)
Aspergillus fumigatus/aislamiento & purificación , /tratamiento farmacológico , Coinfección/diagnóstico , Inmunocompetencia , Inmunosupresores/efectos adversos , Aspergilosis Pulmonar Invasiva/complicaciones , Metilprednisolona/efectos adversos , /aislamiento & purificación , Acetaminofén/uso terapéutico , Anciano , Antiinfecciosos/uso terapéutico , Líquido del Lavado Bronquioalveolar/microbiología , /terapia , Coinfección/microbiología , Coinfección/terapia , Coinfección/virología , Terapia Combinada , Diagnóstico Diferencial , Quimioterapia Combinada , Enoxaparina/uso terapéutico , Humanos , Hidroxicloroquina/uso terapéutico , Inmunosupresores/uso terapéutico , Intubación Intratraqueal , Aspergilosis Pulmonar Invasiva/diagnóstico , Aspergilosis Pulmonar Invasiva/microbiología , Aspergilosis Pulmonar Invasiva/terapia , Masculino , Mananos/sangre , Metilprednisolona/uso terapéutico , Nasofaringe/virología , Neumonía por Mycoplasma/diagnóstico , Pseudomonas aeruginosa/aislamiento & purificación , Reacción en Cadena en Tiempo Real de la Polimerasa , Respiración Artificial , Staphylococcus aureus/aislamiento & purificación , Tráquea/microbiología
17.
Adv Exp Med Biol ; 1324: 29-34, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33346902

RESUMEN

This paper presents a case of coinfection of influenza A virus (H1N1) and respiratory syncytial virus (RSV) in a male newborn. On the first day of life, the newborn required passive oxygen therapy, followed by respiratory support with nasal continuous positive airway pressure (nCPAP) due to respiratory insufficiency. As the newborn's respiratory effort was intensifying, he was intubated. In the second day of life, a nasopharyngeal swab was taken yielding the presence of H1N1 and RSV in the RT-PCR test. The child was isolated and given oseltamivir and empirical antibiotic therapy, which improved his condition. Other newborns who initially stayed with the sick child in the post-delivery room did not obtain oseltamivir prophylactically as their nasopharyngeal swabs were negative. The child's parents denied the occurrence of influenza-like symptoms within 14 days of delivery, which suggests a transplacental transmission of the child's infection or asymptomatic course of infection in the parents. In conclusion, this report confirms the possibility of viral coinfections in newborns, which points attention to considering a panel of respiratory viruses in the diagnostics. Symptoms of influenza in newborns may be atypical, including a fever-free course. Oseltamivir treatment in newborns with influenza seems an effective therapeutic measure.


Asunto(s)
Coinfección , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana , Infecciones por Virus Sincitial Respiratorio , Virus Sincitial Respiratorio Humano , Infecciones del Sistema Respiratorio , Coinfección/diagnóstico , Coinfección/tratamiento farmacológico , Humanos , Lactante , Recién Nacido , Subtipo H1N1 del Virus de la Influenza A/genética , Gripe Humana/complicaciones , Gripe Humana/diagnóstico , Gripe Humana/tratamiento farmacológico , Masculino , Infecciones por Virus Sincitial Respiratorio/complicaciones , Infecciones por Virus Sincitial Respiratorio/diagnóstico , Infecciones por Virus Sincitial Respiratorio/tratamiento farmacológico
18.
Artículo en Inglés | MEDLINE | ID: mdl-33348839

RESUMEN

BACKGROUND: HIV and HCV coinfection leads to accelerated liver fibrosis, in which microbial translocation and systemic inflammation might play important roles. OBJECTIVE: This study aimed to provide an extensive profile of the plasma microbial translocation and inflammation biomarkers associated with advanced liver fibrosis among HIV-HCV-coinfected patients. METHODS: This cross-sectional study recruited 343 HIV-HCV-coinfected patients on combination antiretroviral therapy (cART) from a rural prefecture of Yunnan province in Southwest China. The plasma concentrations of sCD14 and 27 cytokines and chemokines were assayed and compared against advanced or mild levels of liver fibrosis. RESULTS: Of the 343 HIV-HCV-coinfected patients, 188 (54.8%) had severe or advanced liver fibrosis (FIB-4 > 3.25). The patients with advanced liver fibrosis (FIB-4 > 3.25 vs. FIB-4 ≤ 3.25) had higher plasma levels of interleukin (IL)-1ß, IL-6, IL-7, IL-9, IL-12, IL-15, IL-17, granulocyte macrophage colony stimulating factor (GM-CSF), Interferon-γ (IFN-γ), tumor necrosis factor (TNF-α), IL-4, IL-10, IL-13, fibroblast growth factor 2 (FGF-basic), and Monocyte chemoattractant protein-1 (MCP-1). Multivariable logistic regression models showed that advanced liver fibrosis was associated with an increased plasma level of IL-1ß, IL-6, IL-7, IL-12, IL-17, GM-CSF, IFN-γ, IL-4, IL-10, MCP-1, Eotaxin, and FGF-basic, with FGF-basic continuing to be positively and significantly associated with advanced liver fibrosis, after Bonferroni correction for multiple comparisons (adjusted odds ratio (aOR) = 1.92; 95%CI: 1.32-2.81; p = 0.001). Plasma sCD14 was also significantly associated with advanced liver fibrosis (aOR = 1.13; 95%CI: 1.01-1.30; p = 0.049). CONCLUSIONS: HIV-HCV-coinfected patients are living with a high prevalence of advanced liver fibrosis which coexists with a mixture of elevated plasma inflammation and microbial translocation biomarkers. The significant associations of advanced liver fibrosis with FGF-basic and sCD14 may reveal pathogenic mechanisms and potential clinical intervention targets for liver fibrosis in HCV-HIV coinfection.


Asunto(s)
Biomarcadores , Coinfección , Infecciones por VIH , Hepatitis C , Preparaciones Farmacéuticas , Biomarcadores/sangre , China , Coinfección/sangre , Coinfección/diagnóstico , Estudios Transversales , Femenino , Infecciones por VIH/complicaciones , Hepatitis C/sangre , Hepatitis C/complicaciones , Hepatitis C/diagnóstico , Humanos , Cirrosis Hepática/sangre , Cirrosis Hepática/complicaciones , Cirrosis Hepática/diagnóstico , Masculino , Plasma/química
19.
BMJ Case Rep ; 13(12)2020 Dec 13.
Artículo en Inglés | MEDLINE | ID: mdl-33318282

RESUMEN

This report presents the case of a mixed infection of Actinomyces israelii and Fusobacterium nucleatum, presenting as an extensive neck mass progressing through tissue planes and causing bony destruction. Despite multiple abscess aspirates, imaging and serological investigations, the causative organisms proved elusive over the course of the patient's long admission, only to be identified postdischarge. The patient was successfully initiated on a prolonged course of intravenous antibiotics and did not suffer from any complications. This report aims to raise awareness of the presentation, pathogenicity and treatment of Actinomyces and Fusobacteria infections, given a notable difficulty in diagnosis.


Asunto(s)
Absceso/etiología , Actinomyces/aislamiento & purificación , Coinfección/diagnóstico , Coinfección/microbiología , Fusobacterium nucleatum/aislamiento & purificación , Cuello/patología , Absceso/microbiología , Actinomicosis/diagnóstico , Actinomicosis/microbiología , Administración Intravenosa , Anciano , Antibacterianos/administración & dosificación , Coinfección/tratamiento farmacológico , Infecciones por Fusobacterium/diagnóstico , Infecciones por Fusobacterium/microbiología , Humanos , Masculino , Tomografía Computarizada por Rayos X
20.
Medicina (Kaunas) ; 56(11)2020 Oct 29.
Artículo en Inglés | MEDLINE | ID: mdl-33138045

RESUMEN

BACKGROUND AND OBJECTIVES: Streptococcus pneumoniae urinary antigen (u-Ag) testing has recently gained attention in the early diagnosis of severe and critical acute respiratory syndrome coronavirus-2/pneumococcal co-infection. The aim of this study is to assess the effectiveness of Streptococcus pneumoniae u-Ag testing in coronavirus disease 2019 (COVID-19) patients, in order to assess whether pneumococcal co-infection is associated with different mortality rate and hospital stay in these patients. MATERIALS AND METHODS: Charts, protocols, mortality, and hospitalization data of a consecutive series of COVID-19 patients admitted to a tertiary hospital in northern Italy during COVID-19 outbreak were retrospectively reviewed. All patients underwent Streptococcus pneumoniae u-Ag testing to detect an underlying pneumococcal co-infection. Covid19+/u-Ag+ and Covid19+/u-Ag- patients were compared in terms of overall survival and length of hospital stay using chi-square test and survival analysis. RESULTS: Out of 575 patients with documented pneumonia, 13% screened positive for the u-Ag test. All u-Ag+ patients underwent treatment with Ceftriaxone and Azithromycin or Levofloxacin. Lopinavir/Ritonavir or Darunavir/Cobicistat were added in 44 patients, and hydroxychloroquine and low-molecular-weight heparin (LMWH) in 47 and 33 patients, respectively. All u-Ag+ patients were hospitalized. Mortality was 15.4% and 25.9% in u-Ag+ and u-Ag- patients, respectively (p = 0.09). Survival analysis showed a better prognosis, albeit not significant, in u-Ag+ patients. Median hospital stay did not differ among groups (10 vs. 9 days, p = 0.71). CONCLUSIONS: The routine use of Streptococcus pneumoniae u-Ag testing helped to better target antibiotic therapy with a final trend of reduction in mortality of u-Ag+ COVID-19 patients having a concomitant pneumococcal infection. Randomized trials on larger cohorts are necessary in order to draw definitive conclusion.


Asunto(s)
Antibacterianos/uso terapéutico , Antivirales/uso terapéutico , Coinfección/diagnóstico , Infecciones por Coronavirus/tratamiento farmacológico , Mortalidad Hospitalaria , Neumonía Neumocócica/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Anticoagulantes/uso terapéutico , Antígenos Bacterianos/orina , Azitromicina/uso terapéutico , Betacoronavirus , Ceftriaxona/uso terapéutico , Cobicistat/uso terapéutico , Coinfección/orina , Infecciones por Coronavirus/complicaciones , Estudios Transversales , Darunavir/uso terapéutico , Combinación de Medicamentos , Femenino , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Hidroxicloroquina/uso terapéutico , Tiempo de Internación/estadística & datos numéricos , Levofloxacino/uso terapéutico , Lopinavir/uso terapéutico , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Pandemias , Neumonía Neumocócica/complicaciones , Neumonía Neumocócica/diagnóstico , Neumonía Neumocócica/orina , Neumonía Viral/complicaciones , Estudios Retrospectivos , Ritonavir/uso terapéutico , Streptococcus pneumoniae/inmunología
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