Vaccination Recommendations for Adults With Autoimmune Inflammatory Rheumatic Diseases in Latin America.

BACKGROUND/OBJECTIVE: Patients with autoimmune inflammatory rheumatic diseases (AIRDs) are at increased risk of contracting severe infections and suffering complications, particularly when they are receiving immunomodulating therapy. Vaccination is an important means to prevent many potential infections and thereby reduce the morbidity and mortality associated with AIRD. The purpose of this consensus document is to provide health care professionals with recommendations for the vaccination of AIRD patients who reside in Latin America. The recommendations were developed by an expert committee from the region based on a review of the literature and their clinical experience. METHODS: The Americas Health Foundation (AHF) used PubMed and EMBASE to identify clinicians and scientists with an academic or hospital affiliation and who had published in the field of adult vaccination and rheumatic diseases since 2010. As a result of this effort, AHF convened an 8-member panel of clinical and scientific experts from Latin America. Both the AHF and panel members conducted a careful literature review to identify relevant publications in the areas of adult vaccination and rheumatology, and the sum of the articles identified was provided to the entire panel. Prior to the conference, panelists were each asked to prepare a written response to a salient issue on the subject, identified by AHF. RESULTS AND CONCLUSIONS: During the conference, each response was edited by the entire group, through numerous drafts and rounds of discussion until a complete consensus on vaccination recommendations for adult patients with AIRDs was obtained, including 7 key recommendations.

[Etiology and antimicrobial resistance of uncomplicated urinary tract infections]. / Etiología y resistencia a antimicrobianos de la infección no complicada del tracto urinario.

Uncomplicated urinary tract infections rank among the most frequent bacterial infections in women in the outpatient setting and represent a major cause of antimicrobial prescription. The aims of this study were to assess frequencies and antimicrobial resistance of current uropathogens causing uncomplicated urinary tract infection. In a prospective multicenter study, patients were recruited in ambulatory settings of four participating hospitals between June 2011 and December 2013. We analyzed 138 patients that met clinical and bacteriological diagnostic criteria. The mean age was 28 years. Cystitis was defined in 70% (n: 97) and pyelonephritis in 30% (n: 41). Frequencies of isolated microorganisms were: Escherichia coli 70% (n: 97), Staphylococcus saprophyticus 17% (n: 24), Proteus spp. 7% (n: 10), Klebsiella spp. 4% (n: 5), Enterococcus spp. and Pseudomonas aeruginosa 1 (0.7%) each. The antimicrobial resistance was: ampicillin-sulbactam 37% (n: 51) cephalexin 28% (n: 39), trimethoprim/sulfamethoxazole 22% (n: 31), nitrofurantoin 12% (n: 17), gentamicin 7% (n: 10) and ciprofloxacin 5% (n: 7). The levels of resistance found for ampicillin-sulbactam, trimethoprim/sulfamethoxazole and cephalexin were higher than those previously reported in Argentina. A better knowledge of the etiology and local antimicrobial susceptibility allows the design of more adequate guidelines for empirical treatment.

[Levofloxacin prophylaxis in neutropenic patients]. / Profilaxis con levofloxacina en pacientes neutropénicos.

Fluorquinolone-prophylaxis has proven useful in preventing infections in high risk neutropenic patients. The objective of this study was to describe the clinical, microbiological and therapeutic characteristics, and outcome of patients in the first episode of febrile neutropenia, comparing those who received levofloxacin prophylaxis with those who didn't. It was a prospective observational study that included all the episodes of inpatients with febrile neutropenia (February 1997- November 2014), also including the first episode in a same patient in different hospitalizations. Of 946 episodes here included, 821 presented high risk febrile neutropenia. A total of 264 cases (27.9%) received levofloxacin prophylaxis. This group consisted of a higher proportion of high risk febrile neutropenia (99.2% vs. 82.3%, p = 0.0001) and patients that had received an hematopoietic stem cell transplant (67.8% vs. 29.3%, p = 0.0001) compared to those who didn't receive prophylaxis. Those who received levofloxacin prophylaxis presented a similar frequency of clinically diagnosed but a lower proportion of microbiologically documented infections (28.8% vs. 37.5%, p = 0.012) than those who didn't receive prophylaxis. The episodes of bacteremia that occurred in the first group were more frequently caused by multidrug resistant bacteria (MDRB) (34.5% vs. 17.3%, p = 0.007) and by extended spectrum beta lactamase producing Enterobacteriaceae (19% vs. 3.8%, p = 0.0001). The group that received prophylaxis had a lower proportion of adequate empirical antibiotic treatment (69.7% vs. 83.7%, p = 0.009), with similar outcomes in both groups. We suggest that levofloxacin prophylaxis should be stopped whenever there is a rise in the frequency of MDRB infections in this population.

[Influenza and pneumococcal immunization in cardiovascular prevention]. / Inmunización para influenza y neumococo en prevención cardiovascular.

A group of interdisciplinary experts (cardiologists, clinicians, infectologists met with the purpose of analyzing the evidence revealed by the relationship between respiratory diseases caused by influenza, pneumococcal diseases and cardiovascular events, and the role played by immunization strategies applied in cardiovascular prevention. The present statement summarizes the conclusions reached by the expertise of the aforementioned professionals. Systematic revisions imply consistent evidence that influenza and pneumococcal infection lead to acute myocardial infarction and cardiovascular death. Studies published during the last 15 years suggest that vaccination against influenza and S. pneumoniae reduce the risk of acute coronary syndromes. With the current evidence, and considering cost-effectiveness, reducing operating expenses and safety profile of the vaccines, scientific societies, national and international government health agencies strongly recommend incorporating immunization programs in those patients with chronic cardiovascular disease.

Letermovir Primary Cytomegalovirus Prophylaxis in Allogeneic Hematopoietic Cell Transplant Recipients: Real-Life Data from a University Hospital in Argentina.

Background: Cytomegalovirus (CMV) infection remains the most common clinically significant infection after allogeneic hematopoietic stem cell transplantation (allo-HCT) and is associated with considerable morbidity and mortality. Objectives: The present study was designed to describe and compare the incidence of untreated CMV reactivation (uCMVr), clinically significant infection (cs-CMVi) and disease (CMVd), as well as CMV-related hospitalization and outcome of allo-HCT patients, either treated with letermovir (LET) primary prophylaxis or managed with preemptive therapy (PET). Methods: This is a prospective observational cohort study of adult CMV seropositive allo-HCT patients who either received primary prophylaxis with LET within the first 100 days after HCT or were managed with PET. Results: The study population comprised 105 patients (28 in the LET group and 77 in the PET group). Compared to the PET group, patients in the LET group received more allo-HCT from alternative donors (54.5% vs. 82.14%, P=0.012). More than half of the patients in both groups were classified as high risk for CMVd. In the LET vs. PET group, cs-CMVi and CMVd developed respectively in 0 vs. 50 (64.94%), P=<0.0001, and 0 vs. 6 (7.79%), P=0.18. In the LET group, uCMVr occurred in 5 (17.8%) and were all considered blips. Hospital admissions related to cs-CMVi or CMVd in the PET group vs. LET group were 47 (61.04%) vs. 0, respectively, P=<0.0001. No differences were observed in 100-day mortality. Conclusions: LET primary prophylaxis proved effective in preventing cs-CMVi and CMVd and reducing hospitalizations in allo-HCT adults. Blips can occur during prophylaxis and do not require LET discontinuation.

Establishing priorities to strengthen National Immunization Technical Advisory Groups in Latin America and the Caribbean.

Following the COVID-19 pandemic, the Americas faced a significant decline in vaccination coverage as well as increased vaccine hesitancy. The objective of this paper is to summarize the challenges and opportunities outlined by the National Immunization Technical Advisory Groups (NITAGs) in Latin America and the Caribbean (LAC) and prioritize targeted interventions. The exploratory survey included open-ended questions on two primary components: challenges, and opportunities. Free-text comments presented by each NITAG were collated and classified using indicators and sub-indicators of the NITAG Maturity Assessment Tool (NMAT). Opportunities were classified thematically, and priority actions were generated from the responses. All 21 NITAGs in LAC, representing 40 countries, 76 % of which have been active for over a decade, responded to the survey. The most common challenges were establishment and composition (62 %), integration into policymaking (62 %), resources and secretariat (52 %), and stakeholder recognition (48 %). The distribution of responses was seen across the whole sample and did not suggest a more pronounced need in relation to year of establishment. Opportunities included maximizing the Regional NITAG Network of the Americas (RNA) to facilitate collaboration, information sharing, visibility, and communication; existing global, regional, and systemic analyses; the World Health Organization/Pan American Health Organization (WHO/PAHO) templates for standard operating procedures; twinning programs with mature NITAGs; and NITAGs in governance structures. Action plans were outlined to formalize the establishment of NITAGs and broaden their composition; strengthen decision-making and access to data resources; and enhance the credibility of evidence-based recommendations and their uptake by policymakers and the public. NITAG challenges are not unique to LAC. NITAGs have outlined a short-term prioritized action plan which is critical to enhancing NITAG value and importance in countries.

Influenza among the elderly in the Americas: a consensus statement.

Influenza exacts a heavy burden on the elderly, a segment of the population that is estimated to experience rapid growth in the near future. In the past decade most developed and several developing countries have recommended influenza vaccination for those > 65 years of age. The World Health Organization (WHO) set a goal of 75% influenza vaccination coverage among the elderly by 2010, but it was not achieved. In 2011, the Technical Advisory Group at the Pan American Health Organization, Regional Office of WHO for the Americas, reiterated the influenza vaccine recommendation for older adults. Relatively little information has been compiled on the immunological aspect of aging or on reducing its impact, information particularly relevant for clinicians and gerontologist with firsthand experience confronting its effects. To fill this data gap, in 2012 the Americas Health Foundation (Washington, D.C., United States) and the nonprofit, Fighting Infectious Diseases in Emerging Countries (Miami, Florida, United States), convened a panel of Latin American clinicians and gerontologists with expertise in influenza to discuss key issues and develop a consensus statement. The major recommendations were to improve influenza surveillance throughout Latin America so that its impact can be quantified; and to conduct laboratory confirmation of influenza for all patients who have flu-like symptoms and are frail, immunosuppressed, have comorbidities, are respiratory compromised, or have been admitted to a hospital. The panel also noted that: since evidence for antivirals in the elderly is unclear, their use should be handled on a case-by-case basis; despite decreased immunological response, influenza vaccination in older adults is still crucial; indirect immunization strategies should be encouraged; and traditional infection control measures are essential in long-term care facilities.

Short Course of Antibiotic Therapy for Gram-Negative Bacilli Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation: Less Is Possible.

Data about short courses of antibiotic therapy for Gram-negative bacilli (GNB) bacteremia in immunosuppressed patients are limited. This is a prospective observational study performed on adult patients with cancer and hematopoietic stem cell transplant (HSCT) who developed GNB bacteremia and received appropriate empirical antibiotic therapy (EAT), had a clinical response within 7 days and survived 48 h after the end of therapy. They received antibiotic therapy in the range of 7-15 days and were divided into short course, with a median of 7 days (SC), or long course, with a median of 14 days (LC). Seventy-four patients were included (SC: 36 and LC: 38). No differences were observed in baseline characteristics or in the presence of neutropenia: 58.3% vs. 60.5% (p = 0.84). Clinical presentation and microbiological characteristics were similar in SC and LC, respectively: clinical source of bacteremia 72.2% vs. 76.3% (p = 0.68); shock 2.8% vs. 10.5% (p = 0.35) and multidrug-resistant GNB 27.8% vs. 21.1% (p = 0.50). Overall, mortality was 2.8% vs. 7.9% (p = 0.61), and bacteremia relapse was 2.8% vs. 0 (p = 0.30). The length of hospitalization since bacteremia was 7 days (interquartile range (IQR), 6-15) for SC and 12 days (IQR, 7-19) (p = 0.021) for LC. In the case of patients with cancer or HSCT and GNB bacteremia who receive appropriate EAT with clinical response, 7 days of antibiotic therapy might be adequate.

[Human monkeypox: epidemiological and clinical characteristics of a series of cases]. / Viruela símica humana: características epidemiológicas y clínicas de una serie de casos.

INTRODUCTION: Monkeypox It is a zoonotic disease. The etiologic agent is the monkeypox virus. Since January 1, 2022, monkeypox cases have been reported to the World Health Organization (WHO) in 110 Member States across 6 WHO regions. METHODS: The present work is a descriptive-observational-retrospective cohort in the first instance, and prospective at the end, where the epidemiological characteristics, clinical presentation and complications collected by telephone call on day 28, are described 75 patients diagnosed with monkeypox, confirmed by RT-PCR (corresponding to 7% of the cases reported in Argentina). It was developed between July 12, 2022 and October 6, 2022. RESULTS: The affected population was entirely cisgender men, 70 (93.3%) identified as men who have sex with men (MSM). Fifty-one (68%) were co-infected with HIV, 50 (98%) were receiving ART. All patients presented mucocutaneous manifestations. The rash manifested with a variety of lesions: papular, vesicular, and pustular. In 26 (44.1%) the systemic symptoms presented prior to the appearance of the rash, being the increase in body temperature the most frequent. Thirty-four (45.3%) of the patients reported some complication, with proctitis being the most frequent followed by penile edema. Sequelae were observed in 40 (53.3%), the most frequent being skin scars. CONCLUSION: In this case series we were able to observe mostly mild symptoms, with anogenital lesions being the most frequent clinical presentation. The presence of sequelae, the social and emotional impact of this disease make a multidisciplinary approach necessary.

Introducción: Es una enfermedad zoonótica cuyo agente etiológico es el virus de la viruela símica. Desde el 1 de enero de 2022, se han notificado casos de viruela símica a la Organización Mundial de la Salud (OMS) en 110 Estados Miembros en las 6 regiones de la OMS. Métodos: El presente trabajo es un estudio observacional descriptivo de cohorte retrospectivo en primera instancia, y prospectivo al final, donde se describen las características epidemiológicas, la presentación clínica, y las complicaciones recabadas mediante llamado telefónico al día 28 en 75 pacientes con diagnóstico de viruela símica confirmado por RT-PCR (correspondientes al 7% de los casos notificados en Argentina). Fue desarrollado entre el 12 de julio de 2022 y el 6 de octubre de 2022. Resultados: La población afectada fue en su totalidad hombres cisgénero, 70 (93.3%) identificados como hombres que tienen sexo con hombres (HSH). Cincuenta y uno (68%) estaban coinfectados con HIV, 50 (98%) estaban recibiendo TARV. Todos los pacientes presentaron manifestaciones mucocutáneas. El exantema se manifestó con variedad de lesiones: papulares, vesiculares y pustulosas. En 26 (44.1%) los síntomas sistémicos se presentaron previos a la aparición del exantema, siendo el aumento de la temperatura corporal el más frecuente. Treinta y cuatro (45.3%) de los pacientes reportaron alguna complicación, siendo la proctitis la más frecuente seguida por edema de pene. Se observaron secuelas en 40 (53.3%), siendo la más frecuente las cicatrices cutáneas. Conclusión: En esta serie de casos pudimos observar mayormente cuadros leves, siendo las lesiones anogenitales la presentación clínica más frecuente. La presencia de secuelas, el impacto social y emocional de esta enfermedad hacen necesario un enfoque multidisciplinario.

Opinions, Attitudes and Factors Related to SARS-CoV-2 Vaccine Uptake in Eight South American Countries.

This article presents attitudes and practices regarding COVID-19 vaccination in the South American population. The study collected data from a self-administered survey distributed through social media platforms between February and April 2022 (N = 6555). The survey included questions related to participants' sociodemographic background, flu vaccination practices, sources of information about COVID-19, and opinions regarding pandemic management and vaccination against SARS-CoV-2. The respondents agreed with the statement that COVID-19 vaccines were necessary (86.4%), effective (79.8%), safe (79.1%), and should be mandatory (64%). Overall, 83.4% accepted vaccination and 12.3% refused it completely. Main rejection reasons were safety (65.8%) and efficacy (54.9%) issues, and rushed development and approvals (49.1%). Vaccine uptake was associated with being ≥60 years, being a healthcare worker, previous influenza vaccine uptake, adherence to preventive measures, the death of ≥1 close people from COVID-19, and being informed through mass media or health authorities' channels. Vaccine uptake inversely correlated with male gender, low educational level, and use of closed social networks for COVID-19 information purposes. This study provides valuable insights into COVID-19 vaccination attitudes and practices in South America that may be used to promote vaccine uptake in the region. Higher COVID-19 vaccination acceptance among people with previously acquired prevention habits reinforces the importance of routine health promotion strategies.

Influenza among adults in Latin America, current status, and future directions: a consensus statement.

In Latin America, adult influenza is a serious disease that exacts a heavy burden in terms of morbidity, mortality, and cost. Although much has been written about the disease itself, relatively little information has been compiled on what could be done to reduce its impact across the region, particularly from the perspective of clinicians with first-hand experience in confronting its effects. To fill this data gap, in 2011, the Pan American Health and Education Foundation (PAHEF) and the U.S.-based nonprofit Fighting Infectious Diseases in Emerging Countries (FIDEC) organized a conference and convened a panel of Latin American scientist-clinicians with experience and expertise in adult influenza in the region tol) discuss the major issues related to the disease and 2) develop and produce a consensus statement summarizing its impact as well as current efforts to diagnose, prevent, and treat it. The consensus panel concluded a more concerted and better-coordinated effort was needed to reduce the adverse impact of seasonal influenza and future pandemics, including more surveillance, more active involvement by both governmental and nongovernmental organizations, and a much greater effort to vaccinate more adults, especially those at high risk of contracting the disease. In addition, a new approach for diagnosing influenza was recommended.

Outbreak of Klebsiella pneumoniae ST11 Resistant To Ceftazidime-Avibactam Producing KPC-31 and the Novel Variant KPC-115 during COVID-19 Pandemic in Argentina.

We describe an outbreak of Klebsiella pneumoniae sequence type 11 (ST11) producing KPC variants resistant to ceftazidime-avibactam. Six patients hospitalized in the intensive care unit (mostly due to critical COVID pneumonia) presented infection or colonization by this bacterium. They had several comorbidities and required mechanical ventilation, central venous catheters, and urinary catheters. All 6 patients had a history of fecal colonization with KPC-producing Enterobacterales (KPC-E). Three of them had previous episodes of infection with ceftazidime-avibactam-susceptible KPC-producing K. pneumoniae, which were treated with ceftazidime-avibactam. Several phenotypic methods failed to detect carbapenemase production in these 6 ceftazidime-avibactam-resistant isolates, and they showed in vitro susceptibility to imipenem and meropenem. All of them rendered positive results for blaKPC by PCR, and amplicon sequencing identified blaKPC-31 variant in 5 isolates and a novel variant, named blaKPC-115, in the other. Moreover, matrix-assisted laser desorption ionization-time of flight mass spectrometry was able to detect KPC in all isolates. Ceftazidime-avibactam-resistant isolates, as well as those recovered from previous infection episodes (KPC-3-producing K. pneumoniae, ceftazidime-avibactam susceptible), displayed a unique pulse type and belonged to ST11. Based on whole-genome sequencing results of selected isolates, less than 7 single-nucleotide polymorphisms were identified among them, which was indicative of the presence of a unique clone. Both in vivo selection and horizontal transmission seemed to have occurred in our hospital. Detection of these strains is challenging for the laboratory. History of previous KPC-E infections or colonization and systematic testing for resistance to ceftazidime-avibactam might help raise awareness of this possibility. IMPORTANCE Klebsiella pneumoniae is one of the main bacteria that cause infections in health care settings. This pathogen has developed a high level of resistance to many antibiotics. Some K. pneumoniae isolates can produce an enzyme known as carbapenemase KPC, making carbapenems (considered the last line for therapy) not effective to treat their infections. The combination ceftazidime-avibactam, approved by FDA in 2015, is useful to treat infections caused by KPC-producing K. pneumoniae. This study describes the emergence, in one hospital in Argentina, of K. pneumoniae isolates that produce KPC variants (KPC-31 and KPC-115) resistant to ceftazidime-avibactam. The ceftazidime-avibactam-resistant bacteria were isolated in inpatients, including some that previously received this combination as treatment. Transmission of this strain to other patients also occurred in the studied period. Detection of these bacteria is challenging for the laboratory. The knowledge and awareness of the emergence of this pathogen in our region are highly valuable.

A simplified alternative diagnostic algorithm for SARS-CoV-2 suspected symptomatic patients and confirmed close contacts (asymptomatic): A consensus of Latin American experts.

INTRODUCTION: Latin America accounts for one-quarter of global COVID-19 cases and one-third of deaths. Inequalities in the region lead to barriers to the best use of diagnostic tests during the pandemic. There is a need for simplified guidelines that consider the region's limited health resources, international guidelines, medical literature, and local expertise. METHODS: Using a modified Delphi method, 9 experts from Latin American countries developed a simplified algorithm for COVID-19 diagnosis on the basis of their answers to 24 questions related to diagnostic settings, and discussion of the literature and their experiences. RESULTS: The algorithm considers 3 timeframes (≤7 days, 8-13 days, and ≥14 days) and presents diagnostic options for each. SARS-CoV-2 real- time reverse transcription-polymerase chain reaction is the test of choice from day 1 to 14 after symptom onset or close contact, although antigen testing may be used in specific circumstances, from day 5 to 7. Antibody assays may be used for confirmation, usually after day 14; however, if clinical suspicion is very high, but other tests are negative, these assays may be used as an adjunct to decision-making from day 8 to 13. CONCLUSION: The proposed algorithm aims to support COVID-19 diagnosis decision-making in Latin America.

Healthcare personnel infected with novel influenza A H1N1 virus in university hospitals in Buenos Aires, Argentina.

Data on the clinical presentation, risk factors, and outcomes for healthcare personnel (HCP) infected with influenza A H1N1 virus (H1N1) are limited. From June to July 2009, a prospective study was conducted among HCP with influenza-like illness (ILI) at university hospitals in Buenos Aires. A reverse transcription polymerase chain reaction (RT-PCR) was used to diagnose H1N1. A logistic regression model was developed to identify factors associated with H1N1. Among 1519 HCP, 96 (6.3%) were diagnosed with an ILI. Of these, 85 (88.5%) were swabbed for H1N1 detection, with 43 positive cases (2.8%). Seasonal influenza immunization was recorded in 76%. Comparison of H1N1-positive vs. H1N1-negative cases showed that H1N1-positive cases more frequently had asthenia (72% vs. 48%, p = 0.03) and cough (79% vs. 43%, p = 0.008) and less frequently had diarrhoea (9% vs. 29%, p = 0.03) and prior prophylaxis with oseltamivir (5% vs. 31%, p = 0.002). The logistic regression model showed that presence of cough (odds ratio (OR) 6.93, 95% confidence interval (CI) 2.24, 21.4) was associated with an increased risk of H1N1. Prior prophylaxis with oseltamivir (OR 0.08, 95% CI 0.01, 0.43) was associated with a lower probability of H1N1 infection. A high proportion of HCP with an ILI were infected with H1N1. Complication rates were relatively low. Prior prophylaxis with oseltamivir was associated with a lower risk of developing H1N1.

Chronic recurrent vulvovaginitis is not only due to Candida.

BACKGROUND: Recurrent vulvovaginitis is a growing problem that affects millions of women worldwide. In many cases it is treated as vulvovaginal candidiasis, but there is not always microbiological confirmation. AIMS: To determine the etiology of vulvovaginitis in a group of patients. METHODS: This is a cross-sectional study in which the data from the medical records of 316 adult patients who consulted for vulvovaginitis were analyzed. Eighty nine percent of the cases had already suffered previous episodes. RESULTS: The median age was 34 (265 patients were between 16 and 45 years old). Yeasts were isolated in culture from 211 (66.8%) patients, although pseudo-hyphae and yeasts were observed in only 166 samples (52.5%) in the direct microscopic examination. Multiple predisposing factors were found, among which the use of contraceptives or previous antibiotics stand out. Most of the patients (almost 90%) had been treated with antifungals, with or without microbiological confirmation. Candida albicans was isolated in 187 (88.6%) patients, followed by Candida glabrata in 6 (2.8%) patients. Association with bacterial vaginosis was found in 35.1% and with intermediate bacterial microbiota in 33.2% of the cases. A remarkably high proportion of C. albicans isolates resistant to fluconazole (80.1%) and itraconazole (58.8%) was found. CONCLUSIONS: A microbiological analysis is essential to confirm the diagnosis of vulvovaginal candidiasis, whether simple, complicated, or recurrent. Identifying the isolated yeast species and determining its susceptibility to antifungal agents are particularly important.

[SARS-COV-2 infection in patients with hematological malignancies and transplants]. / Infección por SARS-CoV-2 en pacientes con neoplasias hematológicas y trasplantes.

SARS-CoV-2 infection in patients with hematological malignancies and hematopoietic stem cell transplants (HSCT) can be severe and with significant mortality. We carried out a prospective and observational study to describe the clinical and epidemiological characteristics and outcome of SARS-CoV-2 infection in patients with hematological malignancies and HSCT. Twenty adult patients were included with a median age of 58 years and a median Charlson score of 3. Infections were community-acquired and nosocomial in 60% and 40%, respectively, and 30% of the patients had a history of contact with a SARS-CoV-2 infected person. Sixty-five percent had pulmonary infiltrates, mostly with a ground-glass pattern on CT scan. Almost half of the patients had a severe and critical illness, and a high proportion received convalescent plasma as treatment. Twenty percent and 15% had complications and hospital infections, respectively, and had prolonged hospitalization expressed as median days of it. The 30-day mortality was 10%. SARS-CoV-2 infection in our population had a considerable clinical and epidemiological impact.

La infección por SARS-CoV-2 en pacientes con neoplasias hematológicas y trasplantes de células progenitoras hematopoyéticas (TCPH) puede ser grave y con importante mortalidad. Llevamos a cabo un estudio prospectivo y observacional que tuvo como objetivo describir las características clínicas, epidemiológicas y la evolución de la infección por SARS-CoV-2 en pacientes con neoplasias hematológicas y TCPH. Se incluyeron 20 pacientes adultos con una mediana de edad de 58 años y una mediana de score de Charlson de 3. Las infecciones fueron de adquisición comunitaria y nosocomial en el 60% y 40% respectivamente, y el 30% de los pacientes tenía antecedente de contacto con una persona infectada por SARS-CoV-2. El 65% presentó infiltrados pulmonares, mayormente con patrón de vidrio esmerilado en la tomografía computarizada de tórax. Casi la mitad de los pacientes tuvo enfermedad grave y crítica, y una alta proporción recibió plasma de convalecientes como tratamiento. Presentaron complicaciones e infecciones hospitalarias el 20% y 15% respectivamente, y tuvieron una mediana de días de internación prolongada. La mortalidad a 30 días fue del 10%. La infección por SARS-CoV-2 en nuestra población tuvo considerable impacto clínico y epidemiológico.

[Incidence, clinical characteristic and evolution of Clostridioides difficile infection]. / Incidencia, características clínicas y evolución de la infección por Clostridioides difficile.

Clostridioides difficile infection (CDi) is one of the foremost hospital-acquired infections. We present an observational study aimed to describe the incidence, epidemiology, and clinical outcome of CDi in a tertiary university hospital in Buenos Aires. The episodes, diagnosed in 117 consecutive adult patients in the period 01/01/2017 to 01/04/2020, were distributed in three groups: 63 (53.9%) were classified as hospital-acquired infections (HA), 25 (21.4%) as community onset-health care-associated infections (CO-HCA) and 29 (24.8%) as community-associated infections (CA). The incidence of HA CDi infections was 3.1, 5. 2 and 2.8 every 10 000 patient days in 2017, 2018 and 2019, respectively. The microbiological diagnosis was made by immunochromatography with antigen GDH and C. difficile toxin positive in 51 episodes (43.6%) and by GDH positive, toxin negative and PCR positive in 66 episodes (56.4%). Older age (p = 0.018), chronic kidney disease (p = 0.013), immunosuppression (p = 0.021), and higher comorbidity Charlson score (p = 0.001) were observed in patients with IH and CA-HCA infections. No significant differences in clinical features were found among groups. During the hospital st ay, 13 patients (11.1%) required admission to the intensive care unit. Ten recurrences occurred, representing 8.5% of CDI episodes. The 90-day mortality was 19.8%, being significantly higher in HA and CO-HCA infections (p = 0.014). Our findings highlight both the local burden of CDi morbidity and mortality and the need for the implementation of preventive strategies.

La infección por Clostridioides difficile (ICD) es una de las más importantes infecciones intrahospitalarias. Se realizó un estudio observacional que describe la incidencia, las características epidemiológicas y la evolución clínica de la ICD en un hospital universitario de la Ciudad de Buenos Aires. Los episodios, diagnosticados en 117 pacientes adultos consecutivos entre el 01/01/2017 y el 01/04/2020, fueron clasificados en ICD intrahospitalaria (IH) en 63 (53.9%), de inicio comunitario y asociada al ámbito de la salud (ICAAS) en 25 (21.4%) y comunitaria (CO) en 29 (24.8%) pacientes. La incidencia de ICD IH fue 3.1, 5.2 y 2.8 cada 10 000 días paciente en 2017, 2018 y 2019, respectivamente. El diagnóstico microbiológico se realizó mediante inmunocromatografía con glutamato deshidrogenasa y toxina positivas en 51 (43.6%) y mediante glutamato deshidrogenasa positiva, toxina negativa y PCR positiva en 66 (56.4%). Los pacientes con ICD IH e ICAAS presentaron mayor edad (p = 0.018), mayor frecuencia de insuficiencia renal crónica (p = 0.013) e inmunosupresión (p = 0.021) y mayor puntaje en índice Charlson de comorbilidad (p = 0.001). No hubo diferencia significativa en la forma de presentación clínica entre los tres grupos. Durante la evolución de la ICD, 13 (11.1%) pacientes requirieron internación en terapia intensiva. Se registraron 10 recurrencias, que correspondieron al 8.5% de los episodios de ICD. La mortalidad a los 90 días fue 19.8%, significativamente mayor en los pacientes con ICD IH e ICAAS (p = 0.014). Estos hallazgos destacan la considerable carga de morbilidad de la ICD y la necesidad de implementar estrategias preventivas.

Algorithms for testing COVID-19 focused on use of RT-PCR and high-affinity serological testing: A consensus statement from a panel of Latin American experts.

The COVID-19 pandemic has caused an unprecedented public health, social, and economic crisis. Improving understanding on available tests for detecting COVID-19 is critical for effective management of the pandemic. We proposed that a multidisciplinary expert panel can establish recommendations on ideal use of diagnostic tools, with a focus on RT-PCR and serological high-affinity antibodies (both IgM and IgG) tests for the Latin America region. STUDY DESIGN: A collaborative multidisciplinary panel of 5 recognized experts in Latin America (an infectious disease specialist, three pathologists, and an immunologist) was convened and supported by Roche Diagnostics to develop standard guidelines and an evidence-based document of best practices on the use of diagnostic tools for COVID-19. RESULTS: The authors reached consensus on the applicability of diagnostic tools to provide testing algorithms for the use of RT-PCR and serological high-affinity antibodies (both IgM and IgG) tests in three settings: 1) For asymptomatic subjects exposed to a SARS-CoV-2 infected person; 2) For epidemiological purposes and; 3) For symptomatic subjects. CONCLUSION: The serological high-affinity SARS-CoV-2 antibodies (both IgM and IgG) tests play a key role in COVID-19 diagnosis. These tests can be applied for suspected false-negative RT-PCR results and for individual determination of response. The use of these tests can also contribute greatly to public health strategies, such as population screening and supporting vaccination planning. Serological status for high-affinity antibodies (both IgM and IgG) should be performed ideally 21 days after potential infectious contact, given that the majority of exposed individuals will have seroconverted.

A global agenda for older adult immunization in the COVID-19 era: A roadmap for action.

Given our global interconnectedness, the COVID-19 pandemic highlights the urgency of building a global system that can support both routine and pandemic/epidemic adult immunization. As such, a framework to recommend vaccines and build robust platforms to deliver them to protect the rapidly expanding demographic of older adults is needed. Adult immunization as a strategy has the broad potential to preserve and improve medical, social, and economic outcomes, including maintaining functional ability that benefits older adults, their families, communities, and countries. While we will soon have multiple vaccines against COVID-19, we must recognize that we already have a variety of vaccines against other pathogens that can keep adults healthier. They can prevent simultaneous co-infection with COVID-19, and may favorably impact- the outcome of a COVID-19 illness. Further, administering a vaccine against COVID-19 requires planning now to determine delivery strategies impacting how older adults will be immunized in a timely manner. A group of international experts with various backgrounds from health and aging disciplines met to discuss the evidence case for adult immunization and crucial knowledge gaps that must be filled in order to implement effective policies and programs for older adult immunization. This group, coming together as the International Council on Adult Immunization (ICAI), outlined a high-level roadmap to catalyze action, provide policy guidance, and envision a global adult immunization platform that can be adapted by countries to fit their local contexts. Further meetings centered around the value of adult immunization, particularly in the context of COVID-19. There was agreement that programs to deliver existing influenza, pneumococcal, herpes zoster vaccines, and future COVID-19 vaccines to over a billion older adults who are at substantially higher risk of death and disability due to vaccine-preventable diseases are more urgent than ever before. Here we present a proposed framework for delivering routine and pandemic vaccines. We call upon the global community and governments to prioritize action for integrating robust adult immunization programs into the public health agenda.

Pandemic (H1N1) 2009 cases, Buenos Aires, Argentina.

To determine clinical and virologic characteristics of pandemic (H1N1) 2009 in Buenos Aires, Argentina, we conducted real-time reverse transcription-PCR on samples from patients with influenza-like illness, June 11-30, 2009. Of 513 patients tested, 54% were positive for influenza virus subtype H1N1. Infection rate was lowest for patients >or=60 years of age.