Le infezioni in medicina最新文献

The therapeutic armamentarium that has been made available from the beginning of the emergency phase of the COVID-19 pandemic to date is briefly reviewed, and an overview of the real-world clinical evidence published by the Italian medical and scientific community during the last three years is presented herein. Prior to the introduction of a vaccine for SARS-CoV-2, several treatment options were implemented from the onset given the evidence that a "cytokine storm" was present during infection with SARS-CoV-2. However, with the exception of tocilizumab, baricitinib and perhaps anakinra, most studies with anti-cytokine biological agents in patients with severe COVID-19 did not show any significant clinical improvement or decrease in mortality at day 28. The same is true of several repurposed drugs including ivermectin, lactoferrin, interferon ß-1a, lopinavir/ritonavir alone or combined with hydroxychloroquine, and darunavir/ cobicistat, which did not show any benefits in clinical status or mortality. Treatment with neutralizing monoclonal antibodies (mAbs) for COVID-19 is changing continually with the evolution of new viral variants. In Italy, current indications for treatment of COVID-19 outpatients underline that the use of specific mAbs may vary over time depending on the prevalent SARS-CoV-2 variant and the sensitivity to the different mAbs available. Three antiviral drugs against SARS-CoV-2 were studied extensively and initially available in Italy: remdesivir, molnupiravir, and nirmaltrelvir/ritonavir, but at present the latter is the only oral antiviral for SARS-CoV-2 available in Italy. Several real-world studies for the use of nirmatrelvir/ ritonavir in the Italian population have been published. Among the current unmet needs, a clear and universal definition for long COVID along with treatments and prevention are still lacking as is clarity of the pathogenetic mechanisms responsible for it.

Background: Scrub typhus, a mite-borne infection caused by Orientia tsutsugamushi, is endemic in South and Southeast Asia, including India. Although increasing awareness and improved healthcare access have reduced mortality, the disease remains a significant public health concern. Kerala, a southern Indian state, has reported scrub typhus cases for decades; however, comprehensive data on its clinical profile and severity indicators are limited. This study aimed to describe the clinical characteristics of scrub typhus and identify predictors of intensive care unit (ICU) admission.

Methods: A retrospective study was conducted on scrub typhus cases diagnosed at KIMSHEALTH, Thiruvananthapuram, India, from 2015 to 2021 using electronic medical records (EMR). Scrub typhus was defined as an acute febrile disease with positive IgM ELISA. Patients with other diagnoses explaining the febrile illness or those with incomplete data were excluded. Demographic characteristics, clinical features, laboratory findings, and patient outcomes were analyzed. ICU admission was the primary outcome. Binary logistic regression was used to identify independent predictors of ICU admission.

Results: A total of 241 patients were included in the study, of whom 74 (30.7%) required ICU admission. Most cases occurred between September and January, with a peak in December. The median age was 45 years (IQR: 24.5-60.5), and 122 (50.6%) were female. Fever lasting >7 days was present in 46.1% of patients. Common symptoms included headache (38.2%), myalgia (37.3%), vomiting (31.5%), and breathlessness (19.5%). Hepatomegaly and splenomegaly were observed in 33.2% and 28.6% of cases, respectively, while eschar was noted in 20.3%. Most patients received doxycycline (82.6%), with some receiving azithromycin (7.1%) or both (10.4%). In multivariable analysis using binary logistic regression, altered sensorium (adjusted odds ratio [aOR]: 6.63, 95% CI: 1.83-24.12, p=0.004) and breathlessness (aOR: 5.02, 95% CI: 2.31-10.90, p<0.001) were independent predictors of ICU admission.

Conclusions: Scrub typhus in Kerala exhibits seasonal variation, peaking from September to January. Breathlessness and altered sensorium present at admission were the strongest predictors of ICU admission The lower mortality in our study (2.1%) compared to national estimates may be attributed to improved healthcare access, early diagnosis, and prompt treatment. Further multicenter prospective studies are needed to validate these findings and improve risk stratification for severe disease.

Introduction: Dengue is a mosquito-borne viral disease. It has been associated with high maternal and foetal morbidity and mortality. Therefore, this study aimed to describe the outcomes of Dengue infection in pregnant women in terms of maternal bleeding, miscarriage, preterm delivery, severe Dengue, Dengue shock and maternal mortality, as well as foetal outcomes in terms of foetal distress, low birth weight and neonatal mortality.

Methods: This systematic review followed PRISMA guidelines and was PROSPERO-registered (CRD42024578212). It examined publications from 2019-2024 across major databases, including Medline, Scopus, Web of Science, Scielo, and CENTRAL. The selection process utilised Rayyan AI^® for duplicate removal, followed by a two-reviewer screening system. The two reviewers initially filtered the papers by title and, then, by abstract; finally, they read the full text and chose the articles to synthesise. The same two reviewers performed data extraction independently using a Microsoft Excel^® matrix. For the risk of bias assessment and Quality evaluation, the ROBINS-E tool and the STROBE guidelines were employed.

Results: Maternal Dengue was associated with an increased risk of preterm delivery and complications such as obstetric bleeding, especially postpartum haemorrhage, which was a complication that reached proportions of up to 25% in some studies. Severe Dengue and Dengue shock were also complications present in these women; thrombocytopenia was the most common sign, and complications such as pre-eclampsia and multi-organ dysfunction appeared, leading to fatal outcomes such as maternal and foetal mortality.

Conclusions: Dengue infection during gestation carries significant maternal health risks, including complications such as bleeding, miscarriage and preterm delivery. In addition, it is associated with foetal distress and low birth weight, as well as increased foetal and neonatal mortality, highlighting the need for vigilance and appropriate medical care.

Introduction: Insects and the diseases that they are capable to host have played a crucial role in the outcome of major military operations throughout recorded history. As a matter of fact, regular armies had to fight both against enemy uniform and invisible pathogens; the latter often causing battle casualties more disabling than bullets.

Methods: All the sources present on Pubmed and Google Scholar relating to the fight against Bartonella quintana and Rickettsia prowazeki in the military field during the first and second world wars were studied, with particular attention to the articles published during the wars. The sources were then processed in a historical-medical perspective.

Results: First World War (WWI) was a position war also if considering the fight between humans against louse; with the latter being controlled by rudimentary but science-driven hygienic measures. Contrary, during Second World War (WWII) human forces, thanks to new research and development attainments, have gone on the counter-offensive by "shooting flights with cannons".

Conclusions: The fascinating history of Bartonella quintana and Rickettsia prowazekii tells us that the war against armies could mirror the war against infectious diseases and their arthropod vectors.

We report a rare clinical presentation of a 54-year-old male diagnosed with infective endocarditis caused by Granulicatella elegans, a nutritionally variant streptococcus (NVS) characterized by unique growth requirements and high pathogenic potential. The patient presented with prolonged fever and residual hemiparesis following an ischemic stroke. Blood culture confirmed Granulicatella elegans, and imaging identified vegetations on a bicuspid aortic valve. Despite prompt antibiotic therapy, the course was complicated by acute intraventricular hemorrhage (IVH) and hydrocephalus, culminating in a fatal outcome. This report underscores the pathogenic challenges posed by Granulicatella elegans, highlights its catastrophic complications, and reviews its presentation and management in the context of existing literature and emphasizing the importance of prompt diagnosis, tailored antibiotic therapy, and vigilant monitoring.

The first highly pathogenic H5N1 emerged in 1959 on a chicken farm in Scotland. The ancestor of the strains presently circulating was isolated in 1996 from a domestic goose in China. Since 1997, more than 900 severe human infections have been reported. However, in nearly thirty years, H5N1 has failed to adapt to human-to-human transmission. At present the abundant circulation in various animal species, including mammals, increases the possibility of reassortments of new pandemic strains. Particularly alarming was the recent report of H5N1 infection among U.S. dairy cattle. A strong international effort from a global health perspective addressed to limit the avian strains circulation and to improve the preparedness for a new pandemic is urgently needed.

Background: Enterococci are the third most common cause of healthcare-associated infections in the United States, affecting 10-12% of all transplant recipients worldwide. Enterococcal bacteremia complicates the post-transplant recovery and raises mortality to 18%. This study aims to identify factors linked to mortality in hematopoietic stem cell transplant (HSCT) recipients with Enterococcus infection.

Methods: We conducted a retrospective analysis using the National Inpatient Sample Database (2018-2021). Adults treated with HSCT and admitted for Enterococcus infection were identified using ICD-10 codes. The analysis utilized descriptive statistics and multivariate regression, with significance at a p-value ≤0.05.

Results: A total of 40,462 HSCT patients, 1.3% were admitted with Enterococcus infection. The crude mortality rate was higher in the Enterococcus cohort than in the non-Enterococcus cohort (10.4% vs. 4.6%); however, the mortality risk was substantially lower in the Enterococcus cohort (p<0.001). In the Enterococcus cohort, patients with fungal infections, sepsis, acute respiratory failure, and those with invasive ventilation had a high mortality risk (p<0.05). In leukemia patients treated with HSCT, the Enterococcus cohort had higher mortality than the non-Enterococcus cohort (12.5% vs. 5.0%; aOR 1.8, 95% CI 1.9-2.6, p=0.005).

Conclusions: In HSCT recipients, Enterococcus infection is a clinical marker for poor prognosis. Early broad-spectrum antibiotic therapy is essential for patients with sepsis, respiratory compromise, and fungal co-infections. Additionally, a multidisciplinary team is crucial for managing respiratory and renal failure.

Introduction: The incidence of dengue and its complications increases globally, mainly in areas where it is endemic; however, little literature evaluates outcomes in kidney transplant recipients (KTR). The present analysis aimed to determine the incidence, signs and symptoms, and allograft dysfunction in dengue-infected KTR.

Methods: Systematic review of the literature following PRISMA 2020 indications with studies included until November 24, 2023.

Results: Of 309 articles found, seven full-text studies were identified for analysis. 4337 KTRs with 214 dengue cases were evaluated. The incidence of dengue was 4.93%, varying between geographic regions. The average age was 41.50 years, and 61.21% were men. A mortality of 7.01% was reported. The symptoms were fever 83.18%, arthralgia 19.46%, myalgia 43.24% and headache 34.18%. The proportions of febrile dengue, with warning signs and severe dengue, were 63.55%, 23.83% and 11.68%, respectively. Transplant dysfunction and loss occurred in 63.08% and 4.67%, respectively.

Conclusions: Although the global distribution of dengue in KTR is unknown, there is a variable incidence between geographical areas and study times in which the KTR are evaluated. There is a high incidence of febrile symptomatology and transplant dysfunction consistent with global cohorts for non-KTR and KTR patients, respectively. Dysfunction is a prevalent event in KTRs with dengue infection, so correct screening should be done for donors and transplant candidates.

Background: Fever following transcatheter aortic valve implantation (TAVI) poses a clinical challenge, necessitating a comprehensive diagnostic approach to discern between infectious and non-infectious origins. Despite its minimally invasive nature, TAVI disrupts protective anatomical barriers, leading to an increased risk of infection, as well as to aseptic inflammatory responses. Standardized strategies for the management of these patients are lacking.

Methods: We retrospectively analyzed 1074 consecutive patients. Data retrieved from electronic hospital charts included demographics, comorbidities, NYHA functional class, Multidimensional Prognostic Index (MPI), EUROSCORE II and STS risk score, pre- and post-procedural echocardiographic data, and procedural details. Fever was defined as temperature >37.5°C.

Results: Overall, 391 patients (36.4%) experienced at least one episode of fever, in all cases ensuing within the first 2 days after the procedure. Fever lasted only one day (ODF) in most patients (86%). Antibiotic prophylaxis varied, with cefazolin showing the highest efficacy. Management of post-TAVI fever was heterogeneous. Twenty-five percent of febrile patients received an empiric antibiotic therapy, although a presumed site of infection was identified in only 17% of them and just 19 patients (4.9%) had positive blood cultures. Of the 19 patients with positive cultures, 11 had a Gram+ and 8 a Gram-infection. Fever duration, invasive accesses, and clinical suspicion of infection influenced antibiotic initiation. Fever lasting more than one day (MODF) was associated with new-onset atrial fibrillation and prolonged in-hospital stay. Positive blood cultures were linked to higher mortality, especially with Gram-bacteremia. However, patients with short-term fever had a similar mortality to those without fever, highlighting the benign nature of self-limited fever.

Conclusions: Fever is a common complication after TAVI. A watchful waiting strategy is advisable in stable patients without evidence of infection and self-limited episodes of fever, while selected patients may benefit from an aggressive approach.

Syphilitic pneumonia is a rare secondary form of Treponema pallidum infection. In this article, we present a case of syphilitic pneumonia in a patient living with Human Immunodeficiency Virus (HIV) with good immune-virological status. We also performed a systematic review of literature and we found 43 cases of syphilitic pneumonia described since 1886. We added our case report and performed a statistical analysis. Our analysis showed that 40/44 (91%) were males, with a median age of 46 years old (IQR 37-56), 9/28 (32%) were people living with HIV (data not available for 16/44 patients), 17/27 (63%) had syphilitic-related hepatitis during the clinical presentation (data not available for 17/44 patients), and 28/42 (66.6%) of patients had maculopapular rash compatible with secondary forms (data not available for 2/42 patients). Furthermore, 74.4% of patients had nodular lesions on chest X-ray or pulmonary Computed Tomography scan. Given the high rate of nodular pneumonia among patients, clinicians should consider it as a common presentation in syphilitic pneumonia.