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Clinical pharmacology of the SingleTablet Regimen (STR) Bictegravir/Emtricitabine/Tenofovir Alafenamide (BIC/FTC/TAF). Bictegravir/Emtricitabine/替诺福韦Alafenamide单片方案(BIC/FTC/TAF)的临床药理学研究。
Q2 Medicine Pub Date : 2023-01-01 DOI: 10.53854/liim-3103-3
Giovanni Di Perri

In Italy a proportion of HIV patients exceeding 50% are diagnosed at advanced stages of disease. A sizeable proportion of patients under chronic HIV treatment has a story of poor adherence with archived resistance associated mutations, a condition implying some risks in case of treatment with dual regimens. Conventional three-drug regimens will remain necessary in the short-mid term, in order to avoid treatment failure and selection of drug resistance. Efficacy, tolerability, safety, genetic barrier, forgiveness and a good compatibility with concurrent medications are all features that describe the overall quality of BIC/FTC/TAF, a combination whose robustness will remain a point of reference for the next years.

在意大利,超过50%的艾滋病毒患者被诊断为疾病晚期。在接受慢性艾滋病毒治疗的患者中,相当大一部分患者的依从性较差,并伴有存档的耐药性相关突变,这意味着在采用双重方案治疗的情况下存在一些风险。为了避免治疗失败和选择耐药性,在中短期内仍然需要常规的三药方案。疗效、耐受性、安全性、遗传屏障、宽恕性以及与同时使用的药物的良好相容性都是描述BIC/FTC/TAF整体质量的特征,这一组合的稳健性将成为未来几年的参考点。
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引用次数: 0
Effects of COVID-19 pandemic on healthcare-associated infections, antibiotic resistance and consumption rates in intensive care units. COVID-19大流行对医疗保健相关感染、抗生素耐药性和重症监护病房使用率的影响
Q2 Medicine Pub Date : 2023-01-01 DOI: 10.53854/liim-3102-7
Uğur Önal, Ülkü Tüzemen, Esra Kazak, Neval Gençol, Esma Souleiman, Habibe İmer, Yasemin Heper, Emel Yılmaz, Cüneyt Özakın, Beyza Ener, Halıs Akalin

Purpose: This paper aimed to evaluate the effects of the COVID-19 pandemic on healthcare-associated infections (HAIs), antibiotic resistance and consumption rates in intensive care units (ICUs) of a tertiary care university hospital.

Patients and methods: Between 1 January 2018 and 31 December 2021, adult patients diagnosed with HAIs in ICUs were investigated retrospectively. Patients were divided into pre-pandemic (2018-2019) and pandemic periods (2020-2021). Antibiotic consumption index was calculated via using the formula of (total dose (grams)/defined daily dose (DDD) x total patient days) x1000. A p value below 0.05 was accepted as statistically significant.

Results: The incidence of HAIs (per 1000 patient days) in the ICU of COVID-19 patients was 16.59, while it was 13.42 in the other ICUs during the pandemic period (p=0.107). The bloodstream infection (BSI) incidence was 3.32 in the pre-pandemic period and 5.41 in the pandemic period in ICUs other than the ICU of COVID-19 patients (p<0.001). In the pandemic period, the BSI incidence rate was significantly higher in the ICU of COVID-19 patients than in the other ICUs (14.26 vs 5.41, p<0.001). Central venous catheter bloodstream infections incidence rate was 4.72 in the pre-pandemic and 7.52 in the pandemic period in ICUs other than the ICU of COVID-19 patients (p=0.0019). During the pandemic period, the bacteraemia episode rates of Acinetobacter baumannii (5.375 vs 0.984, p<0.001), Enterococcus spp. (1.635 vs 0.268, p<0.001) and Stenotrophomonas maltophilia (3.038 vs 1.297, p=0.0086) in the ICU of COVID-19 patients were significantly found higher than others. The extended-spectrum beta-lactamase (ESBL) positivity rates for Klebsiella pneumoniae and Escherichia coli were 61% and 42% in the pre-pandemic period; 73% and 69% in the pandemic period in ICUs other than the ICU of COVID-19 patients (p>0.05). In the pandemic period, the ESBL positivity rates for K. pneumoniae and E. coli were 83% and 100% in the ICU of COVID-19 patients, respectively. Meropenem (p<0.001), teicoplanin (p<0.001) and ceftriaxone (p<0.001) consumptions were increased while ciprofloxacin (p=0.003) consumption was decreased in all ICUs after the pre-pandemic period.

Conclusions: BSI and CVCBSI incidence rates were significantly increased in all ICUs after the COVID-19 pandemic in our hospital. Bacteraemia episode rates of A. baumannii, Enterococcus spp. and S. maltophilia in ICU of COVID-19 patients were significantly found higher than others. In addition, meropenem, teicoplanin and ceftriaxone consumptions were increased in all ICUs after the COVID-19 pandemic.

目的:评价2019冠状病毒病(COVID-19)大流行对某三级医院重症监护病房(icu)卫生保健相关感染(HAIs)、抗生素耐药性和用药率的影响。患者和方法:回顾性调查2018年1月1日至2021年12月31日期间icu中诊断为HAIs的成年患者。患者被分为大流行前(2018-2019年)和大流行期(2020-2021年)。使用(总剂量(克)/限定日剂量(DDD) x总患者天数)x1000计算抗生素消耗指数。p值小于0.05被认为有统计学意义。结果:疫情期间,新冠肺炎ICU患者HAIs发生率(每1000患者日)为16.59例,其他ICU为13.42例(p=0.107)。COVID-19非ICU ICU患者的血流感染(BSI)发生率在流行前期为3.32,流行期为5.41,其中ICU患者鲍曼pacinetobaci (5.375 vs 0.984)、戊特球菌(1.635 vs 0.268)、嗜麦寡养单胞菌(3.038 vs 1.297, p=0.0086)明显高于其他ICU患者。大流行前肺炎克雷伯菌和大肠杆菌的广谱β -内酰胺酶(ESBL)阳性率分别为61%和42%;COVID-19患者在大流行期非ICU的感染率分别为73%和69% (p>0.05)。疫情期间,重症监护病房肺炎克雷伯菌和大肠杆菌ESBL阳性率分别为83%和100%。结论:2019冠状病毒病大流行后,我院所有icu的BSI、CVCBSI发生率均显著升高。新型冠状病毒肺炎ICU患者鲍曼不动杆菌、肠球菌和嗜麦芽不动杆菌的菌血症发生率明显高于其他病例。此外,COVID-19大流行后,所有icu的美罗培南、替柯planin和头孢曲松用量均有所增加。
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引用次数: 1
Dracunculiasis over the centuries: the history of a parasite unfamiliar to the West. 几个世纪以来的麦地那龙线虫病:西方不熟悉的寄生虫的历史。
Q2 Medicine Pub Date : 2023-01-01 DOI: 10.53854/liim-3102-15
Omar Simonetti, Verena Zerbato, Stefano Di Bella, Roberto Luzzati, Fabio Cavalli

Dracunculiasis (Guinea Worm Disease) is a terrible disease limited, even historically, to the arid and poor areas of our planet and which in the West has always been seen as an exotic disease and therefore has never taken root in the collective imagination. This parasitosis is transmitted to humans by drinking water contaminated with crustacean harboring larvae of Dracunculus medinensis, a nematode. The natural history of the disease is caused by adult worms invading connective tissues and causing blistering, ulceration and edema. Well known in Ancient Egypt where the disease was endemic in its southern area, was known in Europe mainly from the reports of medical writers starting from the Roman imperial period but without direct knowledge. In Middle age the descriptions of this disease that physicians and surgeons could read on medical books, at the end, were attributed to veterinary parasitic disease. In Modern age only during the colonialist era dracunculiasis was perceived as a problem, however sporadic. In 1986 Guinea Worm Eradication Program (GWEP) was launch without success. Thus, the disappearance of this parasitosis should still be postponed but not abandoned.

麦地那龙线虫病(麦地那龙线虫病)是一种可怕的疾病,甚至在历史上仅限于我们星球上的干旱和贫困地区,在西方一直被视为一种外来疾病,因此从未在集体想象中扎根。这种寄生虫病通过被含有麦地那龙线虫(一种线虫)幼虫的甲壳类动物污染的饮用水传播给人类。本病的自然史是由成虫侵入结缔组织引起水泡、溃疡和水肿。这种疾病在古埃及南部地区流行,在欧洲主要是从罗马帝国时期开始的医学作家的报告中得知的,但没有直接的知识。在中世纪,医生和外科医生在医学书籍上读到的对这种疾病的描述,最终被归结为兽医寄生虫病。在现代,只有在殖民主义时代,龙线虫病才被认为是一个问题,然而是零星的。1986年,麦地那龙线虫根除计划(GWEP)启动,但没有成功。因此,这种寄生虫病的消失仍应推迟,但不应放弃。
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引用次数: 0
Response to BNT162b2 mRNA COVID-19 vaccine of ART-experienced people living with HIV: a prospective analysis from a single-center study in Rome, Italy. 经历过art治疗的HIV感染者对BNT162b2 mRNA COVID-19疫苗的反应:来自意大利罗马的一项单中心研究的前瞻性分析
Q2 Medicine Pub Date : 2023-01-01 DOI: 10.53854/liim-3103-9
Francesca Lombardi, Simone Belmonti, Simona Di Giambendetto

Objectives: We aimed to assess the immunologic response to BNT162b2 mRNA COVID-19 vaccine in ART-experienced people living with HIV (PLWH). Methods: In this pilot prospective study, we enrolled 20 PLWH (all on effective ART, 80% with CD4 cells count >500) and 52 immunocompetent health-care workers, as control. All subjects received two doses of vaccine 21 days apart. Serum samples were collected at different time points, immediately before first administration (BL) and 21 days after each dose (T1 and T2) and 45-50 days after second dose (T3). We evaluated the immune response in terms of frequency of responders and antibody titers against SARS-CoV-2 at each timepoint. The viro-immunological parameters of PLWH were also monitored.

Results: We found that the participants displayed an immune response after the first dose that increased markedly at T2. At T3 a significantly descending trend of IgG levels was observed in both groups. No difference in humoral immune response assessed in terms of percentage of responders after first and second dose and in terms of IgG titers over time and at each time point was found between groups. Any significant variation in terms of viremia and immunological parameters was observed in PLWH.

Conclusions: BNT162b2 mRNA COVID-19 vaccine appears immunogenic in this setting of PLWH eliciting an immune response comparable to that of healthy donors.

目的:我们旨在评估经历过art治疗的HIV感染者(PLWH)对BNT162b2 mRNA COVID-19疫苗的免疫反应。方法:在这项前瞻性先导研究中,我们招募了20名PLWH(均接受有效抗逆转录病毒治疗,80% CD4细胞计数>500)和52名具有免疫能力的卫生保健工作者作为对照。所有受试者间隔21天接种两剂疫苗。分别于第一次给药前(BL)、每次给药后21天(T1、T2)和第二次给药后45 ~ 50天(T3)采集血清样本。我们根据应答者的频率和每个时间点针对SARS-CoV-2的抗体滴度来评估免疫反应。同时监测PLWH的病毒免疫学参数。结果:我们发现参与者在第一次剂量后表现出免疫反应,在T2时显着增加。T3时,两组血清IgG水平均有明显下降趋势。在第一次和第二次剂量后的应答者百分比以及随时间和每个时间点的IgG滴度方面,各组之间的体液免疫反应没有差异。在PLWH中观察到病毒血症和免疫学参数的显著变化。结论:BNT162b2 mRNA COVID-19疫苗在这种PLWH环境中表现出免疫原性,引发与健康供者相当的免疫反应。
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引用次数: 0
The sources of antimicrobial peptides against Gram-positives and Gramnegatives: our research experience. 抗革兰氏阳性和革兰氏阴性抗菌肽的来源:我们的研究经验。
Q2 Medicine Pub Date : 2023-01-01 DOI: 10.53854/liim-3103-5
Giulio Rizzetto, Daisy Gambini, Andrea Maurizi, Elisa Molinelli, Edoardo De Simoni, Francesco Pallotta, Lucia Brescini, Oscar Cirioni, Annamaria Offidani, Oriana Simonetti, Andrea Giacometti

Antibiotic resistance of Gram-positive and Gramnegative bacteria is becoming increasingly prevalent. For this reason, the search for new molecules that can overcome current resistance and also recover antibiotics that are no longer effective is becoming increasingly urgent. Our research group at the 'Polytechnic University of Marche' managed to study the effectiveness of certain antimicrobial peptides (AMPs). We decided to review our experience with AMPs by classifying them according to their origin and evaluating their effect on Gram-negative and Gram-positive bacteria. AMPs can derive from mammals, amphibians, microorganisms, and insects. In conclusion, our research experience shows that the richest source of AMPs are amphibians. However, the studies done are mainly in vitro or in animal models, requiring further human studies to assess the efficacy and safety of these molecules. AMPs may be a new therapeutic option for infections sustained by multi-resistant micro-organisms and for overcoming the mechanisms of resistance to antibiotics currently used. In particular, combining AMPs with antibiotics, including those with limited antimicrobial activity due to antimicrobial resistance, has often shown a synergistic effect, increasing or restoring their efficacy. The possibility of using manageable and relatively safe antibiotics again is crucial, considering the widespread increase in bacterial resistance in hospitals and the community. Despite a plethora of research on AMPs and their application as potential treatment on infectious diseases, this area needs further exploration. There is evidence that the characteristics of AMPs can seriously improve through structural chemical modifications and different delivery systems to become alternatives drugs to conventional antibiotics. The aim is to provide an overview of the possible sources from which AMPs are extracted, evaluating their action exclusively on Gram-positive and negative bacteria. This is to determine, based on our experience, which might be the most promising sources of AMPs for future research as well.

革兰氏阳性和革兰氏阴性细菌的抗生素耐药性日益普遍。出于这个原因,寻找能够克服当前耐药性并恢复不再有效的抗生素的新分子变得越来越紧迫。我们在马尔凯理工大学的研究小组成功地研究了某些抗菌肽(amp)的有效性。我们决定回顾我们在抗菌肽方面的经验,根据它们的来源对它们进行分类,并评估它们对革兰氏阴性菌和革兰氏阳性菌的影响。amp可以来自哺乳动物、两栖动物、微生物和昆虫。总之,我们的研究经验表明,AMPs最丰富的来源是两栖动物。然而,这些研究主要是在体外或动物模型中进行的,需要进一步的人体研究来评估这些分子的有效性和安全性。抗菌肽可能是治疗多重耐药微生物感染和克服目前使用的抗生素耐药机制的一种新的治疗选择。特别是,抗菌肽与抗生素联合使用,包括那些由于抗菌素耐药性而抗菌活性有限的抗生素,往往显示出协同效应,增加或恢复其功效。考虑到医院和社区细菌耐药性的普遍增加,再次使用可管理和相对安全的抗生素的可能性至关重要。尽管对抗菌肽及其在感染性疾病治疗方面的潜在应用进行了大量研究,但这一领域仍需进一步探索。有证据表明,通过结构化学修饰和不同的给药系统,抗菌肽的特性可以得到显著改善,成为传统抗生素的替代药物。目的是概述从何处提取抗菌肽的可能来源,评估其仅对革兰氏阳性和阴性细菌的作用。根据我们的经验,这是为了确定哪些可能是未来研究中最有希望的amp来源。
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引用次数: 0
Comparative study of pandemics and their impact on children and adolescents: COVID-19 and Spanish Flu. 流行病及其对儿童和青少年影响的比较研究:COVID-19和西班牙流感。
Q2 Medicine Pub Date : 2023-01-01 DOI: 10.53854/liim-3102-1
Sofia Dalekou, Spyros N Michaleas, Artemis K Tsitsika, Marianna Karamanou

Overview: Pandemics are characterized by an abrupt and sudden outburst and absence of preparation for its management. The focus during pandemics is on the medical aspect of the disease and not on its impact on the citizens' or vulnerable groups' psychosocial wellbeing.

Aim: The purpose of this study was to highlight the impact of the pandemics of the Spanish Flu and COVID-19 on children and adolescents as well as to recognize their short and long-terms effects on children's and adolescents' physical and mental health.

Materials and methods: The material of this review constituted of publications regarding the impact of the Spanish Flu and COVID-19 on children and adolescents via relative search through valid databases and websites of trustworthy organizations.

Results: The main finding of the present review was that pandemics negatively affect children and adolescents undermining their mental and physical health. The factors that negatively impact on this population's normal development include parental death, financial hardships, restrictive measures, disruption of daily routine and absence of social contact. The short-term effects include anxiety, depression, aggressive behavior as well as fear and grief. Mental disorders, disability, poor academic performance and low socioeconomic level are among the long-term effects of the two under study pandemics.

Conclusions: Children and adolescents constitute a vulnerable group amidst pandemics and there is a need for coordinated worldwide and national actions to prevent and timely manage a pandemic's impact.

概述:大流行的特点是突然爆发,缺乏管理准备。大流行期间的重点是疾病的医学方面,而不是其对公民或弱势群体的社会心理健康的影响。目的:本研究的目的是强调西班牙流感和COVID-19大流行对儿童和青少年的影响,并认识到它们对儿童和青少年身心健康的短期和长期影响。材料和方法:本综述的材料包括通过有效的数据库和可信组织的网站进行相关搜索,得出的关于西班牙流感和COVID-19对儿童和青少年影响的出版物。结果:本次审查的主要发现是,流行病对儿童和青少年产生了负面影响,损害了他们的身心健康。对这一人口的正常发展产生负面影响的因素包括父母死亡、经济困难、限制措施、日常生活中断和缺乏社会接触。短期影响包括焦虑、抑郁、攻击性行为以及恐惧和悲伤。精神障碍、残疾、学习成绩差和社会经济水平低是所研究的两种流行病的长期影响。结论:儿童和青少年是大流行病中的弱势群体,需要采取协调一致的全球和国家行动,以预防和及时管理大流行病的影响。
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引用次数: 1
Cerebrovascular disease in COVID-19: a systematic review and meta-analysis. 脑血管病与COVID-19:系统综述和荟萃分析
Q2 Medicine Pub Date : 2023-01-01 DOI: 10.53854/liim-3102-2
Ritesh G Menezes, Tamim Omar Alabduladhem, Ahmed Kamal Siddiqi, Muhammad Talha Maniya, Abdulaziz Mazen Al Dahlawi, Mohammed Waleed Abdulaziz Almulhim, Hadeel Waleed Almulhim, Yasmeen Abdulwahab Ali Saeed, Moath Saad Alotaibi, Sarah Saud Alarifi, Abdulrahman Mohammed Alkathiry, Talal Almas

Background: The association between COVID-19 and acute cerebrovascular disease (CVD) has not been explored extensively. New data has come to light which may change previous results.

Methods: We queried the PubMed electronic database from its inception until February 2022 for studies evaluating the incidence of stroke in COVID-19 patients. Results of the analysis were pooled using a random-effects model and presented as odds ratios (ORs) with 95% confidence intervals (95% CIs).

Results: 37 studies consisting of 294,249 patients were included in our analysis. Pooled results show that the incidence of acute CVD events in COVID-19 positive patients is 2.6% (95% CI: 2.0-3.3; P<0.001). Cardioembolic (OR=14.15, 95% CI: 11.01 to 18.19, P<0.00001) and cryptogenic (OR=2.87, 95% CI: 1.91 to 4.32, P<0.00001) etiologies were associated with COVID-19 positivity. Risk factors for CVD events in patients with COVID-19 were atrial fibrillation (OR=2.60, 95% CI: 1.15 to 5.87, P=0.02), coronary artery disease (OR=2.24, 95% CI: 1.38 to 3.61, P=0.0010), diabetes (OR=2.46, 95% CI: 1.36 to 4.44, P=0.003) and hypertension (OR=3.65, 95% CI: 1.69 to 7.90, P=0.005).

Conclusion: COVID-19 infection is associated with an increased risk for acute CVD and is associated with cardioembolic and cryptogenic etiologies and the risk factors of atrial fibrillation, coronary artery disease, diabetes and hypertension in COVID-19 positive patients.

背景:COVID-19与急性脑血管病(CVD)的关系尚未得到广泛探讨。新数据的出现可能会改变以前的结果。方法:我们查询PubMed电子数据库从建立到2022年2月,评估COVID-19患者卒中发生率的研究。使用随机效应模型汇总分析结果,并以95%置信区间(95% ci)的优势比(ORs)表示。结果:37项研究包括294,249例患者纳入我们的分析。合并结果显示,COVID-19阳性患者急性心血管事件发生率为2.6% (95% CI: 2.0-3.3;结论:COVID-19感染与急性CVD风险增加相关,并与COVID-19阳性患者的心栓子和隐源性病因以及房颤、冠状动脉疾病、糖尿病和高血压等危险因素相关。
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引用次数: 2
Update on Mpox: a brief narrative review. 关于麻疹的最新情况:简要回顾。
Q2 Medicine Pub Date : 2023-01-01 DOI: 10.53854/liim-3103-1
Spinello Antinori, Giacomo Casalini, Andrea Giacomelli, Alfonso J Rodriguez-Morales

Mpox (formerly Monkeypox), a neglected tropical disease once confined to Central and West Africa, emerged as a global epidemic outbreak in May, 2022 with 87,529 cases reported as of May, 23, 2023. It predominantly affected men (96.2%) who have sex with men (84-100%), although other transmission routes have been reported, including occupational exposure and vertical transmission. Concomitant HIV infection has been recorded in 21-46.9% and pre-exposure prophylaxis against HIV infection has been reported in 11-57% of published cases. The current outbreak clinical presentation differs from endemic cases with prodromal symptoms that could be absent: the number of lesions is generally low, with skin lesions predominantly localised in the ano-genital areas and frequent lesions present in different stages of progression (i.e., asynchronous). Asymptomatic Mpox infection can occur in 1.8-6.5% of at-risk subjects. People living with HIV with severe immunodeficiency (less than 100 CD4+ lymphocytes per microliter) are at risk of more severe clinical manifestations and death. According to a systematic review and meta-analysis, the hospitalisation rate is around 6% and the observed case-fatality rate is less than 0.1%. Tecovirimat is the drug of choice for treating severe cases although there is no evidence of efficacy from randomised controlled trials. Immunization with a live non-replicating vaccine (JYNNEOS) effectively reduces the disease's incidence.

Mpox(以前称为猴痘)是一种被忽视的热带病,曾经局限于中非和西非,于2022年5月成为全球流行病暴发,截至2023年5月23日报告了87,529例。它主要影响男男性行为者(96.2%)(84-100%),尽管报告了其他传播途径,包括职业接触和垂直传播。同时发生艾滋病毒感染的比例为21-46.9%,在已公布的病例中,有11-57%报告了暴露前预防艾滋病毒感染。当前暴发的临床表现与可能不存在前体症状的地方性病例不同:病变数量普遍较低,皮肤病变主要局限于非生殖器区域,病变频繁出现在不同的进展阶段(即不同步)。无症状麻疹感染可发生在1.8-6.5%的高危人群中。患有严重免疫缺陷的艾滋病毒感染者(每微升CD4+淋巴细胞少于100个)面临更严重的临床表现和死亡的风险。根据系统评价和荟萃分析,住院率约为6%,观察到的病死率低于0.1%。虽然没有随机对照试验的疗效证据,但替科维莫是治疗重症病例的首选药物。使用非复制活疫苗(JYNNEOS)进行免疫接种可有效降低该病的发病率。
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引用次数: 0
Zoonotic febrile illnesses misdiagnosed as COVID-19: a review of reported clinical cases. 误诊为COVID-19的人畜共患发热性疾病:临床病例报告综述
Q2 Medicine Pub Date : 2023-01-01 DOI: 10.53854/liim-3102-3
Carlos Ramiro Silva-Ramos, Julián A Mejorano-Fonseca, Alfonso J Rodríguez-Morales, Marylin Hidalgo, Álvaro A Faccini-Martínez

COVID-19 is a zoonotic coronavirus disease caused by SARS-CoV-2. Its fast spreading by aerosol transmission has made it a highly contagious disease, causing the most recent 2020 pandemic. Although it mainly affects the respiratory system, atypical forms of the disease have been described, including developing an undifferentiated febrile illness without respiratory symptoms, that can represent a diagnostic challenge, mainly in tropical areas where several zoonotic febrile diseases are circulating. Thus, despite the broad clinical spectrum of COVID-19, in the tropics, other zoonotic etiologies should always be considered as differential diagnoses. According to our case reports review, eight different zoonotic febrile diseases misdiagnosed as COVID-19 have been reported in the available scientific literature of four databases. These were only suspected due to the epidemiological history. Thus, making a complete and detailed clinical history of a febrile patient in the tropics is essential to suspect the etiology and request the necessary confirmatory tests. Therefore, COVID-19 must be included as a differential diagnosis of undifferentiated febrile illness in the tropics, but other zoonotic infectious diseases must not be ruled out.

COVID-19是由SARS-CoV-2引起的人畜共患冠状病毒病。它通过气溶胶传播的快速传播使其成为一种高度传染性疾病,导致了最近的2020年大流行。虽然它主要影响呼吸系统,但已经描述了该疾病的非典型形式,包括发展为无呼吸道症状的未分化发热性疾病,这可能是诊断上的挑战,主要是在几种人畜共患发热性疾病流行的热带地区。因此,尽管COVID-19具有广泛的临床谱系,但在热带地区,应始终将其他人畜共患病因视为鉴别诊断。根据我们的病例报告回顾,在4个数据库的现有科学文献中报告了8种不同的人畜共患发热性疾病被误诊为COVID-19。这些只是由于流行病学历史而被怀疑。因此,对热带地区的发热病人进行完整和详细的临床病史,对于怀疑病因和要求进行必要的确认性检查至关重要。因此,必须将COVID-19纳入热带地区未分化发热性疾病的鉴别诊断,但不能排除其他人畜共患传染病。
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引用次数: 0
Prevention of congenital Chagas disease by screening of mothers and monitoring of serological tests of neonates: the seven years' experience. 通过筛查母亲和监测新生儿血清学试验预防先天性恰加斯病:七年经验。
Q2 Medicine Pub Date : 2023-01-01 DOI: 10.53854/liim-3102-13
Annibale Raglio, Libera Clemente, Davide Guarneri, Marco Arosio, Marzia Maino, Luisa Patanè, Marco Cavallini, Paola Rodari, Giovanna Mangili, Claudio Farina

Approximately 14000 immigrants coming from the Cochabamba area of Bolivia, with an increased risk of congenital Chagas Disease (CD), are currently living in Bergamo, Italy. According to the World Health Organization (WHO) recommendation (2011), prevention of congenital CD involves testing all pregnant women at risk of infection and performing follow-up of their newborns. In our study, all pregnant women of Latin American origin were tested for the presence of Trypanosoma cruzi antibodies and children, born to mothers found to be positive, were followed up after delivery. T. cruzi antibodies were detected using a chemiluminescence immunoassay. The test was also performed on siblings and fathers of children with CD, and women of childbearing age to prevent the congenital infection, as proposed by 2011 WHO recommendation. In the study period 1105 patients were tested for CD, using a serological test: 934 (85%) were females and 171 (15%) were males. Of the 62 newborns, from mothers who tested positive, 28 were females and 34 were males. The number of positive adults and siblings identified was 148 (14%). Among the adults and siblings born between 1991 and 2011 only 3 (2%) of females tested positive to serological test. All neonates, with the exception of one, were classified as non-infected according to the follow-up of index value of CD serology. This study confirms the usefulness of serological tests and of their index value as follow-up. The difference of positivity rate for CD antibodies between people born before and after 1990 should be further investigated to generate information that potentially improve the prevention and control of CD.

来自玻利维亚科恰班巴地区的大约14000名移民目前居住在意大利贝加莫,他们患先天性恰加斯病的风险增加。根据世界卫生组织(世卫组织)的建议(2011年),预防先天性乳糜泻涉及对所有有感染风险的孕妇进行检测,并对其新生儿进行随访。在我们的研究中,所有拉丁美洲的孕妇都检测了克氏锥虫抗体的存在,母亲所生的孩子被发现呈阳性,并在分娩后随访。采用化学发光免疫分析法检测克氏体抗体。根据2011年世卫组织的建议,还对患有乳糜泻儿童的兄弟姐妹和父亲以及育龄妇女进行了该测试,以预防先天性感染。在研究期间,使用血清学测试对1105例患者进行了乳糜泻检测:934例(85%)为女性,171例(15%)为男性。在检测呈阳性的母亲所生的62名新生儿中,28名是女性,34名是男性。成人和兄弟姐妹确诊阳性人数为148人(14%)。在1991年至2011年间出生的成年人和兄弟姐妹中,只有3名(2%)女性血清学检测呈阳性。根据CD血清学指标随访,除1例外,其余新生儿均为未感染。本研究证实了血清学测试的有效性及其作为随访的指标值。应进一步调查1990年前后出生的人乳糜泻抗体阳性率的差异,以提供可能改善乳糜泻预防和控制的信息。
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引用次数: 2
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Infezioni in Medicina
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