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Comparative efficacy of methods for early diagnosis of tuberculosis pleuritis with rifampicin-resistance. 结核性胸膜炎伴利福平耐药早期诊断方法的疗效比较。
Q2 Medicine Pub Date : 2023-01-01 DOI: 10.53854/liim-3102-11
Altyn Almagambetova, Kalzhan Yermekbayeva, Daniyar Dilmagambetov, Galiya Tanzharykova, Bakytzhan Baisalbayev

The purpose of the article was to explore the effectiveness of a complex morphological study of pleural biopsies and molecular genetic study (GeneXpert MBT/Rif) of pleural effusion in verifying the diagnosis of pleurisy of tuberculous aetiology. The participants of the study were 120 patients with a exudative pleurisy who were admitted to the department of extrapulmonary tuberculosis of the Regional Phthisiopulmonology Center (RPPC) in Aktobe (Republic of Kazakhstan) in the period from 2018 to 2020. Significant differences were obtained in the compared groups (p<0.05), which testifies to the rather high diagnostic efficiency of the GeneXpert MBT/RIF molecular genetic method in comparison with bacterioscopy in detecting Mycobacterium tuberculosis (MBT) in pleural fluid obtained by video thoracoscopy. Using the GeneXpert method, positive results of the presence of MBT in the pleural fluid were obtained in 26.3% of patients of the main group, while in patients of the control group, MBT was detected only in 3.2% of cases by simple bacterioscopy (p<0.05). The high diagnostic efficiency of the GeneXpert express method (26.3%) is confirmed and proven by the "gold standard" of bacteriological examination of pleural fluid - the growth of MBT colonies in 24.6% of cases by the BACTEC MGIT-960 method and in 28.1% of cases of MBT growth on solid nutrient medium Lowenstein-Jensen in patients of the main group. The combination of the invasive method of video thoracoscopy diagnostics with the GeneXpert microbiological express method for detecting MBT in the pleural fluid is today, the optimal method for early diagnosis of a drug-resistant form of exudative pleurisy of tuberculous etiology.

本文的目的是探讨胸膜活检的复杂形态学研究和胸膜积液的分子遗传学研究(GeneXpert MBT/Rif)在验证结核性胸膜炎诊断中的有效性。该研究的参与者是2018年至2020年期间在阿克托别(哈萨克斯坦共和国)地区肺结核中心(RPPC)肺外结核科收治的120名渗出性胸膜炎患者。两组胸腔镜胸膜液结核分枝杆菌(MBT)阳性率差异有统计学意义。使用GeneXpert方法,在主要组患者中,26.3%的患者胸膜液中检测到MBT的阳性结果,而在对照组患者中,仅3.2%的患者通过简单的细菌学检查检测到MBT (p
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引用次数: 0
Leptospirosis in India: a systematic review and meta-analysis of clinical profile, treatment and outcomes. 印度钩端螺旋体病:临床概况、治疗和结果的系统回顾和荟萃分析。
Q2 Medicine Pub Date : 2023-01-01 DOI: 10.53854/liim-3103-4
Nitin Gupta, William Wilson, Prithvishree Ravindra

Introduction: Leptospirosis is a zoonotic bacterial infection with significant mortality and morbidity, especially in resource-limited settings. This systematic review aimed to study the clinical profile and outcome of patients with leptospirosis in India.

Methodology: All articles up to 02.08.2022 were searched using the two databases, PubMed and Scopus. A total of 542 articles were found using the search terms related to 'leptospirosis' and 'India'. After two rounds of screening, 55 articles were included. The data were collected on epidemiology, clinical features, laboratory features and treatment of patients with leptospirosis.

Results: Most cases of leptospirosis were reported from the coastal belt. A large percentage of patients were identified as farmers, and exposure to rainfall was identified as an important risk factor. Fever was present in 97%, and conjunctival suffusion was present in 35% of cases. Haemoptysis, gastrointestinal bleeding, and haematuria were present in 5%, 5% and 12% of patients, respectively. Liver and kidney were involved in 34% and 35% of the patients, respectively. The average haemoglobin, leucocyte count and platelet count across various studies ranged from 9.6-12.5 grams/dl, 8.8-11.3 thousand/μl and 20-130 thousand/μl, respectively. Treatment details were sparsely available in some studies, with penicillin, ceftriaxone, and doxycycline used commonly. The pooled mortality across various studies was calculated as 11% [95% CI-8-15%, I2=93%, P<0.001].

Conclusions: Leptospirosis is associated with significant mortality in Indian settings. There is a need for studies focussing on treatment modalities.

前言:钩端螺旋体病是一种人畜共患病的细菌感染,具有很高的死亡率和发病率,特别是在资源有限的地区。本系统综述旨在研究印度钩端螺旋体病患者的临床概况和预后。方法:使用PubMed和Scopus这两个数据库检索截至2022年2月8日的所有文章。使用与“钩端螺旋体病”和“印度”相关的搜索词共发现542篇文章。经过两轮筛选,55篇文章入选。收集钩端螺旋体病患者的流行病学、临床特征、实验室特征和治疗方法等资料。结果:钩端螺旋体病病例以沿海地区为主。很大比例的患者被确定为农民,暴露于降雨被确定为一个重要的风险因素。97%的病例出现发热,35%的病例出现结膜积液。咯血、胃肠道出血和血尿分别占5%、5%和12%。肝脏和肾脏分别有34%和35%的患者受累。在不同的研究中,平均血红蛋白、白细胞计数和血小板计数分别为9.6-12.5克/分升、8.8-11.3克/μl和20-13万克/μl。在一些研究中,治疗细节很少,通常使用青霉素、头孢曲松和强力霉素。各种研究的总死亡率计算为11% [95% CI-8-15%, I2=93%, p]结论:钩端螺旋体病与印度环境中的显著死亡率相关。有必要对治疗方式进行研究。
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引用次数: 0
Markers of liver function as potential prognostic indicators of SARS-CoV-2 infection: A retrospective analysis during the first and second waves of COVID-19 pandemic. 肝功能标志物作为SARS-CoV-2感染的潜在预后指标:第一波和第二波COVID-19大流行期间的回顾性分析
Q2 Medicine Pub Date : 2023-01-01 DOI: 10.53854/liim-3102-9
Ludovica Esposito, Matteo Guarino, Benedetta Perna, Andrea Ciccarone, Alice Eleonora Cesaro, Francesca Manza, Adriana Pretula, Anna Costanzini, Martina Maritati, Elena Forini, Michele Domenico Spampinato, Roberto De Giorgio, Carlo Contini

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is known to cause a predominant respiratory disease, although extrapulmonary manifestations can also occur. One of the targets of Coronavirus disease 2019 (COVID-19) is the hepatobiliary system. The present study aims to describe the correlation between the increase of liver damage markers (i.e. alanine aminotransferase [ALT], aspartate aminotransferase [AST], total bilirubin [TB]) and COVID-19 outcomes (i.e., in-hospital mortality [IHM] and intensive care unit [ICU] transfer).

Methods: All patients with confirmed SARS-CoV-2 infection admitted to the Infectious Diseases Unit of the St. Anna University-Hospital of Ferrara from March 2020 to October 2021 were retrospectively included in this single-centre study. ALT, AST and TB levels were tested in all patients and IHM or ICU transfer were considered as main outcomes. Co-morbidities were assessed using Charlson Comorbidity Index.

Results: A total of 106 patients were retrieved. No hepatic marker was able to predict IHM, whereas all of them negatively predicted ICU transfer (ALT: OR 1.005, 95%CI 1.001-1.009, p= 0.011; AST: OR 1.018, 95%CI 1.006-1.030, p= 0.003; TB: OR 1.329, 95%CI 1.025-1.724, p= 0.032). Age was the only parameter significantly related to mortality.

Conclusions: The present study, by correlating liver damage markers with COVID-19 outcome, showed that an increase of ALT, AST and TB predicted patients' severity, although not mortality.

背景:严重急性呼吸综合征冠状病毒2 (SARS-CoV-2)大流行是已知的主要呼吸道疾病,尽管也可能发生肺外表现。2019冠状病毒病(COVID-19)的目标之一是肝胆系统。本研究旨在探讨肝损伤标志物(如谷丙转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TB))升高与COVID-19结局(即住院死亡率(IHM)和重症监护病房(ICU)转院)之间的相关性。方法:回顾性纳入2020年3月至2021年10月在费拉拉圣安娜大学医院传染病科收治的所有确诊的SARS-CoV-2感染患者。所有患者均检测ALT、AST和TB水平,并将IHM或ICU转移视为主要结局。采用Charlson合并症指数评估合并症。结果:共检索到106例患者。肝脏指标均不能预测IHM,但均阴性预测ICU转移(ALT: OR 1.005, 95%CI 1.001 ~ 1.009, p= 0.011;AST: OR 1.018, 95%CI 1.006-1.030, p= 0.003;TB: OR 1.329, 95%CI 1.025-1.724, p= 0.032)。年龄是唯一与死亡率显著相关的参数。结论:本研究通过将肝损伤标志物与COVID-19预后相关联,表明ALT、AST和TB的升高预测了患者的严重程度,但不能预测死亡率。
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引用次数: 0
Unexpected effects of COVID-19 outbreak: adaption of Anti-Retroviral Therapy (ART) delivery policies improved adherence in a population of People Living With HIV (PLWH). COVID-19疫情的意外影响:抗逆转录病毒治疗(ART)提供政策的调整改善了艾滋病毒感染者(PLWH)的依从性。
Q2 Medicine Pub Date : 2023-01-01 DOI: 10.53854/liim-3102-8
Francesco Maria Fusco, Nadia Sangiovanni, Nunzia Papa, Valentina Mattera Iacono, Nunzia Cuomo, Rosaria Viglietti, Orsola Tambaro, Francesco Borrelli, Raffaella Pisapia, Maria Aurora Carleo, Viviana Rizzo, Micaela Spatarella, Vincenzo Esposito, Vincenzo Sangiovanni

Background: Adherence to Anti-Retroviral Therapy (ART) is crucial for People Living With HIV (PLWH). In Italy, ART is delivered by Hospital Pharmacies, on a renewable prescription from the hospital physician. The measurement of package-refill (the rate of ART packages actually collected out of those to be collected in order to comply with therapy) is an effective tool to evaluate the adherence.During COVID-19 outbreak, at "D. Cotugno" hospital in Naples, Italy, the ART delivery policies have been adapted, in order to reduce the number of patients' access. We analysed the impact of these changes on the pill-refill of ART in January-August 2020, compared with 2018-2019.

Methods: "D. Cotugno" hospital is a mono-specialistic Infectious Diseases hospital, caring for about 2500 PLWH. Since February 2020, the hospital was almost entirely dedicated to COVID-19 patients. All out-patient activities were interrupted, except for those dedicated to HIV/AIDS patients.In this preliminary study we included all patients assigned to one of the three Medical Divisions dedicated to HIV, who were already under treatment since at least 2017. Rate of package-refill was obtained by the Hospital Pharmacy registry, demographic and clinical data were derived from clinical database.During COVID-19, many measures were adopted in order to increase safety of PLWH attending to hospital. Among these, medical prescription validity increased from 4 to 6 months, and number of packages to be collected increased from 2 to 4, adopting a multi-month dispensing strategy.Package-refill is adequate if at least 95% of ART have been actually collected; partial and inadequate if 75%-94% or less than 75% of ART, respectively, have been collected. Package-refill was measured during the first year of COVID-19 (March 2020 - February 2021), compared to the same period in the two years before.

Results: A total of 594 PLWH were included. PLWH with optimal pill-refill significantly increased in 2020-21 compared to 2018-2020 (62% vs 55%, p 0.013).

Discussion: Due to COVID-19, we would have expected a reduction in ART deliveries. Surprisingly, the opposite occurred. The increase of pill-refill rates may be due to different reasons, but we hypothesized that the adaption of delivery policies, with a higher number of packages allowed to be collected, strongly contributed to this result. This study suggests that multi-month dispensing policies may contribute to the improvement of adherence among PLWH.

背景:坚持抗逆转录病毒治疗(ART)对艾滋病毒感染者(PLWH)至关重要。在意大利,抗逆转录病毒治疗由医院药房提供,由医院医生开具可更新的处方。重新包装的测量(为了遵守治疗而实际收集的抗逆转录病毒治疗包的比率)是评估依从性的有效工具。在2019冠状病毒病疫情期间,意大利那不勒斯“D. Cotugno”医院调整了抗逆转录病毒治疗的提供政策,以减少患者获得治疗的人数。我们分析了与2018-2019年相比,这些变化对2020年1月至8月ART补药的影响。方法:“D. Cotugno”医院是一所单专科传染病医院,收治约2500名艾滋病患者。自2020年2月以来,该医院几乎全部用于治疗COVID-19患者。除艾滋病毒/艾滋病患者外,所有门诊活动均被中断。在这项初步研究中,我们纳入了至少自2017年以来已经接受治疗的所有艾滋病患者,这些患者被分配到三个专门针对艾滋病毒的医疗部门之一。药包再填充率由医院药房登记处获得,人口学和临床数据来自临床数据库。在新冠肺炎疫情期间,采取了许多措施,以提高医护人员就医的安全性。其中,药品处方有效期从4个月增加到6个月,收集包数从2个增加到4个,采用多月调剂策略。如果实际收集了至少95%的抗逆转录病毒药物,则可重新包装;如果分别收集了75%-94%或低于75%的抗逆转录病毒药物,则为部分和不充分。与前两年同期相比,在2019冠状病毒病第一年(2020年3月至2021年2月)测量了包装重新填充的情况。结果:共纳入594例PLWH。与2018-2020年相比,最佳补药的PLWH在2020-21年显著增加(62%对55%,p 0.013)。讨论:由于COVID-19,我们原本预计抗逆转录病毒治疗的交付会减少。令人惊讶的是,情况正好相反。药丸补充率的增加可能是由于不同的原因,但我们假设配送政策的调整,允许收集更多的包裹,在很大程度上促成了这一结果。本研究表明,多月配药政策可能有助于改善PLWH的依从性。
{"title":"Unexpected effects of COVID-19 outbreak: adaption of Anti-Retroviral Therapy (ART) delivery policies improved adherence in a population of People Living With HIV (PLWH).","authors":"Francesco Maria Fusco,&nbsp;Nadia Sangiovanni,&nbsp;Nunzia Papa,&nbsp;Valentina Mattera Iacono,&nbsp;Nunzia Cuomo,&nbsp;Rosaria Viglietti,&nbsp;Orsola Tambaro,&nbsp;Francesco Borrelli,&nbsp;Raffaella Pisapia,&nbsp;Maria Aurora Carleo,&nbsp;Viviana Rizzo,&nbsp;Micaela Spatarella,&nbsp;Vincenzo Esposito,&nbsp;Vincenzo Sangiovanni","doi":"10.53854/liim-3102-8","DOIUrl":"https://doi.org/10.53854/liim-3102-8","url":null,"abstract":"<p><strong>Background: </strong>Adherence to Anti-Retroviral Therapy (ART) is crucial for People Living With HIV (PLWH). In Italy, ART is delivered by Hospital Pharmacies, on a renewable prescription from the hospital physician. The measurement of package-refill (the rate of ART packages actually collected out of those to be collected in order to comply with therapy) is an effective tool to evaluate the adherence.During COVID-19 outbreak, at \"D. Cotugno\" hospital in Naples, Italy, the ART delivery policies have been adapted, in order to reduce the number of patients' access. We analysed the impact of these changes on the pill-refill of ART in January-August 2020, compared with 2018-2019.</p><p><strong>Methods: </strong>\"D. Cotugno\" hospital is a mono-specialistic Infectious Diseases hospital, caring for about 2500 PLWH. Since February 2020, the hospital was almost entirely dedicated to COVID-19 patients. All out-patient activities were interrupted, except for those dedicated to HIV/AIDS patients.In this preliminary study we included all patients assigned to one of the three Medical Divisions dedicated to HIV, who were already under treatment since at least 2017. Rate of package-refill was obtained by the Hospital Pharmacy registry, demographic and clinical data were derived from clinical database.During COVID-19, many measures were adopted in order to increase safety of PLWH attending to hospital. Among these, medical prescription validity increased from 4 to 6 months, and number of packages to be collected increased from 2 to 4, adopting a multi-month dispensing strategy.Package-refill is adequate if at least 95% of ART have been actually collected; partial and inadequate if 75%-94% or less than 75% of ART, respectively, have been collected. Package-refill was measured during the first year of COVID-19 (March 2020 - February 2021), compared to the same period in the two years before.</p><p><strong>Results: </strong>A total of 594 PLWH were included. PLWH with optimal pill-refill significantly increased in 2020-21 compared to 2018-2020 (62% vs 55%, p 0.013).</p><p><strong>Discussion: </strong>Due to COVID-19, we would have expected a reduction in ART deliveries. Surprisingly, the opposite occurred. The increase of pill-refill rates may be due to different reasons, but we hypothesized that the adaption of delivery policies, with a higher number of packages allowed to be collected, strongly contributed to this result. This study suggests that multi-month dispensing policies may contribute to the improvement of adherence among PLWH.</p>","PeriodicalId":52423,"journal":{"name":"Infezioni in Medicina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10241403/pdf/1124-9390_31_1_2023_204-208.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9947157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Toxoplasmosis mimicking CMV chorioretinitis in newly diagnosed PLWH: a case report. 弓形虫病模拟巨细胞病毒脉络膜视网膜炎在新诊断PLWH: 1例报告。
Q2 Medicine Pub Date : 2023-01-01 DOI: 10.53854/liim-3103-15
Francesco Lamanna, Rosa Anna Passerotto, Andrea Carbone, Rebecca Jo Steiner, Valentina Iannone, Pierluigi Francesco Salvo, Arturo Ciccullo, Gianmaria Baldin, Alberto Borghetti, Alex Dusina

Background: cytomegalovirus (CMV) retinitis, cerebral and ocular toxoplasmosis are common infections in patients with acquired immunodeficiency syndrome (AIDS). Material and methods: this is a case of a 46-year-old female with previous Kaposi's sarcoma, diagnosed with an HIV infection two weeks prior to hospitalization. Blood test at diagnosis showed a CD4+ count of 77 cell/μL and HIV-RNA 3.758.745 copies/mL. Therapy with bictegravir/emtricitabine/tenofovir alafenamide fumarate was started and clinical, viroimmunological and microbiological investigations were performed.

Results: the patient went to our hospital for the onset of left occipito-parietal headache and blurred vision. Brain CT and MRI were performed which did not show focal lesions or vascular alterations. Syphilis serology was negative, Toxoplasma gondii serology showed positive IgG and negative IgM, serum CMV-DNA was 31.184 IU/mL. Eye fundus evidenced intraretinal hemorrhages, fluorescein angiography and computed optical tomography documented cottony exudates, retinal hemorrhages and vitreous involvement. Therapy with valganciclovir was initiated for suspicion of CMV retinitis. About a month later, the patient reported blurred vision for which she was re-admitted. Ocular fundus showed a cottony lesion near the macula. Molecular test on vitreous body was positive for Toxoplasma gondii, while on cerebrospinal fluid it was negative; in addition, an MRI of the brain with contrast medium was performed which showed an area of altered hyperintense signal compatible with a diagnosis of Toxoplasma gondii uveitis and neurotoxoplasmosis. Therapy with pyrimethamine and clindamycin (allergy for sulfonamide reported by the patient) was started. Allergy counseling was performed with the execution of allergy tests (patch test) with negative result; therefore the administration of clindamycin was replaced with sulfadiazine. A month following the start of anti-toxoplasma therapy, there was a clinical and radiological improvement.

Conclusions: despite progressive developments in the management of PLWH, in this case two different kind of opportunistic infection are found in a late-presenter patient. In particular, two aspects can be highlighted. The first one is that, in the setting of an highly impaired immune system, clinical presentation can be deceptive and more than one opportunistic infection can be observed together in the same patient. The second aspect is that after starting antiretroviral therapy, a rapid improvement of viro-immunologic parameters has been documented, probably leading to an immune reconstitution inflammatory syndrome (IRIS).

背景:巨细胞病毒(CMV)视网膜炎、脑和眼弓形虫病是获得性免疫缺陷综合征(AIDS)患者常见的感染。材料和方法:本病例为46岁女性,既往患有卡波西肉瘤,在住院前两周被诊断为HIV感染。诊断时血检CD4+计数77 cells /μL, HIV-RNA计数3.758.745 copies/mL。开始使用比替格拉韦/恩曲他滨/富马酸替诺福韦阿拉那胺治疗,并进行临床、病毒免疫学和微生物学调查。结果:患者以左枕顶头痛、视力模糊就诊。脑CT和MRI未见局灶性病变或血管改变。梅毒血清学阴性,刚地弓形虫血清IgG阳性,IgM阴性,血清CMV-DNA为31.184 IU/mL。眼底显示视网膜内出血,荧光素血管造影和计算机光学断层扫描记录棉渗出,视网膜出血和玻璃体受累。因怀疑巨细胞病毒性视网膜炎,开始使用缬更昔洛韦治疗。大约一个月后,患者报告视力模糊,因此再次入院。眼底黄斑附近可见棉样病变。玻璃体分子检测弓形虫阳性,脑脊液阴性;此外,用造影剂对大脑进行MRI检查,显示高信号改变的区域与刚地弓形虫葡萄膜炎和神经弓形虫病的诊断相一致。开始乙胺嘧啶和克林霉素治疗(患者报告对磺胺过敏)。进行过敏咨询并进行过敏试验(斑贴试验),结果为阴性;因此用磺胺嘧啶代替克林霉素。开始抗弓形虫治疗一个月后,临床和放射学均有改善。结论:尽管PLWH的管理有了进展,但在该病例中,在迟发患者中发现了两种不同的机会性感染。特别需要强调的是两个方面。首先,在免疫系统高度受损的情况下,临床表现可能具有欺骗性,并且可以在同一患者中同时观察到不止一种机会性感染。第二个方面是,在开始抗逆转录病毒治疗后,病毒免疫参数迅速改善,可能导致免疫重建炎症综合征(IRIS)。
{"title":"Toxoplasmosis mimicking CMV chorioretinitis in newly diagnosed PLWH: a case report.","authors":"Francesco Lamanna,&nbsp;Rosa Anna Passerotto,&nbsp;Andrea Carbone,&nbsp;Rebecca Jo Steiner,&nbsp;Valentina Iannone,&nbsp;Pierluigi Francesco Salvo,&nbsp;Arturo Ciccullo,&nbsp;Gianmaria Baldin,&nbsp;Alberto Borghetti,&nbsp;Alex Dusina","doi":"10.53854/liim-3103-15","DOIUrl":"https://doi.org/10.53854/liim-3103-15","url":null,"abstract":"<p><strong>Background: </strong>cytomegalovirus (CMV) retinitis, cerebral and ocular toxoplasmosis are common infections in patients with acquired immunodeficiency syndrome (AIDS). Material and methods: this is a case of a 46-year-old female with previous Kaposi's sarcoma, diagnosed with an HIV infection two weeks prior to hospitalization. Blood test at diagnosis showed a CD4+ count of 77 cell/μL and HIV-RNA 3.758.745 copies/mL. Therapy with bictegravir/emtricitabine/tenofovir alafenamide fumarate was started and clinical, viroimmunological and microbiological investigations were performed.</p><p><strong>Results: </strong>the patient went to our hospital for the onset of left occipito-parietal headache and blurred vision. Brain CT and MRI were performed which did not show focal lesions or vascular alterations. Syphilis serology was negative, <i>Toxoplasma gondii</i> serology showed positive IgG and negative IgM, serum CMV-DNA was 31.184 IU/mL. Eye fundus evidenced intraretinal hemorrhages, fluorescein angiography and computed optical tomography documented cottony exudates, retinal hemorrhages and vitreous involvement. Therapy with valganciclovir was initiated for suspicion of CMV retinitis. About a month later, the patient reported blurred vision for which she was re-admitted. Ocular fundus showed a cottony lesion near the macula. Molecular test on vitreous body was positive for <i>Toxoplasma gondii</i>, while on cerebrospinal fluid it was negative; in addition, an MRI of the brain with contrast medium was performed which showed an area of altered hyperintense signal compatible with a diagnosis of <i>Toxoplasma gondii</i> uveitis and neurotoxoplasmosis. Therapy with pyrimethamine and clindamycin (allergy for sulfonamide reported by the patient) was started. Allergy counseling was performed with the execution of allergy tests (patch test) with negative result; therefore the administration of clindamycin was replaced with sulfadiazine. A month following the start of anti-toxoplasma therapy, there was a clinical and radiological improvement.</p><p><strong>Conclusions: </strong>despite progressive developments in the management of PLWH, in this case two different kind of opportunistic infection are found in a late-presenter patient. In particular, two aspects can be highlighted. The first one is that, in the setting of an highly impaired immune system, clinical presentation can be deceptive and more than one opportunistic infection can be observed together in the same patient. The second aspect is that after starting antiretroviral therapy, a rapid improvement of viro-immunologic parameters has been documented, probably leading to an immune reconstitution inflammatory syndrome (IRIS).</p>","PeriodicalId":52423,"journal":{"name":"Infezioni in Medicina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10495061/pdf/1124-9390_31_3_2023_404-406.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10589102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparative outcomes of direct-acting antiviral treatment in patients with HIV-Hepatitis C co-infection: insights from a single center experience in Colombia. hiv -丙型肝炎合并感染患者直接抗病毒治疗的比较结果:来自哥伦比亚单一中心经验的见解
Q2 Medicine Pub Date : 2023-01-01 DOI: 10.53854/liim-3103-11
Hernán Vergara-Samur, Samuel Martínez-Vernaza, Alejandro De la Hoz, Julián Barahona-Correa, Juan Pablo Ortiz, Sandra Gualtero-Trujillo, José Rumbo-Romero, Luis Miguel Salazar, Yanette Suárez Quintero, Sandra Valderrama-Beltrán

Background: Direct-acting antivirals (DAA) were introduced to Latin America with the aim of eliminating hepatitis C (HCV) in the region. There are scarce data on the outcomes of people living with HIV and HCV treated with these medications in Colombia. This study compares the outcomes of patients with HIV-HCV co-infection and HCV mono-infection treated with DAAs.

Methods: Retrospective observational study including patients ≥18 years old with HCV infection treated with DAAs from August 2017 to December 2019 in a comprehensive center in Colombia. The main outcome was sustained virologic response (SVR). Secondary outcomes included reinfection, relapse and adverse events.

Results: We included 223 individuals with HCV treated with DAAs; 142 (63.6%) individuals were mono-infected and 81 (36.3%) co-infected. Genotypes 1b (49.7%) and 4 (33.9%) were the most common. Overall SVR after DAA treatment was 96.8%. Relapse rate was 2.24%, reinfection rate was 6.28% and adverse events occurred in 27.8% of cases. SVR was comparable in patients with co- and mono-infection (95% vs 97.8%, p=0.245).

Conclusion: DAA were effective in mono-infected (HCV) and co-infected (HCV/HIV) patients and reinfection was high in this last group.

背景:直接作用抗病毒药物(DAA)被引入拉丁美洲,目的是消除该地区的丙型肝炎(HCV)。关于哥伦比亚艾滋病毒和丙型肝炎病毒感染者接受这些药物治疗的结果的数据很少。这项研究比较了HIV-HCV合并感染和HCV单一感染患者接受DAAs治疗的结果。方法:回顾性观察研究,纳入2017年8月至2019年12月在哥伦比亚某综合中心接受DAAs治疗的≥18岁HCV感染患者。主要结果为持续病毒学应答(SVR)。次要结局包括再感染、复发和不良事件。结果:我们纳入了223例接受DAAs治疗的HCV患者;单独感染142例(63.6%),合并感染81例(36.3%)。基因型1b(49.7%)和基因型4(33.9%)最为常见。DAA治疗后的总SVR为96.8%。复发率为2.24%,再感染率为6.28%,不良事件发生率为27.8%。合并感染和单一感染患者的SVR相当(95% vs 97.8%, p=0.245)。结论:DAA对单一感染(HCV)和合并感染(HCV/HIV)患者均有效,且合并感染患者的再感染率较高。
{"title":"Comparative outcomes of direct-acting antiviral treatment in patients with HIV-Hepatitis C co-infection: insights from a single center experience in Colombia.","authors":"Hernán Vergara-Samur,&nbsp;Samuel Martínez-Vernaza,&nbsp;Alejandro De la Hoz,&nbsp;Julián Barahona-Correa,&nbsp;Juan Pablo Ortiz,&nbsp;Sandra Gualtero-Trujillo,&nbsp;José Rumbo-Romero,&nbsp;Luis Miguel Salazar,&nbsp;Yanette Suárez Quintero,&nbsp;Sandra Valderrama-Beltrán","doi":"10.53854/liim-3103-11","DOIUrl":"https://doi.org/10.53854/liim-3103-11","url":null,"abstract":"<p><strong>Background: </strong>Direct-acting antivirals (DAA) were introduced to Latin America with the aim of eliminating hepatitis C (HCV) in the region. There are scarce data on the outcomes of people living with HIV and HCV treated with these medications in Colombia. This study compares the outcomes of patients with HIV-HCV co-infection and HCV mono-infection treated with DAAs.</p><p><strong>Methods: </strong>Retrospective observational study including patients ≥18 years old with HCV infection treated with DAAs from August 2017 to December 2019 in a comprehensive center in Colombia. The main outcome was sustained virologic response (SVR). Secondary outcomes included reinfection, relapse and adverse events.</p><p><strong>Results: </strong>We included 223 individuals with HCV treated with DAAs; 142 (63.6%) individuals were mono-infected and 81 (36.3%) co-infected. Genotypes 1b (49.7%) and 4 (33.9%) were the most common. Overall SVR after DAA treatment was 96.8%. Relapse rate was 2.24%, reinfection rate was 6.28% and adverse events occurred in 27.8% of cases. SVR was comparable in patients with co- and mono-infection (95% vs 97.8%, p=0.245).</p><p><strong>Conclusion: </strong>DAA were effective in mono-infected (HCV) and co-infected (HCV/HIV) patients and reinfection was high in this last group.</p>","PeriodicalId":52423,"journal":{"name":"Infezioni in Medicina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10495049/pdf/1124-9390_31_3_2023_374-383.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10589104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Antibiotic prophylaxis compliance differences in surgery and gynecology/obstetrics services in Huánuco, Peru. 秘鲁Huánuco外科和妇科/产科服务的抗生素预防依从性差异
Q2 Medicine Pub Date : 2023-01-01 DOI: 10.53854/liim-3103-10
Vicky Panduro-Correa, Walter Gomez-Gonzales, Ali A Rabaan, Juan Carlos Valencia-Martínez, Yeni Gutiérrez-Acuña, Luis Chihuantito-Abal, Jenny Zavaleta-Oliver, Joshuan J Barboza, Alfonso J Rodriguez-Morales, Kovy Arteaga-Livias

Introduction: Surgical site infections (SSIs) can increase mortality and morbidity in patients after surgery. Antibiotic prophylaxis is an effective measure to prevent SSIs, but inappropriate prescription is frequent. The objective of the study was to determine compliance with the clinical practice guideline for antibiotic prophylaxis in the general surgery and gynecology and obstetrics wards in the city of Huánuco, Peru.

Methods: An analytical cross-sectional study was carried out on all surgical interventions in the general surgery and gynecology and obstetrics services during the year 2019. Compliance was determined based on the chosen antibiotic, dose, time of administration, and duration of prophylaxis. Related factors considered were age, presence of co-morbidities, surgery performed, duration of surgery, types of procedure, anesthesia, as well as years as a surgeon and anesthesiologist.

Results: A total of 557 medical records of patients with a median age of 33 years undergoing surgery were collected,. Antibiotic prophylaxis was correctly followed in all aspects in 14.6% of cases in the general surgery service and only in 5.6% of cases in the gynecology and obstetrics service. The correct duration of prophylaxis was 11.6% and 19.7% in general surgery and gynecology and obstetrics, respectively.

Conclusion: Low compliance with institutional clinical practice guidelines for antibiotic prophylaxis was identified in both services. However, surgical interventions in the general surgery service presented better compliance with antibiotic prophylaxis compared to gynecology and obstetrics procedures.

手术部位感染(ssi)可增加术后患者的死亡率和发病率。抗生素预防是预防ssi的有效措施,但处方不当的情况较多。该研究的目的是确定秘鲁Huánuco市普通外科和妇产科病房抗生素预防的临床实践指南的依从性。方法:对2019年普外科和妇产科所有手术干预措施进行分析性横断面研究。依从性根据所选择的抗生素、剂量、给药时间和预防持续时间来确定。考虑的相关因素包括年龄、合并症的存在、手术情况、手术持续时间、手术类型、麻醉以及担任外科医生和麻醉师的年限。结果:共收集手术患者病历557份,中位年龄33岁。14.6%的普通外科病例在各方面都正确使用了抗生素预防,而只有5.6%的妇产科病例正确使用抗生素预防。普通外科和妇产科的正确预防时间分别为11.6%和19.7%。结论:两种服务对机构临床实践抗生素预防指南的依从性较低。然而,与妇产科手术相比,普外科手术干预对抗生素预防的依从性更好。
{"title":"Antibiotic prophylaxis compliance differences in surgery and gynecology/obstetrics services in Huánuco, Peru.","authors":"Vicky Panduro-Correa,&nbsp;Walter Gomez-Gonzales,&nbsp;Ali A Rabaan,&nbsp;Juan Carlos Valencia-Martínez,&nbsp;Yeni Gutiérrez-Acuña,&nbsp;Luis Chihuantito-Abal,&nbsp;Jenny Zavaleta-Oliver,&nbsp;Joshuan J Barboza,&nbsp;Alfonso J Rodriguez-Morales,&nbsp;Kovy Arteaga-Livias","doi":"10.53854/liim-3103-10","DOIUrl":"https://doi.org/10.53854/liim-3103-10","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical site infections (SSIs) can increase mortality and morbidity in patients after surgery. Antibiotic prophylaxis is an effective measure to prevent SSIs, but inappropriate prescription is frequent. The objective of the study was to determine compliance with the clinical practice guideline for antibiotic prophylaxis in the general surgery and gynecology and obstetrics wards in the city of Huánuco, Peru.</p><p><strong>Methods: </strong>An analytical cross-sectional study was carried out on all surgical interventions in the general surgery and gynecology and obstetrics services during the year 2019. Compliance was determined based on the chosen antibiotic, dose, time of administration, and duration of prophylaxis. Related factors considered were age, presence of co-morbidities, surgery performed, duration of surgery, types of procedure, anesthesia, as well as years as a surgeon and anesthesiologist.</p><p><strong>Results: </strong>A total of 557 medical records of patients with a median age of 33 years undergoing surgery were collected,. Antibiotic prophylaxis was correctly followed in all aspects in 14.6% of cases in the general surgery service and only in 5.6% of cases in the gynecology and obstetrics service. The correct duration of prophylaxis was 11.6% and 19.7% in general surgery and gynecology and obstetrics, respectively.</p><p><strong>Conclusion: </strong>Low compliance with institutional clinical practice guidelines for antibiotic prophylaxis was identified in both services. However, surgical interventions in the general surgery service presented better compliance with antibiotic prophylaxis compared to gynecology and obstetrics procedures.</p>","PeriodicalId":52423,"journal":{"name":"Infezioni in Medicina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10495055/pdf/1124-9390_31_3_2023_364-373.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10295046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Dalbavancin in catheter-related bloodstream infections: a pilot study. 达尔巴万辛治疗导管相关血流感染的初步研究
Q2 Medicine Pub Date : 2023-01-01 DOI: 10.53854/liim-3102-14
Sergio Venturini, Ingrid Reffo, Manuela Avolio, Giancarlo Basaglia, Giovanni Del Fabro, Astrid Callegari, Alessandro Grembiale, Elena Garlatti, Viviana Castaldo, Maurizio Tonizzo, Massimiliano Balbi, Michele Cevolani, Barbara Basso, Tommaso Pellis, Massimo Crapis

Background: Catheter-related bloodstream infections (CRBSI) represent a frequent complication of vascular catheterization, with high morbidity, mortality, and associated costs. Most infections are caused by Gram-positive bacteria; thus dalbavancin, a new long-acting lipoglicopeptide, may have a role in early patient discharge strategies optimizing treatment and reducing overall costs.

Methods: In this small pilot feasibility study, we assessed the efficacy and safety of a "single step" treatment strategy combining dalbavancin administration (1500 mg IV single dose), catheter removal, and early discharge in adult patients admitted to medical wards in a three-year period.

Results: We enrolled sixteen patients with confirmed Gram-positive CRBSI, with a mean age of 68 years and relevant comorbidities (median Charlson Comorbidity index=7). The most frequent causative agents were staphylococci, with 25% of methicillin-resistant strains, and the majority of infected devices were short term central venous catheter (CVC) and peripherally inserted central catheter (PICC). Ten out of sixteen patients had been treated empirically before dalbavancin administration. The mean time from dalbavancin administration to discharge was 2 days; none of the patients had adverse drug-related reactions; at 30- and 90-day follow-up, no patients have been readmitted to the hospital due to bacteraemia recurrence.

Conclusions: Our results indicate that single-dose dalbavancin is highly effective, well-tolerated, and cost-saving for Gram-positive CRBSI.

背景:导管相关性血流感染(CRBSI)是血管导管置入的常见并发症,具有高发病率、死亡率和相关费用。大多数感染是由革兰氏阳性细菌引起的;因此,dalbavancin,一种新的长效脂磷脂肽,可能在患者早期出院策略优化治疗和降低总成本方面发挥作用。方法:在这个小型的试点可行性研究中,我们评估了“单步”治疗策略的有效性和安全性,该治疗策略结合达尔巴伐辛给药(1500mg IV单剂量)、拔管和早期出院,为期三年。结果:我们纳入了16例确诊革兰氏阳性CRBSI患者,平均年龄68岁,伴有相关合并症(Charlson共病指数中位数=7)。最常见的病原体是葡萄球菌,占耐甲氧西林菌株的25%,大多数感染装置是短期中心静脉导管(CVC)和外周插入中心导管(PICC)。16例患者中有10例在给药前进行了经验性治疗。用药至出院平均时间2 d;所有患者均未发生药物相关不良反应;在30天和90天的随访中,没有患者因菌血症复发而再次入院。结论:我们的研究结果表明,单剂量达巴文星治疗革兰氏阳性CRBSI是高效、耐受性良好且节省成本的。
{"title":"Dalbavancin in catheter-related bloodstream infections: a pilot study.","authors":"Sergio Venturini,&nbsp;Ingrid Reffo,&nbsp;Manuela Avolio,&nbsp;Giancarlo Basaglia,&nbsp;Giovanni Del Fabro,&nbsp;Astrid Callegari,&nbsp;Alessandro Grembiale,&nbsp;Elena Garlatti,&nbsp;Viviana Castaldo,&nbsp;Maurizio Tonizzo,&nbsp;Massimiliano Balbi,&nbsp;Michele Cevolani,&nbsp;Barbara Basso,&nbsp;Tommaso Pellis,&nbsp;Massimo Crapis","doi":"10.53854/liim-3102-14","DOIUrl":"https://doi.org/10.53854/liim-3102-14","url":null,"abstract":"<p><strong>Background: </strong>Catheter-related bloodstream infections (CRBSI) represent a frequent complication of vascular catheterization, with high morbidity, mortality, and associated costs. Most infections are caused by Gram-positive bacteria; thus dalbavancin, a new long-acting lipoglicopeptide, may have a role in early patient discharge strategies optimizing treatment and reducing overall costs.</p><p><strong>Methods: </strong>In this small pilot feasibility study, we assessed the efficacy and safety of a \"single step\" treatment strategy combining dalbavancin administration (1500 mg IV single dose), catheter removal, and early discharge in adult patients admitted to medical wards in a three-year period.</p><p><strong>Results: </strong>We enrolled sixteen patients with confirmed Gram-positive CRBSI, with a mean age of 68 years and relevant comorbidities (median Charlson Comorbidity index=7). The most frequent causative agents were staphylococci, with 25% of methicillin-resistant strains, and the majority of infected devices were short term central venous catheter (CVC) and peripherally inserted central catheter (PICC). Ten out of sixteen patients had been treated empirically before dalbavancin administration. The mean time from dalbavancin administration to discharge was 2 days; none of the patients had adverse drug-related reactions; at 30- and 90-day follow-up, no patients have been readmitted to the hospital due to bacteraemia recurrence.</p><p><strong>Conclusions: </strong>Our results indicate that single-dose dalbavancin is highly effective, well-tolerated, and cost-saving for Gram-positive CRBSI.</p>","PeriodicalId":52423,"journal":{"name":"Infezioni in Medicina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10241395/pdf/1124-9390_31_1_2023_250-256.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9594787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Candida auris: the new fungal threat. 耳念珠菌:新的真菌威胁。
Q2 Medicine Pub Date : 2023-01-01 DOI: 10.53854/liim-3103-6
Francesco Pallotta, Pierluigi Viale, Francesco Barchiesi

Candida auris is an emergent fungal pathogen of particular concern. Since its first identification in Japan in 2009, it rapidly spread all over the world, including Italy. The main concern related to the diffusion of this fungus is its antifungal resistance. It is speculated that about 90% of isolates are resistant to fluconazole, 30% to amphotericin B and 5% to echinocandins; furthermore, some cases of pan-antifungal resistance have been described. Critically ill patients are particularly at risk of being colonized by this yeast and person-to-person transmission may generate hospital outbreaks. In fact, C. auris can survive on inanimate surfaces for a long time and commonly used disinfectants are not effective. Additionally, devices such as central venous catheters (CVCs) or urinary catheters are particularly at risk of being colonized, representing a possible source for the development of bloodstream infections caused by C. auris, which carries a high mortality rate. Given its capability to spread in the hospital setting and the limited therapeutic options it is of outmost importance to promptly identify C. auris. However, commonly used biochemical tests frequently misidentify C. auris as other Candida species; currently the best identification techniques are MALDI-TOF and molecular methods, such as PCR of the ITS and D1/D2 regions of the 28s ribosomal DNA. Whole genome sequencing remains the gold standard for the phylogenetic investigation of outbreaks. The majority of cases of colonization by C. albicans will not cause bloodstream infections and contact precautions and surveillance of contacts will be sufficient. When invasive fungal infections occur, echinocandins still represent the first therapeutic choice. A combination therapy or the use of novel antifungals (such as ibrexafungerp or fosmanogepix) would be required for echinocandin resistant strains. In conclusion, C. auris represents a growing threat because of its antifungal resistance characteristics, its difficult identification and its easy spread from person to person. The aim of this mini-review is to summarize the main aspects concerning this pathogen.

耳念珠菌是一种特别值得关注的新兴真菌病原体。自2009年在日本首次发现以来,它迅速蔓延到包括意大利在内的世界各地。与这种真菌扩散有关的主要问题是它的抗真菌耐药性。据推测,约90%的分离株对氟康唑耐药,30%对两性霉素B耐药,5%对棘白菌素耐药;此外,还报道了一些泛抗真菌耐药性病例。危重病人特别容易被这种酵母菌定植,人与人之间的传播可能导致医院暴发。事实上,金黄色葡萄球菌可以在无生命的表面存活很长时间,而常用的消毒剂是无效的。此外,中心静脉导管(CVCs)或导尿管等设备特别容易被定植,这可能是由C. auris引起的血流感染的一个来源,这种感染具有很高的死亡率。鉴于其在医院环境中传播的能力和有限的治疗选择,及时识别金黄色葡萄球菌至关重要。然而,常用的生化测试经常将金黄色念珠菌误认为其他念珠菌;目前最好的鉴定技术是MALDI-TOF和分子方法,如28s核糖体DNA ITS区和D1/D2区PCR。全基因组测序仍然是疫情系统发育调查的金标准。大多数白色念珠菌定植病例不会引起血液感染,接触预防和接触监测将是足够的。当侵袭性真菌感染发生时,棘白菌素仍然是首选的治疗选择。对于棘白菌素耐药菌株,需要联合治疗或使用新型抗真菌药物(如ibrexafungerp或fosmangepix)。综上所述,金黄色葡萄球菌具有抗真菌性、鉴定难度大、易人际传播等特点,威胁日益严重。这篇综述的目的是总结有关这种病原体的主要方面。
{"title":"<i>Candida auris:</i> the new fungal threat.","authors":"Francesco Pallotta,&nbsp;Pierluigi Viale,&nbsp;Francesco Barchiesi","doi":"10.53854/liim-3103-6","DOIUrl":"https://doi.org/10.53854/liim-3103-6","url":null,"abstract":"<p><p><i>Candida auris</i> is an emergent fungal pathogen of particular concern. Since its first identification in Japan in 2009, it rapidly spread all over the world, including Italy. The main concern related to the diffusion of this fungus is its antifungal resistance. It is speculated that about 90% of isolates are resistant to fluconazole, 30% to amphotericin B and 5% to echinocandins; furthermore, some cases of pan-antifungal resistance have been described. Critically ill patients are particularly at risk of being colonized by this yeast and person-to-person transmission may generate hospital outbreaks. In fact, <i>C. auris</i> can survive on inanimate surfaces for a long time and commonly used disinfectants are not effective. Additionally, devices such as central venous catheters (CVCs) or urinary catheters are particularly at risk of being colonized, representing a possible source for the development of bloodstream infections caused by <i>C. auris</i>, which carries a high mortality rate. Given its capability to spread in the hospital setting and the limited therapeutic options it is of outmost importance to promptly identify <i>C. auris</i>. However, commonly used biochemical tests frequently misidentify <i>C. auris</i> as other <i>Candida</i> species; currently the best identification techniques are MALDI-TOF and molecular methods, such as PCR of the ITS and D1/D2 regions of the 28s ribosomal DNA. Whole genome sequencing remains the gold standard for the phylogenetic investigation of outbreaks. The majority of cases of colonization by <i>C. albicans</i> will not cause bloodstream infections and contact precautions and surveillance of contacts will be sufficient. When invasive fungal infections occur, echinocandins still represent the first therapeutic choice. A combination therapy or the use of novel antifungals (such as ibrexafungerp or fosmanogepix) would be required for echinocandin resistant strains. In conclusion, <i>C. auris</i> represents a growing threat because of its antifungal resistance characteristics, its difficult identification and its easy spread from person to person. The aim of this mini-review is to summarize the main aspects concerning this pathogen.</p>","PeriodicalId":52423,"journal":{"name":"Infezioni in Medicina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10495051/pdf/1124-9390_31_3_2023_323-328.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10589106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Streptococcus pseudoporcinus bacteremia in a patient with skin and soft tissue infection. A case report and literature review. 皮肤及软组织感染患者的假机会性链球菌菌血症。病例报告及文献复习。
Q2 Medicine Pub Date : 2023-01-01 DOI: 10.53854/liim-3103-14
Michalis Papapanagiotou, Petros Ioannou, Konstantinos Alexakis, Sofia Maraki, Eleni Papadokostaki, Diamantis P Kofteridis

Streptococcus pseudoporcinus is a beta-hemolytic Streptococcus species arranged in short chains, which was first described in 2006. In the last years, there have been several reports of human infections by this bacterium, with five skin and soft tissue infections identified. Herein, a case of S. pseudoporcinus skin and soft tissue infection in a patient, who also developed bacteremia and was successfully treated with intravenous antibiotics, is reported. A 67-year-old man with a history of diffuse large B-cell lymphoma presented to the emergency department because of fever, redness, swelling, and pain in the left lower limb. He was admitted to the medical ward, diagnosed with severe non-purulent skin and soft tissue infection, and treated empirically with intravenous piperacillin/tazobactam at 4.5 gr thrice daily and daptomycin at 10mg/kg once daily. Blood cultures were obtained before the initiation of the antibiotics and grew S. pseudoporcinus. Treatment was de-escalated to ceftriaxone at a dose of 2 gr once daily. He completed two weeks of intravenous antimicrobial treatment. S. pseudoporcinus is an emerging pathogen associated with skin and soft tissue infections, bacteremia, and other invasive, potentially life-threatening infections. Further investigation is warranted to clarify this microorganism's pathogenesis and biological significance.

伪机会链球菌(Streptococcus pseudoporcinus)是一种以短链排列的溶血性链球菌,于2006年首次被发现。在过去的几年里,已经有几起人类感染这种细菌的报道,其中有五起皮肤和软组织感染被确认。本文报告一例假机会链球菌皮肤和软组织感染患者,同时发生菌血症,经静脉注射抗生素成功治疗。67岁男性,有弥漫性大b细胞淋巴瘤病史,因左下肢发热、发红、肿胀和疼痛来到急诊科。他被送进病房,诊断为严重的非化脓性皮肤和软组织感染,并经验性地静脉注射哌拉西林/他唑巴坦4.5克,每日三次,达托霉素10mg/kg,每日一次。在抗生素开始前进行血培养,培养出假机会葡萄球菌。治疗逐步升级为头孢曲松,剂量为2克,每日一次。他完成了两周的静脉抗菌治疗。假机会葡萄球菌是一种新兴病原体,与皮肤和软组织感染、菌血症和其他侵袭性、潜在威胁生命的感染有关。需要进一步的研究来阐明这种微生物的发病机制和生物学意义。
{"title":"<i>Streptococcus pseudoporcinus</i> bacteremia in a patient with skin and soft tissue infection. A case report and literature review.","authors":"Michalis Papapanagiotou,&nbsp;Petros Ioannou,&nbsp;Konstantinos Alexakis,&nbsp;Sofia Maraki,&nbsp;Eleni Papadokostaki,&nbsp;Diamantis P Kofteridis","doi":"10.53854/liim-3103-14","DOIUrl":"https://doi.org/10.53854/liim-3103-14","url":null,"abstract":"<p><p><i>Streptococcus pseudoporcinus</i> is a beta-hemolytic <i>Streptococcus</i> species arranged in short chains, which was first described in 2006. In the last years, there have been several reports of human infections by this bacterium, with five skin and soft tissue infections identified. Herein, a case of <i>S. pseudoporcinus</i> skin and soft tissue infection in a patient, who also developed bacteremia and was successfully treated with intravenous antibiotics, is reported. A 67-year-old man with a history of diffuse large B-cell lymphoma presented to the emergency department because of fever, redness, swelling, and pain in the left lower limb. He was admitted to the medical ward, diagnosed with severe non-purulent skin and soft tissue infection, and treated empirically with intravenous piperacillin/tazobactam at 4.5 gr thrice daily and daptomycin at 10mg/kg once daily. Blood cultures were obtained before the initiation of the antibiotics and grew <i>S. pseudoporcinus.</i> Treatment was de-escalated to ceftriaxone at a dose of 2 gr once daily. He completed two weeks of intravenous antimicrobial treatment. <i>S. pseudoporcinus</i> is an emerging pathogen associated with skin and soft tissue infections, bacteremia, and other invasive, potentially life-threatening infections. Further investigation is warranted to clarify this microorganism's pathogenesis and biological significance.</p>","PeriodicalId":52423,"journal":{"name":"Infezioni in Medicina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10495064/pdf/1124-9390_31_3_2023_399-403.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10295044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Infezioni in Medicina
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