COVID-19 mortality and gross domestic product loss: A wake-up call for government leaders

Government leaders have struggled to reduce the infection and deaths due to coronavirus disease 2019 (COVID-19) as well as to keep the economy and businesses open. There is a large variation of mortality and damage to economy among countries. One possible cause leading to the large variation is the manner in which countries have delt with COVID-19. Some countries or regions such as China, New Zealand, and Taiwan, acted quickly and aggressively by implementing border closures, lockdown, school closures, mass testing, etc. On the other hand, many European countries, United States, and Brazil delayed their decisions to implement these restrictions and measures. No study has assessed the correlation between gross domestic product (GDP) and COVID-19 mortality. In the present study, there was a negative correlation between GDP and COVID-19 mortality suggesting that countries that failed to control the virus (larger COVID-19 mortality) would see a larger decline in GDP. Governmental leaders should act fast and aggressively when making decisions because data shows that countries who have run after two hares have caught neither. Furthermore, citizens of each country need to do their own part by following guidelines and practicing social distancing and mask wearing, which are considered the most effective, easiest, and cheapest measures that can be taken, so that repeated lockdowns can be avoided.

Pharmacodynamics for predicting therapeutic outcome and countering resistance spread: The cefditoren case

The relationship between pharmacokinetics and pharmacodynamics is a key instrument to improve antimicrobial stewardship and should be aimed to identification of the drug exposure measure that is closely associated not only with the ability to kill organisms but also to suppress the emergence of resistant subpopulations. This article reviews published studies for efficacy prediction with cefditoren and those aimed to explore its potential for countering resistance spread, focusing on the three most prevalent community-acquired isolates from respiratory infections: Streptococcus pneumoniae (S. pneumoniae), Haemophilus influenzae (H. influenzae) and Streptococcus pyogenes (S. pyogenes). Studies for efficacy prediction include in vitro pharmacodynamic simulations (using physiological concentrations of human albumin) and mice models (taking advantage of the same protein binding rate in mice and humans) to determine the value of the pharmacodynamic indices predicting efficacy, and Monte Carlo simulations to explore population pharmacodynamic coverage, as weapons for establishing breakpoints. Studies exploring the potential of cefditoren (free concentrations obtained with 400 mg cefditoren bid administration) for countering spread of resistance showed its capability for countering (1) intra-strain spread of resistance linked to ftsI gene mutations in H. influenzae; (2) the spread of H. influenzae resistant strains (with ftsI gene mutations) in multi-strain H. influenzae niches or of S. pneumoniae strains with multiple resistance traits in multi-strain S. pneumoniae niches; and (3) for overcoming indirect pathogenicity linked to β-lactamase production by H. influenzae that protects S. pyogenes in multibacterial niches. This revision evidences the ecological potential for cefditoren (countering resistance spread among human-adapted commensals) and its adequate pharmacodynamic coverage of respiratory pathogens (including those resistant to previous oral compounds) producing community-acquired infections.

Can a radioimmunoassay kit be developed for accurate detection of the S protein of severe acute respiratory syndrome coronavirus 2?

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the end of 2019 spread worldwide within only a few months. The screening and timely isolation of infected individuals have been regarded as an effective means of epidemic prevention and control. Therefore, effective screening of infected individuals plays a vital role in epidemic prevention and control. At present, reverse transcription-polymerase chain reaction (RT–PCR) is the main method for the in vitro detection of SARS-CoV-2. However, RT–PCR requires certified laboratories, expensive equipment, and trained technicians. Therefore, it is necessary to develop simpler and more convenient methods. Some studies have shown that the PepKAA peptide has a high affinity for the S protein of SARS-CoV-2. The tyrosine in PepKAA is labeled with ¹²⁵I and used to design a radioimmunoassay kit for the detection of the S protein of SARS-CoV-2, which is of great significance for the early diagnosis of COVID-19.

Human immunodeficiency virus, atherosclerosis and Chlamydophila pneumoniae

Chlamydophila pneumoniae (C. pneumoniae) is an obligate, intracellular bacterium associated with a wide variety of acute and chronic diseases. C. pneumoniae infection is characterized by persistence and immunopathological damage to host target tissues, including the lung. Over the past 20 years, a variety of studies have investigated a possible link between C. pneumoniae infection and atherosclerosis, because of its role in all stages of atherosclerosis, from initial inflammatory lesions to plaque rupture. In the current highly active antiretroviral therapy (HAART) era, many human immunodeficiency virus (HIV)-infected patients are experiencing health problems that accompany the aging process, mainly the risk of cardiovascular disease (CVD). There is renewed interest in a link between atherosclerotic CVD and as yet poorly defined environmental exposures, including infectious agents. On the one hand, the patient with HIV and lipodystrophy caused by HAART and exacerbated by C. pneumoniae infection could be a factor of risk for atherosclerosis. An assessment of the therapy against C. pneumoniae and HAART should always be conducted. It is advisable that HIV-acquired immune deficiency syndrome patients undergo a serological test to determine exposure to C. pneumoniae and to assess treatment options. On the other hand, in patients with a positive serology to C. pneumoniae, an increment of the body mass index has been found; therefore, it is probable that the recurrent infection may play an important role in creating adverse endothelial conditions allowing the infection by C. pneumoniae in its chronic form, to damage the endothelial surface. Vascular studies would be necessary for corroboration.

Unsuspected imported malaria in a case of sudden infant death

Here we describe the case of a 4-mo-old female who died suddenly without any apparent cause that was initially mistaken as a case of sudden infant death syndrome. Histologic observation of brain sections revealed blue-black bodies in erythrocytes of the blood vessels, suggestive of specific stages of the hematic schizogonic cycle. Further examinations revealed hemozoin and hemosiderin deposits in the parenchyma of all organs, leading to the diagnosis of malaria by Plasmodium falciparum (P. falciparum). The death occurred in Italy, the native country of the infant, two weeks after a Christmas holiday spent in Pakistan, the parents’ birthplace, which has a high malarial endemicity. As this case demonstrates, the diagnosis of malaria should always be considered as a differential diagnosis in subjects, including infants, that die unexpectedly after returning from P. falciparum endemic areas.

Unusual cause of hemorrhagic pleural effusion: A case report

BACKGROUND

Infected aortic aneurysms are uncommon and difficult to treat. We present a case of infected aortic aneurysm with recurrent nontyphoidal Salmonella bacteremia.

CASE SUMMARY

A 68-year-old gentleman presented with non-specific symptoms and was found to have nontyphoidal Salmonella bacteremia and was treated with intravenous ceftriaxone. However his condition did not improve, and he developed a multiloculated right pleural effusion. Thoracocentesis was done to drain hemorrhagic pleural fluid. Chest computed tomography demonstrated descending thoracic aorta saccular aneurysm with periaortic hematoma likely due to recent bleed and extending to the right pleural cavity. He was referred to cardiothoracic surgery team and was planned for medical therapy in view of hemodynamic stability and no evidence of active leakage. He completed intravenous antibiotic for 5 wk and refused surgical intervention. Unfortunately, he was admitted twice for recurrent nontyphoidal Salmonella bacteremia. Finally, he agreed for surgical intervention and underwent endovascular aortic repair 3 mo later. Postoperatively, his condition remained stable with no recurrence of infection.

CONCLUSION

Our case highlights the importance of high index of suspicion of infected aortic aneurysm in patients with Salmonella bacteremia with high-risk factors such as atherosclerosis.

Cutaneous leishmaniasis in Louisiana - one-year follow-up: A case report

BACKGROUND

Reports of leishmaniasis are scarce in North America. It is considered to be one of the neglected tropical diseases. It is seen in immigrants from endemic areas to United States. Treatments are not readily available in the United States. Untreated or inadequately treated cutaneous leishmaniasis not only causes localized disfigurement but can advance to more permanent and devastating mucosal disfigurement and perforation, if caused by a species that can also cause mucocutaneous leishmaniasis.

CASE SUMMARY

A 42-year-old human immunodeficiency virus negative male immigrant from Honduras presented to the emergency department of our facility in Louisiana with a 2-mo history of a left lower extremity ulcer. It started as a painless blister that progressed in size and developed into other smaller lesions tracking up the thigh and became tender and erythematous. Clinically looked nontoxic and healthy. He was afebrile. Blood tests, except inflammatory markers, were within normal limits. The cellulitis of the leg was treated with 6 d of vancomycin that also relieved the pain. Skin biopsy was obtained, and histopathology was suspicious for leishmania. Polymerase chain reaction/deoxyribonucleic acid sequencing done by centers for disease control and prevention confirmed the diagnosis as Leishmania panamensis. There was no involvement of naso-oropharyngeal mucosa, confirmed by otolaryngology. The patient was treated with miltefosine for 28 d. Clinic follow-up after approximately 11 mo revealed a healed skin ulcer.

CONCLUSION

Cutaneous leishmaniasis should be in the differential diagnosis of skin ulcers of travelers from endemic areas. Awareness regarding diagnosis and treatment of leishmaniasis needs to be enhanced.

Steps taken to fight the COVID-19 pandemic at the grassroots level of rural India: Experience of a community physician

Coronavirus disease (COVID-19) was first identified in Wuhan, China and then rapidly spread all over the world. The World Health Organization declared a pandemic on March 11, 2020 as a result of COVID-19. As it has caused substantial morbidity and mortality, most countries took several measures to control its spread, including India. As of now, India has witnessed three major waves of COVID-19. Several measures like nationwide lockdown, active case finding, contact tracing, home isolation, and vaccination were taken. There was involvement of multiple sectors (including private and government) and community participation. During the pandemic, I was posted at a primary health centre in a rural setting in India. A rural primary care setting has its own limitations. All the steps taken had several challenges at the grassroots level. Therefore, through this article, I highlighted the challenges faced during the implementation of steps taken to battle the pandemic and the outcome.

Microbial translocation, residual viremia and immune senescence in the pathogenesis of HIV-1 infection

The pathophysiological mechanisms that underlie the progression of human immunodeficiency virus-1 (HIV-1) disease to full-blown AIDS are not well understood. Findings suggest that, during HIV-1 infection, plasma lipopolysaccharide (LPS) levels, which are used as an indicator of microbial translocation (MT), are elevated throughout the acute and chronic phases of HIV-1 disease. The translocation of bacterial products through the damaged gastrointestinal barrier into the systemic circulation has been described as a driver of immune activation. In contrast, comorbidities that are associated with HIV-1 infection have been attributed to chronic inflammation and immune system dysfunction secondary to MT or low-level HIV-1 replication in plasma and cell reservoirs. Moreover, accelerated aging is significantly associated with chronic inflammation, immune activation, and immune senescence. In this review, we aimed to investigate the role of inflammation as a pivotal marker in the pathogenesis of HIV-1 disease. We will discuss the key features of chronic inflammation and immune activation that are observed during the natural course of the disease and those features that are detected in cART-modified infection. The review will focus on the following aspects of HIV-1 infection: (1) MT; (2) the role of residual viremia; and (3) “immune senescence” or “inflammaging.” Many questions remain unanswered about the potential mechanisms that are involved in HIV-1 pathogenesis. Further studies are needed to better investigate the mechanisms that underlie immune activation and their correlation with HIV-1 disease progression.

Healthcare seeking trends in acute respiratory infections among children of Pakistan

AIM

To assess healthcare seeking trends among Pakistani children with acute respiratory infections through comparative analysis between demographic health surveys (DHS) 2006-2007 and 2012-2013.

METHODS

Data of the last born children 0-24 mo of age of the sampled households from both the DHS was analyzed after seeking permission from the DHS open access website. These were children who had suffered from cough and/or breathing difficulty in the past two weeks and sought health care thereafter. The trends of health care seeking were determined separately for the individual, household and community level according to the study parameters. χ² test was applied to compare these trends. A P-value of < 0.05 was considered significant.

RESULTS

Out of 2508 children in 2006-2007 there were 1590 with acute respiratory infections (ARI) according to case definition along with 2142 out of 3419 children in 2012-2013 DHS, whose data was analyzed. During 2006-2007, 69% cases sought healthcare for ARI which improved to 79% in 2012-2013. Additionally, it was revealed that when compared between 2006-2007 and 2012-2013, improvement in care seeking practices was observed among illiterate mothers (64% vs 77%) although there was minimal change in those literate. Similarly, those women working also showed an increase in healthcare seeking from 67% to 79%. Additionally, those belonging to low and middle socioeconomic class showed a marked increase as compared to those in the higher class where there was no significant change. Whereas those living in rural communities also showed an increase from 66% to 78%.

CONCLUSION

Increasing health budget, improving maternal education and strengthening multi-sectoral coordination are among the effective strategies to improve outcomes associated with healthcare seeking in ARI.

Lymphocyte count predicts the severity of COVID-19: Evidence from a meta-analysis

BACKGROUND

In December 2019, coronavirus disease 2019 (COVID-19) was reported firstly in Wuhan, China. COVID-19 is currently a global pandemic.

AIM

To assess the suitability of lymphocyte count as a biomarker of COVID-19 severity.

METHODS

Five literature databases (PubMed/MEDLINE, Web of Science, Google Scholar, Embase, and Scopus) were searched to identify eligible articles. A meta-analysis was performed to calculate the standard mean difference (SMD) and 95% confidence interval (CI) of lymphocyte counts in coronaviral pneumonia cases.

RESULTS

Eight studies, including 1057 patients, were integrated in the meta-analysis. Lymphocyte counts were associated with severe coronavirus (CoV) infection (SMD = 1.35, 95%CI: 1.97 to 0.37, P < 0.001, I² = 92.6%). In the subgroup analysis stratified by prognosis, lymphocytes were associated with CoV infection mortality (n = 2, SMD = 0.42, 95%CI: 0.66 to 0.19, P < 0.001, I² = 0.0%), severity (n = 2, SMD = 0.93, 95%CI: 1.20 to 0.67, P < 0.001, I² = 0.0%), and diagnostic rate (n = 4, SMD = 2.32, 95%CI: 3.60 to 1.04, P < 0.001, I² = 91.2%).

CONCLUSION

Lymphocyte count may represent a simple, rapid, and commonly available laboratory index with which to diagnosis infection and predict the severity of CoV infections, including COVID-19.

Atypical manifestation of herpes esophagitis in an immunocompetent patient: Case report and literature review

Herpes simplex virus (HSV) is known to cause esophagitis in immunosuppressed patients; however, it is rarely seen in immunocompetent patients. We present a unique case of HSV esophagitis in a healthy male, without any immunocompromising conditions or significant comorbidities. The patient presented with a two-week history of dysphagia, odynophagia and epigastric pain. Physical exam revealed oral hyperemia without any visible ulcers or vesicles. He underwent esophagogastroduodenoscopy which noted severe esophagitis with ulceration. Esophageal biopsies were positive for HSV. Serology was positive for HSV as well. After initiating treatment with Famciclovir 250 mg 3 times/d, high dose proton pump inhibitor and sucralfate, patient had complete resolution of symptoms at his 2.5 wk follow up appointment. Subsequent workup did not reveal any underlying immune disorders. While HSV is a known causative of esophagitis in the immunocompromised, its presentation in healthy patients without any significant comorbidity is uncommon. Presentation with a systemic viral prodrome further makes this case unique.

Liver transplantation in patients with SARS-CoV-2: Two case reports

BACKGROUND

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19). This disease was declared a worldwide health problem with the characteristics of a pandemic. Most patients have mild symptoms and a good prognosis. Information on the evolution and prognosis of COVID-19 in solid organ recipients is scarce.

CASE SUMMARY

We describe two patients who underwent liver transplantation with a positive test result for detection of the viral sequence for COVID-19, using reverse-transcription polymerase chain reaction (RT-PCR), immediately before transplantation. The patients showed good evolution in the postoperative period, without signs of graft dysfunction. The immunosuppressive therapy was not modified. Both patients were discharged for subsequent outpatient follow-up.

CONCLUSION

In conclusion, it is expected that the experience at this center can be used as an example, aimed at the continuation of transplantations by other services and, thus, the morbidity and mortality of patients with liver disease on the transplantation waiting list can be reduced. Transplant centers must be able to readjust daily to the evolution of the COVID-19 pandemic.

Analysis of clinical characteristics and risk factors between elderly patients with severe and nonsevere Omicron variant infection

BACKGROUND

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to millions of confirmed cases and deaths worldwide. Elderly patients are at high risk of developing and dying from COVID-19 due to advanced age, decreased immune function, intense inflammatory response, and comorbidities. Shanghai has experienced a wave of infection with Omicron, a new variant of SARS-CoV-2, since March 2022. There is a pressing need to identify clinical features and risk factors for disease progression among elderly patients with Omicron infection to provide solid evidence for clinical policy-makers, public health officials, researchers, and the general public.

AIM

To investigate clinical characteristic differences and risk factors between elderly patients with severe and nonsevere Omicron SARS-CoV-2 variant infection.

METHODS

A total of 328 elderly patients with COVID-19 admitted to the Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from April 2022 to June 2022 were enrolled and divided into a severe group (82 patients) and a nonsevere group (246 patients) according to the diagnosis and treatment protocol of COVID-19 (version 7). The clinical data and laboratory results of both groups were collected and compared. A chi-square test, t test, Mann-Whitney U test, hierarchical log-rank test, univariate and multivariate logistic regression, and hierarchical analyses were used to determine significant differences.

RESULTS

The severe group was older (84 vs 74 years, P < 0.001), included more males (57.3% vs 43.9%, P = 0.037), had a lower vaccination rate (P < 0.001), and had a higher proportion of comorbidities, including chronic respiratory disease (P = 0.001), cerebral infarction (P < 0.001), chronic kidney disease (P = 0.002), and neurodegenerative disease (P < 0.001), than the nonsevere group. In addition, severe disease patients had a higher inflammatory index (P < 0.001), greater need for symptomatic treatment (P < 0.001), longer hospital stay (P = 0.011), extended viral shedding time (P = 0.014), and higher mortality than nonsevere disease patients (P < 0.001). No difference was observed in the application of Paxlovid in the severe and nonsevere groups (P = 0.817). Oxygen saturation, cerebral infarction, and D-dimer were predictive factors for developing severe disease in patients with COVID-19, with D-dimer having an excellent role (area under the curve: 90.1%, 95%CI: 86.1-94.0%). In addition, D-dimer was a risk factor for developing severe COVID-19 according to multivariate stratified analysis.

CONCLUSION

The clinical course of severe COVID-19 is complex, with a higher need for symptomatic treatment. D-dimer is a suitable biomarker for identifying patients at risk for developing severe COVID-19.

Clinical significance of anti-nucleocapsid-IgG sero-positivity in SARS-CoV-2 infection in hospitalized patients in North Dakota

BACKGROUND

During the peak of the coronavirus diseases 2019 (COVID-19) pandemic, clinicians actively studied the utility of various epidemiologic-clinical parameters to determine the prognosis for patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Serum IgG antibody level, D-Dimer, C-reactive protein and neutrophil to lymphocyte ratio, etc. were studied to assess their association with the clinical course in hospitalized patients and predict who may be at increased risk for poor clinical outcome. However, the influence of SARS-CoV-2-anti-nucleocapsid-IgG antibody (IgG-N) sero-positivity on the clinical outcome of patients with COVID-19 is largely unknown.

AIM

To study the influence of SARS-CoV-2 anti-nucleocapsid-IgG seropositivity on clinical course and diseases severity in hospitalized COVID-19 patients.

METHODS

We conducted a retrospective study of adults admitted to a tertiary care community hospital in North Dakota with COVID-19. Included patients had severe COVID-19 disease or worse and so required supplemental oxygen on admission. They were serologically tested for SARS-CoV-2-anti-nuceocapsid-IgG (IgG-N). The IgG-N positive group were 26 patients and the IgG-N negative group had 33 patients. The groups received similar treatment for COVID-19 as approved by our healthcare system from Day 1 of admission until discharge or death. Measurable parameters for monitoring the patients’ clinical course included the following: Length of hospitalization (LOS), use of high flow nasal canula (HFNC), use of noninvasive bilevel positive pressure ventilation (BiPAP), admission into the intensive care unit, need for mechanical ventilation (VENT); and the patient outcome/discharge or death. Other variables included were age, gender and body-mass-index, and duration of symptoms before presentation. For each variable, the outcome was modeled as a function of SARS-CoV-2-IgG-N status (positive or negative) using a generalized linear model. For LOS-days, a negative binomial distribution was used as it had a better fit than a Poisson or Gaussian distribution as evidenced by a Pearson chi-square/df value closer to 1.0. All other outcomes utilized a binary logistic regression model.

RESULTS

After a thorough examination of patient data, it was found that admission rates to the Intensive Care Unit, as well as the usage of BiPAP, HFNC and VENT support, in conjunction with patient outcomes, were not significantly different across IgG-N status. However, the LOS variable when assessed by IgG-N status was found to be significant (t value = 2.16, P value = 0.0349). IgG-N negative patients had higher than average LOS in comparison to IgG-N positive patients (15.12 vs 9.35 d). Even when removing the extreme value (an LOS of 158 d), IgG-N negative patients still had slightly higher than average stays (10.66 vs 9.35 d) but the relationship was no longer significant. For patient outcome/death, only age (numerical) was a significant predictor (F value = 4.66, P value = 0.0352). No other variables for any of the outcomes were significant predictors of clinical course or disease severity.

CONCLUSION

Our study demonstrated that IgG-N seroconversion had no significant association with clinical outcomes in hospitalized COVID-19 patients.

Helicobacter pylori infection in pregnant women: Gastrointestinal symptoms and pregnancy- related disorders

Helicobacter pylori (H. Pylori) is a gram-negative, flagellated and spiral-shaped bacterial pathogen that impacts approximately 46% among pregnant women globally and has been associated with various maternal-fetal complications. Iron deficiency anemia, fetal growth restriction, cardiovascular diseases, and insufficient nutrient absorption can be observed in pregnant women, as well as miscarriages and pregnancy-specific hypertensive disease, such as pre-eclampsia. Thus, the evidence supports the influence of H. pylori infection on fetal implantation/placentation failure, and positive strains of the cytotoxin-associated gene A of H. Pylori were reported as the most prevalent in these conditions. However, current knowledge indicates a relationship between this infection and the occurrence of hyperemesis gravidarum, characterized by frequent nausea and vomiting. Regarding the diagnosis of this bacterial infection, non-invasive approaches such as stool antigen test, urea breath test, and serological tests are more accepted during pregnancy, as they are easy to carry out and cost-effective. Finally, the bacteria eradication therapy should consider the risks and benefits for the pregnant woman and her child, with pharmacological intervention depending on the clinical presentation.

National preparedness training and exercises for Ebola cases in the United Kingdom

In response to the outbreak of Ebola Virus Disease in West Africa, the Emergency Response Department of Public Health England produced a series of training and exercising materials to help prepare health and partner organisations in England and other jurisdictions in the United Kingdom deal with a possible case of Ebola in the United Kingdom. They were produced with input from health (NHS England, Health Protection Scotland, Public Health Wales) and other partner organisations. The exercising materials have been used by colleagues working in national and local level organisations in the United Kingdom and other countries in the European Union. Presented here is a description of these training and exercising materials and how they were delivered to the end user.

What is the purpose of launching the World Journal of Clinical Infectious Diseases?

Launching of the World Journal of Clinical Infectious Diseases (WJCID) could have been possible due to efforts of the publisher, members of the editorial board, all the authors and definitely our readers. I congratulate everyone for making it possible. Pathogenic organisms of various origin cause infectious diseases often resulting in symptomatic illness. WJCID is an open access peer reviewed journal that will be published bimonthly. WJCID will primarily emphasize on topics relevant to infections affecting human and animal health yet articles from other diseases and relevant issues will also be encouraged. WJCID welcomes articles from either basic or applied research in different disciplines like Epidemiology of communicable and non-communicable infections, Immunology and Genetics. WJCID covers topics like Host-Parasites interactions, Vector biology, development of advanced tools for diagnosis, genetic susceptibility to diseases, and disease prevention and vector control. WJCID will work as an important resource of basic and applied research in the field of infections. It is widely recommended that clinical implementations of basic and applied research be encouraged for the benefit to each stream. So again I welcome everyone and assure that WJCID will be a great platform where you can feel free to share your valuable results, discuss new hypothesis and research problems and update yourself with the most recent advancements made in the field of infections.

Improvement in human immunodeficiency virus-1/acquired immune deficiency syndrome patients’ well-being following administration of “Phyto V7”

AIM: To corroborate the capacity of Phyto V7, a complex of phytochemicals, to improve the physical well-being of human immunodeficiency virus-1 (HIV-1) infected and acquired immune deficiency syndrome (AIDS) patients not undergoing antiretroviral treatment.

METHODS: Two hundred and thirty nine HIV-1 seropositive male and female voluntary inmates were recruited through the Uruguay National Program of AIDS. The study participants received for 90 consecutive days every eight hours two tablets (760 mg/each) of Phyto V7, containing a mix of the following phytochemicals: flavonols (Kaempferol, Quercetin), flavones (Apigenin, Luteolin), hydroxy-cinnamic acids (ferrulic acid), carotenoids (Lutein, Lycopene, Beta carotene) and organosulfur compounds, all from vegetal origin. The participants did not receive any antiretroviral treatment during the study. At days 0, 30, 60 and 90 (± 2 d) the participants were evaluated for body mass index (BMI), tolerance to Phyto V7 and Index of Quality of Life based on the Karfnosky scale. ANOVA, Tukey Post-test, χ² test and Wilcoxon Signed Rank test were used to analyze the effect of treatment.

RESULTS: One hundred and nighty nine study participants finished the study. Already after 30 d of Phyto V7 consumption, the weight, BMI and Karnofsky score statistically significantly improved (P < 0.001), and continued to improve until the end of the study. The mean weight gain per participant during the 90 d was of 1.21 kg (approximately 2% of body weight). The overall increase in the mean Karnofsky score after 90 d was 14.08%. The lower the BMI and Karnofsky score of the participants were at the beginning of the study, the more notorious was the improvement over time. For example, the mean increment of Index of Quality of Life, among the participants with an initial Karnofsky score of 5 or below (n = 33) from day 0 to day 90, was of 35.67% (0.476 ± 0.044 vs 0.645 ± 0.09; P < 0.001). The tolerability to Phyto V7 was very good and no adverse reactions were recorded or reported.

CONCLUSION: Administration of the Phyto V7 can be an important tool to improve the well-being of HIV-1 seropositive individuals and AIDS patients, not undergoing antiretroviral treatment.

Pneumococcal disease in adult solid organ transplantation recipients

In solid organ transplant (SOT) recipients, Streptococcus pneumoniae can cause substantial morbidity and mortality ranging from non-invasive to invasive diseases, including pneumonia, bacteremia, and meningitis, with a risk of invasive pneumococcal disease 12 times higher than that observed in non-immunocompromised patients. Moreover, pneumococcal infection has been related to graft dysfunction. Several factors have been involved in the risk of pneumococcal disease in SOT recipients, such as type of transplant, time since transplantation, influenza activity, and nasopharyngeal colonization. Pneumococcal vaccination is recommended for all SOT recipients with 23-valent pneumococcal polysaccharides vaccine. Although immunological rate response is appropriate, it is lower than in the rest of the population, decreases with time, and its clinical efficacy is variable. Booster strategy with 7-valent pneumococcal conjugate vaccine has not shown benefit in this population. Despite its relevance, there are few studies focused on invasive pneumococcal disease in SOT recipients. Further studies addressing clinical, microbiological, and epidemiological data of pneumococcal disease in the transplant setting as well as new strategies for improving the protection of SOT recipients are warranted.

Top ten tips for perfect corona-2 prophylaxis

The current corona-2 pandemic has stimulated wide research for hydroxychloroquine (Quine) therapy and lately, prophylaxis. To optimize prophylaxis proper methods of use are explained. The focus is on tools of assessment and robust comparison; defining infection objectively; loading and maintenance dose designing based on pharmaco-viro-kinetics; confirming Quine threshold-levels and its sufficiency; and Quine side-effects vigilance/ amelioration. Attention to statistics to study valid endpoints of goals in appropriately-sized population is essential. Mass interactive quine dose auto designer software is built to simplify, optimize and help collaboration of complex Quine dosing system. A similar chloroquine software can be built.

Tuf mRNA rather than 16S rRNA is associated with culturable Staphylococcus aureus

AIM: To study the presence of various nucleic acids targets of Staphylococcus aureus (S. aureus) during bacterial growth and antibiotic induced killing in relation to viability.

METHODS: S. aureus was cultured to log phase and spiked in Todd Hewitt (TH) broth and whole blood of healthy human volunteers. Viability of S. aureus after flucloxacillin treatment (0, 1, 3 and 6 d) was assessed by culture on bloodagar plates. DNA and RNA were isolated from 200 μL. cDNA synthesis was performed by using random primers. The presence of S. aureus DNA, rRNA, and mRNA were determined by real-time polymerase chain reaction of the 16S rDNA and tuf gene (elongation factor Tu).

RESULTS: S. aureus spiked in TH broth without antibiotics grew from day 0-6 and DNA (tuf and 16S), and 16S rRNA remained detectable during this whole period. During flucloxacillin treatment S. aureus lost viability from day 3 onwards, while the 16S rRNA-gene and its RNA transcripts remained detectable. DNA and rRNA can be detected in flucloxacillin treated S. aureus cultures that do not further contain culturable bacteria. However, tuf mRNA became undetectable from day 3 onwards. Tuf mRNA can only be detected from samples with culturable bacteria. When spiking S. aureus in whole blood instead of broth no bacterial growth was seen, neither in the absence nor in the presence of flucloxacillin. Accordingly, no increase in DNA and RNA levels of both 16S rDNA and the tuf gene were detected.

CONCLUSION: Tuf mRNA expression is associated with culturable S. aureus and might be used to monitor antibiotic effects.

Serratia marcescens and other non-AACEK GNB endocarditis: A case report and review of literature

BACKGROUND

Non-Aggregatibacter aphrophilus, Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella spp. (non-AACEK) gram-negative bacilli (GNBs) are an infrequent and challenging cause of endocarditis associated previously with mainly intravenous drug use. Currently, this pathology has increasingly become a healthcare-associated issue. Current guidelines do not clearly define the management of non-AACEK GNB endocarditis due to a lack of prospective trials. We review characteristics, outcomes and treatment of non-AACEK GNB endocarditis, in particular Serratia marcescens endocarditis.

CASE SUMMARY

We describe the case report of a 46-year-old man who presented to the emergency department with high-grade fever and a purulent exudate on an intracardiac device site. Serratia marcescens mitral valve endocarditis as a consequence of complicated generator pocket infection was diagnosed. The patient was treated with complete device removal and a long course of broad-spectrum antibiotics for 6 wk after surgery with intravenous piperacillin-tazobactam and ciprofloxacin, which was later switched to oral ciprofloxacin and sulfamethoxazole-trimethoprim. The patient had complete resolution of symptoms and inflammatory parameters at the end of the treatment and at follow-up.

CONCLUSION

Long-term dual-antibiotic therapy containing a beta-lactam is indicated for most non-AACEK GNB endocarditis, whereas valve surgery may not be necessary in all patients.