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Rev. chil. infectol ; 39(2)abr. 2022.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388354


Resumen Introducción: El nuevo coronavirus ha continuado propagándose por todo el mundo donde existen otras enfermedades endémicas que han sido una carga para la salud pública durante muchos años. Como cualquier infección, se habría esperado encontrar en coinfección con algunas de éstas. Específicamente, los países tropicales y subtropicales han venido manejando la carga del dengue a medida que aumentan los picos con períodos de tiempo más cortos. Objetivo: Resumir la evidencia que existe en la coinfección relacionada con el SARS-CoV-2 y el virus del dengue. Metodología: Se realizó una revisión narrativa en bases de datos sobre reportes de coinfección y diagnóstico erróneo de SARS-CoV-2 y el dengue dado que la temporada de lluvias cada año aumenta la prevalencia de infecciones virales en países endémicos. Informes recientes incluso han descrito casos positivos en uno de estas infecciones que luego resultaron en falso positivo. Una prueba positiva para COVID-19 o fiebre del dengue en áreas endémicas no debe excluir la otra infección. Conclusión: A partir de ahora, estos dos deberían ser considerados como un diagnóstico diferencial y esto debe generar preocupación de salud pública por su coinfección en países endémicos para reforzar la promoción y prevención a las comunidades y mitigar estas enfermedades.

Abstract Background: Novel coronavirus has continued to spread throughout the world where there are other endemic diseases that have been a burden to public health for many years. As any infection, it was expected there could be coinfection between these. Tropical and subtropical countries are currently managing with dengue as peaks increase with shorter periods of time. Aim: To summarize the evidence that exists in the co-infection related to SARS-CoV-2 and the dengue virus. Method: We conducted a narrative review in data bases about reports of coinfection and misdiagnosis of SARS-CoV-2 and dengue virus given the fact that rainy season every year increase the prevalence of viral infections in endemic countries. Recent reports have even described positive cases in one of these infections that later resulted in false positive. A positive test for COVID-19 or dengue fever in endemic areas should not exclude the other infection. Conclusion: From now on, these two should be considered as a differential diagnosis and this should raise public health concern for COVID-19 and dengue coinfection in endemic countries to reinforce promotion and prevention to communities to prevent these diseases.

Biomédica (Bogotá) ; 42(1): 31-40, ene.-mar. 2022. tab, graf
Article in English | LILACS | ID: biblio-1374505


Introduction: Individuals infected with the human T-lymphotropic virus type 1 (HTLV-1) may present severe and disseminated forms of Strongyloides stercoralis infection with low therapeutic response. Objective: To investigate the S. stercoralis infection and the seroprevalence of IgG anti-S. stercoralis antibodies in individuals infected with HTLV-1 attending the Reference Center for HTLV-1 (CHTLV) in Salvador, Bahia, Brazil. Materials and methods: We conducted a cross-sectional study in 178 HTLV-1-infected individuals treated at the HTLV specialized center between January, 2014, and December, 2018. The parasitological diagnosis of S. stercoralis was performed using the Hoffman, Pons and Janer, agar plate culture, and Baermann-Morais methods. The IgG anti-S. stercoralis detection was performed using an in house enzyme-linked immunosorbent assay (ELISA). The HTLV-1 infection was diagnosed using a commercial ELISA and confirmed by Western blot. Results: The frequency of S. stercoralis infection was 3.4% (6/178). Individuals infected with S . stercoralis from rural areas (50.0%; 3/6) also showed S. stercoralis hyperinfection (>3,000 larvae/gram of feces). The frequency of circulating anti-S. stercoralis IgG antibodies was 20.8% (37/178). Conclusions: HTLV-1-infected people living in precarious sanitary conditions are more prone to develop severe forms of S. stercoralis infection. Considering the high susceptibility and unfavorable outcome of the infection in these individuals, the serological diagnosis for S. stercoralis should be considered when providing treatment.

Introducción. Los individuos infectados por el virus linfotrópico T humano tipo 1 (HTLV-1) pueden presentar formas graves y diseminadas de infestación por Strongyloides stercoralis con poca mejoría terapéutica. Objetivo. Investigar la infestación por S. stercoralis y la seroprevalencia de IgG anti-S. stercoralis en individuos infectados por HTLV-1 atendidos en el Centro de Referencia para HTLV-1 (CHTLV), en Salvador, Bahía, Brasil. Materiales y métodos. Se hizo un estudio transversal con 178 individuos infectados por HTLV-1 atendidos en el centro especializado de HTLV entre enero de 2014 y diciembre de 2018. El diagnóstico parasitológico de S. stercoralis se hizo mediante los métodos de Hoffman, Pons y Janer, cultivo en placa de agar y Baermann-Morais. Para la detección de IgG anti-S. stercoralis, se utilizó una prueba casera de inmunoabsorción ligada a enzimas (ELISA). La infección por HTLV-1 se diagnosticó usando un ELISA comercial y se confirmó mediante Western blot. Resultados. La frecuencia de infestación por S. stercoralis fue del 3,4 % (6/178). Además, los individuos infestados por S. stercoralis provenientes de la zona rural (50,0 %; 3/6) también mostraron hiperinfestación por S. stercoralis (>3.000 larvas/gramo de heces). La frecuencia de anticuerpos IgG anti-S. stercoralis fue del 20,8 % (37/178). Conclusiones. Las personas infectadas por HTLV-1 que viven en condiciones sanitarias precarias son más propensas a desarrollar formas graves de infestación por S. stercoralis. Teniendo en cuenta la gran vulnerabilidad y el resultado desfavorable de la infección en estos individuos, se debe considerar el diagnóstico serológico de S. stercoralis para administrar el tratamiento

Strongyloides stercoralis , Strongyloidiasis , Human T-lymphotropic virus 1 , Coinfection , Helminths
Afr. J. Clin. Exp. Microbiol ; 23(3): 323-329, 2022. figures
Article in English | AIM | ID: biblio-1377880


Background: Pulmonary aspergillosis (PA) is common among patients with tuberculosis (TB). With both infections presenting with similar clinical and radiologic features, diagnosis of PA is often made too late or missed completely due to lack of clinical suspicion and poor diagnostic laboratory capacity for mycotic infections prevalent in our settings. We present a case of preventable mortality caused by delayed diagnosis and treatment of PA in a patient with pulmonary TB (PTB). Case presentation: A 13-year-old female was diagnosed and treated for PTB, having received anti-TB regimen for 8 months in a mission hospital from where she was referred due to worsening cough, chest pain and progressive breathlessness. The patient was re-assessed and investigated, with GeneXpert detecting Mycobacterium tuberculosis, susceptible to rifampicin. Diagnosis of pulmonary tuberculosis complicated by right pneumothorax was made indicating an emergency thoracotomy and chest tube insertion and continuation of the first line anti-TB regimen. At about 2 weeks into admission, patients had features of superimposed acute bacterial sepsis with fever becoming high grade, marked neutrophilia with toxic granulation and elevated sepsis biomarker, and this necessitated empiric antibiotic treatment with parenteral meropenem and vancomycin. However, the patient only had mild clinical improvement following which there was progressively worsening respiratory symptoms and massive haemoptysis. Result of sputum fungal study was available on admission day 20 and revealed a growth of Aspergillus flavus. Treatment with intravenous voriconazole was however commenced rather late when the fungal respiratory disease could no longer be remedied. The patient died on admission day 23. Conclusion: Diagnosis of PA in patients with background TB is often made too late to guarantee timely and effective antifungal treatment with negative consequences on patients' outcomes. Improving clinical and laboratory capacities is essential to reducing mortality from PA in healthcare facilities.

Humans , Tuberculosis , Diagnosis , Pulmonary Aspergillosis , Mycobacterium tuberculosis , Voriconazole
Health sci. dis ; 23(7): 18-22, 2022. figures, tables
Article in English | AIM | ID: biblio-1379119


Introduction. We studied malaria in HIV infected subjects hospitalized in the department of infectious diseases at Point G Teaching Hospital in Mali, with the objective to have current data on malaria in patients infected by HIV. Materials and methods. We conducted a prospective study from October, 1st 2016 to September 30th 2018 in patients seropositive for HIV having positive thick smear for Plasmodium and hospitalized in the department of infectious diseases at Point G Teaching Hospital. We collected sociodemographic, clinical and lab data form those patients. Data have been entered and analyzed using SPSS20.0 software. Results. Hospital frequency of malaria among People living with HIV was 24.4% (151/618). This population has a mean-age of 44.1±12.4 y/o and a sex ratio (M/F) of 0.86. Majority of patients were at WHO stage IV of HIV infection (63.4%). Symptoms were by decreasing frequency: fever (98.3%); headache (86.4%); anorexia (72.9%); asthenia (61.0%) and vomiting (42.4%). the mean parasitemia was 172.9±352.1 trophozoite/mm3 . Mean hemoglobin level was 9.1±3.2 g/dl and the mean CD4 count was 9±3 cell/mm3 . Severe malaria was independent from WHO HIV stage and from immunologic deficiency. The malaria treatment when correctly followed conduct to good improvement of the anemia (p = 0.03) and the negativity of the parasitemia (p = 0.00). Death in our HIV patient is linked to association with severe malaria (p = 0,012). Conclusion. Malaria is relatively common and severe among PLWHA in Mali. Prompt treatment is still effective and must be implemented to ensure a good prognosis. Despite cotrimoxazole chemoprophylaxis, a certain number of PLHIV suffer from malaria, raising the hypothesis of plasmodium resistance to antifolates.

HIV Infections , Trimethoprim, Sulfamethoxazole Drug Combination , Inpatients , Malaria , Chemoprevention
Health SA Gesondheid (Print) ; 27(NA): 1-8, 2022. figures, tables
Article in English | AIM | ID: biblio-1380088


Background: People living with HIV (PLHIV) co-infected with Tuberculosis (TB) account for one in three HIV-related deaths. Retention in care and adherence to medication remain key behaviours that PLHIV co-infected with TB must adopt to achieve better health outcomes. Nevertheless, TB with HIV adherence-counselling services provided by nurses designed to enhance these behaviours remain inadequate. Additionally, limited information is found in the literature on the perceptions of nurses regarding their TB with HIV adherence counselling skills pertaining to PLHIV co-infected with TB. Aim: To explore and describe the perceptions of nurses regarding their TB with HIV adherence counselling skills of PLHIV co-infected with TB. Setting: The study was conducted in a health sub-district of Cape Town. Method: An exploratory, descriptive qualitative design was followed. A total of 14 purposively sampled nurses were interviewed individually. Nurses caring for PLHIV co-infected with TB were included and nurses not offering care to PLHIV co-infected with TB were excluded. All interviews were audio recorded with the participants' permission followed by verbatim transcriptions. Thematic analysis was done using ATLASti.8 electronic software. Results: It was established that the varied roles of these nurses increased their workload. Nonetheless, despite the gap in their counselling skills, the majority still maintained work expertise, professionalism and empathy towards the patients. Additionally, there were perceived barriers impacting patients' attendance of their follow up appointments. Conclusion: Based on the findings of this study, there is a need to equip nurses caring for PLHIV co-infected with TB with adherence counselling skills to improve practice.

Humans , Male , Female , Tuberculosis , HIV Infections , Counseling , Coinfection , Nurses , Perception
Article in English | LILACS-Express | LILACS | ID: biblio-1360789


ABSTRACT As leprosy and leprosy reactions are the most prevalent infectious cause of physical disability, it is important to commit efforts to better understand these chronic reactions. Infections, even when asymptomatic, can trigger leprosy reactions and Bartonella spp. in turn, can cause chronic infections. We presented a case of a 51-year-old man who was admitted presenting with chronic type 2 leprosy reactions. He had a lepromatous form of leprosy that was histologically diagnosed six months after the onset of signs and symptoms compatible with a chronic type 2 reaction. He reported a history of a previous hepatitis B diagnosis. During a 24-month multidrug therapy (MDT), chronic reactions were partially controlled with prednisone and thalidomide. Thirty-three months following the leprosy treatment, he still experienced chronic reactions, and whole bacilli as well as globi were found on a new skin biopsy. Since coinfections can trigger type 2 reactions and the patient had close contact with animals and ticks, we investigated the presence of a Bartonella sp. infection. Bartonella henselae DNA was detected in a skin fragment obtained before the beginning of the leprosy retreatment. However, even after six months of a second leprosy MDT, he continued to experience type 2 chronic reactions. He was admitted to the hospital to undergo an intravenous antibiotic therapy for 14 days and then complete the treatment per os for ten more weeks. Leprosy reactions improved following the treatment for B. henselae. After completing the MDT treatment, he has been accompanied for sixty months with no signs of leprosy or leprosy reactions. The asymptomatic infection by B. henselaein this patient was considered the putative trigger of chronic leprosy reactions and leprosy relapse.

Rev. Soc. Bras. Med. Trop ; 55: e0418, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1360827


ABSTRACT Background: Many human immunodeficiency virus (HIV) and syphilis co-infected patients are not diagnosed, which may evolve into asymptomatic neurosyphilis (ANS). We studied the occurrence of ANS an HIV-infected population. Methods: This was a cross-sectional study of cerebrospinal fluid (CSF) samples collected from patients co-infected with HIV and Treponema pallidum. Social-demographic and clinical-laboratory characteristics were studied. Results: Of the 348 patients infected with HIV, 33 (9.5%) had reagent treponemic and non-treponemic tests. CSF was collected from 19 asymptomatic patients. Of these, 8 (42.1%) presented with laboratory alterations suggestive of ANS. Conclusion: Social-demographic and clinical-laboratory variables should be considered for the indication of CSF collection.

Acta Paul. Enferm. (Online) ; 35: eAPE02811, 2022. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-1364205


Resumo Objetivo Descrever e analisar as percepções de pessoas que vivenciam a coinfecção tuberculose/ vírus da imunodeficiência humana, quanto à qualidade de vida e ao cuidado em saúde. Métodos Estudo exploratório, descritivo, com abordagem qualitativa, realizado com dez pessoas que vivenciavam a coinfecção e que recebiam atendimento em um centro de referência do município de São Paulo. Para a coleta de dados, foi utilizado um questionário semiestruturado, composto por questões fechadas e questões norteadoras. A análise dos depoimentos baseou-se na teoria da determinação social do processo saúde-doença. Resultados Os participantes apontaram que as condições precárias de vida interferiam na qualidade de vida e referiram satisfação em relação ao cuidado ofertado e com a rede de atenção à saúde. Vivenciar a coinfecção tuberculose/vírus da imunodeficiência humana acarretou sofrimento, isolamento social e estigma, o que pode contribuir para ideação suicida e diminuição da qualidade de vida. Na percepção dos participantes, os profissionais de saúde contribuem para a manutenção da qualidade de vida, por meio do estabelecimento de vínculo e atenção humanizada. Conclusão Intervenções voltadas à redução das desigualdades sociais, que apoiem a diminuição de estigma e do preconceito e que incrementem a interação humanizada nos serviços de saúde, de forma a atender às necessidades de saúde dos usuários podem repercutir positivamente na percepção sobre a qualidade de vida e o cuidado em saúde daqueles que vivenciam a coinfecção tuberculose/vírus da imunodeficiência humana.

Resumen Objetivo Describir y analizar las percepciones de personas que presentan la coinfección tuberculosis/virus de la inmunodeficiencia humana con relación a la calidad de vida y al cuidado de la salud. Métodos Estudio exploratorio, descriptivo, con enfoque cualitativo realizado con diez personas que presentaron la coinfección y que recibían atención en un centro de referencia del municipio de São Paulo. Para la recopilación de datos se utilizó un cuestionario semiestructurado, compuesto por preguntas cerradas y preguntas orientadoras. El análisis de los relatos se basó en la teoría de la determinación social del proceso salud-enfermedad. Resultados Los participantes señalaron que las condiciones precarias de vida interferían en la calidad de vida y relataron satisfacción con relación al cuidado ofrecido y a la red de atención en salud. Tener la coinfección tuberculosis/virus de la inmunodeficiencia humana conlleva sufrimiento, aislamiento social y estigma, lo que puede contribuir con ideación suicida y reducción de la calidad de vida. Bajo la percepción de los participantes, los profesionales de la salud contribuyen para mantener la calidad de vida, mediante el establecimiento de vínculos y atención humanizada. Conclusión Intervenciones orientadas a la reducción de las desigualdades sociales, que apoyen la disminución del estigma y los prejuicios y que aumenten la interacción humanizada en los servicios de salud, a fin de atender las necesidades de salud de los usuarios, pueden repercutir positivamente en la percepción sobre la calidad de vida y el cuidado de la salud de aquellas personas que padecen la coinfección tuberculosis/virus de la inmunodeficiencia humana.

Abstract Objective To describe and analyze the perceptions of people who experience tuberculosis/human immunodeficiency virus coinfection in relation to quality of life and health care. Methods An exploratory, descriptive, qualitative study conducted with ten people experiencing coinfection who received care at a reference center in the city of São Paulo. A semi-structured questionnaire composed of closed questions and guiding questions was used for data collection. The analysis of testimonies was based on the Theory of Social Determination of the Health-Disease Process. Results Participants mentioned that precarious conditions of life interfered in the quality of life and reported satisfaction with the care provided and the health care network. Experiencing tuberculosis/human immunodeficiency virus coinfection caused suffering, social isolation and stigma, which can contribute to suicidal ideation and lower quality of life. In the perception of participants, health professionals contribute to maintain the quality of life by developing bonds and humanized care. Conclusion Interventions aimed at reducing social inequalities that support the reduction of stigma and prejudice and increase humanized interaction in health services in order to meet users' health needs can exert positive impact on the perception of quality of life and health care of those experiencing tuberculosis/human immunodeficiency virus coinfection.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Quality of Life , Tuberculosis , HIV Infections , Delivery of Health Care , Coinfection , Health-Disease Process , Epidemiology, Descriptive , Interviews as Topic , Surveys and Questionnaires , Evaluation Studies as Topic
Braz. j. infect. dis ; 26(1): 102329, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1364547


Abstract It is debatable whether HIV-infected patients are at greater risk for hepatitis E virus (HEV) infection compared with healthy subjects. The reported anti-HEV seroprevalence among different groups in Bulgaria varied from 9.04% to 25.9%, but the information regarding the HIV population is still missing. The aim of the present study was to evaluate hepatitis E seroprevalence among HIV-infected patients in Bulgaria and to analyze demographic and immunological factors associated with HEV infection. Serum samples of 312 HIV-infected patients were analyzed retrospectively. Age, sex, residence and laboratory markers for HEV, HBV, HCV and HIV infection, and lymphocytes subpopulations were collected for all patients. None of the tested samples were positive for HEV RNA. HEV seroprevalence among HIV-infected patients was 10.9%. Males were more affected with the highest prevalence of positivity in the age group > 30 to ≤ 40 years. The documented HIV transmission routes in HIV/HEV co-infected group were heterosexual, homosexual, intravenous drug use (IDU), and vertical with predominace of the heterosexual route (z = 0.2; p = 0.804). There was a statistically significant trend of HIV mixed infection with routes of HIV transmission other than homosexual - heterosexual in HIV/HEV group and injection drug use in HIV/HBV/HCV co-infected group. The route of HIV transmission, in contexts of patients' behavior, was associated with HEV prevalence among HIV-infected patients.

Ciênc. rural (Online) ; 52(2): e20210141, 2022. ilus, mapas
Article in English | LILACS, VETINDEX | ID: biblio-1286058


Trypanosomosis in sheep is a hemoparasitic disease of worldwide interest due to its effects on the health of animals and the economic impact on producers, is caused by the protozoan Trypanosoma sp. In the present study, the occurrence of Trypanosoma sp. in sheep from the urban-rural area of the canton Salitre was determined, through an applied study with a qualitative descriptive prospective cross-sectional approach, carried out between October 1, 2019, and February 19, 2020. Blood samples were extracted from the jugular vein and analyzed by the blood smear method using the Giemsa and Diff-Quick staining techniques. Previously, in a first study realized between 2018 and 2019, 2 cases (2%) of Trypanosoma sp., 1 case of Babesia sp. (1%), and 4 cases of Anaplasma marginale (4%) were identified, but without the presence of symptoms of the disease. However, in this new research study, of 170 animals sampled from 5 herds and aged between 3 and 8 years, 34 (20%) were positive for Trypanosoma sp., 6 for Babesia sp. (3.52%) and 6 for A. marginale (3.52%) with coinfection between them. In this research, deteriorated clinical aspects and low hematological values were also determined in positive animals; besides of the total of positive cases, 25 presented symptoms of hemoparasitic disease, 3 sheep had abortions and 8 died. The results of this study showed that Trypanosoma sp. could already become an endemic parasitosis in sheep in the country, representing a serious problem of animal health.

A tripanossomose em ovinos é uma doença hemoparasitária de interesse mundial devido a seus efeitos sobre a saúde dos animais e o impacto econômico sobre os produtores, Esta doença é causada pelo protozoário Trypanosoma sp. No presente estudo, foi determinada a ocorrência de Trypanosoma sp. em ovelhas da área urbano-rural do Cantão Salitre, através de um estudo aplicado com uma abordagem transversal descritiva qualitativa prospectiva, realizado entre dia primeiro de outubro de 2019, à 19 de fevereiro de 2020. Amostras de sangue foram extraídas da veia jugular e analisadas pelo método de esfregaço de sangue usando as técnicas de coloração Giemsa e Diff-Quick. Anteriormente, em um primeiro estudo realizado entre 2018 e 2019, dois casos (2%) de Trypanosoma sp., foram identificados um caso de Babesia sp. (1%), e quatro casos de Anaplasma marginale (4%), mas sem a presença de sintomas da doença. Entretanto, neste novo estudo de pesquisa, de 170 animais amostrados de cinco rebanhos e com idades entre três e oito anos, 34 (20%) foram positivos para Trypanosoma sp., seis para Babesia sp. (3,52%) e seis para A. marginale (3,52%) com coinfecção entre eles. Nesta pesquisa, aspectos clínicos deteriorados e baixos valores hematológicos também foram determinados em animais positivos; além do total de casos positivos, 25 apresentaram sintomas de doença hemoparasítica, três ovelhas tiveram abortos e oito morreram. Os resultados deste estudo mostram que o Trypanosoma sp. já poderia se tornar uma parasitose endêmica em ovinos no país, representando um grave problema de saúde animal.

Animals , Female , Babesiosis/diagnosis , Trypanosomiasis/veterinary , Trypanosomiasis/epidemiology , Sheep/parasitology , Anaplasmosis/diagnosis , Ecuador , Coinfection/veterinary
Rev. Soc. Bras. Med. Trop ; 55: e0427, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1394692


ABSTRACT Background: Arthropod-borne viruses have recently emerged and are pathogens of various human diseases, including dengue, zika, and chikungunya viruses. Methods: We collectedAedes aegyptilarvae (N = 20) from Brumado, Bahia, Brazil, and treated and individually preserved the specimens. We analyzed the samples for dengue, zika, and chikungunya viruses using molecular biology methods. Results: We found that 25% (N = 5) and 15% (N = 3) were positive exclusively for dengue and chikungunya viruses, respectively; 15% (N = 3) were coinfected with both. Conclusions: This is the first report of dengue and chikungunya virus coinfection in A. aegypti larvae.

Rev. saúde pública (Online) ; 56: 43, 2022. tab, graf
Article in English | LILACS-Express | LILACS, BBO | ID: biblio-1377232


ABSTRACT OBJECTIVE Analyze, systematize, and compile social, individual, and programmatic vulnerability factors associated with tuberculosis and HIV in homeless persons. METHODS This is a systematic literature review assessing quantitative studies, published between 2014 and 2020, on the prevalence of tuberculosis in homeless persons. Our review grouped studies according to vulnerabilities, followed the PRISMA recommendation guide, and used the Joanna Briggs Institute Critical Appraisal tool for bias analysis. RESULTS Of the 372 publications found, 16 were selected according to our eligibility criteria. In total, 10 studies assessed tuberculosis and HIV. The most commonly described factors for individual, social, and programmatic vulnerability were drug use, HIV coinfection, and tuberculosis treatment failure, respectively. The literature also claims that average homelessness length related to a higher frequency of tuberculosis and latent tuberculosis infection. CONCLUSION All reviewed studies described how homeless persons suffer with stigma and dehumanization, which are important barriers to their access to health services. Homelessness enhances the risks of chronic and infectious diseases and prioritizes issues which are more pragmatic for the maintenance of life, such as safety and food, to the detriment of health. The results can be used to support hypotheses for future research and to reinforce and direct existing public health and social policies to cope with tuberculosis and HIV in homeless persons.

RESUMO OBJETIVO Analisar, sistematizar e compilar os fatores de vulnerabilidade (social, individual e programática) associados à tuberculose e HIV em pessoas em situação de rua. MÉTODOS Revisão sistemática de literatura de publicações quantitativas sobre tuberculose em pessoas em situação de rua entre os anos de 2014 e 2020, seguindo o guia de recomendações PRISMA e, para análise de viés, a ferramenta Joanna Briggs Institute Critical Appraisal. Agrupou-se as publicações segundo as vulnerabilidades. RESULTADOS Entre 372 publicações encontradas, selecionaram-se 16 segundo os critérios de elegibilidade. Em 10 estudos, foi descrita ocorrência de tuberculose e HIV. Os fatores de vulnerabilidade individual, social e programática mais descritas foram uso de drogas, coinfecção com HIV e falha no tratamento da tuberculose, respectivamente. A média de tempo em situação de rua também se mostrou relacionada à maior frequência de tuberculose e da infecção latente da tuberculose segundo literatura. CONCLUSÃO O estigma e a desumanização associados às pessoas em situação de rua foram descritos em todos os estudos revisados, sendo importantes barreiras no acesso aos serviços de saúde. A vivência na rua potencializa os riscos para a ocorrência de doenças crônicas e infecciosas, bem como a priorização de questões mais pragmáticas à manutenção da vida, como segurança e alimentação, em detrimento à saúde. Os resultados encontrados podem ser utilizados para embasar hipóteses para futuras pesquisas e para reforçar e direcionar políticas públicas de saúde e sociais já existentes para o enfrentamento da tuberculose e HIV na pessoa em situação de rua.

Acta Paul. Enferm. (Online) ; 35: eAPE03661, 2022. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1364242


Resumo Objetivo Analisar aspectos relacionados à adesão ao tratamento da tuberculose em pessoas que vivem com coinfecção tuberculose/vírus da imunodeficiência humana. Métodos Trata-se de um estudo exploratório, do tipo descritivo, com abordagem qualitativa sobre a adesão ao tratamento da tuberculose entre pessoas que apresentam a coinfecção tuberculose/vírus da imunodeficiência humana. O cenário do estudo foi um centro de referência para vírus da imunodeficiência humana/síndrome da imunodeficiência adquirida do estado de São Paulo, localizado na capital. O instrumento de coleta de dados continha questões relacionadas ao perfil sóciodemográfico e de saúde. Para a análise do material empírico foi utilizado o método de análise de discurso que permitiu a depreensão de frases temáticas. Resultados Foram entrevistadas 16 pessoas, sendo a maioria do sexo masculino, da cor parda, na faixa etária entre 30 a 39 anos, com 9 a 12 anos de estudo, que moravam sozinhos, solteiros e que se declararam homossexuais. Da análise dos depoimentos emergiram três categorias de análise: Processo saúde doença: o impacto do diagnóstico e os significados de viver a coinfecção; Tratamento medicamentoso: motivos para o seguimento, facilidades e dificuldades envolvidas; e Cuidado no serviço de saúde: acolhimento e redes de apoio que favorecem a adesão ao tratamento. Conclusão A adesão ao tratamento na coinfecção tuberculose/vírus da imunodeficiência humana mostrou-se relacionada à forma como a pessoa está inserida na sociedade, suas condições de vida e trabalho. Ressalta-se também que o cuidado nos serviços de saúde interfere na adesão, dada a importância do vínculo entre o profissional de saúde e o usuário.

Resumen Objetivo Analizar los aspectos relacionados con la adherencia al tratamiento de tuberculosis en personas que viven con la coinfección tuberculosis/virus de la inmunodeficiencia humana. Métodos Se trata de un estudio exploratorio, tipo descriptivo, con enfoque cualitativo, sobre la adherencia al tratamiento de tuberculosis en personas que presentan la coinfección tuberculosis/virus de la inmunodeficiencia humana. El escenario de estudio fue un centro de referencia del virus de la inmunodeficiencia humana/síndrome de inmunodeficiencia adquirida del estado de São Paulo, ubicado en la capital. El instrumento de recopilación de datos contenía preguntas relacionadas con el perfil sociodemográfico y de salud. Para analizar el material empírico se utilizó el método de análisis de discurso que permitió extraer frases temáticas. Resultados Se entrevistaron 16 personas, de las cuales la mayoría era de sexo masculino, de color pardo, del grupo de edad entre 30 y 39 años, con 9 a 12 años de estudios, que vivían solos, solteros y que se declararon homosexuales. Del análisis de los relatos surgieron tres categorías de análisis: Proceso de salud y enfermedad: el impacto del diagnóstico y los significados de vivir la coinfección; Tratamiento farmacológico: motivos para el acompañamiento, facilidades y dificultades relacionadas, y Cuidado en el servicio sanitario: contención y redes de apoyo que favorecen la adherencia al tratamiento. Conclusión La adherencia al tratamiento de la coinfección tuberculosis/virus de la inmunodeficiencia humana demostró estar relacionada con la forma como la persona está insertada en la sociedad, su condición de vida y trabajo. También se observó que el cuidado en los servicios de salud interfiere en la adherencia, debido a la importancia del vínculo entre los profesionales de la salud y los usuarios.

Abstract Objective To analyze aspects related to adherence to tuberculosis treatment in people living with tuberculosis/human immunodeficiency virus coinfection. Methods This is an exploratory, descriptive, qualitative study on adherence to tuberculosis treatment among people with tuberculosis/human immunodeficiency virus coinfection. The study setting was a reference center for human immunodeficiency virus/acquired immunodeficiency syndrome located in the capital of the state of São Paulo. The data collection instrument contained socio-demographic and health profile related questions. The discourse analysis method was used for the analysis of the empirical material, which allowed the comprehension of thematic phrases. Results Sixteen people were interviewed. Most were male, mixed race, in the age group of 30-39 years, with 9-12 years of study, living alone, single and declared themselves homosexuals. Three categories of analysis emerged from the analysis of testimonies: Health-disease process: the impact of the diagnosis and the meanings of living with coinfection; Drug treatment: reasons for follow-up, facilities and difficulties involved; and Care in the health service: embracement and support networks that favor treatment adherence. Conclusion Adherence to treatment in the tuberculosis/human immunodeficiency virus coinfection has shown a relation to the way people are inserted in society, their living and working conditions. The fact that care in health services interferes with adherence is also noteworthy, given the importance of the bond between the health professional and the user.

Humans , Male , Female , Adult , Perception , Tuberculosis/drug therapy , HIV Infections/drug therapy , Antiretroviral Therapy, Highly Active , Coinfection , Treatment Adherence and Compliance , Quality of Life , Health-Disease Process , Epidemiology, Descriptive , Interviews as Topic , Evaluation Studies as Topic
Article in English | LILACS-Express | LILACS | ID: biblio-1387334


ABSTRACT This cross-sectional population-based study compared clinical features of leprosy and American tegumentary leishmaniasis (ATL) in patients diagnosed with both diseases (n=414) and in those diagnosed with only leprosy (n=27,790) or only ATL (n=24,357) in Mato Grosso State, which is a hyperendemic area for both diseases in Midwest Brazil. All new cases of leprosy and ATL reported in the area from 2008 to 2017 were included. Patients diagnosed with both diseases were identified by a probabilistic linkage procedure applied to leprosy and ATL databases of the national reporting system. The distribution of the frequency of clinical features between groups was compared by the chi-square test, followed by a multivariate logistic regression. Patients diagnosed with both leprosy and ATL presented higher odds of having nerve damage (OR: 1.34; 95% CI: 1.09-1.66) and leprosy reactions (OR: 1.35; 95% CI: 1.04-1.76) compared to patients diagnosed only with leprosy. Mucocutaneous leishmaniasis (OR: 2.29; 95% CI: 1.74-3.00) was more frequent among patients with both diagnoses when compared to patients who only had ATL. In conclusion, patients diagnosed with both leprosy and ATL present more severe clinical features of such diseases. Our data can be useful for designing health policies aimed at timely and integrated management of leprosy and ATL in co-endemic areas.

Rev. saúde pública (Online) ; 56: 59, 2022. tab, graf
Article in English | LILACS-Express | LILACS, BBO | ID: biblio-1390028


ABSTRACT OBJECTIVE To evaluate the prevalence and factors associated with HIV/syphilis co-infection in people initiating antiretroviral therapy in Belo Horizonte, capital of the state of Minas Gerais. METHODS A sectional section of a prospective cohort study was carried out with people living with HIV, treatment-naive, initiating antiretroviral therapy, older than 16 years, and in follow-up treatment at specialized HIV/Aids care services in Belo Horizonte. Sociodemographic, behavioral, clinical, laboratory and pharmacological treatment-related data were obtained through interviews, medical records, and information systems for logistical control of antiretroviral medications and laboratory tests. The dependent variable was the first episode of active syphilis, recorded by the physician in clinical records, within 12 months after beginning of the antiretroviral therapy. Factors associated with HIV/syphilis co-infection were assessed using binary multiple logistic regression. RESULTS Among the 459 individuals included, a prevalence of 19.5% (n = 90) of sexually transmitted infections (STI) was observed, with syphilis (n = 49) being the most frequent STI in these individuals. The prevalence of HIV/syphilis co-infection was 10.6% (n = 49), and the associated independent factors were alcohol use (OR = 2.30; 95%CI: 1.01-5.26), and having a diagnosis of other sexually transmitted infections (OR = 3.33; 95%CI: 1.24-8.95). CONCLUSIONS There was a high prevalence of HIV/syphilis co-infection in people living with HIV initiating antiretroviral therapy in Belo Horizonte. HIV/syphilis co-infection was associated with behavioral and clinical factors, such as alcohol use and diagnosis of other sexually transmitted infections. Prior knowledge about the factors associated with this co-infection may support the decisions of health professionals engaged in the care to people living with HIV, with regard to timely diagnosis, guidance, follow-up and adequate treatment, both for syphilis and HIV.

RESUMO OBJETIVO Avaliar a prevalência e os fatores associados à coinfecção HIV/sífilis em pessoas no início da terapia antirretroviral no município de Belo Horizonte, Minas Gerais. MÉTODOS Foi realizado um corte seccional de um estudo de coorte prospectivo, com pessoas vivendo com HIV, sem tratamento prévio da infecção, em início da terapia antirretroviral, maiores de 16 anos e em acompanhamento em serviços de assistência especializada em HIV/aids de Belo Horizonte. Dados sociodemográficos, comportamentais, clínicos, laboratoriais e relacionados ao tratamento farmacológico foram obtidos por meio de entrevistas, coleta em prontuários clínicos e nos sistemas de informação de controle de medicamentos antirretrovirais e exames laboratoriais. A variável dependente foi o primeiro episódio de sífilis ativa, registrado pelo médico em prontuário clínico, em um período de 12 meses após início da terapia antirretroviral. Os fatores associados à coinfecção HIV/sífilis foram avaliados por meio de regressão logística binária múltipla. RESULTADOS Dentre os 459 indivíduos avaliados, observou-se uma prevalência de 19,5% (n = 90) de infecções sexualmente transmissíveis, sendo a sífilis (n = 49) a infecção sexualmente transmissível mais frequente nesses indivíduos. A prevalência da coinfecção HIV/sífilis foi de 10,6% (n = 49) e os fatores independentes associados foram o uso de álcool (OR = 2,30; IC95% 1,01-5,26) e ter diagnóstico de outras infecções sexualmente transmissíveis (OR = 3,33; IC95% 1,24-8,95). CONCLUSÕES Houve alta prevalência de coinfecção HIV/sífilis em pessoas vivendo com HIV em início de terapia antirretroviral em Belo Horizonte. A coinfecção HIV/sífilis foi associada a fatores comportamentais e clínicos, como uso de álcool e diagnóstico de outras infecções sexualmente transmissíveis. O conhecimento prévio sobre os fatores associados à essa coinfecção pode subsidiar as decisões dos profissionais de saúde inseridos no cuidado às pessoas vivendo com HIV, no que diz respeito ao diagnóstico oportuno, orientações, acompanhamento e tratamento adequado, tanto da sífilis quanto do HIV.

Infectio ; 25(4): 207-211, oct.-dic. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1286715


Resumen Objetivo: Describir la proporción, características clínicas, demográficas y programáticas de casos fatales de coinfección TB/VIH de Cali-Colombia, en 2017. Material y Método: Estudio de corte transversal, con información de las bases de datos del programa de tuberculosis, las historias clínicas y unidades de análisis de mortalidad disponibles. Resultados: Se depuraron 257 casos fatales por TB, el 24,5% (63/257) falleció con coinfección TB/VIH. La mediana de edad fue 43 años (Rango Intercuartílico: 30-52), 73% (46/63) eran hombres, 76,2% (48/63) no pertenecían al régimen contributivo, 28,6% eran habitantes de calle. 81,2% (39/48) eran casos nuevos de TB, 76,6% (37/47), inició tratamiento; al 74,6% (47/63) se les realizó unidad de análisis de mortalidad. La presentación pulmonar fue frecuente (75,9%-44/58), en 60% de los registros se observó desnutrición (Índice de Masa Corporal <20), en 39,7% (25/63) dependencia al alcohol, tabaco o farmacodependencia. Conclusiones: La mortalidad asociada a TB/VIH es prevenible, pero en 2017 representó la cuarta parte de la mortalidad por TB en Cali. Hombres adultos con condiciones de vulnerabilidad social, diagnosticados en estados avanzados de enfermedad, fueron blanco de fatalidad. Mejorar los sistemas de información e integrar los programas de TB/VIH, deben ser estrategias prioritarias para la salud pública en Colombia.

Abstract Objective: To describe the proportion, clinical, demographic and programmatic characteristics of fatal cases of TB/HIV coinfection from Cali-Colombia, in 2017. Material and Method: Cross-sectional study, with information from the TB program databases, clinical records and mortality analysis units available. Results: 257 TB fatal cases were cleared in Cali in 2017, 24.5% (63/257) of these died with TB/HIV coinfection. The median age was 43 years (Interquartile Range: 30-52), 73% (46/63) were men, 76.2% (48/63) did not belong to the contributory health regimen, 28.6% were homeless. 81.2% (39/48) were new TB cases, 76.6% (37/47) started treatment; 74.6% (47/63) had mortality analysis register. Pulmonary presentation was frequent (75.9% -44 / 58), in 60% of the registries malnutrition was observed (Body Mass Index <20), in 39.7% (25/63), dependence on alcohol, tobacco or drug dependence was registered. Conclusions: Mortality associated with TB/HIV is preventable, but in 2017 it represented a quarter of the TB mortality in Cali. Adult men with conditions of social vulnerability, diagnosed in advanced stages of disease, were fatally targeted. Improving information systems and integrating TB/HIV programs should be priority strategies for public health in Colombia.

Humans , Male , Female , Adult , Middle Aged , Tuberculosis , HIV , Body Mass Index , HIV Infections , Public Health , Cross-Sectional Studies , Mortality , Health Strategies , Colombia , Social Vulnerability , Malnutrition
Rev. Méd. Inst. Mex. Seguro Soc ; 59(6): 482-489, 01-dic-2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1354788


Introducción: el SARS-CoV-2 es un coronavirus que fue descrito por primera vez en diciembre de 2019 en Wuhan, China. Este virus causa una enfermedad que varía en un espectro de severidad que va desde casos asintomáticos hasta defunciones. Los casos más severos se asocian normalmente con algunas comorbilidades y con la edad del paciente. Sin embargo, existen pacientes que no son parte de estos grupos de riesgo y aun así desarrollan casos graves. Objetivo: determinar la asociación entre las coinfecciones por SARS-CoV-2 y otros virus respiratorios y su desenlace clínico. Material y métodos: se realizó RT-qPCR para determinar la presencia de 16 virus respiratorios en 103 casos confirmados de COVID-19. Se recolectaron datos demográficos y de comorbilidades, y se realizaron análisis estadísticos para determinar asociaciones con gravedad. Resultados: el 13.6% de los casos (14/103) presentaron alguna coinfección, de estos, el 92% nunca requirió ingreso hospitalario, aun en aquellos casos en los que el paciente presentara comorbilidades y edad avanzada. Conclusiones: estos resultados sugieren que la coinfección no está relacionada con un COVID-19 más grave y que, dependiendo del virus involucrado, incluso podría conducir a un mejor pronóstico. Estos hallazgos sientan las bases para nuevos estudios dirigidos a determinar el mecanismo biológico por el cual ocurre este fenómeno y a proponer las estrategias correspondientes para limitar la progresión a casos severos de COVID-19.

Background: SARS-CoV-2 is a coronavirus described for the first time in China, in December 2019. This virus can cause a disease with a very variable spectrum that ranges from asymptomatic cases to deaths. The most severe cases are normally associated with comorbidities and with the age of the patient. However, there are patients who are not part of these risk groups and develop severe cases. Objetive: To determine the association between coinfections by SARS-CoV-2 and other respiratory viruses and their clincal outcome. Material and methods: RT-qPCR was performed to determine the presence of 16 respiratory viruses in 103 confirmed COVID-19 cases. Demographic and comorbid data were collected, and statistical analyzes were performed to determine associations with severity. Results: Of the 103 analyzed cases, 14 (13.6%) presented a coinfection, of these, 92% did not require hospitalization, even in those cases in which the patient presented advanced age and some comorbidities. Conclusions: These results suggest that coinfection of SARS-CoV-2 and other respiratory viruses is not related to a more severe form of COVID-19 and, in some cases, depending on the virus involved, it could even lead to a better prognosis. These findings lay the foundations for the development of new studies that could determine the biological mechanism of this phenomenon.

Humans , Male , Female , Respiratory Tract Diseases , Coinfection , SARS-CoV-2 , COVID-19 , Prognosis , Risk Groups , Health Strategies
Rev. chil. infectol ; 38(5)oct. 2021.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388288


Resumen Introducción: Elizabethkingia es un género de bacterias gramnegativas cuya relevancia como patógeno oportunista en hospederos inmunocomprometidos y pacientes críticos ha sido reconocida progresivamente en los últimos años. Este género está compuesto principalmente por E. meningoseptica, E. anophelis y E. miricola. Si bien inicialmente E. meningoseptica fue considerada la especie patógena más relevante, gracias a los avances en las técnicas de identificación microbiológica se ha reconocido a E. anophelis como el principal patógeno de este grupo. Objetivo: Caracterizar los casos de infecciones por Elizabethkingia spp. en una red de salud y realizar una breve revisión de esta infección. Material y Métodos: Se realizó una revisión de los cultivos positivos para Elizabethkingia spp. en el Laboratorio de Microbiología de la Red de Salud UC-CHRISTUS (Chile) entre los años 2017 y 2021. Resultados: Se obtuvo 17 cultivos positivos correspondientes a siete casos clínicos, todos procedentes de un hospital universitario. Todos los casos poseían factores de riesgo conocidos de infección por Elizabethkingia spp. incluyendo uso de antimicrobianos recientes, por ejemplo, el uso previo de carbapenémicos en 85,7% de los pacientes. Cuatro casos se presentaron en pacientes con neumonía por SARS-CoV-2, una coinfección no previamente reportada en la literatura. Elizabethkingia anophelis fue identificada mediante secuenciación de ARN ribosomal en 80% de las cepas recuperadas, lo que corresponde al primer reporte de esta especie en Chile Conclusión: Comunicamos la experiencia clínica de infecciones por este género en un hospital universitario de Chile, incluyendo los primeros casos de coinfección en pacientes cursando neumonía por SARS-CoV-2 y la primera identificación de Elizabethkingia anophelis en Chile.

Abstract Background: Elizabethkingia is a genus of gramnegative bacteria whose relevance as an opportunistic pathogen in immunosuppressed hosts and critically ill patients has been progressively recognized in recent years. This genus is mainly composed of E. meningoseptica, E. anophelis, and E. miricola. Although E. meningoseptica was initially reported as the most relevant pathogenic species, thanks to advances in microbiological identificaron techniques E. anophelis has been recognized as the main pathogen of this group. Aim: To characterize Elizabethkingia spp.'s infections in a health network and make a brief review of this infection. Method: We conducted a review of clinical cultures that were positive for Elizabethkingia sp. in the Microbiology Laboratory of the UC-CHRISTUS Health Network (Chile), between 2017 and 2021. Results: Seventeen positive cultures were obtained corresponding to seven clinical cases, all originating from a university hospital. All cases had known risk factors for Elizabethkingia sp. infection, including recent use of antibiotics. Notably, previous use of carbapenems was present in 85.7% of the patients. Four cases occurred in patients with SARS-CoV-2 pneumonia, a coinfection not previously reported in the literature. Elizabethkingia anophelis was identified by ribosomal RNA sequencing in 80% of the recovered strains, which corresponds to the first report of this species in Chile. Conclusion: We report the clinical experience of a university hospital with infections by Elizabethkingia spp., including the first cases of coinfection in patients with SARS-CoV-2 pneumonía and the first identification of Elizabethkingia anophelis in Chile.

Rev. chil. infectol ; 38(4)ago. 2021.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388273


Resumen La inmunidad conferida luego de una primera infección por SARS-CoV-2 y el riesgo consiguiente de infección persistente o reinfección no están completamente dilucidados. Existen reportes internacionales de casos de reinfección, incluyendo el primer caso publicado en Sudamérica. Por otra parte, las comunicaciones de casos de coinfecciones han ido en aumento, incluyendo las asociadas a Legionella pneumophila . Presentamos el caso de un varón de 47 años de edad, personal de salud, que luego de cuatro meses de una primera infección por SARS-CoV-2, presenta una neumonía grave, certificándose una nueva infección por SARS-CoV-2 y una coinfección por L. pneumophila mediante detección de antígeno urinario. Fue tratado en UCI, requiriendo ventilación mecánica, dexametaxona y moxifloxacino, con buena respuesta clínica. Actualmente se encuentra en rehabilitación respiratoria y motora.

Abstract The immunity conferred after a first SARS-CoV-2 infection and the consequent risk of persistent infection or reinfection are not fully elucidated. There are reports both in Europe and in North America of reinfection cases, recently highlighting the first case published in South America. On the other hand, reports of co-infections have been increasing, including those associated with Legionella pneumophila . We present the case of a 47-year-old male, health personnel who, after four months of a first SARS-CoV-2 infection, suffers a severe pneumonia certifying a new SARS-CoV-2 infection and a L. pneumophila co-infection by urinary antigen detection. He was treated in the ICU, requiring mechanical ventilation, dexamethasone, and moxifloxacin, with a good response. He is currently in respiratory and motor rehabilitation.

Medicentro (Villa Clara) ; 25(2): 315-323,
Article in Spanish | LILACS | ID: biblio-1279424


RESUMEN Se realizó un estudio descriptivo en el Hospital Universitario Clínico Quirúrgico Cmdte. «Manuel Fajardo Rivero¼, Santa Clara, Villa Clara, marzo - julio de 2020, con el objetivo de describir las infecciones bacterianas y fúngicas asociadas a la COVID-19. La población de estudio fue de 202 pacientes que permanecieron ingresados con diagnóstico confirmado de infección por SARS-CoV-2. Las variables de estudio fueron: edad, sexo, infección asociada, estado al egreso, microorganismos aislados y susceptibilidad antimicrobiana. El 7,9 % de los pacientes presentó una infección asociada; el 7,4 % falleció (la mayoría de las defunciones ocurrieron en los meses de marzo y abril, previo al establecimiento del protocolo definitivo de tratamiento de la COVID-19 en Cuba). El 60 % de los fallecidos presentaron una infección asociada. Escherichia coli fue el microorganismo más aislado. Es necesario establecer un protocolo de diagnóstico terapéutico para determinar las infecciones bacterianas y fúngicas asociadas al coronavirus.

ABSTRACT A descriptive study was carried out at "Cmdte. Manuel Fajardo Rivero" Clinical and Surgical University Hospital in Santa Clara, Villa Clara from March to July 2020, with the aim of describing bacterial and fungal infections associated with COVID-19. The study population consisted of 202 patients who remained hospitalized with a confirmed diagnosis of SARS-CoV-2 infection. Age, gender, associated infection, discharge status, isolated microorganisms, and antimicrobial susceptibility were the variables studied. The 7.9% of the patients had an associated infection; 7.4% died (most deaths occurred in March and April, prior to the establishment of the definitive protocol for the treatment of COVID-19 in Cuba). The 60% of the deceased patients had an associated infection. Escherichia coli was the most isolated microorganism. A diagnostic and therapeutic protocol is necessary to determine the bacterial and fungal infections associated with the coronavirus.

Bacterial Infections , Coronavirus Infections , Coinfection , Mycoses