Co-infection of SARS-CoV-2 and dengue virus: a clinical challenge

Abstract Many regions of the world where dengue epidemics are seasonal are also facing the COVID-19 pandemic. This is a medical concern because both diseases are difficult to distinguish since they have similar clinical symptoms and laboratory findings, and because they have different clinical management. So far, co-infection of SARS-CoV-2 and dengue virus (DENV) has not been studied. Herein we report the first case of a patient with co-infection of COVID-19 and dengue. Both infections were simultaneously laboratory confirmed by positive RT-qPCR for SARS-CoV-2 and RT-qPCR for DENV, NS1, IgM and IgG antibody tests for dengue. The patient had a favorable clinical improvement, without severe symptoms. This case emphasize that, in pandemic era, having a diagnostic of one infection does not rule out the possibility of having another infection concomitantly. In addition, underscores the importance of an accurate and timely diagnosis to prevent the spread of COVID-19.

Brazilian experience in EU-CORE: daptomycin registry and treatment of serious Gram-positive infections

OBJECTIVES: To collect data about non-controlled prescribing use of daptomycin and its impact among Brazilian patients with serious Gram positive bacterial infection, as well as the efficacy and safety outcomes. MATERIALS AND METHODS: This is a multi-center, retrospective, non-interventional registry (August 01, 2009 to June 30, 2011) to collect data on 120 patients (44 patients in the first year and 76 patients in the second year) who had received at least one dose of commercial daptomycin in Brazil for the treatment of serious Gram-positive bacterial infection. RESULTS: Right-sided endocarditis (15.8%), complicated skin and soft tissue infections (cSSTI)wound (15.0%) and bacteremia-catheter-related (14.2%) were the most frequent primary infections; lung (21.7%) was the most common site for infection. Daptomycin was used empirically in 76 (63.3%) patients, and methicillin-resistant Staphylococcus aureus (MRSA) was the most common suspected pathogen (86.1%). 82.5% of the cultures were obtained prior to or shortly after initiation of daptomycin therapy. Staphylococcus spp. - coagulase negative, MRSA, and methicillin-susceptible S. aureus were the most frequently identified pathogens (23.8%, 23.8% and 12.5%, respectively). The most common daptomycin dose administered for bacteremia and cSSTI was 6 mg/kg (30.6%) and 4 mg/kg (51.7%), respectively. The median duration of inpatient daptomycin therapy was 14 days. Most patients (57.1%) did not receive daptomycin while in intensive care unit. Carbapenem (22.5%) was the most commonly used antibiotic concomitantly. The patients showed clinical improvement after two days (median) following the start of daptomycin therapy. The clinical success rate was 80.8% and the overall rate of treatment failure was 10.8%. The main reasons for daptomycin discontinuation were successful end of therapy (75.8%), switched therapy (11.7%), and treatment failure (4.2%). Daptomycin demonstrated a favorable safety and tolerability profile regardless of treatment duration. CONCLUSIONS: Daptomycin had a relevant role in the treatment of Gram-positive infections in the clinical practice setting in Brazil.

Nosocomial outbreak of Pantoea agglomerans in a pediatric urgent care center

Pantoea agglomerans is a Gram-negative bacterium whose isolates can be found in blood cultures and other secretions. This article described one outbreak of sepsis due to this bacterium in the pediatric urgent care center of a tertiary hospital, in Brasilia, Federal District. This was a case-control study and it evaluated the risk factors for acquisition of nosocomial sepsis caused by Pantoea agglomerans. Six case-patients and 15 control-patients have been found. The risk factors were: vomiting in the internment and presence of solution compositions in the intravenous hydration therapy received in bigger number than 2 compositions. The transference tube used for the compositions was contaminated with Pantoea agglomerans, characterizing the outbreak with common source. The evolution of all the patients was favorable.

Profilaxia para pneumonia por Pneumocystis carinii em pacientes infectados pelo virus da imunodeficiencia humana / Pneumocystis carinii prophylaxis in patients with HIV infection

Desde o inicio da epidemia de aids verificou-se que as infeccoes oportunistas ocorriam causando alta morbidade e mortalidade neste grupo de doentes e que a mais frequente era a pneumonia por Pneumocystis carinii. Medidas profilaticas foram instuidas, antes da era da terapia anti-retroviral de alta potencia, influindo no tempo de sobrevida dos pacientes e sao adotadas ate hoje para prevencao de pneumonia por Pneumocystis carinii. Apos a era da terapia anti-retroviral de alta potencia e a avaliacao da efetividade da restauracao imune as mudancas que ocorreram foram a suspensao da mesma apos a contagem de CD4 atingir valores maiores que 200 celulas/mm3. Este artigo reporta como se deu evolucao dos estudos clinicos ate a instituicao das recomendacoes de consenso atuais

Determinantes da aderência à terapia anti-retroviral combinada em Brasília, Distrito Federal, Brasil, 1999-2000 / Predictors of compliance with highly active antiretroviral therapy in Brasilia, Distrito Federal, Brazil, 1999-2000

A aderência ao tratamento é um dos principais problemas relacionados à terapia anti-retroviral, já que a tomada incompleta dos medicamentos pode levar à resistência viral. Efeitos colaterais podem interferir com a qualidade de vida dos pacientes. Buscou-se estimar níveis de aderência à terapia e investigar seus determinantes, através de um estudo transversal. Definiram-se dois pontos de corte como boa aderência: a tomada de pelo menos 80 por cento ou de 95 por cento da medicaçäo conforme a prescriçäo. Realizaram-se entrevistas semi-estruturadas em uma amostra seqüencial de 150 pacientes atendidos no Hospital-Dia de Brasília. Observou-se que a média de aderência foi 85,8 por cento. As variáveis que se mostraram significativamente associadas à baixa aderência foram: idade, escolaridade, situaçäo de emprego, rendas pessoal e familiar, uso de substâncias ilícitas, estrutura familiar e/ou comunitária, presença de infecçäo oportunista no momento do diagnóstico e ocorrência de efeitos colaterais relacionados à terapia. As razöes de prevalência variaram de 1,6 a 4,5. Concluiu-se que variáveis sócio-econômicas e de hábitos tiveram maior força de associaçäo com o nível de aderência do que as relacionadas com a doença ou com o tratamento