Reply to: "Herpes zoster seven days after SARS-CoV-2 vaccination in a patient with ankylosing spondylitis under adalimumab" by Josef Finsterer.

Not available.

Herpes zoster infection following mRNA COVID-19 vaccine in a patient with ankylosing spondylitis.

Since the severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) pandemic outbreak, vaccines gained a growing role. Possible vaccine-related side effects range from minor local events to more prominent systemic manifestations up to anaphylactic reactions. A heterogeneous spectrum of cutaneous reactions has been reported, ranging from local injection site reactions to urticarial and morbilliform eruptions, pernio/chilblains and zoster flares. Here, we describe a case of varicella zoster virus reactivation following mRNA coronavirus 2019 vaccine and discuss the available literature upon the topic published so far.

A case of limbic encephalitis with CSF detection of sars-cov2 virus: Immune-mediated mechanism or direct viral damage?

Background and aims: Pathogenesis of neurologic syndromes COVID 19-related could be categorized in four mechanisms: direct viral damage, para/post-infectious effect, complications of prolonged illness. We present a case of limbic encephalitis (LE) with concurrent detection of SARS-CoV2 virus in cerebrospinal fluid (CSF), which makes the individuation of a unique etiological mechanism insidious. Methods: A 70-year-old man was hospitalized with respiratory symptoms and confusional state. A chest CT-scan and nasopharyngeal swab demonstrated COVID-19 infection;non contrast brain CT-scan was unremarkable. Neurological examination revealed right focal signs and vigilance fluctuations;EEG showed nonspecific mild background activity slowing, basic CSF investigations resulted negative and total-body CT-scan excluded tumours. Brain MRI showed T2-FLAIR hyper intensity in the mesial temporal lobes, strongly supporting the hypothesis of limbic encephalitis. So the patient underwent to a second lumbar puncture to test the autoimmune panel (negative). [Formula presented] [Formula presented] Results: Liquoral PCR for SARS-CoV2 RNA resulted positive. After treatment with 5 days- IV bolus dose of metilprednisolone and a cycle of IV immunoglobulin therapy, he had a slight improvement, especially concerning alertness and cognition. Two months follow-up brain MRI was superimposable to the precedent. [Formula presented] Conclusions: Majority of cases of LE with positive testing for specific antibodies are negative for RT-PCR for SARS-CoV2 tested on LCR (1). In this case, the presence of the virus in CSF supports a direct neural damage;conversely, the answer to immunomodulant treatment could suggest an immunological role;previous autopsy results of patients with SARS-COV1 (2) evidenced the presence of viral RNA in brain tissue, particularly accumulating in and around the hippocampus. 1. Lerzan Dogana, Dilaver Kayab, Tugce Sarikayaa, Rehile Zenginc, Alp Dincerd, et al. Plasmapheresis treatment in COVID19 related autoimmune meningoencephalitis: Case series. Brain, Behavior, and Immunity 87 (2020) 155–158 2. Gu J, Gong E, Zhang B, et al. Multiple organ infection and the pathogenesis of SARS. J Exp Med. 2005;202: 415–424.

Co-Infections in Critically Ill Patients with or without COVID-19: A Comparison of Clinical Microbial Culture Findings

Co-infections in critically ill patients hospitalized for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have an important impact on the outcome of coronavirus disease 2019 (COVID-19). We compared the microbial isolations found in COVID-19 patients hospitalized in an intensive care unit (ICU) with those in a non-COVID-19 ICU from 22 February to 30 April 2020 and in the same period of 2019. We considered blood, urine or respiratory specimens obtained with bronchoalveolar lavage (BAL) or bronchial aspirate (BASP), collected from all patients admitted in ICUs with or without COVID-19 infection. We found a higher frequency of infections due to methicillin-resistant (MR) staphylococci, vancomycin-resistant Enterococcus faecium, carbapenem-resistant Acinetobacter baumannii and Candida parapsilosis in COVID-19-positive patients admitted in ICUs compared to those who were COVID-19 negative. Carbapenem-resistant Pseudomonas aeruginosa was more frequently isolated from patients admitted in non-COVID-19 ICUs. Several conditions favor the increased frequency of these infections by antibiotic-resistant microorganisms. Among all, the severity of the respiratory tracts was definitely decisive, which required assisted ventilation with invasive procedures. The turnover in the ICU of a large number of patients in a very short time requiring urgent invasive interventions has favored the not always suitable execution of assistance procedures. No less important is the increased exposure to infectious risk from bacteria and fungi in patients with severe impairment due to ventilation. The highest costs for antifungal drugs were shown in the ICU-COVID group.