Anti-SARS-CoV-2 antibody responses in convalescent plasma donors with varying clinical manifestation severity of COVID-19

Background/Aim. Plasma containing a high titer of anti-SARS-CoV-2 antibodies, donated from individuals who re-covered from COVID-19, has the potential to be used as initial therapy for patients who have been infected (passive immunization). It is a challenge to find suitable donors. The aim of the study was to successively monitor antibody titer in donations and to investigate the correlation between an-tibody titer and the severity of the clinical manifestations. Methods. The retrospective study was conducted from May 1 to October 31, 2020, at the Blood Transfusion Insti-tute of Vojvodina. Donors had to meet certain criteria for inclusion in the study: proven SARS-CoV-2 infection, de-tected SARS-CoV-2 antibodies in the serum/plasma, ful-fillment of general criteria for performing plasmapheresis, and adequate laboratory findings. Results. During the study, 651 apheresis plasma units were collected and divided into two equal doses. Plasma was donated by 311 COVID-19 convalescents, including 208 (66.9%) men and 103 (33.1%) women. There were 15 (4.8%) plasma donors with asymptomatic infection, 235 (75. 6%) with a mild form of illness, 45 (14.5%) with a moderate form of illness, 16 (5.1%) with a severe form of illness, and none with a critical form of illness. Anti-SARS-CoV-2 IgG antibodies were pre-sent in the plasma of donors for more than 6 months after the disease. Plasma donors with a more severe clinical mani-festation of COVID-19 had stable antibody levels for a longer period. However, the Pearson correlation of clinical severity and antibody titer did not confirm a statistically sig-nificant correlation between the variables. Conclusion. An-ti-SARS-CoV-2 antibodies were present in the sample of re-covered patients, plasma donors, for more than 6 months after the disease. Even though no statistically significant correlation was found between the anti-SARS-CoV-2 anti-body titer and the clinical severity of COVID-19, in patients with a more severe clinical manifestations of the disease, stable antibody levels were maintained for a longer period.Copyright © 2022 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Paraneoplastic Anti-Ma2-antibody associated encephalitis: a case report

Background and aims: A 36-years-old man was admitted to the neurological department with complaints on severe drowsiness, sudden falling asleep, fatigue, unsteadiness when standing and walking, inability to speak and write intelligibly, increased body temperature and appetite. The first symptoms occurred 2 month before admission. To note, before the onset of the disease, patient felt a pain and dissension in the testes. Methods: There weren't any significant findings in neurological status, unless mild cognitive (MMSE - 20 points) and behavioral impairments. He had been administered a list of analysis: hematology (WBC 10.9 10

Concurrent coronavirus disease 2019 and primary syphilis in a young man: A rare case report.

INTRODUCTION: The global rise of syphilis infections and the ongoing coronavirus disease 2019 (COVID-19) pandemic are causes for concern. We herein report a rare case of concurrent primary syphilis and COVID-19. CASE REPORT: A 29-year-old man was admitted with a diagnosis of COVID-19. Although COVID-19 pneumonia appeared during ciclesonide and favipiravir treatment, his symptoms improved without developing severe hypoxemia. A small, red ulcer on the left-side of his glans penis was noted and left inguinal lymph node swellings were detected on computed tomography (CT). He reported that his last engagement in sexual intercourse had been 3 months previously, and that his partner had subsequently been diagnosed with syphilis. Although both serum Treponema pallidum (TP) antibody and rapid plasma reagin (RPR) quantitative tests were negative on the day of admission, we clinically diagnosed a suspected case of primary syphilis and started treatment with amoxicillin (1500 mg/day). We subsequently learned that the TP antibody and RPR quantitative tests had been positive 4 days before starting syphilis treatment. Amoxicillin treatment was continued for 61 days, and the ulcer gradually improved. One year later, the RPR quantitative test was negative, and CT revealed a reduction in size of the inguinal lymph nodes and no residual signs of COVID-19 pneumonia. CONCLUSION: The prevalence of syphilis has been increasing even during the COVID-19 pandemic, and the incidence of concurrent syphilis and COVID-19 might be higher than is recognized. Asking patients with COVID-19 about high-risk sexual behavior and genital lesions could help with early diagnosis of syphilis.

Cycling profiles of unconfirmed syphilis repeat-reactive serology results during influenza and COVID-19 vaccination campaigns: September 2017-January 2022

Background: All donations at Canadian Blood Services (CBS) are screened for syphilis using a serology screening and confirmation test algorithm. Currently, syphilis repeat-reactive (RR) results lead to the indefinite deferral of CBS donors regardless of supplementary test results. We have previously described a temporal association of RR results with seasonal public health influenza vaccination campaigns that generally start in September and continue through winter. As of December 2020, there has also been an intensive COVID-19 public health vaccination campaign in Canada. Aims: To track temporal associations between RR, unconfirmed syphilis results among CBS blood donors and Canadian influenza and COVID-19 vaccination campaigns. Methods: All donations were tested on the PK 7300 instrument (Beckman Coulter;Brea, CA, USA) with the PK TP system test kit. Confirmatory laboratory testing was undertaken at reference laboratories using the Treponema pallidum particle agglutination (TP-PA) test. Syphilis RR results that did not confirm were obtained for CBS donations between September 2017 to January 2022. Data on donor influenza and COVID-19 vaccination histories, within 3 months of donation, were extracted. The temporal periodicity of unconfirmed syphilis RR results was graphed against vaccination data. Respiratory virus data were acquired from the Public Health Agency of Canada Respiratory Virus Detection Surveillance System. Results: Periodicity of RR, unconfirmed syphilis rates: September 2017-January 2022. Summary/Conclusions: We have previously noted a cyclical temporal trend in the number of RR, unconfirmed syphilis specimens with peaks corresponding to influenza vaccine campaigns or widespread community circulation of respiratory viruses. Although insufficient to establish a causal association, this analysis suggests that incidence of RR, unconfirmed syphilis results in Canadian blood donors may be variably influenced at different times of year by one or more of at least three factors: (1) influenza vaccination campaigns, (2) the COVID-19 vaccination campaign, and (3) circulation of respiratory viruses in the presence or absence of circulating seasonal influenza. Moreover, other mechanisms may affect these trends. For example, syphilis assays such as the PK TP test kit that detect IgM may be prone to false positive results that do not confirm either after influenza vaccine, COVID- 19 vaccination or during a respiratory virus season. (Table Presented).

Lipshutz's acute vulvar ulceration and SARS-CoV-2: possible correlation?

Background Vulvar ulcers are mostly caused by sexually transmitted microorganisms, like T. pallidum, HSV and, occasionally, HIV. When genital ulcers occur in not sexually active women and girls, Lipschutz's acute vulvar ulceration is the leading cause. This benign and self-remitting condition is a non-sex-ually acquired condition, generally related to flu-like infections or mono-nucleosis syndrome. A concurrent EBV infection occurs in nearly 50% of cases. Local hygiene, ulcers care and pain control are the mainstay of man-agement of this condition. Case study A 14-year-old-girl, not sexually active, arrives to the emergency referring since four days severe pain in the genital area, enhanced during voiding and associated with vulvar ulcers. No other symptoms are referred. A two days therapy with acyclovir has shown to be ineffective. Local inspection of external genitalia shows 4 ulcerated lesions <5 mm, with no active bleeding and a slight oedema of the right labium minus. Hymen shows to be intact. A diagnosis of Lipschutz ulcers is hypothesize. Some tests are thus performed: microbiological cultures of the lesions are negative for HSV and VZV. Blood panel shows mild isolated lymphopenia and CRP is 2 mg/L. Serologies for CMV, HBV, HCV, HIV, Toxoplasmosis and T. pallidum are negative. Serologies for EBV turn out positive for past infection. PCR for SARS-Cov-2 is otherwise positive. We set home symptomatic therapy with ibuprofen alternating with co-paracetamol, and cold-water vulvar ir-rigation for voiding. A spontaneous resolution takes place in ten days. Due to her moving to Italy and to problems related to non-recognition of swiss immunity documents, the girl had to take the third dose of vaccine (BioN-Tech/Pfizer) one month after healing. Four days later the ulcers recur in the same place, although with eased symptoms. Conclusion According with other literature cases, Covid-19 infection could represent a likely explanation for this clinical situation. The recurrence after vaccine represents a strong evidence for this hypothesis. We therefore suggest to always include Covid-19 infection in the lab tests from now on, while screening for Lipschutz ulcers. Although benign, this clinical picture is con-firmed to be highly invalidating and do not respond to any specific ther-apy. The treatment of pain is critical. It is always important to consider whether pain management can be carried out at home, if hospitalization and eventual catheterization can be avoided.

IMPACT of COVID OUTBREAK on PREVENTION and CARE for HIV and STIs at A LARGE HOSPITAL

Background: Routine medical care was drastically affected by the overwhelming irruption of COVID-19 pandemic. We comprehensively assessed the impact of the COVID-19 pandemic on the prevention and care for HIV and other sexually transmitted infections at a large reference hospital providing preventive and clinical services for HIV infection and other sexually transmitted infections. Methods: We retrospectively compared clinical and laboratory data from March to December 2020 (first ten months of the SARS-CoV-2 epidemics in Spain) vs. the same period 2019 in the setting of Hospital Clínic of Barcelona which provides preventive and clinical services for HIV infection and other sexually transmitted infections for the region of Catalonia and is the largest of its kind in Spain. Monthly clinical data on HIV pre-exposure and post-exposure prophylaxis users and on adults with HIV infection were retrieved from the administrative hospital database. Monthly tests for HIV, hepatitis B and C, Treponema pallidum, Neisseria gonorrhoeae, and Chlamydia trachomatis, and plasma lipids and glucose were recovered from the laboratory database. De novo HIV, hepatitis B, or hepatitis C diagnosis were considered whenever a person had a first known positive laboratory test. Results: There were less (28% reduction) but more advanced (mean [SD] CD4 cell counts per mm3 at HIV diagnosis 305 [167] vs. 370 [170], P<0.001;26 (18%) persons had AIDS-defining conditions at HIV diagnosis vs. 20 (10%), P=0.03) HIV cases and more gonorrhea (39% increase, P<0.001) and chlamydia (37% increase, P<0.001) infections in 2020 vs. 2019. In people with HIV, rates of viral load above the level of detection remained stable (11% vs 11%, P=0.147) despite less scheduled visits (25% reduction, P<0.001). However, they had less antiretroviral prescription changes (10% reduction, P=0.018), worse plasma lipids (mean total cholesterol 190 vs 185 mg/dL, P<0.001;mean LDL cholesterol 114 vs 110 mg/dL, P<0.001;mean triglycerides 136 vs 125 mg/dL, P<0.001;mean HDL cholesterol 47 vs 48 mg/dL, P=0.006), and an excess of mortality (29 deaths vs 11, 264% increase, P=0.006) due in great part to COVID-19 (n=11) but also to other non-COVID-19 causes. Conclusion: In the setting of a large Spanish reference hospital, SARS-CoV-2 epidemics was associated with an increase of some prevalent sexually transmitted infections, with less but more advanced de novo HIV infections, and with worse non-virologic healthcare outcomes and higher mortality in people living with HIV.

DOADORES DE SANGUE DO HEMOCENTRO REGIONAL DE SANTA MARIA COM SOROLOGIA REAGENTE OU INCONCLUSIVA PARA DOENÇA DE CHAGAS DURANTE O PERÍODO DA PANDEMIA DE COVID-19

Objetivos: Analisar o número de doadores de sangue do Hemocentro Regional de Santa Maria (HEMOSM), os quais apresentaram sorologia reagente ou inconclusiva para Doença de Chagas (DC), durante o período de fevereiro/2020 a julho/2021. Material e métodos: Trata-se de um estudo observacional retrospectivo, de abordagem quantitativa, realizado por meio da coleta de dados do Sistema HEMOVIDA (Sistema Nacional de Gerenciamento em Serviços de Hemoterapia) e dos arquivos do Laboratório de Sorologia do HEMOSM durante o período da Pandemia de COVID-19. As amostras de sangue dos doadores foram coletadas em tubos para a obtenção do soro empregado nos ensaios. A técnica para a detecção de anticorpos anti Trypanosoma cruzi foi a eletroquimioluminescência. Resultados: Dos 295 doadores que apresentaram algum impedimento durante a triagem sorológica, 23 deles tiveram as bolsas de sangue descartadas por Doença de Chagas, representando 8% das bolsas desprezadas pela triagem sorológica no mesmo período. Ainda, 4 apresentaram coinfecção por outros agentes etiológicos, sendo 3 por Treponema pallidum (sífilis) e 1 por HIV. Daqueles 23 doadores, 16 apresentaram sorologia reagente com detecção de anticorpos contra o T. cruzi, enquanto 7 apresentaram sorologia inconclusiva. Em relação ao sexo dos doadores, com resultados reagentes ou inconclusivos para a DC, 40% são mulheres e 60% homens. 70% dos doadores que apresentaram marcador sorológico para a DC são residentes da cidade de Santa Maria e os 30% restantes são residentes de cidades próximas pertencentes ao estado do RS. Discussão: A Doença de Chagas é uma condição crônica que leva aproximadamente 40% dos indivíduos infectados a desenvolverem sinais clínicos com envolvimento cardíaco ou digestivo. Trata-se de uma patologia parasitária decorrente da infecção pelo protozoário hemoflagelado T. cruzi, tendo como vetores os insetos triatomíneos. A transmissão pode ocorrer de forma vetorial (maior relevância epidemiológica), congênita, por transplante de órgãos, transmissão oral, através de acidentes de laboratórios e por transfusões sanguíneas, sendo este último modo de transmissão o que faz com que a DC seja pesquisada para doadores de sangue. A pesquisa da DC é importante pois 60% dos portadores do parasita não apresentam manifestações clínicas da doença. Os doadores com sorologia reagente ou indeterminada são convocados ao hemocentro para realização de nova coleta de sangue para confirmação dos resultados e para orientação a respeito do acompanhamento desta infecção. Nesse sentido, conforme os dados encontrados na presente amostra, percebe-se que foi identificado um número significativo de soropositivos para DC durante o período analisado, percentual aproximado ao do HIV, o que fundamenta a importância desse rastreio e da notificação em serviços de saúde. Conclusão: Em comparação com outras causas de descarte de hemocomponentes, como a triagem sorológica para sífilis e hepatites virais, a DC não tem grande destaque, mas de qualquer forma, mesmo que o resultado seja inconclusivo, todos os hemocomponentes produzidos a partir das doações desses voluntários devem ser descartados para a garantia da segurança transfusional.

BOLSAS DE SANGUE DE DOADORES DO HEMOCENTRO REGIONAL DE SANTA MARIA DESPREZADAS EM RAZÃO DE SOROLOGIA REAGENTE OU INCONCLUSIVA PARA SÍFILIS DURANTE O PERÍODO DA PANDEMIA DE COVID-19

Objetivos: Contabilizar o número de doadores de sangue do Hemocentro Regional de Santa Maria (HEMOSM) que apresentaram sorologia inconclusiva ou reagente para sífilis durante o período da pandemia (fevereiro/2020 a julho/2021) e que, em razão disso, tiveram suas bolsas de sangue desprezadas. Material e métodos: Trata-se de um estudo observacional retrospectivo realizado pela coleta de dados do Sistema HEMOVIDA (Sistema Nacional de Gerenciamento em Serviços de Hemoterapia) e dos arquivos do Laboratório de Sorologia do Hemocentro Regional de Santa Maria durante o período de fevereiro/2020 a julho de/2021. A amostra empregada na pesquisa foi o soro dos doadores e a técnica analítica adotada para a detecção de anticorpos antitreponêmicos foi a eletroquimioluminescência. Resultados: O número de doadores que tiveram seus hemocomponentes desprezados em razão das pesquisas sorológicas para sífilis foi de 156, sendo que destes 94 doadores apresentaram sorologia reagente enquanto os outros 62 doadores apresentaram pesquisa inconclusiva. Ainda, quanto ao sexo dos doadores que tiveram seus hemocomponentes desprezados, 46% foram doadores do sexo feminino enquanto 54% são do sexo masculino. Discussão: A sífilis é uma infecção sexualmente transmissível (IST), causada pela bactéria Treponema pallidum, tendo também como via de transmissão a vertical e a sanguínea, motivo pelo qual é uma das doenças pesquisadas para doadores de sangue. Independentemente do resultado reagente ou inconclusivo, estes hemocomponentes foram descartados, em razão da segurança transfusional e controle de qualidade. Todos estes doadores foram convocados para coleta de segunda amostra para confirmação do resultado pela repetição do ensaio, com nova amostra, e para o emprego da técnica de floculação para detecção de anticorpos não-treponêmicos, técnica auxiliar na confirmação da pesquisa. Posteriormente, nos casos de confirmação dos resultados como reagentes, os doadores foram encaminhados para tratamento e acompanhamento médico. Cabe salientar que conforme descrito por outros estudos, a maior porcentagem de doadores com sorologia reagente ou inconclusiva para sífilis, são homens jovens. Conclusão: As pesquisas sorológicas para sífilis foram a maior causa de desprezo de hemocomponentes, dentre aqueles desprezados em razão de alguma sorologia reagente, no Hemocentro Regional de Santa Maria, representando 53% dos descartes. Considerando o primeiro ano da pandemia, em que o HEMOSM apresentou uma queda de aproximadamente 10% das doações em relação ao mesmo período no ano anterior, e que o Ministério da Saúde previa reduções de 15% a 20% das doações, o descarte de hemocomponentes pode significar um agravo na condição dos estoques de sangue, especialmente de concentrados de plaquetas, no caso do HEMOSM, para pacientes atendidos no Hospital Universitário de Santa Maria. Ainda, sendo a sífilis uma IST, companhas de conscientização sobre a doação de sangue e o uso de preservativos para o público jovem podem auxiliar no aumento da captação de doadores e na diminuição da incidência desta IST neste público, contribuindo para a qualidade de vida do doador e consequentemente, na diminuição do descarte de hemocomponentes por este motivo.

Two Treponema pallidum strains account for the majority of syphilis infections, including among females, in Queensland, Australia.

Abstract: An ongoing outbreak of syphilis in Australia, first reported in the state of Queensland in 2011, has led to increasing cases of congenital syphilis, including several deaths. Here, we applied multi-locus sequence typing (MLST) on available Treponema pallidum PCR-positive samples from the state of Queensland from the beginning of the outbreak to July 2020. In total, 393 samples from 337 males and 56 females were genotyped. Of 36 different Treponema pallidum sequence types (ST) observed, the two most common STs, ST 1 (also reported to be a dominant strain in various other countries) and ST 100 (the latter differing from ST 1 by only one single nucleotide polymorphism (SNP) based on the MLST scheme), together comprised 69% (271/393) of all samples, including the majority of samples in females (79%; 44/56). ST 1 was prevalent throughout the entire study period. Both strains remained the most common STs during the year 2020 where social distancing and other measures were implemented due to the COVID-19 pandemic. Both STs had high male-to-female ratios and included male rectal infections, therefore suggestive of occurrence primarily among men-who-have-sex-with-men (MSM). Hence, bridging from MSM to heterosexual networks may potentially contribute to infections among females, but further studies are needed to confirm this. Overall, there was considerable diversity of Treponema pallidum genotypes observed throughout the study period, but the fact that two key strains accounted for the majority of infections, including among females, stresses the need for further investigations into the transmission of these strains, and potentially a need for targeted public health interventions to better control the spread of syphilis in Queensland.

Description of the risk factors of children's growth and development

The growth and development of children is very important, as this would form the foundation for the quality of future generations in the nation. The slightest developmental disorders in infancy, if not detected and not handled properly will lead to a bad impact. Various genetic and environmental factors influence Toddler growth and development. Purpose: To distinguish the description of the risk factors related to child growth and development. Method: This research uses quantitative method. The design of the research is based on a cross-sectional approach in the analysis survey design. In the study, all toddlers under 59 month old were collected using a total of 366 samples in 2020 at the Ngalang Village, Gedangsari public health center and Gunungkidul Regency. Data analysis used univariate analysis of frequency distribution.

Summary of national data of class A, B and C communicable diseases in China, October 2021

In October 2021 (from 00: 00, 1 October to 24: 00, 31 October), a total of 523 006 cases of notifiable communicable diseases, including 2 040 deaths, were reported in China (except Hong Kong, Macao Special Administrative Regions and Taiwan Province, the same below). In communicable diseases in class A, 2 cases of cholera were reported without death. In communicable diseases in class B, no cases and no deaths of severe acute respiratory syndrome, poliomyelitis, human infection with highly pathogenic avian influenza virus, diphtheria and human infection with avian influenza A (H7N9) virus were reported. For the remaining 22 communicable diseases in class B, 249 605 cases were reported, a decrease of 8% compared with last month (272 332 cases) and a decrease of 3% compared with the same period in 2020 (258 591 cases). The first 5 diseases in terms of reported case number were viral hepatitis, pulmonary tuberculosis, syphilis, gonorrhea and AIDS, accounting for 95% of the total reported cases in class B. A total of 2 039 deaths were reported, a decrease of 6% (133 deaths) compared with last month (2 172 deaths) and an increase of 17% compared with the same period in 2020 (1 737 deaths). According to the website of the National Health Commission of China, a total of 1 081 confirmed COVID-19 cases were reported, without death, by 31 provinces (municipalities, autonomous regions) and Xinjiang Production and Construction Corps from 00: 00, 1 October to 24: 00, 31 October, 2021. In class C communicable diseases, a total of 273 399 cases were reported, an increase of 20% compared with last month (228 597 cases) and a decrease of 13% compared with the same period in 2020 (315 366 cases). The first 3 diseases in terms of reported case number were hand foot and mouth disease (HFMD), other infectious diarrhea and influenza, accounting for 95% of the total reported cases in class C. Compared with last month, except filariasis which had no incidences in both months, the diseases with reported cases increases were HFMD (45 435 cases, 52%), influenza (17 811 cases, 50%) and rubella (11 cases, 12%), but the reported cases of other diseases all decreased, the diseases with obvious case decreases were other infectious diarrhea (16 519 cases, 18%), mumps (1 490 cases, 12%) and acute hemorrhagic conjunctivitis (327 cases, 14%). Compared with the same period in 2020, except filariasis which had no incidences in both years, the diseases with reported case increases were influenza (33 177 cases, 164%), typhus fever (15 cases, 9%), rubella (8 cases, 9%) and leprosy (3 cases, 17%), but the diseases with reported case decreases were HFMD (65 002 cases, 33%), other infectious diarrhea (4 111 cases, 5%) and mumps (1 574 cases, 12%). One death caused by class C communicable diseases was reported, an increase of 1 death compared with last month and a decrease of 1 death compared with the same period in 2020 (2 deaths).

Summary of national data of class A, B and C communicable diseases in China, September 2021

In September 2021 (from 00:00, 1 September to 24: 00, 30 September), a total of 500 929 cases of notifiable communicable diseases, including 2 172 deaths, were reported in China (except Hong Kong, Macao Special Administrative Regions and Taiwan Province, the same below). In communicable diseases in class A, no case and no death were reported. In communicable diseases in class B, no cases and no deaths of severe acute respiratory syndrome, poliomyelitis, human infection with highly pathogenic avian influenza virus, diphtheria and human infection with avian influenza A(H7N9) virus were reported. For the remaining 22 communicable diseases in class B, 272 332 cases were reported, a decrease of 0.9% compared with last month (274 917 cases) and a decrease of 5% compared with the same period in 2020 (287 923 cases). The first 5 diseases in terms of reported case number were viral hepatitis, pulmonary tuberculosis, syphilis, gonorrhea and brucellosis, accounting for 94% of the total reported cases in class B. A total of 2 172 deaths were reported, an increase of 5% (95 deaths) compared with last month (2 077 deaths) and a decrease of 5% compared with the same period in 2020 (2 291 deaths). According to the website of the National Health Commission of China, a total of 1 264 confirmed COVID-19 cases were reported, without death, by 31 provinces (municipalities, autonomous regions) and Xinjiang Production and Construction Corps from 00:00, 1 September to 24: 00, 30 September, 2021. In class C communicable diseases, a total of 228 597 cases were reported, an increase of 10% compared with last month (207 153 cases) and a decrease of 7% compared with the same period in 2020 (247 112 cases). The first 3 diseases in terms of reported case number were other infectious diarrhea, hand foot and mouth disease (HFMD) and influenza, accounting for 93% of the total reported cases in class C. Compared with last month, except filariasis, visceral leishmaniasis, leprosy and other infectious diarrhea which decreased by 1 case, 11 cases (39%), 12 cases (33%) and 12 747 cases (12%) respectively, the reported cases of all other diseases increased, the diseases with obvious case increases were HFMD (15 352 cases, 22%), influenza (14 160 cases, 66%) and mumps (4 253 cases, 51%). Compared with the same period in 2020, the diseases with reported case increases were influenza (17 269 cases, 95%), visceral leishmaniasis (4 cases, 31%), rubella (19 cases, 27%) and typhus fever (32 cases, 18%), filariasis had no incidences in both years, and the diseases with obvious reported case decreases were HFMD (26 506 cases, 23%). other infectious diarrhea (5 628 cases, 6%) and mumps (523 cases, 4%). No death caused by class C communicable diseases was reported, same to the last month and a decrease of 3 deaths compared with the same period in 2020 (3 deaths).

Testing and diagnosis of HIV, hepatitis B and C, and bacterial STI in French STI clinics (CeGIDD) in 2020: individual data from SurCeGIDD surveillance. (S..ropositivit.. au VIH: diagnostic, pr..vention et v..cu au temps de la Covid-19.) [French]

Introduction - The CeGIDDs are centres of information, screening and diagnosis for HIV, viral hepatitis and bacterial sexually transmitted infections (STIs), a network of French free-to-use clinics created in 2016. This article describes the characteristics of CeGIDD visitors as well as the screening and diagnostic activities carried out by the structures for the year 2020, comparing them with 2018. Method - We present a repeated cross-sectional study, based on continuous monitoring data from the SurCeGIDD system, which relies on the secure transmission of individual visitor data according to a predefined format. The socio-demographic and behavioural data of the visitors, and their reasons for consultation, are described. The proportions of visitors tested and the positivity rates for HIV, hepatitis B (HBV) and C (HCV), syphilis, gonococcus (NG), Chlamydia trachomatis (CT) and Mycoplasma genitalium (MG) are described according to sexual practices. Results - In 2020, 336,333 consultations were reported by 50.3% of the 336 CeGIDDs identified in 2020. Attendance at CeGIDDs fell sharply in the second quarter of 2020 (-58% compared to the first quarter). In 2020, the visitors were mostly men (62.1%) and young people under 30 (64.5%). About a quarter (23.5%) of the visitors were born abroad. The proportion of men having sex with men (14.8%) and trans people (0.38%) had increased compared to 2018. The most frequent reasons for consultation remained risk exposure (60.4%) and systematic screening (43.3%). Some reasons for consultation increased between 2018 and 2020, such as initiating or monitoring a post-exposure prophylaxis. An increase in positivity rate between 2018 and 2020 is observed for HIV (from 0.37% to 0.41%), but especially for NG (from 2.8% to 4.0%), undoubtedly related to changes in visitor characteristics. At the same time, positivity rates decreased for HBV (from 1.3% to 0.93%) and HCV (from 0.94% to 0.60%). They are relatively stable for CT (7.0% in 2020), MG (6.8%) and syphilis (1.0%). Conclusion - Despite a drop in consultations in 2020 related to the COVID-19 pandemic, the CeGIDDs continued to carry out their screening/diagnostic missions in a comprehensive sexual health approach. SurCeGIDD surveillance provides elements for monitoring the national sexual health strategy, hence the need to improve the comprehensiveness and completeness of the data collected.

REEMERGÊNCIA DA SÍFILIS EM MULHERES E SUA ASSOCIAÇÃO COM O AUMENTO DA SÍFILIS CONGÊNITA NO BRASIL NA ÚLTIMA DÉCADA: UM ESTUDO ECOLÓGICO

Introdução/objetivos: A Sífilis é uma infecção sexualmente transmissível (IST) causada pela infecção pela bactéria Treponema pallidum. Sua manifestação clinica se dá em três estágios: primária, secundária e terciária, cada uma com características clínicas, sendo que ocorre a maior probabilidade de ocorrência de disseminação em seus dois primeiros estágios. Durante a gestação, o T. pallidum pode ultrapassar a barreira placentária, levando à contaminação fetal. Metade das gestantes infectadas com T. pallidum, que não são tratadas durante o pré-natal, transmitem a infecção aos filhos antes do nascimento, causando sífilis congênita. O objetivo deste estudo foi examinar a incidência da sífilis em mulheres em idade reprodutiva, a incidência da sífilis congênita e o número de mortes neonatais na população brasileira durante 2010-2020. Metodologia: Foi realizado um estudo ecológico para coletar informações sobre a incidência de sífilis em gestantes, sífilis congênita e morte neonatal por sífilis congênita (dados até junho de 2020), sendo os dados coletados mediante busca eletrônica nos registros do Departamento de Informática do Sistema Único de Saúde/Brasil (DATASUS), por meio do Sistema de Informação de Agravos de Notificação (SINAN). Resultados: Foram totalizadas 3.013 óbitos decorrentes da sífilis congênita no Brasil de 1998-2020. Os casos de óbitos infantil em decorrência de sífilis congênita aumentaram de 90 óbitos (sendo 6.946 casos confirmados) em 2010 para 261 (sendo 24.130 casos confirmados) em 2019. O aumento dos casos de sífilis em gestantes de 20 a 29 anos (55,7%) foi associado ao aumento dos casos de sífilis congênita. Em 2020, foram notificados 173 óbitos infantis (sendo 8.932 casos confirmados) decorrentes da sífilis congênita, sendo 96,8% óbitos antes dos 7 dias de vida. Foram notificados 49.154 casos de sífilis adquirida em 2020 no Brasil, sendo 18.337 em mulheres. A taxa de detecção de sífilis em gestantes subiu de 3,5 em 2010 para 20,8 em 2019 (para cada 1000 nascidos vivos). Conclusão: Com o ressurgimento da sífilis na população em idade reprodutiva, se faz necessário abordar e tratar a sífilis, haja vista o número de casos e óbitos notificados em 2020. Os dados devem ser avaliados com cautela tendo em vista a situação de isolamento social decorrente a pandemia da COVID-19, o que levou a menor procura por serviços de saúde e nesse sentido, a queda dos casos notificados, podendo estes representar um risco epidemiológico e de saúde iminente.

Large vessel vasculitis related to COVID-19 infection

Case report-IntroductionBy June 2020, 175,000 cases of COVID-19 had been identified in London alone. The most common symptoms include fever, headache, loss of smell, cough, myalgia, and sore throat. The major complication is acute respiratory distress syndrome (ARDS) but systemic complications such as cardiomyopathy, acute kidney injury, encephalopathy and coagulopathy are being identified. A delayed multi-system inflammatory syndrome in children has also been recognised and further complications are likely to be identified as our experience increases. Here, we report the case of a patient with large vessel vasculitis who initially presented with symptoms highly likely to be due to COVID-19 infection.Case report-Case descriptionA 36-year-old black African nurse presented in May 2020, with acute onset 7 days prior of high-grade fevers, rigors, nights sweats, generalised myalgia, sore throat, headache with photophobia, anosmia, dysgeusia and a widespread rash. She was a smoker with no other relevant medical, travel nor sexual history, and no drug use. A COVID-19 swab on day 2 had been negative and she had taken a course of Doxycycline.Examination revealed firm palpable subcutaneous nodules on lower limbs, upper back and forehead and cervical lymphadenopathy. She was photophobic with no meningism. The rest of her physical examination was normal. BP was 116/97 mmHg, heart rate 109 bpm and satO2 100%. Investigations demonstrated C-reactive protein 330mg/L, erythrocyte sedimentation rate 140, Ferritin 479, lymphopaenia 0.7x109, eGFR 54 with no haematoproteinuria, D-dimer 3.05 mg/L with INR 1.1, aPTT 1.3, fibrinogen 8.8 g/L. Hb, WCC, liver function, CK, serum ACE and triglycerides were normal. Infectious screen revealed negative blood cultures, HIV, Hepatitis B and C, EBV, CMV and Treponema pallidum serology. CT brain and CSF analysis were normal including bacterial culture and viral PCR. ANA, ENA, dsDNA, ANCA and aPL antibodies were negative with normal complement levels. Throat swab grew group A streptococcus and she was treated with broad spectrum antibiotics for 7 days maintaining fevers up to 39oC. Skin biopsy was non-specific with negative direct immunofluorescence but showed microvascular thrombi in the papillary dermis. COVID-19 PCR tests (three naso-pharyngeal swabs and one stool PCR) and IgG test (day 38) were negative. CT showed no pneumonitis but non-specific retroperitoneal stranding with medium/large vessel vasculitis involving both proximal renal arteries and a 6 cm segment of mid abdominal aorta on PET-CT. We started oral prednisolone 40mg with immediate resolution of her fevers, myalgia, and inflammatory markers, remaining well a month later.Case report-DiscussionTakayasu's arteritis is the most common autoimmune large vessel vasculitis (LVV) affecting young females and involves inflammation of the arterial wall ultimately resulting in stenosis and obstruction of the vessel. However, it is rare in patients with African heritage and usually presents with a prolonged prodromal phase. Given the atypical presentation and symptoms consistent with COVID-19 infection we feel that this patients' LVV may have been a complication of COVID-19 infection. The relationship between infections and vasculitis is complex. TB and syphilis cause aortitis and a relationship between infection and vasculitis has been proven in HBV associated PAN and HCV associated cryoglobulinemia.Experimental data supports a possible association between CMV and herpes virus and Takayasu arteritis. It could, therefore, be hypothesised that COVID-19 infection can trigger LVV. Our patient had a throat swab positive for Streptococcus pyogenes which is an uncommon cause of infective endocarditis and mycotic aneurism, but this patient had no evidence of either endocarditis or aneurism formation and so it was felt the throat swab finding was incidental. Our patient had repeated negative COVID-19 nasopharyngeal swabs and a negative antibody test at day 38.Although this argues against a diagnosis of COVID-19 related illness, the relative lack of inform tion we currently have regarding sensitivities of the tests, at what point COVID-19 PCR becomes negative in the illness and when/if patients develop antibodies, means these negative tests in the presence of typical symptoms cannot exclude the diagnosis. We believe this case is extremely important to highlight a possible novel inflammatory complication of COVID-19 infection. We decided to treat this patient in line with guidance for the management of LVV, including the introduction of methotrexate, but it will be interesting to observe her long-term outcome.Case report-Key learning points Increasing numbers of COVID-19 related systemic inflammatory conditions are likely to be recognised over the coming months. We present the case of patient with large vessel vasculitis who initially presented atypically with symptoms consistent with COVID-19 infectionTo identify these complications, COVID-19 symptoms questioning should be part of any routine medical historyMore information is required regarding the sensitivity of COVID-19 PCR and antibody tests to aid the diagnosis of these conditionsThe long-term management of inflammatory conditions associated with COVID-19 infection is not clear and a discussion is warranted as to whether DMARDs should be initiated.

Syphilis-associated septic cardiomyopathy: case report and review of the literature.

BACKGROUND: Septic cardiomyopathy has been observed in association with influenza, indicating that not only bacteria but also other infective agents can cause this condition. There has been no systematic study as to whether Treponema pallidum infection induces septic cardiomyopathy, and we are the first to report this possibility. CASE PRESENTATION: We report two cases of a 48-year-old man and a 57-year-old man who were diagnosed with syphilis-related septic cardiomyopathy. The diagnosis of cardiomyopathy was made based on elevation of cardiogenic markers and decrease in ejection fraction evaluated by echocardiography. Screen for infective pathogens was negative except for syphilis, which supported our diagnosis. The two patients recovered following effective anti-syphilis treatment and advanced life support technology. Syphilis serology became negative after treatment. CONCLUSION: Syphilis has the potential to cause septic cardiomyopathy. Clinicians should consider Treponema pallidum in cases of septic cardiomyopathy with unknown pathogens. However, the specific pathophysiological mechanism of syphilis-associated septic cardiomyopathy has not been elucidated, and more specific studies are needed.