ABSTRACT
Background And Aims: S100A8 and S100A9 alarmins and their heterodimer calprotectin are diversely involved in myeloid neoplasm pathophysiology as well as infectious and inflammatory diseases. In the context of COVID-19, circulating calprotectin was identified as a powerful biomarker of disease severity. Calprotectin impact on CD34+ hematopoietic stem and progenitor cells remains poorly understood. Method(s): Calprotectin effects on healthy donor and chronic myeloid neoplasm-derived CD34-positive hematopoietic stem and progenitor cells were tested in liquid culture for up to 7 days. The pro-inflammatory cytokine IL-6 was used as a control. Cytokine effects alone or in combination were explored by the use of bulk and single cell RNA sequencing, Assay for Transposase-Accessible Chromatin with high-throughput sequencing, cytokine secretion analyses and semi-solid cultures. Result(s): CD34+ cells exposed to IL-6 generate monocytic cells that overproduce calprotectin. Calprotectin inhibits erythroid differentiation of healthy CD34+ cells, possibly through CD36 receptor. Chronic myeloid neoplasm CD34+ cells over-react to calprotectin, with large transcriptomic rewiring of erythro-megakarocytic and granulo-monocytic populations. Calprotectin-induced inhibition of erythroid progenitor proliferation correlates with increased synthesis of ribosomal subunits and p53 pathway activation, while the cytokine impact on granulo-monocytic cells indicates an autocrine or paracrine amplification loop. Conclusion(s): Calprotectin secreted by monocytes generated by CD34+ cells upon IL-6 stimulation may be a pathophysiological component of inflammatory anemia, a role that is amplified in the context of myeloid neoplasms in which calprotectin effects extend to the granulo-monocytic lineage.Copyright © 2023 Elsevier Ltd. All rights reserved.
ABSTRACT
Objective: The impact of COVID-19 on the number and antibiogram profile of Salmonella was studied between January 2018 and December 2021. The present time period included years before the COVID-19 pandemic, which are 2018 and 2019, and during the pandemic, which are 2020 and 2021. Material(s) and Method(s): Salmonella infections were classified into eight distinct serogroups using slide agglutination with specific antisera (A, B, C, D, E, F, G, and I). The susceptibility to antimicrobial agents were evaluated by the standard disk diffusion method. Result(s): Four hundred fifty-one isolates were detected (139 in 2018, 119 in 2019, 102 in 2021, and 91 in 2021). Salmonella infection decreased by 25.2% from 258 isolates in 2018 and 2019 to 193 in 2020 and 2021. When comparing Salmonella infections in different age groups (0 to 10, 11 to 20, 21 to 30, 31 to 40, 41 to 50, 51 to 60, 61 to 70, and older than 70 years), before and during COVID-19, statistical significance was noted only in patients aged 11 to 20 (p=0.016). For clinical specimens (stool, blood, urine, pus, etc.), statistical significance was found only in blood specimens (p=0.036). The four most predominant Salmonella serogroups were B (31.1%), C (30.6%), E (15.7%), and D (11.4%). S. Typhi was present in 2.1% (4/193) of Salmonella isolates during COVID-19. The findings of a susceptibility test using the disk diffusion method for four commonly used drugs in treatment of severe salmonellosis as ampicillin, cefotaxime, ciprofloxacin, trimethoprim/sulfamethoxazole, before and during COVID-19 demonstrated statistical significance only in Salmonella serogroup D (p=0.028). Overall, drug susceptibility of Salmonella serogroup B, C, D, and E was ampicillin (range 15.1% to 55.9%), cefotaxime (range 66.7% to 100%), ciprofloxacin (range 18.8% to 59.1%), and trimethoprim/sulfamethoxazole (range 70.0% to 93.8%). Conclusion(s): The present study results suggested the importance of monitoring the prevalence of Salmonella at a hospital in Bangkok. The antibiogram of susceptibility helps provide guidelines for clinician to consider empirical treatment.Copyright © 2023 JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND.
ABSTRACT
Background: Dalbavancin is a lipoglycopeptide antibiotic approved for treatment of acute bacterial skin infection by GRAM +, also used for his long half-life in bone infection. Case Report: A 72 years old patient was admitted to hospital with low-grade fever for 40 days and back pain after two hospitalization for COVID19 infection and ischemic stroke. Blood examinations showed: elevated white blood cells count, increased inflammatory markers and anemia. CT showed bilateral pleural effusion, MRI configured vertebral alteration (D7-D9) suggesting infectious spondylodiscitis, blood and pleural liquid culture evidenced Staphylococcus Aureus MSSA. Levoxacin 500mg2/day and linezolid 600mg2/day IV were started with clinical improvement. Following the patient request, he was discharged with oral Linezolid. Two weeks later he showed worsening back pain and high inflammatory index. Levoxacin 500mg and Rifampicin 600mg were administered 2/day, soon Rifampicin substituted with Minocycline 100mg/day for side effect onset. After 4 week, MRI confirmed worsening of inflammatory state. Based on proven efficacy, Dalbavancin 1500mg/day IV on day 1 and 8 was started, with Minocycline for 24 week, with significant improvement in followup MRI;pleural effusion and inflammatory markers decreased. Conclusions: This case shows high efficacy of dalbavancin in spondylodiscitis pyogenic infection and pleural empyema, avoiding complications and high cost of long-term hospitalization during pandemic. In particular condition the use off label of dalbavancin is a safe and cost effective treatment.
ABSTRACT
Background: 35yrs female, without comorbidities hospitalised in emergency in icu due to sudden severe breathlessness and chest pain, fever, weakness, cold, throat pain, vomiiting of 4 to 5 days duration. Case Study: H/o 1st dose covid vaccination received 4 to 5 days ago. Latest COVID RT-PCR negative. Patient required o2 support as her Spo2 on admission was 87%.All necessary lab done. 2DECHO done by cardiologist s/o moderate pericardial effusion causing temponade, also dilated RA/ RV, RV dysfunction, septal buging s/o effussion/constrictive pericarditis. Hence emergency pericardiocentesis was done under fluroscopic guidence. 500ml pale yellow fluid aspirated and pigtail was placed. Fluid was sent for testing. It showed on Gene Xpert detection of mycobacterium tuberculosis and no resistance to rifampicin. Pulmonary embolism and other systemic causes of pericardial effusion ruled out. Patient gave history of Miliary tuberculosis and completed treatment 1 month ago with HRCT chest after treatment completed showing normal lung parenchyama. All symptoms started on the day of vaccination in evening. She also had associated bilateral moderate pleural effusion L>>R. Left sided pleural fluid tapping done and sent for examination. Pt was started on 1st line anti-TB drugs along with diuretics, steroids. She responded well to treatment. Subsequent follow up 2DECHO screening and CXR showed resolution of effusion. Pigtail pericardial catheter removed, O2 tapered off and patient discharged home. Called for follow up after 1 week for 2DECHO screening. Pericardial fluid TB liquid culture was sent which showed no growth after 8 weeks. Discussion: Reactivation of tuberculosis doesn't occur in all cases who has received covid-19 vaccination but we noted in 1 of our case. Conclusion: Reactivation of tuberculosis causing life threatning complication post COVID-19 vaccination.
ABSTRACT
Background: Pyomysitis is a bacterial infection of skeletal muscle characterized by intramuscular abscess formation that arises in endemic areas (tropical) or in patients with immunocompromised condition such as HIV or Diabetes Mellitus. Staphylococcus aureus is the most common culprit, with rising proportion of MRSA. Description of the case: A 35-year-old man with history of diabetes mellitus in poor control was admitted to our ward with ketoacidotic state, fever, repiratory insufficiency and diffuse myalgia. After the prompt correction of DKA, Chest X-ray reveald bilateral interstitial pneumonia and nasopharyngeal swab for CoViD-19 resulted positive. He started dexamethasone, remdesivir and noninvasive ventilation with improvement of gas exchanges. A MRI revealed an intramuscular abscess on left paravertebral muscle and bedside ultrosound showed multiple muscolar abscesses (right rectus femoris, right gastrocnemius, left teres minor and left semitendinosus). Ultrasound assisted drainage was performed and liquid culture yielded MSSA, thus antibiogram guided treatment with linezolid plus sulphametoxazole/trimetroprim was started. Follow-up PET at two weeks demonstrated a dramatic reduction in the inflammations. Conclusions: Pyomyositis is a potentially severe but uncommon complication of poorly controlled diabetes that could be difficult to detect in the setting of a concomitant viral illness. Bedside ultrasound has a unique role in the diagnosis, in the surgical drainage and in the follow-up. The cornerstone of optimal antimicrobic therapy is antibiogram-guided due to the rising proportion of MRSA.