Molecular Detection of Canine Parvovirus-2c (Cpv-2c) in Diseased Coyote Pups (Canis Latrans) at Northeastern Mexico

Intro: Canine parvovirus type 2 (PVC-2), Protoparvovirus genus of the Parvoviridae family, is a worldwide distribution virus that affects the Canidae family. In free-living coyotes (Canis latrans), the presence of the PCV-2a, PCV-2b and PCV-2c subtypes of PVC-2 has been reported, but there are no reports of their presence as a cause of clinical damage. The objective of this study is to report the presence of PVC-2c in an outbreak of mild gastroenteritis in three coyote pups detected in northeastern Mexico Methods: During the fall of 2019, in the suburban area of Monterrey, N.L., 3 affected coyote pups were detected with a mild gastroenteric condition consisting of mild diarrhea with loose stools, vomiting, dehydration, loss of appetite, pale mucous membranes, and low weight. Stool samples were tested for Canine Parvovirus (CPV-2), Canine Coronavirus (CCV) or Giardia antigens with a commercial kit. All samples were positive for CPV-2 and these were subsequently analyzed by PCR and sequencing of the CPV-2 VP2 gene. Using bioinformatics, the VP2 gene sequence data obtained were used to establish phylogenetic relationships with homologous sequences reported in coyotes and CPV-2 vaccines. Finding(s): The genetic sequence of VP2 obtained showed a high homology (98.1 to 100%) with CPV-2c. The sequences obtained from the pups showed 100% homology to each other. The phylogenetic tree showed that the sequences reported in coyotes are grouped in different clades and that the sequence of the VP2 gene of CPV-2c from coyote pups is grouped in a different monophyletic group. Conclusion(s): Information suggests that wild coyotes may not only act as asymptomatic reservoir hosts but may also be clinically affected by PVC-2c. It is necessary to carry out studies to know the effects of the genetic subtypes of PVC-2 in the population of coyotes and other wild canids of northeastern Mexico.Copyright © 2023

Successful matched unrelated donor hematopoietic stem cell transplantation for infantile Wolman disease

Introduction: Wolman disease is a rare genetic disorder with an autosomal recessive inheritance. A mutation in the LIPA gene causes lysosomal acid lipase (LAL) deficiency results in lipid storage and adrenal insufficiency. Death in early infancy is due to liver failure. Patients and methods: We describe the clinical course of a three-month-old infant diagnosed with Wolman disease. A rapid mutational analysis confirmed a LIPA gene defect. Results: He underwent matched unrelated donor peripheral blood stem cell hematopoietic stem cell transplantation (HSCT) at 3 months of age, with a treosulfan-based conditioning, which resulted in engraftment with donor-derived hematopoietic cells. He required supportive care for sinusoidal obstruction syndrome and mucositis. He was administered low dose prednisolone for grade I skin graft versus host disease, and a complete donor chimerism was documented on several occasions. At one year post HSCT, his growth and development were optimal, and there was no hepatosplenomegaly. He is maintained on glucocorticoid and mineralocorticoid supplements for primary hypoaldosteronism. Conclusion: The case emphasizes the timely diagnosis and the potential for successful treatment of Wolman disease by HSCT. © 2022 Pediatric Hematology Oncology Chapter of Indian Academy of Pediatrics

Delayed IBD diagnosis leads to worse outcomes over years, with multiple implications on service delivery

Background: Delays in diagnosis can be patient and health-system related. Such delays have been reported to increase overall complications in Inflammatory Bowel Diseases (IBD). The aim of our study was to report on the impact of delays on IBD-related adverse outcomes (AOs), as hospitals currently face challenges with long waiting lists in the post-COVID-19 era. Method(s): New patients referred for suspected IBD to a single tertiary care centre between Jan 2013 to Dec 2017 were identified using EMR. A cut-off time was set for each delay-type based on best average hospital waiting times. Reasons for delays until start of treatment and data on pre-defined AOs (steroid & other rescue therapies, hospitalisations, surgery) were recorded for each patient until end of June 2021. Data was analysed using multiple Pearson correlations and Cox proportional Hazard model to determine if there was a difference in survival without AOs between patients with and without delay. Result(s): 105 patients were identified using strict criteria (M=58;median age=32y) with a median follow-up of 55 months. The most frequent presenting complaints were abdominal pain (44, 41.9%), loose stools (40, 38.1%), bloody diarrhoea (37, 35.2%) and bleeding perrectum (33, 31.4%). 65, 27 and 13 patients had a final diagnosis of Ulcerative colitis, Crohn's disease and Unclassified colitis respectively, and were analysed jointly. The longest delay-types noted: Patients seeking medical attention (median= 4 months;range 1 to 84 months);arranging gastroenterology clinic review after GP referral (median=5 weeks;1 to 30 weeks);and waiting for index endoscopy (median=3 weeks;1 to 36 weeks). Patient stratification based on delay-type, using specific cut-off times for each showed a statistically significant difference in survival without AOs for all (when comparing delay vs no delay). - delay in seeking medical attention (cut-off=1m;p=0.004) (Fig 1A) - delay in GP referral to specialty review (cut-off=1w;p=0.048) - delay in index endoscopy (cut-off=4w;p=0.01) (Fig 1B) - delay in starting treatment (cut-off=4w;p=0.03) Conclusion(s): Several bottlenecks of delays increase AOs in IBD over the follow-up period. A delay as short as a week, between GP referral to specialty review, is significant in determining AOs, relevant for specialist IBD centres particularly in the post-Covid period. Endoscopy units should prioritise suspected IBD patients to reduce AOs, which is likely to have implications on service delivery and planning. Long delays observed in patients seeking medical attention highlights the need for better patient education in the community.

Isolated Colonic Histoplasmosis in Renal Transplant Recipient Post Covid-19 Infection

Introduction: Histoplasmosis is caused by the dimorphic fungus - Histoplasma capsulatum. The presentation of histoplasmosis is often disseminated, though primary intestinal involvement can rarely be seen in patients with cell mediated immune dysfunction like in patients with AIDS. We report a case of renal allograft recipient, who had history of COVID 19 infection and also underwent anti-rejection treatment for renal graft dysfunction, presented with chronic diarrhea and was diagnosed as a case of colonic histoplasmosis. Method(s): We report a case of 45 years old male who underwent renal transplant surgery one and a half year prior (February 2021) and was having stable graft function on tacrolimus, mycophenolate and steroid. He had history of fever and diarrhea in February 2022 and was diagnosed COVID-19 positive with RT-PCR, and was treated conservatively with intravenous dexamethasone and lowering of immunosuppressants. He had mild graft dysfunction in April 2022;renal graft biopsy had acute T-Cell mediated rejection (Banff Grade 1 B) and was treated with pulse steroids for 3 days. He had complaint of intermittent diarrhea, weight loss and intermittent fever since May 2022. He was evaluated and treated on outpatient basis with empirical oral antibiotics. He was admitted in June 2022 with complaint of high grade fever, loose stools leading to hypovolemic shock and renal dysfunction. He had marked thrombocytopenia and neutrophilic leukocytosis. He showed initial response to intravenous broad spectrum antibiotics and crystalloids, but intermittently symptoms of increased stool frequency and altered consistency were still persisting. Stool studies for ova, cyst, parasites and clostridium difficile were negative. Indian ink staining of stool sample had no evidence of Cryptococcosis. Serum PCR for cytomegalovirus was also negative. CT abdomen showed normal visualized bowel and other viscera. Upper GI endoscopy was unremarkable. Colonoscopy revealed multiple small ulcers with erythematous hue and clean base particularly in ceacum and along ascending colon. Multiple colonic biopsies were taken. Histopathology showed lymphoplasmacytic infilterate in the lamina propria. It also showed increased presence of foamy histiocytes, several of which also showed interacellular organism bearing a pseudocapsule. PAS stain also confirmed budding of these interacellular organisms which is consistent with Histoplasmosis. His HRCT chest revealed hyperinflated lungs, cylindrical bronchiectasis in left upper lobe. Urine for histoplasma antigenuria was negative. Result(s): He was treated with intravenous liposomal amphotericin B for initial two weeks followed by oral itraconazole. His symptoms responded remarkably to the treatment. In view of persisting thrombocytopenia and histoplasmosis his mycophenolate was stopped and tacrolimus was titrated as per trough levels Conclusion(s): Colonic histoplasmosis is associated with significant mortatlity and morbidity. Prolonged use of immunosuprresants, use of antirejection therapies (like high dose pulse methyl prednisolone and bortezomib) and even in some case reports COVID 19 infection have shown to increase the risk of histoplasmosis. Primary and isolated colonic histoplasmosis like in this case can be the atypical presentation which emphasizes the importance of maintaining a low threshold for consideration of histoplasmosis in renal allograft recipients. No conflict of interestCopyright © 2023

Seroprevalence of SARS-CoV-2 among Children Visiting a Tertiary Hospital in Himachal Pradesh, India

Introduction: Research on Coronavirus Disease-2019 (COVID-19) seroprevalence in children and adolescent population across the globe is quite limited. In India, there is a dearth of data on COVID-19 seropositivity, especially in unvaccinated paediatric population, particularly in the Himalayan region. Aim: To estimate the seroprevalence of COVID-19 in children presenting in a tertiary care health institution. Materials and Methods: A hospital-based cross-sectional serosurvey was conducted on 500 children, from October 2021 to March 2022 in paediatric age group, attending Indira Gandhi Medical College Shimla, Himachal Pradesh, India, for various health related concerns such as fever, cough, loose stools, vomiting and fast breathing using convenience sampling. Socio-demographic profile was recorded and blood sample was drawn for COVID-19 antibody titre estimation. Chi-squared and Fisher's-exact tests for proportions was used for testing statistical significance. Results: A total of 500 children, age ranged from 12 hours to 17 years 7 months were enrolled with maximum children belonging to 01-05 years age group and there was slight male preponderance. Seropositivity in males (27.3%) was significantly higher than females (8.3%). Highest (42.3%) seropositivity was seen in age group of 06 months to 01 year. About 10.8% of cases were positive for Immunoglobulin (Ig) G antibody, 4.4% were positive for IgM antibody, while about 6.6% cases were positive for both antibodies. Conclusion: The seroprevalence status of children and adolescents is quite low in this region, revealing the high susceptibility of children to SARS-CoV-2 in the study region. It further emphasises benefits of serological testing in children for SARS-CoV-2 as well as the need of safe and effective vaccination for the unimmunised, unprotected and vulnerable paediatric age group.

It's not the shunt: an atypical cause of fever in an infant with hydrocephalus

Case Report:We present a 5-year-old male with two days of fever, cough, vomiting, and loose stools. His history is significant for premature birth (35 weeks gestational age) and shunted hydrocephalus. A ventriculoperitoneal (VP) shunt was placed 6 days prior to presentation. Parental report included episodes of post-tussive, nonbloody, non-bilious emesis, poor oral intake, tachypnea, and increased work of breathing. Physical examination demonstrated a dehydrated infant with sunken fontanelles. He had no notable rash, no lymphadenopathy, and clear conjunctiva. His VP shunt site appeared normal without swelling or erythema. Initial evaluation showed elevated inflammatory markers -ESR 51 and CRP 12.32 mg/dL. A viral respiratory PCR panel returned positive for coronavirus (not SARS-CoV-2). A head CT scan and shunt radiography series showed no abnormalities with his shunt. The following morning, Radiology reported an incidental retropharyngeal fluid collection on a re-read of the patient's initial CT scan. A neck CT was obtained and demonstrated a fluid pocket with secondary mass effect in addition to bilateral cervical lymphadenopathy. Screening blood cultures were negative. The patient remained febrile (tmax 103.6F) and developed a transaminitis (ALT 264.9, AST 654), elevated fibrinogen 476, elevated INR 1.4, and low albumin 2.1. Abdominal ultrasound showed a normal the liver and biliary tract. His transaminitis resolved without treatment. The next day, the patient developed lip erythema and conjunctival injection. An echocardiogram showed a dilated right coronary artery (z-score of 3.59) and his inflammatory markers (ESR 26, CRP 9.63) remained elevated. Treatment was initiated with IVIG and moderate-dose aspirin. The patient defervesced, and he remained afebrile for over 48 hours prior to discharge. A repeat echocardiogram 2 days later showed a slight reduction in coronary artery dilatation (z-score 3.39). Hewas discharged on lowdose aspirin, and followed up with cardiology as an outpatient. Kawasaki's Disease (KD) is most common in children from ages 1 to 4 years and is classically characterized by persistent fever with a constellation of symptoms including limbal sparing conjunctivitis, cervical lymphadenopathy, polymorphous rash, strawberry tongue, oral changes, and extremity changes. Our patient presented at a younger age with a concurrent diagnosis of coronavirus upper respiratory tract infection. His atypical hospital course and incidental finding of retropharyngeal edema and transaminitis increased the clinical suspicion for KD. His symptoms rapidly improved after administration of IVIG. Younger patients are at an increased risk for severe complications of KD including coronary aneurysm. KD has been shown in the literature to have an association with coronavirus infection as well as presentation with retropharyngeal edema. Clinicians should consider KD in their differential even if patients do not meet all criteria for diagnosis on initial presentation. Copyright © 2023 Southern Society for Clinical Investigation.

Clinical profile and outcome of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 infection: a single-center observational study from South India

Background: Multisystem inflammatory syndrome in children (MIS-C) is a post-infectious sequelae of acute COVID-19 infection affecting children. This study was done over a period of 12 months from December 2020 to November 2021 to describe the clinical presentation, laboratory abnormalities, and outcome of children with MIS-C. Method(s): Seventy-eight children below 12 years of age who satisfied the WHO diagnostic criteria for MIS-C were included in the study. Clinical parameters were recorded at admission. Relevant laboratory investigations, radiological studies, and outcome were documented. Result(s): The most commonly affected age group was 6-12 years with a female predominance. COVID RTPCR was negative in all patients. Most cases presented 2-6 weeks after the onset of acute COVID-19 infection. Lethargy, poor feeding, vomiting, abdominal pain, loose stools, cough, and cold are common symptoms of MIS-C syndrome in children and the common signs were rash, conjunctival congestion, hypotension, tachycardia, tachypnea, and hypoxemia. Gastrointestinal system was the commonly affected followed by the hepatic, renal, and cardiovascular systems. Coronary artery abnormalities were seen in 20% of cases. IVIg was the mainstay of therapy used in 95% of patients. Mortality was 1.3%. Cases responded well to IVIg and steroids. Conclusion(s): Overall, the short-term outcome was favorable with low mortality in our study cohort. One-fifth of children had coronary artery abnormalities during acute phase underscoring the need for long-term follow-up. Copyright © 2022, The Author(s).

DELAYED IBD DIAGNOSIS LEADS TO WORSE OUTCOMES OVER YEARS, WITH MULTIPLE IMPLICATIONS ON SERVICE DELIVERY

Background Delays in diagnosis could be patient-related and health-system related. It has been reported that such delays increase overall complications in Inflammatory Bowel Diseases (IBD). The aim of our study was to report on the impact of delays on IBD-related adverse outcomes (AOs), as most hospitals currently face challenges with long waiting lists in the post-Covid-19 era. Methods New patients referred for suspected IBD to a single tertiary care centre between Jan 2013 to Dec 2017 were identified using EMR. For purposes of the study, a cut-off time was set by investigators for each delay-type based on best average hospital waiting times. The reasons for delays in patient journey until start of treatment and data on predefined AOs (steroid & other rescue therapies, hospitalisations, surgery) were recorded for each patient until end of June 2021. The data were analysed using multiple Pearson correlations and Cox proportional Hazard model to determine whether there is a difference in survival without AOs between patients with and without a delay. Results Total of 105 patients were identified using stringent criteria (M=58 ;median age=32y) with a long median followup of 55 months. The most frequent presenting complaints were abdominal pain (44, 41,9%), loose stools (40, 38,1%), bloody diarrhoea (37, 35,2%) and bleeding per-rectum (33, 31,4%) and only 16% declared a family history. 65, 27 and 13 patients had final diagnosis of Ulcerative colitis, Crohn's disease and Unclassified colitis respectively, and analysed collectively. In our cohort, the longest delay-types noted were - patients seeking medical attention (median= 4 months;range 1 to 84 months), arranging gastroenterology clinic review after referral from primary care (median=5 weeks;range 1 to 30 weeks), and waiting for index endoscopy (median=3 weeks;1 to 36 weeks). Patient stratification based on delay-type, using specific cutoff times for each showed a statistically significant difference in survival without AOs for all (when comparing delay v/s no delay). 1. delay in seeking medical attention (cut-off=1m;p=0.004) (figure 1A) . delay in GP referral specialty review (cut-off=1w;p=0.048) . delay in index endoscopy (cut-off= 4w;p=0.01) (Fig 1B) . delay in starting treatment (cut-off= 4w;p=0.03) Conclusion . Several bottlenecks of delays increase AOs in IBD over the follow-up period. . A delay as short as a week, between GP referral specialty review, is significant in determining AOs;this has implications on specialist IBD centres particularly in the post-Covid period. . Endoscopy units should prioritise suspected IBD patients to reduce AOs, which is likely to have implications on service delivery and planning. . Long delays observed in patients seeking medical attention highlights the need for both primary and secondary care to undertake patient education in the community.

Hepato-biliary Manifestations of Multisystem Inflammatory Syndrome in Children: Single Centre Experience

Background: Multisystem inflammatory syndrome in children (MIS-C) has been recognised as a rare and serious complication that involves multiple systems. Gastrointestinal (GI) symptoms like pain abdomen, vomiting, loose stools are common presenting features. Despite an abundance of ACE2 and TMPRSS2 cell receptors in intestine and biliary epithelium severe liver dysfunction is uncommon and very few studies have elaborated hepatic manifestations. Aims: To analyse spectrum of hepatic manifestations in MIS-C. Methods: We retrospectively reviewed the data of children diagnosed with MIS-C at our centre during first and second COVID wave (April 2020-May2021). 30 children were identified and recruited in the study. Their demographic, clinical and biochemical parameters were studied. Results: The mean age of presentation was 7 years. 76.6%(n=23) were male and 23.3%(n=7) were female. 90%(n=27) children had concomitant or isolated gastrointestinal complaints. 44.4% presented with abdominal pain (n=12), 33.3%(n=9) had loose stools, 18.5%(n=5) had vomiting. Only 1 child presented with blood in stool. All patients had positive COVID-19 IgG antibodies (mean titre- 40.1AU/ml). Mean C-reactive protein was 94.7mmHr. 50%(n=15) had deranged liver function tests. Both hyperbilirubinemia with raised liver enzymes were noted in 3(20%), both aspartate aminotransferase (AST) and alanine aminotransferase (ALT) elevation in 8 (53.3%), isolated AST elevation in 4 (26.6%). International normalised ratio (INR) was normal in all. Abdominal imaging (n=8) was normal in 2(25%), two showed distal ileal diffuse mural thickening, two had cholecystitis and one had pancreatitis. 1 expired (3.3%) and 29(96.6%) were discharged successfully. Conclusion: GI manifestations are common and so is the hepatobiliary involvement. Hepatocellular injury leading to hepatitis pattern is common, but involvement of pancreatico-biliary system should also be ruled out. Prognosis is excellent without any residual damage to the liver clinically, biochemically, and radiologically.

Clostridioides difficile Burden of Disease: A Prospective Population-Based Surveillance Study of Hospitalized Adults in Louisville, Kentucky

Background. Clostridioides difficile (C. difficile) is an important cause of morbidity and mortality. C. difficile infection (CDI) may be frequently under-diagnosed because laboratory confirmation requires collection of a stool specimen from a patient with diarrhea and appropriate laboratory testing. Methods. A prospective population-based CDI surveillance study was launched in 8 adult hospitals in Louisville, Kentucky on September 16, 2019. Surveillance officers in each hospital identified all cases of new-onset diarrhea (≥3 loose stools in the past but not preceding 24 hours) in Louisville residents ≥50 years of age. After informed consent, stool samples were collected and tested at the University of Louisville reference laboratory for 1) glutamate dehydrogenase (GDH) and 2) Clostridioides difficile toxins A and B using C. DIFF QUIK CHEK COMPLETE®, Techlab. We defined CDI as GDH positive and toxin positive. The study was paused on April 3, 2020, due to COVID-19 restrictions. Results. There were 85,719 eligible patient-days during the study period. A total of 1541 patients had new-onset diarrhea corresponding to 1.8 cases of new-onset diarrhea per 100 eligible patient-days. We enrolled 84% (1291/1541) of patients with new-onset diarrhea and tested stool samples for C. difficile from 82% (1055/1291) for a testing density of 123 per 10,000 patient-days. Of the 1055 tested stool specimens, 73 (7%) were GDH positive and toxin positive (Figure 1) yielding a hospital-based CDI incidence of 8.5 CDI cases per 10,000 patient-days. Conclusion. New-onset diarrhea was common among hospitalized adults ≥50 years of age. CDI was frequently identified through stool specimens collected from eligible inpatients with new-onset diarrhea. Further analysis of these data and additional laboratory testing will contribute to a better understanding of the frequency of CDI underdiagnosis and the burden of CDI in the United States.

Functional Gastrointestinal And Somatoform Symptoms Five Months After Sars-Cov-2 Infection: A Controlled Cohort Study

Background and aim: Gastrointestinal infections represent a risk factor for functional gastrointestinal and somatoform extraintesti-nal disorders. We investigated the prevalence and relative risk (RR) of gastrointestinal and somatoform symptoms five months after SARS-CoV-2 infection compared with a control cohort. Materials and methods: 378 subjects, age range 18-60 years, were stu-died. 177 SARS-CoV-2 infected patients and 201 controls responded to an online questionnaire about symptoms and signs during the acute phase of the infection and after 4.8±0.3 months. 13 and 18 patients were respectively excluded because of a previous gastrointestinal dise-ase. Presence and severity of gastrointestinal symptoms, somatization, anxiety and depression were recorded with a structured standardized questionnaire, including the Structured Assessment of Gastrointestinal Symptoms (SAGIS) questionnaire, the Symptom Check List (SCL)-12 for somatization and the Hospital Anxiety and Depression Scale (HADS). Stool form through Bristol Stool scale and a yes/no question summari-zing the Rome IV criteria for Irritable Bowel Syndrome (IBS) were also recorded. Any association between exposure to infection and symp-toms was evaluated by calculating crude and adjusted RR values and score differences with 95% confidence intervals (CI). Results: Fever, dyspnea, loss of smell/taste/weight, diarrhea, myal-gia, arthralgia and asthenia were reported by more than 40% of patients during the acute phase. Abdominal pain/discomfort, diar-rhea/incontinence and gastroesophageal reflux disease/regurgita-tion symptoms persisted after SARS-CoV-2 infection, but with very low severity;the relative increase on the mean score of each domain was minimal (score difference up to +0.16). Compared with con-trols, adjusted RRs for loose stools, chronic fatigue and somatization were increased after infection: 1.88 (95% CI 0.99–3.54), 2.24 (95% CI 1.48–3.37), 3.62 (95% CI 1.01–6.23) respectively. The prevalence of IBS and HADS scores tended to be greater in patients than in con-trols. Gastrointestinal sequelae were greater in patients with diar-rhea during the acute phase. Conclusions: Mild gastroenterological symptoms persist five months after SARS-CoV-2 infection, in particular in patients report-ing diarrhea in the acute phase. Infected patients are at increased risk of chronic fatigue and somatoform disorders, thus supporting the hypothesis that both functional gastrointestinal and somato-form disorders may have a common biological orig

The Paradox Of Covid-19 Pandemic: Effect Of Lockdown On The Improvement Of Irritable Bowel Syndrome Severity

Background and aim: Irritable bowel syndrome (IBS) is a multifac-torial condition with intestinal, psychological, and environmental factors participating to symptoms onset. The enforced condition of isolation due to the coronavirus 2019 (COVID-19) pandemic led to radical changes in lifestyle, probably affecting quality of life (QoL) and mental health. Our aim was to investigate the influence of COVID-19 lockdown in a well-studied cohort of IBS patients. Materials and methods: 41 IBS patients (28F, age range 18-65 ys) from the outpatients’ clinic of the University Federico II of Naples were invited to join an online survey during the first and second lockdown (April - October 2020). The survey consisted of 5 sections assessing: i) anthropometric data, ii) IBS symptoms (IBS symptom severity scale, IBS-SSS and Bristol Stool Form Scale, BSFS), iii) life-style changes, iv) psychological data (Visceral Sensitivity Index, VSI, and Patient Health Questionnaire-15, PH15), v) QoL (Short Form 12, SF-12, including the physical and mental component summary;PCS and MCS, respectively). Data from the first (T1) and second (T2) lockdown were compared with those collected in person before the pandemic (T0). Results: All subjects completed the study. Compared to baseline, at T1 there was a significant improvement in IBS symptoms (257±69 vs 222±105), loose stools frequency (4±1 vs 2±2) and PCS (46± 7 vs 51±7;all p<0,05), whilst MCS remained unchanged (40±10 vs 41±10). These findings were associated with a radical change in lifestyle with 81% of the subjects working remotely from home. At T2, both BSFS and PCS (4±1 vs 2±2 and 46±6 vs 50±8;all p<0,05) remained steadily improved;however, IBS-SSS scores returned to baseline (257±69 vs 245±93). This effect was not associated with a worsened mental status since the MCS (40±10 vs 41±10), VSI (55±20 vs 56± 19) and PH15 scores (8± 4 vs 8±4;all p=ns) were unchanged between T1 and T2. On the contrary, at T2 most patients resumed their routinely work (57% vs 19%, p<0.05). Conclusions: Our survey showed an unforeseen improvement of IBS symptoms during the first Italian lockdown without a nega-tive impact on patients’ QoL. However, during the second COVID-19 wave, we observed an inverted trend with a new clinical worsen-ing associated with the return to patients’ pre-pandemic routine. Symptoms improvement during the first lockdown is likely the result of the forced slow-down of patients’ hectic lifestyle, underly-ing the importance of the routinely job-related stress on symptoms severity