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Streptococcus agalactiae, also known as Group B Streptococcus (GBS), is a common pathogen in the neonatal period, causing meningitis and sepsis. In non-pregnant adults it is an unusual cause of meningitis. We report about an elderly female with several risk factors for invasive GBS infection who developed GBS meningoencephalitis one month after treatment for COVID-19 upper respiratory tract infection. The patient presented with mania, and the classic triad of headache, neck stiffness, and fever was absent which contributed to the delay in diagnosis. Following initiation of treatment with intravenous ceftriaxone she attained full recovery, and her behavior returned to baseline. This case illustrates an unusual presentation of an emerging infection and should alert clinicians about this presentation. By reporting this case we want to raise awareness about mania as a presenting feature of meningoencephalitis. This should lead to more timely diagnosis and better outcomes for future patients.
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The neuropathogenicity of COVID-19 was reported shortly after detection of the virus when patients began reporting symptoms of diminished taste and smell, headaches, mental status changes, and more. As the virus spread, increasing data on viral symptoms in conjunction with novel theories on COVID-19 virulence factors indicated that the virus had neurotropic properties. Several mechanisms have been proposed detailing severe acute respiratory syndrome coronavirus disease 2019 (SARS-CoV-2) transport past the blood–brain barrier and into neural tissue. This chapter offers a comprehensive review of possible neurotropic mechanisms including transport via the angiotensin-converting enzyme 2 (ACE-2) receptor, transportation directly past or through the blood–brain barrier, transsynaptic neuronal transfer, and olfactory conduction. © 2023 Elsevier Inc. All rights reserved.
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"5 However, more recent findings, such as the presentation of joint swelling without EM in Black children, are the result of research efforts to identify differences among racial and ethnic groups in presentations of disease symptoms, with the aim of greater diagnostic accuracy and reduced health care disparities.4 Treatment of Lyme disease Although most resources, such as the CDC's website,1 published articles and sites,2,3 and the Red Book,5 recommend that pediatric, adolescent, and young adult patients with Lyme disease receive an antibiotic, such as doxycycline, amoxicillin, or cefuroxime (for penicillin-allergic patients), these publications differ in recommended dosage and duration of treatment. [...]PHCPs who are unfamiliar with antibiotic treatments for Lyme disease should consult with infectious disease specialists. Children who have evidence of Lyme carditis, Lyme arthritis, cranial neuritis, Lyme meningitis, or radiculoneuritis should immediately be referred to infectious disease and the appropriate pediatric specialists.2 Respiratory infections and health care inequities Although researchers have reported studies on racial and ethnic inequities among children related to respiratory diseases over the last 20 years, few randomized controlled trials have scientifically investigated the problem or have identified and rigorously investigated evidencebased interventions. The COVID-19 pandemic brought a new focus in pediatric health care on the inequities experienced by Black, Hispanic, American Indian or Alaska Native, and Pacific Islander children living in poverty, who regularly experience a disproportionate number of respirator y illnesses and infections.6 Several studies have shown increased hospitalization rates for Blac k and H ispan ic children who contracted COVID-19.6 One team of researchers studying children from birth to 4 years old reported a hospitalization rate of 55% for Black and Hispanic children.7 For years, PHCPs have observed and treated children for asthma in all health care settings. Bhavnani et al reported that Black children had a 7-fold higher rate of emergency department visits compared with White children in 2019, 1 year before the pandemic began.8 However, the difference decreased to a 2-fold increase for Black children compared with White children in 2020, when COVID-19 measures such as masking, social distancing, and school closures were in place.8 Researchers are continuing to investigate why Black and Hispanic children are more vulnerable to upper respiratory infections with viruses such as influenza, rhinovirus, and adenovirus.8 Summertime prevention of respiratory infections Talking about prevention strategies with families is the first step toward reducing asthma episodes and exacerbations.
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Background: Lymphoproliferation is the persistent proliferation of lymphoid cells and it's incidence in inborn errors of immunity varies from 0.7 to 18%. Material(s) and Method(s): This is a retrospective analysis of patients referred to the department of Immunology, B. J. Wadia Hospital for Children, Mumbai between March 2017 to December 2022. Inclusion criteria consisted of 3 months duration of significant lymphadenopathy and/or splenomegaly or history of lymphoma. The clinical characteristics, laboratory and molecular findings of the included patients were analyzed. Result(s): A total of 66 patients were included. There was a male preponderance with male:female ratio of 25:8. Median age of onset of lymphoproliferation was 4.75 years(Range 1 year to 60 years). Splenomegaly was seen in 75%. Infections included recurrent pneumonia (14/66), recurrent ear infections(5/66), COVID(4/66), one episode of pneumonia(6/66), herpes zoster(3/66), recurrent subcutaneous abscess (3/66), abdominal koch(3/66), chronic sinusitis(2/66), dermatophytosis(2/66), esophageal candidiasis(2/66), recurrent malaria(1/66), recurrent varicella(1/66), cryptococcal meningitis(1/66), gram negative sepsis(1/66), BCG adenitis(1/66), pseudomonas osteomyelitis(1/66), impetigo (1/66), pseudomonas urinary tract infection (1/66), chicken pox(1/66), herpes keratitis(1/66), dengue(1/66), Other manifestations included Evans plus phenotype(10/66), Evans phenotype(8/66), Autoimmune hemolytic anemia(5/66), bronchiectasis(5/66), Type 1 diabetes(3/66), hyper reactive airway disease(2/66), inflammatory bowel disease(4/66), autoimmune thrombocytopenia(2/66), stroke(3/66), hemophagocytic lymphohistiocytosis(2/66), hypertriglyceridemia(2/66), hypothyroidism(2/66), celiac disease(1/66), Type 2 diabetes(1/66), autoimmune encephalitis(1/66), autoimmune hepatitis(2/66), anti-parietal cell antibody(1/66), arthritis(1/66), autoimmune enteropathy(1/66), systemic lupus erythromatosus(1/66), primary biliary cirrhosis requiring liver transplant(1/66), nephrotic syndrome(1/66), lymphoedema(1/66), hypersplenism(1/66), recurrent oral ulcers(1/66), gout(1/66), dermatitis(1/66), ovarian teratoma(1/66), alopecia areata(1/66). Hodgkin's lymphoma(HL) was the most common malignancy(9/66), followed by non Hodgkin lymphoma(NHL)(6/66), transformation from NHL to HL(1/66), Burkitt to T-cell lymphoma(1/66), HL to DLBCL(1/66), HL to anaplastic T-cell lymphoma(1/66). EBV driven lymphoproliferation was seen in biopsy of21/66. Genetic testing showed mutations in LRBA(11/66), PIK3CD(5/66), CTLA4(3/66), TET2(2/66), IL2RA (1/66), IL12RB1(1/66), BACH2(1/66), PRKCD(1/66), TNFSFR13B(1/66), TNFAIP3(1/66), FAS(2/66), FASL(1/66), Caspase8(1/66), CARD11(1/66), RTEL1(1/66), AICD(1/66), PIK3R1(1/66), IKBKB(1/66). Treatment included IVIG, chemotherapy, rituximab, sirolimus, abatacept, HSCT. Conclusion(s): All children with persistent lymphoproliferation, with or without autoimmunity and/or infections should be worked up for an underlying monogenic disorder of immune dysregulation. Lymphomas presenting at abnormal site and/or age, relapse and EBV driven lymphomas require further evaluation. Presence of monogenic cause helps in providing targeted therapy.Copyright © 2023 Elsevier Inc.
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Introduction: TBX1 haploinsufficiency is an inborn error of immunity with the phenotype of DiGeorge Syndrome. DiGeorge Syndrome has variable immunodeficiency associated with grade of thymic hypoplasia ranging from mild with no infections to severe requiring thymus implant. Enterovirus is an example of an opportunistic infection that can be fatal in these patients. Case Presentation: A 1 year old girl with TBX1 haploinsufficiency complicated by Tetralogy of Fallot, pulmonary atresia, high arched palate, and vesicovaginal fistula presented for elective cardiac repair surgery from another country due to failure to thrive and cyanosis. She had no prior infectious history but was on sulfamethoxazole-trimethoprim for prophylaxis. She was asymptomatic with a negative COVID test but no other infectious studies performed. Immediately postoperatively, she was febrile and nasal respiratory viral panel was positive for rhinovirus/enterovirus with increased procalcitonin and leukocytosis with left shift. She decompensated with multi-organ failure and cardiac arrest on postoperative day two. She was cannulated to veno-arterial extracorporeal membrane oxygenation (ECMO). Pre-operatively, she had a normal absolute lymphocyte count. No thymus tissue was observed in surgery. She had profound CD3 lymphopenia to 130 cells/cmm when critically ill. Enteroviral meningitis was suspected as no infectious, cardiac, or other pathology could be identified causing decompensation. Enteroviral serum polymerase chain reaction (PCR) test was negative while lumbar puncture deferred due to clinical status. She was treated with immunoglobulin. Offlabel investigational drug pocapavir was considered but deferred to patient's irreversible neurological status. The patient was disconnected from ECMO and expired. Discussion(s): Though we cannot confirm that this patient had enteroviral meningitis, invasive enteroviral infections are associated with elevated transaminases, coagulopathy, and seizures all present in our patient. There has also been reported negative serum enteroviral PCR but positive CSF enteroviral PCR in an immunodeficient patient. Additionally, this case highlights the importance of immunologic evaluation in patients with DiGeorge Syndrome and questions if asymptomatic viral screening for viruses like enterovirus should be considered pre-operatively in patients with inborn errors of immunity. This case highlights potential treatment options for invasive enteroviral infections in patients with inborn errors of immunity: high dose immunoglobulin, fluoxetine, and pocapavir.Copyright © 2023 Elsevier Inc.
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Infections of the central nervous system (CNS) are mainly caused by viruses, and these infections can be life-threatening in pediatric patients. Although the prognosis of CNS infections is often favorable, mortality and long-term sequelae can occur. The aims of this narrative review were to describe the specific microbiological and clinical features of the most frequent pathogens and to provide an update on the diagnostic approaches and treatment strategies for viral CNS infections in children. A literature analysis showed that the most common pathogens worldwide are enteroviruses, arboviruses, parechoviruses, and herpesviruses, with variable prevalence rates in different countries. Lumbar puncture (LP) should be performed as soon as possible when CNS infection is suspected, and cerebrospinal fluid (CSF) samples should always be sent for polymerase chain reaction (PCR) analysis. Due to the lack of specific therapies, the management of viral CNS infections is mainly based on supportive care, and empiric treatment against herpes simplex virus (HSV) infection should be started as soon as possible. Some researchers have questioned the role of acyclovir as an empiric antiviral in older children due to the low incidence of HSV infection in this population and observed that HSV encephalitis may be clinically recognizable beyond neonatal age. However, the real benefit-risk ratio of selective approaches is unclear, and further studies are needed to define appropriate indications for empiric acyclovir. Research is needed to find specific therapies for emerging pathogens. Moreover, the appropriate timing of monitoring neurological development, performing neuroimaging evaluations and investigating the effectiveness of rehabilitation during follow-up should be evaluated with long-term studies.
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Cryptococcal meningitis is an opportunistic infection associated with altered immunity. Immunomodulatory agent use in severe coronavirus disease 2019 (COVID-19) may predispose such infections. Here, we present a 75-year-old male patient who presented with fever and altered general status after severe COVID-19 infection and developed cryptococcal meningitis. Opportunistic infection may arise from the use of immunomodulation in severe COVID-19, especially in the elderly population. This article describes the case and extensively reviews cryptococcal disease post-COVID-19 literature, highlighting the risk from immunosuppressive treatment.
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COVID-19 , Cryptococcus neoformans , Meningitis, Cryptococcal , Opportunistic Infections , Aged , Male , Humans , Meningitis, Cryptococcal/diagnosis , Meningitis, Cryptococcal/drug therapy , Meningitis, Cryptococcal/epidemiology , ImmunomodulationABSTRACT
Listeriosis is a saprozoonotic infection that occurs when eating foods contaminated with Listeria. Invasive forms of listeriosis can have extremely severe consequences. Respiratory viral diseases predispose to the occurrence of combined viral-bacterial infections. With a mixed infection of listeriosis and COVID-19, a severe course of the disease is observed, which has a serious prognosis. The aim of the study was to analyze the frequency of various variants of invasive listeriosis and their outcomes in the period before the COVID-19 pandemic and against the background of its development, as well as to determine the genetic diversity of L. monocytogenes isolates. Material and methods. We analyzed 55 cases of invasive listeriosis in patients observed in 2018-2021 in various medical organizations in Moscow. The diagnosis was established on the basis of epidemiological, clinical and laboratory data, listeriosis was confirmed by bacteriological and molecular genetic methods, COVID-19 was confirmed by the detection of SARS-CoV-2 RNA in an oropharyngeal swab using real-time RT-PCR, as well as computed tomography of the lungs. Results. During the current COVID-19 pandemic (2020-2021), the incidence of listeriosis in pregnant women and invasive listeriosis occurring in the form of sepsis and/or lesions of the central nervous system did not differ significantly from similar indicators registered in 2018-2019. Listeria sepsis and/or meningitis/meningoencephalitis in association with severe SARS-CoV-2 novel coronavirus infection are at high risk of death. During the years of the COVID-19 pandemic, the diversity and range of L. monocytogenes genotypes in invasive listeriosis changed, new genotypes appeared that were not previously characteristic of the Russian Federation. Conclusion. The likelihood of developing listeriosis sepsis and/or meningitis/meningoencephalitis against the background of a severe course of COVID-19, and a high risk of an adverse outcome, require increased awareness of medical workers in the field of diagnosis and treatment of invasive listeriosis in order to conduct the earliest and most adequate antibiotic therapy.Copyright © 2022 Geotar Media Publishing Group. All Rights Reserved.
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According to results of a multicountry survey conducted by Ipsos Healthcare, 50% of parents queried had canceled or delayed their children's scheduled meningitis vaccination appointments during the pandemic. According to the results, 83% of parents said it was important that their children continue to receive recommended vaccines, including meningitis vaccinations, during the COVID-19 pandemic. According to the authors, "Urgent action is required to maintain vaccination rates and continue reducing the incidence of vaccine-preventable infections and diseases." ¦ REFERENCE 1.
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In light of the current pandemic, doctors need to raise the suspicion of concurrent SARS-CoV-2 infection with Neisseria meningitides infection. In this article we reported a case of invasive meningococcal infection in an adolescent with COVID-19. Severity of the disease depended on septic shock due to invasive meningococcal infection associated with sepsis and meningitis. The differential diagnosis with a multisystem inflammatory syndrome was tricky considering the fever, shock, meningeal symptoms, elevated levels of C-reactive protein and D-dimer, patient age, and a positive test for SARS-CoV-2. The disease outcome was good. Given the risk of invasive forms of meningococcal infection, the possible synergy of SARS-CoV-2 and Neisseria meningitidis, the complexity of differential diagnosis in patients in critical condition, immunization against meningococcal infection should be carried out according to epidemic indications, despite the COVID-19 pandemic.Copyright © 2022 Sorbtsionnye i Khromatograficheskie Protsessy. All rights reserved.
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Purpose of Study: Affective symptoms, such as depression, nervousness, anxiety, and irritability, are common yet complicating aspects for concussion patients, therefore addressing exasperations of these symptoms is essential for injury management. This is an especially important consideration for patient populations increasingly susceptible to affective disorders, such as those in rural regions and adolescents. Increases in adolescent mental health problems during the time of the COVID-19 pandemic pose an additional challenge for clinicians managing affective concussion symptoms in rural adolescents. The aim of this study is to quantify the mental health effects of the pandemic by comparing affective concussion symptoms in groups of adolescents with concussion and without concussion in the Central Oregon region. Methods Used: The study is a secondary data analysis of ImPACT Concussion Test symptom scores from a cohort of non-concussed (Baseline) and concussed (Post-Injury) adolescents between the ages of 12-18, pre-pandemic (January 1, 2015 - March 20, 2020) and pandemic (March 21, 2020 - April 1, 2022). Subjects were excluded from the study if they received special education, had a diagnosis of learning disabilities, ADD, dyslexia, autism, or received treatment for headaches, migraines, epilepsy, brain surgery, meningitis, substance use or psychiatric conditions. Prevalence of symptoms of 'headache', 'trouble falling asleep', 'irritability', 'nervousness', 'sadness', and 'feeling more emotional' were noted for each group during each time period. Summary of Results: A total of pre-pandemic non-concussed (n =2667), pre-pandemic concussed (n=643), pandemic non-concussed (n = 593) and pandemic concussed (n=87) were included in the final analysis. There was a statistically significant increase in the proportions of 'nervousness' (p=0.0209) and 'sadness' (p=0.0117) in pre-pandemic and pandemic non-concussed groups. Furthermore, there were statistically significant increases in the proportions of 'headache' (p=0.0331), 'irritability' (p=0.0006), 'nervousness' (p=0.0135), 'sadness' (p=0.0357) and 'feeling more emotional' (p=0.0039) between pre-pandemic and pandemic concussed adolescents. Conclusion(s): This study demonstrates a significant increase in affective symptoms in both concussed and non-concussed groups during the COVID-19 pandemic consistent with other studies. However, those with concussion during the COVID-19 pandemic showed greater number of affective symptoms as well as somatic symptoms (headache) compared to concussed pre-pandemic adolescents. The results of this study support the broader body of research examining the mental health burden of the COVID-19 pandemic on adolescents, and further encourages a biopsychosocial approach to injury management, in which social and emotional components of a patient's life are considered.
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Purpose of study COVID-19 primarily affects the respiratory system from flu-like syndrome to acute hypoxic respiratory failure. Neurological manifestations are uncommon and can result in serious complications. We report a unique case of sudden onset of rapidly progressive encephalopathy in the setting of COVID-19. Methods used Reviewed the manifestations, clinical course, and outcome for a patient presenting with altered mental status secondary to COVID-19. Summary of results A 48-year-old with no significant past medical history presented to the emergency department complaining of severe headache for four days. His vital signs on presentation showed a blood pressure of 154/90, pulse of 114 bpm, temperature of 99.6 degreeF, and oxygen saturation of 97% on room air. Physical exam was unremarkable. Lab work showed elevated D-dimer 8,500 ng/L, Elevated ESR:42, LDH:340 and Ferritin:692. White blood count: 7.59 uL, Platelets 50 x 103 uL. Computer tomography angiography (CTA) of the chest showed bilateral multifocal pneumonia. CT Head was performed and was negative for an acute hemorrhage, hydrocephalus or territorial infarcts. Patient spiked a fever shortly after admission 103degreeF. Patient was started on Ceftriaxone and Azithromycin. Blood and urine cultures were positive for Klebsiella pneumonia. Patient was re-evaluated in the morning and was found altered with associated neck stiffness. Antibiotics were switched to cover for suspected meningitis. Neurology was consulted and recommended lumbar puncture. Within a few hours, the patient's mental status deteriorated and was found to be hypertensive with a blood pressure of 220/110. Repeat CT Head was negative. The patient was tested and found to be positive for COVID-19. Patient further decompensated within a few hours and became unresponsive, pulseless. ACLS was performed and the patient was transferred to the intensive care unit. Conclusions This case report highlights the heterogenous presentation in patients with COVID-19 and the importance of recognizing a new onset, severe headache as the only initial presentation. Headaches in some cases may precede the respiratory symptoms or may be the only manifestations in COVID-19 patients and it is crucial to be aware of the neurological complications and the rapid decompensation these patients may undergo if not recognized early.
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Case Report: West Nile Virus (WNV) was first isolated from the West Nile district of Northern Uganda in 1937, but was first detected in the United States well over half a century later in 1999. The arthropod-borne virus has since persisted, with 2,401 cases reported to the CDC on average annually. The infection typically causes a nonspecific acute systemic febrile illness with occasional gastrointestinal and skin manifestations;however, in less than 1% of infected patients, it can cause severe and potentially fatal neuroinvasive disease, presenting as meningitis, encephalitis or acute flaccid paralysis. Immunosuppression is one of the risk factors associated with the development of neuroinvasive disease, and chemotherapy thus places patients at risk. Uterine leiomyosarcoma is a rare gynecological malignancy. Palliative chemotherapy is common in late stage disease, but may predispose patients to conditions that present as neutropenic fever, leading to a diagnostic conundrum. This is the first case report where patient with neutropenic fever was found to have West Nile neuroinvasive disease, so it is important to include West Nile disease in the differential diagnosis. Case Description: This is a case of a 45-year-old female with history of diabetes, hypothyroidism and recently diagnosed uterine leiomyosarcoma status post tumor debulking with metastasis on palliative chemotherapy with gemcitabine that presented to the Emergency Room for a fever of 103.8 degrees Fahrenheit. Given the history of advanced leiomyosarcoma, the patient was admitted for neutropenic fever with an absolute neutrophil count of 1000. During the hospitalization, the patient became acutely altered and confused. CT head without contrast and lumbar puncture were performed. Due to clinical suspicion of meningitis, she was started on broad spectrum antibiotics. Lumbar puncture revealed leukocytosis of 168 with lymphocytic predominance and elevated protein level in the cerebrospinal fluid, therefore acyclovir was started due to high suspicion of viral meningoencephalitis. An EEG showed severe diffuse encephalopathy as the patient was persistently altered. A broad workup of infectious etiology was considered including HIV, syphilis, hepatitis A, B, C, COVID-19, adenovirus, pertussis, influenza, WNV, HHV6, coccidiomycosis, aspergillus, and tuberculosis. Patient was ultimately found to have elevated IgM and IgG titers for West Nile Virus. Discussion(s): It is important to consider a broad spectrum of diagnosis in patients with metastatic carcinoma presenting with new-onset fever and acute encephalopathy. This includes working up for other causes of altered mental status including cardiac, neurologic, psychiatric, endocrine, metabolic, electrolyte, drug, and infectious etiology. While uncommon in the healthy population, WNV encephalitis should be on the radar for any patient who is immunocompromised or on immunosuppressive therapy, especially those who present with a neutropenic fever.
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Background and ImportanceBacillus cereus is a spore-forming, gram-positive bacterium that is ubiquitous in the environment. It is frequently dismissed as contaminants, however, in the proper setting these organisms have the potential to be virulent. Clinical infections caused by B. cereus fall into six broad groups: local infections of wounds, burns, bacteraemia, CNS infections, respiratory infections, endocarditis and food poisoning. Despite aggressive treatment with broad-spectrum antibiotics and using them appropriately, the mortality is high.Aim and ObjectivesTo describe a case of Bacillus cereus central nervous system infection associated with post-surgical meningitis and a patient successfully treated with antibiotics.Material and MethodsDescriptive and retrospective clinical case. Data were obtained by review of electronic medical records.ResultsA 72-year-old woman underwent a decompressive laminectomy due to lumbar spinal stenosis. Past medical history included hypertension and dyslipidaemia. She was discharged without complications. One week later, the patient was brought to the emergency room for altered consciousness, dysarthria, hemiplegia and fever. Her vital signs included a blood pressure of 109/82 mmHg, heart rate 125 beats/min, SpO2 92%, and Glasgow Coma Scale score of 7/15. C-reactive protein (CRP) level was 95 mg/l (reference <5 mg/l). Polymerase chain reaction (PCR) testing for SARS-CoV-2 was negative. Blood culture was negative. After a lumbar puncture, Bacillus cereus was isolated. The isolate was found resistant to β-lactam antibiotics (including penicillin, ampicillin and cephalosporin) and trimethoprim/sulfamethoxazole, and showed susceptibility to macrolides, vancomycin, clindamycin, carbapenems and quinolones. Triple antibiotherapy with meropenem, vancomycin and linezolid was initiated. After a few days of clinical stability, absence of fever and negative microbiological cultures, the triple antibiotic therapy was withdrawn and vancomycin and meropenem were continued. With adequate control of the source of infection and after a good evolution of the surgical wound, antibiotic therapy was switched to the oral route with linezolid. The patient was discharged with no evidence of sequelae from the meningeal infection, normal neurologic examination and CRP levels within the normal range.Conclusion and RelevanceThis case highlights the clinical challenge to diagnose B. cereus and the importance of the delay between the detection of B. cereus and the establishment of an effective, targeted antibiotic therapy, especially in immunocompromised patients.References and/or AcknowledgementsConflict of InterestNo conflict of interest
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INTRODUCTION: Invasive meningococcal disease (IMD) is a leading cause of life-threatening bacterial meningitis and septicemia. Evidence points to a knowledge gap among parents, teenagers, and healthcare providers (HCPs) regarding IMD and available vaccines, including those against the highly prevalent serogroup B. AREAS COVERED: An online survey was conducted between March 27 and 12 April 2019, to gather insights into the knowledge that parents/guardians have about IMD vaccines. The children were aged 2 months to 10 years in Australia, Brazil, Germany, Greece, Italy, and Spain, 5-20 years in the UK, and 16-23 years in the USA. The findings were discussed in the context of the available literature and solutions were proposed to minimize the knowledge gap and the barriers to vaccination against IMD. EXPERT OPINION: The survey demonstrated that parents have a good understanding of IMD but a limited understanding of the different serogroups and vaccines. The available literature highlighted multiple barriers to IMD vaccine uptake; these may be reduced through education of HCPs, clear recommendations to parents by HCPs, the use of technology, and disease-awareness initiatives that engage parents through physical and digital channels. Further studies are warranted to assess the impact of the COVID-19 pandemic on IMD vaccination.
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COVID-19 , Meningococcal Infections , Meningococcal Vaccines , Child , Adolescent , Humans , Pandemics , Meningococcal Infections/epidemiology , Meningococcal Infections/prevention & control , Meningococcal Infections/microbiology , Vaccination , SerogroupABSTRACT
Haemophilus influenzae (Hi) causes invasive disease (IE). Capsulated strains are distinguished, such as serotype b (Hib), and non-typeable strains (HNT). One year after the COVID-19 pandemic was declared, we observed an increase in cases.The clinical-epidemiological characteristics of children with IE due to Hi admitted to the hospital (July 2021-July 2022) are described. There were 14 cases;12 previously healthy. Isolates: Hib (n = 6), Hi serotype a (n = 2), HNT (n = 5), 1 was not typed. Median age: 8.5 months (IQR 4-21). Manifestations: meningitis (n = 5), pneumonia (n = 6), cellulitis (n = 2), arthritis (n = 1). Nine had incomplete vaccination for Hib.We observed a 2.5-fold increase in EI per Hi compared to previous years. These data suggest a resurgence of Hib due to the fall in vaccination coverage and because other Hib non-b strains are on the rise.
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A Cryptococcus subspecies, neoformans, represents the most pathogenic infection for humans, particularly in immunocompromised hosts (e.g., cancer patients, drug users). In the present study, we described a 67-year old woman with non-Hodgkin lymphoma who developed an infectious disease sustained by Cryptococcus neoformans. Biochemical data documented a decrease in lymphocytes count while clinical evaluation was suggestive on meningeal infection. The microbiological analysis of the serum, using a dilution pattern through the CrAg lateral flow assay (Immy, Norman, OK 73069, USA) detected the antigen of Cryptococcus (dilution 1/1280), and a treatment with liposomal amphotericin B (3 mg/kg id) plus flucytosine (100 mg/kg per day orally in four divided doses) were started, showing an improvement of symptoms. This case report suggests that an antigen dilution can be used to perform a rapid diagnosis and to quickly start the pharmacological treatment.
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While COVID-19 has gained popularity as a pandemic and as a cause of pulmonary-systemic disease, the condition continues to evolve our knowledge and understanding of immunology and medicine through its myriad clinical presentations. This article features a previously healthy 65-year-old female who presented with sudden features of cryptococcal meningitis, the progression of which raises questions as to what role the virus plays in the innate, adaptive, and overall host factors leading to immunosuppression.
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Funding: None. Synopsis: 61-year-old male who initially presented to an outside facility with streptococcal pneumoniae meningitis and bacteremia. Of note, he had history of COVID-19 pneumonia a month prior. On hospital day 15, he reported sudden onset lower back pain prompting imaging which demonstrated a contained rupture of an infrarenal aortic aneurysm that had significantly evolved in comparison to admission imaging where his infrarenal aorta had the largest dimension measuring 2.9cm. We present the successful application of neoaortoiliac system (NAIS). Method(s): Proceeding with midline laparotomy we encountered dense adhesive disease due to his history of surgery for colon cancer. After adhesiolysis, we exposed the aorta and aneurysm with severe surrounding inflammatory changes. 20cm of femoral vein was harvested, reversed, and joined for a span of 4cm using an Endo GIA 45mm vascular load to create our neoaorta. Proximal and distal clamp zones were developed. Upon entering the aneurysm, a foul smell was encountered, revealing that the noxious process had destroyed the posterior wall of the aorta and paraspinal tissues. Our neoaorta was anastomosed in end-to-end fashion to the infrarenal aorta and subsequently to the common iliac arteries. Flow was initially restored to the hypogastric arteries and then the external iliac arteries. The retroperitoneum was closed over our repair and covered with omentum. Result(s): On post-operative day 2, he had hematochezia;intraoperatively, the IMA was noted to be 1mm in size, though had brisk back-bleeding and was ultimately ligated. A flexible sigmoidoscopy revealed ischemic sloughing of the sigmoid colon near his previous anastomosis from his colon cancer resection though no transmural necrosis. He remains on high-dose ceftriaxone to complete a 6-week course and metronidazole for 10 days due to his sigmoid mucosal ischemia per infectious disease recommendations. He is now post-operative day 10 and remains in the ICU. Conclusion(s): Mycotic aortic aneurysms constitute 1-1.8% of aortic aneurysms. The standard of treatment is aggressive debridement of involved aortic wall and periaortic tissue, in-situ or extra-anatomic reconstruction, coverage with an omental flap and long-term antibiotic therapy. NAIS is resistant to infection and aneurysmal dilation, however, is a time-consuming procedure with a mean completion time of 8 hours. Dorweiler et al. demonstrated that vascular reconstruction with femoral vein in infected aortoiliofemoral fields has a mortality of 9-10% with negligible rate of late complications (graft stenosis, thrombosis, and dilation) and that venous morbidity after femoral vein harvest is well tolerated. Clagett et al. demonstrated that NAIS fashioned from greater saphenous vein had a failure rate requiring intervention of 64% compared to 0% for those constructed with deep femoral vein. Lastly, it is important to note that our patient was previously COVID-19 positive. This case demonstrates that the sequela of COVID-19 may have been a significant factor in our patient's pathophysiology. As we continue to learn about the effects of COVID-19 on vascular pathology, we must keep a large repertoire of operative techniques at hand in order to treat complex presentations of vascular emergencies. [Formula presented] [Formula presented] [Formula presented] Institution: Orlando Health, Orlando, FLCopyright © 2022