ABSTRACT
A 25-year-old woman, gravida 2, with no medical history of cardiovascular nor other chronic diseases, came to the gynaecologist and described symptoms of a flu-like disease, including very high fever. The gyneacologist prescribed her antibiotics and paracetamol to calm down the fever. At 37 week of gestation she was admitted to the provincial COVID-19 treatment center for isolation and health care in University Clinical Center of Kosovo in Gynecology/Obstetrics department. All bacteriological tests, including hemocultures and cultures of urines were negative. She received antipyretics (acetaminophen), antispasmodics trimethylphloroglucinol and antibiotics (oral azithromycin for 5 days and intravenous ceftriaxone). Despite this treatments, fever and uterine contractions persisted therefor the commission of doctors decided to deliver the baby via ceserean section. The peritoneal cavity and uterus were found to be very inflamed. Fetal appendages as well as the bladder were strewn with eruptive, vesicular lesions bleeding on contact. After few hours after the delivery her temperature (36.5 degreeC) and blood pressure (120/60 mmHg) were normal. The baby was healthy and tested negative on the COVD-19 tests performed. The patients after 2 weeks of treatment and a negative COVID-19 result she was released to go home and was counselled to eat healthy and prescribed multivitamins for her immune system and regular follow ups with the gynecologist. In a period of 8 months the patient became pregnant again and got infected with the COVID-19 again at 25 weeks pregnant. This time the symptoms were not severe and she was followed up at home. The delivery was planned with cesarean section and the baby was in healthy conditions. The patient got vaccinated with Astra Zeneca COVID-19 vaccine after the delivery. Because of their changed physiology, susceptibility to infections, and weakened mechanical and immunological processes, pregnant women are a particularly vulnerable group in any infectious disease outbreak. The requirement to protect the fetus adds to the difficulty of controlling their health. Keywords: COVID-19, pregnant women, cesarean section, Kosovo, astra-zeneca vaccineCopyright © 2023
ABSTRACT
Up to 70% of patients hospitalized for COVID-19 need respiratory support, up to 10% need high-flow oxygen therapy, non-invasive and invasive ventilation. However, standard methods of respiratory support are ineffective in 0.4-0.5% of patients. In case of potentially reversible critical refractory respiratory failure that patients may require ECMO. Management of patients with extremely severe COVID-19 associates with numerous clinical challenges, including critical illness, multiple organ dysfunction, blood coagulation disorders, requiring prolonged ICU stay and care, use of multiple pharmacotherapies including immunosuppressive drugs. Pharmacological suppression of immunity is associated with a significant increase in the risk of secondary bacterial and fungal infections. Currently, data on epidemiology of secondary infections in patients with COVID-19 undergoing ECMO is limited. Aim. To study the prevalence and etiology of secondary infections associated with positive blood cultures in patients with extremely severe COVID-19 requiring ECMO. Materials and methods. A single-center retrospective non-interventional epidemiological study including 125 patients with extremely severe COVID-19 treated with ECMO in April 2020 to December 2021. Results. Out of 700 blood culture tests performed in 125 patients during the study, 250 tests were positive confirming bacteremia/fungemia. Isolated pathogens varied depending on the duration of ECMO: gram-positive bacteria (primarily coagulase-negative staphylococci) dominated from the initiation of ECMO support;increased duration of ECMO associated with an increasing the proportion of pathogens common in ICU (Klebsiella pneumoniae and/or Acinetobacter baumannii with extensively drug resistant and pan-drug resistant phenotypes, and vancomycin-resistant Enterococcus faecium). When ECMO lasted more than 7-14 days, opportunistic pathogens (Candida species, Stenotrophomonas maltophilia, Providencia stuartii, non-diphtheria corynebacteria, Burkholderia species and others) prevailed as etiological agents. Conclusion. Longer duration of ECMO resulted in increasing the rates of infectious complications. In patients undergoing ECMO for more than 14 days, the microbiological landscape becomes extremely diverse, which hampers choosing an empirical antimicrobial therapy. Since potential pathogens causing secondary infections in patients during ECMO are difficult to predict, rapid identification of rare opportunistic pathogens and their sensitivity profile, followed by targeted administration of antimicrobials, seems most beneficial.Copyright © 2023, V.A. Negovsky Research Institute of General Reanimatology. All rights reserved.
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Objective. To study spectrum of pathogens and the time to colonization of respiratory samples in patients with severe and critical COVID-19 as well as to analyze incidence of nosocomial infections and structure of prescribed antibacterial drugs. Materials and methods. The prospective observational study included patients aged 18 years and older with confirmed severe and critical COVID-19 from December 2021 to February 2022. During the first 48 hours and then every 2-3 days of hospitalization, a respiratory sample was collected: sputum, tracheal aspirate (if intubated), bronchoalveolar lavage (if bronchoscopy was performed) for microscopy and microbiological examination. Some patients were screened for invasive aspergillosis. Clinical and demographic data, comorbidities, pathogenetic therapy for COVID-19, antibiotic therapy, cases of probable/documented bacterial nosocomial infections, antibiotic-associated diarrhea, and hospital treatment outcomes were recorded. Results. A total of 82 patients were included in this study. Patients with lung parenchyma involvement of more than 50% by computer tomography predominated;most of them (77%) required intubation and mechanical ventilation due to progression of respiratory failure, and 76% of patients had a lethal outcome. During the first 48 hours, a respiratory sample was obtained from 47 patients;the rest of the patients presented with non-productive cough. No growth of microorganisms was detected in 31 (36.8%) cases;clinically significant pathogens were detected in 16 (19.5%) patients. A subsequent analysis included data from 63 patients with a sufficient number of samples for dynamic observation were used. During the first 3 days of ICU stay, the most common bacterial pathogens were Klebsiella pneumoniae without acquired antibiotic resistance and methicillin-susceptible Staphylococcus aureus. From 3rd day and afterwards, an increase in the proportion of Acinetobacter baumannii, other non-fermenting bacteria, and carbapenem-resistant Enterobacterales was noted. Among the pathogens causing lower respiratory tract infections, A. baumannii and carbapenem-resistant K. pneumoniae were predominant pathogens and accounted for 76% of cases. Positive galactomannan test results were obtained in 4 cases. Conclusions. The study confirmed importance of bacterial nosocomial infections in patients with severe and critical COVID-19. In the case of the development of nosocomial lower respiratory tract infections, empirical antimicrobial therapy should take into account the predominance of carbapenem-resistant Enterobacteria and A. baumannii, as well as the possibility of invasive aspergillosis.Copyright © 2022, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy. All rights reserved.
ABSTRACT
The oral cavity, like the lungs, is often referred to as the <<ecological niche of commensal, symbiotic, and pathogenic or-ganisms,>> and the emigration and elimination of microbes between them are constant, ensuring a healthy distribution of saprophytic microorganisms that maintains organ, tissue, and immune homeostasis. The prolonged hospital stays due to COVID-19 complications, cross-infection, oxygenation therapy through the mask or incubation, and long-term intravenous infusions limit the patient's ability to care about the oral cavity, regularly clean teeth, floss interdental, etc., which creates extremely favorable conditions for colonization by aerobic and anaerobic pathogens of the oral cavity and periodontal pockets and leads to the rapid progression of chronic generalized periodontitis in this category of patients in the future. The goal of the study was to assess the state of the microbiome of the periodontal pockets of dental patients in the post-covid period. Methods. The object of the study was 140 patients with generalized periodontitis of the I and II stages of development in the chronic course (GP), among which 80 patients had coronavirus disease in the closest past. The patients were randomized by age, sex, and stage of GP development. The diagnosis of periodontal disease was established according to the classification by Danilevskyi. The bacteriological material for aerobic and facultative anaerobic microflora and yeast-like fungi was collected from periodontal pockets with a calibrated bacteriological loop and immediately seeded on blood agar. Results. Significant qualitative and quantitative changes in the nature of the oral microbiocenosis were observed in patients with GP after the recent coronavirus disease, compared with similar patients who did not suffer from COVID-19. We have noticed almost complete disappearance of bacteria that belong to the transient representatives of the oral microflora such as Neisseria, corynebacteria (diphtheria), micrococci, and lac-tobacilli. The main resident representatives of the oral microflora, i.e., alpha-hemolytic Streptococci of the mitis group, were found in all healthy individuals and patients of groups A and C, but in 30.0 +/- 4.58% of patients in group B, alpha-hemolytic streptococci in the contents of periodontal pockets are present in quantities not available for detection by the applied method (<2.7 lg CCU/mL). In terms of species, Streptococcus oralis and Streptococcus salivarius are more characteris-tic in gingival crevicular fluid in healthy individuals (93.8% of selected strains). In 68.4 +/- 3.32% of patients in group A, 64.0 +/- 3.43% of patients in group B, and 67.5 +/- 3.76% of patients in group C, the dominant species were Streptococcus gordonii and Streptococcus sanguinis (p<0.01), which increased pathogenic potential as they produce streptolysin-O, inhibit complement activation, bind to fibronectine, actively form biofilms on the surface of tooth enamel and gum epithelial surface, and can act as an initiator of adhesion of periodontal pathogens. The other representatives of the resident microflora of the oral cavity - Stomatococcus mucilaginosus and Veillonella parvula for the patients of group C are also found in periodontal pockets with a significantly lower index of persistence and minimal population level. In the post-covid period, both the population level and the frequency of colonization of periodontal pockets by Staphylo-cocci and beta-hemolytic Streptococci decreases rapidly. For these patient groups, unlike for those that did not suffer from COVID-19, we did not find any case of colonization with Staphylococcus aureus, as well as beta-hemolytic Streptococci and Epidermal staphylococcus were also absent. The most characteristic in the post-covid period is a decrease in the proportion of alpha-hemolytic Streptococci, an increase in the proportion of yeast-like fungi of Candida species, as well as the appearance of a significant number of gram-negative rod-shaped bacteria (Enterobacteria and Pseudomonads). In periodontal patien s, the microbial count is approximately 2 orders of magnitude lower than in those with GP who did not suffer from COVID-19 (p<0.05). Conclusions. The overpassed coronavirus disease due to intensive antibiotic therapy leads to a marked decrease in the number of viable saprophytic microorganisms in the periodontal pockets of patients with GP. In the post-covid period for the patients with GP, there is a decrease in the level of colonization of periodontal pockets by species of resident oral microflora - alpha-hemolytic Streptococci, reduction of resident micro-organism's species, and almost complete disappearance of transient microflora. On the other hand, the frequency of colonization of periodontal pockets by fungi species, enterobacteria, and pseudomonads significantly increases. There are more expressed disorders in the periodontal pocket's microbiome for the patients with a severe and complicated course of coronavirus disease, such as post-covid pulmonary fibrosis, which requires reconsideration of approaches to therapeutic and pharmacological treatment in this category of patients.Copyright © 2022, Zabolotny Institute of Microbiology and Virology, NAS of Ukraine. All rights reserved.
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Introduction: Coronavirus disease 2019 (COVID-19) pandemic continues to be a global public health problem. The present study aimed to investigate SARS-CoV-2 antibodies and evaluate the results using an immunochromatographic method and an ELISA method, in patients with suspected COVID-19, who were tested by reverse transcription polymerase chain reaction (RT-PCR) technique to detect SARS-CoV-2 RNA. Materials and Methods: The study was conducted at the SARS-CoV-2 authorized diagnostic laboratory of our hospital at the beginning of the COVID-19 pandemic, between 27 March and 14 May 2020. The nasopharynx and oropharynx swab samples of the patients included in the study were tested by the SARS-CoV-2 RT-PCR (Bioeksen, Ístanbul, Turkey), where the serum samples were tested by an immunochromatographic test (Beijing Hotgen Biotech Co., Ltd, China) and Anti-SARS-CoV-2 ELISA IgG (Euroimmun, Luebeck, Germany) test. The dates the patients’ symptoms started and the samples were collected for RT-PCR and serological testing were recorded. The patients were divided into two groups based on the data retrieved from the files containing the clinical information and microbiological results of the patients: individuals, who were diagnosed with COVID-19, and individuals, for whom the COVID-19 diagnosis was excluded. Results: Of the 115 patients included in the study, 92 (80%) individuals presented to the clinic with COVID-19 similar symptoms, while 23 (20%) individuals had contact with patients diagnosed with COVID-19. Sixty-one (66.3%) of 92 patients with symptoms were diagnosed with COVID-19, where 6 (26%) individuals out of 23 without symptoms were diagnosed with COVID-19. Fifty-one (76.1%) individuals out of 67 patients diagnosed with COVID-19 had positive RT-PCR results. Sixteen individuals with COVID-19, who were tested negative for RT-PCR, had positive Euroimmun Anti-SARS-CoV-2 ELISA IgG results. Of the 67 patients diagnosed with COVID-19, 61 (91%) were symptomatic and the extended time periods between the onset of the symptoms and the date of sampling for the RT-PCR test was associated with lower rates of being tested positive for the RT-PCR test (p= 0.01). Conclusion: The present study investigated the performance of the COVID-19 tests and showed that antibody tests intended for patients with suspected COVID-19, even in cases where the RT-PCR test is negative, would contribute to the diagnosis. The study contributes in the relevant literature as to which tests would be more useful in certain conditions, considering the fact that there is no test available that can provide 100% accurate results for the diagnosis of COVID-19.
ABSTRACT
In this study, it was aimed to evaluate the relationship between the clinical course of the disease and hematological data, serum 25-hydroxyvitamin D (25 (OH) D), iron (Fe), free iron-binding capacity (UIBC), and D-dimer levels in calves with diarrhea in the neonatal period. Within the scope of the study, 10 healthy calves (group-I) and 30 diarrheal calves in the neonatal period of different races, ages and genders were used. Calves with diarrhea were divided into mild (group-II, n=10), moderate (group-III, n=10) and severe (group-IV, n=10) groups. Blood samples were taken from calves in all groups at once. Hematological analyzes were performed using a veterinary-specific hematology analyzer device. In serum samples, 25 (OH) D3, Fe and UIBC levels were determined with an autoanalyzer, and D-dimer levels were determined with an automatic immunoassay analyzer. In the hematological analysis, an increase was observed in the number of LYMs (lymphocytes) in group-II (5.04±1.3) and III (5.2±3.3) compared to group-I (4.47±1.2), and a decrease was observed in group IV (2.76±0.9) (P<0.05). Fe levels in group-II (59±56), group III (56±52) and group IV (72±63) were found to be decreased compared to group-I (131±66) (P<0.05). It was determined that the 25 (OH) D3 level of group IV (13.4±8.5) was higher than that of group-I (6.12±2.73) (P<0.05). D-dimer levels of group-III (1.15±1.13) and group-IV (0.96±0.88) were found to be higher than group-I (0.10±1.46) (P<0.05).
ABSTRACT
Background: Fever of unknown origin (FUO) is a challenging clinical problem in medicine that needs collaboration of various diagnostic techniques to establish the accurate diagnosis. We evaluated the diagnostic performance of 18F-FDG PET/CT in patients who presented themselves with FUO. Our study included 40 patients with FUO who underwent PET/CT examination and their results were compared to the results of laboratory, histopathological, microbiological investigations and/or response to therapy. Results: The final diagnosis included malignancy in 20 patients (50%), infectious causes in 7 patients (17.5%) and non-infectious inflammatory causes in 6 patients (15%). Fever resolved without diagnosis in 4 patients (10%), while no definite diagnosis was reached in 3 patients (7%). PET/CT successfully contributed to diagnosis of 35 out of 40 patients with diagnostic accuracy of 87.5%. The sensitivity, specificity, positive predictive value and negative predictive value of PET/CT in our study were 93.5%, 66.7%, 90.6% and 75%, respectively. Conclusion: PET/CT is a useful tool to investigate and diagnose the cause of FUO. It provides information that can guide the treatment strategy of the patients.
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AIM: We sought to describe the aetiology, demographics and outcomes of patients with pneumonia undergoing venovenous extracorporeal membrane oxygenation (VV-ECMO) in Aotearoa New Zealand. METHODS: Retrospective observational study. RESULTS: Between January 2004 and August 2020, 133 patients underwent VV-ECMO for pneumonia. This VV-ECMO cohort is representative of the geographic and ethnic distribution of the population of Aotearoa New Zealand. Six-month survival was 85/133 (64%). A primary viral aetiology was identified in 63/133 cases (47%) with bacterial co-infection present in 34/63 viral pneumonias (54%). Primary bacterial pneumonia was identified in 48/133 cases (36%). Twenty-three (17%) of 133 patients developed necrotising pneumonia. The most commonly identified microorganisms were influenza A, Staphylococcus aureus and Streptococcus pneumoniae. Infection with Staphylococcus aureus or Streptococcus species was strongly associated with necrotising pneumonia (OR 10.18, 95% CI 3.52–37.13, P<0.0001). Necrotising pneumonia was more common in Māori and Pacific Peoples than in other ethnic groups (OR 3.08, 95% CI 1.16–7.96, P=0.02). DISCUSSION: Outcomes from VV-ECMO for pneumonia in Aotearoa New Zealand are comparable to large international series. Although the use of VV-ECMO was matched to the ethnic distribution of the population of Aotearoa New Zealand, Māori may have reduced access because they have higher rates of pneumonia than non-Māori.