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Health service station is a place in which close contacts with the COVID-19 and other key populations are centralized quarantined for medical observation.A newly built health service station is equipped with 4 700 beds and a supporting sewage treatment station with a designed treatment scale of2 200 m~3/d.The treatment process consists of enhanced biological treatment system,sewage virus disinfection and sterilization system,aerosol disinfection and sterilization system and sludge disinfection and sterilization system.After treatment,the effluent and waste gas can meet the limit specified in Discharge Standard of Water Pollutants for Medical Organization （GB 18466-2005）.The average COD,NH3-N and SS in effluent are 14.53 mg/L,1.26 mg/L and 9.11 mg/L,respectively,and the average concentrations of H2S,NH3 and odor at the outlet are 0.01 mg/L,0.8 mg/L and 6.3,respectively.The sludge is disinfected regularly and then transported outside for disposal.This project can provide reference for sewage treatment design of emergency medical temporary isolation and observation facility and cabin hospital.
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Designing the next mass vaccination campaign will require ideas and techniques from behavioral economics. History and current events have shown how failing to consider features of human behavior, from individual biases in information processing to the relationships between people and policymakers, frustrated public health efforts. Behavioral economics can inform how a vaccination campaign needs to deliver processes and information necessary to help people decide to vaccinate, especially when mandates to vaccinate are not possible. Such campaigns need to employ both "nudges" (i.e., promote action) and remove "sludge" (i.e., break down blockers) to influence decisions directly. Strategies must be both acute and systemic to the current approach to public health.
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Municipal sewage carries SARS-CoV-2 viruses shed in the human stool by infected individuals to wastewater treatment plants (WWTPs). It is well-established that increasing prevalence of COVID-19 in a community increases the viral load in its WWTPs. Despite the fact that wastewater treatment facilities serve a critical role in protecting downstream human and environmental health through removal or inactivation of the virus, little is known about the fate of the virus along the treatment train. To assess the efficacy of differing WWTP size and treatment processes in viral RNA removal we quantified two SARS-CoV-2 nucleocapsid (N) biomarkers (N1 and N2) in both liquid and solids phases for multiple treatment train locations from seven coastal New England WWTPs. SARS-CoV-2 biomarkers were commonly detected in the influent, primary treated, and sludge samples (returned activated sludge, waste activated sludge, and digested sludge), and not detected after secondary clarification processes or disinfection. Solid fractions had 470 to 3,700-fold higher concentrations of viral biomarkers than liquid fractions, suggesting considerably higher affinity of the virus for the solid phase. Our findings indicate that a variety of wastewater treatment designs are efficient at achieving high removal of SARS CoV-2 from effluent;however, quantifiable viral RNA was commonly detected in wastewater solids at various points in the facility. This study supports the important role municipal wastewater treatment facilities serve in reducing the discharge of SARS-CoV-2 viral fragments to the environment and highlights the need to better understand the fate of this virus in wastewater solids.
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Introduction: Disseminated histoplasmosis (DH) presents as primarily lung manifestations with extrapulmonary involvement in immunocompromised hosts. Granulomatous hepatitis as first presentation of DH in an immunocompetent host is uncommon. Case Description/Methods: 25-year-old female presented with one month of fever, fatigue, myalgias, 30-pound weight loss, cough, nausea, vomiting, and epigastric pain. She has lived in the Midwest and southwestern US. Presenting labs: TB 1.9 mg/dL, AP 161 U/L, AST 172 U/L, ALT 463 U/L. Workup was negative for COVID, viral/autoimmune hepatitis, sarcoidosis, tuberculosis, and HIV. CT scan showed suspected gallstones and 9 mm left lower lobe noncalcified nodule. EUS showed a normal common bile duct, gallbladder sludge and enlarged porta hepatis lymph nodes which underwent fine needle aspiration (FNA). She was diagnosed with biliary colic and underwent cholecystectomy, with white plaques noted on the liver surface (A). Liver biopsy/FNA showed necrotizing granulomas (B) and fungal yeast on GMS stain (C). Although histoplasmosis urine and blood antigens were negative, histoplasmosis complement fixation was >1:256. She could not tolerate itraconazole for DH, requiring amphotericin B. She then transitioned to voriconazole, discontinued after 5 weeks due to increasing AP. However, her symptoms resolved with normal transaminases. At one year follow up, she is asymptomatic with normal liver function tests. Discussion(s): DH is a systemic granulomatous disease caused by Histoplasma capsulatum endemic to Ohio, Mississippi River Valley, and southeastern US. DH more commonly affects immunocompromised hosts with AIDS, immunosuppressants, and organ transplant. Gastrointestinal involvement is common in DH (70-90%) with liver involvement in 90%. However, granulomatous hepatitis as primary manifestation of DH is rare (4% of liver biopsies). Hepatic granulomas are seen in < 20%. Patients may present with nonspecific systemic symptoms. Serum/urine antigens may be negative. Gold standard for diagnosis is identifying yeast on tissue stains. Recommended treatment is amphotericin B followed by 1 year of itraconazole. However, shorter treatment duration may be effective in immunocompetent hosts. This case is unique in that granulomatous hepatitis was the first presentation of DH in our immunocompetent patient diagnosed on EUS FNA and liver biopsy. Clinicians must have a high degree of suspicion for DH in patients with fever of unknown origin especially in endemic areas regardless of immunologic status. (Table Presented).
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Introduction: Pancreatitis is a very common gastrointestinal disease that results in hospital admission. Early detection and treatment leads to better outcomes. This is the first reported case of pancreatitis secondary to elevated tacrolimus in a patient with prior renal transplantation after receiving Paxlovid for a COVID-19 infection. Case Description/Methods: A 57-year-old male with past medical history of 4 renal transplants secondary to posterior urethral valves who presented to the emergency room with acute onset epigastric pain for 24 hours. He was on tacrolimus 5 mg every 48 hours monotherapy for his immunosuppression. 10 days prior to his presentation he had developed chills and anxiety. He tested positive for COVID-19 at that time on a home rapid test. His symptoms had not significantly improved and given his immunosuppressed state he was given Paxlovid (Nirmatrelvir/ritonavir). He took 2 days of Paxlovid, however after his second day of treatment he developed severe epigastric pain requiring him to go to the emergency room. On admission his labs were notable for a lipase of 150 U/L (ULN 63 U/L). He underwent a CT scan was notable for an enlarged pancreatic head and neck with peripancreatic fat stranding (Figure). He also had a right upper quadrant ultrasound without any cholelithiasis and only trace sludge noted. His creatinine was noted to be 1.81 mg/dl which was above his baseline of 1.2 mg/dl. His tacrolimus trough level resulted at a level 45.6 ng/ml and later peaked at 82.2 ng/ml. His liver enzymes were normal. He was treated as acute pancreatitis with hydration and his tacrolimus was held with overall clinical improvement. Discussion(s): Tacrolimus is one of the most common medications used in solid organ transplantation. It is a calcineurin inhibitor that inhibits both T-lymphocyte signal transduction and IL-2 transcription. It is metabolized by the protein CYP3A and levels are monitored closely. Paxlovid is currently prescribed as an antiviral therapy for COVID-19 infection. The ritonavir compound in Paxlovid is potent inhibitor of CYP3A. Currently the guidelines do not recommend Paxlvoid as a therapeutic in patients taking tacrolimus as there is concern about increased drug levels. There have been several case reports of pancreatitis in setting of tacrolimus. This case report helps to demonstrate the need for close monitoring of therapeutics levels, especially in medications with high risk of drug to drug interaction to help prevent serious side effects such as tacrolimus induced pancreatitis.
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The COVID-19 pandemic caused by the SARS-CoV-2 virus led to changes in the lifestyle and human behaviour, which resulted in different consumption patterns of some classes of pharmaceuticals including curative, symptom-relieving, and psychotropic drugs. The trends in the consumption of these compounds are related to their concentrations in wastewater systems, since incompletely metabolised drugs (or their metabolites back transformed into the parental form) may be detected and quantified by analytical methods. Pharmaceuticals are highly recalcitrant compounds and conventional activated sludge processes implemented in wastewater treatment plants (WWTP) are ineffective at degrading these substances. As a results, these compounds end up in waterways or accumulate in the sludge, being a serious concern given their potential effects on ecosystems and public health. Therefore, it is crucial to evaluate the presence of pharmaceuticals in water and sludge to assist in the search for more effective processes. In this work, eight pharmaceuticals from five therapeutic classes were analysed in wastewater and sludge samples collected in two WWTP located in the Northern Portugal, during the third COVID-19 epidemic wave in Portugal. The two WWTP demonstrated a similar pattern with respect to the concentration levels in that period. However, the drugs loads reaching each WWTP were dissimilar when normalising the concentrations to the inlet flow rate. Acetaminophen (ACET) was the compound detected at highest concentrations in aqueous samples of both WWTP (98. 516 µg L - 1 in WWTP2 and 123. 506 µg L - 1in WWTP1), indicating that this drug is extensively used without the need of a prescription, known of general public knowledge as an antipyretic and analgesic agent to treat pain and fever. The concentrations determined in the sludge samples were below 1.65 µg g - 1 in both WWTP, the highest value being found for azithromycin (AZT). This result may be justified by the physico-chemical characteristics of the compound that favour its adsorption to the sludge surface through ionic interactions. It was not possible to establish a clear relationship between the incidence of COVID-19 cases in the sewer catchment and the concentration of drugs detected in the same period. However, looking at the data obtained, the high incidence of COVID-19 in January 2021 is in line with the high concentration of drugs detected in the aqueous and sludge samples but prediction of drug load from viral load data was unfeasible.
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Increasing amounts of surfactants are used and emitted into the environment due to the COVID-19 pandemic, posing potential threats to ecological health. Algal-bacterial aerobic granular sludge (A-BAGS), with the advantages of compact structure, high-efficient nutrient uptake, and high tolerance to harsh conditions, was attempted in this study to treat surfactant-containing wastewater at relatively high concentrations. The treatment performance was also compared to bacterial AGS (BAGS). Results showed that A-BAGS is preferable for treating wastewater containing a high SDS concentration (30 mg/L), achieving nutrient removal efficiency of 86.3 % for organic carbon, 60.5 % for total nitrogen, and 58.7 % for total phosphorus within a short duration, compared to 70.1 %, 52.8 % and 42.3 % in BAGS reactor. Besides, the removal rate of ammonia nitrogen by A-BAGS was much faster than that of BAGS. The above results confirmed that A-BAGS is a promising technology for treating surfactant-containing wastewater with high nutrient removal efficiency being maintained.Copyright © 2023 Elsevier Ltd
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Ciprofloxacin and ofloxacin belong to a class of antibiotics called Fluoroquinolones (FQs), which have a wide anti-bacterial activity against Gram-positive and Gram-negative bacteria. Since the recent Covid-19 pandemic witnessed a magnanimous rise in the use of antibiotics to prevent secondary bacterial infections, it led to vast production and use of such antibiotics. Ultimately the antibiotics get discharged into the municipal sewer pipes, thereby killing the useful microbial colony. In order to prevent environmental degradation a commercial scale-up of the adsorption of these antibiotics using raw sewage sludge is an absolute necessity. In this study, a continuous adsorption operation is conducted in a packed bed of semi-dried raw sewage sludge to remove the FQs from wastewater. Two transient convective-diffusion models are developed including pseudo-first and second-order kinetics driven depletion terms. The models are optimised using the data collected under various dynamic conditions in order to analyse the performance of the packed bed in terms of bed height, flow rate and initial concentration of the FQs. Damköhler numbers of the FQs are estimated to predict the breakthrough times of both the FQs. The ratios of Damköhler numbers of ciprofloxacin and ofloxacin do not change much with flow rate. In all the experiments, Das << 1 for both the FQs, indicating a faster diffusion process with respect to the rate of pseudo-reaction. Diffusion reaches an ‘equilibrium' well before the reaction achieves pseudo-chemical equilibrium. Ratios of the Damköhler numbers, meant to represent the first-order and second-order convective-diffusion models for ciprofloxacin to ofloxacin is < 1. © 2023 Elsevier Ltd
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Biodrying is an essential part of the mechanical–biological treatment process that minimizes moisture content and simultaneously maximizes heating value for refuse-derived fuel (RDF) production. Although the mechanical separation process operates effectively in Thailand's RDF production, high organic content levels and their degradation cause moisture contamination in RDF, producing wet RDF. Aeration is essential for an effective biodrying process, and can reduce RDF's moisture content as well as increase its heating value. To maximize the biodrying effect, aeration should be optimized based on the waste conditions. This study proposes a modified aeration-supplied configuration for wet RDF biodrying. The aeration rate was modified based on the period within the biodrying operation;the first period is from the beginning until day 2.5, and the second period is from day 2.5 to day 5. The optimal aeration supply configuration was 0.5 m3/kg/day in the first period and then 0.3 m3/kg/day until the end of the process;this configuration yielded the greatest moisture content decrease of 35% and increased the low heating value of the biodried product by 11%. The final moisture content and low heating value were 24.07% and 4787 kcal/kg, respectively. Therefore, this optimal aeration-supplied configuration could be applied to meet the moisture content and low heating value requirements of the RDF production standard for Thailand's local cement industry.
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Reasonable estimates for quantities and qualities (Q&Q) of fecal sludge that accumulate in onsite sanitation containments are fundamental for the design of appropriate management and treatment solutions, from community to city-scale. There are increasing attempts to improve Q&Q estimates, but current approaches are still at a conceptual level, and are not yet standardized with confirmed statistical relationships. To reach this level, we will need consistent approaches for planning, measuring, and global collaborations. Hence, the objectives of this study were: (1) to assess and compare Q&Q of fecal sludge from seven cities and communities, and explore statistical relationships that could be used to increase accuracy of Q&Q estimations;(2) to test and launch the Volaser device for measuring in situ volumes of fecal sludge;and (3) to capture lessons learned from field implementation with collaborators in seven countries during a global pandemic when no international travel was possible. The study took place in Ghana, India, Lebanon, Kenya, Sierra Leone, Uganda, and Zambia during the COVID-19 pandemic. Q&Qs were measured in 204 containments with a Volaser, laboratory analysis, and questionnaire. Results indicate that there are differences in Total Solids (TS) and Chemical Oxygen Demand (COD) in fecal sludge based on containment type, toilet type, source, and whether there is a water connection on the premises. Based on the results of this study, together with previously published open-source data, an empirical relationship for Volatile Solids (VS) and TS of 0.49 (R2 = 0.88) was established using 1,206 data points. For COD/TS, no significant relationship was observed. Developing such empirical relationships will be useful for planning and modeling approaches. An external evaluation was conducted to evaluate overall project management, Volaser technology transfer, and effects of collaborating during the COVID-19 pandemic. Success factors for collaborating with new and existing partners without face-to-face meetings included laboratory capacity and experience with analytical methods, study objectives that were relevant for the partner and locality, and a strong quality assurance plan to ensure comparability of results. The lessons learned can be taken forward as ways to reduce carbon footprint, and contribute to resilient, inclusive development research projects. Copyright © 2023 Andriessen, Appiah-Effah, Browne, al Jahjah, Kabika, Kinobe, Korir, Nishimwe, Niwagaba, Pradeep, Prasad, Tembo, William, Ambuehl and Strande.
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Sludge generation as an organic by-product of wastewater treatment has seen a consistent increase worldwide due to population growth and industrial activities. This poses a chronic challenge regarding management options and environmental concerns. The agricultural valorization of unconventional organic materials has become inevitable, especially in semi-arid and arid countries that suffer from depleted soils and shortages in farm manure supply. High-income countries have also been interested in this recycling practice to mitigate landfilling or incineration issues. Sewage and some industrial sludges contain a complex mixture of beneficial and harmful substances, which varies with the origin of effluents. Therefore, sludge land application should be well managed in order to achieve sustainable agro-environmental goals. This review paper focuses on different aspects related to sludge reuse in agriculture, starting by investigating the diversity of sludge types and composition. In addition to the preponderant urban sewage sludge, the less-studied industrial sludges, such as those generated from pulp and paper mills or gas-to-liquid industries, are hereby addressed as well. Then, post-land application effects are discussed in relation to sludge quality, dose, and reuse conditions. The present paper also examines the disparities between guidelines that determine sludge conformity for land application in various countries or regions. Accordingly, special attention is given to increasing risks related to emerging pollutants in sludge such as pharmaceuticals, which have been overused since the outbreak of COVID-19 pandemic. This exhaustive investigation will assist the establishment of sustainable strategies for the safe agricultural reuse of biosolids.
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The International Water Association (IWA) initiated a Task Force in April 2020 to serve as a leadership team within IWA whose role is to keep abreast and communicate the emerging science, technology, and applications for understanding the impact and the ability to respond to the COVID-19 pandemic and specifically designed for water professionals and industries. Expertise was nominated across the world with the purpose of collectively providing the water sector with knowledge products for the guidance on the control of COVID-19 and other viruses. This review paper developed by a working group of the IWA Task Force focuses on the control of COVID-19. The purpose of this review paper is to provide an understanding of existing knowledge with regards to COVID-19 and provide the necessary guidance of risk mitigation based on currently available knowledge of viruses in wastewater. This review paper considered various scenarios for both the developed world and the developing world and provided recommendations for managing risk. The review paper serves to pool the knowledge with regards to the pandemic and in relation to other viruses. The IWA Task Team envisage that this review paper provides the necessary guidance to the global response to the ongoing pandemic.
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As for the SARS coronavirus in the 2003 epidemic, the presence of SARS-CoV-2 has been demonstrated in faeces and, in some cases, urine of infected people, as well as in wastewater. This paper proposes a critical review of the state of the art regarding studies on the presence of SARS-CoV-2 in wastewater and sewage sludge, the factors affecting its inactivation and the main proposed treatments. In-vitro tests demonstrated low resistance of SARS-CoV-2 to high temperature, while even significant changes in pH would not seem to determine the disappearance of the virus. In real wastewater and in sewage sludge, to date studies on the influence of the different parameters on the inactivation of SARS-CoV-2 are not available. Therefore, studies involving other HCoVs such as SARS-CoV and HCoV-229E have been also considered, in order to formulate a hypothesis regarding its behaviour in sewage and throughout the steps of biological treatments in WWTPs. Finally, SARS-CoV-2 in wastewater might track the epidemic trends: although being extremely promising, an effective and wide application of this approach requires a deeper knowledge of the amounts of viruses excreted through the faeces and the actual detectability of viral RNA in sewage.
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Urban sewage sludge (USS) is increasingly being used as an alternative organic amendment in agriculture. Because USS originates mostly from human excreta, partially metabolized pharmaceuticals have also been considered in risk assessment studies after reuse. In this regard, we investigated the cumulative effect of five annual USS applications on the spread of antibiotic-resistant bacteria (ARB) and their subsequent resistance to toxic metals in two unvegetated soils. Eventually, USS contained bacterial strains resistant to all addressed antibiotics with indices of resistance varying between 0.25 for gentamicin to 38% for ampicillin and azithromycin. Sludge-amended soils showed also the emergence of resistome for all tested antibiotics compared to non-treated controls. In this regard, the increase of sludge dose generally correlated with ARB counts, while soil texture had no influence. On the other hand, the multi-antibiotic resistance (MAR) of 52 isolates selected from USS and different soil treatments was investigated for 10 most prescribed antibiotics. Nine isolates showed significant MAR index (≥ 0.3) and co-resistance to Cd, As and Be as well. However, events including an extreme flash flood and the termination of USS applications significantly disrupted ARB communities in all soil treatments. In any case, this study highlighted the risks of ARB spread in sludge-amended soils and a greater concern with the recent exacerbation of antibiotic overuse following COVID-19 outbreak.
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Human pathogenic viruses can be introduced into sewage sludge and soils via fecal material from a variety of human activities. These contaminated matrices can play a substantial role in the dispersion of pathogenic viruses in the environment, constituting a potential public health problem if they enter the water cycle or the food chain. However, the interactions between pathogenic viruses and these matrices have received less attention compared to other environmental compartments. Understanding the presence of viruses, their persistence and fate in solid or semi-solid matrices like sludge and soil is important for the effective control of the infections they may cause. In this chapter, we summarize current knowledge about human pathogenic viruses in sewage sludge and soil, their importance in public health, and the factors that govern their transport and persistence in soil matrices. We also review the occurrence and variety of common and emerging viruses excreted in the feces and their presence in sewage sludge and soil, as well as the potential use of certain viruses as indicators of fecal pollution. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Energy crisis and increasing rigorous management standards pose significant challenges for solid waste management worldwide. Several emerging diseases such as COVID-19 aggravated the already complex solid waste management crisis, especially sewage sludge and food waste streams, because of the increasingly large production year by year. As mature waste disposal technologies, landfills, incineration, composting, and some other methods are widespread for solid wastes management. This paper reviews recent advances in key sewage sludge disposal technologies. These include incineration, anaerobic digestion, and valuable products oriented-conversion. Food waste disposal technologies comprised of thermal treatment, fermentation, value-added product conversion, and composting have also been described. The hot topic and dominant research foci of each area are summarized, simultaneously compared with conventional technologies in terms of organic matter degradation or conversion performance, energy generation, and renewable resources production. Future perspectives of each technology that include issues not well understood and predicted challenges are discussed with a positive effect on the full-scale implementation of the discussed disposal methods. © 2022 Elsevier Ltd
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The COVID-19 pandemic is a worldwide problem. The clinical spectrum of SARS-CoV-2 infection varies from asymptomatic or paucity-symptomatic forms to conditions such as pneumonia, acute respiratory distress syndrome and multiple organ failure. Objective was to describe a clinical case of SARS-CoV-2 infection in the patient with sarcoidosis and cardiovascular pathology developing acute respiratory syndrome and lung edema. Material and methods. There were analyzed accompanying medical documentation (outpatient chart, medical history), clinical and morphological histology data (description of macro- and micro-preparations) using hematoxylin and eosin staining. Results. Lung histological examination revealed signs of diffuse alveolar damage such as hyaline membranes lining and following the contours of the alveolar walls. Areas of necrosis and desquamation of the alveolar epithelium in the form of scattered cells or layers, areas of hemorrhages and hemosiderophages are detected in the alveolar walls. In the lumen of the alveoli, a sloughed epithelium with a hemorrhagic component, few multinucleated cells, macrophages, protein masses, and accumulated edematous fluid were determined. Pulmonary vessels are moderately full-blooded, surrounded by perivascular infiltrates. Signs of lung sarcoidosis were revealed. Histological examination found epithelioid cell granulomas consisting of mononuclear phagocytes and lymphocytes, without signs of necrosis. Granulomas with a proliferative component and hemorrhage sites were determined. Giant cells with cytoplasmic inclusions were detected - asteroid corpuscles and Schauman corpuscles. Non-caseous granulomas consisting of clusters of epithelioid histiocytes and giant Langhans cells surrounded by lymphocytes were detected in the lymph nodes of the lung roots. Hamazaki-Wesenberg corpuscles inside giant cells were found in the zones of peripheral sinuses of lymph nodes. In the lumen of the bronchi, there was found fully exfoliated epithelium, mucus. Granulomas are mainly observed subendothelially on the mucous membrane, without caseous necrosis. Histological examination of the cardiovascular system revealed fragmentation of some cardiomyocytes, cardiomyocyte focal hypertrophy along with moderate interstitial edema, erythrocyte sludge. Zones of small focal sclerosis were determined. The vessels of the microcirculatory bed are anemic, with hypertrophy of the walls in small arteries and arterioles. Virological examination of the sectional material in the lungs revealed SARS-CoV-2 RNA. Conclusion. Based on the data of medical documentation and the results of a post-mortem examination, it follows that the cause of death of the patient R.A., 50 years old, was a new coronavirus infection COVID-19 that resulted in bilateral total viral pneumonia. So-morbidity with competing diseases such as lung sarcoidosis and cardiovascular diseases aggravated the disease course, led to the development of early ARDS and affected the lethal outcome. Copyright © 2022 Saint Petersburg Pasteur Institute. All rights reserved.
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Disinfectants are routinely used in human environments to control and prevent the transmission of microbial disease, and this is particularly true during the current COVID-19 crisis. However, it remains unclear whether the increased disinfectant loadings to wastewater treatment plants facilitate the dissemination of antibiotic resistance genes (ARGs) in sewage sludge microbiomes. Here, we investigated the impacts of benzalkonium chlorides (BACs), widely used disinfectants, on ARGs profiles and microbial community structures in sewage sludge by using high-throughput quantitative PCR and Illumina sequencing. A total of 147 unique ARGs and 39 mobile genetic elements (MGEs) were detected in all sewage sludge samples. Our results show that exposure to BACs disinfectants at environmentally relevant concentrations significantly promotes both the diversity and absolute abundance of ARGs in sludge microbiomes, indicating the co-selection of ARGs by BACs disinfectants. The enrichment of ARGs abundance varied from 2.15-fold to 3.63-fold compared to controls. In addition, BACs exposure significantly alters bacterial and protistan communities, resulting in dysbiosis of the sludge microbiota. The Mantel test and Procrustes analysis confirm that bacterial communities are significantly correlated with ARGs profiles under BACs treatments. The structural equation model explains 83.8 % of the total ARGs variation and further illustrates that the absolute abundance of MGEs exerts greater impacts on the variation of absolute abundance of ARGs than microbial communities under BACs exposure, suggesting BACs may promote antibiotic resistance by enhancing the horizontal gene transfer of ARGs across sludge microbiomes. Collectively, our results provide new insights into the proliferation of antibiotic resistance through disinfectant usage during the pandemic and highlight the necessity to minimize the environmental release of disinfectants into the non-target environment for combating antibiotic resistance.
Subject(s)
COVID-19 , Disinfectants , Microbiota , Humans , Sewage/microbiology , Benzalkonium Compounds/pharmacology , Genes, Bacterial , Anti-Bacterial Agents/pharmacology , Drug Resistance, Microbial/genetics , Bacteria/geneticsABSTRACT
Background. SARS-COV-2 infection is known to cause tissue damage in several organs outside of the respiratory tract. The pathogenesis of tissue damage is hypothesized to be caused by direct viral damage, endothelial injury, and ischemic or thrombotic events. Gastrointestinal symptoms were first characterized mainly as diarrhea and diffuse abdominal pain and discomfort, which can be hard to interpret in the setting of a generalized inflammatory response;gallbladder injury and inflammation causing acute acalculous cholecystitis has been scarcely reported Methods. Here we discuss five cases of patients presenting with symptoms of cholecystitis. All five patients underwent multiple imaging studies, and all of them were compatible with acute cholecystitis;some of them had an imaging report of lithiasic cholecystitis, while the rest were reported with microlithiasis or biliary sludge. Four out of the five patients underwent laparoscopic cholecystectomy;biopsies were taken, consistently those reported with acalculous cholecystitis. The remaining patient died of CoVID 19 complications prior to surgery, but after a percutaneous cholecystostomy tube was placed. Results. All these patients have in common the prolonged fasting, because they all required invasive mechanical ventilation, consequently, they all developed multiple focal pneumonia and respiratory distress syndrome. This fast is related to the development of gangrenous ischemia in the gallbladder, which manifests as a late complication due to SARS-CoV-2 infection, in addition to being related to angiotensin-2 converting receptors and virus replication proteins, as well as the pro-inflammatory and hypoxia state that in itself causes the infection (9). All showed a cholestatic pattern, highlighting that this complication developed in an average time of 3 weeks after the onset of SARS-CoV2 symptoms, in addition to the fact that in most cases a negative test was already shown at the time of the complication. Conclusion. Acalculous cholecystitis is one of the extrapulmonary complications that has been seen in patients with this infection, not being the most common, but one of those that has generated a higher mortality rate in patients due to its late diagnosis and non-specific clinical picture in certain occasions (9).