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1.
Clinical Microbiology Newsletter ; 44(18):161-167, 2022.
Article in English | EMBASE | ID: covidwho-2061008

ABSTRACT

Strongyloidiasis, typically caused by Strongyloides stercoralis, is a neglected tropical disease that affects 30 to 100 million people worldwide. Despite the commonly asymptomatic nature of the infection, S. stercoralis infection of immunocompromised individuals can be lethal. Infected but asymptomatic immunocompetent individuals can develop hyperinfection or disseminated infection if they experience any significant change in their immune status, and recently, cases have been described following the use of corticosteroids to treat COVID-19-related pneumonia. Definitive diagnosis is established via stool examination for rhabditiform larvae;however, contemporary methods, including serologic and molecular testing, are increasingly used as adjunct tests. Importantly, exposed individuals and those expected to become immunosuppressed should be screened and pre-emptively treated before starting immunosuppressive agents to avoid cases of dissemination and hyperinfection. Copyright © 2022 Elsevier Inc.

2.
Chest ; 162(4):A1120, 2022.
Article in English | EMBASE | ID: covidwho-2060774

ABSTRACT

SESSION TITLE: Critical Gastrointestinal Case Reports SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: Histoplasma capsulatum is a dimorphic fungus most commonly encountered as an opportunistic infection in immunosuppressed patients, particularly those with HIV/AIDS. However, patients immunosuppressed from other causes can also be at risk. Here is presented the case of a patient on multi-immunosuppressant therapy as treatment for Crohn's disease, who developed disseminated histoplasmosis. CASE PRESENTATION: A 44-year-old male with a past medical history of Crohn's disease (previously been on azathioprine, adalimumab and currently on Prednisone therapy), recently started on infliximab infusion for uncontrolled symptoms of IBD, diabetes mellitus, hypothyroidism, and COVID-19 infection (not requiring oxygen therapy) one month prior to the current admission initially presented to the hospital with chief complaints of exacerbated weakness, myalgias, fevers and diarrhea for 5 days;Symptoms of weakness, myalgias began after first infusion of infliximab and it got progressively worse after the 2nd infusion 2 weeks prior to the admission. White Blood Cell count was 1.1 K/uL, platelet count was 7 K/uL, hemoglobin was 7.9 g/dL. CRP was elevated to 142 mg/L, and ferritin was elevated to 39,000 ug/L. CT abdomen and pelvis demonstrated probable rectosigmoid colitis and splenomegaly. Subsequent chest x-ray demonstrated bilateral opacities with haziness over bilateral lung fields. Respiratory viral panel, stool panel, blastomyces antigen, cryptococcal antigen, toxoplasma antibodies, HIV antibody, CMV PCR, and blood cultures were unrevealing. Urinary histoplasma antigen was positive, and BD-glucan was elevated to over 500 ng/L. EBV panel was positive for reactivation, with EBV DNA 2.02 IU/mL. He was subsequently started on amphotericin B lipid complex, with itraconazole destination therapy. He was treated empirically for pneumocystis jiroveci pneumonia (PJP) with sulfamethoxazole-trimethoprim due to him being on chronic Prednisone therapy. Echocardiogram demonstrated left ventricular ejection fraction (LVEF) of 40%, with diffuse hypokinesis and wall motion abnormalities, posing some question of myocarditis. He was later discharged home in an improved state. DISCUSSION: Disseminated histoplasmosis in the setting of Crohn's disease on chronic immunosuppressive therapy has been very rarely reported,(1) with similar reports in patients on immunosuppressive therapy in the setting of rheumatologic disease being slightly more common.(2) The most commonly involved areas in gastrointestinal histoplasmosis are the terminal ileum and colon,(3) with this patient's rectosigmoid colitis and symptomatology being consistent with this pattern. The patient's myocarditis is also consistent with disseminated histoplasmosis infection. CONCLUSIONS: Clinicians should maintain suspicion for opportunistic infections in patients on immunosuppressive therapy in the setting of critical illness. Reference #1: Bhut, B., Kulkarni, A., Rai, V. et al. A rare case of disseminated histoplasmosis in a patient with Crohn's disease on immunosuppressive treatment. Indian J Gastroenterol 37, 472–474 (2018). https://doi.org/10.1007/s12664-018-0886-1 Reference #2: Wood KL, Hage CA, Knox KS, et al. Histoplasmosis after treatment with anti-tumor necrosis factor-alpha therapy. Am J Respir Crit Care Med. 2003;167(9):1279-1282. doi:10.1164/rccm.200206-563OC Reference #3: Galandiuk S, Davis BR. Infliximab-induced disseminated histoplasmosis in a patient with Crohn's disease. Nat Clin Pract Gastroenterol Hepatol. 2008;5(5):283-287. doi:10.1038/ncpgasthep1119 DISCLOSURES: no disclosure on file for Donald Dumford;No relevant relationships by Abhilash Bhat Marakini No relevant relationships by Palak Rath No relevant relationships by Sterling Shriber

3.
Chest ; 162(4):A901, 2022.
Article in English | EMBASE | ID: covidwho-2060721

ABSTRACT

SESSION TITLE: Cases of Overdose, OTC, and Illegal Drug Critical Cases Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Anchoring bias is a cognitive bias where one relies too heavily on initial information early on in the decision making process, affecting subsequent decisions due to future arguments being discussed in relation to the "anchor. Overemphasis on COVID-19 due to the pandemic has impacted the timely diagnosis and treatment of other diseases. CASE PRESENTATION: A 39-year-old man with a past medical history of COVID 19 in 12/2020 presents to the ED with increasing weakness, chest pain, recurrent fevers, diarrhea, and cough. CXR revealed bilateral infiltrates suggestive of pneumonia/pulmonary edema. Patient was empirically started on ceftriaxone. CT chest was suspicious of COVID-19;however repeat testing was negative. Diarrhea did not improve. Patient later admitted to recent travel to Jamaica. Ova and parasite, C-difficile, and stool culture were negative. On hospital day 8, the patient was intubated and placed on mechanical ventilation for worsening hypoxic respiratory failure Infectious disease was consulted for recurrent fevers of unknown origin and diarrhea with recent travel. Testing for typhoid fever, hantavirus, malaria, HIV, zika virus, chikungunya, dengue, and yellow fever were performed. Consent was obtained for HIV testing. HIV antibody tests were positive, CD4 count of 7, and viral load greater than 900k. Since a new diagnosis of AIDS with a CD4 count of 7 was obtained, the patient was subsequently tested for opportunistic infections such as TB. TB sputum PCR testing was positive but AFB smear was negative for TB. Antiretroviral and tuberculosis treatments were initiated. DISCUSSION: Anchoring bias can delay critical diagnoses and impede patient care if it is not recognized. According to Watson et. al, one way physicians circumvent the thought of pretest probability when ordering tests based on patient history and the subsequent list of differential diagnoses is anchoring bias. Bypassing the pretest probability also alters the sensitivity and specificity of testing because results that do not confirm or rule out a top differential diagnosis are thought to be inaccurate and are then repeated attributing the initial result to a bad specimen or an improper collection of the specimen. CONCLUSIONS: The case presented exemplifies clearly the concept of anchoring bias. Upon initial presentation, the patient had nonspecific symptoms such as weakness, chest pain, recurrent fevers, diarrhea, and cough, all of which can be symptoms of COVID 19 in the setting of a global pandemic. It is clear that the initial diagnosis based on these symptoms was COVID 19. When initial testing was negative, anchoring bias still played a role in the decision to test the patient once again, despite the first negative test. Repeat testing still did not support the diagnosis of COVID 19, which expanded the differential diagnosis and ultimately led to the correct diagnosis of AIDS with concomitant TB infection. Reference #1: Saposnik, et. Al. Cognitive Biases Associated with Medical Decisions: A Systematic Review. BMC Med Inform Decis Mak. 2016 Nov. 3. PMID: 27809908 Reference #2: Harada, et. al. COVID Blindness: Delayed Diagnosis of Aseptic Meningitis in the COVID-19 Era. Eur J Case Rep Intern Med. 2020 Oct 23. PMID: 33194872. Reference #3: Singh, et. al. The Global Burden of Diagnostic Errors in Primary Care. BMJ Qual Saf. 2016 Aug 16. PMID: 27530239. DISCLOSURES: No relevant relationships by Sagar Bhula

4.
Chest ; 162(4):A858, 2022.
Article in English | EMBASE | ID: covidwho-2060710

ABSTRACT

SESSION TITLE: Management of COVID-19-Induced Complications SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Up to 17% of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been shown to develop pancreatic lesions (1). We present 2 cases of coronavirus disease 2019 (COVID-19) patients that presented with pancreatic lesions. CASE PRESENTATION: Case1 A 47-year-old lady with a history of type 2 diabetes mellitus present to the emergency department (ED) with complaints of flu-like symptoms for ten days. She tested positive for COVID-19 by rapid PCR. Computed tomography (CT) scan without contrast on admission shows an incidental finding of a pancreatic mass (see Figure 1). Abdominal CT with contrast shows a large, multiloculated cystic mass in the pancreatic tail (see Figure 2). Laboratory examination depicted lipase: 27 U/L, CA19-9: 72 U/mL, CEA: 6.5 ng/mL, CA125: 24 U/mL, erythrocyte sedimentation rate (ESR):2 mm/h, Total Bilirubin: 0.6 mg/dl, Direct Bilirubin: 0.1 mg/dl. Following treatment, the patient recovered fully and is discharged from the hospital 10 days later with home oxygen therapy. Case2 An 81-year old Caucasian lady presented to the outpatient clinic with complaints of fecal incontinence. She tested positive for COVID-19, four months before her visit. CT scan of the abdomen with oral contrast revealed multiple hypodense masses on the pancreas measuring 0.3cm in diameter (see Figure 3). Laboratory tests reveal CA19-9: 57 U/mL, CA125: 8 U/mL, CEA: 1.9 ng/mL, erythrocyte sedimentation rate (ESR):11 mm/h, C-reactive protein: 0.7 mg/L, Total Bilirubin: 1.5 mg/dl, Direct Bilirubin: 1.3 mg/dl. Following outpatient treatment and follow-up, the patient's symptoms were relieved. DISCUSSION: Pancreatic lesions in COVID-19 patients can be caused directly by the cytopathic effects of the viral infection, or indirectly by systemic responses to inflammation or respiratory failure. Several studies have shown that ACE2 is the functional receptor used by SARS-CoV-2 to gain access to target cells (2) and ACE-2 receptors are expressed in significant amounts in the pancreas (3). In the first case, an incidental finding of a multi-cystic pancreatic mass on admission was reported. There was no pancreatic ductal dilation on the CT scan, which may indicate a direct injury caused by cytopathic effects of the virus rather than inflammation resulting in exocrine secretions forming cysts. In the second case, multiple masses on the pancreas were found after recovering from COVID-19. These lesions could be remnants of a previous pancreatic injury during the acute phase of the infection. CONCLUSIONS: COVID-19 infection may trigger pancreatic injury in some patients. Reference #1: Yong, Shin Jie. Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments. Infectious diseases. 2021 Oct;53(10): 737–754. Reference #2: Ma C, Cong Y, Zhang H. COVID-19, and the Digestive System. Vol. 115, American Journal of Gastroenterology. Wolters Kluwer Health;2020. p. 1003–6. Reference #3: Liu F, Long X, Zhang B, Zhang W, Chen X, Zhang Z. ACE2 Expression in Pancreatic Damage After SAERS-CoV-2 Infection. Gastroenterology. 2020 Aug 1;18(9): 2128 – 2130.e2. DISCLOSURES: No relevant relationships by Ailine Canete Cruz No relevant relationships by Claudia Ramirez No relevant relationships by Joseph Varon No relevant relationships by Mohamed Ziad

5.
Chest ; 162(4):A804, 2022.
Article in English | EMBASE | ID: covidwho-2060693

ABSTRACT

SESSION TITLE: Critical Gastrointestinal Case Reports SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: Magnesium citrate is an osmotic laxative which is occasionally used in the intensive care unit (ICU) for refractory constipation. We present a patient in whom a bowel regimen containing magnesium citrate resulted in severe hypermagnesemia with paralytic ileus, requiring renal replacement therapy. CASE PRESENTATION: 70-year-old male was admitted to the ICU for COVID-19 associated acute hypoxic respiratory failure and suffered multi-day, refractory constipation, treated with one dose of 17 grams of magnesium citrate. Vital signs were remarkable for bradycardia and hypotension. On examination, patient was lethargic and the abdomen was soft and non-distended, but there were decreased bowel sounds throughout. Subsequently, laboratory findings were notable for a magnesium level of 8.8 mg/dL and serum creatinine of 2.3 mg/dL (estimated glomerular filtration rate 28mL/min/1.73m2), all of which were previously normal at admission. Computerized Tomography of the abdomen was performed showing dilated cecum, ascending and transverse colon and moderate to large amount of intraluminal rectal stool and air. Patient was started on intravenous fluids, loop diuretics, and calcium gluconate, however, the patient required renal replacement therapy for magnesium clearance. Patient clinically improved with normalization of kidney function and magnesium levels as well as resolution of ileus. DISCUSSION: Magnesium homeostasis is regulated by gastrointestinal absorption and renal excretion, for which the kidney maintains magnesium equilibrium until creatinine clearance falls below 20 ml/min [1]. Elevated magnesium levels can decrease bowel motility by blocking myenteric neurons and interfere with excitation - contraction coupling of smooth muscle cells as well as serve as a reservoir for continuous magnesium absorption [2]. Our patient suffered acute kidney injury, likely from COVID-19 pneumonia and acute tubular necrosis from shock, placing him at increased risk for hypermagnesemia. One retrospective study identified that patients with COVID-19 are more prone to the development of hypermagnesemia, which is associated with renal failure and increased risk of mortality [3]. The magnesium load from magnesium citrate in our patient created for a seemingly out of proportion effect of hypermagnesemia-induced paralytic ileus and presumably a magnesium reservoir, refractory to conservative measures. CONCLUSIONS: The use of magnesium containing bowel regimens should be considered with caution due to the possibility of hypermagnesemia in at-risk patients, which may result in paralytic ileus and other sequelae. Hypermagnesemia reduces colonic peristalsis and interferes with magnesium equilibrium, prolonging its effects. There are rare case reports in the literature discussing this phenomenon, but should be further evaluated for specific patient susceptibility and effects on morbidity and mortality. Reference #1: Cascella, M. (2022, February 5). Hypermagnesemia. StatPearls [Internet]. Retrieved March 16, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK549811/ Reference #2: Bokhari, S., Siriki, R., Teran, F., & Batuman, V. (2018, September 8). Fatal Hypermagnesemia due to laxative use. The American Journal of the Medical Sciences. Retrieved March 16, 2022, from https://www.amjmedsci.org/article/S0002-9629(17)30467-6/fulltext Reference #3: Stevens, J. S., Moses, A. A., Nickolas, T. L., Husain, S. A., & Mohan, S. (2021, July 29). Increased mortality associated with hypermagnesemia in severe covid-19 illness. American Society of Nephrology. Retrieved March 16, 2022, from https://kidney360.asnjournals.org/content/2/7/1087 DISCLOSURES: No relevant relationships by Adnan Abbasi No relevant relationships by Sarah Upson

6.
Chest ; 162(4):A585, 2022.
Article in English | EMBASE | ID: covidwho-2060637

ABSTRACT

SESSION TITLE: COVID-19 Case Report Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Acute eosinophilic pneumonia (AEP) is a rare cause of acute respiratory failure. AEP has been reported in association with smoking, drugs, and infections. Very few reports of AEP accompanied by Coronavirus disease 2019 (COVID-19) exist in current literature. Here we describe a case of AEP in association with COVID-19. CASE PRESENTATION: A 58-year-old female, non-smoker, with no medical history presented to the emergency room with fever, cough, and shortness of breath for 10 days. She received two doses of vaccine against COVID-19. Her vital signs were notable for oxygen saturation of 56% on room air and respiratory rate of 35 breaths per minute. Her physical exam was notable for distress, tachypnea, and diffuse rhonchi on lung auscultation. Her chest x-ray showed multifocal bilateral peripheral and basilar airspace opacities. A respiratory pathogen panel detected SARS-CoV-2. She was admitted to the medical intensive care unit and suffered worsening acute hypoxemic respiratory failure requiring intubation. She was treated with dexamethasone 6mg for a 10-day course with gradually decreasing oxygen requirements, and she underwent tracheostomy on hospital day 11. Despite this, she continued to deteriorate clinically. Review of laboratory results showed significant eosinophilia of 15.6% on her complete blood count upon withdrawal of steroids. A CTA scan of the chest showed no evidence of pulmonary embolic disease and demonstrated bilateral extensive dense consolidations. A diagnosis of acute eosinophilic pneumonia was suspected. Fungal cultures and stool ova and parasites were negative. She was started on methylprednisolone 1mg/kg and a bronchoscopy was performed with bronchioalveolar lavage (BAL) samples showing 4% eosinophils despite high dose steroid therapy. She was continued on high dose steroids with rapid improvement in her oxygen requirements. DISCUSSION: AEP is an acute febrile illness that can lead to acute respiratory failure. The presence of dense infiltrates in the early stages of COVID-19 and elevated inflammatory markers and reticence to perform bronchoscopy can delay making a diagnosis of AEP in a patient diagnosed with COVID19. The diagnostic hallmark of AEP is the detection of > 25% eosinophils in BAL samples. While this patient did not meet that criterion, she received high dose corticosteroids which may have suppressed pulmonary eosinophilia. A high index of suspicion for AEP should be maintained in patients with COVID-19 with evidence of eosinophilia and clinical deterioration, given that AEP improves rapidly with the appropriate treatment. CONCLUSIONS: AEP is an uncommon cause of respiratory failure that should be considered in patients with unexplained worsening respiratory status and evidence of eosinophilia. Bronchoscopy with bronchoalveolar lavage should be considered early, even in the setting of COVID-19 in patients without risk factors who develop severe disease. Reference #1: De Giacomi F, Vassallo R, Yi ES, Ryu JH. Acute Eosinophilic Pneumonia. Causes, Diagnosis, and Management. Am J Respir Crit Care Med. 2018;197(6):728-736. doi:10.1164/rccm.201710-1967CI Reference #2: Murao K, Saito A, Kuronuma K, Fujiya Y, Takahashi S, Chiba H. Acute eosinophilic pneumonia accompanied with COVID-19: a case report. Respirol Case Rep. 2020;8(9): e00683. Published 2020 Nov 16. doi:10.1002/rcr2.683 DISCLOSURES: No relevant relationships by Hadya Elshakh No relevant relationships by Christina Jee Ah Rhee no disclosure on file for Lourdes Sanso;

7.
Journal of Pediatric Gastroenterology and Nutrition ; 75(Supplement 1):S258-S259, 2022.
Article in English | EMBASE | ID: covidwho-2058386

ABSTRACT

Background: NASPGHAN guidelines for fellowship training in pediatric gastroenterology (GI) highlight the importance of multidisciplinary treatment across GI conditions. Specific required medical knowledge for pediatric GI fellows includes (1) understanding of the biopsychosocial model and brain-gut axis involvement in functional GI disorders (FGIDs) and (2) familiarity with the role of psychological evaluation and interventions within the multidisciplinary management of FGIDs. Pediatric psychologists are well-suited to provide this training as education of interdisciplinary professionals is a defining competency in pediatric psychology. While pediatric GI psychologists may be informally involved in the training of GI fellows through shared multidisciplinary patient care, we sought to develop a didactic series to formalize a GI Psychology curriculum consistent with clinical training guidelines and the expressed interests of fellows at our institution. Method(s): GI psychologists and GI chief fellows at Children's Hospital of Philadelphia (CHOP) developed an 8-lecture didactic series to be incorporated into an existing weekly didactic meeting for all GI fellows. GI psychologists presented a topic quarterly over the course of 2 training years (FY20-FY21). Topics for the inaugural 2-year series were: Introduction to GI Psychology, Giving the Positive Functional Diagnosis, Cognitive Behavioral Therapy for Functional Abdominal Pain Disorders, Behavioral Interventions for Constipation and Encopresis, Psychosocial Adjustment in Inflammatory Bowel Disease, Behavioral Treatment of Rumination Syndrome, Somatic Symptom Disorders, and Treatment Adherence. In summer 2020, GI psychologists also presented an unplanned didactic session related to coping with secondary traumatic stress during the COVID-19 pandemic. For the next iteration of the 2-year series (FY22-FY23), GI psychologists selected a new topic of Feeding and Eating Difficulties: Role of GI Psychology to replace Introduction to GI Psychology. Introduction to GI Psychology was moved to a fellow orientation session. Fellows participated in the first three years of the program which spanned the inaugural 2-year series and 1 year of a second series (n = 12, 11, 11). Attendance at specific didactic sessions was not recorded. At the end of each training year, fellows completed an anonymous program evaluation survey via REDCap for ongoing quality improvement. Fellows rated 5 items assessing the impact of the didactics on their knowledge of the biopsychosocial approach, delivery of clinical impressions and recommendations, confidence with description of psychological goals and strategies, and recommendations for continuation of the GI Psychology didactics. Items were scored on a 5-point Likert scale ranging from Strongly Agree to Strongly Disagree. During the inaugural 2-year series, the survey also included items rating the value of each didactic topic. Each year the survey allowed for open-ended suggestions for additional topics. Result(s): The GI Psychology didactic series for GI fellows has been implemented successfully at CHOP for an inaugural 2-year series (FY20-FY21) with a second series currently in progress (FY22-FY23). Although survey response rate was low (33% FY20;9% FY21;45% FY22), 100% of the fellows completing the survey Agree/Strongly Agree the didactic series increased their knowledge of the biopsychosocial approach to managing GI conditions, informed how they deliver clinical impressions and treatment recommendations for patients/families, recommended continued GI Psychology involvement in GI fellow didactics and recommended other institutions consider Psychology involvement in GI fellow didactic education. Additionally, 80% of the fellows Agree/Strongly Agree the didactic series increased their confidence to describe common goals and strategies within psychological treatment for patients with GI conditions. Conclusion(s): We describe development of a novel GI Psychology curriculum for GI fellows at CHOP focused on core topics to enhance competency in the biopsychosocial approach across GI conditions, which was favorably evaluated by GI fellows. Fellowship training programs in pediatric GI may wish to consider a similar approach to incorporating didactic training from pediatric psychologists. Doing so may increase relevant medical knowledge and facilitate experience with and use of a multidisciplinary approach to evaluation and management across GI conditions, consistent with NASPGHAN clinical training guidelines and calls for best practice to incorporate integrated psychological care across GI conditions.

8.
Journal of Pediatric Gastroenterology and Nutrition ; 75(Supplement 1):S151-S153, 2022.
Article in English | EMBASE | ID: covidwho-2058337

ABSTRACT

Background: The rapid spread and recurrent infections of SARS-CoV-2 has led to increased use and availability of at-home antigen testing, but widespread testing of antibodies against spike and nucleocapsid to monitor vaccine-induced immunity and exposure to the virus is lacking. Most serological tests require a serum sample from a venous blood draw, increasing risk of exposure to COVID-19 and limiting availability and scalability of testing for many patients. This is especially the case for individuals who are immunocompromised, such as those with inflammatory bowel diseases (IBD), which are frequently on medications that might alter their immune response and impact vulnerability to SARS-CoV-2. Use of easily acquired and stably stored dried fingerstick blood serves a promising specimen source for at-home, remote testing for SARS-CoV-2 antibodies. Aim(s): Validate the use of fingerstick blood (dried and then eluted) versus serum as a specimen for the measurement of quantitative spike and nucleocapsid antibodies to SARS-CoV-2 in a diverse cohort of healthy and immunocompromised patients. Method(s): Patients were consented and enrolled into the Pediatric Gastrointestinal Tissue, Stool, Saliva and Blood Registry prior to having an endoscopic procedure. Five mL of blood was obtained by venipuncture and 10 muL of fingerstick blood was collected and dried on a Neoteryx Mitra device. Blood was eluted from the Neoteryx Mitra samples in 200 muL of dilution buffer (1% BSA, 0.05% Tween-20, 140 mM NaCl, 50 mM Tris (pH 8.0), 0.025% sodium azide) and placed on an orbital shaker at a speed of 500 RPM for 3 h. Paired serum and fingerstick blood eluate specimens were run on the quantitative Roche Elecsys SARS-CoV-2 spike antibody assay and the qualitative Roche Elecsys SARS-CoV-2 nucleocapsid antibody assay. Linear regression were performed on each assay with exclusion of values that were above the upper limit of detection of the assay. Result(s): We observed an excellent correlation in both SARS-CoV-2 antibody assays when comparing fingerstick blood eluates and serum. The linear regression for the nucleocapsid antibody assay had a slope of 15.5, intercept of 4.05, and R2 of 0.92, indicating that a Neoteryx value of 1.00 COI (cut-off index) equates to a serum value of 19.6 COI. The linear regression for the spike assay had a slope of 13.6, intercept of 953, and R2 of 0.95, indicating that a value of 1,000 U/mL from a fingerstick sample equates to a serum value of 14,544 U/mL. Conclusion(s): These data demonstrate that fingerstick blood collected on Neoteryx Mitra devices can be used as a specimen source in Roche Elecsys SARS-CoV-2 antibody assays to calculate the serum levels of spike and nucleocapsid antibodies. This can serve as a platform to remotely and reliably monitor the durability of antibody responses to natural infection with and immunization against SARS-CoV-2 in patients. Chart comparisons of nucleocapsid (top) and spike (bottom) protein antibody levels detected via remote fingerstick collection (Neoteryx, x-axis) and venous blood serum (y-axis).

9.
Journal of Pediatric Gastroenterology and Nutrition ; 75(Supplement 1):S277-S278, 2022.
Article in English | EMBASE | ID: covidwho-2058223

ABSTRACT

Purpose: The COVID-19 pandemic affected children and families in multiple ways- schools closed and migrated online and parents altered work schedules and childcare. Our randomized controlled intervention trial for parents of children with Functional Abdominal Pain Disorders (FAPDs) was underway when the pandemic began. This provided the opportunity to examine how the pandemic and mitigation efforts might affect our research. We evaluated differences in recruitment rates and data completion before vs. during the pandemic, hypothesizing that recruitment would be lower and it would take longer for participants to complete baseline measures. Method(s): The number of participants screened, consented, and randomized to the study was captured from February 2019 to November 2021. At baseline, parents of children with FAPD completed a 14-day pain and stool diary, 3-day food diary, and several psychosocial questionnaires. Based on the date of consent, participants were categorized into two groups: before or during the COVID-19 pandemic (beginning March 2020). A series of independent sample t-tests was conducted to evaluate differences between the two groups on the number of participants screened, consented, and randomized per month and the number of days it took participants to complete the baseline measures. Result(s): A total of 272 parents of children ages 7-12 years who met Rome IV criteria for FAPD were screened for participation in the study. Of these, 110 eligible parents consented to participate, and 92 were randomized to treatment. There were no differences between the before and during COVID-19 groups on the number of participants screened per month and the number of days to complete the pain and stool diary. We found significant differences between the two groups for the number of participants consented and randomized per month and the number of days to complete the food diary and psychosocial questionnaires (Table 1). Conclusion(s): Our findings indicate that rate of recruitment and baseline data collection differed significantly from before to during the COVID-19 pandemic. While there were no significant differences in the number of families screened, significantly fewer of those eligible agreed to participate and were randomized during the pandemic, as we expected. For those who consented, however, it took significantly fewer days for them to complete several study measures, contrary to our hypotheses. While the overall recruitment rate for the trial did decrease during the COVID-19 pandemic (possibly due to parents feeling overwhelmed by the pandemic), data collection became more efficient for those who were enrolled (perhaps reflecting more time spent at home and online). Overall, our findings suggest that conducting studies involving parents of school-age children during the COVID-19 pandemic may face greater challenges, primarily in recruitment. (Table Presented).

10.
Journal of Pediatric Gastroenterology and Nutrition ; 75(Supplement 1):S169-S170, 2022.
Article in English | EMBASE | ID: covidwho-2057931

ABSTRACT

Objective: The primary aim of this quality improvement project focuses on improving compliance with diagnostic testing by 20% over a 6 month period. Background(s): Following the COVID-19 pandemic, there was a rapid upscaling in the use of telehealth. Telehealth is now being used to provide follow up visits in our pediatric gastroenterology fellows clinic, which is comprised of an underserved patient population. Limited access to care has been shown to disproportionately affect underserved populations. Prior to the use of telemedicine, diagnostic testing including blood work was completed or scheduled at the time of visit to promote compliance. With expansion of telemedicine, compliance with diagnostic testing in this patient population became a concern due to limited access and health literacy. Without timely completion of testing and results, there is potential for missed and delayed diagnoses, impeding the ability to treat effectively. Method(s): Prior to initiating intervention, preliminary data was collected including blood work, imaging, and stool studies completed at 2 weeks and by next visit. In PDSA 1, a standardized phrase was created to limit variability amongst providers. Our intervention involved sending Epic patient portal reminder messages within 24 hours of each appointment. In PDSA 2, a second reminder was added 2 weeks post visit. The quality improvement study began August of 2021 and is ongoing. Result(s): Background data was collected for compliance of diagnostic testing at 2 weeks for blood work (33%), imaging (17%), and stool samples (0%). We also collected data on diagnostic testing completed by next visit for blood work (50%), imaging (50%), and stool samples (0%). Post intervention data was then collected over a 6 month period. Our data showed improvement to 50% compliance for completed blood work and 20% compliance for submitted stool samples 2 weeks out from visit. Data showed 100% compliance with blood work and 60% compliance with submitted stool studies prior to next visit, surpassing our goal of 20% improvement in compliance over a 4 month period. Our team also looked at completion of imaging orders, and scheduling of upper endoscopy and colonoscopy procedures prior to next visit. However the numbers were insufficient to draw any meaningful conclusions at this time. Conclusion(s): Our data supports the use of electronic medical record portal messaging systems as a valuable tool for promoting compliance with diagnostic testing in an underserved population following telemedicine visits. This is an opportunity to improve access to care and health equity. Data collection is ongoing for PDSA 2.

11.
Journal of Pure and Applied Microbiology ; 16(3):1628-1632, 2022.
Article in English | EMBASE | ID: covidwho-2044322

ABSTRACT

Strongyloidiasis is a neglected parasitic disease caused by the intestinal parasite, Strongyloides stercoralis. Most patients with strongyloidiasis are asymptomatic, but few present with varied clinical manifestations such as cutaneous, gastrointestinal, pulmonary, and disseminated disease. It creates a diagnostic dilemma and undue delay in the diagnosis of patients. We report the case of a 79-yearold male who presented with fever and abdominal pain due to strongyloidiasis with no history of immunosuppression. The infection resolved entirely on treatment with ivermectin.

12.
Journal of Arthropod Borne Diseases ; 15(4):358-365, 2021.
Article in English | CAB Abstracts | ID: covidwho-2040530

ABSTRACT

Background: Due to the confirmation of the presence of the novel coronavirus in the feces and municipal sewerage system, and the feeding of domestic insects from fecal matter, as well as the ability of these insects to mechanically transmit microbes from the sewerage system. This study was aimed at molecular evaluation of the novel coronavirus infection isolated on cockroaches and flies collected from Kamkar-Arabnia Hospital in Qom City, Iran.

13.
Chinese Journal of Virology ; 36(6):989-996, 2020.
Article in Chinese | GIM | ID: covidwho-2040437

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has become a public-health crisis worldwide. Accurate identification of the virus that causes COVID-19, SARS-CoV-2, carriers of SARS-CoV-2, and infected people is crucial for the prevention and control of this pandemic. Detection of the nucleic acids (NAs) of SARS-CoV-2 is one of the main criteria for COVID-19 diagnosis. Pharyngeal swabs (PSs) and fecal specimens (FSs) tend to be positive for SARS-CoV-2. However, there have been no reports of differences in the detection results of SARS-CoV-2 NAs in PSs and FSs of COVID-19 patients and asymptomatic SARS-CoV-2 infected persons at different exposure times. Forty-six patients diagnosed with COVID 19 in Nanyang City, China, from 2 February to 17 February 2020 and 27 asymptomatic SARS-CoV-2 infected persons screened through epidemiologic history and PSs and FSs at different exposure times were evaluated through detection of SARS-CoV-2 NAs. COVID-19 patients and asymptomatic SARS-CoV-2 infected persons had the highest positive rate of NAs in PSs at week 2 and the highest positive rate for NAs in FSs at week 3. The positive rate of NAs in PSs was significantly higher than that of FSs (P < 0.05). The difference in the positive rate of NAs in PSs between the two groups at 1, 3, and 4 weeks was significant (P < 0.05). The difference in the positive rate of NM in FSs between the two groups at 1-4 weeks was not significant (P > 0.05). The time for SARS-CoV-2 NAs to test positive in FSs lagged behind that for SARS-CoV-2 NAs to test positive in PSs (P > 0.05). The time for SARS-CoV-2 NAs to test positive in the PSs and FSs of asymptomatic SARS-CoV-2 infected persons lagged behind that for COVID-19 patients (P > 0.05). There was no significant difference in the average cycle threshold (Ct) value of the ORFlab gene and N gene of PSs and FSs between COVID-19 patients and asymptomatic SARS-Cov-2 infected persons at each exposure time tested (P > 0.05). The more severe the COVID-19, the higher was the positive rate of SARS-CoV-2 NAs in PSs and FSs, and the shorter was the time taken for SARS-CoV-2 NAs to test positive (P < 0.05). The re-positive rate of asymptomatic SARS-CoV-2 infected persons was 14.81% (4/27), higher than that of COVID-19 patients (6.52%;3/46), and the difference was significant (X2=8.193, P=0.016). Our study suggests that SARS-CoV-2 has a fecal mouth transmission route. The time taken for SARS-CoV-2 NM from FSs to turn positive lags behind that for SARS-CoV-2 NAs in PSs to turn positive, and the positive rate is lower. Test specimens should be selected according to different exposure times. Attention should he paid to younger asymptomatic SARS-CoV-2 infected persons.

14.
Chinese Journal of Virology ; 36(6):997-1003, 2020.
Article in Chinese | GIM | ID: covidwho-2034152

ABSTRACT

To investigate the characteristics of the nucleic acids of severe acute respiratory syndrome coronavirus (SARS-CoV) -2 and antibodies in different specimens obtained from coronavirus disease 2019 (COVID-19) patients;if a correlation between these parameters and the disease course was present. The throat swabs and stool samples of 39 COVID-19 patients admitted to our hospital were collected in this study. Real-time reverse transcription-quantitative polymerase chain reaction (RT-PCR) was undertaken on throat swabs and stool samples. Peripheral blood was taken and serum levels of immunoglobulin IgM and IgG measured. Results showed That, Throat swabs and stool samples tested positive for the nucleic acid of SARS-CoV-Z, but nucleic acid levels were reduced significantly 15 days after disease onset compared with that upon diagnosis. The Ct value of the nucleic acid test was increased significantly. Serum levels of IgM and IgG were significantly higher than those of healthy people. nucleic acid loads in throat swabs and stool samples as well as serum levels of IgM and IgG were highly correlated with the disease course (r = 0.7387,0.5696, -0.546 and 0.6117,respectively, P < 0.05). In this study nucleic acid loads in throat swabs and stool samples as well as serum levels of IgM and IgG are highly correlated with the course of COVID-19.

15.
GERMS ; 12(2):298-303, 2022.
Article in English | EMBASE | ID: covidwho-2033515

ABSTRACT

Introduction COVID-19 is an emerging infectious disease that remains to be further investigated. Case report Here, we describe a case of COVID-19 in an octogenarian woman with comorbidities who slowly recovered during hospitalization, but died due to sudden cardiac death after 2 weeks of hospitalization. Her nasopharyngeal and anal swabs returned positive for SARS-CoV-2 by RT-PCR on day 7 of hospitalization. The NGS showed possible intraindividual evolution of virus. The sample from the nasopharyngeal swab yielded a B.1470 variant classified as clade GH. This variant showed mutation in the spike gene D614G;N gene;NS3 gene;NSP2 gene and NSP12 gene. The sample from the anal swab showed similar mutation but with additional point mutation in spike gene S12F and was classified as B.1.465 variant. Conclusions The possibility of the gastrointestinal tract that served as reservoir for virus mutation accumulation should also be considered and the potential impact of viral fecal transmission in the environment should be further investigated.

16.
Journal of the Canadian Association of Gastroenterology ; 4, 2021.
Article in English | EMBASE | ID: covidwho-2032052

ABSTRACT

Background: Leflunomide is an oral disease-modifying antirheumatic drug (DMARD), with anti-inflammatory and immunomodulatory properties that has been in use since 1998. Common leflunomide side-effects include gastrointestinal symptoms (nausea, abdominal pain and diarrhea), occurring in 10-20% of patients treated with leflunomide. Scarce evidence exists that leflunomide can cause colitis. Aims: We present the case of a 61-year-old female, with Lupus Erythematosus who presented with colitis induced by long-term leflunomide treatment. Methods: Case report and review of literature Results: A 61-year-old female was seen by the gastroenterology team with complaints of diarrhea ongoing for 6 weeks associated with 10 lb weight loss. The patient had a complex medical history, including lupus, hypothyroidism, asthma, atrial fibrillation, recurrent C. difficile infection, Bell's palsy and avascular necrosis secondary to long-term corticosteroid therapy. Previous immunosuppressive therapies included prednisone, mycophenolic acid (Myfortic), hydroxychloroquine, azathioprine, mycophenolate (CellCept) but due to multiple intolerances, she was initiated on leflunomide in 2014 and has been maintained on it since. Stool analysis ruled out infectious causes. COVID-19 testing was also negative. A CT of the abdomen revealed pancolitis. This was confirmed on colonoscopy, which revealed mild, Mayo 1 pancolitis and normal terminal ileum. She was initiated on Mezavant as a treatment for possible ulcerative colitis. However, during the hospitalization her symptoms, worsened and bloody diarrhea was noted. She underwent a subsequent endoscopic evaluation which revealed more severe disease, Mayo 2-3 colitis, with mucosal hyperemia and ulcerations, as well as effacement of the vasculature. Initial pathology results revealed mild colitis, but repeat pathology results revealed moderate active colitis, with cryptitis, crypt abscesses and significant apoptosis consistent with drug-induced colitis. Given these findings, the diagnosis of leflunomide-induced colitis was made. Leflunomide was therefore discontinued, the patient was initiated on a higher dose of corticosteroids and cholestyramine was initiated. Following these measures, her diarrhea resolved. Conclusions: Leflunomide may cause diarrhea in up to 33% of patients. Challenges related to the diagnosis of leflunomide-induced colitis exist, including the rarity of the diagnosis, a not completely understood mechanism for acute leflunomide-induced diarrhea, as well as variable endoscopic and histologic findings associated with the diagnosis. This report illustrates a case of leflunomide-induced colitis which should be considered in patients on leflunomide, who present with symptoms of abdominal pain and diarrhea, even years after medication initiation.

17.
Journal of the Canadian Association of Gastroenterology ; 4, 2021.
Article in English | EMBASE | ID: covidwho-2032051

ABSTRACT

Background: Appropriate management of inflammatory bowel disease (IBD) often requires multiple specialist appointments per year. Living in rural locations may pose a barrier to regular specialist care. Saskatchewan (SK) has a large rural population. Prior to COVID-19, telehealth (TH) in SK was not routinely used for either patient assessment or follow up. Furthermore, TH was exclusively between hospitals and specific TH sites without direct contact using patient's personal phones. Aims: The objective of this study was to assess the differences in demographics, disease characteristics, outcomes, and health care utilization between patients from rural SK with IBD who used TH and those who did not. Methods: A retrospective chart review was completed on all rural patients (postal code S0∗) with IBD in SK who were followed at the Multidisciplinary IBD Clinic in Saskatoon between January 2018 and February 2020. Patients were classified as using TH if they had ever used it. Information on demographics, disease characteristics, and access to IBD-related health care in the year prior to their last IBD clinic visit or endoscopy was collected. Data was not collected for clinic visits after March 1, 2020 as all outpatient care became remote secondary to the COVID-19 pandemic. Mean, standard deviations, median and interquartile ranges (IQR) were reported. Mann-Witney U and Chi-Square tests were used to determine differences between the groups. Results: In total, 288 rural SK IBD patients were included, 30 (10.4%) used TH and 258 (89.6%) did not. Patient demographics were not significantly different between the two groups;although, there was a statistically significant difference in the proportion of ulcerative colitis patients (17% TH vs. 38% non-TH, p=0.02). The percentage of patients with clinical remission was 87% for TH patients and 74% for non-TH patients (p=0.13). There were no significant differences in health care utilization patterns and biochemical markers of disease, including c-reactive protein (CRP) and fecal calprotectin (FCP) (p>0.05). Conclusions: Prior to the pandemic, a small percentage of patients with IBD in rural SK ever used TH. A small proportion of UC patients used TH. No significant differences in disease characteristics, outcomes, or health care utilization were identified. Further study is warranted to identify barriers to use of this technology to tailor care to this patient group and improve access to care, especially now as the COVID-19 pandemic has drastically changed the use of virtual care.

18.
Gut ; 2022.
Article in English | ProQuest Central | ID: covidwho-2020118

ABSTRACT

Inflammatory bowel disease (IBD) continues to carry an increased risk of colon cancer and national protocols for endoscopic surveillance are in place. [...]we propose the patient factors to consider when withdrawal of surveillance may be contemplated. Alternative strategies, such as the qFIT and virtual colonoscopy (either via CT or capsule), have not been used in IBD surveillance. qFIT, which measures the concentration of degraded haemoglobin and is raised in ulcerative colitis (UC) patients with active inflammation,12 13 has not been validated as a marker of IBD-related dysplasia. A faecal calprotectin threshold of >250 [micro]g/g to indicate disease activity is based on consensus and published evidence. 31-33 A three-point colonoscopy indicates a 45-minute procedure. 1st DR, first degree relative;CRC, colorectal cancer;FH, family history;IBD, inflammatory bowel disease;PSC, primary sclerosing cholangitis;qFIT, quantitative Faecal Immunochemical Test for haemoglobin The Gastroenterology GIRFT report has recommended the use of stool biomarkers to aid in the prioritisation of colonoscopy procedures on waiting lists.

19.
Archives of Disease in Childhood ; 107(Suppl 2):A214, 2022.
Article in English | ProQuest Central | ID: covidwho-2019872

ABSTRACT

AimsIntroductionCampylobacter infection is not uncommon in children, and extraintestinal manifestations following Campylobacter is a recognized entity, although hepatitis is rare. We present a case of anicteric hepatitis associated with Campylobacter infection in a 13-year-old boyMethodsCase StudyA previously healthy 13-year-old boy was admitted to the paediatric department with a 4-day history of fever and crampy abdominal pain which was localized to the right upper quadrant. He reported loss of appetite and nausea.He was not encephalopathic. His clinical examination was unremarkable, except for diffuse tenderness on deep palpation of the abdomen, especially of the right upper quadrant.His stools were normal initially but 48 hours after admission he developed severe diarrhoea.ResultsHe had elevated alanine transaminase (ALT) level (181 IU/L) on admission. The full blood count showed elevated white cell count with neutrophil leukocytosis, and C-reactive protein level was high (196mg/L). His prothrombin time (PT) and activated partial thromboplastin time (APTT) were within normal limits. The faecal molecular assay detected presence of Campylobacter by polymerase chain reaction (PCR). It did not identify any other organism.The viral hepatitis (Hepatitis A IgM, Hepatitis B surface antigen, Hepatitis C IgM, Hepatitis E IgM, and IgG) panel, Epstein-Barr virus (IgG for nuclear antigen, IgM, and IgG for viral capsid antigen), Cytomegalovirus (IgM and IgG) and Parvovirus B19 (IgM and IgG) screening were negative. Pandemic corona virus was not detected on PCR testing. The auto-antibody panel for autoimmune hepatitis (Anti-nuclear antibody, Anti-smooth muscle antibody, Anti-mitochondrial antibody, Liver kidney microsomal antibody) were normal. The ceruloplasmin level and Alpha-1 anti-trypsin levels were not low. The ultrasound scan of the abdomen revealed normal hepatic architecture, making a chronic liver disease less likely. An alternative explanation for high transaminases were not found.He improved clinically within a week and his liver functions continued to improve.ConclusionDiscussionCampylobacter infection has been associated with extra-intestinal manifestations like Guillain-Barre Syndrome, pancreatitis, erythema nodosum, haemolytic uremic syndrome, thrombotic thrombocytopenic purpura, haemolytic anaemia, glomerular nephritis, and reactive arthritis. Hepatitis is a rare complication of Campylobacterinfection and is rarely reported in medical literature.

20.
Medicine Today ; 22(4):43-46, 2021.
Article in English | Scopus | ID: covidwho-2011566

ABSTRACT

Coronavirus disease 2019 (COVID-19) is known to result in gastrointestinal symptoms and liver damage. Consideration needs to be given to COVID-19 as a potential cause of new-onset gastrointestinal symptoms. Awareness of special issues affecting patients with chronic gastrointestinal and liver diseases in a pandemic is important. © 2021 Medicine Today Pty Ltd. All rights reserved.

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