A case of Legionnaires' disease with severe rhabdomyolysis misdiagnosed as COVID-19.

Background: COVID-19 case numbers have begun to rise with the recently reported Omicron variant. In the last two years, COVID-19 is the first diagnosis that comes to mind when a patient is admitted with respiratory symptoms and pulmonary ground-glass opacities. However, other causes should be kept in mind as well. Here we present a case of Legionnaires' disease misdiagnosed as COVID-19. Case presentation: A 48-year-old male was admitted with complaints of dry cough and dyspnea. Chest computed-tomography revealed bilateral ground-glass opacities; therefore, a preliminary diagnosis of COVID-19 was made. However, two consecutive COVID PCR tests were negative and the patient deteriorated rapidly. As severe rhabdomyolysis and acute renal failure were present, Legionnaires' disease was suspected. Urine antigen test for Legionella and Legionella pneumophila PCR turned out to be positive. The patient responded dramatically to intravenous levofloxacin and was discharged successfully. Discussion: Legionnaires' disease and COVID-19 may present with similar signs and symptoms. They also share common risk factors and radiological findings. Conclusions: Shared clinical and radiological features between COVID-19 and other causes of acute respiratory failure pose a challenge in diagnosis. Other causes such as Legionnaires' disease must be kept in mind and appropriate diagnostic tests should be performed accordingly.

The impact of COVID-19 pandemic on nosocomial multidrug-resistant bacterial bloodstream infections and antibiotic consumption in a tertiary care hospital Auswirkungen der COVID-19-Pandemie auf nosokomiale Blutstrominfektionen durch multiresistente Bakterien und auf den Antibiotikaverbrauch in einem Krankenhaus der Tertiärversorgung

We investigated the change in the epidemiology of nosocomial bloodstream infections (BSIs) caused by multidrug-resistant bacteria during Coronavirus Disease (COVID-19) and antibiotic consumption rates at a pandemic hospital and at the Oncology Hospital which operated as COVID-19-free on the same university campus. Significant increases in the infection density rate (IDRs) of BSIs caused by carbapenem-resistant Acinetobacter baumannii (CRAB) and ampicillin-resistant Enterococcus faecium (ARE) were detected at the pandemic hospital, whereas carbapenem-resistant Klebsiella pneumoniae BSIs were increased at the non-pandemic Oncology Hospital. Pulsed field gel electrophoresis showed a polyclonal outbreak of CRAB in COVID-19 intensive care units. Antibiotic consumption rates were increased for almost all antibiotics, and was most significant for meropenem at both of the hospitals. Increased IDRs of CRAB and ARE BSIs as well as an increased consumption rate of broad-spectrum antibiotics emphasize the importance of a multimodal infection prevention strategy combined with an active antibiotic stewardship program.

The impact of COVID-19 pandemic on nosocomial multidrug-resistant bacterial bloodstream infections and antibiotic consumption in a tertiary care hospital.

We investigated the change in the epidemiology of nosocomial bloodstream infections (BSIs) caused by multidrug-resistant bacteria during Coronavirus Disease (COVID-19) and antibiotic consumption rates at a pandemic hospital and at the Oncology Hospital which operated as COVID-19-free on the same university campus. Significant increases in the infection density rate (IDRs) of BSIs caused by carbapenem-resistant Acinetobacter baumannii (CRAB) and ampicillin-resistant Enterococcus faecium (ARE) were detected at the pandemic hospital, whereas carbapenem-resistant Klebsiella pneumoniae BSIs were increased at the non-pandemic Oncology Hospital. Pulsed field gel electrophoresis showed a polyclonal outbreak of CRAB in COVID-19 intensive care units. Antibiotic consumption rates were increased for almost all antibiotics, and was most significant for meropenem at both of the hospitals. Increased IDRs of CRAB and ARE BSIs as well as an increased consumption rate of broad-spectrum antibiotics emphasize the importance of a multimodal infection prevention strategy combined with an active antibiotic stewardship program.

Relative Vaccine Effectiveness of the Third Dose of CoronaVac or BNT162b2 Following a Two-Dose CoronaVac Regimen: A Prospective Observational Cohort Study from an Adult Vaccine Center in Turkey.

Coronavirus disease 2019 (COVID-19) continues to pose a threat to public health with the potential for the emergence of new variants. Vaccines are the milestones to control and slow down the damage of the pandemic. As of January 2021, a two-dose regimen with CoronaVac was authorized in Turkey. Due to the waning seroprevalence rate of SARS-CoV-2 over time, BNT162b2 or CoronaVac has been administered as the third dose following a two-dose CoronaVac regimen as a national vaccination policy. As of 14 January 2021, 5243 volunteers who received two doses of the CoronaVac vaccine at Hacettepe University Adult Vaccine Center were followed prospectively. In our study, relative vaccine effectiveness (VEff) for the third dose of the CoronaVac was 58.24% and 87.27% for BNT162b2 in preventing symptomatic COVID-19 cases. There were no hospitalizations, intensive care unit admissions, or deaths in third-dose booster groups with either BNT162b2 or CoronaVac, yielding 100% effectiveness. Both homologous or heterologous third-dose boosters provided further protection against severe COVID-19 and should be prioritized as an effective strategy to combat the COVID-19 pandemic.

A screening study for COVID-19-associated pulmonary aspergillosis in critically ill patients during the third wave of the pandemic.

BACKGROUND: COVID-19-associated pulmonary aspergillosis (CAPA) has been reported as an important cause of mortality in critically ill patients with an incidence rate ranging from 5% to 35% during the first and second pandemic waves. OBJECTIVES: We aimed to evaluate the incidence, risk factors for CAPA by a screening protocol and outcome in the critically ill patients during the third wave of the pandemic. PATIENTS/METHODS: This prospective cohort study was conducted in two intensive care units (ICU) designated for patients with COVID-19 in a tertiary care university hospital between 18 November 2020 and 24 April 2021. SARS-CoV-2 PCR-positive adult patients admitted to the ICU with respiratory failure were included in the study. Serum and respiratory samples were collected periodically from ICU admission up to CAPA diagnosis, patient discharge or death. ECMM/ISHAM consensus criteria were used to diagnose and classify CAPA cases. RESULTS: A total of 302 patients were admitted to the two ICUs during the study period, and 213 were included in the study. CAPA was diagnosed in 43 (20.1%) patients (12.2% probable, 7.9% possible). In regression analysis, male sex, higher SOFA scores at ICU admission, invasive mechanical ventilation and longer ICU stay were significantly associated with CAPA development. Overall ICU mortality rate was higher significantly in CAPA group compared to those with no CAPA (67.4% vs 29.4%, p < .001). CONCLUSIONS: One fifth of critically ill patients in COVID-19 ICUs developed CAPA, and this was associated with a high mortality.

Pretreatment serum uric acid level is not a surrogate marker for the outcome of favipiravir treatment in COVID-19 patients.

BACKGROUND: To the editor, Favipiravir (FVP) was developed against the influenza virus infection and licensed for the treatment of influenza in Japan [1]. In addition to influenza viruses, FVP demonstrates a broad-spectrum activity against many RNA viruses including Ebola, Lassa, rabies, and severe fever with thrombocytopenia [2]. FVP exhibited a comparable in vitro efficacy against SARS-CoV-2 with remdesivir in a cell culture model [3]. DISCUSSION: The authors would like to acknowledge the contributions of numerous physicians, nurses, and healthcare personnel of Hacettepe University's COVID-19 response team for their selfless efforts in follow-up and care of the patients. Authors declare that there is no conflict of interest.

Outcome of noncritical COVID-19 patients with early hospitalization and early antiviral treatment outside the ICU

Background/aim: Despite the fact that the COVID-19 pandemic has been going on for over 5 months, there is yet to be a standard management policy for all patients including those with mild-to-moderate cases. We evaluated the role of early hospitalization in combination with early antiviral therapy with COVID-19 patients in a tertiary care university hospital. Materials and methods: This was a prospective, observational, single-center study on probable/confirmed COVID-19 patients hospitalized in a tertiary care hospital on COVID-19 wards between March 20 and April 30, 2020. The demographic, laboratory, and clinical data were collected. Results: We included 174 consecutive probable/confirmed COVID-19 adult patients hospitalized in the Internal Medicine wards of the University Adult Hospital between March 20 and April 30, 2020. The median age was 45.5 (19­92) years and 91 patients (52.3%) were male. One hundred and twenty (69%) were confirmed microbiologically, 41 (23.5%) were radiologically diagnosed, and 13 (7.5%) were clinically suspected (negative microbiological and radiological findings compatible with COVID-19); 35 (20.1%) had mild, 107 (61.5%) moderate disease, and 32 (18.4%) had severe pneumonia. Out of 171 cases, 130 (74.3%) showed pneumonia; 80 were typical, and 50 showed indeterminate infiltration for COVID-19. Patients were admitted within a median of 3 days (0-14 days) after symptoms appear. The median duration of hospitalization was 4 days (0-28 days). In this case series, 13.2% patients were treated with hydroxychloroquine alone, 64.9% with hydroxychloroquine plus azithromycin, and 18.4% with regimens including favipiravir. A total of 15 patients (8.5%) were transferred to the ICU. Four patients died (2.2%). Conclusion: In our series, 174 patients were admitted to the hospital wards for COVID-19, 69% were confirmed with PCR and/or antibody test. At the time of admission, nearly one fifth of the patients had severe diseases. Of the patients, 95.4% received hydroxychloroquine alone or in combination. The overall case fatality rate was 2.2%.

Prolonged viral shedding in a lymphoma patient with COVID-19 infection receiving convalescent plasma.

Acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first identified in Wuhan, China; and spread all over the world. Reverse-transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2 usually returns to negative in 20 days post-infection, but prolonged positivity has been reported up to 63 days. A case whose viral shedding lasted 60 days is reported from China. Herein we report a patient with a history of autologous stem cell transplantation (ASCT) for lymphoma whose RT-PCR test remained positive for SARS-CoV-2 for 74 days. The prolonged RT-PCR positivity, despite convalescent plasma infusion, may suggest that the given antibodies may be ineffective in terms of viral clearance. In patients with hematological malignancies or immunosuppression, such as ASCT, may lead to prolonged viral shedding, and strict isolation is warranted for long-term SARS-CoV-2 infection control.

The effects of blood group types on the risk of COVID-19 infection and its clinical outcome

Background/aim: COVID-19 (Coronavirus disease of 2019) is an infectious disease outbreak later on declared as a pandemic, caused by the SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2). It spreads very rapidly and can result in severe acute respiratory failure. The clinical studies have shown that advanced age and chronic diseases increase the risk of infection. However, influence of the blood groups on COVID-19 infection and its outcome remains to be confirmed. The aim of this study is to investigate whether there exists a relationship between the blood groups of the patients and risk of SARS-CoV-2 infection and the clinical outcomes in COVID-19 patients Material and method: 186 patients with PCR confirmed diagnosis of COVID-19 were included in this study. Age, sex, blood groups, comorbidities, need for intubation and intensive care unit follow up and mortalities of the patients were analyzed retrospectively. 1881 healthy individuals, who presented to the Hacettepe University Blood Bank served as the controls. Results: The most frequently detected blood group was blood group A (57%) amongst the COVID-19 patients. This was followed by blood group O (24.8%). The blood group types did not affect the clinical outcomes. The blood group A was statistically significantly more frequent among those infected with COVID-19 compared to controls (57% vs. 38%, P < 0.001; OR: 2.1). On the other hand, the frequency of blood group O was significantly lower in the COVID-19 patients, compared to the control group (24.8% vs. 37.2%, P: 0.001; OR: 1.8). Conclusions: The results of the present study suggest that while the blood group A might have a role in increased susceptibility to the COVID-19 infection, the blood group O might be somewhat protective. However, once infected, blood group type does not seem to influence clinical outcome.