Comparative Analysis of Circulating Levels of SARS-CoV-2 Antibodies and Inflammatory Mediators in Healthcare Workers and COVID-19 Patients.

Advances in knowledge of the pathophysiology of COVID-19 have been acquired; however, the host factors that could explain the mild and severe forms of the disease are not fully understood. Thus, we proposed to evaluate anti-SARS-CoV-2 antibodies and the inflammatory response of different groups of individuals, including healthcare workers (HCW), sick and dead COVID-19 patients and also recovered patients to contribute to this knowledge gap. Our objective is to relate the clinical evolution of these individuals with the level of detection and functionality of specific antibodies and with the production of inflammatory mediators. As main findings, IgA and IgG anti-SARS-CoV-2 were detected in asymptomatic HCW. IFN-γ and TNF-α levels were higher in symptomatic HCWs than patients with COVID-19 and those who died. Patients who died had higher levels of IL-6, IL-10, and CCL2/MCP-1. We found an imbalance between antiviral and pro-inflammatory mediators in the groups, in which IFN-γ and TNF-α seem to be more associated with protection and IL-6 and CCL2/MCP-1 with pathology. Our work is pioneering the Brazilian population and corroborates data from people from other countries.

Infective endocarditis caused by Enterobacteriaceae: phenotypic and molecular characterization of Escherichia coli and Klebsiella pneumoniae in Rio de Janeiro, Brazil.

The etiological agent for infective endocarditis (IE), a life-threatening disease, is usually gram-positive bacteria. However, gram-negative bacteria can rarely cause IE and 4% of cases are associated with morbidity and mortality. This study aimed to characterize Escherichia coli and Klebsiella pneumoniae isolates from the blood of patients with IE. The characteristics of blood isolates were compared with those of urinary isolates from patients with urinary tract infections (UTIs). The results of this study revealed that K. pneumoniae isolates from patients with IE were phylogenetically related to those from patients with UTI. Additionally, the resistance phenotype, resistance gene, virulence gene, and plasmid profiles were similar between the blood and urinary isolates. The isolates belonging to the sequence types (STs) 76, 36, 101 (K. pneumoniae), and 69 (E. coli) are reported to be associated with drug resistance. The Enterobacteriaceae isolates from patients with IE did not produce extended-spectrum ß-lactamase or carbapenemase. Additionally, this study investigated the virulence phenotype, biofilm formation ability, and the ability to adhere to the epithelial cells in vitro of the isolates. The isolates from patients with IE exhibited weaker biofilm formation ability than the urinary isolates. All isolates from patients with IE could adhere to the renal epithelial cells. However, three isolates from patients with UTIs could not adhere to the epithelial cells. The closely related K. pneumoniae isolates (648, KP1, KP2, KP3, and KP4) could not form biofilms or adhere to the epithelial cells. In summary, the molecular analysis revealed that the genetic characteristics of IE-causing K. pneumoniae and E. coli were similar to those of UTI-causing isolates. These isolates belonged to the STs that are considered treatable. Genetically similar isolates did not exhibit the same virulence phenotype. Thus, these non-hypervirulent clones must be monitored as they can cause complex infections in susceptible hosts.

Risk factors associated with mortality in patients hospitalized for coronavirus disease 2019 in Rio de Janeiro, Brazil.

INTRODUCTION: Understanding the mortality-associated risk factors of coronavirus disease 2019 will impact clinical decisions. METHODS: This retrospective longitudinal study included patients hospitalized for coronavirus disease in Rio de Janeiro, Brazil. The Kaplan-Meier method and multivariate Cox regression analysis were used. RESULTS: Sequential Organ Failure Assessment score of ≥2 (hazard ratio 4.614; 95% confidence interval =2.210-9.634; p<0.001) and neutrophil/lymphocyte ratio of >5 (hazard ratio=2.616; 95% confidence interval=1.303-5.252; p=0.007) were independently associated with mortality. CONCLUSIONS: Sequential Organ Failure Assessment score and neutrophil/lymphocyte ratio on admission can identify coronavirus disease patients at increased risk of death and guide subsequent clinical decisions.

Risk factors associated with mortality in patients hospitalized for coronavirus disease 2019 in Rio de Janeiro, Brazil

Abstract INTRODUCTION: Understanding the mortality-associated risk factors of coronavirus disease 2019 will impact clinical decisions. METHODS: This retrospective longitudinal study included patients hospitalized for coronavirus disease in Rio de Janeiro, Brazil. The Kaplan-Meier method and multivariate Cox regression analysis were used. RESULTS: Sequential Organ Failure Assessment score of ≥2 (hazard ratio 4.614; 95% confidence interval =2.210-9.634; p<0.001) and neutrophil/lymphocyte ratio of >5 (hazard ratio=2.616; 95% confidence interval=1.303-5.252; p=0.007) were independently associated with mortality. CONCLUSIONS: Sequential Organ Failure Assessment score and neutrophil/lymphocyte ratio on admission can identify coronavirus disease patients at increased risk of death and guide subsequent clinical decisions.