Treatment of persistent COVID-19 in two B-cell-depleted patients with the monoclonal antibody Sotrovimab.

Background: Patients having undergone B-cell-depletion with anti-CD20-antibodies have a higher risk of mortality, delayed viral clearance and prolonged infection due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report two cases of patients with persistent coronavirus disease 2019 (COVID-19) in association with B-cell-depletion that were treated with the monoclonal antibody Sotrovimab. Case presentation: Both patients presented with chronic symptoms of COVID-19 such as dyspnea, fatigue, and chest pain. Nasopharyngeal swabs remained positive months after the initial infection with fluctuating cycle threshold (Ct) values around 30. Both patients received a single infusion with the monoclonal SARS-CoV-2 antibody Sotrovimab, which resulted in a rapid improvement of symptoms and inflammation markers as well as negative SARS-CoV-2 swabs. A follow-up after a month showed ongoing improvement of symptoms, persistent negative SARS-CoV-2 swabs, and positive serum antibodies. Conclusion: Infusion with the monoclonal SARS-CoV-2 antibody led to rapid improvement in two patients with persistent COVID-19 after B-cell depletion.

Distinct differences in clinical manifestation and viral laboratory parameters between children and adults with influenza A(H1N1)pdm09 infection--a retrospective comparative analysis.

During the influenza pandemic 2009 children and adults differed in the clinical course of the influenza disease. In following the question arose, if the case definitions used within the national and international organizations are an adequate tool for the clinical diagnosis of influenza in children as well as in adults. Therefore medical charts from 146 children and 229 adults were retrospectively analyzed. In addition, the initial viral loads of all 375 patients and the duration of virus shedding of a subset of 79 patients were also investigated. Children show a wider clinical spectrum including gastro enteric symptoms and also a different spectrum of laboratory parameters like elevated CRP-levels, leucocytosis, and higher viral loads. Further, children show significantly more often complications, for example, myositis that may be underdiagnosed. In patients receiving antiviral-therapy complications occurred significantly less often and the presence of symptoms was significantly shorter compared to the untreated group (2.3 days vs. 6.0 days). In summary, the differences in the clinical picture between children and adults should be taken into consideration for the clinical diagnosis of influenza and also for a future discussion on age specific influenza case definitions.

Annoying vacation souvenir: Fish tapeworm (Diphyllobothrium sp.) infestation in an Austrian fisherman.

Diphyllobothriosis is infestation with the fish tapeworm. Although the worldwide incidence has decreased in recent decades, increased travel and the new popularity of dishes involving raw fish (e.g. sushi) may provide a higher risk of infestation in formerly low-risk areas. We report an Austrian fisherman who passed a 75 cm tapeworm segment in his stool. Infestation presumably occurred 14 months earlier during a fishing tour in Alaska. At presentation, the patient was asymptomatic, reported no weight loss and showed neither anaemia nor eosinophilia. He was cured with a single dose of 10 mg/kg body weight praziquantel.

[Are new antibiotics in therapy of respiratory tract infections necessary?]. / Sind neue Antibiotika in der Therapie respiratorischer Infekte notwendig?

Increasing worldwide antibacterial resistance among respiratory pathogens, especially S. pneumoniae, are an emerging problem in the treatment of respiratory tract infections. In some areas penicillin-resistant S. pneumoniae increased to 80% and macrolide-resistance and MLSb-resistance are an evolving problem. In addition, increasing resistance to quinolones has been documented in Hong Kong and in Spain. One way to combat increasing resistance is the development of new antimicrobial drugs. However, the practice of just changing one drug for another without also altering poor prescribing habits merely results in different resistance issues. In the long-term, to prevent increasing resistance, clinicians must be aware of restrictive antibiotic prescription and adequate dosages.

Intestinal Candida phospholipase is not elevated in patients with antibiotic-associated diarrhea.

In order to assess the role of Candida-secreted phospholipase in antibiotic-associated diarrhea (AAD), 43 fecal Candida isolates from patients with AAD and from controls were tested on egg yolk agar for production of phospholipase. Phospholipase zones did not differ between the isolates from patients with AAD and from controls. The data indicate that the fungal virulence factor phospholipase may not be responsible for AAD in adults.