Correlations between D-Dimer, C-Reactive Protein and Hematologic Data in Outpatients with COVID-19.

BACKGROUND: The main goal of this study is to evaluate correlations between D-dimer, C-reactive protein (CRP), and hematologic data in outpatients with COVID-19. We also aimed to assess if the correlations found for hospitalized patients can be applied to outpatients. METHODS: We performed a retrospective study including 100 outpatients, 51 women and 49 men, mean age 51 ± 15 years, from August 2020 to January 2022, diagnosed positive with COVID-19 by real time RT-PCR or rapid antigens test. RESULTS: The most affected age group with COVID-19 was 51 - 60 years with 29%, whereas 73% of outpatients were less than 60 years. Hematologic data in most outpatients were normal, only 23% of them had an increased neutrophil to lymphocyte ratio (NLR) and 22% had decreased the lymphocyte count. Regarding inflammatory parameters 42% had CRP above the reference range and only 22% had an increased value of D-dimer. We have found correlations between D-dimer and CRP (r = 0.39, p < 0.02). CRP and WBC (r = 0.42, p < 0.011), CRP and NLR (r = 0.73, p < 0.001). White blood cells (WBC) and NLR (r = 0.58, p < 0.001), WBC and platelets (r = 0.45, p < 0.004). CONCLUSIONS: We conclude that the correlations found between the variables studied are found to be present in outpatients and therefore they can serve as good markers to decide whether further tests need to be performed for the diagnosis of severe cases and prognosis of COVID-19.

Accuracy of the QIAxcel Automated System for MIRU-VNTR Genotyping of Mycobacterium tuberculosis in Two Limited Resource Settings.

Mycobacterial interspersed repetitive units variable number tandem repeat (MIRU-VNTR) typing of Mycobacterium tuberculosis complex (MTBC) isolates, based on 24 loci, is still widely used as the standard for routine molecular surveillance of tuberculosis (TB). QIAxcel system is proposed as an affordable tool that could replace conventional gel electrophoresis and provide high concordance with the reference methods regarding MIRU-VNTR typing of MTBC. We aimed to evaluate the QIAxcel accuracy for allele calling of MIRU-VNTR loci in two regional reference laboratories. A total of 173 DNA were used for the study. Results obtained with QIAxcel were compared to the reference results obtained with an ABI 3730 DNA analyzer. In Albania, the overall agreement with the reference method was 97.92%. A complete agreement result was obtained for 17 loci. In Tunisia, the overall agreement with the reference method was 98.95%. A complete agreement result was obtained for 17 loci. Overall agreement in both centers was 98.43%. In our opinion, use of QIAxcel technology has the potential to be reliable, given an optimized algorithm. Inaccuracies in sizing of long fragments should be solved, especially regarding locus 4052.

Isolation of the first New Delhi metallo-ß-lactamase-1 (NDM-1)-producing and colistin-resistant Klebsiella pneumoniae sequence type ST15 from a digestive carrier in Albania, May 2018.

OBJECTIVES: Carbapenemases represent a public health threat, as they can spread through horizontal gene transfer and cause outbreaks. New Delhi metallo-ß-lactamase-1 (NDM-1) is a metallo-ß-lactamase that has spread rapidly in the last decade, causing worldwide alarm. This study aimed to describe the first isolate of NDM-1-producing and extensively drug resistant Klebsiella pneumoniae in Albania, its clinical context and genetic characterization. METHODS: Strain was isolated from both oral and rectal intensive care unit admission screening swabs of a 70-year-old male patient with no history of international travel in the previous 6 months. Sequencing was performed by Illumina NextSeq500 platform, with a paired-end run of 2 by 150bp, after Nextera XT paired-end library preparation. Sequencing reads were assembled using SPAdes Genome (version 3.6.1) with accurate de novo settings. The assembled contigs were uploaded into the online tools: BIGSdb-Kp, ResFinder and PlasmidFinder. RESULTS: Isolate was resistant to all tested antibiotics but tigecycline and trimethoprim-sulfamethoxazole. Sequencing revealed the presence of acquired resistance genes conferring resistance to ß-lactams (blaNDM-1, blaCMY-6, blaCTX-M-15and blaSHV-28), aminoglycosides (rmtC, aac(6')-Ib3), fluoroquinolones (oqxA, oqxB, aac(6')-Ib-cr), fosfomycin (fosA) and sulfonamides (sul1). The blaNDM-1 gene was located on an IncA/C2 plasmid. Plasmid mediated mcr-1 to mcr-8 genes were absent in both isolates. Resistance to colistin was due to an amino acid substitution (Thr157Pro) in PmrB protein. CONCLUSIONS: NDM-1-producing Enterobacteriaceae are spreading in the Balkans. Identification of NDM-1-producing and extensively drug resistant K. pneumoniae ST15 in Albania is a cause for serious concern. There should be a continuous national and Balkan multinational surveillance of blaNDM-1-carrying isolates.

Fulminate Hepatic Failure in a 5 Year Old Female after Inappropriate Acetaminophen Treatment.

BACKGROUND: Acetaminophen is a drug widely used in children because of its safety and efficacy. Although the risk of its toxicity is lower in children such reactions occur in pediatric patients from intentional overdoses and less frequently attributable to unintended inappropriate dosing. The aim of reporting this case is to attract the attention to the risk of the acetaminophen toxicity when administered in high doses. CASE PRESENTATION: We report here a 5 year old girl who developed fulminate liver failure with renal impairment and acute pancreatitis, as a result of acetaminophen toxicity caused from unintentional repeated supratherapeutic ingestion, with a total administered dose of 4800 mg in three consecutive days, 1600 mg/day, approximately 90 mg/kg/day. The blood level of acetaminophen after 10 hours of the last administered dose was 32 mg/l. The patient presented with high fever, jaundice, lethargic, agitating with abdominal pain accompanied by encephalopathy. The liver function test revealed with high level of alanine aminotransferase 5794 UI/l and aspartate aminotransferase 6000 UI/l. Early initiation of oral N-acetylcysteine (NAC) after biochemical evidence of liver toxicity was beneficial with rapid improvement of liver enzymes, hepatic function and encephalopathy. During the course of the illness the child developed acute pancreatitis with hyperamylasemia 255 UI/L and hyperlypasemia 514 UI/L. Patient totally recovered within 29 days. CONCLUSION: Healthcare providers should considered probable acetaminophen toxicity in any child who has received the drug and presented with liver failure. When there is a high index of suspicion of acetaminophen toxicity NAC should be initiated and continued until there are no signs of hepatic dysfunction.

Early infective endocarditis due to Staphylococcus aureus following dental procedures.

Staphylococcus aureus is now the most common cause of infective endocarditis (IE) in many areas of the developed world. Patients with S. aureus IE exhibit different characteristics compared to patients with IE deriving from oth- er organisms [1]. IE in general is a complication of bacteremia following invasive procedures.

Streptococcus bovis isolated in haemoculture a signal of malignant lesion of the colon.

S. bovis is known for causing bacteremia and endocarditis as well as accompanying malignant diseases of the gastrointestinal tract. Hence, identification of this species and recognition of the clinical characteristics of infections caused are essential for both therapy and prognosis. S. bovis isolated from haemoculture requires an immediate search for gastrointestinal tract lesions.