Negative impact of hyperglycemia on Tocilizumab therapy in COVID-19 patients

Tocilizumab is used for treating moderate-severe Covid-19 pneumonia by targeting IL-6 receptors (IL-6R) and reducing cytokine release, but the pooled rate ratio among diabetic patients with adverse vs those with the more favorable course was 2.26. To date, the hyperglycemia has been shown to increase IL-6 and IL-6R, which has been suggested as a severity predictor in lung diseases of Covid-19 patients. However, there are no data about the effects of tocilizumab therapy on outcomes of hyperglycemic Covid-19 patients with pneumonia. To investigate this unsolved need, 475 Covid-19 positive patients were retrospectively studied since March 1st, 2020. Among them, 78 patients with pneumonia disease and treated with tocilizumab were further evaluated for a severe outcome (encompassing both the use of mechanical ventilation and/or death). Thirty-one (39.7%) hyperglycemic and 47 (60.3%) normoglycemic Covid-19 positive patients (blood glucose levels >140 mg/dl, at admission and/or during hospital stay) were evaluated. Noteworthy, 20 (64%) of hyperglycemic and 11 (23.4%) of normoglycemic patients were also diabetics (P<0.01). At admission, more elevated IL-6 levels in hyperglycemic patients were found and persists even after Tocilizumab administration. In a risk adjusted Cox-regression analysis, Tocilizumab in hyperglycemic did not attenuate the risks of severe outcome as did in normoglycemic patients (p<0.009). Therefore, we could conclude that reduced effects of Tocilizumab in hyperglycemic patients may due to the higher plasma IL-6 levels. Interestingly, when we added IL-6 levels in a Cox regression model the significance for the tocilizumab effect was lost (p<0.07). In this context, our observations evidence that optimal Covid-19 infection management with tocilizumab is not achieved during hyperglycemia both in diabetic and non-diabetic patients.

Occult Hepatitis B Infection in Recent Immigrants to Italy: Occult B Infection in Immigrants.

This study determined the prevalence and clinical features of occult hepatitis B infection (OBI) in a population of recent immigrants to Italy. Two hundred-five immigrants were tested for HBV-infection and were classified as seropositive-OBI or false-OBI. Biochemical/virological activities and imaging diagnostics were determined in anti-HBc-positive subjects. Among the tested subjects, 39.0% were anti-HBc-positive/HBsAg-negative; 11.2% had persistently normal ALT levels with mild detectable HBV-DNA, seropositive-OBI; 6.2% had slightly elevated ALT and positive serum HBV-DNA with a mean level of viral load: 3275 copies/mL-false-OBI. The total prevalence of OBI was 6.8%; 4.4% were seropositive-OBI and 2.4% were false-OBI. Diagnosis by echo-tomography was achieved in 35.7% OBI subjects with alterations of the hepatic echo-texture. We found a moderate prevalence of occult hepatitis B-infection in immigrants. Frequently, these subjects present false-OBI.

Screening for infectious diseases in newly arrived asymptomatic immigrants in southern Italy

Background: Screenings for infectious diseases in asymptomatic immigrants currently takes place when receiving new arrivals.Aims: We describe the frequency of infections in a cohort of newly arrived asymptomatic immigrants in Southern Italy. Methods: We studied a cohort of 238 Sub-Saharan African and Asian men hosted at a reception centre (CARA) in Foggia between January and December 2015. The tuberculin skin test for diagnosis of latent tuberculosis infection (LTBI) and serology/virology testing for HBV, HCV, HIV were performed. Results: From this cohort, 205 individuals agreed to be tested for serological/virological markers only, while 82 agreed to be tested for LTBI only; 49 people agreed to have both tests. Among those tested for virological markers, 23/205 (11.2%) were HBsAg positive; 12/23 (52.2%) individuals had chronic active hepatitis; 77/205 (37.6%) individuals had only anti-HBc positivity. HCV infection was present in 8/205 (3.9%) individuals, and chronic HCV infection, was diagnosed in only two people. Only 2/205 (1.0%) individuals presented with anti-HIV and HIV-RNA positivity. We found LTBI in 29.6% of TB-test-ed individuals. Conclusions: Asymptomatic immigrants are at increased risk for some infections, mainly HBV and tuberculosis.

Contexte : Le dépistage de maladies infectieuses chez les immigrants asymptomatiques est actuellement effectué lors de l’accueil de nouveaux arrivants.Objectifs : La présente étude a pour objectif de décrire la fréquence des infections dans une cohorte d’immigrants asymptomatiques nouvellement arrivés en Italie du Sud. Méthodes : Nous avons étudié une cohorte de 238 hommes originaires d’Afrique subsaharienne et d’Asie hébergés dans un centre d’accueil (CARA) à Foggia, entre janvier et décembre 2015. Le test cutané à la tuberculine permettant de diagnostiquer l’infection tuberculeuse latente ainsi que le test sérologique/virologique pour l’infection par le VHB, le VHC et le VIH ont été réalisés. Résultats : Dans cette cohorte, seuls 205 individus ont accepté de se soumettre aux tests de recherche des marqueurs sérologiques/virologiques, tandis que 82 autres ont choisi de réaliser seulement le test de dépistage de l’infection tuberculeuse latente ; 49 personnes ont accepté les deux tests. Parmi les hommes ayant fait le dépistage des marqueurs virologiques, 23 sur 205 (11,2 %) étaient positifs à l’AgHBs ; 12 sur 23 (52,2 %) avaient une hépatite active chronique ; 77 sur 205 (37,6 %) étaient uniquement positifs pour l’anticorps anti-HBc. Sur les 205 individus, 8 (3,9 %) présentaient une infection par le VHC et une infection chronique par le VHC n’a été diagnostiquée que chez deux personnes. Seuls deux (1,0 %) individus sur 205 étaient positifs au test anti-VIH et à l’ARN du VIH. Une infection tuberculeuse latente a été détectée chez 29,6 % des personnes ayant effectué le test de dépistage de la tuberculose. Conclusions : Les immigrants asymptomatiques présentent un risque accru face à certaines infections, principalement l’hépatite C et la tuberculose.