Serratia marcescens outbreak in a COVID-19 intensive care unit - Are there any factors specific to COVID-19 units that facilitate bacterial cross-contamination between COVID-19 patients?

COVID-19 dedicated units were created early in the pandemic. Despite their need, factors specific to these units can possibly increase the risk of bacterial cross-contamination between COVID-19 patients. We report a Serratia marcescens outbreak in a COVID-19 intensive care unit, later discussing factors specific to COVID-19 units that may facilitate bacterial cross-contamination in such units, and raising awareness for such an issue.

Spontaneous Tumor Lysis Syndrome: A Rare Presentation in Plasmablastic Lymphoma.

Tumor lysis syndrome is an oncological emergency, which can ultimately lead to death if not recognized early and treated accordingly. The institution of adequate prophylactic measures can decrease its incidence and severity; but very rarely, a highly aggressive neoplasm such as acute lymphoblastic leukemia or Burkitt's lymphoma can present with spontaneous tumor lysis syndrome (sTLS). We present the case of a 58-year-old male with newly diagnosed plasmablastic lymphoma with a retroperitoneal bulky mass invading the bladder, who presented with severe sTLS and was admitted to an intensive care unit due to acute renal failure and hyperkalemia requiring emergent renal replacement therapy. With urgent chemotherapy, several hemodialysis sessions and rasburicase, all the metabolic derangements were corrected and the patient fully recovered a normal renal function. This report highlights the importance of early recognition of sTLS in any patient presenting with severe and de novo multiple metabolic derangements involving uric acid, phosphorus, calcium and creatinine, even in patients with tumors not usually presenting with this complication.

Cytomegalovirus Reactivation in Patients with Sepsis in an Intensive Care Unit in Portugal.

INTRODUCTION: In the last few years, cytomegalovirus reactivation has been considered an aggravating factor for septic patients in Intensive Care units. The main objectives of this study were to determine cytomegalovirus reactivation in patients with a diagnosis of sepsis admitted to an intensive care unit, and whether this reactivation was related to the evolution of the patient's clinical condition. MATERIAL AND METHODS: The detection of cytomegalovirus DNA was performed by real-time polymerase chain reaction and the concentration of nine cytokines (IL-1α, IL-1ß, IL-2, IL-4, IL-6, IL-8, IL- TNF-α, and INFγ) were determined by a Multiplex ELISA technique. RESULTS: Eight of 22 septic patients (36.3%) from the Intensive Care Unit of the Hospital da Luz had cytomegalovirus reactivation. No association was found between cytomegalovirus reactivation and gender, age, length of Intensive Care unit stay, duration of mechanical ventilation, and patient death. No significant differences were found in cytokine concentrations in patients with and without reactivation. However, patients with cytomegalovirus reactivation had a longer hospital stay from Intensive Care unit entry to hospital discharge or patient death (p = 0.025). DISCUSSION: Despite the low sampling rate, the present study suggests that reactivation is a frequent event in patients diagnosed with sepsis and may be related to prolonged hospital stay in these patients. CONCLUSION: The overall analysis of the results obtained and the literature review do not support the concept that cytomegalovirus monitoring should be implemented in routine practice, but it seems prudent to wait for further randomized trials using antiviral prophylaxis, before assuming a definitive attitude towards the role of cytomegalovirus in sepsis.

Introdução: A reativação do citomegalovírus tem sido considerada um factor de agravamento nos doentes diagnosticados com sépsis nas unidades de Cuidados Intensivos. Os principais objetivos deste estudo consistiram na determinação da reativação do Cytomegalovirus em doentes internados numa unidade de Cuidados Intensivos com diagnóstico de sépsis, e se essa reativação estaria relacionada com a evolução do quadro clínico do doente.Material e Métodos: Na presente investigação foram estudados 22 doentes, internados com o diagnóstico de sépsis na Unidade de Cuidados Intensivos do Hospital da Luz. A deteção do ácido desoxirribonucleico do citomegalovírus foi realizada por técnica de polymerase chain reaction em tempo real e as concentrações de nove citocinas (IL-1α, IL-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, TNF-α, e INFγ) foram determinadas através de uma técnica de ELISA Multiplex.Resultados: A reativação ocorreu em oito doentes (36,3%). Não foram encontradas relações entre a reativação do citomegalovírus e o sexo, idade, tempo de permanência na unidade de Cuidados Intensivos, duração da ventilação mecânica e morte do doente. Também não foram encontradas diferenças significativas nas concentrações das citocinas nos doentes com e sem reativação. Contudo, os doentes com reativação do citomegalovírus apresentaram um maior tempo de internamento no hospital desde a entrada na unidade de Cuidados Intensivos até a alta hospitalar ou morte do doente (p = 0,025).Discussão: Apesar da amostra de pequena dimensão, o presente estudo indicia que a reativação é um evento frequente nos doentes diagnosticados com sépsis e que pode estar relacionada com o prolongamento do tempo de permanência no hospital destes doentes.Conclusão: A análise conjunta dos resultados obtidos e da revisão da literatura não apoiam o conceito de que a monitorização do citomegalovírus deva ser implementada na prática clínica, mas parece prudente aguardarem-se por mais ensaios randomizados utilizando profilaxia antiviral, antes de se assumir uma atitude definitiva relativamente ao papel do citomegalovírus na sépsis.

Inverted Variant of Takotsubo Syndrome Caused by Inhaled Adrenergic Beta-2 agonists.

Takotsubo syndrome (TS) is an acute and reversible clinical syndrome characterized by transient hypokinesis of the left ventricular (LV) apex. Variant forms of LV dysfunction have been reported, including inverted Takotsubo syndrome (ITS), which represents only 5% of cases and has previously been linked to excessive use of inhaled adrenergic beta-2 agonists. The authors describe the case of a 60-year-old female patient who was diagnosed with ITS after the excessive use of inhaled adrenergic beta-2 agonists. This case highlights an uncommon variant of this syndrome that may not be obvious and must be suspected in this particular context. LEARNING POINTS: Takotsubo syndrome (TS) was initially described with a classic pattern of LV apical akinesis and accounts for around 75-80% of cases. Variants including inverted Takotsubo (also known as basal variant) can affect other areas of the myocardium.Several physiopathological mechanisms have been implicated. Catecholamine-induced cardiotoxicity is one of the most supported theories, while other triggers, including excessive use of inhaled beta-2 agonists, have also been described.Treatment of TS is mainly symptomatic and conservative and frequently leads to rapid resolution and LV function recovery.