Prevalence and Characteristics of Long COVID 7-12 Months After Hospitalization Among Patients From an Urban Safety-Net Hospital: A Pilot Study.

Introduction: Little is known about the burden of long COVID among Black and Hispanic patients in the U.S. We surveyed adult patients hospitalized for COVID-19 at John H. Roger, Jr. Hospital of Cook County, a safety-net hospital predominantly serving Black and Hispanic patients in Chicago, for persistent symptoms after hospitalization to assess prevalence and identify risk factors. Methods: Cross-sectional data were obtained over 6 months after discharge from patients hospitalized at John H. Roger, Jr. Hospital of Cook County who tested positive for SARS-CoV-2 between October 1, 2020 and January 12, 2021. Multivariable logistic regression was used to analyze the associations between patient characteristics and symptom persistence. Results: Of 145 patients surveyed at a median follow-up period of 255 days (IQR=238-302), 80% were Black or Hispanic, and 50 (34%) reported at least 1 symptom. In multivariable logistic regression, the risk of long COVID was associated with the severity of acute COVID-19 illness, consistent with findings from population-based cohort studies. Conclusions: Long COVID prevalence remains high 7 months to a year after an initial illness in a majority Black and Hispanic hospitalized cohort. There is a long-term and ongoing need to assess and address the burden of long COVID, especially among minority communities disproportionately affected by acute COVID-19.

Should CD4 Levels be Monitored in a Patient on Temozolomide?

INTRODUCTION: Temozolomide is an alkylating agent, indicated in the treatment of refractory anaplastic astrocytoma and newly diagnosed glioblastoma. We describe a case of Salmonella typhimurium bacteraemia associated with septic arthritis in the setting of concurrent temozolomide use. CASE: A 67-year-old woman presented with acute onset of bilateral knee pain and swelling. She had a medical history of glioblastoma multiforme treated with temozolomide. Synovial fluid analysis and blood cultures revealed S. typhimurium, confirming a diagnosis of S. typhimurium bacteraemia associated with septic arthritis. CONCLUSION: We conclude that chemotherapy with temozolomide and corticosteroid use will increase an individual's susceptibility to a wide variety of opportunistic infections akin to HIV-associated acquired immunodeficiency syndrome (AIDS). Furthermore, we hypothesize a possible benefit of monitoring CD4 levels and prophylaxis against opportunistic infections (based on the CD4 levels) in individuals receiving temozolomide-based chemotherapy, similar to HIV-AIDS. LEARNING POINTS: Chemotherapy with temozolomide and corticosteroid use will increase an individual's susceptibility to a wide variety of opportunistic infections akin to HIV-associated acquired immunodeficiency syndrome (AIDS).There may be a benefit in monitoring CD4 levels in patients who are receiving temozolomide.Given selective CD4 lymphopenia while on temozolomide, there may be a possible benefit of prophylaxis against opportunistic infections in individuals based on their CD4 levels, similar to HIV-AIDS (current guidelines recommend considering Pneumocystis jirovecii pneumonia prophylaxis for patients receiving concomitant radiotherapy and temozolomide, and high-dose steroids).

Intracranial thrombosis associated with MSSA bacteraemia in the setting of influenza A.

The authors present a case of a 42-year-old previously healthy man who presented in sepsis, with right lateral gaze palsy. He was found to have bilateral cavernous sinus thrombosis (CST) and bilateral internal jugular thrombosis in the setting of Staphylococcus aureus bacteraemia. The patient was successfully treated and recovered from his illness after a protracted stay in the medical intensive care unit. We go over the treatment course and follow-up of this patient and discuss the need to have a high degree of clinical suspicion for CST and suppurative thrombophlebitis of the internal jugular veins. We also discuss the possible role of the Panton-Valentine leukocidin in causing thrombotic complications of S. aureus bacteraemia.

Protein-Energy Malnutrition Increases Mortality in Patients Hospitalized With Bacterial Pneumonia: A Retrospective Nationwide Database Analysis.

Background Malnutrition is a less commonly recognized risk factor for various infections. It encompasses both undernutrition or protein-energy malnutrition (PEM) and overnutrition, including obesity. This study aimed to evaluate whether PEM impacts bacterial pneumonia (BP) and, if so, to quantify the degree of impact on inpatient outcomes. Methods This was a retrospective cohort study involving adult hospitalizations for BP using the nationwide inpatient database. Outcomes included comparing inpatient mortality, total hospital charges, length of hospital stay, as well as complications from bacterial pneumonia. Results The in-hospital mortality for adults with BP was 2.62%. Patients with PEM had a higher adjusted odds ratio (aOR) of inpatient mortality (adjusted odds ratio (aOR): 2.31, 95% confidence interval (CI): 2.14 - 2.48, p<0.001) as compared to non-PEM patients. PEM was also associated with higher odds of sepsis (aOR: 2.24, 95% CI: 2.04 - 2.46, p<0.001), septic shock (aOR: 3.29, 95% CI: 2.82 - 3.85, p<0.001), requiring mechanical ventilation (aOR: 2.51, 95% CI: 2.31 - 2.71, p<0.001), requiring vasopressors (aOR: 2.90, 95% CI: 2.20 - 3.83, p<0.001), acute respiratory distress syndrome (ARDS) (aOR: 1.63, 95% CI: 1.33 - 2.00, p<0.001), acute kidney failure (AKI) (aOR: 1.24, 95% CI: 1.18 - 1.29, p<0.001), deep vein thrombosis (DVT) (aOR: 1.80, 95% CI: 1.62 - 2.00, p<0.001), and pulmonary embolism (PE) (aOR: 1.25, 95% CI: 1.08 - 1.45, p=0.003). Conclusion The study concluded that PEM was an independent mortality predictor for those with BP, with an increased risk of systemic complications, as well as increased healthcare utilization costs.

Heparin-Induced Thrombocytopenia in COVID-19.

COVID-19 (coronavirus disease-2019) infection is a highly prothrombotic state, resulting from a dysregulation of the coagulation cascade. Therefore, thromboprophylaxis is strongly recommended in these patients, with some experts even advocating for therapeutic dosing to prevent thromboembolic events. Heparin-induced thrombocytopenia (HIT) is a well-known complication of heparin therapy. In this article, we report a case of HIT in a patient with COVID-19. A 63-year-old male presented with 1 week of dry cough and diarrhea. He had a positive nasopharyngeal COVID-19 reverse-transcriptase-polymerase chain reaction. On admission, the platelet count and liver function tests were within normal limits. During his hospitalization, he developed a right femoral deep venous thrombosis and was started on therapeutic anticoagulation. Due to worsening respiratory failure, he was intubated and mechanically ventilated. Between days 11 and 12 of hospitalization, platelet count dropped from 304 000 to 96 000 cells/µL. He had a high pretest probability for HIT with a 4T score of 6 and a positive anti-PF4/heparin antibody. Heparin drip was discontinued and was switched to argatroban. The serotonin release assay eventually returned positive, which confirmed the diagnosis of HIT. We also discuss potential overdiagnosis of HIT in COVID-19 through 4 cases with false-positive HIT antibodies.

A case of H3N2 complicated by acute kidney injury secondary to rhabdomyolysis.

H3N2 was first detected in July 2011 in the USA. It is responsible for sporadic cases of influenza and localised outbreaks and has not yet taken over on an epidemic or pandemic scale. An 84-year-old man presented with a dry cough, fever and myalgia for 3 days. On examination, he had a pulse of 98 bpm and blood pressure of 124/88 mm Hg. The patient was tachypnoeic, SpO2 was 90%. Auscultation revealed bilateral diffuse wheeze and crackles. He had generalised muscle tenderness on examination. On admission, creatinine was 1.9 mg/dL and CK(creatine kinase) was 44 000 U/L. Chest X-ray was suggestive of ARDS (acute respiratory distress syndrome). Throat swab was positive for H3N2. The patient was given intravenous fluids, oral sodium bicarbonate, oxygen and oseltamivir tablet. In view of ARDS, he was given intravenous methylprednisolone and bronchodilators for bronchospasm. The patient improved symptomatically; vitals and lab reports were normal at the time of discharge.