Trasplante de microbiota fecal por colonoscopía en paciente mayor de 65 años con infección recurrente de Clostridioides difficile: aún una estrategia subutilizada / Fecal microbiota transplantation in an older patient with Clostridioides difficile recurrent infection. Report of one case

Clostridioides difficile infection (CDI) is a major public health problem and responsible for significant morbidity and mortality. Eighty percent of CDIs occur in adults older than 65 years of age due to a decreased gastrointestinal microbial diversity, immunosenescence and frailty. Thus, the most reported risk factor for recurrent CDI is older age since nearly 60% of cases occur in individuals aged ≥ 65 years. Fecal microbiota transplantation (FMT) is a highly cost-effective alternative to antibiotic treatment for patients with recurrent CDI. We report a 75-year-old male with recurrent CDI, who received a FMT after several unsuccessful antimicrobial treatments. He had a satisfactory evolution after the procedure and remained without diarrhea during the ensuing five months.

[Fecal microbiota transplantation in an older patient with Clostridioides difficile recurrent infection. Report of one case]. / Trasplante de microbiota fecal por colonoscopía en paciente mayor de 65 años con infección recurrente de Clostridioides difficile: aún una estrategia subutilizada.

Clostridioides difficile infection (CDI) is a major public health problem and responsible for significant morbidity and mortality. Eighty percent of CDIs occur in adults older than 65 years of age due to a decreased gastrointestinal microbial diversity, immunosenescence and frailty. Thus, the most reported risk factor for recurrent CDI is older age since nearly 60% of cases occur in individuals aged ≥ 65 years. Fecal microbiota transplantation (FMT) is a highly cost-effective alternative to antibiotic treatment for patients with recurrent CDI. We report a 75-year-old male with recurrent CDI, who received a FMT after several unsuccessful antimicrobial treatments. He had a satisfactory evolution after the procedure and remained without diarrhea during the ensuing five months.

Alternativas aos antibióticos na profilaxia das infecções urinárias recorrentes não complicadas na mulher / Alternatives to antibiotics in the prophylaxis of recurrent uncomplicated infections in women

A infecção do trato urinário (ITU) é a doença bacteriana mais comum no sexo feminino, e cerca de 25% a 30% das mulheres apresentam ITUs recorrentes ao longo da vida. Os antibióticos são muito utilizados para o tratamento e prevenção dessas infecções. Entretanto, o uso excessivo e indevido desses medicamentos, além dos efeitos adversos, está relacionado ao surgimento de uropatógenos multirresistentes. Há um interesse crescente na comunidade científica para encontrar alternativas ao uso de antibióticos para tratamento e/ou prevenção das infecções bacterianas. Esta revisão tem por objetivo discutir algumas dessas alternativas.(AU)

Urinary tract infection (UTI) is the most common bacterial disease in females, and about 25% to 30% of women experience recurrent UTIs throughout their lives. Antibiotics are widely used standard for treating and preventing these infections. However, the excessive and improper use of these drugs, in addition to the adverse effects, is related to the emergence of multidrug-resistant uropathogens. There is a growing interest in the scientific community to find alternatives to the use of antibiotics for the treatment and/or prevention of bacterial infections. This review aims to discuss some of these alternatives.(AU)

Elucidating reasons of COVID-19 re-infection and its management strategies.

BACKGROUND AND AIMS: Reinfection is gradually being recognised after symptomatic or asymptomatic COVID-19 infection. We try to elucidate various explanations behind COVID-19 reinfection and suggest possible strategies to counteract this threat. METHODS: We carried out a comprehensive review of the literature using suitable keywords such as 'COVID-19', 'Pandemics', 'Reinfection', 'Vaccines' and 'India' on the search engines of PubMed, SCOPUS, Google Scholar and Research Gate in March 2021 and first half of April 2021 during the current COVID-19 pandemic. Epidemiology, risk factors and trends of reinfection were assessed. RESULTS: A multitude of factors have been associated with rising incidence of COVID-19 reinfection in India and across the world. Emergence of 'Variants of Concern (VOC)', pandemic fatigue and disregard of infection prevention strategies appear to be the most obvious reasons. CONCLUSIONS: COVID-19 reinfection is an emerging concern amongst the worldwide population with newer mutant strains demonstrating increasing transmissibility and responsible for continuing waves of the pandemic. COVID Appropriate Behaviour (CAB), improvised vaccines and enhanced vaccination drives are necessary to mitigate global threat.

Respiratory Viral Shedding in Healthcare Workers Reinfected with SARS-CoV-2, Brazil, 2020.

We documented 4 cases of severe acute respiratory syndrome coronavirus 2 reinfection by non-variant of concern strains among healthcare workers in Campinas, Brazil. We isolated infectious particles from nasopharyngeal secretions during both infection episodes. Improved and continued protection measures are necessary to mitigate the risk for reinfection among healthcare workers.

Predictors of severe symptomatic laboratory-confirmed SARS-CoV-2 reinfection.

OBJECTIVE: The aim of the study was to evaluate factors predicting severe symptomatic laboratory-confirmed (via Reverse transcription polymerase chain reaction, RT-PCR polymerase chain reaction) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection. STUDY DESIGN: This is a nationwide retrospective cohort study that was conducted in Mexico. METHODS: Data from 258 reinfection cases (at least 28 days between both episodes onset) were analyzed. We used risk ratios (RRs) and 95% confidence intervals (CIs) to evaluate predictors of severe (dyspnea requiring hospital admission) secondary SARS-CoV-2 infection. RESULTS: The risk of severe disease was 14.7%, and the observed overall fatality rate was 4.3%. Patients with more serious primary disease were more likely to develop severe symptoms (39.5% vs. 5.5%, P < 0.001) during reinfection. In multiple analysis, factors associated with an increased risk of severe symptomatic SARS-CoV-2 reinfection were increasing age (RRper year = 1.007, 95% CI = 1.003-1.010), comorbidities (namely, obesity [RR = 1.12, 95% CI = 1.01-1.24], asthma [RR = 1.26, 95% CI = 1.06-1.50], type 2 diabetes mellitus [RR = 1.22, 95% CI = 1.07-1.38]), and previous severe laboratory-confirmed coronavirus disease 2019 (RR = 1.20, 95% CI = 1.03-1.39). CONCLUSIONS: To the best of our knowledge, this is the first study evaluating disease outcomes in a large set of laboratory-positive cases of symptomatic SARS-CoV-2 reinfection, and factors associated with illness severity were characterized. Our results may contribute to the current knowledge of SARS-CoV-2 pathogenicity and to identify populations at increased risk of a poorer outcome after reinfection.

A new positive SARS-CoV-2 test months after severe COVID-19 illness: reinfection or intermittent viral shedding?

We present a case of a patient who had a history of severe coronavirus disease (COVID-19) 4 months prior to this current presentation and, after a long asymptomatic period, subsequently tested positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by a RNA PCR assay, after several interval negative SARS-CoV-2 RNA tests. We present this potential case of SARS-CoV-2 reinfection in order to incite discussion around differentiating persistent infection with intermittent viral shedding and reinfection, as well as to discuss evolving knowledge and approaches to the clinical management, follow-up molecular testing and treatment of COVID-19 reinfection.

The Prognostic Value of a Novel Magnetic Resonance Imaging-Based Classification for Septic Arthritis of the Shoulder.

BACKGROUND: The purposes of the present study were (1) to create a magnetic resonance imaging (MRI)-based classification system for septic shoulder arthritis and to show the results of arthroscopic debridement based on the classification in eradicating the infection, and (2) to determine the distribution of the Gächter stages, which are determined on the basis of arthroscopic findings only, in each grade of the novel classification system. METHODS: The present study included 31 patients who underwent arthroscopic debridement for the treatment of acute septic arthritis of the shoulder between January 2001 and December 2015. The mean duration of follow-up was 2.3 years. The included patients were assessed with use of a novel classification system based on preoperative radiographic and MRI findings. MRI findings were classified as Grade I (only synovitis or joint effusion), Grade II (marrow edema in the bare area of the humeral head), Grade III (cartilaginous erosion), Grade IV (osseous erosion), and Grade V (osseous erosion on MRI also observed on radiographs). No changes on radiographs were observed in Grades I to IV. The intraclass correlation coefficients (ICCs) for interobserver and intraobserver reliability were calculated. RESULTS: The overall reinfection rate was 54.8% (17 of 31). Among patients with Grade-I, II, III, IV, and V involvement, the reinfection rates were 0 of 4, 1 of 6, 2 of 4, 9 of 12, and 5 of 5, respectively. A diverse distribution of Gächter stages were found in each grade of the novel classification system, with the exception of Grade V. The ICCs for interobserver and intraobserver reliability were 0.81 and 0.80 for the novel classification system. The ICCs for interobserver and intraobserver reliability were 0.75 and 0.78 for Gächter stages. CONCLUSIONS: This novel classification system for the grading of acute shoulder infections on the basis of radiographs and MRI allows preoperative grading of septic arthritis to be performed objectively. Patients who were classified as Grade III or higher in the novel classification system had higher reinfection rates than those who were classified as Grade I or II and required more aggressive treatment to eradicate the infection.

Recurrent mucocutaneous infections caused by PVL-positive Staphylococcus aureus strains: a challenge in clinical practice.

BACKGROUND: Recurrent mucocutaneous infections caused by PVL-positive Staphylococcus (S.) aureus strains represent an increasing problem in Germany. Although there have been several outbreaks at day care centers and in urban communities in recent years, there are currently no diagnostic algorithms or treatment recommendations for these particular infections in Germany. METHODS: We performed a literature search in the PubMed/MEDLINE database with the goal of developing an algorithm for diagnosis and treatment of these infections. National and international recommendations were also considered. RESULTS: Panton-Valentine leukocidin (PVL) is a pore-forming protein produced by certain S. aureus strains. Both methicillin-susceptible (MSSA) and methicillin-resistant S. aureus (MRSA) strains may carry the lukS-lukF gene responsible for PVL production. The clinical presentation of infections caused by PVL-positive S. aureus ranges from isolated recurrent abscesses to extensive furunculosis. Despite adequate treatment of primary infections, approximately 40 % of patients develop recurrent disease. The choice of treatment regimen is guided by the clinical presentation of the infection. In addition, some scientific literature recommends bacteriological screening of patients and their contacts, followed by decolonization of affected individuals. CONCLUSIONS: The present article focuses on the pathogenesis and risk factors of recurrent mucocutaneous infections caused by PVL-positive S. aureus strains and proposes a diagnostic and therapeutic algorithm for optimal patient care.

Probable segundo evento por SARS-CoV-2: 12 casos / Probable second event due to SARS-CoV-2: 12 cases

Con el avance de la pandemia por COVID-19, la aparición de pacientes con un segundo episodio confirmado por reacción en cadena de la polimerasa, con transcripción inversa (rt-PCR) compatible con reinfección, puso de manifiesto la falta de recomendaciones para su abordaje.Presentamos un estudio descriptivo multicéntrico retro-prospectivo de una serie de doce casos atendidos entre el 01/06/2020 y el 20/10/2020. En la misma, diez casos presentaron el segundo episodio en un período de tiempo menor a 90 días.Por su complejidad, la confirmación de una reinfección no está al alcance en la práctica diaria. Esto requiere de estudios que incluyan comparaciones genómicas de cepas virales involucradas en ambos episodios, determinación de la infectividad del ARN por cultivo viral y análisis molecular.Es necesario establecer definiciones operativas y algoritmos clínicos para la atención de los segundos episodios

As COVID-19 pandemic progresses, patients with a second confirmed episode by reverse transcription-polymerase chain reaction (RT PCR) compatible with reinfection reveals the lack of recommendations for its approach.A multicenter retro-prospective descriptive work was done of a series of 12 cases evaluated between June 1, 2020 and October 20, 2020. In this study, 10 out of 12 cases presented the second episode occurred in less than 90 days.Due to the diagnosing reinfection complexity, its confirmation is not available in the daily practice, this requires studies, which include viral strains genomic comparisons involved in both episodes, ARN determination infectivity by viral culture and molecular analysis.It is necessary to establish operational and clinical algorithms definitions to assist second episodes