Clinical presentation and disease course in patients with flu-like illness: does microbiological aetiology matter?

Background: There is little evidence about the relation between aetiology, illness severity and clinical course of respiratory tract infections (RTI) in primary care. Understanding these associations would aid to develop effective management strategies for these infections. Aim: To investigate whether the clinical presentation and illness course differ between RTI in whom a viral pathogen was detected and those in whom a potential bacterial pathogen was found. Design and setting: Post hoc analysis of data from a pragmatic randomised trial on the effects of oseltamivir in patients with influenza-like illness (ILI) in primary care (n=3266) in 15 European countries. Methods: Patient characteristics, signs and symptoms were registered at baseline. Naso-pharyngeal (adults) or nasal and pharyngeal (children) swabs were taken for PCR analysis. Patients were followed up until 28 days after inclusion. Regression models and Kaplan-Meier curves were used to analyse the relation between aetiology, clinical presentation at baseline and course of disease including complications. Results: Except for a less prominent congested nose (OR 0.55, CI 0.35 – 0.86) and acute cough (OR 0.52, CI 0.27 – 0.65) in ILI patients in whom a possible bacterial pathogen was isolated, there were no clear clinical differences in presentations between those with a possible bacterial aetiology than in those with a viral one. Also the course of disease and complications were not related to aetiology. Conclusion: Given the currently available microbiological tests and antimicrobial treatments, and outside pandemics like COVID-19, microbiological testing in primary care patients with ILI seems to have limited value.

Development of fundamental and applied research in the field of food hygiene

The review summarizes the directions of the results of scientific activities of the Department of Food Hygiene of the Federal Scientific Center for Hygiene named after F.F. Erisman of the Federal Service for Supervision in Protection of the Rights of Consumer and Man Wellbeing. Since the day of its foundation, the employees have been working on the examination of food products, the development of methods for the study of food and ready-made meals, the prevention of food poisoning of bacterial and non-bacterial aetiology, as well as the hygienic assessment and control of the produced utensils and containers. Based on the department, capital studies were carried out to study and rationalize the nutrition of certain groups of the population: industrial workers (engaged in the development of coal mines, working at metallurgical and mining enterprises, etc.), children and adolescents of various institutions. The article highlights the main directions of work on the study and development of methods for hygienic and chemical research of public catering and food industry products, on the hygienic assessment of pesticides and new methods of food processing technology. Attention is paid to studies on establishing migration patterns and deciphering the mechanisms of biological action of toxic substances released from materials in contact with food. A significant contribution was the scientific substantiation of hygienic food system optimization using preventive foods for contingents of persons in extreme environmental conditions, including astronauts. The result of the research was the development of medico-biological requirements for specialized products intended for feeding people in extreme conditions of space flight and wounded with damage to the skeletal system. The works of the outstanding employees of the department have made a significant contribution to the science of hygiene and sanitary practice.

Seeking diagnostic and prognostic biomarkers for childhood bacterial pneumonia in sub-Saharan Africa: study protocol for an observational study

IntroductionClinically diagnosed pneumonia in children is a leading cause of paediatric hospitalisation and mortality. The aetiology is usually bacterial or viral, but malaria can cause a syndrome indistinguishable from clinical pneumonia. There is no method with high sensitivity to detect a bacterial infection in these patients and, as result, antibiotics are frequently overprescribed. Conversely, unrecognised concomitant bacterial infection in patients with malarial infections occur with omission of antibiotic therapy from patients with bacterial infections. Previously, we identified two combinations of blood proteins with 96% sensitivity and 86% specificity for detecting bacterial disease. The current project aimed to validate and improve these combinations by evaluating additional biomarkers in paediatric patients with clinical pneumonia. Our goal was to describe combinations of a limited number of proteins with high sensitivity and specificity for bacterial infection to be incorporated in future point-of-care tests. Furthermore, we seek to explore signatures to prognosticate clinical pneumonia.Methods and analysisPatients (n=900) aged 2–59 months presenting with clinical pneumonia at two Gambian hospitals will be enrolled and classified according to criteria for definitive bacterial aetiology (based on microbiological tests and chest radiographs). We will measure proteins at admission using Luminex-based immunoassays in 90 children with definitive and 160 with probable bacterial aetiology, and 160 children classified according to the prognosis of their disease. Previously identified diagnostic signatures will be assessed through accuracy measures. Moreover, we will seek new diagnostic and prognostic signatures through machine learning methods, including support vector machine, penalised regression and classification trees.Ethics and disseminationEthics approval has been obtained from the Gambia Government/Medical Research Council Unit The Gambia Joint Ethics Committee (protocol 1616) and the institutional review board of Boston University Medical Centre (STUDY00000958). Study results will be disseminated to the staff of the study hospitals, in scientific seminars and meetings, and in publications.Trial registration numberH-38462.

Association between bacterial finding, antibiotic treatment and clinical course in patients with pharyngotonsillitis: a registry-based study in primary healthcare in Sweden

Background The role of non-group A streptococci and Fusobacterium necrophorum in pharyngotonsillitis has been disputed and few prospective studies have evaluated the effect of antibiotic treatment. This study uses registry data to investigate the relation between antibiotic prescription for pharyngotonsillitis in primary healthcare and return visits for pharyngotonsillitis, complications, and tonsillectomy. Methods Retrospective data were extracted from the regional electronic medical record system in Kronoberg County, Sweden, for all patients diagnosed with pharyngotonsillitis between 2012 and 2016. From these data, two cohorts were formed: one based on rapid antigen detection tests (RADT) for group A streptococci (GAS) and one based on routine throat cultures for β-haemolytic streptococci and F. necrophorum. The 90 days following the inclusion visit were assessed for new visits for pharyngotonsillitis, complications, and tonsillectomy, and related to bacterial aetiology and antibiotic prescriptions given at inclusion. Results In the RADT cohort (n = 13,781), antibiotic prescription for patients with a positive RADT for GAS was associated with fewer return visits for pharyngotonsillitis within 30 days compared with no prescription (8.7% vs. 12%; p = 0.02), but not with the complication rate within 30 days (1.5% vs. 1.8%; p = 0.7) or with the tonsillectomy rate within 90 days (0.27% vs. 0.26%; p = 1). In contrast, antibiotic prescription for patients with a negative RADT was associated with more return visits for pharyngotonsillitis within 30 days (9.7% vs. 7.0%; p = 0.01). In the culture cohort (n = 1 370), antibiotic prescription for patients with Streptococcus dysgalactiae ssp. equisimilis was associated with fewer return visits for pharyngotonsillitis within 30 days compared with no prescription (15% vs. 29%; p = 0.03). Conclusions Antibiotic prescription was associated with fewer return visits for pharyngotonsillitis in patients with a positive RADT for GAS but with more return visits in patients with a negative RADT for GAS. There were no differences in purulent complications related to antibiotic prescription.

Bacteriological Profile and Antibiogram of Acute Dacryocystitis in a Rural Tertiary Healthcare Centre, Maharashtra, India

BACKGROUND Dacryocystitis is one of the most frequent diseases of the efferent lacrimal system. It is the infection or inflammation of the lacrimal sac. This is usually because of nasolacrimal duct obstruction. Acute dacryocystitis can cause severe morbidity and rarely mortality in patients. This study wanted to identify the aerobic bacterial aetiology, and demonstrate the antibiogram of bacterial isolates of acute dacryocystitis. METHODS A retrospective record-based study was conducted in Rural Tertiary Healthcare Centre. Clinical Data of 89 patients was collected from medical records of 2014 to 2018 documents. Data of bacterial isolates and their antibiogram were retrieved from records in the Department of Microbiology. RESULTS The most common aerobic Gram-positive bacteria were Staphylococcus aureus (29.8 %) and Coagulase Negative staphylococcus (23.3 %). The most common Gramnegative bacteria were pseudomonas spp. (19.4 %) and klebsiella spp. (12.9 %). CONCLUSIONS The knowledge of bacterial profile in different geographic region, different age group will help to develop and implement treatment protocol. KEY WORDS Acute Dacryocystitis, Bacterial Profile, Antibiogram

Turicella otitidis: a rare agent causing microbial keratitis

A 10-year-old boy treated for alkali injury with multiple interventions presented with a perforated corneal ulcer with clinically suspected bacterial aetiology. Cornea scraping and tissue adhesive application were planned. During surgery, an eyelash was found embedded at the perforated site. Gram staining of corneal scraping revealed the presence of Gram-positive bacilli on the first day which later was identified as Turicella otitidis with culture followed by VITEK V.2.0 (Biomerieux) identification. The bacterium was found to be sensitive to amikacin, ciprofloxacin, cefazolin, gatifloxacin, moxifloxacin, ofloxacin and vancomycin antibiotics as per Clinical and Laboratory Standards Institute guidelines. Coryneform bacteria is a rare cause of keratitis, and this is the first reported case of microbial keratitis caused by one of the rare corynebacterium species T. otitidis to the best of our knowledge. Literature search does not reveal any specific ocular features typical to this organism. This case supports the growing evidence for pathogenicity of T. otitidis in ocular samples. This study demonstrates the utility of VITEK for the identification of rare pathogen and may facilitate the use of certain antibiotics in the treatment regimen of T. otitidis infections.

Study of keratomycosis at a tertiary care teaching hospital

Corneal infections are one of the leading causes of ocular morbidity and blindness world-wide. If normal defence mechanisms of the eye are compromised, almost any microorganism can invade the cornea. It is important to know the exact aetiology of corneal ulcer to institute appropriate therapy in time, least serious consequences may follow. To isolate and identify the fungi from corneal scrapings of suspected keratitis patients. A prospective study of Fungal keratitis was conducted at Al-Azhar Medical College & Super Speciality Hospital in Thodupuzha, Kerala a tertiary care hospital with a capacity of 650 beds. The duration of the study was two years from January 2018 to January 2020. Patients with suspected fungal corneal ulcers presenting in the Out-Patient Department (OPD) of Ophthalmology were investigated for fungal etiology in the Department of Microbiology were included in this study. Each patient was examined with slit lamp. Data collected from history given by patient and patient examination. Using standard techniques. The specimens collected were then smeared on two slides, which were stained with Gram stain (for bacterial keratitis) and 10% potassium hydroxide preparation (for fungal keratitis) studied under light microscope. Of the 866 patients with corneal ulcer investigated, 83 cases with fungal and 36 with bacterial aetiology was identified. Males were more commonly affected and were mostly in the age group of 31-40 year. It was seen that trauma was the most common predisposing factor especially in the agriculturists and the farmers. Among the identified fungi, most were hyaline. Of the 83 positive specimens, the most frequent agent isolated was Fusarium species in 31 (37.3%) cases. 23 (27.7%) was the second most common followed by , ., . Candida albicans were 5 (6%) followed by 1 (1.2%). Fungal Keratitis is a serious problem usually following corneal trauma, it requires rapid detection and identification of fugal agents for treatment to prevent disastrous consequences.