The Effect of HSV-1 Seropositivity on the Course of Pregnancy, Childbirth and the Condition of Newborns

The goal of this research was to evaluate seropositivity to HSV-1 among pregnant women and its effect on the course of pregnancy, childbirth and the condition of newborns. Methods: The serological status, socio-demographic characteristics, parity of pregnancy and childbirth and condition of newborns in women seronegative and seropositive to HSV-1 with recurrent infection and its latent course during pregnancy were analyzed. Newborns from these mothers made up the corresponding groups. Results: Low titers of IgG antibodies to HSV-1 in women in the first trimester of pregnancy are associated with threatened miscarriage, anemia in pregnancy and chronic placental insufficiency. High titers of IgG antibodies to HSV-1 in women in the second trimester of pregnancy are associated with late miscarriages and premature births, anemia in pregnancy, chronic placental insufficiency, labor anomalies, early neonatal complications (cerebral ischemia, respiratory distress syndrome) and localized skin rashes. Low titers of IgG antibodies to HSV-1 in women in the third trimester of pregnancy are associated with premature birth, anemia in pregnancy, chronic placental insufficiency, endometritis, complications of the early neonatal period and localized skin rashes. Conclusions: Our research showed that low or high titers of IgG antibodies to HSV-1, determined by the timing of recurrence of infection during pregnancy, are associated with a high incidence of somatic pathology and complications in pregnancy, childbirth and the neonatal period.

Infectious outcomes of fibrin sheath disruption in tunneled dialysis catheters

Background and objectives: Fibrin sheath (FS) formation around tunneled central venous catheters (CVC) increases the risk of catheter-related bloodstream infections due to bacterial adherence to a biofilm. We sought to investigate whether FS disruption (FSD) at the time of CVC removal or exchange affects infectious outcomes in patients with CVC-related infections. Design, setting, participants, and measurements: Retrospective cohort study of 307 adult maintenance hemodialysis patients aged 18 years or older at a single center academic-based hemodialysis program (UHN, Toronto) who developed CVC-related infections requiring CVC removal or exchange between January 2000 and January 2019. Exposure was FSD at the time of CVC removal or exchange. Outcomes were infectious metastatic complications, recurrent infection with the same organism within 1 year, or death due to infection. We created a Markov Multi-State Model (MMSM) to assess patients’ trajectories through time as they transitioned between states. A time-to-event analysis was performed, adjusted for clinically relevant factors. Results: There was no significant relationship between FSD status at the time of CVC removal, the development of infectious complications in the multivariable model (adjusted HR = 0.71, 95% CI 0.09−5.80, p = 0.76), or mortality from infection (HR = 0.84, 95% CI 0.34−2.11, p = 0.73). Conclusions: FSD at the time of CVC removal was not associated with increased risk of infectious complications or death due to infection. Further prospective study is needed to determine whether FSD contributes to reducing CVC infectious related complications.

Differential response of Candida species morphologies and isolates to fluconazole and boric acid

Candida albicans is the most prevalent cause of vulvovaginal candidiasis ('yeast infection') and recurrent vulvovaginal candidiasis, though the incidence of non-albicans yeast species is increasing. The azole fluconazole is the primary antifungal drug used to treat R/VVC yet isolates from some species have intrinsic resistance to fluconazole, and recurrent infection can occur even with fluconazole-susceptible populations. The second-line broad-spectrum antimicrobial drug, boric acid, is an alternative treatment that has been found to successfully treat complicated VVC infections. Far less is known about how boric acid inhibits growth of yeast isolates in different morphologies compared to fluconazole. We found significant differences in drug resistance and drug tolerance (the ability of a subpopulation to grow slowly in high levels of drug) between C. albicans, C. glabrata, and C. parapsilosis isolates, with the specific relationships dependent on both drug and phenotype. Population-level variation for both susceptibility and tolerance was broader for fluconazole than boric acid in all species. Unlike fluconazole, which neither prevented hyphal formation nor disrupted mature biofilms, boric acid inhibited C. albicans hyphal formation and reduced mature biofilm biomass and metabolic activity in all isolates in a dose-dependent manner. Variation in planktonic response did not generally predict biofilm phenotypes. Overall, our findings illustrate that boric acid is broadly effective at inhibiting growth across many isolates and morphologies, which could explain why it is an effective treatment for R/VVC.

Long-Term Outcomes in Patients on Life-Long Antibiotics: A Five-Year Cohort Study

Background: Little is known about the impacts at an individual level of long-term antibiotic consumption. We explored health outcomes of long-term antibiotic therapy prescribed to a cohort of patients to suppress infections deemed incurable. Methods: We conducted a 5-year longitudinal study of patients on long-term antibiotics at Monash Health, a metropolitan tertiary-level hospital network in Australia. Adults prescribed antibiotics for >12 months to suppress chronic infection or prevent recurrent infection were included. A retrospective review of medical records and a descriptive analysis was conducted. Results: Twenty-seven patients were followed up during the study period, from 29 patients originally identified in Monash Health in 2014. Seven of the 27 patients (26%) died from causes unrelated to the suppressed infection, six (22%) ceased long-term antibiotic therapy and two (7%) required treatment modification. Fifteen (56%) were colonised with multiresistant microorganisms, including vancomycin resistant Enterococci, methicillin resistant Staphylococcus aureus, and carbapenem resistant Enterobacteriaciae. Conclusions: This work highlights the potential pitfalls of long-term antibiotic therapy, and the frailty of this cohort, who are often ineligible for definitive curative therapy.

SARS-CoV-2 Vaccine Responses in Individuals with Antibody Deficiency: Findings From The COV-AD Study

Background Vaccination prevents severe morbidity and mortality from COVID-19 in the general population. The immunogenicity and efficacy of SARS-CoV-2 vaccines in patients with antibody deficiency is poorly understood. Objectives COVID in patients with antibody deficiency (COV-AD) is a multi-site United Kingdom study that aims to determine the immune response to SARS-CoV-2 infection and vaccination in patients with primary or secondary antibody deficiency, a population that suffers from severe and recurrent infection and does not respond well to vaccination. Methods Individuals on immunoglobulin replacement therapy or with an IgG less than 4g/L receiving antibiotic prophylaxis were recruited from April 2021. Serological and cellular responses were determined using ELISA, live-virus neutralisation and interferon gamma release assays. SARS-CoV-2 infection and clearance were determined by PCR from serial nasopharyngeal swabs. Results 5.6% (n=320) of the cohort reported prior SARS-CoV-2 infection, but only 0.3% remained PCR positive on study entry. Seropositivity, following two doses of SARS-CoV-2 vaccination, was 54.8% (n=168) compared with 100% of healthy controls (n=205). The magnitude of the antibody response and its neutralising capacity were both significantly reduced compared to controls. Participants vaccinated with the Pfizer/BioNTech vaccine were more likely to be seropositive (65.7% vs 48.0%, p=0.03) and have higher antibody levels compared with the AstraZeneca vaccine (IgGAM ratio 3.73 vs 2.39, p=0.0003). T cell responses post vaccination were demonstrable in 46.2% of participants, were associated with better antibody responses but there was no difference between the two vaccines. Eleven vaccine-breakthrough infections have occurred to date, 10 of them in recipients of the AstraZeneca vaccine. Conclusion SARS-CoV-2 vaccines demonstrate reduced immunogenicity in patients with antibody deficiency with evidence of vaccine breakthrough infection.

Should all patients with a culture-negative periprosthetic joint infection be treated with antibiotics?

Aims The aim of this study was to analyze the prevalence of culture-negative periprosthetic joint infections (PJIs) when adequate methods of culture are used, and to evaluate the outcome in patients who were treated with antibiotics for a culture-negative PJI compared with those in whom antibiotics were withheld. Methods A multicentre observational study was undertaken: 1,553 acute and 1,556 chronic PJIs, diagnosed between 2013 and 2018, were retrospectively analyzed. Culture-negative PJIs were diagnosed according to the Muskuloskeletal Infection Society (MSIS), International Consensus Meeting (ICM), and European Bone and Joint Society (EBJIS) definitions. The primary outcome was recurrent infection, and the secondary outcome was removal of the prosthetic components for any indication, both during a follow-up period of two years. Results None of the acute PJIs and 70 of the chronic PJIs (4.7%) were culture-negative; a total of 36 culture-negative PJIs (51%) were treated with antibiotics, particularly those with histological signs of infection. After two years of follow-up, no recurrent infections occurred in patients in whom antibiotics were withheld. The requirement for removal of the components for any indication during follow-up was not significantly different in those who received antibiotics compared with those in whom antibiotics were withheld (7.1% vs 2.9%; p = 0.431). Conclusion When adequate methods of culture are used, the incidence of culture-negative PJIs is low. In patients with culture-negative PJI, antibiotic treatment can probably be withheld if there are no histological signs of infection. In all other patients, diagnostic efforts should be made to identify the causative microorganism by means of serology or molecular techniques. Cite this article: Bone Joint J 2022;104-B(1):183–188.

Association of meningitis and clival canal defect: case illustration, management, and systematic review of the literature

OBJECTIVE Improper embryological development of the clivus, a bony structure that comprises part of the skull base, can lead to a clival canal defect. Previously thought to be a benign condition, clival canals have been reported to be associated with meningitis and meningoceles. In this review, the authors sought to present an unpublished case of a patient with a clival canal defect associated with meningitis and to evaluate all other reported cases. METHODS In October 2020, a search of PubMed, Web of Science, and Scopus was conducted to identify all cases of clival canals reported from January 1, 1980, through October 31, 2020. RESULTS Including the case presented herein, 13 cases of clival canals, 11 in children (84.6%) and 2 in adults (15.4%), have been identified. Of the pediatric patients, 5 (45.5%) had an associated meningocele, and 8 (72.7%) had meningitis. Nine of the 13 patients (69.2%) had defects that were treated surgically, 5 (38.5%) by a transnasal approach and 4 (30.8%) by a transoral approach. Two patients (15.4%) were treated with drainage and antibiotics, 1 patient (7.7%) was treated solely with antibiotics, and 1 patient (7.7%) was not treated. In the literature review, 8 reports of clival canals were found to be associated with meningitis, further contributing to the notion that the clival canal may be an overlooked source of recurrent infection. In several of these cases, surgical repair of the lesion was curative, thus preventing continued episodes of meningitis. CONCLUSIONS When a patient has recurrent meningitis with no clear cause, taking a closer look at clival anatomy is recommended. In addition, if a clival canal defect has been identified, surgical repair should be considered a safe and effective primary treatment option.

Critical study of Haritakyadi Yoga in Mutrakricchra (Urinary Tract Infection) - A Review

Urinary tract infections (UTI), the second most common type of infection. It is one of the most serious health problem affecting millions of people each year. UTI have been considered a risk factor for the development of end stage renal diseases in children. It is of greatest concern as recurrent infection of UTI can threat to the normal course of growth and development of children. The term Mutrakricchra comes under the disorders of Mutravaha Strotas. ‘Dukhen mutra pravritti’ (Difficulty while micturition-disurea) is cardinal symptom of Mutrakricchra vyadhi. Due to nidana sevana, doshas gets vitiated by their own causes and they enters in basti (Urinary bladder) and produce srotorodha, sankocha and kshobha at mutra marga which further causes Basti pradesh shotha and produce pain and difficulty while passing urine. Ayurveda has significant remedy in the management of Mutrakricchra. Haritakyadi yoga is one of the Ayurvedic formulation used in treatment of Mutrakricchra by means of Shamana chikitsa. Conclusion: Effect of ‘Haritakyadi Yoga’ was seems to be significant in reducing symptoms of Mutrakricchra as well as decreases possibility of drug resistance and recurrence of UTI.

Efficacy of Bupivacaine Infiltration in Post Tonsillectomy Pain Relief

Background: Tonsillectomy is a common surgical procedure required to prevent recurrent infection, inflammation and related distress to the patients. Intervention in this highly vascularized area results in inflammatory responses and subsequent pain. Due to inadequate management 30-70% patients suffer from post-operative pain. Post tonsillectomy pain has its impact on analgesic consumption, hospital stay and return to normal activity. Methodology: This randomized control trial study design is a prospective randomized controlled including convenience sample of 32 patients of both genders, aged 4-30 years undergoing tonsillectomy.Tonsillectomy was performed by standard dissection method after giving general anesthesia to the patients. After completing the tonsillectomy on right side, surgeon infiltrated 6ml of 0.25 % bupivacaine in the tonsillar fossa on the right side. The surgeon did not infiltrate into the left side being observed as control. Postoperative pain score was recorded by asking patients on a VAS graded 1-10 scale (0= no pain and 10= maximum pain) after half an hour in recovery, 2 hours, 4 hours and 6 hours after the operation. Results: The mean age of the study patients was 14.08±7.32 years which included 20 (62.5%) females and 12(37.5%) males. The mean of duration of operation was 42.03±14.75 minutes. There was statistically significant difference between pain scores on VAS in infiltrated bupivacaine (right side) and control (left side) after ½, 2,4 and 6 hours respectively. Conclusion: Infiltration of 0.25% bupivacaine significantly reduces post tonsillectomy pain. Keywords: Tonsillectomy, Bupivacaine infiltration, Pain

Severe polymicrobial and fungal periprosthetic osteomyelitis persisting after hip disarticulations treated with caspofungin in risk patients: a case series

Background Periprosthetic fungal infections are considered rare and opportunistic infections. Treatment is difficult, and established standards do not yet exist. The choice of the appropriate antifungal drug might affect the patient outcome. Cases All the three cases presented showed polybacterial recurrent infection of the revision hip arthroplasty. All patients were of younger age, had multiple revisions of the endoprosthesis, each had a large partial femoral replacement greater than 40% of the femoral length, gentamycin-loaded cement, and a long anchoring distance of the used intramedullary stem. Due to the severe life-threatening infection with deep osteomyelitis, an amputation had to be performed. However, despite surgical intervention, the fungal dominated infection persisted. Finally, only the use of caspofungin allowed permanent infection control. Conclusion The polybacterial infection is driven by the symbiosis between fungi and bacteria. Therefore, eradication of the fungus is required to achieve elimination of the bacteria. Antimycotics of the echinocandin-class, such as caspofungin, may be considered as initial treatment.