Microbiology and Outcomes of Institutionalized Patients With Stroke-Associated Pneumonia: An Observational Cohort Study

Background: The attributable mortality and microbial etiology of stroke-associated pneumonia (SAP) vary among different studies and were inconsistent.Purpose: To determine the microbiology and outcomes of SAP in the lower respiratory tract (LRT) for patients with invasive mechanical ventilation (MV).Methods: In this observational study, included patients were divided into SAP and non-SAP based on a comprehensive analysis of symptom, imaging, and laboratory results. Baseline characteristics, clinical characteristics, microbiology, and outcomes were recorded and evaluated.Results: Of 200 patients, 42.5% developed SAP after the onset of stroke, and they had a lower proportion of non-smokers (p = 0.002), lower GCS score (p < 0.001), higher serum CRP (p < 0.001) at ICU admission, and a higher proportion of males (p < 0.001) and hypertension (p = 0.039) than patients with non-SAP. Gram-negative aerobic bacilli were the predominant organisms isolated (78.8%), followed by Gram-positive aerobic cocci (29.4%). The main pathogens included K. pneumoniae, S. aureus, H. influenzae, A. baumannii, P. aeruginosa, E. aerogenes, Serratia marcescens, and Burkholderia cepacia. SAP prolonged length of MV (p < 0.001), duration of ICU stay (p < 0.001) and hospital stay (p = 0.027), shortened MV-free days by 28 (p < 0.001), and caused elevated vasopressor application (p = 0.001) and 60-day mortality (p = 0.001). Logistic regression analysis suggested that patients with coma (p < 0.001) have a higher risk of developing SAP.Conclusion: The microbiology of SAP is similar to early phase of HAP and VAP. SAP prolongs the duration of MV and length of ICU and hospital stays, but also markedly increases 60-day mortality.

Multisystem inflammatory syndrome with persistent neutropenia in neonate exposed to SARS-CoV-2 virus: A case report and review of literature

BACKGROUND: Multisystem inflammatory syndrome in Children (MIS-C) is a postinfectious immune mediated hyperinflammatory state seen in children and adolescent below 21 year of age and develop after 4–6 weeks of severe acute respiratory syndrome coronavirus -2 (SARS-CoV-2) infection, however, it is rare in neonates. We report an extremely rare and first of its kind case of MIS-C in a neonate with persistent neutropenia. CASE DESCRIPTION: A 19-day old boy presented with complaints of fever and loose stools for 1 day and developed rash after admission. Baby was investigated for sepsis and commenced on IV antibiotics empirically. In view of persistent fever, diarrhoea, rash and absence of obvious microbial etiology of inflammation, with elevated inflammatory marker and an epidemiologic link to SARS-CoV-2 infection, the diagnosis of MIS-C-was made. Intravenous immunoglobulin (IVIg) was administered and defervescence occurred within 24 hours. He also developed neutropenia during course of illness which persisted on follow up. CONCLUSION: MIS-C in neonates is uncommon and fever with elevated inflammatory markers during COVID-19 pandemic should alert the pediatrician to the possibility of MIS-C. Neutropenia may be associated with MIS-C in neonates and warrants prolonged follow up.

Impact of Leucocytospermia on Semen Parameters among Sudanese Sub-Fertile Men Port Sudan -2019

Background: For a long time, bacterial infection of the male genital tract was thought to be one of the leading causes of male infertility. Various clinical studies have identified Leucocytospermia as a proxy marker for these infections, although other causes of inflammation may also play a role. Objective: The study was conducted at the Dermatology Teaching Hospital in Port Sudan with the aim of determining the impact of leucocytospermia on semen parameters and defining the microbial etiology among infertile males. Methods: Between September 2019 and February 2020, a descriptive, cross-sectional, hospital-based investigation was applied. After meeting the study requirements, 140 patients were randomly selected; patient information was collected via a closed-ended questionnaire after patients provided their authorization. Results: A total of 140 male infertility patients were evaluated. The mean age of respondents was 43.5 + 2.6 years old, 61.4% of the patients had infertility for 1-5 years, 55.7% of the patients had secondary infertility, 32.1% of the patients demonstrated leucocytospermia on their semen analysis. Semen analysis results showed that 37.8 of the leucospermic patients’ sperm count was <15 X 106. In 73.3% of the patients, the motile sperms were < 40%, and normal morphology was less than 4% in 46.7% of the patients. The analysis showed mixed infection by both gram positive and negative bacteria are common (42.2%). Conclusion: According to the findings, there is an association between leucocytospermia and male infertility.

Metabolomic profiling of microbial disease etiology in community-acquired pneumonia

Diagnosis of microbial disease etiology in community-acquired pneumonia (CAP) remains challenging. We undertook a large-scale metabolomics study of serum samples in hospitalized CAP patients to determine if host-response associated metabolites can enable diagnosis of microbial etiology, with a specific focus on discrimination between the major CAP pathogen groups S. pneumoniae, atypical bacteria, and respiratory viruses. Targeted metabolomic profiling of serum samples was performed for three groups of hospitalized CAP patients with confirmed microbial etiologies: S. pneumoniae (n = 48), atypical bacteria (n = 47), or viral infections (n = 30). A wide range of 347 metabolites was targeted, including amines, acylcarnitines, organic acids, and lipids. Single discriminating metabolites were selected using Student’s T-test and their predictive performance was analyzed using logistic regression. Elastic net regression models were employed to discover metabolite signatures with predictive value for discrimination between pathogen groups. Metabolites to discriminate S. pneumoniae or viral pathogens from the other groups showed poor predictive capability, whereas discrimination of atypical pathogens from the other groups was found to be possible. Classification of atypical pathogens using elastic net regression models was associated with a predictive performance of 61% sensitivity, 86% specificity, and an AUC of 0.81. Targeted profiling of the host metabolic response revealed metabolites that can support diagnosis of microbial etiology in CAP patients with atypical bacterial pathogens compared to patients with S. pneumoniae or viral infections.

PSOAS ABSCESS – THE CHANGING TRENDS

Introduction: Psoas abscess (IPA) is an abscess collection in the retroperitoneal space tracking along the psoas major muscle. The microbial etiology of Psoas abscess is variable and depends on the geographical area. This study attempts to evaluate the microbial etiology, its implication in deciding the management modalities, and outcomes in patients with Psoas abscess from a tertiary care center in South India. Materials and Methods: This was a retrospective study done in a tertiary care center in Southern India. Results: A total of 47 patients were enrolled in the study, with causative organism identified in 40 (85.15%) patients. In 17 patients (36.17%), it was found to be tuberculous origin; and of nontuberculous origin in 23 patients (48.93%). No causative organism could not be isolated in 7 patients (14.89%). While 33 patients were treated with percutaneous drainage (70.12%), open drainage was done in 14 patients (29.78%) and 1 patient died (2.12%). Conclusion: The most common causative organism of psoas abscess is found to be of nontuberculous origin and PCD was found to be better modality of treatment. Empirical administration of anti-tuberculous drugs needs further evaluation. Key words: psoas, retroperitoneal, retrospective, tuberculous, drainage, empirical

Dental biofilm-induced gingivitis in children and adolescents. A literature review

Dental biofilm-induced gingivitis is extremely common in children and adolescents and it affects the majority of children over 7 years old. It is characterised by inflammation, consisting in changes of colour, size, consistency and texture. Although most of the times gingivitis does not progress into periodontitis, it is important to diagnose and properly treat this disease, as gingivitis precedes periodontitis. The present paper aims to review the main findings of microbial etiology and epidemiology of dental biofilm-induced gingivitis mediated by local risk factors, as well as the role of oral hygiene in preventing bacterial colonization.

Serial Procalcitonin Levels and Bacterial Etiology in Hospitalized Patients with Community-Acquired Pneumonia

Background: Accurate determination of the microbial etiology of pneumonia has important consequences for appropriate administration of antimicrobials and antimicrobial stewardship. Procalcitonin (PCT) is a biomarker that is finding increasing diagnostic and prognostic utility in lower respiratory infections, however, it remains unclear whether it can be helpful in predicting the bacterial etiology of pneumonia. In this study, we examined the relationship between serial PCT measurements and bacterial etiology in hospitalized patients with community-acquired pneumonia, including those at high risk for infections due to multi-drug resistant organisms (MDRO), to determine whether PCT at admission and its trajectory early in the hospital course of patients provides distinguishing information between different bacterial causes of pneumonia.Methods: We analyzed data collected from a prospective cohort study of 505 patients admitted to a tertiary care center with a clinical syndrome consistent with pneumonia. Bacterial etiology of pneumonia was determined from high quality respiratory samples, blood cultures and other relevant diagnostic tests according to standard protocols in conjunction with clinical review. Daily plasma procalcitonin levels were measured for these patients serially during the first four days of hospitalization. We compared procalcitonin levels associated with different bacterial etiologies of pneumonia over the first four days of admission, using the Mann-Whitney-U test to assess for statistical significance.Results: Out of 505 patients, the diagnosis of pneumonia was adjudicated in 322, and bacterial etiology determined in 64 cases. The predominant pathogens were Staphylococcus aureus (n = 19; 12 Methicillin Resistant (MRSA) and 7 Methicillin Susceptible (MSSA)), Pseudomonas aeruginosa (n = 12), Streptococcus pneumoniae (n = 6), and Haemophilus influenza (n=5). We found higher procalcitonin values for S. pneumoniae relative to other etiologies, a delayed rise for Pseudomonas over time, and consistently low PCT values for infections due to multiple bacteria. In addition, our results also suggest that procalcitonin values on the second day of hospitalization, rather than at admission, may have the most utility in distinguishing between bacterial etiologies.Conclusion: Serial procalcitonin values during the early course of bacterial pneumonia reveal a difference between pneumococcal and other bacterial etiologies, and may have an adjunct role in guiding antibiotic choice and duration.

Phage therapy in antibiotic resistant pneumonia: immunomodulation or redistribution?

Our report concerns the observations made during the treatment of pneumonia with individually selected bacteriophages in HCAI patients on mechanical ventilation. 19 patients on mechanical ventilation whose condition was complicated by antibiotic-resistant pneumonia were examined. The treatment of patients was supplemented with phage therapy, bacteriophages were selected individually for each patient, taking into account the microbial etiology of the disease (Pseudomonas aeruginosa, Кlebsiella pneumoniae, Acinetobacter baumanii). Immunophenotyping of blood lymphocytes was carried out using 2-3-parameter flow cytometry. The functional activity of blood leukocytes was assessed by their ability to produce IFNα and IFNγ during cultivation. The level of interferons production in supernatants collected after cultivation was quantitatively evaluated both by their concentration (ELISA, reagents from “Vector-Best-Europe”, Russia) and by their biological activity. Statistical processing of the results was carried out using the Statistica 6 program according to the nonparametric Mann-Whitney U-test. In the course of successful phage therapy with individually selected bacteriophages overcoming of lymphopenia (if there was one) and an increase in both the number and functional activity of peripheral blood lymphocytes in all patients with pneumonia observed are noted. The relationship between the microbial load (mono- or mixed infection, the number of CFU pathogens of pneumonia, the need for repeated courses of phage therapy) and the degree of deficiency in one or another subpopulation of lymphocytes was not detected. Activation of the immune system achieved after one course of phage therapy was maintained for at least 3 weeks after phage administration was discontinued.