Occurrence of Dengue Virus Infection with Multiple Serotypes at Central Karnataka, India

Objective To find the incidence of concurrent infection of dengue and correlate the difference in clinical features, laboratory diagnoses, and outcomes between dengue and dengue-like illnesses. Methodology A total of 2,256 patients with suspected dengue fever during the period of July 2014 to June 2020 as per the WHO case definition for dengue fever were enrolled in the study. All patients admitted with a suspected dengue fever were studied in detail in terms of demographic features, clinical features, and laboratory profiles. Two blood samples were collected from each patient with a history of fever for 5 to 7 days. Investigation consisted of CBC, Widal test, malarial card test, Weil Felix test, Scrub typhus test, chikungunya, dengue parameters such as dengue NS1, IgM, and IgG, and real-time PCR for dengue serotypes were performed for each sample. Results A total of 1,412 males (62.6%) and 844 females (37.4%) of age 2 to 44 years were hospitalized. Out of 2,256 clinically suspected dengue cases, 1,306 cases were positive and 950 were negative by RT-PCR test. Fever was the most common clinical features among the RT-PCR-positive cases, followed by retroorbital pain (85.9%), flushing in 77.5%, and rashes in 84.8% of patients. ARDS was seen in 9.7% and splenomegaly in 27.5% patients. A platelet count of less than 100,000 was observed in 1,838 (81.5%) patients, and a platelet count of less than 20,000 was observed in 147 (6.5%) patients.Of 2,256 samples, 1,306 (57.9%) tested positive for dengue viral RNA by RT-PCR. Also, 798 cases were infected with a single DENV serotype, and 608 had a concurrent infection. Of the 798 single DENV serotype infection cases, 392 (54.2%) were typed as DENV-2 and 218 (29.2%) as DENV-3. Coinfection with serotypes DENV-2 and DENV-3 was found to account for 67.8% of all concurrent infections. Conclusion The study showed that dengue fever with concurrent infection with multiple serotypes is on the rise, and an occurrence of recombination may lead to the emergence of more virulent strains showing varied clinical presentations.

1364. Microbiology of Sepsis in a Combat-Trauma Military Population

Background There are limited data on sepsis in combat casualties. We examined characteristics of sepsis, specific infections, and associated microbiology in a complex combat trauma population. Methods The Trauma Infectious Disease Outcomes Study collected infection-related data from military personnel wounded during deployment (2009-2014). Medevac patients transferred to participating US military hospitals with sepsis or septic shock based on the Sepsis-1 SIRS criteria were analyzed for associated potential sources and infection-associated clinical microbiology. Results Prevalence of sepsis was 24.7% (667 of 2699 patients) with 93 (14%) patients meeting septic shock criteria. There were 1013 sepsis/shock episodes (SSE) among 667 subjects. Infections attributed to SSE were identified in 996 (98.3%) of 1013 episodes, primarily being bloodstream infections (BSI) +/- other infections (29.5%), skin and soft tissue (SSTI)/osteomyelitis (35.3%), pneumonia (12.1%), and multiple concurrent infections (14.2%). At least 1 organism was identified in 96% of SSE and 53% were polymicrobial. Gram-positive organisms (GP) were identified in 54% of SSE: 16% with multiple GP, of monomicrobial infections 4.1% were S. aureus, 15.8% other staphylococci, and 13% Enterococcus spp. Gram-negative bacilli (GN) were identified from 74.5% of SSE: 34% with multiple GN, of monomicrobial infections 11% were Pseudomonas spp., 8% E. coli, 6% Enterobacter spp., and 6% Acinetobacter spp. Mycobacterial species were uncommon (0.9%). Yeast, mold, and anaerobes were identified from 19%, 22%, and 12.5% of SSE, respectively. Compared to sepsis, septic shock infections were more often polymicrobial (p< 0.001), and had more infections with ESKAPEE pathogens, only Mucor spp., and only Bacteroides (p< 0.05). More infections with only Pseudomonas spp. and only non-lugdunensis coagulase-negative Staphylococci were identified among sepsis patients (p< 0.05). Conclusion Sepsis rates, using the Sepsis-1 criteria are sensitive but lack specificity supporting reclassification using updated Sepsis-3 criteria. In a complex trauma population, sepsis is common with most frequent infections related to SSTI/osteomyelitis, as well as BSI and multiple concurrent infections with a diverse spectrum of microbiology. Disclosures Dana M. Blyth, MD, Nothing to disclose

Concurrent and Concordant Anal and Oral Human PapillomaVirus Infections Are Not Associated with Sexual Behavior in At-Risk Males

Men who have sex with men (MSM) harbor the highest prevalence of anal and oral Human Papillomavirus (HPV) infection, particularly if HIV-infected. We investigated anal and oral HPV infections in HIV-infected and HIV-uninfected MSM, to assess concurrent (HPV detected at both sites, irrespective of the genotypes), and concordant infections (same genotype[s] detected at both sites). Matched anal and oral samples from 161 MSM (85 HIV-infected, and 76 HIV-uninfected) were tested with the Linear Array. Determinants of concurrent and concordant infections were evaluated using logistic regression. Anal infections were 4 to 7 times more frequent than oral infections in both study groups (p < 0.0001). Concurrent infections were not significantly different in HIV-infected (25.9%) and HIV-uninfected MSM (17.1%), p = 0.18. A concordant infection was found in 15 MSM (9.3%). Concordance was for one genotype in 14 individuals and for four genotypes in the remaining subject. In the overall population, only age was independently associated with a concurrent infection (AOR = 3.10, 95% CI: 1.34–7.19 for >39 vs. ≤39 years). None of the parameters of sexual behavior showed independent association with concordant infections. Among MSM, concordant anal and oral HPV infections do not seem to be explained by sexual behavior, but might derive from sequential acquisition by autoinoculation.

Cryptosporidium spp. Infections in Combination with Other Enteric Pathogens in the Global Calf Population

The most common worldwide diarrhoea-causing agents in neonatal calves are Cryptosporidium spp. (Crypto), bovine rotavirus (BRV), bovine coronavirus (BCoV), and enterotoxigenic Escherichia coli F5 (K99) (ETEC). Crypto is a zoonotic pathogen of diarrhoea in humans, particularly for children and immunocompromised adults. Four weighted-stratified random-effect meta-analyses including meta-regression analyses were performed to calculate the worldwide mean prevalence of Crypto and associated concurrent infections with BRV, BCoV and ETEC, as well as their potential influencing factors. The meta-analysis incorporated 28 studies (56 substudies) in 17 countries that determined the presence or absence of concurrent infections with Crypto in the global calf population. Approximately half of all considered studies presented here were conducted in Europe independently of the type of infections with Crypto. Within Europe, the highest estimated mean Crypto-BRV prevalence was identified in Ireland (16.7%), the highest estimated mean Crypto-BCoV prevalence was detected in the United Kingdom (4.3%), and the highest estimated mean Crypto-ETEC prevalence across the literature was determined in Turkey (4.7%). The chance of detecting BRV, BCoV, and ETEC in calves with diarrhoea was 0.8 (confidence interval (CI): 0.6–1.0), 0.7 (CI: 0.5–1.0) and 0.6 (CI: 0.4–0.9) lower in the presence of Crypto compared to calves without Crypto. This may indicate an inhibitory effect between BRV, BCoV, ETEC, and Crypto in calves. The variance in the published prevalence across the literature can mainly be explained by the “diagnostic” factor (R2 min–max: 0.0–40.3%), followed by the “health status of the sampled animals” (R2 min–max: 1.4–27.3%) and “geographical region” (R2 min–max: 5.9–23.6%).

Incidence of Infections and Predictors of Mortality during Checkpoint Inhibitors Immunotherapy in Patients with Advanced Lung Cancer: A Retrospective Cohort Study

Background Immune checkpoint inhibitors (ICIs) have revolutionized non–small cell lung cancer (NSCLC) treatment, significantly increasing overall survival of patients. However, the incidence of concurrent infections and their management is still debated. Methods From August 2015 to October 2019, all consecutive patients with NSCLC who received Nivolumab or Pembrolizumab as first- or second-line therapy have been retrospectively evaluated. At the time of analysis all patients were dead. Clinical characteristics of patients, type of infections and predictors of mortality were analyzed. Results A total of 118 patients, 74 in the Nivolumab group and 44 in the Pembrolizumab group, were identified. At least one infection was recorded in 22% of the Nivolumab-group vs 27% of the Pembrolizumab-group (p=.178). In both groups, the main infection was a pneumonia, followed by skin and soft tissue infections, urinary tract infections and gastroenteritis. Crude mortality for first infection was 10.7%, followed by 25% and 40% for second and third recurrence, respectively (p for trend=.146). No opportunistic infections were recorded. Notably, by Cox-regression model, the independent predictor of mortality was a higher Eastern-Cooperative-Oncology-Group (ECOG) performance status at baseline (p&lt;.001), while the multidisciplinary diagnosis and treatment of concurrent infections was associated with a reduced probability of mortality (aHR= 0.50; 95%CI=0.30 – 0.83, p&lt;.001). Conclusions In patients with NSCLC treated with ICIs, multidisciplinary management of concurrent infections may reduce the risk of mortality. Further studies to investigate risk factors for infections, as well as appropriate management strategies and preventive measures in this setting are warranted.

Organization of activities of TB medical units in the context of the COVID-19 pandemic

The article analyzes the organization of work of N.V. Postnikov Samara Regional Clinical TB Dispensary in 2020. The special procedure has been developed for COVID-19 tests in patients referred to TB department. All cases of the new coronavirus infection (COVID-19) in tuberculosis patients that occurred in the Samara region in 2020 (n = 31) were studied. Infection control activities are the following: separate filter boxes have been provided for personnel and patients in each department; two observational departments have been organized where patients are admitted depending on the type of medical care. The polymerase chain reaction has been used to examine patients for COVID-19 before admission to TB hospital for planned medical care, and express tests for immunoglobulins M and G have been used when patients were admitted in an emergency. Of the 30 cases of intravital detection of concurrent infections (tuberculosis + COVID-19), in 56.7% (17 people), COVID-19 was treated in the in-patient unit specializing in treatment of the new coronavirus infection, and in 43.3% (13 people), treatment was outpatient; lethality made 1/30 (3.33%).

Mycoplasma pneumoniae co-infection with SARS-CoV-2: A case report

We report co-infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Mycoplasma pneumoniae in a patient with pneumonia in India. Atypical bacterial pathogens causing community-acquired pneumonia may share similar clinical presentations and radiographic features with SARS-CoV-2 making a thorough differential diagnosis essential. The co-infection of SARS-CoV-2 and M. pneumoniae is infrequently reported in the literature. Broader testing for common respiratory pathogens should be performed in severe COVID-19 cases to rule out other concurrent infections. Early identification of co-existing respiratory pathogens could provide pathogen-directed therapy, and can save patient lives during the ongoing COVID-19 outbreak.

Differences in clinical severity of respiratory viral infections in hospitalized children

It is uncertain whether clinical severity of an infection varies by pathogen or by multiple infections. Using hospital-based surveillance in children, we investigate the range of clinical severity for patients singly, multiply, and not infected with a group of commonly circulating viruses in Nha Trang, Vietnam. RT-PCR was performed to detect 13 respiratory viruses in nasopharyngeal samples from enrolled patients. We apply a novel clinical severity score and examine associations with the odds of being severe and differences in raw severity scores. We find no difference in severity between 0-, 1-, and 2-concurrent infections and little differences in severity between specific viruses. We find RSV and HMPV infections to be associated with 2- and 1.5-fold increase in odds of being severe, respectively, and that infection with ADV is consistently associated with lower risk of severity. Clinically, based on the results here, if RSV or HMPV virus is suspected, PCR testing for confirmatory diagnosis and for detection of multiple coinfecting viruses would be fruitful to assess whether a patient’s disease course is going to be severe.