Nutritional Status of Patients Co-Infected with TB/HIV During Tuberculosis Treatment at Conakry-Guinea UHC

Introduction: The aim was to assess weight gain during tuberculosis treatment in patients co-infected with tuberculosis and HIV. Methods: Tuberculosis patients co-infected with HIV and undergoing tuberculosis treatment in the pneumophtisiology and infectious and tropical diseases departments of the CHU in Conakry were included. Results: 562 patients were included, with a mean age of 35.6±11.3 years, and 52.5% were women. The average Body Mass Index [BMI] at baseline was 17.8 3.3 kg/m2. 71.5% of patients had a favorable result and 28.5% had an unfavorable result [death, abandonment]. Healed and lost patients gained an average of 2.6 kg and 0.1 kg respectively. Deceased patients lost an average of 3.6 kg. The weight variations of the cured patients were different from those of the deceased [p < 0.001]. A weight gain of 5% after 6 months of treatment was associated with the treatment site [OR=3.81; 95% CI 1.08 to 13.45], alcohol consumption [OR=10.33; 95% CI 1.20 to 89.16], malnutrition before treatment [OR=2.72; 95% CI 1.43 to 5.17] and the form of tuberculosis [OR=3.27; 95% CI 1.15 to 9.33]. Conclusion: Newly diagnosed patients co-infected with TB-HIV at Conakry's CHU are often malnourished. Weight gain during treatment seems to be a reliable indicator of the overall response to treatment.

Clarithromycin versus Amoxicillin alone or with Clavulanate in Acute Maxillary Sinusitis: A Meta-analysis of Clinical Trials

Objective: A meta-analysis was performed to explore the relative effects of clarithromycin and amoxicillin (with or without clavulanate potassium) in the treatment of acute maxillary sinusitis. Methods: Six studies were identified in the peer-reviewed literature. All were randomized single-blind (investigator-blind) or open-label trials in outpatients diagnosed with acute maxillary sinusitis. A total of 1580 patients were enrolled, of whom 1194 were clinically evaluable. The total daily dose of clarithromycin was 1000 mg; the total daily dose of amoxicillin (with or without clavulanate potassium) was either 1500 or 2000 mg. The duration of study drug treatment varied from 8 to 14 days. Endpoints comprised clinical and radiological success within 48 h of the end of study drug treatment plus bacteriologic cure and eradication. Success and cure rate differences were analyzed using fixed- and random-effect models. The absence of between-study heterogeneity was tested using Cochran’s Q-test. Results: Clinical success rates varied between 85.8% and 97.9% for clarithromycin and between 84.2% and 96.8% for amoxicillin. The combined rate difference in clinical success rates between clarithromycin and amoxicillin was +1.9% (P=0.14). Radiological success rates (four studies) varied from 78.2% to 94.0% for clarithromycin and 79.7% to 95.0% for amoxicillin, with a combined rate difference of zero (P=1.00). Bacteriologic cure rates (four studies) were 87.1–94.6% for clarithromycin, compared with 89.8–98.1% for amoxicillin, with a combined difference in cure rates of –3.2% (P=0.16). Overall bacterial eradication rates were comparable between the two treatments (clarithromycin, 89.3%; amoxicillin, 92.1%). Conclusion: These data, with their limitations properly acknowledged, identify clarithromycin as a valid and viable alternative to amoxicillin for the treatment of acute maxillary sinusitis in adults.

Can Ivermectin be Useful for COVID-19 Management as an Immunomodulating Agent?

The possibility of using ivermectin in the treatment of COVID-19 as an immunomodulating agent, has been discussed, which may prevent life-threatening virally driven cytokine storm syndrome.

Human Brucellosis as an Epidemic Zoonosis in Zenica-Doboj Canton (Bosnia and Herzegovina) During 2008-2018

Background: Brucellosis is associated with people living in close proximity to their animals, where conditions for disease onset and spread exist. An epidemic of brucellosis in Bosnia and Herzegovina (B&H) has persisted since 2004. Zenica-Doboj Canton is one of the most affected areas. Objective: To investigate the epidemiological characteristics of human brucellosis from the year 2008 to2018. Methods: Data collected from paper-based patients/cases reported to the Epidemiology Department were analyzed. Results: After 2008, the annual number of patients diagnosed with brucellosis was decreasing, except in 2017 and 2018 with 20 and 35 cases, respectively. Within the 2008-2018 period, a total of 263 human brucellosis cases were recorded, decreasing from 102 (incidence of 44.7/100,000) cases in 2008 to three cases in 2012, but increased to 35 cases in 2018. Males were predominant, with a total of 205 (77.9%) cases. The mean age of the affected patients was 39.2 years; but the most affected age group was the 25-49 years age group with 117 (44.5%) cases. Most cases (151 cases, 66%) were reported during the period of March-July, and 242 (92%) cases were from the rural areas. Conclusion: With the implementation of the small ruminant vaccination program in 2009, the number of infected humans had declined, while brucellosis still remains.

Comparison of the Demographics, Clinical Presentations, Seasonality, and Outcome between Adult Patients with Influenza A and B in Two Seasons (2014-2015 and 2015-2016) with Emphasis on H1N1 Infection Outcome

Background: Studies comparing Influenza A and B in our community are extremely limited. Methods: Adult patients (n=1708) with ILI who visited the outpatient clinics or emergency department with FIA-positive nasal swab in two seasons were included in the analysis. Data on demographics, clinical presentation, comorbidities, and prolonged illness (revisit after 48 hours with same presentation and no admission), hospital admissions, death, and LOS were collected. Data on patients tested for H1N1 (309) by Cepheid Xpert Flu Assay (H1N1 positive, 143 [46%]; H1N1 negative, 166 [54%]) were also collected. Results: Prolonged illness was more frequent in patients with influenza B than those with influenza A (15.21% and 10.18%, respectively; P=0.002). There was no significant difference in frequency of total admissions, medical unit or intensive care unit admissions, LOS, and death between patients with influenza A and B. Total admissions were more frequent in H1N1-positive patients than H1N1-negative patients (23.1% and 13.3%, respectively; P=0.024). Prolonged illness was more frequent in H1N1-positive patients (23.1%) than H1N1-negative patients (4.8%) (P < 0.001). There was no statistically significant difference in admission to the medical unit or ICU, death, and LOS between H1N1-positive and H1N1-negative patients. The peak months of influenza A were December in the first season and October in the second season. April was the peak month of influenza B in both seasons. There was no statistically significant difference in the outcome of pregnant patients with influenza (either A or B) compared to non-pregnant women with influenza within the same childbearing age (maternal outcome was not studied). Conclusion: Prolonged illness was more frequent in flu B than in flu A patients. Patients with positive H1N1 had more frequent prolonged illness, and total hospital admissions than those with H1N1-negative patients. There was a different peak month(s) of patients with flu A compared to flu B.

Vitamin D and HTLV Infection: A Systematic Review

Background:Vitamin D has been associated with the pathogenesis of infectious diseases.Objective:To perform a systematic review on the association of vitamin D and outcomes of HTLV (Human T-cell lymphotropic virus) infection.Methods:We searched PubMed, LILACs, Scielo, Embase and Cochrane Library for studies addressing vitamin D and HTLV infection. We included studies published in English since 1980. Studies associated with HIV, bone metabolism and not related to HTLV- associated myelopathy/ tropical spastic paraparesis (HAM/TSP) or adult T cell leukemia/lymphoma (ATL) were excluded.Results:Twenty-three studies were selected and sixteen studies were included in the review (eight experimental studies, three case reports, three cases series, one cross-sectional study and one review). Fourteen studies were focused on ATL, and two on HAM/TSP. The available data show thatin vitroexposure to 1,25(OH)2D inhibits proliferation of HTLV-infected lymphocytes in patients with ATL or HAM/TSP. It has been observed that hypercalcemia, the main cause of death in patients with ATL, is not associated with serum levels of 1,25(OH)2D or parathyroid hormone-related protein, but leukemia inhibitory factor/D factor seems to be an important factor for hypercalcemia pathogenesis. It was also demonstrated an association between the VDRApaIgene polymorphism and a decreased risk of HAM/TSP in HTLV positive individuals.Conclusion:Despite the small number and heterogeneity of the studies, this systematic review suggests that vitamin D play a role in the pathogenesis of HTLV-associated diseases.

A Global Overview of β-lactam Resistance Genes in Klebsiella pneumoniae

Klebsiella pneumoniae is a gram-negative bacillus of the Enterobacteriaceae family, commonly associated with nosocomial infections. This pathogen is a serious public health problem as some of its strains are resistant to about 95% antimicrobials of the pharmaceutical market. This resistance is promoted by the production of the β-lactamase extended spectrum (ESBL) enzymes, one of the major causes of therapeutic failure. This review evaluated the incidence and distribution of resistance genes from Klebsiella pneumoniae to β-lactams worldwide. Our study was conducted with the subject the organism K. pneumoniae and β-lactamic resistance. The most reported genes were blaSHV-12, blaCTX-M-2 and blaSHV-5; with blaSHV-12 being the most described. The last two were present in all continents, characterizing its cosmopolitan profiles. The greatest genetic diversity was observed in the Asian and Oceania, where 41 different genes were isolated. Additionally, our review points out the coexistence of different classes of β-lactamases in a single bacterial isolate. Finally, knowledge of mechanisms associated with resistance of K. pneumoniae is of great public interest and the verification of resistance genes shows a variation over time and location highlights the importance of evaluating the mechanisms or strategies by which these variations occur.

Loco-Regional BCGitis Revealing a HIV Infection in an Infant: A Case Report

The BCG disease is a specific complication of the Bacille Calmette and Guerin (BCG) vaccine. It is often in the form of benign local BCGitis, however the BCGosis is a lethal disseminated disease that can occur in a patient with immunodeficiency. The prognosis depends on the immune status of the patient, and the quality of management. Therapeutic modalities are very controversial. In this article, the authors report a case of loco-regional BCGitis revealing an HIV infection.

Bacterial Nosocomial Infection: Experience of the Neonatal Intensive Care Unit at the University Hospital of Marrakech

Background and AimNosocomial infections are one of the major causes of morbidity in the Neonatal Intensive Care Unit (NICU). Known risk factors include birth weight, gestational age, severity of illness and its related length of stay, and instrumentation.Objective:The purpose of this article is to determine the occurrence of Nosocomial Infections (NIs), including infection rates, main infection sites, and common microorganisms.Methods:A retrospective study was conducted between June 2015 and December 2016.Results:The incidence of nosocomial infection was 16%. The primary reasons for admission were intauterin growth retardation (52.5%).Klebsiella Pneumoniaewas the most commonly identified agent in the blood cultures and in the hospital unit (43.6%). The mortality rate from nosocomial infection was 52.6%. The proportion of infected newborns with a lower than normal birth weight was predominant (58.13%).Conclusion:Thus, prevention of bacterial infection is crucial in these settings of unique patients. In this view, improving neonatal management is a key step, and this includes promotion of breast-feeding and hygiene measures.