• Frank Hussein opublikował 1 rok, 3 miesiące temu

    Few cases of complicated infections with Listeria monocytogenes (LM) have been reported to date in patients with multiple sclerosis (MS) treated with alemtuzumab. Primary prevention strategies may be suggested in such patients to avoid infections. However, these may be ineffective because patients may already be carriers of LM. We report herein a case of bloodstream infection due to LM in a 25-year-old woman with MS treated with alemtuzumab. We searched the UMC/WHO Vigibase system for all reported cases of LM in patients treated with alemtuzumab and found 29 cases overall up to 21 July 2019. We also performed a literature review of MS cases with LM on alemtuzumab, in order to evaluate epidemiology, clinical characteristics, and outcome of this complication. Since the published cases (N=8) were mainly reported in recent years but more cases were found in the UMC/WHO Vigibase system (although not necessarily in patients with MS), we hypothesize that this complication is more frequent than currently believed and may become even more important in the future. Therefore, it is worth reaching a consensus on appropriate algorithms to stratify individuals by risk so as to implement targeted prevention strategies (whether primary or secondary).Neisseria gonorrhoeae is an uncommon present-day cause of septic arthritis. It is generally seen in the younger patient population and is often difficult to isolate in the lab. Blood cultures performed as routine work are usually negative, and when positive tend to be seen in the classic form of disseminated gonococcal infection. Here we report a case of acute septic monoarthritis, associated with N. gonorrhoea bacteraemia, in a 67-year-old male patient with multiple chronic comorbidities, who presented with acute pain and swelling at his left elbow, and no associated skin changes. Arthrocentesis findings were consistent with septic arthritis. Blood cultures drawn on admission grew N. gonorrhoeae. Synovial fluid culture was sterile but did exhibit Gram-negative cocci on Gram stain. The patient was started on IV antibiotics, and later underwent incision and drainage with subsequent improvement in symptoms. We thus present an unusual form of disseminated gonococcal infection in the setting of epidemiology, physical presentation, as well as microbiologic findings. Although less common, DGI should be considered in the differential for septic join in the older adult population, and a sexual history should be obtained in all patients. This patient ultimately had an excellent outcome given his prompt presentation after symptom onset and immediate initiation of medical therapy.Dengue Fever (DF), transmitted by Aedes mosquitoes, is the most common arthropod-borne infection, it is almost ubiquitous in tropical and subtropical areas with an estimate of 360 million infections per year. A competent vector (A. albopictus) is present in most of Southern Europe and is endemic in Italy. We conducted a 16-year retrospective study of probable/confirmed dengue fever observed at the Department of Infectious Diseases of Luigi Sacco Hospital in Milan, Italy. Overall 122 patients were included in the study, 106 with probable and 16 with proven diagnosis of dengue fever. Most patients (91%) were Italian, with a median age of 35 years (IQR 29-46 years) and similar gender distribution, travelling for tourism (80%). Asia (mainly South East Asia and Indian Subcontinent) was the most frequent travel destination (55%), followed by Central America and the Caribbeans (22%). August-September was the peak season of presentation (42.6%). The majority of our diagnoses were based on serology alone. The most common signs and symptoms were fever (99,2%), maculopapular rash (50,8%), headache (50,8%), arthralgias (50,8%) and myalgias (46,7%). Leukopenia (77%), thrombocytopenia (81%) and altered LDH, AST and ALT (respectively 60,6%, 54,1% and 45,9%) were the most common laboratory test’s abnormalities. No cases of severe DF were recorded. Our epidemiological and clinical findings are largely in accordance with most recent studies about imported DF in Europe. Although very similar in presentation to other arthropod-borne illnesses, some clinical features may help in differentiating DF from other causes of fever in the returning traveler.The present study is aimed to assess the risk factors for mortality in the first 107 rRT-PCR confirmed cases of SARS-CoV-2 infections in Bolivia. For this observational, retrospective and cross-sectional study, the epidemiological data records were collected from the Hospitals and the Ministry of Health of Bolivia, obtaining the clinical and epidemiological data of the COVID-19 cases that were laboratory-diagnosed during March 2-29, 2020. Samples were tested by rRT-PCR to SARS-CoV-2 at the Laboratory of the National Center of Tropical Diseases (CENETROP), following the protocol Charite, Berlin, Germany. The odds ratio (OR) with respective 95% confidence interval (95%CI) for mortality as dependent variable was calculated. When we comparatively analyzed survivors and non-survivors in this first group of 107 cases in Bolivia, we found that at bivariate analyses, age (±60 years old), hypertension, chronic heart failure, diabetes, and obesity, as well as the requirement of ICU, were significantly exposure variables associated with death. At the multivariate analysis (logistic regression), two variables remained significantly associated, age, ±60 years-old (OR=9.4, 95%CI 1.8-104.1) and hypertension (OR=3.3, 95%CI 1.3-6.3). As expected, age and comorbidities, particularly hypertension, were independent risk factors for mortality in Bolivia in the first 107 cases group. More further studies are required to better define risk factors and preventive measures related to COVID-19 in this and other Latin American countries.The human immunodeficiency virus (HIV) is currently a global threat with an estimated 38.6 million people affected with HIV worldwide. According to the Joint United Nations Program on HIV/AIDS (UNAIDS), since 2004 the total number of cases of HIV in Pakistan has risen from 2700 to 130,000. In light of the rising burden of HIV/AIDS across the country, it is essential that medical students possess appropriate knowledge regarding the subject. Therefore, we aimed to assess the knowledge, attitude and practice of medical students towards HIV patients in their pre-clinical and post-clinical years in Karachi, Pakistan. A cross-sectional study was conducted among 518 pre-clinical (year 1 and 2) and post-clinical (year 3, 4, and 5) medical students from two medical schools in Karachi during the months of October – December 2019. Similar numbers of participants were taken from each year. Data were analyzed using SPSS. Descriptive statistics were used to report frequencies and proportions for categorical responses. Chi-th the psycho-social problems of an HIV/AIDS patient. Finally, regarding practice, only one-third of the participants were willing to treat an HIV/AIDS patient, most of whom belonged to the pre-clinical 2nd year group and fewer to the post-clinical 3rd year group. Knowledge amongst medical students regarding HIV/AIDS was generally high, although there are some knowledge inadequacies which require more emphasis in the medical school curriculum. However, contrasting with the level of knowledge, in terms of attitude the majority were anxious or somewhat anxious when treating an HIV patient, and only one-third were willing to treat a patient with HIV.Perinatal transmission of Human Immunodeficiency Virus (HIV) infection is an important mode of transmission in developing countries. The aim of this study was to evaluate the epidemiology of perinatal transmission of HIV infection in pregnant women living with HIV/Acquired Immune Deficiency Syndrome (AIDS). A cross-sectional study was conducted in which HIV positive females who were pregnant at any time between April 2015 and July 2017 were interviewed and their case records analyzed. The collected data were entered and analyzed using Stata v11. Results were expressed as numbers and percentages for categorical variables and as mean and standard deviation (SD) for continuous variables. In all, 51 women were included in the study, 41 of whom had little knowledge concerning the transmission mode of HIV and its prevention. A total of 28 of these females were diagnosed with HIV during their pregnancy (First trimester -4, second trimester -18 and third trimester -6). A total of four babies delivered by these women were diagnosed with HIV. All the four babies were delivered by mothers who were diagnosed with HIV in or after the second trimester of the pregnancy. There is a need to create awareness amongst pregnant women about the importance of antenatal checkups.In Southern Italy, viral hepatitis B and C still represent an important public health problem, with a serious social impact, and significant economic consequences. The objective of our community-based study was to assess the prevalence of risk factors and access to the test for viral hepatitis to get information for guiding prevention and screening strategies in our setting. The study was conducted among population of four selected districts in Southern Italy during May 2019. An anonymous structured questionnaire consisting of multiple-choice questions was administered by trained research assistants in order to assess any possible risk factor for HCV or HBV acquisition, and if any screening was previously performed. Six-hundred participants were included 367 (61.2%) were females, with a mean age of 51 years (standard deviation, SD 18 years). The three most frequent risk factors were dental treatments in 425/600=70.8% (of whom 76/425=17.8% were previously tested), unprotected sexual intercourses in 340/600=56.6% (of whom 54/340=15.8% were previously tested), and injections with glass syringes in 162/600=27% (of whom 32/162=19.7% were previously tested). Only 47/502 (9.3%) patients who were never been tested, did not report any risk factors for HCV or HBV acquisition, while 433 (86.2%) reported at least one risk factor, 293 (58.3%) at least two, 97 (19.3%) at least three, 16 (3.1%) at least four, and 2 reported to have at least five risk factors for HBV/HCV acquisition.Ebola Virus Disease (EVD), also known as Ebola Hemorrhagic Fever (EHF), initially emerged over 40 years ago in the Democratic Republic of Congo. Endemic to Africa, outbreaks have been recorded in six African countries since its detection in 1976. Fruit bats are believed to be the natural hosts of Ebola viruses (EBoV), with humans and other mammals serving as accidental hosts. Transmission of EBoV has been reported in various ways, including human to human transmission through close contact with blood and bodily fluids. The virus has an incubation period ranging from two to twenty-one days, followed by a multitude of clinical manifestations such as the sudden onset of high fever, chills and myalgia depicting a flu-like syndrome. It is usually diagnosed based on several clinical symptoms such as the sudden onset of illness, high fevers for less than three weeks, and at least two hemorrhagic symptoms despite no predisposing factors. This generally provides enough evidence for clinicians to consider EHF and begin supportive treatment until the virus is confirmed through laboratory findings.

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