Bacterial and fungal co-infection is a major barrier in COVID-19 patients: A specific management and therapeutic strategy is required

Microbial co-infections are another primary concern in patients with coronavirus disease 2019 (COVID-19), yet it is an untouched area among researchers. Preliminary data and systematic reviews only show the type of pathogens responsible for that, but its pathophysiology is still unknown. Studies show that these microbial co-infections are hospital-acquired/nosocomial infections, and patients admitted to intensive care units with invasive mechanical ventilation are highly susceptible to it. Patients with COVID-19 had elevated inflammatory cytokines and a weakened cell-mediated immune response, with lower CD4⁺ T and CD8⁺ T cell counts, indicating vulnerability to various co-infections. Despite this, there are only a few studies that recommend the management of co-infections.     

儿童肺炎支原体感染的临床特征及混合感染相关因素研究

目的 了解儿童肺炎支原体（Mp）感染的临床特征,分析Mp与其他病原体混合感染的相关因素,为完善儿童社区获得性肺炎（CAP）防治提供证据支持。方法 基于在苏州大学附属儿童医院（SCH）开展的急性呼吸道感染病例监测,筛选2018-2021年在SCH住院的<16岁CAP病例,采用统一的调查表收集研究对象基本情况、基础疾病史、临床表现等信息,通过医院检验信息系统查询研究对象的病原检测结果,比较Mp、细菌、病毒等病原体感染者的临床特征,比较Mp混合其他病原感染对病情严重性的影响,采用logistic回归模型分析Mp混合其他病原感染的相关因素。结果 共收集8 274名CAP住院病例,其中Mp阳性2 184例（26.4%）;Mp检出率女童高于男童（P<0.001）,随月龄增加而升高（P<0.001）,夏秋季高于冬春季（P<0.001）。喘息、气促、喘鸣音及肺部呈片状阴影的发生率,以及发热和住院天数等指标在Mp、细菌和病毒感染病例中的差异均有统计学意义（均P<0.05）。<60月龄Mp混合感染病例出现喘息症状及痰鸣音和喘鸣音的比例高于单纯感染病例,≥60月龄混合感染病例较Mp单纯感染更易出现气促症状（均P<0.05）。多因素logistic回归模型分析显示,男童（aOR=1.38,95%CI：1.15~1.67）、<6月龄（aOR=3.30,95%CI：2.25~4.89）、6~月龄（aOR=3.44,95%CI：2.63~4.51）、24~月龄（aOR=2.50,95%CI：1.90~3.30）、48~71月龄（aOR=1.77,95%CI：1.32~2.37）和3个月内呼吸系统感染史（aOR=1.28,95%CI：1.06~1.55）为Mp混合其他病原感染的相关因素。结论 Mp是导致儿童CAP住院的主要病原体,单纯Mp感染病例较细菌、病毒感染病例发热天数更长;Mp常与细菌和病毒混合感染,男童、<72月龄和3个月内呼吸系统感染史是Mp混合感染的相关因素。     

A case of community-acquired pneumonia due to influenza A virus and Nocardia farcinica co-infection

Nocardia spp. has not been reported previously as a cause of post-influenza pneumonia. Here we present a first case of post-influenza bacterial pneumonia due to Nocardia farcinica. Initial reason for hospitalization of the 90 year old female patient was a pneumonia with the symptoms of fever and productive cough. A rapid test for influenza antigen was positive for influenza A virus. Treatment with Zanamivir and piperacillin was initiated. However, after 1 week of treatment, the infiltration shadows on chest X-ray had worsened. Because the expectorated sputum collected on admission for culture was found to be positive for Nocardia spp., piperacillin was replaced with trimethoprim/sulfamethoxazole, and a chest X-ray showed some improvement.Although pulmonary nocardiosis with co-infection with influenza A is extremely rare, clinicians should be alert to the possibility.     

HIV–tuberculosis co–infection in an Indian scenario: The role of associated evidence of immunosuppression

ObjectiveTo determine the relationship between tuberculosis and the degree of immunosuppression as determined by CD4 count. The impact of immunosuppression on the severity of tuberculosis was also studied.MethodsA retrospective analysis was performed in patients newly diagnosed with HIV infection and antiretroviral therapy (ART)-naive patients with known HIV seropositivity. All patients were diagnosed with active tuberculosis between January 2008 and December 2010, based on review of their medical records. Patients on chemoprophylaxis for opportunistic infection were excluded. Pattern and severity of tuberculosis, associated stigmata of immunosuppression, and CD4 counts were noted.ResultsOf 140 patients satisfying the inclusion criteria, 52 had mild tuberculosis with no other evidence of immunosuppression, 52 had tuberculosis of variable severity with associated evidence of immunosuppression, and 36 had severe tuberculosis with no other evidence of immunosuppression. The CD4 count was highest in the first group [(109.2±99.9) cells/μL] and least in the second group [(58.4±39.8) cells/μL], and the difference was statistically significant (P=0.004). No statistical difference was observed in the CD4 count between those with mild tuberculosis and those with severe tuberculosis.ConclusionsIn developing countries with a high prevalence of tuberculosis in the general population, the possibility of incidental tuberculosis in patients with HIV should always be considered. CD4 count does not appear to influence the severity of tuberculosis. The presence of concomitant evidence of immunosuppression in the form of category B and C conditions is indicative of underlying immunosuppression and associated with a significantly lower CD4 count.     

HIV、HBV共感染患者HIV病毒载量与HBV病毒载量及细胞免疫功能的相关性

目的 研究HIV、HBV共感染患者HIV病毒载量与HBV病毒载量及细胞免疫功能的相关性.方法 分别使用流式细胞仪和荧光定量PCR测定HIV、HBV共感染患者的CD3+、CD4+、CD8+细胞数目和HBV、HIV病毒载量,并采用Pearson相关分析研究病毒载量和免疫细胞数目的相关性.结果 在共感染患者中,HIV载量与CD3+及CD4+细胞负相关,HBV载量与CD4+/CD8+负相关,HIV与HBV载量正相关.结论 HBV可能存在促进HIV复制的功能,并加速HIV患者的免疫功能损伤.     

A case of liver abscess co-infected with Desulfovibrio desulfuricans and Escherichia coli and review of the literature

A 73-year-old woman was admitted with consciousness disturbance following a fever. Abdominal computed tomography revealed a large liver abscess with which the presence of Desulfovibrio desulfuricans and Escherichia coli was confirmed by thorough blood and abscess content culture. Empiric meropenem treatment was switched to cefoperazone/sulbactam, followed by ampicillin/sulbactam based on susceptibility testing. Desulfovibrio desulfuricans is a common bacterium that rarely causes liver abscess and may be overlooked during co-infection due to overgrowth of the accompanying bacteria. Clinicians should bear Desulfovibrio desulfuricans in mind and select the appropriate antibiotics according to susceptibility testing when anaerobic bacteria are detected in a liver abscess.     

Cognitive Dysfunction in Chronic Hepatitis C: A Review

The hepatitis C virus (HCV) is a common blood-borne illness that affects up to 2% of the world’s population and almost 4 million Americans. Cognitive impairment, or difficulty with thinking, has become a well-established symptom in persons with end stage liver disease. It was previously assumed that cognitive impairment was a consequence of cirrhosis-associated hepatic encephalopathy. Recent evidence, however, suggests that approximately one-third of people with chronic HCV experience cognitive impairment even in the absence of cirrhosis and that its occurrence is unrelated to other indices of liver function, such as laboratory values, viral load, and genotype. In the present review, evidence outlining the presence of cognitive deficits associated with HCV, possible etiological factors, effects of antiviral therapy, and co-infection with human immunodeficiency virus (HIV) is presented. Implications of these findings and directions for future work are discussed.     

SARS-CoV-2-induced immunodysregulation and the need for higher clinical suspicion for co-infection and secondary infection in COVID-19 patients

Cases of co-infection and secondary infection emerging during the current Coronavirus Disease-19 (COVID-19) pandemic are a major public health concern. Such cases may result from immunodysregulation induced by the SARS-CoV-2 virus. Pandemic preparedness must include identification of disease natural history and common secondary infections to implement clinical solutions.     

Co-circulation of classic and novel astrovirus strains in patients with acute gastroenteritis in Germany

Objectives

In order to analyze the molecular epidemiology of human astroviruses (HAstV) in Germany, a retrospective long-term study was performed to characterize circulating human astrovirus in patients with acute gastroenteritis in Germany.

Human immunodeficiency virus and hepatitis C virus/hepatitis B virus co-infection in Southern Brazil: clinical and epidemiological evaluation

Hepatitis B virus, hepatitis C virus and human immunodeficiency virus share a similar transmission pathway and are often diagnosed in the same patient. These patients tend to have a faster progression of hepatic fibrosis. This cross-sectional study describes the demographic features and clinical profile of human immunodeficiency virus/hepatitis co-infected patients in Paraná, Southern Brazil. A total of 93 human immunodeficiency virus-infected patients attending a tertiary care academic hospital in Southern Brazil were included. Clinical, demographic and epidemiological data were evaluated. Hepatitis B virus and/or hepatitis C virus positive serology was found in 6.6% of patients. The anti-hepatitis C virus serum test was positive in 85% (79/93) of patients, and the infection was confirmed in 72% of the cases. Eighteen patients (19%) were human immunodeficiency virus/hepatitis B virus positive (detectable HBsAg). Among co-infected patients, there was a high frequency of drug use, and investigations for the detection of co-infection were conducted late. A low number of patients were eligible for treatment and, although the response to antiretroviral therapy was good, there was a very poor response to hepatitis therapy. Our preliminary findings indicate the need for protocols aimed at systematic investigation of hepatitis B virus and hepatitis C virus in human immunodeficiency virus-infected patients, thus allowing for early detection and treatment of co-infected patients.