GERMS

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Open AccessCommunication

Low Secondary Transmission Rates of SARS-CoV-2 Infection Among Contacts of Construction Laborers at Open Air Environment

by Varun Sundar and Emmanuel Bhaskar

GERMS 2021, 11(1), 128-131; https://doi.org/10.18683/germs.2021.1250 - 15 Mar 2021

Cited by 11

Abstract

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection spreads through droplet and aerosols. Household contacts have a high risk of infection and transmission outside the home can occur at closed and open locations. We studied the transmission risk at open environment among [...] Read more.

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection spreads through droplet and aerosols. Household contacts have a high risk of infection and transmission outside the home can occur at closed and open locations. We studied the transmission risk at open environment among contacts of construction laborers. Methods: Close contacts of 18 SARS-CoV-2 infected construction laborers were assessed for symptomatic or asymptomatic infection. Contacts were classified as: (a) persons at residence of index case (b) persons at workplace (open and closed environment), and (c) persons outside the index case residence or workplace who are traceable. Relative risk of infection among contacts at different locations and observed parameters were compared between them. Results: Four hundred and ninety-six contacts were assessed. The secondary transmission rate was maximum among household contacts (n = 28, 43.7%) followed by contacts at closed environment at workplace (n = 44, 26%), traceable other contacts (n = 8, 15.7%) and contacts at open environment at workplace (n = 3, 1.4%). Relative risk of SARS-CoV-2 infection among household contacts was 30.9 (CI 9.7–98.3, p < 0.001) compared to open environmental work contacts and 1.68 (CI 1.15–2.44, p = 0.006) compared to closed environmental work contacts. Relative risk was 18.3 (CI 5.8–58.2, p < 0.001) among closed environmental work contacts compared to open environmental work contacts. One index and one secondary case died. Conclusions: The low secondary transmission rate of SARS-CoV-2 infection among open environmental contacts emphasizes the fact that free air flow has the ability to dilute or probably blow away the virus particles and lowers the transmission risk substantially. Full article

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Open AccessCase Report

Multisystem Inflammatory Syndrome in Children (MIS-C) Temporally Associated With SARS-CoV-2: The First Clinical Case in Ternopil, Ukraine

by Halyna Pavlyshyn, Viktoriia Slyva, Olha Dyvonyak and Ivanna Horishna

GERMS 2021, 11(1), 120-127; https://doi.org/10.18683/germs.2021.1249 - 15 Mar 2021

Cited by 2

Abstract

Introduction: Coronavirus disease (COVID-19) has led to a global pandemic among patients of all ages around the world. A new delayed inflammatory syndrome, with potentially severe evolution, has been described in the pediatric population, a population previously considered to be less vulnerable to [...] Read more.

Introduction: Coronavirus disease (COVID-19) has led to a global pandemic among patients of all ages around the world. A new delayed inflammatory syndrome, with potentially severe evolution, has been described in the pediatric population, a population previously considered to be less vulnerable to the severe forms of COVID-19. Case report: We describe the first clinical case of multisystem inflammatory syndrome (MIS-C) in a 7-year-old child of the Ternopil region, Ukraine. Our clinical case fulfills the Royal College of Paediatrics and Child Health definition of MIS-C temporarily associated with COVID-19 –systemic disease with long-term fever, multiorgan dysfunction, laboratory evidence of hyperinflammation, positive SARS-CoV-2 tests, and the absence of an alternative cause that would explain the clinical picture. The patient was treated according to the treatment guidelines and subsequently was discharged with the resolution of his clinical symptoms. Conclusions: This clinical case draws the attention of general practitioners and pediatricians to the importance of timely diagnosis of a rare, but potentially severe multisystem inflammatory syndrome temporarily associated with COVID-19 in children. Full article

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Open AccessCase Report

The Autochthonous Cases of Acute Strongyloidiasis in the Moscow Region

by Alexandr M. Bronstein, Alexandr N. Lukashev, Maria S. Maximova and Tatiana V. Sacharova

GERMS 2021, 11(1), 116-119; https://doi.org/10.18683/germs.2021.1248 - 15 Mar 2021

Cited by 3

Abstract

Introduction: At present, strongyloidiasis is considered by the World Health Organizaiton (WHO) as one of the most neglected diseases. Case report: A husband and a wife, both born in the Moscow region and never having traveled, initially presented with fever and unexplained peripheral [...] Read more.

Introduction: At present, strongyloidiasis is considered by the World Health Organizaiton (WHO) as one of the most neglected diseases. Case report: A husband and a wife, both born in the Moscow region and never having traveled, initially presented with fever and unexplained peripheral eosinophilia. Parasitological examination revealed Strongyloides stercoralis in feces samples. Helminth infection was strongly associated with poor sanitary conditions. While albendazole was ineffective, after the treatment with ivermectin, both patients were asymptomatic, their ELISA tests were negative, and no larvae of S. stercoralis were found in the feces. Conclusions: We concluded that patients with unexplained eosinophilia must be checked for the presence of parasites before steroid or immunosuppressive therapy. These patients, if infected, may develop the highly fatal hyperinfective syndrome. The cases reported here raise concern about possible hidden strongyloidiasis in the Moscow region and re-emergence of this infection in this and other temperate regions in Russia. Full article

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Open AccessCase Report

Post-Infectious Focal Encephalitis Due to COVID-19

by Elisa Fumi Akagi Fukushima, Abdulla Nasser, Ashish Bhargava and Shyam Moudgil

GERMS 2021, 11(1), 111-115; https://doi.org/10.18683/germs.2021.1247 - 15 Mar 2021

Cited by 11

Abstract

Introduction: Several publications described neurological manifestations caused by SARS-CoV-2. Immune-mediated neurological damages caused by COVID-19 are increasingly recognized. Case report: A young male presented in March 2020 with a new-onset seizure. Later, he started to experience a severe headache. During the second admission [...] Read more.

Introduction: Several publications described neurological manifestations caused by SARS-CoV-2. Immune-mediated neurological damages caused by COVID-19 are increasingly recognized. Case report: A young male presented in March 2020 with a new-onset seizure. Later, he started to experience a severe headache. During the second admission in May, the MRI of the brain showed left frontal lesion. Nasal PCR for SARS-CoV-2 was negative, but the serology was positive, raising the suspicion of immune-mediated encephalitis. Elevated cerebrospinal fluid immunoglobulin G with two oligoclonal bands were also seen. The patient received IV immunoglobulin and showed improvement in headache. Follow-up MRIs of the brain revealed complete resolution of the lesion. Discussion: Neurological complications from COVID-19 have been increasingly recognized. The proposed pathophysiology is either direct damage of neurological tissues, or indirectly through immune-mediated mechanisms. The timeline of the patient's presentation with seizure, as well as the lesion on the brain MRI with complete resolution after the IV immunoglobulin, strongly suggest that the patient had immune-mediated encephalitis after exposure to SARS-CoV-2. Conclusions: Several cases of encephalitis caused by SARS-CoV-2 have been reported. Immune-mediated encephalitis as probable pathophysiology is described here. Full article

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Open AccessCase Report

First Case of Whipple’s Disease Successfully Treated With Tigecycline

by Kalliopi Foteinogiannopoulou, Ioannis Mouzas, Maria Tzardi, Eleni Orfanoudaki, Eirini Theodoraki and Diamantis Kofteridis

GERMS 2021, 11(1), 105-110; https://doi.org/10.18683/germs.2021.1246 - 15 Mar 2021

Cited by 3

Abstract

Introduction: Whipple’s disease is a rare chronic infectious disease caused by Tropheryma whipplei. The infection mainly affects the small intestine of middle-aged patients, approximately three times more often in males than in females causing malabsorption and excessive weight loss but other organs [...] Read more.

Introduction: Whipple’s disease is a rare chronic infectious disease caused by Tropheryma whipplei. The infection mainly affects the small intestine of middle-aged patients, approximately three times more often in males than in females causing malabsorption and excessive weight loss but other organs may be affected as well. Case report: We describe a case of a 42-year-old woman with a history of chronic diarrhea and weight loss evolving for at least the last 6 years. The diagnosis of Whipple’s disease was confirmed by histopathological examination of duodenal biopsy samples with Periodic acid–Schiff positive macrophages and by polymerase chain reaction technique detecting the DNA of Tropheryma whipplei. The patient was commenced on several antimicrobials including beta-lactams and co-trimoxazole but she did not improve. Finally, after-long lasting i.v. tigecycline 100 mg BID she was commenced on p.o. doxycycline along with hydroxychloroquine 200 mg TID for one year and after by p.o. doxycycline alone. Discussion: The intriguing thing with this case was not only the natural resistance to co-trimoxazole but that the infection was controlled empirically with long-lasting i.v. tigecycline since several failed attempts to discontinue i.v. treatment followed. This might be due to erratic absorption of oral drugs due to gut inflammation. Conclusions: To our knowledge, this is the first case of Whipple’s disease successfully treated with long-lasting induction parenteral tigecycline followed by p.o. doxycycline along with hydroxychloroquine for one year and after by p.o. doxycycline alone. Full article

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Open AccessReview

An Update on Prevalence of Slow-Growing Mycobacteria and Rapid-Growing Mycobacteria Retrieved from Hospital Water Sources in Iran—A Systematic Review

by Maryam Arfaatabar, Pezhman Karami and Azad Khaledi

GERMS 2021, 11(1), 97-104; https://doi.org/10.18683/germs.2021.1245 - 15 Mar 2021

Cited by 12

Abstract

Introduction: This study aimed to assess the prevalence of slow growing mycobacteria (SGM) and rapid-growing mycobacteria (RGM) retrieved from hospital water sources in Iran from 2016 to 2020. Methods: The review was conducted to get eligible published studies from 1^st January 2016 [...] Read more.

Introduction: This study aimed to assess the prevalence of slow growing mycobacteria (SGM) and rapid-growing mycobacteria (RGM) retrieved from hospital water sources in Iran from 2016 to 2020. Methods: The review was conducted to get eligible published studies from 1^st January 2016 to 25^th March 2020 based on PRISMA protocol. A combination of related words from the Medical Subject Heading Terms (MeSH), with (AND, OR) were used to search for published studies reporting the prevalence of nontuberculous mycobacteria (NTM) in Scopus, MEDLINE, Web of Sciences, Google Scholar, and Iranian databases. Then data from the studies were extracted and reported. Results: Our study showed that different water sources of hospitals were contaminated with NTMs. The prevalence of RGM isolates in hospital water samples varied between 42.2%-67.5%, and the prevalence of SGM varied between 32.5%-57.7%, respectively. M. lentiflavum (84.7%), M. avium complex (2.8%-56.4%) and M. gordonae (2.8%-56.2%) were the most prevalent NTM species amongst SGM, whereas M. fortuitum (2.9%-44.2%), M. chelonae (8%-36.8%), M. mucogenicum (8%-25.6%) were the most leading NTM isolates among RGM. Conclusions: A high prevalence of NTM was reported from hospital environments particularly hospital water sources which can colonize medical devices, solutions, and water used for patients and cause nosocomial infection. Therefore, the hospitals should check the microbiological quality of the water used. Full article

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Open AccessReview

Salmonella spp. Infection—A Continuous Threat Worldwide

by Gabriela Loredana Popa and Mircea Ioan Papa

GERMS 2021, 11(1), 88-96; https://doi.org/10.18683/germs.2021.1244 - 15 Mar 2021

Cited by 173

Abstract

Acute diarrheal disease remains a major public health issue. Salmonella spp. infection is one of the leading causes of acute diarrheal disease despite the preventive measures implemented. The clinical picture of salmonellosis varies from a common gastroenteritis to enteric fevers which are life-threatening [...] Read more.

Acute diarrheal disease remains a major public health issue. Salmonella spp. infection is one of the leading causes of acute diarrheal disease despite the preventive measures implemented. The clinical picture of salmonellosis varies from a common gastroenteritis to enteric fevers which are life-threatening diseases requiring a prompt and correct antibiotic treatment. In this review we present recent salmonellosis outbreaks and point out that Salmonella infections continue to be an important health issue. Numerous outbreaks of Salmonella spp. have been reported worldwide in recent years, indicating that prevention and control programs need to be improved as well as the infectious diseases surveillance, all over the world. Full article

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Open AccessArticle

Preinvasive Cervical Lesions and High Prevalence of Human Papilloma Virus Among Pregnant Women in Cameroon

by Gilbert Doh, Edwin Mkong, George Mondinde Ikomey, Adetayo Emmanuel Obasa, Martha Mesembe, Charles Fokunang and Graeme Brendon Jacobs

GERMS 2021, 11(1), 78-87; https://doi.org/10.18683/germs.2021.1243 - 15 Mar 2021

Cited by 4

Abstract

Introduction: With the exception of breast cancer, gynecologic neoplasms constitute the most common cancers that complicate pregnancy. Pregnancy therefore presents a window of opportunity for all pregnant women who do not take part in routine free cervical cancer screening program to undergo a [...] Read more.

Introduction: With the exception of breast cancer, gynecologic neoplasms constitute the most common cancers that complicate pregnancy. Pregnancy therefore presents a window of opportunity for all pregnant women who do not take part in routine free cervical cancer screening program to undergo a free voluntary cytological test and human papillomavirus (HPV) DNA testing. This study aimed to determine prevalent HPV genotypes among pregnant women using exfoliated cells from cervical swabs and determine risk factors responsible for the upsurge of cervical precancerous lesions. Methods: In a cross-sectional study conducted from October 2017 to March 2018, a total of 482 pregnant women were enrolled. Cervical swabs and samples for cytology were collected from each enrolled participant during their routine prenatal consultation. The Papanicolaou’s (Pap) staining technique was performed and all cervical swab samples were amplified through conventional PCR. HPV genotypes were identified using the Roche Linear Array Genotyping Assay. SAS 9.2 software (SAS Institute Inc., USA) was used for statistical analysis and p values >0.05 were considered significant. Results: Among the 482 participants, 354 (73.4%) had normal cytology and 128 (26.6%) had abnormal cytology. HPV DNA was identified in 62/464 (13.4%). The most prominent HPV types identified were HPV 16 (24%), HPV 18 (36.4%), HPV 45 (28%), HPV 53 (18.9%) and HPV 67 (24.3%). Early intercourse, number of sexual partners and age at first pregnancy were some of the risk factors that influenced the etiology of preinvasive cervical lesion. Conclusions: Prevalent HPV types identified in our study were HPV 16, 18, 45, 53 and 67. Organizing effective screening programs in prenatal care facilities is crucial in order to detect prevalent HR-HPV types and precursors for cervical lesions. The addition of HPV vaccination in the national immunization program with focus on the different epidemiological HPV genotypes circulating in the country is warranted. Full article

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Open AccessArticle

Exhaustion and Senescence of CD4 and CD8 T Cells That Express Co-Stimulatory Molecules CD27 and CD28 in Subjects That Acquired HIV by Drug Use or by Sexual Route

by Leontina Bănică, Ovidiu Vlaicu, Raluca Jipa, Adrian Abagiu, Ionelia Nicolae, Emil Neaga, Dan Oţelea and Simona Paraschiv

GERMS 2021, 11(1), 66-77; https://doi.org/10.18683/germs.2021.1242 - 15 Mar 2021

Cited by 5

Abstract

Introduction: The human immunodeficiency virus (HIV) infection leads to immune activation, senescence and exhaustion of T cells. Co-stimulatory molecules play important roles in controlling these processes. The CD28 signaling triggers efficient T cell activation, while CD27 provides survival signals to CD28- T cells. [...] Read more.

Introduction: The human immunodeficiency virus (HIV) infection leads to immune activation, senescence and exhaustion of T cells. Co-stimulatory molecules play important roles in controlling these processes. The CD28 signaling triggers efficient T cell activation, while CD27 provides survival signals to CD28- T cells. Loss of these molecules was associated with senescent phenotype and resistance to checkpoint inhibitors. Romania has faced an HIV outbreak among people who inject drugs (PWID), most of them chronically infected with hepatitis C virus (HCV). HIV/HCV co-infection was associated with increased immune activation and rapid disease progression. Methods: We evaluated by flow cytometry the expression of CD27, CD28, CD38, HLA-DR, CD57 and PD-1 on CD4 and CD8 T cells from 34 subjected infected with HIV (22 PWID and 12 people who acquired HIV by sexual route – PWHS) and 18 HIV-negative individuals (controls). Results: We found that as compared to controls, HIV patients, regardless of infection route, have high percentages of intermediately differentiated (CD27+CD28-) and low percentages of less differentiated (CD27+CD28+) CD8 T cells. Significantly higher levels of CD8+CD27+CD28- T cells were found in PWHS than in PWID. A lower percentage of intermediately and highly differentiated (CD27-CD28-) CD8 T cells express CD57 in people living with HIV (PLWH) than in controls. Increased levels of less and intermediately differentiated CD4 and CD8 T cells expressing PD-1 were identified in PLWH, especially in PWID; these directly correlated with HIV viral load and T cell activation and negatively correlated with CD4 counts. Conclusions: Our data show that induction of PD-1 on T cells expressing co-stimulatory molecules CD27 and/or CD28 might contribute to poor control of HIV infection and to immune activation. Full article

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Open AccessArticle

Across Regions: Are Most COVID-19 Deaths Above or Below Life Expectancy?

by Rondy J. Malik

GERMS 2021, 11(1), 59-65; https://doi.org/10.18683/germs.2021.1241 - 15 Mar 2021

Cited by 1

Abstract

Introduction: Life expectancy varies across geographical and political landscapes for a multitude of reasons. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the 2020 coronavirus disease (COVID-19) and pandemic, is present in 215 countries, and is described as a pathogen [...] Read more.

Introduction: Life expectancy varies across geographical and political landscapes for a multitude of reasons. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the 2020 coronavirus disease (COVID-19) and pandemic, is present in 215 countries, and is described as a pathogen that is most deadly to individuals 65 years and older. However, it is unclear if the majority of COVID-19-related deaths are targeting individuals above or below life expectancy. Methods: Through seven months of the 2020 COVID-19 pandemic, an association between life expectancy and COVID-19 related deaths was assessed. The reported age of those suffering from COVID-19-related deaths was evaluated across eight countries (United States, Germany, Italy, Hungary, Poland, South Africa, Sweden, and Switzerland), and placed into binary categories depending on whether or not the death occurred above or below the country’s life expectancy. Results: Given this dataset, it was observed that there was a greater proportion of COVID related deaths above life expectancy (M=64.58%, SD=6.46) as opposed to below life expectancy (M=35.41%, SD=6.46), as these differences were significant (95%CI [18.518, 42.881], p<0.001). In contrast, an insignificant trend was observed when examining the relationship between deaths above life expectancy and Gini index (Pearson correlation coefficient r= -0.62, n=8, p=0.09). The disparity, or percent difference in death occurring above versus below life expectancy was greatest in the countries with life expectancies of 80+ (Sweden, Switzerland, Germany). Conclusions: Considering life expectancy may be an appropriate approach for reporting COVID-19-related deaths, as well as planning responses to localized COVID-19 outbreaks, prioritizing drug treatment, and assessing ICU capacity. Full article

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Open AccessArticle

The Prevalence of HCV RNA Positivity in Anti-HCV Antibodies-Negative Hemodialysis Patients in Thrace Region. Multicentral Study

by Eleni I. Konstantinidou, Eftychia G. Kontekaki, Aristidis Kefas, Theocharis Konstantinidis, Gioulia Romanidou, Eleni Fotiadou, Viki Rekari, Eleni Triantafyllidou, Stavroula Zisaki, Evi Kasmeridou, Mariana Andreadou, Konstantina Kantartzi, Konstantinos Mavromatidis, George Martinis, Dimitrios Cassimos, Elias Thodis, Maria Panopoulou and Konstantinos Mimidis

GERMS 2021, 11(1), 52-58; https://doi.org/10.18683/germs.2021.1240 - 15 Mar 2021

Cited by 2

Abstract

Introduction: HCV infection in patients under hemodialysis for end stage chronic kidney disease (ESCKD) may exist despite the absence of anti-HCV antibodies. Molecular methods are widely accepted as “gold standard” techniques for the detection of viral RNA. However, the molecular methods are more [...] Read more.

Introduction: HCV infection in patients under hemodialysis for end stage chronic kidney disease (ESCKD) may exist despite the absence of anti-HCV antibodies. Molecular methods are widely accepted as “gold standard” techniques for the detection of viral RNA. However, the molecular methods are more expensive in comparison to conventional methods and their replacement is not cost-effective. The aim of this study was to estimate the prevalence of HCV RNA positivity in anti-HCV negative hemodialysis patients and evaluate new diagnostic methods for the detection and the monitoring of hepatitis C in ESCKD patients. Methods: The study was performed in four hospitals of Thrace region of Greece and 233 patients with no history of hepatitis C were enrolled. Measurement of anti-HCV antibodies and HCV core antigen was performed by microparticle chemiluminescence immunoassay. Molecular detection of viral RNA was performed by the real-time RT PCR. Results: The mean age of the patients was 64.9 ± 23.3 years. HCV-Ag was positive in 2/233 patients (0.86%). Nevertheless, viral RNA was negative in those patients. Conclusions: The results of the present study showed that the incidence of HCV-RNA in patients with negative anti-HCV Abs, in hemodialysis patients in Thrace region of Greece was negligible (0/233). Full article

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Open AccessArticle

Microbial Profile, Antimicrobial Resistance, and Molecular Characterization of Diabetic Foot Infections in a University Hospital

by Azza A. Ismail, Marwa A. Meheissen, Talaat A. Abd Elaaty, Nermine E. Abd-Allatif and Heba S. Kassab

GERMS 2021, 11(1), 39-51; https://doi.org/10.18683/germs.2021.1239 - 15 Mar 2021

Cited by 17

Abstract

Introduction: Diabetic foot infections (DFIs) are among the most severe complications of diabetes. The aim of this study was to determine the etiological pathogens of DFIs in different Wagner’s and IDSA/IWGDF grades, and to assess their antimicrobial susceptibility pattern together with molecular characterization [...] Read more.

Introduction: Diabetic foot infections (DFIs) are among the most severe complications of diabetes. The aim of this study was to determine the etiological pathogens of DFIs in different Wagner’s and IDSA/IWGDF grades, and to assess their antimicrobial susceptibility pattern together with molecular characterization of antibiotic resistance genes. Methods: A prospective study was conducted on 120 DFI patients at Main Alexandria University Hospital, Egypt. The aerobic and anaerobic etiological pathogens were determined using semi-quantitative culture and PCR respectively. The antimicrobial susceptibility pattern was done according to Clinical Laboratory Standards Institute guidelines. Detection of carbapenemases and class-1 integron genes was carried out by polymerase chain reaction (PCR). Results: A total of 178 (124 aerobic, 54 anaerobic) pathogens were identified from patients with DFI, with an average of 1.82 isolates/subject. Among aerobic pathogens, Gram-negative predominated (98/124; 79%), of which Pseudomonas spp. and Proteus spp. were the most common. MRSA constituted more than 50% of Gram-positive isolates. Polymicrobial infection was found in 42 (42.9%) subjects. The proportion of Gram-negative bacteria and anaerobes increased with increased DFI grades and severity. Multidrug and extensively drug resistant isolates were observed in 86 patients (87.7%). PCR identified carbapenemases genes in 14 (11.7%) and class 1 integron in 28 (23.3%) DFI cases. Vancomycin, teicoplanin, linezolid were the most effective antimicrobial agents against Gram-positive pathogens, while colistin, imipenem, meropenem, and piperacillin-tazobactam were effective against Gram-negative pathogens. Conclusions: Multidrug and extensively drug resistant Gram-negative bacteria were the dominant pathogens among all DFI severity grades. However, the proportion of Gram-positive bacteria decreased with the severity of infection. The clinical role of our relatively high rate of anaerobes should be investigated. The results found in this study could be beneficial for designing future empiric antimicrobial protocols in relation to the severity of DFIs. Full article

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Open AccessArticle

Association Between Clinical, Laboratory Findings and Chest CT in COVID-19 in a Secondary Hospital in Jakarta, Indonesia

by Muhammad Hafiz, Aziza Ghanie Icksan, Annisa Dian Harlivasari, Sita Andarini, Febrina Susanti and Merryl Esther Yuliana

GERMS 2021, 11(1), 32-38; https://doi.org/10.18683/germs.2021.1238 - 15 Mar 2021

Cited by 2

Abstract

Introduction: A new emerging infectious disease caused by SARS-CoV-2 has caused a global pandemic. Early diagnosis is essential to prevent and halt the spread of the disease, patient management and isolation. In this study, we aimed to reveal correlations between clinical and laboratory [...] Read more.

Introduction: A new emerging infectious disease caused by SARS-CoV-2 has caused a global pandemic. Early diagnosis is essential to prevent and halt the spread of the disease, patient management and isolation. In this study, we aimed to reveal correlations between clinical and laboratory findings with chest CT. Methods: This in an observational case series single center study in a secondary hospital in Jakarta, Indonesia. Patients were included if they had typical symptoms and positive RT-PCR for SARS-CoV-2. Results: Forty-two patients with positive RT-PCR were included in this study. Typical CT findings were present in 33 (78.6%). We found a positive correlation between patients in whom the imaging was performed after the 4th day of symptoms and chest CT findings (r = 0.365 p < 0.05). In receiver operating characteristic analysis of this parameter, the area under curve (AUC) was 0.678, and the sensitivity and specificity were 0.96 and 0.44, respectively. Conclusions: Early diagnosis of COVID-19 is essential to promptly isolate and treat suspected patients. Utilization of chest CT to help diagnosis in this pandemic era needs to be considered by healthcare facilities especially if RT-PCR is limited. Full article

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Open AccessArticle

Comparative Analysis Between Tuberculous Meningitis and Other Forms of Extrapulmonary Tuberculosis

by Fatma Hammami, Makram Koubaa, Amal Chakroun, Khaoula Rekik, Wiem Feki, Chakib Marrakchi, Fatma Smaoui and Mounir Ben Jemaa

GERMS 2021, 11(1), 23-31; https://doi.org/10.18683/germs.2021.1237 - 15 Mar 2021

Cited by 5

Abstract

Introduction: Tuberculosis is a multisystem disease that may affect any organ or tissue. Tuberculous meningitis (TBM) is the most severe form of tuberculosis and commonly affects the brain. We aimed to study the epidemiological, clinical, therapeutic and evolutionary features of TBM among adults [...] Read more.

Introduction: Tuberculosis is a multisystem disease that may affect any organ or tissue. Tuberculous meningitis (TBM) is the most severe form of tuberculosis and commonly affects the brain. We aimed to study the epidemiological, clinical, therapeutic and evolutionary features of TBM among adults and to compare them with other forms of extrapulmonary tuberculosis. Methods: We conducted a retrospective study including all patients hospitalized for extrapulmonary tuberculosis in the infectious disease department in Sfax, Tunisia between 1993 and 2018. We specified the particularities of TBM cases, and we compared them with other extrapulmonary tuberculosis cases. Results: We encountered 78 patients diagnosed with TBM, among 519 patients with extrapulmonary tuberculosis (15%). The median age was 36 years (23–50) years. There were 44 females (56.4%). In comparison with other forms of extrapulmonary tuberculosis, fever [odds ratio (OR) = 4.4; p < 0.001], asthenia (OR = 3.4; p < 0.001) and anorexia (OR = 2.3; p = 0.001) were significantly more frequent in TBM patients. Adverse effects of antitubercular therapy were more frequent among TBM patients (OR = 3.1; p < 0.001). The mean duration of antitubercular therapy was 15 (12–20) months. Recovery occurred in 66 cases (84.6%), complications in 44 cases (56.4%) and death in 7 cases (9%). Comparison of the disease evolution showed that complications (OR = 7.4; p < 0.001) and mortality rates (OR = 10.7; p < 0.001) were significantly more frequent in TBM patients, while recovery was significantly more frequent in other sites of extrapulmonary tuberculosis patients (OR = 0.5; p = 0.02). Conclusions: In our country, TBM remains a disabling disease. Despite antitubercular therapy, the prognosis was more severe with the occurrence of not only complications but also a high mortality rate in comparison with other forms of extrapulmonary tuberculosis. When clinical and laboratory features suggest the diagnosis of TBM, clinicians should look for tuberculosis elsewhere in the body. Full article

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Open AccessArticle

Effect of Multidimensional Intervention To Reduce Surgical Site Infection Rate After Knee and Hip Arthroplasty

by Samar Saeed Morsi, Abeer Omar, Gautam Hebbar, Mariam Al-Fadhli and Wafaa S Hamza

GERMS 2021, 11(1), 10-22; https://doi.org/10.18683/germs.2021.1236 - 15 Mar 2021

Cited by 2

Abstract

Introduction: Prevention strategies are critical to reduce infection rates in joint arthroplasty. This study aimed to investigate the effectiveness of a set of evidence-based practices to reduce surgical site infection (SSI) rates after knee and hip arthroplasty (HPRO & KPRO). Methods: A quasi-experimental [...] Read more.

Introduction: Prevention strategies are critical to reduce infection rates in joint arthroplasty. This study aimed to investigate the effectiveness of a set of evidence-based practices to reduce surgical site infection (SSI) rates after knee and hip arthroplasty (HPRO & KPRO). Methods: A quasi-experimental study design (comparing pre- and post-intervention phases) was applied. Interventions were selected, adapted, and implemented in knee and hip arthroplasty procedures as a prospective practice. They consisted of 13 processes throughout the surgical encounter, including preoperative, intraoperative, and postoperative elements. Results: Regarding hip arthroplasty procedures, the overall SSI rate during the pre-intervention period was 11.9%, which was reduced significantly to 5.1% (57% reduction) in the intervention period (p = 0.042). For knee arthroplasty procedures, the overall baseline SSI rate during the pre-intervention period was 2.7%, which was reduced to 2.0% (26% reduction) in the intervention period. However, this reduction was not statistically significant (p = 0.561). Combined methicillin-resistant Staphylococcus aureus (MRSA) screening with appropriate decolonization and targeted prophylaxis were associated with a 50% reduction in SSI caused by MRSA in knee arthroplasty. Conclusions: The implementation of multidimensional evidence-based practices was associated with a reduction in SSI following knee and hip arthroplasties. Full article

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Open AccessEditorial

Bugs, Babies and Bumps

by Veronica Georgiana Preda

GERMS 2021, 11(1), 9; https://doi.org/10.18683/germs.2021.1235 - 15 Mar 2021

Abstract

During the last year viral infections have certainly increased everybody’s awareness [...] Full article

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GERMS, Volume 11, Issue 1 (03 2021) – 16 articles

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