GERMS

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Open AccessCommunication

Synthesizing and Assessing Influenza Vaccine Evidence: Strengths and Limitations of the Recent ECDC Report on the Effectiveness of New and Enhanced Influenza Vaccines. Communication on: The “European Centre for Disease Prevention and Control. Systematic Review Update on the Efficacy, Effectiveness and Safety of Newer and Enhanced Seasonal Influenza Vaccines for the Prevention of Laboratory Confirmed Influenza in Individuals Aged 18 Years and Over. Stockholm: ECDC; 2024”

by George Kassianos, Rok Civljak, Gerrit Adrianus van Essen, Oana Falup Pecurariu, Filipe Froes, Andrey Galev, Kadri Kõivumägi, Zuzana Kristufkova, Ernest Kuchar, Jan Kyncl, Helena C. Maltezou, Miloš Marković, Anne Mosnier, Raúl Ortiz de Lejarazu Y Leonardo, Alessandro Rossi and Jörg Schelling

GERMS 2024, 14(3), 301-305; https://doi.org/10.18683/germs.2024.1441 - 30 Sep 2024

Cited by 2 | Viewed by 77

Abstract

High quality research is critical for evidence-based decision making in public health and fundamental to maintain progress and trust in immunization programs in Europe. In 2024 the European Centre for Disease Prevention and Control (ECDC) conducted an update of the 2020 systematic review [...] Read more.

High quality research is critical for evidence-based decision making in public health and fundamental to maintain progress and trust in immunization programs in Europe. In 2024 the European Centre for Disease Prevention and Control (ECDC) conducted an update of the 2020 systematic review to capture more recent evidence on of the efficacy, effectiveness of influenza vaccines in individuals aged 18 years and older in the prevention of laboratory-confirmed influenza. While this report was highly anticipated due to the strength of the protocol and processes put in place, during our assessment, we expressed two chief concerns. We are concerned by the grading of the evidence certainty applied and being unable to reproduce some data extracted in the report from the primary sources. While the systematic review benefited of strong methods and processes, the execution of the research protocol warrants revision due to the issues discussed. We encourage the ECDC to work towards an updated review within a reasonable time frame to avoid misinterpretation by decision-making bodies across Europe. Full article

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Open AccessCase Report

In Vivo Systemic Vancomycin Determination from Polymethyl Methacrylate and Morselized Bone Allograft Used in Two Stage Septic Knee Revision Arthroplasty

by Andrei Bunea, Dan Lăptoiu, Isabela Târcomnicu, Dan Oţelea, Gheorghe Popescu and Rodica Marinescu

GERMS 2024, 14(3), 294-300; https://doi.org/10.18683/germs.2024.1440 - 30 Sep 2024

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Abstract

Introduction: This paper examines the use of local antibiotic therapy in one-stage septic revision surgery for late periprosthetic joint infections (PJIs). This case study suggests that morselized bone allografts impregnated with antibiotics in powder form are a preferable alternative to polymethyl methacrylate (PMMA) [...] Read more.

Introduction: This paper examines the use of local antibiotic therapy in one-stage septic revision surgery for late periprosthetic joint infections (PJIs). This case study suggests that morselized bone allografts impregnated with antibiotics in powder form are a preferable alternative to polymethyl methacrylate (PMMA) because they can generate higher local antibiotic concentrations. Current research also recommends using vancomycin and aminoglycosides as the preferred choice of antibiotics, as they may have low diffusion in tissues when administered intravenously, but are effective when administered locally. The article emphasizes the importance of achieving high local antibiotic concentrations to eradicate bacterial biofilms and provides guidelines for the preparation of bone allografts. Case report: The paper assesses the case study of a 68-year-old male patient who underwent two-stage total revision surgery for a late septic failure of the endoprosthesis (approximatively one year after implantation). The first stage involved removing the implant, debridement, lavage, and setting a fixed spacer manually made from polymethyl methacrylate impregnated with 4 g of vancomycin. The second stage of revision surgery utilized a morselized bone allograft impregnated with 4 g of vancomycin as a means of local antibiotic therapy and bone defect coverage. Systemic levels of vancomycin were measured at 4, 8, 12 and 24 hours respectively after surgery. During this period, no systemic vancomycin was administered. After the second stage was carried out and the testing was carried out, systemic vancomycin therapy was initiated and the plasma levels of the drug were assessed and subsequently therapeutic doses were adjusted. Conclusions: Vancomycin loaded bone allograft achieved higher systemic concentrations that its polymethyl methacrylate counterpart, when being manually loaded with the same amount of antibiotic. Nonetheless, the levels were well below nephrotoxic levels, indicating that this may be a valuable tool for local means of antibiotic therapy in selected patients that could not endure such a systemic therapeutic regiment. For septic revisions, antibiotic loaded bone allograft holds a valuable place in the surgical arsenal of local antimicrobial treatment, by far exceeding that of the polymethyl methacrylate. Full article

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Open AccessCase Report

The First Case of Alveolar Echinococcosis from Southern Croatia: Progressive Course of the Disease in an Immunocompromised Patient

by Ivan Mihanovic, Relja Beck, Marin Petric, Natasa Males Raskovic, Ana Dunatov Huljev, Dijana Perkovic and Mirela Pavicic Ivelja

GERMS 2024, 14(3), 287-293; https://doi.org/10.18683/germs.2024.1439 (registering DOI) - 30 Sep 2024

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Abstract

Introduction: Alveolar echinococcosis is one of the most pathogenic zoonoses caused by the larval forms of Echinococcus multilocularis. It is endemic in central Europe, but from 2001 to 2018, eight European countries reported their first cases of alveolar echinococcosis. These numbers testify [...] Read more.

Introduction: Alveolar echinococcosis is one of the most pathogenic zoonoses caused by the larval forms of Echinococcus multilocularis. It is endemic in central Europe, but from 2001 to 2018, eight European countries reported their first cases of alveolar echinococcosis. These numbers testify to unprecedented spread of the infection. Case report: We report the first case of alveolar echinococcosis from southern Croatia that was incidentally found in an immunocompromised 70-year-old male patient. He was admitted to the hospital due to macrohematuria and renal insufficiency. Diagnostic assessment of kidney impairment revealed a large liver infiltration whose radiographic appearance was suspicious of a cancer. Nevertheless, histopathological and molecular analysis of the liver biopsy confirmed alveolar echinococcosis. The lesion was irresectable due to expansion along the major liver vessels. Therefore, conservative treatment with albendazole was started and the existing immunosuppressive therapy was modulated. The control imaging following 11 months of albendazole treatment showed regression of the lesions. Conclusions: It is not clear whether this case was imported or autochthonous, but it is evident that the incidence of alveolar echinococcosis is rising in Europe. Due to its rareness and malignant nature of the disease, it is often misdiagnosed or diagnosed late when radical surgical treatment is impossible to perform. Clinicians should be aware of this emerging parasitic disease, especially in immunocompromised patients, because every delay in reaching the diagnosis seriously hampers therapeutic efficacy. Better therapeutic options and standardized guidelines on the modulation of immunosuppressive therapy in these patients are highly needed. Full article

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Open AccessArticle

Investigation of Risk Factors for Household-Based Dengue Virus Infection in Borobudur Subdistrict, Magelang, Indonesia

by Naufal Arif Ismail, Jamaluddin Haikhah, Evania Tasnim Fauziah, Muhammad Adam Prabasunu, Fadila Husnia Rahma, Siswanto Siswanto and Vita Widyasari

GERMS 2024, 14(3), 277-286; https://doi.org/10.18683/germs.2024.1438 - 30 Sep 2024

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Abstract

Introduction: Dengue infection poses a serious threat to global public health, including Indonesia. The rapid spread and significant economic impact are crucial concerns for control efforts. Investigating risk factors of dengue virus infection is necessary to formulate effective strategies, particularly at the household [...] Read more.

Introduction: Dengue infection poses a serious threat to global public health, including Indonesia. The rapid spread and significant economic impact are crucial concerns for control efforts. Investigating risk factors of dengue virus infection is necessary to formulate effective strategies, particularly at the household level. This study aims to investigate contributing risk factors to dengue virus transmission in the Borobudur Subdistrict, Magelang, Indonesia, an area with persistently high dengue infection mortality rates. Methods: This study adopted a case-control design and utilized secondary data collected from six villages in the Borobudur Subdistrict. A total of 111 households (37 cases and 74 controls) participated in the study and completed a questionnaire encompassing: (1) Sociodemographic data; (2) Healthy housing components; (3) Sanitation and behavioral components; and (4) Dengue infection prevention practices. Data were analyzed bivariately using statistical software to identify differences in group proportions. Results: The findings of this study indicate that the presence of stagnant water (odds ratio [OR]: 5.02) and mosquito larvae (OR: 4.80) around the house, morning sleep habits (OR: 6.97), and lack of participation in anti-dengue programs (OR: 3.23) are significant risk factors (p0.05) were found in healthy housing components between the case and control groups. Conclusions: This study has identified contributing risk factors to dengue virus transmission in the Borobudur Subdistrict. These results can serve as a foundation for designing more effective intervention programs for dengue infection and future prevention efforts. Full article

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Open AccessArticle

Varicella Zoster Virus Central Nervous System Infection—A Retrospective Study from a Tertiary Center in Greece

by Konstantinos Alexakis, Petros Ioannou, George Sourvinos and Diamantis P. Kofteridis

GERMS 2024, 14(3), 267-276; https://doi.org/10.18683/germs.2024.1437 - 30 Sep 2024

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Abstract

Introduction: Central nervous system (CNS) infection due to the varicella zoster virus (VZV) can complicate the primary infection or the reactivation, leading to significant mortality and morbidity. This study aimed to describe the clinical, laboratory, and radiological characteristics of patients with confirmed VZV [...] Read more.

Introduction: Central nervous system (CNS) infection due to the varicella zoster virus (VZV) can complicate the primary infection or the reactivation, leading to significant mortality and morbidity. This study aimed to describe the clinical, laboratory, and radiological characteristics of patients with confirmed VZV CNS infection in a tertiary hospital in Greece. Methods: Data about patients hospitalized from January 2018 to September 2023 with CNS infection by VZV, confirmed by a syndromic polymerase chain reaction in the cerebrospinal fluid (CSF), were retrospectively collected and evaluated. Results: In total, 14 patients were recorded. The median age was 49 years, and 35.7% were male. Headache was present in 71.4%, a rash in 57.1%, and fevers, nausea or vomiting, and disorientation in 35.7%. The CSF showed lymphocytic pleocytosis in all patients. Brain magnetic resonance imaging was performed in 53.8%. Empirical antivirals were given in 69.2%, and intravenous acyclovir was given to all patients after identification of VZV in the CSF. Only 7.1% (1 patient) required intensive care unit admission, and 7.1% (1 patient) died. Patients presenting without a rash may be slightly younger, have a slightly lower Charlson comorbidity index, be more likely to present with photophobia or phonophobia, and have lower serum CRP. Conclusions: Patients presenting with VZV CNS infection have lymphocytic pleocytosis in the CSF and usually have a favorable outcome with antiviral treatment. Those presenting without a rash may have a different overall clinical phenotype from those with a rash; however, this must be evaluated in larger studies in the future. Full article

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Open AccessArticle

Comparative Phenotypic and Proteomic Analysis of Colistin-Exposed Pseudomonas aeruginosa

by Nguyen Bao Vy Tran, Thuc Quyen Huynh, Hong Loan Ngo, Ngoc Hoa Binh Nguyen, Thi Hiep Nguyen, Thi Hang Tong, Thi Truc Ly Trinh, Van Dung Nguyen, Le Nhat Minh Pham, Prem Prakash Das, Teck Kwang Lim, Qingsong Lin and Thi Thu Hoai Nguyen

GERMS 2024, 14(3), 246-266; https://doi.org/10.18683/germs.2024.1436 (registering DOI) - 30 Sep 2024

Cited by 1 | Viewed by 40

Abstract

Introduction: The emergence of colistin resistance threatens the treatment of Pseudomonas aeruginosa infections. Methods: In this study, in vitro development of colistin resistance was investigated using comparative phenotypic and proteomic analysis of P. aeruginosa ATCC 9027, its 14-day colistin sub-MIC exposed strain (Col-E1), [...] Read more.

Introduction: The emergence of colistin resistance threatens the treatment of Pseudomonas aeruginosa infections. Methods: In this study, in vitro development of colistin resistance was investigated using comparative phenotypic and proteomic analysis of P. aeruginosa ATCC 9027, its 14-day colistin sub-MIC exposed strain (Col-E1), and 10-day antibiotic-free cultured Col-E1 strain (Col-E2). Antibiotic susceptibility, morphology, virulence factors, and proteomic changes were assessed using disc-diffusion, agar-based, spectrophotometry, SEM, and iTRAQ-LC-MS/MS methods. Results: Colistin-exposed strains decreased susceptibility to colistin while remaining susceptible to other antibiotics. Col-E1 reduced the cell lengths by 17.67% and the colony size by 36.16% compared to the initial strain. The reduction remained in Col-E2. The pyocyanin production was reduced in Col-E1 (p=0.025, Tukey HSD) and increased again in Col-E2 (p=0.005, Tukey HSD). In contrast, no significant changes in elastase, protease, rhamnolipid, pyoverdine, and biofilm production were observed (p>0.05, Tukey HSD). In Col-E1, the proteome analysis showed 135 differentially expressed proteins (DEPs) of which 94 DEPs (69.23%) maintained their expression change in Col-E2. Among DEPs, 82 were involved in metabolism and protein synthesis. Some DEPs (6/135) played a role in stress response such as GrpE (fold change: 14.93) and Hmp (fold change: 12.08). In particular, membrane proteins like OprD, DdlB, and OprI showed significant colistin response with fold change of -8.47, 6.43 and 6.19, respectively. Conclusions: In summary, colistin response in P. aeruginosa seemed to affect morphology, production of pyocyanin, and proteins of metabolism, protein synthesis, stress response and membrane. Full article

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Open AccessArticle

Vitamin D and COVID-19: Comparative Analysis with Other Respiratory Infections and impact of Comorbidities

by Laura Constantin, Anca Ungurianu, Isabela Ţârcomnicu, Ema Bălulescu and Denisa Margină

GERMS 2024, 14(3), 232-245; https://doi.org/10.18683/germs.2024.1435 - 30 Sep 2024

Cited by 2 | Viewed by 36

Abstract

Introduction: The COVID-19 pandemic has promoted an intensive investigation into the pathophysiological mechanisms of SARS-CoV-2 infection, risk factors, and its impact on disease severity. Vitamin D has generated significant attention for its potential role in viral prevention and immune defense due to its [...] Read more.

Introduction: The COVID-19 pandemic has promoted an intensive investigation into the pathophysiological mechanisms of SARS-CoV-2 infection, risk factors, and its impact on disease severity. Vitamin D has generated significant attention for its potential role in viral prevention and immune defense due to its pleiotropic functions, including immunomodulation and antimicrobial effects. This study aimed to assess serum 25(OH)D3 levels in patients with COVID-19 compared to those with other viral respiratory infections and to evaluate associations of vitamin D levels with symptomatology, clinical characteristics, presence of comorbidities and laboratory investigation. Methods: The study included 78 patients admitted to a hospital with COVID-19 (52 patients) or other viral respiratory infections (26 patients). Routine blood biomarkers, markers of inflammation, markers of endothelial dysfunction, serum 25(OH)D3 were analyzed, and patients were classified according to vitamin D levels and presence of comorbidities. Results: Most patients had vitamin D levels <30 ng/mL and there was no significant difference in 25(OH)D3 levels between patients with and without COVID-19 (p=0.768). Aging and comorbidity prevalence were significantly increased in the COVID-19 than in the non-COVID-19 group (p<0.001; p=0.049). A significant positive correlation was determined between endocan level and serum ferritin concentration in patients with COVID-19 and vitamin D deficiency. A borderline significantly elevated NLR was observed in patients with COVID-19 who were also vitamin D deficient, compared with the similar non-COVID-19 subgroup (p=0.05). In patients with COVID-19 and insufficient vitamin D, levels of 25(OH)D negatively correlated with endocan. Interestingly, COVID-19 patients with diabetes exhibited significantly lower 25(OH)D3 levels compared to non-diabetic patients (p=0.003), along with higher ferritin levels, suggesting a potential association between vitamin D deficiency and diabetes in COVID-19. Conclusions: These findings contribute to the understanding of the complex interplay between vitamin D status, comorbidities, and COVID-19 outcomes, emphasizing the need for further research to elucidate their underlying mechanisms and clinical implications. Full article

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GERMS, Volume 14, Issue 3 (09 2024) – 7 articles , Pages 232-305

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