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OBJECTIVES: This study was conducted to assess poultry farmers’ knowledge and practices regarding antibiotics, antimicrobial usage (AMU), and antimicrobial resistance (AMR), and to identify the sociodemographic factors of inappropriate use of antibiotics in commercial poultry farms in Bangladesh. METHODS: A qualitative survey of 140 farmers in Bangladesh was conducted from March to May 2019. A logistic regression model was used to identify factors associated with the inappropriate use of antibiotics. RESULTS: 47.1% of farmers were unable to explain antibiotics, 42.9% used antibiotics for preventive purposes, 4.3% used them as growth promoters, 25.7% used them as suggested by veterinarians, 42.9% used leftover antibiotics, 50% did not maintain antibiotics residual withdrawal period, and 98.6% did not know about AMR. In bivariable regression analysis, sex and primary occupation of poultry farmers, their knowledge about withdrawal periods for antibiotics, and no contact with veterinary surgeons (VS) were found to be significantly associated with the inappropriate use of antibiotics, while only ‘no contact with VS’ was identified in multivariable regression analysis. CONCLUSIONS: The findings suggest an urgent need to improve understanding of antibiotics and AMR. Adequate supervision by veterinarians would ensure adherence to appropriate AMU patterns, and would limit the misuse of antibiotics and associated AMR development in farms.

Background Workplace absenteeism increases significantly during influenza epidemics. Sick leave records may facilitate more timely detection of influenza outbreaks, as trends in increased sick leave may precede alerts issued by sentinel surveillance systems by days or weeks. Sick leave data have not been comprehensively evaluated in comparison to traditional surveillance methods. The aim of this paper is to study the performance and the feasibility of using a detection system based on sick leave data to detect influenza outbreaks. Methods Sick leave records were extracted from private French health insurance data, covering on average 209,932 companies per year across a wide range of sizes and sectors. We used linear regression to estimate the weekly number of new sick leave spells between 2016 and 2017 in 12 French regions, adjusting for trend, seasonality and worker leaves on historical data from 2010 to 2015. Outbreaks were detected using a 95%-prediction interval. This method was compared to results from the French Sentinelles network, a gold-standard primary care surveillance system currently in place. Results Using sick leave data, we detected 92% of reported influenza outbreaks between 2016 and 2017, on average 5.88 weeks prior to outbreak peaks. Compared to the existing Sentinelles model, our method had high sensitivity (89%) and positive predictive value (86%), and detected outbreaks on average 2.5 weeks earlier. Conclusion Sick leave surveillance could be a sensitive, specific and timely tool for detection of influenza outbreaks.

La linfocitopenia T CD4 idiopática (LCI) es un síndrome clínico inusual que se caracteriza por un déficit de células T CD4+ circulantes en ausencia de infección por VIH u otra condición de inmunosupresión. Los pacientes con dicha enfermedad pueden presentarse asintomáticos o con infecciones oportunistas, las más frecuentes son por criptococo, micobacterias o virales como herpes zoster. Presentamos el caso de un hombre de 32 años, sin antecedentes, en quien se descartó infección por retrovirus, con recuento de linfocitos T CD4+ menor a 300 células/m3; se diagnosticó LCI posterior al diagnóstico de criptococomas cerebrales mediante hallazgos imagenológicos los cuales fueron congruentes con estudios microbiológicos.

Introduction: Antibiotic-resistance is a phenomenon by which bacteria manage to survive antimicrobial treatment; with incidence in intra and extra hospital environments such as: water sources, agricultural / livestock sector and fomites. Aim: To describe bacteria present in high circulation fomites in a central-western region of Colombia, with their phenotypic sensitivity profile and presence of genes beta-lactamases (TEM, OXA3 and SHV). Methodology: We isolate bacterial strains from banknotes, escalator handrails and ATM buttons. We evaluated its phenotypic sensitivity profile by minimal inhibitory concentration automated technique using Vitek 2® and presence of genes for beta-lactamases type TEM-full, OXA-3 and SHV-full by conventional PCR. Results: A total of 30 isolates were obtained; Acinetobacter baumannii complex, was the most common; banknotes were the form with the highest number of isolates and resistance. Of the total isolates, 53% carried at least one of the genes studied. Phenotypically, gram-negative bacteria were identified with resistance against: Imipinem, Piperacillin / Tazobactam, Colistin, Ceftazidime, Tigecycline and Ceftriaxone; Gram-positive bacteria with resistance to: Quinupristin / Dalfopristin, Minocycline, Tetracycline, Teicoplanin, Nitrofuratoin, Oxacillin, Clindamycin, Trimethropine-sulfamethoxazole, and Minocycline. Conclusion: Taking into account the circulation of strains with these resistances, it is important to educate the community to avoid the acquisition or spread of infections due to the inappropriate handling of this type of inanimate elements.

La tuberculosis (TB) es una de las enfermedades infecciosas con mayor carga de morbimortalidad a nivel mundial, la presentación pulmonar es la forma más común, sin embargo, las manifestaciones extrapulmonares, especialmente las osteoarticulares, pueden ser difíciles de diagnosticar debido a sus síntomas inespecíficos sugestivos de otras entidades como neoplasias o enfermedades infiltrativas, lo que hace de su diagnóstico un reto clínico. Está enfermedad esta asociada a múltiples factores de riesgo como inmunosupresión, contacto cercano con pacientes con tuberculosis, hacinamiento, residir en zona endémica, entre otros. A continuación, se presentan dos casos de pacientes pediátricos sin compromiso inmune que cursaron con cuadros sugestivos de neoplasias musculoesqueleticas, con hallazgos imagenológicos congruentes, pero con estudios microbiológicos positivos para TB.

Una vacuna para COVID 19 es una necesidad urgente de la comunidad global. El justificado temor por la premura con la cual se han desarrollado las evaluaciones de candidatos vacunales para COVID 19 no debe evitar un análisis racional, detallado e integral de los pasos que se deben cumplir y superar para dar licencia a una vacuna

Resumen Objetivo: describir las características socio-demográficas, presentación clínica y condiciones extrínsecas que pueden favorecer el desarrollo de la pitiriasis versicolor. Material y métodos: estudio observacional descriptivo, de corte transversal y prospectivo, en el que se incluyeron pacientes con diagnóstico clínico y micológico de pitiriasis versicolor entre enero y diciembre de 2018, que asistieron al Hospital Universitario Centro Dermatológico Federico Lleras Acosta. Resultados: se incluyeron un total de 42 pacientes con diagnóstico de pitiriasis versicolor confirmado por examen directo, el 62% fueron hombres con una edad promedio de 33 años. La localización más común fue el tórax anterior (68%) y posterior (65%), en fototipos III y IV (78.5%), con una tonalidad hipocrómica. El 28% presentaron cuadros recurrentes, con síntomas hasta 7 años antes de la consulta. El signo de Besnier fue positivo en el 95% de los casos. El 64% refirió antecedente personal de hiperhidrosis y el 67% practicaba algún deporte como buceo, natación o gimnasia. Discusión: la identificación de las condiciones extrínsecas presentes esta población permite orientar medidas de prevención para evitar recurrencias de pitiriasis versicolor. Los viajes a lugares de clima cálido y la práctica de deportes son factores que favorecen el desarrollo de la micosis. En las formas clínicas atípicas se sugiere realizar siempre el examen micológico directo para confirmar el diagnóstico. El signo de Besnier es una maniobra útil para el diagnóstico clínico de la pitiriasis versicolor, particularmente cuando el acceso al examen directo es limitado. Abstract Objective: to describe the sociodemographic aspects, clinical presentation and extrinsic conditions that may increase the risk of developing pityriasis versicolor. Materials and methods: a descriptive, cross-sectional and prospective observational study was conducted. Patients with clinical and mycological diagnosis of ptyriasis versicolor were included from january to december 2018 who attended to the Hospital Universitario Centro Dermatológico Federico Lleras Acosta. Results: a total of 42 patients were included in the study, all of them had confirmed mycological diagnosis of pityriasis versicolor. The most common location of the lesions was the anterior thorax (68%) and posterior thorax (65%), in III and IV phototypes (78.5%) with a hypochromic color. 28% had recurrent infection, with symptoms mean of 7 years before the consultation. The Besnier sign was positive in 95% of cases, 64% reported personal history of hyperhidrosis and 67% practiced some sports: diving, swimming and gymnastics. Discussion: recognizing extrinsic conditions that may increase the risk of developing pitiraisis versicolor in this population allows identifying control measures to prevent a relapse. The main factors involved in the development of pitiraisis versicolor were traveling to places with high temperatures and sport practice. In atypical clinical presentation it is mandatory to perform the mycological direct test to confirm the diagnosis. The Besnier sign is a useful method for the clinical diagnosis of pityriasis versicolor, particularly when access to direct examination is limited.

Objetivo: Aislar STEC en las heces del ganado bovino en el municipio de Ulloa, Valle del Cauca y detectar factores de virulencia asociados con la patogénesis. Materiales y métodos: Se tomaron 21 muestras provenientes de bovinos, las cuales fueron tomadas directamente del recto del animal mediante hisopos. Las muestras se procesaron hasta obtener colonias puras a las cuales se les evaluó la presencia de los genes stx1, stx2, eae, saa y hlyA mediante PCR y posteriormente, se evaluó el efecto citotóxico de las muestras positivas sobre células Vero (ATCC-CCL-81.4). Resultados: De las 21 muestras de heces de bovinos,12 presentaron bacterias con uno o ambos genes stx. Se obtuvieron 106 aislamientos totales de STEC y se observaron diferencias en cuanto a la presencia y ausencia de los genes de virulencia evaluados en los aislamientos de cada bovino, obteniendo cinco combinaciones de genes. 48 aislamientos presentaron únicamente el gen stx2 y 58 presentaron tanto el gen stx1 como el gen stx2; de los 106 aislamientos, se detectaron 44 con el gen hlyA y 57 con el gen saa. Conclusiones: Todos los sobrenadantes de STEC analizados mostraron actividad citotóxica sobre las células Vero, mientras que en ausencia de STEC las células formaron monocapa después de 48 h de incubación. Este trabajo es el primer reporte en Colombia que aporta información sobre la presencia de STEC en el ganado bovino, la presencia de factores de virulencia y el potencial efecto citotóxico que poseen estas cepas nativas.

Background Matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectrometry (MS) has become a widely used technique for the rapid and accurate identification of bacteria, mycobacteria and certain fungal pathogens in the clinical microbiology laboratory. Thus far, only few attempts have been made to apply the technique in clinical parasitology, particularly regarding helminth identification. Methods We systematically reviewed the scientific literature on studies pertaining to MALDI-TOF MS as a diagnostic technique for helminths (cestodes, nematodes and trematodes) of medical and veterinary importance. Readily available electronic databases (i.e. PubMed/MEDLINE, ScienceDirect, Cochrane Library, Web of Science and Google Scholar) were searched from inception to 10 October 2018, without restriction on year of publication or language. The titles and abstracts of studies were screened for eligibility by two independent reviewers. Relevant articles were read in full and included in the systematic review. Results A total of 84 peer-reviewed articles were considered for the final analysis. Most papers reported on the application of MALDI-TOF for the study of Caenorhabditis elegans, and the technique was primarily used for identification of specific proteins rather than entire pathogens. Since 2015, a small number of studies documented the successful use of MALDI-TOF MS for species-specific identification of nematodes of human and veterinary importance, such as Trichinella spp. and Dirofilaria spp. However, the quality of available data and the number of examined helminth samples was low. Conclusions Data on the use of MALDI-TOF MS for the diagnosis of helminths are scarce, but recent evidence suggests a potential role for a reliable identification of nematodes. Future research should explore the diagnostic accuracy of MALDI-TOF MS for identification of (i) adult helminths, larvae and eggs shed in faecal samples; and (ii) helminth-related proteins that are detectable in serum or body fluids of infected individuals. Electronic supplementary material The online version of this article (10.1186/s13071-019-3493-9) contains supplementary material, which is available to authorized users.

Targeted therapy and immunotherapy have markedly improved prognosis of advanced melanoma patients. With expanded use of these drugs, a range of cutaneous adverse events has emerged. Although the vast majority of adverse events are low-grade, they many cause significant morbidity and can affect patients' quality of life. Early diagnosis and prompt intervention may prevent unnecessary discontinuation of life-saving anticancer therapies. In this article, we review the cutaneous adverse events of small molecules and monoclonal antibodies used for the therapy of melanoma and discuss their pathophysiology and recommendations for prevention and management of these adverse events.

Celulite dissecante e foliculite decalvante podem apresentar, em estágios iniciais, quadro clínico semelhante. Este artigo apresenta os achados ecográficos da celulite dissecante que auxiliam no diagnóstico e na abordagem terapêutica. A ecografia não se substitui à observação, tricoscopia e histopatologia mas pode ajudar ao diagnóstico. Em fase activa, observam-se lesões ovóides de bordos relativamente bem definidos, não encapsuladas, com conteúdo hipoecogénico que comunica com a derme através dos bulbos dilatados de folículos pilosos. Permite distinção com foliculite decalvante, com quisto de triquilema (no caso de lesão única ou poucas lesões) e ao permitir avaliar a inflamação quando combinado com Doppler a cores, poderia servir para monitorizar o controlo da inflamação e a resposta terapêutica. Os autores compartilham 2 casos clínicos ilustrativos, sendo apresentada uma revisão da literatura sobre o tema.

Introdução: A dermatite atópica (DA) é uma doença inflamatória crônica e multifatorial. Casos graves afetam a qualidade de vida. A patogénese é complexa, marcada por resposta imune celular defeituosa, exacerbação da resposta inflamatória Th2 e comprometimento da função de barreira da pele. Evidências sugerem que a vitamina D atua na regulação da resposta imune inata e adaptativa, na redução do processo inflamatório e na melhora da barreira cutânea. O nosso objectivo foi correlacionar os níveis séricos de vitamina D com a gravidade da DA. Material e Métodos: Foram analisados prontuários de 30 pacientes assistidos em um ambulatório de Dermatologia, entre 2015 e 2018. Os pacientes foram divididos em 2 grupos: doença leve (terapia tópica) e doença moderada a grave (usuários de imunossupressores). Resultados: Foram selecionados 10 casos com DA leve e 20 com DA moderada a grave. Entre os pacientes com doença leve, 20% apresentaram deficiência de vitamina D. Quanto aos pacientes com doença moderada a grave, 40% apresentaram vitamina D deficiente. Comparando a média de vitamina D nos dois grupos, não houve diferença estatística entre o valor médio. Conclusão: Estudos sobre associação entre os níveis de vitamina D e gravidade da DA permanecem controversos. Alguns trabalhos reforçam essa associação. Neste estudo, apesar da proporção de pacientes com deficiência de vitamina D ser duas vezes maior entre os pacientes com DA moderada a grave, não houve significância estatística entre os dois grupos, corroborando estudos já publicados. Mais estudos relacionando a dermatite atópica à vitamina D são desejáveis, tendo em vista a sua possível aplicabilidade como terapêutica auxiliar.

Introduction: Atopic dermatitis (AD) is a chronic inflammatory disease that affects both children and adults. The main symptom is pruritus, which has an important impact on quality of life (QoL). The objective of our study was to assess the impact of AD on the quality of life of children through the CDLQI score. Population and Methods: We performed a cross-sectional survey, with descriptive and analytical aims, carried out on the basis of prospective recruitment, carried out over a period of 7 months from December 2017 to June 2018. The study included children (5-16 years) with AD selected during dermatology consultations at the Centre Hospitalier Universitaire of Treichville. Data collected included the socio-demographic characteristics of patients and their AD and the results of a questionnaire on the severity score (SCORAD) and the quality of life index in these children (CDLQI). Results: We included 60 children, mainly within the group from 05 to 09 years (57%). CDLQI average score was 9.9 and mean SCORAD 24. Pruritus, insomnia and sadness had more impact on QoL. We found a strong association between the severity of AD objectified by SCORAD and the CDLQI. Conclusion: The study reveals a high impact of AD on the QoL of children in Abidjan mainly through pruritus, insomnia and sadness. It opens up reflection on the need for education for AD management and the prospect of creating an atopy school in Côte d’Ivoire.

Introdução: As doenças de pele apresentam alta prevalência em ambientes hospitalares. Pacientes hospitalizados com dermatoses associadas apresentam maior risco de mortalidade do que indivíduos sem doenças de pele, reforçando a importância do diagnóstico e tratamento precoces. Métodos: Foi realizada uma revisão sistemática em cinco bases de dados Medline, SciELO, LILACS, Web of Science e Scopus, utilizando as palavras- chave “Inpatients” AND “Dermatology”, abrangendo o período de 2010 a 2020. Em seguida, foi realizada uma revisão narrativa por meio dos autores 'seleção de referências relevantes sobre dermatologia hospitalar, incluindo artigos de revisão, livros e outras publicações. Resultados: Com base na estratégia de busca, foram encontradas 166 publicações, das quais 26 estudos foram elegíveis para inclusão no estudo. A partir desta revisão da literatura, analisamos as frequências de dermatoses em pacientes hospitalizados e os tipos de cuidados dermatológicos. As doenças dermatológicas constituem patologias importantes nos hospitais, sendo as erupções infecciosas e medicamentosas as dermatoses mais prevalentes. Conclusão: Este estudo demonstra que as doenças dermatológicas são altamente frequentes entre os pacientes hospitalizados. A maioria dos estudos corrobora a contribuição da dermatologia para a assistência hospitalar.

Background Accurate diagnosis in patients with suspected coronavirus disease 2019 (COVID-19) is essential to guide treatment and limit spread of the virus. The combined nasal and throat swab is used widely, but its diagnostic performance is uncertain. Methods In a prospective, multi-centre, cohort study conducted in secondary and tertiary care hospitals in Scotland, we evaluated the combined nasal and throat swab with reverse transcriptase-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in consecutive patients admitted to hospital with suspected COVID-19. Diagnostic performance of the index and serial tests was evaluated for a primary outcome of confirmed or probable COVID-19, and a secondary outcome of confirmed COVID-19 on serial testing. The diagnosis was adjudicated by a panel, who recorded clinical, laboratory and radiological features blinded to the test results. Results We enrolled 1368 consecutive patients (median age 68 [interquartile range, IQR 53–80] years, 47% women) who underwent a total of 3822 tests (median 2 [IQR 1–3] tests per patient). The primary outcome occurred in 36% (496/1368), of whom 65% (323/496) and 35% (173/496) had confirmed and probable COVID-19, respectively. The index test was positive in 255/496 (51%) patients with the primary outcome, giving a sensitivity and specificity of 51.4% (95% confidence interval [CI] 48.8 to 54.1%) and 99.5% (95% CI 99.0 to 99.8%). Sensitivity increased in those undergoing 2, 3 or 4 tests to 60.1% (95% CI 56.7 to 63.4%), 68.3% (95% CI 64.0 to 72.3%) and 77.6% (95% CI 72.7 to 81.9%), respectively. The sensitivity of the index test was 78.9% (95% CI 74.4 to 83.2%) for the secondary outcome of confirmed COVID-19 on serial testing. Conclusions In patients admitted to hospital, a single combined nasal and throat swab with RT-PCR for SARS-CoV-2 has excellent specificity, but limited diagnostic sensitivity for COVID-19. Diagnostic performance is significantly improved by repeated testing.

There is a serious concern over the variation of case fatality of COVID-19 patients that reflects the preparedness of the medical care system in response to the surge of pneumonia patients. We aimed to quantify the disease spectrum of COVID-19 on which we are based to develop a key indicator on the probability of progression from pneumonia to acute respiratory disease syndrome (ARDS) for fatal COVID-19. The retrospective cohort on 12 countries that have already experienced the epidemic of COVID-19 with available open data on the conformed cases with detailed information on mild respiratory disease (MRD), pneumonia, ARDS, and deaths were used. The pooled estimates from three countries with detailed information were 73% from MRD to pneumonia and 27% from MRD to recovery and the case-fatality rate of ARDS was 43%. The progression from pneumonia to ARDS varied from 3% to 63%. These key estimates were highly associated with the case fatality rates reported for each country with a statistically significant positive relationship (adjusted R2 = 95%). Such a quantitative model provides key messages for the optimal medical resources allocation to a spectrum of patients requiring quarantine and isolation at home, isolation wards, and intensive care unit in order to reduce deaths from COVID-19.

Genomic surveillance is an essential part of effective disease control, enabling identification of emerging and expanding strains and monitoring of subsequent interventions. Whole-genome sequencing was used to analyze the genomic diversity of all Neisseria meningitidis isolates submitted to the New Zealand Meningococcal Reference Laboratory during 2013-2018. Of the 347 isolates submitted for whole-genome sequencing, we identified 68 sequence types belonging to 18 clonal complexes (CC). The predominant CC was CC41/44; next in predominance was CC11. Comparison of the 45 New Zealand group W CC11 isolates with worldwide representatives of group W CC11 isolates revealed that the original UK strain, the 2013 UK strain, and a distinctive variant (the 2015 strain) were causing invasive group W meningococcal disease in New Zealand. The 2015 strain also demonstrated increased resistance to penicillin and has been circulating in Canada and several countries in Europe, highlighting that close monitoring is needed to prevent future outbreaks around the world.

We report trends in manifestations, treatment, and outcomes of 355 children with culture-confirmed melioidosis over 10 years at a pediatric hospital in northern Cambodia. Bacteremia and presentation with pneumonia were risk factors for death. A total of 39 children recovered after being given only oral antimicrobial drug treatment.

Tesfaye Andualem Demissie,1 Dereje Belayneh2 1Department of Medical Laboratory Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia; 2Shegaw Motta General Hospital, Amhara, EthiopiaCorrespondence: Tesfaye Andualem DemissieDepartment of Medical Laboratory Science, College of Health Science, Debre Tabor University, P.O. Box 272, EthiopiaEmail tesfayeandu@gmail.comBackground: Mycobacterium Tuberculosis (MTB) and its drug resistance form are the devastating infectious diseases in the world. It is the major cause of morbidity and mortality in low-income countries with Ethiopia carrying a heavy burden. Data on the magnitude of MTB and rifampicin resistance using Xpert- MTB/RIF assay is limited in the study area. Therefore, this study aimed to assess the prevalence of Mycobacterium tuberculosis and rifampicin resistance among presumptive TB patients using GeneXpert at Motta General Hospital, North West Ethiopia.Methods: A retrospective cross-sectional study was conducted from 1st October to 30 November 2020 among patients tested for GeneXpert at Motta General Hospital, Northwest Ethiopia. Data recorded on GeneXpert test results were collected on laboratory registration book in Microbiology laboratory. Data were analyzed by using the Statistical Package for Social Sciences (SPSS) version 20.Results: A total of 4109 specimens were tested using the GeneXpert automated system. Of these, the majority 2148 (52.3%) of participants were males and 1961 (47.7%) were females. Similarly, about 1553 (37.8%) were in the age range of 25– 44 years followed by 1347 (32.8%) in 45– 64 years. Moreover, about 2486 (60.5%) participants were from rural. The overall prevalence of M. tuberculosis was 346 (8.4%) among these, the majority 222 (5.4%) had unknown HIV status, 48 (1.2%) were HIV positive, and 314 (7.6%) was new MTB cases. The overall prevalence of rifampicin resistance was 15 (4.3%) and 8(1.7%) were intermediate. Among rifampicin resistance, 10 (2.9%) were males, 8(2.3%) lived in rural, 9 (2.6%) had unknown HIV status, 13 (3.8%) were new TB patients, and 13 (3.8%) had pulmonary tuberculosis.Conclusion: The prevalence of M. tuberculosis was 8.4% and relatively higher rate of rifampicin-resistant M. tuberculosis was found.Keywords: drug resistance, GeneXpert, Mycobacterium tuberculosis, prevalence, rifampicin

Background Severe acute respiratory syndrome coronavirus 2 (SARS-cov-2), first described in December 2019, has now infected more than 28 million cases with almost one million deaths. Reinfection is not definitely established however disease recurrence is increasingly reported. Cases presentation Four patients presented with a second episode of coronavirus disease 2019 (COVID-19) occurring 27–85 following their first illness. The initial episode was mild or asymptomatic while the second attack was severe requiring hospital admission. All four patients had a SARS-CoV-2 PCR test positive in the second episode. The chest-X-ray and/or computerized tomography (CT) scan showed bilateral alveolar shadows. Furthermore, the inflammatory markers were raised in the four patients. Three patients recovered following treatment with favipravir in addition tocilizumab and/or dexamethasone. Conclusion Covid19 reinfection Recurrent COVID-19 is increasingly reported. However; other etiologies including superadded infection or pulmonary embolism should be ruled out, particularly if recurrence occurs less than 3 weeks.

Background Coronavirus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2 was first identified in Wuhan, China. All ages are susceptible to SARS-CoV-2 infection. Few studies had reported milder course in children however, severe course of illness has been reported. We aimed to describe the clinical features of COVID-19 in pediatric patients including diagnostic findings and therapeutic interventions in sever disease manifestation. Methods We retrospectively reviewed 742 patients with SARS-CoV-2 proven infection at King Abdullah Specialist Children’s Hospital, from April 2020 and July 2020. Inpatients, outpatient, including those with sever manifestation treated at the Intensive Care Unit (ICU) were included. We collected data including demographic data, comorbidities, symptoms, imaging data, laboratory findings, treatments and clinical outcomes of patients with COVID-19. Results Among of 742 patients, 71 (9.6%) were hospitalized. The median age of patients was 75 months old and 53.6 were male. A total of 461 (62.1%) had close contact with confirmed cases, 45 (6.1%) had no contact history, and 236 (31.8%) with unknown exposure risk. The most common symptoms at the onset of illness were fever (32.5%), respiratory symptoms (21%) and gastrointestinal symptoms (10.3%). Among the entire cohort, 7 patients were admitted to PICU with COVID-19 related symptoms, five patients diagnosed with MIS-C, one patient with Kawasaki, and one patient with pneumonia. All patients received supportive therapy, no antiviral treatment had been used however, in MIS-C patients IVIG had been given to all patients, five patients received Anakinra; and one patient received tocilizumab. Conclusions In this study, children infected with SARS-CoV-2 are less likely to develop symptomatic or serious diseases. Among symptomatic children, the most common clinical features were fever and respiratory symptoms followed by gastrointestinal manifestations. The majority of infected children have reported contact with an infected individual. MIS-C associated with COVID-19 is a severe presentation of SARS-CoV-2 infection and of a major concern as an overlapping features with other diseases could happen, making the diagnosis challenging.

The emergence of multidrug-resistant Gram negative bacteria has given rise to significant therapeutic challenges. These pathogens may have developed resistance to tigecycline, which is an alternative antibiotic used empirically in the treatment of serious infections. The objectives of this study were to identify the in-vitro activity of tigecycline against multidrug-resistant Gram negative strains isolated from clinical specimens and their related genes, at a university hospital. For this, 150 clinical isolates of multidrug-resistant Gram negative cultures from various clinical specimens were collected. Bacterial isolates were cultured, identified and their antibiotic susceptibilities were determined. Polymerase chain reaction was performed to amplify AcrB, AmpC, RamR, MexR, AdeB, TetA genes. Results revealed that all isolates were multidrug-resistant. The resistance of isolates was 91.4% to aztreonam, 94.6% to piperacillin, 34% to imipenem, 38.7% to meropenem, 71.3% to levofloxacin, 97.3% to ceftriaxone, 94.7% to cefepime, 9.3% to colistin, 78% to tetracycline, 21.4% to tigecycline and 68% to trimethoprim. AcrB, AmpC, RamR, MexR, AdeB, TetA genes were present in multidrug-resistant Gram negative bacteria. AcrB, RamR, TetA genes were related to tigecycline resistance. It is concluded that infections caused by multidrug-resistant Gram negative bacteria occur at a high rate. Most isolates were multi drug resistant, with 21.4% being resistant to tigecycline.

Ekta Gupta,1 Reshu Agarwal,1 Aayushi Rastogi,2 Nitiksha Rani,1 Ankur Jindal3 1Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India; 2Department of Epidemiology, Institute of Liver and Biliary Sciences, New Delhi, India; 3Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, IndiaCorrespondence: Ekta GuptaDepartment of Clinical Virology, Institute of Liver and Biliary Sciences, Sector D1, Vasant Kunj, New Delhi, 110070, IndiaTel + 91 11 46300000Fax + 91 11 26123501Email ektagaurisha@gmail.comPurpose: Limited literature on the prevalence of baseline resistance associated substitutions (BL-RAS) among HCV–HIV co-infected patients and their association with treatment outcomes is available especially from India. Hence, the present study aimed to study naturally occurring RAS among non-cirrhotic HCV–HIV co-infected patients and their impact on the response to anti-HCV therapy.Patients and Methods: In this retrospective study, archived blood samples of 80 HCV–HIV co-infected patients, before anti-HCV therapy initiation, were tested for substitutions at the drug acting sites (NS5a and NS5b) in the HCV genome by direct PCR sequencing.Results: BL-RAS were seen in 19 (23.7%) patients. As well as BL-RAS, all patients were given sofosbuvir (SOF) 400 mg+ daclatasvir (DCV) 60 mg for 12 weeks. Overall, sustained virological response (SVR) was achieved in 63 (78.8%) patients, in 13 with BL-RAS and in 50 without BL-RAS. All the SVR failure cases (n=17) were retreated with SOF (400 mg) +DCV (60 mg)+ ribavirin (RBV) for 24 weeks. SVR was eventually attained in 14 (82.3%) patients, in 4/6 (66.6%) with BL-RAS and in 10/11 (91%) without BL-RAS. On univariate analysis, age more than 30 years (OR: 11.6; 95% CI: 3.0– 45.5, p-value< 0.001) and female gender (OR: 8.6; 95% CI: 1.1− 69, p-value < 0.009) were found to be significant factors associated with the attainment of SVR.Conclusion: BL-RAS are common in HCV–HIV co-infected patients. The existence of BL-RAS, however, did not affect the attainment of SVR among non-cirrhotic, treatment naive HCV–HIV co-infected patients.Keywords: HCV–HIV co-infection, drug resistance, direct acting antiviral, resistance associated substitutions

Adrien Roussot,1,2 Karine Goueslard,1,2 Jonathan Cottenet,1– 4 Peter Von Theobald,5 Patrick Rozenberg,6,7 Catherine Quantin1– 4,8 1Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France; 2Bourgogne Franche-Comté University, Dijon, France; 3Inserm, CIC 1432, Dijon, France; 4Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon University Hospital, Dijon, France; 5Department of Gynecology and Obstetrics, Hospital Felix Guyon, CHU La Reunion, France; 6EA 7285, Versailles Saint Quentin University, Versailles, France; 7The Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France; 8High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, Inserm, Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, FranceCorrespondence: Catherine QuantinBiostatistics and Bioinformatics (DIM), University Hospital, Dijon, BP 77908, Dijon, 21079, FranceTel +33 3 8029 3629Fax +33 3 8029 3973Email catherine.quantin@chu-dijon.frPurpose: To analyze the socio-residential factors associated with extremely and very preterm deliveries occurring in non-level 3 maternity units in France.Materials and Methods: This is a population-based observational retrospective study using national hospital data from 2012 to 2014. A generalized estimating equations regression model was used to study the characteristics of women who delivered very preterm and the socio-residential risk factors for not delivering in a level 3 maternity unit at 24– 31+6d weeks of gestation.Results: Among deliveries resulting in live births and without contraindication to in-utero transfer, we identified 9198 extremely or very preterm deliveries; 2122 (23.1%) of these were managed in a non-level 3 unit. Our study showed that young maternal age (women under 20 years at delivery) was associated with the risk of giving birth prematurely in a non-level 3 maternity, and particularly in a level 1 maternity unit (adjusted relative risk, 1.53; 95% CI 1.09– 2.16). Living more than 30 minutes away from the closest level 3 unit increased the risk of delivering very preterm in a level 1 or 2 unit. Living in an urban area or urban periphery increased the risk of giving birth in a level 2 maternity unit (adjusted relative risk, 1.53; 95% CI 1.28– 1.83 and 1.42; 95% CI 1.17– 1.71, respectively).Conclusion: This study shows that young pregnant women living more than 30 minutes from a level 3 hospital have an increased risk of delivering in a maternity unit that is not equipped to deal with premature births. The risk also increases with an urban place of residence when the delivery occurs in a level 2 unit. A clearer understanding of the population at risk of delivering prematurely in a non-level 3 maternity could lead to improvements in structuring healthcare to encourage earlier management and better support.Keywords: preterm delivery, hospital claims data, neonatal intensive care unit, NICU, maternity level, socio-residential factors

Min Zhang,1,2 Jia Li,3 Yuemei Lu,4 Weiyuan Wu,4 Jinsong Wu,4 Yanji Xu,1,5 Yuxin Zhong,1,2 Shiyi Liu,1,2 Chuchu Lin,6 Shuye Xu,3 Dandan Chen,1,2 Xuefeng Gao,7 Yutian Luo,8 Huaisheng Chen,8 Xueyan Liu,8 Wei Huang1,2 1Shenzhen People’s Hospital, Shenzhen Institute of Respiratory Diseases, Shenzhen, Guangdong, People’s Republic of China; 2Bacteriology & Antibacterial Resistance Surveillance Laboratory, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, People’s Republic of China; 3Department of Nosocomial Infection Control, Bengbu Third People’s Hospital, Bengbu, People’s Republic of China; 4Department of Clinical Microbiology, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, People’s Republic of China; 5Nanshan District Center of Chronic Disease Control, Shenzhen, People’s Republic of China; 6Department of Nosocomial Infection Control, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, People’s Republic of China; 7Department of Gastroenterology and Hepatology, Shenzhen University General Hospital, Shenzhen, People’s Republic of China; 8Department of Intensive Care Unit, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, People’s Republic of ChinaCorrespondence: Wei HuangBacteriology & Antibacterial Resistance Surveillance Laboratory, Shenzhen Institute of Respiratory Diseases, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University The First Affiliated Hospital, Southern University of Science and Technology), No. 1017 Dongmen North Road, Shenzhen People’s Hospital, Shenzhen, 518020, Guangdong, People’s Republic of ChinaTel +86 7522942513Fax +86 7522942514Email whuang_sz@163.comBackground: ST11 is the most prevalent sequence type of clinical Klebsiella pneumoniae in China.Methods: We investigated the characteristics of the ST11 subclones using core genome multi-locus sequence typing (cgMLST). Ninety-three carbapenemase-producing K. pneumoniae isolates were collected at Shenzhen People’s Hospital. Then, whole-genome sequencing and cgMLST were used to discriminate apparent subclones within the ST11 group.Results: We analyzed the prevalence and genetic relationships of these subclones. ST11 and K. pneumoniae carbapenemase (KPC-2) were the predominant genotype and carbapenemase, respectively, in the clinical carbapenemase-producing K. pneumoniae strains. cgMLST scheme genotyping divided the ST11 group into two clades across seven complex types (CTs). CT1313 was the most prevalent subclone. The deletion of galF and a high frequency of SNPs in genes associated with the stress- and SOS-responses were found in CT1291 and CT2405 over time, respectively.Conclusion: Our results indicated that the subclones of the ST11 group had different patterns of prevalence. Highly discriminatory genotyping techniques, such as cgMLST scheme, should be used in further molecular epidemiology investigations.Keywords: Klebsiella pneumoniae, whole genome sequencing, cgMLST, ST11, carbapenem-resistance

Elias Bodendoerfer, 1 Nicolas Personnic, 1 Carlos A Mestres, 2 Markus J Wilhelm, 2 Lilly Meyer, 3 Barbara Hasse 3 1University of Zurich, Institute of Medical Microbiology, Zurich, Switzerland; 2University Hospital Zurich, Clinic for Cardiac Surgery, Zurich, Switzerland; 3University Hospital Zurich, Department of Infectious Diseases and Hospital Epidemiology, Zurich, SwitzerlandCorrespondence: Elias BodendoerferInstitute of Medical Microbiology, University of Zurich, Gloriastrasse 28/30, Zürich, CH-8006, SwitzerlandTel +41 44 634 26 18Email ebodendoerfer@imm.uzh.chAbstract: Bacteremia by Pandoraea spp. has rarely been described before. We report the first case of a P. pnomenusa possible prosthetic valve endocarditis, according to the modified Duke criteria, in a 37-year old male injecting drug user suffering from recurrent endocarditis. Furthermore, we demonstrate biofilm formation by the P. pnomenusa isolates of this patient and investigate antibiotic resistance.Keywords: prosthetic valve endocarditis, central venous catheter, bacteremia, Pandoraea pnomenusa, biofilm formation, antibiotic resistance

Serena Capici,1,* Luca Sala,1,* Stefania Galimberti,2 Maria Grazia Valsecchi,2 Nicola Squillace,3 Giulia Gustinetti,3 Marina Elena Cazzaniga,1,4 Paolo Bonfanti3,4 1Phase 1 Research Unit, ASST Monza, Monza, Italy; 2Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy; 3Infectious Disease Unit, ASST Monza, Monza, Italy; 4School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy*These authors contributed equally to this workCorrespondence: Marina Elena CazzanigaPhase 1 Research Unit, ASST Monza, Monza, ItalyTel +390392339037Email marina.cazzaniga@asst-monza.itAbstract: The severe acute respiratory syndrome coronavirus 2 pandemic has dominated the global health scenario from the beginning of 2020 and still represents a major health emergency. Cytokine inhibitors as tocilizumab have been used to treat COVID-19 severe pneumonia with conflicting results. We performed a retrospective study whose results can contribute to the general overview regarding the role of these agents in severe COVID-19 pneumonia, suggesting an interesting, even not statistically significant evidence of the effectiveness of tocilizumab treatment in this disease and sow a seed of reflection about their use in future waves of pandemic. We compared two cohorts of patients treated with local standard of care and with tocilizumab in the experimental one. With a median follow-up of 92 days, deaths were 6 and 16 in the tocilizumab and the standard of care group, respectively. With a longer follow-up than previous studies, a trend in difference with regards to mortality of the groups was observed.Keywords: Sars-Cov-2, COVID-19, pneumonia, tocilizumab

Gebremdhin Yenehun Worku,1 Yerega Belete Alamneh,2 Woldaregay Erku Abegaz3 1Department of Microbiology, Addis Ababa Public Health Research and Emergency Management Directorate, Addis Ababa, Ethiopia; 2Department of Microbiology, Immunology and Parasitology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 3Department of Microbiology, Immunology and Parasitology, Faculty of Medicine, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Yerega Belete Alamneh Tel +251920735677Email yereb2000@gmail.comBackground: Urinary tract infection (UTI) is caused by colonization and growth of microorganisms within the urinary system. Diabetic patients are more prone to bacterial UTI due to impaired host defense and high glucose concentration in urine. Surveillance of uropathogens and their antibiogram is a key to patient management.Methods: A hospital-based cross-sectional study was conducted from May to July, 2018. Urine samples were collected for culture and identification based on the standard protocol. An antimicrobial susceptibility test (AST) was done for all isolates using the Kirby–Bauer disk diffusion method. Data were entered into Epi-data version 3.2.1 and exported to the Statistical Package for the Social Science (SPSS) version 20.Results: Out of 225 participants, significant bacteriuria was reported in 9.8% of the cultures. Five species of bacteria were isolated and E. coli (63.6%) was the leading uropathogen, followed by K. pneumoniae (13.6%). Duration of diabetes, previous history of UTIs and symptomatic UTI were found to be strongly associated with significant bacteriuria. Gram-negative bacterial isolates showed high sensitivity to nitrofurantoin and meropenem (100%). In contrast, a high level of resistance to ampicillin, doxycycline and cefuroxime (100%) and to amoxicillin-clavulanate (94.4%) was observed. Gram-positive bacteria showed high level of resistance to penicillin (100%). Multiple-drug resistance (MDR) was high for Gram-negative bacteria (100%).Conclusion: Previous history of UTIs and duration of diabetes were found to be important factors that increase the prevalence of UTI among diabetes patients. This study also showed a high prevalence of drug resistance to doxycycline, amoxicillin-clavulanate, cefuroxime and penicillin for both Gram-negative and Gram-positive bacteria. Since therapeutic selection for empirical treatment and management should be based on knowledge of the local bacterial profile and antimicrobial response, we suggest physicians take this high resistance profile in to consideration when prescribing antimicrobials against the pathogens in question.Keywords: UTI, antibiotic susceptibility, diabetes mellitus, significant bacteriuria

Tsukasa Kuwana, Kosaku Kinoshita, Marina Hirabayashi, Shingo Ihara, Nami Sawada, Tomokazu Mutoh, Junko Yamaguchi Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo, JapanCorrespondence: Kosaku KinoshitaDivision of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamichou Itabashi-ku, Tokyo, JapanTel +81-3-3972-8111Fax +81-3-5995-1069Email kinoshita.kosaku@nihon-u.ac.jpAbstract: Hypercytokinemia induced by coronavirus disease-19 (COVID-19) is associated with severe pulmonary involvement, which may lead to respiratory failure. These conditions play an important role in the worsening of clinical symptoms in patients with severe COVID-19. There is no established treatment for hypercytokinemia. We report on two patients whose clinical symptoms improved after direct hemoperfusion using polymyxin B-immobilized fiber column (PMX-DHP), following the administration of the anti-inflammatory agent tocilizumab. Case A was a 70-year-old man diagnosed with COVID-19 pneumonia. Despite treatment with ciclesonide and favipiravir, supplemental oxygen was administered due to the worsening of dyspnea with tachypnea. Although tocilizumab was started on day 6, the patient deteriorated into deoxygenation, presenting with the PaO2/FIO2 (P/F) ratio of 92. On days 8 and 10, the patient received PMX-DHP therapy. On day 11, his dyspnea improved. On day 13, his P/F ratio began to improve, and oxygen therapy was discontinued on day 18. The patient recovered without requiring mechanical ventilation. Case B was a 70-year-old man diagnosed with COVID-19 pneumonia and treated with favipiravir, starting on day 0. Despite starting ciclesonide inhalation and tocilizumab on day 2, his P/F ratio was 53. On day 5, he received PMX-DHP therapy. On day 6, his dyspnea improved, as did his P/F ratio, reaching 81 on day 8. Finally, his clinical symptoms resolved, and he was discharged from the intensive care unit without requiring mechanical ventilation. These cases indicate that PMX-DHP therapy might be a suitable treatment option for dyspnea and deoxygenation in COVID-19 pneumonia, especially in cases where an anti-inflammatory agent, such as tocilizumab, has failed to achieve the desired effect.Keywords: blood cytokine, hypercytokinemia, P/F ratio, respiratory failure, tocilizumab

Mei-fang Wang, Li Lin, Lin-feng Li Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of ChinaCorrespondence: Lin-feng LiDepartment of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of ChinaTel +8613693620186Email zoonli@sina.comBackground: Giant condyloma acuminatum (GCA), also called Buschke–Löwenstein tumor, presents as a verrucous infiltrating lesion and is caused by sexual transmission of human papilloma virus. The optimal treatment is controversial and there are no standard guidelines because of its rarity and frequent recurrence. It has a relatively high local recurrence rate.Objective: We here report eight patients (six men and two women) with GCA whose lesions were successfully treated topically with traditional Chinese medicine (TCM) preparations, paiteling.Methods and Materials: We administered topical TCM preparations to eight patients diagnosed with GCA who had refused surgery. The treatment process included three stages, their durations depending on the speed of resolution of the lesions and the results of visual inspection with acetic acid.Results: No significant complications occurred in any patient. The functional and esthetic outcomes were satisfactory. No recurrences were detected during follow-up.Conclusion: Topical treatment with TCM preparations may be a good alternative to surgery or other traditional methods for the treatment of GCA. This treatment has the advantages of being non-invasive, painless, and having a low risk of recurrence, and may be a useful adjunct to mainstream medical treatments.Keywords: giant condyloma acuminatum, GCA, traditional Chinese medicine, TCM, treatment, dermatosis symptoms, paiteling

Lemlem Bogale,1 Tewodros Tsegaye,1 Mohamed Abdulkadir,1 Temesgen Yihunie Akalu2 1Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 2Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Temesgen Yihunie AkaluDepartment of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Po Box 196, Gondar, EthiopiaTel +251 929390709Email temesgenyihunie@gmail.comBackground: According to the 2017 global report, Ethiopia is among the top 30 high tuberculosis (TB) and multidrug-resistant tuberculosis (MDR-TB) burden countries. However, studies on MDR-TB treatment outcomes in Southern Ethiopia was very limited. Therefore, the study was aimed at determining the unfavorable treatment outcome and its predictors among patients with multidrug-resistant tuberculosis in Southern Ethiopia MDR-TB treatment centers.Subjects and Methods: A retrospective follow-up study was conducted in Southern Ethiopia MDR-TB treatment initiating centers. Three hundred sixty-three patients were included in the study. Kaplan–Meier failure curve, median time, and Log rank test were used to present the descriptive findings. Then, a Cox regression analysis was used to identify predictors of unfavorable treatment outcome. The strength of the association was reported using an adjusted hazard ratio (AHR) and a 95% confidence interval (CI). Finally, the Cox Snell residual test was used to check the goodness of fit.Results: For the entire cohort, the unfavorable treatment outcome was 23.68% (19.29, 28.09). Hospitalization for care (AHR = 2.07; 95% CI = 1.21, 3.63), male sex (AHR = 1.85; 95% CI = 1.002, 3.42), attending tertiary education (AHR = 0.31; 95% CI = 0.11, 0.91), and those with low hemoglobin (AHR = 2.89; 95% CI = 1.55, 5.38) were predictors for unfavorable treatment outcome.Conclusion: The unfavorable treatment outcome was higher compared with the national goal of END-TB by 2020. Hospitalizations for care, male sex, and low hemoglobin level increased the hazard of the unfavorable treatment outcome. On the other hand, attending territory education decreased the hazard of the unfavorable treatment outcome.Keywords: multidrug-resistant tuberculosis, unfavorable treatment outcome, Southern Ethiopia

Muhammad Fazal Hameed,1 Yanan Chen,1 Ying Wang,2 Muhammad Shafiq,3 Hazrat Bilal,1 Linqing Liu,4 Jinming Ma,1 Pengying Gu,4 Honghua Ge1 1Institutes of Physical Science and Information Technology, Anhui University, Hefei, Anhui, 230601, People’s Republic of China; 2Department of Laboratory Medicine, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, People’s Republic of China; 3College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, People’s Republic of China; 4The Department of Geriatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, People’s Republic of ChinaCorrespondence: Honghua GeInstitutes of Physical Science and Information Technology, Anhui University, Hefei, Anhui, 230601, People’s Republic of ChinaTel +86-551-63861773Email hhge@ahu.edu.cnPengying GuThe Department of Geriatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, People’s Republic of ChinaEmail hellengpy@163.comPurpose: Antimicrobial resistance, especially carbapenem resistance Enterobacteriaceae and plasmid mediated mobile colistin resistance, is a serious issue worldwide. This study was designed to determine the epidemiological characteristics of plasmid mediated colistin resistance and carbapenem resistant Enterobacteriaceae from tertiary A hospital located in Hefei, China.Methods: Totally, 158 carbapenems resistant Enterobacteriaceae (CRE) were screened for antibiotic susceptibility, mcr-1, extended spectrum β-lactamases (ESBLs), metallo-β-lactamases (MBLs), and fosfomycin resistance genes using PCR and sequencing. The sequence types were identified by multilocus sequence typing (MLST). Plasmid profiles were determined by PCR based replicon typing (PBRT), and the plasmid sizes were confirmed by southern blotting.Results: The isolates showed high MIC50 and MIC90 for all antimicrobials, except tigecycline, meropenem, and colistin. The main Carbapenemase genes were blaKPC-2 (90.5%), blaNDM-1(3.7%), blaOXA-48(5.6%) and fosA3 (14.5%). The blaCTXM-15 found 36.7%, mcr-1 (3.7%) recorded in six isolates. PBRT revealed blaKPC-2 in K. pneumoniae on IncR, IncFII, and IncA/C. blaNDM-1 in E. coli on IncFII, whereas in E. cloacae noticed on IncHI2 plasmid. mcr-1 was recorded among IncFIIK, IncFII, and IncF in E. coli, K. pneumoniae, and E. cloacae. Resistance genes (mcr-1, blaNDM-1, blaKPC-2) harboring plasmids are successfully trans-conjugant to EC-600. A high incidence of ST11 was observed in K. pneumoniae carbapenem resistant isolates. While in E. coli, multiple STs were identified. However, mcr-1 in ST23 was identified for the first time in Anhui Province. Among Enterobacter cloacae, ST270 detected carrying blaNDM-1. Southern-hybridization confirmed the plasmid sizes 35– 150kb.Conclusion: This study indicates the co-carrying of mcr-1, blaKPC-2, and blaNDM-1 among clinical isolates, the prevalence of different Enterobacteriaceae STs is alarming, especially in E. coli. Holding such a resistance profile is a threat for humans and animals, which may be transferred between the strains through plasmid transfusion. Persistent control actions are immediately necessary to combat this hazard.Keywords: ESBL, MBL, KPC2, mcr-1, NDM-1, CTXM-15

Background Schistosomiasis japonica is a chronic parasitic disease that seriously harms people's health. Oncomelania hupensis is the only intermediate host of Schistosoma japonicum. The micro-environmental factors surrounding the snail have a great impact on the survival, growth and reproduction of O. hupensis, but there are few relevant systematic analyses until the present. This scoping review aims to identify and summarize the micro-environmental factors that greatly affect O. hupensis, and to find gaps in research thus to provide directions for future in-depth studies. Main body This scoping review searched databases with search terms of the combinations of “Micro(-)environment”, “Oncomelania” and their expanded aspects. A total of 133 original articles were recruited. Predefined data fields were extracted including research methods, influencing factors, and their effects on O. hupensis. Most studies focused on vegetation factors (54.1%), and other factors noted were soil composition (27.8%), water environmental factors (24.1%), and predator (3.0%), respectively. The factors with positive impacts included water level, pH value, soil temperature, soil humidity, the coverage and height of vegetation at suitable levels. This could provide more detailed information for O. hupensis habitat identification and prediction. The factors with negative impacts included plant extracts, snail control and disease prevention forests, and microorganisms with molluscicidal activities. It revealed a potential application as ecological molluscicides in the future. Factors such as physico-chemical properties of water, soil chemistry showed a gap in scientific studies, thus required further extensive research. Conclusions Micro-environmental factors including water quality, soil composition as well as the technology and application of biomolluscicides (plant extracts and microorganisms) deserve more attention. Relative study findings on micro-environment have good potentials in snail control applications. Further studies should be implemented to investigate the impact of micro-environmental factors on snails and close the research gaps.

Background Existing evidence showed that Human Immunodeficiency Virus counselling and testing uptake among Ethiopian youths is low, and factors contributing to it are not well studied. Therefore, this study aims to assess the status of uptake and identify its determinants using the 2016 Ethiopia Demographic and Health Survey data. Method Data of 10,903 Ethiopian youths were extracted from the 2016 Ethiopian Demographic and Health Survey. The association between the response variable and the predictors was modeled by multilevel binary logistic regression, whereas adjusted odds ratio and confidence intervals were used to measure associations and their statistical significance. The variation in the uptake of counselling and testing of HIV across regions of Ethiopia was quantified by intra-class correlation. Result The current study revealed that, overall, 34.9% (95% CI: 33.5, 36.2%) Ethiopian youths were ever tested for human immunodeficiency virus. Results show that about 9% of the variation in the probability of being tested for the disease was due to the regional variations. Moreover, having moderate and comprehensive HIV knowledge, being rich, having risky sexual behaviour, having a better educational level, having professional work, being married, owning of mobile, and having access to media were positively associated with human immunodeficiency virus voluntary counselling and testing uptake. On the other hand, being male, following protestant religion, following Muslim religion, and following other religions than orthodox religion were negatively associated with the uptake of human immunodeficiency virus counselling and testing. Conclusion Voluntary human immunodeficiency virus counselling and testing uptake among Ethiopian youths is very low and varies across the regions which might hamper the ambitious plan of Ethiopia to end the disease as a public health threat by 2030. Emphasis should be given to promoting the youths’ HIV-related knowledge through community-based education, encouraging and empowering the youths to participate in professional works by giving due focus to poor youths, and promoting mass media utilization to better achieve the plan.

The median time from symptom onset to diagnosis and the severity of illness suggest that surveillance underestimates the true number of cases., Blastomycosis is caused by inhalation of Blastomyces spp. fungi. Limited data are available on the incidence and geographic range of blastomycosis in the United States. To better characterize its epidemiologic features, we analyzed combined surveillance data from the 5 states in which blastomycosis is reportable: Arkansas, Louisiana, Michigan, Minnesota, and Wisconsin. Surveillance identified 4,441 cases during 1987–2018, a mean of 192 cases per year. The mean annual incidence was 20 cases/100,000 population in some northern counties of Wisconsin. Median patient age was 46 years, 2,892 (65%) patients were male, 1,662 (57%) were hospitalized, and 278 (8%) died. The median time from symptom onset to diagnosis was 33 days. The severity of illness and diagnostic delays suggest that surveillance underestimates the true number of cases. More in-depth surveillance in additional states could elucidate blastomycosis incidence and inform efforts to increase awareness.

Background Increasing antimicrobial resistance is a serious societal challenge affecting outpatient, inpatient and veterinary care. The German One-Health project, RAI (Rational use of Antibiotics via Information and Communication) addresses all three sectors. In the outpatient sector, General Practitioners (GPs) are the main prescribers of antibiotics and were therefore, targeted for this study. A multimodal intervention focusing on Acute Respiratory Tract infections (ARI) was designed and implemented. The aim of this study was to evaluate acceptance, rating and the self-reported impact of the intervention among GPs. Methods The intervention offered six tools: a GP training on rational antibiotic use, an app for self-monitoring, a leaflet and a set of posters (both for use as information materials in waiting rooms) and both digital and printed information prescriptions (material for ‘prescribing’ information instead of an antibiotic to the patient). The tools could be used according to individual preferences. The intervention was conducted between August 2016 and July 2017. Following the intervention, a three pages anonymous questionnaire was sent to all 271 participants. Items covered socio-demographic and professional background, use and judgement of the intervention tools (6 point Likert scale), impact of the intervention tools (4 point Likert scale). Results The response rate was 39% (n = 107). On average, respondents used 3.1 of the six available tools, with printed information prescriptions used most frequently (79%). Digital information prescriptions were used more frequently by men than by women (OR 2.8; 95% CI 1.16–7.24; p = 0.02). Eighty-seven percent of respondents stated that information prescriptions supported doctor-patient communication. In a comparison of the overall impression of the different intervention tools the GP training on rational antibiotic use was rated best (1.67 on a 6 point scale with 1 = highest, 6 = lowest) and most often noted as having had a “strong” or “very strong” impact on personal antibiotic prescribing behavior. Conclusions The multimodal intervention addressing education and communication was well accepted among GPs and could help in fostering rational use of antibiotics in primary care.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tickborne infectious disease caused by SFTS virus (SFTSV). We report 7 cases of spontaneous fatal SFTS in felines. Necropsies revealed characteristic lesions, including necrotizing lymphadenitis in 5 cases and necrotizing splenitis and SFTSV-positive blastic lymphocytes in all cases. We detected hemorrhagic lesions in the gastrointestinal tract in 6 cases and lungs in 3 cases, suggesting a more severe clinical course of SFTS in felids than in humans. We noted necrotic or ulcerative foci in the gastrointestinal tract in 3 cases, the lung in 2 cases, and the liver in 4 cases. We clarified that blastic lymphocytes are predominant targets of SFTSV and involved in induction of necrotic foci. We also found that thymic epithelial cells were additional targets of SFTSV. These results provide insights for diagnosing feline SFTS during pathological examination and demonstrate the similarity of feline and human SFTS cases.

The global transmission of SARS-COV-2 constitutes a highly challenging situation for long-term care facilities, especially with the lack of standardized and approved procedures. Residents in these facilities are at high risk for contamination due to proximity, and to morbidity and mortality given their advanced age and critical baseline health conditions. This paper exposes the experience and outcomes of a COVID-19 outbreak in a long-term facility in Jeddah, Saudi Arabia, which occurred after admission of a new resident despite high baseline level of alertness including systematic isolation and screening of all newly admitted residents. We highlight the challenges for case detection and application of protective measures, and describe the adaptive management strategies implemented to contain the outbreak.

Background Tuberculosis (TB) is a serious infectious disease caused by Mycobacterium tuberculosis (MTB). An estimated 1.7 billion people worldwide are infected with Mycobacterium tuberculosis (LTBI) during the incubation period without any obvious symptoms. Because of MTB’s high infection and mortality rates, there is an urgent need to develop a fast, portable, and sensitive diagnostic technology for its detection. Methods We included research from PubMed, Cochrane Library, Web of Science, and Embase and extracted the data. MetaDisc and STATA were used to build forest plots, Deek’s funnel plot, Fagan plot, and bivariate boxplot for analysis. Results Forty-six articles were analyzed, the results of which are as follows: sensitivity and specificity were 0.92 (0.91–0.93) and 0.95 (0.94–0.95) respectively. The NLR and PLR were 0.04 (95% CI 0.03–0.07) and 25.32 (95% CI 12.38–51.78) respectively. DOR was 639.60 (243.04–1683.18). The area under the SROC curve (AUC) was 0.99. Conclusions MPT64 exhibits good diagnostic efficiency for MTB. There is no obvious heterogeneity between the three commercial kits.

Background Staphylococcus aureus (S. aureus) bacteraemia is increasingly acquired from community settings and is associated with a mortality rate of up to 40% following complications. Identifying risk factors for complicated S. aureus bacteraemia would aid clinicians in targeting patients that benefit from expedited investigations and escalated care. Methods In this prospective observational cohort study, we aimed to identify risk factors associated with a complicated infection in community-onset S. aureus bacteraemia. Potential risk factors were collected from electronic medical records and included: - patient demographics, symptomology, portal of entry, and laboratory results. Results We identified several potential risk factors using univariate analysis. In a multiple logistic regression model, age, haemodialysis, and entry point from a diabetic foot ulcer were all significantly protective against complications. Conversely, an unknown entry point of infection, an entry point from an indwelling medical device, and a C-reactive protein concentration of over 161 mg/L on the day of admission were all significantly associated with complications. Conclusions We conclude that several factors are associated with complications including already conducted laboratory investigations and portal of entry of infection. These factors could aid the triage of at-risk patients for complications of S. aureus bacteraemia.

Background Rapid and simple serological assays for characterizing antibody responses are important in the current COVID-19 pandemic caused by SARS-CoV-2. Multiplex immunoblot (IB) assays termed COVID-19 IB assays were developed for detecting IgG and IgM antibodies to SARS-CoV-2 virus proteins in COVID-19 patients. Methods Recombinant nucleocapsid protein and the S1, S2 and receptor binding domain (RBD) of the spike protein of SARS-CoV-2 were used as target antigens in the COVID-19 IBs. Specificity of the IB assay was established with 231 sera from persons with allergy, unrelated viral infections, autoimmune conditions and suspected tick-borne diseases, and 32 goat antisera to human influenza proteins. IgG and IgM COVID-19 IBs assays were performed on 84 sera obtained at different times after a positive RT-qPCR test from 37 COVID-19 patients with mild symptoms. Results Criteria for determining overall IgG and IgM antibody positivity using the four SARS-CoV-2 proteins were developed by optimizing specificity and sensitivity in the COVID-19 IgG and IgM IB assays. The estimated sensitivities and specificities of the COVID-19 IgG and IgM IBs for IgG and IgM antibodies individually or for either IgG or IgM antibodies meet the US recommendations for laboratory serological diagnostic tests. The proportion of IgM-positive sera from the COVID-19 patients following an RT-qPCR positive test was maximal at 83% before 10 days and decreased to 0% after 100 days, while the proportions of IgG-positive sera tended to plateau between days 11 and 65 at 78–100% and fall to 44% after 100 days. Detection of either IgG or IgM antibodies was better than IgG or IgM alone for assessing seroconversion in COVID-19. Both IgG and IgM antibodies detected RBD less frequently than S1, S2 and N proteins. Conclusions The multiplex COVID-19 IB assays offer many advantages for simultaneously evaluating antibody responses to different SARS-CoV-2 proteins in COVID-19 patients.

Background Plant-based mosquito control methods may use as a supplementary malaria vector control strategy. This study aimed to evaluate the effect of smoking ethno-medicinal plants on indoor density and feeding activity of malaria vectors at early hours of the night and its residual effect after midnight in southern Ethiopia. Methods Both field and tent trials were conducted to evaluate the impact of smoking Juniperus procera leaves, Eucalyptus globulus seeds and Olea europaea leaves in Kolla Shara Village from July 2016 to February 2017. For the field trial, five grass-thatched traditional huts (three for ethno-medicinal plants and two as control [only charcoal smoking and non-charcoal smoking]) were used. Indoor host-seeking mosquitoes were collected by CDC light traps. A Latin square design was employed to minimize the bias due to the variation in house location and different sampling nights. For the tent experiment, 25 3–5-day-old starved wild female Anopheles mosquitoes reared from the larvae were released into the tents where a calf was tethered at the mid-point of each tent. Results A total of 614 Anopheles mosquitoes belonging to 5 species were collected from 5 huts, of which 93.4% was An. arabiensis; O. europaea, E. globulus and J. procera reduced the indoor density of An. arabiensis, with the mean percentage drop of 80%, 73% and 70%, respectively. In the tent trial, smoking of these plants had significant knockdown effects and inhibited feeding on the calves (F = 383.5, DF = 3, P O. europaea was relatively high (17.7 ± 0.54; 95% CI 16.8–18.6), while it was only 0.9 ± 0.1 (95% CI 0.29–1.52) in the control tents. All the test plants used in the tent trial caused significantly inhibited feeding activity of An. arabiensis on the host (F = 383.5, DF = 3, P O. europaea, E. globulus and J. procera, respectively, whereas only 19.5% were unfed in the control tent. Conclusions Smoking ethno-medicinal plant materials reduced indoor density of malaria vectors and inhibited feeding on calves inside the tents. Thus, plant-based mosquito control methods may play a vital role in reducing mosquito bites in the early hours of the night and thereby reduce residual malaria transmission. Graphical Abstract

In August 2018, a fatal autochthonous case of Crimean-Congo hemorrhagic fever was confirmed in western Spain. The complete sequence of the viral genome revealed circulation of a new virus because the genotype differs from that of the virus responsible for another case in 2016. Practitioners should be alert to possible new cases. This study was partially funded by ISCIII, RD16CIII/0003/0003, “Red de Enfermedades Tropicales,” Subprogram RETICS Plan Estatal de I+D+I 2013-2016, and co-funded by FEDER “Una manera de hacer Europa.” Sí

Liang Chen,1 Xiudi Han,2 YanLi Li,3 Chunxiao Zhang,4 Xiqian Xing5 1Department of Infectious Diseases, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, People’s Republic of China; 2Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao City, People’s Republic of China; 3Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China; 4Department of Pulmonary and Critical Care Medicine, Beijing Huimin Hospital, Beijing, People’s Republic of China; 5Department of Pulmonary and Critical Care Medicine, The 2nd People’s Hospital of Yunnan Province, Kunming City, People’s Republic of ChinaCorrespondence: Liang Chen Email chenliang1995@sina.comPurpose: Influenza virus infections are a key cause of community-acquired pneumonia (CAP). Cardiovascular events (CVEs) are common among CAP and influenza patients, but there have been few population-based studies of influenza-related pneumonia (Flu-p) patients published to date.Methods: A retrospective analysis of 1191 immunocompetent hospitalized adult Flu-p patients from January 2012 to December 2018 in five teaching hospitals in China was conducted.Results: A total of 24.6% (293/1191) of patients developed at least one form of CVE-related complication while hospitalized. In a multivariate logistic regression analysis, hypertension, cerebrovascular disease, coronary artery disease, preexisting heart failure, systolic blood pressure < 90 mmHg, respiratory rates ≥ 30 breaths/min, a lymphocyte count < 0.8× 109/L, PaO2/FiO2 < 300 mmHg, and systemic corticosteroid administration were independently associated with the incidence of CVEs; while early neuraminidase inhibitor treatment and angiotensin converting enzyme inhibitors/angiotensin II receptor blocker treatment were associated with a lower risk of CVEs. After controlling for potential confounding variables, we determined that CVEs were linked to a higher risk of 30-day mortality (OR 3.307, 95% CI 2.198– 4.975, p < 0.001) in Flu-p patients.Conclusion: CVE-related complications are common among hospitalized Flu-p patients and are associated with negative patient outcomes. Clarifying these CVE-related risk factors can aid in their clinical prevention and management.Keywords: cardiovascular event, influenza-related pneumonia, risk factor, clinical outcome

Alice Kit Ying Chan, Yiu Cheung Tsang, Chun Hung Chu, Chiu Shun Peter Tsang Faculty of Dentistry, University of Hong Kong, Prince Philip Dental Hospital, Hong Kong Special Administrative Region of the People’s Republic of ChinaCorrespondence: Chiu Shun Peter TsangFaculty of Dentistry, University of Hong Kong, Prince Philip Dental Hospital, 34 Hospital Road, Hong Kong Special Administrative Region of the People’s Republic of ChinaTel +852-2859-0310Fax +852-2858-6144Email csptsang@hku.hkBackground: The antibiotic lock technique (ALT) has been recommended for the prevention and treatment of catheter-related candidaemia. Biofilms of Candida species are resistant to some of the antifungal agents currently used. Aspirin has been shown to have anti-fungal effect but its effect on candidal biofilm is poorly understood.Purpose: The aim of the current study was to evaluate the anti-biofilm effect of aspirin on Candida biofilms including C. albicans, C. glabrata, C. krusei and C. tropicalis formed on surgical catheters and the concentration and time required to eradicate the biofilms.Methods: Biofilms of Candida species were grown on silicone catheters and incubated in aspirin at different concentrations for 2, 4 and 24 hours. The biofilms remaining were then determined quantitatively by colony-forming unit (CFU) counts and XTT assays.Results: The results demonstrated that among the tested Candida species, C. albicans was the most sensitive species towards aspirin. Aspirin at a concentration of 40 mg/mL in 4 hours was effective in eradicating the biofilm. For all the other tested species, they were eradicated by aspirin at a concentration of 40 mg/mL in 24 hours.Conclusion: Our results showed that aspirin may be used as an anti-fungal agent in lock therapy in the treatment of catheter-related candidaemia.Keywords: Candida species, lock therapy, antifungal, aspirin, catheter-related infection

In the absence of robust testing programs, timely and detailed outbreak reporting is essential for HIV control., Unsafe injection practices and injection drug use have been linked to multiple HIV outbreaks in Pakistan since 2003; however, few studies have systematically analyzed the causes of these outbreaks. We conducted a systematic review of published English-language literature indexed in bibliographic databases and search engines and a focused gray literature review to collate and analyze all reported HIV outbreaks in Pakistan during 2000–2019. Of 774 unique publications reviewed, we identified 25 eligible publications describing 7 outbreaks. More than half occurred during 2016–2019. The primary sources of transmission were iatrogenic transmission, affecting children, persons with chronic medical conditions, and the general population (4 outbreaks); injection drug use (2 outbreaks); and a combination of both (1 outbreak). In the absence of robust HIV testing and surveillance in Pakistan, timely and detailed outbreak reporting is important to understand the epidemiology of HIV in the country.

Gebreselassie Demeke, Abebe Fenta, Tebelay Dilnessa Department of Medical Laboratory Science, Health Science College, Debre Markos University, Debre Markos, EthiopiaCorrespondence: Gebreselassie Demeke Tel +251924338828Email gebredemeke@yahoo.comBackground: Intestinal parasitic infection has serious medical and public health impacts in developing countries. Intestinal parasites were under reported via direct wet mount method due to its poor sensitivity. So, the selection of a more sensitive and reliable diagnostic method is essential.Objective: The aim of the study was to evaluate the diagnostic performance of wet mount and concentration techniques of stool examination for intestinal parasites identification.Methods: A cross-sectional study among 797 pregnant women was conducted from October 2018 to February 2019 at Debre Markos Comprehensive Specialized Hospital. The study participants were selected by using a systematic random sampling technique. Stool sample was processed by using Wet Mount (WM) and Formol-Ether Concentration (FEC) techniques. Data was entered into Epi-data version 3.1 and analysis using SPSS version 20.0. The sensitivity, specificity, positive predictive value, and negative predictive value were determined against the combined result as “Gold” standard. Kappa value was determined to estimate the agreement of the diagnostic methods.Results: The overall prevalence of intestinal parasites (IP) was 35.2% with a combined method. By using WM and FEC the prevalence of IP was 13.1% and 25.7%, respectively. The sensitivity and negative predictive value of WM method were 37.1% and 74.6%, and for FEC method 73.5% and 87.5%, respectively. Test efficiency of direct WM and FEC were 77.9% and 90.7%, respectively. The agreement of WM and FEC techniques with combined technique were moderate (κ=0.434) and perfect (κ=0.783), respectively.Conclusion: The prevalence of intestinal parasites was under-reported by wet mount technique. The diagnostic performance of FEC technique for the diagnosis of intestinal parasites in pregnant women was notably high as compared to WM technique in the present study. Therefore, the WM and FEC combined method should be used as a routine diagnostic technique for the diagnosis of intestinal parasites identification.Keywords: diagnostic method comparison, intestinal parasites, pregnant women, Ethiopia

Noel S Weiss,1 Esther Perez Trejo,2 Richard Kronmal,3 Joao Lima,4 Susan R Heckbert1 1Department of Epidemiology, University of Washington, Seattle, WA, USA; 2School of Public Health, University of Montreal, Montreal, QC, Canada; 3Department of Biostatistics, University of Washington, Seattle, WA, USA; 4Department of Medicine, Johns Hopkins University, Baltimore, MD, USACorrespondence: Noel S WeissDepartment of Epidemiology, University of Washington, 18372 Ridgefield Road NW, Shoreline, WA, 98177, USAEmail nweiss@uw.eduObjective: While persons in the upper fourth or fifth of the distribution of serum levels of N-terminal pro-B type natriuretic peptide (NT-proBNP) are at a sharply increased risk of developing atrial fibrillation, their absolute risk of this condition (about 20 per 1000 per year) is not clearly high enough to justify prevention or early detection measures. We sought to determine whether the incidence of atrial fibrillation among persons with VERY high levels of NT-proBNP might be sufficiently high to warrant further action.Design and Setting: Among persons enrolled in the Multi-Ethnic Study of Atherosclerosis, we documented rates of new onset atrial fibrillation in those with increasingly high serum levels of NT-proBNP.Results: There was a monotonic increase in the incidence of atrial fibrillation with increasing serum level of NT-proBNP, reaching rates of about 50– 70 cases per 1000 person-years among those in the upper 3.1% of the distribution (above 422 pg/mL). In this group the incidence tended to be somewhat higher still among persons who were at increased risk of atrial fibrillation for other reasons (eg older age), but in no subgroup did the incidence reach 100 per 1000 person-years.Conclusion: Serum levels of NT-proBNP have a considerable ability to predict the development of atrial fibrillation. However, the value of screening middle aged and older adults for these levels hinges largely on the ability of interventions in screen-positive people to lead to a reduced incidence of atrial fibrillation and its complications.Keywords: atrial fibrillation, NT-proBNP

Yingying Shen,1 Yuzhu Li,2 Hangchao Li,2 Qi Liu,2 Huijie Dong,2 Bo Wang,1 Baodong Ye,1 Shenyun Lin,1 Yiping Shen,1 Dijiong Wu1 1Department of Hematology, First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of TCM, Hangzhou, Zhejiang Province, People’s Republic of China; 2First Clinical Medical College, Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of TCM, Hangzhou, Zhejiang Province, People’s Republic of ChinaCorrespondence: Dijiong Wu; Yiping ShenDepartment of Hematology, First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou, Zhejiang Province, People’s Republic of ChinaEmail wudijiong@zcmu.edu.cn; shenyp_@126.comAbstract: Monocytopenia and mycobacterial infection (MonoMAC) syndrome is a rare disease. Herein, we reported a 65-year-old Asian woman, previously diagnosed with myelodysplastic syndrome (MDS), suffering from recurrent pneumonia, intermittent fever, fatigue, and chest tightness lasting for five months. She was ultimately diagnosed with MonoMAC syndrome with Mycobacterium kansasii (M. kansasii) infection and GATA2 mutation through metagenomic generation sequencing (mNGS) of peripheral blood specimen, for which she was given anti-NTM therapy. Her situation significantly improved within 2 weeks of therapy. We discussed the clinical features, genetic characteristic, and prognosis of this disorder, aiming to further elucidate this rare syndrome. For MDS/AML patient with recurrent mixed infection and pancytopenia (especially with monocyte absence), MonoMAC syndrome should be highly suspected, and germline mutation and pathogen sequencing should be performed.Keywords: monocytopenia and mycobacterial infection syndrome, MonoMAC, M. kansasii, GATA-2 germline mutation, nontuberculous mycobacteria, next-generation sequencing