Spondylodiscitis and Its Mimickers: A Pictorial Review Claudia Lucia Piccolo, Alberta Villanacci, Federica Di Stefano, Nicoletta Fusco, Davide Roberto Donno, et al. Biomedicines, 2024 Spondylodiscitis is an infection of the intervertebral disc, the adjacent vertebral body, and/or contiguous structures due to the introduction of infectious agent, usually by the hematogenous route. Imaging is crucial in assessing bacterial and tubercular spondylodiscitis, as well as their associated complications. Magnetic resonance imaging in particular can clearly depict osteo-structural changes in the vertebral body and the associated disc, as well as any soft-tissue complications, such as paravertebral abscess and/or epidural abscess, improving disease characterization and helping to recognize the agent involved. Nevertheless, other non-infectious diseases may mimic imaging appearances of spondylodiscitis and one should be aware of these conditions when interpreting MR images, which include Modic type I degenerative changes, ankylosing spondylitis, acute Schmorl’s node, porotic fractures, and spinal neuropathy arthropathy. This pictorial review aims at describing imaging findings of bacterial and non-bacterial spondylodiscitis, complications, and those pathologies that mimic these infections.
Giant cell arteritis after COVID-19 vaccination/disease: suggestions for further shots? Pierangelo Chinello, Francesca Gavaruzzi, Anna Chiara Epifani, Fabrizio Taglietti Vascular, 2024 Sirs, We read with great interest the article of Gabrielli and coll. describing a case of giant cell arteritis (GCA) after COVID-19 mRNA vaccine and COVID-19 asymptomatic infection, since we had the opportunity to visit such a patient at our Institution. Different infectious agents have been suggested to be involved in the pathogenesis of GCA, including VaricellaZoster Virus, Epstein Barr Virus, Parvovirus B19 and Chlamydia pneumoniae; more recently, the role of SARSCoV-2 is also under investigation. Several cases of GCA in SARS-CoV-2 infected patients have been described (Table 1). COVID-19 is known for its immune dysregulation and a strong association between interleukins and rheumatic diseases was found during the COVID-19 pandemic: for example, IL-6 and IL-17 showed association between polymyalgia rheumatica (PMR) and arthritis among COVID-19 patients. Oda et al. reported a case of adult large vessel vasculitis after SARS-CoV-2 infection and hypothesised, after a previous report on endothelial cell infection and endotheliitis in patients with COVID-19, that this infection and endotheliitis could have led to vasculitis. Furthermore, cases of aortitis linked to SARS-CoV-2 infection have been described. Cases of GCA following SARS-CoV-2 vaccination have also been reported (Table 1). In a pharmacovigilance study using VigiBase, among 2,499,457 spontaneous reports with mRNA COVID-19 vaccines Mettler et al. identified 2125 vasculitis cases (8.5 per 10,000 reports), of which 501 were GCA. However, not only mRNA vaccines have been proposed to be linked to GCA: in a previous report, Mettler at al. observed among 1,295,482 reports concerning COVID-19 vaccines 147 GCA cases, 290 PMR cases and 9 cases of GCA with PMR; cases reported after mRNA vaccine were 61.9% and after viral vector vaccine were 37.4% of the total. Which could be the mechanisms of post-vaccinal GCA? Liozon et al. reported 10 cases of post-influenza vaccine GCA and reviewed other cases from the literature. Their conclusion was that the onset of GCA or PMR postinfluenza vaccine is not exceptional and may be a serious form of autoimmune/inflammatory syndrome induced by adjuvants (ASIA syndrome), especially in people with personal or familial risk of GCA/PMR. ASIA syndrome is thought to be triggered by the adjuvants of the vaccines. However, mRNA SARS-CoV-2 vaccines are considered essentially adjuvant free, but they can themselves stimulate innate immunity with activation of Toll-like receptors (TLRs), notably TLR-7 and TLR-9, which may trigger an autoimmune response. At the end of their work, the Authors state that they continue to encourage COVID-19 vaccination because the benefits of vaccination far outweigh any theorical risk of immune dysregulation following administration. We agree with them from a general point of view; however, in this particular patient a synergy between the vaccine immunological stimulation and the subsequent immunological stimulation by the infection could have contributed to the development of GCA. Therefore, we suggest that the need and the advisability of further anti-SARS-CoV-2 vaccine shots should be carefully evaluated for this relatively young patient, taking into account the balance between benefits and risks.
Tackling Acinetobacter baumannii Guido Granata, Fabrizio Taglietti, Nicola Petrosillo Journal of Clinical Medicine, 2023 Globally, multidrug-resistant (MDR) bacteria represent a menace to public health [...]
Clostridioides difficile and Enterococci’s Interplay in the Human Gut: Bacterial Alliance or Competition? A Systematic Literature Review Guido Granata, Francesco Schiavone, Fabrizio Taglietti, Nicola Petrosillo Journal of Clinical Medicine, 2023 Clostridioides difficile and Enterococcus spp. are two common bacterial pathogens populating the human microbiota. We possess scant data on how Clostridioides difficile interacts with Enterococcus spp. in the gut microbiota in subjects colonized with Clostridioides difficile or during a Clostridioides difficile infection. We carried out a systematic review of studies on Enterococcus spp. and Clostridioides difficile’s interaction in the gut microbiota and on the effect of Enterococcus spp. gut colonization on CDI development. Studies on Enterococcus spp. and Clostridioides difficile’s interaction in the gut microbiota and on the effect of Enterococcus spp. gut colonization on CDI were searched using the search terms “clostridium”, “clostridioides”, “difficile” and “enterococcus” on the MEDLINE and SCOPUS databases. PubMed was searched until 1 May 2023. An English language restriction was applied. The risk of bias in the included studies was not assessed. Quantitative and qualitative information was summarized in textual descriptions. Fourteen studies, published from August 2012 to November 2022, on Clostridioides difficile and Enterococcus spp.’s interaction in the gut microbiota met the inclusion criteria. The studies included in our systematic review reported evidence that the Enterococcus spp. intestinal burden represents a risk factor for the occurrence of CDI. There is supporting evidence that Enterococcus spp. play a role in CDI development and clinical outcomes.
Streptococcus intermedius Brain Abscess with Lung Abscess and Aortic Valve Endocarditis: A Case Report and Literature Review Francesca Gavaruzzi, Pierangelo Chinello, Giuseppe Cucinotta, Gianluigi Oliva, Alessandro Capone, et al. Infectious Disease Reports, 2023 Streptococcus intermedius is frequently associated with brain and liver abscesses, while pleuropulmonary infections are considered rarer. Even less frequent is the association of lung and brain abscesses due to this agent with infective endocarditis. We describe the case of a 40-year-old man complaining of cough, fever, and headache who was diagnosed with a brain abscess due to S. intermedius, a concomitant lung abscess, and aortic native valve endocarditis. He was treated with surgical drainage of the brain abscess and a 4-week course of intravenous ceftriaxone, followed by oral amoxicillin/clavulanate, obtaining healing of the lesions without relapse of the infection.
Evolution of SARS-CoV-2 variants of concern over a period of Delta and Omicron cocirculation, among patients hospitalized for COVID-19 in an Italian reference hospital: Impact on clinical outcomes Annalisa Mondi, Ilaria Mastrorosa, Pierluca Piselli, Claudia Cimaglia, Giulia Matusali, et al. Journal of Medical Virology, 2023 Despite the higher transmissibility of Omicron Variant of Concern (VOC), several reports have suggested lower risk for hospitalization and severe outcomes compared to previous variants of SARS‐CoV‐2. This study, enrolling all COVID‐19 adults admitted to a reference hospital who underwent both the S‐gene‐target‐failure test and VOC identification by Sanger sequencing, aimed to describe the evolving prevalence of Delta and Omicron variants and to compare the main in‐hospital outcomes of severity, during a trimester (December 2021 to March 2022) of VOCs' cocirculation. Factors associated with clinical progression to noninvasive ventilation (NIV)/mechanical ventilation (MV)/death within 10 days and to MV/admission to intensive care unit (ICU)/death within 28 days, were investigated through multivariable logistic regressions. Overall, VOCs were: Delta n = 130/428, Omicron n = 298/428 (sublineages BA.1 n = 275 and BA.2 n = 23). Until mid‐February, Delta predominance shifted to BA.1, which was gradually displaced by BA.2 until mid‐March. Participants with Omicron VOC were more likely to be older, fully vaccinated, with multiple comorbidities and to have a shorter time from symptoms' onset, and less likely to have systemic symptoms and respiratory complications. Although the need of NIV within 10 days and MV within 28 days from hospitalization and the admission to ICU were less frequent for patients with Omicron compared to those with Delta infections, mortality was similar between the two VOCs. In the adjusted analysis, multiple comorbidities and a longer time from symptoms' onset predicted 10‐day clinical progression, while complete vaccination halved the risk. Multimorbidity was the only risk factor associated with 28‐day clinical progression. In our population, in the first trimester of 2022, Omicron rapidly displaced Delta in COVID‐19 hospitalized adults. Clinical profile and presentation differed between the two VOCs and, although Omicron infections showed a less severe clinical picture, no substantial differences for clinical progression were found. This finding suggests that any hospitalization, especially in more vulnerable individuals, may be at risk for severe progression, which is more related to the underlying frailty of patients than to the intrinsic severity of the viral variant.
Antibiotics Use in COVID-19 Patients: A Systematic Literature Review Guido Granata, Francesco Schiavone, Giuseppe Pipitone, Fabrizio Taglietti, Nicola Petrosillo Journal of Clinical Medicine, 2022 The issue of bacterial infections in COVID-19 patients has received increasing attention among scientists. Antibiotics were widely prescribed during the early phase of the pandemic. We performed a literature review to assess the reasons, evidence and practices on the use of antibiotics in COVID-19 in- and outpatients. Published articles providing data on antibiotics use in COVID-19 patients were identified through computerized literature searches on the MEDLINE and SCOPUS databases. Searching the MEDLINE database, the following search terms were adopted: ((antibiotic) AND (COVID-19)). Searching the SCOPUS database, the following search terms were used: ((antibiotic treatment) AND (COVID-19)). The risk of bias in the included studies was not assessed. Both quantitative and qualitative information were summarized by means of textual descriptions. Five-hundred-ninety-three studies were identified, published from January 2020 to 30 October 2022. Thirty-six studies were included in this systematic review. Of the 36 included studies, 32 studies were on the use of antibiotics in COVID-19 inpatients and 4 on antibiotic use in COVID-19 outpatients. Apart from the studies identified and included in the review, the main recommendations on antibiotic treatment from 5 guidelines for the clinical management of COVID-19 were also summarized in a separate paragraph. Antibiotics should not be prescribed during COVID-19 unless there is a strong clinical suspicion of bacterial coinfection or superinfection.
Proteomic analysis identifies a signature of disease severity in the plasma of COVID-19 pneumonia patients associated to neutrophil, platelet and complement activation Fabiola Ciccosanti, Manuela Antonioli, Alessandra Sacchi, Stefania Notari, Anna Farina, et al. Clinical Proteomics, 2022 Most patients infected with SARS-CoV-2 display mild symptoms with good prognosis, while 20% of patients suffer from severe viral pneumonia and up to 5% may require intensive care unit (ICU) admission due to severe acute respiratory syndrome, which could be accompanied by multiorgan failure.Plasma proteomics provide valuable and unbiased information about disease progression and therapeutic candidates. Recent proteomic studies have identified molecular changes in plasma of COVID-19 patients that implied significant dysregulation of several aspects of the inflammatory response accompanied by a general metabolic suppression. However, which of these plasma alterations are associated with disease severity remains only partly characterized.A known limitation of proteomic studies of plasma samples is the large difference in the macromolecule abundance, with concentration spanning at least 10 orders of magnitude. To improve the coverage of plasma contents, we performed a deep proteomic analysis of plasma from 10 COVID-19 patients with severe/fatal pneumonia compared to 10 COVID-19 patients with pneumonia who did not require ICU admission (non-ICU). To this aim, plasma samples were first depleted of the most abundant proteins, trypsin digested and peptides subjected to a high pH reversed-phase peptide fractionation before LC–MS analysis.These results highlighted an increase of proteins involved in neutrophil and platelet activity and acute phase response, which is significantly higher in severe/fatal COVID-19 patients when compared to non-ICU ones. Importantly, these changes are associated with a selective induction of complement cascade factors in severe/fatal COVID-19 patients. Data are available via ProteomeXchange with identifier PXD036491. Among these alterations, we confirmed by ELISA that higher levels of the neutrophil granule proteins DEFA3 and LCN2 are present in COVID-19 patients requiring ICU admission when compared to non-ICU and healthy donors.Altogether, our study provided an in-depth view of plasma proteome changes that occur in COVID-19 patients in relation to disease severity, which can be helpful to identify therapeutic strategies to improve the disease outcome.
Epidemiology of ventilator-associated pneumonia in ICU COVID-19 patients: an alarming high rate of multidrug-resistant bacteria Nardi Tetaj, Alessandro Capone, Giulia Valeria Stazi, Maria Cristina Marini, Gabriele Garotto, et al. Journal of Anesthesia Analgesia and Critical Care, 2022 Background COVID‑19 is a novel cause of acute respiratory distress syndrome (ARDS) that leads patients to intensive care unit (ICU) admission requiring invasive ventilation, who consequently are at risk of developing of ventilator‑associated pneumonia (VAP). The aim of this study was to assess the incidence, antimicrobial resistance, risk factors, and outcome of VAP in ICU COVID-19 patients in invasive mechanical ventilation (MV). Methods Observational prospective study including adult ICU admissions between January 1, 2021, and June 31, 2021, with confirmed COVID-19 diagnosis were recorded daily, including demographics, medical history, ICU clinical data, etiology of VAPs, and the outcome. The diagnosis of VAP was based on multi-criteria decision analysis which included a combination of radiological, clinical, and microbiological criteria in ICU patients in MV for at least 48 h. Results Two hundred eighty-four COVID-19 patients in MV were admitted in ICU. Ninety-four patients (33%) had VAP during the ICU stay, of which 85 had a single episode of VAP and 9 multiple episodes. The median time of onset of VAP from intubation were 8 days (IQR, 5–13). The overall incidence of VAP was of 13.48 episodes per 1000 days in MV. The main etiological agent was Pseudomonas aeruginosa (39.8% of all VAPs) followed by Klebsiella spp. (16.5%); of them, 41.4% and 17.6% were carbapenem resistant, respectively. Patients during the mechanical ventilation in orotracheal intubation (OTI) had a higher incidence than those in tracheostomy, 16.46 and 9.8 episodes per 1000-MV day, respectively. An increased risk of VAP was reported in patients receiving blood transfusion (OR 2.13, 95% CI 1.26–3.59, p = 0.005) or therapy with Tocilizumab/Sarilumab (OR 2.08, 95% CI 1.12–3.84, p = 0.02). The pronation and PaO2/FiO2 ratio at ICU admission were not significantly associated with the development of VAPs. Furthermore, VAP episodes did not increase the risk of death in ICU COVID-19 patients. Conclusions COVID-19 patients have a higher incidence of VAP compared to the general ICU population, but it is similar to that of ICU ARDS patients in the pre-COVID-19 period. Interleukin-6 inhibitors and blood transfusions may increase the risk of VAP. The widespread use of empirical antibiotics in these patients should be avoided to reduce the selecting pressure on the growth of multidrug-resistant bacteria by implementing infection control measures and antimicrobial stewardship programs even before ICU admission.
