This article is one of a series on acute, severe diseases of humans caused by emerging viruses for which there are no or limited licensed medical countermeasures. We approached this summary on South American Hemorrhagic Fevers (SAHF) from a clinical perspective that focuses on pathogenesis, clinical features, and diagnostics with an emphasis on therapies and vaccines that have demonstrated potential for use in an emergency situation through their evaluation in nonhuman primates (NHPs) and/ or in humans. Methods: A standardized literature review was conducted on the clinical, pathological, vaccine, and treatment factors for SAHF as a group and for each individual virus/disease. Results: We identified 2 treatments and 1 vaccine platform that have demonstrated potential benefit for treating or preventing infection in humans and 4 other potential treatments currently under investigation.
Conclusion:We provide succinct summaries of these countermeasures to give the busy clinician a head start in reviewing the literature if faced with a patient with South American Hemorrhagic Fever. We also provide links to other authoritative sources of information.
Murine typhus is a flea-borne disease of worldwide distribution with a recent reemergence in the United States of America. There are limited data about the presentation, treatment, and outcomes in the pregnant population. We report on two cases of murine typhus during pregnancy and review the literature to compile previously reported cases. A comprehensive search was performed via the PubMed database for published articles between 1990 and 2020. Seven articles met the criteria of symptomatic pregnant murine typhus infection. A total of 37 patients were identified. Patients frequently presented with a prolonged duration of fevers prior to presentation, headache, and elevated hepatic transaminases. The diagnosis was predominantly based on serology. Treatment varied. Overall, the pregnancy outcome was favorable. Murine typhus can mimic other pregnancy-related pathologies. More exclusive and large-scale studies are needed to learn more of murine typhus during pregnancy.
A facultatively anaerobic gram-positive bacillus, Erysipelothrix rhusiopathiae is widely present in the environment and also as a commensal and pathogenic organism associated with livestock, birds, and fish. Invasive infections in humans are rare, classically affect patients with exposures to animal products, and frequently progress to include endocarditis. Here we present our successful experience of treating 2 patients with E. rhusiopathiae bacteremia, both frequently exposed to fish. One patient presented in new-onset heart failure after a protracted illness and was found to have subacute aortic and mitral valve endocarditis successfully treated with surgical valve replacement and prolonged intravenous penicillin therapy. The other patient had acute uncomplicated bacteremia responsive to ceftriaxone followed by step-down treatment with oral penicillin, the first published report using such regimen. Our experience highlights the spectrum of clinical disease seen in E. rhusiopathiae bacteremia and offers new perspectives to optimize treatment for these patients.
Objective: Evaluate the association between SARS-CoV-2 serologic status in immunologically naïve patients and risk of preeclampsia at time of delivery.
Study design: We conducted a retrospective cohort study of pregnant patients admitted to our institution from August 1st to September 30th, 2020. We recorded maternal medical and obstetric characteristics, and SARS-CoV-2 serologic status. Our primary outcome was the incidence of preeclampsia. Antibody testing was performed and patients were classified into seropositive groups: IgG+, IgM+, or both IgG+ and IgM+. Bivariate and multivariable analyses were performed.
Results: We included 275 patients that were negative for SARS-CoV-2 antibodies, and 165 that were positive. Seropositivity was not associated with higher rates of preeclampsia (p=0.183), or with preeclampsia with severe features (p=0.916) even after adjusting for maternal age> 35, BMI≥ 30, nulliparity, and previous history of preeclampsia, and type of serologic status. Previous preeclampsia had the greatest association with development of preeclampsia (OR=13.40 95% CI [4.98-36.09]; p< 0.05), and with preeclampsia with severe features (OR=5.46 95% CI [1.65-18.02]; p< 0.05).
Conclusions: We found that in an obstetric population there was no association between SARS-CoV-2 antibody status and the risk of preeclampsia.
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