Patient: Male, 51-year-old Final Diagnosis: COVID-19 Symptoms: Anosmia • dysgeusia • nocturnal diaphoresis Medication: — Clinical Procedure: — Specialty: Infectious Diseases Objective: Rare co-existance of disease or pathology Background: Coinfection with severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2) and Mycobacterium tuberculosis (MBT) has been reported, albeit rarely, in various parts of the world and has received attention from health systems because up to one-third of the world’s population has been infected with SARS-CoV-2. Mexico was not included in the first-ever report on a global cohort of patients with this coinfection. We report on a case of SARS-CoV-2/MBT coinfection in a 51-year-old taxi driver from Mexico City that underscores the importance of rapid and accurate laboratory testing, diagnosis, and treatment. Case Report: We present the case of a man in the sixth decade of life who was admitted to the National Institute of Respiratory Diseases (INER) with a diagnosis of COVID-19 pneumonia, which was confirmed by nasopharyngeal exudate using real-time polymerase chain reaction (RT-PCR) for the identification of SARS-CoV-2. Findings from imaging studies suggested that the patient might be coinfected with MBT. That suspicion was confirmed with light microscopy of a sputum sample after Ziehl-Neelsen staining and when a Cepheid Xpert MTB/RIF assay, an automated semi-quantitative RT-PCR assay, failed to detect rifampicin resistance. The patient was discharged from the hospital 10 days later. Conclusions: The present report underscores the importance of using validated molecular diagnostic tests to identify coin-fections in areas where there is a high prevalence of other causes of pneumonia, such as MBT, as a way to improve clinical outcomes in patients during the COVID-19 pandemic. While it is imperative to control the COVID-19 pandemic, the medical community must not forget about the other pandemics to which populations are still prey, and tuberculosis is one of them. We must remain alert to any clinical subtleties so as to ensure timely and accurate diagnosis and stay one step ahead of COVID-19.
Introduction: Histoplasmosis is the most prevalent systemic mycosis in Mexico. However, since 1995, the routine registry of this disease was interrupted in the country; therefore, the current magnitude of the disease is unknown. This study aimedto describe the epidemiological, clinical, and paraclinical characteristics of the histoplasmosis infectionwhich has a wide variety of clinical manifestations -in the population that received care in Mexico's National Institute for Respiratory Diseases. Material and methods:This study used a retrospective design, and the analyzed data were collected from January 2013 to December 2016.We conducted a comparison of characteristics between patients with pulmonary or disseminated forms of histoplasmosis through χ2, Student's T, or Mann-Whitney U tests.Results: In total, 61 patients were included. The average age was 36.1 years ± 12.4; 53 (87%) were men, and the male-female ratio was 6:1. Moreover, 80% of the patients had immunosuppression; 94% had HIV; 50.8% had disseminated histoplasmosis, so it had the most common presentation;and 57% had anemia (i.e. median Hb 10 g/dL). Of the 118 fungus cultures, 74% (87) reported growth. The Histoplasma antigen was positive in 67% (14/21) of the cases, andmortality rate was estimated at 7%. Conclusions:Compared with data published in 1995, we observed a change in the epidemiology and risk factors of histoplasmosis; specifically, there was a lower proportion of occupational exposure and an increase in the number of cases in non-endemic areas (i.e. low risk of transmission). Our results generally corroborate the literature, suggesting that the acquired immunodeficiency syndrome (AIDS) pandemic, the use of immunosuppressant therapy, and the rise in the number of transplants have increased the overall risk of histoplasmosis, even in areas that were not previously identified as endemic. Generally, our studyhighlights the importance of routine registry of this disease in Mexico.
BackgroundRT-PCR is the currently recommended laboratory method for diagnosing acute SARS-CoV-2 infection. Nevertheless, to carry out this assay, numerous manual steps are necessary, but they are long lasting and error-prone. A new sample preparation solution was launched, the Qiaprep & amp Viral RNA UM kit, that combines a short, liquid-based sample preparation with one-step RT-PCR amplification and detection of SARS-CoV-2. Such alternative allows reducing the handling of samples and obtaining a result in a shorter period of time. The objective of the study was to compare the performance of the kit with RT-PCR.MethodsA prospective trial was carried out in the clinical microbiology laboratory of a tertiary care hospital. The pharyngeal and nasopharyngeal swabs included in the study were taken from patients who underwent medical consultation because compatible COVID-19 symptoms. Samples were processed simultaneously for the reference RT-PCR and by the QIA P&A kit.Results190 samples were included in the clinical trial. The reference RT-PCR method indicated that 125 (66%) samples, out of the 190, were positive. The QIA P&A kit showed 112 positive samples for SARS-CoV-2. The QIA P&A kit has a sensitivity of 86% to detect SARS-CoV-2 and a 100% specificity, the positive predictive value was of 96%, the negative predictive value 78%, and the obtained Kappa value was 0,76. QIA P&A kit showed a lower mean cycle threshold compared with the diagnostic standard, with a statistically significant difference (p < 0.05).ConclusionThe QIA P&A kit has an acceptable, yet not optimal performance for sample preparation and amplification of SARS-CoV-2 and further studying is required for it to be validated as a cost-effective, rapid diagnostic method for detecting infections.
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