Objectives To outline the burden, risk factors and outcomes for critical COVID-19 patients with co-infections or superinfections. Methods This was a retrospective descriptive study of adults who were admitted with critical COVID-19 for ≥ 24 hours. Data collected included demographic profiles and other baseline characteristics, laboratory and radiological investigations, medical interventions, and clinical outcomes. Outcomes of interest included presence or absence of co-infections and superinfections and in-hospital mortality. Differences between those with and without co-infections and superinfections were compared for statistical significance. Results We reviewed 321 patient records. Baseline characteristics included a median age (IQR) of 61.4 (51.4-72.9) years, male (71.3%) and African/black predominance (66.4%). Death occurred in 132 (44.1%) patients with significant difference noted between those with added infections (58.2%) compared to those with none (36.6%) (p = 0.002, odds ratio (OR) = 2.41). One patient had co-infection with pulmonary tuberculosis. Approximately two-thirds of patients received broad-spectrum antimicrobial therapy. Conclusion Added infections in critically ill COVID-19 patients were relatively uncommon but where present, were associated with higher mortality. Empiric use of broad spectrum antimicrobials was common and may have led to selection of multidrug resistant organisms. More robust local data on antimicrobial susceptibility patterns may help in appropriate antibiotic selection to improve outcomes without driving up rates of drug resistant pathogens.
Background Acute COVID‐19–related myocardial, pulmonary, and vascular pathology and how these relate to each other remain unclear. To our knowledge, no studies have used complementary imaging techniques, including molecular imaging, to elucidate this. We used multimodality imaging and biochemical sampling in vivo to identify the pathobiology of acute COVID‐19. Specifically, we investigated the presence of myocardial inflammation and its association with coronary artery disease, systemic vasculitis, and pneumonitis. Methods and Results Consecutive patients presenting with acute COVID‐19 were prospectively recruited during hospital admission in this cross‐sectional study. Imaging involved computed tomography coronary angiography (identified coronary disease), cardiac 2‐deoxy‐2‐[fluorine‐18]fluoro‐D‐glucose positron emission tomography/computed tomography (identified vascular, cardiac, and pulmonary inflammatory cell infiltration), and cardiac magnetic resonance (identified myocardial disease) alongside biomarker sampling. Of 33 patients (median age 51 years, 94% men), 24 (73%) had respiratory symptoms, with the remainder having nonspecific viral symptoms. A total of 9 patients (35%, n=9/25) had cardiac magnetic resonance–defined myocarditis. Of these patients, 53% (n=5/8) had myocardial inflammatory cell infiltration. A total of 2 patients (5%) had elevated troponin levels. Cardiac troponin concentrations were not significantly higher in patients with and without myocarditis (8.4 ng/L [interquartile range, IQR: 4.0–55.3] versus 3.5 ng/L [IQR: 2.5–5.5]; P =0.07) or myocardial cell infiltration (4.4 ng/L [IQR: 3.4–8.3] versus 3.5 ng/L [IQR: 2.8–7.2]; P =0.89). No patients had obstructive coronary artery disease or vasculitis. Pulmonary inflammation and consolidation (percentage of total lung volume) was 17% (IQR: 5%–31%) and 11% (IQR: 7%–18%), respectively. Neither were associated with the presence of myocarditis. Conclusions Myocarditis was present in a third patients with acute COVID‐19, and the majority had inflammatory cell infiltration. Pneumonitis was ubiquitous, but this inflammation was not associated with myocarditis. The mechanism of cardiac pathology is nonischemic and not attributable to a vasculitic process. Registration URL: https://www.isrctn.com ; Unique identifier: ISRCTN12154994.
Background Lower respiratory tract infections continue to contribute significantly to morbidity and mortality across all age groups globally. In sub-Saharan Africa, many studies of community acquired pneumonia in adults have focused on HIV-infected patients and little attention has been given to risk factors and etiologic agents in an urban area with a more moderate HIV prevalence. Methods We prospectively enrolled 77 patients admitted to a 280 bed teaching hospital in Kenya with radiographically confirmed community acquired pneumonia from May 2019 to March 2020. The patients were followed for etiology and clinical outcomes. Viral PCR testing was performed using the FTD respiratory pathogen-21 multiplex kit on nasopharyngeal or lower respiratory samples. Additional microbiologic workup was performed as determined by the treating physicians. Results A potential etiologic agent(s) was identified in 57% including 43% viral, 5% combined viral and bacterial, 5% bacterial and 4% Pneumocystis. The most common etiologic agent was Influenza A which was associated with severe clinical disease. The most common underlying conditions were cardiovascular disease, diabetes and lung disease, while HIV infection was identified in only 13% of patients. Critical care admission was required for 24, and 31% had acute kidney injury, sometimes in combination with acute respiratory distress or sepsis. Conclusion Viruses, especially influenza, were commonly found in patients with CAP. In contrast to other studies from sub-Saharan Africa, the underlying conditions were similar to those reported in high resource areas and point to the growing concern of the double burden of infectious and noncommunicable diseases.
PURPOSE Antiretroviral therapy (ART) has resulted in a higher life expectancy of persons living with HIV. This has led to an aging population at risk for both non–AIDS-defining cancers (NADCs) and AIDS-defining cancers (ADCs). HIV testing among patients with cancer in Kenya is not routinely performed, making its prevalence undefined. The aim of our study was to determine the prevalence of HIV and the spectrum of malignancies among HIV-positive and HIV-negative patients with cancer attending a tertiary hospital in Nairobi, Kenya. MATERIALS AND METHODS We conducted a cross-sectional study between February 2021 and September 2021. Patients with a histologic cancer diagnosis were enrolled. Demographic data and HIV- and cancer-related clinical variables were obtained. HIV pretest counseling and consent were done, and testing was performed using a fourth-generation assay. Positive results were confirmed using a third-generation assay. RESULTS We enrolled 301 patients with cancer; 67.8% (204 of 301) were female; the mean age was 50.7 ± 12.5 years. From our cohort, 10.6% (95% CI, 7.4 to 14.7, n = 32 of 301) of patients were HIV-positive with the prevalence of a new HIV diagnosis of 0.7% (n = 2 of 301). Of the HIV-positive patients, 59.4% (19 of 32) had a NADC. The commonest NADC was breast cancer (18.8%; 6 of 32), whereas non-Hodgkin lymphoma (18.8%; 6 of 32) and cervical cancer (18.8%; 6 of 32) were the most prevalent ADCs among HIV-positive patients. CONCLUSION The prevalence of HIV infection among patients with cancer was twice the Kenya national HIV prevalence. NADCs comprised a larger percentage of the cancer burden. Universal opt-out HIV testing of patients attending for cancer care regardless of cancer type may facilitate early recognition of HIV-infected patients and aid in appropriate selection of ART and cancer therapies and preventive strategies.
Background Maternal peripartum infection is still a widespread avoidable problem in Low and Middle Income countries (LMICs) despite developments in postnatal care. Lately systems approach, encompassing all the factors in the health system, is being recognized as ameliorate option for the improvement of maternal health and prevention of maternal mortality. Objective:The aim of this systematic review was to identify and evaluate interventions to prevent maternal peripartum infection in LMICs. Methods -The Cochrane Library, CINAHL, MEDLINE (via PubMed) and Scopus,World Health Organization (WHO) ,the National Institute for Health and Care Excellence (NICE) websites were searched to identify interventional studies to prevent maternal peripartum infection using the PRISMA model. The article searching was conducted for a period of 3 months (01/08/2022 to 30/10/2022). Search terms were “Peripartum”, “Infection”, “Genital tract”, and their MESH terms. The inclusion criteria were primary studies that reported interventions for the prevention of maternal peripartum infection, studies from LMICs and those written in English language. Cochrane Risk of Bias tools were used to appraise the quality of the studies. Results – From 1662 article results,29 articles were included covering 56,151 participants. The interventions were grouped into six domains: antibiotic prophylaxis 11(37.9% of studies), self-care training 6 (20.6%), skin preparation 6 (20.6%), systems approach 2 (6.9%), Traditional Birth Attendant training (6.9 %) and use of Clean Delivery Kit 2(6.9%).12 studies reported a significantly lower risk of infection. Six studies reported a significantly improved knowledge and practice of women regarding maternal peripartum infection. Two studies reported no change in the risk of infection. Conclusion- There is limited research from LMICs on interventions to prevent maternal peripartum infection, however the studies are of good quality. The study identified six domains of interventions which were mainly inpatient settings targeting maternal peripartum infection in isolation without consideration of other system components. This provides an opportunity for achieving optimum reduction in maternal peripartum infection though systems approach. Health systems interventional studies are therefore needed to further the gains in maternal peripartum infections prevention in LMICs. Study registration: PROSPERO CRD42022342550
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