HANDOC can be used in to identify patients with NBHS bacteremia who have a risk of IE so low that echocardiography can be omitted; therefore, its implementation might reduce the use of echocardiography.
Aerococci are increasingly recognized as causative agents in human infective endocarditis (IE). Information on the clinical presentation and the prognosis of IE caused by aerococci is limited. We employed the Swedish Registry of Infective Endocarditis (SRIE) to identify cases of aerococcal IE. The medical records were analysed and comparisons with cases of IE caused by other pathogens reported to the SRIE were made. Available bacterial isolates were reanalysed using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF) and the aetiology was confirmed to be Aerococcus urinae in fourteen cases and Aerococcus sanguinicola in two cases. The bacteria were sensitive to penicillin and Etest-based synergy testing and time-kill experiments suggested synergy between penicillin and gentamicin towards some isolates. The patients had a median age of 79 years, which was significantly higher than that of patients with IE caused by streptococci or Staphylococcus aureus. Most patients with IE caused by aerococci had underlying urinary tract diseases and many presented with symptoms suggesting a urinary tract focus of the infection. Despite the fact that many patients with aerococcal IE presented with severe sepsis, ICU treatment was needed only in one patient and there was no fatality. Valve exchange surgery was needed in four of sixteen patients with aerococcal IE and embolization was seen in three patients. This report is by far the largest on aerococcal IE and suggests that the prognosis of aerococcal IE is relatively favourable despite the fact that the patients are old and have significant comorbidities.
SARS-CoV-2 has spread rapidly worldwide, causing the COVID-19 pandemic. Platelet activation and platelet-leukocyte complex formation are proposed to contribute to disease progression. Here, we report platelet and leukocyte activation during acute and convalescent COVID-19 in patients recruited between May-July 2020. Blood samples were analyzed by flow cytometry and ELISA using paired comparison between inclusion (day 0) and 28 days later. The majority of patients were mildly or moderately ill with significantly higher cytokine levels (IL-6 and IL-10) on day 0 as compared with day 28. Platelet activation and granule release were significantly higher on day 0 compared with day 28, as determined by ADP-or thrombin-induced surface CD62P expression, baseline released CD62P, and thrombin-induced platelet-monocyte complex formation. Monocyte activation and procoagulant status at baseline and post activation were heterogeneous but generally lower on day 0 compared with day 28. Baseline and thrombin-or fMLF-induced neutrophil activation and procoagulant status were significantly lower on day 0 compared with day 28. We demonstrate that during the acute phase of COVID-19 compared with the convalescent phase, platelets are more responsive while neutrophils are less responsive. COVID-19 is associated with thromboembolic events where platelet activation and interaction with leukocytes may play an important role.
The coronavirus disease 2019 (COVID-19) pandemic has created a global health-and economic crisis. Detection of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which causes COVID-19 by serological methods is important to diagnose a current or resolved infection. In this study, we applied a rapid COVID-19 IgM/IgG antibody test and performed serology assessment of antibody response to SARS-CoV-2. In PCRconfirmed COVID-19 patients (n = 45), the total antibody detection rate is 92% in hospitalized patients and 79% in non-hospitalized patients. The total IgM and IgG detection is 63% in patients with <2 weeks from disease onset; 85% in non-hospitalized patients with >2 weeks disease duration; and 91% in hospitalized patients with >2 weeks disease duration. We also compared different blood sample types and suggest a higher sensitivity by serum/plasma over whole blood. Test specificity was determined to be 97% on 69 sera/plasma samples collected between 2016-2018. Our study provides a comprehensive validation of the rapid COVID-19 IgM/IgG serology test, and mapped antibody detection patterns in association with disease progress and hospitalization. Our results support that the rapid COVID-19 IgM/IgG test may be applied to assess the COVID-19 status both at the individual and at a population level.
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