Asian Pacific Journal of Tropical Medicine

337-346

Authors: Yasser Ali Kamal, Seham Abdelwakeel Abdel-Gaber

Objective: To explore the clinical features, diagnosis, etiology, treatment, and outcomes of COVID-19 related empyema. Methods: Using PRISMA statement, a systematic search of relevant case reports published between December 2019 and April 2023 was performed through seven databases. The collected data included demographics, clinical manifestations, diagnostic findings, treatment, and outcomes. Results: Thirty-six case reports were identified with 43 cases of empyema. The included cases had a median age of 55 years (range: 12-78 years) and 79.1% (34/43) were males. The majority of cases presented during hospitalization for management of acute COVID-19 infection (29/43, 67.4%) and Charlson comorbidity index <3 (40/43, 93.0%). Pseudomonas aeruginosa was the most commonly isolated microorganism from the pleural fluid (9/43, 20.9%) and 16.3% of the cases (7/43) had polymicrobial infections. Chest drainage was performed in all cases while surgery was indicated in 24 cases (55.8%). The most common complication of COVID-19-related empyema was broncho-pleural fistula (2/43, 4.7%). The mortality rate was 23.3% (10/43). Sepsis and/or multi-organ failure were the most commonly reported causes of death. On univariate analysis, no statistically significant risk factor for mortality was identified. Conclusions: COVID-19-associated empyema has a variety of predisposing factors, time of presentation, clinical features, and causative organisms. Invasive or minimally invasive surgical procedures are performed more frequently than isolated chest drainage. Empyema in COVID-19 patients worsens their prognosis and can lead to serious complications.

354-362

Authors: Nurhayat Yakut, Zeynep Ergenc, Sevgi Aslan Tuncay, Sezin Bayraktar, Elvan Sayin, Arzu Ilki, Eda Kepenekli

Objective: To describe clinical and epidemiological characteristics, antimicrobial susceptibility and mortality-associated factors of healthcare-associated infections (HCAIs) caused by Staphylococcus (S.) aureus in children. Methods: We conducted a retrospective, single-centre study of pediatric HCAIs caused by S. aureus from a tertiary care hospital in Turkey between February 2014 and December 2019. The clinical and epidemiological characteristics and antimicrobial susceptibility of the methicillin-susceptible and methicillin-resistant S. aureus (MSSA and MRSA) isolates was evaluated. Results: A total of 310 pediatric patients were examined. Overall, 225 (72.6%) isolates were MSSA and 85 (27.4%) were MRSA. All S. aureus isolates were susceptible to teicoplanin, vancomycin, linezolid, tigecycline, mupirocin, and daptomycin. Penicillin resistance rates were high (89.0%), while fosfomycin, gentamicin, and clindamycin resistance rates were low (1.3%, 1.0%, and 2.3%, respectively). Except susceptibility to fosfomycin, which was significantly lower in 2014 compared to 2018 and 2019, no significant difference was found in the antimicrobial susceptibility of S. aureus isolates between the years. Baseline characteristics and mortality rate were similar comparing MRSA and MSSA causing HCAIs. The mortality rate of HCAIs caused by S. aureus was 6.5% (20 patients). Malignancy was an independent risk factor associated with mortality in the multivariate analysis (OR 5.446, 95% CI 1.573- 18.849). Conclusions: Our findings demonstrate that MSSA remained the most causative agent of HCAIs caused by S. aureus. The mortality rate was 6.5%, the antibiotic resistance rate was quite high for penicillin and diagnosis of malignancy was the main risk factor for increasing mortality in children. These findings could help improve the management of HCAIs caused by S. aureus in children.

371-378

Authors: J. Y. Kumari, L.D. Amarasinghe, H.A.K. Ranasinghe

Objective: To determine the prevalence of tick-borne pathogens with a particular focus on Rickettsia spp. in ticks collected from cattle in Gauteng and Limpopo Provinces, South Africa. Methods: A total of 200 ticks were collected from cattle within the Madala livestock, Pretoria, Gauteng Province and in Mankweng Township, Polokwane, Limpopo Province in 2019. The ticks were morphologically identified and processed individually for a total genomic DNA extraction. Specific primers targetting ompA, ompB, and the 17KDa genes were used for a molecular screening and delineation of Rickettsia from the extracted genetic materials using polymerase chain reaction (PCR) technique. PCR amplicons of positive samples were sequenced bidirectionally using the Sanger sequencing method. Sequences generated were processed and analysed using appropriate bioinformatics software. Results: The ticks were morphologically identified as Amblyomma spp. PCR profiling of the genomic DNA samples revealed the presence of the Rickettsia pathogen in 42 (21%) of the ticks collected from both Provinces. Out of the genes profiled, 14 (7%) were positive for 17KDa, 42 (21%) for ompA and 32 (16%) were positive for ompB genes respectively. The nucleotide blast of the sequenced genomes showed high similarity, as high as 100% with other reference Rickettsia (R.) africae in the GenBank. The phylogenetic analysis of the sequences further validated them as R. africae with their characteristic clustering pattern with related reference sequences. Conclusions: There is an abundance of R. africae in Amblyomma ticks collected from cattle in the study areas. This has serious public health implications as individuals who accidentally get infested with the ticks could acquire R. africae. Hence, adequate precautions in terms of sensitization of farmers about the risk and mass mobilization drive to control the vectors in the areas are highly recommended to safeguard public health.