The impact of sonication cultures when the diagnosis of prosthetic joint infection is inconclusive

Background In the absence of a gold standard criterion for diagnosing prosthetic joint infections (PJI), sonication of the removed implant may provide superior microbiological identification to synovial fluid and peri-implant tissue cultures. The aim of this retrospective study was to assess the role of sonication culture compared to tissue cultures for diagnosing PJI, using different consensus and international guidelines for PJI definition. Methods Data of 146 patients undergoing removal of hip or knee arthroplasties between 2010 and 2018 were retrospectively reviewed. The International Consensus Meeting (ICM-2018), Musculoskeletal Infection Society (MSIS), Infectious Diseases Society of America (IDSA), the European Bone and Joint Infection Society (EBJIS), and a modified clinical criterion, were used to compare the performance of microbiological tests. McNemar´s test and proportion comparison were employed to calculate p-value. Results Overall, 56% (82/146) were diagnosed with PJI using the clinical criteria. Out of these cases, 57% (47/82) tested positive on tissue culture and 93% (76/82) on sonication culture. Applying this clinical criterion, the sensitivity of sonication fluid and tissue cultures was 92.7% (95% CI: 87.1%- 98.3%) and 57.3% (95% CI: 46.6%-68.0%) (p<0.001), respectively. When both methods were combined for diagnosis (sonication and tissue cultures) sensitivity reached 96.3% (95% CI: 91.5%-100%). Sonication culture and the combination of sonication with tissue cultures, showed higher sensitivity rates than tissue cultures alone for all diagnostic criteria (ICM-18, MSIS, IDSA and EBJIS) applied. Conversely, tissue culture provided greater specificity than sonication culture for all the criteria assessed, except for the EBJIS criteria, in which sonication and tissue cultures specificity was 100% and 95.3% (95% CI: 87.8–100%), respectively (p = 0.024). Conclusions In a context where diagnostic criteria available have shortcomings and tissue cultures remain the gold standard, sonication cultures can aid PJI diagnosis, especially when diagnostic criteria are inconclusive due to some important missing data (joint puncture, histology).

48. Clinical Characteristics of Acute Flaccid Myelitis Cases Associated with Enteroviruses D68 and A71 — United States, 2018

Background Acute flaccid myelitis (AFM) is an uncommon but serious condition that causes paralysis in previously healthy children. Multiple viruses can be associated with AFM. In 2018, enteroviruses D68 (EV-D68) and A71 (EV-A71) were the most common viruses detected among patients with confirmed AFM. We described and compared clinical characteristics of cases associated with EV-D68 and EV-A71. Methods Health departments report cases meeting AFM clinical criterion (acute onset of flaccid limb weakness) to the Centers for Disease Control and Prevention along with medical records. Confirmed AFM cases were patients who met clinical criterion and had magnetic resonance imaging (MRI) showing spinal cord lesions largely restricted to gray matter. We abstracted clinical data and laboratory results from records of confirmed case-patients with onset of limb weakness during 2018. EV-D68 and EV-A71 cases were compared using chi-square and Wilcoxan rank sum tests. Results Among 238 confirmed AFM cases, 34 had EV-D68 and 12 had EV-A71 detected in a respiratory, serum, stool, or cerebrospinal fluid specimen. Median age of EV-D68 and EV-A71 cases were 5.9 and 1.6 years, respectively (p&lt; 0.01). EV-D68 cases came from 20 states, while 11/12 EV-A71 cases were from Colorado. Prodromal respiratory illness was more common among EV-D68 (97%) than EV-A71 cases (58%) (p&lt; 0.01). Prodromal rash was more common among EV-A71 (58%) than EV-D68 cases (9%) (p&lt; 0.01). At presentation, the most common symptoms accompanying limb weakness among EV-D68 cases were neck/back pain (59%), gait difficulty (56%), and fever (47%). Among EV-A71 cases, the most common symptoms were fever (67%), ataxia (67%), gait difficulty (50%), and altered consciousness (50%). EV-A71 cases were more likely to have ataxia, altered consciousness, and brainstem (92% vs. 45%) or cerebellar (75% vs. 9%) lesions on MRI (all p&lt; 0.01). EV-D68 cases were more likely to require mechanical ventilation (44% vs. 8%, p 0.03). Conclusion These national data suggest that EV-D68 and EV-A71 are associated with overlapping but different clinical phenotypes. Differences in demographics, prodromal illness, symptoms, and brain MRI findings were identified. Additional research is needed to determine whether pathogenesis and optimal treatment also vary by virus type. Disclosures All Authors: No reported disclosures

Oxygen-ozone immunoceutical therapy in COVID-19 outbreak: facts and figures

The problems related to the approach to the outbreak of COVID-19 in the world require that all possible effective treatment options be explored. The clinical criterion of the researcher is not to refuse a priori, but to verify and evaluate the proposals that are made. Italian Society of Oxygen Ozone Therapy (SIOOT) proposed to the Italian ISS (Italian Institute of Health) to use oxygen ozone therapy (O2O3) in patients with COVID-19. (...)

ABORTUS HABITUALIS PADA ANTIPHOSPHOLIPID SYNDROME

A 30 year old woman, complaining no menstruation for 5 months and had abortion history about 5 times, was admitted to the Dr.Soetomo Hospital outpatient unit. She was then diagnosed of antiphospholipid syndrome on pregnancy. The diagnosis was erected bythe presence of aborts habitualis as a clinical criterion, and the finding of IgG anticardiolipin antibody in two times examination withinterval 9 weeks as laboratory criteria. The criteria were relevant to The International consensus for APS classification (InternationalWorkshop 1999) as well. The patient had lack of financial support so she was just treated with ASA (acetyl salicylic acid), roborantia,and tocolitic-nifedipin or alilestrenol whenever they are needed. These medications were administered until the baby was delivered bysectio caecarea (healthy and normal baby).