Rhabdomyolysis is a serious clinical condition, which if left untreated can lead to kidney failure and in extreme cases, to death. It has also been reported in association with SARS COV2 infection and can be its initial presentation. COVID-19 is a disease caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2), which has many variants that change the characteristics of the disease affecting, among other things, the method of transmission or treatment. Some investigators have implicated excessive immune response in the causes of muscle damage during SARS-CoV-2 infection. Others point to direct damage caused by the virus or involving immune factors. In this study we described cases of COVID-19 infection from 1 June 2022 to 15 July 2022 with elevated muscle enzymes in the blood and hospitalized to the first division of Cotugno hospital in Campania. Of 39 patients with SARS-CoV-2 infection, 15 patients presented also rhabdomyolysis. The most common symptoms were: asthenia, fever, arthomyalgia, lipothymia and syncope. No patient had myocardial infarction and 2 patients had atrial fibrillation. All patients were affected by omicron SARS-CoV-2 variants. Of these patients: 4 patients died (2 due to rhabdomyolysis and 2 due to sepsis) and only one patient presented acute kidney injury.

Background and aims. Real-time reverse transcription polymerase chain reaction (RT-PCR) is the gold-standard assay to detect SARS-CoV-2, but it has limitations compared to viral load analysis. Quantitative detection improves surveillance, diagnosis, and prevention. We performed a comparative study of qualitative and quantitative tests for the diagnosis of COVID-19 on respiratory samples from patients screened for SARS-CoV-2 infection, and explored the correlation between viral load compared to the threshold cycle (Ct) value obtained in RT-PCR.Materials and methods. Sixty respiratory samples from patients affected by SARS-CoV-2 were subjected to both the qualitative (Allplex ™ 2019-nCoV Seegene) and the quantitative (Clonit® Quanty COVID-19) assays, and the relationship between viral load and Ct value was assessed by Spearman correlation analysis (ρ). In addition, the viral load of samples collected from a patient with symptomatic cancer was monitored. Results. The results show 100% agreement between the results obtained with quantitative assay and the reference standards, whereas 99.2% agreement was found for the qualitative test. A strong negative Spearman’s correlation between the Ct values of the N genes and RdRP gene was observed from qualitative assay values and viral loads.Conclusions. Quantitative assay has a higher sensitivity than qualitative assay, and viral load testing allows the clinicians to better orient themself in the choice of therapeutic treatment to be adopted. The constantly higher viral load of clinical cases considered, irrespective of the different therapies used, confirms that viral load monitoring could represent a great advantage in clinical practice.

In December 2019, a novel coronavirus, “SARS-CoV-2”, was recognized as the cause of coronavirus disease 2019 (COVID-19). Several studies have explored the changes and the role of inflammatory cells and cytokines in the immunopathogenesis of the disease, but until today, the results have been controversial. Based on these premises, we conducted a retrospective assessment of monocyte intracellular TNF-α expression (iTNF-α) and on the frequencies of lymphocyte sub-populations in twenty-five patients with moderate/severe COVID-19. We found lymphopenia in all COVID-19 infected subjects compared to healthy subjects. On initial observation, in patients with favorable outcomes, we detected a high absolute eosinophil count and a high CD4+/CD8+ T lymphocytes ratio, while in the Exitus Group, we observed high neutrophil and CD8+ T lymphocyte counts. During infection, in patients with favorable outcomes, we observed a rise in the lymphocyte count, in the monocyte and in Treg lymphocyte counts, and in the CD4+ and in CD8+ T lymphocytes count but a reduction in the CD4+/CD8+ T lymphocyte ratio. Instead, in the Exitus Group, we observed a reduction in the Treg lymphocyte counts and a decrease in iTNF-α expression. Our preliminary findings point to a modulation of the different cellular mediators of the immune system, which probably play a key role in the outcomes of COVID-19.

Since February 2020, Italy has been facing a dramatic spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, mostly confined to the northern regions [1Remuzzi A. Remuzzi G. COVID-19 and Italy: what next?.Lancet. 2020; 395: 1225-1228Abstract Full Text Full Text PDF PubMed Scopus (1978) Google Scholar, 2http://www.salute.gov.it/portale/nuovocoronavirus/homeNuovoCoronavirus.htmlDate accessed: April 23, 2020Google Scholar, 3Coronavirus latest: Italy death toll overtakes China's. Nature NEWS, 20 March 2020https://www.nature.com/articles/d41586-020-00154-wDate accessed: March 25, 2020Google Scholar]. Such overwhelming diffusion of coronavirus disease 2019 (COVID-19) compelled national authorities to enforce an unprecedented restriction to citizen mobility and, most importantly, made the entire nation aware of the stringent need to act for the slowing of contagion [[4]Decreto del Presidente del Consiglio dei Ministri 09 marzo Ulteriori disposizioni attuative del decreto-legge 23 febbraio 2020, n. 6, recante misure urgenti in materia di contenimento e gestione dell'emergenza epidemiologica da COVID-19, applicabili sull'intero territorio nazionale.in: Gazzetta Ufficiale Repubblica Italiana Serie Generale 2020. 2020: 62Google Scholar]. Southern Italian regions had therefore more time to implement infection prevention and control measures, especially within hospitals and health-care facilities. Indeed, health-care personnel (HCP) immediately appeared to be among the categories at highest risk for contagion. Between 23 February and 5 March, the Monaldi Hospital in Naples, Italy, adopted a diffuse policy of infection prevention and control, specifically directed to SARS-CoV-2 containment among HCP, as well as patients. The infection prevention and control plan included: (a) an immediate halt to further admissions in wards with positive cases; (b) screening of all HCP and patients currently admitted to the index unit with nasal and oropharyngeal swabs for SARS-CoV-2 real-time RT-PCR detection, irrespective of symptoms, to be completed within 12 hours from activation of the plan; (c) reinforced personal protective equipment (PPE) use; (d) quarantine of SARS-CoV-2-positive cases only and further clinical assessment as per current protocols; (e) sanitation of the entire unit capacity with temporary patient removal; (f) restart of unit admissions with RT-PCR-negative staff and patients. The plan included standard precautions, contact precautions and droplet precautions, and led to a dramatic increase in the use of surgical face masks and hydro-alcoholic gel solutions. Despite that, on 16 March 2020, three nurses staffing the hospital were diagnosed with COVID-19. Here, we describe the results of the consequential epidemiological investigation. All HCP/patients working/dwelling in the index clinical units underwent nasal and oropharyngeal swabs using Sigma Virocult Duo swabs (Medical Wire & Equipment, Corsham, UK). The preserving swab solution was used for the extraction of RNA that was subsequently used as a template in a multiplex, RT-PCR for screening and simultaneous confirmation of SARS-CoV-2 infection (Allplex 2019-nCoV assay, Seegene, Seoul, Republic of Korea). With this assay, molecular targets were those approved by the WHO, the US CDC and the Chinese CDC. Results were deemed positive when target detection occurred before 37 RT-PCR cycles. Between 13 March and 16 March 2020, three HCP from three different hospital units (specialist medical unit, specialist surgical unit, general surgery unit) were found to be positive at SARS-CoV-2 swab after becoming symptomatic for COVID-19. Table 1 describes the clinical features and timing of the infection for these three individuals. Cases 1 and 2 were sisters, and had another sister who was diagnosed with COVID-19 during the same time frame. Case 3 had an unknown source of infection. The three individuals were deemed to have acquired the infection out of hospital. All actively worked during the pre-symptomatic phase for 4 days, and for one shift after becoming symptomatic. Therefore, there was enough time for SARS-CoV-2 to potentially spread in the three involved units.Table 1Clinical and epidemiological features of SARS-CoV-2 infection in the three index casesSexAgeRoleWardSymptomsaSymptoms: F, fever; C, cough; M, myalgia; D, diarrhoea; A/D, anosmia/dysgeusia.Suspected sourceDates of potential contagionDate of symptom onsetDays of symptoms before diagnosis/admissionNumber of days on duty after potential contagionNumber of days on duty after symptom onsetFCMDA/DCase 1Female61NurseMedical specialty✓✓✓✗✗Family outbreak1↔5/03/202008/03/20741Case 2Female53NurseSurgical specialty✓✓✓✗✓Family outbreak6↔10/03/202013/03/20141Case 3Male25NurseSurgery✓✓✓✗✗Unknown7↔11/03/202014/03/20241a Symptoms: F, fever; C, cough; M, myalgia; D, diarrhoea; A/D, anosmia/dysgeusia. Open table in a new tab SARS-CoV-2 screening swabs were performed on 17 March 2020, on all unit HCP (n = 107) as well as all current inpatients (n = 29). Only one additional nurse, who was working the same shifts as the index Case 1, was found to be positive for SARS-CoV-2 nasal/oropharyngeal swab. None of the 29 patients screened was positive. As of 23 April 2020, no additional HCP developed any sign or symptom suggestive of COVID-19 in the three index units. Our results suggest that the propensity of SARS-CoV-2 to spread from person to person within an indoor environment characterized by obliged closed contacts is low, provided ordinary PPE are used and routine sanitation procedures are implemented. It should be noted that the time index cases remained at work after the event of contagion could only be estimated based on known average incubation times, i.e. 5 days [[5]Li Q. Guan X. Wu P. Wang X. Zhou L. Tong Y. et al.Early transmission dynamics in Wuhan, China, of novel coronavirus–infected pneumonia.N Engl J Med. 2020; 82: 1199-1207Crossref Scopus (9726) Google Scholar]. In addition, the analysed sample size is relatively low and comes from a tertiary-care hospital not directly involved in triage of suspected/confirmed COVID-19 cases. Finally, because of the short time of index patient circulation after symptom onset, the actual intensity (number and duration) of contacts was probably limited. Our observation may be of help in estimating the risk of intra-hospital spread of SARS-CoV-2 from HCP to other staff and admitted patients. Ordinary PPE may be effective to contain COVID-19 in the health-care setting when the local population incidence of infection is moderate. In light of the global shortage of PPE, our experience suggests that the use of fitted respirator masks as opposed to surgical masks may not be essential, provided gloves are also used and the HCP is not directly exposed to aerosol-generating procedures. Most importantly, there was absence of transmission between HCP wearing surgical masks and inpatients. EDM and RA worked on concept/design of the study; LB and FM worked on data collection; MB, MG, NC, CT, EF, ADS and MR performed laboratory work; MGR, LA and RZ worked on data analysis/interpretation; EDM and RZ drafted and critically revised the manuscript. All authors read and approved the final draft. This work was supported by the AORN Ospedali dei Colli.

Clinical presentation of COVID-19 is common to other respiratory infections. We compared the characteristics at hospital admission of confirmed and not-confirmed COVID-19 patients, in the early phase of the epidemic. Thirty-seven suspected patients were enrolled, and COVID-19 was confirmed in 17. Confirmed patients are older, have more frequently contact with confirmed cases. Distinctive clinical characteristics among COVID-19 were the grand-glass opacities at CT scan, and a pO2/FiO2 ratio less than 250. In not-confirmed group, Influenza represented the most frequent alternative diagnosis. This study contributes to highlight the characteristics to consider at hospital admission in order to promptly suspect COVID-19.

The Hepatitis C viral genome is highly variable and is classified into 6 genotype groups, based on phylogenetic analysis of the genomic sequence. Here we show a case of acute Hepatitis C in which a rare genotype 3h was evidenced by direct RNA sequencing.We confirm that analysis of the early kinetics of HCV RNA during antiviral therapy is an important prognostic parameter, and that a (to-t3)log10HCV RNA value is a strong predictor for Rapid Virological Response (RVR) and End Therapy Response (ETR).

Methicillin-resistent Staphylococcus aureus (MRSA) is one of the most common pathogen responsible for nosocomial infections. Laboratory diagnosis and assays of antimicrobial susceptibility are basic in controlling and preventing infection by MRSA. Our study was conducted for one year (May 2008-April 2009) on patients hospitalized to monitor the eventual colonization by MRSA.The use of chromogenic agar MRSA allowed us to identify pink-mauve colonies of MRSA within 24 hours and to make a timely e careful diagnosis.

Endocarditis is an inflammatory state of the endothelium that promotes thrombus formation and tissue damage on the surface of heart valves. Recent studies have reported endocarditis mortality rates ranging from 12% to 46% (2008). The Streptococcus gordonii is a normal inhabitant of the human oral cavity. It is a component of the microbial communities responsible of plaque formation, associated with dental caries and also regarded as the main causative agent in the development of subacute bacterial endocarditis (SBE).