Background Respiratory failure and death are the leading causes of severe Coronavirus disease 2019 (COVID-19). Hyper-inflammation and cytokine storm cause lung damage. This study aimed to compare the low-dose and high-dose effects of tocilizumab, an IL-6 receptor antagonist. Method Patients with severe pneumonia and hyper-inflammation signs due to COVID-19 were included in this retrospective study. Patients receiving tocilizumab < 200 mg intravenously were classified as the low-dose group, and receiving ≥ 200 mg as the high-dose group, and those not treated with tocilizumab as the control group. Demographic and clinical data of patients who died and survived in both low-high dose and control patients were compared. According to symptom day and radiological infiltration, patients with tocilizumab were also evaluated in two groups as early and late periods at tocilizumab administration time. Results A total of 160 patients were included in the study; 70 were treated with a low dose and 50 with high dose tocilizumab. Forty patients were in the control group. Age, comorbidity, and clinical features were similar in the control, low-dose tocilizumab, and high-dose tocilizumab groups. The mortality rate (12.9%, 30.0%, 37.5, p = 0.008) was less in the low-dose tocilizumab group. The secondary infection rate was higher in the high-dose group than in the low-dose tocilizumab and control groups (44.0%, 10.0%, 10.0%, p<0.001). Distinguishing between those patients who died and survived, age (OR: 1.1589, p<0.001), higher APACHE II scores (OR: 1.225, p=0.001), and needs for non-invasive mechanical ventilation (OR: 14.469, p<0.001) were the most critical risk factors. Low-dose tocilizumab was associated with a lower mortality rate (OR: 0.244, p=0.012). Conclusion The use of tocilizumab at a low dose is associated with lower secondary infections and mortality.

Aim: This study aimed to present the characteristics and poor prognostic factors of Crimean–Congo hemorrhagic fever (CCHF) patients. Materials & methods: Adult patients (>18 years) with CCHF were i... Plain language summary Crimean–Congo hemorrhagic fever is a disease caused by a virus that causes a high fever and bleeding. Unfortunately, there is no cure for this disease yet. It is important fo... Tweetable abstract De Ritis ratio (aspartate transaminase/alanine transaminase) increases in correlation with clinical severity in patients with Crimean–Congo hemorrhagic fever. If the De Ritis rat...

A 22‐year‐old man presented with headache, night sweats, intermittent fever, tremors, sleep disturbances, agitation, and hallucinations for 2 months. Thoracic computed tomography (CT) showed widespread interstitial nodular lesions, but initial cranial CT showed no significant pathology. Cerebrospinal fluid (CSF) analysis revealed 25 cells/mm ³ of white blood cells (72% neutrophils), 83 mg/dL protein, and 30 mg/dL glucose (concurrent serum glucose was 103 mg/dL). Gram and Ziehl–Neelsen stains were negative for acid‐fast bacilli. Tuberculosis (TB) cultures and Mycobacterium PCR tests remained negative. Biopsy of the bronchoalveolar lavage sample showed necrotizing granulomatous inflammation, and the Mycobacterium tuberculosis PCR result was positive. During the first month of first‐line anti‐TB treatment, the patient experienced recurrent severe headaches, persistent fever, and decreased visual acuity. Contrast‐enhanced MRI revealed lesions that were consistent with tuberculous meningitis (TBM). Considering the possibility of drug‐resistant TB, streptomycin 1 gr/qd (quaque die) intramuscularly and linezolid 600 mg/bid (bid in die) intravenously were added to the regimen. The patient’s symptoms persisted during the second month of treatment. The patient experienced epileptic seizures. The control MRI showed an enlargement of the lesions. A paradoxical reaction was considered. Intravenous methylprednisolone 500 mg/day was initiated. The patient did not respond clinically, and his complaints continued. The patient was started on the IL‐1 inhibitor anakinra. Paradoxical inflammatory reactions are common in TBM but challenging to predict. When severe, they can lead to significant neurological morbidity and death. This article aimed to share a case that did not respond to corticosteroids, a standard treatment for paradoxical reactions, but was successfully managed with the IL‐1 inhibitor anakinra.

Background: Venetoclax‐based (ven) combinations have become a standard of care for acute myeloid leukemia (AML) patients ineligible for intensive chemotherapy. However, the associated risk of infectious adverse events (IAEs) remains a significant clinical concern. Aims: This study aimed to evaluate the incidence, characteristics, and risk factors for IAEs in newly diagnosed AML patients treated with venetoclax combinations in a real‐world setting. Methods and Results: We conducted a retrospective cohort study of AML patients treated with ven in combination with hypomethylating agents or low‐dose cytarabine (LDAC), with analyses performed on a treatment cycle basis. Clinical and laboratory data, including IAE characteristics, duration of neutropenia, and concomitant medications, were collected, and grade ≥ 2 IAEs were included according to CTCAE v5.0 criteria. The cohort included 143 treatment cycles of 43 patients, with a median neutropenia duration of 13 days (5–35). A total of 34 (23.8%) grade ≥ 2 IAEs occurred, with an incidence of 1 per 121 patient‐days. Multivariate analysis identified prolonged neutropenia (days, OR = 1.037, p = 0.005) and interacting concomitant medications (OR = 9.99, p < 0.001) as independent risk factors for IAEs. The rate of invasive fungal infections was as low as 3.5%, and the use of antifungal or antibacterial prophylaxis was not associated with a reduction in the rate of IAEs. Conclusion: IAEs remain a substantial risk in venetoclax‐treated AML patients, particularly during prolonged neutropenia and with concomitant drug interactions. Optimizing venetoclax regimens and careful management of interacting medications may mitigate these risks.

Invasive Fusariosis with Disseminated Skin Lesions in an Allogeneic Hematopoietic Stem Cell Transplant Recipient: A Case Report and Literature Review - Mediterranean Journal of Infection Microbes and Antimicrobials

Background: Mucormycosis, a fatal fungal infection, has increased during the COVID-19 pandemic and posed significant challenges for clinicians. Objectives: Our research focused on identifying the clinical traits of patients with COVID-19-associated mucormycosis (CAM), comparing them with a control group, and identifying risk factors for the development of CAM. Methods: Our study was conducted on 39 CAM patients and 78 control patients from September 2020 to October 2022 at a tertiary education center and regional hospital. The control group was selected blindly in a 1:2 ratio among patients who did not develop mucormycosis, were hospitalized due to COVID-19, and were either discharged or deceased. The control group was matched to the case group regarding age and hospitalization date. To test potential risk factors for CAM, we performed a binary logistic regression analysis. The variables included in the multivariate binary logistic regression model were gender, diabetes, cumulative steroid dose (dexamethasone equivalent), duration of steroid treatment, and tocilizumab/anakinra treatment. Results: In our study, 39 patients were diagnosed with CAM. The average age of the patients was 66 ± 11.5 years. Of the patients, 54.7% (n = 64) were male, with a statistically significantly higher proportion of men in the CAM group (74.4% vs. 44.9%, P = 0.003). The diabetes rate was 51.3% (n = 60) among all patients, and it was higher in the CAM group (69.2% vs. 42.3%, P = 0.006). Regarding in-hospital mortality, the rate was higher in the CAM group (56.4% vs. 14.1%, P < 0.001). The median length of stay in the hospital was 37 days for the CAM group and 10 days for the control group (P < 0.001). The cumulative steroid dose was elevated in the CAM group compared to the control group (191 ± 61.4 mg vs. 117 ± 69.8 mg, P < 0.001). The duration of steroid treatment was 16.5 ± 6.2 days in the CAM group, compared to 9.8 ± 4.7 days in the control group (P < 0.001). Among CAM cases, paranasal involvement was the most common (56.4%), followed by rhino-orbital involvement (33.3%). In binary logistic regression analysis, male gender (OR, 3.9; 95% CI, 1.4 – 11.3), diabetes mellitus (OR, 4.4; 95% CI, 1.5 – 12.4), more than ten days of steroid use (OR, 5.5; 95% CI, 1.3 – 22.4), and tocilizumab/anakinra use (OR, 0.23; 95% CI, 0.06 – 0.8) were identified as risk factors for the development of CAM (p values 0.011, 0.005, 0.019, and 0.020, respectively). Conclusions: Male gender, diabetes mellitus, and steroid use for more than ten days were identified as positive risk factors, while tocilizumab/anakinra use was identified as a negative risk factor for the development of CAM.