1.Range of Varicella Zoster Co-Infections with COVID-19, Singapore
Jerold LOH ; Sai Meng THAM ; Paul Anantharajah TAMBYAH ; Gabriel YAN ; Chun Kiat LEE ; Louis Yi Ann CHAI
Infection and Chemotherapy 2021;53(2):391-394
There have been recent descriptions of the novel coronavirus disease 2019 (COVID-19) presenting as ‘varicella-like exanthem’. We report three cases of patients with VaricellaZoster Virus (VZV) and COVID-19 co-infections, presenting in three varied ways. These cases highlight the need for heightened alertness to how such co-infections can present, to pick up overlapping ‘dual pathologies’ during this current pandemic given that infection control measures including airborne precautions are crucial for both COVID-19 and VZV.
2.Range of Varicella Zoster Co-Infections with COVID-19, Singapore
Jerold LOH ; Sai Meng THAM ; Paul Anantharajah TAMBYAH ; Gabriel YAN ; Chun Kiat LEE ; Louis Yi Ann CHAI
Infection and Chemotherapy 2021;53(2):391-394
There have been recent descriptions of the novel coronavirus disease 2019 (COVID-19) presenting as ‘varicella-like exanthem’. We report three cases of patients with VaricellaZoster Virus (VZV) and COVID-19 co-infections, presenting in three varied ways. These cases highlight the need for heightened alertness to how such co-infections can present, to pick up overlapping ‘dual pathologies’ during this current pandemic given that infection control measures including airborne precautions are crucial for both COVID-19 and VZV.
3.Risk factors for adverse outcomes and multidrug-resistant Gram-negative bacteraemia in haematology patients with febrile neutropenia in a Singaporean university hospital.
Li Mei POON ; Jing JIN ; Yen Lin CHEE ; Ying DING ; Yee Mei LEE ; Wee Joo CHNG ; Louis Yi-An CHAI ; Lip Kun TAN ; Li Yang HSU
Singapore medical journal 2012;53(11):720-725
INTRODUCTIONInstitutional febrile neutropenia (FN) management protocols were changed following the finding of a high prevalence of ceftazidime-resistant Gram-negative bacteraemia (CR-GNB) among haematology patients with FN. Piperacillin/tazobactam replaced ceftazidime as the initial empirical antibiotic of choice, whereas carbapenems were prescribed empirically for patients with recent extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae colonisation/infection. An audit was conducted to determine the impact of these changes.
METHODSData from all FN episodes between October 2008 and December 2010 were collected prospectively, with mid-November 2009 demarking the transition between pre-intervention and intervention periods. Outcomes measured included 30-day mortality post-development of FN and the presence of CR-GNB.
RESULTSThere were 427 FN episodes (200 in the pre-intervention period) from 225 patients. The prevalence of CRGNB was 10.3%, while the 30-day mortality was 4.7%, with no difference between pre-intervention and intervention periods. Independent risk factors for 30-day mortality included the presence of active haematological disease, vancomycin prescription and older age. Independent factors associated with initial CR-GNB were profound neutropenia, the presence of severe sepsis and active haematological disease. Recent ESBL-producing Enterobacteriaceae colonisation/infection was not predictive of subsequent CR-GNB (positive predictive value 17.3%), whereas a model based on independent risk factors had better negative predictive value (95.4%) but similarly poor positive predictive value (21.4%), despite higher sensitivity.
CONCLUSIONA change in the FN protocol did not result in improved outcomes. Nonetheless, the audit highlighted that empirical carbapenem prescription may be unnecessary in FN episodes without evidence of severe sepsis or septic shock, regardless of previous microbiology results.
Academic Medical Centers ; Adult ; Bacteremia ; complications ; drug therapy ; Carbapenems ; therapeutic use ; Ceftazidime ; pharmacology ; Drug Resistance, Multiple ; Febrile Neutropenia ; complications ; drug therapy ; Female ; Gram-Negative Bacteria ; Humans ; Male ; Middle Aged ; Penicillanic Acid ; administration & dosage ; analogs & derivatives ; Piperacillin ; administration & dosage ; Prevalence ; Prospective Studies ; Risk Factors ; Sepsis ; Singapore ; Treatment Outcome ; Universities
4.Clinical efficacy and long-term immunogenicity of an early triple dose regimen of SARS-CoV-2 mRNA vaccination in cancer patients.
Matilda Xinwei LEE ; Siyu PENG ; Ainsley Ryan Yan Bin LEE ; Shi Yin WONG ; Ryan Yong Kiat TAY ; Jiaqi LI ; Areeba TARIQ ; Claire Xin Yi GOH ; Ying Kiat TAN ; Benjamin Kye Jyn TAN ; Chong Boon TEO ; Esther CHAN ; Melissa OOI ; Wee Joo CHNG ; Cheng Ean CHEE ; Carol L F HO ; Robert John WALSH ; Maggie WONG ; Yan SU ; Lezhava ALEXANDER ; Sunil Kumar SETHI ; Shaun Shi Yan TAN ; Yiong Huak CHAN ; Kelvin Bryan TAN ; Soo Chin LEE ; Louis Yi Ann CHAI ; Raghav SUNDAR
Annals of the Academy of Medicine, Singapore 2023;52(1):8-16
INTRODUCTION:
Three doses of SARS-CoV-2 mRNA vaccines have been recommended for cancer patients to reduce the risk of severe disease. Anti-neoplastic treatment, such as chemotherapy, may affect long-term vaccine immunogenicity.
METHOD:
Patients with solid or haematological cancer were recruited from 2 hospitals between July 2021 and March 2022. Humoral response was evaluated using GenScript cPASS surrogate virus neutralisation assays. Clinical outcomes were obtained from medical records and national mandatory-reporting databases.
RESULTS:
A total of 273 patients were recruited, with 40 having haematological malignancies and the rest solid tumours. Among the participants, 204 (74.7%) were receiving active cancer therapy, including 98 (35.9%) undergoing systemic chemotherapy and the rest targeted therapy or immunotherapy. All patients were seronegative at baseline. Seroconversion rates after receiving 1, 2 and 3 doses of SARS-CoV-2 mRNA vaccination were 35.2%, 79.4% and 92.4%, respectively. After 3 doses, patients on active treatment for haematological malignancies had lower antibodies (57.3%±46.2) when compared to patients on immunotherapy (94.1%±9.56, P<0.05) and chemotherapy (92.8%±18.1, P<0.05). SARS-CoV-2 infection was reported in 77 (28.2%) patients, of which 18 were severe. No patient receiving a third dose within 90 days of the second dose experienced severe infection.
CONCLUSION
This study demonstrates the benefit of early administration of the third dose among cancer patients.
Humans
;
SARS-CoV-2
;
COVID-19/prevention & control*
;
Treatment Outcome
;
Neoplasms/drug therapy*
;
Hematologic Neoplasms
;
Vaccination
;
RNA, Messenger
;
Antibodies, Viral
;
Immunogenicity, Vaccine