Chryseobacterium indologenes is a rare non-fermenting gram-negative pathogen that can cause opportunistic infections in humans. Most infections are nosocomial and acquired through contaminated devices such as ventilators, endotracheal tubes, and indwelling catheters. An increasing number of infections have been reported in recent years after the first reported case of ventilator-associated pneumonia in 1993. Blood, lung, ocular, and peritoneal infections, among others, have been reported. The high rate of intrinsic resistance to broad-spectrum antibiotics is a matter of concern since there are no standard guidelines for the management and treatment of this infection. Here, we present the case of a 94-year-old female who was admitted and intubated after a cerebral vascular accident. During her stay, she developed a fever. The deep tracheal aspirate culture was positive for gram-negative bacilli with smooth, circular, and yellow-pigmented colonies that were later identified as C. indologenes. Antimicrobial susceptibility tests done with VITEK 2 and by the Kirby-Bauer disc diffusion method showed susceptibility to ciprofloxacin, minocycline, and trimethoprim-sulfamethoxazole and resistance to all other tested antimicrobials. The infection was successfully treated with ciprofloxacin antibiotic. To the best of our knowledge, this is the first reported case of C. indologenes infection in Lebanon.

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Hemophagocytic lymphohistiocytosis (HLH), a hyperinflammatory hyperferritinemic syndrome, is triggered by various etiologies and diseases and can lead to multiorgan dysfunction and death. There are two types of HLH: primary and secondary. Primary HLH (pHLH) is caused by a genetic mutation resulting in dysfunction in cytotoxic T lymphocytes (CTLs), natural killer (NK) cells, hyperactivated immune cells, and hypercytokinemia. In secondary HLH (sHLH), an underlying etiology is the cause of the disease. Infections, malignancy, and autoimmune diseases are well-known triggers for sHLH. Infectious triggers for sHLH are most frequently viruses, where different mechanisms, including dysregulated CTLs and NK cell activity and persistent immune system stimulation, have been reported. Similarly, in severe coronavirus disease 2019 (COVID-19) patients, a hyperinflammatory mechanism leading to hypercytokinemia and hyperferritinemia has been demonstrated. A similar dysfunction in CTLs and NK cells, persistent immune system stimulation with increased cytokines production, and severe end-organ damage have been reported. Therefore, a significant overlap is present between the clinical and laboratory features seen in COVID-19 and sHLH. However, SARS-CoV-2, similar to other viruses, can trigger sHLH. Hence, a diagnostic approach is needed in severe COVID-19 patients presenting with multiorgan failure, in whom sHLH should be considered.

COVID-19 pandemic has emerged over more than 200 countries leading to more than 117 million infection cases and more than 2.6 million deaths. Lebanon is one of the countries affected by this disease especially in the second half of 2020 reaching its peak early this year. In this study, we studied the impact of multiple factors on this surge and analyzed the positive tests among different age groups over a period of one year (from March 2020 to February 2021). Data was collected from one medical center in Beirut where more than 20,000 PCR tests were done using RT-PCR method between March 2020 and February 2021 and analyzed the pattern of increase of the rate of positivity over this period. The SARS-CoV-2 positivity rate was 13% over a period of one year. The highest number of positive PCR tests was in patients aged between 20 and 39 years. Furthermore, the number of positive tests was low in the first 4 months, which was followed by a dramatic increase in July 2020 reaching a peak in January 2021. Lebanon is among the countries affected lately by the COVID-19 pandemic with most cases arising after August 2020 affected by the blast of Beirut and emergence of new variants resulting in higher positivity rate. Moreover, our data shows a distribution of age similar to other countries and suggest its role in the rapid increase of positivity rate.

Introduction: Antimicrobial resistance (AMR) is a worldwide problem that threatens treatment effectiveness against the most serious bacterial infections. AMR in Enterobacterales is highly prevalent in Lebanon. However, recent reports regarding the distribution of Enterobacterales and related antimicrobial susceptibility are scarce. Methodology: In this retrospective study at the Lebanese Hospital Geitaoui Medical Center in Lebanon, all data regarding culture specimens from urine, blood, sputum, deep tracheal aspirate, broncho-alveolar lavage, wounds, surgical sites, tissue, body fluids, and central venous catheter that were positive for at least one of the 4 bacterial isolates (Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae and Proteus mirabilis) were collected. All susceptibility testing was performed according to the Clinical and Laboratory Standards Institute guidelines. Results: A total of 4283 non-duplicate Enterobacterales were isolated during the study period (January 2017 to December 2020). Urine was the most common site of infection. E. coli was the most detected isolate as well as the leading pathogen in urine, wounds and surgical sites, and blood. Regarding antimicrobial susceptibility, the mean susceptibility to third generation cephalosporins was 55.53% and a mean extended-spectrum β-lactamases production of 31.2% was measured in E. coli. Mean carbapenem susceptibility was the lowest in K. pneumoniae and E. cloacae. The lowest mean susceptibility to fluoroquinolones was detected in E. coli isolates. Conclusions: This study identified the predominance of E. coli among Enterobacterales in Lebanese patients, with the urinary tract being the most common site of infection and underlined the high rates of AMR in Enterobacterales in Lebanon.