We aimed to describe the clinical presentation, treatment, outcome and report on factors associated with mortality over a 90-day period in Clostridioides difficile infection (CDI). Descriptive, univariate, and multivariate regression analyses were performed on data collected in a retrospective case-control study conducted in nine hospitals from seven European countries. A total of 624 patients were included, of which 415 were deceased (cases) and 209 were still alive 90 days after a CDI diagnosis (controls). The most common antibiotics used previously in both groups were β-lactams; previous exposure to fluoroquinolones was significantly (p = 0.0004) greater in deceased patients. Multivariate logistic regression showed that the factors independently related with death during CDI were older age, inadequate CDI therapy, cachexia, malignancy, Charlson Index, long-term care, elevated white blood cell count (WBC), C-reactive protein (CRP), bacteraemia, complications, and cognitive impairment. In addition, older age, higher levels of WBC, neutrophil, CRP or creatinine, the presence of malignancy, cognitive impairment, and complications were strongly correlated with shortening the time from CDI diagnosis to death. CDI prevention should be primarily focused on hospitalised elderly people receiving antibiotics. WBC, neutrophil count, CRP, creatinine, albumin and lactate levels should be tested in every hospitalised patient treated for CDI to assess the risk of a fatal outcome.

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Cytokines are mediators of inflammation induced in the course of Clostridioides difficile infection (CDI). High Mobility Group Box 1 (HMGB1) is a cytokine playing an important role in the pathogenesis of numerous inflammatory and autoimmune diseases. The aim of the study was to assess the HMGB1 gene expression in the course of CDI. We have performed a prospective case-control study- including 55 adult patients, among them 27 with CDI, who were hospitalized from October 2018 to February 2020 and 28 healthy volunteers. We assessed: a complete blood count with differential leukocyte count, blood creatinine, albumin, and C-reactive protein (CRP) levels. Then, the expression of the HMGB1 gene was evaluated using quantitative Real-Time PCR. Patients with CDI were found to have a significant increase in white blood cells (WBC), neutrophil count, and CRP levels, they also exhibited decreased levels of albumin compared with controls. The HMGB1 gene expression was significantly lower among patients with CDI compared with the control group and significantly, inversely correlated with CRP level in blood. In conclusion, we have observed a decreased expression of the HMGB1 gene in peripheral blood of patients with mild or moderate CDI, which hypothetically could reflect their diminished capability to fight the pathogen.

It is thought that chronic liver disease affects a person's risk of cardiovascular disease (CVD) development. The aim of this study was to assess the effect of Chronic Hepatitis B (HBV) infection, Chronic Hepatitis C (HCV) infection, and liver damage on cardiovascular risk and selected vascular parameters contributing to CVD risk. This case-control study included a group of 114 patients composed of 34 patients with HBV, 35 patients with HCV, and 45 patients as the control group. Cardiovascular risk was assessed by analyzing classic risk factors, and the SCORE system. The following arterial properties were analyzed using applanation tonometry with SphygmoCor Vx technology: central systolic blood pressure (cSBP), central pulse pressure, augmentation pressure, augmentation index, and carotid-femoral pulse wave velocity (PWV). Asymmetric dimethyloarginine (ADMA) blood levels were analyzed using ELISA as a marker of vascular function. In a univariable analysis we found no significant differences between the hepatitis B, hepatitis C, and control groups in terms of PWV (respectively: median 7.2 [Q25-Q75 6.4-8.5], 7.3 [6.9-8.7], 7.8 [6.5-8.9]), cSBP (115 [109-126], 118 [107-123], 116 [107-129]), ADMA (0.52 [0.47-0.60], 0.53 [0.45-0.62], 0.58 [0.51-0.63]), SCORE (0 [0-1], 0 [0-2], 0 [0-2]). No significant differences in cardiovascular variables were observed between cirrhotic and non-cirrhotic patients. A multivariable analysis confirmed the above findings. (PWV, p=0 . 29; cSBP, p=0.26; ADMA, p=0.19). We concluded that chronic hepatitis B or C was not independently associated with an adverse cardiovascular risk profile nor with an unfavorable pattern of vascular parameters contributing to CVD risk in our study population, even in the case of liver cirrhosis. The same was true for blood ADMA levels.

Lyme borreliosis (LB) is a zoonotic disease caused by Gram-negative bacteria Borrelia burgdorferi sensu lato. The majority of reported cases of LB originate in the northern hemisphere, mostly in the US and Europe. One of the typical manifestations of LB are musculoskeletal symptoms; they may appear in any of the three LB stages. The diagnosis is based on clinical manifestations and confirmed by serological tests. One course of antibiotic therapy is sufficient for LB to dissipate in most cases, although for some patients, the symptoms subside gradually even after completion of therapy. Patients who have been demonstrated to have specific antibodies but are symptomless should not be treated. In instances where the advised treatment proved to be unsuccessful, patients should be referred to rheumatologist for additional diagnostics. The goal of this review is to update physicians on current scientific knowledge on musculoskeletal manifestations of LB.