Study: 3% of adults with COVID pneumonia develop new-onset dementia

Three percent of 10,403 adults with COVID-19 pneumonia were diagnosed as having new-onset dementia after a median of 182 days, a significantly higher proportion than that observed with other types of pneumonia, finds a study yesterday in Open Forum Infectious Diseases.

University of Missouri at Columbia researchers conducted a case series of COVID-19 pneumonia patients along with matched contemporary control patients who had non–SARS-CoV-2 pneumonia from 110 US healthcare centers to identify new diagnoses of dementia at least 30 days after hospitalization.

Of the 10,403 patients with COVID-19 pneumonia, 3% (95% confidence interval [CI], 2.7% to 3.4%) were diagnosed as having new-onset dementia over a median of 182 days. In contrast, 2.5% (95% CI, 2.2% to 2.9%) of the 10,403 patients with other pneumonias developed dementia.

The risk of new-onset dementia was significantly greater with COVID-19 pneumonia than with other pneumonias (odds ratio [OR], 1.3; (95% CI, 1.1 to 1.5) after adjustment for age, sex, race, high blood pressure, diabetes, abnormal cholesterol levels, tobacco use, alcohol misuse, atrial fibrillation (abnormally rapid heart rhythm), history of stroke, and congestive heart failure.

The link between COVID-19 pneumonia and new dementia diagnoses remained significant after further adjustment for stroke, septic shock, and mechanical ventilation during hospitalization (OR, 1.3; 95% CI, 1.1 to 1.5).

Risk factors for new-onset dementia were age 55 to 70 years (OR, 13.1), age older than 70 (OR, 49.0), Hispanic race (OR, 1.8), alcohol use or abuse (OR, 1.8), and history of depression (OR, 1.3), encephalopathy (disease that alters brain function or structure; OR, 2.2), delirium (OR, 3.1), or stroke during COVID-19 hospitalization (OR, 1.8).

New-onset dementia may increase the burden of disability among COVID-19 survivors, the study authors noted, including the need for personal care and the financial consequences of an inability to return to work.

"Future studies should investigate the underlying pathophysiological processes associated with SARS-CoV-2 infection to identify optimal strategies to prevent long-term disabling sequelae like new onset dementia," the researchers concluded.
Mar 7 Open Forum Infect Dis study

Serial-passage study shows increase in CWD attack rates in raccoons

US Department of Agriculture and US Geological Survey scientists showed through an experiment that repeatedly passing chronic wasting disease (CWD) isolates through meadow voles led to changes in the biologic behavior of the CWD prion in raccoons, including increased attack rates and decreased incubation periods.

The research was published yesterday in Emerging Infectious Diseases. Previously, the researchers had shown raccoons are able to propagate CWD prions from white-tailed deer and elk but with low attack rates (25%).

By passing the CWD homogenates through voles up to five times before inoculating raccoons, the researchers found that the incubation period was shortened, and the attack rate grew to 75%. The average survival time after inoculation was 23 months.

"These results provide strong evidence for the emergence of a novel strain of CWD after passage in meadow voles and raccoons," the authors concluded.

"Interspecies transmission of CWD prions between cervids and noncervid species that share the same habitat might represent a confounding factor in CWD-management programs. In addition, passage of CWD prions through off-target species might represent a source of novel CWD strains with unknown biologic characteristics, including zoonotic potential."

CWD is a fatal prion disease that has affected cervids like deer, moose, and elk in North America and Europe. Previously, scientists have documented the successful transmission of CWD prions from white-tailed deer to four species of native North America rodents, and eastern meadow voles (Microtus pennsylvanicus) were found to be the most susceptible species.
Mar 7 Emerg Infect Dis study

Meta-analysis documents resistance in COVID-19 co-infections

More than a quarter of bacterial samples from patients with COVID-19 and bacterial co-infection during the first 18 months of the pandemic were resistant to antimicrobials, according to a review and meta-analysis published yesterday in Antimicrobial Resistance and Infection Control.

Of the 38 studies pertaining to patients with confirmed SARS-CoV-2 and co-infections caused by resistant organisms that were included in the review, a total of 1,959 unique isolates were identified, and 569 (29%) were resistant organisms. Co-infection with resistant bacterial or fungal infections ranged from 0.2% to 100% across studies, and the pooled prevalence of co-infection with a resistant bacterial or fungal infection was 24% (95% confidence interval [CI], 8% to 40%) and 0.3% (95% CI, 0.1% to 0.6%), respectively.

Among multidrug-resistant organisms identified, methicillin-resistant Staphylococcus aureus, carbapenem-resistant Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and multidrug-resistant Candida auris were most commonly reported. Stratified analyses found higher proportions of antimicrobial resistance (AMR) outside of Europe and in intensive care units, though these results were not statistically significant.

The study authors note that the findings are limited by the variation in patient populations within the studies, along with the lack of a standardized definition of AMR and an inability to distinguish between isolates from true co-infections and those involving colonization and contamination. They suggest the findings could represent a small subset of the true burden of resistant co-infections.

"Despite the large body of literature describing the potential effects of the COVID-19 pandemic on AMR, this is the first study to summarize data surrounding AMR which may have major implications for current and future antimicrobial stewardship as well highlighting gaps in methods of organism identification and reporting of resistance," they wrote. "However, with very few reports and poor-quality data, further research is warranted to better understand the landscape of AMR during COVID-19."
Mar 7 Antimicrob Resist Infect Control study

ECDC calls for efforts to stem infectious diseases in Ukrainian refugees

With more than 1.6 million refugees having fled Ukraine as of Mar 6, and more on their way, the European Centre for Disease Prevention and Control (ECDC) today published guidance to help European health officials and healthcare providers prevent and control the spread of infectious diseases among Ukrainian refugees.

The document highlights three main infectious diseases of concern among Ukrainian refugees that could be exacerbated by temporary living conditions during displacement: COVID-19, polio, and measles. As of Feb 10, Ukraine was reporting a 7-day average of 35,978 COVID-19 cases, and uptake of a primary COVID-19 vaccination series was only 35%—well below the European Union/European Economic Activity average of 71.7%. Vaccine uptake is uniformly low across all age-groups.

Among Ukrainian children, there is still considerable vulnerability to polio—particularly for children under age 6—and measles. Overall vaccination coverage for polio in 2021 was 80%, with considerably lower coverage in certain areas of the country, and the 81.9% vaccination rate for measles is not high enough to prevent outbreaks, the ECDC says, adding that crowding in bomb shelters and receptions centers could facilitate the start of a measles outbreak.

Seasonal flu, tuberculosis (TB), and HIV are also a concern. Ukraine reported the second most TB cases in Europe in 2019, is among the 10 countries with the highest burden of multidrug-resistant TB, and has the second highest prevalence of HIV/TB co-infection in the World Health Organization European Region.

In addition, the report notes that high rates of AMR have been reported in Ukraine, which the ECDC says could pose problems for treating Ukrainian soldiers who have infected war wounds.

The ECDC recommends that public health authorities, particularly in the countries bordering Ukraine, make frontline healthcare providers aware of these infectious disease vulnerabilities so that they can adjust their diagnostic and reporting algorithms appropriately. It also recommends prioritizing vaccination coverage for refugees against polio, measles, and COVID-19 and providing continuity of care for people with TB and HIV.

Reception centers, which are likely to become more crowded, are urged to assess their needs for communicable disease control and consider syndromic surveillance for displaced people.
Mar 8 ECDC technical report