Archives of Clinical Infectious Diseases
Volume:19 Issue: 1, Feb 2024

Context: 

Liver transplant recipients are highly susceptible to infections, including those affecting the central nervous system (CNS), due to their compromised immune systems and underlying chronic comorbidities.

 Despite recent advancements in diagnostic and treatment modalities, post-transplant fungal infections continue to affect these patients. CNS fungal infections following liver transplantation pose a significant challenge in the diagnostic and therapeutic management of transplant recipients. Timely diagnosis and treatment are crucial because these infections are often identified late, leading to substantial morbidity and mortality in this patient population.

 This mini-review aims to explore the incidence of CNS fungal infections in liver transplant recipients, the key opportunistic pathogens involved, the associated risk factors, various clinical presentations, and the importance of preventive measures.

 The symptoms of coronavirus disease 2019 (COVID-19) range from asymptomatic to severe respiratory distress or death. Reviews on potential COVID-19 treatments show no established therapy. Photobiomodulation can help in reducing inflammation and speed up tissue repair. In addition, due to its few side effects, it appears to be effective in restricting COVID-19. Therefore, it was decided to use this method in disease control to achieve the systemic impact of intravascular photobiomodulation therapy in this study.

 A total of 60 patients were randomly divided into three groups of 20 subjects: A control group that received common treatments for COVID-19, a group treated with a low-power gallium arsenide laser diode (660 nm) with an output dose of 2 J/cm2 for 7 minutes and 5 days in a row in addition to standard treatments, and another group that received common treatments with the same laser dose at the same time as the first group with a low-power diode laser (450 nm). Laboratory data and clinical criteria between groups were compared before and after the treatment.

 An increase in O2 and partial pressure of oxygen (PO2) was significant in the two laser therapy groups (P < 0.05). In addition, the partial pressure of carbon dioxide (PCO2) decreased significantly in the blue laser group (mean difference = -1.44 ± 12.72). The COP score was reduced in all groups; however, only in the blue laser group the reduction in COP score was significant (P < 0.05). In the blue laser group, the COP score before and after the treatment was reduced.

 The use of an intravenous laser with red and blue wavelength with an output dose of 2 J/cm2 for 7 minutes and 5 days in a row, in addition to standard treatments, showed the improvement of oxygenation (O2 and PO2 in arterial blood gas [ABG]) and the reduction of inflammatory factors (erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]) and COP scores. However, further extensive studies are needed to prove the therapeutic effects of intravenous lasers, along with the usual treatments for COVID-19.

 Inducing a humoral response to SARS-CoV-2 may partially control virus dissemination. However, there is a lack of consistency in the reported kinetics of IgM and IgG responses to SARS-CoV-2. Additionally, the humoral response to SARS-CoV-2 may differ from that elicited by vaccination. Therefore, we were motivated to evaluate the kinetics of antibodies against SARS-CoV-2 in both infected and vaccinated individuals.

 This study aimed to investigate the seroconversion patterns of specific antibodies against various antigens of SARS-CoV-2 in hospitalized COVID-19 patients and vaccinated individuals, focusing specifically on comparing the humoral responses elicited by infection and vaccination.

 Serial blood and swab samples were collected from 134 COVID-19 patients at six time points following admission. Real-time RT-PCR specific for SARS-CoV-2, as well as anti-SARS-CoV-2 IgM and IgG, were tested using ELISA. Additionally, 141 serum samples were obtained from vaccinated individuals. Anti-SARS-CoV-2 spike and RBD IgGs, along with neutralizing antibodies (NAs), were assessed using ELISA in both the vaccinated group and 96 COVID-19 patients.

 Anti-SARS-CoV-2 IgM was found positive in 23.3% of patients at 0 - 7 days after symptom onset, with seropositivity increasing to 71.7% at 15 - 21 days. Subsequently, IgM positivity gradually decreased to 62.7% at > 28 days post-symptom onset. Meanwhile, anti-SARS-CoV-2 IgG was positive in 28.3% of patients at 0 -7 days, rising to 83.7% at 22 - 28 days after symptom onset, and remained constant thereafter. Anti-spike and RBD IgGs, along with NAs, were detected in 89.7%, 87.4%, and 87.9% of vaccinated individuals, respectively, and in 37.5%, 32.3%, and 32.3% of COVID-19 patients, respectively. There was a significant correlation between anti-spike IgG and anti-RBD IgG levels and NAs in both COVID-19-infected and vaccinated individuals. The mean concentrations of anti-spike and RBD IgGs were higher in vaccinated individuals with a history of COVID-19 infection compared to those without prior infection.

 The antibody profile for IgM and IgG against SARS-CoV-2 suggests that as time passes after the onset of disease symptoms, the seropositivity in COVID-19 patients increases. Furthermore, antibodies against SARS-CoV-2 are produced more efficiently through COVID-19 vaccination than natural infection.

 Several coronavirus disease 2019 (COVID-19) vaccines, utilizing different platforms, have successfully obtained emergency clinical use authorization to prevent severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections. Most published data from COVID-19 vaccine trials have frequently observed mild-to-moderate side effects, with varying severity depending on various vaccine types.

 This study aimed to estimate the prevalence of side effects associated with four types of COVID-19 vaccines among vaccinated healthcare workers following the first and second vaccine doses and to identify possible risk factors for COVID-19 vaccine side effects.

 This cross-sectional study was conducted from April 2021 to March 2022 by administering a questionnaire and conducting direct interviews with healthcare workers in Kerman, southeastern Iran, who had received 2 or more doses of COVID-19 vaccines.

 Out of 861 individuals enrolled in the study, 38.7% received Sputnik, 32.4% AstraZeneca, 19.6% Covaxin, and 9.3% Sinopharm vaccines. Overall, the most common side effects after the first and second doses included general symptoms, fever and chills, injection site reactions, neurological symptoms, and gastrointestinal symptoms. Furthermore, the frequency of symptoms significantly reduced after the second dose.

 General symptoms and injection site reactions were significantly more common after receiving the first dose of vaccines compared to the second dose. No severe vaccine side effects were observed in this study. However, further research is required to evaluate the long-term symptoms and safety profiles of COVID-19 vaccines.

 The coronavirus disease 2019 (COVID-19) vaccines are very good at protecting individuals from serious illness, needing hospital care, and dying from different strains of the virus. However, vaccines might not completely prevent individuals from catching and spreading the virus, and this might depend on some personal factors.

 To find out the immune response of COVID-19 vaccines, this cross-sectional study conducted within June 2021 to May 2023 assessed different types of COVID-19 vaccine antibody responses among healthcare professionals and their associations with demographic factors and comorbidity risk factors.

 This descriptive-analytical study was conducted on recruited healthcare professionals from Sina, Imam Khomeini Complex, 501 AJA, Baqiayatallah, and Firoozgar hospitals in Tehran, Iran. The vaccines whose antibody response was investigated in this study are Sinopharm® (China), AstraZeneca® (United Kingdom), Sputnik® (Russia), and Covaxin® (India). Anti-spike, anti-receptor-binding domain (RBD), and anti-neutralizing immunoglobulin G (IgG) were evaluated by commercial kits according to instructions.

 This study involved 1 029 healthcare workers who were over 18 years old. The average age was 41.48 ± 9.9 years, and 602 (58.5%) of them were male. The vaccines they received were Sputnik V (392 or 38.16%), AstraZeneca (335 or 32.61%), Baharat (45 or 4.3%), and Sinopharm (255 or 24.82%). The Covaxin and AstraZeneca vaccines increased both anti-RBD and anti-neutralizing IgG Ab levels; however, the Sinopharm vaccine increased only the latter. The Sputnik vaccine was the least effective. Gender and diabetes influenced the antibody levels, but age did not.

 This study revealed the substantial effectiveness of COVID-19 vaccines in generating robust antibody responses among healthcare professionals. All four vaccine types, Sinopharm, AstraZeneca, Sputnik, and Covaxin, elicited significant antibody responses in over 70% of participants, highlighting the crucial role of vaccination in building defense against COVID-19.

 Sepsis is the leading cause of death in newborns, particularly in underdeveloped countries. Early diagnosis and appropriate treatment are critical in reducing neonatal mortality. Since blood culture results are often unavailable for 48 - 72 hours, other hematologic findings may provide useful information for early diagnosis.

 We examined the relationship between neonatal sepsis and blood indices in order to achieve early diagnosis.

 In this hospital-based retrospective multiple-event case-control study, we allocated the neonates into three groups: Culture-positive sepsis, culture-negative sepsis, and neonates without sepsis. We compared the lab data within these three groups.

 The study included 319 neonates: 209 cases of culture-positive sepsis, 65 cases of culture-negative sepsis, and 45 cases without neonatal sepsis. Pearson's test demonstrated a significant correlation between thrombocytopenia, positive C-reactive protein (CRP), and high cell distribution width with culture-positive sepsis (P = 0.000), indicating a statistical difference between the three groups. The mean CRP and eosinophil levels were higher in the culture-positive group with fungal sepsis.

 In septic neonates with high CRP levels, particularly in conjunction with eosinophilia, fungal coverage should be considered.

 When coronavirus disease 2019 (COVID-19) first broke out, much literature was reported on the re-detectable positive phenomenon of COVID-19 patients during recovery; however, there were few studies on the lymphocyte subsets, T-lymphocyte activation indicators, and levels of specific antibodies between the re-detectable positive (RP) and non-re-detectable positive (NRP) patients.

 This study aimed to analyze the immunological characteristics of RP and NRP patients among convalescent patients from post-discharge COVID-19 patients and to explore immunological factors related to RP.

 Anticoagulated whole blood samples were collected from 11 healthy controls (HCs) and 66 COVID-19 convalescent patients. Then, the percentage of lymphocyte subsets and CD4+CD38+/HLA-DR+ T cells were tested with flow cytometry, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) anti-spike protein receptor-binding domain immunoglobulin G (S-RBD-IgG) antibody was detected by chemiluminescence.

 B cells (%) in the RP group were significantly lower than that in the HC group (P = 0.014), and B cells (%) decreased successively in HC, NRP, and RP groups, with significant differences among the three groups (P = 0.016). CD3+ and CD8+ T cells (%) in the RP group were noticeably higher than that in the NRP group (P = 0.004 and 0.019, respectively); nevertheless, there was no difference in CD4+ T cells (%) and natural killer (NK) cells (%) among the three groups. The CD4+CD38+ and CD4+HLA-DR+ T cells (%) in the RP group were noticeably higher than that in the HC group (P = 0.013 and 0.025). The analysis of differences among the three groups showed that CD4+CD38+ and HLA-DR+ T cells (%) were also significantly different (P = 0.037 and 0.015), and CD4+HLA-DR+ T cells (%) in the three groups increased in turn. Meanwhile, there was a positive correlation between RBD-IgG titer and CD4+HLA-DR+ (%) (P = 0.003, r = 0.517), and the RBD-IgG titer of HLA-DR+ high group was higher than that of HLA-DR+ Low group (P = 0.005) in the COVID-19 convalescent patients.

 In this study, the immunological characteristics of the RP patients of COVID-19 convalescent patients were analyzed based on the lymphocyte subsets and the relationship between S-RBD-IgG and activated CD4+ T cells. The results showed that the low B cells (%) and the increased CD4+HLA-DR+ T cells (%) in the convalescent patients of COVID-19 might be related to the RP phenomenon, and the activated CD4+ T cells might play a crucial role in specific antibody responses.

 Clove (Syzygium aromaticum) is an ancient medicinal plant with a long history of use in traditional medicine. It possesses a diverse array of bioactive compounds and has been employed for centuries in Asian countries, especially India and other developing nations, to address fungal infections affecting the skin, mouth, urinary system, and vaginal tract.

 This study aimed to assess the antibacterial effects of an ethanolic extract derived from the S. aromaticum plant on clinical isolates of Enterococcus faecalis. This was achieved by conducting an agar diffusion susceptibility test, indicating the presence of an inhibitory zone against the growth of the microorganisms.

 In this study, 251 clinical urine samples were collected from women suffering from urinary tract infections (UTIs) aged 17 to 52 years in Baghdad City, Iraq, from September 2021 to January 2022. The samples were examined to determine the occurrence of E. faecalis through morphological identification. This involved employing conventional and differential culture media, performing biochemical tests, and utilizing the Vitek II system.

 Enterococcus faecalis isolates were found in 35 (16.43%) of 213 samples that showed positive bacterial cultures detected by conventional bacteriological methods and Vitek II. Based on antimicrobial susceptibility test results, 4 concentrations (100, 50, 25, and 12.5 mg/mL) of alcoholic extract of S. aromaticum showed considerable effectiveness against all 35 E. faecalis isolates, where the diameters of the inhibition zones ranged from 21.13 to 7.14 mm; however, no inhibition of zone was seen at concentrations of 6.25 and 3.125 mg/mL.

 The ethanolic extract obtained from the dried flower buds of clove (S. aromaticum) exhibited significant potential as an antibacterial agent. Furthermore, it suggests the exploitation of this plant as a novel therapeutic alternative for the treatment of UTIs to deal with the problem of drug resistance.

Rabies is a zoonotic viral infection with a worldwide distribution, primarily found in Asia and Africa, leading to an annual mortality rate of approximately 60 000 cases. The rabies virus is an RNA virus primarily transmitted through mucosal surfaces or contact with compromised skin. In this study, we present a case of rabies associated with acute respiratory distress syndrome (ARDS).

 A 64-year-old male who had been bitten by a dog three weeks prior to admission presented to our emergency department with restlessness. A lung CT scan revealed nearly complete opacification of both lungs, indicative of ARDS. Unfortunately, the patient passed away within 5 hours of admission. An autopsy was conducted, and brain samples tested positive for rabies using the direct fluorescent antibody technique.

 ARDS is a rare but fatal extra-neural complication of rabies, potentially linked to cytokine storms and nitric oxide as etiological factors. Nevertheless, further investigations are warranted to gain a more precise understanding of the pathogenesis.