Archives of Clinical Infectious Diseases
Volume:19 Issue: 4, Aug 2024

Context: 

It's crucial to monitor hematologic biomarkers in patients with coronavirus disease 2019 (COVID-19) to identify abnormalities and guide treatment decisions. These biomarkers provide valuable information about the severity of the disease and assist healthcare providers in making informed decisions about patient care.

Evidence Acquisition: 

The present study reviewed the most recent literature on hematologic biomarker abnormalities in patients with COVID-19 and considered their clinical significance.

Various abnormalities were observed in hematologic biomarkers, including prothrombin time (PT), partial thromboplastin time (PTT), red blood cell indices, interferon regulatory factor (IRF-7), and white blood cell (WBC) count. Notably, significant lymphocytopenia, thrombocytopenia, and leukocytosis were reported in patients with severe and fatal COVID-19 compared to those with non-severe disease and survivors.

Hematologic biomarkers play a crucial role in understanding COVID-19 pathogenesis and guiding clinical management. Utilizing these markers allows clinicians to assess disease severity, predict prognosis, and tailor treatment strategies to improve patient outcomes. Continued research in this area is essential to fully realize the potential of hematologic biomarkers for COVID-19 management.

Over the past decades, the role of biofilm-forming Staphylococcus aureus strains in urinary tract infections (UTIs) has garnered significant attention.

This study aimed to determine the epidemiological characteristics and diversity of S. aureus strains isolated from patients with UTIs in Isfahan, Iran, in 2017, with regard to their antimicrobial resistance, biofilm formation, and phylogenetic profiles. Additionally, the study investigated potential relationships among these factors statistically to develop efficient control and treatment approaches.

All patients with symptomatic UTIs who had positive urine cultures for S. aureus during the study period at the laboratory of a referral hospital in Isfahan were included. All isolates were identified using specific primers for the nuc A gene. Their biofilm formation capacity was evaluated using a combination of the microtiter plate and Congo-red agar methods. Antibiotic susceptibility testing was performed using the disk diffusion method. The presence of genes involved in biofilm formation and resistance to cefoxitin, aminoglycosides, and fluoroquinolones was detected using polymerase chain reaction (PCR). Staphylococcal cassette chromosome mec (SCC mec ) typing, agr typing, and phene plate (PhP) typing were employed to investigate the diversity of collected strains.

Results showed that 19%, 57%, and 24% of confirmed S. aureus strains were strong, intermediate, and non-biofilm formers, respectively. The highest rate of resistance was against nalidixic acid (77%), followed by streptomycin (73%). The ica D and ica A genes had the highest frequency among biofilm-producing strains. gyr A (44%) and grl A (35%) were the most frequent genes among fluoroquinolone-resistant strains, while aph (3′)-IIIa was the most prevalent aminoglycoside-modifying enzyme gene. The majority of bacterial strains harbored SCC mec type III and agr type I. PhP typing of strains revealed the presence of 8 common types (CTs) and 14 single types (STs), with CT2 being the dominant type.

The present investigation revealed various biofilm production capacities, antimicrobial resistance profiles, and clonal lineages in S. aureus isolated from patients with UTIs. These findings provide further insights into the epidemiology and pathogenicity of S. aureus strains in Iran, thereby improving the quality of surveillance and therapeutic protocols.

COVID-19 may trigger the progression of atherosclerosis, potentially leading to its clinical manifestation. Among the serum biomarkers related to atherosclerotic disease, it seems helpful to evaluate biochemical factors such as CD147, ACE2, and ACE in patients with COVID-19.

In this case-control study, serum samples from 90 patients were analyzed. The cohort included 30 patients hospitalized in the intensive care unit with COVID-19, 30 patients hospitalized in the ward with COVID-19, and 30 healthy individuals from Ayatollah Kashani Hospital (Tehran, Iran). These patients were admitted between December 10, 2022, and March 10, 2023. The concentrations of cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and the activity levels of angiotensin-converting enzyme (ACE), angiotensin-converting enzyme 2 (ACE2), troponin, CPK, CPK-MB, and CD147 were determined and analyzed among the three groups.

There was no significant difference in age between the patients (55.40 ± 10.34 years) and the control group (58.34 ± 11.71 years). SARS-CoV2 viral RNA was detected in the pharyngeal swab samples of the COVID-19 patients. The levels of CD-147 (2528.43 ± 12.43 vs. 2176.7 ± 9.87 vs. 1346.3 ± 14.23), ACE (83 ± 3.05 vs. 97 ± 1.55 vs. 30.1 ± 2.32), troponin (0.972 ± 0.25 vs. 0.784 ± 0.21 vs. 0.021 ± 0.68), and cholesterol (199.73 ± 2.43 vs. 175.87 ± 5.21 vs. 144.97 ± 8.74) were significantly higher in severe cases compared to non-severe cases (P < 0.05). ACE (AUC = 0.894) and CD147 (AUC = 0.821) had the highest sensitivity and specificity among the studied factors, respectively. Patients with normal levels of ACE and CPK-MB had a 0.16 times lower and 4.37 times greater chance of experiencing severe disease, respectively. Three strong correlations were found among the studied parameters: CD147 with ACE2 (r = 0.721) and cholesterol with triglyceride (r = 0.602) (P < 0.05).

Examining ACE and CD147 can help determine a person's susceptibility to atherosclerosis. These two factors have greater sensitivity and specificity and could be used as potential markers for monitoring disease progression.

Atherosclerosis and periodontitis are chronic inflammatory diseases characterized by inflammation and tissue destruction. Porphyromonas gingivalis , a key pathogen in periodontal disease, is implicated in initiating inflammation and tissue damage.

Given the potential link between periodontitis and the development of atherosclerotic plaques, this study aimed to investigate the presence of P. gingivalis DNA in subgingival and atherosclerotic plaques obtained from cadavers at the Tehran Forensic Medicine Center.

In this cross-sectional study, cadavers with a postmortem interval of 6 hours and atherosclerotic plaques in their coronary arteries, along with subgingival plaques exhibiting pocket depths exceeding 5 mm, were examined. Subgingival plaque samples were collected from the deepest sites, while atherosclerotic plaque samples were harvested. Real-time PCR was employed to detect the presence of P. gingivalis in all samples, and the McNemar test was used for data analysis.

A total of 25 cadavers were included in the analysis, and both subgingival and atherosclerotic plaque samples were assessed. P. gingivalis DNA was identified in 40% of subgingival plaque samples and 16% of atherosclerotic plaque samples. Moreover, all positive atherosclerotic plaque samples also tested positive for P. gingivalis in the subgingival plaque. McNemar's analysis revealed a statistically significant difference between the subgingival and atherosclerotic samples (P-value = 0.03). Additionally, a correlation coefficient of 0.53 was obtained.

While the study has certain limitations, the findings indicate a significant association between the presence of P. gingivalis in subgingival and coronary atherosclerotic plaques. Further investigations are warranted to elucidate the precise role of this periopathogen in atherosclerotic plaque formation.

Acquired immune deficiency syndrome (AIDS) remains a significant public health concern in China. Treatment coverage has been expanded by revising the antiretroviral therapy (ART) for people living with HIV (PLWH). Several years after implementing the new “Test and Treat” strategy, it is essential to evaluate its impact on people living with HIVsince its implementation.

This study was conducted to comprehensively analyze the deaths of PLWH from 2017 to 2022 in Baise City, China.

A retrospective cohort study was conducted to comprehensively analyze the deaths of PLWH in Baise from 2017 to the first half of 2022. The data was acquired from the AIDS Information System (AIDSIS). The all-cause and AIDS-related mortality rates were calculated for PLWH, along with the proportion of specific death causes. Interrupted time series analysis was utilized to examine changes in all-cause mortality pre- and post-implementation of the new strategy. Kaplan-Meier curves were drawn to compare the mortality risk within 1 year of diagnosis between treated and untreated patients, as well as between late discoverers and non-late discoverers. Related factors of death were also analyzed using the Cox proportional hazards regression model.

During the observation period, among a total of 8,922 PLWH cases, 1,265 people died, resulting in an all-cause mortality rate of 4.19 per 100 person-years. Acquired immune deficiency syndrome -related deaths numbered 438, accounting for 34.62% of the total deaths, with a mortality rate of 1.45 per 100 person-years. There were 730 non-AIDS-related deaths, representing 57.71%, with a mortality rate of 2.42 per 100 person-years. The overall mortality rate from all causes within 1 year after diagnosis was 5.58 per 100 person-years. No significant difference was identified in the all-cause mortality rate between the periods before and after the implementation of the new strategy. Untreated PLWH and late discoverers exhibited a high risk of death within 1 year of diagnosis. Most deaths were caused by common chronic diseases, while AIDS-related mortality was mainly due to opportunistic infections. Factors such as gender, age at diagnosis, occupation, educational background, ethnic group, infection route, history of ART, and baseline CD4 level were associated with the risk of all-cause mortality and AIDS-related mortality.

After the implementation of the “Test and Treat” strategy, no significant difference in mortality among PLWH was recorded in Baise City, China. We recommend that the health department strengthen the testing of PLWH and improve treatment options. Additionally, we suggest encouraging the maintenance of long-term ART treatment and taking measures to prevent and control tuberculosis and common chronic diseases in individuals who are HIV positive.

Today, according to various studies, the gut microbiome is closely linked to various diseases such as cardiovascular disease, metabolic disorders, and neurological disorders like Alzheimer's disease (AD).

The primary purpose of this investigation was to evaluate the quality and quantity of the gut microbiota in a mouse model of AD.

The mice were randomly divided into either an AD group injected with streptozotocin (STZ, 3 mg/kg) or a control group. After 16 - 17 days, the mice were evaluated for their memory capacity and learning, using the Morris water maze (MWM) and passive avoidance response tests. Specific primers were designed to target the 16S rRNA genes of Enterobacter , Clostridium , Lactobacillus , and Bifidobacterium species in the fecal samples of mice by real‐time PCR assay.

The MWM and passive avoidance tests confirmed that STZ caused AD in the mouse model. According to the results of real-time PCR assays, unlike Lactobacillus , Clostridium , and Enterobacter , the population of Bifidobacterium decreased significantly in mice after AD in day 28 (P < 0.05). In other words, mean difference of Bifidobacterium CFU between AD group in day 28 and control group was -5.680 (95% CI: -11.3826 to -0.0174).

Restructuring the gut microbiota using personalized dietary approaches or targeted interventions aimed at beneficial microbiota can potentially modify the composition of microbial communities and their metabolic byproducts, offering novel therapeutic possibilities for AD.

Angiostrongylus cantonensis is a parasitic nematode that typically inhabits the pulmonary arteries of rats but can also reside in the central nervous systems of rats and mollusks. Humans can become infected with A. cantonensis by eating infected hosts or consuming contaminated food, especially if it is raw or undercooked. This infection can lead to various neurological symptoms, including neuropathic pain, which is often an early indication of the condition. In this report, we present a case in which the patient experienced neuropathic pain as the initial clinical manifestation of A. cantonensis infection.

We present a rare case of a 27-year-old female who required intensive care unit (ICU) monitoring due to heavy sedation after receiving high doses of sedative-analgesics for back pain. The patient reported experiencing severe, slow-progressing low back pain radiating to her arms and legs. The pain was described as sharp, tingling, and numbing, severely limiting her movements. To manage the pain, a combination of morphine, intermittent fentanyl, ketamine, dexmedetomidine, duloxetine, and pregabalin was administered. Consequently, the patient had to be intubated due to the effects of the analgesics.During the first two weeks in the ICU, diagnosis proved challenging as the MRI was normal and the initial lumbar puncture revealed only an eosinophilic infection. However, during a follow-up lumbar puncture, multiple parasites were discovered in the cerebrospinal fluid, which were identified as A. cantonensis . The patient remains on a ventilator as the infection has affected the spinal nerve roots, cord, meninges, and brain. We explore the crucial role of ICU care in providing both supportive and definitive treatment for this patient.

This report underscores the critical role of the ICU in providing care for a patient with a progressively deteriorating condition without an initial definitive diagnosis. The ICU's ability to deliver optimal pain relief and sedation, advanced monitoring, and prompt therapy for deteriorating symptoms was of utmost significance. Furthermore, the multidisciplinary team in the ICU was instrumental in managing the continuum of care for the patient.