Pathogenesis and clinical management of arboviral diseases

Arboviral diseases are viral infections transmitted to humans through the bites of arthropods, such as mosquitoes, often causing a variety of pathologies associated with high levels of morbidity and mortality. Over the past decades, these infections have proven to be a significant challenge to health systems worldwide, particularly following the considerable geographic expansion of the dengue virus (DENV) and its most recent outbreak in Latin America as well as the difficult-to-control outbreaks of yellow fever virus (YFV), chikungunya virus (CHIKV), and Zika virus (ZIKV), leaving behind a substantial portion of the population with complications related to these infections. Currently, the world is experiencing a period of intense globalization, which, combined with global warming, directly contributes to wider dissemination of arbovirus vectors across the globe. Consequently, all continents remain on high alert for potential new outbreaks. Thus, this review aims to provide a comprehensive understanding of the pathogenesis of the four main arboviruses today (DENV, ZIKV, YFV, and CHIKV) discussing their viral characteristics, immune responses, and mechanisms of viral evasion, as well as important clinical aspects for patient management. This includes associated symptoms, laboratory tests, treatments, existing or developing vaccines and the main associated complications, thus integrating a broad historical, scientific and clinical approach.

Insights into gastrointestinal manifestation of human immunodeficiency virus: A narrative review

Human immunodeficiency virus (HIV) modifies CD4-positive cells, resulting in immunodeficiency and a wide range of gastrointestinal (GI) manifestations. The burden of HIV-related GI illnesses has significantly evolved with the widespread use of antiretroviral therapy (ART). While ART has effectively reduced the occurrence of opportunistic infections, it has led to an increase in therapy-related GI illnesses. Common esophageal conditions in HIV patients include gastroesophageal reflux disease, idiopathic esophageal ulcers, herpes simplex virus, cytomegalovirus (CMV), and candidal esophagitis. Kaposi's sarcoma, a hallmark of acquired immunodeficiency syndrome, may affect the entire GI system. Gastritis and peptic ulcer disease are also frequently seen in patients with HIV. Diarrhea, often linked to both opportunistic infections and ART, requires careful evaluation. Bloody diarrhea, often a sign of colitis caused by bacterial infections such as Shigella or Clostridium difficile, is prevalent. Small bowel lymphoma, although rare, is increasing in prevalence. Anorectal disorders, including proctitis, fissures, and anal squamous cell carcinoma, are particularly relevant in homosexual men, underlining the importance of timely diagnosis. This review comprehensively explores the epidemiology, pathogenesis, and treatment considerations for the various GI disorders associated with HIV, highlighting the importance of accurate diagnosis and effective treatment to improve outcomes for HIV-infected patients.

Convergence of COVID-19 and recurrent stroke: In-hospital mortality risks explored

This editorial comments on the article by Desai et al, which investigates the impact of coronavirus disease 2019 (COVID-19) on in-hospital mortality among patients with recurrent stroke using data from the 2020 National Inpatient Sample. The findings reveal significantly higher mortality rates in COVID-19-positive patients compared to non-COVID-19 patients, particularly among middle-aged individuals, males, and ethnic minorities. This editorial explores the underlying mechanisms contributing to these outcomes and discusses the clinical implications for targeted management strategies in high-risk groups. The results emphasize the need for comprehensive approaches to mitigate the heightened risks faced by recurrent stroke patients during the COVID-19 pandemic.

Crimean-Congo hemorrhagic fever: Pathogenesis, transmission and public health challenges

The dangerous Crimean-Congo hemorrhagic fever virus (CCHFV), an encapsulated negative-sense RNA virus of the family Nairoviridae, is transmitted from person to person via ticks. With a case fatality rate between 10% to 40%, the most common ways that the disease may spread to humans are via tick bites or coming into touch with infected animals' blood or tissues. Furthermore, the transfer of bodily fluids between individuals is another potential route of infection. There is a wide range of symptoms experienced by patients throughout each stage, from myalgia and fever to extreme bruising and excess bleeding. Tick management measures include minimising the spread of ticks from one species to another and from people to animals via the use of protective clothing, repellents, and proper animal handling. In order to prevent the spread of illness, healthcare workers must adhere to stringent protocols. Despite the lack of an authorised vaccine, the main components of treatment now consist of preventative measures and supportive care, which may include the antiviral medicine ribavirin. We still don't know very much about the virus's mechanisms, even though advances in molecular virology and animal models have improved our understanding of the pathogenesis of CCHFV. A critical need for vaccination that is both safe and effective, as well as for quick diagnosis and efficient treatments to lessen the disease's impact in areas where it is most prevalent. Important steps towards lowering Crimean-Congo hemorrhagic fever mortality and morbidity rates were to anticipatethe future availability of immunoglobulin products.

Dexamethasone in coronavirus disease 2019 care: Dosage and utilization insights

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2. It was declared a global pandemic on March 11, 2020, by the World Health Organization. An excessive inflammatory response is a severe respiratory manifestation of COVID-19, which becomes predominant in later stages. Due to its immunosuppressive and anti-inflammatory properties, dexamethasone is the first systemic glucocorticoid to treat severe COVID-19 patients. This editorial reviews the efficacy and safety of high-dose vs low-dose dexamethasone in patients with COVID-19. Findings indicate that using low-dose dexamethasone is beneficial and emphasize the need for additional research on the use of high-dose dexamethasone. While the study provides a robust evidence base, it is limited by the lack of long-term data, focus on specific outcomes and heterogeneity of the included studies. Future research should focus on the long-term effects of dexamethasone and its impact across varying disease severities and patient populations to refine treatment strategies and improve patient care.

Revisiting dexamethasone dosage in COVID-19 management

The ongoing coronavirus disease 2019 (COVID-19) pandemic has necessitated rapid advancements in therapeutic strategies, with dexamethasone emerging as a key treatment for severe cases. This editorial discusses the systematic review conducted by Sethi et al, published in the World Journal of Virology. The review critically examines the efficacy and safety of varying dosages of dexamethasone in severe COVID-19 patients, providing a comprehensive meta-analysis that underscores the current clinical recommendations favoring a low-dose regimen. Despite these findings, the review highlights the potential benefits of tailored dosages for specific patient subgroups, suggesting a need for personalized treatment approaches. This editorial expands on the implications of these findings, advocating for the integration of evolving clinical data into treatment protocols and calling for further research into patient-specific responses to therapy. It emphasizes the importance of adaptability and precision in pandemic response, urging the medical community to consider both the robustness of existing evidence and the potential for innovative approaches to enhance patient outcomes in the face of global health challenges.

Rhabdomyolysis-related acute kidney injury in COVID-19: A critical concern

Rhabdomyolysis is a severe condition characterized by the breakdown of muscle tissue leading to the release of intracellular components into the bloodstream. This condition, when associated with acute kidney injury (AKI), can result in significant morbidity and mortality, particularly in the context of coronavirus disease 2019 (COVID-19). This editorial discusses a retrospective study on patients with COVID-19 who developed rhabdomyolysis-related AKI. The study highlights that patients with rhabdomyolysis exhibited higher inflammatory markers, such as C-reactive protein, ferritin, and procalcitonin, and experienced worse clinical outcomes compared to those with other causes of AKI. The findings underscore the importance of early recognition and management of rhabdomyolysis in COVID-19 patients to improve prognosis and reduce mortality rates.

Rising incidence of acute hepatitis A among adults and clinical characteristics in a tertiary care center of Pakistan

BACKGROUND

For decades, hepatitis A virus (HAV) has been a leading cause of acute hepatitis among children and was less prevalent among adults. However, recently a paradigm shift has been observed in the epidemiology of HAV, as evident by cases of acute hepatitis due to HAV among adults.

AIM

To estimate frequency of HAV in acute viral hepatitis and compare characteristics in HAV and hepatitis E virus (HEV) infection.

METHODS

This was a trend analysis conducted at Aga Khan University Hospital Karachi (Sindh, Pakistan) from February 2024 to May 2024. Individuals aged 18 years and older diagnosed with acute viral hepatitis attributed to hepatotropic viruses in 2024 were reviewed. To compare the trend patients admitted with acute hepatitis during 2019-2023 were also reviewed. Data regarding clinical and laboratory parameters were recorded. The yearly trend of acute hepatitis due to HAV and HEV was analyzed, and comparative analysis was done between HAV and HEV cases among adults.

RESULTS

A total of 396 patients were found to have acute hepatitis during our study duration. HAV was diagnosed in 234 patients (59%) while 157 patients (39.6%) were found to have acute HEV infection. Additionally, acute hepatitis B virus infection was identified in 3 patients (0.7%), whereas acute hepatitis C virus infection was found in 2 (0.5%) cases of acute hepatitis. Yearly trends showed increasing occurrence of HAV infection among adults over last 5 years. The patients with acute HAV were younger than patients with HEV (28 years ± 8 years vs 30 years ± 8 years; P < 0.01). Higher levels of total bilirubin were seen in HEV infection, while higher levels of alanine transaminase were seen in HAV infection. However, a higher proportion of acute liver failure (ALF), coagulopathy, and mortality were observed in HEV.

CONCLUSION

An increase in acute hepatitis A cases among adults shows less severity than hepatitis E, highlighting the need for better sanitation, hygiene, and adult hepatitis A vaccination programs.

Unveiling the impact: COVID-19's influence on bacterial resistance in the Kingdom of Bahrain

BACKGROUND

Antibiotic resistance is a growing global health threat, and understanding local trends in bacterial isolates and their susceptibility patterns is crucial for effective infection control and antimicrobial stewardship. The coronavirus disease 2019 (COVID-19) pandemic has introduced additional complexities, potentially influencing these patterns.

AIM

To analyze trends in bacterial isolates and their antibiotic susceptibility patterns at Salmaniya Medical Complex from 2018 to 2023, with a specific focus on the impact of the COVID-19 pandemic on these trends.

METHODS

A retrospective analysis of microbiological data was conducted, covering the period from 2018 to 2023. The study included key bacterial pathogens such as Escherichia coli (E. coli), Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Staphylococcus aureus, among others. The antibiotic susceptibility profiles of these isolates were assessed using standard laboratory methods. To contextualize the findings, the findings were compared with similar studies from other regions, including China, India, Romania, Saudi Arabia, the United Arab Emirates, Malaysia, and United States.

RESULTS

The study revealed fluctuating trends in the prevalence of bacterial isolates, with notable changes during the COVID-19 pandemic. For example, a significant increase in the prevalence of Staphylococcus aureus was observed during the pandemic years, while the prevalence of E. coli showed a more variable pattern. Antibiotic resistance rates varied among the different pathogens, with a concerning rise in resistance to commonly used antibiotics, particularly among Klebsiella pneumoniae and E. coli. Additionally, the study identified an alarming increase in the prevalence of multidrug-resistant (MDR) strains, especially within Klebsiella pneumoniae and E. coli isolates. The impact of the COVID-19 pandemic on these trends was evident, with shifts in the frequency, resistance patterns, and the emergence of MDR bacteria among several key pathogens.

CONCLUSION

This study highlights the dynamic nature of bacterial isolates and their antibiotic susceptibility patterns at Salmaniya Medical Complex, particularly in the context of the COVID-19 pandemic. The findings underscore the need for continuous monitoring and effective anti-microbial stewardship programs to combat the evolving threat of antibiotic resistance. Further research and policy initiatives are required to address the identified challenges and improve patient outcomes in the face of these ongoing challenges.

Serological surveillance for SARS-CoV-2 antibodies among students, faculty and staff within a large university system during the pandemic

BACKGROUND

At the end of December 2019, the world faced severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), which led to the outbreak of coronavirus disease 2019 (COVID-19), associated with respiratory issues. This virus has shown significant challenges, especially for senior citizens, patients with other underlying illnesses, or those with a sedentary lifestyle. Serological tests conducted early on have helped identify how the virus is transmitted and how to curb its spread. The study hypothesis was that the rapid serological test for SARS-CoV-2 antibodies could indicate the immunoreactive profile during the COVID-19 pandemic in a university population.

AIM

To conduct active surveillance for serological expression of anti-SARS-CoV-2 antibodies in individuals within a university setting during the COVID-19 pandemic.

METHODS

This sectional study by convenience sampling was conducted in a large university in Niteroi-RJ, Brazil, from March 2021 to July 2021. The study population consisted of students, faculty, and administrative staff employed by the university. A total of 3433 faculty members, 60703 students, and 3812 administrative staff were invited to participate. Data were gathered through rapid serological tests to detect immunoglobulin (Ig) M and IgG against SARS-CoV-2. The χ² or Fisher's exact test was used to conduct statistical analysis. A 0.20 significance level was adopted for variable selection in a multiple logistic regression model to evaluate associations.

RESULTS

A total of 1648 individuals were enrolled in the study. The proportion of COVID-19 positivity was 164/1648 (9.8%). The adjusted logistic model indicate a positive association between the expression of IgM or IgG and age [odds ratio (OR) = 1.16, 95%CI: 1.02-1.31] (P < 0.0024), individuals who had been in contact with a COVID-19-positive case (OR = 3.49, 95%CI: 2.34-5.37) (P < 0.001), those who had received the COVID-19 vaccine (OR = 2.33, 95%CI: 1.61-3.35) (P < 0.001) and social isolation (OR = 0.59, 95%CI: 0.41-0.84) (P < 0.004). The likelihood of showing a positive result increased by 16% with every ten-year increment. Conversely, adherence to social distancing measures decreased the likelihood by 41%.

CONCLUSION

These findings evidenced that the population became more exposed to the virus as individuals discontinued social distancing practices, thereby increasing the risk of infection for themselves.

Prevalence of transfusion transmissible infections among various donor groups: A comparative analysis

BACKGROUND

Transfusion transmissible infections (TTIs) are illnesses spread through contaminated blood or blood products. In India, screening for TTIs such as hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV)-I/II, malaria, and syphilis is mandatory before blood transfusions. Worldwide, HCV, HBV, and HIV are the leading viruses causing mortality, affecting millions of people globally, including those with co-infections of HIV/HCV and HIV/HBV. Studies highlight the impact of TTIs on life expectancy and health risks, such as liver cirrhosis, cancer, and other diseases in individuals with chronic HBV. Globally, millions of blood donations take place annually, emphasizing the importance of maintaining blood safety.

AIM

To study the prevalence of TTIs, viz., HBV, HCV, HIV I/II, syphilis, and malaria parasite (MP), among different blood donor groups.

METHODS

The study assessed the prevalence of TTIs among different blood donor groups in Delhi, India. Groups included total donors, in-house donors, total camp donors, institutional camp donors, and community camp donors. Tests for HIV, HBV, and HCV were done using enzyme-linked immunosorbent assay, while syphilis was tested with rapid plasma reagins and MP rapid card methods. The prevalence of HBV, HCV, HIV, and syphilis, expressed as percentages. Differences in infection rates between the groups were analyzed using χ² tests and P-values (less than 0.05).

RESULTS

The study evaluated TTIs among 42158 blood donors in Delhi. The overall cumulative frequency of TTIs in total blood donors was 2.071%, and the frequencies of HBV, HCV, HIV-I/II, venereal disease research laboratory, and MP were 1.048%, 0.425%, 0.221%, 0.377%, and 0.0024%, respectively. In-house donors, representing 37656 donors, had the highest transfusion transmissible infection (TTI) prevalence at 2.167%. Among total camp donors (4502 donors), TTIs were identified in 1.266% of donors, while community camp donors (2439 donors) exhibited a prevalence of 1.558%. Institutional camp donors (2063 donors) had the lowest TTI prevalence at 0.921%. Statistical analysis revealed significant differences in overall TTI prevalence, with total and in-house donors exhibiting higher rates compared to camp donors.

CONCLUSION

Ongoing monitoring and effective screening programs are essential for minimizing TTIs. Customizing blood safety measures for different donor groups and studying socio-economic-health factors is essential to improving blood safety.

Septic shock due to cytomegalovirus colitis associated with rituximab use: A case report

BACKGROUND

Cytomegalovirus (CMV) infections can cause significant morbidity and mortality in immunocompromised individuals. CMV targets dysfunctional lymphocytes. Chronic rituximab (RTX) therapy can cause B-lymphocyte dysfunction, increasing CMV risk. Rarely, CMV infections present with critical illness such as septic shock.

CASE SUMMARY

A 64-year-old African American woman presented with generalized weakness and non-bloody watery diarrhea of 4-6 weeks duration. She did not have nausea, vomiting or, abdominal pain. She had been on monthly RTX infusions for neuromyelitis optica. She was admitted for septic shock due to pancolitis. Blood investigations suggested pancytopenia and serology detected significantly elevated CMV DNA. Valganciclovir treatment led to disease resolution.

CONCLUSION

This case illustrates an extremely rare case of CMV colitis associated with RTX use presenting with septic shock. High suspicion for rare opportunistic infections is imperative in individuals with long-term RTX use.

COVID-19 in pregnancy: Perinatal outcomes and complications

BACKGROUND

The risk of severe coronavirus disease 2019 (COVID-19) in pregnant women is elevated.

AIM

To examine the outcomes of pregnant women with COVID-19 and report perinatal outcomes and complications, while providing a brief review of current literature.

METHODS

The study included pregnant women presenting from April 2020 to February 2022 to the emergency department (ED) of a tertiary hospital. We retrospectively recorded the maternal and perinatal files, including patient epidemiological and clinical characteristics, laboratory values, outcomes, treatment modalities and associations were explored.

RESULTS

Among the 60 pregnant women, 25% required hospitalization, all of whom were symptomatic. Preterm delivery occurred in 30% of cases. Ten percent of neonates required admission to the neonatal intensive care unit, and 5% were classified as small for their gestational age. All mothers survived COVID-19 and pregnancy, with 6.6% requiring invasive mechanical ventilation. Preterm delivery rates did not differ between hospitalized and non-hospitalized pregnant women; composite unfavorable perinatal outcomes, including stillbirth, small for gestational age, or neonatal intensive care unit (ICU) admission, did not significantly increase in the cases hospitalized for COVID-19 (P = 0.09). The odds of hospitalization increased 2.3-fold for each day of delayed ED presentation [adj. OR (95%CI: 1.46-3.624), P < 0.001]. Comorbidity status was an independent predictor of hospitalization, albeit with marginal significance [adj. OR = 16.13 (95%CI: 1.021-255.146), P = 0.048]. No independent predictors of adverse fetal outcome (composite) were identified, and eventual hospitalization failed to reach statistical significance by a slight margin (P = 0.054).

CONCLUSION

Delayed ED presentation and comorbidities increase hospitalization odds. This study highlights the importance of continuous and specific guidance for managing pregnant COVID-19 patients, including timely and appropriate interventions to minimize maternal and perinatal morbidity and mortality.

Climate-driven dengue fever outbreaks in Nepal: Trends, challenges, and strategies

Dengue fever (DF) has become a major public health concern in Nepal, with increasing outbreaks in recent years. Transmitted by Aedes mosquitoes, this climate-sensitive viral disease presents a significant challenge for healthcare providers and policymakers. Since 2004, Nepal has experienced a sharp increase in DF cases, peaking in 2022 with 54784 cases and 88 deaths. The surge, driven mainly by serotypes 1, 2, and 3, is exacerbated by climate change, which prolongs mosquito breeding seasons due to warmer temperatures and increased rainfall. This trend has even impacted previously unaffected hilly regions. Effective dengue control strategies must focus on climate change adaptation, strengthening healthcare system reinforcement, raising public awareness, and enhancing vector control measures. Government initiatives, like the national dengue control program, play a critical role, but research and community engagement are also vital for prevention and early detection. Integrating climate resilience into public health efforts is essential to reducing the dengue burden in Nepal.

Viral-host molecular interactions and metabolic modulation: Strategies to inhibit flaviviruses pathogenesis

Flaviviruses, which include globally impactful pathogens, such as West Nile virus, yellow fever virus, Zika virus, Japanese encephalitis virus, and dengue virus, contribute significantly to human infections. Despite the ongoing emergence and resurgence of flavivirus-mediated pathogenesis, the absence of specific therapeutic options remains a challenge in the prevention and treatment of flaviviral infections. Through the intricate processes of fusion, transcription, replication, and maturation, the complex interplay of viral and host metabolic interactions affects pathophysiology. Crucial interactions involve metabolic molecules, such as amino acids, glucose, fatty acids, and nucleotides, each playing a pivotal role in the replication and maturation of flaviviruses. These viral-host metabolic molecular interactions hijack and modulate the molecular mechanisms of host metabolism. A comprehensive understanding of these intricate metabolic pathways offers valuable insights, potentially unveiling novel targets for therapeutic interventions against flaviviral pathogenesis. This review emphasizes promising avenues for the development of therapeutic agents that target specific metabolic molecules, such as amino acids, glucose, fatty acids, and nucleotides, which interact with flavivirus replication and are closely linked to the modulation of host metabolism. The clinical limitations of current drugs have prompted the development of new inhibitory strategies for flaviviruses based on an understanding of the molecular interactions between the virus and the host.

Understanding rhabdomyolysis induced acute kidney injury in patients with COVID-19

This work comments on an article published in the recent issue of the World Journal of Virology. Rhabdomyolysis is a complex condition with symptoms such as myalgia, changes to urination, and weakness. With the potential for substantial kidney impairment, it has also been shown to be a severe complication of coronavirus disease 2019 (COVID-19). To date, various theoretical explanations exist for the development of rhabdomyolysis induced acute kidney injury (RIAKI) in COVID-19 infection, including the accumulation of released striated muscle myoglobin in the urine (myoglobinuria). In their article, they (2024) demonstrate in a retrospective study that RIAKI in COVID-19 patients tended to have elevated levels of C-reactive protein, ferritin, and procalcitonin. These patients also had poorer overall prognoses when compared to COVID-19 patients who have acute kidney injury (AKI) due to other causes. It is clear from these findings that clinicians must closely monitor and assess for the presence of rhabdomyolysis in COVID-19 patients who have developed AKIs. Moreover, additional research is required to further understand the mechanisms behind the development of RIAKI in COVID-19 patients in order to better inform treatment guidelines and protocols.

Candidemia chronicles: Retrospective analysis of candidemia epidemiology, species distribution, and antifungal susceptibility patterns in Bahrain

BACKGROUND

Invasive fungal infections, particularly candidemia, pose significant clinical challenges globally. Understanding local epidemiology, species distribution, and antifungal susceptibility patterns is crucial for effective management despite regional variations.

AIM

To investigate the epidemiology, species distribution, antifungal susceptibility patterns, and associated risk factors of candidemia among patients in Bahrain from 2021 to 2023.

METHODS

This retrospective study analyzed demographic data, Candida species distribution, antifungal susceptibility profiles, and risk factors among candidemia patients treated at a tertiary care hospital in Bahrain over three years. Data was collected from medical records and analyzed using descriptive statistics.

RESULTS

A total of 430 candidemia cases were identified. The mean age of patients was 65.7 years, with a mortality rate of 85.5%. Candida albicans (C. albicans) was the most common species, followed by Candida parapsilosis, Candida tropicalis (C. tropicalis), and emerging multidrug-resistant Candida auris (C. auris). Antifungal susceptibility varied across species, with declining susceptibility to azoles observed, particularly among C. albicans and C. tropicalis. Major risk factors included central venous catheters, broad-spectrum antibiotics, and surgical procedures.

CONCLUSION

This study highlights the substantial burden of candidemia among older adults in Bahrain, characterized by diverse Candida species. It also concerns levels of antifungal resistance, notably in C. auris. The findings underscore the importance of local epidemiological surveillance and tailored treatment strategies to improve outcomes and mitigate the spread of multidrug-resistant Candida species. Future research should focus on molecular resistance mechanisms and optimizing therapeutic approaches to address this growing public health concern.

Climate change and the emergence and exacerbation of infectious diseases: A review

Experts expressed severe concerns over the possibility of increasing burden of infectious diseases as the planet's climate began to change years ago. There have been increased rates of climate-related catastrophes and as global temperatures rise, emergence of certain viruses has become a serious concern. Vectors are susceptible to changing temperatures as they exhibit innate responses to thermal stress to increase survivability. Climate change impacts virus reservoirs, increasing transmission rates of vectors. Vector-borne diseases have already witnessed increasing numbers compared to before. Certain non-endemic areas are encountering their first-ever infectious disease cases due to increasing temperatures. Tick-borne diseases are undergoing transformations provoking a heightened prevalence. Food-borne illnesses are expected to increase owing to warmer temperatures. It is important to recognize that climate change has a multivariable impact on the transmission of viruses. With climate change comes the potential of increasing interspecies interactions promoting jumps. These factors must be considered, and an informed strategy must be formulated. Adaptation and mitigation strategies are required to curb these diseases from spreading. Despite significant evidence that climate change affects infectious diseases, gaps in research exist. We conducted this review to identify the potential role climate change plays in the emergence of new viruses.

Impact of vitamin D on COVID-19 and other viral diseases

This editorial aims to elucidate the intricate relationship between vitamin D and viral pathogenesis. It explores the anticipated role of vitamin D as a modulator in the immune response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other viral pathogens. The editorial comments are based on the review article by Engin et al. The potential role of vitamin D in modulating immune responses has been highlighted by several studies, suggesting that it may influence both the risk and severity of infections. Vitamin D receptors are present in immunocompetent cells, which indicates that vitamin D can potentially modulate innate and adaptive immune responses. This context is relevant in the pathophysiology of coronavirus disease 2019 (COVID-19), where the immune response to the virus can significantly impact the disease progression and outcome. The immunomodulatory effects of vitamin D can protect against SARS-CoV-2 infection by enhancing innate and adaptive immune responses. It also maintains the integrity of the body's physical barriers and modulates inflammatory responses, thereby preventing entry and replication of the virus. Many studies have suggested that adequate vitamin D levels help alleviate morbidity and mortality associated with COVID-19. Furthermore, vitamin D supplementation has been linked with a lower risk of severe disease and mortality in COVID-19 patients, particularly in those with a deficiency during seasons with less sunlight exposure.

Insights from respiratory virus co-infections

Respiratory viral co-infections present significant challenges in clinical settings due to their impact on disease severity and patient outcomes. Current diagnostic methods often miss these co-infections, complicating the epidemiology and management of these cases. Research, primarily conducted in vitro and in vivo, suggests that co-infections can lead to more severe illnesses, increased hospitalization rates, and greater healthcare utilization, especially in high-risk groups such as children, the elderly, and immunocompromised individuals. Common co-infection patterns, risk factors, and their impact on disease dynamics highlight the need for advanced diagnostic techniques and tailored therapeutic strategies. Understanding the virological interactions and immune response modulation during co-infections is crucial for developing effective public health interventions and improving patient outcomes. Future research should focus on the molecular mechanisms of co-infection and the development of specific therapies to mitigate the adverse effects of these complex infections.

Acceptance of COVID-19 vaccine and its related determinants in Nigeria: An online survey

BACKGROUND

Vaccine hesitancy is a major challenge in the fight against the coronavirus disease 2019 (COVID-19) pandemic. Identifying the sociodemographic factors associated with vaccine acceptance among Nigerians is crucial for improving vaccine uptake.

AIM

To assess the acceptance rate of COVID-19 vaccine and its related determinants among Nigerians.

METHODS

An online cross-sectional survey (observational study) was conducted between February 2021 and May 2021, using a questionnaire hosted on SurveyMonkey. The invitation to take part in the poll was sent out to participants through social networking platforms. A logistic regression was used to determine which sociodemographic factors were associated with vaccine acceptance constructs.

RESULTS

A total of 1800 persons responded to the survey, a larger proportion of whom were males (53.9%) and within the age group of 21-30 years (29.4%) and earned an average income of less than $500 per month (43.3%). Only 0.56% of participants had a high perceived risk of COVID-19 infection, while only 1.11% had a perceived risk of dying from COVID-19. The perception rate of the COVID-19 vaccine among participants was 51.1%, while the acceptance rate was 63.9%. There was no significant association between the COVID-19 vaccine acceptance rate and related determinants assessed, particularly age (χ² = 3.049, P = 0.550), sex (χ² = 0.102, P = 0.749), average income (χ² = 3.802, P = 0.875), and religion (χ² = 2.819, P = 0.420). Participants with chronic conditions demonstrated a higher acceptance rate compared to the general population.

CONCLUSION

Despite the positive perception observed and substantial vaccine acceptance rate among the study participants, more public health interventions are still needed to enhance vaccine acceptability in Nigeria.

Role of viruses in periodontitis: An extensive review of herpesviruses, human immunodeficiency virus, coronavirus-19, papillomavirus and hepatitis viruses

Periodontitis is the inflammation of the supporting structures around the dentition. Several microbial agents, mostly bacteria, have been identified as causative factors for periodontal disease. On the other hand, oral cavity is a rich reservoir for viruses since it contains a wide variety of cell types that can be targeted by viruses. Traditionally, the focus of research about the oral flora has been on bacteria because the most widespread oral diseases, like periodontitis and dental caries, are outcomes of bacterial infection. However, recently and especially after the emergence of coronavirus disease 2019, there is a growing tendency toward including viruses also into the scope of oral microbiome investigations. The global high prevalence of periodontitis and viral infections may point out to a concomitant or synergistic effect between the two. Although the exact nature of the mechanism still is not clearly understood, this could be speculated through the manipulation of the immune system by viruses; hence facilitating the furthermore colonization of the oral tissues by bacteria. This review provides an extensive and detailed update on the role of the most common viruses including herpes family (herpes simplex, varicella-zoster, Epstein-Barr, cytomegalovirus), Human papillomaviruses, Human immunodeficiency virus and severe acute respiratory syndrome coronavirus 2 in the initiation, progression and prognosis of periodontitis.

Review of Albanian studies suggests the need for further efforts to counteract significant hepatitis B virus prevalence

BACKGROUND

Hepatitis B virus (HBV) is categorized as one of the smallest enveloped DNA viruses and is the prototypical virus of the Hepatoviridae family. It is usually transmitted through body fluids such as blood, semen, and vaginal secretions. The majority (more than 95%) of immunocompetent adults infected with HBV spontaneously clear the infection. In the context of the high prevalence of HBV infection in Albania, the research gap is characterized by the lack of studies aimed at advancing the current understanding and improving the prevailing situation. The main objective of this study was to address the low rate of HBV diagnosis and the lack of a comprehensive national program to facilitate widespread diagnosis.

AIM

To analyze the prevalence of HBV infection in Albania and elucidate the persistently high prevalence despite efforts and measures implemented.

METHODS

Using a systematic literature review, we collected existing research on the epidemiology of HBV in Albania from PubMed, Cochrane Library, Google Scholar, and Albanian Medical Journals, focusing on studies published after the 1980s and conducted solely in the Albanian population.

RESULTS

The findings reveal a dynamic shift in HBV prevalence in Albania over several decades. Initially high, the prevalence gradually declined following the implementation of screening and vaccination programs. However, the prevalence rates have remained notably high, exceeding 8% in recent years. Contributing factors include vertical transmission, inadequate healthcare infrastructure, and challenges in screening and diagnosis. Studies among Albanian refugees in neighboring countries also reported high prevalence rates, emphasizing the need for transnational interventions. Despite advancements in screening, vaccination, and healthcare infrastructure, Albania continues to face a substantial burden of HBV infection.

CONCLUSION

The persistence of high prevalence underscores the complexity of the issue, requiring ongoing efforts to ensure a comprehensive understanding and effective mitigation. Addressing gaps in vaccination coverage, improving access to screening and diagnosis, and enhancing public awareness are crucial steps toward reducing HBV prevalence in Albania.

Diagnosis of West Nile virus infections: Evaluation of different laboratory methods

BACKGROUND

The diagnosis of West Nile virus (WNV) is challenging due to short-term and low-level viremia, flavivirus cross-reactivity, and long immunoglobulin M (IgM) persistence.

AIM

To evaluate different methods for WNV detection [reverse transcription-polymerase chain reaction (RT-PCR), IgM/IgG antibodies, IgG avidity] in serum, cerebrospinal fluid (CSF), and urine samples of patients with confirmed WNV infection.

METHODS

The study included patients with confirmed WNV neuroinvasive infection (n = 62), asymptomatic WNV seropositive individuals (n = 22), and individuals with false-positive WNV IgM antibodies (n = 30). WNV RNA was detected using RT-PCR. A commercial ELISA was used to detect WNV IgM/IgG antibodies with confirmation of cross-reactive samples using a virus neutralization test (VNT). IgG-positive samples were tested for IgG avidity.

RESULTS

The WNV-RNA detection rates were significantly higher in the urine (54.5%)/serum (46.4%) than in CSF (32.2%). According to the sampling time, the WNV-RNA detection rates in urine collected within 7 days/8-14/≥ 15 days were 29.4/66.6/62.5% (P = 0.042). However, these differences were not observed in the CSF. The median RT-PCR cycle threshold values were significantly lower in urine (32.5, IQR = 28-34) than in CSF (34.5, IQR = 33-36). The frequency of positive WNV IgM and IgG significantly differed according to the sampling time in serum but not in CSF. Positive IgM/IgG antibodies were detected in 84.3/9.3% of serum samples collected within 7 days, 100/71.1% of samples collected 8-14, and 100% samples collected after ≥ 15 days. Recent WNV infection was confirmed by low/borderline avidity index (AI) in 13.6% of asymptomatic individuals. A correlation between ELISA and AI was strong negative for IgM and strong positive for IgG. No significant correlation between ELISA IgG and VNT was found.

CONCLUSION

The frequency of WNV RNA and antibody detection depends on the sampling time and type of clinical samples. IgG avidity could differentiate recent WNV infections from long-persisting IgM antibodies.

Possible viral agents to consider in the differential diagnosis of blepharoconjunctivitis

BACKGROUND

Blepharoconjunctivitis poses a diagnostic challenge due to its diverse etiology, including viral infections. Blepharoconjunctivits can be acute or chronic, self-limiting, or needing medical therapy.

AIM

To review possible viral agents crucial for accurate differential diagnosis in cases of blepharoconjunctivitis.

METHODS

The PubMed database was searched for records relating to viral blepharoconjunctivitis. The search string generated was "("virally"[All Fields] OR "virals"[All Fields] OR "virology"[MeSH Terms] OR "virology"[All Fields] OR "viral"[All Fields]) AND "Blepharoconjunctivitis"[All Fields]".

RESULTS

A total of 24 publications were generated from the search string. Reference lists from each relevant article were also searched for more information and included in this review. Viral etiologies such as adenovirus, herpes simplex virus (HSV), varicella-zoster virus (VZV), and Epstein-Barr virus (EBV) are frequently implicated. Adenoviral infections manifest with follicular conjunctivitis and preauricular lymphadenopathy, often presenting as epidemic keratoconjunctivitis. HSV and VZV infections can result in herpetic keratitis and may exhibit characteristic dendritic corneal ulcers. EBV, although less common, can cause unilateral or bilateral follicular conjunctivitis, particularly in immunocompromised individuals. Other potential viral agents, such as enteroviruses and molluscum contagiosum virus, should also be considered, especially in pediatric cases.

CONCLUSION

Prompt recognition of these viral etiologies is essential for appropriate management and prevention of complications. Thus, a thorough understanding of the clinical presentation, epidemiology, and diagnostic modalities is crucial for accurate identification and management of viral blepharoconjunctivitis.