Dilute Povidone-Iodine Irrigation: The Science of Molecular Iodine (I2) Kinetics and Its Antimicrobial Activity

Dilute povidone-iodine (polyvinylpyrrolidone iodine [PVP-I]) irrigation in spine surgery and total joint arthroplasty has seen a rapid and substantial increase in its use during the past decade. Yet, most surgeons do not know the chemistry and biochemistry that explain its efficacy in preventing infections. PVP-I forms a complex with molecular iodine (I2), facilitating the delivery of I2 to the membrane of the infectious organism. Here, PVP-I establishes an equilibrium between complexed and noncomplexed (free) I2 in the aqueous solution. The I2 acts at numerous cellular targets of infecting organisms augmenting its role as a biocidal molecule. The paradoxical increase in the concentration of I2 that occurs with dilution of PVP-I is a result of equilibrium kinetics and is associated with an enhanced antimicrobial activity. Cytotoxicity studies have yielded conflicting results, but most endorse diluted concentrations as being less damaging to tissues. Clinical studies have verified notable reductions in surgical site infections with a 3-minute soak of 0.35% dilute povidone-iodine irrigation. Guidelines from the World Health Organization, Centers for Disease Control and Prevention, and International Consensus Meeting on Musculoskeletal Infection support the use of prophylactic incisional wound irrigation with aqueous PVP-I to reduce and prevent surgical site infections.

Foresight 2035: a perspective on the next decade of research on the management of Legionella spp. in engineered aquatic environments

The disease burden from Legionella spp. infections has been increasing in many industrialized countries and, despite decades of scientific advances, ranks amongst the highest for waterborne diseases. We review here several key research areas from a multidisciplinary perspective and list critical research needs to address some of the challenges of Legionella spp. management in engineered environments. These include: (i) a consideration of Legionella species diversity and cooccurrence, beyond Legionella pneumophila only; (ii) an assessment of their environmental prevalence and clinical relevance, and how that may affect legislation, management, and intervention prioritization; (iii) a consideration of Legionella spp. sources, their definition and prioritization; (iv) the factors affecting Legionnaires' disease seasonality, how they link to sources, Legionella spp. proliferation and ecology, and how these may be affected by climate change; (v) the challenge of saving energy in buildings while controlling Legionella spp. with high water temperatures and chemical disinfection; and (vi) the ecological interactions of Legionella spp. with other microbes, and their potential as a biological control strategy. Ultimately, we call for increased interdisciplinary collaboration between multiple research domains, as well as transdisciplinary engagement and collaboration across government, industry, and science as the way toward controlling and reducing Legionella-derived infections.

Monitoring cellular dynamics upon infection using a holotomography-based approach

Many intracellular bacteria interfere with mitochondrial dynamics or target other organelles, thereby inducing a specific cellular response that could emerge as a strategy of the pathogen to ensure its survival, or as a form of defense employed by the host cell to restrict dissemination. In this context, the concomitant monitoring of both pathogen migration and (intra)cellular dynamics in live cells emerges as a pivotal aspect for the comprehension of the infection sequence and to visualize the pathogen-mediated remodeling that could occur to the entire cellular system. Holotomographic microscopy can be used to achieve this goal, allowing the simultaneous analysis of both bacterial movement and intracellular alteration for extended periods of time, with high spatial resolution and avoiding side-effects due to phototoxicity. Here we provide a holotomography-based approach to detect Listeria monocytogenes dynamics and its effects on the entire cellular system at morphological level.

Disseminated enterovirus infection treated with intravenous immunoglobulin in a patient on maintenance ocrelizumab for multiple sclerosis

We present a case of a woman in her 40s with disseminated enterovirus infection in the setting of maintenance therapy with ocrelizumab for relapsing-remitting multiple sclerosis. The patient originally presented with fever, bilateral lower limb swelling and hypoalbuminaemia. She subsequently developed a productive cough and diarrhoea, and a viral respiratory multiplex panel detected rhino/enterovirus. Despite supportive care, the patient continued to deteriorate with persistent high-grade fevers and progressive derangement of her liver biochemistry. Repeat viral respiratory multiplex testing failed to detect rhino/enterovirus and, therefore, she was investigated for a fever of unknown origin. However, initial extensive special investigations identified no alternate infective, inflammatory or malignant cause. On further testing, enterovirus RNA was detected by specific monoplex nucleic acid amplification test (NAAT) in whole blood, stool and from a targeted enterovirus nasopharyngeal swab. The patient was eventually treated with intravenous immunoglobulin, which led to marked clinical and biochemical improvement.

Molecular characterization of enteroviruses circulating among pigs and goats in two Central African countries, Cameroon and the Central African Republic

To date, data on animal enteroviruses (EVs) are scarce, especially in Central Africa. The aim of this study was to characterize EVs among pigs and goats in Cameroon and the Central African Republic (CAR). A total of 226 pig and goat faecal samples collected in two previous studies carried out in Cameroon and CAR were pooled and screened with molecular assays targeting EV-Es, EV-Fs and EV-Gs. EV genomes were amplified by RT-PCR and their sequences were obtained by Illumina sequencing and de novo assembly. Based on the capsid sequences, 27 EV-G sequences were identified and assigned to 11 virus types, while no EV-E or EV-F was observed. Phylogenetic analysis revealed that the EV-Gs detected in Central Africa do not form specific clusters compared to EV-Gs previously reported in other continents. This suggests a worldwide circulation of EV-Gs, which is likely due to the massive international trade of live animals. One human EV, EV-C99, which belongs to the species Enterovirus C, was detected in pigs. This is the third detection of such an event in a similar context, reinforcing the hypothesis that some EV-Cs could be infecting pigs. Our work provides new data on the genetic diversity of EVs circulating among domestic animals in Central Africa.

Experience and Perspectives on Antibacterial Therapy for Listeriosis in a Tertiary Teaching Hospital in China: A Retrospective Study and Health Care Provider Survey

Listeriosis is a rare, life-threatening bacterial infection. Prompt, appropriate antibiotic treatment is essential to save lives. We aimed to investigate antibiotic selection and listeriosis knowledge among health care providers. We first performed a retrospective study on patients with listeriosis who were treated in a hospital in China from January 2013 to March 2023. Patient characteristics and antibiotic selections were recorded. Antibiotics were classified as effective or ineffective based on the efficacy classifications listed in The Sanford Guide to Antimicrobial Therapy (50th edition). We then conducted a questionnaire survey of health care providers to investigate their listeriosis knowledge and practices between April 2023 to May 2023. Fifteen listeriosis patients were identified, with a case fatality rate of 26.7% (4/15). Empirical treatments assessed as effective antibiotics or ineffective antibiotics were given to 33.3% (5/15) and 66.7% (10/15) of the patients, respectively. After Listeria monocytogenes was identified, 40% (6/15) of the patients received an adjustment to their antibiotics, although 50% (3/6) patients still received ineffective antibiotics. The questionnaire survey of 77 participating health care providers showed that 32.9% (24/73) of the clinicians were unaware of the appropriate antibiotics for listeriosis. Most participants (83.1%, 64/77) would read the drug sensitivity report before selecting the antibiotics. The selection of effective antibiotics differed between the infectious diseases department and other departments (p < 0.001), but did not differ between junior title and other titles (p = 0.088). Most patients with listeriosis did not receive appropriate antibiotics, which might have accounted for the high fatality rate, and may have resulted from inadequate listeriosis knowledge. More education and correct reporting of drug sensitivity results are urgently needed.

Hyperactivity and Pro-inflammatory Functions of Platelets in Diabetes

Cardiovascular complications claim the lives of up to 70% of patients with diabetes mellitus (DM). The mechanisms increasing cardiovascular risk in DM remain to be fully understood and successfully addressed. Nonetheless, there is increasing evidence in the scientific literature of the participation of platelets in the cardiovascular complications of DM. Multiple reports describe the hyperactivity of platelets in DM and their participation in inflammatory responses. The understanding of the mechanisms underlying the contribution of platelets to cardiovascular pathologies in DM will help the development of targeted therapeutic strategies able to reduce cardiovascular risk in these patients. In this literature review, we summarise our current understanding of the molecular mechanisms leading to the contribution of platelets to cardiovascular risk in DM. Both platelet haemostatic activity leading to thrombus formation and their participation to inflammatory processes are stimulated by the biochemical conditions associated with DM. We also present evidence on how DM affect the efficacy of existing therapeutic treatments for thrombosis and, by converse, how antidiabetic drugs may affect platelet function and the haemostasis/thrombosis balance. Taken together, the growing evidence of the different and unexpected roles of platelets in the progression of DM provides a strong rationale for the design of cardiovascular drugs targeting specifically platelets, their pro-inflammatory activity and their activation mechanisms in this disease. Overall, this article provides an important up-to-date overview of the pathophysiological alterations of platelets in DM, which need to be taken into account for the effective management of cardiovascular health in this disease.

Comparison of the STANDARD M10 C. difficile, Xpert C. difficile, and BD MAX Cdiff assays as confirmatory tests in a two-step algorithm for diagnosing Clostridioides difficile infection

Current guidelines recommend a two-step algorithm rather than relying solely on a single test for diagnosing Clostridioides difficile infection. This algorithm starts with enzyme immunoassay (EIA) for detecting glutamate dehydrogenase (GDH) and toxins A/B, followed by nucleic acid amplification test (NAAT) for GDH-positive but toxin-negative cases. This study compared the performance of three commercial NAATs: the STANDARD M10 C. difficile, Xpert C. difficile, and BD MAX Cdiff assays, utilized as confirmatory testing of the two-step algorithm. Two hundred archived stool specimens, previously tested GDH-positive but toxin-negative by EIA, were analyzed in parallel with these NAATs and toxigenic culture, which served as the reference standard. Sensitivity, specificity, positive predictive value, and negative predictive value were 89.1%, 92.6%, 94.6%, and 85.2%, respectively, for the M10 assay; 95.8%, 86.4%, 91.2%, and 93.3%, respectively, for the Xpert assay; and 89.8%, 91.4%, 93.8%, and 86.0%, respectively, for the BD MAX assay. The rates of invalid results were 1.0%, 0.5%, and 1.0% for the M10, Xpert, and BD MAX assays, respectively. In conclusion, the M10 assay is a reliable diagnostic tool, performing comparably to the Xpert and BD MAX assays when used as confirmatory testing in the two-step algorithm.IMPORTANCEWhile numerous studies have assessed nucleic acid amplification tests (NAATs) as stand-alone tests for diagnosing Clostridioides difficile infection, limited research has compared their performance as confirmatory tests in a two-step algorithm. This study evaluated the performance of three commercial NAATs (M10, Xpert, and BD MAX assays) using 200 archived stool specimens initially tested as glutamate dehydrogenase (GDH)-positive but toxin-negative by GDH/toxin A/B enzyme immunoassay, the first step in the two-step algorithm. All three assays demonstrated high sensitivity (89.1% to 95.8%) and specificity (86.4% to 92.6%), with low rates of invalid results (≤1%). Our findings suggest that the M10 assay performs comparably to the Xpert and BD MAX assays when used as confirmatory testing in the two-step algorithm. Offering similar performance and turnaround time to these widely used assays at a slightly lower cost, the M10 assay serves as a practical alternative in this setting.

Paucity of viral infection symptoms in patients with immune-mediated inflammatory diseases

OBJECTIVES

Although patients with immune-mediated inflammatory diseases (IMID) are thought to be more susceptible to viral infections, it is unclear whether their presentation differs between patients with IMID and healthy controls. This study aimed to investigate the symptom pattern of common viral infections in patients with IMID and compare it with controls without IMIDs.

DESIGN

A cross-sectional study conducted between 1 February and 30 April 2020, using a questionnaire.

SETTING

Seven tertiary regional care centers in Germany, which specialised in the care of patients with IMID (namely, in gastroenterology, dermatology, rheumatology and immunology clinical care).

PARTICIPANTS

One thousand nine hundred nine participants completed the survey (757 patients with IMID; 1152 non-IMID controls).

PRIMARY OUTCOME MEASURE

The occurrence of 11 common viral illness symptoms within the preceding 3 months in patients with IMID and non-IMID controls.

RESULTS

Symptom data were clustered, based on number and co-occurrance, into 3 major clusters and 2 subclusters ranked by the average number of symptoms. Patients with inflammatory bowel disease and psoriasis were significantly overrepresented in the lower-frequency subcluster of the polysymptomatic cluster. Patients with rheumatoid arthritis were overrepresented in the lower-frequency subclusters of the intermediate and oligo-/asymptomatic clusters. Controls were over-represented only in the higher-frequency subclusters of each major cluster where none of the IMIDs were over-represented. Spondyloarthritis and other IMIDs were also overrepresented in the low-frequency subcluster, but the results were not significant. Overall, patients with rheumatoid arthritis patients reported fewer symptoms (rate ratio=0.68, 95% CI, 0.59 to 0.80) than non-IMID controls.

CONCLUSION

Patients with IMID are over-represented in low-frequency subclusters, even among individuals who have reported a broad range of viral infection symptoms. This pattern suggests that the manifestations of viral infections are different between patients with IMID and controls, thus challenging the accurate and early diagnosis of infections.

Anti-SARS-CoV-2 serology based on ancestral RBD antigens does not correlate with the presence of neutralizing antibodies against Omicron variants

Neutralizing antibody titers and binding antibody levels are considered correlates of protection against severe SARS-CoV-2 infection. The clinical utility of serology should be reevaluated in light of the emergence of escape variants, as commercial antibody-binding assays have not been adapted to the virus' antigenic evolution. We compared anti-SARS-CoV-2 antibody titers in four quantitative serological tests based on variable ancestral spike antigens (three in-house ELISAs and the prototype VIDAS SARS-CoV-2 IgG QUANT assay) and neutralization assays against the pseudotyped Wuhan, BA.2, BA.4/5, BQ.1.1, and XBB.1.1 viruses in a cohort of 100 patients infected in 2020 or during the Omicron waves. Binding antibody levels correlated well with neutralizing antibody titers for Wuhan, BA.2, and BA.4/5, but the association decreased for BQ.1.1 and XBB.1 (for the VIDAS assay, Spearman's correlation was 0.82 [95% CI 0.74-0.88] and 0.61 [0.46-0.72] for BA.2 and XBB.1, respectively). In 15% of patients with no neutralizing antibodies against XBB.1, the VIDAS assay still yielded binding antibody levels ranging from 74 to 7,652 binding antibody units/mL. Using an adjusted threshold based on receiver operating characteristic (ROC) curve analysis, the specificity of neutralizing antibody detection increased from 0.15 (95% CI 0.02-0.45) and 0.17 (0.04-0.41) to 0.92 (0.64-1.00) and 0.83 (0.59-0.96) against BQ.1.1 and XBB.1, respectively. Serological tests based on receptor-binding domain antigens from the ancestral virus fail to predict neutralizing activity against the latest circulating Omicron variants. Adapting serological tests may improve their clinical utility in immunocompromised patients.

IMPORTANCE

Anti-SARS-CoV-2 serology was developed in 2020 in response to the COVID-19 pandemic to diagnose SARS-CoV-2 infection and monitor an individual's immunity following natural infection or vaccination. Given the relationship between neutralizing antibody titers and protection against severe infection, many studies have evaluated the correlation between serology tests and neutralization assays in the pre-Omicron era. An important potential clinical use of serology, which explores binding antibodies, is estimating an individual's level of protection against new infection, particularly in immunosuppressed individuals and those at risk of severe COVID. However, in the Omicron era, as new viruses evade the immunity induced by previous infections and vaccination, the correlation between binding antibody levels determined by serological assays developed from ancestral antigens and neutralizing antibody titers against new viruses should be re-examined in order to determine whether these assays should be optimized by adapting antigens to the circulating SARS-CoV-2 strains.

Prospective study of peripartum group B streptococcus colonization in Japanese mothers and neonates

Group B streptococcus (GBS) is a major global cause of neonatal, infant, and maternal infections. In Japan, national guidelines based on Centers for Disease Control and Prevention recommendations mandate culture-based screening and intrapartum antibiotic prophylaxis (IAP) for GBS-positive pregnant women. Despite initial reductions in GBS infections, the incidence has plateaued, and there are notable limitations in current prevention methods. Approximately 15% of pregnant women are not screened for GBS, and intermittent colonization undermines screening accuracy, contributing to early-onset disease. IAP does not prevent late-onset disease, the incidence of which is increasing in Japan. This study reviewed maternal and neonatal GBS colonization using polymerase chain reaction, evaluated capsular type distributions, and explored late-onset disease infection routes. Among 525 mother-neonate pairs, the study found a higher detection rate of GBS via polymerase chain reaction compared to culture methods and identified significant discrepancies between antepartum and intrapartum colonization. GBS was detected in 3.5% of neonates from initially negative mothers at 4 days of age. Capsular types varied between mothers and neonates, indicating potential horizontal transmission. This study underscores the need for improved rapid diagnostic tests and highlights the potential of maternal GBS vaccination as a future prevention strategy.

A Binational Sample-Initiated Retrospective Outbreak Investigation of Listeria monocytogenes Infections in the United States and Canada Linked to Enoki Mushrooms Imported from China 2022-2023

In 2022, the U.S. Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), U.S. state and local partners, the Public Health Agency of Canada (PHAC), and the Canadian Food Inspection Agency (CFIA) conducted a binational sample-initiated retrospective outbreak investigation (SIROI) of Listeria monocytogenes illnesses linked to enoki mushrooms. The FDA and CDC investigated the first known L. monocytogenes outbreak linked to enoki mushrooms from 2016 to 2020, making the 2022 outbreak the second time this pathogen-commodity pair was investigated by FDA and CDC. The 2022 outbreak included six ill people, all of whom were hospitalized. Epidemiologic, laboratory, and traceback evidence led to multiple public health actions, including voluntary recalls by firms, public communications about the outbreak, and FDA's country-wide Import Alert for enoki mushrooms from China. This SIROI illustrates the importance of surveillance sampling, national and international coordination of efforts, and rapid information sharing to identify and stop foodborne outbreaks on a global scale. To reduce the risk of listeriosis illnesses linked to contaminated enoki mushrooms, public health and regulatory agencies in the United States and Canada remain committed to conducting comprehensive surveillance for Listeria in foods and in people, efficiently investigating identified outbreaks, and implementing control measures to potentially minimize the impact of future outbreaks.

Impact of respiratory pathogens detection by a rapid multiplex polymerase chain reaction assay on the management of community-acquired pneumonia for children at the paediatric emergency department. A randomized controlled trial, the Optimization of Pneumonia Acute Care (OPTIPAC) study

OBJECTIVES

The pathogen of community-acquired pneumonia (CAP) in children is typically uncertain during initial treatment, leading to systematic empiric antibiotic use. This study investigates if having rapid multiplex PCR results in the emergency department (ED) improves empiric treatment.

METHODS

OPTIPAC, a French multicentre study (2016-2018), enrolled patients consulting for CAP at the paediatric ED in 11 centres. Patients were randomized to either receive a multiplex PCR test plus usual care or usual care alone and followed for 15 days. The primary outcome was the appropriateness of initial antimicrobial management, determined by a blinded committee.

RESULTS

Of the 499 randomized patients, 248 were tested with the multiplex PCR. Appropriateness of the antibiotic treatment was higher in the PCR group (168/245, 68.6% vs. 120/249, 48.2%; Relative risk 1.42 [1.22-1.66]; p < 0.0001), chiefly by reducing unnecessary antibiotics in viral pneumonia (RR 3.29 [2.20-4.90]). No adverse events were identified.

DISCUSSION

The multiplex PCR assay result at the ED improves paediatric CAP's antimicrobial stewardship, by both reducing antibiotic prescriptions and enhancing treatment appropriateness.

Monitoring SARS-CoV-2 variants with complementary surveillance systems: risk evaluation of the Omicron JN.1 variant in France, August 2023 to January 2024

BackgroundEarly detection and characterisation of SARS-CoV-2 variants have been and continue to be essential for assessing their public health impact. In August 2023, Santé publique France implemented enhanced surveillance for BA.2.86 and sub-lineage JN.1 because of their genetic divergence from other variants and increased prevalence.AimTo detail how combining epidemiological and laboratory data sources, targeted investigations and modelling enabled comprehensive characterisation of sub-lineage JN.1.MethodsData were collected from epidemiological investigations using a standardised questionnaire and from routine and novel (RELAB network) surveillance systems. JN.1 cases were compared with cases infected with previously circulating variants, such as EG.5, BA.4/BA.5 and other BA.2.86 sub-lineages. The growth rate and doubling time of JN.1 were estimated.ResultsJN.1 was first detected in September 2023 in the Île-de-France region, France, and spread widely across the country. By late November, doubling time was estimated to be 8.6 to 26.4 days depending on the region. For all data sources, cases infected by JN.1 showed similar demographics, rates of hospitalisation and RT-PCR cycle threshold values compared with those infected by previous variants. JN.1 cases also had older median age (54 years; 40-71 vs 47 years; 30-59), more frequent reports of feverish feeling and less frequent cough or nausea compared with BA.4/BA.5 cases. JN.1 cases had significantly higher frequency of anosmia compared with other BA.2.86 cases.ConclusionCombining different data sources played a key role in detecting emerging variant JN.1, for which no evidence of increased public health impact was found despite its genetic divergence.

Mechanistic models of humoral kinetics following COVID-19 vaccination

COVID-19 vaccine programmes must account for variable immune responses and waning protection. Existing descriptions of antibody responses to COVID-19 vaccination convey limited information about the mechanisms of antibody production and maintenance. We describe antibody dynamics after COVID-19 vaccination with two biologically motivated mathematical models. We fit the models using Markov chain Monte Carlo to seroprevalence data from 14 602 uninfected individuals in England between May 2020 and September 2022. We analyse the effect of age, vaccine type, number of doses and the interval between doses on antibody production and longevity. We find evidence that individuals over 35 years old twice vaccinated with ChAdOx1-S generate a persistent antibody response suggestive of long-lived plasma cell induction. We also find that plasmablast productive capacity is greater in: younger people than older people (≤4.5-fold change in point estimates); people vaccinated with two doses than one dose (≤12-fold change); and people vaccinated with BNT162b2 than ChAdOx1-S (≤440-fold change). We find the half-life of an antibody to be 23-106 days. Routinely collected seroprevalence data are invaluable for characterizing within-host mechanisms of antibody production and persistence. Extended sampling and linking seroprevalence data to outcomes would enable conclusions about how humoral kinetics protect against disease.

Kinetic and proteomic studies in milk show distinct patterns among major Listeria monocytogenes clones

Listeria monocytogenes, a contaminant of raw milk, includes hypervirulent clonal complexes (CC) like CC1, CC4, and CC6, highly overrepresented in dairy products when compared to other food types. Whether their higher prevalence in dairy products is the consequence of a growth advantage in this food remains unknown. We examined growth kinetics of five L. monocytogenes isolates (CC1, CC4, CC6, CC9, and CC121) at 37 and 4 °C in ultra-high temperature (UHT) milk and raw milk. At 4 °C, hypovirulent CC9 and CC121 isolates exhibit better growth parameters in UHT milk compared to the hypervirulent CC1, CC4, and CC6 isolates. CC9 isolate in raw milk at 4 °C exhibited the fastest growth and the highest final concentrations. In contrast, hypervirulent isolates (CC1, CC4, and CC6) displayed better growth rates in UHT milk at 37 °C, the mammalian host temperature. Proteomic analysis of representative hyper- (CC1) and hypovirulent (CC9) isolates showed that they respond to milk cues differently with CC-specific traits. Proteins related to metabolism (such as LysA or different phosphotransferase systems), and stress response were upregulated in both isolates during growth in UHT milk. Our results show that there is a Listeria CC-specific and a Listeria CC-common response to the milk environment. These findings shed light on the overrepresentation of hypervirulent L. monocytogenes isolates in dairy products, suggesting that CC1 and CC4 overrepresentation in dairy products made of raw milk may arise from contamination during or after milking at the farm and discard an advantage of hypervirulent isolates in milk products when stored at refrigeration temperatures.

Alcohol induces α2-6sialo mucin O-glycans that kill U937 macrophages mediated by sialic acid-binding immunoglobulin-like lectin 7 (Siglec 7)

Alcohol misuse increases infections and cancer fatalities, but mechanisms underlying its toxicity are ill-defined. We show that alcohol treatment of human tracheobronchial epithelial cells leads to inactivation of giantin-mediated Golgi targeting of glycosylation enzymes. Loss of core 2 N-acetylglucosaminyltransferase 1, which uses only giantin for Golgi targeting, coupled with shifted targeting of other glycosylation enzymes to Golgi matrix protein 130-Golgi reassembly stacking protein 65, the site normally used by core 1 enzyme, results in loss of sialyl Lewis x and increase of sialyl Lewis a and α2-6sialo mucin O-glycans. The α2-6sialo mucin O-glycans induced by alcohol cause death of U937 macrophages mediated by sialic acid-binding immunoglobulin-like lectin 7. These results provide a mechanistic insight into the cause of the toxic effects of alcohol and might contribute to the development of therapies to alleviate its toxicity.

Rapid molecular assays versus blood culture for bloodstream infections: a systematic review and meta-analysis

Background

Timely management of sepsis with early targeted antimicrobial therapy improves patient outcomes. Rapid molecular assays (RMAs) have emerged, enabling the detection of bloodstream infection (BSI) with a shorter turnaround time than blood cultures (BCs). The accuracy of several RMAs has not been comprehensively reviewed. We aimed to identify commercial RMAs reported in the literature and evaluate their diagnostic performance compared to BC.

Methods

A systematic review and meta-analysis was conducted, covering MEDLINE, Cochrane Library, Embase, and Web of Science from inception to September 23, 2024. Eligible studies included patients with suspected or documented BSI, tested with both an RMA (turnaround time of ≤12 h, targeting ≥20 pathogens) and BC. Non-original research articles and animal studies were excluded. The primary outcomes were pooled sensitivity and specificity of RMAs for pathogen detection compared to BC. Bivariate analysis was used to produce summary receiver operating characteristic plots and diagnostic metric measures stratified by different units of analysis (sample versus patient), RMA types, and patient populations. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and Quality Assessment of Diagnostic Accuracy Studies-Comparative (QUADAS-C) tools. The study was registered with PROSPERO, CRD42022377280.

Findings

A total of 63,916 articles were identified, of which 104 were included in the qualitative synthesis and 75 in the quantitative synthesis, covering 17,952 samples and 11,393 patients analyzed separately. Eleven RMAs were identified, with four included in the RMA-based subgroup analysis (LightCycler SeptiFast Test MGRADE®, IRIDICA BAC BSI assay, SepsiTest, MagicPlex Sepsis Test) and five additional ones in the pooled analysis (UMD-SelectNA, VYOO®, MicrobScan assay, MicrobScan-Kairos24/7, REBA Sepsis-ID test). Two RMAs were included in the qualitative synthesis only (InfectID-BSI, Pilot Gene Technology droplet digital polymerase chain reaction). Pooled specificity of RMAs was higher (0.858, 95% confidence interval (CI) 0.830-0.883) than sensitivity (0.659, 95% CI 0.594-0.719) by patient. Sensitivities varied by RMA type from 0.492 (95% CI 0.390-0.594, MagicPlex Sepsis Test) to 0.783 (95% CI 0.662-0.870, IRIDICA BAC BSI assay) by patient. Specificities varied more by patient population, ranging from 0.811 (95% CI 0.716-0.879) in the intensive care population to 0.892 (95% CI 0.838-0.930) in the emergency department population, by patient. Similar metrics were observed when the analysis was done by sample. Risk of bias was judged to be high in all included articles.

Interpretation

Despite their shorter turnaround time, low sensitivity means RMAs cannot replace BCs. However, our data indicate that RMAs may have value as an add-on test by increasing pathogen detection rates. Higher-sensitivity RMAs are needed which could possibly be achieved by expanding pathogen coverage and increasing blood sample volumes. High-quality implementation studies and standardized reporting are required to assess the clinical advantages of RMAs.

Funding

Centre for Translational Medicine, Semmelweis University.

Rapid Icm/Dot T4SS Inactivation Prevents Resuscitation of Heat-Induced VBNC Legionella pneumophila by Amoebae

Legionella pneumophila, the causative agent of Legionnaires' disease, employs the Icm/Dot Type IV secretion system (T4SS) to replicate in amoebae and macrophages. The opportunistic pathogen responds to stress by forming 'viable but non-culturable' (VBNC) cells, which cannot be detected by standard cultivation-based techniques. In this study, we document that L. pneumophila enters the VBNC state after exposure to heat stress at 50°C for 30 h, at 55°C for 5 h or at 60°C for 30 min, while still retaining metabolic activity and intact cell membranes. Resuscitation of heat-induced VBNC L. pneumophila neither occurred in amoebae nor in macrophages. VBNC L. pneumophila showed impaired uptake by phagocytes, formation of Legionella-containing vacuoles (LCVs), and Icm/Dot-dependent secretion of effector proteins. The T4SS was rapidly inactivated already upon exposure to 50°C for 3-5 h, while the bacteria were still culturable. The Legionella quorum sensing (Lqs)-LvbR network is implicated in VBNC induction, since the ∆lvbR and ∆lqsR mutant strains showed a more pronounced heat sensitivity than the parental strain, and the ∆lqsA mutant was less heat sensitive. Taken together, our results reveal that heat exposure of L. pneumophila rapidly inactivates the Icm/Dot T4SS before the VBNC state is induced, thus impairing resuscitation by amoebae.

Spine surgical site infection outcome with preoperative application of a presaturated 10% povidone-iodine nasal decolonization product in a 32-bed surgical hospital

BACKGROUND

To pursue an irreducible minimum overall surgical site infection (SSI) rate, a 32-bed surgical hospital employed an outside consultant and performed sterile processing and surgery internal audits: No obvious improvements were identified. A 10-year review determined that 70% of SSI's were spine procedure patients. After a nasal decolonization product literature review, an intervention was implemented. The purpose of this study was to assess if the intervention impacted spine SSI rates.

METHODS

A 36-month implementation science study was conducted. The 18-month intervention was the immediate preoperative application of a manufactured presaturated 10% povidone-iodine nasal decolonization product in spine surgery patients, with monthly product application documentation surveillance feedback to the preoperative staff. Chi-square test was used to determine the difference in types of spine SSI surgery rates pre and post intervention.

RESULTS

Overall spine SSI decreased 35.7% (P = .04) with a 58.7% reduction in superficial incisional SSI (P = .02). The 16.1% decline in deep incisional SSI was not significant (P = .29).

CONCLUSIONS

Within this hospital, conducting 7,576 surgical spine procedures over 36 months, with the immediate preoperative application of a presaturated 10% povidone-iodine nasal decolonization product, the only intervention in SSI prevention protocol, produced a statistically significant decrease in spine patient SSI rate percent.

Low cluster of differentiation 4+ T-cell count associated with thrombocytopenia among people living with human immunodeficiency virus-1 receiving antiretroviral in West Papua

Introduction. Anaemia and thrombocytopenia are blood-related irregularities linked to an increased likelihood of disease progression, leading to death in people living with human immunodeficiency virus 1 (PLHIV).Gap statement. Severe clinical conditions associated with human immunodeficiency 1 (HIV-1) infection may be related to blood irregularities among PLHIV.Aim. The study aimed to examine the factors correlated with blood irregularities among PLHIV receiving antiretroviral treatment in West Papua.Methodology. We conducted a study at hospitals in West Papua involving 80 participants who received antiretroviral therapy (ART) and agreed to provide informed consent. Standardized and validated questionnaires were used for data collection. Sequential assessment of haematological and immunological parameters was performed using Sysmex haematology and PIMA CD4+ analyser. Fisher's exact test and logistic regression analysis were applied, with a significance level set at P<0.05, to identify the key factors positively associated with blood irregularities.Results. The overall incidences of anaemia and thrombocytopenia were 56.3 and 40%, respectively. Fisher's exact test indicated that anaemia [adjusted odds ratio (AOR): 3.02; 95% confidence interval (CI): 1.160-7.866; P<0.05] and low CD4+ T-cell count (AOR: 3.81; 95 % CI: 1.485-9.820, P<0.05) were significantly associated with thrombocytopenia. Logistic regression analysis revealed that the most influential factor contributing to thrombocytopenia-related blood irregularities was the clinical CD4+ T-cell count (B=3.818; 95% CI: 1.485-9.820, P<0.05).Conclusion. CD4+ T-cell count was indicated as the main factor causing thrombocytopenia among PLHIV receiving ART in West Papua. It is crucial to conduct screening and regular haematological assessments among PLHIV having low CD4+ T-cell counts to mitigate morbidity and mortality risks.

Cytomegalovirus Isolated to a Colon Polyp in a Patient with Ulcerative Colitis on Ozanimod: A Case Report

Introduction

Cytomegalovirus (CMV) infection is a notable gastrointestinal infection affecting immunocompromised patients. In the gastrointestinal tract, CMV often presents with patchy or diffuse mucosal involvement and can cause fulminant colitis. However, polypoid CMV lesions are rare. We present a case of a 49-year-old man with ulcerative colitis (UC) in remission on ozanimod who developed CMV isolated to inflammatory colon polyps.

Case Presentation

A 49-year-old patient with UC in clinical remission on ozanimod underwent routine surveillance colonoscopy, which revealed multiple inflamed polyps with white caps. Biopsy results confirmed inflammatory polyps with positive CMV immunostaining, while adjacent tissues and plasma CMV PCR tests were negative. The patient successfully completed a 3-week course of valganciclovir. Follow-up colonoscopy revealed additional inflammatory polyps but no evidence of CMV. He remained in clinical remission and continued ozanimod therapy.

Conclusion

The unusual nature of this presentation suggests a clinically silent CMV reactivation or, alternatively, a primary CMV infection in our patient, with an unclear natural history and optimal management. This report emphasizes the importance of considering CMV in UC patients with unusual endoscopic findings and the need for multidisciplinary collaboration to optimize care.

Two Decades Rituximab Therapy in Anti-Neutrophil Cytoplasmic Antibody Associated Vasculitis

Remission failure and relapse numerate as one of the main problems in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAVs). The need for new agents that provide effective and safe induction accompanied by sustained remission seems to be urgent in clinical care. The efficacy and safety of rituximab (RTX) for AAVs therapy has been reported in various studies. RTX therapy offers several advantages to treating AAVs patients compared to other therapeutic approaches including reduction of Glucocorticoids (GCs) and conventional Immunosuppressive therapy (IST) usage during both the induction of remission and maintenance phases. This reduction can lead to a lower rate of serious complications making RTX therapy a safer option. It seems that RTX may provide improved clinical outcomes in these patients mediated via B-lymphocyte depletion, Proteinase 3-antineutrophilic cytoplasmic antibody (PR3-ANCA), and myeloperoxidase-antineutrophilic cytoplasmic antibody (MPO-ANCA) titers reduction. In this regard, some uncertainties have been reported to validate the association between such depletion and clinical improvement, as suggested by other sources of autoreactive B cells that did not target with RTX. Due to the prolonged B cell depletion, fixed intervals and adjusted dosage of RTX may be required in patients with AAVs. In this narrative review, we aimed to insight better understand regarding the efficacy of RTX for effective induction and sustained remission in patients with AAVs. It seems that discovering new biomarkers predicting relapse in AAVs patients can lead to future targeted therapy.

Marginal zone B cells are required for optimal humoral responses to allograft

Antibody-mediated rejection (AMR) is among the leading causes of graft failure in solid organ transplantation. However, AMR treatment options are limited by an incomplete understanding of the mechanisms underlying de novo donor-specific antibody (DSA) generation. The development of pathogenic isotype-switched DSA in response to transplanted allografts is typically attributed to follicular B cells undergoing germinal center reaction whereas the contribution of other B cell subsets has not been previously addressed. The current study investigated the role of recipient marginal zone B cells (MZ B cells) in DSA responses using mouse models of heart and renal allotransplantation. MZ B cells rapidly differentiate into antibody-secreting cells in response to allotransplantation. Despite the selective depletion of follicular B cells in heart allograft recipients, MZ B cells are sufficient for T-dependent IgM and early IgG DSA production. Furthermore, the presence of intact MZ B cell subset is required to support the generation of pathogenic isotype-switched DSA in renal allograft recipients containing donor-reactive memory helper T cells. These findings are the first demonstration of the role of MZ B cells in humoral alloimmune responses following solid organ transplantation and identify MZ B cells as a potential therapeutic target for minimizing de novo DSA production and AMR in transplant recipients.

Hemostatic function, immunomodulatory capacity, and effects of lipemia in cold-stored whole blood

BACKGROUND

Whole blood (WB) is increasingly being used for resuscitation of trauma patients. Although platelet-, red blood cell (RBC)- and plasma-specific parameters in cold-stored WB are well characterized, there has been limited investigation of biological response modifiers (BRMs), which may induce adverse reactions in recipients. The aim of this study was to evaluate the quality and function of RBC, platelets, plasma proteins, and BRMs in cold-stored WB during storage.

METHODS

WB (n = 24) was collected into collected into citrate-phosphate-dextrose (CPD) anticoagulant, held overnight, processed through a platelet-sparing filter, and stored at 2-6°C for 21 days. RBC, platelet, coagulation factor quality and function, and BRM concentrations were measured throughout the duration of storage.

RESULTS

WB was effectively leukoreduced, with 99.98% reduction in leukocyte count and 81% platelet count recovery following filtration. Five WB units were significantly lipemic, with a visible lipid layer appearing after being cold storage overnight. These were more turbid with higher hemolysis compared to non-lipemic units (p = .023). Despite a decrease in platelet count during storage (p < .001), hemostatic function as measured by thromboelastography was maintained for at least 21 days (R time and maximum amplitude; both p < .001). There was a significant increase in PF4, CD62P, and RANTES during cold storage (all p < .001).

DISCUSSION

WB retains hemostatic potential for at least 21 days of cold storage, and with further development, may be suitable for transfusion in Australia. Before implementation in Australia, quality control measures for lipemia and hemolysis would need to be defined as part of our manufacturing processes.

Platelet Additive Solutions and Pathogen Reduction Impact on Transfusion Safety, Patient Management and Platelet Supply

Since 1998, leuko-reduction is used in France for all platelet concentrates (PCs), apheresis-derived (APCs) and pooled whole blood-derived buffy-coats (BCPCs). Platelet additive solutions (PAS), introduced in 2005, accounted for over 80% of the platelet supply from 2011 to 2017. The Intercept pathogen reduction technology (PR), started in a pilot study in 2007, was generalized in 2018. Between 2007 and 2021, the use of BCPCs increased steadily from 23% to 70% of the supply. Objectives: to analyze the impact of these modifications on adverse transfusion reactions (ATRs), patient management and blood transfusion organization. Results: The overall incidence of ATRs /105 PCs is significantly lower with PAS- and PR-PCs as compared to PCs in plasma (PL), with the decreasing hierarchy PL > PAS > PR. PAS- and PR-PCs lead to significantly lower incidences of allergy and alloimmunization to RBC antigens (RC-AI) ATRs. The incidence of bacteria transmission (TTBI) is significantly reduced by 95% with PR-PCs. APC-related ATR incidence is significantly higher than BCPC for allergy (+233%), TTBI (+100%), APTR (+75%), Major-ABO-II (+65%), HLA/HPA-AI (+38%), FNHTR (+22%), and life-threatening ATRs (+106%). A single diagnosis is significantly less associated with APCs: RC-AI (-47%). The generalization of PR-PCs, which exhibit a lower platelet content than PAS- and PL-PCs, is associated with a significant 9% decrease in the ATR incidence per PC, a 13% increase in the number of PCs transfused per patient, and a nonsignificant 3% increase in the ATR incidence per patient. The outdated PCs percentage declined significantly from 3.7% to 1.7%.

Development and validation of a nomogram for predicting bacterial infections in patients with acute exacerbation of chronic obstructive pulmonary disease

Bacterial infection is a significant contributory factor in the pathogenesis of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and it has a pivotal role in exacerbating symptoms and precipitating mortality among patients with chronic obstructive pulmonary disease (COPD). The early identification of bacterial infection in individuals with COPD remains a challenge. Therefore, the present study aimed to create and validate a risk assessment tool using easily accessible serum biomarkers to predict bacterial infection in individuals with AECOPD. A retrospective cohort study was carried out at Pingxiang People's Hospital (Pingxiang, China) from January 2023 to December 2023, involving individuals diagnosed with AECOPD. A total of 544 patients with AECOPD were randomly allocated to the two following groups: The training set, which included 70% (n=384) of the patients, and the validation set, which included 30% (n=160) of the patients. Subsequently, a nomogram model was constructed using multivariate logistic regression analysis in the training set. Its discriminatory ability and calibration were internally validated, while decision curve analyses were employed to assess the clinical utility of the nomogram. The incidence of bacterial infection in hospitalized patients with AECOPD was 50% in the training set and 48.1% in the validation set. The nomogram model incorporated independent factors associated with bacterial infection, including C-reactive protein, neutrophil elastase, procalcitonin and eosinophils, identified by univariate and multivariate logistic regression analyses. The area under the curve of the nomogram model was 0.835 [95% confidence interval (CI): 0.795-0.875] in the training set and 0.785 (95% CI: 0.715-0.856) in the validation set. The model demonstrated excellent discrimination and calibration in the validation set [c-statistic: 0.79 (95% CI: 0.68-0.90)]. Furthermore, the discrimination and overfitting bias of the model were assessed through internal validation, revealing a C-index of 0.836 for the initial group and 0.788 for the subsequent validation set. The straightforward risk prediction model for early identification of bacterial infections is valuable for hospitalized patients with AECOPD.

[Understanding vaccination behavior of healthcare workers in German hospitals-results from the OKaPII study]

BACKGROUND

Influenza vaccination coverage in Germany is generally low. Even in hospitals, the demand for influenza vaccination is lacking although it has the potential to prevent the spread of the influenza virus and diseases. To take effective actions, a deeper understanding of vaccination behavior of healthcare workers is crucial.

METHODS

OKaPII is an annual German-wide online survey of clinical staff on influenza vaccination. Differences in vaccination behavior were tested for occupation, sex, and age, and differences in knowledge were tested between physicians and nurses. We used logistic regressions to analyze associations between psychological determinants and vaccination behavior among physicians and nursing staff.

RESULTS

From 115 clinics, 15,312 employees participated in the survey (17 April to 15 May 2023). In the 2022/23 season, 58.7% of the participants were vaccinated against influenza. The vaccination coverage was 80.7% for physicians and 51.1% for nursing staff . The vaccination behavior of physicians and nursing staff was significantly associated with collective responsibility and confidence in vaccination safety. Of the knowledge items, 87.2% were answered correctly by physicians and 62% by nursing staff.

DISCUSSION

We identified significant differences in vaccine uptake between occupational groups in German hospitals. Low vaccination coverage has existed for years, especially among nursing staff. Tailored interventions should promote the idea of protecting vulnerable people and confidence in the safety of vaccination. Increased education, especially on vaccination safety issues, can have a positive impact on the decision to vaccinate. Possibilities to get vaccinated despite time constraints in the workplace should be provided.

Comparison of the Efficacy of Povidone-Iodine with Mupirocin in Decolonizing Staphylococcus aureus from the Nasal Cavity of Healthcare Workers: A Single-Blinded Randomized Controlled Trial

BACKGROUND

Nasal colonization of Staphylococcus aureus increases the risk of nosocomial infections. Therefore, medications that can decolonize this pathogen can help prevent such infections.

OBJECTIVE

Our study aimed to compare the efficacy of povidone-iodine solution with intranasal mupirocin ointment in decolonizing S. aureus from the nasal cavity of healthcare workers.

METHODS

This single-blinded randomized controlled trial was conducted on healthcare workers carrying S. aureus nasally. After confirming nasal colonization through culture tests, participants were assigned to intervention groups A and B with an allocation ratio of 1:1. Group A received intranasal mupirocin ointment twice daily for five days, while group B received intranasal povidone-iodine solution twice daily for five days. After the decolonization period, samples were taken to compare the efficacy of both interventions in decolonizing S. aureus.

RESULTS

In this study, 54 healthcare workers with a mean age of 39.37±7.80 years were included, 42.6% and 57.4% of whom were male and female, respectively. They were randomly assigned to each of the intervention groups. After the intervention, individuals who received povidone-iodine had significantly more positive cultures than those who received mupirocin (37.0% vs. 11.1%, P = 0.026). Additionally, factors such as age, gender, wards, and employment duration may affect the efficacy of mupirocin and povidone-iodine in decolonizing S. aureus from the nasal cavity.

CONCLUSION

The study findings revealed that both mupirocin and povidone-iodine were effective in decolonizing S. aureus from nasal carriers. However, mupirocin was more effective compared with povidone-iodine.

CLINICAL TRIAL REGISTRATION NUMBER

IRCT 20170417033487 N2.

Reduction in Balloon Pump Size Reduces Axillary Intraaortic Balloon Pump Failure Risk

Axillary artery intra-aortic balloon pump (axIABP) placement has been implemented as a bridging solution before heart transplantation. This study evaluates complications associated with axIABP support and describes an approach to minimize adverse events. We previously described a percutaneous approach for axIABP placement. However, patients receiving axIABP between September 1, 2017, and September 26, 2019 (n = 32) demonstrated a high rate of balloon pump malfunction (8/32; 25%) and other complications (totaling 15/32; 47%). Sixty-four patients were sequentially treated under a revised protocol. Compared to the initial cohort, no significant differences in demographics were noted. A significant reduction in rate of balloon malfunction (8/32, 25% vs. 1/64, 2%; p < 0.001) and total complications (15/32, 47% vs. 10/64, 16%; p = 0.0025) during the period of support were noted after intervention. Subsequent analysis of total complications per device size (40 vs. ≤ 34 ml balloon) revealed significantly reduced complications in patients with smaller devices (40% vs. 13%, respectively; p = 0.0022). This study provides guidelines to limit complications in patients supported with axIABP, facilitating a protracted period of bridging support.

Chlorhexidine gluconate versus povidone-iodine for nasal bacteria decolonization before transsphenoidal surgery in patients with pituitary neuroendocrine tumors: a prospective, randomized, double-blind, noninferiority trial

BACKGROUND

This study aimed to compare the nasal decolonization efficacy and comfort between chlorhexidine gluconate (CHG) and povidone-iodine (PVP) to provide an evidence basis for clinical guidance.

METHODS

A prospective, randomized, single-blinded, noninferior clinical trial was conducted in 174 patients with pituitary neuroendocrine tumors (PitNETs) who were scheduled to undergo transsphenoidal surgery. The noninferiority margin was δ=-0.1. The primary outcome was the effective rate of disinfection. The secondary outcomes included postoperative inflammatory indicators, the intracranial infection rate, and the proportion of intracranial infection.

RESULTS

The effective clearance rate of postoperative nasal bacteria was nonsignificantly different between the CHG and PVP groups (88.64% vs. 82.56%; between-group difference 6.10%; 95% CI [-5.30 to 17.50]). There was no significant difference in the incidence of postoperative central nervous system infections or serum inflammation-related indications between the two groups, but sterilization tended to occur quicker and last longer in the CHG group. CHG seemed to have advantages in terms of comfort, including less nasal irritation, less pungency, and better intranasal coloration.

CONCLUSION

CHG and PVP have equal efficacy in nasal decolonization before transsphenoidal surgery, but CHG seems to have comfort-related advantages in terms of less nasal irritation, less pungency, and better intranasal coloration.

Effective Eradication of Mouse Norovirus and Helicobacter spp. in Laboratory Mice (Mus musculus) via Iodine Immersion and Cross-Fostering Technique

Eradication of pathogens from mouse colonies is crucial for scientific research reproducibility and animal welfare. The previously described techniques for eradicating pathogens by rederivation through embryo transfer or caesarian technique can be costly and technically challenging. The objective of our study was to assess the efficacy of iodine immersion combined with cross-fostering for eradicating murine norovirus (MNV) and Helicobacter spp. in laboratory mice. The iodine immersion technique was modified to prevent pathogen transmission and reduce the risk of cannibalism. The hypothesis of this study was that iodine immersion combined with cross-fostering of pups would be as effective at eliminating MNV as it is at clearing Helicobacter in laboratory mice. This study was performed on newborn litters of various mice strains housed in a room positive for both these pathogens. The pups were immersed in warmed, diluted iodine within 48 h of birth, and then cross-fostered to a Swiss Webster dam negative for MNV and Helicobacter. The presence of MNV and Helicobacter in donor dams, weanlings, and adult post-immersion animals was tested using fecal PCR. All 27 litters born to MNV- and Helicobacter-positive dams tested negative for both pathogens at weaning and at 8 wk postweaning. Follow-up PCR exhaust dust testing from the housing racks confirmed a negative status for MNV and Helicobacter over multiple quarterly pathogen screening tests conducted over an 18-mo period. This study is, to our knowledge, the first to demonstrate successful eradication of MNV through iodine immersion combined with cross-fostering, proving this method to be effective for eliminating MNV and Helicobacter spp. in affected colonies.

Knowledge, concerns, and vaccine acceptance related to Mpox (Monkeypox) among university students in North and Northeast China: An online cross-sectional study

The growing number of Mpox cases in China has posed a challenge to public health. The prevalence of men who have sex with men behaviors among students has been consistently increasing each year in China, accompanied by a high frequency of unprotected anal sex. As crowded places, schools are highly likely to cause an Mpox outbreak among students through long-term close contact. Understanding university students' perceptions about Mpox and willingness to vaccinate play a vital role in implementing preventive measures in schools. This study aimed to assess knowledge, concerns, and vaccine acceptance toward Mpox among university students in North and Northeast China. A cross-sectional study was conducted among 3831 university students from seven universities in North and Northeast China between September 10 and September 25, 2023. This study found a relative insufficiency in Mpox knowledge among university students (71.60%), with less than half expressing concern about the Mpox outbreak (39.57%), and the majority exhibiting a positive attitude to vaccination (76.30%). Multivariate regression analysis revealed that a good knowledge level was associated with age, study discipline, education level, and a high level of concern about Mpox. Male, elderly, or highly educated participants had a low level of concern about Mpox. Participants with a high level of knowledge toward Mpox were more likely to have the vaccination willingness. This study might help governments and schools to understand students' Mpox perceptions and vaccination intentions, enabling them to implement effective measures in addressing the issue of inadequate understanding regarding Mpox among university students.

Systematic literature review and meta-analysis on the prevalence of rotavirus genotypes in Europe and the Middle East in the post-licensure period

Previous systematic literature reviews of rotavirus genotype circulation in Europe and the Middle East are limited because they do not include country-specific prevalence data. This study documents country-specific evidence on the prevalence of rotavirus genotypes in Europe and the Middle East to enable more precise epidemiological modeling and contribute to the evidence-base about circulating rotavirus genotypes in the post-vaccination era. This study systematically searched PubMed, Embase and Scopus for all empirical epidemiological studies that presented genotype-specific surveillance data for countries in Europe and the Middle East published between 2006 and 2021. The STROBE checklist was used to assess the quality of included studies. Proportional meta-analysis was conducted using the generic inverse variance method with arcsine transformation and generalized linear-mixed models to summarize genotype prevalence. Our analysis estimated the genotype prevalence by country across three date categories corresponding with rotavirus seasons: 2006-2010, 2011-2015, 2016-2021. A total of 7601 deduplicated papers were identified of which 88 studies were included in the final review. Rotavirus genotypes exhibited significant variability across regions and time periods, with G1P[8], G2P[4], G3P[8], G4P[8], G9P[8], and, to a lesser extent G12P[8], being the most prevalent genotypes through different regions and time-periods. Uncommon genotypes included G3P[9] in Poland, G2P[6] in Iraq, G4P[4] in Qatar, and G9P[4] as reported by the European Rotavirus Network. There was high genotype diversity with routinely identified genotypes being G1P[8], G2P[4], G3P[8], G4P[8], and G9P[8]; there was high variability across time periods and regions. Continued surveillance at the national and regional levels is relevant to support further research and inform public health decision-making.

Discovery of a broad-spectrum monoclonal antibody recognizing a conserved, linear epitope WFYDGYPT on VP1 protein of Enterovirus A species

BACKGROUND

The hand, foot and mouth disease (HFMD) was caused by species of Enterovirus A and Enterovirus B in the Asian-Pacific region. Broad-spectrum monoclonal antibodies (mAb) that can bind multiple serotypes of enteroviruses have gradually become a research hotspot in the diagnosis, prevention and treatment of HFMD.

METHODS

In this study, a mAb 1H4 was obtained using monoclonal antibody technology by immunizing purified virus particles of Coxsackievirus A5 (CV-A5). Examined by indirect immunofluorescence and Western blotting, 1H4 detected successfully all seven selected serotypes CV-A2, CV-A4, CV-A5, CV-A6, CV-A10, CV-A16 and EV-A71 of Enterovirus A and targeted structural protein VP1.

RESULTS

The mAb 1H4 showed no cross-reactivity to strains of Enterovirus B and Enterovirus C. A linear epitope 202WFYDGYPT209 was identified as the minimal binding region of 1H4 by indirect ELISAs with overlapped and truncated peptides of VP1. Alanine scanning test found that W202, F203, D205, G206, Y207, P208, and T209 were key residues in the epitope region. BLAST of the epitope in the NCBI genus Enterovirus protein database indicates that the epitope sequence is highly conserved among Enterovirus A species, but not among the other Enterovirus species.

CONCLUSIONS

The results suggest that the mAb 1H4 may be a useful tool for development with a cost-effective and accurate method for surveillance and early differentiation of serotypes from Enterovirus A species to other species.

After the Infection: A Survey of Pathogens and Non-communicable Human Disease

There are many well-established relationships between pathogens and human disease, but far fewer when focusing on non-communicable diseases (NCDs). We leverage data from The UK Biobank and TriNetX to perform a systematic survey across 20 pathogens and 426 diseases, primarily NCDs. To this end, we assess the association between disease status and infection history proxies. We identify 206 pathogen-disease pairs that replicate in both cohorts. We replicate many established relationships, including Helicobacter pylori with several gastroenterological diseases and connections between Epstein-Barr virus with multiple sclerosis and lupus. Overall, our approach identified evidence of association for 15 pathogens and 96 distinct diseases, including a currently controversial link between human cytomegalovirus (CMV) and ulcerative colitis (UC). We validate this connection through two orthogonal analyses, revealing increased CMV gene expression in UC patients and enrichment for UC genetic risk signal near human genes that have altered expression upon CMV infection. Collectively, these results form a foundation for future investigations into mechanistic roles played by pathogens in NCDs. All results are easily accessible on our website, https://tf.cchmc.org/pathogen-disease.

Hospital-Based Surveillance of Respiratory Viruses Among Children Under Five Years of Age with ARI and SARI in Eastern UP, India

Acute respiratory infections (ARIs) are a leading cause of death in children under five globally. The seasonal trends and profiles of respiratory viruses vary by region and season. Due to limited information and the population's vulnerability, we conducted the hospital-based surveillance of respiratory viruses in Eastern Uttar Pradesh. Throat and nasal swabs were collected from outpatients and inpatients in the Department of Paediatrics, Baba Raghav Das (BRD) Medical College, Gorakhpur, between May 2022 and April 2023. A total of 943 samples from children aged 1 to 60 months were tested using multiplex real-time PCR for respiratory viruses in cases of ARI and SARI. Out of 943 samples tested, the highest positivity was found for parainfluenza virus [105 (11.13%) PIV-1 (79), PIV-2 (18), PIV-4 (18)], followed by adenovirus [82 (8.7%), RSV-B, [68 (7.21%)], influenza-A [46(4.9%): H1N1 = 29, H3N2 = 14), SARS CoV-2 [28 (3%)], hMPV [13(1.4%), RSV-A [4 (0.42%), and influenza-B (Victoria lineage) 1 (0.10%). The maximum positivity of respiratory viruses was seen in children between 1 to 12 months. The wide variation in prevalence of these respiratory viruses was seen in different seasons. This study enhances understanding of the seasonal and clinical trends of respiratory virus circulation and co-infections in Eastern Uttar Pradesh. The findings highlight the importance of targeted interventions to reduce the burden of respiratory infections in this region.

Quantitative IgG response to SARS-CoV-2 membrane protein in infected individuals strongly correlates with lung injury

The clinical manifestations of SARS-CoV-2 infection may range from asymptomatic or minor conditions to severe and life-threatening outcomes. The respiratory system is a principal target of the virus and in the majority of cases of severe disease, an acute form of pneumonia develops. Despite concerted global efforts to elucidate the pathogenic mechanisms of COVID-19, the progression of the infection leading to pulmonary damage remains poorly understood. The present study aimed to analyse the immunological profile of subjects with a previous SARS-CoV-2 infection and predisposition to lung injury. The results showed a strong correlation between IgG anti-membrane antibodies and lung injury.

Autoantibodies in hospitalised patients with COVID-19

Objectives

CD209L and its homologous protein CD209 act as alternative entry receptors for the SARS-CoV-2 virus and are highly expressed in the virally targeted tissues. We tested for the presence and clinical features of autoantibodies targeting these receptors and compared these with autoantibodies known to be associated with COVID-19.

Methods

Using banked samples (n = 118) from Johns Hopkins patients hospitalised with COVID-19, we defined autoantibodies against CD209 and CD209L by enzyme-linked immunosorbent assay (ELISA). Clinical associations of these antibodies were compared with those of patients with anti-interferon (IFN) and anti-angiotensin-converting enzyme-2 (ACE2) autoantibodies.

Results

Amongst patients hospitalised with COVID-19, 19.5% (23/118) had IgM autoantibodies against CD209L and were more likely to have coronary artery disease (44% vs 19%, P = 0.03). Antibodies against CD209 were present in 5.9% (7/118); interestingly, all 7 were male (P = 0.02). In our study, the presence of either antibody was positively associated with disease severity [OR 95% confidence interval (95% CI): 1.80 (0.69-5.03)], but the association did not reach statistical significance. In contrast, 10/118 (8.5%) had IgG autoantibodies against IFNα, and 21 (17.8%) had IgM antibodies against ACE2. These patients had significantly worse prognosis (intubation or death) and prolonged hospital stays. However, when adjusting for patient characteristics on admission, only the presence of anti-ACE2 IgM remained significant [pooled common OR (95% CI), 4.14 (1.37, 12.54)].

Conclusion

We describe IgM autoantibodies against CD209 and CD209L amongst patients hospitalised with COVID-19. These were not associated with disease severity. Conversely, patients with either anti-ACE2 IgM or anti-IFNα IgG antibodies had worse outcomes. Due to the small size of the study cohort, conclusions drawn should be considered cautiously.

Effect of Bacterial Nanocellulose with Chemisorbed Antiseptics on Alveolar Bone Repair in Rats Undergoing Bisphosphonate Therapy

Objectives: This work investigated the effect of bacterial nanocellulose (BNC) alone or with chemisorbed chlorhexidine or povidone-iodine on post-tooth extraction repair in rats undergoing bisphosphonate therapy. Methods: Forty Wistar rats were treated with zoledronic acid, subjected to tooth extractions and allocated into groups according to the material inserted in the post-extraction socket: (1) BNC (n = 10); (2) BNC/Iodine (n = 10); (3) BNC/Chlorhex (n = 10); (4) Control (n = 10). Maxillae were dissected and macro- and microscopically analyzed. Results: Oral lesion frequency on macroscopic examination did not differ between the groups, whereas it was larger in the BNC/Iodine group compared to the BNC/Chlorhex and Control. BNC/Chlorhex had significantly more connective tissue than did BNC but did not differ from the BNC/Iodine and Control. Epithelium, vital bone, non-vital bone, tooth fragment and inflammatory infiltrate did not significantly differ between the groups. BNC/Iodine showed greater CD31 immunostaining compared to BNC and the Control. Myeloperoxidase staining did not differ between the groups, and scanning electron microscopy analysis showed similar characteristics in all groups. Conclusions: BNC with chemisorbed povidone-iodine is associated with increased vascularization in post-extraction wounds of rats undergoing bisphosphonate therapy, whereas BNC with chemisorbed chlorhexidine improves connective tissue formation. BNC works as an effective carrier for the antiseptics tested.

Platelet's plea to Immunologists: Please do not forget me

Platelets are non-nucleated mammalian cells originating from the cytoplasmic expulsion of the megakaryocytes. Megakaryocytes develop during hematopoiesis through megakaryopoiesis, whereas platelets develop from megakaryocytes through thrombopoiesis. Since their first discovery, platelets have been studied as critical cells controlling hemostasis or blood coagulation. However, coagulation and innate immune response are evolutionarily linked processes. Therefore, it has become critical to investigate the immunological functions of platelets to maintain immune homeostasis. Advances in immunology and platelet biology research have explored different critical roles of platelets, including phagocytosis, release of different immune mediators, and controlling functions of different immune cells by direct interaction and immune mediators. The current article discusses platelet's development and their critical role as innate immune cells, which express different pattern recognition receptors (PRRs), recognizing different pathogen or microbe-associated molecular patterns (PAMPs or MAMPs) and death/damage-associated molecular patterns (DAMPs) and their direct interactions with innate and adaptive immune cells to maintain immune homeostasis.

Synthesis, physicochemical properties and antimicrobial activity of a di-aminopropionic acid hydrogen tri-iodide coordination compound

OBJECTIVE

The objective of this study is to synthesize and comprehensively characterize a novel iodine-containing coordination compound, di-aminopropionic acid hydrogen tri-iodide. This involves determining its structural, physicochemical, and thermal properties, as well as evaluating its antimicrobial activity against a range of bacterial strains, including multidrug-resistant pathogens. The aim is to explore the potential of this compound as a candidate for developing new antibacterial agents to address the challenge of antibiotic resistance.

RESULTS

An original iodine-containing semiorganic coordination compound was synthesized and characterized. The physicochemical properties were studied via diffraction, FTIR spectroscopy and thermogravimetric/differential scanning calorimetry (TG/DSC). In vitro antimicrobial activity evaluation was performed using two-fold serial dilution method. The obtained results demonstrated efficiency against both gram-positive (Staphylococcus aureus) and gram-negative (Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii) bacteria including MDR strains that cause infectious disease. The results of the antibacterial evaluation revealed that the new iodine coordination compound - di-aminopropionic acid hydrogen tri-iodide possesses high bactericidal properties and exhibits better antimicrobial activity against both susceptible and multidrug-resistant strains than does Lugol solution and ampicillin sodium, which are used as reference drugs.

Activated/Cycling Treg Deficiency and Mitochondrial Alterations in Immunological Non-Responders to Antiretroviral Therapy

BACKGROUND

Regulatory T-cells (Tregs) play a crucial role in maintaining immune homeostasis, but their dynamics are altered in a subset of people living with Human Immunodeficiency Virus (HIV) known as immunological non-responders (INRs). INRs fail to reconstitute CD4+ T-cell counts despite viral suppression. This study aimed to examine Treg dysregulation in INRs, comparing them to immunological responders (IRs) and healthy controls (HCs).

METHODS

The study included 40 INRs, 42 IRs, and 23 HCs. Peripheral blood mononuclear cells were isolated and analyzed by flow cytometry. Conventional CD4+ T-cells (Tconvs) were identified as CD25-/loFOXP3- cells, while Tregs were identified as CD25+CD127loFOXP3+ CD4+ T-cells. Cells were further divided into naive, central memory, effector memory, and effector memory cells re-expressing CD45RA (TEMRA) subsets. Activated/cycling cells were identified as CD71+ and quiescent cells were CD71-. Mitochondrial mass and transmembrane potential were measured using MitoTracker Green and MitoTracker Orange dyes, respectively. Statistical comparisons were made using the Kruskal-Wallis test with Dunn's post-hoc analysis and Mann-Whitney U-test.

RESULTS

INRs exhibited the highest frequencies of activated/cycling CD4+ T-cells. The proportion of activated/cycling cells was higher in Tregs compared to Tconvs in all groups. Cycling rates of Tregs and Tconvs were correlated, suggesting Tregs help control Tconv proliferation. Despite high overall Treg frequencies in INRs, they showed a Treg deficiency in activated/cycling CD4+ T-cells, specifically in naive and central memory subsets, causing an imbalance in the Tconv/Treg ratio. This deficiency was hidden by increased Treg frequencies in quiescent effector memory CD4+ T-cells. Activated/cycling naive and memory Tregs from INRs had normal forkhead box P3 (FOXP3) and CD25 expression, but activated/cycling memory Tregs showed decreased ability to regulate mitochondrial transmembrane potential, indicating impaired mitochondrial fitness. These mitochondrial abnormalities were similar to those observed in memory conventional T-cells.

CONCLUSIONS

The complex Treg dysregulation in immunological non-responders involves quantitative and functional alterations, including a Treg deficiency within activated/cycling naive and central memory CD4+ T-cells, impaired mitochondrial fitness of activated/cycling memory Tregs, and functional disorders of the parent conventional T-lymphocytes. These findings underscore the need for a nuanced understanding of Treg dynamics in suboptimal CD4+ T-cell reconstitution during HIV-infection.

Colonic dysmotility regulated by downregulation of PDGFRα+ cells / SK3 channel in DSS-induced colitis mice

Colitis is a complex multifactorial disease with an unknown aetiology that mainly manifests as chronic refractory colon transmission disorders. Smooth muscle, the main source of colon transmission power, consists of not only smooth muscle cells (SMCs) but also PDGFRα+ cells that mediate smooth muscle relaxation and ICCs that mediate contraction. PDGFRα+ cells and their unique small conductance Ca2+-activated K (SK3) channels are crucial in regulating colonic transit by exerting inhibitory effects. In this study, the contributions of the SK3 signalling pathway in PDGFRα+ cells to colitis-induced colonic transit dysmotility were investigated in DSS-induced colitis mice. An experiment was conducted to record the transmission of waves during smooth muscle contraction in the colon, using a colonic migrating motor complex(CMMC). Western blotting was utilized for protein expression detection, while PCR was employed for gene expression analysis. Immunofluorescence staining was used to detect the co-localization of SK3 channels with PDGFRα+ cells. In the colitis group, the weight of mice was reduced, the length of colon was shortened, and the disease activity index (DAI) was significantly increased. In the CMMC experiment, colon transmission was significantly disrupted in the colitis group compared to the control group, with a consistent colonic transmission amplitude and frequency. The sensitivity of mice with colitis to SK3 antagonists and agonists (apamin and CyPPA) was lower than that of the control group in CMMC experiment. The expression levels of mRNA and protein of PDGFRα and SK3 channels in colon of mice with colitis were decreased. Less SK3 channel colocalization with PDGFRα+ cells was observed in the colitis mouse group than in the control group. The findings indicated that colonic transit disorder in DSS-induced colitis mice is caused by the down-regulation of PDGFRα+ cells / SK3 channel expression.

Antifungal peptides from living organisms

In the post-COVID-19 era, people are increasingly concerned about microbial infections, including fungal infections that have risen in recent years. However, the currently available antifungal agents are rather limited. Worse still, the widespread use of the antifungal agents has caused the emergence of antifungal resistance in Candida, Cryptococcus, and Aspergillus species. Therefore, the development of novel antifungals is urgently needed. Antimicrobial peptides (AMPs), as components of the first-line defense of the host, are found to exhibit broad antimicrobial activity against bacteria, fungi, parasites, viruses, and protozoa. AMPs with antifungal activity are specifically referred to as antifungal peptides (AFPs). AFPs are currently regarded as the most promising alternative to conventional antifungal agents due to the fact that they are highly selective and less prone to facilitate the selection of drug resistance. In this review, we present an overview of the origin and classification of natural AFPs as well as their modes of action. Additionally, the production of natural, semisynthetic, and synthetic AFPs with a view to greater levels of exploitation is discussed. Finally, we evaluate the current and potential applications of AFPs in clinics and in the food industry.

Lipid nanoparticles as adjuvant of norovirus VLP vaccine augment cellular and humoral immune responses in a TLR9- and type I IFN-dependent pathway

Norovirus (NoV) virus-like particles (VLPs) adjuvanted with aluminum hydroxide (Alum) are common vaccine candidates in clinical studies. Alum adjuvants usually inefficiently assist recombinant proteins to induce cellular immune responses. Thus, novel adjuvants are required to develop NoV vaccines that could induce both efficient humoral and robust cellular immune responses. Lipid nanoparticles (LNPs) are well-known mRNA delivery vehicles. Increasing evidence suggests that LNPs may have intrinsic adjuvant activity and can be used as adjuvants for recombinant protein vaccines; however, the underlying mechanism remains poorly understood. In this study, we compared the adjuvant effect of LNPs and Alum for a bivalent GI.1/GII.4 NoV VLP vaccine. Compared with Alum, LNP-adjuvanted vaccines induced earlier production of binding, blocking, and neutralizing antibodies and promoted a more balanced IgG2a/IgG1 ratio. It is crucial that LNP-adjuvanted vaccines induced stronger Th1-type cytokine-producing CD4+ T cell and CD8+ T cell responses than Alum. The adjuvant activity of LNPs depended on the ionizable lipid components. Mechanistically, LNPs activated innate immune responses in a type I IFN-dependent manner and were partially dependent on Toll-like receptor (TLR) 9, thus affecting the adaptive immune responses of the vaccine. This conclusion was supported by RNA-seq analysis and in vitro cell experiments and by the deeply blunted T cell responses in IFNαR1-/- mice immunized with LNP-adjuvanted vaccines. This study not only identified LNPs as a high quality adjuvant for NoV VLP vaccines, but also clarified the underlying mechanism of LNPs as a potent immunostimulatory component for improving protein subunit vaccines.IMPORTANCEWith the rapid development of mRNA vaccines, recurrent studies show that lipid nanoparticles (LNPs) have adjuvant activity. However, the mechanism of its adjuvant effect in protein vaccines remains unknown. In this study, we found that the LNP-adjuvanted norovirus bivalent virus-like particle vaccines led to durable antibody responses as well as Th1-type cytokine-producing CD4+ T cell and CD8+ T cell responses, which exceeded the efficiency of the conventional adjuvant aluminum hydroxide. Mechanistically, LNPs activated innate immune responses in a type I IFN-dependent manner and were partially dependent on Toll-like receptor 9, thus affecting the adaptive immune responses of the vaccine. This work unveils that LNPs as a potent immunostimulatory component may be ideal for generating CD8+ T cell and B cell responses for recombinant protein vaccines.

Multiple Cross Displacement Amplification Combined with Real-Time Fluorescence Monitoring for Efficient, Specific, and Sensitive Neisseria meningitidis Detection

Invasive meningococcal disease, caused by Neisseria meningitidis (N. meningitidis), is a critical global health issue, necessitating swift and precise diagnostics for effective management and control. Here, we introduce a novel diagnostic assay, NM-RT-MCDA, that combines multiple cross displacement amplification (MCDA) with real-time fluorescence detection, targeting a specific ctrA gene region in the N. meningitidis genome. The assay utilizes a primer set designed for high specificity and incorporates a fluorophore-quencher pair with a restriction endonuclease site for real-time monitoring. Optimized at 65 °C for 40 min, NM-RT-MCDA demonstrates exceptional specificity, with no cross-reactivity observed with nontarget species. It achieves a remarkable sensitivity, detecting as low as 100 fg of genomic DNA per reaction, and has been successfully applied to clinical sputum samples, matching the sensitivity of nanoparticle-based lateral flow biosensors. The assay's rapid turnaround time, completed within an hour including DNA extraction and amplification, positions NM-RT-MCDA as a promising diagnostic tool for various clinical scenarios, potentially facilitating timely diagnosis and intervention in invasive meningococcal disease management.

The Dynamics of Antibody Titres Against SARS-CoV-2 in Vaccinated Healthcare Workers: A Systemic Literature Review

Background and Objectives: Given that COVID-19 vaccination is a relatively recent development, particularly when compared to immunisation against other diseases, it is crucial to assess its efficacy in vaccinated populations. This literature review analysed studies that monitored antibody titres against SARS-CoV-2 in healthcare workers who received COVID-19 vaccines. Methods: Using the PICO (Population, Intervention, Comparators, Outcomes) model recommended in the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines we included 43 publications which analyse antibody dynamics following primary vaccination, the effects of booster doses, and the influence of factors such as COVID-19C infection, age, and sex on antibody kinetics. Results: All the studies demonstrated a strong immunogenic response to the vaccines. Re-gardless of the vaccine used, over 95% of the pre-vaccination seronegative population be-came seropositive in all studies. Depending on the sampling intervals provided by the re-searchers, antibody levels were quantitatively highest during the first three months after vaccination, but levels inevitably declined over time. The monthly decline in antibodies observed in all these studies highlighted the necessity for booster doses. Studies analysing the impact of revaccination on antibody dynamics have confirmed that revaccination is an effective tool to boost humoral immunity against SARS-CoV-2. An-tibodies appear to persist for a longer period of time after revaccination, although they are subject to similar factors influencing antibody dynamics, such as age, comorbidities, and exposure to COVID-19. In addition, heterogeneous revaccination strategies have been shown to be more effective than homogeneous revaccination. Conclusions: Our review demonstrated that antibody levels against SARS-CoV-2 inevitably decline after vaccination, leaving the question of ongoing booster strategies open. The studies reviewed provided evidence of the effectiveness of booster vaccination, despite differences in age, sex, and prior COVID-19 infection. This suggests that repeated vaccination remains a highly effective method for mitigating the continued threat posed by COVID-19.

Factors associated with preterm birth and mother-to-child transmission in HIV-positive pregnant women in Henan, China, 2016-2022: a retrospective cohort study

INTRODUCTION

HIV can greatly impact the quality of life of pregnant women and may cause adverse pregnancy outcomes, such as preterm birth (PB) and mother-to-child transmission (MTCT). The purpose of this study was to analyse the influencing factors of PB and MTCT in HIV-positive pregnant women.

METHODS

HIV-positive pregnant women in Henan Province between January 2016 and December 2022 were selected for the study. Data were collected through the Management Information System for the Prevention of MTCT of HIV, syphilis and hepatitis B. Information on their demographic and clinical characteristics, treatment status and pregnancy outcomes was collected. A logistic regression model and χ2 automatic interaction detector (CHAID) decision tree model were used to analyse the correlation factors of PB and MTCT.

RESULTS

The average age of the 1073 study participants was 28.44 years, with an incidence of 11.93% for PB and 6.71% for MTCT. Hepatitis B virus or hepatitis C virus coinfection (OR=3.686, 95% CI 1.630 to 8.333) and Han nationality (OR=0.426, 95% CI 0.194 to 0.936) were risk factors for PB. Unknown HIV infection prior to pregnancy (OR=2.006, 95% CI 1.233 to 3.264) and primipara (OR=5.125, 95% CI 1.202 to 21.849) were risk factors for MTCT. The CHAID decision tree model was used to screen for the six and two influencing factors of PB and MTCT in HIV-positive women, respectively.

CONCLUSION

Early HIV testing, scientific counselling, precise maternal HIV infection assessment and targeted prevention measures can help prevent PB and MTCT in HIV-positive pregnant women.

West Nile virus encephalitis: Clinical characteristics and a comparison to other infectious encephalitides

PURPOSE

To compare functional outcomes and help differentiate between important causative agents of acute infectious encephalitis in adults, focusing on West Nile virus encephalitis (WNVE).

METHODS

The electronic database of Tel Aviv Medical Center was screened for patients admitted during 2010-2020 with acute encephalitis. Additionally, patient laboratory results during the same period were screened for CSF samples positive for common pathogens causing encephalitis. The main patient groups were compared in terms of clinical characteristics and functional outcomes.

RESULTS

One hundred and five infectious encephalitis patients were identified. WNVE patients (n = 31) and VZV encephalitis (VZVE) patients (n = 31) were older than HSV1 encephalitis (HSV1E) patients (n = 15) (median ages 73, 76, 51, respectively). WNVE patients had a more prominent inflammatory profile. CSF characteristics significantly differed between groups, with an extreme mononuclear white blood cell predominance in VZVE patients (median 98%). Functional outcomes at discharge were significantly worse in WNVE patients (median modified Rankin Scale score 4 at hospital discharge, 2.5 at last follow-up) when compared with HSV1E patients (2.5, 1, respectively) and VZVE patients (1.5, 1, respectively).

CONCLUSION

In odds with previous reports, WNVE and VZVE in this study were far more prevalent than HSV1E. Differences in clinical characteristics could prove clinically useful early in encephalitis, including an association of WNVE with a relatively prominent inflammatory profile (somewhat resembling a bacterial infection) and an extreme mononuclear white blood cell predominance in VZVE. The detrimental outcome of WNVE emphasizes the need to advance research on WNV infection.