Acute Infection Group Research Articles

Effect of omicron infection on maternal and neonatal delivery outcomes: A retrospective cohort study

BackgroundPeople are very concerned about the adverse effects of Omicron infection on delivery modes, duration of labor, and the postpartum status of pregnant women and neonates. Methods382 pregnant women (Omicron group: 136 cases; non-Omicron group: 246 cases) giving birth in our hospital were collected, demographic characteristics, vaccination, clinical manifestation and medication, delivery outcomes of pregnant women and neonates were recorded. Delivery outcomes were compared between the Omicron and non-Omicron groups, acute infection and non-acute infection groups to explore the relationship between adverse delivery outcomes and Omicron infection. ResultsPregnant women in the Omicron group had a longer hospitalization time (6.3 ± 3.6 days vs.5.5 ± 2.3 days), more 2-hour postpartum hemorrhage (291.7 ± 104.9 mL vs.262.7 ± 91.2 mL) and higher neonatal-pediatric transfer rate (20.6 % vs. 2.8 %), which might be associated with fetal distress, prenatal fever and pneumonia/respiratory distress. Neonates transferred to pediatrics due to jaundice were unique in the Omicron group. Fever-pregnant women have a more prolonged second stage of labor and hospital stay while coughing or expectoration ones have a shorter third stage of labor. Delivery outcomes did not differ whether the infected pregnant women were in the acute phase and whether to use antipyretics. ConclusionOmicron infection can increase the 2-hour postpartum hemorrhage volume and the neonatal-pediatric transfer rate. The symptoms can affect the duration of labor and hospital stay. However, whether the infected pregnant women are in the acute phase or use antipyretics do not affect the delivery outcome.

New insights into swine dysentery: faecal shedding, macro and microscopic lesions and biomarkers in early and acute stages of Brachyspira hyodysenteriae infection

BackgroundSwine dysentery (SD) is a severe mucohaemorrhagic colitis in pigs caused classically by Brachyspira hyodysenteriae. Although several aspects of B. hyodysenteriae infection dynamic are already described, further research in the early stage of this infection is required. In this study, 7-week-old pigs were orally challenged with B. hyodysenteriae to obtain information about faecal shedding, macro and microscopic intestinal lesions and serum acute phase proteins in pigs at the onset of B. hyodysenteriae shedding (early infection group, n = 8), in pigs with mucohaemorrhagic diarrhoea (acute infection group, n = 8) and in non-infected controls (n = 16).ResultsFirst B. hyodysenteriae detection by q-PCR and first loose stools with blood and mucus occurred both at 8 days post-inoculation. The lapse between a positive q-PCR and observation of mucohaemorrhagic diarrhoea ranged from 0 to 3 days, except in a single pig in which this period lasted 5 days. Macroscopic lesions were observed in the large intestine from both infected groups although more frequent and severe in acute infection group. Microscopic observation of the apex mucosa revealed that in early infection only higher ulceration values were observed compared to healthy controls. In contrast, the acute infection group exhibited higher ulceration, neutrophils infiltration and increased mucosal thickness compared to the other two groups. Among the serum biomarkers tested, only haptoglobin, C-reactive protein, and creatine kinase showed a significant increase in pigs in the acute infection period compared to controls, whereas haptoglobin was the only factor with a significant increase at the early infection compared to non-infected animals.ConclusionsThis study provides new insights about SD and remarks the complex and limited options to perform an early detection of infected animals beyond PCR diagnosis.

Direct-Acting Antiviral Treatment for Acute Hepatitis C in Japanese Patients: Clinical Course and Outcomes.

We diagnosed six cases of acute hepatitis C virus (HCV) infection at our hospital between October 2003 and December 2022. During the same period, we diagnosed 402 cases of chronic HCV infection and 636 cases of acute hepatic injury. Acute HCV infection cases accounted for 1.4% of all HCV infections and 0.9% of all acute hepatic injury cases. The acute HCV infection group was younger, had more severe hepatitis, and exhibited higher levels of bilirubinemia compared to the chronic HCV infection group. Two acute HCV infection cases achieved spontaneous viral clearance, while the remaining four cases progressed to chronic infection and were treated with direct-acting antivirals (DAAs). Liver enzyme elevation and liver function deterioration did not differ significantly between the acute HCV and other acute liver injury groups. Notably, DAA treatment was equally effective for acute and chronic HCV cases (75% vs. 90%, p = 0.34). Early DAA treatment in acute cases might contribute to interrupting viral transmission among high-risk populations, such as people who inject drugsor men who have sex with men. While there are currently no specific guidelines for acute HCV infection treatment in Japan, our findings suggest that DAA therapy should be initiated immediately following diagnosis. Further studies with larger patient cohorts are warranted to confirm these observations.

Higher diagnostic value of metagenomic next-generation sequencing in acute infection than chronic infection: a multicenter retrospective study.

The aim of this study is to compare the diagnostic value of metagenomic next-generation sequencing (mNGS) vs. conventional culture methods (CM) in chronic infection and acute infection. We retrospectively analyzed the bronchoalveolar lavage fluid (BALF) of 88 patients with acute infection and 105 patients with chronic infection admitted to three hospitals from 2017 to 2022. The results showed that the sensitivity and specificity of mNGS were higher than those of CM. The number of patients who changed the antibiotic treatment in the mNGS positive group was larger than that of patients in the mNGS negative group in both the acute infection group (60.5 vs. 28.0%, P = 0.0022) and chronic infection group (46.2 vs. 22.6%, P = 0.01112). High levels of temperature (OR: 2.02, 95% CI: 1.18-3.70, P: 0.015), C-reactive protein (CRP) (OR: 15, 95% CI: 2.74-280.69, P: 0.011), neutrophil count (OR: 3.09, 95% CI: 1.19-8.43, P: 0.023), and low levels of lymphocyte count (OR: 3.43, 95% CI:1.26-10.21, P: 0.020) may lead to positive mNGS results in the acute infection group while no significant factor was identified to predict positive results in the chronic infection group. mNGS could provide useful guidance on antibiotic strategies in infectious diseases and may be more valuable for the diagnosis and treatment of acute infection vs. chronic infection.

Epstein–Barr virus downregulates the α7 nicotinic acetylcholine receptor of CD8+ T lymphocytes might associate with coronary artery lesions in Kawasaki disease patients

ObjectivesKawasaki disease (KD) is a systemic vasculitis that is caused by immunological dysregulation in children exposed to pathogens like Epstein–Barr virus (EBV). Myocardial ischemia or infarction due to coronary artery lesions (CALs) might be lethal. However, it is unclear how pathogens, immunomodulation, and CALs interact, particularly in KD patients co-infected with the most widespread virus, EBV. MethodsWe investigated pathogen carriage and fundamental clinical data in 281 KD patients. Immunological differences between CALs and non-CALs in KD patients under different conditions were analyzed. Then, the effect of infection by different pathogens on the immune response was excluded, and most EBV co-infected KD patients were included to assess the incidence of CALs, the level of immune modulation, and regulatory mechanisms in different EBV infection states. ResultsOur results showed multiple pathogenic infections occur in KD patients, with EBV being the most prevalent. The incidence of CALs in the EBV-DNA (+) acute infection group, EBV-DNA (−) acute infection group, and EBV latent infection group was 0 (0/6), 27.27% (3/11) and 41.67% (10/24), respectively. The two groups were younger and had increased IL-6 levels and B cells, decreasing CD8+ T cells than the EBV-DNA (+) acute infection group. Interestingly, the increased B cells were not associated with immunoglobulin release. Additionally, these patients down-regulated α7 nicotinic acetylcholine receptor (α7nAChR) and downstream molecule PI3K/AKT/mTOR while activating the NF-κB. ConclusionPatients with different EBV infection statuses exhibit different incidences of CALs. In acute EBV-DNA (−) infected and latent EBV-infected patients, the number of CD8+ T cells decreased and downregulated CD8+ T cells' α7nAChR and PI3K/AKT/mTOR, which may associate with CALs, while the expression of NF-κB and the pro-inflammatory factor IL-6 was upregulated by inhibiting the anti-inflammatory molecule α7nAChR.

How symptoms of simple acute infections affect the SSS-8 and SSD-12 as screening instruments for somatic symptom disorder in the primary care setting.

Somatic symptom disorder (SSD) is one of the most common reasons for consultations in primary care, in addition to simple acute infections. Questionnaire-based screening instruments to identify patients at high risk of SSD are thus of great clinical relevance. Although screening instruments are frequently used, it is currently unclear to what extent they are influenced by the concurrent presence of simple acute infections. Therefore, this study aimed to investigate how symptoms of simple acute infections affect the two established questionnaires as screening instruments for somatic symptom disorder in the primary care setting. In our cross-sectional, multicenter design, a total of 1,000 patients in primary care practices were screened using the two most established SSD screening questionnaires, the 8-item Somatic Symptom Scale (SSS-8) and the 12-item Somatic Symptom Disorder-B Criteria Scale (SSD-12), followed by clinical assessment by the primary care physician. A total of 140 patients with a simple acute infection (acute infection group, AIG) and 219 patients with chronic somatic symptoms (somatic symptom group, SSG) were included. The patients in the SSG showed higher total SSS-8 and SSD-12 scores than the patients in the AIG; however, the SSS-8 was more susceptible to changes triggered by symptoms of a simple acute infection than the SSD-12. These results suggest that the SSD-12 is less susceptible to symptoms of a simple acute infection. Its total score and corresponding cutoff value provide a more specific and thus less susceptible screening tool for identifying SSD in primary care.

Are International Units of Anti-HBs Antibodies Always Indicative of Hepatitis B Virus Neutralizing Activity?

Anti-HBs antibodies are elicited upon hepatitis B vaccination, and concentrations above 10 mIU/mL are considered protective. Our aim was to assess the relationship between IU/mL of anti-HBs and neutralization activity. Immunoglobulins G (IgGs) were purified from individuals who received a serum-derived vaccine (Group 1), a recombinant vaccine, Genevac-B or Engerix-B (Group 2), or who recovered from acute infection (Group 3). IgGs were tested for anti-HBs, anti-preS1, and anti-preS2 antibodies and for their neutralizing activity in an in vitro infection assay. Anti-HBs IUs/mL value did not strictly correlate with neutralization activity. The Group 1 antibodies demonstrated a greater neutralizing activity than those of Group 2. Anti-preS1 antibodies were detected in Groups 1 and 3, and anti-preS2 in Group 1 and Group 2/Genhevac-B, but the contribution of anti-preS antibodies to neutralization could not be demonstrated. Virions bearing immune escape HBsAg variants were less susceptible to neutralization than wild-type virions. The level of anti-HBs antibodies in IUs is not sufficient to assess neutralizing activity. Consequently, (i) an in vitro neutralization assay should be included in the quality control procedures of antibody preparations intended for HB prophylaxis or immunotherapy, and (ii) a greater emphasis should be placed on ensuring that vaccine genotype/subtype matches with that of the circulating HBV.

Dysregulation of memory B cells and circulating T follicular helper cells is a predictor of poor immune recovery in HIV‐infected patients on antiretroviral therapy

T follicular helper (Tfh) cells and their interactions with B cells within the germinal center play extensive roles in human immunodeficiency virus (HIV) pathology. However, their association with immune reconstitution during antiretroviral therapy (ART) is still unclear. The aim of this study was to determine the impact of Tfh and memory B cell function on T helper cell recovery in patients with acute or chronic HIV infection. A total of 100 HIV-infected individuals were enrolled in our study, classified into acute and chronic HIV infection groups (60 and 40, respectively), and subsequently classified into immunological responder (IR) and immunological nonresponder (INR) subgroups according to immune recovery outcomes after 96 weeks of ART. Liquid chromatography-mass spectrometry was used to quantify the temporal regulation patterns of B and CD4+ T-cell profiles among patients, and flow cytometry was used to investigate certain subsets of B and T cells. Here we showed that the prevalence of Tfh cells in the T helper cell population correlated negatively with CD4+ T-cell recovery. The proportion of CXCR3- Tfh cells in patients with acute or chronic infection was associated with CD4+ T-cell count recovery, and the proportion of CD21+ memory B cells at baseline was significantly higher in those with improved immune recovery outcomes. Universal proteomic dysregulation of B and CD4+ T cells at baseline was detected in patients with acute infected and poor CD4+ T-cell recovery. Proteomics analysis revealed distinct temporal regulation profiles of both T helper cells and B cells between IRs and INRs among patients with acute infection. Our results suggest that the functions of memory B cells in INRs are dysregulated at the early stage of ART, possibly through disruption of Tfh cell function. The frequency and function of Tfh cells and their subsets are potential predictors of poor immune recovery.

HPB P06 Availability of healthy human liver segments for ethical pre-clinical research: a tertiary centre experience

Abstract Background There is a well-documented scarcity of the availability of healthy human livers for transplantation. The majority of discarded donor livers are used for organ preservation studies in the context of liver transplantation. Hemi-hepatectomies are a common procedure performed in tertiary hepatobiliary units. The specimen, also consisting of healthy liver, is eventually discarded despite the presence of healthy human liver tissue which would be invaluable for research. In 1959, Russel and Burch described the “3Rs” of animal research as replacement, reduction, and refinement (Flecknell, 2002). Optimising the use of hemi-hepatectomy human liver tissue for research would reduce the need for live animals and provide a more economical and physiological model to study invasive hepatic disease. Ex vivo perfusion of human hepatic segments has enormous potential and we are currently investigating this tool to be used as a translational model for invasive disease, including macrophage response to the earliest phases of infection, as demonstrated in porcine organs by Wanford et al (2021). Methods This retrospective service evaluation project was registered locally with audit registration numbers 11852 and 11852a. All liver resections booked electronically over a six month period, between 1/10/20 and 31/3/21, were assessed. Patient records, including intra-operative notes, were reviewed to identify which patients had a partial hepatectomy (left hemi-hepatectomy, right hemi-hepatectomy, or left lateral segmentectomy). The data was then compared against histology reports to identify which segments from the specimen were pathological and which segments were disease-free. A prospective Research Ethics Committee-approved clinical trial was registered by the name of “Tissue Models for Liver Disease” or TIMOLD (ClinicalTrials.gov Identifier: NCT05255042; 8/9/2021). Patients recruited were those aged eighteen or over undergoing elective liver resections. Exclusion criteria included those with acute invasive infection, children and vulnerable groups. A re-audit was performed following implementation of the TIMOLD study for the same time period the following year, between 1/10/21 and 31/3/22. Data analysis was performed using GraphPad Prism. Results Between 1/10/20 and 31/3/21, 43 liver resections were listed. Intra-operatively, 3/43 patients had inoperable disease and 2/43 did not require a resection. Of the 38 liver resections performed, 30 (79%) were for colorectal liver metastases (CRLM), 4/38 (11%) were for hepatocellular carcinoma (HCC), and the remainder for cholangiocarcinoma, neuroendocrine tumours and adenomas. 19/38 (50%) liver resections were a hemi-hepatectomy or left lateral segmentectomy. Histology review found that 11/19 (58%) specimens contained at least one healthy liver segment which was eventually discarded. Between 1/10/21 and 31/3/22, following implementation of the TIMOLD study, 57 liver resections were listed. 6/57 patients were found to have inoperative disease and 1/57 did not require a resection. Of 50 liver resections, 32/50 (64%) were for CRLM, 9/50 (18%) were for HCC and the remainder for cholangiocarcinoma, neuroendocrine tumours, IPMN and benign disease. 27/50 (54%) had a hemi-hepatectomy or left lateral segmentectomy. 17/27 (63%) partial hepatectomies were found to contain at least one healthy liver segment with potential for research use. As part of the TIMOLD trial, 8/17 healthy liver segments were retrieved and used for research during a six-month period, in comparison to none the previous year (p<0.05; Chi-Squared). Conclusions We demonstrate that at least 50% of patients undergoing liver resection at a tertiary HPB unit require a hemi-hepatectomy or left lateral segmentectomy over 12 months. Furthermore, at least half of these partial resections involve healthy anatomical liver segments as part of the specimen. Over six months, eight disease-free human liver segments, which would otherwise have been discarded, were perfused ex vivo in an attempt to develop a model representing human hepatic physiology at the organ level. Expanding this research model to other hepatobiliary units provides scientists an invaluable model for pre-clinical research, negating the need for live animal experimentation.

Two-year Decay of Zika Virus Neutralizing Antibodies in People Living in an Endemic Region in Brazil.

It is currently not clear whether humoral immunity to Zika virus (ZIKV) elicited upon natural ZIKV infection is long-lasting. In addition, cross-reactivity of anti-ZIKV antibodies with antigenically related dengue viruses (DENV) may have biological implications in nonnaive individuals who subsequently acquire a heterotypic infection. Cross-reactive humoral immunity between ZIKV and DENV also complicates the interpretation of serological tests to evaluate previous exposure to either virus. Here, we have measured the 2-year decay of ZIKV neutralizing antibodies in people living in a ZIKV/DENV endemic area in Brazil who were identified as having an acute infection (group 1) or past (but recent) infection (group 2) with ZIKV in 2015-16. The titers of neutralizing antibodies to ZIKV decreased 9.1 and 2.3 times in groups 1 and 2, respectively. We also show that the plaque reduction neutralization assay (PRNT) is a reliable method to measure past exposure to ZIKV in coendemic areas.

Evaluation of the serum level of CRP for diagnosing acute periprosthetic infection after TKA*

Objective: To determine the serum level of C-reactive protein (CRP) with greater accuracy for diagnosing acute periprosthetic infection after total knee arthroplasty (TKA). Method: Case-control study evaluating serum levels of CRP after TKA in infected and uninfected groups. The serum levels of CRP were assessed in patients submitted to TKA who had been readmitted in the acute phase for surgical debridement with implant retention and had their diagnosis of periprosthetic infection confirmed. These values were compared with a control group, which did not present infectious complications. Results: Between March 2014 and March 2016, 1,373 TKAs were performed in the institution, and 28 patients (0.49%) were readmitted in the acute phase with a diagnosis of periprosthetic infection. Sixteen patients met the inclusion criteria. Gender, skin color, age, and body mass index (BMI) were similar between the groups. The patients in the acute periprosthetic infection group had significantly higher mean serum levels of CRP than the control group (p<0.001). For CRP levels = 30.615, the test's highest sensitivity (75%) and specificity (77%) were achieved, with an accuracy of 77.3% for the diagnosis of infection. The area under the 0.762 Receiver Operating Characteristics (ROC) curve showed satisfactory performance of the proposed test. Conclusion: Serum levels of CRP greater than 30.615 mg/L in the third week after TKA associated with clinical signs are highly suggestive of acute periprosthetic infection.Keywords: Knee; Osteoarthritis; Arthroplasty; Infection; CRP.*Study performed at the Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brazil.

Machine Learning-Based Feature Selection and Classification for the Experimental Diagnosis of Trypanosoma cruzi

Chagas disease, caused by the Trypanosoma cruzi (T. cruzi) parasite, is the third most common parasitosis worldwide. Most of the infected subjects can remain asymptomatic without an opportune and early detection or an objective diagnostic is not conducted. Frequently, the disease manifests itself after a long time, accompanied by severe heart disease or by sudden death. Thus, the diagnosis is a complex and challenging process where several factors must be considered. In this paper, a novel pipeline is presented integrating temporal data from four modalities (electrocardiography signals, echocardiography images, Doppler spectrum, and ELISA antibody titers), multiple features selection analyses by a univariate analysis and a machine learning-based selection. The method includes an automatic dichotomous classification of animal status (control vs. infected) based on Random Forest, Extremely Randomized Trees, Decision Trees, and Support Vector Machine. The most relevant multimodal attributes found were ELISA (IgGT, IgG1, IgG2a), electrocardiography (SR mean, QT and ST intervals), ascending aorta Doppler signals, and echocardiography (left ventricle diameter during diastole). Concerning automatic classification from selected features, the best accuracy of control vs. acute infection groups was 93.3 ± 13.3% for cross-validation and 100% in the final test; for control vs. chronic infection groups, it was 100% and 100%, respectively. We conclude that the proposed machine learning-based approach can be of help to obtain a robust and objective diagnosis in early T. cruzi infection stages.

YKL-40 as a novel diagnostic biomarker in Toxoplasmosis.

Toxoplasmosis is one of the most globally prevalent zoonotic infection caused by an obligate, intracellular parasite called Toxoplasma gondii. Toxoplasmosis actively triggers an acute immune response and inflammatory reactions, which causes serious pathological changes in various tissues in the human body, and more evidently localizes in different nervous tissues of various body organs. The YKL-40 is a glycoprotein secreted by numerous cell types in different patterns associated with various pathological processes such as inflammatory reactions, tissue remodeling, and fibrosis, and is a disease-specific biomarker of neuroinflammation. Therefore, this study aimed to determine whether the YKL-40 is markedly increased in toxoplasmosis or not and whether its level is different between the acute and chronic phases of the infection to determine if it can be used as a clinically useful biomarker in the diagnosis, and determination of disease severity and follow-up of toxoplasmosis. Accordingly, a total of 80 serum samples were collected from previously diagnosed female patients of different ages with toxoplasmosis. In addition, serum samples of 10 healthy females were used as the control. Patients were first divided into two groups (30 patients with acute infection, and 50 patients with chronic infection) depending on the results of detection of specific anti-Toxoplasma IgM and IgG by enzyme-linked immunosorbent assay (ELISA). The level of YKL-40 was then measured in the patients' serum by ELISA. The statistical analysis of data clearly disclosed very highly significant differences (P < 0.001) between the level of YKL-40 in the acute infection group and healthy controls, chronic infection group and healthy controls, and between the groups with acute and chronic infections. These findings led to conclude that YKL-40 classify as a unique and sophisticated biomarker in the diagnosis of toxoplasmosis where it can vitally be used to detect the stage of the disease, whether acute or chronic, besides its ability to detect the infection.

Antepartum acute maternal infection: Is the preterm neonate protected?

One of two preterm neonates born < 29 weeks gestational age exhibits some degree of cerebral white matter injury, the etiology of which remains unclear. We hypothesized that systemic maternal inflammation from infection leads to fetal neuroinflammation, which has a strong role in the pathogenesis of poor short-term and long-term neonatal outcomes. The aim of this study was to examine the relationship between antepartum maternal infection and short-term neonatal outcomes. We conducted a retrospective cohort study of preterm neonates < 29 weeks of gestational age born at our institution from 01/2010-12/2020. We excluded those with neonates receiving comfort care in the delivery room or with congenital or chromosomal abnormalities. Maternal data was extracted including co-morbidities, obstetric outcomes and complications, and maternal infections and treatments. Maternal antepartum infection status was categorized as (1) no infection, (2) non-severe acute infection and (3) severe acute infection. Infant data extracted included short-term outcomes of bronchopulmonary dysplasia, necrotizing enterocolitis, sepsis, intraventricular hemorrhage, pneumothorax, pneumonia, pulmonary hypertension, days ventilated, days on CPAP, and maximum FiO2. Analyses included c2, Fisher’s exact test, one-way analysis of variance, and Kruskal-Wallis test with p < .05 considered significant. 1121 neonates were born < 29 weeks to 983 women; 788 (70.3%) had no infection documented prenatally, 240 (21.4%) an acute non-severe infection, and 93 (8.3%) an acute severe infection. Rates of prolonged rupture of membranes were higher in the severe acute infection group whereas rates of preeclampsia and cesarean section were lower (Table 1). The presence of any acute infection did not correlate with short-term neonatal outcomes (Table 2). Acute maternal infection does not correlate with short-term neonatal outcomes. The neonate may be protected from maternal inflammation through placental-mediate mechanisms.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

#49: Management and Outcomes of Infants Born to Mothers with SARS-CoV-2 Infection in Pregnancy

BackgroundSARS-CoV-2 infections during pregnancy continue in this ongoing pandemic. Care of mother-infant dyads affected by SARS-CoV-2 infection in pregnancy has evolved. Perinatal viral transmission is rare. However, there remain few detailed reports on characteristics and management of these infants during neonatal hospitalization. Our objective was to investigate management and outcomes of infants born to women with laboratory-confirmed SARS-CoV-2 infection in pregnancy including resuscitation, NICU care, separation, and breastfeeding.MethodsThis is a study of mother-infant dyads with SARS-CoV-2 in pregnancy at Prentice Women’s Hospital in Chicago, IL (3/2020-11/2020). Dyads were tracked prospectively with data obtained by review of electronic medical records including demographics, maternal clinical history, COVID symptoms, and neonatal course. Women were universally screened with SARS-CoV-2 PCR at admission. Mothers were categorized as 1) acute infection (-14–0 days from delivery) vs. previous infection (>14 days), and 2) symptomatic vs. asymptomatic (defined by CDC criteria). Infants of mothers with acute infection were tested for SARS-CoV-2.ResultsWe report a diverse cohort of 210 women with SARS-CoV-2 in pregnancy, 114 acute and 96 previous infection (range 0–229 days between positive PCR and delivery) [Table 1]. Over half (56%) of women were symptomatic, 29/114 (25%) with acute infection, 89/96 (93%) with previous infection. Of 211 infants, one asymptomatic infant tested positive for SARS-CoV-2. The overall rate of preterm birth was 10.9% in this cohort. The rate of preterm birth was 26.6% (8/30) in the symptomatic acute infection group (p=0.055) and birthweight was significantly lower (p=0.03). There was no apparent increased need for resuscitation at delivery. APGARs were 8 (8–9) and 9 (8–9) at 1 and 5 minutes, respectively. Six percent of infants >35 weeks had respiratory distress. About 7% had failed hearing screen (historic Prentice rate ~4%). Separation of infants from mothers with acute infection decreased over time due to policy changes based on available safety data for rooming in (Cuzick’s test for trend p<0.001). Most infants (75%) received breastmilk in the hospital over this timeframe; this was low initially and increased over this timeframe (p<0.001). For example, 45% of mothers with acute infection provided breastmilk in May compared to nearly 100% in November. Twelve women were diagnosed with chorioamnionitis due to fever in labor and also had acute SARS-CoV-2 infection.ConclusionInfants of mothers with SARS-CoV-2 in pregnancy had favorable short-term outcomes, with decrease in separation and increase in breastfeeding over this timeframe. Complex factors likely contribute to differences in birthweight and prematurity in the acute symptomatic group. Isolated fever in the setting of acute SARS-CoV-2 presents a dilemma regarding maternal chorioamnionitis, resulting in antibiotic exposure. Longitudinal follow-up is needed to determine infant outcomes (true hearing loss, development) following maternal SARS-CoV-2 infection.Table 1:Characteristics and Outcomes of Infants of Women with SARS-CoV-2 Infection in PregnancyTotal N=211 1 twinAcute Infection(n= 115)Previous Infection(n = 96)Symptomatic# Acute Infection(n = 30)Symptomatic# Previous Infection(n = 89)p-value*Agemean (std)30.5 (6.2)29. 8 (6.1)31.4 (6.2)30.5 (6.3)31.7 (6.1)0.06 0.36Maternal Racen (%)<0.01 0.20Black/African American45 (21%)35 (30%)10 (10%)7 (23%)10 (11%)White61 (29%)30 (26%)31 (32%)7 (23%)29 (33%)Asian8 (4%)5 (4%)3 (3%)2 (7%)3 (3%)American Indian or Alaskan Native1 (0.5%)1 (1%)01 (3.5%)0Other96 (46%)44 (38%)52 (54%)13 (43%)47 (53%)Latina/Hispanicn (%)110 (52%)51 (44%)59 (62%)15 (50%)53 (60%).03 .39Days between test and delivery0 - 3 days91 (43%)91 (79%)14 (47%)4 - 14 days24 (11%)24 (21%)15 (50%)15 - 60 days49 (23%)49 (51%)49 (55%)61 - 120 days31 (15%)31 (32%)28 (32%)121+16 (8%)16 (17%)15 (17%)Vaginal delivery147 (70%)79 (69%)68 (71%)18 (60%)63 (71%)0.81 0.38Gestational age at birth0.67^ 0.055^<32 weeks2 (1%)1 (1%)1 (1%)1 (4%)1 (1%)32–36 weeks21 (10%)11 (10%)10 (10%)7 (23%)8 (9%)37+ weeks188 (89%)103 (90%)85 (89%)22 (73)80 (90%)Birth weight (g) mean (std dev)3263 (550)3264 (583)3263 (511)2997 (640)3260 (517)0.88 0.03NICU admission39 (18%)23 (20%)16 (17%)10 (31%)15 (17%)0.53 0.06ResuscitationDry and Stimulation151 (72%)96 (83%)55 (57%)24 (79%)52 (58%)<0.01 0.04Oxygen/Positive pressure19 (9%)9 (7%)10 (10%)5 (14%)10 (11%)0.46 0.74Intubation4 (2%)3 (2%)1 (1%)1 (4%)1 (1%)0.62 0.43Volume Expansion1 (0.5%)1 (1%)000Hearing screen failed196 (93%)109 (96%)87 (91%)28 (97%)80 (90%)0.26 0.58Respiratory distress17 (8%)12 (8%)5 (5%)7 (21%)5 (6%).21 .01Infants >35 weeks gestation12/199 (6%)7/108 (7%)5/87 (6%)4/27 (15%)5/84 (6%)1 0.21Administration of antibiotics30 (14%)20 (17%)10 (10%)9 (30%)9 (10%)0.15 <0.01Maternal chorioamnionitis20 (10%)12 (10%)8 (8%)2 (7%)8 (9%)0.64 0.99#Symptomatic infection was defined as any symptom consistent with SARS-CoV-2 infection/COVID-19 including fever, upper or lower respiratory symptoms, nausea, vomiting, diarrhea, myalgia/fatigue, anosmia*The top p-value listed comapres pregnancies affected by acute vs. previous infection. Bottom p-value listed compares only symptomatic acute vs. symptomatic previous infection. Comparisons were by Chi-square and Fisher’s exact tests.^Comparing dichotomized preterm (<37 weeks) vs full term

Changes in circulating follicular helper T cells in peripheral blood of patients with acute hepatitis C virus infection.

To investigate the changes in circulating follicular helper T cells (cTfh) in peripheral blood of patients with acute hepatitis C virus (HCV) infection and its correlation with symptom severity of the disease. A total of 105 subjects were enrolled in this study, including 35 healthy people, 35 patients with acute HCV infection and 35 acute HCV patients with antiviral therapy. Flow cytometry was used to detect the expression of molecular markers related to the surface of cTfh cells, such as CD69, HLA-DR and CD57, and ELISA was used to detect the secretion of cytokines (IL-21, IL-4) in each group. The relationship between these markers and disease was analyzed statistically. Flow cytometry analysis demonstrated that the percentage of CD69 in peripheral blood of patients with acute hepatitis C infection was (18.90%±9.29%) significantly higher than that of normal control group (5.10%±4.21%) and antiviral treatment group (11.50%±5.38%). The difference was statistically significant (P<0.05). The results of HLA-DR and CD57 were consistent with CD69. The serum levels of IL-4 and IL-21 in the acute HCV infection group were significantly higher than those in the treatment and the control groups. After antiviral treatment, IL-4 and IL-21 levels significantly decreased but remained higher than those in the control group. This showed that antiviral treatment was effective, and the difference was statistically significant (P<0.05). The ratio of cTfh in infected group was negatively correlated with HCV RNA content (r=-0.6858, P=0.0028). Antiviral immune response in patients with acute hepatitis C infection may be related to the proportion of T helper cells in peripheral blood circulation follicles. Dynamic detection of the number of T helper cells in clinical practice is conducive to identifying more effective methods to treat acute hepatitis C infection, which has important theoretical and clinical significance.

Study on acute HIV-1 infection in men who have sex with men in Tianjin

Objective: To understand the immunological and virological characteristics of HIV-1 infected men who have sex with men (MSM) in the acute phase in Tianjin and evaluate the effects of the fourth generation HIV ELISA and the P24 ELISA for acute HIV-1 infected samples. Methods: From October 2015 to October 2016, MSM were recruited through the community-based organizations in Tianjin. All the participants received rapid HIV test, positive samples were confirmed by Western Blot and negative samples underwent pooled nucleic acid testing. The participants with HIV-1 RNA reactive result underwent testing for viral load and T-cell count after second blood collection. Acute HIV-1 infection was defined as negative rapid HIV test result and the positive results of two HIV RNA tests, then the sensitivity were compared between the fourth generation HIV ELISA and the P24 ELISA to detect the initial HIV-1 RNA positive samples. Results: Among 3 016 MSM screened, 193 were positive in rapid HIV test. Western blot testing indicated that 179 cases were HIV positive, 7 cases were HIV indeterminate and 7 cases were negative. Of 2 823 sero-negative cases, 17 were acute HIV-1 infections. The HIV-1 infection rate was 6.53% (197/3 016) and the acute HIV-1 infection rate was 0.56% (17/3 016), with an average viral load of (5.63±1.50) log(10) copies/ml, an average CD(4) count of (442.82±268.17) cells/μl, an average CD(8) count of (1 069.65±668.22) cells/μl and an average CD(4)/CD(8) ratio of (0.49±0.25). Higher viral load, CD(4) and CD(4)/CD(8) ratio were seen in the acute HIV-1 infection group compared with the chronic HIV-1 infection group (U=148, P<0.01; U=272, P=0.042 and t=3.147, P=0.005). Demographic characteristics were similar between two groups, except the occupation (χ(2)=11.016, P=0.026). The sensitivity of P24 ELISA was higher than the fourth generation HIV ELISA in the HIV-1 detection for acute infection (Fisher's exact test, P=0.017). Conclusions: MSM are at risk for acute HIV-1 infection. Screening for acute HIV-1 infection with P24 ELISA would increase the sensitivity of diagnosis and reduce HIV transmission in MSM.

Serum CXCL10, CXCL11, CXCL12, and CXCL14 chemokine patterns in patients with acute liver injury

Background & aimsThe chemokines CXCL10 (interferon ϒ-inducible protein 10 [IP-10]), CXCL11 (Human interferon inducible T cell alpha chemokine [I-TAC]), CXCL12 (stromal cell derived factor 1 [SDF-1]), and CXCL14 (breast and kidney-expressed chemokine [BRAK]) are involved in cell recruitment, migration, activation, and homing in liver diseases and have been shown to be upregulated during acute liver injury in animal models. However, their expression in patients with acute liver injury is unknown. Here, we aimed to provide evidence of the presence of circulating CXCL10, CXCL11, CXCL12, and CXCL14 during human acute liver injury to propose new inflammation biomarkers for acute liver injury. MethodsWe analyzed the serum concentration of the studied chemokines in healthy donors (n = 36) and patients (n = 163) with acute liver injuries of various etiologies. ResultsSerum CXCL10, CXCL11 and CXCL12 levels were elevated in all the studied groups except biliary diseases for CXCL11. CXCL14 was associated with only acute viral infection and vascular etiologies. The strongest correlation was found between the IFN-inducible studied chemokines (CXCL10 and CXCL11) in all patients and more specifically in the acute viral infection group. ConclusionThese data provide evidence for the presence of circulating CXCL10, CXCL11, CXCL12, and CXCL14 during acute liver injury and are consistent with data obtained in animal models. CXCL10, CXCL11 and CXCL12 were the most highly represented and CXCL14 the least represented chemokines. Differential expression patterns were obtained depending on acute liver injury etiology, suggesting the potential use of these chemokines as acute liver injury biomarkers.

Serological survey of Toxoplasma gondii infection in women with adverse pregnancy outcomes in Longhua region, Hebei Province

To understand the status of Toxoplasma gondii infection in women with adverse pregnancy outcomes in Longhua region, Hebei Province. A total of 393 women with adverse pregnancy outcomes were chosen as respondents in the Longhua County Maternal and Child Health Care Center between January 2013 and June 2016 and were divided into an acute infection group, a previous infection group, and an active infection group according to the test results. Totally 256 women without adverse pregnancy outcomes were selected as a control group. IgM and IgG antibodies to T. gondii were detected by using ELISA in each group. The risk factors of T. gondii infection were surveyed by questionnaires. The T. gondii infection rate of the women with adverse pregnancy outcomes was 27.23% (107/393), which was significantly higher than 8.20% (21/ 256) in the control group (χ2 = 35.46, P＜0.01). The rates of acute infection, previous infection, active infection in the women with adverse pregnancy outcomes were 6.87% (27/393), 18.58% (73/393), and 2.54% (10/393) respectively, which was significantly higher than those［1.17% (3/256), 7.03% (18/256), 0 (0/256) ］in the control group (χ2 = 11.43, 17.15, 7.90 respectively, P＜0.01). The ratios of the career in contact with raw meat, feeding pets (dog and cat), tasting raw meat, chopping board regardless of uncooked or cooked food, frequently eating rinsing boiler or barbecue, frequently eating outside of the women with T. gondii infection were significantly higher than those of the women without T. gondii infection (χ2 ＝12.08, 29.23, 8.55, 13.41, 7.28, 6.06 respectively, P < 0.01 or 0.05). T. gondii infection could lead to serious adverse pregnancy outcomes. Therefore, to avoid contacting with pets, not eating undercooked food, and strengthening personal health protection are the important keys to avoid T. gondii infection.

Differences in Rab protein expressions in McCoy cells with acute versus persistent Chlamydia trachomatis infection

Objective To investigate differences in Rab protein expressions in McCoy cells with acute versus persistent Chlamydia trachomatis (Ct)infection. Methods Cultured McCoy cells were infected with different amounts(400, 500, 550 μl/well)of Ct strain D suspensions , then cultured with the medium containing 100 U/ml penicillin G(persistent Ct infection groups)or that without penicillin G (acute Ct infection groups). Ctuninfected McCoy cells receiving no penicillin G treatment served as the blank control group, and those receiving penicillin G treatment as the penicillin group. After 48-hour culture, McCoy cells were lysed, proteins were collected, and total RNA was extracted from the cells. Enzyme-linked immunosorbent assay (ELISA)was conducted to measure protein levels of Rab4A, Rab6A, Rab10, Rab11A and Rab14, and fluorescence-based quantitative PCR to quantify mRNA expressions of Rab4A and Rab14 (expressed as 2-ΔΔCt). Results Protein levels of Rab4A, Rab6A, Rab10, Rab11A and Rab14 were all significantly lower in the acute than in the persistent Ct infection groups (all Z = 3.621, P 0.05). In addition, the expressions of Rab4A and Rab14 mRNAs were consistent with those of their proteins in these groups. Conclusion The transcriptional and expression levels of Rab proteins are higher in McCoy cells persistently infected with Ct than in those acutely infected with Ct. Key words: Chlamydia trachomatis; Chlamydia infections; rab GTP-binding proteins; Acute infection; Persistent infection; McCoy cells