Airborne Route Research Articles

Transmission Routes and Prevention Strategies of Multidrug-Resistant Organism Infections in Hospitals

With the spread of multidrug-resistant organisms (MDROs) in hospitals, infection control faces significant challenges. MDROs refer to microorganisms resistant to three or more antimicrobial agents, commonly including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and extended-spectrum β-lactamase-producing bacteria (ESBL). These resistant organisms primarily transmit through direct contact, indirect contact, and airborne routes within hospitals. Effective prevention and control of these infections require a comprehensive approach, including strict hand hygiene and personal protection, implementation of infection control standards, environmental cleaning and disinfection, management of medical device sterilization, and rational use of antimicrobial agents along with resistance monitoring. This paper summarizes the transmission routes and prevention strategies for MDRO infections, providing references for hospital management and clinical practice. Future research should focus on optimizing prevention measures and resistance monitoring to address the changing patterns of resistant organisms and enhance infection control effectiveness.

Respiratory Isolation for Tuberculosis: A Historical Perspective.

Although tuberculosis is an ancient disease, recognition of its airborne route of transmission, with implications for respiratory isolation, is only relatively recent. Since the time of Hippocrates, the dogma among health practitioners was that the disease was hereditary or that it could be contracted by inhaling "miasma", or corrupted air. Consequently, isolation of patients was not routine practice, and, in fact, patients with scrofula (morbus regius, or "king's evil) sought to be cured by the "royal touch" throughout the middle ages. The sanatorium, which emerged in the mid-19th century, initially served as a place of healing, where patients could receive the appropriate diet, rest therapy, graduated exercise, and abundant fresh air. Major scientific breakthroughs, including Robert Koch's 1882 discovery of the tubercle bacillus as the disease's etiological agent and early 20th century experimental evidence that the organism could be transmitted via expectorated droplet nuclei, helped to reinforce the important public health role of sanatoria and tuberculosis hospitals in preventing disease transmission through isolation. The advent of highly efficacious and oral antitubercular regimens in the mid-20th century and the concurrent declining incidence of the disease contributed to the closure of tuberculosis sanatoria and hospitals in the US and western Europe. Over the past several decades, tuberculosis treatment in the US has been conducted in the outpatient setting under the supervision of local public health departments. Patients receiving treatment are required to remain in respiratory isolation in the home until they are deemed noninfectious based on multiple sputum samples. This historical review demonstrates that despite changing medical knowledge, drug therapies, and social conditions over time, the role of isolation remains an important topic of debate in the treatment of patients with pulmonary tuberculosis.

Study of Knowledge, Attitude, and Practices of Use of Masks among Health-care Workers at a Tertiary Care Center in Mumbai

ABSTRACT Introduction: Airborne transmission of infectious diseases poses a significant public health challenge. Nosocomial outbreaks of airborne infections such as influenza H1N1, H5N1, and drug-resistant tuberculosis (TB) variants have been documented, with substantial morbidity and mortality attributed to inadequate airborne infection control strategies. N-95 respirators and surgical masks (face masks) are the examples of personal protective equipment that are used to protect the wearer from airborne particles and liquid contamination of the face. Aim and Objectives: The aim of this study was to assess the knowledge, practices, and attitude of health-care workers (HCWs) regarding the use of mask, especially N-95 mask. Materials and Methods: A prospective, was conducted over a period of 6 months at a tertiary care hospital. This study was carried out in the department of microbiology of a tertiary care hospital over a period of 6 months. A total of 500 HCWs from various departments of the hospital were included in the study. HCWs were given a questionnaire based on N-95 respirator usage, and participation was voluntary. Results: The analysis of survey data provides insightful perspectives on respondents’ comprehension and attitudes toward airborne infection transmission and the usage of N-95 masks. 68.6% of respondents recognized that all listed diseases (measles, TB, and chickenpox) were spread by the airborne route. 55.6% of respondents correctly acknowledged that all masks, including surgical masks, N-95 masks, and cotton masks, do not offer airborne protection. 76.0% of respondents acknowledged that N-95 masks possess a high filtration efficiency against 0.3-micron particles, 58.3% correctly identified that “N” in N-95 stands for “not resistant to oil,” and 90.8% acknowledged that the N-95 respirator as the most common type of respirators. 41.7% correctly acknowledged that N-95 masks with an exhalation valve are not recommended for use. 22.2% of respondents incorrectly believe that wearing a face mask can lead to carbon dioxide poisoning, and 52.1% of respondents correctly identified that pulmonary TB patients need not be provided with N-95 masks in isolation rooms. 76.8% of respondents understood that fit testing is required every time one dons an N-95 mask. 95.5% of respondents recognized the necessity of hand hygiene before donning and after doffing N-95 masks. 82.7% of respondents agreed regarding the necessity for consultation before N-95 mask usage for chronic lung disease and asthma patients. 93.7% are aware that there is a protocol for donning and doffing N-95 masks. 71.3% of respondents understood that extended use involves wearing the same N-95 respirator for repeated close contact encounters without removing the mask between patient encounters, while 64.4% correctly define reuse as using the same N-95 respirator for multiple encounters but removing it after each encounter.

Experimental and numerical study on upper-room Far-UVC system under different ventilation schemes to disinfect airborne microorganisms in indoor environments

Many deadly infectious diseases are transmitted through airborne routes in indoor environments. Far UV upper-room system combined with proper ventilation is regarded as an effective approach to disinfect airborne microorganisms. Despite the current advances in the far UV upper-room system, various types of data are still lacking to guide the efficient design and the safe operation. This study combines field air sampling, laboratory experiments and computational fluid dynamics simulations to advance the knowledge on the potential of far UV radiation for disinfection and its safety design. Our findings reveal that seven out of the eight measured room spaces are categorised as slightly polluted (1201–2000 CFU m−3) or polluted (>2000 CFU m−3). Proteobacteria and Firmicutes constitute 65.2 ± 10.6 % and 21.2 ± 5.68 % of the bacterial composition in congregate settings, respectively. Ultraviolet radiation proves effective in deactivating pathogenic microorganisms, characterized by a decay rate constant ranging from 0.0446 m2 J−1 to 0.464 m2 J−1, depending on the wavelength and the type of pathogenic microorganisms. The time response of Ultraviolet radiation is up to 12 min to achieve 92.1 % sterilisation. Despite the reduction in the sterilisation ratio of Ultraviolet radiation, maintaining a high ventilation rate is highly recommended to eliminate genetic material from pathogenic microorganisms. When the excimer lamp is installed higher than 1.9 m above the floor level, the radiation intensities at both standing and sitting height become lower than the safety threshold value of 0.166 W m−2. A combination of UV radiation at 222 nm and ventilation is effective for neutralising both gram-positive and -negative bacteria and can contribute to stop the spread of infectious diseases in congregate settings.

Human behavior-based COVID-19 transmission in two dining spaces

Since December 2019, the COVID-19 pandemic has rapidly disseminated globally, posing significant threats to the world. The dining spaces are high-risk indoor environments for the transmission of SARS-CoV-2, posing challenges for intervention and control. This study, based on surveillance videos from two COVID-19 outbreak cases in restaurants, obtained real data on human behaviors of close contact and surface touch. A respiratory infectious disease transmission model was developed, incorporating four transmission routes: short-range airborne, long-range airborne, fomite and large droplet. The results indicate that diners and staff spent 21.9 %−28.7 % and 17.5 %−27.8 % of their time on speaking, respectively, while spending 85.9 %−90.7 % and 83.4 %−87.6 % of their time on surface touching. The primary transmission routes were short-range (contributing 5.8 %−70.9 %) and long-range airborne (contributing 28.4 %−93.0 %), with fomite and large droplet routes contributing less than 12.0 %. Staff-only mask wearing reduced infection risk by 12.8 %−31.8 %. It is recommended that mandatory mask wearing for staff is necessary, while diners should wear masks as much as possible, and that the equivalent ventilation rate of clean fresh air is suggested to 30.0 m3/ (h·person). This study provides a scientific support to make non-pharmaceutical interventions in dinning spaces.

Transmission potential of Streptococcus pyogenes during a controlled human infection trial of pharyngitis.

Controlled human infection (CHI) models can provide insights into transmission of pathogens such as Streptococcus pyogenes (Strep A). As part of the Controlled Human Infection with Penicillin for Streptococcus pyogenes (CHIPS) trial, we explored the potential for transmission among participants deliberately infected with the Strep A emm75 strain. Three approaches to understanding transmission were employed: the use of agar settle plates to capture possible droplet or airborne spread of Strep A; measurement of distance droplets could spread during conversation; and environmental swabbing of high-touch items to detect Strep A on surfaces. Of the 60 (27%) CHIPS trial participants across five cohorts, 16 were enrolled in this sub-study; availability of study staff was the primary reason for selection. In total, 189 plates and 260 swabs were collected. Strep A was grown on one settle plate from a participant on the second day, using plates placed 30 cm away. This participant received the placebo dose of penicillin and had met the primary endpoint of pharyngitis. Whole-genome sequencing identified this to be the challenge strain. Strep A was not detected on any swabs. In this small sample of CHI participants, we did not find evidence of Strep A transmission by the airborne route or fomites, and just one instance of droplet spread while acutely symptomatic with streptococcal pharyngitis. Although these experiments provide evidence of minimal transmission within controlled clinical settings, greater efforts are required to explore Strep A transmission in naturalistic settings.IMPORTANCEStreptococcus pyogenes remains a significant driver of morbidity and mortality, particularly in under-resourced settings. Understanding the transmission modalities of this pathogen is essential to ensuring the success of prevention methods. This proposed paper presents a nascent attempt to determine the transmission potential of Streptococcus pyogenes nested within a larger controlled human infection model.

Transmission dynamics of MERS-CoV in a transgenic human DPP4 mouse model

Since 2002, three novel coronavirus outbreaks have occurred: severe acute respiratory syndrome coronavirus (SARS-CoV-1), Middle East respiratory syndrome coronavirus (MERS-CoV), and SARS-CoV-2. A better understanding of the transmission potential of coronaviruses will result in adequate infection control precautions and an early halt of transmission within the human population. Experiments on the stability of coronaviruses in the environment, as well as transmission models, are thus pertinent.Here, we show that transgenic mice expressing human DPP4 can be infected with MERS-CoV via the aerosol route. Exposure to 5 × 106 TCID50 and 5 × 104 TCID50 MERS-CoV per cage via fomites resulted in transmission in 15 out of 20 and 11 out of 18 animals, respectively. Exposure of sentinel mice to donor mice one day post inoculation with 105 TCID50 MERS-CoV resulted in transmission in 1 out of 38 mice via direct contact and 4 out of 54 mice via airborne contact. Exposure to donor mice inoculated with 104 TCID50 MERS-CoV resulted in transmission in 0 out of 20 pairs via direct contact and 0 out of 5 pairs via the airborne route. Our model shows limited transmission of MERS-CoV via the fomite, direct contact, and airborne routes. The hDPP4 mouse model will allow assessment of the ongoing evolution of MERS-CoV in the context of acquiring enhanced human-to-human transmission kinetics and will inform the development of other transmission models.

Selection of DNA aptamer for label-free electrochemical aptasensor for the detection of rubella virus

The Rubella virus (RUBV) is a highly contagious pathogen classified within the rubivirus genus, primarily infecting humans and transmitted via airborne routes. RUBV infection generally manifests as a mild illness reminiscent of measles. However, when affecting pregnant women, it can lead to a severe condition known as congenital rubella syndrome (CRS). Rubella infection could be also associated with joint pain, arthritis, and neurological disorders. Determination of Rubella immunity and diagnosis conventionally involve the Hemagglutination Inhibition (HI) test or the Enzyme-Linked Immunosorbent Assay (ELISA). In this study, we describe the selection and characterization of specific aptamers targeting the Rubella virus by using the process of Systematic Evolution of Ligands by EXponantial enrichment (SELEX). The Binding affinity studies have shown that the two aptamers; R-7 and R-5 display the lowest dissociation constants (Kd) of 6.58 nM and 19.05 nM, respectively. Then, R-7 aptamer was modified with a thiol group to enable its immobilization on screen-printed gold electrodes for the Rubella virus aptasensing. The label-free electrochemical detection was achieved using square wave voltammetry (SWV). The designed aptasensor has shown an excellent performance in detecting the Rubella virus within the range of 0.0005 ng/ml to 1000 ng/ml antigen and a limit of detection (LOD) of 0.00015 ng/ml. Selectivity studies were also performed against other viral antigens and serum proteins. Finally, the biosensor applicability was successfully demonstrated in spiked serum samples.

An Integrative Approach to the Study of Cognitive Abilities in a Non-Human Primate Model in a Virology Laboratory Environment.

Non-human primates, due to their similarities in immune response to humans, are the preferred model for studying infectious processes and any associated cognitive impairments. Behavioral tests are indispensable for investigating pathogenesis in neuroinfections, especially those that do not manifest with noticeable clinical symptoms, as well as in the transition to a chronic form of the disease. Modeling viral infection requires specialized experimental conditions. Our work describes techniques for investigating mnemonic functions, tiredness, attentional focus, quick-wittedness, and basic behavioral responses in primates under the assumed conditions for infections with viruses that do not have an airborne route of transmission. It also outlines approaches to the training and selection of primates for virological research, as well as analyzing gender differences in learning abilities, the impact of housing conditions on the results, and the correlation between training success and behavioral test scores. These methods will allow a more detailed study of non-human primates as a model for researching cognitive and behavioral impairments under infectious and immune stress, as well as the design of less energy-intensive experiments for evaluating the efficacy and safety of therapeutic and prophylactic strategies at early stages of infection.

Coinfection of Influenza A and B and Human OC43 Coronavirus in Normal Human Bronchial Epithelial Cells.

Influenza viruses and seasonal coronaviruses are pathogens transmitted via an airborne route that can cause respiratory diseases in humans that have similar symptoms such as fever, cough, and pneumonia. These two viruses can infect similar human tissues, such as the respiratory tract and nasal, bronchial, and alveolar epithelial cells. Influenza virus and seasonal coronavirus coinfections are poorly understood. Here, we coinfected normal human bronchial epithelial (NHBE) cells with influenza A/California/04/09 (IAV) or B/Victoria/504/2000 (IBV) strains and the seasonal human beta-coronavirus OC43 and evaluated viral replication capacities. We also examined changes in the expression of various cytokines/chemokines by qPCR and Luminex assay. We observed that the replication of IAV and IBV was not affected by coinfection with OC43. However, coinfection reduced OC43 titers (~3-fold) compared with infection with OC43 alone. Select cytokine/chemokine expression was increased in coinfected cells compared with all single infections with greater differences seen between coinfected cells and cells infected with OC43 alone compared with IAV- or IBV-infected cells. In addition, IL-8 and IL-1RA showed the highest expression among a panel of 22 cytokines by Luminex. As the rate of influenza and seasonal coronavirus coinfection continue to increase, our findings may help set guidelines for the treatments of the individuals coinfected with both viruses.

Evaporation of bacteria-laden surrogate respiratory fluid droplets: On a hydrophilic substrate vs contact-free environment confers differential bacterial infectivity

The transmission of viruses/bacteria causes infection predominantly via aerosols. The transmission mechanism of respiratory diseases is complex, which includes direct or indirect contact, large droplet, and airborne routes apart from close contact transmission. With this premise, two modes of droplet evaporation are investigated to understand its significance in airborne disease transmission; a droplet in a contact-free environment, which evaporates and forms droplet nuclei, and a droplet on a hydrophilic substrate (fomite). The study examines mass transport, the deposition pattern of bacteria in the precipitates, and their survival and virulence. The osmotic pressure increases with the salt concentration, inactivating the bacteria embedded in the precipitates with accelerated evaporation. Furthermore, the bacteria's degree of survival and enhanced pathogenicity are compared for both evaporation modes. The striking differences in pathogenicity are attributed to the evaporation rate, oxygen availability, and reactive oxygen species generation.

Impact of air humidity on the tenacity of different agents in bioaerosols.

Despite the variety of pathogens that are transmitted via the airborne route, few data are available on factors that influence the tenacity of airborne pathogens. In order to better understand and thus control airborne infections, knowledge of these factors is important. In this study, three agents, S. aureus, G. stearothermophilus spores and the MS2 bacteriophage, were aerosolized at relative humidities (RH) varying between 30% and 70%. Air samples were then analyzed to determine the concentration of the agents. S. aureus was found to have significantly lower survival rate in the aerosol at RH above 60%. It showed the lowest recovery rates of the three agents, ranging from 0.13% at approximately 70% RH to 4.39% at 30% RH. G. stearothermophilus spores showed the highest tenacity with recovery rates ranging from 41.85% to 61.73% with little effect of RH. For the MS2 bacteriophage, a significantly lower tenacity in the aerosol was observed with a recovery rate of 4.24% for intermediate RH of approximately 50%. The results of this study confirm the significant influence of the RH on the tenacity of airborne microorganisms depending on the specific agent. These data show that the behavior of microorganism in bioaerosols is varies under different environmental conditions.

Antimicrobial activity of safe concentrations of ozone, hydrogen peroxide, and triethylene glycol in air and surfaces

The application of low and non-toxic concentrations of antimicrobial compounds in indoor air is an interesting strategy to reduce airborne bacteria and fungi thereby reducing infection risk.

Optical Microscopic Methods for Testing Face Mask Efficacy for COVID-19

COVID-19 has spread worldwide and it is leaving everyone wondering how to protect themselves or help those who are affected. Furthermore, the increased number of infectious diseases has become a significant health concern over recent decades. The respiratory droplets or airborne route, one of the transmission methods, impacts social relationships most significantly and can be avoided by using a face mask. Face masks are available in a variety of degrees of protection. Even in the face of the ongoing pandemic, individuals made their masks from household items due to the lack of face masks worldwide. In developing countries, surgical masks (SMs) and cloth masks (CMs) made of various cloth materials are very common. These types of masks are typically used for months after being repeatedly washed and dried. However, there is no indication of how washing, drying, or stretching practices affect the quality of CMs and SMs. Various efforts have been devoted to making effective face masks by using antimicrobial activity and super-hydrophobicity. This review article aims to discuss the mask efficiency of commercial SMs and homemade CMs from the public health and technical perspective. Recent advancements in mask engineering, disinfection, and material science have also been discussed. Optical microscopic methods were employed to assess the efficiency of different face masks and determine the quality of masks after washing, drying, and stretching. The filtration efficiency of CMs ranges from 63% to 84%. However, the SM had the highest filtering effectiveness and efficiency of 94%.

Insights into varicella-zoster virus assembly from the B- and C-capsid at near-atomic resolution structures

Varicella-zoster is a highly communicable virus that can be transmitted through the airborne route. About one quarter of people are infected with this virus. Previous studies have described the structure of A-capsid and a blurred reconstruction of the C-capsid with icosahedral symmetry. In this study, we have determined the more precise detailed structures of the varicella-zoster virus (VZV) B- and C-capsid in icosahedral symmetry using a combination of block-based reconstruction and symmetry relaxation strategies. In addition, we are reporting structural details of the portal vertex reconstructions in five-fold symmetry and portal reconstructions in twelve-fold symmetry. The structures unveil the basis for the high thermal stability of the VZV capsid. The conformational flexibility of structural elements of the capsid plays a role in the assembly of the capsid and drives processes critical for the viral life cycle. The results of the study open up new avenues for the development of drugs against a highly prevalent and contagious pathogen.

Droplet digital PCR application for the detection of SARS-CoV-2 in air sample.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) may transmit through airborne route particularly when the aerosol particles remain in enclosed spaces with inadequate ventilation. There has been no standard recommended method of determining the virus in air due to limitations in pre-analytical and technical aspects. Furthermore, the presence of low virus loads in air samples could result in false negatives. Our study aims to explore the feasibility of detecting SARS-CoV-2 ribonucleic acid (RNA) in air samples using droplet digital polymerase chain reaction (ddPCR). Active and passive air sampling was conducted between December 2021 and February 2022 with the presence of COVID-19 confirmed cases in two hospitals and a quarantine center in Klang Valley, Malaysia. SARS-CoV-2 RNA in air was detected and quantified using ddPCR and real-time reverse transcriptase-polymerase chain reaction (RT-PCR). The comparability of two different digital PCR platforms (QX200 and QIAcuity) to RT-PCR were also investigated. Additionally negative staining transmission electron microscopy was performed to visualize virus ultrastructure. Detection rates of SARS-CoV-2 in air samples using ddPCR were higher compared to RT-PCR, which were 15.2% (22/145) and 3.4% (5/145), respectively. The sensitivity and specificity of ddPCR was 100 and 87%, respectively. After excluding 17 negative samples (50%) by both QX200 and QIAcuity, 15% samples (5/34) were found to be positive both ddPCR and dPCR. There were 23.5% (8/34) samples that were detected positive by ddPCR but negative by dPCR. In contrast, there were 11.7% (4/34) samples that were detected positive by dPCR but negative by ddPCR. The SARS-CoV-2 detection method by ddPCR is precise and has a high sensitivity for viral RNA detection. It could provide advances in determining low viral titter in air samples to reduce false negative reports, which could complement detection by RT-PCR.

Host range, transmissibility and antigenicity of a pangolin coronavirus.

The pathogenic and cross-species transmission potential of SARS-CoV-2-related coronaviruses (CoVs) remain poorly characterized. Here we recovered a wild-type pangolin (Pg) CoV GD strain including derivatives encoding reporter genes using reverse genetics. In primary human cells, PgCoV replicated efficiently but with reduced fitness and showed less efficient transmission via airborne route compared with SARS-CoV-2 in hamsters. PgCoV was potently inhibited by US Food and Drug Administration approved drugs, and neutralized by COVID-19 patient sera and SARS-CoV-2 therapeutic antibodies in vitro. A pan-Sarbecovirus antibody and SARS-CoV-2 S2P recombinant protein vaccine protected BALB/c mice from PgCoV infection. In K18-hACE2 mice, PgCoV infection caused severe clinical disease, but mice were protected by a SARS-CoV-2 human antibody. Efficient PgCoV replication in primary human cells and hACE2 mice, coupled with a capacity for airborne spread, highlights an emergence potential. However, low competitive fitness, pre-immune humans and the benefit of COVID-19 countermeasures should impede its ability to spread globally in human populations.

Impact of respiratory aerosol size and number distribution on the relative importance of different routes in SARS-CoV-2 transmission.

Exploring the relative importance of different routes in SARS-CoV-2 transmission is crucial in infection prevention. However, even in the same environmental setting, the relative importance of different routes has varied in different studies. We hypothesize that respiratory aerosol size and number distribution might play a key role. In this study, size and number distribution of respiratory droplets emitted from breathing, talking, and coughing were identified from PubMed and Web of Science. The infection risk of SARS-CoV-2 via airborne, droplet, and fomite transmission routes was modeled in a household and a healthcare setting. The relative importance of three routes varied with different size distributions in both settings. Generally, the contribution of the airborne route increased with the volume percentage of respirable droplets emitted. And the increase of the total number of emitted droplets leads to an increase in the contribution of tdroplet route. In the healthcare setting, as the total number of emitted droplets increased from 110 to 4,973, the contribution of droplet route increased from 62.24% to 98.11%. Next, by considering the combination of breathing, coughing, and talking when the infected person was asymptomatic, the airborne route predominated over the droplet and contact routes. When the infected person had developed symptoms, that is, cough, the droplet route played a dominant role in SARS-CoV-2 transmission. In conclusion, risk analyses will be improved with improved sampling methods that enable characterization of viruses within respiratory droplets of different sizes.

Monitoring of airborne fungi during the second wave of COVID-19 in selected wards of the referral university hospital in southeastern Iran.

Microbiological monitoring of the air hospital is essential for prevention and control, due to the possible airborne route of infection transmission, especially in high-risk wards. This study aimed to monitor the airborne fungi during the second wave of the COVID-19 pandemic in selected wards of the biggest university educational hospital in Kerman, southeastern Iran. This study was conducted in 11 different wards, separated into the patient room and nursing station, of the Afzalipour hospital from May to August 2021. Fungal isolates were characterized to the species level by conventional and sequencing methods. Out of 93 obtained fungal colonies, 70 (75.3%) isolates were filamentous and 23 (24.7%) isolates were yeast. Aspergillus species were the predominant fungal isolates among the filamentous colonies (n=19; 27.1%), and Naganishia albida (formerly Cryptococcus albidus) was identified as the most common yeast isolate (n=13/23; 56.8%). The infectious ward was the most contaminated unit (n=19/93), while the least contaminated units were the neonatal intensive care unit (n=3/93), and oncology (n=3/93). The statistical findings displayed that the number of fungal isolates in patients' rooms is significantly higher than in nurses' stations (p-value=0.013). Our study demonstrated the presence of diverse fungal species in all wards of the hospital. Considering the presence of airborne fungi in hospitals and related public health problems is one of the critical issues for health systems management. In this regard, efficient monitoring of airborne fungi might play an influential role in hospital infection control and surveillance, particularly in high-risk hospitalization patients in critical wards.

Oral Manifestations in COVID-19 Patients Associated with Oral Hygiene in Aceh, Indonesia: A Literature Review

COVID-19 became a pandemic because of its high-speed transmission via salivary and airborne droplet routes. Viruses can enter host cells through ACE-2 receptors in various human organs, including the oral cavity. The oral manifestations that arise include white plaque, ulceration, burning sensation, oral mucositis, depapillation of the tongue, dry mouth, halitosis, and loss of the sense of taste. Poor oral hygiene, comorbidities, decreased immunity, and stress can exacerbate these manifestations. This review study aimed to report various oral manifestations of COVID-19 related to oral hygiene. Relevant articles were identified from PubMed, ScienceDirect, Elsevier, and Google Scholar. Out of the 60 articles selected, only 36 could be reviewed. The World Health Organization recommends early detection for individuals with suspected exposure to the COVID-19 virus to control its spread, including checking for oral manifestations. Oral hygiene is an important factor affecting the manifestations of the oral cavity of COVID-19 patients, so examination of the condition of oral hygiene is recommended in the medical management of COVID-19 patients. To conclude, oral hygiene is related to the emergence of oral manifestation in COVID-19-infected patients.