Atypical Infection Research Articles

AN INTERESTING STUDY OF RHINO-ORBITAL MUCORMYCOSIS IN COVID-19 PATIENTS

The Severe Acute Respiratory Syndrome (SARS) coronavirus-2 is a novel coronavirus, belonging to the family coronaviridae and is now known to be responsible for the outbreak of a series of recent acute atypical respiratory infections originating in Wuhan, China, termed as coronavirus disease 19 (COVID-19) and has been declared a pandemic by WHO on March 11, 2020. COVID-19 infections may be associated with a wide range of bacterial and fungal co-infections. We report the study of 4 cases, who in our hospital, developed Rhino-orbital mucormycosis, who were diagnosed as COVID-19 positive, with or without associated co-morbidities, involving all age groups. Extensive use of steroids may lead to development or exacerbation of a pre-existing fungal disease in patients with COVID-19 infections.

Articles of Significant Interest in This Issue

Viruses have long been viewed as entities relying on the host cell machinery to propagate. Blanc-Mathieu et al. (e02446-20) describe a novel giant alga-infecting virus with a unique structure, an atypical infection profile, and an unprecedented number of genes involved in energy metabolism (such as the tricarboxylic acid [TCA] cycle and the β-oxidation pathway). One of these genes (the succinate dehydrogenase subunit A gene) is transcribed during infection. Moreover, homologs of this gene seem to be widely present in viral genomes of the Tara Oceans data set. This discovery provides evidence that viruses which are able to directly modulate the energy metabolism of their hosts by using their own genetic repertoire are widespread in the global ocean.

SARS-CoV-2 Re-Infection in a Lung Transplant Recipient

IntroductionSince the onset of the SARS-CoV-2 pandemic, increasing evidence has shown waning immunity after initial SARS-CoV-2 infection, and re-infection in patients with a prior history of COVID-19 has been reported. We report a case of SARS-CoV-2 re-infection in a lung transplant recipient 3 months after initial illness.Case ReportThe patient is a 56-year-old man with a history of bilateral lung transplant in August 2018 for idiopathic pulmonary fibrosis. His post-transplant course was complicated by insulin-dependent diabetes mellitus (HbA1c 5.8%), chronic renal insufficiency (eGFR nadir 48 mL/min/1.73m2), and peripheral arterial disease requiring bilateral below-knee amputations. At the time of transplant, he was induced with basiliximab and remained on standard 3-drug immunosuppression with mycophenolate mofetil (500 mg BID), prednisone (5 mg daily), and tacrolimus. He contracted SARS-CoV-2 from his wife and tested positive for the virus on July 2, 2020 after presenting to the emergency department (ED) with headache, chills, nausea, body aches, shortness of breath, and generalized weakness. His oxygen saturation and chest X-ray were normal, and he was therefore discharged from the ED to recover at home. His symptoms resolved 17 days after diagnosis and serial SARS-CoV-2 testing via nasal washing were positive on July 16, 2020 and negative on July 30, 2020 and August 11, 2020. In addition, on October 21, 2020, he tested positive for SARS-CoV-2 antibodies (3.41, positive: index ≥1.4). On October 23, 2020, he presented to the ED with generalized chest pain, low-grade fever (100.1F), dyspnea, and weakness. His nasal swab was positive for SARS-CoV-2 and CT of the chest showed bibasilar ground-glass opacities consistent with atypical infection vs. atelectasis. His labs were notable for a CRP of 132 mg/L, ferritin of 2,307 ng/mL, LDH 304 units/L, D-dimer 240 ng/mL, and procalcitonin of 0.05 ng/mL. He was admitted for monitoring and treated with remdesivir, corticosteroids, and anticoagulation.SummaryWe present a case of SARS-CoV-2 re-infection 3 months after initial illness in a lung transplant recipient living in a high-incidence area. Unexpectedly, recurrent infection occurred despite development of SARS-CoV-2 antibodies. This case speaks to the vulnerability of this patient population to COVID-19 and the need for ongoing precautions to prevent infection even among patients who have seroconverted.

A Case of Unremitting Cellulitis in a Lung Transplant Recipient: What is the Infectious Etiology?

<h3>Introduction</h3> <i>Mycobacterium chelonae</i> is a rare, non-tuberculous mycobacterium that is highly pathogenic in immunosuppressed patients. Herein, we describe a chronic presentation of cellulitis which was later biopsy-proven as <i>M. chelonae</i> in a lung transplant recipient. <h3>Case Report</h3> A 61-year-old female bilateral lung transplant recipient presented 15-months post-transplant with multiple erythematous cutaneous lesions of the right arm. She had a 3-month history of waxing and waning cutaneous lesions that had not fully cleared despite antibiotic therapy. The first transplant year was eventful with two episodes of acute cellular rejection necessitating high-dose corticotherapy. Dermatological biopsy performed in a prior visit demonstrated features consistent with dermatitis. Autoimmune etiologies were ruled out, and the patient reported no history of trauma or other nidus of entry for infection. At the time of the current presentation, we observed nodular changes to the cutaneous lesions, which necessitated repeat biopsy, revealing granulomatous infiltrate (Figure 1). Acid-fast staining was positive, and <i>M. chelonae</i> was properly identified. Given her immunosuppressed state, the patient was started on multidrug antibiotic therapy, guided by antibiogram. Skin showed some improvement on observation, however, one large, nodular cutaneous lesion persisted. Decision was made to perform excision in effort to reduce bacterial growth burden. Subsequent biopsy findings were negative, likely a result of immunological phenomenon. She ultimately finished multidrug treatment with complete resolution of skin nodules. <h3>Summary</h3> This case underlines the role of corticotherapy and immunosuppression as a major risk factor for atypical infections, such as <i>M. chelonae</i>, in lung transplant recipients. Eradication can be difficult as demonstrated, and thus early recognition and multidrug antibiotic therapy are the cornerstone for management in this population.

A26 A SYSTEMTIC REVIEW OF MONOGENIC INFLAMMATORY BOWEL DISEASE: CLINICAL PHENOTYPE AND GENOTYPE

Abstract Background Advances in genomic technologies have led to an increase in reports of monogenic inflammatory bowel disease (IBD). The majority of the studies on monogenic IBD have focused only on young children aged &amp;lt;6 years. There are no detailed reports containing a comprehensive picture of monogenic IBD with specific numbers on the clinical features, genetic profiles and disease course. Since each gene-specific cause of monogenic IBD is rare, it is difficult to collect cases in a single study even with international cohort studies. Aims To elucidate a comprehensive picture of monogenic IBD, we conducted a systematic review of all reported cases of monogenic IBD. Methods A systematic review of MEDLINE articles published between January 2000 and December 2019 was conducted. 662 monogenic IBD cases were identified from 273 eligible articles. Data on clinical manifestation, genotype, and management were collected. Results The most frequently reported genes causative of monogenic IBD patients were IL10RA, CYBB, IL10RB, and TTC7A (Figure). In total, 64.8% of patients developed IBD before six years old, 15.6% between ages 10 and 17.9 years, and 11.6% at age 18 years or older. Only 32.7% had any history of extra-intestinal manifestation (EIM) before IBD onset. There was substantial difference in the onset age groups and the underlying monogenic disorders. 74.4% developed at least one EIM during their clinical course. The most common EIMs were atypical infection (44.1%), dermatologic abnormality (39.2%), autoimmunity (22.7%) and lymphoid organ abnormality (11.5%). Autosomal recessive (62.8%) was the most common inheritance pattern, and missense-variants (44.3%) were the most identified type of genetic variants. Deletions including CNVs, intronic, synonymous and inversion, which have the possibility to be overlooked by whole exome sequencing were shown in some cases. Bowel surgery, biologics, and hematopoietic stem cell transplantation were performed in 28.3%, 32.8%, and 24.4% of patients, respectively. Conclusions Monogenic IBD diagnosis and management is a challenging clinical problem across age groups; the EIMs are more diverse and the management is evidently more difficult compared to non-monogenic IBD. An improved understanding of the characteristics of the genes and underlying disease processes in monogenic IBD is necessary for effective management. Funding Agencies CAG, CIHRUehara Memorial Foundation Fellowship

Editorial: Coronavirus disease 2019 (COVID-19) - advances in epidemiology, diagnostics, treatments, host-directed therapies, pathogenesis, vaccines, and ongoing challenges.

Editorial: Coronavirus disease 2019 (COVID-19) - advances in epidemiology, diagnostics, treatments, host-directed therapies, pathogenesis, vaccines, and ongoing challenges.

Legionella Pneumonia on Point-of-care Ultrasound in the Emergency Department: A Case Report.

IntroductionLegionella is an uncommon, atypical organism that can cause community-acquired pneumonia. Commonly associated with high fevers, gastrointestinal symptoms, and hyponatremia, it can be easily overlooked, especially during the coronavirus disease of 2019 (COVID-19) pandemic. Legionella has specific antibiotic treatment that will improve outcome; thus, its recognition is important.Case ReportWe present a case of Legionella pneumonia in a man presenting with shortness of breath and fever. The patient’s initial chest radiography was negative. With the use of point-of-care ultrasound (POCUS) the changes of atypical pneumonia could be seen. Ultimately Legionella was confirmed with urine antigen testing, and appropriate antibiotic treatment was started.DiscussionGiven the increased awareness of COVID-19 it is important to consider a broad differential with respiratory illness. Legionella pneumonia on POCUS is consistent with atypical pneumonia descriptions on ultrasound. Point-of-care ultrasound can be used to diagnose atypical pneumonia, specifically caused by Legionella in our case.ConclusionLegionella is evident on POCUS but is difficult to distinguish from other infections with POCUS alone. One should consider Legionella if POCUS is positive for signs of atypical infection.

A case of inguinal hernia associated with atypical Dirofilaria repens infection in a dog

BackgroundDirofilaria repens is a filarioid nematode transmitted by mosquitoes. Adult D. repens are typically localized in the subcutaneous tissue of the host, but other, atypical localizations have also been reported. There have been several reports of clinical cases involving an association of parasites and hernias in both animals and humans. However, it is unclear if parasitic infection can act as a triggering factor in the development of hernias.MethodsA 12-year-old dog was referred to a private veterinarian clinic in Satu Mare, northwestern Romania due to the presence of a swelling in the lateral side of the penis (inguinal area). The dog underwent hernia repair surgery during which four long nematodes were detected in the peritoneal serosa of the inguinal hernial sac. One female specimen was subjected to genomic DNA extraction to confirm species identification, based on amplification and sequencing of a 670-bp fragment of the cytochrome c oxidase subunit 1 (cox1) gene. Treatment with a single dose of imidacloprid 10% + moxidectin 2.5% (Advocate, Bayer AG) was administered.ResultsThe nematodes were morphologically identified as adult D. repens, and the BLAST analyses revealed a 100% nucleotide similarity to a D. repens sequence isolated from a human case in Czech Republic.ConclusionsWe report a case of an atypical localization of D. repens in the peritoneal cavity of a naturally infected pet dog with inguinal hernia and discuss the associations between hernia and parasitic infections.Graphical

The Japanese respiratory society guidelines for the management of cough and sputum (digest edition)

Cough and sputum are common complaints at outpatient visits. In this digest version, we provide a general overview of these two symptoms and discuss the management of acute (up to three weeks) and prolonged/chronic cough (longer than three weeks). Flowcharts are provided, along with a step-by-step explanation of their diagnosis and management. Most cases of acute cough are due to an infection. In chronic respiratory illness, a cough could be a symptom of a respiratory infection such as pulmonary tuberculosis, malignancy such as a pulmonary tumor, asthma, chronic obstructive pulmonary disease, chronic bronchitis, bronchiectasis, drug-induced lung injury, heart failure, nasal sinus disease, sinobronchial syndrome, eosinophilic sinusitis, cough variant asthma (CVA), atopic cough, chronic laryngeal allergy, gastroesophageal reflux (GER), and post-infectious cough. Antibiotics should not be prescribed for over-peak cough but can be considered for atypical infections. The exploration of a single/major cause is recommended for persistent/chronic cough. When sputum is present, a sputum smear/culture (general bacteria, mycobacteria), cytology, cell differentiation, chest computed tomography (CT), and sinus X-ray or CT should be performed. There are two types of rhinosinusitis. Conventional sinusitis and eosinophilic rhinosinusitis present primarily with neutrophilic inflammation and eosinophilic inflammation, respectively. The most common causes of dry cough include CVA, atopic cough/laryngeal allergy (chronic), GER, and post-infectious cough. In the last chapter, future challenges and perspectives are discussed. We hope that the clarification of the pathology of cough hypersensitivity syndrome will lead to further development of "pathology-specific non-specific therapeutic drugs" and provide benefits to patients with chronic refractory cough.

Challenges of Hematopoietic Stem Cell Transplantation in the Era of COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic raised unprecedented concerns in the hematopoietic stem cell transplant community. The diagnosis of COVID-19 in these transplant recipients may require extensive laboratory testing and high clinical suspicion, as atypical clinical manifestations or other respiratory viral infections are common in this patient population. The underlying malignancies, immunosuppressed state, frequently observed coinfections, and advanced age in some patients may also predispose them to worse clinical outcomes. Similar outcomes have been previously described with other human coronaviruses, including the severe acute respiratory syndrome coronavirus and the Middle East respiratory syndrome coronavirus. Many hematopoietic stem cell transplant organizations have issued elaborative guidelines that aim to prevent transmission and hence adverse patient outcomes. All potential donors are thoroughly screened, and donated products are cryopreserved in advance. Potential hematopoietic stem cell transplant recipients are also screened, and most nonurgent transplant cases with low risk of progression and/or death are deferred. Current hematopoietic stem cell transplant recipients should adhere to precaution and isolation measures, while their transplant units should also follow strict safety protocols, similar to other infectious outbreaks. The prolonged susceptibility of hematopoietic stem cell transplant recipients to respiratory viral infections might necessitate extending these measures even after the peak of the outbreak until a gradually return to normality is possible.

Primary leptomeningeal melanomatosis manifesting as new-onset refractory status epilepticus a case report – Where do you get the best cerebrospinal fluid sample?

New-onset refractory status epilepticus (NORSE) is an increasingly recognized syndrome requiring aggressive antiepileptic management. A wide range of etiologies are associated with NORSE, including atypical infections and antibody mediated disorders [1].

A persistent giant algal virus, with a unique morphology, encodes an unprecedented number of genes involved in energy metabolism.

Viruses have long been viewed as entities possessing extremely limited metabolic capacities. Over the last decade, however, this view has been challenged, as metabolic genes have been identified in viruses possessing large genomes and virions-the synthesis of which is energetically demanding. Here, we unveil peculiar phenotypic and genomic features of Prymnesium kappa virus RF01 (PkV RF01), a giant virus of the Mimiviridae family. We found that this virus encodes an unprecedented number of proteins involved in energy metabolism, such as all four succinate dehydrogenase (SDH) subunits (A-D) as well as key enzymes in the β-oxidation pathway. The SDHA gene was transcribed upon infection, indicating that the viral SDH is actively used by the virus- potentially to modulate its host's energy metabolism. We detected orthologous SDHA and SDHB genes in numerous genome fragments from uncultivated marine Mimiviridae viruses, which suggests that the viral SDH is widespread in oceans. PkV RF01 was less virulent compared with other cultured prymnesioviruses, a phenomenon possibly linked to the metabolic capacity of this virus and suggestive of relatively long co-evolution with its hosts. It also has a unique morphology, compared to other characterized viruses in the Mimiviridae family. Finally, we found that PkV RF01 is the only alga-infecting Mimiviridae virus encoding two aminoacyl-tRNA synthetases and enzymes corresponding to an entire base-excision repair pathway, as seen in heterotroph-infecting Mimiviridae These Mimiviridae encoded-enzymes were found to be monophyletic and branching at the root of the eukaryotic tree of life. This placement suggests that the last common ancestor of Mimiviridae was endowed with a large, complex genome prior to the divergence of known extant eukaryotes.IMPORTANCE Viruses on Earth are tremendously diverse in terms of morphology, functionality, and genomic composition. Over the last decade, the conceptual gap separating viruses and cellular life has tightened because of the detection of metabolic genes in viral genomes that express complex virus phenotypes upon infection. Here, we describe Prymnesium kappa virus RF01, a large alga-infecting virus with a unique morphology, an atypical infection profile, and an unprecedented number of genes involved in energy metabolism (such as the tricarboxylic (TCA) cycle and the β-oxidation pathway). Moreover, we show that the gene corresponding to one of these enzymes (the succinate dehydrogenase subunit A) is transcribed during infection and is widespread among marine viruses. This discovery provides evidence that a virus has the potential to actively regulate energy metabolism with its own gene.

High burden of infections in Indian patients with Idiopathic Inflammatory Myopathy: validation of observations from the MyoCite dataset.

To determine the prevalence, profile and predictors of infections in an Indian cohort with idiopathic inflammatory myopathies (IIM). We reviewed the records of a retrospective cohort with IIM enrolled from consecutive patients being followed up in the clinic, and these constituted the observation cohort. A newly diagnosed inception cohort with IIM were followed prospectively as the validation cohort for confirmation of observations and comparison with the observation cohort. Among the 68 patients in the observation cohort (average age 33.4 years, female:male 4.2:1), 37 (54.4%) experienced 54 infections between them; of these 54 infections, 21 (38.8%) were major and recurrent infections and they occurred in 11 patients (16.17%) over 3.08 years. Tuberculosis was the most common infection (12, 22.2%), with a predominance of extrapulmonary forms. Serum protein [odds ratio (OR) 0.44], platelets (0.44) at disease onset and daily steroid dose (1.04) predicted major infections on multivariate analysis. A higher daily dose of steroids at first infection correlated with number of recurrent infections. The infection-free 1-year survival was 73.8%.Of the 70 patients in the validation cohort (average age 35.7 years, female:male 3.7:1), 3 had myositis attributed to an infection. A similar proportion of the cohort experienced infections (22, 33.3%) with similar number of major (10, 45.4%) and recurrent (4, 18%) infections being recorded. The most common infection was community-acquired pneumonia, followed by tuberculosis, with serum albumin (OR 0.25) at disease onset being the only predictor. The one-year infection-free survival rate was 64.7%. Those who had a major infection had increased mortality at 1 year, with a survival rate of 60%, compared with 89.09% in those without.In both cohorts, a daily prednisone dose >6.25 mg predisposed to major infections. Major and recurrent infections are common in Indian IIM patients and confer higher risk for future infections and lower survival. Respiratory and atypical bacterial infections such as tuberculosis occur throughout the disease course.

MiRNA Regulation of NK Cells Antiviral Response in Children With Severe and/or Recurrent Herpes Simplex Virus Infections.

Severe and/or recurrent infection with Herpes simplex virus (HSV) is observed in a large group of patients treated in clinical immunology facilities. Atypical and prolonged HSV infection is the most common clinical manifestation of disturbed NK cell development and functions, yet the molecular basis of these disorders is still largely unknown. Since recent findings indicated the importance of miRNA in regulating NK cell development, maturation and functions, the aim of our study was to investigate miRNA expression pattern in NK cells in patients with severe and/or recurrent infections with HSV and analyze the role of these miRNAs in NK cell antiviral response. As a result, miRNA expression pattern analysis of human best known 754 miRNAs revealed that patients with severe and/or recurrent HSV infection had substantially upregulated expression of four miRNAs: miR-27b, miR-199b, miR-369-3p and miR-491-3p, when compared to healthy controls. Selective inhibition of miR-27b, miR-199b, miR-369-3p and miR-491-3p expression in NK-92 cells resulted in profound upregulation of 4 genes (APOBEC3G, MAP2K3, MAVS and TLR7) and downregulation of 36 genes taking part in antiviral response or associated with signaling pathways of Toll-like receptors (TLR), NOD-like receptors, the retinoic acid-inducible gene I (RIG-I)-like receptors (RLRs) and type I IFN-related response. Additionally, flow cytometry analysis revealed that miR-369-3p and miR-491-3p inhibitors downregulated NK cell intracellular perforin expression, while the expression of granzyme B and IFNγ remained unchanged. Taken together, our study suggests a novel mechanism which may promote recurrence and severity of HSV infection, based on miRNAs-dependent posttranscriptional regulation of genes taking part in antiviral response of human NK cells.

Pneumorrhachis due to invasive mucormycosis in a renal transplant recipient

Pneumorrhachis is often associated with trauma or postsurgical changes; few cases are reported as a result of infectious causes in adults. Here, we describe a 61-year-old male with a history of renal transplantation and diabetes with weight loss and imaging findings suggestive of atypical infection. He progressively deteriorated, was intubated, and was found to have new weakness. Imaging revealed necrotizing pneumonia with pneumospinal fistula through the spinal foramen, pneumorrhachis, and cord infarction, which ultimately proved fatal and were found to be due to Rhizopus spp on autopsy.

Astrovirus VA1 in patients with acute gastroenteritis.

Human astroviruses (AstVs) are usually associated with acute gastroenteritis. In recent years, atypical animal-like AstVs have been identified, but their pathogenic role in humans has not been determined. Starting from 2010, there has been a growing evidence that AstVs may also be associated with encephalitis in human and animal hosts. Some human atypical AstV strains (VA1, MLB1/MLB2) display neurotropic potential, as they have been repeatedly identified in patients with AstV-related encephalitis, chiefly in immunosuppressed individuals. In this study, a VA1-like AstV was identified from a single stool sample from an outbreak of foodborne acute gastroenteritis occurred in Italy in 2018. On genome sequencing, the virus was related to the VA1-like strain UK1 (99.3% at the nucleotide level). Similar viruses were also found to circulate in paediatric patients hospitalized with AGE in the same time span, 2018, but at low prevalence (0.75%, 3/401). Gathering epidemiological data on atypical AstVs will be useful to assess the risks posed by atypical AstV infections, chiefly in medically fragile patients.

Imaging of COVID-19 simulators

BackgroundCoronavirus (COVID-19) pneumonia emerged in Wuhan, China, in December 2019. It was highly contagious spreading all over the world, with a rapid increase in the number of deaths. The reported cases have reached more than 14 million with more than 600,000 deaths around the world. So, the pandemic of COVID-19 became a surpassing healthcare crisis with an intensive load on the healthcare resources.In this study, the aim was to differentiate COVID-19 pneumonia from its mimickers as atypical infection, interstitial lung diseases, and eosinophilic lung diseases based on CT, clinical, and laboratory findings.ResultsThis retrospective study included 260 patients, of which 220 were confirmed as COVID-19 positive by two repeated RT-PCR test and 40 were classified as non-COVID by two repeated negative RT-PCR test or identification of other pathogens, other relevant histories, or clinical findings.In this study, 158 patients were male (60.7 %) and 102 patients were female (39.3%). There was 60.9% of the COVID-19 group were male and 39.1% were female. Patients in the non-COVID group were significantly older (the mean age was 46.4) than those in the confirmed COVID-19 group (35.2y). In the COVID-19 group, there was exposure history to positive cases in 84.1% while positive exposure history was 20% in the non-COVID group.ConclusionThe spectrum of CT imaging findings in COVID-19 pneumonia is wide that could be contributed by many other diseases making the interpretation of chest CTs nowadays challenging to differentiate between different diseases having the same signs and act as deceiving simulators in the era of COVID-19.

A case report of suspicious lung cancer or atypical mycobacteria amidst the pandemic era

Background: Starting 2020, the medical guidelines were shacked by COVID-19 pandemic. The threshold for hospital admission increased in order to limit Severe Acute Respiratory Syndrome coronavirus 2 spread. All this affected screening such as for lung cancer which remained largely undiagnosed. On the other hand, it became challenging to differentiate easily between COVID-19 and other diseases such as atypical infections and simple community acquired pneumonia. Moreover, immunocompromised patients are at higher risk of COVID-19 infection overshadowing any other infection such as tuberculosis and non-tuberculosis infections. Case Presentation: We present the case of an 85-year-old female with a long history of scleroderma treated with methotrexate. Patient had non-resolving pneumonia and after two negative RT-PCR, bronchoalveolar lavage showed positive Real Time Polymerase Chain Reaction. Imaging showed persistent 2.6 cm solid nodule in left upper lobe worrisome for an underlying neoplasm. However, culture of Bronchoalveolar lavage grew with few colonies of acid fast bacilli making the diagnosis atypical mycobacteria highly probable especially that patient is chronically immunosuppressed. Unfortunately, she refused further genotyping. Conclusion: To authors’ knowledge that are no, or few reported cases of associated COVID-19 with atypical mycobacterial infections and the treatment modalities are unclear. The diagnosis of mycobacterial infections is usually difficult and in the setting of COVID-19 this becomes more challenging. Hence, a more thorough clinical approach is needed for the future to help clinicians diagnose and treat complicated cases of COVID-19 and concomitant other infections such as TB or Nontuberculous Mycobacteria. Furthermore, amidst the pandemic screening of lung cancer should continue while maintaining safety precautions.

Implications of Unani medicine in the management of Covid-19: An overview

The severe acute respiratory syndrome (SARS) coronavirus-2 is a novel coronavirus belonging to the family Coronaviridae and is now known to be responsible for the outbreak of a series of recent acute atypical respiratory infections originating in Wuhan, China in early December 2019. The disease caused by this virus, termed coronavirus disease 19 or simply COVID-19. COVID-19 has now spread globally with increasing morbidity and mortality among all populations. While going through Unani literature there is no direct description in about coronavirus in general and in particular coronavirus disease 2019 (COVID-19), but Amraz-e-Waba is used. It is an umbrella term which is used in Unani medicine for all types of epidemics but the clinical features of COVID-19 resemble with those of Nazla-e-Wabaiya, a type of Amraze-Waba (epidemic disease). As per Unani classical wisdom, improving immunity with immune boosters is one of the key approaches for prevention of disease and maintenance of health. Therefore, a strategy to enhance immunity and provide symptomatic relief in upper respiratory tract infection is advocated.

Application Value of Metagenomics Next Generation Sequencing of Alveolar Lavage Fluid Metagenome in Unexplained Pulmonary Infection

To explore the application value of metagenomics next generation sequencing of alveolar lavage fluid metagenome in unexplained pulmonary infection. A total of 40 patients with pulmonary infection diagnosed in our hospital from January 2020 to December 2020 were collected. All patients underwent routine blood cell analysis, C-reactive protein, procalcitonin, 1,3-Beta-D glucan test, galactomannan test, sputum smear, sputum culture, blood culture+drug sensitivity, chest computed tomography and other examinations. In addition, sputum, broncho alveolar lavage fluid, blood, pleural effusion and other samples were collected to detect etiology and metagenomics next generation sequencing. Traditional laboratory methods detected pathogens in 60.00 % (24/40) samples, while metagenomics next generation sequencing detected pathogens in 87.50 % (35/40) samples. 12 cases were completely consistent with the traditional method; the results of 5 cases of metagenomics next generation sequencing were partially consistent with those of traditional methods. In these 5 cases, metagenomics next generation sequencing detected potential pathogens which were not detected by traditional methods; In 7 cases, the results of traditional methods were inconsistent with metagenomics next generation sequencing. Chlamydia psittaci was detected in 2 cases by metagenomics next generation sequencing. The results of etiological diagnosis showed that there was no difference in the positive rates of bacterial infection and fungal infection between metagenomics next generation sequencing and traditional methods (p>0.05). The positive rate of metagenomics next generation sequencing virus infection was 84.62 % (11/13), which was significantly higher than that of traditional methods 38.46 % (5/13) (p<0.05). In addition, 7 patients were diagnosed as atypical pathogen infection and the positive rate of metagenomics next generation sequencing was 100 % (7/7), which was significantly higher than that of traditional methods (14.29 %, 1/7) (p<0.05). For difficult and critical patients with infection, using metagenomics next generation sequencing to detect pathogens can improve the early detection rate of pathogens, achieve accurate and individualized treatment, shorten the length of hospital stay and reduce the mortality.