Had Human Immunodeficiency Virus Research Articles

Preexposure prophylaxis for preventing HIV infection: Routine practice in primary care.

An estimated 1.2 million people in the United States have human immunodeficiency virus (HIV) infection per US Centers for Disease Control and Prevention 2021 data. The highest risk of HIV transmission occurs during injection drug use with needle sharing and during sexual activity, most significantly in condomless, receptive anal intercourse. Preexposure prophylaxis (PrEP) for the prevention of HIV infection is part of a larger biobehavioral strategy that uses antiretroviral medication, an oral formulation taken daily or during anticipated exposure events, or an injectable formulation administered every 8 weeks. PrEP consists of 3 possible regimens: emtricitabine/tenofovir disoproxil fumarate, emtricitabine/tenofovir alafenamide, or injectable cabotegravir. Primary care clinicians are strategically positioned to provide PrEP education and access.

1790. Characteristics of Patients with Mpox Treated with Tecovirimat during the 2022 Outbreak in Puerto Rico

Abstract Background In June 2022, the first case of Mpox, was diagnosed in Puerto Rico, followed by a sharp increase in cases that peaked in August 2022. In total, 108 cases were confirmed during this period. Throughout this time period, Tecovirimat (Tpoxx) was already available upon request to the Puerto Rico Department of Health (PRDoH). In this report we aim to describe the clinical characteristics and outcomes of all the patients in Puerto Rico who received Tecovirimat. Methods A cross sectional study was conducted to describe clinical and epidemiological profile of Mpox patients who received Tecovirimat. We use the data collected from our institution (PRDoH), who was responsible for the approval, delivery and monitoring of Tecovirimat prescription during the outbreak. The analysis period ranges from August 2022 to November 2022. Univariate analysis was conducted, including the median and percentage, to provide a summary of the distribution of the variables of interest. Results We present the clinical characteristics of 27 male patients who received Tecovirimat for a diagnosis of Mpox during the outbreak in Puerto Rico. Most patients were treated during August and September (85%), followed by October and November 2022 (15%). Most received treatment in outpatient settings at private clinics (63%) followed by government clinics (37%). Of the patients that required Tecovirimat, 67% had human immunodeficiency virus (HIV) and the median age was 32 years. Prior immunization with smallpox vaccine was reported by two patients, while 70% were not immunized and the immunization status of 22% was unknown. The most common indications for Tecovirimat prescription were genital structure involvement (67%), severe pain (37%), oral cavity involvement (22%), proctitis (19%), and immunosuppression (11%). Only two patients received Tecovirimat while admitted to an acute care setting. No severe adverse events or deaths were reported among these patients, and there were no suspected cases of Tecovirimat resistance. Conclusion This study provides relevant clinical information on the use of Tecovirimat in patients with Mpox during the outbreak in Puerto Rico. These findings may have important implications for the clinical management of future outbreaks of Mpox and other related infections. Disclosures Iris Cardona Gerena, MD, Valneva: Honoraria

The pentalogy of cantrell in limited resources: A case report

Background: Pentalogy of Cantrell (PC) is a rare anomaly, and the incidence varies from 5.5 to 7.9 per million live births. The components are defined as a defect of the lower sternum, a midline supraumbilical thoracoabdominal wall defect, a deficiency of the diaphragmatic pericardium, a deficiency of the anterior diaphragm, and congenital cardiac anomalies. The pathognomonic characteristic of this syndrome is the coexistence of omphalocele and ectopia cordis. Diagnosis is possible by antenatal or physical examination, and other tests should be performed to detect other anomalies, including the heart's anomaly. Surgical treatment is complex, and various operative techniques often require a staged approach. The mortality rate is quite high, with a survival rate of less than 5%. Case presentation: Two-day-old male infant was complained that his heart had been outside his chest wall since birth without covering by skin or sternum. He was born on aterm through section cesarean with a vigorous baby condition. Section cesarean was chosen because his mother has Human Immunodeficiency Virus (HIV)—no family history with similar symptoms. While pregnant, the mother regularly checks with the midwife and fetal ultrasonography only once during the third trimester but did not find the defect, no history of drug abuse, teratogen exposure, smoking, alcohol, or consanguinity. The midline defect extended from the lower part of the sternum completely. Echocardiography found defects such as classic Tetralogy of Fallot, mild atrial regurgitation, mild mitral regurgitation, mild tricuspid regurgitation, and suspect mass at left atrium (LA). The patients underwent surgery by covering the heart with a silo bag. Three days after the procedure, the patient's condition worsened and death because of the sepsis. Conclusion: Prenatal diagnosis is important in guiding the surgical team to estimate the prognosis and reduce a postnatal management strategy. Early management can provide the basic care necessary to keep the patients until definitive management can be provided.

The Impact of Asymptomatic Human Immunodeficiency Virus-Positive Disease Status on Inpatient Complications Following Spine Surgery: A Propensity Score-Matched Analysis

In the United States, nearly 1.2 million people > 12 years old have human immunodeficiency virus (HIV), which is associated with postoperative complications following orthopedic procedures. Little is known about how asymptomatic HIV (AHIV) patients fare postoperatively. This study compares complications after common spine surgeries between patients with and without AHIV. The Nationwide Inpatient Sample (NIS) was retrospectively reviewed from 2005-2013, identifying patients aged > 18 years who underwent 2-3-level anterior cervical discectomy and fusion (ACDF), ≥4-level thoracolumbar fusion (TLF), or 2-3-level lumbar fusion (LF). Patients with AHIV and without HIV were 1:1 propensity score-matched. Univariate analysis and multivariable binary logistic regression were performed to assess associations between HIV status and outcomes by cohort. 2-3-level ACDF (n = 594 total patients) and ≥4-level TLF (n = 86 total patients) cohorts demonstrated comparable length of stay (LOS), rates of wound-related, implant-related, medical, surgical, and overall complications between AHIV and controls. 2-3-level LF (n = 570 total patients) cohorts had comparable LOS, implant-related, medical, surgical, and overall complications. AHIV patients experienced higher postoperative respiratory complications (4.3% vs. 0.4%,). AHIV was not associated with higher risks of medical, surgical, or overall inpatient postoperative complications following most spine surgical procedures. The results suggest the postoperative course may be improved in patients with baseline control of HIV infection.

Final Condition of HIV Patients Infected with COVID-19 after Receiving Hospital Treatment: A Systematic Review

Introduction: Coronavirus disease 2019 (COVID-19) can attack anyone, including those who have human immunodeficiency virus (HIV) due to low immune systems. This study aimed to evaluate the final condition of people living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) (PLWHA) who received treatment at the hospital. Methods: A literature investigation of the last three years (2020-2022) were inquired. Electronic databases (Science Direct, Scopus, ProQuest) with case series or case report designs were examined. The titles, abstracts, and full texts were screened to obtain relevant studies. Data tabulation and narrative analysis were conducted, resulting in 14 studies that met the inclusion criteria. Most of them were case series and case report methods. Each study had different numbers of patients and criteria discussing COVID-19 infection in HIV patients. Results: A total of 14 reviewed studies revealed that HIV patients with COVID-19 could recover from the infection if proper treatments were performed. Some articles also stated that self-isolation at home can manage HIV-infected patients who are not yet severe. In the case of patients with severe infections, intensive care is performed using supplemental oxygen or a ventilator to prevent respiratory failure or acute respiratory distress. Conclusion: COVID-19 can worsen the condition of patients with HIV if not appropriately treated. Otherwise, if the proper treatment is properly performed, it can cure the infection.

Primary Esophageal Lymphoma: A Histopathological Experience from Two Tertiary Hospitals, Western Saudi Arabia.

Primary esophageal lymphoma (PEL) is a rare disorder. The objective of this study was to document the clinicopathological features of PEL at two tertiary hospitals in the western region of the Kingdom of Saudi Arabia. All PELs diagnosed between May 2002 and June 2022 were retrieved. Histopathological and immunohistochemical slides were reviewed. Additional immunohistochemistry stains were performed in selected cases. Follow-up data were collected. There were only eight cases of PEL in the records of the two hospitals. The age of the patients ranged between 50 and 74 years (median 62 years and mean 62.5 years). There were six males (80%) and two females (20%). None of the patients were immunocompromised or had human immunodeficiency virus (HIV) infection. The clinical manifestation included dysphagia and loss of weight. Six cases were diffuse large B-cell lymphoma (DLBCL), and two were low-grade mucosa-associated lymphoid tissue lymphoma. PEL is an extremely rare disease with male predominance. DLBCL is the most common pathological type in our community. There was no relation to immune status or HIV infection in this series. Clinical presentations were typically dysphagia with weight loss. Further reporting of PEL cases might help explain this disease and improve its diagnosis and management.

Computed tomography chest findings in post-acute COVID-19 lung disease at a South African regional hospital - a descriptive study.

whilst many studies have focused on acute and chronic complications of COVID-19, few studies have been performed on the immediate post-acute COVID-19 phase complications. The objective of the study was to describe computed tomography (CT) imaging findings in patients from a South African (SA) cohort during the post-acute COVID-19 phase. To describe the findings using existing CT description systems and, if present, pulmonary imaging findings unique to our cohort. a review of CT chest examinations performed over the second wave of COVID-19 in SA for post-acute COVID-19 cardiorespiratory complaints at Worcester Hospital. The CT findings were described using a modified semi-quantitative tabulation method. eight males and 12 females met the inclusion criteria with a mean age of 56 years. Half had hypertension, 11 had diabetes, two had human immunodeficiency virus (HIV), half had raised D-dimers and six had pre-existing lung disease. The predominant parenchymal pattern was mixed ground glass and reticular changes in a diffuse/peripheral multilobar distribution with relative sparing of the left upper lobe. Four cases demonstrated pulmonary emboli, 50% pulmonary hypertension, three pleural effusions and nine lymphadenopathy. None of the cases had evidence of active pulmonary tuberculosis. CT lung findings appear to mirror global findings with expected evolutionary differences. An interesting observation was the relative sparing of the left upper lobe. Reporting using the modified table proved efficient. Real-world extrapolation of our findings is limited by low-case numbers.

Detection of Monkeypox Virus according to The Collection Site of Samples from Confirmed Cases: A Systematic Review.

Due to the rapid evolution of the monkeypox virus, the means by which the monkeypox virus is spread is subject to change. Therefore, the present study aims to analyze the detection of the monkeypox virus according to the collection site of samples from confirmed monkeypox cases. A systematic literature review was performed using PubMed, Scopus, Web of Science, and Embase databases until 5 October 2022. A total of 1022 articles were retrieved using the search strategy. After removing duplicates (n = 566) and examining by title, abstract, and full text, 65 studies reporting monkeypox case reports were included with a detailed description of risk factors, sexually transmitted infections (STIs), site of monkeypox virus-positive specimens, location of skin lesions, and diagnostic test. A total of 4537 confirmed monkeypox cases have been reported, of which 98.72% of the cases were male with a mean age of 36 years, 95.72% had a sexual behavior of being men who have sex with men, and 28.1% had human immunodeficiency virus (HIV). The most frequent locations of lesions in patients diagnosed with monkeypox were: 42.85% on the genitalia and 37.1% in the perianal region. All confirmed monkeypox cases were diagnosed by reverse transcriptase polymerase chain reaction (RT-PCR), and the most frequent locations of samples collected for diagnosis that tested positive for monkeypox virus were: 91.85% from skin lesions, 20.81% from the oropharynx, 3.19% from blood, and 2.43% from seminal fluid. The disease course of the cases with monkeypox was asynchronous, with no severe complications, and most patients did not report specific treatment but simply followed a symptomatic treatment.

Psychosocial- and disclosure-related challenges among HIV-serodiscordant couples: an interpretative phenomenological analysis study

Background: Serodiscordant refers to a couple where one has human immunodeficiency virus (HIV), and the other partner is HIV negative. HIV-serodiscordancy often results in diverse psychological and emotional challenges. Evidence demonstrates that the dynamics of living in an HIV-serodiscordant relationship are often stressful. This study explored the psychosocial- and disclosure-related challenges faced by couples in HIV-serodiscordant relationships in South Africa. Methods: An interpretative phenomenological analysis (IPA) design was followed. A total of 13 HIV-serodiscordant partners were purposively sampled. Data were collected through individual face-to-face interviews and analysed using the IPA framework. Results: The findings indicated that HIV-serodiscordant couples experienced diverse psychosocial challenges such as shock, sadness, hurt, denial and disbelief. Participants also experienced challenges such as selective disclosure and fear of further disclosure. Conclusions: The findings have implications for public health and are critical in programming and designing couple-based HIV care interventions. Couples in HIV-serodiscordant relationships would benefit more from differentiated, client-centred psychosocial support. To contribute to the HIV epidemic control and reduction of new HIV infections, specific interventions such as couples counselling, disclosure counselling, support groups, health education and safer conception risk reduction strategies need to be implemented.

P498 Pneumocystis Jirovecii pneumonia: Clinical profile and diagnostic modalities

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM ObjectivesIn developing countries like India, the diagnosis of Pneumocystis jirovecii infection is often made either by conventional staining or clinically. This study was planned to know the utility of polymerase chain reaction (PCR) in diagnosing Pneumocystis jirovecii pneumonia (PJP), to compare the PCR results with that of the staining technique, and also to correlate the results with the radiological condition of patients from a tertiary care center in India.MethodA retrospective study included 3500 adult in-patients with symptoms of lower respiratory tract infection. Sputum and bronchoalveolar lavage samples were proceeded for both staining and PCR for multicopy mtLSU gene and singlecopy DHPS fas gene of P. jirovecii.ResultsThe present study was carried out in the Department of Microbiology, Max, Hospital, Saket, New Delhi, India. Between the years 2019 and 2022, the patients with clinically suspected pneumocystis pneumonia who attended outpatient or admitted to the Departments of Medicine, Gastroenterology, and Neurology, etc. of our hospital were retrospectively analyzed. The details of these patients were analyzed as per a well-structured proforma that included the detailed clinical history and laboratory data from the hospital records. A total of 3500 patients were included in the present study. Of these 3500 patients, 1.42% (50/3500) patients of pneumocystis pneumonia were confirmed, based on positivity by at least any two of the above-mentioned techniques. The age of the patients ranged from 29 to 80 years (mean 32 years). Among these 50 patients, 34 (68%) were males and 16 (32%) were females and the male-to-female ratio was 2:1. A total of 10 patients had human immunodeficiency virus (HIV) infection, while the other 25 were HIV negative. The immune status of five patients was unknown. Fever and dyspnea (n = 44, 88%), non-productive cough and abnormal auscultation sound (n = 30, 60%), and also chills and weight loss (n = 10, 20%) were the documented clinical symptoms of PJP. Radiological diagnosis of Pneumocystis pneumonia was noticed in 34 cases. Foamy alveolar casts were present in 19 cases. Silver methenamine stain enhanced the rounded, helmet, or cleft forms of sporozoites. Inflammatory infiltrate was mainly polymorphonuclear. All the cases were confirmed as P. jiroveci by PCR amplification.ConclusionClinicians often face the diagnostic dilemmas presented in the study. Individual modalities of the diagnosis are available, but all have drawbacks with varied sensitivity and specificity. Combining the available clinical, radiological, and microbiological modalities to reach early diagnosis can go a long way to avoid misdiagnosis and unnecessary delays in treatment.

Microsporidia, a Highly Adaptive Organism and Its Host Expansion to Humans

Emerging infectious disease has become the center of attention since the outbreak of COVID-19. For the coronavirus, bats are suspected to be the origin of the pandemic. Consequently, the spotlight has fallen on zoonotic diseases, and the focus now expands to organisms other than viruses. Microsporidia is a single-cell organism that can infect a wide range of hosts such as insects, mammals, and humans. Its pathogenicity differs among species, and host immunological status plays an important role in infectivity and disease severity. Disseminated disease from microsporidiosis can be fatal, especially among patients with a defective immune system. Recently, there were two Trachipleistophora hominis, a microsporidia species which can survive in insects, case reports in Thailand, one patient had disseminated microsporidiosis. This review gathered data of disseminated microsporidiosis and T. hominis infections in humans covering the biological and clinical aspects. There was a total of 22 cases of disseminated microsporidiosis reports worldwide. Ten microsporidia species were identified. Maximum likelihood tree results showed some possible correlations with zoonotic transmissions. For T. hominis, there are currently eight case reports in humans, seven of which had Human Immunodeficiency Virus (HIV) infection. It is observed that risks are higher for the immunocompromised to acquire such infections, however, future studies should look into the entire life cycle, to identify the route of transmission and establish preventive measures, especially among the high-risk groups.

Oral Swab Specimens Tested With Xpert MTB/RIF Ultra Assay for Diagnosis of Pulmonary Tuberculosis in Children: A Diagnostic Accuracy Study.

Microbiologic diagnosis of childhood tuberculosis may be difficult. Oral swab specimens are a potential noninvasive alternative to sputum specimens for diagnosis. This was a prospective diagnostic accuracy study of oral swab specimens (buccal and tongue) for pulmonary tuberculosis diagnosis in children (aged ≤ 15 years) in 2 South African hospital sites. Children with cough of any duration as well as a positive tuberculin skin test result, tuberculosis contact, loss of weight, or chest radiograph suggestive of pulmonary tuberculosis were enrolled. Two induced sputum specimens were tested with Xpert MTB/RIF (or Xpert MTB/RIF Ultra) assay and liquid culture. Oral swab specimens were obtained before sputum specimens, frozen, and later tested with Xpert MTB/RIF Ultra. Children were classified as microbiologically confirmed tuberculosis, unconfirmed tuberculosis (receipt of tuberculosis treatment), or unlikely tuberculosis according to National Institutes of Health consensus definitions based on sputum microbiologic results. Among 291 participants (median age [interquartile range], 32 [14-73] months), 57 (20%) had human immunodeficiency virus (HIV), and 87 (30%) were malnourished; 90 (31%) had confirmed pulmonary tuberculosis (rifampicin resistant in 6 [7%] ), 157 (54%), unconfirmed pulmonary tuberculosis, and 44 (15%), unlikely tuberculosis. A single oral swab specimen was obtained from 126 (43%) of the participants (tongue in 96 and buccal in 30) and 2 swab specimens from 165 (57%) (tongue in 110 and buccal in 55). Sensitivity was low (22% [95% confidence interval, 15%-32%]) for all swab specimens combined (with confirmed pulmonary tuberculosis as reference), but specificity was high (100% [91%-100%]). The highest sensitivity was 33% (95% confidence interval, 15%-58%) among participants with HIV. The overall yield was 6.9% with 1 oral swab specimen and 7.2% with 2. Use of the Xpert MTB/RIF Ultra assay with oral swab specimens provides poor yield for microbiologic pulmonary tuberculosis confirmation in children.

SHINE trial of shorter course tuberculosis treatment

Journal of Paediatrics and Child HealthVolume 58, Issue 5 p. 935-935 Heads UpFree Access SHINE trial of shorter course tuberculosis treatment First published: 02 April 2022 https://doi.org/10.1111/jpc.15957 edited by Craig Mellis (craig.mellis@sydney.edu.au) [Correction added on 12 April 2022, after first online publication: Figure 1 has been removed from the article.] AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat The World Health Organization (WHO) estimates that 1.1 million children worldwide became ill with tuberculosis (TB) in 2020. Treatment adherence is a possible issue in the development of multidrug-resistant TB. The SHINE trial randomised 1204 African and Indian children (median age 3.5 years, range 2 months to 15 years) diagnosed with respiratory sample smear-negative, ‘non-severe’ TB to either 4 or 6 months of anti-tuberculous treatment using child-friendly fixed dose combinations (8 weeks of isoniazid, rifampicin and pyrazinamide ± ethambutol followed by 8 or 16 weeks of isoniazid and rifampicin).1 Of these, 52% were male, 11% had human immunodeficiency virus (HIV) infection, and 14% had bacteriologically confirmed TB. Retention (95% at 72 weeks) and treatment adherence (94%) were very high. The primary endpoint, unfavourable outcome (treatment failure or death), occurred in 16 participants (3%) in the 4-month group compared with 18 (3%) in the 6-month group (adjusted difference, −0.4%; 95% CI, −2.2 to 1.5). Adverse events mainly occurred in the first 8 weeks of treatment and were equally common (8%) in both groups. As a result of the SHINE trial, new WHO guidelines recommend that children with non-severe TB can now receive 4 months of anti-TB treatment. The challenges are accurate classification of ‘non-severe’ disease in resource-limited settings where disease burdens are highest, and whether clinicians in developed countries will feel comfortable treating for 4 months before more clinical experience accumulates. Reference 1Turkova A, Wills GH, Wobudeya E et al. Shorter treatment for nonsevere tuberculosis in African and Indian children. N. Engl J Med 2022; 399: 911– 22. CrossrefWeb of Science®Google Scholar Reviewers: David Isaacs (david.isaacs@health.nsw.gov.au) and Ben Marais (ben.marais@health.nsw.gov.au), Children's Hospital at Westmead and University of Sydney Volume58, Issue5May 2022Pages 935-935 ReferencesRelatedInformation

Burkitt lymphoma – no impact of HIV status on outcomes with rituximab-based chemoimmunotherapy

We analyzed the prognostic factors for treatment outcomes amongst 34 patients with adult Burkitt lymphoma (BL) who received rituximab with standard first-line chemotherapy. Seven patients had human immunodeficiency virus (HIV)-associated BL. Overall, we observed a complete remission (CR) rate of 91.2%, and 10-year progression-free survival (PFS) and overall survival (OS) was 84.8 and 88.2%, respectively. In patients with concomitant HIV, the prognosis was not different with 10-year PFS of 100% and OS of 88.2%. The majority (71.4%) of HIV-associated BL patients received dose-adjusted EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab) and had excellent outcomes with 100% CR and no relapses. Central nervous system (CNS) disease, bone marrow involvement and elevated serum lactate dehydrogenase (LDH) levels more than 3 times upper limit of normal (ULN) were associated with poorer survival outcomes. Patients with refractory disease, whilst uncommon (n = 4), had dismal outcomes. Patients with adult BL, including HIV-related cases, harbor generally good prognosis in the modern era.

Experience of Non-Hodgkin's Lymphoma in the Central Nervous System Presented as Neurological Deficit from 2017-2021 in a Medical Center in Mexico City.

To show the oddity of primary central nervous system lymphoma (PCNSL) and illustrate the histopathological and magnetic resonance imaging (MRI) characteristics of this disease entity. We obtained the histopathological diagnosis through stereotactic biopsy, and all lesions were resected at the Department of Neurosurgery, Centro Medico Nacional 20 de Noviembre. We identified and included six lymphoma cases in a 5-year period: none of the patients had human immunodeficiency virus (HIV) infection; none were Epstein-Barr virus (EVB)-positive; all of them received chemotherapy and radiotherapy; and the survival rate was ≥1 year. Regarding the clinical data, the symptoms entirely depended on the location of the lesions. If the symptoms suggest malignancy, such as fever, weight loss, and night sweats, we searched for causes, other than the usual ones, to find a diagnosis. This is a rare disease, which responds well to medical treatment and has a survival greater than 5 years in some cases.

COVID Booster Shot and the Third Dose

The protection provided by the original shot(s) has begun to decrease over time, then a Coronavirus Disease (COVID) booster shot is given. Moreover, the immunity from the initial dose(s) naturally starts to wane, and you would get a booster. Accordingly, the booster is designed in order to maintain the people’s level of immunity for longer [1]. There is evidence that the effect of the vaccine wanes over time, so the officials recommended booster shots for everyone who is eighteen and older [2]. Therefore, the medics instructed the third dose for individuals who are immuno-compromised. The third dose is needed when a person’s immune response likely has not responded fully to the vaccine after the first doses. Subsequently, the Food and Drug Administration (FDA) counseled that the EUAs of the Moderna and Pfizer vaccines boost people who are older than eighteen. Moreover, FDA instructed Pfizer third boosters for persons older than sixteen [3]. Accordingly, the reader is eligible for a COVID-19 booster if your age is 18 or older and received the Janssen/Johnson & Johnson vaccine at least two months ago, 18 or older, and received both required doses of the Moderna vaccine at least six months ago and 16 or older and received both doses of the Pfizer-BioNTech vaccine at least six months ago [1]. Hereafter, the Centers for Disease Control and Prevention (CDC) and the FDA suggested the third dose of a COVID-19 vaccine for patients on cancer treatment, patients after an organ transplant, patients on immune suppressant drugs, patients on stem cell transplant, patients who have primary immunodeficiency, patients have Human Immunodeficiency Virus (HIV) disease, patients on steroids or other medications that may cause severe suppression of the immune system [2]. After any person gets a COVID booster, he might encounter some transient symptoms such as a sore, swollen injected area. Furthermore, he could undergo generalized aches and felt a slight fever, headache, and tiredness for a day or two. Moreover, some persons sensed chills, swollen axillary lymph nodes. Hence, these sufferings denote that the body’s immune system responds to the Covid shots to immunize against the coronavirus [1]. Consequently, the COVID booster shot might be from the same trademark or mixed. Moreover, the FDA, Pfizer-BioNTech, Moderna, and Janssen suggest three vaccine boosters and approved that it is unassailable to get a COVID-19 vaccine third dose even from the other trademark the initial shot. Further, the administrators ordered Sinopharm and Pfizer-BioNTech vaccines boosters safely for people aged sixteen years old [1]. It is important to note that numerous documented investigations revealed the effective broad spectrum of nanoparticles and bacteriophages as promising killer agents on viruses by inhalation. Therefore, the experimenters employed inhalational bacteriophages and nanoparticles in their functional formulations and doses to achieve an acceptable and excellent concentration on the respiratory system [4-5].

COVID Booster Shot and the Third Dose

The protection provided by the original shot(s) has begun to decrease over time, then a Coronavirus Disease (COVID) booster shot is given. Moreover, the immunity from the initial dose(s) naturally starts to wane, and you would get a booster. Accordingly, the booster is designed in order to maintain the people’s level of immunity for longer [1]. There is evidence that the effect of the vaccine wanes over time, so the officials recommended booster shots for everyone who is eighteen and older [2]. Therefore, the medics instructed the third dose for individuals who are immuno-compromised. The third dose is needed when a person’s immune response likely has not responded fully to the vaccine after the first doses. Subsequently, the Food and Drug Administration (FDA) counseled that the EUAs of the Moderna and Pfizer vaccines boost people who are older than eighteen. Moreover, FDA instructed Pfizer third boosters for persons older than sixteen [3]. Accordingly, the reader is eligible for a COVID-19 booster if your age is 18 or older and received the Janssen/Johnson & Johnson vaccine at least two months ago, 18 or older, and received both required doses of the Moderna vaccine at least six months ago and 16 or older and received both doses of the Pfizer-BioNTech vaccine at least six months ago [1]. Hereafter, the Centers for Disease Control and Prevention (CDC) and the FDA suggested the third dose of a COVID-19 vaccine for patients on cancer treatment, patients after an organ transplant, patients on immune suppressant drugs, patients on stem cell transplant, patients who have primary immunodeficiency, patients have Human Immunodeficiency Virus (HIV) disease, patients on steroids or other medications that may cause severe suppression of the immune system [2]. After any person gets a COVID booster, he might encounter some transient symptoms such as a sore, swollen injected area. Furthermore, he could undergo generalized aches and felt a slight fever, headache, and tiredness for a day or two. Moreover, some persons sensed chills, swollen axillary lymph nodes. Hence, these sufferings denote that the body’s immune system responds to the Covid shots to immunize against the coronavirus [1]. Consequently, the COVID booster shot might be from the same trademark or mixed. Moreover, the FDA, Pfizer-BioNTech, Moderna, and Janssen suggest three vaccine boosters and approved that it is unassailable to get a COVID-19 vaccine third dose even from the other trademark the initial shot. Further, the administrators ordered Sinopharm and Pfizer-BioNTech vaccines boosters safely for people aged sixteen years old [1]. It is important to note that numerous documented investigations revealed the effective broad spectrum of nanoparticles and bacteriophages as promising killer agents on viruses by inhalation. Therefore, the experimenters employed inhalational bacteriophages and nanoparticles in their functional formulations and doses to achieve an acceptable and excellent concentration on the respiratory system [4-5].

Clinical profile and risk stratification in multidrug-resistant tuberculosis (MDR-TB) and non-MDR-TB patients: A prospective study in a tertiary care hospital

Background: Multidrug resistant tuberculosis (MDR-TB) is a major threat for successful control of TB. Early diagnosis and drug sensitivity testing helps in improving disease prevalence. This study was undertaken to determine clinical profile and risk factors for MDR-TB and factors differentiating it from non MDR-TB. Materials and methods: This is a prospective study conducted at a TB hospital attached to Vijayanagara institute of medical sciences, Bellary, Karnataka in South India over a period of 2 years. All patients diagnosed with MDR-TB were studied for clinical parameters and another cohort of non MDR-TB in same study period were included for comparison. Clinical and radiological characteristics, and risk factors were compared between two groups. Results: A total of 59 MDR-TB and 72 non MDR-TB patients were studied in this period. Males were predominant in both groups. Body mass index (BMI) was significantly low in MDR-TB group (18.5 vs 20.3 kg/m2). Among clinical symptoms, breathlessness was significantly seen in MDR-TB group. Defaulter, failure and relapse were seen in 6.8%, 54.3% and 37.3% respectively. Cavitary lesions and reticulonodular patterns in imaging were significantly seen in MDR group. Eight patients in non MDR group had human immunodeficiency virus (HIV) infection compared to one patient in MDR. Conclusion: Presence of cavity and reticulonodular patterns in imaging, significant breathlessness and lower BMI are significantly common in MDR TB patients. These parameters maybe considered for early suspicion and monitoring for drug resistance in index presentation. Keywords: multidrug resistant TB; breathlessness; human immunodeficiency virus; cavity lesion; reticulonodular patterns

Primary Effusion Lymphoma: A Clinicopathological Study of 70 Cases.

Simple SummaryPrimary effusion lymphoma (PEL) is a rare HHV8 driven large B-cell lymphoma. It is often associated with HIV infection and seldom occurs in HIV-negative immunocompromised patients. Patients with PEL usually present with effusion only, but occasionally with an extracavitary mass, or both. This retrospective study aimed to better characterize the clinicopathological features of PEL by comparing effusion-only PEL versus the extracavitary-only PEL and HIV-positive versus HIV-negative cases in a large cohort of 70 patients. All 70 (100%) cases were positive for HHV8. Fifty-six (80%) patients had HIV infection. Patients presenting with effusion only versus extracavitary disease were associated with different clinicopathologic features. After a median follow-up time of 40 months (range 0–96), 26 of 52 (50%) patients with clinical follow-up died, and the median survival was 42.5 months. PEL is an aggressive lymphoma with a poor prognosis, regardless of extracavitary presentation or HIV status.Primary effusion lymphoma (PEL) is a rare type of large B-cell lymphoma associated with human herpesvirus 8 (HHV8) infection. Patients with PEL usually present with an effusion, but occasionally with an extracavitary mass. In this study, we reported a cohort of 70 patients with PEL: 67 men and 3 women with a median age of 46 years (range 26–91). Of these, 56 (80%) patients had human immunodeficiency virus (HIV) infection, eight were HIV-negative, and six had unknown HIV status. Nineteen (27%) patients had Kaposi sarcoma. Thirty-five (50%) patients presented with effusion only, 27 (39%) had an extracavitary mass or masses only, and eight (11%) had both effusion and extracavitary disease. The lymphoma cells showed plasmablastic, immunoblastic, or anaplastic morphology. All 70 (100%) cases were positive for HHV8. Compared with effusion-only PEL, patients with extracavitary-only PEL were younger (median age, 42 vs. 52 years, p = 0.001), more likely to be HIV-positive (88.9% vs. 68.6%, p = 0.06) and EBV-positive (76.9% vs. 51.9%, p = 0.06), and less often positive for CD45 (69.2% vs. 96.2%, p = 0.01), EMA (26.7% vs. 100%, p = 0.0005), and CD30 (60% vs. 81.5%, p = 0.09). Of 52 (50%) patients with clinical follow-up, 26 died after a median follow-up time of 40.0 months (range 0–96), and the median overall survival was 42.5 months. The median OS for patients with effusion-only and with extracavitary-only PEL were 30.0 and 37.9 months, respectively (p = 0.34), and patients with extracavitary-only PEL had a lower mortality rate at the time of last follow-up (35% vs. 61.5%, p = 0.07). The median OS for HIV-positive and HIV-negative patients were 42.5 and 6.8 months, respectively (p = 0.57), and they had a similar mortality rate of 50% at last follow-up. In conclusion, patients presenting with effusion-only versus extracavitary-only disease are associated with different clinicopathologic features. PEL is an aggressive lymphoma with a poor prognosis, regardless of extracavitary presentation or HIV status.

Varicella-Zoster Virus Meningitis and Encephalitis: An Understated Cause of Central Nervous System Infections.

BackgroundVaricella-zoster virus (VZV) and herpes zoster cause infections of the central nervous system (CNS) manifesting as meningitis or encephalitis. As compared to enterovirus (EV) and herpes simplex virus 1 (HSV-1) and 2 (HSV-2), it is not often tested in CNS infections due to VZV and herpes zoster. There is a certain tendency to think that the findings in the cerebrospinal fluid in infections of the CNS by viruses are comparable among themselves. The exact proportion of patients with VZV primary and reactivation infection who present with lesions prior to or concomitant to its involvement in the CNS is unknown. It is also not known about the risk factors that lead to the reactivation of VZV and CNS involvement.ObjectiveTo describe the clinical characteristics and laboratory results of patients with a positive VZV polymerase chain reaction (PCR) and neurological signs and symptoms.MethodsA retrospective and descriptive study was performed at the Hospital Universitario de la Pontificia Universidad Católica de Chile (Hospital Clínico UC CHRISTUS) from September 2012 to July 2014. The following parameters were recorded: neurological signs and symptoms, PCR for VZV in cerebrospinal fluid (CSF), comorbidities, personal medical history, cutaneous lesions, CSF characteristics, CNS imaging, electroencephalography (EEG), treatment, mortality, and neurological sequelae. Adult patients with meningitis, encephalitis, or meningoencephalitis due to VZV diagnosed with PCR were included.ResultsOut of 70 CSF samples analyzed in the previously mentioned period, 21 cases were VZV positive, 16 cases that had clinical information available were included. The mean age with VZV CNS reactivation was 47 years (range 19-80 years). Five patients (31.25%) were immunocompromised: three had human immunodeficiency virus (HIV), one had kidney transplantation, and one had primary immunodeficiency. Clinical presentation was meningitis in 11 patients (68.75%) and encephalitis in five patients (31.25%). Pleocytosis in CSF was observed in all the samples. The five immunocompromised patients had cutaneous lesions. All patients received antiviral treatment. Therapy duration was from 10 up to 21 days. The clinical course was positive in most patients and the mean hospitalization time was 15 days (range 5-60 days). No mortality was observed.ConclusionsVZV is a worldwide virus and a common cause of CNS infection. The rising incidence is probably due to a better diagnostic method and a frequent clinical suspicion even in the absence of cutaneous lesions, except in immunocompromised cases, as it was observed in the present study. CNS infection presented as a wide spectrum of clinical manifestations with possible neurological sequelae. There was a reduction in neurological morbidity with antiviral therapy. Nonetheless, both the incidence and the morbidity of CNS VZV infection are expected to be diminished by varicella and herpes zoster vaccination. Additionally, there was no increase in mortality in these patients.