Infection Research Articles

Post-infection symptoms up to 24 months after COVID-19: a matched cohort study in Berlin, Germany

Abstract Background Long-term health consequences after mild COVID-19 are not well described. Our aim was to estimate their prevalence and describe the time course of signs and symptoms for a period of up to 24 months after confirmed SARS-CoV-2 infection. Methods We conducted a cohort study matched for age, sex, and test week among individuals who had attended the public COVID-19 test center at Charité - Universitätsmedizin Berlin, Germany. In early 2022, 576 former COVID-19 patients (>95% non-hospitalised) and 302 uninfected individuals responded to a questionnaire on retrospective monthly symptoms since the test date up to 24 months after. Results Symptoms compatible with long COVID were present in 42.9% (247/576) of former COVID-19 patients, compared with 21.2% (64/302) in the uninfected group. In former patients, unadjusted odds ratios (OR) were highest for disturbed taste/smell (OR 9.1 [95% CI: 4.0 - 21.1]), memory difficulties (OR 5.1 [95% CI: 2.9 - 8.9]) and shortness of breath at rest (OR 4.5 [95% CI: 1.9 - 10.6]). Whilst in most former COVID-19 patients, symptoms occurred in one coherent period and resolved after a median of 6.5 months, taste/smell disturbance and neurological/cognitive symptoms showed longer times until recovery and 28.7% (31/108) still reported long COVID-compatible symptoms 18 months after initial COVID-19. Factors associated with long COVID-compatible symptoms included hospitalisation (OR 4.2 [95% CI: 1.7 - 10.8], symptomatic COVID-19 infection (OR 3.4 [95% CI: 1.9 - 6.3], low household income (OR 1.8 [95% CI: 1.2 - 2.7], and female sex (OR 1.7 [95% CI: 1.2 - 2.4]). Conclusions Post-infection symptoms in mild COVID-19 mostly persist for about half a year, but sometimes longer. Among uninfected individuals who never experienced COVID-19, 21.2% also reported long COVID-compatible symptoms. The current long COVID definition might require revision to prevent misclassification and over-reporting, and to improve diagnosis and prevalence estimates. Key messages • A more precise definition of long COVID is needed to prevent over-reporting of symptoms compatible with long COVID, and to improve diagnosis, prevalence estimates and research harmonisation. • Post-infection symptoms after mild COVID-19 are common, mostly persist for about half a year but sometimes longer for more than 20 months.

Risk factors for COVID-19 among healthcare workers: a hospital-based cohort study in Portugal

Abstract Background Healthcare workers (HCWs) have an increased risk of transmitting SARS-CoV-2 infection to frail patients and are also at higher risk of exposure. Hence, it is essential to understand the risk factors for infection of HCWs to limit adverse events occurring in healthcare facilities. This study aimed to identify risk factors for symptomatic COVID-19 infection among HCWs in the hospital context. Methods We used data from a hospital-based cohort study followed between December 2020 and January 2022 in three central Portuguese hospitals. Following the study protocol, RT-PCR testing was performed whenever an HCW reported any symptom compatible with COVID-19. Characteristics of infected (at least one positive RT-PCR with symptoms) versus non-infected HCW were compared using the Chi-square test. Results A total of 3034 HCWs were followed during 13 months and 533 had a positive test for SARS-CoV-2. A higher percentage (> 40 %) of infections were in individuals without a primary vaccination scheme. Other than age, no differences were found regarding individual characteristics: infected HCWs had a higher percentage of individuals aged 18 to 50 years old compared to the non-infected HCWs (74.7 % versus 66.2 %, p < 0.001). Regarding work functions, no differences were found for self-report of working in direct contact with COVID-19 patients. Additionally, the percentage of HCWs who declared to perform tracheal intubation procedures was similar in infected versus non-infected HCWs (6.2 % versus 8.9 %, p = 0.080). Conclusions Infected HCWs were younger than the non-infected. HCWs working in direct contact with patients or performing tracheal intubations didn’t exhibits increased rates of infection suggesting the success of preventive measures and other standard procedures in limiting infection transmission in healthcare facilities. Key messages • HCWs working in direct contact with COVID-19 patients or performing tracheal intubations were not the most infected personnel. • Preventive measures and other standard procedures were successful in limiting COVID-19 infection transmission in healthcare facilities.

England RCT of air filtration to prevent respiratory infections (including covid-19) in care homes

Abstract Context There is evidence that portable high-efficiency-particulate-air (HEPA) filtration units remove microbial particles from the air, but it is unclear whether this is sufficient to reduce infections in care home residents. Objectives To investigate the effectiveness of portable HEPA filtration units for winter respiratory infection episode reduction in care home residents. Study design and analysis: Cluster controlled trial with intention-to-treat analysis. Setting: 90 residential care homes for older adults in England. Population: Residents expected to reside in the care home for ≥1 month. Intervention care homes: Five HEPA filtration units in communal rooms and one HEPA filtration unit in 10 to 16 bedrooms. Control care homes: Usual care. Outcome measures: The primary outcome is the number of symptomatic winter respiratory infection episodes recorded by care home staff. Secondary outcomes: other infection measures; falls /near falls; laboratory confirmed infections; hospitalisations; and staff sickness. Process evaluation to assess intervention acceptability and implementation. Results Care homes were randomised between January 2022 and February 2024, 43 to intervention and 47 to usual care. Respectively, in intervention and control group care homes: 43% and 45% provided nursing care; 87% and 87% dementia care; and median (IQR) number of communal rooms were 4 (3-5) in both groups. 1126 residents were consented, of whom 31 (3%) moved away; 151 (13%) died; and 5 stopped participating. Primary outcome data is 98% complete with 175,318 'resident days' symptom data collected. Comparing intervention and control group residents: median (IQR) age was 88 (81-92) and 88 (82-92) years; 33% and 43% were receiving nursing care; 58% and 57% had dementia; frailty scores were 6 (4-7) and 6 (5-7); 94% and 94% received influenza; and 97% and 95% COVID vaccines. Conclusions Final analytic results of this world-first RCT will be available for the conference. Key messages • This world-first RCT using HEPA filters in care homes will report the evidence of effectiveness of respiratory infection episode reduction in care home residents. • The trial will inform policy makers about the effectiveness, acceptability and implementation of HEPA filters in care homes.

Treatment of Posttraumatic Zygomatic Coronoid Ankylosis. Systematic Review.

Facial trauma is mostly associated with traffic accidents, fights, and sports accidents. The mandible, midface, and temporomandibular joint are usually the region's most frequently affected. Coronoid process fractures are rare, representing ∼2% of facial fractures in the literature, usually being the result of direct trauma to the zygomatic region. Due to the anatomical relationship of the coronoid process, it may be associated with other facial fractures, such as fractures of the zygomatic bone. Zygomatic-coronoid ankylosis is a rare clinical entity with variable etiology. It is most commonly associated with trauma (13%-100%), local or systemic infection (0%-53%), or systemic diseases, such as ankylosing spondylitis, rheumatoid arthritis, or psoriasis. The aim of this research is to evaluate the different treatments for ankylosis from the coronoid process to the zygoma after trauma, allowing to determine the treatment to obtain the best results. A systematic review was carried out following PRISMA "preferred reports for systematic reviews and meta-analyses" search matrix, based on a PICO question; was used PubMed, Embase, Sciencedirect, Cochrane, Google Scholar, and manual search in high-impact journals between 1946 and 2023 publications in English or Spanish, including randomized and nonrandomized clinical trials, prospective and retrospective cohort studies, case-control studies, series, and case reports. A total of 1993 articles were obtained from the 4 databases. After corroborating duplicate articles, 847 articles were excluded. Another 1112 articles were excluded in the title evaluation, and an additional 1093 after the abstract review; a total of 19 articles eligible for full-text evaluation were established and 1 article was added as a result of the manual search. After the full-text review, it was decided to include 16 articles in the study that met the objectives of the systematic review. After evaluating the different treatments described in the literature, the authors can determine that coronoidectomy through an intraoral approach is the most appropriate treatment for zygomatic coronoid ankylosis, accompanied by postoperative physiotherapy to achieve greater oral opening without recurrences.

The Contribution of Neutrophil Extracellular Traps to Coagulopathy in Patients with COVID-19-Related Thrombosis

COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is associated with hypercoagulability and increased incidence of thrombotic events. In this study, we investigated the levels of neutrophil extracellular trap biomarkers and von Willebrand factor to assess if these could predict the occurrence of a thrombotic event in COVID-19 patients. We enrolled 202 patients hospitalized with symptomatic COVID-19 infection. Of those, 104 patients did not experience any type of thrombotic events before or during their hospitalization. These patients were compared to the other cohort of 98, who experienced thrombotic events before or during their hospitalization. In total, 61 patients who experienced thrombotic events had the event after initial blood collection, so the predictive capacity of biomarkers in these patients was evaluated. Citrullinated histone H3 was the best predictive biomarker for thrombotic events in COVID-19 regardless of age, sex, and race; disease severity was also a significant predictor in most thrombotic event groups. These results may better inform treatment and prophylaxis of thrombotic events in COVID-19 and similar viral illnesses in the future to improve outcomes and reduce mortality.

The effect of COVID-19 vaccination on symptomatic infection and related symptoms among preterm-born children aged 3–7 years in China

Vaccination plays a crucial role in preventing and controlling SARS-CoV-2 infections as well as their associated adverse outcomes. But there is a notable lack of research on the effectiveness of COVID-19 vaccination in children, particularly those young preterm-born children, who are more vulnerable to severe outcomes from SARS-CoV-2 infection. We aimed to determine the effect of vaccination with inactivated vaccines BBIBP-CorV and CoronaVac on symptomatic COVID-19 infection and related symptoms in preterm-born children aged 3–7 years after relaxation of the COVID-19 prevention and control measures in December 2022 in China. We performed a retrospective cohort study involving 242 preterm-born children aged 3–7 years and the data were collected in March 2023. Logistic regression models and modified Poisson regression models combined with entropy balancing were used to explore the associations of vaccination against SARS-CoV-2 with symptomatic COVID-19, specific symptoms, and persistent symptoms one month after recovery from COVID-19. Of the 242 recruited preterm-born children, 156 (64.5%) were vaccinated with inactivated vaccines BBIBP‐CorV and CoronaVac. After entropy balancing, the covariates were balanced between the vaccinated and the unvaccinated groups, with standardized mean difference < 0.001. Vaccination with the said SARS-CoV-2 vaccines lowered the risk of developing symptomatic COVID-19 in preterm-born children (risk ratio [RR] = 0.783; 95% confidence interval [CI]: (0.711, 0.861). Likewise, COVID-19 vaccination was associated with a decline in the risk of pneumonia (odds ratio [OR] = 0.318; 95% CI 0.110, 0.913), fever (RR = 0.710; 95% CI 0.635, 0.794), high fever (RR = 0.542; 95% CI 0.297, 0.988), sore throat (OR = 0.304; 95% CI 0.139, 0.664), and persistent symptoms (RR = 0.425; 95% CI 0.182, 0.993). Immunization with inactivated vaccines BBIBP‐CorV and CoronaVac provides protection against symptomatic COVID-19 for preterm-born children 3–7 years.

Serotype-specific epidemiological patterns of inapparent versus symptomatic primary dengue virus infections: a 17-year cohort study in Nicaragua.

Dengue is the most prevalent mosquito-borne viral disease and a major public health problem worldwide. Most primary infections with the four dengue virus serotypes (DENV1-4) are inapparent; nonetheless, whether the distribution of symptomatic versus inapparent infections by serotype varies remains unknown. Here, we present (1) the evaluation of a DENV1-4 envelope domain III multiplex microsphere-based assay (EDIII-MMBA) to serotype inapparent primary infections and (2) its application leveraging 17 years of prospective sample collection from the Nicaraguan Pediatric Dengue Cohort Study (PDCS). We analysed primary DENV infections in the PDCS from 2004 to 2022 detected by inhibition ELISA (iELISA) or RT-PCR. First, we evaluated the performance of the EDIII-MMBA for serotyping with samples characterised by RT-PCR or focus reduction neutralisation test. Next, we analysed a subset of inapparent primary DENV infections in the PDCS with the EDIII-MMBA to evaluate the epidemiology of inapparent infections. Remaining infections were inferred using stochastic imputation, taking year and neighbourhood into account. Infection incidence and percentage of inapparent, symptomatic, and severe infections were analysed by serotype. Between Aug 30, 2004, and March 10, 2022, a total of 5931 DENV-naive participants were followed in the PDCS. There were 1626 primary infections (382 symptomatic, 1244 inapparent) detected by iELISA or RT-PCR over the study period. The EDIII-MMBA demonstrated excellent overall accuracy (100%, 95% CI 95·8-100) for serotyping inapparent primary DENV infections when evaluated against gold-standard serotyping methods. Of the 1244 inapparent infections, we analysed 574 (46%) using the EDIII-MMBA. We found that the majority of primary infections were inapparent, with DENV3 exhibiting the highest likelihood of symptomatic (pooled odds ratio compared with DENV1: 2·13, 95% CI 1·28-3·56) and severe (6·75, 2·01-22·62) primary infections, whereas DENV2 was similar to DENV1 in both analyses. Considerable within-year and between-year variation in serotype distribution between symptomatic and inapparent infections and circulation of serotypes undetected in symptomatic cases were observed in multiple years. Our study indicates that case surveillance skews the perceived epidemiological footprint of DENV. We reveal a more complex and intricate pattern of serotype distribution in inapparent infections. The substantial differences in infection outcomes by serotype emphasises the need for vaccines with balanced immunogenicity and efficacy across serotypes. National Institute of Allergy and Infectious Diseases (National Institutes of Health) and Bill & Melinda Gates Foundation. For the Spanish translation of the abstract see Supplementary Materials section.

Vaccination against respiratory syncytial virus (RSV)-For the protection of infants and older adults

Respiratory syncytial virus (RSV) is afrequent cause of respiratory infections in all age groups. Infections in infants and older adults frequently result in severe disease and complications. There is no specific antiviral treatment against RSV. The characterization of the structure of the fusion (F) protein in its immunogenic prefusion conformation has enabled the development of novel vaccines directed against the prefusion protein as the antigen. These include an adjuvanted monovalent vaccine (Arexvy) and anonadjuvanted bivalent vaccine (Abrysvo). Both are approved and indicated for use in older adults, in whom they have been shown to be over 80% effective in the protection against symptomatic RSV infections and associated lower respiratory tract diseases. Abrysvo is approved for use in pregnancy to protect the newborn through the transplacental transfer of high-titer maternal antibodies. The vaccine has been shown to have an efficacy of over 80% in the first 3 months of life to protect the infant from severe RSV-associated lower respiratory disease but slightly deceases after an age of 6 months. The clinical studies demonstrated the safety of the vaccines in both adults and pregnant women. The rate of undesired side effects was low in all studies and severe side effects were very rare. The new vaccines are efficacious new tools to prevent RSV-associated disease and complications in high-risk groups. For infants, an alternative strategy can be passive immunization with monoclonal antibodies, including the recently developed nirsevimab, which has also shown high efficacy.

Evaluation of Geh gene expression in Staphylococcus aureus isolated from acne patients

Acne vulgaris is a chronic skin disease that affects the hair follicle and sebaceous glands. Staphylococcus aureus colonizes human skin and causes infections ranging from local skin infections to systemic infections that may threaten human life due to its ability to produce many virulence factors and antibiotic resistance. The objective of this study is to measure the genetic expression of Geh gene responsible for producing the lipase enzyme from S. aureus isolated from acne patients. This study was conducted by collecting 130 swabs from acne patients at Tikrit Teaching Hospital. Using routine bacterial isolation and identification methods, 50 samples (38.4%) of the total samples were identified as S. aureus through its ability to grow in mannitol salt agar medium, the fermentation of mannitol sugar, and the change of the medium color to yellow. The Geh gene expression of ten S. aureus isolates from acne patients was examined using RT-PCR. The results showed that Geh gene was expressed in all isolates, with an expression ranging from 1.5 to 7.2, and that the mean folding of the Geh gene for ten samples was 4.2. This indicates the presence of high gene expression of the Geh gene in S. aureus isolates. Therefore, it is concluded that Lipase enzyme plays an important role in the pathogenesis of S. aureus in acne patients.

Long-term Immunity of a Microneedle Array Patch of SARS-CoV-2 S1 Protein Subunit Vaccine Irradiated by Gamma Rays in Mice.

COVID-19 vaccines effectively prevent symptomatic infection and severe disease, including hospitalization and death. However, unequal vaccine distribution during the pandemic, especially in low- and middle-income countries, has led to the emergence of vaccine-resistant strains. This underscores the need for alternative, safe, and thermostable vaccine platforms, such as dissolved microneedle array patches (MAP) delivering a subunit vaccine, which eliminate the need for cold chain and trained healthcare personnel. This study demonstrates that the SARS-CoV-2 S1 monomer with RS09, a TLR-4 agonist peptide, serves as an optimal protein subunit immunogen. This combination stimulates a stronger S1-specific immune response, resulting in binding to the membrane-bound spike on the cell surface and ACE2-binding inhibition, compared to the monomer S1 alone or trimer S1, regardless of RS09. MAP delivery of the rS1RS09 subunit vaccine elicited higher and longer-lasting immunity compared to conventional intramuscular injection. S1-specific IgG levels remained significantly elevated for up to 70 weeks post-administration. Additionally, different doses of 5, 15, and 45 μ g of MAP vaccines induced robust and sustained Th2-prevalent immune responses, suggesting a dose-sparing effect and inducing significantly high neutralizing antibodies against the Wuhan, Delta, and Omicron variants at 15 and 45 μ g dose. Moreover, gamma irradiation as a terminal sterilization method did not significantly affect immunogenicity, with irradiated vaccines maintaining comparable efficacy to non-irradiated ones. The stability of MAP vaccines was evaluated after long-term storage at room temperature and refrigeration for 19 months, showing minimal protein degradation. Further, after an additional one-month of storage at elevated temperature (42°C), rS1RS09 in both non-irradiated and irradiated MAP degraded less than 3%, while the liquid subunit vaccine degraded over 23%. Overall, these results indicate that gamma irradiation sterilized MAP-rS1RS09 vaccines maintain stability during extended storage without refrigeration, supporting their potential for mass production and widespread use in global vaccination efforts.

Purple urine bag syndrome: a unique clinical case and management considerations

Purple urine bag syndrome (PUBS) is a rare and unusual event. It is related to symptomatic urinary infection and asymptomatic bacteriuria in patients with indwelling bladder catheters. The purple color of the urine is due to metabolic products of biochemical reactions formed by bacterial enzymes in the urine. Gastrointestinal tract flora breaks down the amino acid tryptophan into indole, which is subsequently absorbed into the portal circulation and converted into indoxyl sulfate. Indoxyl sulfate is then excreted into the urine, where it can be broken down into indoxyl if the appropriate alkaline environment and bacterial enzymes are present. The breakdown products, indigo, and indirubin appear blue and red. We reported on an elderly woman who was kept in a nursing home, had multiple comorbidities such as history of cerebrovascular accident (CVA), acute kidney injury (AKI) and she was hospitalized due to decreased consciousness, fever and kidney failure. On the third day of hospitalization, the patient developed PUBS while undergoing urinary catheterization in the hospital. She had no history of previous catheterization and chronic use of antibiotics, she was only using Tolterodine for a long time due to urinary urgency. Due to antibiotic resistance, the drugs were not changed and the purple color disappeared after changing the catheter and urinary bag.This was the first patient in this region to be reported with this manifestation.

Epstein-Barr virus infection induces tissue-resident memory T cells in mucosal lymphoid tissues.

EBV contributes to around 2% of all tumors worldwide. Simultaneously, more than 90% of healthy human adults persistently carry EBV without clinical symptoms. In most EBV carriers, it is thought that virus-induced tumorigenesis is prevented by cell-mediated immunity. Specifically, memory CD8+ T cells recognize EBV-infected cells during latent and lytic infection. Using a symptomatic primary infection model, similar to infectious mononucleosis (IM), we found EBV-induced CD8+ tissue resident memory T cells (TRMs) in mice with a humanized immune system. These human TRMs were preferentially established after intranasal EBV infection in nasal-associated lymphoid tissues (NALT), equivalent to tonsils, the primary site of EBV infection in humans. They expressed canonical TRM markers, including CD69, CD103, and BLIMP-1, as well as granzyme B, CD107a, and CCL5. Despite cytotoxic activity and cytokine production ex vivo, these TRMs demonstrated reduced CD27 expression and proliferation and failed to control EBV viral loads in the NALT during infection, although effector memory T cells (TEMs) controlled viral titers in spleen and blood. Overall, TRMs are established in mucosal lymphoid tissues by EBV infection, but primarily, systemic CD8+ T cell expansion seems to control viral loads in the context of IM-like infection.

Candidemia in Pediatric-Clinic: Frequency of Occurrence, Candida Species, Antifungal Susceptibilities, and Effects on Mortality (2020-2024).

Objective: Invasive candidiasis is defined as an important infection that increases the duration of patients' hospital stay, costs, mortality and morbidity. In this study, we aimed to investigate the frequency of candidiasis in blood cultures of pediatric hematology patients, Candida species, antifungal susceptibilities, and their effects on mortality. Materials and Methods: Patients with Candida growth in their blood cultures at follow-up in the pediatric hematology clinic of our hospital between 2020 and 2024 were included in the study. Age, gender, primary diseases and risk levels, subtypes and antifungal susceptibilities of Candida grown in blood cultures, the presence of neutropenia in patients, the antifungals used for prophylaxis and treatment, the duration of infection, other bacteria grown additionally during the fungal infection period, the local infection source and the patients' discharge status were obtained from medical records. These constituted the study data. Results: Blood cultures were requested for 594 patients from the Pediatric hematology Clinic, and Candida was grown in only 37 (6.7%) of them. A total of 43.2% of them were the Candida parapsilosis complex, 29.7% were Candida albicans and 8.1% were the Candida haemulonii complex. Antifungal susceptibilities were over 90% for anidulafungin, micafungin, caspofungin, posaconazole, itraconazole and amphotericin B, followed by 86.7% for fluconazole and 84.4% for voriconazole. The mean age of the patient group was 6.8 years, 50.5% of whom were female and 40.5% of whom were male. The Candida infections developed on the 12.1th day of the neutropenia process on average. The mean invasive Candida infection period was 7 days. A total of 18.9% had a second bacterial infection and 13.5% had a local infection. A total of 51.4% had a single antifungal, 18.9% had two antifungals and 2.1% had more than two antifungals. A total of 35.1% of the patients with invasive candidiasis died. The primary diagnosis of the disease, Patient risk level, and the female gender were important factors affetting mortality. Conclusions: In a pediatric hematology clinic, the non-albicans group in invasive candidiasis infections was notable, with the C. parapsilosis complex occurring most frequently. There was still a high sensitivity to echinocandin antifungals and a decreased sensitivity to triazoles. It was found that the factor of the clinical diagnosis, being in the high-risk group and being female had significant effects on the survival rate of patients with candidiasis infections.

Congenital Cytomegalovirus Infection: Update on Screening, Diagnosis and Treatment: Scientific Impact Paper No. 56.

Cytomegalovirus (CMV) is the most common cause of viral infection in newborn babies, and affects 1 in 200 of all live born infants in high-income countries; and 1 in 71 in low- and middle-income countries. It is a major cause of hearing loss and brain damage. Women may get CMV infection for the first time during pregnancy (primary infection) or may experience 'non-primary' infection, either by reactivation of previous CMV infection or by a new infection with a different strain of the virus. The most common source of infection to pregnant women is the saliva and urine of young children. Therefore, all pregnant women, especially those in regular contact with young children, should be informed about hygiene-based measures to reduce the risks, e.g. handwashing. The UK National Screening Committee recommends against universal antenatal or newborn screening for CMV. Testing for CMV is usually offered only to women who develop symptoms of influenza, glandular fever or hepatitis (liver inflammation) during pregnancy, or for those whom a routine ultrasound scan detects fetal anomalies that suggests possible CMV infection. The risk of harm to the fetus is greatest following primary CMV infection of the woman in early pregnancy, and appears to be very low following infection after 12 weeks of pregnancy. Babies with CMV infection at birth may have jaundice, a rash, enlarged liver or spleen, a small brain, or be small for their gestational age. Around 1 in 8 babies born with CMV infection will have clinically detectable signs at birth. The rest will not have any features detectable by clinical examination alone. Therefore, all infants with CMV infection at birth should be followed up at a minimum of up to 2 years of age or later, depending upon the disease status, to check hearing and brain development. Following primary CMV infection in the first 12 weeks of pregnancy, if the woman starts taking the antiviral medicine valaciclovir (valacyclovir) it reduces the risk of the baby becoming infected. Where CMV infection of the fetus in the womb has been confirmed (by amniocentesis, for example), regular ultrasound scans should be offered every 2-3 weeks until birth. Detailed assessment of the fetal brain is an essential part of these scans. Where maternal CMV infection occurs, but fetal infection is not confirmed, repeated ultrasound scans of the fetus should be offered every 2-3 weeks until birth. In infected fetuses, as well as ultrasound scans, an MRI scan of the brain should be offered at 28-32 weeks of gestation (and sometimes repeated 3-4 weeks later) to assess for any signs of harm to the fetal brain. All babies born to women with confirmed or suspected CMV infection should be tested for CMV with a urine or saliva sample within the first 21 days of life. In newborns with symptomatic CMV infection at birth, treatment with antiviral medicine (valganciclovir or ganciclovir) can reduce hearing loss in 5 out of 6 babies, and improve long-term brain development outcomes in some. There is no licensed vaccine for CMV.

In Vitro Assessment of Gallium Nanoalloy Hydrogels for Antimicrobial and Wound Healing Applications.

Chronic and recurring wounds pose a significant challenge in modern healthcare, leading to substantial morbidity. These wounds allow pathogens to colonize, potentially resulting in local and systemic infections. Current interventions need to be revised and become increasingly less reliable due to the emergence of antibiotic resistance. In the present study, we aim to address these issues by fabricating hydrogels impregnated with gallium-based nanoalloys for their antimicrobial activity. Gallium liquid metal nanoparticles (approximately 100 nm in diameter) were alloyed in different combinations with bismuth and silver ions through a galvanic replacement reaction. These multimetallic hydrogels showed favorable antibacterial activity against the Gram-positive Staphylococcus aureus and the Gram-negative Pseudomonas aeruginosa, as observed with fluorescence microscopy and inhibition assays. The multimetallic hydrogels showed no toxicity against murine macrophages or human dermal fibroblasts and enhanced in vitro wound healing. The development of these innovative gallium-based hydrogels represents a promising strategy to combat chronic wounds and their associated complications, offering an effective alternative to current antimicrobial treatments amidst rising antibiotic resistance.

Pseudomonas monteilii bacteremia and sepsis following insertable cardiac monitor implantation: a case report

BackgroundInsertable cardiac monitor implantation is a simple and safe procedure commonly performed in patients with embolic stroke with undetermined source. Routine periprocedural antibiotic use is not recommended, because infection rate is very low, although some local infection or gram-positive bacteremia have been reported. We report a case of Pseudomonas monteilii sepsis immediately after insertable cardiac monitor implantation.Case presentationA 55-year-old Korean male with embolic stroke of undetermined source presented with gram-negative sepsis immediately after implantable cardiac monitor implantation as a first reported complication after the procedure. Pseudomonas monteilii was identified in the blood culture, and no other infection source was seen. He was treated with intravenous antibiotics without removing the device.ConclusionsPrompt diagnosis and adequate management is required in such a patient with sepsis post-insertable cardiac monitor implantation procedure. It can be managed with adequate antibiotic treatment without device removal if there is no sign of inflammation at the insertion site. Further reports or studies should be investigated to reinforce this finding.Learning objectivesThe infection rate after insertable cardiac monitor insertion is extremely low; however, sepsis may occur without pocket infections. Physicians should be aware of signs of systemic infection, particularly when the procedure is performed outside the catheterization room. Sepsis after insertable cardiac monitor implantation can be managed with adequate antibiotic treatment without device removal if there is no sign of inflammation at the insertion site.

Gallbladder Polyps: A Literature Review of Basic Concepts, Diagnosis and Treatment Options

Gallbladder polyps (GP) are projections of the mucosa toward the light, most of them are benign caused by cholesterol deposits, focal adenomatosis, or hyperplastic lesions secondary to a local infection. It has an estimated prevalence of 5% of the world population. Cholesterol polyps are usually formed by an asymptomatic process, rarely obstructive jaundice or cholangitis due to the blockage of distal bile ducts by detached fragments of polyps. A small number of patients may be symptomatic; cholesterolosis and adenomatosis can also cause chronic dyspeptic abdominal pain, nausea, and vomiting. Ultrasound is the main imaging modality to diagnose polyps of the gallbladder, endoscopic ultrasonography can be a useful tool in patients with clinical pictures suggestive of vesicular pathology and non-invasive imaging studies, and inconclusive. In a patient aged less than 50 years with GP, the likelihood of malignancy is minimal and does not require cholecystectomy. However, those with a size greater than or equal to 10 mm should be resected by cholecystectomy for high risk of malignancy, and those with a size less than 10 mm should be submitted to ultrasound monitoring, observing the risk characteristics during follow-up, to provide timely treatment.

Pathological and Fungal Isolation study of dog skin disease in Iraq Governorates

Dogs are susceptible to several types of infectious diseases can be worrisome for their owner because some of them are fatal if not treated soon enough. Fungal infection can be contracted through different parts of body furthermore many of them are zoonotic infection among human and dogs the signs of any disease typical depend on location of infection either local or system infection. Local infection usually involves skin surface that look like wound the objective of this study was to briefly about the most common pathogenic fungal infection in dogs by describing information about the causative agent, clinical signs and grossly appearance with histopathological change skin examination current study were done on 200 dogs collected in Iraq governorates (Baghdad, Erbil, Anbar, Sulaymaniyah) during a period 6 months (January – June) 2023. 200 examined dogs with different age, breed and sex ( k9, ornamental and stray dogs ) were observed fungal isolation and pathological examination with clinical signs by using diagnostic tools for skin biopsies (biopsy punch) from suspected infected skin dogs. Results showed pathogenic fungi after collected on fungal culture for detection pathogenic fungal (Dermatophyte Test Agar) D.T.M Agar Base. Fungal isolation constitutes the following pathogenic fungi (100 infected samples from 200 suspected samples). 60% Aspergillus niger, 30% Trichophyton Verrucosum, 10% Alternaria spp. Clinical signs and grossly lesion showed complete skin ulcer, allopecia, odema, abscessation while microscopic appearance revealed skin ulcer, hyperkeratosis, folliculitis, necrosis, apoptosis, pyogranuloma and granulation tissue with septate hyphae in skin dermis and epidermis which infected with Aspergillus niger.

Impact of urinary catheters including reusable catheters on quality of life and work productivity in persons with spinal cord lesion

While preventing renal damage and symptomatic urinary tract infection are of paramount importance to persons with a spinal cord lesion (SCL), patient-reported outcomes (PROs) are receiving much more attention than ever before. We performed a cross-sectional internet survey of 282 adult members of SCL patient advocacy groups and investigated, for the first time, the impact of different types of urinary catheter, including a Japanese reusable silicone catheter and a reusable intermittent balloon catheter, on PROs of persons with SCL. Intermittent self-catheterization (ISC) did not surpass continuous indwelling catheterization in terms of a disease-specific urinary quality of life. Urinary incontinence, regular ISC, and performing ISC away from home confronted these individuals. Work productivity and regular activities correlated fairly well with the disease-specific urinary quality of life. Bowel management problems affected all PROs evaluated. The absence of differences in PROs among the types of catheter used for ISC implies that Japanese reusable catheters have the potential to benefit selected persons with SCL. Further research is warranted to develop measures for maximizing work productivity by overcoming urinary as well as bowel problems.

Assessment of neutralizing antibody response as a correlate of protection against symptomatic SARS-CoV-2 infections after administration of two doses of the CoronaVac inactivated COVID-19 vaccine: A phase III randomized controlled trial

The emergence of variants of concerns of SARS-CoV-2 highlights the need for comprehensively elucidating the correlates of protection for different COVID-19 vaccine types. Inactivated COVID-19 vaccines are currently amongst the most widely administered vaccines globally. However, investigations into the correlates of protection for inactivated COVID-19 vaccines are relatively rare. Data from a phase III double-blind, randomized, placebo-controlled clinical trial (NCT0445659) that evaluated the efficacy and safety of the CoronaVac vaccine in healthcare professionals were utilized in this secondary analysis. Additionally, the correlation between neutralizing antibody levels measured by micro-cytopathic effect (CPE) neutralization assay and the occurrence of laboratory-confirmed infections was assessed using neutralizing antibodies measured in blood samples collected on day 28 after receiving two doses of the vaccine. Finally, the protective threshold required to provide 50% protection against symptomatic illness and virus infections was estimated. The risk of infection was negatively correlated with the levels of post-vaccination neutralizing antibodies measured on day 28 after the second dose. A neutralization titer of 30 (95% CI: 2-56) was predicted to provide 50% efficacy against symptomatic infection, whilst a titer of 42 (95% CI: 24-62) was predicted to provide 50% efficacy against total infection. Lastly, a neutralization titer of 247 (95% CI: 139-506) or higher was required to achieve 80% or higher protection against symptomatic infections. The results highlight the value of neutralizing antibody response as a correlate of protection, which can be used to inform future vaccine development and implementation. Further studies of immune correlates of protection for other vaccines are warranted.