Opportunistic Bacterial Infections Research Articles

A Study of the Progression, Complications, and Outcome of Mucormycosis in a Case of Coronavirus Disease 2019 Pneumonitis at a Tertiary Care Hospital in Gujarat.

Introduction: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused coronavirus disease 2019 (COVID-19) has been connected to numerous opportunistic bacterial and fungal infections. Mucormycosis is a fatal opportunistic disease that became much more common with the second COVID-19 wave. We plan to look into the prognosis and course of mucormycosis following COVID-19, as well as the risk of mucormycosis in cases with COVID-19 pneumonitis. Materials and methods: Just 100 verified cases of mucormycosis that were admitted to a civil hospital in Rajkot between April 2021 and March 2022 were included in this retrospective cross-sectional investigation. Data gathered from medical records included diagnoses, vital signs, test findings, microbiological information, usage of antibiotics, and outcomes. After entering the data into Microsoft Excel, we performed analysis and computations to determine frequency, percentage, and the Chi-squared test for variable comparison. Results: About 77.0% of the 100 mucormycosis patients were between the ages of 41 and 70. The bulk of them were male. The most frequent associated comorbidity was diabetes mellitus (DM) (30.0%). The most commonly impacted sinuses were the maxillary and ethmoidal ones. Amphotericin B was administered intravenously to each patient. In total, 82.0% of patients survived while 18.0% of patients died. Conclusion: Mucormycosis is an extremely rare, serious, and sometimes fatal infection. Because of comorbidities like diabetes and smoking, it went up with COVID-19. The use of glucocorticoids during COVID-19 treatment was the main risk factor.

Pathogen-specific social immunity is associated with erosion of individual immune function in an ant

Contagious diseases are a major threat to societies in which individuals live in close contact. Social insects have evolved collective defense behaviors, such as social care or isolation of infected workers, that prevent outbreaks of pathogens. It has thus been suggested that individual immunity is reduced in species with such ‘social immunity’. However, this hypothesis has not been tested functionally. Here, we characterize the immune response of the ant Lasius niger using a combination of genomic analysis, experimental infections, gene expression quantification, behavioural observations and pathogen quantifications. We uncover a striking specialization of immune responses towards different pathogens. Systemic individual immunity is effective against opportunistic bacterial infections, which are not covered by social immunity, but is not elicited upon fungal infections, which are effectively controlled by social immunity. This specialization suggests that immune layers have evolved complementary functions predicted to ensure the most cost-effective response against a wide range of pathogens.

Nocardia Infection in Patients With Anti-Granulocyte-Macrophage Colony-Stimulating Factor Autoantibodies: A Prospective Multicenter French Study.

Nocardiosis, a bacterial opportunistic infection caused by Nocardia spp, has recently been reported in patients with anti-granulocyte-macrophage colony-stimulating factor (GM-CSF) autoantibodies, but insufficient data are available about disease presentation, outcomes, and occurrence of autoimmune pulmonary alveolar proteinosis (aPAP) in this population. We performed a prospective, multicenter, nationwide study in France and included patients with a Nocardia infection who had anti-GM-CSF autoantibodies. We describe their clinical, microbiological, and radiological characteristics, and their outcome at 1 year of follow-up. Twenty patients (18 [90%] male) were included, with a median age of 69 (interquartile range, 44-75) years. The organs most frequently involved were the brain (14/20 [70%]) and the lung (12/20 [60%]). Half of the infections were disseminated (10/20 [50%]). Nocardia identification was predominantly made in abscess fluid (17/20 [85%]), among which 10 (59%) were brain abscesses. The 1-year all-cause mortality was 5% (1/20), and only 1 case of aPAP (1/20 [5%]) occurred during the follow-up period. Nocardiosis with anti-GM-CSF autoantibodies is associated with a low mortality rate despite a high incidence of brain involvement. Although the occurrence of aPAP was infrequent during the 1-year follow-up period, long-term clinical data are needed to fully understand the potential relationship between nocardiosis, anti-GM-CSF autoantibodies, and aPAP.

The role of macrophage phagocytosis on respiratory pneumovirus infection and host defense

Abstract Lung macrophages play a pivotal role in the defense against viral and bacterial infections. These specialized cells are equipped with multiple mechanisms, such as phagocytosis, to detect the presence of pathogens and clear the infections. Human Metapneumovirus (HMPV) is a leading cause of acute lung infection, affecting particularly young children and the elderly. During and after the HMPV infection, individuals are at an increased risk of secondary bacterial infections due to a decreased immune response capacity, which increases the severity of the disease. However, the cellular contribution of macrophages in the HMPV infection remains understudied. In this work, we investigated the role of macrophage phagocytosis in HMPV infection and the effect of HMPV on macrophage phagocytic activity. For that, we used THP-1- and PBMC-derived macrophages as experimental models. We found that macrophages were susceptible to HMPV infection and that phagocytosis is one of the mechanisms used by the virus to infect the cells. However, macrophages do not replicate the virus efficiently. Furthermore, viral infection decreases the capacity of macrophages to phagocyte bacteria, as demonstrated by the activity of intracellular pH indicator dye. These data highlight the importance of phagocytosis as a mechanism to control respiratory viral infections and the subversion of the host immunity by HMPV that may contribute to subsequent opportunistic bacterial infections.

The association of bacterial agents and flagellated protozoans in the etiopathogenesis of subspectacular abscesses in snakes.

To describe the etiology, clinical pathology, and treatment of subspectacular abscesses (SAs) in 16 snakes. Sixteen snakes from private captive collections that were presented at a veterinary teaching hospital and diagnosed with SAs. Exudate was collected from SAs via percutaneous aspiration or by performing a partial spectaculectomy and submitted to direct light microscopic examination and/or microbiological examination. Bacterial isolates were cultured from exudate samples in 12 out of 16 snakes and comprised Pseudomonas aeruginosa isolates that showed identical antimicrobial susceptibility patterns in seven cases. Direct light microscopic examination demonstrated the presence of flagellated protozoa in the exudate in 10 out of 16 snakes and in all of these snakes, concurrent oropharyngeal flagellated protozoan infection could be demonstrated. Combined flagellated protozoan and bacterial SA infection was demonstrated in six snakes. Comparison of small subunit ribosomal RNA gene sequences of flagellated protozoans that were detected in the exudate of SAs from four snakes revealed they represented the parabasalians Monocercomonas colubrorum and Hypotrichomonas acosta in one and three cases, respectively. In all snakes, successful treatment of the SAs was achieved following surgical debridement of the subspectacular space combined with antimicrobial treatment. Bacteria as well as flagellates are considered to reach the subspectacular space through ascending infection from the oral cavity via the lacrimal duct. Although opportunistic bacterial infection presumably constitutes the predominant cause of SAs in snakes, the role of flagellate infection in the pathogenesis of this disorder should be further elucidated.

Facultatively ectoparasitic mites as vectors for entomopathogenic bacteria in Drosophila

Opportunistic bacterial infections are common in insect populations but there is little information on how they are acquired or transmitted. We tested the hypothesis that Macrocheles mites can transmit systemic bacterial infections between Drosophila hosts. We found that 24% of mites acquired detectable levels of bacteria after feeding on infected flies and 87% of infected mites passed bacteria to naïve recipient flies. The probability that a mite could pass Serratia from an infected donor fly to a naïve recipient fly was 27.1%. These data demonstrate that Macrocheles mites are capable of serving as vectors of bacterial infection between insects.

Disaster of Retrobulbar Hemorrhage

Introduction : Retrobulbar hemorrhage is a rare case, 3.6% of which are caused by ocular trauma. However, this case is an ophthalmic emergency and must be treated quickly and accurately. We present a case of neglected traumatic retrobulbar hemorrhage with compartment-syndrome and opportunistic bacterial infection which underwent dilemmatic exenteration and orbitectomy.
 Case Illustration : A 39-year-old man was referred with a history of being beaten, 11 days before admission. He felt a dark vision, pain and swelling in his left eye. The visual acuity was no light perception. Eyelid necrosis with proptosis and periorbital edema. We found severe chemosis and cloudy cornea. Negative-light reflex with increase intraocular pressure and limited eye movement in all directions. We did three surgeries due to serious complication. First, evacuation of retrobulbar bleeding. The second was total exenteration. The last was left orbitectomy, necrotomy and reconstruction performed together with plastic-surgeon and neuro-surgeon. Patient was hospitalized for 1.5 months.
 Discussion : Accumulation of blood in retrobulbar space leads to increased orbital pressure, which can stretch the optic nerve and impair blood flow in the eye which can lead to orbital compartment-syndrome. Unwanted complications can be prevented with prompt treatment within the first-two hours. Orbital decompression with lateral canthotomy and inferior cantholysis is considered as an emergency procedure. In this case, our patient had chronic compartment-syndrome and had no previous orbital decompression.
 Conclusion : Retrobulbar hemorrhage is an ophthalmic emergency. Early diagnosis and treatment are critical to ensure the best clinical outcome. Delayed treatment causes blindness and opportunistic infections can destroy the surrounding structure, a disaster.

An obligate microsporidian parasite modulates defense against opportunistic bacterial infection in the yellow fever mosquito, Aedes aegypti.

The microsporidium Edhazardia aedis is a parasite of the yellow fever mosquito, Aedes aegypti. This mosquito transmits multiple viruses to humans in the United States and around the world, including dengue, yellow fever, and Zika viruses. Hundreds of millions of people worldwide will become infected with one of these viruses each year. E. aedis infection significantly reduces the lifespan of Ae. aegypti and is therefore a promising novel biocontrol agent. Here, we show that when the mosquito is infected with this parasite, it is also significantly more susceptible to infection by an opportunistic bacterial pathogen, Serratia marcescens. This novel discovery suggests the mosquito's ability to control infection by other microbes is impacted by the presence of the parasite.

Temperature and microbe mediated impacts of the San Diego Bay ostreid herpesvirus (OsHV-1) microvariant on juvenile Pacific oysters

Abstract The ostreid herpesvirus (OsHV-1) was recently detected in San Diego Bay for the first time in farmed juvenile Pacific oysters (Crassostrea gigas). Due to the virus’ ability to cause mass mortality (50%–100%), it is important to determine the factors that promote infection as well as the consequences of infection. Here, we assess the role of temperature in controlling OsHV-1 induced mortality. Pacific oysters were exposed to the San Diego Bay microvariant of OsHV-1 at four different temperatures (15°C, 18°C, 21°C, and 24°C). While OsHV-1 was able to replicate in oyster tissues at all temperatures, it did not induce mortality at 15°C, only at the higher temperatures. Additionally, we examined oyster tissue-associated bacterial response to OsHV-1 infection. As shown previously, bacterial richness increased following OsHV-1 exposure and then decreased as the oysters became sick and died. Four bacterial taxa linked to the San Diego Bay microvariant infection, including Arcobacter, Vibrio, Amphritea, and Pseudoalteromonas, were the same as those shown for other microvariant infections in other studies from globally distributed oysters, suggesting a similar spectrum of co-infection irrespective of geography and microvariant type. The significant shift in the bacterial community following exposure suggests a weakening of the host defenses as a result of OsHV-1 infection, which potentially leads to adverse opportunistic bacterial infection.

Herpesviruses and SARS-CoV-2: Viral Association with Oral Inflammatory Diseases.

The oral cavity is a niche for diverse microbes, including viruses. Members of the Herpesviridae family, comprised of dsDNA viruses, as well as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), an ssRNA virus, are among the most prevalent viruses infecting the oral cavity, and they exhibit clinical manifestations unique to oral tissues. Viral infection of oral mucosal epithelia triggers an immune response that results in prolonged inflammation. The clinical and systemic disease manifestations of HHV have been researched extensively, and several recent studies have illuminated the relationship between HHV and oral inflammatory diseases. Burgeoning evidence suggests the oral manifestation of SARS-CoV-2 infection includes xerostomia, dysgeusia, periodontal disease, mucositis, and opportunistic viral and bacterial infections, collectively described as oral post-acute sequelae of COVID-19 (PASC). These diverse sequelae could be a result of intensified immune responses initially due to the copious production of proinflammatory cytokines: the so-called "cytokine storm syndrome", facilitating widespread oral and non-oral tissue damage. This review explores the interplay between HHV, SARS-CoV-2, and oral inflammatory diseases such as periodontitis, endodontic disease, and peri-implantitis. Additionally, the review discusses proper diagnostic techniques for identifying viral infection and how viral diagnostics can lead to improved overall patient health.

Next-Generation Sequencing-Based Identification of Enterobacter hormaechei as Causative Agent of High Mortality Disease in NOD.Cg-PrkdcscidIl2rgtm1Wjl/SzJ (NSG) Mice.

NOD.Cg-PrkdcscidIl2rgtm1Wjl/SzJ (NSG) mice, lacking many components of a mature immune system, are at increased risk of disease. General understanding of potential pathogens of these mice is limited. We describe a high mortality disease outbreak caused by an opportunistic bacterial infection in NSG mice. Affected animals exhibited perianal fecal staining, dehydration, and wasting. Histopathologic lesions included a primary necrotizing enterocolitis, with inflammatory and necrotizing lesions also occurring in the liver, kidneys, heart, and brain of some mice. All affected individuals tested negative for known opportunistic pathogens of immunodeficient mice. We initially identified a member of Enterobacter cloacae complex (ECC) in association with the outbreak by traditional diagnostics. ECC was cultured from extraintestinal organs, both with and without histopathologic lesions, suggesting bacteremia. Infrared spectroscopy and MALDI-TOF mass spectrometry demonstrated that isolates from the outbreak shared molecular features and likely a common origin. We subsequently hypothesized that advanced sequencing methods would identify a single species of ECC associated with clinical disease. Using a novel targeted amplicon-based next-generation sequencing assay, we identified Enterobacter hormaechei in association with this outbreak. Knowledge of this organism as a potential opportunistic pathogen in NSG mice is critical for preclinical studies to prevent loss of animals and confounding of research.

Recent Records on Bacterial Opportunistic Infections via the Dietary Route.

This narrative review was aimed at identifying the opportunistic bacterial pathogens that can be transmitted by contaminated food and represent a current threat for patients particularly susceptible to infections because of underlying conditions or predisposing factors. The analysis was focused on recent case or outbreak reports and systematic reviews published in the years 2019 to 2023 and resulted in sorting 24 bacterial groups comprising the genera or species able to cause a variety of systemic or invasive infections if ingested with food or drinking water. These included both bacteria known to cause mild infections in immunocompetent persons and bacteria considered to be innocuous, which are used in food fermentation or as probiotics. No recent cases of infections transmitted through dietary routes were reported for the critical nosocomial pathogens widely found in food products, primarily Acinetobacter baumannii and Klebsiella pneumoniae. However, the very first sources of their introduction into the clinical environment still need to be established. In many instances, risky dietary habits, such as eating raw fish, seafood, raw meat, unpasteurized milk, and their derived products or the lack of control in fermentation processes, has led to the reported illnesses, pointing out the necessity to improve the hygiene of production and consumer awareness of the risks.

Nanosilver-Functionalized Hybrid Hydrogels of Carboxymethyl Cellulose/Poly(Vinyl Alcohol) with Antibacterial Activity for Prevention and Therapy of Infections of Diabetic Chronic Wounds.

Diabetic foot ulcers (DFUs) are considered one of the most severe chronic complications of diabetes and can lead to amputation in severe cases. In addition, bacterial infections in diabetic chronic wounds aggravate this scenario by threatening human health. Wound dressings made of polymer matrices with embedded metal nanoparticles can inhibit microorganism growth and promote wound healing, although the current clinical treatments for diabetic chronic wounds remain unsatisfactory. In this view, this research reports the synthesis and characterization of innovative hybrid hydrogels made of carboxymethyl cellulose (CMC) and poly(vinyl alcohol) (PVA) chemically crosslinked by citric acid (CA) functionalized with silver nanoparticles (AgNPs) generated in situ using an eco-friendly aqueous process. The results assessed through comprehensive in vitro and in vivo assays demonstrated that these hybrid polymer hydrogels functionalized with AgNPs possess physicochemical properties, cytocompatibility, hemocompatibility, bioadhesion, antibacterial activity, and biocompatibility suitable for wound dressings to support chronic wound healing process as well as preventing and treating bacterial infections. Hence, it can be envisioned that, with further research and development, these polymer-based hybrid nanoplatforms hold great potential as an important tool for creating a new generation of smart dressings for treating chronic diabetic wounds and opportunistic bacterial infections.

Legionnaires Disease in Solid Organ Transplant Recipients: A Decade-Long Nationwide Study in France

Legionnaires disease (LD) is a rare, life-threatening opportunistic bacterial infection that poses a significant risk to patients with impaired cell-mediated immunity such as solid organ transplant recipients. However, the epidemiologic features, clinical presentation, and outcomes of LD in this population are poorly described. What are the clinical manifestations, radiologic presentation, risk factors for severity, treatment, and outcome of LD in solid organ transplant recipients? In this 10-year multicenter retrospective cohort study in France, where LD notification is mandatory, patients were identified by hospital discharge databases. Diagnosis of LD relied on positive culture findings from any respiratory sample, positive urinary antigen test (UAT) results, positive specific serologic findings, or a combination thereof. Severe LD was defined as admission to the ICU. One hundred one patients from 51 transplantation centers were eligible; 64 patients (63.4%) were kidney transplant recipients. Median time between transplantation and LD was 5.6 years (interquartile range, 1.5-12 years). UAT results were positive in 92%of patients (89/97). Among 31 patients with positive culture findings in respiratory samples, Legionella pneumophila serogroup 1 was identified in 90%. Chest CT imaging showed alveolar consolidation in 98%of patients (54 of 57), ground-glass opacity in 63%of patients (36 of 57), macronodules in 21%of patients (12 of 57), and cavitation in 8.8%of patients (5 of 57). Fifty-seven patients (56%) were hospitalized in the ICU. In multivariate analysis, severe LD was associated with negative UAT findings at presentation (P= .047), lymphopenia (P= .014), respiratory symptoms (P= .010), and pleural effusion (P= .039). The 30-day and 12-month mortality rates were 8%(8 of 101) and 20%(19 of 97), respectively. In multivariate analysis, diabetes mellitus was the only factor associated with 12-month mortality (hazard ratio, 3.2; 95%OR, 1.19-8.64; P= .022). LD is a late and severe complication occurring in solid organ transplant recipients that may present as pulmonary nodules on which diabetes impacts its long-term prognosis.

Antifungal activity of the endophytic Aspergillus against Candida albicans

Medicinal plants remain a reliable source of bioactive compound principles known for their proven therapeutic abilities against various infectious diseases. Endophytes, microorganisms residing within plant tissues, hold promise for producing novel metabolites with potential medical applications. This study analyzes the antagonism of endophytic fungi Aspergillus sp., isolated from medicinal plants, and their extract against Candida albicans, and their effectiveness was compared with that of a medical treatment, Phanazol 1% ointment. After isolating, purifying, and identifying endophytic fungi from the medicinal plants Lavandula officinalis, Rosmarinus officinalis, Eucalyptus bicolor and Mentha piprita, a total of ten endophytic fungi were obtained. These included two yeasts (yeast and Rhodotorula sp.), as well as eight moulds (Aspergillus sp., Aspergillus niger, Nigrospora sp., Curvularia sp., Alternaria sp., Penicillium sp.), and sterile mycelium. All these fungi were tested for their antagonism against C. albicans; using the cross-streak and disk diffusion methods for yeasts and moulds respectively, with the measurement of the diameter of the growth inhibition zone of the culture. Only the strain Aspergillus sp. and its ethyl acetate extract exhibited good activity against C. albicans, with inhibition zone widths of 27.5 and 20.3 mm, respectively. Its effectiveness is comparable to that of Phanazol 1% ointment. The use of gas chromatography mass spectrometry (GC/MS) unveiled the metabolite profiles of Aspergillus sp., enabling the recognition of 10 bioactive compounds, with butanedioic acid, kojic acid, and Cyclo L-prolyl-L-valine being the major ones, constituting 45.1%, 23.1%, and 5.1% of the total, respectively. These compounds serve as valuable platform chemicals that can be transformed into various other useful chemicals with various applications in agriculture, pharmaceuticals, food, cosmetics, and the healthcare industry. In addition to refining the active substances within this extract, it has the potential to open doors for creating novel bio-sourced medications aimed at addressing resistant opportunistic fungal or bacterial infections.

Anti-quorum sensing activity of selected cationic amino acids against Chromobacterium violaceum and Pseudomonas aeruginosa

Antibiotic-resistant strains and "superbugs" have emerged as a result of unrestricted use and overuse of antibiotics. N-Acyl homoserine lactones, also known as autoinducers, are unique type of signaling molecule and passively permeate to the cells of Gram-negative bacteria. Accumulation of signaling molecules in the environment regulates the bacterial population. The organisms Pseudomonas aeruginosa and Chromobacterium violaceum are Gram-negative bacteria when exposed to humans, cause fatal infections. The selected cationic amino acids histidine, arginine, and ornithine were assessed for their anti-quorum sensing activity against the P. aeruginosa and C. violaceum. The MIC and sub-MIC concentrations of the selected amino acids have been found by the broth dilution method. Both the cultures have been treated with MIC and sub-MIC levels and the virulence factors like rhamnolipid, protease, elastase, pyoverdine, pyocyanin for P. aeruginosa and violacein, chitinase for C. violaceum is quantified. The quantification of exo-polysaccharides and the biofilm as well as visualization by confocal laser scanning microscope have been done for both organisms. The movement of the cells was assessed by swarming and swimming motility in both organisms. The genes activated for all these virulence factors were quantified by RT-qPCR and expressed in fold change. From the results, it is evident that the histidine inhibited both the organisms at concentrations of MIC and sub-MIC more than the percentage of virulence factors production by arginine and ornithine. The selected cationic amino acids prove to be an effective compound in antimicrobial therapeutics in order to reduce opportunistic bacterial infections.

A Case of Mycobacterium avium Complex Vertebral Osteomyelitis in a Patient With Human Immunodeficiency Virus

Abstract Mycobacterium avium complex (MAC) infection is one of the most common bacterial opportunistic infections in persons living with human immunodeficiency virus (PLWH). Mycobacterium avium complex infections are caused by either M. avium or Mycobacterium intracellulare, which are nontuberculous mycobacterial species. Mycobacterium avium complex is prevalent in soil, water, and animals in the environment. Mycobacterium avium complex infections are commonly seen in persons with CD4 counts less than 50 cells/μL and are the most common cause of disseminated disease in immunocompromised patients. Vertebral osteomyelitis caused by MAC, however, remains uncommon in PLWH, with few cases reported in the literature (Lancet Infect Dis. 2004;4:557–565; Infect Dis Clin Pract. 2001;10:17–20). We present a case of vertebral osteomyelitis secondary to MAC in a person with human immunodeficiency virus and compare 10 other cases reported in the literature. Our case also highlights the importance of resuming secondary MAC prophylaxis when CD4 counts decline below 100 cells/μL in PLWH.

PATHOLOGY OF HATCHLING HAWKSBILL SEA TURTLE (ERETMOCHELYS IMBRICATA) MORTALITIES OCCURRING WHILE UNDER REHABILITATIVE CARE, 2015-21.

Increasing hatchling survival is an important element of conservation of the critically endangered hawksbill sea turtle (Eretmochelys imbricata). Yet, there is little information regarding mortality-associated pathological states of hawksbill hatchlings. The aim of this study was to describe lesions affecting hawksbill hatchlings that died while under rehabilitative care. Forty-four turtles representing the nesting sites of two islands and a 7-yr study period were subjected to comprehensive postmortem examination. The most common lesions included dermatitis (34%), skeletal malformations (23%), and pneumonia (23%). Dermatitis and pneumonia were caused by a variety of presumptively opportunistic bacterial and fungal infections. Fungal infections affected 23% of study turtles, also causing rhinitis and esophagitis. Around half of the cases of dermatitis presented with history of skin lesions, and all those involving periocular areas had clinical history of eye lesions. Pneumonia was not predicted by clinical signs or time in rehabilitation. Malformations included carapace compressions, supra- or subnumerary scutes, and dysmelias with many of those affected having concurrent pathology involving other organs. Other lesions included bacterial yolk sacculitis (15%), skeletal muscle degeneration and necrosis (13%), and acute renal tubular necrosis (13%). The study population was female biased (93%), raising concern for skewed hatchling sex ratios and high incubation temperatures in the eastern Caribbean. The pathology described by this study improves our understanding of threats to hawksbill hatchlings and may be taken into consideration by clinicians when implementing strategies for rehabilitative care.

Non-Neoformans Pulmonary Cryptococcosis Due to Cryptococcus Laurentii in a Positive SARS-COV-2 Patient

Non-neoformans Cryptococcus species were formerly considered to be saprophytes and nonpathogenic to humans [1-2]. However, the incidence of Cryptococcus laurentii infections in immunocompromised and immunocompetent patients has been gradually increasing over the last decades [1-2]. During the COVID-19 pandemic, multiple cases of opportunistic bacterial and fungal infections have been reported in patients after a severe SARS-CoV-2 infection. The author reports the first case of opportunistic pulmonary cryptococcosis caused by Cryptococcus laurentii in a severely ill COVID-19 patient who received treatment with Tocilizumab and dexamethasone. This case contributes to the expanding knowledge of emergent secondary infectious complications including opportunistic pathogens after a SARS-COV-2 infection.

Specialized pro-resolving lipid mediators regulate inflammatory macrophages: A paradigm shift from antibiotics to immunotherapy for mitigating COVID-19 pandemic.

The most severe clinical manifestations of the horrifying COVID-19 disease, that claimed millions of lives during the pandemic time, were Acute respiratory distress syndrome (ARDS), Coagulopathies, septic shock leading eventually to death. ARDS was a consequence of Cytokine storm. The viral SARS-COV2infection lead to avalanche of cytokines and eicosanoids causing "cytokine storm" and "eicosanoid storm." Cytokine storm is one of the macrophage-derived inflammatory responses triggered by binding of virus particles to ACE2 receptors of alveolar macrophages, arise mainly due to over production of various pro-inflammatory mediators like cytokines, e.g., interleukin (IL)-1, IL-2, and tumor necrosis factor (TNF)- α, causing pulmonary edema, acute respiratory distress, and multi-organ failure. Cytokine storm was regarded as the predictor of severity of the disease and was deemed one of the causes of the high mortality rates due to the COVID-19. The basis of cytokine storm is imbalanced switching between an inflammation increasing - pro-inflammatory (M1) and an inflammation regulating-anti-inflammatory (M2) forms of alveolar macrophages which further deteriorates if opportunistic secondary bacterial infections prevail in the lungs. Lack of sufficient knowledge regarding the virus and its influence on co-morbidities, clinical treatment of the diseases included exorbitant use of antibiotics to mitigate secondary bacterial infections, which led to the unwarranted development of multidrug resistance (MDR) among the population across the globe. Antimicrobial resistance (AMR) needs to be addressed from various perspectives as it may deprive future generations of the basic health immunity. Specialized pro-resolving mediators (SPMs) are generated from the stereoselective enzymatic conversions of essential fatty acids that serve as immune resolvents in controlling acute inflammatory responses. SPMs facilitate the clearance of injured tissue and cell debris, the removal of pathogens, and augment the concentration of anti-inflammatory lipid mediators. The SPMs, e.g., lipoxins, protectins, and resolvins have been implicated in exerting inhibitory influence on with cytokine storm. Experimental evidence suggests that SPMS lower antibiotic requirement. Therefore, in this review potential roles of SPMs in enhancing macrophage polarization, triggering immunological functions, hastening inflammation resolution, subsiding cytokine storm and decreasing antibiotic requirement that can reduce AMR load are discussed.