Recurrent Infections Research Articles

Pemanfaatan Budidaya Lele Sebagai Pemberian Makanan Tambahan (PMT) untuk Peningkatan Gizi Balita dalam Pencegahan Stunting Melalui Program Genting

Stunting, a developmental disorder in children caused by chronic malnutrition and recurrent infections, characterized by below-standard height, remains a critical issue for Indonesia. In Mayang Village, one of the communities supported by the University of Jember, 2.46% of the population experiences stunting. To address this issue, the PPK Ormawa Team of BEM FKG UNEJ developed a stunting prevention program utilizing catfish farming as a source of nutritionally balanced supplementary food, named GENTING (Mayang Village Movement Against Stunting). This initiative involves empowering integrated health post (posyandu) cadres through training in catfish cultivation and the processing of nutritionally balanced supplementary foods. The program outcomes include the production of supplementary food to meet the nutritional needs of toddlers in Mayang Village and the enhancement of knowledge and skills among posyandu cadres in stunting prevention

Management of thoracic aortic graft infections with combined omental and bilateral pectoralis major flaps

BackgroundAortic vascular graft/endograft infection (VGEI) has historically been managed through graft removal and re-replacement, but new approaches suggest vascularized tissue transfer is an effective adjunctive treatment. Here we describe our experience with treating thoracic aortic vascular graft infection with combined omental and bilateral pectoralis major myocutaneous (PMM) advancement flaps. MethodsAll patients undergoing combined flap closure by the senior author at a high-acuity cardiac surgery center from 1995-2023 were reviewed. Patients with clinical and radiographic signs of thoracic aortic vascular graft infection were included. ResultsComplete data were available for 598 patients with sternal and mediastinal wounds. Combined PMM and omental flaps were mobilized in 11 thoracic aortic vascular graft infection patients. Indications for flap management included culture-positive infection (8/11; 72.7%), dehiscence (5/11; 45.5%), drainage (7/11; 63.6%), and inability to close the sternotomy due to hemodynamic instability (5/11; 45.5%). During chest exploration, 6/11 (54.5%) underwent complete removal of the infected graft, compared to 5/11 (45.5%) who underwent graft-preserving washout and debridement. Immediate flap closure was performed in 6/11 (54.5%). Post-op complications included dehiscence (2/11; 18.2%), seroma (1/11; 9.1%), hematoma (1/11, 9.1%), abdominal hernia (1/11; 9.1%), and recurrent infection (1/11; 9.1%). One patient (9.1%) died within 30 days of sternal reconstruction from mitral valve failure tachyarrhythmia. None has undergone reoperation for flap-related complications. ConclusionsDespite significant comorbidities, low postoperative morbidity and mortality indicate that combined omental and pectoralis major flaps are a safe and effective adjunctive treatment to the antimicrobial and surgical management of select thoracic aortic vascular graft infections.

Investigating pulmonary and non-infectious complications in common variable immunodeficiency disorders: a UK national multi-centre study.

Common Variable Immunodeficiency Disorders (CVID) encompass a spectrum of immunodeficiency characterised by recurrent infections and diverse non-infectious complications (NICs). This study aimed to describe the clinical features and variation in NICs in CVID with and without interstitial lung disease (ILD) from a large UK national registry population. Retrospective, cross-sectional data from a UK multicentre database (previously known as UKPIN), categorising patients into those with CVID-ILD and those with NICs related to CVID but without pulmonary involvement (CVID-EP; EP= extra-pulmonary involvement only). 129 patients were included. Chronic lung diseases, especially CVID-ILD, are prominent complications in complex CVID, occurring in 62% of the cohort. Bronchiectasis was common (64% of the cohort) and associated with greater pulmonary function impairment in patients with CVID-ILD compared to those without bronchiectasis. Lymphadenopathy and the absence of gastrointestinal diseases were significant predictors of ILD in complex CVID. Although the presence of liver disease did not differ significantly between the groups, nearly half of the CVID-ILD patients were found to have liver disease. Patients with CVID-ILD were more likely to receive immunosuppressive treatments such as rituximab and mycophenolate mofetil than the CVID-EP group, indicating greater need for treatment and risk of complications. This study highlights the significant burden of CVID-ILD within the CVID population with NICs only. The lungs emerged as the most frequently affected organ, with ILD and bronchiectasis both highly prevalent. These findings emphasise the necessity of a comprehensive and multidisciplinary approach in managing CVID patients, considering their susceptibility to various comorbidities and complications.

Daptomycin Dosage Optimization in Renal Impairment Using Model-Informed Precision Dosing.

Daptomycin's efficacy and toxicity are closely related to its exposure, which can vary widely among individuals. The patient, a 59-year-old male with an estimated glomerular filtration rate (eGFR) of 12 mL/min/1.73 m² and a weight of 64 kg, was treated with 850 mg of daptomycin every other day for infective endocarditis caused by methicillin-resistant Staphylococcus aureus (MRSA). For patients with an estimated glomerular filtration rate of less than 30 mL/min/1.73 m², the dosing recommendations are not explicitly defined in the endocarditis guidelines. Subsequently, the pharmacology department was contacted to adjust the dosage. A population pharmacokinetic model developed by Dvorchik et al. was used for Bayesian estimation of the patient's pharmacokinetic parameters. The 24-hour area under the curve (AUC24) of daptomycin was calculated at steady state using peak and trough plasma samples. The minimum inhibitory concentration (MIC) of the MRSA strain was 0.25 mg/L. An AUC24/MIC ratio below 666 is associated with higher mortality risk, while an AUC24 above 939 h·mg/L correlates with increased risk of muscular toxicity. Initial AUC24 estimation was 1091 h·mg/L. Following a dosage reduction to 700 mg every other day, the AUC24 increased to 1600 h·mg/L. Further reduction to 500 mg every other day brought the AUC24 down to 750 h mg/L, with two subsequent measurements showing consistent AUC24 values of 500 h·mg/L, which is within the target range. Daptomycin ended 6 weeks after the initial negative blood culture, with no adverse effects or recurrence of MRSA infection. This case underscores the need for therapeutic drug monitoring and a multidisciplinary approach to adjust daptomycin doses in patients with renal impairment.

Longitudinal Incidence of Kidney/Urinary Stones in Individuals With Severe Motor and Intellectual Disabilities.

To investigate the longitudinal incidence of kidney/urinary stones in patients with severe motor and intellectual disabilities and explore health burden events in patients with stone formation. This was a retrospective, observational study. We identified patients with severe motor and intellectual disabilities who had the following: 1) admission to our hospital wards for >10 years; 2) two or more assessments for stone formation by ultrasonography or computed tomography; and 3) absence of kidney/urinary stones in the first imaging study. The Kaplan-Meier method was used to analyze the cumulative incidence of kidney/urinary stones. Recurrent urinary tract infections, hydronephrosis, renal dysfunction, and death were identified as health burdens. Among the 41 patients (19 men, 22 women; median age, 28 years; range, 8-50 years), stone formation was detected in 11 (27%) patients during the observation period. The cumulative incidence rate of stone formation was 9.8% (95% confidence interval, 3.8-23.9) and 18.7% (95% confidence interval, 9.2-35.7) at five and 10 years, respectively. Death was frequently observed in patients with stone formation; six (55%) of the 11 patients with stone formation died during the follow-up period; two (15%) died among the other 30 patients without stone formation. However, only one patient with stone formation died in a renal event; the causal relationship between the stone formation and the deaths was not clarified. The longitudinal incidence of kidney/urinary stones was higher in patients with severe motor and intellectual disabilities than in the general population. Considering the difficulty of patients with severe motor and intellectual disabilities in conveying their symptoms, regular assessment of the kidney using abdominal imaging may be recommended.

The highly stabilized biologically derived peptide VIESPPEI alleviates DSS-induced colitis in mice by preventing colonic atrophy and modulating gut microbiota

Ulcerative colitis (UC) is a recurrent gastrointestinal infection within the spectrum of inflammatory bowel disease, posing risks associated with long-term medication. Consequently, this study aimed to investigate the effects of novel duck liver protein-derived bioactive peptides, characterized by a higher safety profile, on dextran sulfate sodium (DSS)-induced colitis in mice. The results indicated that the retention rate of VIESPPEI remained above 80% following simulated gastrointestinal digestion in vitro, demonstrating strong stability and practical application potential. The peptide VIESPPEI was found to alleviate weight loss in colitis-afflicted mice, inhibit the elevation of the disease activity index (DAI), and significantly improve symptoms such as atrophy and shortening of the colon. Histological examination further confirmed that VIESPPEI intake promoted the recovery of acute colitis in mice. Additionally, it significantly reduced myeloperoxidase activity and increased superoxide dismutase and catalase activities in the colon tissues of UC mice. Notably, a substantial increase in beneficial gut microbiota and the populations of three beneficial bacteria species (Anaplasma spp., Tannabacterium spp., and Bifidobacterium spp.) that produce short-chain fatty acids, along with a decrease in pathogenic groups such as Streptococcus and Turicibacter, may account for the improvement in colitis observed in UC mice treated with VIESPPEI. This study provides new evidence that VIESPPEI alleviates UC and provides a theoretical basis for the development of functional peptide beverages.

Recent Advances in the Study of Alphaherpesvirus Latency and Reactivation: Novel Guidance for the Design of Herpesvirus Live Vector Vaccines.

Alphaherpesviruses, including herpes simplex virus type 1 (HSV-1), herpes simplex virus type 2 (HSV-2), and varicella-zoster virus (VZV), infect a diverse array of hosts, spanning both humans and animals. Alphaherpesviruses have developed a well-adapted relationship with their hosts through long-term evolution. Some alphaherpesviruses exhibit a typical neurotropic characteristic, which has garnered widespread attention and in-depth research. Virus latency involves the retention of viral genomes without producing infectious viruses. However, under stress, this can be reversed, resulting in lytic infection. Such reactivation events can lead to recurrent infections, manifesting as diseases like herpes labialis, genital herpes, and herpes zoster. Reactivation is a complex process influenced by both viral and host factors, and identifying how latency and reactivation work is vital to developing new antiviral therapies. Recent research highlights a complex interaction among the virus, neurons, and the immune system in regulating alphaherpesvirus latency and reactivation. Neurotropic alphaherpesviruses can breach host barriers to infect neurons, proliferate extensively within their cell bodies, and establish latent infections or spread further. Whether infecting neurons or spreading further, the virus undergoes transmission along axons or dendrites, making this process an indispensable part of the viral life cycle and a critical factor influencing the virus's invasion of the nervous system. Research on the transmission process of neurotropic alphaherpesviruses within neurons can not only deepen our understanding of the virus but can also facilitate the targeted development of corresponding vaccines. This review concentrates on the relationship between the transmission, latency, and activation of alphaherpesviruses within neurons, summarizes recent advancements in the field, and discusses how these findings can inform the design of live virus vaccines for alphaherpesviruses.

Clinical phenotype and genetic analysis of a rare case with 6p duplication and terminal deletion syndrome

To explore the genetic basis for a child with developmental delay and intellectual deficit (DD/ID). A child who was admitted to the Maternal and Child Health Care Hospital of Longhua District of Shenzhen City on June 3, 2023 due to DD/ID, craniofacial malformations, and recurrent infections of upper respiratory tract was selected as the study subject. G-banded chromosomal karyotyping was carried out for the child and her parents. Low-depth genome-wide copy number variation sequencing (CNV-seq) and chromosomal microarray analysis (CMA) were used to screen for genome-wide copy number variations (CNV), and fluorescence in situ hybridization (FISH) was used to verify the origin of candidate CNV. The child, an 8-year-old girl, had featured unexplained growth and intellectual development delay, multiple craniofacial malformations, and recurrent infections of the upper respiratory tract. She was found to have a karyotype of 46,XX,der(6)add(6)(q23), while both of her parents were normal. Both CNV-seq and CMA showed that the child has harbored a 21.38 Mb interstitial duplication at 6p25.3p22.3 and a 0.78 Mb terminal deletion at 6p25. FISH verified that both the duplication and deletion had occurred de novo. The abnormal phenotype of the child may be attributed to the 6p duplication and terminal deletion.

The duration of antibiotic therapy for fracture related infection does not affect recurrence but leads to increased adverse effects: a comparison among 6, 12 and 24weeks of treatment.

The optimal duration of antibiotic therapy for fracture-related infection (FRI) has not been well defined. Our aim was to assess the recurrence rate of infection in patients who underwent six, 12, or 24weeks of antibiotic therapy following surgical treatment for FRI one year after antibiotic discontinuation. Additionally, complications were monitored. Patients with FRI underwent surgical treatment, and antibiotic therapy was initiated. The patients were divided into groups at the 6th and 12th weeks of antibiotic therapy. The primary endpoint was the recurrence of deep or superficial infection at 90days and one year after the end of antimicrobial therapy. There was no difference in the recurrence of infection 90days or one year after stopping antibiotic therapy among patients treated for six, 12, or 24weeks (p = 0.98 and p = 0.19, respectively). The overall recurrence rate of infection 90days after stopping antibiotic therapy was 4.9% (8/163), and one year after discontinuation of antibiotic therapy was 9.8% (16/163). There was a statistically significant difference in the incidence of adverse effects among the three groups (chi-square; p = 0.01). Adverse effects were more common in the group treated for 24weeks than in the groups treated for 6weeks (z score, p = 0.017) or 12weeks (z score, p = 0.005). Antibiotic therapy longer than 6weeks did not reduce the recurrence of FRI after one year of follow-up. Additionally, antibiotic treatment for 24weeks increases adverse events such as skin reactions and acute renal failure.

Relationship between the Presence of Human Papillomavirus in the Female Urethra and Recurrent Urinary Tract Infections.

Introduction: Recurrent urinary tract infections (rUTIs) are highly prevalent health issues among women, significantly impacting their quality of life. Urethral pain or urethritis can arise from infectious or non-infectious origins. The presence of Human Papillomavirus (HPV) in the urogenital tract has been associated with high-risk sexual behaviors, but its presence in the female urethra without such behaviors has not been thoroughly investigated. Objectives: The study aims to determine the presence of HPV in the urethra of women with recurrent urinary tract infections (rUTIs) and concomitant urethral syndrome and to compare the clinical and microbiological characteristics of women with and without urethral HPV, specifically focusing on those without high-risk sexual behaviors. Methods: This prospective multicenter study included 138 women over 18 years old with rUTIs and concomitant urethral pain syndrome. High-risk sexual behaviors, sexually transmitted infections, and vaginitis were set as exclusion criteria. Participants were divided into two groups: NHPV (n = 72) with no urethral HPV and HPV (n = 66) with urethral HPV presence. Variables analyzed included age, body mass index (BMI), follow-up duration, comorbidities, treatments, toxic habits, surgical history, main symptoms, urine sediment findings, and cultures from urine and vaginal exudate. HPV genotyping was also performed. Descriptive statistics were used, along with Student's t-test, Chi-square, Fisher's exact test, ANOVA, and multivariate cluster analysis. Results: The NHPV group was older on average (48.75 years) compared to the HPV group (39.09 years). The HPV group had a longer follow-up period (2634 days vs. 1975 days in NHPV). Urinary incontinence was significantly more common in NHPV (63.89%) compared to HPV (18.18%) (p = 0.001). HPV-positive women had a higher prevalence of verrucous lesions in the vaginal introitus (64% vs. 8% in NHPV). Additionally, the HPV group showed higher rates of pyuria (27.27%), vaginal Candida albicans (36.26%), and positive urine cultures for Escherichia coli (47.83%), Enterococcus faecalis (36.36%), and Klebsiella pneumoniae (21.74%). No significant differences were observed between the groups concerning BMI, smoking habits, diabetes, or the main symptom at consultation. The most common HPV genotypes identified were G35, G42, and G66 (each 27%). Multivariate analysis revealed that sensitivity to nitrofurantoin was the most significant variable in the HPV group (importance of 0.96), followed by fosfomycin (0.79), trimethoprim (0.79), and amoxicillin (0.71). Conclusions: HPV was present in the urethra of 47.8% of women with rUTIs and concomitant urethral syndrome who did not exhibit high-risk sexual behaviors. These women were younger and had a longer duration of symptoms compared to those without urethral HPV. The identification of Enterococcus faecalis, Escherichia coli, and Klebsiella pneumoniae was more common in the HPV group. The sensitivity of bacteria to nitrofurantoin and fosfomycin is crucial for the clinical management of these patients. The presence of urethral HPV should be considered in the evaluation and treatment of women with rUTIs and urethral syndrome.

SP1.3 - Surgical Practices in Emergency Umbilical Hernia Repair and Implications for Trial Design

Abstract Aims There is variation in the investigation, management, and surgical technique of acutely symptomatic abdominal wall hernias and optimal strategies remain to be established. This survey aimed to identify key variables influencing decision-making and preferred surgical techniques in emergency umbilical hernia care to help inform trial design and understand potential challenges to trial delivery. Methods A survey was distributed to surgeons through social media, personal contacts, and ASGBI lists. It comprised five sections: (i) performer of repair, (ii) repair preferences, (iii) important outcomes, (iv) antibiotic use, and (v) trial design. Results There were 105 respondents, of which 49 (46.6%) were consultants. The median largest defect surgeons would attempt to repair with sutures alone was 2cm (IQR 2-4cm). In the acute setting, the most common mesh preferences are preperitoneal plane placement (n=61, 58.1%), with synthetic non-absorbable mesh (n=72, 68.6%), in clean (n=41, 39.0%) or clean-contaminated (n=52, 49.5%) wounds. Respondents believed suture repair to be associated with better short-term outcomes, and mesh repair with better long-term outcomes. The trial design felt to most likely influence practice is comparing mesh and suture repair, and also comparing post-operative antibiotics versus no post-operative antibiotics. Respondents indicated that to change their practice, the median difference in surgical site infection rate and recurrence rate would both need to be 5%. Conclusion This survey provides insight into surgical preferences in emergency umbilical hernia management, offering guidance for future trial designs. Such designs should align with existing evidence and incorporate patient and public involvement to ensure a meaningful impact.

Lower Urinary Tract Symptoms Produced by a Large Congenital Urinary Bladder Diverticulum: Surgical Decision Challenged?

Abstract Urinary bladder diverticula represent herniation of the urothelium through muscularis propria of the urinary bladder wall. Bladder diverticula do not contain a defined functional muscularis propria layer and therefore empty poorly with micturition. In the adult, bladder diverticula are often associated with bladder outlet obstruction or neurogenic vesicourethral dysfunction. Congenital bladder diverticula are usually solitary, associated with a smooth-walled bladder, and occur in the absence of bladder outlet obstruction. Bladder diverticula are most often diagnosed incidentally during the evaluation of nonspecific lower urinary tract symptoms or infection. We present the case report of a very large congenital diverticulum of the urinary bladder (probably aggravated by bladder outlet obstruction), presented in a 75-year-old man with symptoms of urinary obstruction, leading to chronic retention, frequency, and recurrent urinary tract infections.

Utilization of Healthcare Services in Patients with Chronic Diseases under 18 Years Old: Differences and Contributing Factors.

Pediatric patients with chronic conditions frequently have unmet care needs, make extensive use of healthcare services, and often encounter fragmented, non-centered care. This study aimed to analyze the differences in the utilization of primary care (PC) and hospital care (HC) services by these patients according to sex, age, and complexity and to identify associated factors. A cross-sectional study was conducted in a basic health area of Madrid, including patients under 18 years. Among these patients, 15.7% had ≥1 chronic disease, 54.1% were male, the average age was 9.5 years, 3.5% had complexity, and 11.3% had multimorbidity. The mean number of contacts/year with the healthcare system was 9.1, including 8.3 contacts/year with PC (4.9 with pediatricians and 1.9 with nurses) and 0.8 contacts/year with HC (0.8 in external consultations and 0.01 hospitalizations). The factors associated with PC utilization were complexity; female sex; European origin; and diseases like asthma, epilepsy, stroke, recurrent urinary infection, attention deficit hyperactivity disorder, and anxiety, while older age was negatively associated. Thyroid disorders were significantly associated with HC utilization. These findings could help guide the design of optimized pediatric patient-centered care approaches to coordinate care across healthcare services and reduce high healthcare utilization, therefore improving the healthcare outcomes and quality of life for these patients.

Rational use of immunoglobulins (IVIgs and SCIgs) in secondary antibody deficiencies.

Immunoglobulins for intravenous use (IVIgs) and subcutaneous use (SCIgs) can prevent recurrent and severe infections in patients with secondary antibody deficiencies that are frequently linked to haematological/oncological malignancies as well as other clinical conditions and their respective treatments. Even so, as IVIgs and SCIgs are costly and their supply is limited, their clinical use must be optimised. The aim of this position paper is to provide structured practical guidance on the optimal use of IVIgs and SCIgs in secondary antibody deficiencies, particularly in haematological and oncological practice. The authors agree that the occurrence of severe infections is a prerequisite for the use of IVIgs. Serum IgG levels in general as well as IgG subclass levels can be additional indicators of whether a patient could benefit from IVIgs. Responsiveness to vaccines can help to identify immunodeficiency. Patients with chronic lymphocytic leukaemia or multiple myeloma who are receiving respective treatment, especially B-cell depletion therapy, but also some patients with autoimmune diseases are prone to antibody deficiencies and need IVIgs. For the optimal use of IVIgs and to maximise their potential benefit, the indication must be individually assessed for each patient. As a primary treatment goal, the authors define a sufficient prophylaxis of severe infections, which can be supported by normalising IgG levels. If the initiated treatment is insufficient or linked to intolerable adverse reactions, switching the product within the class of IVIgs or changing to a different batch of the same product can be considered. Pausing treatment can also be considered if there are no infections, which happens more frequently in summer, but treatment needs to be resumed once infections return. These structured recommendations for IVIg treatment in patients with secondary antibody deficiency may provide guidance for clinical practice and therefore help to allocate IVIgs to those who will benefit the most, without overusing valuable resources.

Awareness Regarding the Disease and Its Prevention amongst Women with Recurrent Urinary Tract Infection: A Cohort Study

Abstract Introduction: Urinary tract infection (UTI) is regarded as the most common bacterial infection in the community. This disease is more common in females and those in the perimenopausal age group are particularly vulnerable. One of the dreaded complications of UTI is its recurrence. Although the use of antibiotics is the primary modality of treatment of UTI, recurrence can be prevented by adopting behavioural and lifestyle changes and other non-antibacterial measures. Awareness regarding this amongst the patients is of paramount importance. Aims and Objectives: This study was undertaken to assess the knowledge regarding UTI and its preventive measures in a cohort of women with primary UTI attending various Urological clinics in an urban population. Methodology: One hundred and eighty patients with proven UTIs having no comorbid diseases and structural/functional abnormalities in the urinary system were included in the study. A structured questionnaire was prepared to assess the knowledge of patients regarding the basics of UTI and lifestyle modifications, including non-antibacterial measures that could potentially prevent the recurrence of UTI in them. The total scores obtained by patients were categorised into those with inadequate knowledge, moderate knowledge and adequate knowledge. The percentage of patients in each category was calculated. Results: While assessing the overall knowledge using the scale, it was observed that 80% of the patients had inadequate knowledge, while 16.67% had moderate knowledge. Only 3.34% had overall adequate knowledge on the questionnaire. The mean percentage of patients having adequate knowledge on the three subsets of questionnaire given was 18.0%, 8.45% and 7.45%, respectively. The overall mean percentage of adequate knowledge level was only 8.97%. Conclusions: Poor awareness on UTI and its preventive measures could be an important factor in averting recurrent UTI (RUTI) in the community women, particularly belonging to the perimenopausal age group. Since there is a strong correlation between knowledge and practice, educating these women with UTI regarding preventive measures could significantly reduce the incidence of RUTI.

The relationship between severity of periapical periodontitis and next-generation systemic inflammatory biomarkers in children with early childhood caries

IntroductionEarly childhood caries (ECC) is closely associated with poor oral hygiene and cariogenic diet. Untreated ECC results in recurrent odontogenic infections and local and systemic consequences. In this study, our goal is to assess the relationship between the intensity of odontogenic infection-associated periapical periodontitis and new generation of systemic inflammatory markers (SII, NLR, PLR) in ECC-affected children.Material and method95 healthy patients in early childhood and demonstrating periapical periodontitis who underwent dental treatment under general anesthesia (GA) in the last two years were included in the present study. Their periapical statuses were dichotomized as mild and severe. Periapical Index (PAI) scores of 2 and 3 were regarded as “mild” whereas 4 and 5 as “severe”. Of the complete blood test (CBC) parameters, systemic inflammatory index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), neutrophilic granulocyte (NEUT), lymphocyte (LYMPH) and platelet (PLT) were recorded. The relationship between the degree of periapical pathology and the evaluated markers was assessed using Receiver Operating Characteristic (ROC) analysis.ResultsResults of the present study revealed that mean NLR, SII and NEUT index scores of the patients having severe periapical periodontitis were statistically higher than those of the ones with mild pathology (p < 0.05). A positive, statistically significant interrelationship was found between the number of teeth demonstrating a PAI score of severe periapical periodontitis with the signs of exacerbation (PAI 5) and NLR and SII values (p < 0.05). Area under the ROC curve (AUC) values for NLR and SII were determined as 66.8% and 66.6% respectively, indicating that classification performance was sufficient and statistically significant (p < 0.05).ConclusionPostponing the management of odontogenic infections will induce some complications such as, infective endocarditis and cause the systemic inflammatory process to continue by aggravating the systemic effects of local lesions. Thus, underlying mechanism should be eliminated and oral hygiene should be maintained, also novel biomarkers may be recommended to be used for the decision-making process for the teeth with persistent periapical lesions unresponsive to treatment.

Immunological Considerations for the Development of an Effective Herpes Vaccine.

Research is underway to develop a vaccine to prevent and cure infection from herpes simplex virus (HSV). It emphasizes the critical need for immunization to address public health issues and the shortcomings of existing treatment options. Furthermore, studies on the HSV vaccine advance the field of immunology and vaccine creation, which may help in the battle against other viral illnesses. The current lack of such a vaccine is, in part, due to herpes viral latency in sensory ganglions. Current vaccines rely on tissue-resident memory CD8+ T cells, which are known to provide protection against subsequent HSV reinfection and reactivation without correlating with other immune subsets. For that reason, there is no effective vaccine that can provide protection against latent or recurrent herpes infection. This review focuses on conventional methods for evaluating the efficacy of a herpes vaccine using differential CD8+ T cells and important unaccounted immune aspects for designing an effective vaccine against herpes.

Therapeutics involved in managing initial and recurrent Clostridium difficile infection: An updated literature review.

Clostridium difficile infection (CDI) has been increasing due to the effect of recurrent hospitalizations. The use of antibiotics has been shown to alter the gut microbiome and lead to CDIs. The treatment is limited to three major antibiotics; however, the incidence of recurrent CDIs has been increasing and drug resistance is a major concern. This aspect is a growing concern in modern medicine especially in the elderly population, critical care patients, and immunocompromised individuals who are at high risk of developing CDIs. Clostridium difficile can lead to various complications including septic shock and fulminant colitis that could prove to be lethal in these patients. Newer modalities of treatment have been developed including bezlotoxumab, a monoclonal antibody and fecal microbiota transplant. There have been studies showing asymptomatic carriers and drug resistance posing a major threat to the healthcare system. Newer treatment options are being studied to treat and prevent CDIs. This review will provide an insight into the current treatment modalities, prevention and newer modalities of treatment and challenges faced in the treatment of CDIs.

Challenge of diagnosing acute infections in poor resource settings in Africa

Frequent disease outbreaks and acute infections occur in rural and low-income urban areas of Africa, with many health systems unprepared to diagnose and control diseases that are recurrent, endemic or have extended their geographic zone. In this review, we focus on acute infections that can be characterized by sudden onset, rapid progression, severe symptoms and poor prognosis. Consequently, these infections require early diagnosis and intervention. While effective vaccines have been developed against some of these diseases, lack of compliance and accessibility, and the need for repeated or multiple vaccinations mean large populations can remain vulnerable to infection. It follows that there is a need for enhancement of national surveillance and diagnostic capacity to avert morbidity and mortality from acute infections. We discuss the limitations of traditional diagnostic methods and explore the relative merits and applicability of protein-, carbohydrate- and nucleic acid-based rapid diagnostic tests that have been develope for some infectious diseases. We also discuss the utility and limitations of antibody-based serological diagnostics and explore how systems biology approaches can better inform diagnosis. Lastly, given the complexity and high cost associated with after-service support of emerging technologies, we propose that, for resource-limited settings in Africa, multiplex point-of-care diagnostic tools be tailor-made to detect both recurrent acute infections and endemic infections.

Clinical diagnosis of chronic mucocutaneous candidiasis in a patient with recurrent staphylococcal infections

Chronic mucocutaneous candidiasis is a primary immunodeficiency characterized by persistent or recurrent candidal infections of the skin, nails, or mucous membranes. It can be associated with endocrinopathies and autoimmune diseases. A 37-years-old male patient is presented who attended an immunology consultation referred from the dermatology service due to recurrent pyodermitis of several years of evolution; the physical examination also revealed signs of candidiasis in the oral mucosa and lip corners, in the eyelids of both eyes and skin in the abdominal region, which were recurrent, as well as onychomycosis in all toenails. The microbiological study of the pyodermitis lesions showed infection by staphylococcus aureus, and the lesions of the mouth, eyes, abdominal skin and nails showed the presence of Candida albicans. Delayed intradermal skin testing was performed with no T cell response to Candida and Trichophyton antigens. Complementary drugs were indicated to rule out any associated endocrine disorder