Clinical spectrum of melioidosis can vary from a simple skin infection and pneumonia to severe septicaemia with multiorgan failure. Bone involvement in melioidosis is generally low, and the major risk factor is the delay in diagnosing the primary site infection. We present a case of septic arthritis with primary lung melioidosis, whose diagnosis of pulmonary melioidosis was delayed for 5 weeks leading to a septicaemia and septic arthritis. This case highlights the importance of improved clinical awareness among health practitioners and a low threshold for radiological screening of high-risk patients, even in non-endemic areas. It also highlights the fact that having adjunctive open arthrotomy in managing joint infection in melioidosis improves the clinical response to treatment.
{"title":"A case report from non-endemic Australia on systemic melioidosis presenting with septic arthritis","authors":"Buddhika Dhananjalee Alahakoon, Monarita Handa, Shiromali Malalasekara","doi":"10.1016/j.imj.2024.100161","DOIUrl":"10.1016/j.imj.2024.100161","url":null,"abstract":"<div><div>Clinical spectrum of melioidosis can vary from a simple skin infection and pneumonia to severe septicaemia with multiorgan failure. Bone involvement in melioidosis is generally low, and the major risk factor is the delay in diagnosing the primary site infection. We present a case of septic arthritis with primary lung melioidosis, whose diagnosis of pulmonary melioidosis was delayed for 5 weeks leading to a septicaemia and septic arthritis. This case highlights the importance of improved clinical awareness among health practitioners and a low threshold for radiological screening of high-risk patients, even in non-endemic areas. It also highlights the fact that having adjunctive open arthrotomy in managing joint infection in melioidosis improves the clinical response to treatment.</div></div>","PeriodicalId":100667,"journal":{"name":"Infectious Medicine","volume":"4 1","pages":"Article 100161"},"PeriodicalIF":0.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-21DOI: 10.1016/j.imj.2024.100159
Jiongjiong Wang , Xiaoying Li , Xinying Du , Huiqun Jia , Hui Chen , Jian Wu , Guangcai Duan , Haiyan Yang , Ligui Wang
Background
Vancomycin resistant enterococci (VRE) are now considered a global public health issue. In this study, we explored the relationship between vancomycin resistance incidence and various demographic and climatic factors.
Methods
This retrospective study was performed between January 1st, 2014 and December 31st, 2021. Data covering the consumption of vancomycin, the prevalence of vancomycin resistance, and relevant demographics were collected. Spearman's rank correlation, beta regression, and spatial statistical analysis were performed using R version 4.2.2 and ArcGIS version 10.7.
Results
Spearman's rank correlation described the positive relation between vancomycin consumption and the prevalence of vancomycin resistant Enterococcus faecium (VREfm). Multiple regression analysis showed that vancomycin consumption, rural population, proportion of population aged ≥65, annual temperature, and bed number in medical institutions per thousand people were significantly correlated with VREfm prevalence (r = 56.22, p < 0.001; r = 0.0002, p < 0.001; r = 0.06, p < 0.001; r = −0.07, p < 0.001; and r = −0.37, p < 0.001, respectively).
Conclusions
Vancomycin utilization was the predominant factor contributing to VREfm resistance; the effects of rural populations and the proportion of the population aged ≥ 65 were significant but relatively minimal. Annual temperature and the number of beds in medical institutions per thousand people were protective factors against VREfm.
{"title":"Unveiling the drivers of vancomycin-resistant enterococcus in China: A comprehensive ecological study","authors":"Jiongjiong Wang , Xiaoying Li , Xinying Du , Huiqun Jia , Hui Chen , Jian Wu , Guangcai Duan , Haiyan Yang , Ligui Wang","doi":"10.1016/j.imj.2024.100159","DOIUrl":"10.1016/j.imj.2024.100159","url":null,"abstract":"<div><h3>Background</h3><div>Vancomycin resistant enterococci (VRE) are now considered a global public health issue. In this study, we explored the relationship between vancomycin resistance incidence and various demographic and climatic factors.</div></div><div><h3>Methods</h3><div>This retrospective study was performed between January 1st, 2014 and December 31st, 2021. Data covering the consumption of vancomycin, the prevalence of vancomycin resistance, and relevant demographics were collected. Spearman's rank correlation, beta regression, and spatial statistical analysis were performed using R version 4.2.2 and ArcGIS version 10.7.</div></div><div><h3>Results</h3><div>Spearman's rank correlation described the positive relation between vancomycin consumption and the prevalence of vancomycin resistant <em>Enterococcus faecium</em> (VRE<sub>fm</sub>). Multiple regression analysis showed that vancomycin consumption, rural population, proportion of population aged ≥65, annual temperature, and bed number in medical institutions per thousand people were significantly correlated with VRE<sub>fm</sub> prevalence (<em>r</em> = 56.22, <em>p</em> < 0.001; <em>r</em> = 0.0002, <em>p</em> < 0.001; <em>r</em> = 0.06, <em>p</em> < 0.001; <em>r</em> = −0.07, <em>p</em> < 0.001; and <em>r</em> = −0.37, <em>p</em> < 0.001, respectively).</div></div><div><h3>Conclusions</h3><div>Vancomycin utilization was the predominant factor contributing to VRE<sub>fm</sub> resistance; the effects of rural populations and the proportion of the population aged ≥ 65 were significant but relatively minimal. Annual temperature and the number of beds in medical institutions per thousand people were protective factors against VRE<sub>fm</sub>.</div></div>","PeriodicalId":100667,"journal":{"name":"Infectious Medicine","volume":"4 1","pages":"Article 100159"},"PeriodicalIF":0.0,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.imj.2024.100146
Marina E. Eremeeva, Shobhan Das
Background
This scoping review provides a baseline summary of the current records of the ticks, fleas, and mites of public health importance that are present in Bangladesh. It summarizes their geographic distributions and reports the levels of their infestation of livestock, pets, wildlife, and humans, and the clinical and epidemiological studies pertinent to these vectors and their pathogens.
Methods
Sixty-one articles were identified in a literature search, including 43 published since 2011.
Results
Twelve articles contained reliable information on ticks and their associated hosts. However, information on fleas and mites in Bangladesh is very limited. Seventeen species of ixodid ticks that commonly parasitize peridomestic animals and can bite humans are described: Rhipicephalus microplus, R. appendiculatus, R. sanguineus, Haemaphysalis bispinosa, Hyalomma anatolicum, and Amblyomma testudinarium. Thirty-eight veterinary articles describe livestock pathogens, including Babesia, Anaplasma, and Theileria, and the diseases they cause. Few of those studies used modern molecular techniques to identify these pathogens. Eleven articles reported human diseases or surveillance studies, 10 from the last 10 years. Two country-wide serosurveys of 1,209 and 720 patients, using Enzyme Linked Immunosorbent Assay (ELISA) and Indirect Immunofluorescence Assay (IFA), respectively, reported human exposure to Orientia tsutsugamushi (8.8%–23.7%), typhus and spotted-fever group rickettsiae (19.7%–66.6%), and Coxiella burnetii (3%). The seropositivity rates varied regionally. PCR-based studies confirmed that febrile patients in Bangladesh may be infected with O. tsutsugamushi, Rickettsia typhi, Rickettsia felis, or Bartonella elizabethae. Only limited molecular research has been done with dogs and cats. These studies have reported PCR-confirmed canine infections with Babesia gibsoni (30%), Anaplasma bovis (58%), or Rickettsia monacenis (14%, n=50), and feline infections with Rickettsia felis (21%, n=100). Similarly, fleas from cats tested positive for Rickettsia felis (20.6%).
Conclusions
These findings indicate that diseases borne by non-mosquito vectors in Bangladesh urgently require more attention from public health, medical, and veterinary specialists to establish their true occurrence.
{"title":"Tick-, flea- and mite-borne pathogens and associated diseases of public health importance in Bangladesh: a review","authors":"Marina E. Eremeeva, Shobhan Das","doi":"10.1016/j.imj.2024.100146","DOIUrl":"10.1016/j.imj.2024.100146","url":null,"abstract":"<div><h3>Background</h3><div>This scoping review provides a baseline summary of the current records of the ticks, fleas, and mites of public health importance that are present in Bangladesh. It summarizes their geographic distributions and reports the levels of their infestation of livestock, pets, wildlife, and humans, and the clinical and epidemiological studies pertinent to these vectors and their pathogens.</div></div><div><h3>Methods</h3><div>Sixty-one articles were identified in a literature search, including 43 published since 2011.</div></div><div><h3>Results</h3><div>Twelve articles contained reliable information on ticks and their associated hosts. However, information on fleas and mites in Bangladesh is very limited. Seventeen species of ixodid ticks that commonly parasitize peridomestic animals and can bite humans are described: <em>Rhipicephalus microplus, R. appendiculatus, R. sanguineus, Haemaphysalis bispinosa, Hyalomma anatolicum</em>, and <em>Amblyomma testudinarium</em>. Thirty-eight veterinary articles describe livestock pathogens, including <em>Babesia, Anaplasma</em>, and <em>Theileria</em>, and the diseases they cause. Few of those studies used modern molecular techniques to identify these pathogens. Eleven articles reported human diseases or surveillance studies, 10 from the last 10 years. Two country-wide serosurveys of 1,209 and 720 patients, using Enzyme Linked Immunosorbent Assay (ELISA) and Indirect Immunofluorescence Assay (IFA), respectively, reported human exposure to <em>Orientia tsutsugamushi</em> (8.8%–23.7%), typhus and spotted-fever group rickettsiae (19.7%–66.6%), and <em>Coxiella burnetii</em> (3%). The seropositivity rates varied regionally. PCR-based studies confirmed that febrile patients in Bangladesh may be infected with <em>O. tsutsugamushi, Rickettsia typhi, Rickettsia felis</em>, or <em>Bartonella elizabethae</em>. Only limited molecular research has been done with dogs and cats. These studies have reported PCR-confirmed canine infections with <em>Babesia gibsoni</em> (30%), <em>Anaplasma bovis</em> (58%), or <em>Rickettsia monacenis</em> (14%, <em>n</em>=50), and feline infections with <em>Rickettsia felis</em> (21%, <em>n</em>=100). Similarly, fleas from cats tested positive for <em>Rickettsia felis</em> (20.6%).</div></div><div><h3>Conclusions</h3><div>These findings indicate that diseases borne by non-mosquito vectors in Bangladesh urgently require more attention from public health, medical, and veterinary specialists to establish their true occurrence.</div></div>","PeriodicalId":100667,"journal":{"name":"Infectious Medicine","volume":"3 4","pages":"Article 100146"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142747701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.imj.2024.100150
Jinzhu Huang , Shiwei Wang , Xiaoxue Lu , Liangpeng Suo , Minyang Wang , Juanjuan Yue , Rong Lin , Xuhu Mao , Qian Li , Jingmin Yan
Background
Burkholderia pseudomallei is a gram-negative bacterium widely found in Southeast Asia and northern Australia. This bacterium, which lacks an available vaccine, is the causative agent of melioidosis and has properties that potentially enable its exploitation as a bioweapon.
Methods
Polymerase chain reaction assays targeting each of the lipopolysaccharide (LPS) genetic types were used to investigate genotype frequencies in B. pseudomallei populations. Silver staining, gas chromatography-mass spectrometry (GC-MS), and immunofluorescence were used to characterize LPS.
Results
In our study, a total of 169 clinical B. pseudomallei isolates were collected from Hainan Province, China between 2004 and 2016. The results showed that LPS genotype A was the predominant type, comprising 91.1% of the samples, compared with only 8.9% of LPS genotype B. The majority of patients were male and were diagnosed with sepsis or pneumonia. Silver staining and GC-MS demonstrated that LPS genotypes A and B exhibited distinct phenotypes and molecular structures. Immunofluorescence tests showed there was no cross-reaction between LPS genotypes A and B.
Conclusions
This is the first report on the molecular epidemiology of B. pseudomallei based on O-antigen in China. Tracking the regional distribution of different LPS genotypes offers significant insights relevant to the development and administration of LPS-based vaccines.
{"title":"Molecular epidemiology of Burkholderia pseudomallei in Hainan Province of China based on O-antigen","authors":"Jinzhu Huang , Shiwei Wang , Xiaoxue Lu , Liangpeng Suo , Minyang Wang , Juanjuan Yue , Rong Lin , Xuhu Mao , Qian Li , Jingmin Yan","doi":"10.1016/j.imj.2024.100150","DOIUrl":"10.1016/j.imj.2024.100150","url":null,"abstract":"<div><h3>Background</h3><div><em>Burkholderia pseudomallei</em> is a gram-negative bacterium widely found in Southeast Asia and northern Australia. This bacterium, which lacks an available vaccine, is the causative agent of melioidosis and has properties that potentially enable its exploitation as a bioweapon.</div></div><div><h3>Methods</h3><div>Polymerase chain reaction assays targeting each of the lipopolysaccharide (LPS) genetic types were used to investigate genotype frequencies in <em>B. pseudomallei</em> populations. Silver staining, gas chromatography-mass spectrometry (GC-MS), and immunofluorescence were used to characterize LPS.</div></div><div><h3>Results</h3><div>In our study, a total of 169 clinical <em>B. pseudomallei</em> isolates were collected from Hainan Province, China between 2004 and 2016. The results showed that LPS genotype A was the predominant type, comprising 91.1% of the samples, compared with only 8.9% of LPS genotype B. The majority of patients were male and were diagnosed with sepsis or pneumonia. Silver staining and GC-MS demonstrated that LPS genotypes A and B exhibited distinct phenotypes and molecular structures. Immunofluorescence tests showed there was no cross-reaction between LPS genotypes A and B.</div></div><div><h3>Conclusions</h3><div>This is the first report on the molecular epidemiology of <em>B. pseudomallei</em> based on O-antigen in China. Tracking the regional distribution of different LPS genotypes offers significant insights relevant to the development and administration of LPS-based vaccines.</div></div>","PeriodicalId":100667,"journal":{"name":"Infectious Medicine","volume":"3 4","pages":"Article 100150"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142759503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.imj.2024.100148
Li Zhuang , Awais Ali , Ling Yang , Zhaoyang Ye , Linsheng Li , Ruizi Ni , Yajing An , Syed Luqman Ali , Wenping Gong
Background
Tuberculosis (TB) remains a global public health challenge. The existing Bacillus Calmette–Guérin vaccine has limited efficacy in preventing adult pulmonary TB, necessitating the development of new vaccines with improved protective effects.
Methods
Computer-aided design and artificial intelligence technologies, combined with bioinformatics and immunoinformatics approaches, were used to design a multi-epitope vaccine (MEV) against TB. Comprehensive bioinformatics analyses were conducted to evaluate the physicochemical properties, spatial structure, immunogenicity, molecular dynamics (MD), and immunological characteristics of the MEV.
Results
We constructed a MEV, designated ZL12138L, containing 13 helper T lymphocyte epitopes, 12 cytotoxic T lymphocyte epitopes, 8 B-cell epitopes, as well as Toll-like receptor (TLR) agonists and helper peptides. Bioinformatics analyses revealed that ZL12138L should exhibit excellent immunogenicity and antigenicity, with no toxicity or allergenicity, and had potential to induce robust immune responses and high solubility, the immunogenicity score was 4.14449, the antigenicity score was 0.8843, and the immunological score was 0.470. Moreover, ZL12138L showed high population coverage for human leukocyte antigen class I and II alleles, reaching 92.41% and 90.17%, respectively, globally. Molecular docking analysis indicated favorable binding affinity of ZL12138L with TLR-2 and TLR-4, with binding energies of −1173.4 and −1360.5 kcal/mol, respectively. Normal mode analysis and MD simulations indicated the stability and dynamic properties of the vaccine construct. Immune simulation predictions suggested that ZL12138L could effectively activate innate and adaptive immune cells, inducing high levels of Type 1 T helper cell cytokines.
Conclusions
This study provides compelling evidence for ZL12138L as a promising TB vaccine candidate. Future research will focus on experimental validation and further optimization of the vaccine design.
{"title":"Leveraging computer-aided design and artificial intelligence to develop a next-generation multi-epitope tuberculosis vaccine candidate","authors":"Li Zhuang , Awais Ali , Ling Yang , Zhaoyang Ye , Linsheng Li , Ruizi Ni , Yajing An , Syed Luqman Ali , Wenping Gong","doi":"10.1016/j.imj.2024.100148","DOIUrl":"10.1016/j.imj.2024.100148","url":null,"abstract":"<div><h3>Background</h3><div>Tuberculosis (TB) remains a global public health challenge. The existing Bacillus Calmette–Guérin vaccine has limited efficacy in preventing adult pulmonary TB, necessitating the development of new vaccines with improved protective effects.</div></div><div><h3>Methods</h3><div>Computer-aided design and artificial intelligence technologies, combined with bioinformatics and immunoinformatics approaches, were used to design a multi-epitope vaccine (MEV) against TB. Comprehensive bioinformatics analyses were conducted to evaluate the physicochemical properties, spatial structure, immunogenicity, molecular dynamics (MD), and immunological characteristics of the MEV.</div></div><div><h3>Results</h3><div>We constructed a MEV, designated ZL12138L, containing 13 helper T lymphocyte epitopes, 12 cytotoxic T lymphocyte epitopes, 8 B-cell epitopes, as well as Toll-like receptor (TLR) agonists and helper peptides. Bioinformatics analyses revealed that ZL12138L should exhibit excellent immunogenicity and antigenicity, with no toxicity or allergenicity, and had potential to induce robust immune responses and high solubility, the immunogenicity score was 4.14449, the antigenicity score was 0.8843, and the immunological score was 0.470. Moreover, ZL12138L showed high population coverage for human leukocyte antigen class I and II alleles, reaching 92.41% and 90.17%, respectively, globally. Molecular docking analysis indicated favorable binding affinity of ZL12138L with TLR-2 and TLR-4, with binding energies of −1173.4 and −1360.5 kcal/mol, respectively. Normal mode analysis and MD simulations indicated the stability and dynamic properties of the vaccine construct. Immune simulation predictions suggested that ZL12138L could effectively activate innate and adaptive immune cells, inducing high levels of Type 1 T helper cell cytokines.</div></div><div><h3>Conclusions</h3><div>This study provides compelling evidence for ZL12138L as a promising TB vaccine candidate. Future research will focus on experimental validation and further optimization of the vaccine design.</div></div>","PeriodicalId":100667,"journal":{"name":"Infectious Medicine","volume":"3 4","pages":"Article 100148"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142747569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-09DOI: 10.1016/j.imj.2024.100151
Zeyu Zhang , You Wu
{"title":"The critical role of health policy and management in epidemic control: COVID-19 and beyond","authors":"Zeyu Zhang , You Wu","doi":"10.1016/j.imj.2024.100151","DOIUrl":"10.1016/j.imj.2024.100151","url":null,"abstract":"","PeriodicalId":100667,"journal":{"name":"Infectious Medicine","volume":"3 4","pages":"Article 100151"},"PeriodicalIF":0.0,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142699326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-08DOI: 10.1016/j.imj.2024.100149
Malik W.Z. Khan , Muhammad Ahmad , Salma Qudrat , Fatma Afridi , Najia Ali Khan , Zain Afridi , Fahad , Touba Azeem , Jibran Ikram
This review investigates the therapeutic potential of vagal nerve stimulation (VNS) in managing long COVID, a condition marked by persistent symptoms following acute SARS-CoV-2 infection. Long COVID manifests as ongoing fatigue, cognitive impairment, and autonomic dysfunction, hypothesized to arise from sustained inflammatory and neurological dysregulation. The vagus nerve, central to modulating systemic inflammation and autonomic homeostasis, represents a promising therapeutic target for symptom alleviation through VNS. A comprehensive literature search was conducted across PubMed, Scopus, and Web of Science to identify studies evaluating VNS in the context of long COVID. Preliminary evidence from small-scale pilot studies suggests VNS may attenuate systemic inflammation through activation of the cholinergic anti-inflammatory pathway (CAP), thus restoring autonomic balance and ameliorating symptoms such as fatigue, cognitive dysfunction, and anxiety. In targeting the inflammatory cascade that underlies both acute COVID-19 pathophysiology and its prolonged sequelae, VNS holds potential as an innovative intervention for persistent post-viral symptoms. While these initial findings indicate promise, current data remain limited in scope and robustness, underscoring the need for larger, controlled trials to validate the efficacy and mechanisms of VNS in long COVID management. Establishing a clearer understanding of VNS's impact on inflammation and autonomic regulation in this context is crucial to inform clinical guidelines and therapeutic strategies for long COVID, potentially offering a targeted approach for mitigating this disabling condition.
{"title":"Vagal nerve stimulation for the management of long COVID symptoms","authors":"Malik W.Z. Khan , Muhammad Ahmad , Salma Qudrat , Fatma Afridi , Najia Ali Khan , Zain Afridi , Fahad , Touba Azeem , Jibran Ikram","doi":"10.1016/j.imj.2024.100149","DOIUrl":"10.1016/j.imj.2024.100149","url":null,"abstract":"<div><div>This review investigates the therapeutic potential of vagal nerve stimulation (VNS) in managing long COVID, a condition marked by persistent symptoms following acute SARS-CoV-2 infection. Long COVID manifests as ongoing fatigue, cognitive impairment, and autonomic dysfunction, hypothesized to arise from sustained inflammatory and neurological dysregulation. The vagus nerve, central to modulating systemic inflammation and autonomic homeostasis, represents a promising therapeutic target for symptom alleviation through VNS. A comprehensive literature search was conducted across PubMed, Scopus, and Web of Science to identify studies evaluating VNS in the context of long COVID. Preliminary evidence from small-scale pilot studies suggests VNS may attenuate systemic inflammation through activation of the cholinergic anti-inflammatory pathway (CAP), thus restoring autonomic balance and ameliorating symptoms such as fatigue, cognitive dysfunction, and anxiety. In targeting the inflammatory cascade that underlies both acute COVID-19 pathophysiology and its prolonged sequelae, VNS holds potential as an innovative intervention for persistent post-viral symptoms. While these initial findings indicate promise, current data remain limited in scope and robustness, underscoring the need for larger, controlled trials to validate the efficacy and mechanisms of VNS in long COVID management. Establishing a clearer understanding of VNS's impact on inflammation and autonomic regulation in this context is crucial to inform clinical guidelines and therapeutic strategies for long COVID, potentially offering a targeted approach for mitigating this disabling condition.</div></div>","PeriodicalId":100667,"journal":{"name":"Infectious Medicine","volume":"3 4","pages":"Article 100149"},"PeriodicalIF":0.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142723067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-19DOI: 10.1016/j.imj.2024.100147
Anna Kamdar , Robert Sykes , Cameron R. Thomson , Kenneth Mangion , Daniel Ang , Michelle AW Lee , Tom Van Agtmael , Colin Berry
Causal associations between viral infections and acute myocardial injury are not fully understood, with mechanisms potentially involving direct cardiovascular involvement or systemic inflammation. This review explores plausible mechanisms of vascular fibrosis in patients with post-COVID-19 syndrome, focusing on extracellular matrix remodelling. Despite global attention, significant mechanistic or translational breakthroughs in the management of post-viral syndromes remain limited. No effective pharmacological or non-pharmacological interventions are currently available for patients experiencing persistent symptoms following COVID-19 infection. The substantial expansion of scientific knowledge resulting from collaborative efforts by medical experts, scientists, and government organisations in undertaking COVID-19 research could inform treatment strategies for other post-viral syndromes and respiratory illnesses. There is a critical need for clinical trials to evaluate potential therapeutic candidates, providing evidence to guide treatment decisions for post-COVID-19 syndromes.
{"title":"Vascular fibrosis and extracellular matrix remodelling in post-COVID 19 conditions","authors":"Anna Kamdar , Robert Sykes , Cameron R. Thomson , Kenneth Mangion , Daniel Ang , Michelle AW Lee , Tom Van Agtmael , Colin Berry","doi":"10.1016/j.imj.2024.100147","DOIUrl":"10.1016/j.imj.2024.100147","url":null,"abstract":"<div><div>Causal associations between viral infections and acute myocardial injury are not fully understood, with mechanisms potentially involving direct cardiovascular involvement or systemic inflammation. This review explores plausible mechanisms of vascular fibrosis in patients with post-COVID-19 syndrome, focusing on extracellular matrix remodelling. Despite global attention, significant mechanistic or translational breakthroughs in the management of post-viral syndromes remain limited. No effective pharmacological or non-pharmacological interventions are currently available for patients experiencing persistent symptoms following COVID-19 infection. The substantial expansion of scientific knowledge resulting from collaborative efforts by medical experts, scientists, and government organisations in undertaking COVID-19 research could inform treatment strategies for other post-viral syndromes and respiratory illnesses. There is a critical need for clinical trials to evaluate potential therapeutic candidates, providing evidence to guide treatment decisions for post-COVID-19 syndromes.</div></div>","PeriodicalId":100667,"journal":{"name":"Infectious Medicine","volume":"3 4","pages":"Article 100147"},"PeriodicalIF":0.0,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142699319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-18DOI: 10.1016/j.imj.2024.100144
Helena C. Maltezou , Maria N. Gamaletsou , Maria Chini , Vasileios Petrakis , Vasiliki Rapti , Theodoros V. Giannouchos , Eleni Karantoni , Konstantinos Kounouklas , Panagiota Stamou , Αmalia Karapanou , Dimitrios Basoulis , Andrianna-Chrysovalanto Verykokkou , Kyriakos Souliotis , Periklis Panagopoulos , Dimitrios Hatzigeorgiou , Garyfalia Poulakou , Konstantinos N. Syrigos , Nikolaos V. Sipsas
Background
To estimate the protection that coronavirus disease 2019 (COVID-19) vaccine doses conferred to hospitalized patients with COVID-19 against adverse outcomes and longer length of stay during the Omicron BA.2 and BA.5 subvariant epidemics in Greece.
Methods
The study was conducted from November 2022 to May 2023. Multivariable logistic and negative binomial regression models were applied to estimate the association between any adverse outcomes and length of stay with the number of COVID-19 vaccine doses.
Results
We studied 962 patients (median age: 78 years; mean length of stay: 9.2 days), of whom 847 (88.0%) had ≥ 1 comorbidity. Of these, 39 (4.0%) were admitted to the intensive care unit, 44 (4.6%) received invasive mechanical ventilation, and 110 (11.4%) died in hospital. There were 184 (19.1%) unvaccinated patients, 125 (13.0%) with one or two vaccine doses, and 653 (67.9%) with ≥ 3 doses. In multivariable analyses, patients with ≥ 3 doses had lower odds of experiencing any adverse outcomes (adjusted odds ratio: 0.57; 95% confidence interval [CI]: 0.37–0.86) compared with unvaccinated patients. On average, patients with one or two doses and those with ≥ 3 had decreased length of hospital stay (−1.5 days [95% CIs: −2.6 to −0.4] and −2.8 days [95% CIs: −4.1 to −1.4], respectively] compared with unvaccinated patients. Other characteristics consistently associated with adverse outcomes and longer length of stay included older age, having three or more comorbidities compared with none, and being admitted to the hospital two or more weeks post-diagnosis.
Conclusions
A history of ≥ 3 vaccine doses conferred significant protection against any adverse outcome and longer length of stay in hospitalized patients with COVID-19.
{"title":"Protection conferred by booster vaccine doses in hospitalized patients with COVID-19 during the SARS-CoV-2 Omicron BA.2 and BA.5 epidemics from 2022 to 2023 in Greece","authors":"Helena C. Maltezou , Maria N. Gamaletsou , Maria Chini , Vasileios Petrakis , Vasiliki Rapti , Theodoros V. Giannouchos , Eleni Karantoni , Konstantinos Kounouklas , Panagiota Stamou , Αmalia Karapanou , Dimitrios Basoulis , Andrianna-Chrysovalanto Verykokkou , Kyriakos Souliotis , Periklis Panagopoulos , Dimitrios Hatzigeorgiou , Garyfalia Poulakou , Konstantinos N. Syrigos , Nikolaos V. Sipsas","doi":"10.1016/j.imj.2024.100144","DOIUrl":"10.1016/j.imj.2024.100144","url":null,"abstract":"<div><h3>Background</h3><div>To estimate the protection that coronavirus disease 2019 (COVID-19) vaccine doses conferred to hospitalized patients with COVID-19 against adverse outcomes and longer length of stay during the Omicron BA.2 and BA.5 subvariant epidemics in Greece.</div></div><div><h3>Methods</h3><div>The study was conducted from November 2022 to May 2023. Multivariable logistic and negative binomial regression models were applied to estimate the association between any adverse outcomes and length of stay with the number of COVID-19 vaccine doses.</div></div><div><h3>Results</h3><div>We studied 962 patients (median age: 78 years; mean length of stay: 9.2 days), of whom 847 (88.0%) had ≥ 1 comorbidity. Of these, 39 (4.0%) were admitted to the intensive care unit, 44 (4.6%) received invasive mechanical ventilation, and 110 (11.4%) died in hospital. There were 184 (19.1%) unvaccinated patients, 125 (13.0%) with one or two vaccine doses, and 653 (67.9%) with ≥ 3 doses. In multivariable analyses, patients with ≥ 3 doses had lower odds of experiencing any adverse outcomes (adjusted odds ratio: 0.57; 95% confidence interval [CI]: 0.37–0.86) compared with unvaccinated patients. On average, patients with one or two doses and those with ≥ 3 had decreased length of hospital stay (−1.5 days [95% CIs: −2.6 to −0.4] and −2.8 days [95% CIs: −4.1 to −1.4], respectively] compared with unvaccinated patients. Other characteristics consistently associated with adverse outcomes and longer length of stay included older age, having three or more comorbidities compared with none, and being admitted to the hospital two or more weeks post-diagnosis.</div></div><div><h3>Conclusions</h3><div>A history of ≥ 3 vaccine doses conferred significant protection against any adverse outcome and longer length of stay in hospitalized patients with COVID-19.</div></div>","PeriodicalId":100667,"journal":{"name":"Infectious Medicine","volume":"3 4","pages":"Article 100144"},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142652590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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