世界病毒学杂志(英文版)最新文献

Background: Chronic diarrhoea in people living with human immunodeficiency virus (PLHIV)/acquired immunodeficiency syndrome presents a diagnostic challenge, often resulting from opportunistic infections (OIs), malignancies, or disease progression itself. We present a case of an advanced human immunodeficiency virus (HIV) patient with chronic diarrhoea, significant weight loss, and antiretroviral therapy (ART) non-compliance, highlighting the diagnostic dilemma between HIV wasting syndrome, OIs, and malignancy.

Case summary: A 36-year-old female, diagnosed with HIV five years ago on family screening, presented with three months of profuse watery diarrhoea, associated with crampy abdominal pain and weight loss (14 kg, 30% in 3 months). She was non-compliant with ART. There was no history of recent travel, food contamination, or tuberculosis contact. Fever episodes were mild and transient. Physical examination revealed pallor and bilateral pedal oedema without lymphadenopathy or organomegaly. Genital examination was unremarkable. Routine investigations revealed severe anaemia and confirmed PLHIV status. CD4 count was < 36 cells/µL. Empirical treatment with nitazoxanide was initiated for possible cryptosporidiosis. After ruling out OIs, ART was restarted. With treatment, her diarrhoea resolved, and she tolerated oral intake. Nutritional support was provided, and she was discharged in stable condition with ART, prophylactic antibiotics, and follow-up instructions for further evaluation.

Conclusion: In ART-noncompliant PLHIV with chronic diarrhoea, distinguishing between HIV wasting syndrome, OIs (Cryptosporidium, Mycobacterium avium complex, cytomegalovirus colitis) and malignancies (non-Hodgkin lymphoma and anal carcinoma) are critical. Gradual CD4 decline, systemic inflammation, and malnutrition favour progressive HIV/acquired immunodeficiency syndrome rather than an acute OI or malignancy. Early recognition and management, including ART reinitiation and nutritional support, are crucial for prognosis.

The community of microorganisms that colonize certain areas of the human body is called microbiota. Microorganisms such as bacteria, fungi and viruses make up the microbiota. The sum of the genomes of these microorganisms and microorganisms refers to the microbiome. It has been shown that microbiota has important effects such as protecting the organ from pathogens, contributing to metabolic functions (such as vitamin synthesis, carbohydrate digestion) and providing immunoregulation. Dysbiosis refers to compositional and functional changes in the microbiota. At the beginning of the 21^st century, numerous studies have investigated the human microbiota and its imbalance in relation to various diseases and found that dysbiosis is associated with many diseases. The aim of this mini-review article is to provide brief information about dysbiosis and its care and to raise awareness.

The Marburg virus (MARV) is a dangerous infection that causes a deadly sickness known as MARV disease. This severe hemorrhagic fever is a major concern for people all over the world. Since the initial identification in 1967 during simultaneous outbreaks in Germany and Serbia, MARV has caused recurrent epidemics predominantly in sub-Saharan Africa with fatality rates ranging from 24% to 90% as a result of differences in virus strains, healthcare infrastructure, and the quality of patient treatment. Like Ebola virus, MARV causes a viral hemorrhagic fever identified in some of the same principles of clinical and epidemiological concern. However, MARV has unique biologic characteristics that require specialized research and response by public health and among researchers. Diagnosis relies on molecular tools such as real-time reverse transcriptase-polymerase chain reaction and enzyme-linked immunosorbent assay, as well as clinical and epidemiological assessments. Despite advancements in understanding MARV biology, no vaccines or antiviral therapies have been approved, with treatment limited to supportive care. Experimental therapeutics, monoclonal antibodies, RNA-based drugs, and adenovirus-based vaccines, show promise but require further validation. Current efforts in outbreak containment include surveillance, rapid diagnostics, case isolation, and safe burial practices. However, gaps in understanding MARV pathogenesis, limited diagnostic tools, and the absence of regulatory-approved vaccines underscore the urgent need for global collaboration and investment in research. Bridging these gaps is critical to mitigating the public health impact of MARV, ensuring effective response strategies for future outbreaks.

Background: For decades, hepatitis A virus (HAV) has been a leading cause of acute hepatitis among children and was less prevalent among adults. However, recently a paradigm shift has been observed in the epidemiology of HAV, as evident by cases of acute hepatitis due to HAV among adults.

Aim: To estimate frequency of HAV in acute viral hepatitis and compare characteristics in HAV and hepatitis E virus (HEV) infection.

Methods: This was a trend analysis conducted at Aga Khan University Hospital Karachi (Sindh, Pakistan) from February 2024 to May 2024. Individuals aged 18 years and older diagnosed with acute viral hepatitis attributed to hepatotropic viruses in 2024 were reviewed. To compare the trend patients admitted with acute hepatitis during 2019-2023 were also reviewed. Data regarding clinical and laboratory parameters were recorded. The yearly trend of acute hepatitis due to HAV and HEV was analyzed, and comparative analysis was done between HAV and HEV cases among adults.

Results: A total of 396 patients were found to have acute hepatitis during our study duration. HAV was diagnosed in 234 patients (59%) while 157 patients (39.6%) were found to have acute HEV infection. Additionally, acute hepatitis B virus infection was identified in 3 patients (0.7%), whereas acute hepatitis C virus infection was found in 2 (0.5%) cases of acute hepatitis. Yearly trends showed increasing occurrence of HAV infection among adults over last 5 years. The patients with acute HAV were younger than patients with HEV (28 years ± 8 years vs 30 years ± 8 years; P < 0.01). Higher levels of total bilirubin were seen in HEV infection, while higher levels of alanine transaminase were seen in HAV infection. However, a higher proportion of acute liver failure (ALF), coagulopathy, and mortality were observed in HEV.

Conclusion: An increase in acute hepatitis A cases among adults shows less severity than hepatitis E, highlighting the need for better sanitation, hygiene, and adult hepatitis A vaccination programs.

Human immunodeficiency virus (HIV) modifies CD4-positive cells, resulting in immunodeficiency and a wide range of gastrointestinal (GI) manifestations. The burden of HIV-related GI illnesses has significantly evolved with the widespread use of antiretroviral therapy (ART). While ART has effectively reduced the occurrence of opportunistic infections, it has led to an increase in therapy-related GI illnesses. Common esophageal conditions in HIV patients include gastroesophageal reflux disease, idiopathic esophageal ulcers, herpes simplex virus, cytomegalovirus (CMV), and candidal esophagitis. Kaposi's sarcoma, a hallmark of acquired immunodeficiency syndrome, may affect the entire GI system. Gastritis and peptic ulcer disease are also frequently seen in patients with HIV. Diarrhea, often linked to both opportunistic infections and ART, requires careful evaluation. Bloody diarrhea, often a sign of colitis caused by bacterial infections such as Shigella or Clostridium difficile, is prevalent. Small bowel lymphoma, although rare, is increasing in prevalence. Anorectal disorders, including proctitis, fissures, and anal squamous cell carcinoma, are particularly relevant in homosexual men, underlining the importance of timely diagnosis. This review comprehensively explores the epidemiology, pathogenesis, and treatment considerations for the various GI disorders associated with HIV, highlighting the importance of accurate diagnosis and effective treatment to improve outcomes for HIV-infected patients.

Background: Transfusion transmissible infections (TTIs) are illnesses spread through contaminated blood or blood products. In India, screening for TTIs such as hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV)-I/II, malaria, and syphilis is mandatory before blood transfusions. Worldwide, HCV, HBV, and HIV are the leading viruses causing mortality, affecting millions of people globally, including those with co-infections of HIV/HCV and HIV/HBV. Studies highlight the impact of TTIs on life expectancy and health risks, such as liver cirrhosis, cancer, and other diseases in individuals with chronic HBV. Globally, millions of blood donations take place annually, emphasizing the importance of maintaining blood safety.

Aim: To study the prevalence of TTIs, viz., HBV, HCV, HIV I/II, syphilis, and malaria parasite (MP), among different blood donor groups.

Methods: The study assessed the prevalence of TTIs among different blood donor groups in Delhi, India. Groups included total donors, in-house donors, total camp donors, institutional camp donors, and community camp donors. Tests for HIV, HBV, and HCV were done using enzyme-linked immunosorbent assay, while syphilis was tested with rapid plasma reagins and MP rapid card methods. The prevalence of HBV, HCV, HIV, and syphilis, expressed as percentages. Differences in infection rates between the groups were analyzed using χ² tests and P-values (less than 0.05).

Results: The study evaluated TTIs among 42158 blood donors in Delhi. The overall cumulative frequency of TTIs in total blood donors was 2.071%, and the frequencies of HBV, HCV, HIV-I/II, venereal disease research laboratory, and MP were 1.048%, 0.425%, 0.221%, 0.377%, and 0.0024%, respectively. In-house donors, representing 37656 donors, had the highest transfusion transmissible infection (TTI) prevalence at 2.167%. Among total camp donors (4502 donors), TTIs were identified in 1.266% of donors, while community camp donors (2439 donors) exhibited a prevalence of 1.558%. Institutional camp donors (2063 donors) had the lowest TTI prevalence at 0.921%. Statistical analysis revealed significant differences in overall TTI prevalence, with total and in-house donors exhibiting higher rates compared to camp donors.

Conclusion: Ongoing monitoring and effective screening programs are essential for minimizing TTIs. Customizing blood safety measures for different donor groups and studying socio-economic-health factors is essential to improving blood safety.

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2. It was declared a global pandemic on March 11, 2020, by the World Health Organization. An excessive inflammatory response is a severe respiratory manifestation of COVID-19, which becomes predominant in later stages. Due to its immunosuppressive and anti-inflammatory properties, dexamethasone is the first systemic glucocorticoid to treat severe COVID-19 patients. This editorial reviews the efficacy and safety of high-dose vs low-dose dexamethasone in patients with COVID-19. Findings indicate that using low-dose dexamethasone is beneficial and emphasize the need for additional research on the use of high-dose dexamethasone. While the study provides a robust evidence base, it is limited by the lack of long-term data, focus on specific outcomes and heterogeneity of the included studies. Future research should focus on the long-term effects of dexamethasone and its impact across varying disease severities and patient populations to refine treatment strategies and improve patient care.

Background: Cytomegalovirus (CMV) infections can cause significant morbidity and mortality in immunocompromised individuals. CMV targets dysfunctional lymphocytes. Chronic rituximab (RTX) therapy can cause B-lymphocyte dysfunction, increasing CMV risk. Rarely, CMV infections present with critical illness such as septic shock.

Case summary: A 64-year-old African American woman presented with generalized weakness and non-bloody watery diarrhea of 4-6 weeks duration. She did not have nausea, vomiting or, abdominal pain. She had been on monthly RTX infusions for neuromyelitis optica. She was admitted for septic shock due to pancolitis. Blood investigations suggested pancytopenia and serology detected significantly elevated CMV DNA. Valganciclovir treatment led to disease resolution.

Conclusion: This case illustrates an extremely rare case of CMV colitis associated with RTX use presenting with septic shock. High suspicion for rare opportunistic infections is imperative in individuals with long-term RTX use.

The ongoing coronavirus disease 2019 (COVID-19) pandemic has necessitated rapid advancements in therapeutic strategies, with dexamethasone emerging as a key treatment for severe cases. This editorial discusses the systematic review conducted by Sethi et al, published in the World Journal of Virology. The review critically examines the efficacy and safety of varying dosages of dexamethasone in severe COVID-19 patients, providing a comprehensive meta-analysis that underscores the current clinical recommendations favoring a low-dose regimen. Despite these findings, the review highlights the potential benefits of tailored dosages for specific patient subgroups, suggesting a need for personalized treatment approaches. This editorial expands on the implications of these findings, advocating for the integration of evolving clinical data into treatment protocols and calling for further research into patient-specific responses to therapy. It emphasizes the importance of adaptability and precision in pandemic response, urging the medical community to consider both the robustness of existing evidence and the potential for innovative approaches to enhance patient outcomes in the face of global health challenges.

The dangerous Crimean-Congo hemorrhagic fever virus (CCHFV), an encapsulated negative-sense RNA virus of the family Nairoviridae, is transmitted from person to person via ticks. With a case fatality rate between 10% to 40%, the most common ways that the disease may spread to humans are via tick bites or coming into touch with infected animals' blood or tissues. Furthermore, the transfer of bodily fluids between individuals is another potential route of infection. There is a wide range of symptoms experienced by patients throughout each stage, from myalgia and fever to extreme bruising and excess bleeding. Tick management measures include minimising the spread of ticks from one species to another and from people to animals via the use of protective clothing, repellents, and proper animal handling. In order to prevent the spread of illness, healthcare workers must adhere to stringent protocols. Despite the lack of an authorised vaccine, the main components of treatment now consist of preventative measures and supportive care, which may include the antiviral medicine ribavirin. We still don't know very much about the virus's mechanisms, even though advances in molecular virology and animal models have improved our understanding of the pathogenesis of CCHFV. A critical need for vaccination that is both safe and effective, as well as for quick diagnosis and efficient treatments to lessen the disease's impact in areas where it is most prevalent. Important steps towards lowering Crimean-Congo hemorrhagic fever mortality and morbidity rates were to anticipatethe future availability of immunoglobulin products.