Pub Date : 2022-06-29eCollection Date: 2022-07-01DOI: 10.1097/ID9.0000000000000059
The 2019-nCoV (also as SARS-CoV-2) belongs to the beta genus of coronaviruses. It has an envelope, round or oval particles, and a diameter of 60 to 140nm. It has 5 essential genes, respectively targeting RNA-dependent RNA polymerase and 4 structural proteins of nucleoprotein (N), envelope protein (E), matrix protein (M), and spike protein (S). TheN protein wraps the RNA genome to form a nucleocapsid, which is surrounded by an E that contains the M and the S proteins. The S protein enters the cell by binding to angiotensin converting enzyme 2 (ACE-2). When isolated and cultured in vitro, the 2019-nCoV can be found in human respiratory epithelial cells in about 96hours, while it takes about 4 to 6days to isolate and culture in Vero E6 and Huh-7 cell lines. The 2019-nCoV, like all other viruses, mutates, and certain mutations may affect the biological characteristics of the virus. For example, the change in the binding affinity of the spike protein and ACE-2 may affect the virus’s ability of cell invasion, replication, and transmission, as well as period of recovery, antibodies produced after vaccination, and the neutralizing ability of antibody therapeutics. Therefore, such mutation has attracted wide attention. There are five “variants of concern” defined by the World Health Organization (WHO), namely Alpha, Beta, Gamma, Delta, and Omicron. At present, the Omicron variant has quickly replaced the Delta variant to become the dominant variant. Currently available evidence shows that the Omicron variant is more transmissible than the Delta variant, but with weakened pathogenicity. Omicron variant does not impact SARS-CoV-2 detection capability of RTPCR assays diagnostic, but it may reduce the neutralizing effect of some monoclonal antibody drugs.
{"title":"Diagnosis and Treatment Protocol for COVID-19 Patients (Tentative 9th Version).","authors":"","doi":"10.1097/ID9.0000000000000059","DOIUrl":"10.1097/ID9.0000000000000059","url":null,"abstract":"The 2019-nCoV (also as SARS-CoV-2) belongs to the beta genus of coronaviruses. It has an envelope, round or oval particles, and a diameter of 60 to 140nm. It has 5 essential genes, respectively targeting RNA-dependent RNA polymerase and 4 structural proteins of nucleoprotein (N), envelope protein (E), matrix protein (M), and spike protein (S). TheN protein wraps the RNA genome to form a nucleocapsid, which is surrounded by an E that contains the M and the S proteins. The S protein enters the cell by binding to angiotensin converting enzyme 2 (ACE-2). When isolated and cultured in vitro, the 2019-nCoV can be found in human respiratory epithelial cells in about 96hours, while it takes about 4 to 6days to isolate and culture in Vero E6 and Huh-7 cell lines. The 2019-nCoV, like all other viruses, mutates, and certain mutations may affect the biological characteristics of the virus. For example, the change in the binding affinity of the spike protein and ACE-2 may affect the virus’s ability of cell invasion, replication, and transmission, as well as period of recovery, antibodies produced after vaccination, and the neutralizing ability of antibody therapeutics. Therefore, such mutation has attracted wide attention. There are five “variants of concern” defined by the World Health Organization (WHO), namely Alpha, Beta, Gamma, Delta, and Omicron. At present, the Omicron variant has quickly replaced the Delta variant to become the dominant variant. Currently available evidence shows that the Omicron variant is more transmissible than the Delta variant, but with weakened pathogenicity. Omicron variant does not impact SARS-CoV-2 detection capability of RTPCR assays diagnostic, but it may reduce the neutralizing effect of some monoclonal antibody drugs.","PeriodicalId":73371,"journal":{"name":"Infectious diseases & immunity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5f/fb/id9-2-135.PMC9295936.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9898284","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 : 2022-04-01DOI: 10.1097/ID9.0000000000000053
Tingting Cui, Mingzhu Huang, Xiaoling Su, Zhengfang Lin, Jiaying Zhong, Xiaoyun Yang, Zhong-fang Wang
Abstract Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has caused a global pandemic that has resulted in millions of casualties. Although researchers have reported the existence of neutralizing antibodies and viral T cell immunity against SARS-CoV-2, little is known about the presence of antibody-dependent cellular cytotoxicity (ADCC) and its role in combating SARS-CoV-2 infection. Methods: Nineteen acute COVID-19 patients at the First Affiliated Hospital of Guangzhou Medical University from January to February, 2020 and 55 recovery COVID-19 patients at the Second Peoples Hospital of Changde City from February, 2020 to February, 2021 were recruited in this study. Longitudinal plasma samples were collected. A virus-specific ADCC assay was performed to study the COVID-19 plasma samples. The correlations between ADCC and total IgG titer, including anti-RBD, anti-N, and neutralizing antibody titer were analyzed. Results: A high level of ADCC with 0.86% of IFN-γ+CD107a+ NK cells induced by anti RBD antibodies and with 0.54% of IFN-γ+CD107a+ NK cells induced by anti N antibodies was observed. This activity peaked at 3 weeks after disease onset with 1.16% and 0.63% of IFN-γ+CD107a+ NK cells induced by anti RBD and anti N antibodies respectively, declined to 0.32% and 0.32% of IFN-γ+CD107a+ NK cells respectively after more than 2 months, and persisted for 12 months after disease onset. The ADCC did not aggravate the severity of COVID-19 in terms of sequential organ failure assessment, although ADCC decreased with the age of COVID-19 patients. Interestingly, ADCC response is not correlated with neutralizing antibody titer or total IgG titers against S protein RBD and N protein in acute patients. ADCC in recovered patients showed a significant correlation with anti RBD IgG titer (R2 = 0.33, P < 0.001). Conclusion: Antibodies from COVID-19 patients against the N protein and S protein RBD domains could stimulate high levels of ADCC response. Our results provide evidence that vaccination should not only focus on neutralizing antibodies but also binding antibodies that may facilitate the antiviral function of ADCC, especially in the elderly.
{"title":"Potential of Antibody-Dependent Cellular Cytotoxicity in Acute and Recovery Phases of SARS-CoV-2 Infection","authors":"Tingting Cui, Mingzhu Huang, Xiaoling Su, Zhengfang Lin, Jiaying Zhong, Xiaoyun Yang, Zhong-fang Wang","doi":"10.1097/ID9.0000000000000053","DOIUrl":"https://doi.org/10.1097/ID9.0000000000000053","url":null,"abstract":"Abstract Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has caused a global pandemic that has resulted in millions of casualties. Although researchers have reported the existence of neutralizing antibodies and viral T cell immunity against SARS-CoV-2, little is known about the presence of antibody-dependent cellular cytotoxicity (ADCC) and its role in combating SARS-CoV-2 infection. Methods: Nineteen acute COVID-19 patients at the First Affiliated Hospital of Guangzhou Medical University from January to February, 2020 and 55 recovery COVID-19 patients at the Second Peoples Hospital of Changde City from February, 2020 to February, 2021 were recruited in this study. Longitudinal plasma samples were collected. A virus-specific ADCC assay was performed to study the COVID-19 plasma samples. The correlations between ADCC and total IgG titer, including anti-RBD, anti-N, and neutralizing antibody titer were analyzed. Results: A high level of ADCC with 0.86% of IFN-γ+CD107a+ NK cells induced by anti RBD antibodies and with 0.54% of IFN-γ+CD107a+ NK cells induced by anti N antibodies was observed. This activity peaked at 3 weeks after disease onset with 1.16% and 0.63% of IFN-γ+CD107a+ NK cells induced by anti RBD and anti N antibodies respectively, declined to 0.32% and 0.32% of IFN-γ+CD107a+ NK cells respectively after more than 2 months, and persisted for 12 months after disease onset. The ADCC did not aggravate the severity of COVID-19 in terms of sequential organ failure assessment, although ADCC decreased with the age of COVID-19 patients. Interestingly, ADCC response is not correlated with neutralizing antibody titer or total IgG titers against S protein RBD and N protein in acute patients. ADCC in recovered patients showed a significant correlation with anti RBD IgG titer (R2 = 0.33, P < 0.001). Conclusion: Antibodies from COVID-19 patients against the N protein and S protein RBD domains could stimulate high levels of ADCC response. Our results provide evidence that vaccination should not only focus on neutralizing antibodies but also binding antibodies that may facilitate the antiviral function of ADCC, especially in the elderly.","PeriodicalId":73371,"journal":{"name":"Infectious diseases & immunity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61733685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.1097/ID9.0000000000000037
Bo Tu, Sulaiman Lakoh, Biao Xu, Marta Lado, Reginald Cole, Fang Chu, Susan Hastings-Spaine, Mohamed Bole Jalloh, Junjie Zheng, Weiwei Chen, Stephen Sevalie
Background: The coronavirus disease 2019 (COVID-19) is a highly infectious respiratory disease. There is no recommended antiviral treatment approved for COVID-19 in Sierra Leone, and supportive care and protection of vital organ function are performed for the patients. This study summarized the clinical characteristics, drug treatments, and risk factors for the severity and prognosis of COVID-19 in Sierra Leone to provide evidence for the treatment of COVID-19.
Methods: Data of 180 adult COVID-19 patients from the 34th Military Hospital in Freetown Sierra Leone between March 31, 2020 and August 11, 2020 were retrospectively collected. Patients with severe and critically ill are classified in the severe group, while patients that presented asymptomatic, mild, and moderate disease were grouped in the non-severe group. The clinical and laboratory information was retrospectively collected to assess the risk factors and treatment strategies for severe COVID-19. Demographic information, travel history, clinical symptoms and signs, laboratory detection results, chest examination findings, therapeutics, and clinical outcomes were collected from each case file. Multivariate logistic analysis was adopted to identify the risk factors for deaths. Additionally, the clinical efficacy of dexamethasone treatment was investigated.
Results: Seventy-six (42.22%) cases were confirmed with severe COVID-19, while 104 patients (57.78%) were divided into the non-severe group. Fever (56.67%, 102/180) and cough (50.00%, 90/180) were the common symptoms of COVID-19. The death rate was 18.89% (34/180), and severe pneumonia (44.12%, 15/34) and septic shock (23.53%, 8/34) represented the leading reasons for deaths. The older age population, a combination of hypertension and diabetes, the presence of pneumonia, and high levels of inflammatory markers were significantly associated with severity of COVID-19 development (P < 0.05 for all). Altered level of consciousness [odds ratio (OR) = 56.574, 95% confidence interval (CI) 5.645-566.940, P = 0.001], high levels of neutrophils (OR = 1.341, 95%CI 1.109-1.621, P = 0.002) and C-reactive protein (CRP) (OR = 1.014, 95%CI 1.003-1.025, P = 0.016) might be indicators for COVID-19 deaths. Dexamethasone treatment could reduce mortality [30.36% (17/56) vs. 50.00% (10/20)] among severe COVID-19 cases, but the results were not statistically significant (P > 0.05).
Conclusions: The development and prognosis of COVID-19 may be significantly correlated with consciousness status, and the levels of neutrophils and CRP.
背景:新型冠状病毒病2019 (COVID-19)是一种高度传染性呼吸道疾病。塞拉利昂没有批准针对COVID-19的推荐抗病毒治疗，并为患者提供支持性护理和重要器官功能保护。本研究总结了塞拉利昂COVID-19的临床特点、药物治疗、严重程度和预后的危险因素，为COVID-19的治疗提供依据。方法:回顾性收集2020年3月31日至2020年8月11日塞拉利昂弗里敦第34军医院收治的180例成人COVID-19患者资料。重症、危重患者分为重症组，无症状、轻、中度患者分为非重症组。回顾性收集临床和实验室信息，评估重症COVID-19的危险因素和治疗策略。从每个病例档案中收集人口统计信息、旅行史、临床症状和体征、实验室检测结果、胸部检查结果、治疗方法和临床结果。采用多因素logistic分析确定死亡危险因素。并观察地塞米松治疗的临床疗效。结果:确诊重症76例(42.22%)，非重症104例(57.78%)。发热(56.67%，102/180)和咳嗽(50.00%，90/180)是新冠肺炎的常见症状。死亡率为18.89%(34/180)，其中重症肺炎(44.12%，15/34)和感染性休克(23.53%，8/34)是主要死亡原因。老年人群、高血压和糖尿病的合并、肺炎的存在和高水平的炎症标志物与COVID-19发展的严重程度显著相关(P P = 0.001)，高水平的中性粒细胞(OR = 1.341, 95%CI 1.109-1.621, P = 0.002)和c反应蛋白(CRP) (OR = 1.014, 95%CI 1.003-1.025, P = 0.016)可能是COVID-19死亡的指标。地塞米松治疗可降低重症病例死亡率[30.36%(17/56)比50.00%(10/20)]，但差异无统计学意义(P > 0.05)。结论:COVID-19的发展和预后可能与意识状态、中性粒细胞和CRP水平显著相关。
{"title":"Risk Factors for Severity and Mortality in Adult Patients Confirmed with COVID-19 in Sierra Leone: A Retrospective Study.","authors":"Bo Tu, Sulaiman Lakoh, Biao Xu, Marta Lado, Reginald Cole, Fang Chu, Susan Hastings-Spaine, Mohamed Bole Jalloh, Junjie Zheng, Weiwei Chen, Stephen Sevalie","doi":"10.1097/ID9.0000000000000037","DOIUrl":"https://doi.org/10.1097/ID9.0000000000000037","url":null,"abstract":"<p><strong>Background: </strong>The coronavirus disease 2019 (COVID-19) is a highly infectious respiratory disease. There is no recommended antiviral treatment approved for COVID-19 in Sierra Leone, and supportive care and protection of vital organ function are performed for the patients. This study summarized the clinical characteristics, drug treatments, and risk factors for the severity and prognosis of COVID-19 in Sierra Leone to provide evidence for the treatment of COVID-19.</p><p><strong>Methods: </strong>Data of 180 adult COVID-19 patients from the 34th Military Hospital in Freetown Sierra Leone between March 31, 2020 and August 11, 2020 were retrospectively collected. Patients with severe and critically ill are classified in the severe group, while patients that presented asymptomatic, mild, and moderate disease were grouped in the non-severe group. The clinical and laboratory information was retrospectively collected to assess the risk factors and treatment strategies for severe COVID-19. Demographic information, travel history, clinical symptoms and signs, laboratory detection results, chest examination findings, therapeutics, and clinical outcomes were collected from each case file. Multivariate logistic analysis was adopted to identify the risk factors for deaths. Additionally, the clinical efficacy of dexamethasone treatment was investigated.</p><p><strong>Results: </strong>Seventy-six (42.22%) cases were confirmed with severe COVID-19, while 104 patients (57.78%) were divided into the non-severe group. Fever (56.67%, 102/180) and cough (50.00%, 90/180) were the common symptoms of COVID-19. The death rate was 18.89% (34/180), and severe pneumonia (44.12%, 15/34) and septic shock (23.53%, 8/34) represented the leading reasons for deaths. The older age population, a combination of hypertension and diabetes, the presence of pneumonia, and high levels of inflammatory markers were significantly associated with severity of COVID-19 development (<i>P</i> < 0.05 for all). Altered level of consciousness [odds ratio (OR) = 56.574, 95% confidence interval (CI) 5.645-566.940, <i>P</i> = 0.001], high levels of neutrophils (OR = 1.341, 95%CI 1.109-1.621, <i>P</i> = 0.002) and C-reactive protein (CRP) (OR = 1.014, 95%CI 1.003-1.025, <i>P</i> = 0.016) might be indicators for COVID-19 deaths. Dexamethasone treatment could reduce mortality [30.36% (17/56) <i>vs</i>. 50.00% (10/20)] among severe COVID-19 cases, but the results were not statistically significant (<i>P</i> > 0.05).</p><p><strong>Conclusions: </strong>The development and prognosis of COVID-19 may be significantly correlated with consciousness status, and the levels of neutrophils and CRP.</p>","PeriodicalId":73371,"journal":{"name":"Infectious diseases & immunity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e2/fd/id9-2-83.PMC9112504.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9964950","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 : 2022-03-10DOI: 10.1097/ID9.0000000000000051
Liyuan Wang, Yuchen Fan
Abstract Acute-on-chronic hepatitis B liver failure (ACHBLF) is a term used to define the acute deterioration of liver function that occurs in patients with chronic hepatitis B virus infection or hepatitis B virus-related liver cirrhosis. The specific pathogenesis of ACHBLF is still not completely understood. Current research has shown that an intense systemic inflammation is involved in the development of acute-on-chronic liver failure (ACLF). Meanwhile, a subsequent immune paresis over the course of ACLF favors the development of infection and sepsis. Deregulation in both the innate and adaptive immunity is the notable feature of ACLF. The dysregulated immune responses play a crucial role in disease progression and potentially drive organ failure and mortality in ACHBLF. In this review, we highlight the current knowledge of innate and adaptive immune cells in ACHBLF.
{"title":"Current Advances of Innate and Adaptive Immunity in Acute-on-Chronic Hepatitis B Liver Failure","authors":"Liyuan Wang, Yuchen Fan","doi":"10.1097/ID9.0000000000000051","DOIUrl":"https://doi.org/10.1097/ID9.0000000000000051","url":null,"abstract":"Abstract Acute-on-chronic hepatitis B liver failure (ACHBLF) is a term used to define the acute deterioration of liver function that occurs in patients with chronic hepatitis B virus infection or hepatitis B virus-related liver cirrhosis. The specific pathogenesis of ACHBLF is still not completely understood. Current research has shown that an intense systemic inflammation is involved in the development of acute-on-chronic liver failure (ACLF). Meanwhile, a subsequent immune paresis over the course of ACLF favors the development of infection and sepsis. Deregulation in both the innate and adaptive immunity is the notable feature of ACLF. The dysregulated immune responses play a crucial role in disease progression and potentially drive organ failure and mortality in ACHBLF. In this review, we highlight the current knowledge of innate and adaptive immune cells in ACHBLF.","PeriodicalId":73371,"journal":{"name":"Infectious diseases & immunity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42871067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-24DOI: 10.1097/ID9.0000000000000050
Zhigang Yi, Zhenghong Yuan
Abstract Hepatitis C virus (HCV) causes chronic infection in over 75% of the HCV-infected individuals, resulting in liver cancer in substantial patients. Since its discovery in 1989, HCV experiences a journey from discovery to cure, largely due to the virology studies and success of direct antiviral agent (DAA) development. We reviewed the HCV research journey, from the discovery of this virus to the development of DAAs for cure. Learning the methodology used in HCV studies and the knowledge of developing DAAs against HCV may inspire the studies of other difficult-to-culture viruses, such as hepatitis E virus and norovirus, as well as the development of DAAs for other single-stranded positive-sense RNA viruses, including the pandemic-causing SARS-CoV-2 virus, which shares the common replication strategy of forming a membrane-bound viral replicase.
{"title":"From Discovery to Cure, A Great Journey of the Hepatitis C Virus Study","authors":"Zhigang Yi, Zhenghong Yuan","doi":"10.1097/ID9.0000000000000050","DOIUrl":"https://doi.org/10.1097/ID9.0000000000000050","url":null,"abstract":"Abstract Hepatitis C virus (HCV) causes chronic infection in over 75% of the HCV-infected individuals, resulting in liver cancer in substantial patients. Since its discovery in 1989, HCV experiences a journey from discovery to cure, largely due to the virology studies and success of direct antiviral agent (DAA) development. We reviewed the HCV research journey, from the discovery of this virus to the development of DAAs for cure. Learning the methodology used in HCV studies and the knowledge of developing DAAs against HCV may inspire the studies of other difficult-to-culture viruses, such as hepatitis E virus and norovirus, as well as the development of DAAs for other single-stranded positive-sense RNA viruses, including the pandemic-causing SARS-CoV-2 virus, which shares the common replication strategy of forming a membrane-bound viral replicase.","PeriodicalId":73371,"journal":{"name":"Infectious diseases & immunity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48977756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-23DOI: 10.1097/ID9.0000000000000048
Zebao He, F. Rui, Hongli Yang, Zhengming Ge, Rui Huang, L. Ying, Hai-hong Zhao, Chao Wu, J. Li
Abstract Background: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease and has spread worldwide. Clinical risk factors associated with the severity in COVID-19 patients have not yet been well delineated. The aim of this study was to explore the risk factors related with the progression of severe COVID-19 and establish a prediction model for severity in COVID-19 patients. Methods: We retrospectively recruited patients with confirmed COVID-19 admitted in Enze Hospital, Taizhou Enze Medical Center (Group) and Nanjing Drum Tower Hospital between January 24 and March 12, 2020. Take the Taizhou cohort as the training set and the Nanjing cohort as the validation set. Severe case was defined based on the World Health Organization Interim Guidance Report criteria for severe pneumonia. The patients were divided into severe and non-severe groups. Epidemiological, laboratory, clinical, and imaging data were recorded with data collection forms from the electronic medical record. The predictive model of severe COVID-19 was constructed, and the efficacy of the predictive model in predicting the risk of severe COVID-19 was analyzed by the receiver operating characteristic curve (ROC). Results: A total of 402 COVID-19 patients were included in the study, including 98 patients in the training set (Nanjing cohort) and 304 patients in the validation set (Nanjing cohort). There were 54 cases (13.43%) in severe group and 348 cases (86.57%) in non-severe group. Logistic regression analysis showed that body mass index (BMI) and lymphocyte count were independent risk factors for severe COVID-19 (all P < 0.05). Logistic regression equation based on risk factors was established as follows: Logit (BL)=–5.552–5.473 ×L + 0.418 × BMI. The area under the ROC curve (AUC) of the training set and the validation set were 0.928 and 0.848, respectively (all P < 0.001). The model was simplified to get a new model (BMI and lymphocyte count ratio, BLR) for predicting severe COVID-19 patients, and the AUC in the training set and validation set were 0.926 and 0.828, respectively (all P < 0.001). Conclusions: Higher BMI and lower lymphocyte count are critical factors associated with severity of COVID-19 patients. The simplified BLR model has a good predictive value for the severe COVID-19 patients. Metabolic factors involved in the development of COVID-19 need to be further investigated.
{"title":"Establishment and Evaluation of a Prediction Model of BLR for Severity in Coronavirus Disease 2019","authors":"Zebao He, F. Rui, Hongli Yang, Zhengming Ge, Rui Huang, L. Ying, Hai-hong Zhao, Chao Wu, J. Li","doi":"10.1097/ID9.0000000000000048","DOIUrl":"https://doi.org/10.1097/ID9.0000000000000048","url":null,"abstract":"Abstract Background: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease and has spread worldwide. Clinical risk factors associated with the severity in COVID-19 patients have not yet been well delineated. The aim of this study was to explore the risk factors related with the progression of severe COVID-19 and establish a prediction model for severity in COVID-19 patients. Methods: We retrospectively recruited patients with confirmed COVID-19 admitted in Enze Hospital, Taizhou Enze Medical Center (Group) and Nanjing Drum Tower Hospital between January 24 and March 12, 2020. Take the Taizhou cohort as the training set and the Nanjing cohort as the validation set. Severe case was defined based on the World Health Organization Interim Guidance Report criteria for severe pneumonia. The patients were divided into severe and non-severe groups. Epidemiological, laboratory, clinical, and imaging data were recorded with data collection forms from the electronic medical record. The predictive model of severe COVID-19 was constructed, and the efficacy of the predictive model in predicting the risk of severe COVID-19 was analyzed by the receiver operating characteristic curve (ROC). Results: A total of 402 COVID-19 patients were included in the study, including 98 patients in the training set (Nanjing cohort) and 304 patients in the validation set (Nanjing cohort). There were 54 cases (13.43%) in severe group and 348 cases (86.57%) in non-severe group. Logistic regression analysis showed that body mass index (BMI) and lymphocyte count were independent risk factors for severe COVID-19 (all P < 0.05). Logistic regression equation based on risk factors was established as follows: Logit (BL)=–5.552–5.473 ×L + 0.418 × BMI. The area under the ROC curve (AUC) of the training set and the validation set were 0.928 and 0.848, respectively (all P < 0.001). The model was simplified to get a new model (BMI and lymphocyte count ratio, BLR) for predicting severe COVID-19 patients, and the AUC in the training set and validation set were 0.926 and 0.828, respectively (all P < 0.001). Conclusions: Higher BMI and lower lymphocyte count are critical factors associated with severity of COVID-19 patients. The simplified BLR model has a good predictive value for the severe COVID-19 patients. Metabolic factors involved in the development of COVID-19 need to be further investigated.","PeriodicalId":73371,"journal":{"name":"Infectious diseases & immunity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46800582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-14DOI: 10.1097/id9.0000000000000047
Yaling Chen, J. Ouyang, S. Isnard, Cecilia T. Costinuik, Jiangyu Yan, Xin Zhou, J. Routy, Yaokai Chen
{"title":"Fungal Translocation Marker in People Living with HIV Needing Treatment for Onychomycosis","authors":"Yaling Chen, J. Ouyang, S. Isnard, Cecilia T. Costinuik, Jiangyu Yan, Xin Zhou, J. Routy, Yaokai Chen","doi":"10.1097/id9.0000000000000047","DOIUrl":"https://doi.org/10.1097/id9.0000000000000047","url":null,"abstract":"","PeriodicalId":73371,"journal":{"name":"Infectious diseases & immunity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49258143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-27DOI: 10.1097/ID9.0000000000000043
Lijun Xu, Ying Chen, Minghan Zhou, R. Tao, Yong-zheng Guo, Fangyuan Lou, Zongxing Yang
Abstract Background: Diabetes is a risk factor for acquisition of cryptococcal meningitis (CM). However, the effects of diabetes on outcomes of CM patient have not been fully studied. Methods: In this retrospective study, 49 diabetic CM patients and 98 non-diabetic CM patients from January 2008 to December 2018 in the First Affiliated Hospital of Zhejiang University were included by propensity score-matched method (1:2). Demographic characteristics, symptoms, and clinical assay parameters between the two groups were compared. Kaplan-Meier analysis and Cox proportional hazards model were used to assess factors associated with 10-week mortality. Results: The mean age of diabetic patients was 58.2 ± 13.8 years; 71.4% (35/49) were more than 50 years old and 46.9% were male. No difference in symptoms was found between diabetic and non-diabetic CM patients. The Charlson comorbidity score was higher in the diabetic group (1.9 vs. 0.7, P < 0.001). CM patients with diabetes had higher white blood cells count (×106 /L, 111.0 (18.0– 242.5) vs. 50.0 (10.0–140.0), P = 0.034) in cerebrospinal fluid (CSF), lower CSF India ink positivity (40.8% vs. 60.2%, P = 0.039), and Cryptococcus culture positivity (42.9% vs. 60.2%, P = 0.047). The overall 10-week survival rate was 79.7% in diabetic patients vs. 83.2% in non-diabetic patients (log-rank P = 0.794). Conclusion: Diabetic CM patients have higher CSF glucose and Charlson comorbidity score, but lower CSF India ink and culture positivity than non-diabetic CM patients. No difference in 10-week mortality was found between patients with and without diabetes. Other comorbidities may have a greater effect on prognosis.
{"title":"Diabetes Is Not Associated with Increased 10-week Mortality Risk in Patients with Cryptococcal Meningitis","authors":"Lijun Xu, Ying Chen, Minghan Zhou, R. Tao, Yong-zheng Guo, Fangyuan Lou, Zongxing Yang","doi":"10.1097/ID9.0000000000000043","DOIUrl":"https://doi.org/10.1097/ID9.0000000000000043","url":null,"abstract":"Abstract Background: Diabetes is a risk factor for acquisition of cryptococcal meningitis (CM). However, the effects of diabetes on outcomes of CM patient have not been fully studied. Methods: In this retrospective study, 49 diabetic CM patients and 98 non-diabetic CM patients from January 2008 to December 2018 in the First Affiliated Hospital of Zhejiang University were included by propensity score-matched method (1:2). Demographic characteristics, symptoms, and clinical assay parameters between the two groups were compared. Kaplan-Meier analysis and Cox proportional hazards model were used to assess factors associated with 10-week mortality. Results: The mean age of diabetic patients was 58.2 ± 13.8 years; 71.4% (35/49) were more than 50 years old and 46.9% were male. No difference in symptoms was found between diabetic and non-diabetic CM patients. The Charlson comorbidity score was higher in the diabetic group (1.9 vs. 0.7, P < 0.001). CM patients with diabetes had higher white blood cells count (×106 /L, 111.0 (18.0– 242.5) vs. 50.0 (10.0–140.0), P = 0.034) in cerebrospinal fluid (CSF), lower CSF India ink positivity (40.8% vs. 60.2%, P = 0.039), and Cryptococcus culture positivity (42.9% vs. 60.2%, P = 0.047). The overall 10-week survival rate was 79.7% in diabetic patients vs. 83.2% in non-diabetic patients (log-rank P = 0.794). Conclusion: Diabetic CM patients have higher CSF glucose and Charlson comorbidity score, but lower CSF India ink and culture positivity than non-diabetic CM patients. No difference in 10-week mortality was found between patients with and without diabetes. Other comorbidities may have a greater effect on prognosis.","PeriodicalId":73371,"journal":{"name":"Infectious diseases & immunity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44750103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-21DOI: 10.1097/ID9.0000000000000045
Yangyang Li, Junxian Hong, Linqi Zhang
Abstract Human immunodeficiency virus (HIV)-1 infection creates a persistent latent reservoir even after antiretroviral therapy, which is the main barrier to HIV cure. One of the most explored strategies is the use of latent reversal agents (LRAs) to activate HIV latent reservoirs, followed by immunotherapy to remove infected cells. Immunomodulatory LRAs have the dual advantage of activating viral latency and promoting immune cell elimination of HIV-infected cells. The emergence of novel immunotherapies has also enhanced the possibility of HIV clearance. Here we review the activity and potential mechanisms of immunomodulatory agonists and immunotherapies. The possible combinational strategies to achieve HIV functional cure and the problems encountered using this approach are discussed.
{"title":"The Rational Combination Strategy of Immunomodulatory Latency Reversing Agents and Novel Immunotherapy to Achieve HIV-1 Cure","authors":"Yangyang Li, Junxian Hong, Linqi Zhang","doi":"10.1097/ID9.0000000000000045","DOIUrl":"https://doi.org/10.1097/ID9.0000000000000045","url":null,"abstract":"Abstract Human immunodeficiency virus (HIV)-1 infection creates a persistent latent reservoir even after antiretroviral therapy, which is the main barrier to HIV cure. One of the most explored strategies is the use of latent reversal agents (LRAs) to activate HIV latent reservoirs, followed by immunotherapy to remove infected cells. Immunomodulatory LRAs have the dual advantage of activating viral latency and promoting immune cell elimination of HIV-infected cells. The emergence of novel immunotherapies has also enhanced the possibility of HIV clearance. Here we review the activity and potential mechanisms of immunomodulatory agonists and immunotherapies. The possible combinational strategies to achieve HIV functional cure and the problems encountered using this approach are discussed.","PeriodicalId":73371,"journal":{"name":"Infectious diseases & immunity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46438975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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