reactivation

The recent coronavirus (COVID-19) is a rapidly spreading multisystemic disease with a broad spectrum of cutaneous manifestations. Recently, DNA-based/RNA-based vaccines, inactivated vaccines, and non-replicating viral vector vaccines have been manufactured to reduce viral transmission and attenuate the morbidity and mortality of COVID-19. The neurotropic virus of varicella-zoster can reactivate spontaneously or in response to a trigger such as trauma, fever, or immunosuppression. Recently, COVID-19 infection was assumed as a potential trigger as well. Up to now, 91 cases of herpes zoster have been reported after COVID-19 vaccinations. The present study reported a case of a 69-year-old woman from Iran. She had received an Astra Zeneca COVID-19 vaccine 5 days before the skin eruption. A clinical diagnosis of herpes zoster infection was confirmed by a polymerase chain reaction (PCR) test for varicella zoster DNA. Oral acyclovir 800 mg five times a day together with gabapentin 300 mg every night resulted in the resolution of the lesions in 2 weeks with no sequelae. The present study then discussed the potential contribution of vaccination against COVID-19 and the reactivation of the varicella-zoster virus.

We have previously reported that during future space missions the risk of severe COVID-19 infection will be a cardinal issue that needs careful attention. Our studies show that even with the most reliable pre-mission screening and quarantine strategies, astronauts with a latent (hidden, inactive, or dormant) SARS-CoV-2 infection might be sent to space. Given this consideration, an asymptomatic individual with dormant SARS-CoV-2 infection may successfully pass all the pre-launch medical tests. Then during a space mission such as a journey to Mars or beyond, when the immune system of these astronauts starts to weaken, the dormant infection may progress to a severe infection that possibly affects the chance of the mission’s success. The effects of microgravity and the elevated space radiation are two key factors that should be evaluated. Furthermore, the limited size of the spacecraft, the proximity of crew members during flight operations, spacecraft atmospheric composition, limited exercise capability, effects of viral response to space radiation, and uncertainty in the likelihood of the virus to mutate and evolve during a space mission merit additional study.

Despite developing strategies for antiviral treatment, cytomegalovirus (CMV) infection remains one of the most common challenges in kidney transplant recipients (KTRs). The evaluation of CMV viral load is still the most practical main clinical approach for CMV assessment and guides decision-making in recipient antiviral treatment. However, there is not a specific viral load cut off for initiating treatment yet. On the other hand, the cellular immune system and the innate immune response prove their roles in diagnosing CMV reinfection and monitoring the therapeutic regime to control CMV. Interactions among the components of cellular immunity encounter CMV reactivation provide a strong treatment management plan for clinical decisions about antiviral therapy against CMV. Natural killer (NK) cells, as essential effector cells, present potentially antiviral activity through distinct subpopulations. CCR7expressing NK cells were identified by high cytotoxicity and functionality among NK cell subsets. Here, we explored the correlation between CCR7+ expressing NK cells with viral load in CMV reactivated-kidney transplant recipients.

A cross-sectional study was conducted among ten CMV reactivated KTRs. The CMV DNA copy number was evaluated utilizing real-time PCR.NK cell phenotypic profiling was done using flow cytometry.

Increasing of CMV viral load in CMV reactivated KTRs had a negative correlation with CCR7+CD57+ CD56/CD16+ NK cell (P < .05 r = -0.7) after CMV reactivation. Significantly increased level of CCR7-CD57- CD56/CD16+ NK cell was associated with CMV viral load within CMV reactivated KTRs (P < .05, r = 0.68).

CCR7 expression is associated with CMV reactivation, which offers a new aspect of CMV-associated immunity within the NK cell compartment.

Returning symptomatic patients with a history of recovered COVID-19 with a new positive SARS CoV-2 PCR test after several weeks to months of a negative PCR result is challenging during the COVID-19 pandemic.

We aimed to determine such Iranian patients’ clinical and laboratory characteristics and discuss possible reasons.

We retrospectively investigated SARS CoV-2 PCR tests in three referral hospitals. All patients who had the following criteria were included in the study: two SARS CoV-2 PCR-positive tests three months apart, no symptoms, a negative PCR test between the two positive tests, and access to the patient and medical information. Then, we retrospectively recorded the clinical and laboratory characteristics of the eligible patients. We also compared the clinical and laboratory features in the first and second episodes.

Among 1,899 patients, 37 cases were eligible in the study based on our criteria. The majority of patients were males and nurses. The mean age was 37.54 ± 15.16 years. Weakness, myalgia, and fever were the most frequent clinical symptoms in both episodes. The mean interval between discharge and second presentation was 117 ± 61.42 days. The clinical, radiological, and laboratory characteristics were not significantly different between the two episodes, except for significantly more dexamethasone use in the second episode (P = 0.03).

We could not cultivate the virus and perform the phylogenic sequencing of SARS-CoV-2; however, the prolonged interval between the two episodes suggests probable reinfection in our cases. Finally, this clinical phenomenon may be more common in HCW without a significant consequence; however, most cases were HCW who had more compatibility with our criteria due to the availability of their medical information

Reactivation of the hepatitis B virus (HBV) either during or after chemotherapy may cause serious and sometimes fatal hepatitis. All patients undergoing chemotherapy should therefore be screened in terms of HBV before chemotherapy. The purpose of this research was to identify HBV screening rates in patients with solid cancer undergoing parenteral chemotherapy and to determine the outcomes of patients undergoing HBV screening.

Data for patients undergoing parenteral chemotherapy for solid cancer from January 1, 2012 to December 30, 2018 were retrieved from our electronic health record patient files in this retrospective study. Screening was defined as hepatitis B surface antigen (HBsAg) and/or hepatitis B core antibody (HBcAb) tests carried out within six months prior the first chemotherapy session.

Four thousand fifty-eight (63%) of the 6440 patients who underwent parenteral chemotherapy were screened for HBsAg and/or HBcAb. The proportions of patients screened for HBsAg and HBcAb improved from 38.8% (2012) to 76.3% (2018), and from 0.2% (2012) to 43% (2018), respectively (P<0.001). The HBsAg and HBcAb positivity rates were 2.9% and 36.5%, respectively. Antiviral prophylaxis was started in 11.8% of HBsAg-negative/HBcAb-positive patients and 40.5% of HBsAg-positive patients. HBV reactivation did not occur in patients receiving antiviral prophylaxis, but was identified in 7.2% of HBsAg-positive patients and 0.6% of HBsAg-negative/HBcAb-positive patients without antiviral prophylaxis.

Although HBV screening rates before chemotherapy are increasing among solid cancer patients, the rate of initiation of antiviral prophylaxis is still low. It is therefore important to raise awareness regarding HBV reactivation during/after chemotherapy