Archives of Clinical Infectious Diseases
Volume:17 Issue: 5, Oct 2022

Herpes simplex virus (HSV) is a neurotropic DNA virus with a high prevalence. Following primary infection, HSV remains dormant in the neural ganglia. Secondary infection can emerge after the reactivation of latent infection, presenting as neurological manifestations. Previous studies have demonstrated the relationship between HSV reactivation and selective involvement of cranial nerves. Depending on the affected nerve, cranial mononeuropathies can present with symptoms, including diplopia, blurred vision, vertigo, unilateral facial palsy, speech impairment, swallowing difficulties, and hoarseness.

This study used a serological assay to compare HSV reactivation frequency between patients with recent idiopathic cranial mononeuropathies and normal individuals.

Plasma samples from 35 idiopathic cranial mononeuropathy cases (57.2% women, mean age 58.37 years) and 35 age and sex-matched healthy controls were analyzed for anti-HSV immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies by enzyme-linked immunosorbent assay (ELISA).

Anti-HSV IgG antibody was positive in 91.4% of patients and 88.6% of controls. The mean serum anti-HSV IgG antibody level was significantly higher in patients (146.78 ± 60 RU/mL) than in the controls (130.61 ± 52.99 RU/mL) (P-value = 0.037). Anti-HSV IgM antibody was positive in 37.1% of patients and 14.3% of controls (P = 0.042).

The frequency of HSV reactivation was significantly higher in patients with acute idiopathic cranial mononeuropathy than in the healthy controls, indicating the possible role of HSV as an etiology of cranial mononeuropathy.

 Although COVID-19 preferentially affects the respiratory system, it has been demonstrated that coronaviruses frequently invade the nervous system.

 We aimed to report the frequency and type of neurological manifestations in hospitalized patients with COVID-19.

 This is a retrospective, prospective observational cohort study. Data were collected from April to July 2020 at Bu-Ali Sina University Hospital, Sari, Iran. Demographic data and clinical symptoms were recorded at the onset of the disease. Neurological manifestations were recorded into 5 categories: nonspecific central nervous system (CNS) manifestations, acute cerebrovascular disease (CVD), meningitis/encephalitis, peripheral nervous system manifestations, and inflammatory disorders (myelitis and acute disseminated encephalomyelitis).

 A total of 420 patients were admitted to the hospital with confirmed SARS-CoV-2 infection. Of the 420 patients hospitalized with COVID-19, 282 (67%) showed some form of neurological symptoms, of whom 48.33% had nonspecific neurological symptoms. Further, 35 (8.3%) patients had acute CVD, 2 patients had encephalitis (the RNA of SARS-CoV-2 was detected in cerebrospinal fluid (CSF), 1 patient had myelitis, and 83 (19.76%) patients had peripheral nervous system manifestations.

 Neurologic symptoms (from mild symptoms to life-threatening CNS disorders) are common in admitted patients with COVID-19. As a result of coagulation disorder in patients with COVID-19, some conditions (such as stroke) can be seen, even during recovery.

 About a year after the start of the coronavirus disease 2019 (COVID-19) pandemic, the results of the studies conducted to investigate the effectiveness of interferon (INF) compounds in this disease were contradictory.

 This study was carried out to examine the safety and efficacy of a treatment protocol containing INF-β-1b, hydroxychloroquine, and Kaletra (lopinavir/ritonavir) in patients with severe COVID-19.

 In this open-label, randomized controlled trial, severe cases of COVID-19 were included. Patients were eligible if they had epidemiological and radiological evidence compatible with COVID-19 or a positive polymerase chain reaction result and their disease was severe. They were randomly allocated into a control group that received the standard regimen (hydroxychloroquine and Kaletra) and an intervention group that received INF-β-1b treatment and the standard treatment regimen. Then, the two groups were compared in terms of in-hospital mortality, intubation, length of hospital stay, oxygen saturation, and lactate dehydrogenase before and after the intervention.

 A total of 91 cases of severe COVID-19 were enrolled for analysis [intervention (n = 47) and control (n = 44)]. The length of hospital stay in the intervention group was significantly longer than in the control group (13.21 ± 6.88 vs. 10.52 ± 5.77 days; P = 0.047). The mortality rate did not significantly differ between the intervention and control groups (19.15% and 13.64%, respectively; P = 0.509). The intubation rate did not significantly differ between the intervention and control groups (12.76% and 11.36%, respectively; P = 0.838).

 The use of INF-β-1b-containing treatment regimens does not reduce mortality and intubation rates among patients with severe COVID-19. Furthermore, it might even increase the severity of the disease and the length of hospital stay for some patients; therefore, it is not recommended to use INF-β-1b in severe cases of COVID-19.

Acinetobacte is the leading cause of pneumonia and sepsis in the ICU ward. Accordingly, in the present study, the antibiotic susceptibility pattern, presence, and dissemination of different classes of integrons and fluoroquinolone resistance genes were investigated among A. baumannii isolates.

In this descriptive, cross-sectional study, during a period of 24 months (2018-2020), 100 isolates of A. baumannii were isolated from different clinical specimens of patients admitted to the two teaching hospital in Ardabil province in the northwest of Iran. Kirby -Bauer disk diffusion, PCR, and sequencing methods were used for antimicrobial susceptibility testing and gene and mutation verification.

The resistance rates to all tested antibiotics were found to be between 78% and 100%. No isolate was resistant to polymyxin B. Multidrug-resistant (MDR) rate among tested clinical isolates was about 99%. The prevalence of class 1, 2, and 3 integrons was found to be 70%, 21%, and 0%, respectively. The aadA1 cassette gene was detected in all class 1 integron-carrying strains.

High-level antibiotic resistance and a high prevalence of integrons were observed among these clinical isolates. Our findings highlighted the need for continuous monitoring of resistant isolates.

 Coronavirus disease 2019 (COVID-19) is a contagious infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The World Health Organization (WHO) declared this infection a global pandemic in 2020. In addition, various methods have been developed to diagnose COVID-19 rapidly and accurately to reverse transcription-polymerase chain reaction (RT-PCR) as a gold standard method. One of these methods is the detection of volatile organic compounds (VOC) in exhaled breath.

 The aim was to collect and investigate studies on the accuracy of VOC detection as a diagnostic method for COVID-19.

 A literature search was performed in five electronic databases, including PubMed, Cochrane Library, ProQuest, EBSCOhost, and Scopus, along with hand searching. The search was conducted in the titles and abstracts of articles using keywords and their equivalent terms, combined with the Boolean operators (OR and AND). The search results were then selected according to the inclusion and exclusion criteria and compatibility with the Population, Intervention, Control, and Outcomes (PICO) framework.

 Based on the search results, two cross-sectional studies by Wintjens et al. and Ruszkiewicz et al. were selected, which were then critically appraised. Both studies showed good validity. Wintjens et al. reported 86% sensitivity and 54% specificity for their method, with a positive predictive value (PPV) and a negative predictive value (NPV) of 40% and 92%, respectively. Besides, Ruszkiewicz et al., who conducted a study in two different locations, reported 82.4% sensitivity and 75% specificity for their method in Edinburgh (UK), with PPV and NPV of 87.5% and 66.7%, respectively, while they reported 90% sensitivity and 80% specificity in Dortmund (Germany), with PPV and NPV of 45% and 97.8%, respectively. The accuracy of these three methods was 62%, 80%, and 82%, respectively.

 Detection of VOCs from exhaled breath can be a rapid, cost-effective, and simple method for diagnosing COVID-19. However, the accuracy of this method is still relatively low (62 - 82%) and inconsistent; therefore, it is only recommended for screening.

 Coronavirus disease 2019 (COVID-19) has turned into a global public health crisis since the end of 2019. It may thus take years to develop new drugs, so evaluating the existing ones can play a key role in suppressing or even mitigating the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.

 This study reflected on the effects of ivermectin (IVM) and metronidazole (MTR) vs. standard treatment protocols on symptoms, humoral immune responses, and outcomes of COVID-19 in hospitalized patients.

 This triple-blinded randomized controlled trial (RCT) of IVM and MTR vs. standard treatment protocols was conducted from February 2021 to May 2021. A total number of 107 participants were accordingly selected from all patients infected with SARS-CoV-2 and positive results for SARS-CoV-2 based on the reverse transcription-polymerase chain reaction (RT-PCR) or the computerized tomography (CT) scan results at three teaching hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. In this RCT, several indicators, including some vital signs, biomedical parameter, length of hospital stay (LOS), and death, were considered the outcomes.

 A total number of 107 patients were recruited in this study. The results revealed that 10 patients (10.4%) expired during hospitalization. The mortality rate in IVM group (4.5%) was lower compared with MTZ (15.8%) and standard treatment (11.8%) (P = 169). After five days, the mean differences of lymphocyte and neutrophil counts differed significantly between groups (P = 0.020 and P = 0.029, respectively). But, other outcomes did not differ (P > 0.05).

 Based on this RCT, neither IVM nor MTZ could significantly affect COVID-19 patients’ recovery patterns compared with the standard treatment protocols. Hence, more studies are needed to test diverse combinations of immunological response triggering and anti-inflammatory drugs. Moreover, including and relying on IVM in clinical guidelines for COVID-19 should be cautioned and based on more evidence.

 Cerebrovascular incidents are considered uncommon but important complications of vaccination against coronavirus disease-2019 (COVID-19). Subarachnoid hemorrhages (SAH) usually occur due to an underlying cerebral aneurysm. In this study, we have reported a subarachnoid hemorrhage incidence in a patient shortly after receiving the COVID-19 vaccine (ChAdOx1-AstraZeneca).

 A 69-year-old male with no remarkable risk factors referred to the emergency room with complaints of headache, nausea, and vomiting. The patient had received his first dose of vaccine against COVID-19 four days before symptoms started. An aggravated headache, nausea, elevated blood pressure (180/100), and drowsiness occurred on the second day of admission. Imaging implied on acute hydrocephalus and increased intracranial pressure (ICP) caused by subarachnoid hemorrhage. The condition was treated by inserting an external ventricular drain (EVD). We found no underlying vascular abnormality in primary and follow-up cerebral angiographies.

 Reported cerebral haemorrhages caused by COVID-19 vaccination are mostly intra-parenchymal. Our study observed a type of cerebrovascular event that has not been reported frequently. Vaccine-associated cerebrovascular events, however rarely, are critical. It is important to demonstrate possible risks and complications, as vaccination programs against COVID-19 have become an essential part of health care in most countries.