Archives of Clinical Infectious Diseases
Volume:18 Issue: 5, Oct 2023

 This study aimed to investigate the incidence and clinical characteristics of flare-ups in patients with systemic lupus erythematosus (SLE) following immunization with inactivated SARS-CoV-2 vaccines.

 In this cross-sectional study at Imam Hossein Hospital's Rheumatology Clinic (Iran), we investigated 72 SLE patients in remission who received the Sinopharm BIBP inactivated COVID-19 vaccine. Their post-vaccination status was monitored for 3 months using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) checklist by an internal medicine specialist.

 Fourteen patients (19.44%) experienced symptom flare-ups after vaccination. The most common symptoms were arthritis (64.29%) and skin rash (21.43%). Age, sex, organ involvement, and treatment regimen did not significantly differ between those with and without symptom recurrence (P > 0.05). The second vaccine dose led to more flare-ups compared to the first dose (12.12% vs. 8.33%, P < 0.001). However, the severity of symptom recurrence, measured by the SLEDAI-2K score (P = 0.763), and the interval from vaccination to symptom recurrence (P = 0.075) did not significantly differ between the 2 groups. Except for 2 patients, none of the participants required hospitalization, and flare-up symptoms were effectively managed by prednisolone dosage adjustments. For these 2 patients, the treatment regimen was changed, and the steroid dose was increased; one of them was admitted to the hospital, and the other one was managed on an outpatient basis.

 The incidence of flare-ups in SLE patients in remission following COVID-19 vaccination with Sinopharm BIBP vaccine was low; most of them were mild and did not require hospitalization, except for 1 patient who was hospitalized after the first dose of vaccination and received rituximab due to vasculitis flare. These findings highlight vaccine safety and underscore the importance of close monitoring, especially after the second dose.

Context: 

In recent years, antimicrobial resistance (AMR) has become a global public health threat. Health system decision-makers need valid and reliable situation analysis to better plan for mitigating this threat.

 This scoping review investigated the research gaps in AMR publications in Iran and provided an evidential base to support the identification of priority research to better address antibiotic resistance needs in Iran.

 A search of academic databases, including Scopus, Institute for Scientific Information (ISI), Web of Science, MEDLINE/PubMed, EMBASE, and Iranian Database of Medical Literature (IDML), was performed in February 2018. The identified studies evaluated the resistance or susceptibility of antibiotics against any bacteria in an Iranian population. Title, abstract, and full-text screening were conducted, and the included studies were accordingly analyzed with respect to the study protocol.

 From 37,769 identified studies, 1,718 studies met all inclusion criteria. These studies evaluated the susceptibility of 131 antibiotics to 82 types of bacteria by conducting 3,509 antibiotic resistance tests. Ofloxacin, ciprofloxacin, and gentamicin had the highest number of studies, samples, and tested bacteria. Regarding the characteristics of the studies, 306 studies had an insufficient explicit definition of study characteristics, 231 studies published their results more than three years after conducting them, and 803 studies (46.7%) were published in local journals.

 Considering the importance of the AMR crisis, this scoping review debates the low quality of reporting in AMR-related publications in Iran despite extensive research.

 Staphylococcus aureus is one of the most significant bacteria involved in ear infections. However, insights into the molecular attributes of S. aureus collected from patients with chronic otitis media have yet to be reported in Iran.

 The objective of this study was to assess the molecular characteristics of S. aureus isolated from patients with chronic otitis media.

 A total of 55 S. aureus strains retrieved from patients with chronic otitis media were analyzed by the disk diffusion method and polymerase chain reaction (PCR) to identify the nucA gene. Isolates were genetically classified using the coagulase typing method. S. aureus protein A (spa) typing, staphylococcal cassette chromosome mec (SCCmec) typing, and multilocus sequence typing (MLST) were performed on isolates with resistance to specific antibiotics.

 Overall, out of 55 S. aureus isolates, resistance to mupirocin, fusidic acid, and tigecycline was identified in 12.7%, 5.4%, and 3.6% of isolates, respectively. Fusidic acid-resistant isolates belonged to ST5-SCCmecII/t002/coaII. Two tigecycline-resistant isolates belonged to CC8/ST239-SCCmecIII/t234/coaVIII. One positive mecC isolate belonged to the CC/ST130-SCCmecXI/t843/coaIII clone. Isolates with the iMLSB phenotype belonged to CC/ST80-SCCmecIV/t044/coaII (4 isolates), CC8/ST239-SCCmecIII/t388/coaVI (3 isolates), and CC8/ST8-SCCmecIV/t008/coaIII (1 isolate).

 Our results indicated that S. aureus isolated from patients with chronic otitis media possesses a unique molecular profile with a high percentage of resistance to multiple medications. These findings suggest that resuming the molecular analysis to improve the control and prevention of ear infections related to S. aureus is necessary.

 Crimean Congo hemorrhagic fever (CCHF) is a tick-borne, zoonotic disease distributed globally. As the clinical features of CCHF and COVID-19 are similar, getting an early and reliable diagnosis may be difficult.

 We report the first misdiagnosed case of CCHF in the setting of a COVID-19 pandemic from Ravansar County of Kermanshah province in Iran. Our patient was initially misdiagnosed with COVID-19, got hospitalized, but later tested positive for CCHF. However, the delay in diagnosis caused her death.

 Crimean Congo hemorrhagic fever should be considered among people in endemic areas who show COVID-19 symptoms for urgent medical attention.

 Among the serum biomarkers of infectious diseases, calprotectin and heparin-binding protein (HBP) seem to be of clinical and diagnostic value in patients with COVID-19.

 This study aimed to investigate the serum levels of calprotectin, HBP, and some other inflammatory markers in COVID-19 patients.

 In this case-control study, serum samples of 35 outpatients with COVID-19 and 35 healthy individuals were collected, and the levels of calprotectin, HBP, C-reactive protein (CRP), ferritin (FERR), as well as platelet (PLT) and neutrophil (NEU) counts and LDH activity, were determined.

 At first, SARS-CoV2 viral RNA was detected in the pharyngeal swab specimens of COVID-19 patients. Calprotectin, FERR, and CRP levels, LDH activity, and PLT and NEU counts were found to be significantly higher in COVID-19 patients compared with controls (P < 0.05), whereas no statistically significant difference was observed in HBP level (P > 0.05). Serum calprotectin showed a significant correlation with CRP and FERR levels, LDH activity, and NEU count (P < 0.001).

 Our findings showed that an increment in serum calprotectin level, together with increased CRP levels, might be a promising indicator of SARS-CoV2 infection.

 Currently, the global HIV epidemic remains ongoing, with a significant number of patients having undiagnosed advanced HIV disease. Providing medical care to patients with both COVID-19 and advanced HIV disease presents specific challenges due to the simultaneous lung damage caused by the SARS-CoV-2 virus and opportunistic pathogens.

 This study aimed to explain the rationale behind recommending HIV screening for patients with severe COVID-19.

 A single-center retrospective cohort study was conducted using electronic medical records from a specialized hospital in Moscow that focused on coinfection with HIV/COVID-19. Among the 3,563 patients hospitalized in the relevant departments during the study period, 408 patients were included based on the inclusion/exclusion criteria. Out of the 408 patients with both COVID-19 and advanced HIV disease, 132 individuals were newly diagnosed with HIV infection, while 276 individuals had a previously established HIV diagnosis.

 The mortality rate in the group of patients with COVID-19 and advanced HIV disease was 31.7% (95% CI, 27.3 - 36.3%). Among patients with COVID-19 and newly diagnosed advanced HIV disease, the mortality rate was 45.5% (95% CI, 37.1 - 54%), while in the group of patients with previously diagnosed advanced HIV disease, the mortality rate was 25% (95% CI, 20.2 - 30.4%). The proportion of individuals with critical CT-4 lung disease in the first group was 32.3% compared to 9.4% in the second group (P < 0.001). The median CD4+ count was 20 cells/µL in the first group compared with 88 cells/µL in the second group (P < 0.001).

 The presence of pneumocystis pneumonia increased the risk of death by 2.51 times in patients with COVID-19 and newly diagnosed advanced HIV disease. Additionally, Kaposi's sarcoma increased the risk of death by 1.31 times in the same patient group. Furthermore, the detection of HIV infection for the first time during hospitalization due to COVID-19 in the entire study cohort increased the risk of death by 2.21 times.

Passively acquired maternal antibodies through the placenta and/or breastfeeding may protect neonates against SARS-CoV-2 before they are considered eligible for active immunization.

This study aimed to determine the concentration and correlation of maternal and cord blood anti-SARS-CoV-2 IgG antibodies in Iranian seropositive women. In this preliminary study, attempts were also made to assess the effects of some variables on the transplacental transfer efficiency.

From September 2021 to November 2021, pregnant women presenting to Kamali Hospital in Karaj, Iran, were enrolled in this monocentric study. The maternal and neonatal demographic characteristics were collected. The maternal and cord blood spike protein-specific antibody levels, measured at delivery (119 paired samples), were evaluated by the enzyme-linked immunosorbent assay (ELISA).

Based on the transplacental antibody transfer ratios, the participants were divided into 2 groups: Transfer ratio ≤ 1 (n = 53) and transfer ratio > 1 (n = 66). The results revealed that anti-SARS-CoV-2 IgG antibodies were transferred across the placenta in all seropositive pregnant Iranian women, and a significant correlation was found between maternal and cord blood-specific IgG antibody levels (r = 0.9646; P < 0.05). A relatively efficient transplacental transfer ratio was observed in Iranian seropositive women (transfer ratio > 1 in 66 out of 119 individuals; 55.46%). Although there were significant differences in the transplacental transfer ratio regarding the neonatal birth weight and maternal body mass index (BMI), more extensive investigations with a larger sample size are needed to confirm the significant association of these variables with the transplacental transfer efficiency of specific SARS-CoV-2 IgG antibodies.

The present study highlighted the importance of vaccination during pregnancy to improve neonatal immune responses against SARS-CoV-2.