Archives of Clinical Infectious Diseases
Volume:18 Issue: 6, Dec 2023

Context: 

The COVID-19 pandemic has had profound impacts on public health, resulting in nearly 1 million deaths. Emerging evidence suggests an association between certain metabolites produced by gut microbiota and potential alterations in the severity of infection. Trimethylamine N-oxide (TMAO) is a waste metabolite generated by gut microbes from dietary choline and betaine.

Evidence Acquisition: 

Several investigations have indicated an association between serum TMAO concentrations and the development of inflammation and thrombosis. Trimethylamine N-oxide, produced by the gut microbiome in a state of dysbiosis, upregulates various molecular mechanisms, such as the nuclear factor kappa (NF-kB) molecular pathway, and promotes the expression of scavenger receptors (SRs) on the surfaces of macrophages, leading to foam cell formation and inflammation. High levels of TMAO have been shown to induce the expression of pro-inflammatory cytokines like tumor necrosis factor-alpha (TNF-α) and interleukin 1β (IL-1β) while reducing the expression of anti-inflammatory cytokines such as interleukin-10 (IL-10). Additionally, gut-derived TMAO enhances platelet aggregation and adhesion to collagen, increasing the risk of thrombosis.

 Understanding the association between gut microbiome compositions such as gut TMAO and their effects on SARS-CoV-19 infection progression helps to control disease severity. In this review, we presented a hypothesis that the gut TMAO has the potential to increase COVID-19 disease severity.

 Staphylococcus aureus ranks among the leading causes of serious nosocomial infections. One critical route for the spread of this bacterium within hospitals is via asymptomatic carriers, particularly healthcare providers. Staphylococcus aureus can exist as part of the normal skin flora and within the anterior nostrils of individuals, making healthcare providers a significant vector for transmission. Several genes associated with virulence, such as toxic shock syndrome toxin-1 (tsst-1), alpha-toxin (hla), and panton-valentine leucocidin (pvl), play pivotal roles in the pathogenicity and severity of infections caused by S. aureus.

 This study aimed to characterize S. aureus nasal carriage among healthcare providers in an intensive care unit (ICU), with a particular focus on antibiotic resistance profiles and the prevalence of virulence genes.

 Nasal swabs were collected from 120 healthcare workers in the ICU of Ganjavian hospital, Dezful, Iran. Standard microbiological procedures were employed for S. aureus detection. Antibiotic susceptibility testing was conducted using both disk diffusion and minimum inhibitory concentration methods. Polymerase chain reaction (PCR) was employed to identify the presence of the mecA gene and the virulence genes hla, tsst-1, and pvl. A statistical analysis was performed to evaluate the data.

 The study revealed that 12.5% of healthcare providers were carriers of S. aureus, with 26.6% of them harboring methicillin-resistant S. aureus (MRSA) strains. Antibiotic resistance patterns varied, with a notable resistance to erythromycin and penicillin. The hla gene was detected in 66.6% of S. aureus strains; nevertheless, the tsst-1 and pvl genes were not identified. The study suggests a potential association between high expression of the hla and mecA genes and antibiotic resistance.

 This study underscores the prevalence of S. aureus nasal carriage, antibiotic resistance patterns, and the distribution of virulence genes among healthcare providers in an ICU setting. The findings emphasize the significance of continuous surveillance and infection control strategies to mitigate the transmission of S. aureus and associated infections within healthcare facilities. The study recommends routine screening of ICU healthcare providers for asymptomatic S. aureus carriers and appropriate interventions to eliminate colonization.

 The coronavirus disease 2019 (COVID-19) pandemic has been a global shock since its initial spread in 2019. Medically, patients with coronavirus disease, especially those with pneumonitis, face serious life-threatening risks and often require mechanical ventilation and intensive care. Ventilator-associated pneumonia (VAP) remains a significant concern for critical care providers. Recent reports have highlighted the susceptibility of patients with confirmed COVID-19 receiving mechanical ventilation to nosocomial pneumonia (NP).

 This study was a cross-sectional study conducted in the intensive care unit (ICU) at Imam Khomeini Hospital Complex (IKHC) in Tehran, Iran, within April 2020 to April 2021. The study focused on critically ill COVID-19 patients who required mechanical ventilation and met the criteria for VAP. Standard biochemical assays were used to identify pure colonies in patients’ sample cultures, and antimicrobial susceptibility tests were conducted to assess antimicrobial resistance profiles. The findings were analyzed statistically using SPSS software (version 23.0).

 Out of 93 endotracheal aspirate samples, 64 samples tested positive for bacteria. Among the 64 eligible patients with positive cultures, 42 (65.6%) and 22 (34.4%) patients were male and female, respectively, with a mean age of 60.56 ± 13.58 years. A total of 52 patients (81.25%) had underlying conditions, such as hypertension, diabetes, and kidney or heart diseases. According to the study results, the most common pathogens were extensively drug-resistant (XDR) Klebsiella pneumoniae (7%) and Acinetobacter baumannii (23%). Additionally, 80% of Klebsiella pneumoniae and 90% of Acinetobacter baumannii were observed to be multi-drug resistant (P < 0.05).

 The COVID-19 pandemic has posed significant risks to critically ill patients, often necessitating mechanical ventilation and intensive care. Furthermore, VAP remains a serious challenge in this context, with high rates of XDR K. pneumoniae and A. baumannii. Effective infection control measures and surveillance are critical to mitigating the risk of NP in these vulnerable patients.

 Although the COVID-19 pandemic is over, the disease remains a public health threat. Contracting and transmitting SARS-COV-2 among individuals under 18 is significant.

 This study aims to identify potential side effects and symptomatic reinfections among 12-18-year-olds after receiving COVID-19 vaccines.

 In this longitudinal study conducted in 2021 - 2022 in Dezful, Iran, 1,000 vaccinated individuals were followed up for 6 months. Side effects and symptomatic reinfections of the first and second doses of PastoCovac and Sinopharm vaccines and a history of prior SARS-COV-2 infection were recorded.

 Only 7.6% received the PastoCovac vaccine, while 92.4% received the Sinopharm vaccine. The most common side effect for both vaccines was local pain at the injection site, while the least common was skin rash. Side effects were 1.9 times more prevalent with the PastoCovac vaccination. Women had a 2.3 times higher chance of experiencing side effects after the first dose and a 1.9 times higher chance after the second dose compared to men. Over the 6-month follow-up period, 11.6% and 14.3% of individuals experienced re-infection after the first and second vaccine doses, respectively. It seems with the passage of time and the decrease in the level of immunity, the possibility of re-infection increases.

 Both vaccines were considered safe for 12-18-year-olds. However, receiving two doses does not guarantee protection against reinfection.

 The pregnancy and lactation periods are special times when individuals are more susceptible to morbidity and mortality from COVID-19. Breastfeeding individuals like pregnant women are at a higher risk of experiencing symptoms and requiring hospitalization, including intensive care. Therefore, vaccination is considered the most effective approach to help pregnant and lactating women cope with COVID-19. Despite recommendations for COVID-19 vaccination, the coverage among lactating mothers has been insufficient.

 This cross-sectional comparative study aimed to determine the chance of COVID-19 vaccination among lactating women with associated variables such as COVID-19 fear, breastfeeding self-efficacy, and some demographic characteristics.

 A total of 450 breastfeeding women were included in the study, divided into two groups: those who received the COVID-19 vaccine (n = 225) and those who did not (n = 225). Individuals were 18-49 years old, had an infant aged under 6 months based on the birth card, a single pregnancy, a healthy newborn, and no contraindications to breastfeeding based on electronic health records. After receiving approval from the Ethics Committee of Iran University of Medical Sciences, the participants from health centers in Tehran, Iran, were selected using a multi-stage sampling method. Data were collected using demographic forms including mothers’, babies’, and husbands’ ages, mothers’ and husbands’ educational level and occupation, child number, household economic level, childbirth type, type of baby feeding, history of COVID-19 infection, COVID-19 questionnaires, and Dennis’ Breastfeeding Self-efficacy Scale. The data were analyzed using SPSS16 software, employing statistical methods such as independent t-tests, chi-squared tests, and logistic regression.

 Two groups of breastfeeding women (225 vaccinated) and (225 unvaccinated) were compared regarding demographic characteristics, fear of COVID-19, and self-efficacy in breastfeeding. There were no differences in mothers’ ages, educational levels, baby’s age, childbirth type, husbands’ occupation, household economic level, history of COVID-19 infection, and husband’s age between the two groups. The variables that had a significance level lower than 0.2 were entered into the logistic regression model. The findings from 450 breastfeeding women showed that husbands’ education level (crude odds ratio [OR] = 95% confidence interval (CI)]: 0.44 [0.19-0.76], P = 0.04), having more than 4 children (OR = 0.56, CI: 0.31-0.89, P = 0.04), and lower fear level of the COVID-19 (OR = 0.90, CI: 0.87-0.94, P<0.001) had higher odds of receiving vaccine than others. So, the type of baby feeding, women’s education level, women’s and their husbands’ occupation, and breastfeeding self-efficacy did not predict receiving vaccination.

 This study highlights that unvaccinated breastfeeding women have a higher fear of COVID-19 infection, have husbands with lower levels of education, and have fewer children. Vaccination has emerged as a critical topic impacting the health and well-being of communities worldwide. When it comes to unvaccinated breastfeeding women, it is necessary to consider various factors with a holistic perspective. Understanding the importance, safety, and efficacy of vaccines is crucial. So, the decision to vaccinate is personal and should be based on a comprehensive understanding of available information. Unvaccinated breastfeeding women should engage in prevention programs even before that. Both pregnant women and their husbands should be educated in preparation classes for childbirth. Of course, other factors could affect refusal to receive vaccines. These data could help health providers and policymakers in future crises.

This study aimed to investigate the possible side effects and short-term safety of coronavirus disease 2019 (COVID-19) vaccines in pregnant women.

This cross-sectional study was conducted on a sample of 500 pregnant women who had received various types of COVID-19 vaccines between June and August 2022. The participants were selected using convenience sampling until the desired sample size was achieved. Data analysis was performed using SPSS software (version 20).

The mean age of the participants was 30 years, and 34.2% of them had a history of COVID-19 infection. Furthermore, 40 of the participants had underlying hypothyroidism, and 13 cases were smokers. The most commonly reported side effects were abdominal pain, fatigue, headache, and fever; nevertheless, the lowest frequency was associated with localized swelling (0%) and ageusia, localized pruritus, and urticaria (0.4%).

There was no increase in miscarriage or serious side effects observed as a result of COVID-19 vaccination in pregnant women.

 Chikungunya virus (CHIKV) spreads by Aedes mosquitoes in tropical and subtropical regions. Due to the geographical and social situation of the border cities of Sistan and Baluchestan province, this study was conducted to evaluate the prevalence of the Chikungunya infection in the southeastern cities of Iran using enzyme-linked immunosorbent assay (ELISA).

 In this cross-sectional study, 203 participants were randomly selected from 4 southeastern cities of Iran (Taftan, Sib-and-Suran, Mehrestan, and Mirjaveh). First, sociodemographic and clinical data were gathered by a questionnaire. Next, individual blood samples were taken, and ELISA was performed to measure anti-CHIKV IgG levels.

 The participants’ ages ranged from 6 - 50 years, with 27.5% of them being 21 - 30 years old. Based on the results, 17 cases (8.37%) had episodes of fever, 13 (6.40%) had fever and arthralgia, and 12 (5.91%) had a history of hospitalization. In addition, there were 3 positive samples (1.48%). One of these people lived in Mehrestan, and two lived in Sib-and-Suran. The incidence of the virus infection was significantly higher in the age groups of 41 - 50 and 21 - 30 years old (P = 0.046). The likelihood of CHIKV infection was higher in farmers, independent contractors, and housewives (P = 0.001). Moreover, the most indicative clinical symptoms were the simultaneous occurrence of fever and arthralgia.

 The findings of this study confirm the presence of CHIKV in Sistan and Baluchestan. The geographic distribution of the positive samples indicates that other factors are involved in the spread of infection besides the tropical climate and proximity to Pakistan.

 Cryptococcal meningitis is a significant leading cause of death among individuals with HIV worldwide. It is caused by Cryptococcus neoformans and the C. gattii species complex. The primary predisposing factor is HIV, but it can also be observed in conditions such as immunodeficiency, sarcoidosis, liver disease, solid organ transplantation, and steroid treatment.

 This report discusses a 61-year-old man with a medical history of liver transplantation, open-heart surgery, diabetes, hypertension, and previous cryptococcal meningitis. He had been receiving antifungals and was discharged in good condition to continue maintenance treatment at home. During his latest admission, he was hospitalized to investigate weakness and suspicious ulcerated skin lesions refractory to glucantime through biopsy. Two days after hospitalization and before receiving the biopsy result, the patient gradually developed lethargy, headache, and nausea. Laboratory examinations of cerebrospinal fluid (CSF) and skin biopsies revealed encapsulated yeast cells identified as Cryptococcus neoformans using culture media and the PCR method. The patient died shortly after receiving liposomal amphotericin B and oral fluconazole.

 This case emphasizes the importance of follow-up visits for high-risk patients, early screening for fungal infections, and long-term antifungal treatment, especially in immunocompromised patients, to reduce unfavorable outcomes.