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Oral fungal infections are frequently encountered in clinical practice, and with the advent of the Coronavirus disease 2019 (COVID-19) pandemic, their incidence has quite increased. Increased emergence of oral candidal and non candidal infections is evident in patients with uncontrolled diabetes, patients on steroids or antibiotic therapies, and immunocompromised and immunosuppressed individuals. Also, habits of smoking and alcohol consumption, intake of carbohydrate-rich food, and salivary dysfunction have many times influenced the colonisation of fungal infections in the oral cavity. Aspergillosis once considered exotic is now more prevalent than before and presents itself in two forms: non invasive or invasive form, which has led to the rapid dissemination of the disease. Hence, a timely diagnosis of such lesions is important to prevent their invasion into other parts of the body. This article discusses a rare case report of Aspergillosis occurring in the oral cavity at the site of the extraction socket in a 50-year-old woman, who is a known diabetic without any history of COVID-19 infection. Aspergillosis unlike other fungal infections of the oral cavity has been reported more in immunocompetent individuals. Here, we report a unique case limited to the oral cavity in an immunocompromised patient.
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Dental implants are a standard of care in contemporary dental practice and are widely employed for the restoration of missing teeth. The long-term utility of an implant is largely dependent on the successful implant osseointegration and maintenance of the same over time. Bone metabolism and inflammatory mechanism are interrelated phenomena and are usually collectively termed osteoimmunology, which may affect the predictability and success of implant osseointegration. Many biochemical mediators of inflammation, especially Interleukin (IL)1, IL-6, and Tumour necrosis factor (TNF)alpha, have been documented to increase the activity of bone-resorbing cells through the Receptor Activator of Nuclear Factor Kappa-B (RANK) and Receptor Activator of Nuclear Factor Kappa-B Ligand (RANKL)systems. Some of the earlier studies with very limited data suggest that SARS-CoV2 infection may also directly affect bone resorption. Thus, it is imperative to understand the pathophysiology of osseointegration in COVID-19 patients, to enhance successful implant osseointegration and prevent peri-implant bone loss in these patients. Here, we present a summary of the connection between inflammatory pathways and bone metabolism on a molecular basis which may assume a significant bearing in situations of exaggerated host immune response as seen in COVID-19 infection.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Emerging Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-Cov-2) variants continue to be a threat to tackling the pandemic and a challenge to scientists as they continue to find solutions to the evolving complexities of the pandemic. This rapid literature scan aims to synthesize evidence related to the existence of the new variants, their epidemiology, and data related to vaccine efficacy. Previous variants, such as Alpha, Beta, Gamma, Delta, and Omicron were identified as “Variants of Concern” (VOCs), whereas Lambda and Mu were classified as “Variants of Interest” (VOIs). The risk of hospitalization largely differs among all these variants and the research landscape is still evolving. According to the collective evidence, Gamma variant had the highest hospitalization risk (adjusted hazard ratio, aHR 3.20, 95% CI: 2.40 to 4.26) followed by Beta (aHR 2.85, 95% CI: 1.56 to 5.23), Delta (aHR 2.28, 95% CI: 1.56 to 3.34), Alpha (aHR 1.64, 95% CI: 1.29 to 2.07), and Omicron (aHR 0.92, 95% CI: 0.56 to 1.52) as compared to the original Wuhan strain. It was also found that vaccination decreased the risk of hospitalization following infections with more virulent strains, such as Alpha, Beta, Gamma, and Delta. The risk of hospitalization was the lowest following Omicron infection among vaccinated individuals. Deltacron, a new hybrid strain (AY.4/BA.1) is believed to result from the previous co-circulation of SARS-CoV-2 Delta and Omicron during November 2021-February 2022. This hybrid virus may have been formed in the body of a person who was exposed to both viruses at the same time. Existing evidence suggested no change in epidemiology and severity of infections resulting from this hybrid strain. The COVID-19 pandemic continues to be insidious and treacherous in every form and variant. Vaccination offers a pragmatic solution to fight against the pandemic and in reducing the risk of hospitalizations. Further research and epidemiological surveillance will be needed to determine the evolving complexities of the variants and the pandemic, especially as the pandemic changes its course towards endemicity. The development of efficacious therapeutic interventions and increased vaccine uptake could reduce the morbidity and mortality associated with the SARS-CoV-2 variants. Take-home message: The SARS-CoV-2 virus and its variants are going to appear as the part of typical evolution cycle. This review emphasizes the need for performing continuous genomic surveillance at all levels (local, national, and global) to monitor variant trajectories and outcomes. © 2022 by the authors.
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SESSION TITLE: Unusual Presentations of Sarcoidosis SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 01:35 pm - 02:35 pm INTRODUCTION: COVID-19 infection has brought high morbidity and strain on hospitals. Multiple vaccines have been developed against COVID and are now widely available. These vaccines have been linked to various side effects listed by the Centers for Disease Control and prevention (CDC) website- https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverse-events.html. We present a case of multisystem sarcoidosis after receiving an mRNA COVID-19 vaccine. CASE PRESENTATION: Our patient is a 42-year-old African American woman who reported low grade fever after her first dose of the BNT162b2 mRNA COVID-19 vaccine (Pfizer). After her second dose, the fever continued, and fatigue and lethargy were noted. She denied any respiratory symptoms and other review of systems were negative. She was referred for autoimmune workup by her PCP. Then, she received her booster dose (~6 months after the second dose) and 2 weeks later, she noticed a right posterior calf mass that was firm and non-tender on exam. Rest of the exam was unremarkable. Orthopedic surgery was involved, and an excision-biopsy was done. Pathology demonstrated non-necrotizing granulomatous inflammation (Figure 1A). Her blood counts and metabolic panel were normal. Other labs showed elevated C-reactive protein of 19 mg/L (normal < 5 mg/L), angiotensin-converting enzyme level of 93 U/L (normal is 9-67 ) and Vitamin D level of 8.4 ng/mL (normal is 20-50 ng/mL). She was referred to pulmonary clinic for further evaluation. Pulmonary function test showed mild restrictive physiology. CT chest revealed enlarged mediastinal and hilar lymph nodes (Figure 2) and lung parenchymal involvement (Figure 3). EBUS-guided TBNA was performed and showed granulomatous inflammation. (Figure 1B). DISCUSSION: We present a case of multisystem sarcoidosis with mediastinal and soft tissue compromise in a temporal association with Pfizer mRNA COVID-19 vaccine. This is an uncommon adverse reaction and has not been reported by the CDC. In our case, there is a strong temporal relationship between the vaccination schedule and onset of symptoms, starting with fever and tiredness as common side effects that progressed to mass-like lesion in leg and mediastinal adenopathy. Cutaneous sarcoidosis might occur with COVID-19 vaccines (#1), however only 3 cases of multisystem sarcoidosis have been reported so far. Two cases developed Lofgren syndrome after the COVID-19 vaccination (#2) and one case with uveitis and parotid compromise (#3). To the best of our knowledge, this is the first case reporting sarcoidosis with soft tissue involvement in association with Pfizer mRNA COVID-19 vaccine. CONCLUSIONS: Our patient met criteria for multisystem sarcoidosis and there is a strong temporal relationship between the onset of symptoms/disease and COVID-19 vaccine. Immunological adverse events related to vaccines are uncommon. Our case elucidates to consider the diagnosis in right clinical context. Reference #1: Niebel D, Novak N, Wilhelmi JZ, Wilsmann-Theis D, Bieber T et al. Cutaneous adverse reactions to COVID-19 vaccines: Insights from an immune-dermatological perspective. Vaccines 2021,9,944. Reference #2: Rademacher J, Tampe B and Korsten P. First Report of Two Cases of Löfgren's Syndrome after SARS-CoV-2 Vaccination-Coincidence or Causality? Vaccines 2021, 9, 1313. https://doi.org/10.3390/ vaccines9111313 Reference #3: Matsuo T, Honda H, Tanaka T, Uraguchi K, Kawahara M et al. COVID-19 mRNA vaccine-associated uveitis leading to diagnosis of Sarcoidosis: case report and review of literature. J Investig Med High Impact Case Rep. 2022 Jan-Dec;10: 23247096221086450. DISCLOSURES: No relevant relationships by Chien Chen No relevant relationships by Eleonora Fiorletta Quiroga No relevant relationships by Manish Joshi No relevant relationships by Angel Mitma No relevant relationships by PRACHI SALUJA
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SESSION TITLE: Pathologies of the Post-COVID-19 World SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 10:15 am - 11:10 am INTRODUCTION: SARS-CoV-2 related autoimmune and thrombotic complications due to vigorous immune system stimulation and induction of hypercoagulable state are not uncommon. Two hypotheses have been proposed for thrombotic microangiopathy associated with low ADAMTS13 levels in patients with COVID-19 disease. First underscores a significant increase in von Willebrand factor (vWF), likely due to endothelial activation, that overwhelms ADAMTS13. It is observed in the absence of thrombocytopenia or ADAMTS13 inhibitor. The second highlights the formation of autoantibodies against ADAMTS13 because of an immunological trigger (SARS-CoV-2), resulting in the diagnosis of TTP. CASE PRESENTATION: This is a case of a 72-year-old Caucasian man with a history of hypertension, diabetes, chronic obstructive lung disease, and asymptomatic SARS-CoV-2 infection three weeks ago who was transferred to our institution to initiate plasmapheresis for suspected TTP due to new-onset confusion, anemia and worsening renal function. Patient had presented with confusion a day before transfer. Vital signs were remarkable for tachycardia (heart rate of 105 beats/min). Labs were significant for anemia (hemoglobin:6.7 g/dL), thrombocytopenia (platelet count:13 K/µL), acute kidney injury (creatinine:1.8 mg/dL), elevated lactate dehydrogenase (1983 IU/L), high bilirubin (2.3 mg/dL), low haptoglobin (<4 mg/dL), and demonstration of schistocytes on peripheral smear. The coagulation profile was normal. On arrival, he required emergent intubation due to multiple seizures. Computed tomography scan of the head was normal. SARS-CoV-2 molecular testing was negative. Given a PLASMIC score of six, urgent plasmapheresis and high-dose methylprednisolone were started. Screening for human immunodeficiency virus, hepatitis viruses, Epstein-Barr virus, and Cytomegalovirus were negative. Subsequently, his ADAMTS13 activity resulted as being ≤5% with an elevated inhibitor Bethesda titer of 0.9 (normal < 0.4). The patient completed six sessions of plasmapheresis. He was discharged on steroid taper and weekly rituximab. DISCUSSION: COVID-19 associated de-novo TTP has been mostly reported with typical COVID-19 symptoms within a few days of a positive test. One report described presentation with only neurological symptoms 19 days after a positive test with low autoantibody titers, favoring the hypothesis of consumption of ADAMTS13. To the best of our knowledge, this is the first case of new, late-onset immune TTP developing three weeks after asymptomatic COVID-19 infection with a robust positive inhibitor screen and infinitesimal ADATMS13 levels. The temporal sequence of events and lack of other plausible causes aided in the diagnosis of COVID-19 induced TTP. CONCLUSIONS: Our report aims to make clinicians aware of ruling out TTP as a cause of thrombocytopenia and/or altered mental status in patients with past COVID-19 infection, aiding in early management. Reference #1: 1. Mancini I, Baronciani L, Artoni A, Colpani P, Biganzoli M, Cozzi G, Novembrino C, Boscolo Anzoletti M, De Zan V, Pagliari MT, Gualtierotti R, Aliberti S, Panigada M, Grasselli G, Blasi F, Peyvandi F. The ADAMTS13-von Willebrand factor axis in COVID-19 patients. J Thromb Haemost. 2021 Feb;19(2):513-521. doi: 10.1111/jth.15191. Epub 2020 Dec 18. PMID: 33230904;PMCID: PMC7753796. Reference #2: 2. Tehrani HA, Darnahal M, Vaezi M, Haghighi S. COVID-19 associated thrombotic thrombocytopenic purpura (TTP);A case series and mini-review. Int Immunopharmacol. 2021;93:107397. doi:10.1016/j.intimp.2021.107397 Reference #3: 3. Beaulieu, M.-C., Mettelus, D.S., Rioux-Massé, B. and Mahone, M. (2021), Thrombotic thrombocytopenic purpura as the initial presentation of COVID-19. J. Thromb. Haemost., 19: 1132-1134. https://doi-org.libproxy.uams.edu/10.1111/jth.15231 DISCLOSURES: No relevant relationships by Harmeen Goraya No relevant relationships by PRACHI SALUJA
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The severe acute respiratory syndrome coronavirus 2 which is the source of pandemic coronavirus disease 2019 has engulfed almost whole world. This virus was first reported in Wuhan city (China) in December 2019. Since the discovery of the virus, till today the researchers and scientists have been working to develop new vaccines or therapeutic agents against severe acute respiratory syndrome coronavirus 2. However, thus far no vaccine has emerged that can be approved to treat or prevent coronavirus disease 2019. Due to lack of specific preventative and therapeutic options for the treatment of coronavirus disease 2019, the use of convalescent plasma therapy may be of great benefit in the current situation. Previous use of immune plasma has resulted in successful treatment of hemagglutinin type 1 and neuraminidase type 1 influenza virus, Middle East respiratory syndrome coronavirus and severe acute respiratory syndrome coronavirus 1 epidemics. In the current scenario raised by coronavirus disease 2019, the convalescent plasma therapy has been applied successfully among many patients across various regions. This article presents an up-to-date review of existing literature on recovery through convalescent plasma as a treatment of choice, safety and its efficacy, possibility and its challenges for the treatment of coronavirus disease 2019. © 2022 Indian Pharmaceutical Association. All rights reserved.
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BACKGROUND COVID 19 has been labelled as a global pandemic by the World Health Organization (WHO). The sudden rise in death toll and devastation associated with it has put the entire infrastructure, economy and health sector to test. The only way for the prevention and control of this infectious disease is rapid and accurate screening of masses. Public Health Authorities mainly use antibody testing in hot spots using a mix of RT-PCR and antibody testing nasopharyngeal and orpharyngeal swabs. Considering the potential risk factors, constraints of time, cost and manpower, mass screening for COVID is not possible through nasopharyngeal and oropharyngeal swabs alone. Hence, to search an alternate method to diagnose for the initial screening of patients is the need of the hour globally. Saliva can also be used as one of the diagnostic modalities for coronavirus, helping in the rapid testing of individuals at home or at hospital. The article intends to explain the evidence regarding the reliability of saliva as a diagnostic specimen in COVID-19 patients and demonstrates the association and potential of detecting novel coronavirus in saliva of patients and how its implication in future can aid in diagnosis as a non - invasive diagnostic modality.