Oesophageal and oral ulcer tuberculous associated with human T-cell lymphotropic virus type 1 (HTLV-1) and SARS-CoV-2 infection

Oesophageal involvement due to tuberculosis (TB) and coinfection with HTLV-1 is rare and can be complicated by the presence of other infections that affect the mucosa of the upper respiratory tract, such as COVID-19. We present the case of a 27-year-old male patient, with 3 months of illness, weight loss, dysphagia, and ulcers in the oral cavity. Tomography showed oesophageal perforation and after oesophageal ulcer biopsy, TB was diagnosed, in addition to infection by HTLV-1 and severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). The patient responded satisfactorily to antituberculous treatment and corticosteroids. Considering the association between rare extrapulmonary tuberculosis and other immunosuppressive pathologies, it is crucial to identify these pathologies in such patients.

19th Seminar on Tropical Pathology and Public Health 12th Biotechnology Week 1st Physical Therapy Week, Virtual, 23-25 November 2022

These proceedings comprise 85 articles spanning diverse fields such as bacteriology, molecular biology, biotechnology, dermatology, infectious and parasitic diseases, epidemiology, physiotherapy, immunology, mycology, parasitology, pathology, collective health, and virology. The articles delve into a wide range of research topics, from repurposing drugs for Mycobacterium abscessus complex infections to utilising artificial intelligence for SARS-CoV-2 diagnosis. In bacteriology, investigations explore the correlation between smoking and Helicobacter pylori infection in gastric adenocarcinoma patients, as well as the resistance profiles of Staphylococcus aureus and Pseudomonas aeruginosa in tracheostomised children. Molecular biology studies focus on gene polymorphisms related to diseases like paracoccidioidomycosis. Biotechnology research emphasises bioactive molecules in species like Croton urucurana and the development of computational models for cytotoxicity prediction. Dermatology articles address stability characterisation in vegetable oil-based nanoemulsions. The section on infectious and parasitic diseases encompasses studies on COVID-19 vaccine response in pregnant women and the impact of infection prevention measures in rehabilitation hospitals. Epidemiology investigations analyse trends in premature mortality, tuberculosis in diabetic patients, and public adherence to non-pharmacological COVID-19 measures. Physiotherapy research covers topics such as telerehabilitation through a developed game and the prevalence of congenital anomalies. Immunology studies explore immune responses in HIV and Leishmaniasis, whilst mycology investigates the biotechnological potential of fungi from the cerrado biome. Parasitology research evaluates treatment efficacy against vectors parasites such as Aedes aegypti and Toxoplasma gondii. Pathology articles discuss intentional intoxication in cattle and the influence of curcumin on acute kidney injury therapy. Collective health studies focus on intervention plan development in healthcare settings and pesticide use in horticulture. Lastly, virology research investigates parvovirus occurrence in hospitalised children during the COVID-19 pandemic, hidden hepatitis B virus infection in inmates, and the prevalence of HPV and HTLV-1/2 infections in specific populations.

Landscape Analysis of Quercetin: A Potential Candidate Against SARS-CoV-2

Fruit, vegetables, and green tea contain quercetin (a flavonoid). Some of the diet's most signifi-cant sources of quercetin are apples, onions, tomatoes, broccoli, and green tea. Antioxidant, anticancer, anti-inflammatory, antimicrobial, antibacterial, and anti-viral effects have been studied of quercetin. The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus, ribonucleic acid (RNA) polymer-ase, and other essential viral life-cycle enzymes are all prevented from entering the body by quercetin. Despite extensive in vitro and in vivo investigations on the immune-modulating effects of quercetin and vitamin C treatment. 3-methyl-quercetin has been shown to bind to essential proteins necessary to convert minus-strand RNA into positive-strand RNAs, preventing the replication of viral RNA in the cytoplasm. Quercetin has been identified as a potential SARS-CoV-2 3C-like protease (3CLpro) suppressor in recent molecular docking studies and in silico assessment of herbal medicines. It has been demonstrated that quercetin increases the expression of heme oxygenase-1 through the nuclear factor erythroid-related factor 2 (Nrf2) signal network. Inhibition of heme oxygenase-1 may increase bilirubin synthesis, an endoge-nous antioxidant that defends cells. When human gingival fibroblast (HGF) cells were exposed to lipo-polysaccharide (LPS), inflammatory cytokine production was inhibited. The magnesium (Mg+2) cation complexation improves quercetin free radical scavenging capacity, preventing oxidant loss and cell death. The main objective of this paper is to provide an overview of the pharmacological effects of quercetin, its protective role against SARS-CoV-2 infection, and any potential molecular processes.Copyright © 2022 Bentham Science Publishers.

DERMATOMYOSITIS AFTER COVID-19 PNEUMONIA

SESSION TITLE: Unique Inflammatory and Autoimmune Complications of COVID-19 Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Viral infections can induce an immune cascade which may incite varied autoimmune disease to take action. One such disease is dermatomyositis, a rare inflammatory disease with multisystemic involvement. As we enter the post pandemic era, several unique complications related to COVID-19 are now surfacing. Here we present a case of a 57-year-old female who developed dermatomyositis after recent Covid-19 infection. CASE PRESENTATION: Patient is a 57-year-old female who presented to our pulmonary clinic with complaints of cough and shortness of breath (SOB). Patient reported feeling ill since contracting COVID-19 in November 2020. Two months after being diagnosed with COVID-19 she started to experience generalized muscle and joint pain;she underwent extensive rheumatological workup which was consistent with Sjogren disease for which she was started on hydroxychloroquine. A month after initiation of medication she started to experience worsening cough and SOB and underwent pulmonary function testing (PFT) in our clinic which showed evidence of restrictive lung disease. Chest CT was consistent with interstitial changes, therefore a diagnosis of ILD (interstitial lung disease) due to connective tissue disorder was made. Further assessment revealed positive CPK and anti-Jo1 antibodies indicative of dermatomyositis as a cause of her ILD. She was started on oral steroids which helped improve her symptoms. DISCUSSION: Several viruses including EBV, Hepatitis C, Rubella, HTLV-1 and Parvovirus have been associated with development of autoimmune diseases. Viral infections, like COVID-19 have shown to trigger an intense immune response which in turn may lead to autoimmune activity against host antigen. SARS-CoV2 has been found to enter muscle cells through ACE-2 receptors, allowing for transfer of genetic material and skeletal muscle damage. Another proposed mechanism of COVID induced myopathy has been T-cell clonal expansion by the virus up regulating TLR4 receptors increasing expression of ACE2, therefore facilitating entry of viruses leading to further inflammation. Identification of very specific T cell receptor epitopes for SARS-COv2 in patients with dermatomyositis has suggested COVID-19 as a trigger for CD8-T cells which leads to dermatomyositis in these patients. Autoimmune reactions occur from varying mechanisms like epitope spreading and bystander activation to molecular mimicry triggered by viral infections. CONCLUSIONS: SARS-COv2 presented with several challenges in the field of medicine. As we enter the post COVID period in medicine, we will continue to face several challenges proposed by the inflammatory surge caused by this disease. It is therefore important clinicians recognize and report these rare cases to increase awareness regarding several post covid diseases. Reference #1: HUSSEIN, H. M.;RAHAL, E. A. The role of viral infections in the development of autoimmune diseases. Critical Reviews in Microbiology, [s. l.], v. 45, n. 4, p. 394–412, 2019. DOI 10.1080/1040841X.2019.1614904. Disponível em: https://search-ebscohost-com.proxy.lib.wayne.edu/login.aspx?direct=true&db=a9h&AN=138199390&site=ehost-live&scope=site. Acesso em: 4 abr. 2022. DISCLOSURES: No relevant relationships by Kevser Akyuz No relevant relationships by Ranim Chamseddin No relevant relationships by Padmini Giri No relevant relationships by verisha khanam No relevant relationships by Emad Shehada No relevant relationships by Abdullah Yesilyaprak

DOES COVID-19 INCREASE YOUR RISK OF DEVELOPING HAIRY CELL LEUKEMIA?

SESSION TITLE: Pathology Identifying Chest Infections Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Coronavirus disease 2019 (COVID-19) patients presented in a wide variety and had multiple complications. The well-known associations found are myocardial infraction, pulmonary embolism, meningitis, encephalitis. We are presenting a new diagnosis of Hairy cell leukemia in COVID 19 patients. CASE PRESENTATION: We present a 55-year-old pleasant female with no significant past medical history;non immunocompromised who presented with 7 days history of shortness of breath on exertion, fever, fatigue, and cough. Her physical exam was unremarkable, but she was desaturating on presentation hence was placed on oxygen via nasal canula. On work up she tested positive for COVID-19. Initial chest Xray revealed bilateral diffuse pulmonary infiltrates. Complete blood count (CBC) showed pancytopenia with white blood cell count (WBC) 0.8 × 103/μL (4–10 × 103/μL), absolute neutrophil count (ANC) 0.5 × 103/μL (2–7 × 103/μL), hemoglobin (Hgb) 10.4 g/dL (13.0–17.0 g/dL), and platelet count 156× 103/μL (150–400 × 103/μL). She received treatment for COVID 19 pneumonia as per the protocol. On repeat CBC check there was minimal improvement in her counts. The rest of her WBC differential showed a lymphopenia with ALC ranging from 350–500 with no other obvious immature cells or blasts to suggest a myeloid neoplasm such as acute leukemia. Work-up including vitamin B12, folate, TSH, EBV, ANA, and hepatitis were unremarkable. She also received treatment with supportive granulocyte colony-stimulating factor (G-CSF) but there was minimal improvement. As her pancytopenia persisted for 1 week the peripheral blood smear was done which showed pancytopenia (with prominent red cell agglutination, with rare, atypical lymphoid cells with multiple hairy projections. A bone marrow (BM) aspirate was hypocellular showing markedly decreased trilineage hematopoiesis with atypical lymphoid cells with oval or indented nuclear borders, unclumped chromatin, absent or inconspicuous nucleoli, and moderate to abundant pale blue cytoplasm with multiple circumferential cytoplasmic projections (hairy cells) [Figure:1]. The hairy cells showed strong positivity for CD20[Figure:2]. She was followed up by hematology and was started on treatment. DISCUSSION: Hairy cell leukemia (HCL) is a rare B cell lymphoproliferative disease with marked cytopenia and circulating leukemia cells. Multiple viruses (EBV, HTLV1) were found to be associated with multiple different malignancies. It is found that COVID19 is not associated with any malignancy so far, but our patient got diagnosed with HCL during COVID19 illness. CONCLUSIONS: The association of HCL could be an incidental finding but we need to do further studies to clarify the associations Reference #1: Kohla, Samah et al. "A Rare Case of Hairy Cell Leukemia with Unusual Loss of CD123 Associated with COVID-19 at the Time of Presentation.” Case reports in oncology vol. 13,3 1430-1440. 4 Dec. 2020, doi:10.1159/000512830 DISCLOSURES: No relevant relationships by Apurwa Karki No relevant relationships by Shobha Mandal No relevant relationships by Rajamurugan Meenakshisundaram

THE ERA OF HIV-NEGATIVE PNEUMOCYSTIS PNEUMONIA

SESSION TITLE: Chest Infections in Immunocompromised Patients Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Pneumocystis pneumonia (PCP) is a life-threatening opportunistic infection caused by Pneumocystis jirovecii. HIV-negative patients with PCP are primarily individuals receiving immunosuppressive therapy for other disease processes. In rare instances, PCP could be an initial manifestation of underlying defected or suppressed cell-mediated immunity that needs to be diagnosed to prevent morbidity and mortality. CASE PRESENTATION: 75-year-old female with a history of hypertension and hypothyroidism presented to the emergency department for evaluation of cough, fever, and shortness of breath gradually worsening over the last few weeks. She received outpatient treatment with no improvement. She was vaccinated against covid-19. On presentation, the temperature was 103F, heart rate was 108 bpm, blood pressure was 163/93 mm Hg, and oxygen saturation was 86% on room air. Hemogram showed leukocytosis with left shift with elevated inflammatory markers. Chest X-ray revealed bilateral ground glass opacities. She was started on broad-spectrum antibiotics, but symptoms worsened over the next few days. CT chest showed diffuse bilateral ground glass opacities with prominent interstitial markings. BAL obtained from bilateral upper lobes was lymphocyte predominant with pneumocystis jirovecii diagnosed on Gomori methenamine silver (GMS) staining. She was started on PCP-directed antibiotics with intravenous glucocorticoids, and workup for an underlying immunodeficiency was started. Subsequent BATS biopsy revealed diffuse organizing alveolar damage, with possible associated acute interstitial pneumonia pattern. This could be a rare manifestation of PCP or a primary presentation in the appropriate clinical setting. Autoimmune panel, leukemia, and lymphoma panel came back negative. AFB smear, HIV, EBV, CMV, HTLV I/II also returned negative. The lymphocyte subset panel revealed a CD4 count of 205 and a subsequent count a few days later of 64 with decreased total IgG. The patient was treated with high dose steroids for an extended period along with treatment for PCP however continued to decline clinically. The patient and family eventually decided to pursue comfort care. DISCUSSION: The predisposition to PCP in patients is primarily due to a decrease in cell-mediated immunity regardless of HIV infection. In our patient, the etiology of idiopathic CD4+ T cell lymphocytopenia cannot be determined due to the lack of serial laboratory data measurement. One of the proposed etiologies of ICL is systemic persistent immune activation in the setting of exogenous mRNA, the current technology that is being widely used for vaccine development. CONCLUSIONS: In this era of biotechnology, with advancements in immunosuppressive therapy and mRNA-based vaccines, increased awareness around the potential immune system activation and potential downstream complications needs to be further highlighted to raise awareness among physicians. Reference #1: Li, Y., Ghannoum, M., Deng, C., Gao, Y., Zhu, H., Yu, X., & Lavergne, V. (2017). Pneumocystis pneumonia in patients with inflammatory or autoimmune diseases: usefulness of lymphocyte subtyping. International Journal of Infectious Diseases, 57, 108-115. Reference #2: Pardi, N., Hogan, M. J., Porter, F. W., & Weissman, D. (2018). mRNA vaccines - a new era in vaccinology. Nature reviews. Drug discovery, 17(4), 261–279. https://doi.org/10.1038/nrd.2017.243 Reference #3: Vijayakumar, S., Viswanathan, S., & Aghoram, R. (2020). Idiopathic CD4 Lymphocytopenia: Current Insights. ImmunoTargets and therapy, 9, 79–93. https://doi.org/10.2147/ITT.S214139 DISCLOSURES: No relevant relationships by Santhosh Gheevarghese John No relevant relationships by Konstantin Golubykh No relevant relationships by Iuliia Kovalenko No relevant relationships by Maidah Malik No relevant relationships by Hafiz Muhammad Siddique Qurashi No relevant relationships by Taj Rahman No rel vant relationships by Tabinda Saleem

What about infection in travellers, migrants and refugees

Several factors have been linked to emerging infectious diseases including new agents (coronaviruses, zika virus), extension of geographical areas (schistosomiasis, dengue, West Nile, zika virus), increase in incidence (HIV, tuberculosis) and travel/migration (Chagas disease, cysticercosis). According to the World Migration Report 2020, the number of international migrants reached 272 million globally in 2019, and nearly two-thirds were labour migrants. Epidemiological evidence about infectious diseases and neuroinfection among travellers, migrants and refugees will be reviewed. Traveller's diarrhoea, dengue fever and other tropical diseases are reported in travellers. Re-emergence of infections in Europe includes chikungunya, dengue and malaria. Migration of asymptomatic people spread American trypanosomiasis in non-endemic areas and cases have been reported in Europe, Japan, and North-America. Neurocysticercosis is a common cause of seizures among South American migrants in USA. Migrants may be asymptomatic carriers (Chagas, HTLV-1). The involvement of CNS may occur in viral infections (HIV, HTLV-1, dengue, zika), malaria, schistosomiasis (myeloradiculopathy), Chagas disease (encephalitis, stroke), etc. Refugees may be at slightly higher risk of infectious diseases including tuberculosis, HIV, hepatitis and schistosomiasis. Systematic reviews have found that tuberculosis and hepatitis B and C prevalence is higher among migrants arriving in Europe, and the prevalence of antimicrobial resistance and infections was higher in refugees and asylum seekers than in other migrant groups. Infectious diseases in migrants may be explained by a higher prevalence in migrants' countries of origin, barriers to health care in host/transit countries, and poor living conditions. These factors are especially relevant in vulnerable populations (refugees, documented migrants).

DOADORES DE SANGUE DO HEMOCENTRO REGIONAL DE SANTA MARIA COM SOROLOGIA REAGENTE OU INCONCLUSIVA PARA HTLV I/II DURANTE O PERÍODO DA PANDEMIA DE COVID-19

Objetivos: Analisar o número de doadores de sangue do Hemocentro Regional de Santa Maria (HEMOSM) que apresentaram sorologia reagente ou inconclusiva para infecção por HTLV I/II durante o período da pandemia de COVID-19. Materiais e métodos: Esta pesquisa é um estudo observacional retrospectivo realizado a partir da coleta de dados do Sistema HEMOVIDA (Sistema Nacional de Gerenciamento em Serviços de Hemoterapia) e dos arquivos do Laboratório de Sorologia do HEMOSM durante o período de fevereiro/2020 a julho/2021. A amostra empregada nos ensaios foi o soro dos doadores e a técnica de análise foi a eletroquimioluminescência. Resultados: O número total de doadores que apresentaram resultado de sorologia reagente ou inconclusiva para a infecção por HTLV I/II foi de 13 doadores, os quais tiveram todos os seus hemocomponentes descartados. Nessa triagem sorológica, 2 doadores tiveram resultados reagentes e 11 inconclusivos. Destes 13 doadores, 10 são do sexo masculino e apenas 3 do sexo feminino. Além disso, houve 2 casos de coinfecção por sífilis. Discussão: O HTLV (vírus T-linfotrópico humano) é um vírus, da mesma família do HIV, que infecta células muito importantes para a resposta imunológica, os linfócitos T. Os dois principais tipos desse vírus são o HTLV-I e o HTLV-II. O subtipo I está relacionado a doenças neurológicas graves e degenerativas e doenças hematológicas, como o linfoma de células T do adulto, enquanto o subtipo II está associado à tricoleucemia de células T. A maioria das pessoas infectadas pelo vírus não desenvolve sintomas ao longo da vida, mantendo, desta forma, uma cadeia de transmissão silenciosa. A transmissão do HTLV se dá por meio do contato com sangue ou outros fluidos corporais de uma pessoa infectada, podendo ser transmitido de forma vertical (de mãe para o filho), pela relação sexual desprotegida ou por meio de uma transfusão sanguínea advinda de um doador infectado, sendo este último motivo a razão pela qual esta doença integra a triagem sorológica para doadores de sangue. Do total de bolsas desprezadas em razão de sorologia reagente ou indeterminada (295 unidades de sangue total no mesmo período) a pesquisa de marcador sorológico para o HTLV I/II representou apenas 4,4% dos descartes. Assim sendo, o HTLV foi a menor causa de descartes relativos à triagem sorológica, mas esta observação não implica na diminuição da importância dessa pesquisa para a garantia da segurança transfusional. Tendo em vista o momento em que nos encontramos, é compreensível que haja insegurança com relação à exposição social para doar sangue, porém é preciso que o trabalho realizado pelos hemocentros continue (com protocolos de segurança) e para isso, é necessária a solidariedade da população para manter os estoques de sangue em níveis adequados. A sorologia reagente ou indeterminada de um doador implica no descarte de todos os componentes sanguíneos produzidos a partir da sua doação, contribuindo para a diminuição dos estoques em um momento em que já há a redução de doações. Conclusão: Dessa forma, faz-se de suma importância a conscientização sobre a prevenção dessa doença (e de quaisquer outras doenças transmissíveis pelo sangue) visando tanto a saúde e bem-estar do doador, quanto a garantia do uso de sua doação de forma segura para transfusões em pacientes nos serviços de saúde.

A case report on younger case of T-cell leukemia with COVID 19

Lymphocyte leukemia/lymphoma (ATLL) is a fringe T-cell harm brought about by human T-cell leukemia infection type. Lymphocyte leukemia (ATL) is an exceptionally forceful developed T-cell neoplasm related with human T-cell lymphotropic infection type 1 (HTLV-1) contamination, which influences around 10 million individuals on the planet. Of them, roughly 1-5% at last creates indicative ATL. Patient history: A 15 years male was admitted in AVBRH with complaint of fever, decrease appetite from 1 month, vomiting with blood tinged food particles and melena. Patient was diagnosed case of T-cell variant ALL. Before coming to AVBRH he was admitted to GMC Nagpur where he was diagnosed to had T-cell ALL with aberrant expression of CD10. He also had generalised lymphadenopathy and massive hepatosplenomegaly. He was advised blood transfusion but gives no H/O the same. Then he was discharged. After that patient developed malaena and blood tinged vomiting for which he came to AVBRH for further management. After his arrival, he was covid-19 positive so shifted to COVID ward. After two weeks, RTPCR status was negative then he shifted to PICU. . Clinical finding: The patient had done all necessary investigations by physician order. Medical Management: Patient was treated with IV. Fluids, platelet transfusion, chemotherapy, steroids, calcium gluconate, antibiotics, antacid, vit c and multivitamins. Nursing management: Administered fluid replacement i.e. D5, chemotherapy, platelet transfusion monitored all vital signs half hourly.