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1.
Front Public Health ; 10: 833783, 2022.
Article in English | MEDLINE | ID: covidwho-1847235

ABSTRACT

Background: In the era of the COVID-19 pandemic, people living with HIV (PLWH) face more challenges. However, it is unclear if PLWH is more susceptible to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection than HIV-negative individuals. This study aimed to explore the prevalence of the SARS-CoV-2 infection and the associated risk factors among PLWH. Methods: From 1 to 30 May 2020, we conducted a cross-sectional survey that enrolled 857 PLWH and 1,048 HIV-negative individuals from the Wuchang district in Wuhan, China. Our data analysis compared the rate of the SARS-CoV-2 infection among PLWH and HIV-negative participants, and the proportions of symptomatic patients and asymptomatic infectors between the two groups. We also assessed the risk factors associated with the SARS-CoV-2 infection among PLWH. Results: Overall, 14/857 (1.6%) PLWH and 68/1,048 (6.5%) HIV-negative participants were infected with SARS-CoV-2. Among the SARS-CoV-2-infected PLWH participants, 6/14 (42.8%) were symptomatic patients, 4/14 (28.6%) were SARS-CoV-2 nucleic acid-positive asymptomatic infectors, and 4/14 (28.6%) were serology-positive asymptomatic infectors. Among the infected HIV-negative participants, 5/68 (7.4%) patients were symptomatic and 63/68 (92.6%) were serology-positive asymptomatic infectors. The rate of the SARS-CoV-2 infection was lower among the PLWH than in the HIV-negative group (1.96% vs. 5.74%, p = 0.001) and the rate of morbidity among the symptomatic patients was similar between the two groups (p = 0.107). However, there were more serology-positive asymptomatic infectors among the infected HIV-negative participants than among the infected PLWH (0.54% vs. 5.46%, p = 0.001). Furthermore, being 50 years or older (aOR = 4.50, 95% CI: 1.34-15.13, p = 0.015) and having opportunistic infections (aOR = 9.59, 95% CI: 1.54-59.92, p = 0.016) were associated with an increased risk of SARS-CoV-2 infection among PLWH. Conclusions: PLWH has more varied forms of the SARS-CoV-2 infection than the HIV-negative population and should, therefore, undertake routine screening to avoid late diagnosis. Also, older age (≥50 years) and having opportunistic infections increase the risks of SARS-CoV-2 infection among PLWH.


Subject(s)
COVID-19 , HIV Infections , Opportunistic Infections , COVID-19/epidemiology , Cross-Sectional Studies , HIV Infections/complications , HIV Infections/epidemiology , Humans , Opportunistic Infections/complications , Opportunistic Infections/epidemiology , Pandemics , SARS-CoV-2
2.
Infection ; 50(4): 1013-1017, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1767729

ABSTRACT

PURPOSE: SARS-CoV-2 infection produces lymphopenia and CD4+ T-cell decrease, which could lead to a higher risk of bacterial co-infection or impair immunological evolution in people living with HIV (PLWH). METHODS: We investigated the rate of co-infection and superinfection, and the evolution of CD4+ count and CD4+/CD8+ ratio, in hospitalized PLWH with COVID-19. RESULTS: From March to December 2020, 176 PLWH had symptomatic COVID-19 and 62 required hospitalization (median age, 56 years, 89% males). At admission, 7% and 13% of patients had leukocytosis or increased procalcitonin values and 37 (60%) received empiric antibiotic therapy, but no bacterial co-infection was diagnosed. There were seven cases of superinfection (12%), and one case of P. jiroveci pneumonia during ICU stay. No significant change in CD4+ count or CD4+/CD8+ ratio was observed after discharge. CONCLUSION: Bacterial co-infection is not frequent in PLWH with COVID-19. Immune recovery is observed in most of patients after the disease.


Subject(s)
COVID-19 , HIV Infections , Bacterial Infections/epidemiology , COVID-19/epidemiology , COVID-19/immunology , Coinfection/epidemiology , Female , HIV Infections/epidemiology , HIV Infections/immunology , Humans , Immunosuppression Therapy/statistics & numerical data , Male , Middle Aged , Opportunistic Infections/epidemiology , Risk Assessment
3.
J Infect Public Health ; 15(4): 466-479, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1693246

ABSTRACT

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is yet to be controlled worldwide, especially in India. The second wave of coronavirus disease 2019 (COVID-19) led to panic and confusion in India, owing to the overwhelming number of the population that fell prey to this highly infectious virus of recent times. In the second wave of COVID-19, the patients had to fight both the virus and opportunistic infections triggered by fungi and bacteria. Repeated use of steroids, antibiotics, and oxygen masks during the management of severely and critically ill COVID-19 patients nurtured opportunistic infections such as mucormycosis. Despite mucormycosis being a decades-old disease, it has gained notice of its widespread occurrence in COVID-19 patients throughout India. Instances of mucormycosis are usually unearthed in immunocompromised individuals and are caused by the inhalation of filamentous fungi, either from the natural environment or through supportive care units. In the recent outbreak during the second wave of COVID-19 in India, it has been seen to cause secondary infection as it grows along with the treatment of COVID-19. Furthermore, COVID-19 patients with comorbidities such as diabetes were more likely to have the mucormycosis co-infection because of their challenged immune systems' inability to fight it. Despite the hype, mucormycosis still remains neglected and least studied, which is predominantly due to all focus on diagnostics, vaccine, and therapeutic research. In this review, we emphasize mainly on the association of mucormycosis in COVID-19 patients. We also present the molecular mechanism of mucormycosis for a better understanding of the fungal infections in patients who have recently been infected with SARS-CoV-2. Better understanding of fungal pathogens, immediate diagnosis, and management of the infections are crucial in COVID-19 patients, as high mortalities have been recorded in co-infected patients despite recovery from COVID-19.


Subject(s)
COVID-19 , Coinfection , Mucormycosis , Opportunistic Infections , Coinfection/epidemiology , Humans , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Mucormycosis/epidemiology , Opportunistic Infections/complications , Opportunistic Infections/epidemiology , Pandemics , SARS-CoV-2
6.
Mol Biol Rep ; 49(1): 747-754, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1491296

ABSTRACT

COVID-19-associated-mucormycosis, commonly referred to as the "Black Fungus," is a rare secondary fungal infection in COVID-19 patients prompted by a group of mucor molds. Association of this rare fungal infection with SARS-CoV-2 infection has been declared as an endemic in India, with minor cases in several other countries around the globe. Although the fungal infection is not contagious like the viral infection, the causative fungal agent is omnipresent. Infection displays an overall mortality rate of around 50%, with many other secondary side effects posing a potential threat in exacerbating COVID-19 mortality rates. In this review, we have accessed the role of free iron availability in COVID-19 patients that might correlate to the pathogenesis of the causative fungal agent. Besides, we have analyzed the negative consequences of using immunosuppressive drugs in encouraging this opportunistic fungal infection.


Subject(s)
COVID-19/complications , Hyperferritinemia , Mucormycosis , Fungi/isolation & purification , Fungi/pathogenicity , Humans , Hyperferritinemia/complications , Hyperferritinemia/microbiology , Immunosuppressive Agents/adverse effects , India/epidemiology , Iron/metabolism , Mortality , Mucormycosis/epidemiology , Mucormycosis/etiology , Mucormycosis/microbiology , Opportunistic Infections/epidemiology , Opportunistic Infections/microbiology , Rhizopus oryzae/isolation & purification , Rhizopus oryzae/pathogenicity
7.
World J Gastroenterol ; 27(27): 4276-4297, 2021 Jul 21.
Article in English | MEDLINE | ID: covidwho-1344407

ABSTRACT

Over the past decades, the treatment of inflammatory bowel diseases (IBD) has become more targeted, anticipating the use of immune-modifying therapies at an earlier stage. This top-down approach has been correlated with favorable short and long-term outcomes, but it has also brought with it concerns regarding potential infectious complications. This large IBD population treated with immune-modifying therapies, especially if combined, has an increased risk of severe infections, including opportunistic infections that are sustained by viral, bacterial, parasitic, and fungal agents. Viral infections have emerged as a focal safety concern in patients with IBD, representing a challenge for the clinician: they are often difficult to diagnose and are associated with significant morbidity and mortality. The first step is to improve effective preventive strategies, such as applying vaccination protocols, adopt adequate prophylaxis and educate patients about potential risk factors. Since viral infections in immunosuppressed patients may present atypical signs and symptoms, the challenges for the gastroenterologist are to suspect, recognize and diagnose such complications. Appropriate treatment of common viral infections allows us to minimize their impact on disease outcomes and patients' lives. This practical review supports this standard of care to improve knowledge in this subject area.


Subject(s)
Colitis , Inflammatory Bowel Diseases , Opportunistic Infections , Virus Diseases , Humans , Immunocompromised Host , Inflammatory Bowel Diseases/epidemiology , Inflammatory Bowel Diseases/therapy , Opportunistic Infections/diagnosis , Opportunistic Infections/epidemiology , Opportunistic Infections/prevention & control , Virus Diseases/epidemiology
8.
Curr Rheumatol Rep ; 23(9): 74, 2021 07 16.
Article in English | MEDLINE | ID: covidwho-1315363

ABSTRACT

PURPOSE OF REVIEW: We reviewed the current data on infections associated with rituximab use published over the last 5 years. RECENT FINDINGS: New literature was available on rates of serious infections, Hepatitis B reactivation and screening, and infection with Severe Acute Respiratory Syndrome Coronavirus 2. Rates of infection varied by study and population, however, higher risk of infection in patients with underlying rheumatologic diseases was seen in those who required a therapy switch, had a smoking history, and those undergoing retreatment who had a serious infection with their first course of therapy. With regards to HBV, the proportion of patients screened continues to be inadequate. Despite the upfront cost, HBV screening and prophylaxis were found to be cost effective. There is still limited data regarding COVID-19 severity in the setting of rituximab, however, rituximab, especially in combination with steroids, may lead to more severe disease and higher mortality.


Subject(s)
Antirheumatic Agents/therapeutic use , COVID-19/epidemiology , Hepatitis B/epidemiology , Opportunistic Infections/epidemiology , Rituximab/therapeutic use , Antiviral Agents/therapeutic use , Hepatitis B/diagnosis , Hepatitis B/drug therapy , Hepatitis B/prevention & control , Humans , Immunocompromised Host , Latent Infection/diagnosis , Latent Infection/drug therapy , Latent Infection/epidemiology , Latent Infection/prevention & control , Mass Screening , Risk , SARS-CoV-2 , Virus Diseases/epidemiology
10.
Infect Dis Clin North Am ; 35(2): 261-277, 2021 06.
Article in English | MEDLINE | ID: covidwho-1232974

ABSTRACT

Various uncommon fungal pathogens have been increasingly identified as causes of disseminated and invasive fungal disease (IFD) worldwide. Growing recognition and clinical knowledge of these emerging fungal pathogens has occurred through improved molecular diagnostics, nucleic sequence databases, and taxonomic reclassification of medically significant fungi. However, emerging fungal diseases carry significant morbidity and mortality and, due to a paucity of published literature, the collective clinical experience with these fungi is often limited. In this review, we focus on unusual emerging fungal pathogens not extensively covered elsewhere in this issue of Infectious Diseases Clinics of North America.


Subject(s)
Communicable Diseases, Emerging , Invasive Fungal Infections , Mycoses , Opportunistic Infections , Communicable Diseases, Emerging/diagnosis , Communicable Diseases, Emerging/drug therapy , Communicable Diseases, Emerging/epidemiology , Fungi , Humans , Invasive Fungal Infections/diagnosis , Invasive Fungal Infections/drug therapy , Invasive Fungal Infections/epidemiology , Mycoses/diagnosis , Mycoses/epidemiology , North America , Opportunistic Infections/diagnosis , Opportunistic Infections/drug therapy , Opportunistic Infections/epidemiology
11.
Future Microbiol ; 15: 1405-1413, 2020 09.
Article in English | MEDLINE | ID: covidwho-883809

ABSTRACT

As the global COVID-19 pandemic spreads worldwide, new challenges arise in the clinical landscape. The need for reliable diagnostic methods, treatments and vaccines for COVID-19 is the major worldwide urgency. While these goals are especially important, the growing risk of co-infections is a major threat not only to the health systems but also to patients' lives. Although there is still not enough published statistical data, co-infections in COVID-19 patients found that a significant number of patients hospitalized with COVID-19 developed secondary systemic mycoses that led to serious complications and even death. This review will discuss some of these important findings with the major aim to warn the population about the high risk of concomitant systemic mycoses in individuals weakened by COVID-19.


Subject(s)
Coronavirus Infections/complications , Mycoses/complications , Opportunistic Infections/complications , Pneumonia, Viral/complications , Betacoronavirus/pathogenicity , COVID-19 , Coronavirus Infections/drug therapy , Coronavirus Infections/pathology , Glucocorticoids/adverse effects , Humans , Invasive Fungal Infections/complications , Invasive Fungal Infections/diagnosis , Invasive Fungal Infections/epidemiology , Invasive Fungal Infections/microbiology , Lung Diseases, Fungal/complications , Lung Diseases, Fungal/diagnosis , Lung Diseases, Fungal/epidemiology , Lung Diseases, Fungal/microbiology , Mycoses/diagnosis , Mycoses/epidemiology , Mycoses/microbiology , Opportunistic Infections/diagnosis , Opportunistic Infections/epidemiology , Opportunistic Infections/microbiology , Pandemics , Pneumonia, Viral/drug therapy , Pneumonia, Viral/pathology , Risk , SARS-CoV-2
13.
Clin Res Cardiol ; 109(12): 1531-1539, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-708875

ABSTRACT

AIMS: Heart transplantation may represent a particular risk factor for severe coronavirus infectious disease 2019 (COVID-19) due to chronic immunosuppression and frequent comorbidities. We conducted a nation-wide survey of all heart transplant centers in Germany presenting the clinical characteristics of heart transplant recipients with COVID-19 during the first months of the pandemic in Germany. METHODS AND RESULTS: A multicenter survey of all heart transplant centers in Germany evaluating the current status of COVID-19 among adult heart transplant recipients was performed. A total of 21 heart transplant patients with COVID-19 was reported to the transplant centers during the first months of the pandemic in Germany. Mean patient age was 58.6 ± 12.3 years and 81.0% were male. Comorbidities included arterial hypertension (71.4%), dyslipidemia (71.4%), diabetes mellitus (33.3%), chronic kidney failure requiring dialysis (28.6%) and chronic-obstructive lung disease/asthma (19.0%). Most patients received an immunosuppressive drug regimen consisting of a calcineurin inhibitor (71.4%), mycophenolate mofetil (85.7%) and steroids (71.4%). Eight of 21 patients (38.1%) displayed a severe course needing invasive mechanical ventilation. Those patients showed a high mortality (87.5%) which was associated with right ventricular dysfunction (62.5% vs. 7.7%; p = 0.014), arrhythmias (50.0% vs. none; p = 0.012), and thromboembolic events (50.0% vs. none; p = 0.012). Elevated high-sensitivity cardiac troponin T- and N-terminal prohormone of brain natriuretic peptide were significantly associated with the severe form of COVID-19 (p = 0.017 and p < 0.001, respectively). CONCLUSION: Severe course of COVID-19 was frequent in heart transplanted patients. High mortality was associated with right ventricular dysfunction, arrhythmias, thromboembolic events, and markedly elevated cardiac biomarkers.


Subject(s)
COVID-19/epidemiology , Heart Transplantation/adverse effects , Immunosuppressive Agents/adverse effects , Opportunistic Infections/epidemiology , Aged , COVID-19/immunology , COVID-19/mortality , COVID-19/therapy , Female , Germany/epidemiology , Health Care Surveys , Humans , Immunocompromised Host , Male , Middle Aged , Opportunistic Infections/immunology , Opportunistic Infections/mortality , Opportunistic Infections/therapy , Risk Factors , Time Factors , Transplant Recipients , Treatment Outcome
14.
Mycopathologia ; 185(4): 607-611, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-691056

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic emerged in Wuhan, China, in late 2109, and has rapidly spread around the world. Until May 25, 2020, there were 133,521 confirmed COVID-19 cases and 7359 deaths in Iran. The role of opportunistic fungal infections in the morbidity and mortality of COVID-19 patients remains less defined. Based on our multicenter experiences, we categorized the risks of opportunistic fungal infections in COVID-19 patients in Iran. The COVID-19 patients at high risk included those with acute respiratory distress syndrome, in intensive care units, receiving broad-spectrum antibiotics, immunosuppressants or corticosteroid, and supported by invasive or noninvasive ventilation. The patients were most likely to develop pulmonary aspergillosis, oral candidiasis, or pneumocystis pneumonia. Most diagnoses were probable as the accurate diagnosis of opportunistic fungal infections remains challenging in resource-poor settings. We summarize the clinical signs and laboratory tests needed to confirm candidiasis, aspergillosis, or pneumocystosis in our COVID-19 patients.


Subject(s)
Coronavirus Infections/complications , Mycoses/complications , Opportunistic Infections/complications , Pneumonia, Viral/complications , COVID-19 , Candidiasis, Oral/complications , Candidiasis, Oral/diagnosis , Candidiasis, Oral/epidemiology , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Humans , Iran/epidemiology , Mycoses/diagnosis , Mycoses/epidemiology , Opportunistic Infections/diagnosis , Opportunistic Infections/epidemiology , Pandemics , Pharyngeal Diseases/complications , Pharyngeal Diseases/diagnosis , Pharyngeal Diseases/epidemiology , Pharyngeal Diseases/microbiology , Pneumocystis carinii , Pneumonia, Pneumocystis/complications , Pneumonia, Pneumocystis/diagnosis , Pneumonia, Pneumocystis/epidemiology , Pneumonia, Pneumocystis/microbiology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pulmonary Aspergillosis/complications , Pulmonary Aspergillosis/diagnosis , Pulmonary Aspergillosis/epidemiology
15.
Exp Clin Transplant ; 18(3): 270-274, 2020 06.
Article in English | MEDLINE | ID: covidwho-594580

ABSTRACT

OBJECTIVES: The novel 2019 coronavirus (COVID-19) was first described in December 2019 in Wuhan, China and subsequently announced as a pandemic on March 12, 2020. In several studies, solid-organ transplant recipients were reported to have higher risk for COVID-19. Here, we aimed to determine the frequency of COVID-19 in our kidney and liver transplant patients. MATERIALS AND METHODS: Our study included 583 transplant patients who were admitted to our outpatient transplant clinics and emergency departments between March 1 and May 1, 2020. Seventy-four of them were liver transplant recipients (46 male, 28 female, of which 14 were pediatric and 60 were adult patients) and 509 of them were kidney transplant recipients (347 male, 162 female, of which 16 were pediatric and 493 were adult patients). We retrospectively evaluated demographic characteristics, currently used immunosuppressant treatment, present complaints, treatment and diagnosis of comorbid diseases, and results of COVID-19 tests. RESULTS: Of 583 transplant recipients, 538 were seen in our outpatient transplant clinics and 45 were seen in our emergency departments. Of these, 18 patients who had had cough and fever were evaluated by respiratory clinic doctors, and nasopharyngeal swab samples were taken. One kidney transplant recipient had a positive COVID-19 test; he was followed with home isolation. He received treatment with hydroxychloroquine (400 mg/day). The other 17 patients had negative tests. There were no mortalities due to COVID-19. CONCLUSIONS: Transplant patients also got affected during the COVID-19 pandemic. According to the data of our centers, this effect is not much more different from the normal population. We recommend that transplant recipients should be warned in terms of personal hygiene and should be closely monitored by organ transplant centers. If there is an indication for hospitalization, they should be followed in an isolated unit, with no aggressive changes made to immunosuppressive doses unless necessary.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/epidemiology , Immunocompromised Host , Immunosuppressive Agents/administration & dosage , Kidney Transplantation/adverse effects , Liver Transplantation/adverse effects , Opportunistic Infections/epidemiology , Pneumonia, Viral/epidemiology , Betacoronavirus/immunology , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/immunology , Coronavirus Infections/virology , Drug Therapy, Combination , Female , Host-Pathogen Interactions , Humans , Immunosuppressive Agents/adverse effects , Male , Opportunistic Infections/diagnosis , Opportunistic Infections/immunology , Opportunistic Infections/virology , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/immunology , Pneumonia, Viral/virology , Retrospective Studies , Risk Assessment , Risk Factors , SARS-CoV-2 , Treatment Outcome , Turkey/epidemiology
16.
Exp Clin Transplant ; 18(3): 275-283, 2020 06.
Article in English | MEDLINE | ID: covidwho-594579

ABSTRACT

OBJECTIVES: COVID-19 is a great threat to the modern world and significant threat to immunocompromised patients, including patients with chronic renal failure. We evaluated COVID-19 incidence among our hemodialysis patients and investigated the most probable immune mechanisms against COVID-19. MATERIALS AND METHODS: Baskent University has 21 dialysis centers across Turkey, with 2420 patients on hemodialysis and 30 on peritoneal dialysis. Among these, we retrospectively evaluated 602 patients (257 female/345 male) with chronic renal failure receiving hemodialysis as renal replacement therapy; 7 patients (1.1%) were infected with SARS-CoV-2. We retrospectively collected patient demographic characteristics, clinical data, and immunological factors affecting the clinical course of the disease. We divided patients into groups and included 2 control groups (individuals with normal renal functions): group I included COVID-19-positive patients with normal renal function, group II included COVID-19-positive hemodialysis patients, group III included COVID-19-negative hemodialysis patients, and group IV included COVID-19-negative patients with normal renal function. Lymphocyte subsets in peripheral blood and typing of human leukocyte antigens were analyzed in all groups, with killer cell immunoglobulin like receptor genes analyzed only in COVID-19-positive patients and healthy controls. RESULTS: No deaths occurred among the 7 COVID-19-positive hemodialysis patients. Group I patients were significantly older than patients in groups II and III (P = .039, P = .030, respectively) but not significantly different from group IV (P = .060). Absolute counts of natural killer cells in healthy controls were higherthan in other groups (but not significantly). ActivatedT cells were significantly increased in both COVID-19-positive groups versus COVID-19-negative groups. Groups showed significant differences in C and DQ loci with respect to distribution of alleles in both HLA classes. CONCLUSIONS: Although immunocompromised patients are at greater risk for COVID-19, we found lower COVID-19 incidence in our hemodialysis patients, which should be further investigated in in vitro and molecular studies.


Subject(s)
Betacoronavirus/immunology , Coronavirus Infections/epidemiology , Immunocompromised Host , Kidney Failure, Chronic/therapy , Opportunistic Infections/epidemiology , Pneumonia, Viral/epidemiology , Renal Dialysis/adverse effects , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Betacoronavirus/pathogenicity , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/immunology , Coronavirus Infections/virology , Female , HLA Antigens/immunology , Host-Pathogen Interactions , Humans , Incidence , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/immunology , Killer Cells, Natural/immunology , Lymphocyte Activation , Male , Middle Aged , Opportunistic Infections/diagnosis , Opportunistic Infections/immunology , Opportunistic Infections/virology , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/immunology , Pneumonia, Viral/virology , Retrospective Studies , Risk Assessment , Risk Factors , SARS-CoV-2 , T-Lymphocytes/immunology , Treatment Outcome , Turkey/epidemiology , Young Adult
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