ABSTRACT
As a respiratory viral infection caused by a novel coronavirus, COVID-19 became rapidly pandemic within a few months. Despite the wide range of manifestations and organ involvement in COVID-19 patients, the exact pathogenesis of severe and fatal types of COVID-19 and causes involved with the individual base of the disease is not yet understood. Several studies have reported clinical, laboratory, and histopathological data in favor of vascular injury in multiple organs of critically ill patients with COVID-19 as a result of hyperactive immune response, inflammation, and cytokine storm. Also, both clinical and histopathological evidence points to such vascular involvements in the skin. Given the ease of clinical examinations and skin biopsy and the lower risks of transmission of COVID-19 to healthcare workers, the present review article was conducted to investigate the vascular skin manifestations of COVID-19 patients clinically and/or histopathologically as helpful clues for better understanding the pathogenesis and predicting the prognosis of the disease, especially in severe cases.
Subject(s)
COVID-19/complications , Peripheral Vascular Diseases/pathology , Peripheral Vascular Diseases/virology , Skin/pathology , Humans , SARS-CoV-2 , Skin/blood supplyABSTRACT
Adeno-associated virus type 2 (AAV2) mediated gene therapy providing a potential treatment in the eye. However, immune responses can limit virally mediated gene transfer and therapy. To assess preexisting AAV2 neutralizing factors (NF) titers in peripheral blood and the vitreous in patients with age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). 130 subjects were enrolled: 50 with neovascular AMD, 30 with PCV, and 50 controls. The serum and the vitreous were obtained for AAV2 NF assay. We found AAV2 NF are present in all of AMD, PCV patients and controls we tested. There were no significant differences in prevalence of NAb in serum between AMD, PCV and controls (P=0.999). There was no correlation between NF in serum and in vitreous (P>0.05), and NF in vitreous was significantly less than in serum. Our results for the first time showed in Chinese population, NF against AAV2 was present in serum of all the patients with AMD or PCV and controls, and there were no significant differences among these groups. Therefore, it demonstrated there were no correlations between AAV2 NF titer and these diseases. We found NF in vitreous was considerably less than in serum in all groups. We also found no direct correlation between NF in vitreous and in serum suggesting serum antibody levels may not be used to predict their counterparts in the vitreous. Our results will provide crucial information for future clinical studies in the development of new therapies based on AAV2 mediated gene delivery in the eye.
Subject(s)
Choroidal Neovascularization/virology , Dependovirus/immunology , Macular Degeneration/virology , Peripheral Vascular Diseases/virology , Aged , Case-Control Studies , Dependovirus/genetics , Female , Genetic Therapy/methods , Humans , Male , Middle Aged , Neutralization Tests/methods , Serum/immunology , Vitreous Body/virologySubject(s)
Arterial Occlusive Diseases/virology , Chickenpox Vaccine/adverse effects , Herpes Zoster/virology , Peripheral Vascular Diseases/virology , Thrombosis/virology , Vaccines, Attenuated/adverse effects , Acyclovir/therapeutic use , Aged , Anticoagulants/therapeutic use , Antiviral Agents/therapeutic use , Arterial Occlusive Diseases/drug therapy , Arterial Occlusive Diseases/pathology , Drug Therapy, Combination , Heparin/therapeutic use , Herpes Zoster/pathology , Herpesvirus 3, Human , Humans , Male , Peripheral Vascular Diseases/drug therapy , Peripheral Vascular Diseases/pathology , Thrombosis/pathology , Treatment OutcomeSubject(s)
Cerebral Arterial Diseases/virology , Herpesvirus 3, Human/pathogenicity , Ischemic Attack, Transient/etiology , Peripheral Vascular Diseases/virology , Stroke/etiology , Afferent Pathways/virology , Animals , Antiphospholipid Syndrome/complications , Cats , Cerebral Arterial Diseases/complications , Cerebral Arteries/innervation , Cerebral Arteries/virology , Ganglia, Spinal/virology , Hemiplegia/etiology , Humans , Ischemic Attack, Transient/virology , Protein S Deficiency/complications , Stroke/virology , Thrombophilia/etiology , Trigeminal Nerve/virology , Virus LatencySubject(s)
Brain Ischemia/etiology , Cerebral Arterial Diseases/virology , Herpes Zoster/complications , Herpesvirus 3, Human/pathogenicity , Peripheral Vascular Diseases/etiology , Thrombosis/etiology , Adult , Antiphospholipid Syndrome/virology , Brain Ischemia/virology , Cerebral Arterial Diseases/complications , Cerebral Arteries/virology , Hemianopsia/etiology , Hemiplegia/etiology , Humans , Male , Perceptual Disorders/etiology , Peripheral Vascular Diseases/virology , Protein S Deficiency/virology , Retinal Artery Occlusion/etiology , Retinal Artery Occlusion/virology , Thrombophilia/virology , Thrombosis/virologyABSTRACT
Our aim was to detect markers of Chlamydia pneumoniae (CPN) and human cytomegalovirus (HCMV) infection in patients with peripheral vascular occlusive disease and to follow markers of inflammation, endothelial dysfunction and lipid metabolism alteration in patients with active infection. CPN genome was detected in 9 (47.4 %) patients by at least one PCR method. Serological markers of acute CPN infection were found in 5 (26.3 %) subjects; each of them showed also positivity in at least one of the PCR methods. HCMV DNA were detected in 2 (10.5 %) patients; HCMV-specific antibodies were detected in 14 (73.7 %) subjects, however only in IgG subclass. Subjects with HCMV PCR positivity thus showed no serological markers of active HCMV infection. Laboratory findings of acute CPN infection were associated with increased plasma levels of Lp(a), triacylglycerols, atherogenic index of plasma and E-selectin (p < 0.05). No significant differences were found in the other markers, including plasma levels of total cholesterol, ferritin, homocysteine, oxidized LDL, IL-6, IL-8, IL-18, TNF-alpha, soluble forms of VCAM-1 and ICAM-1, von Willebrand factor, C-reactive protein, and plasma nitrites & nitrates. Frequent presence of chlamydial DNA in atheromatous plaques from patients with peripheral vascular disease was confirmed. HCMV DNA was detected only sporadically and with positivity in anamnestic anti-HCMV antibodies (IgG) only, indicating a rare presence of latent virus rather than active replication. Patients with laboratory markers of acute CPN infection exhibited more pronounced alterations in lipid metabolism and endothelial dysfunction.
Subject(s)
Atherosclerosis/etiology , Chlamydophila Infections/complications , Chlamydophila pneumoniae/isolation & purification , Cytomegalovirus Infections/complications , Dyslipidemias/etiology , Endothelium, Vascular/physiopathology , Femoral Artery/pathology , Peripheral Vascular Diseases/etiology , Popliteal Artery/pathology , Vasculitis/etiology , Adult , Aged , Atherosclerosis/diagnostic imaging , Atherosclerosis/metabolism , Atherosclerosis/microbiology , Atherosclerosis/physiopathology , Atherosclerosis/virology , Biomarkers , Chlamydophila Infections/metabolism , Chlamydophila Infections/microbiology , Chlamydophila Infections/physiopathology , Constriction, Pathologic , Cytokines/blood , Cytomegalovirus Infections/metabolism , Cytomegalovirus Infections/physiopathology , Cytomegalovirus Infections/virology , DNA, Bacterial/analysis , DNA, Bacterial/blood , DNA, Viral/analysis , DNA, Viral/blood , Female , Femoral Artery/diagnostic imaging , Femoral Artery/metabolism , Femoral Artery/microbiology , Femoral Artery/virology , Humans , Ischemia/etiology , Leg/blood supply , Lipoprotein(a)/blood , Male , Middle Aged , Peripheral Vascular Diseases/diagnostic imaging , Peripheral Vascular Diseases/metabolism , Peripheral Vascular Diseases/microbiology , Peripheral Vascular Diseases/physiopathology , Peripheral Vascular Diseases/virology , Popliteal Artery/diagnostic imaging , Popliteal Artery/metabolism , Popliteal Artery/microbiology , Popliteal Artery/virology , Radiography , Vasculitis/metabolism , Vasculitis/microbiology , Vasculitis/physiopathology , Vasculitis/virology , Young AdultABSTRACT
OBJECTIVES: The aim of this case control study was to evaluate whether periodontitis was associated with peripheral arterial disease (PAD). SUBJECTS AND METHODS: Twenty-five patients diagnosed with aorto-iliac and/or femoro-popliteal occlusive disease and thirty-two generally healthy control subjects were enrolled in this study. Polymerase chain reaction (PCR) was used to identify Porphyromonas gingivalis, Treponema denticola, Actinobacillus actinomycetemcomitans, Prevotella intermedia, Cytomegalovirus (CMV), Chlamydia pneumoniae, and Helicobacter pylori in tissue specimens taken from the anastomotic site of distal bypasses. Periodontal status was evaluated; serum IgG titres against the four listed bacteria were measured. RESULTS: Periodontopathic bacteria were detected in 13/25 (52%) atherosclerotic specimens. CMV or C. pneumoniae was detected in 1/25 (4%) specimens; H. pylori was not detected from any of these specimens. Fontaine grade III or IV patients showed higher detection frequency of P. gingivalis than Fontaine grade II patients (57.1% vs 22.2%, P=0.09). After adjusting for age, gender, diabetes and smoking, periodontitis increased 5-fold the risk of having PAD (OR 5.45). There were preliminary indications that periodontitis was associated with increased serum IL-6 and TNF-alpha concentrations. CONCLUSIONS: This study suggests that periodontitis may be associated with an increased risk of PAD. This association could result from the increased concentration of serum inflammatory cytokines in those with periodontitis.
Subject(s)
Aortic Diseases/etiology , Arterial Occlusive Diseases/etiology , Femoral Artery , Iliac Artery , Periodontitis/complications , Peripheral Vascular Diseases/etiology , Popliteal Artery , Aged , Anastomosis, Surgical , Antibodies, Bacterial/blood , Antibodies, Viral/blood , Aortic Diseases/microbiology , Aortic Diseases/surgery , Aortic Diseases/virology , Arterial Occlusive Diseases/microbiology , Arterial Occlusive Diseases/surgery , Arterial Occlusive Diseases/virology , Case-Control Studies , Female , Femoral Artery/microbiology , Femoral Artery/surgery , Femoral Artery/virology , Humans , Iliac Artery/microbiology , Iliac Artery/surgery , Iliac Artery/virology , Interleukin-1beta/blood , Interleukin-6/blood , Male , Middle Aged , Odds Ratio , Periodontitis/microbiology , Periodontitis/surgery , Periodontitis/virology , Peripheral Vascular Diseases/microbiology , Peripheral Vascular Diseases/surgery , Peripheral Vascular Diseases/virology , Popliteal Artery/microbiology , Popliteal Artery/surgery , Popliteal Artery/virology , Risk Assessment , Risk Factors , Severity of Illness Index , Tumor Necrosis Factor-alpha/blood , Vascular Surgical ProceduresABSTRACT
Cardiovascular complications in the course of human immunodeficiency virus (HIV) infection are multifactorial and may be caused by the virus itself or by the related opportunistic infections and neoplasms. Highly active antiretroviral therapy (HAART) has prolonged many patients' lives, but many cardiac sequelae of HIV are not affected by HAART and continue to develop even with treatment. In addition, HAART itself causes in a high proportion of patients a metabolic syndrome, characterized by lipodystrophy/lipoatrophy, dyslipidemia and insulin resistance that may be associated with an increase in peripheral artery and coronary artery diseases. Careful cardiovascular evaluation in the course of HIV disease can identify cardiac complications early enough to treat. All HIV-infected patients candidate to antiretroviral therapy and patients already under treatment should undergo an assessment that includes the evaluation of the cardiovascular risk with the available guidelines.
Subject(s)
Anti-HIV Agents/adverse effects , Cardiovascular Diseases/chemically induced , Cardiovascular Diseases/virology , HIV Infections/drug therapy , HIV-1 , Protease Inhibitors/adverse effects , Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active , Arteriosclerosis/chemically induced , Arteriosclerosis/virology , Blood Coagulation Disorders/chemically induced , Blood Coagulation Disorders/virology , Coronary Disease/etiology , Coronary Disease/virology , Coronary Vessels/virology , Endothelium, Vascular/drug effects , Endothelium, Vascular/virology , Humans , Hypertension/chemically induced , Hypertension/virology , Peripheral Vascular Diseases/chemically induced , Peripheral Vascular Diseases/virology , Protease Inhibitors/therapeutic useABSTRACT
BACKGROUND: Chlamydia pneumoniae is a human respiratory pathogen that has recently been related to the genesis of symptomatic atherosclerosis. C. pneumoniae has been studied more widely in relation to coronary atherosclerosis than to peripheral arterial occlusive disease (PAOD). The present study aimed to retrospectively analyze the presence of C. pneumoniae DNA in patients with PAOD. MATERIALS AND METHODS: A seminested PCR method was applied on 85 samples from 71 patients with PAOD secondary to surgical treatment. The control group comprised 50 patients with chronic superficial venous insufficiency who required varicose resection surgery. RESULTS: The number of patients, number of samples studied and percentage of patients found to be positive in the PCR study were 17, 18 and 59%, respectively, for arteries of the lower extremities; 15, 16 and 60% for aneurysm of the abdominal aorta; 22, 23 and 73% for carotid stenosis and 17, 18 and 65% for aortic stenosis. C. pneumoniae DNA was found in six external pudendal arteries (12%) of the control group, significantly lower than the incidence in the patient group (p < 0.0001). CONCLUSION: A causal relationship between chronic C. pneumoniae infection and PAOD cannot be ruled out. On the contrary, the high incidence of C. pneumoniae DNA detected in our patients suggests that C. pneumoniae infection may play some role in the pathogenesis of peripheral vascular disease.
Subject(s)
Chlamydophila pneumoniae/isolation & purification , DNA, Bacterial/isolation & purification , Iliac Artery/virology , Peripheral Vascular Diseases/virology , Popliteal Artery/virology , Aged , Carotid Arteries/virology , Chlamydophila pneumoniae/genetics , Endarterectomy, Carotid , Female , Humans , Male , Middle Aged , Polymerase Chain Reaction , Retrospective StudiesSubject(s)
Anti-Bacterial Agents/therapeutic use , Peripheral Vascular Diseases/drug therapy , Skin Diseases/drug therapy , Anti-HIV Agents/therapeutic use , Bacterial Infections/drug therapy , Drug Therapy, Combination , HIV Infections/drug therapy , Humans , Peripheral Vascular Diseases/microbiology , Peripheral Vascular Diseases/virology , Skin Diseases/microbiology , Skin Diseases/prevention & controlABSTRACT
A woman with peripheral vascular disease developed cytomegalovirus colitis following repair of abdominal aortic aneurysm. Cytomegalovirus colitis developing in an immunocompetent individual may be caused by a breach in the integrity of the mucosal lining of the colon from various causes and should alert the clinician to explore these causes in order to provide effective care.