COVID - 19 Presenting with Fungal Infections - The Hidden Pandemic within Pandemic?

As the pandemic continues to spread vigorously, it is being noted that the COVID 19 virus is associated with various complications during the disease and also a great deal of post disease sequel.1 These gruelling complications are integrated with the overwhelming infection caused by the cytokine storm produced by the virus. While the treatment modalities are still under trial, glucocorticoids seem to have played a pivotal role in putting a check to the inflammation caused by the virus and have forbidden the organ damage caused thereafter. However, the aftermath of glucocorticoids usage has its own benefits and risks. Glucocorticoids cause cellular immunodeficiency and thus have immunosuppressive effects, additionally the use of immunomodulators such as tocilizumab alters the immune system and it subsequently predisposes the host to various secondary opportunistic infective agents. In the current state, as the pandemic abstains from fading away, an increasing trend of secondary fungal infections has been seen with COVID-19, resulting in an outbreak of fungal infections such as mucormycosis and candidiasis. Mucormycosis refers to any infection caused by the fungi of the Order Mucorales. Mucormycosis has been documented in the literature to be associated with a high rate of mortality due to its potential to spread drastically.2 Altered immunity is an important risk factor for mucormycosis. Additionally, diabetes has been noted to be critical for the development of mucormycosis in immunocompetent patients. Candidiasis is an infection caused by the candida species due to the immunosuppressed state developed by the use of glucocorticoids, which results in secondary fungal infection requiring urgent medical attention. The objective of this case report is to highlight the impending secondary fungal infection outbreak in COVID-19 and the need to contain this emerging spread of fungal infections under the blanket of this deadly pandemic.

MAIN FACTORS OF DECOMPENSATION SYSTEM I NFLAMMATORY REACTION SYNDROME THE PATIENTS WITH ABDOMINAL SEPSIS

Summary. The goal of the robot is to determine the factors of decompensation of the systemic inflammatory response syndrome (SIRS) in abdominal sepsis (AS). Materials and methods. Based on the results of a comprehensive examination of 295 patients with AS according to the indicators of clinical and laboratory, biochemical, immunological examination and study of intra-abdominal pressure and the severity of enteral insufficiency, the leading factors in the development of DSIRS were determined. Results and discussion. It was found that against the background of secondary cellular immunodeficiency, the development of severe compartment syndrome with decompensated enteric insufficiency syndrome (EIS) was determined, which in combination deepened pathological changes with the progression of the inflammatory reaction and the development of organ failure. Indicators of the level of C-reactive protein 2.5 times, and procalcitonin 2.4 times were higher during hospitalization of patients with decompensated syndrome (P<0.001). With decompensation, a severe degree of SES was diagnosed 18.5 times more often, and with a compensated one, a mild degree of insufficiency was diagnosed 57 times more often, P <0.001. At the same time, a direct correlation was determined between the severe degree of EIS and symptoms of nausea (r = 0.420), vomiting (r = 0.573) and bloating (r = 0.251), (P <0.005). The immunoregulatory index (IRI) played the role of a marker of decompensation in patients with AS, (r = + 0.74, at p <0.01) with the development of secondary immunodeficiency, according to the T-suppressor type. In 60.8 % (n = 101) of cases with DSIRS, the fourth degree of intra-abdominal pressure was determined, on average it was (46.3 ± 6.3) mm, and I degree was determined only in the case of compensation, (P <0.001). More often in patients with DSIRS, the associations of gram-positive microorganisms and enterococci were determined — in 55.6 % and streptococci — in 38.1 % of cases. At the same time, in 81.3 % of cases, patients with DSIRS were diagnosed with aerobic-anaerobic mixed flora. Сonclusion. The obtained results of the study require the development of treatment methods that will effectively correct these pathogenetic changes in all directions in patients with AS.

DiGeorge syndrome presenting with seizure in neonatal period: a case report

DiGeorge syndrome is caused by a micro-deletion of chromosome 22q11.2 that disrupts development of the third and fourth pharyngeal pouches during early embryogenesis. Other structures forming at the same period are also frequently affected. So, the phenotypic spectrum shows a wide variability. In this case report, we describe a 1-month and 24-day old male child who presented with history of recurrent afebrile seizure and noisy breathing since early neonatal period. He had history of repeated chest infections. On examination, patient had stridor, facial dysmorphism, pectus excavatum and clinical features of pneumonia. Investigations revealed hypocalcaemia, hypoparathyroidism, consolidation on X-ray chest and cellular immunodeficiency. Echocardiography findings were normal. Fluorescent in situ hybridization (FISH) was performed which confirmed the diagnosis 22q11.2 deletion. Birdem Med J 2021; 11(2): 128-132

Developing Threshold Parameters to Administer Live Vaccines in Cellular Immunodeficiency: A Survey of Practicing Clinical Immunologists

Live vaccines are contraindicated in patients with severe cellular immunodeficiencies while guidelines regarding the administration of live vaccines in patients with more mild disease are ill-defined. We sought to decipher different parameters used by practicing immunologists for the administration of live vaccines in cellular immunodeficiency patients. A 27-question survey assessing clinical and laboratory threshold parameters used in the administration of live vaccines to immunodeficient patients was distributed to practicing clinicians specializing in immune deficiencies. There were 83 survey respondents, 65% identified as female, and 71% were based in the United States. Allergy / Immunology and Immunodeficiency were the most common identified specialties, accounting for 84% of respondents. Most clinicians did administer live vaccines to patients with humoral (54/67; 80.6%), cellular (41/67; 61.2%), and combined diseases (37/67; 55.2%) . Most clinicians who reported giving live vaccines to patients with immune deficiencies considered a threshold CD4 count of ≥ 400 cells/mm3 (MMR 48/60 [80%], Varicella 42/53 [79%], Rotavirus 40/45 [88.89%]), a CD8 count of ≥ 250 cells/mm3 (MMR 30/39 [76.92%], Varicella 29/37 [78.34%], Rotavirus 27/34 [79.41%]), and normal mitogen function (MMR 44/53 [83.02%], Varicella 40/48 [83.33%], Rotavirus 37/40 [92.5%]). Using these survey results, we propose a treatment threshold of using CD4 count of ≥ 400 cells/mm3, a CD8 count of ≥ 250 cells/mm3, and normal lymphocyte proliferative responses to mitogen. Future studies are needed to determine clinical efficacy and safety using these thresholds.

Immune profile of oil production enterprise employees

Introduction. The assessment of the immune profile of employees of the oil-producing enterprise, the formation of the immunological status of which is determined by the conditions of harmful production factors affecting their health.The aim of the study was to assess the state of cellular immunity in oil-producing enterprise employees (on the example of the Perm region).Materials and methods. 60 men working at the oil-producing enterprise of the Perm region were examined. In the observation group (n=30) were included surveyed male workers-operators of oil production, in the comparison group — surveyed male workers — representatives of the administrative apparatus. The state of cellular immunity was assessed by indicators of cellular regulation and apoptosis. Cell differentiation marker T-reg-CD4+CD127 -, expression level of Bcl–2, Bax, p53 proteins, TNFR receptors and AnnexinV-FITC+7AAD negative cells were determined by flow cytometry.Results. The comparative analysis with physiological norm indicators allowed to reveal reliable hyperproduction of membrane and intracellular factors of cellular immunity in oil production operators. Expression of regulatory marker CD127-, proteins Bax, Bcl–2 and p53, TNFR receptor content and AnnexinV-FITC+7AAD negative cells responsible for natural cell death (p<0.05) was established. The indicators of the observation group differed significantly from those of the comparison group. There was a significant inhibition of expression of CD-marker CD127-and apoptic protein Bcl–2 by more than 10%, an increase in TNFR, AnnexinV-FITC+7AAD negative cells, protein Bax and p53 by 1.3, 1.6 and 1.2 times, respectively.Conclusions. The results of immunological screening allowed to establish an imbalance of cellular immunity in oil-producing enterprise workers — a deficiency of regulatory cells and a protein-controller of cell death with simultaneous excessive activation of cell reception, which later forms the phenomenon of cellular immunodeficiency. The high sensitivity of the membrane and cytoplasmic components of the immune profile allows them to be used as indicators of the health status of oil production operators, timely identify the development of regulatory imbalance of the immune system, early violations of cell-associated pathological processes (cellular immunodeficiency, autoimmune and proliferative processes), as well as timely and effective implementation of measures to prevent the development of production-related diseases working at oil production facilities.

Immunotropic aspect of the Bacillus coagulans probiotic action

Immunotropic aspect of the Bacillus coagulans probiotic actionObjectiveCurrently, probiotics are increasingly used as the alternative to antibiotics as well as the preventive measures in humans. In particular, probiotics occupy a key position in the treatment of antibiotics-associated intestinal dysbiosis. A spore-forming microorganism lactobacillus Bacillus coagulans is one of the most promising probiotics. However, some of its pharmacological effects remain poorly understood.Aim.This study is aimed at investigation of the effect of Bacillus coagulans (Laktovit Forte) on the intestinal dysbiosis syndrome in mice caused by streptomycin against the background of cyclophosphamide-induced cellular immunodeficiency.Methods.Pharmacological method: mouse model in vivo with immunodeficiency caused by cyclophosphamide.Key findings.In mice with colitis caused by streptomycin treatment, the administration of Bacillus coagulans (Laktovit Forte medicinal product) resulted in an antidiarrheal effect, normalization of gastrointestinal motility, and prevention of the animals’ weight loss. Given the cyclophosphamide-induced immunosuppression and streptomycin-associated diarrhoea, the immunity was completely restored only under the action of Bacillus coagulans.Conclusions.According to all parameters, Bacillus coagulans has been proved to be more effective as compared to the Linex Forte reference product containing lacto‐ and bifidobacteria.