Fungal infection profile in critically ill COVID-19 patients: a prospective study at a large teaching hospital in a middle-income country.

BACKGROUND: Critically ill COVID-19 patients are highly susceptible to opportunistic fungal infection due to many factors, including virus-induced immune dysregulation, host-related comorbidities, overuse and misuse of antibiotics or corticosteroids, immune modulator drugs, and the emergencies caused by the pandemic. This study aimed to assess the incidence, identify the potential risk factors, and examine the impact of fungal coinfection on the outcomes of COVID-19 patients admitted to the intensive care unit (ICU). METHODS: A prospective cohort study including 253 critically ill COVID-19 patients aged 18 years or older admitted to the isolation ICU of Zagazig University Hospitals over a 4-month period from May 2021 to August 2021 was conducted. The detection of a fungal infection was carried out. RESULTS: Eighty-three (83) patients (32.8%) were diagnosed with a fungal coinfection. Candida was the most frequently isolated fungus in 61 (24.1%) of 253 critically ill COVID-19 patients, followed by molds, which included Aspergillus 11 (4.3%) and mucormycosis in five patients (1.97%), and six patients (2.4%) diagnosed with other rare fungi. Poor diabetic control, prolonged or high-dose steroids, and multiple comorbidities were all possible risk factors for fungal coinfection [OR (95% CI) = 10.21 (3.43-30.39), 14.1 (5.67-35.10), 14.57 (5.83-33.78), and 4.57 (1.83-14.88), respectively]. CONCLUSION: Fungal coinfection is a common complication of critically ill COVID-19 patients admitted to the ICU. Candidiasis, aspergillosis, and mucormycosis are the most common COVID-19-associated fungal infections and have a great impact on mortality rates.

Autoantibodies profile in autoimmune liver diseases and chronic viral hepatitis.

Despite their low prevalence, autoimmune liver diseases (AILD) cause liver cirrhosis, progress and leads to mortality from liver failure. Autoantibodies are confirmed to have significance in the early screening of AILD patients, especially in those who are asymptomatic before onset of clinical signs. This study aimed to assess levels of liver autoantibodies and their association with clinical manifestations of autoimmune liver diseases and chronic viral hepatitis (CVH) patients. This case-control study included 50 patients (case group of 25 patients with AILD and control group of 25 patients with CVH). They were investigated for presence of antibodies against LKM-1, AMA-M2, PML, M2-3E (BPO), gp210, Sp100, LC-1, Ro52 and SLA/LP using the line immune blot technique, and for the presence of antinuclear antibodies (ANA), as non-organ specific autoantibodies, using indirect immunofluorescence technique. Specific autoantibodies were detected in all AILD cases and some of their levels were significantly higher when compared with CVH group. Among AILD patients, 52% were positive for ANA, whereas 61.1% of chronic hepatitis C and 28.6% of chronic hepatitis B patients were positive for ANA with no significant difference (p=0.3). In conclusion, early diagnosis of autoimmune liver diseases has been linked to assessment of autoantibodies, allowing for prompt therapeutic intervention to stop the progression of liver cirrhosis and the accompanying complications.

Mannose-Binding Lectin Serum Level and Gene Polymorphism in Systemic Lupus Erythematosus Egyptian Patients.

Systemic lupus erythematosus (SLE) is an autoimmune disease in which the complement system plays a role in its pathogenesis. Mannose-binding lectin (MBL) is a serum protein, being a component of innate immune system, it is responsible for lectin pathway of complement activation. The presence of several polymorphisms at the coding regions of the MBL-2 gene, especially single point mutation at codon 54, leads to decreased level and /or functional deficits of MBL, which seems to be a risk factor for occurrence of autoimmune diseases, such as in SLE. So, this study was carried out to determine the role of the serum MBL concentration and the genetic polymorphisms of MBL-2 gene exon 1 codon 54 in Egyptian patients with SLE. Forty-eight SLE patients and 48 matched healthy controls were investigated. MBL serum level was measured by ELISA technique. MBL-2 polymorphism at exon 1 codon 54 was determined by PCR-RFLP. Our results revealed a significant reduction in MBL serum level among SLE patient group in comparison to the control group (P < 0.001). MBL-2 genotyping among SLE patients, revealed the wild type (A/A) in 52.1% and mutant types (A/B, B/B) in 47.9%. While among healthy controls, the wild type was detected in 81.2% and the mutant types in 18.8% with a statistically significant association between this polymorphism and SLE susceptibility (P=0.008). Comparison of MBL serum level among different genotypes within the patient group showed that the mutant allele had a suppressive effect on MBL serum level. In conclusion, carrying MBL-2 exon-1 codon 54 variant allele B was shown to be a risk factor for SLE.

Evaluation of Procalcitonin, C-Reactive Protein, and Interleukin-6 as Early Markers for Diagnosis of Neonatal Sepsis.

BACKGROUND: Neonatal sepsis diagnosis is a challenge because of its nonspecific presentation together with low sensitivity of the time-consuming bacterial cultures. So, many sepsis markers, like C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6), are emerging to improve its diagnosis. AIM: This study was done to investigate the role of CRP, PCT, and IL-6 in promoting the early diagnosis of neonatal sepsis in an attempt to decrease morbidity and mortality. METHODS: This cross-sectional study was conducted on 50 neonates suspected with sepsis enrolled from the neonatal intensive care unit (NICU) of Zagazig University Hospitals, Egypt. Blood cultures for these neonates were done before starting antibiotics. Also, bacterial DNA was revealed from the blood by broad-range 16S rDNA polymerase chain reaction (PCR). Measurements of CRP using the immunoturbidimetry method, PCT using fluorescence immunoassay quantitative method, and IL-6 using commercially available ELISA kit were done to all enrolled neonates. RESULTS: Forty-one neonates with proved sepsis were found to be positive in blood culture and/or PCR for bacterial 16S rDNA. The most common isolated organisms were Klebsiella (61.3%), followed by E. coli (9.7%) and CONS (9.7%). We detected much significant higher levels of PCT, CRP, and IL-6 in the proved sepsis group than the suspected neonatal sepsis cases (p ≤ 0.001, 0.001, and 0.004, respectively). Serum PCT levels showed the highest sensitivity, specificity, PPV, NPV, and accuracy of 97.6%, 89%, 97%, 88.9%, and 96% than other studied sepsis markers. CONCLUSION: PCT has satisfactory characteristics as a good marker than IL-6 and CRP for the diagnosis of neonatal sepsis.

Serum Level of CD48 and Its Expression on Blood Leukocytes in Persistent Asthmatic Patients.

CD48 is a surface receptor (mCD48) expressed on most hematopoietic cells, as well as in a soluble form (sCD48). It seems to play a major role in asthma through the interactions of mast cells with eosinophils via its ligand CD244. Hence, this study was done to evaluate the role of CD48, in its membrane and soluble forms, as a novel biomarker in asthma with various degrees of severity. One hundred participants were enrolled in this study and divided into 4 equal groups matched in age and sex; mild asthma, moderate asthma, severe asthma and apparently healthy controls. All were investigated for blood leukocytes mCD48 expression using flow cytometry and sCD48 in serum using ELISA. Our results revealed that the sCD48 was significantly elevated in patients with mild asthma compared with the controls (P<0.001) while significantly decreased in severe asthma than mild asthma (P<0.001) and moderate asthma (P=0.002) patient groups. Expression of mCD48 on eosinophils in moderate asthma group was significantly elevated compared with the control and the mild asthmatic groups (P<0.001). However, it was significantly decreased in severe asthma compared with moderate and mild asthma (P<0.001 and P=0.03, respectively). While it was significantly upregulated in severe asthmatic group compared to controls, patients with mild and moderate asthma on T-cell, B cells, Monocytes and NK cells (P<0.001 for all). In conclusion, CD48 may play a role in asthma and its level varies with severity of the disease being a useful marker in mild asthma.

Serum Level of IL 10 is Significantly Increased in Allergic Rhinitis Patients on Subcutaneous Immunotherapy and Vitamin D Supplementation.

For allergic rhinitis (AR), subcutaneous immunotherapy (SCIT) is proved to be effective in improving symptoms and outcome. It increases IL-10 production which helps in inducing peripheral tolerance to allergens. The role of vitamin D supplementation as an adjuvant to SCIT in patients with allergic rhinitis should be investigated. Objective of this study was to assess role of Vitamin D supplementation with SCIT in inducing tolerance to pollen, increasing IL10 and improving symptoms in AR patients. 48 AR patients were included. Skin prick test was done then baseline and final nasal symptoms scores rating, serum level of IL 10 and specific IgE were measured in two groups of patients; group 1 on SCIT and group 2 on SCIT and vitamin D supplementation. A statistically significant decrease of total nasal symptoms scores in group 2 when compared with group 1 (P < 0.001). IL 10 was increased in group 2 than group 1 with a statistically significant difference (P < 0.001) while, specific IgE was decreased in group 2 than group 1 with a statistically significant difference (P =0.01).There was a significant negative correlation between serum level of IL 10 and both nasal symptoms scoring and specific IgE (P < 0.001 and 0.028, respectively). In conclusion, serum level of IL 10 is significantly increased in AR patients on SCIT and Vitamin D supplementation.

Correlation between Relative Expression of IL 17 and PERP in Rheumatoid Arthritis Patients and Disease Activity.

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disorder. Decreased apoptosis is considered an important leading cause of autoimmune diseases. As IL17 and PERP can affect apoptosis process, they may contribute the pathogenesis and activity of RA. Objectives of this study were to investigate the possible correlation of IL 17 and PERP levels with RA pathogenesis and activity. Peripheral blood mononuclear cells (PBMCs) were isolated from fifty RA patients and fifty healthy subjects, RNA was extracted and subjected to real time PCR to detect the relative expression of IL17 and PERP. Results were correlated with RA disease activity parameters. Increased IL17 and decreased PERP mRNA expression levels were detected in patients as compared to the healthy controls (P˂0.001) and they were positively and inversely correlated with disease activity score for 28 joints (DAS28), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and rheumatoid factor (RF). A significant negative correlation between PERP and IL-17 mRNA expression levels was found (P ˂0.001). In conclusion, increased level of IL 17 and decreased level of PERP may constitute two major factors in the pathogenesis and activity of RA.