Mpox: Risks and approaches to prevention.

Since early May 2022, an outbreak due to Mpox virus (formerly called monkeypox) has occurred in many countries around the world. On July 23, the World Health Organization declared the outbreak 'Public Health Emergency of International Concern'. In order to combat the outbreak, it is important to have effective infection prevention and control plans. The first step is to qualitatively and quantitatively determine the risks of infections, followed by the design and implementation of infection prevention and control measures. Mpox is transmitted through direct, indirect, and prolonged contact, through sexual transmission, and via the respiratory route. Men who have sex with men are identified as the most vulnerable population. Home pet-raisers, and health care workers are at risk of catching the disease. The outcome of infection is catastrophic among the elderly, immunocompromised individuals, pregnant female and children. The spillover to animals is of great concern. It is important to communicate the risks and have community engagement in the control of this outbreak. The availability of vaccines will add to the capability of containing the outbreak. It is critical to prevent the virus from spreading further. Hence, we review the recent findings on the risk management of Mpox along with the preventive strategies.

Role of interferon gamma in SARS-CoV-2-positive patients with parasitic infections.

BACKGROUND: By 27 June 2020, almost half a million people had died due to COVID-19 infections. The susceptibility and severity of infection vary significantly across nations. The contribution of chronic viral and parasitic infections to immune homeostasis remains a concern. By investigating the role of interferon (IFN)-γ, we conducted this study to understand the connection between the decrease in numbers and severity of COVID-19 cases within parasitic endemic regions. Our research included 375 patients referred to hospitals for diagnosis of COVID-19 infection. Patients were subjected to full investigations, in particular severe acute respiratory syndrome coronavirus-2 nucleic acid and Toxoplasma IgM and IgG antibody detection, stool examination, and quantitative IFN-γ measurement. RESULTS: The majority of the studied cases had chest manifestation either alone (54.7%) or in association with gastrointestinal (GIT) manifestations (19.7%), whereas 25.6% had GIT symptoms. We reported parasitic infections in 72.8% of mild COVID-19 cases and 20.7% of severe cases. Toxoplasma gondii, Cryptosporidium, Blastocyst, and Giardia were the most common parasitic infections among the COVID-19 cases studied. CONCLUSION: The remarkable adaptation of human immune response to COVID-19 infection by parasitic infections with high levels of IFN-γ was observed in moderate cases compared with low levels in extreme cases. The potential therapeutic efforts aimed at the role of parasitic infection in immune system modulation are needed if this hypothesis is confirmed.

The Role of antiFcεRIα Autoantibodies Detection and Autologous Serum Skin Test in Comparison To Histamine Release Assay in Diagnosis of Chronic Autoimmune Urticaria.

Chronic autoimmune urticaria is manifested by wheals and itching for 6 weeks, which is mediated mainly by autoantibodies against IgE receptors (FcεRIα). We aimed to assess the role of IgG autoantibody against FcεRIα in combination with autologous plasma skin test (APST), and autologous serum skin test (ASST) for autoimmune urticaria (AIU) diagnosis. This study was a case control study of 47 chronic spontaneous urticaria (CSU) patients and 47 healthy controls. Patients and control were subjected to ASST, APST, and ELISA assay of serum autoantibodies to FcεRIα. Histamine release assay (HRA) as the gold standard method for autoimmune urticaria diagnosis was performed after basophil percoll isolation and subjected to sera of both patients and control. The validity of ASST and autoantibodies to FcεRIα were determined in comparison to HRA. Autologous serum skin test was positive in 30 (63.8%) of CSU patients, and 12.7% of the healthy control (P=0.000). IgG autoantibodies to FcεRIα were demonstrated in 55.5% of the patients and were more common in patients with positive (80%) than negative ASST (11.7%) (P=0.000). There was significant positive correlation between "ASST" and "APST" positivity, and clinical severity as Spearman coefficient for this correlation was 0.477 (P=0.001). There was a significant association between IgG positivity to FcεRIα and disease severity as Spearman coefficient was 0.360 (P=0.02). Combined "ASST", "APST" and FcεRIα autoantibody tests revealed 100% sensitivity and 100% specificity for autoimmune urticaria diagnosis. In conclusion, combined anti-FcεRIα assay, with ASST, and APST improved the diagnosis of chronic autoimmune urticaria among patients with chronic spontaneous urticaria.

Association between SERPINB2 Gene Expression by Real Time PCR in Respiratory Epithelial Cells and Atopic Bronchial Asthma Severity.

Atopic bronchial asthma is chronic respiratory diseases of high frequency and high morbidity and mortality especially in patients refractory to the ordinary medical management. This study aimed to investigate the association between Serpin family B Member 2 (SERPINB2) gene expression and bronchial asthma severity. A total of 127 adult patients with asthma were enrolled in this study. Allergic respiratory symptoms were assessed and patients were classified according to Global Initiative for Asthma (GINA) criteria. The patients were subjected to skin prick test (SPT) by commonly encountered aeroallergens and pulmonary function tests. Sputum samples were subjected to RNA extraction and real time PCR amplification (q PCR) of SERPINB2 mRNA. The relative gene expression was determined by fold change (2-??Ct) after calculation of delta-delta Ct (Cycle threshold of patients- Cycle threshold of healthy control). Assessment of the q PCR results was done by Receiver operating characteristic curve (ROC). Patients with severe bronchial asthma constituted 44% of asthma patients and mild asthma 22% of asthmatics. SPT revealed that 23 % of the patients were mono-sensitized and 77 % were poly-sensitized. The mites and pollens were the most frequently sensitizing allergens detected by SPT (53%, and 47%, respectively. SERPINB2 gene expression in asthma group that discriminated them from healthy control was > 0.01. The highest increase of expression was found ( > 1.92 fold) severe asthma compared to the mild group. A negative correlation was found between SERPINB2 expression and pulmonary function tests FEV1/FVC % and FEV1% (r?=?-0.921 and -0.805, P < 0.001), respectively. While significant positive correlation was found between SERPINB2 expression and total IgE levels (r?=?0.932 and P-value < 0.001), and SPT results (r?=?0.923 and P-value < 0.001). In conclusion, the expression level of SERPINB2 gene significantly correlated with the severity of bronchial asthma.

Food Specific IgE as A Biomarker of Oral Immunotherapy Efficacy in Comparison to Double Blind Food Challenge Test.

Specific immunotherapy (SIT) is one of the important lines for the treatment of food allergy. Efficacy tests for clinical response to SIT are limited and subjective. In this study, we aimed to evaluate the validity of food specific Ig E levels as a biomarker of clinical improvement in children with food allergy treated with oral immunotherapy (OIT). We analysed 184 children with food allergy, 143 had undergone 2 years of food OIT and 41 were on allergen restricted diet and considered as control. All patients were subjected to Double-Blind Placebo-Controlled Food Challenge test (DBPCFC), allergic symptom score calculation, and serum food specific Ig E level before and after oral immunotherapy for treated patients and after 2 year of allergen restricted diet for the control group. Receiver Ooperating Ccharacteristic Ccurves (ROCs) analysis was done to determine the cut off, areas under the curve, sensitivity, and specificity were calculated for the specific Ig E test. According to the result of DBPCFC and result of food specific Ig E test, milk Milk allergy was the most frequently food allergy as it was encountered in 76 children out of 184 children (41.3%) , followed by egg and fish allergy in 64(34.7%), and 44 (23.7%) cases, respectively. Oral desensitization was successful in 91 %, 82%, and 67% of patients with milk, Egg, and fish allergy, respectively. The OIT group showed a statistically significant greater reduction in symptom scores compared to the control group (P < 0.001). Also, there was a significant decrease in food specific Ig E level in responders for all types of food allergy tested (P ˂0.001), and . In responders group, there was significant correlation between the specific IgE level and symptom scores (r = 0.5, P = 0.03). Food specific Ig E levels cut off levels were < 0.8, < 2.05, and < 23 IU/ml allowed detection of effective OIT for milk, egg, and fish allergy, respectively. It is concluded that serum specific Ig E is correlated correlates with the clinical response to OIT and offers an advantage over double blind challenge test which is a risky and time consuming process.

Validity of Specific Immunoglobulin E Assay in Tear Film for Detection of Allergens Inducing Different Types of Allergic Conjunctivitis.

This is a prospective interventional comparative study which aimed to investigate correlation between tear film allergen specific IgE levels and the skin prick test in diagnosing different types of allergic conjunctivitis. One hundred twenty patients with allergic conjunctivitis were included in this study and were classified into 4 groups based on the type of allergic conjunctivitis. Patients were subjected to skin prick test (SPT). Micro capillary method was used to collect tear samples for the quantitative assessment of specific IgE by Immune blot assay. The most common allergens were mixed mould, mixed pollen, and mixed mite. The results of tear film specific IgE in detection of allergens were evaluated against the SPT. The Receiving Operating Characteristic Curve (ROCs) revealed that tear film allergen-specific IgE specificity was 100% and sensitivity was 75%-100% to the three common allergens in the 4 studied groups. The correlation between tear's specific IgE and skin prick test was statistically significant for pollen, mite, and mould allergens in patient with SAK (r = 0.821, P ˂ 0.001 for pollen, r = 0.964, P ˂ 0.001 for mite, and r= 0.811, P ˂ 0.02 for mould ), PAC (r = 0.851, P ˂ 0.001 for pollen, r = 0.826, P ˂ 0.001 for mite, and r= 0.861, P ˂ 0.001 for mould) and VKC (r = 0.802, P ˂ 0.001 for pollen, r = 0.894, P ˂ 0.001 for mite, and r= 0.861, P ˂ 0.061 for mould). In patient with AKC, the correlation was statistically significant for only mite allergen (r = 1, P ˂ 0.001). We concluded that Tear film specific IgE test can be considered as a good alternative to skin prick test in diagnosis of the causative allergens in allergic conjunctivitis.

Assessment of Nasal Immunoglobulin E Level in Atopic and Non-atopic Rhinitis Patients: A Tool for Diagnosis of Local Allergic Rhinitis.

Many cases of AR can be miss-diagnosed due to deficiency in the conventional laboratory tools. Detection of local Ig E immune response and allergy associated genes may aid in diagnosis of these cases. The local immune response and the allergy associated genes of these suspected cases must be evaluated as they may help in their characterization. This study was conducted on 129 patients with chronic rhinitis to determine the frequency of LAR, and analyze the association of IgE receptor (FcεR1ß) gene polymorphism with LAR. All participants were subjected to clinical questionnaire, skin prick test, specific IgE measurement in serum and nasal secretions and analysis of FcεR1ß gene polymorphism. LAR constituted 24.8 % of total rhinitis cases and 44.4% of non-allergic cases. Cockroach was the main sensitizing agent in local allergic rhinitis in comparison with allergic cases (OR =0.11; 95% CI= 0.04-0.34; P<0.001). In LAR, nasal specific Ig E was significantly lower than that in AR patients (P < 0.001). FcεR1ß genotype TT was more frequently expressed in LAR and AR than non-allergic rhinitis (NAR) (P< 0.001). It is concluded that LAR is an emerging allergic condition that could be diagnosed by nasal specific IgE, and that FcεR1ß polymorphism is one of the genetic factors associated with AR and LAR.