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Radiology Case Reports Jul 2022Infected endometriomas are rarely described in the literature with most cases being managed laparoscopically or open laparotomy. We present an infected endometrioma in a...
Infected endometriomas are rarely described in the literature with most cases being managed laparoscopically or open laparotomy. We present an infected endometrioma in a 48-year-old female with a history of extensive peritoneal adhesions in the setting of a contralateral tubo-ovarian abscess that was unresponsive to antibiotic therapy. Initially, the tubo-ovarian abscess was percutaneously drained, however, the patient did not clinically improve. The suspected infected endometrioma was then percutaneously drained which then led to clinical improvement. Typically, endometriomas are managed laparoscopically chiefly due to the risk of content spillage into the peritoneum, however, the case presented demonstrated that an ultrasound-guided transabdominal approach drainage can be feasible in a surgically complicated patient who was unresponsive to antibiotics in which a percutaneous approach was favored rather than a surgical approach.
PubMed: 35601388
DOI: 10.1016/j.radcr.2022.04.027 -
Epidemiology and Infection Nov 2022Episodes of bacterial superinfections have been well identified for several respiratory viruses, notably influenza. In this retrospective study, we compared the...
Episodes of bacterial superinfections have been well identified for several respiratory viruses, notably influenza. In this retrospective study, we compared the frequency of superinfections in COVID-19 patients to those found in influenza-positive patients, and to controls without viral infection. We included 42 468 patients who had been diagnosed with COVID-19 and 266 261 subjects who had tested COVID-19 negative between 26 February 2020 and 1 May 2021. In addition, 4059 patients were included who had tested positive for the influenza virus between 1 January 2017 and 31 December 2019. Bacterial infections in COVID-19 patients were more frequently healthcare-associated, and acquired in ICUs, were associated with longer ICU stays, and occurred in older and male patients when compared to controls and to influenza patients ( < 0.0001 for all). The most common pathogens proved to be less frequent in COVID-19 patients, including fewer cases of bacteraemia involving ( < 0.0001) and ( = 0.027) when compared to controls. In respiratory specimens ( < 0.0001) was more frequent in controls, while ( < 0.0001) was more frequent in influenza patients. Likewise, species associated with nosocomial transmission, such as and , were more frequent among COVID-19 patients. Finally, we observed a high frequency of bacteraemia among COVID-19 patients, which were mainly ICU-acquired and associated with a longer timescale to acquisition.
Topics: Humans; Male; Aged; COVID-19; Superinfection; Retrospective Studies; Influenza, Human; Escherichia coli; Bacterial Infections; Hospitals; Bacteremia
PubMed: 36345840
DOI: 10.1017/S0950268822001704 -
Annals of Hepatology 2023Hepatitis E virus (HEV) superinfection is a common excerbating event in patients with chronic hepatitis B, but the impact on the long-term prognosis is not clear. This... (Observational Study)
Observational Study
INTRODUCTION AND OBJECTIVES
Hepatitis E virus (HEV) superinfection is a common excerbating event in patients with chronic hepatitis B, but the impact on the long-term prognosis is not clear. This study investigates the specific role of HEV superinfection in the long-term outcome of hepatitis B virus (HBV) patients with liver cirrhosis.
PATIENTS AND METHODS
A retrospective, observational cohort study was conducted using clinical, laboratory, and survival data collected from patients suffering from hepatitis B cirrhosis with or without HEV superinfection. Disease progression and mortality rates were analyzed.
RESULTS
After a two-year follow-up, HEV superinfection was identified in 27 of 811 patients. The transplantation-free mortality was significantly increased (51.9% vs. 14.3%, p< 0.001) in HEV superinfection compared to that in hepatitis B cirrhosis patients without HEV superinfection. Logistic regression analysis demonstrated that elderly people were independent host risk factors for hepatitis B cirrhosis patients with HEV superinfection before and after propensity score matching (PSM). Moreover, HEV superinfection was a risk factor for patients with hepatitis B cirrhosis with new acute decompensation (AD) and acute-on-chronic liver failure (ACLF) during hospitalization. A multivariate Cox proportional hazards regression model demonstrated that acute HEV co-infection is associated with two-year mortality (hazard ratio [HR]: 2.49; 95% CI: 1.40-4.43; p= 0.002; and HR: 5.79; 95% CI: 1.87-17.87; p= 0.002) in patients with hepatitis B cirrhosis before and after PSM.
CONCLUSIONS
Elder patients with hepatitis B cirrhosis are susceptible to HEV superinfection, accelerating disease progression and increasing long-term mortality in hospitalized patients with HBV-related decompensated liver cirrhosis.
Topics: Humans; Aged; Hepatitis B virus; Hepatitis E virus; Retrospective Studies; Superinfection; Hepatitis B, Chronic; Hepatitis E; Liver Cirrhosis; Hepatitis B; Disease Progression; Acute-On-Chronic Liver Failure; Acute Disease
PubMed: 36417965
DOI: 10.1016/j.aohep.2022.100878 -
Viruses Nov 2020"Cross-protection", a nearly 100 years-old virological term, is suggested to be changed to "close protection". Evidence for the need of such change has accumulated over... (Review)
Review
"Cross-protection", a nearly 100 years-old virological term, is suggested to be changed to "close protection". Evidence for the need of such change has accumulated over the past six decades from the laboratory experiments and field tests conducted by plant pathologists and plant virologists working with different plant viruses, and, in particular, from research on (CTV). A direct confirmation of such close protection came with the finding that "pre-immunization" of citrus plants with the variants of the T36 strain of CTV but not with variants of other virus strains was providing protection against a fluorescent protein-tagged T36-based recombinant virus variant. Under natural conditions close protection is functional and is closely associated both with the conservation of the CTV genome sequence and prevention of superinfection by closely similar isolates. It is suggested that the mechanism is primarily directed to prevent the danger of virus population collapse that could be expected to result through quasispecies divergence of large RNA genomes of the CTV variants continuously replicating within long-living and highly voluminous fruit trees. This review article provides an overview of the CTV cross-protection research, along with a discussion of the phenomenon in the context of the CTV biology and genetics.
Topics: Citrus; Closterovirus; Cross Protection; Evolution, Molecular; Genome, Viral; Genomics; Host-Pathogen Interactions; Phenotype; Plant Diseases; Superinfection; Virus Replication
PubMed: 33256049
DOI: 10.3390/v12121353 -
Critical Care Explorations Jun 2021To describe the epidemiology of superinfections (occurring > 48 hr after hospital admission) and their impact on the ICU and 28-day mortality in patients with...
UNLABELLED
To describe the epidemiology of superinfections (occurring > 48 hr after hospital admission) and their impact on the ICU and 28-day mortality in patients with coronavirus disease 2019 with acute respiratory distress syndrome, requiring mechanical ventilation.
DESIGN
Retrospective analysis of prospectively collected observational data.
SETTING
University-affiliated adult ICU.
PATIENTS
Ninety-two coronavirus disease 2019 patients admitted to the ICU from February 21, 2020, to May 6, 2020.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
The prevalence of superinfection at ICU admission was 21.7%, and 53 patients (57.6%) had at least one superinfection during ICU stay, with a total of 75 (82%) ventilator-associated pneumonia and 57 (62%) systemic infections. The most common pathogens responsible for ventilator-associated pneumonia were ( = 26, 34.7%) and ( = 14, 18.7%). Bloodstream infection occurred in 16 cases, including methicillin-resistant ( = 8, 14.0%), species ( = 6, 10.5%), and species ( = 2, 3.5%). Fungal infections occurred in 41 cases, including 36 probable (30 by , six by ) and five proven invasive candidiasis (three , two ). Presence of bacterial infections (odds ratio, 10.53; 95% CI, 2.31-63.42; = 0.005), age (odds ratio, 1.17; 95% CI, 1.07-1.31; = 0.001), and the highest Sequential Organ Failure Assessment score (odds ratio, 1.27; 95% CI, 1.06-1.63; = 0.032) were independently associated with ICU or 28-day mortality.
CONCLUSIONS
Prevalence of superinfections in coronavirus disease 2019 patients requiring mechanical ventilation was high in this series, and bacterial superinfections were independently associated with ICU or 28-day mortality (whichever comes first).
PubMed: 34136819
DOI: 10.1097/CCE.0000000000000430 -
Proceedings of the National Academy of... Oct 2022A key but poorly understood stage of the bacteriophage life cycle is the binding of phage receptor-binding proteins (RBPs) to receptors on the host cell surface, leading...
A key but poorly understood stage of the bacteriophage life cycle is the binding of phage receptor-binding proteins (RBPs) to receptors on the host cell surface, leading to injection of the phage genome and, for lytic phages, host cell lysis. To prevent secondary infection by the same or a closely related phage and nonproductive phage adsorption to lysed cell fragments, superinfection exclusion (SE) proteins can prevent the binding of RBPs via modulation of the host receptor structure in ways that are also unclear. Here, we present the cryogenic electron microscopy (cryo-EM) structure of the phage T5 outer membrane (OM) receptor FhuA in complex with the T5 RBP pb5, and the crystal structure of FhuA complexed to the OM SE lipoprotein Llp. Pb5 inserts four loops deeply into the extracellular lumen of FhuA and contacts the plug but does not cause any conformational changes in the receptor, supporting the view that DNA translocation does not occur through the lumen of OM channels. The FhuA-Llp structure reveals that Llp is periplasmic and binds to a nonnative conformation of the plug of FhuA, causing the inward folding of two extracellular loops via "reverse" allostery. The inward-folded loops of FhuA overlap with the pb5 binding site, explaining how Llp binding to FhuA abolishes further infection of by phage T5 and suggesting a mechanism for SE via the jamming of TonB-dependent transporters by small phage lipoproteins.
Topics: Bacterial Outer Membrane Proteins; Bacteriophage Receptors; Bacteriophages; Escherichia coli; Escherichia coli Proteins; Humans; Lipoproteins; Receptors, Virus; Superinfection; T-Phages
PubMed: 36215462
DOI: 10.1073/pnas.2211672119 -
Microbiology Spectrum Jun 2022Superinfection exclusion (SIE) is a phenomenon in which a primary viral infection interferes with secondary viral infections within that same cell. Although SIE has been...
Superinfection exclusion (SIE) is a phenomenon in which a primary viral infection interferes with secondary viral infections within that same cell. Although SIE has been observed across many viruses, it has remained relatively understudied. A recently characterized glycoprotein D (gD)-independent SIE of alphaherpesviruses presents a novel mechanism of coinfection restriction for herpes simplex virus 1 (HSV-1) and pseudorabies virus (PRV). In this study, we evaluated the role of multiplicity of infection (MOI), receptor expression, and trafficking of virions to gain greater insight into potential mechanisms of alphaherpesvirus SIE. We observed that high-MOI secondary viral infections were able to overcome SIE in a manner that was independent of receptor availability. We next assessed virion localization during SIE through live microscopy of fluorescently labeled virions and capsid assemblies. Analysis of these fluorescent assemblies identified changes in the distribution of capsids during SIE. These results indicate that SIE during PRV infection inhibits viral entry or fusion while HSV-1 SIE inhibits infection through a postentry mechanism. Although the timing and phenotype of SIE are similar between alphaherpesviruses, the related viruses implement different mechanisms to restrict coinfection. Most viruses utilize a form of superinfection exclusion to conserve resources and control population dynamics. gD-dependent superinfection exclusion in alphaherpesviruses is well documented. However, the undercharacterized gD-independent SIE provides new insight into how alphaherpesviruses limit sequential infection. The observations described here demonstrate that gD-independent SIE differs between PRV and HSV-1. Comparing these differences provides new insights into the underlying mechanisms of SIE implemented by two related viruses.
Topics: Animals; Coinfection; Herpesvirus 1, Human; Herpesvirus 1, Suid; Superinfection; Virion
PubMed: 35604159
DOI: 10.1128/spectrum.00684-22 -
PLoS Computational Biology May 2022Viral superinfection occurs when multiple viral particles subsequently infect the same host. In nature, several viral species are found to have evolved diverse...
Viral superinfection occurs when multiple viral particles subsequently infect the same host. In nature, several viral species are found to have evolved diverse mechanisms to prevent superinfection (superinfection exclusion) but how this strategic choice impacts the fate of mutations in the viral population remains unclear. Using stochastic simulations, we find that genetic drift is suppressed when superinfection occurs, thus facilitating the fixation of beneficial mutations and the removal of deleterious ones. Interestingly, we also find that the competitive (dis)advantage associated with variations in life history parameters is not necessarily captured by the viral growth rate for either infection strategy. Putting these together, we then show that a mutant with superinfection exclusion will easily overtake a superinfecting population even if the latter has a much higher growth rate. Our findings suggest that while superinfection exclusion can negatively impact the long-term adaptation of a viral population, in the short-term it is ultimately a winning strategy.
Topics: Humans; Superinfection
PubMed: 35536864
DOI: 10.1371/journal.pcbi.1010125 -
Chest Jul 2021A 65-year-old man presented with shortness of breath, gradually worsening for the previous 2 weeks, associated with dry cough, sore throat, and diarrhea. He denied...
A 65-year-old man presented with shortness of breath, gradually worsening for the previous 2 weeks, associated with dry cough, sore throat, and diarrhea. He denied fever, chills, chest pain, abdominal pain, nausea, or vomiting. He did not have any sick contacts or travel history outside of Michigan. His medical history included hypertension, diabetes mellitus, chronic kidney disease, morbid obesity, paroxysmal atrial fibrillation, and tobacco use. He was taking amiodarone, carvedilol, furosemide, pregabalin, and insulin. The patient appeared to be in mild respiratory distress. He was afebrile and had saturation at 93% on 3 L of oxygen, heart rate of 105 beats/min, BP of 145/99 mm Hg, and respiratory rate of 18 breaths/min. On auscultation, there were crackles on bilateral lung bases and chronic bilateral leg swelling with hyperpigmented changes. His WBC count was 6.0 K/cumm (3.5 to 10.6 K/cumm) with absolute lymphocyte count 0.7 K/cumm (1.0 to 3.8 K/cumm); serum creatinine was 2.81 mg/dL (0.7 to 1.3 mg/dL). He had elevated inflammatory markers (serum ferritin, C-reactive protein, lactate dehydrogenase, D-dimer, and creatinine phosphokinase). Chest radiography showed bilateral pulmonary opacities that were suggestive of multifocal pneumonia (Fig 1). Nasopharyngeal swab for SARS-CoV-2 was positive. Therapy was started with ceftriaxone, doxycycline, hydroxychloroquine, and methylprednisolone 1 mg/kg IV for 3 days. By day 3 of hospitalization, he required endotracheal intubation, vasopressor support, and continuous renal replacement. Blood cultures were negative; respiratory cultures revealed only normal oral flora, so antibiotic therapy was discontinued. On day 10, WBC count increased to 28 K/cumm, and chest radiography showed persistent bilateral opacities with left lower lobe consolidation. Repeat respiratory cultures grew Pseudomonas aeruginosa (Table 1). Antibiotic therapy with IV meropenem was started. His condition steadily improved; eventually by day 20, he was off vasopressors and was extubated. However, on day 23, he experienced significant hemoptysis that required reintubation and vasopressor support.
Topics: Aged; Antifungal Agents; Aspergillus niger; COVID-19; Clinical Deterioration; Critical Illness; Critical Pathways; Diagnosis, Differential; Hemoptysis; Humans; Invasive Pulmonary Aspergillosis; Lung; Male; Pseudomonas aeruginosa; Radiography, Thoracic; Respiration, Artificial; SARS-CoV-2; Superinfection; Tomography, X-Ray Computed; Treatment Outcome; Voriconazole
PubMed: 34246387
DOI: 10.1016/j.chest.2021.01.069 -
Blood Purification 2023This study investigates the impact of sequential extracorporeal treatments with oXiris® or CytoSorb® plus Seraph-100® on the clinical and laboratory parameters of... (Observational Study)
Observational Study
INTRODUCTION
This study investigates the impact of sequential extracorporeal treatments with oXiris® or CytoSorb® plus Seraph-100® on the clinical and laboratory parameters of critically ill COVID-19 patients with bacterial superinfection.
METHODS
Patients admitted to the intensive care unit with COVID-19, bacterial superinfection, and undergoing blood purification (BP) were enrolled in this prospective, single-center, observational study. "standard BP" with oXiris® or CytoSorb® were used in 35 COVID-19 patients with bacterial infection. Seraph-100® was added in 33 patients when available serially in the same oXiris® circuit or as sequential treatment with CytoSorb® as a sequential BP.
RESULTS
A significant reduction in SOFA score 3 days after treatment was observed in patients undergoing sequential BP (11.3 vs. 8.17, p < 0.01) compared to those undergoing "standard BP" (11.0 vs. 10.3, p > 0.05). The difference between the observed and expected mortality rate based on APACHE IV was greater in the sequential BP group (42.4% vs. 81.7%, p < 0.001) than the "standard BP" (74.2% vs. 81.7%, p > 0.05). Patients treated with sequential BP had a longer survival than those treated with "standard BP" (22.4 vs. 18.7 months; p < 0.001).
CONCLUSIONS
The sequential approach may enhance the positive effect of BP on organ dysfunction among critically ill patients with COVID-19 and bacterial superinfection.
Topics: Humans; COVID-19; Critical Illness; Prospective Studies; Superinfection; Intensive Care Units; Retrospective Studies
PubMed: 37482053
DOI: 10.1159/000531356