Some Clinical and Immunological Features of Imported COVID-19 Cases in Mongolia

SARS-CoV-2 disturbs the normal immune responses causing an uncontrolled inflammatory response in patients with severe COVID-19. The pattern of the immune response to the SARS-CoV-2 in individuals may fluctuate. Some have a virus-dependent protective immune response resulting in asymptomatic or mild disease with elimination of the virus within 7-10 days after onset of infection. Others develop virus non-dependent uncontrolled hyper-inflammation in the later period, leading to severe disease with cytokine storm, acute respiratory distress syndrome, disseminated intravascular coagulation and multi-organ failure. Methods: The serum of 72 patients was investigated for titers of 15 cytokines and chemokines using Enzyme-linked immunosorbent assay (ELISA) kits in the serum of peripheral blood samples. The means of groups were compared using ANOVA followed by Tukey multiple post hoc comparisons if the ANOVA p-value was <0.05. Results: Patients with pulmonary infiltrates on CT demonstrated a lower percentage of eosinophils (1.38±1.46%) and elevated level of serum CRP (8.57±19.10 mg/dL) compared to patients without pulmonary infiltrates (2.52±1.47% and 1.96±3.02 mg/dL respectively; p<0.05). ROC analysis for patients aged ≥35 years showed patients with mild disease (n=3) had a significantly higher titer of IL-1α and MCP-1 (AUC, 0.958 and 0.917 respectively, p<0.05) compared to patients with moderate disease (n=7).

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Characterization of the Immune Response during Infection Caused by Clostridioides difficile

Microorganisms ◽

10.3390/microorganisms7100435 ◽

2019 ◽

Vol 7 (10) ◽

pp. 435 ◽

Cited By ~ 2

Author(s):

Hamo ◽

Azrad ◽

Nitzan ◽

Peretz

Keyword(s):

Immune Response ◽

Severe Disease ◽

Interferon Α ◽

T Helper 1 ◽

Serum Samples ◽

Mild Disease ◽

Clostridioides Difficile ◽

Cytokines And Chemokines ◽

Clostridioides Difficile Infection ◽

Macrophage Colony

The high risk of complications and death following Clostridioides difficile infection (CDI) requires identifying patients with severe disease and treating them accordingly. We characterized the immune response of CDI patients in relation to infection severity. Concentrations of 28 cytokines and chemokines were measured in serum samples, obtained from 54 CDI patients within a median timeframe of 24–48 h after laboratory confirmation of C. difficile infection. Demographic and clinical data were retrospectively collected from medical records. Disease severity score was determined by “Score indices for Clostridioides difficile infection severity”. Of 54 patients (mean age, 76.6 years, 61.1% female), 38 (70.4%) had mild disease and 16 (29.6%) had moderate disease. Seven cytokines were associated with a more severe CDI: granulocyte-macrophage colony-stimulating factor (p = 0.0106), interleukin (IL)-1β (p = 0.004), IL-8 (p = 0.0098), IL-12p70 (p = 0.0118), interferon-α (p = 0.0282), IL-15 (p = 0.0015), and IL-2 (p = 0.0031). Additionally, there was an increased T-helper 1 response in more severe cases of CDI. Cytokines may serve as biomarkers for early prediction of CDI severity. Better and earlier assessment of illness severity will contribute to the adjustment of medical treatment, including monitoring and follow-up.

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1329 Can One Size Fit All: Is Laparoscopic Roux-En-Y Gastric Bypass the Best Bariatric Procedure for Treating Type 2 Diabetes Mellitus (T2DM)?

British Journal of Surgery ◽

10.1093/bjs/znab259.194 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

V Mahendran ◽

P Ricart ◽

S Robinson ◽

A Perry ◽

M Wadley

Keyword(s):

Bariatric Surgery ◽

Gastric Bypass ◽

Retrospective Cohort ◽

Severe Disease ◽

Morbidly Obese ◽

Disease Remission ◽

Mild Disease ◽

Moderate Disease ◽

Remission Rates

Abstract Introduction Bariatric surgery produces superior weight loss and reversal of comorbidities in morbidly obese individuals compared to medical therapy alone. Laparoscopic Roux-en-Y gastric bypass (LRYGB) was traditionally considered to prolonged remission of T2DM compared to other procedures such as Laparoscopic Sleeve-Gastrectomy (LSG). But recently published studies seek to disprove this by emphasising on duration and severity of T2DM before surgery rather than the type of procedure. We aim to verify if the severity of T2DM and type of operation (LRYGB Vs LSG) influence remission rates. Method In this retrospective cohort study, 204 patients were diagnosed with T2DM pre-operatively and had undergone either LRYGB or LSG. We used the Individualised Metabolic Surgery Score (IMSS) tool to divide patients into mild, moderate, and severe categories. Results Results showed that of the 204 patients 15% (n = 31) had mild disease, 62%( n = 127) had moderate disease and 23% (n = 46) had severe disease. Remission rates in each category were as follows: Conclusions We agree that patients with longstanding and severe T2DM have low remission rates after bariatric surgery, probably due to diminished beta-cell reserve. It is in contrary to recent publications which recommend LSG over LRYGB in patients with severe disease. This evidence necessitates further prospective studies before deciding which is the best procedure for patients with severe and longstanding T2DM.

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Comparison of the Immunogenicities and Cross-Lineage Efficacies of Live Attenuated Peste des Petits Ruminants Virus Vaccines PPRV/Nigeria/75/1 and PPRV/Sungri/96

Journal of Virology ◽

10.1128/jvi.01471-18 ◽

2018 ◽

Vol 92 (24) ◽

Cited By ~ 12

Author(s):

Sophia Hodgson ◽

Katy Moffat ◽

Holly Hill ◽

John T. Flannery ◽

Simon P. Graham ◽

...

Keyword(s):

Immune Response ◽

T Cells ◽

Immune Responses ◽

Severe Disease ◽

Small Ruminants ◽

Virus Antigen ◽

Enzyme Linked Immunosorbent Assay ◽

Peste Des Petits Ruminants ◽

Systematic Analysis ◽

Genetic Lineages

ABSTRACTPeste des petits ruminants (PPR) is a severe disease of goats and sheep that is widespread in Africa, the Middle East, and Asia. Several effective vaccines exist for the disease, based on attenuated strains of the virus (PPRV) that causes PPR. While the efficacy of these vaccines has been established by use in the field, the nature of the protective immune response has not been determined. In addition, while the vaccine derived from PPRV/Nigeria/75/1 (N75) is used in many countries, those developed in India have never been tested for their efficacy outside that country. We have studied the immune response in goats to vaccination with either N75 or the main Indian vaccine, which is based on isolate PPRV/India/Sungri/96 (S96). In addition, we compared the ability of these two vaccines, in parallel, to protect animals against challenge with pathogenic viruses from the four known genetic lineages of PPRV, representing viruses from different parts of Africa, as well as Asia. These studies showed that, while N75 elicited a stronger antibody response than S96, as measured by both enzyme-linked immunosorbent assay and virus neutralization, S96 resulted in more pronounced cellular immune responses, as measured by virus antigen-induced proliferation and interferon gamma production. While both vaccines induced comparable numbers of PPRV-specific CD8+T cells, S96 induced a higher number of CD4+T cells specifically responding to virus. Despite these quantitative and qualitative differences in the immune responses following vaccination, both vaccines gave complete clinical protection against challenge with all four lineages of PPRV.IMPORTANCEDespite the widespread use of live attenuated PPRV vaccines, this is the first systematic analysis of the immune response elicited in small ruminants. These data will help in the establishment of the immunological determinants of protection, an important step in the development of new vaccines, especially DIVA vaccines using alternative vaccination vectors. This study is also the first controlled test of the ability of the two major vaccines used against virulent PPRV strains from all genetic lineages of the virus, showing conclusively the complete cross-protective ability of these vaccines.

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Human Lung Innate Immune Response to Bacillus anthracis Spore Infection

Infection and Immunity ◽

10.1128/iai.00046-07 ◽

2007 ◽

Vol 75 (8) ◽

pp. 3729-3738 ◽

Cited By ~ 35

Author(s):

Kaushik Chakrabarty ◽

Wenxin Wu ◽

J. Leland Booth ◽

Elizabeth S. Duggan ◽

Nancy N. Nagle ◽

...

Keyword(s):

Immune Response ◽

Bacillus Anthracis ◽

Innate Immune Response ◽

Human Lung ◽

Rnase Protection Assay ◽

Innate Immune ◽

Enzyme Linked Immunosorbent Assay ◽

Rnase Protection ◽

Cell Signal ◽

Cytokines And Chemokines

ABSTRACT Bacillus anthracis, the causative agent of inhalational anthrax, enters a host through the pulmonary system before dissemination. We have previously shown that human alveolar macrophages participate in the initial innate immune response to B. anthracis spores through cell signal-mediated cytokine release. We proposed that the lung epithelia also participate in the innate immune response to this pathogen, and we have developed a human lung slice model to study this process. Exposure of our model to B. anthracis (Sterne) spores rapidly activated the mitogen-activated protein kinase signaling pathways ERK, p38, and JNK. In addition, an RNase protection assay showed induction of mRNA of several cytokines and chemokines. This finding was reflected at the translational level by protein peak increases of 3-, 25-, 9-, 34-, and 5-fold for interleukin-6 (IL-6), tumor necrosis factor alpha, IL-8, macrophage inflammatory protein 1α/β, and monocyte chemoattractant protein 1, respectively, as determined by an enzyme-linked immunosorbent assay. Inhibition of individual pathways by UO126, SP600125, and SB0203580 decreased induction of chemokines and cytokines by spores, but this depended on the pathways inhibited and the cytokines and chemokines induced. Combining all three inhibitors reduced induction of all cytokines and chemokines tested to background levels. An immunohistochemistry analysis of IL-6 and IL-8 revealed that alveolar epithelial cells and macrophages and a few interstitial cells are the source of the cytokines and chemokines. Taken together, these data showed the activation of the pulmonary epithelium in response to B. anthracis spore exposure. Thus, the lung epithelia actively participate in the innate immune response to B. anthracis infection through cell signal-mediated elaboration of cytokines and chemokines.

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Defining Antibody Seroprevalence and Duration of Humoral Responses to SARS-CoV-2 Infection and/or Vaccination in a Greek Community

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19010407 ◽

2021 ◽

Vol 19 (1) ◽

pp. 407

Author(s):

Ourania S. Kotsiou ◽

Dimitrios Papagiannis ◽

Evangelos C. Fradelos ◽

Dimitra I. Siachpazidou ◽

Garifallia Perlepe ◽

...

Keyword(s):

Immune Response ◽

Antibody Response ◽

Severe Disease ◽

Vaccination Status ◽

Antibody Responses ◽

Antibody Testing ◽

Mild Disease ◽

Antibody Titers ◽

Humoral Responses ◽

Pandemic Wave

Background: In this work we aimed to evaluate antibody-response longevity to SARS-CoV-2 infection and/or vaccination in one of the Greek communities that was worst hit by the pandemic, Deskati, five months after a previous serosurveillance and nine months after the pandemic wave initiation (October 2020). Methods: The SARS-CoV-2 IgG II Quant method (Architect, Abbott, IL, USA) was used for antibody testing. Results: A total of 69 subjects, who previously tested positive or negative for COVID-19 antibodies, participated in the study. We found that 48% of participants turned positive due to vaccination and 27% of participants were both previously infected and vaccinated. All previously infected participants retained antibodies to the virus, irrespective of their vaccination status. The antibody titers were significantly higher in previously infected participants that had been vaccinated than those who were unvaccinated and in those that had been previously hospitalized for COVID-19 than those with mild disease. Conclusions: Antibody responses to SARS-CoV-2 infection were maintained nine months after the pandemic. Vaccination alone had generated an immune response in almost half of the population. Higher antibody titers were found in the case of vaccination in previously infected subjects and especially in those with severe disease leading to hospitalization

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SARS-CoV-2 Infection in Fully Vaccinated Individuals of Old Age Strongly Boosts the Humoral Immune Response

Frontiers in Medicine ◽

10.3389/fmed.2021.746644 ◽

2021 ◽

Vol 8 ◽

Author(s):

Lisa Müller ◽

Marcel Andrée ◽

Philipp Niklas Ostermann ◽

Nathalie Jazmati ◽

Greta Flüh ◽

...

Keyword(s):

Immune Response ◽

Nursing Home ◽

Old Age ◽

Humoral Immune Response ◽

Severe Disease ◽

High Titre ◽

Local Health Authority ◽

Local Health ◽

Humoral Immune ◽

Mild Disease

Prophylactic vaccination against SARS-CoV-2 is one of the most important measures to contain the COVID-19 pandemic. Recently, break-through infections following vaccination against this virus have been reported. Here, we describe the humoral immune response of break-through infections in fully vaccinated individuals of old age from an outbreak in a nursing home. In cooperation with the local health authority, blood samples from fully vaccinated and infected as well as fully vaccinated and uninfected residents of the nursing home were collected 4 weeks after the onset of the outbreak. The humoral immune response was determined in a neutralisation assay with replication-competent virus isolates and by a quantitative ELISA. In this outbreak a total of 23 residents and four health care workers were tested positive for SARS-CoV-2. Four residents were unvaccinated, including one with a severe course of disease who later severe disease course who later succumbed to infection. Despite their old age, all vaccinated residents showed no or only mild disease. Comparison of the humoral immune response revealed significantly higher antibody levels in fully vaccinated infected individuals compared to fully vaccinated uninfected individuals (p < 0.001). Notably, although only a minority of the vaccinated uninfected group showed neutralisation capacity against SARS-CoV-2, all vaccinated and infected individuals showed high-titre neutralisation of SARS-CoV-2 including the alpha and beta variant. Large SARS-CoV-2 outbreaks can occur in fully vaccinated populations, but seem to associate with mild disease. SARS-CoV-2 infection in fully vaccinated individuals is a strong booster of the humoral immune response providing enhanced neutralisation capacity against immune evasion variants.

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Characterization of the Immune Response in Patients Infected with Clostridioides Difficile Due to Serum Biomarkers' Level with Correlation to Clinical Characteristics and Bacterial Toxin Production

10.21203/rs.3.rs-35006/v1 ◽

2020 ◽

Author(s):

Dor Gotshal ◽

Maya Azrad ◽

Zohar Hamo ◽

Orna Nitzan ◽

Avi Peretz

Keyword(s):

Clinical Characteristics ◽

Severe Disease ◽

Toxin Production ◽

Bacterial Toxin ◽

Serum Samples ◽

Clostridioides Difficile ◽

Cytokines And Chemokines ◽

Immunological Markers ◽

Laboratory Confirmation ◽

Moderate Disease

Abstract Background: Clostridioides difficile infection (CDI) have a high risk for complications up to death which requires identifying patients with severe disease and treating them accordingly. We examined the serum level of 6 cytokines and chemokines (IL-6, IL-21, IL-23, IL-33, BCA-1, TRAIL) and we checked the correlation between them to the patients' clinical characteristics and the bacterial strain.Methods: Concentrations of 6 cytokines and chemokines were measured using the MILLIPLEX®MAP kit (Billerica, USA) based on the Luminex xMAP® technology, in serum samples, attained from 54 CDI patients within a median time of 24-48 hours after laboratory confirmation of C. difficile presence. The demographic and clinical data were retrospectively collected from medical records. Disease severity score was determined according to the guidelines of the "Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America" (SHEA-IDSA).Results: Out of 54 patients (mean age, 76.6 years, 61.1% female), 20 (37%) had mild to moderate disease and 34 (63%) had severe disease. Two immunological markers were associated with a more severe disease: IL-16 (p = 0.005) and BCA-1 (p = 0.012). The study didn’t show a correlation between the immunological markers to the gender, the type of toxin which produced by the bacteria, in hospital mortality and infection acquisition.Conclusions: cytokines and chemokines may serve as a biomarker for early prediction of CDI severity in the future. Improved and more accessible assessment of CDI severity will contribute to adjustment of the medical treatment which will lead to a better patient outcome and hopefully will reduce the patient's mortality.

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Epidemic process of COVID-19 in the Russian Federation: interim results. 2nd report

Infekcionnye bolezni ◽

10.20953/1729-9225-2021-1-10-15 ◽

2021 ◽

pp. 10-15

Author(s):

N.Yu. Pshenichnaya ◽

◽

I.A. Lizinfeld ◽

G.Yu. Zhuravlev ◽

A.A. Ploskireva ◽

...

Keyword(s):

Russian Federation ◽

Severe Disease ◽

Age Groups ◽

Social Institutions ◽

Age Group ◽

Epidemic Process ◽

Mild Disease ◽

Household Contacts ◽

Moderate Disease ◽

The Russian Federation

Objective. To perform an interim analysis of epidemiological parameters of COVID-19 related to contacts and secondary cases of infection in the Russian Federation. Materials and methods. We analyzed 190,856 primary COVID-19 cases and 146,996 people who had been in contact with them. We used some data of monitoring performed by the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing in January–June 2020. We characterized the foci of infection and people who had contacts with primary COVID-19 cases and secondary cases of infection. Results. Just over half (50.02%) of study participants who had contacts with COVID-19 contacted with primary patients with mild disease, whereas 45.40% of individuals contacted with patients with moderate disease and 4.58% of individuals had contacts with patients with severe disease. Patients with mild COVID-19 interacted with more people, which resulted in a greater number of secondary cases of infection. The highest proportion of both primary COVID-19 patients and people who had contact with COVID-19 was observed in the age group of 41–64 years (44.42% and 44.51%, respectively). Approximately one third of COVID-19 patients and people who had contact with COVID-19 were 18 to 40 years old (30.20% and 34.21% respectively). The proportions of children aged 0–6 years and 7–17 years among COVID-19 patients were 2.70% and 4.02%, respectively; the same proportions among those who had contact with COVID-19 cases were 1.94 and 3.13%, respectively. Household contacts were the most common ways of COVID-19 transmission in all age groups. Patients aged between 40 and 64 years played the most significant role in the transmission of this infection in different foci. Individuals from this age group comprised 42.02% of patients infected in social institutions, 43.40% of those who had household contacts, and 47.70% of those infected at work. Conclusion. Patients with mild and moderate disease aged 18 to 64 years had the highest number of contacts and, therefore, caused the highest number of secondary cases of infection. Household contacts played the most important role in COVID-19 transmission in all age groups. Among people aged 18 to 64 years, COVID-19 transmission at work was also important. In all foci of infection, the majority of patients were in the age group of 40–64 years. Our findings can be used to optimize the preventive measures for COVID-19. Key words: epidemic process, age groups, severity, contacts, COVID-19, Russia, household contacts

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Ulcerative colitis

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0307 ◽

2020 ◽

pp. 2937-2950

Author(s):

Jeremy Sanderson ◽

Peter Irving

Keyword(s):

Ulcerative Colitis ◽

Severe Disease ◽

Stool Culture ◽

Volume Depletion ◽

Mild Disease ◽

Gradual Onset ◽

Moderate Disease ◽

Variable Extent ◽

Maintenance Of Remission ◽

Intravenous Steroids

Ulcerative colitis is a chronic relapsing and remitting disease in which chronic inflammation affects the rectum and extends proximally to a variable extent. The precise aetiology remains unknown but involves an interplay between reduced diversity in the gut microbiota and a genetically dysregulated gut immune system and epithelial barrier. Typical presentation of mild or moderate disease is with a gradual onset of symptoms including diarrhoea, rectal bleeding, and the passage of mucus. Severe disease is characterized by anorexia, nausea, weight loss, and severe diarrhoea, with the patient likely to look unwell with fever, tachycardia, and other signs of volume depletion, and the abdomen may be distended and tympanitic, with reduced bowel sounds and marked colonic tenderness. Diagnosis is usually made on the basis of exclusion of infective colitis by stool culture and the finding of typical diffuse inflammation in the rectum and above at sigmoidoscopy. Management requires rapid control of symptoms with induction therapy followed by maintenance of remission. Mild disease is typically treated with 5-aminosalicyclic acid delivered both orally and by enema, and moderate disease by 5-aminosalicyclic acid and steroids. Patients with severe disease require hospital admission, intravenous steroids, and daily review by both a physician and a surgeon experienced in the management of ulcerative colitis. Ciclosporin or infliximab are used as rescue therapies for steroid-resistant acute severe ulcerative colitis, but colectomy should not be delayed when this is required. Maintenance therapy with immunomodulators and biological therapies are both effective at maintaining remission, and several new biologicals are in clinical trials.

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COVID-19 Disease Severity and Determinants among Ethiopian Patients: A study of the Millennium COVID-19 Care Center

10.1101/2020.10.09.20209999 ◽

2020 ◽

Cited By ~ 2

Author(s):

Tigist W. Leulseged ◽

Kindalem G. Abebe ◽

Ishmael S. Hassen ◽

Endalkachew H. Maru ◽

Wuletaw C. Zewde ◽

...

Keyword(s):

Diabetes Mellitus ◽

Disease Severity ◽

Multinomial Logistic Regression ◽

Care Center ◽

Severe Disease ◽

P Value ◽

Age Group ◽

Disease Category ◽

Mild Disease ◽

Significant Difference

ABSTRACTBackgroundUnderstanding determinants of developing severe COVID-19 disease is important as studies show that severe disease is associated with worse outcomes.ObjectiveThe study aimed to assess the determinants of COVID-19 disease severity among COVID-19 patients admitted to Millennium COVID-19 Care Center in Ethiopia.MethodsA cross-sectional study was conducted from June to August 2020 among randomly selected 686 patients. Chi-square test was used to detect the presence of a statistically significant difference in the characteristics of the patients based on disease severity (Mild Vs Moderate Vs Severe), where p-value of <0.05 was considered as having a statistically significant difference. A Multivariable multinomial logistic regression model was used to assess the presence of a significant association between the independent variables and COVID-19 disease severity where Adjusted Odds ratio (AOR), 95% CIs for AOR and P-values were used for testing significance and interpretation of results.ResultsHaving moderate as compared with mild disease was significantly associated with having hypertension (AOR= 2.302, 95% CI= 1.266, 4.184, p-value=0.006), diabetes mellitus (AOR=2.607, 95% CI= 1.307, 5.198, p-value=0.007 for diabetes mellitus), fever (AOR= 6.115, 95% CI= 2.941, 12.716, p-value=0.0001) and headache (AOR= 2.695, 95% CI= 1.392, 5.215, p-value=0.003). Similarly, having severe disease as compared with mild disease was associated with age group (AOR= 4.428, 95% CI= 2.497, 7.853, p-value=0.0001 for 40-59 years and AOR=18.070, 95% CI=9.292, 35.140, p-value=0.0001 for ≥ 60 years), sex (AOR=1.842, 95% CI=1.121, 3.027, p-value=0.016), hypertension (AOR= 1.966, 95% CI= 1.076, 3.593, p-value=0.028), diabetes mellitus (AOR= 3.926, 95% CI= 1.964, 7.847, p-value=0.0001), fever (AOR= 13.218, 95% CI= 6.109, 28.601, p-value=0.0001) and headache (AOR= 4.816, 95% CI= 2.324, 9.979, p-value=0.0001). In addition, determinants of severe disease as compared with moderate disease were found to be age group (AOR= 4.871, 95% CI= 2.854, 8.315, p-value=0.0001 for 40-59 years and AOR= 18.906, 95% CI= 9.838, 36.334, p-value=0.0001 for ≥ 60 years), fever (AOR= 2.161, 95% CI= 1.286, 3.634, p-value=0.004) and headache (AOR= 1.787, 95% CI= 1.028, 3.107, p-value=0.039).ConclusionsBeing old, male sex, hypertension, diabetes mellitus, and having symptoms of fever and headache were found to be determinants of developing a more severe COVID-19 disease category. We recommend a better preventive practice to be set in place so that these groups of patients can be protected from acquiring the disease. And for those who are already infected, a more careful follow-up and management should be given so that complication and death can be prevented. Furthermore, considering the above non respiratory symptoms as disease severity indicator could be important.

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