A Clinical Case of COVID-19-Associated Pulmonary Aspergillosis (CAPA), Illustrating the Challenges in Diagnosis (Despite Overwhelming Mycological Evidence)

The COVID-19 pandemic has resulted in large numbers of patients requiring critical care management. With the established association between severe respiratory virus infection and invasive pulmonary aspergillosis (7.6% for COVID-19-associated pulmonary aspergillosis (CAPA)), the pandemic places a significant number of patients at potential risk from secondary invasive fungal disease. We described a case of CAPA with substantial supporting mycological evidence, highlighting the need to employ strategic diagnostic algorithms and weighted definitions to improve the accuracy in diagnosing CAPA.

BATF promotes group 2 innate lymphoid cell–mediated lung tissue protection during acute respiratory virus infection

BATF regulates ILC2-mediated tissue repair and inflammation resolution during acute respiratory virus infection.

Associação entre vírus respiratórios e asma em crianças e adolescentes: uma revisão de escopo

A asma é uma doença inflamatória crônica que acomete as vias aéreas e causa sintomas como dispneia, sibilos e tosse. Estima-se que existam cerca de 339 milhões de pessoas convivendo com asma no mundo e que a influência de microrganismos seja considerada um fator de risco para o aparecimento de asma na infância. Diante disso, esta revisão teve por objetivo analisar a relação entre a exposição a vírus respiratórios e a ocorrência de asma em crianças e adolescentes. Para tal metodologia, fora realizada buscas nas bases de dados Pubmed e Science Direct por artigos em inglês utilizando a estratégia de pesquisa respiratory virus AND (children OR adolescence) AND (wheezing OR asthma). Dos 2.717 artigos encontrados, apenas 17 foram incluídos na revisão com base nos critérios de inclusão e exclusão considerados. Os resultados mostraram que o Rinovírus e o Vírus Sincicial Respiratório foram os mais prevalentes nos artigos. Adicionalmente, ocorreram detecções para Adenovírus, Coronavírus, Enterovírus, Bocavírus, Influenza, Metapneumovírus e Parainfluenza, além da presença de coinfecção entre os vírus destacados e com bactérias. Os achados nesta revisão poderão auxiliar na elaboração de estratégias em saúde pública para se prevenir exacerbações de doenças respiratórias induzidas por vírus, tendo em vista que muitas das infecções causadas por esses agentes têm caráter sazonal.

The Incidence and Risk Factors of Extrapulmonary Manifestations in Mycoplasma Pneumoniae Pneumonia

Background: Mycoplasma pneumoniae pneumonia (MP) is a major cause of community acquired pneumonia (CAP) in children and it is known to be associated with extrapulmonary manifestations (EPM). The incidence and risk factors of EPM in children are not known.Methods: This is a retrospective study involving 65,243 pediatric CAP patients between 2010 and 2015 at 23 nationwide hospitals was conducted in South Korea. The medical records were reviewed to collect the information regarding the clinical characteristics, radiological results, and laboratory findings. In total, 9,190 children with MP were identified and included in the analysis. Logistic regression with multivariable analysis was performed to evaluate the risk factors associated with EPM in MP.Results: The mean age of the enrolled patients with MP was 64.3±39.8 months, and the proportion of male patients was 49.5%. The incidence of EPM was 23.9% and included elevation of liver enzymes (18.1%), mucocutaneous manifestations (4.4%), proteinuria (4.1%), cardiovascular and neurologic manifestation (0.4%), hematologic manifestation (0.2%) and arthritis (0.2%). Statistical analysis showed that mucocutaneous manifestations were significantly increased with elevated alanine aminotransferase (adjusted odds ratio [aOR] 3.623, 95% confidence intervals [CI] 1.933-6.790) and atopic sensitization (aOR 2.973, 95% CI 1.615-5.475) and decreased with respiratory virus co-infection (aOR 0.273, 95% CI 0.084-0.887). Elevated liver enzymes was significantly associated with the elevation of lactate dehydrogenase (aOR 3.055, 95% CI 2.257-4.137) and presence of pleural effusion (aOR 2.635, 95% CI 1.767-3.930) and proteinuria with respiratory virus co-infection (aOR 2.245, 95% CI 1.113-4.527). Conclusions: About 24% of pediatric MP patients were identified with various EPM. Since risk factors associated with each EPM was different, it is necessary to evaluate the various clinical aspects and findings of MP to predict and prepare for the occurrence of EPM.

Broad neutralization of SARS-CoV-2 variants by an inhalable bispecific single-domain antibody

The effectiveness of SARS-CoV-2 vaccines and therapeutic antibodies has been limited by the continuous emergence of viral variants, and by the restricted diffusion of antibodies from circulation into the sites of respiratory virus infection. Here, we report the identification of two highly conserved regions on Omicron variant RBD recognized by broadly neutralizing antibodies. Based on this finding, we generated a bispecific single-domain antibody that was able to simultaneously and synergistically bind these two regions on a single Omicron variant RBD as revealed by Cryo-EM structures. This inhalable antibody exhibited exquisite neutralization breadth and therapeutic efficacy in mouse models of SARS-CoV-2 infections. The structures also deciphered an uncommon cryptic epitope within the spike trimeric interface that may have implications for the design of broadly protective SARS-CoV-2 vaccines and therapeutics.