Neurological repercussions after COVID-19 in a young pregnant patient: a case report

Context: Most patients with COVID-19 have mild respiratory disease, however, neurological manifestations have also been associated. Case report: Female, 21 years old, 24 weeks pregnant, admitted with severe acute respiratory distress syndrome, by COVID-19. Evolved with respiratory failure. On the 14th day of hospitalization, fetal death occurred. After clinical stabilization, she started neurological symptoms, with altered state of consciousness, delusions, tremor in extremities, paresis in right dimidium and paresthesia in extremities. Nuclear magnetic resonance imaging showed numerous old micro- hemorrhagic foci, complemented with angio resonance and inflammatory activity evaluation, with embolic event and vasculitis ruled out. Electroneuromyography showed multiple mononeuritis. She recovered gradually, maintaining the tremor in extremities. Conclusions: Neurological manifestations can occur both by viral cytopathic action and by systemic complications resulting from immunomediated phenomena. In a study carried out in the United Kingdom, by Varatharaj et al, with 125 patients with COVID-19 and neuropsychiatric disorders, the most observed conditions were cerebrovascular event (62%), altered mental status (31%), both present in the case and, in addition, encephalopathy (23%) and encephalitis (18%). The neurological manifestations observed in COVID-19 can affect both the central and the peripheral nervous system. This patient has multiple mononeuropathy, characterized by the involvement of two or more peripheral nerve trunks, with motor and sensory manifestations.

SARS-CoV-2-Associated Nephropathy: Direct Renal Infection and Damage

Acute kidney injury is a frequent complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), principally because of hypotension and decreased kidney perfusion secondary to haemodynamic or haemostatic factors, drug-induced nephrotoxicity, and cytokine storm syndrome related to sepsis. Additionally, several factors support the existence of SARS-CoV-2-associated nephropathy, such as early, new-onset proteinuria and haematuria in many patients, the identification of SARS-CoV-2 viral load in precisely defined kidney compartments, ultrastructural and immunohistochemical evidence of direct viral infection of the kidneys, and, most importantly, morphological alterations associated with cytopathic action induced by the virus. In addition, collapsing glomerulopathy that has been reported in patients of African American descent with underlying apolipoprotein L1 (APOL1) kidney risk alleles and SARS-CoV-2 infection is evidence of a distinct form of SARS-CoV-2-associated nephropathy, the APOL1-SARS-CoV2-associated nephropathy.

Nefropatia associata al SARS-CoV-2: cosa sappiamo finora

Acute kidney injury (AKI) is a frequent complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) attributable to i) hypotension and decreased kidney perfusion secondary to hemodynamic or hemostatic factors, ii) drug-induced nephrotoxicity, iii) cytokine storm syndrome related to sepsis. However: i) early new-onset proteinuria and hematuria in many patients, ii) the identification of SARS-CoV-2 viral load in precisely defined kidney compartments, iii) ultrastructural evidence of direct viral infection of the kidneys, and most importantly, iv) morphological alterations associated to cytopathic action induced by the virus support the existence of SARS-CoV-2 associated nephropathy. In addition, collapsing glomerulopathy reported in African American patients with underlying APOL1 kidney risk alleles and SARS-CoV-2 infection is the evidence of a distinct form of SARS-CoV-2 associated nephropathy, the APOL1-SARS-CoV2-associated nephropathy.

CYPOPATHIC EFFECT OF DIPHTHERIA PATHOGEN IN THE COMPOSITION OF BIOFILM

When the nasopharynx is colonized with toxigenic strains of the diphtheria pathogen, toxin is released, which contributes to the death of epithelial cells. But in bacterial carriers, the development of the clinical picture of the disease does not occur. This is due to the peculiarities of the state of their immune system, as well as the peculiarities of the production of diphtheria exotoxin by corynebacteria in the biofilm. Goal. Determining the nature of the cytopathic effect of C. diphtheriae as part of a biofilm in CHO-K1 cell culture. The planktonic and biofilm (120- and 720-hour) cultures of the strains were studied: C. diphtheriae gravis tox+ № 665, C. diphtheriae gravis tox+ № 6765, C. diphtheriae mitis tox+ № 269, C. diphtheriae gravis tox+ isolated from a patient with a diagnosis Localized oropharyngeal diphtheria C. diphtheriae gravis with a silent tox-gene. Biofilm (120- and 720-hour) cultures of diphtheria pathogen strains were obtained according to the Watnik method. The cytopathic effect of corynebacterial strains was studied on a CHO-K1 cell culture, taking into account in an inverted microscope. When studying the cytopathic effect of planktonic cultures of toxigenic strains of corynebacteria, it was found that the number of living CHO-K1 cells after 24 hours was insignificant (25.3±1.2%) and sharply decreased (2.5±0.5%) after 72 hours of cultivation. Under the influence of biofilm and, especially, 720-hour cultures, a different cytopathic effect dynamics was found: the number of living cells after 24 hours remained significant (82.5±2.2%), while at 72-hour it decreased to 25.0±3.0%. In the study of filtrates of planktonic and biofilm cultures of C. diphtheriae strain with a «silent» tox-gene, similar patterns were revealed. However, the number of live CHO-K1 cells when exposed to the filtrate of a 720-hour biofilm culture was significantly higher (p≤0.05) than when studying toxigenic strains of corynebacteria. Considering the nature of the cytopathic action, it was found that planktonic cultures of toxigenic strains of corynebacteria are characterized by a change in the cell monolayer, manifested by their thinning and elongation. The study of 720-hour biofilm cultures at 72-hour exposure revealed the appearance of a large number of rounded cells (63-69%). The cytopathic effect, formed under the influence of filtrates of planktonic and biofilm cultures of C. diphtheriae with a «silent» tox-gene, as well as strains of non-diphtheria corynebacteria, is characterized by rounding of cells and the formation of symplasts. In the biofilm, the intensity of the cytopathic effect of toxigenic C. diphtheriae strains and C. diphtheriae strain with a silent tox-gene decreased. CPD, manifested by thinning and lengthening of CHO-K1 cells, is associated with the action of diphtheria exotoxin, and rounding is associated with corynebacterial enzymes and, apparently, fragments of surface structures - adhesins. Decreased release of toxin and enzymes beyond the C. bihfilm matrix is a significant cause of the «asymptomatic» carriage of diphtheria.

Study of Glutoxim antiviral activity in the fibroblast cell line infected with vesicular stomatitis virus

New strategy for the treatment of animal infectious diseases is based upon the modulation of the host immune response in order to enhance the clearance of infectious agents and reduce the damaging effects of inflammation in the tissues. The modern approach to the use of immunomodulators (IMD) in veterinary practice consists in the usage of such drugs, which are not only immunomodulating, but also have antiviral, antioxidant, anti-inflammatory, hemostimulating and/or other important properties. The aim of the study was to identify possible antiviral activity of known IMD Glutoxim (GLT) during infection of diploid fibroblast cell lines M-8 and M-22 with vesicular stomatitis virus (VSV). Materials and methods: VSV, strain Indiana, was used. Antiviral activity of GLT investigated: 1) at doses recommended for experiments in vitro: 1, 4 and 8 µg/ml; 2) at low doses: 0,1; 0,25 and 0,5 µg/ml. GLT was added to the cell monolayer according to preventive (for 24 hours prior to VSV infection of cells) and treatment (unanimous with VSV infection) protocols. The antiviral activity of GLT was assessed by the following criteria: ability of the drug to prevent the development of virus cytopathic action, to inhibit the reproduction of VSV, and by expessing virucidal action. Results: GLT in doses recommended for in vitro experiments (1, 4, 8 µg/ml) did not delay the development of a specific virus-induced cytopathic action. The VSV titers in infected cells in the presence of GLT did not differ from those in the control cell lines infected with VSV without the addition of GLT. The latter had no virucidal effect against the VSV. Inoculation of GLT into the cell culture at low doses of 0.1, 0.25 and 0.5 mg/ml led to a significant (more than 100-fold) inhibition of VSV replication 24 hours after infection of cells. At later stages, 40 and 48 hours following infection, the antiviral effect of GLT was not detected. Thus, we established that GLT possesses antiviral effect in vitro, which is manifested 24 hours following infection of diploid fibroblast cell lines with VSV.

Influence of Enovid on the Cytopathic Action of Staphylococcal Alpha Toxin

The effect of the widely employed oral contraceptive steroid, Enovid, on the cytolytic action of the staphylococcal alpha toxin was investigated as an extension of previous studies in which it was shown that steroids were capable of suppressing induced staphylococcal infection in experimental animals. The cytotoxic action of alpha toxin for tissue cultures was evaluated by use of such parameters as total and viable cell counts, glucose and protein determination, and cytopathic effects in the presence and absence of Enovid. To 3-day-old primary rabbit baby kidney tissue cultures a mixture of 20 μg of norethynodrel per ml [17α-ethynyl-hydroxy-5(10)-estren-3-one] and 5 μg of mestranol per ml (17-ethynelestradiol-3-methyl ether) was added; growth of tissue cultures in Eagle medium was continued till the sixth day, and then one tissue cytopathic dose of alpha toxin per ml was added and the subsequent fate of tissue cultures was assayed. Such cultures yielded higher total and viable cell counts, utilized more glucose, and contained more protein than the control cultures. In control cultures, cytopathogenicity appeared on the third day after the addition of alpha toxin, and it was complete in 24 hr, whereas in tissue cultures treated with Enovid cytopathogenicity was significantly reduced. Thus the mixture of synthetic hormones known as Enovid, in pharmacological concentrations, was found capable of reducing the cytopathic action of alpha toxin, but only to a slightly lesser degree than such natural hormone as progesterone.