Combatting SARS-CoV-2: Potential Therapeutic Candidates Against COVID-19

Background: COVID-19, a global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in December 2019 in China and has spread to 210 countries and territories. Since then, it has infected >187.3 million people worldwide, causing >4.0 million deaths, and numbers are continuing to rise. Fever, dry cough, shortness of breath, and pneumonia are the main symptoms of this disease, which does not have any specific antiviral treatment or vaccines to date, and clinical management is mainly symptomatic treatment. Summary: The global spread of SARS-CoV-2 has necessitated the development of novel therapeutic agents against the virus to stop the pandemic. Drugs targeting viral as well as host factors may have a potential antiviral effect. The development of novel drugs may take years; hence, the best alternative available is to repurpose existing antiviral drugs with a known safety profile in humans. Further, compounds with known in vitro and in vivo efficacy against SARS-CoV and Middle East respiratory syndrome coronavirus have been included in recent clinical trials and exhibited encouraging results against SARS-CoV-2. Here, the authors provide a summary of therapeutic compounds that have shown antiviral effects against SARS-CoV-2 infections in cell lines, animal models, and patients. Key Messages: With every passing day, knowledge about SARS-CoV-2 is increasing due to continued efforts of scientists working in this area globally. Approximately 15% of patients with COVID-19 are affected by severe illness and treatments are desperately needed. In this time of global pandemic, collective and co-ordinated efforts are needed to develop therapeutic agents against this disease.

High-Sensitivity Assays for C-Reactive Protein as a Systemic Inflammatory Marker in Assessing Asthma

Asthma is a chronic inflammatory condition, and the main features include airway hyper-responsiveness and inflammation of the airway with the accumulation of inflammatory cells. Increased level of plasma fibrinogen and serum amyloid A suggests the involvement of systemic inflammation in asthma. C-reactive protein (CRP) is an acute-phase protein that produced mainly by hepatocytes and is an inflammatory marker. CRP levels monitoring is useful in the evaluation of early inflammation and efficacy of treatment in acute-phase illnesses. Several studies show that asthma alone can cause an increase in high-sensitivity CRP (hs-CRP) when compared with the healthy controls. Besides that, steroid-naïve patients have a higher mean value of hs-CRP levels compared with those on inhaled corticosteroid. Furthermore, studies have shown that an elevated hs-CRP level has a positive correlation with non-atopic asthma but not atopic asthma. Additionally, an increase in serum hs-CRP levels correlates with the severity of asthma. Therefore, serum hs-CRP is a useful surrogate marker to predict the severity of inflammation of the bronchus in asthma and assess the asthma status.

Lymphatic Filariasis: An Immunologic Perspective

Introduction: This paper provides an overview of the current immunologic research findings of lymphatic filarial worms, which affect millions of people worldwide. Objectives: This paper aims to discuss the immunologic features of lymphatic filarial worms. It also aims to highlight their potential anti-inflammatory actions and the use of anti-filarial drugs against COVID-19. Methods: A literature review was performed to obtain insights on the immunologic features of lymphatic filarial worms. Results: The CD4+ (Th2) response profile is the main defence against filarial worms. Modulation of human immune responses are primarily mediated by parasite-secreted peptides. Lymphatic filarial worms have anti-inflammatory potentials. Drug repurposing of diethylcarbamazepine, doxycycline, and ivermectin can be looked upon against COVID-19. Conclusion: Lymphatic filarial worms have several immunologic effects on host immune systems, which promote chronic infection and curtail anti-inflammatory responses. Insights in this paper can serve as a guide for the understanding of immunologic aspects of lymphatic filarial worms.

The Role of Infection and Autoimmunity in Urticaria and Angioedema as a Common Entity

Chronic spontaneous urticaria with angioedema is prevalent, affecting approximately 1% of the general population, and has a significant impact on quality of life, according to epidemiological data. This article aims to broaden the view on the mechanisms of urticaria and the role of infection in the current environment. It is not easy to identify the cause of urticaria but appropriate steps to treat an underlying infection can, in some cases, improve the symptoms of urticaria and angioedema, reduce severity and duration, or lead to remission. Although chronic spontaneous urticaria with angioedema is a multifactorial condition involving inflammation, autoimmunity, and coagulation, IgE-mediated autoimmunity, or autoallergy, is thought to play a major role. Every year, more is learnt about the role of cells releasing mediators, underlying autoimmune processes that lead to the development of mast cell activation and urticaria. It has become increasingly clear that mast cell roles in immune system responses are not limited to an allergic role; they are key players in protective immune responses, both innate and adaptive, to various pathogens and in defence of some infections. Several guidelines, consensus papers, and practice parameters have been developed for the management of chronic urticaria. The Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the Global Allergy and Asthma European Network (GA2LEN), the European Dermatology Forum (EDF), and the World Allergy Organization (WAO) produce a guideline, which is revised every 4 years by a global panel of experts in the field. Infections may be a cause, aggravating factor, or unassociated bystander in chronic urticaria. The author looked at evidence, using a keyword search, for the role of viral and bacterial infections in acute, acute recurrent, and chronic urticaria and angioedema, including COVID-19, herpes, viral hepatitis, and Helicobacter pylori.

A Qualitative Enquiry into the Lived Experiences of Adults with Atopic Dermatitis

Background: atopic dermatitis (AD) has been related to poorer health-related quality of life (HRQoL) in adults and there is lack of qualitative research that explores how this long-term condition affects the lives of adults. The purpose of this study was to explore the impact of AD on the HRQoL of adults through semi-structured interviews. Study design: this was a qualitative study using semi-structured interviews. Methods: adults with a clinical diagnosis of AD were recruited by advertising on a university campus and through social media sites. All participants completed a screening questionnaire on AD diagnosis, treatment, duration, and severity. Semi-structured interviews were conducted either face-to-face or on the telephone then audio-taped, transcribed verbatim, and analysed using thematic analysis. Results: the study group (n=19) consisted of 10 White and nine Black and ethnic minority participants, aged 19–52, of whom 18 were female. Three superordinate themes emerged from the analysis: 1) visibility of AD; 2) threats to inner sense of self; and 3) contrasting reactions and support from others. There were qualitative differences in the narratives of those who were diagnosed with AD at an early age compared to a later age, and across ethnic groups. Conclusions: AD has a great impact on the QoL of adults. Participants in this study discussed issues that have not been reported in quantitative research, particularly around the lack of understanding of the psychological impact of AD and the stigma attached to it. Consideration of these factors may enhance disease management and improve HRQoL. Understanding and recognition of AD as a complex long-term condition involving significant psychosocial impact is crucial. The findings from this study suggest more integrated and accessible psychological support is required for people with AD. Males were under-represented in this study, and further exploration of the impact on AD in males is needed.

The Psychosocial Impact of Adolescent Food Allergy: A Review of The Literature

Previous research has suggested adolescents and young people with food allergies (FA) have the highest risk of fatal reactions to food. As the prevalence of FA has been increasing there has been increased demand for psychosocial support of adolescents with food allergy, with anxiety around food and social interactions affecting the lives of adolescents and their families. This narrative review aims to explore the psychosocial impact of having a FA in adolescence, including the suggested impact, coping, risk-taking behaviour, and effect of peers and social support. The review concludes with considerations of the wider community which may also have an effect.

A Review of Primary Immune Deficiency Disorders

This scenario-based review of primary immunodeficiency diseases (PIDD) discusses the differential diagnosis, usual presentations, work-up, and treatment of children with the most commonly encountered immune disorders. Newborn screening (NBS) for severe combined immunodeficiency (SCID) is covered, as are later presenting disorders caused by B cell defects and disorders of the innate immune system.

Post Fever Uveoretinal Manifestations in an Immunocompetent Individual

Background: Post fever uveoretinal sequelae (PFURS) are the various uveoretinal manifestations seen after a systemic febrile illness in an immunocompetent individual caused by bacteria, viruses, and protozoa. These may be the result of a direct invasion by the pathogen or by indirect mechanism mediated through immune mechanisms. Method: The authors aim to review the ocular manifestations, utility of relevant diagnostic tests, management, and prognosis of PFURS. A comprehensive literature search was conducted on PubMed and Google Scholar databases with the search words “retinitis”, “choroiditis”, “neuroretinitis”, “macular edema”, “maculopathy”, “multifocal retinitis”, “chikungunya”, “dengue”, “West Nile”, “typhoid”, and “rickettsiosis”. Only articles published or translated into English language were considered. The key data were extracted, evaluated, and combined. Results: The authors search yielded 95 articles for the period between 1986 and May 2020. Painless blurring of vision was the most common symptom. Patients can have varied posterior segment manifestations, including vitritis, focal and multifocal patches of retinitis which could be unilateral or bilateral, optic nerve involvement, serous detachment at the macula, macular oedema, and localised involvement of the retinal vessels in the form of beading of the vessel wall, tortuosity, and perivascular sheathing. Conclusion: PFURS presents with a similar morphological pattern irrespective of the aetiology and follows a preset natural course before resolution. Treatment may or may not be required. Treating physicians need to be aware of this important ophthalmic condition even after complete resolution of fever.

Lupus Panniculitis in Association with Anti-Phospholipid Antibody Syndrome on a Background of Systemic Lupus Erythematosus: A Case Report and Literature Review

Lupus panniculitis occurs in 1–3% of the patients diagnosed with systemic lupus erythematosus (SLE) and 10% of the patients diagnosed with discoid lupus erythematosus (DLE). It is a disorder of autoimmune origin, manifesting as deep erythematous plaques and nodules involving the trunk, breasts, buttocks, face, and proximal extremities. It does not commonly ulcerate. This report highlights the case of a 22-year-old Asian female with a history of coeliac disease and significant family history of antiphospholipid antibody syndrome (APS) who presented with fever, malaise, weight loss, and subcutaneous non-tender nodules over the forearm, back, bilateral thighs, and feet. Laboratory investigations revealed positive antinuclear antibodies, anti-Ro/SSA antibody, and lupus anticoagulant, resulting in a diagnosis of APS. Biopsies of lesions were consistent with findings of lupus panniculitis. Every case of SLE and DLE with discrete skin lesions should be reviewed for any distinct entity such as lupus panniculitis, as it may be associated with greater risk of flares and systemic involvement. The purpose of this case report is to emphasise that early diagnosis and prompt treatment is crucial to improving the prognosis of such patients.

Erythroderma: A Manifestation of Cutaneous and Systemic Diseases

Introduction: Erythroderma, or generalised exfoliative dermatitis, is a rare inflammatory disorder characterised by generalised erythema, involving more than 90% body surface area accompanied by a variable degree of scaling. Objectives: This retrospective study aimed to determine characteristics of erythroderma as a marker of cutaneous and systemic disease and to identify the underlying causes of this condition. Materials and methods: Hospitalised patients diagnosed with erythroderma at the dermatology and venereology department of UHC ‘Mother Teresa’ from 2012–2017 were selected for this study. Epidemiological, clinical, laboratory, and histological data of these patients were electronically compiled and analysed using SPSS© software (IBM, Armonk, New York, USA). Results: 116 patients were diagnosed with erythroderma. Of these, 43.1% were female and 56.9% were male. The average age of onset was 55.1 years. A variable hospitalisation period was observed from 1–49 days. Previous episodes of erythroderma were indicated in 11.2% of cases, and 29.3% of cases appeared as emergencies. The most common cause of erythroderma was exacerbation of pre-existing dermatoses, namely psoriasis (53.4%), eczema (3.4%), and dermatitis (10.3%). Drug hypersensitivity reactions were evidenced in 4.3% of cases. In 16.4% of cases, the cause of erythroderma was undetermined. This study demonstrated a high percentage of secondary erythroderma to a pre-existing cutaneous pathology, psoriasis in 53.4% of cases, and a low percentage of primary erythroderma. Conclusions: Erythroderma can be a manifestation of systemic and cutaneous diseases, but mostly erythrodermic psoriasis. Often it presents as a life-threatening emergency. The condition masks the primary pathology lesions, making it difficult to establish the correct diagnosis of the underlying aetiology. However, biopsy provides a positive correlation between clinical findings and anatomopathological diagnosis.