2022年 · 第02卷第04期

Few studies have reported Legionella sainthelensi infection. This infection primarily presents with respiratory manifestations. Here, we report an immunocompromised patient with cavitary pneumonia caused by L. sainthelensi who mainly had abdominal symptoms. The timely administration of moxifloxacin provided clinical improvement and resolution of symptoms. To our knowledge, this is one of the rare cases of L. sainthelensi infection presenting uniquely with abdominal distension and liver function impairment but without obvious respiratory symptoms.

Severe acute respiratory syndrome coronavirus-2 infection is usually self-limited, with a short duration for viral shedding within several weeks. However, prolonged viral shedding has been observed in severe or immune-compromised coronavirus disease 2019 (COVID-19) cases. Here, we reported that three young adult cases of COVID-19 patients, who were either immunosuppressed nor severe, showed prolonged viral RNA shedding from the upper respiratory tract for 58, 81, and 137 days since initial diagnosis. To our knowledge, this is the longest duration of viral shedding reported to date in young adult patients. Further studies on factors relevant to prolonged viral positivity, as well as the correlation between viral positivity and transmission risk are needed for the optimal management of COVID-19 patients with prolonged nucleic acid positive.

Transparency Ecosystem for Research and Journals in Medicine (TERM) Working Group summarized the essential recommendations that should be considered to review and publish a high-quality guideline. These recommendations from editors and reviewers included the 10 components of essential requirements: systematic review of existing relevant guidelines, guideline registration, guideline protocol, stakeholders, conflicts of interest, clinical questions, systematic reviews, recommendation consensus, guideline reporting, and external review. TERM Working Group abbreviates them as PAGE (essential requirements for Publishing clinical prActice GuidelinEs), recommends guideline authors, editors, and peer reviewers use them for high-quality guidelines.

Hemorrhagic fever with renal syndrome (HFRS) is an acute zoonosis with a global distribution. China is one of the countries with a high incidence of HFRS, which has long endangered the lives and health of the Chinese people. The Infectious Disease Branch of the Chinese Preventive Medicine Association and the Infectious Diseases Branch of the Chinese Medical Association organized national multidisciplinary experts, based on domestic and international research results combined with experts’ practical experiences, to reach this consensus after thorough discussion. This consensus contains 17 recommendations aimed at prevention and identification of important clinical issues to further standardize the prevention, diagnosis, and treatment of HFRS.

Background: With the high prevalence of pre-treatment drug resistance (PDR) and the potential impact to the virological inhibition, the detection of PDR was particularly necessary. This study aimed to determine the prevalence of PDR in Guangdong, China, and its impact on antiretroviral therapy (ART) in treatment-naive HIV patients. Methods: A retrospective cohort study was conducted. A total of 1936 HIV-1-infected treatment-naive patients in the clinic of the infectious department, Guangzhou Eighth People’s Hospital, between August 2018 and December 2019 were assayed for PDR mutations before initiating ART. Patients with PDR mutations (PDR arm) were screened and compared with those without drug-resistant mutations (non-PDR arm). The rate of HIV-1 virologic failure (VF) and CD4+ T-cell counts of the 2 arms were compared at the 96th week after ART to evaluate the impact of PDR on the efficacy of ART. Results: Pretreatment drug resistance was detected in 125 cases (6.46%) from the 1936 enrolled participants, most of which were resistant to non-nucleoside reverse transcriptase inhibitors (64.00%, 80/125). One hundred and eight of 125 completed the follow-up of 96 weeks (PDR arm). In this cohort, 52 patients whose ART regimen containing the resistant drug were grouped as con-PDR arm, and the remaining 56 patients whose ART regimen did not contain the resistant drug were grouped as non-con-PDR arm. A total of 125 patients without PDR were randomly selected as the control group (non-PDR arm), 112 of whom had completed the 96-week follow-up. At the 96th week after ART initiation, 7 patients (6.5%, 7/108) in the PDR arm and 1 patient (0.9%, 1/112) in the non-PDR arm developed VF, exhibiting a significant difference (χ2 = 4.901, P = 0.029). Meanwhile, 3 patients (5.8%, 3/52) in the con-PDR arm developed VF; the rate was also higher than that in the non-PDR arm, but without a significant difference (χ2 = 3.549, P = 0.095). The CD4+ T-cell count in the non-PDR arm increased more than the PDR arm (386.6 vs. 319.1 cells/μL, t = 2.448, P = 0.015) or the con-PDR arm (386.6 vs. 325.1 cells/μL, t = 1.821, P = 0.070) at 12 weeks after ART. However, no significant differences were observed in the CD4+ T-cell count from the 24th week after ART onward. Conclusions: Pretreatment drug resistance was moderately prevalent in Guangdong, China, and could affect the antiretroviral efficacy during a 96-week observation period, indicating the need to closely monitor PDR before ART initiation.

Monkeypox is usually considered as a zoonosis caused by monkeypox virus with potential threat to public health in the post-smallpox era. The recent outbreak of monkeypox began in May 7, 2022, and has been found in many countries out of Africa. The World Health Organization declared that this endemic is an "atypical" phenomenon with definite human-to-human transmission. To understand the situation more clearly, this review briefly summarizes the epidemiologic and clinical characteristics of the disease and highlights the clinical management and preventive strategies.

Acquired immune deficiency syndrome is still one of the most severe global infectious diseases that pose a significant threat to human health. With the successful application of antiretroviral therapy, productive replication of human immunodeficiency virus type 1 (HIV-1) can be effectively blocked; however, antiretroviral therapy alone cannot cure the infection because of the presence of a stable and reactivatable viral latent reservoir. Thus, it is of great importance to have a better comprehension of the mechanisms driving HIV-1 pathogenesis and long-term persistence in infected individuals, based on which to further discover novel targets for therapeutic applications to treat or even cure the infection. Various studies have revealed that cellular metabolism is a critical factor impacting the fate and intracellular activities of immune cells. Emerging evidence implies that the alternations of cellular metabolism induced by HIV-1 infection play an important role in HIV-1 pathogenesis. Consequently, a promising approach of "metabolism as a therapeutic target" raised the possibility of using metabolic reprogramming as a treatment option for chronic HIV-1 infection. In this review, we summarize the latest studies about the interplay of the hosts' reprogramming of glucose metabolism and HIV-1 infection and introduce potential applications of searching for hallmarks and therapeutic targets of metabolic interventions for HIV-1 infection.

Innate immune responses are the host's first line of defense against human immunodeficiency virus type 1 (HIV-1) infection, with pattern recognition receptors detecting viral specific pathogen-associated molecular patterns and initiating antiviral responses. In response to HIV-1 nucleic acids or proteins, some pattern recognition receptors have the ability to assemble a large multiprotein complex called the inflammasome, which triggers pro-inflammatory cytokine release and a form of lytic programmed cell death called pyroptosis. Here, we review our current understanding of the mechanism of the inflammasome in sensing HIV-1 infection. Furthermore, we discuss the contribution of inflammasome activation in HIV-1 pathogenesis as well as potential strategies of targeting inflammasome activation for the treatment of HIV-1 infection.

Host immune surveillance can achieve powerful clearance of infectious pathogens. Acute human immunodeficiency virus type I (HIV-1) infection can establish viral reservoirs in humans, and persistent chronic activation by the virus exhausts the immune system and ultimately causes acquired immunodeficiency syndrome. Although antiretroviral therapy (ART) can reduce the viral load and viremia in patients, latent HIV-1 reservoirs are still the biggest challenge that needs to be overcome to eradicate the virus. However, the low or absent viral antigen expression and epitope mutation caused during durable ART result in host immune escape and reservoir cell inaccessibility. In addition, durable ART accompanied by inflammation and persistent activation of immune cells, especially dysfunction and/or exhaustion of T cells. With the development of immunology, genetics, and genetic engineering technology, researchers can construct chimeric antigen receptors (CARs) to modify immune cells to enhance HIV clearance. The important research goals of creating CARs to modify natural killer (NK) and T cells are an attempt to enhance the functional effects of immune cells and restore the function of the immune system. This article reviews the latent characteristics of HIV, the development of CAR molecules, and the strategies for reprogramming T cells and NK cells with CARs, and aims to clear the HIV reservoirs and related potential problems.

Human immunodeficiency virus (HIV)-1 infection creates a persistent latent reservoir even after antiretroviral therapy, which is the main barrier to HIV cure. One of the most explored strategies is the use of latent reversal agents (LRAs) to activate HIV latent reservoirs, followed by immunotherapy to remove infected cells. Immunomodulatory LRAs have the dual advantage of activating viral latency and promoting immune cell elimination of HIV-infected cells. The emergence of novel immunotherapies has also enhanced the possibility of HIV clearance. Here we review the activity and potential mechanisms of immunomodulatory agonists and immunotherapies. The possible combinational strategies to achieve HIV functional cure and the problems encountered using this approach are discussed.

Hemorrhagic fever with renal syndrome (HFRS) is an acute natural focus epidemic disease characterized by fever, shock, hemorrhage and kidney injury caused by hantavirus infection. Hantavirus mainly infects human vascular endothelial cells, and induces extensive damage to small blood vessels and capillaries. Increased vascular permeability is the pathological basis for clinical manifestations of HFRS. Although domestic and foreign scholars have carried out many studies on the hantavirus pathogenesis, such as the immune pathological response induced by hantavirus, host genetics and apoptosis, thrombocytopenia, coagulation and fibrinolysis dysfunction, and the vascular endothelial damage, the pathogenesis of HFRS has not been fully elucidated and there is no effective drug yet. In-depth discussion of the molecular mechanism of HFRS and finding effective therapeutic drugs are still the research hotspots on the field of hantavirus/HFRS. This review will elaborate the research progress on the pathogenesis of HFRS in recent years.

As the SARS-CoV-2 virus shares relatively large protein sequences homologous to grass pollens, dust mites, and molds, our objective was to assess the potential overlap between the COVID-19 mRNA vaccines from Pfizer-BioNtech and Moderna and known allergens. We found 7 common allergens with potential for cross-reactivity with the Pfizer vaccine and 19 with the Moderna vaccine, including common grasses, molds, and dust mites. T-cell mediated antigen cross-reactivity between viruses and allergens is a relatively new area of study in clinical immunology; a discipline that may be particularly useful regarding the SARS-CoV-2 virus and the allergic response in humans. These results suggest that vaccination with the Pfizer-BioNtech and Moderna COVID-19 vaccines may contribute to T-cell cross-reactivity with allergens that impact allergic asthma and allergic rhinitis. Further research should assess the clinical implications of COVID-19 vaccination on the severity and symptomatology of the allergic disease, in addition to natural viral infection.