Mpox (Monkeypox) Virus and Its Co-Infection with HIV, Sexually Transmitted Infections, or Bacterial Superinfections: Double Whammy or a New Prime Culprit?

Epidemiologic studies have established that mpox (formerly known as monkeypox) outbreaks worldwide in 2022-2023, due to Clade IIb mpox virus (MPXV), disproportionately affected gay, bisexual, and other men who have sex with men. More than 35% and 40% of the mpox cases suffer from co-infection with HIV and sexually transmitted infections (STIs) (e.g., Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, and herpes simplex virus), respectively. Bacterial superinfection can also occur. Co-infection of MPXV and other infectious agents may enhance disease severity, deteriorate outcomes, elongate the recovery process, and potentially contribute to the morbidity and mortality of the ensuing diseases. However, the interplays between MPXV and HIV, bacteria, other STI pathogens and host cells are poorly studied. There are many open questions regarding the impact of co-infections with HIV, STIs, or bacterial superinfections on the diagnosis and treatment of MPXV infections, including clinical and laboratory-confirmed mpox diagnosis, suboptimal treatment effectiveness, and induction of antiviral drug resistance. In this review article, we will discuss the progress and knowledge gaps in MPXV biology, antiviral therapy, pathogenesis of human MPXV and its co-infection with HIV, STIs, or bacterial superinfections, and the impact of the co-infections on the diagnosis and treatment of mpox disease. This review not only sheds light on the MPXV infection and co-infection of other etiologies but also calls for more research on MPXV life cycles and the molecular mechanisms of pathogenesis of co-infection of MPXV and other infectious agents, as well as research and development of a novel multiplex molecular testing panel for the detection of MPXV and other STI co-infections.

Key roles for phosphorylation and the Coiled-coil domain in TRIM56-mediated positive regulation of TLR3-TRIF-dependent innate immunity

Tripartite-motif protein-56 (TRIM56) positively regulates the induction of type I interferon response via the TLR3 pathway by enhancing IRF3 activation and depends on its C-terminal residues 621-750 for interacting with the adaptor TRIF. However, the precise underlying mechanism and detailed TRIM56 determinants remain unclear. Herein, we show ectopic expression of murine TRIM56 also enhances TLR3-dependent interferon-β promoter activation, suggesting functional conservation. We found that endogenous TRIM56 and TRIF formed a complex early (0.5-2 h) after poly-I:C stimulation and that TRIM56 overexpression also promoted activation of NF-κB by poly-I:C but not that by TNF-α or IL-1β, consistent with a specific effect on TRIF prior to the bifurcation of NF-κB and IRF3. Using transient transfection and Tet-regulated cell lines expressing various TRIM56 mutants, we demonstrated the Coiled-coil domain and a segment spanning residues ∼434-610, but not the B-box or residues 355-433, were required for TRIM56 augmentation of TLR3 signaling. Moreover, alanine substitution at each putative phosphorylation site, Ser471, Ser475, and Ser710, abrogated TRIM56 function. Concordantly, mutants bearing Ser471Ala, Ser475Ala, or Ser710Ala, or lacking the Coiled-coil domain, all lost the capacity to enhance poly-I:C-induced establishment of an antiviral state. Furthermore, the Ser710Ala mutation disrupted the TRIM56-TRIF association. Using phospho-specific antibodies, we detected biphasic phosphorylation of TRIM56 at Ser471 and Ser475 following TLR3 stimulation, with the early phase occurring at ∼0.5 to 1 h, prior to IRF3 phosphorylation. Together, these data reveal novel molecular details critical for the TRIM56 augmentation of TLR3-dependent antiviral response and highlight important roles for TRIM56 scaffolding and phosphorylation.

Laboratory diagnosis of CNS infections in children due to emerging and re-emerging neurotropic viruses

Recent decades have witnessed the emergence and re-emergence of numerous medically important viruses that cause central nervous system (CNS) infections in children, e.g., Zika, West Nile, and enterovirus/parechovirus. Children with immature immune defenses and blood-brain barrier are more vulnerable to viral CNS infections and meningitis than adults. Viral invasion into the CNS causes meningitis, encephalitis, brain imaging abnormalities, and long-term neurodevelopmental sequelae. Rapid and accurate detection of neurotropic viral infections is essential for diagnosing CNS diseases and setting up an appropriate patient management plan. The addition of new molecular assays and next-generation sequencing has broadened diagnostic capabilities for identifying infectious meningitis/encephalitis. However, the expansion of test menu has led to new challenges in selecting appropriate tests and making accurate interpretation of test results. There are unmet gaps in development of rapid, sensitive and specific molecular assays for a growing list of emerging and re-emerging neurotropic viruses. Herein we will discuss the advances and challenges in the laboratory diagnosis of viral CNS infections in children. This review not only sheds light on selection and interpretation of a suitable diagnostic test for emerging/re-emerging neurotropic viruses, but also calls for more research on development and clinical utility study of novel molecular assays. IMPACT: Children with immature immune defenses and blood-brain barrier, especially neonates and infants, are more vulnerable to viral central nervous system infections and meningitis than adults. The addition of new molecular assays and next-generation sequencing has broadened diagnostic capabilities for identifying infectious meningitis and encephalitis. There are unmet gaps in the development of rapid, sensitive and specific molecular assays for a growing list of emerging and re-emerging neurotropic viruses.

Clinical significance of measuring serum cytokine levels as inflammatory biomarkers in adult and pediatric COVID-19 cases: A review

Coronavirus disease 2019 (COVID-19) is a rapidly evolving infectious/inflammatory disorder which has turned into a global pandemic. With severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as its etiologic agent, severe COVID-19 cases usually develop uncontrolled inflammatory responses and cytokine storm-like syndromes. Measuring serum levels of pro-inflammatory cytokines (e.g., IL-6 and others) as inflammatory biomarkers may have several potential applications in the management of COVID-19, including risk assessment, monitoring of disease progression, determination of prognosis, selection of therapy and prediction of response to treatment. This is especially true for pediatric patients with COVID-19 associated Kawasaki-like disease and similar syndromes. In this report, we review the current knowledge of COVID-19 associated cytokines, their roles in host immune and inflammatory responses, the clinical significance and utility of cytokine immunoassays in adult and pediatric COVID-19 patients, as well as the challenges and pitfalls in implementation and interpretation of cytokine immunoassays. Given that cytokines are implicated in different immunological disorders and diseases, it is challenging to interpret the multiplex cytokine data for COVID-19 patients. Also, it should be taken into consideration that biological and technical variables may affect the commutability of cytokine immunoassays and enhance complexity of cytokine immunoassay interpretation. It is recommended that the same method, platform and laboratory should be used when monitoring differences in cytokine levels between groups of individuals or for the same individual over time. It may be important to correlate cytokine profiling data with the SARS-CoV-2 nucleic acid amplification testing and imaging observations to make an accurate interpretation of the inflammatory status and disease progression in COVID-19 patients.

Role of Host Immune and Inflammatory Responses in COVID-19 Cases with Underlying Primary Immunodeficiency: A Review

Coronavirus disease 2019 (COVID-19) has spread rapidly and become a pandemic. Caused by a novel human coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), severe COVID-19 is characterized by cytokine storm syndromes due to innate immune activation. Primary immunodeficiency (PID) cases represent a special patient population whose impaired immune system might make them susceptible to severe infections, posing a higher risk to COVID-19, but this could also lead to suppressed inflammatory responses and cytokine storm. It remains an open question as to whether the impaired immune system constitutes a predisposing or protective factor for PID patients when facing SARS-CoV-2 infection. After literature review, it was found that, similar to other patient populations with different comorbidities, PID patients may be susceptible to SARS-CoV-2 infection. Their varied immune status, however, may lead to different disease severity and outcomes after SARS-CoV-2 infection. PID patients with deficiency in antiviral innate immune signaling [eg, Toll-like receptor (TLR)3, TLR7, or interferon regulatory factor 7 (IRF7)] or interferon signaling (IFNAR2) may be linked to severe COVID-19. Because of its anti-infection, anti-inflammatory, and immunomodulatory effects, routine intravenous immunoglobulin therapy may provide some protective effects to the PID patients.

Spectrum and features of congenital heart disease in Xi'an, China as detected using fetal echocardiography

This study aimed to investigate the spectrum and features of congenital heart disease (CHD) in Xi'an, China using fetal echocardiography. All pregnant women referred for fetal echocardiography underwent a systematic fetal echocardiographic examination. Each case of complex defects was diagnosed according to the predominant pathophysiology, and the overall frequency of each defect was recorded and classified according to its location in the fetal heart. CHD was diagnosed in 195 fetuses. The top 5 types of CHD were, in order, single ventricle (15.9%, 31/195), atrioventricular septal defect (12.3%, 24/195), ventricular septal defect (VSD) (11.8%, 23/195), tetralogy of Fallot (10.8%, 21/195), and double-outlet right ventricle (8.2%, 16/195). The 195 cases of CHD comprised 316 defects in total. The most common defect was ventricular malformation (40.5%, 128/316), followed by great artery anomalies (38.0%, 120/316), endocardial cushion abnormalities (11.7%, 37/316), atrial abnormalities (6.6%, 21/316), and semilunar valve abnormalities (3.2%, 10/316). VSD accounted for the largest proportion (24.4%, 77/316) of the ventricular malformations. The total proportion of obstructive lesions in this group was much higher for the right than for the left side of the heart (18.4% (58/316) vs 9.5% (30/316), respectively). The spectrum of fetal CHD detected by echocardiography was much different compared to that accepted in the past. Complex defects were more common prenatally. Ventricular malformations were the largest constituent of all of the defects associated with fetal CHD, and VSD was the most common component of complex defects. Chinese fetal CHD encompassed more right-sided than left-sided obstructive lesions.

Lack of an association between the XRCC1 Arg399Gln polymorphism and gastric cancer based on a meta-analysis

Association between the XRCC1 Arg399Gln polymorphism and susceptibility to gastric cancer has been investigated; overall, the results have been inconclusive. We made a meta-analysis of 13 case-control studies, including 3278 cases and 6243 controls. Crude odds ratios (OR) with 95% confidence intervals (95%CI) were used to assess this possible association. We found no evidence of a significant association between the XRCC1 Arg399Gln polymorphism and gastric cancer risk (in the additive inheritance model, OR = 0.986, 95%CI = 0.831-1.156, in the dominant inheritance model, OR = 1.044, 95%CI = 0.890-1.224 and in the recessive inheritance model, OR = 0.975, 95%CI = 0.894-1.063). We conclude that the XRCC1 Arg399Gln polymorphism is not a risk factor for developing gastric cancer.

[Determination of nodakenin in Peucedanum]

OBJECTIVE

To establish a HPLC method to determine the contents of nodakenin in Peucedanum.

METHOD

The determination method was achieved by RP-HPLC on an ODS column by UV detection at 334 nm; with nodakenin as external standard and H2O-CH3OH-CH3CN(75:5:20) as mobile phase.

RESULT

Several samples of 6 species of Peucedanum were analyzed by this method. The contents of nodakenin ranged from 0.005%-3.090%.

CONCLUSION

Nodakenin cannot be used to control the quality of Peucedanum for pharmaceutical use, but this method is a simple and feasible way to control the quality of P. decursivum.

Influential factors affecting prognosis of snakebite patients management: Kaohsiung Chang Gung Memorial Hospital experience

BACKGROUND

The objective of this study was to determine the most influential factors affecting the prognosis of snakebite patients in Kaohsiung Chang Gung Memorial Hospital.

METHODS

A thorough review of the medical records of poisonous snakebite from June 1986 to November 1999 was carried out in this retrospective study.

RESULTS

Of the identified snakes in 39 bite victims, 70% of these cases were hemorrhagic type: Trimeresurus stejnegeri 20/27, T. mucrosquamatus 6/27, and Agkistrodon acutus 1/27; 28% were neurotoxic type: Naja naja atra 6/11 and Bungarus multicinctus 5/11; and 2% was mixed type: Vipera russelli formosensis 1/39. Three of four acute renal failure victims were bitten by T. mucrosquamatus. Two of the 5 victims bitten by B. multicinctus required endotracheal intubation to maintain their respiration. Five patients received skin grafting, 3 of whom were bitten by Naja naja atra. Most of our patients (55%) received only a single dose of antivenin, and 83% (29/35) of the antivenin was given within 6 hours after the bite; the antivenin infusion was finished in less than 2 hours in most cases (33/36).

CONCLUSION

Bites from Trimeresurus stejnegeri are the most common poisonous snakebite recorded in our emergency department. T. mucrosquamatus is prominent in causing bleeding tendency and acute renal failure. Bungarus multicinctus is more prominent than Naja naja atra in causing acute respiratory failure. The dosage of antivenin used to treat patient bitten by cobra was less than that recommended by the poison control center, and the complication of skin necrosis requiring skin grafting was more severe than that of the other species.

Health statistics on older persons United States, 1986

The National Center for Health Statistics (NCHS) collects data on the health of older persons through numerous data systems. The Vital Statistics Program and the National Health and Nutrition Examination Survey (NHANES) are examples. This report contains statistics from the data systems covering four general areas-mortality, other measures of health status and determinants of health, use of health care, and health costs . The structure of this report is patterned after the annual publication Health, United States, with detailed tables and accompanying text. Where data permit, the tables contain age, sex, and race categorizations including the age group 85 years and over as well as aggregated data for persons aged 65 years and over and 75 years and over. For comparison purposes, the tables also include data concerning the transition age group 55-64 years of age.

Home care expenses for the disabled elderly

This article presents descriptive statistics from the 1982 Long-Term Care Survey on noninstitutionalized elderly Americans with limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL). The focus of this article is on private expenses for home-based care related to ADL and IADL limitations. We describe the amounts of out-of-pocket payments expended relative to the characteristics of the home-based, disabled elderly population. We also discuss several possible implications of the findings for policymakers and further research.

Distance between nucleotide site and cysteine-373 of G-actin by resonance energy transfer measurements

The distance between the nucleotide site and the reactive cysteine-373 of G-actin was determined from resonance energy transfer measurements by using 1,N6-ethenoadenosine triphosphate (epsilon ATP) as the donor and 4-[N-(iodoacetoxy)ethyl N methyl]amino 7 nitrobenz 2 oxa 1,3 diazole covalently attached to the sulphydryl group as acceptor. The quenching of the lifetime of bound donor in the presence of attached acceptor arose predominantly from transfer of excitation energy. The polarization spectrum of free epilson ATP in glycerol revealed that the minimum value of its fundamental anisotropy is 0.32 at 340 nm, indicating that the maximum value of the angle between the absorption and emission dipoles of the ethenoadenosine moiety is 21 degrees. The polarization result indicates that the bound nucleotide is depolarized and has considerable motional freedom. This motion is restricted and unlikely to be rapid or isotropic during the time interval of energy transfer. The attached acceptor is highly immobile, however. The range of the donor-acceptor distance is 24-45 A. This range was not affected by polymerization. In the absence of independent structural information it is not possible to assign a single value to the donor-acceptor separation.

Nanosecond fluorescence spectroscopy of human immunoglobulin A

The solution properties of five samples of human immunoglobulin A (IgA) were investigated with covalent and hydrophobic fluorescence probes. The immunoglobulins included a secretory IgA and four myeloma proteins of both IgA1 and IgA2 subclasses in the monomeric and dimeric forms. The probe 8-anilinonaphthalene-1-sulfonate (ANS) was found to bind to both monomeric and dimeric IgA with comparable affinity. Pyrenesulfonyl chloride covalently linked to the proteins exhibited multiexponential decays. The decay of ANS complexed to the same proteins showed similar multiple exponential character. The rotational motions of the immunoglobulins were investigated by the nanosecond fluorescence anisotropy decay method. The decay of both probes attached to these proteins was characterized by a fast component followed by a slow component. The rapid component was in the range 14-26 ns for th covalent conjugates and 26-41 ns for the ANS complexes. These results are interpreted in terms of a segmental motion arising from a mass in the range 60 000-100 000 daltons, If the decrease in the anisotropy value at long times is taken as a measure of restricted diffusion of the mobile fragment, the half-angle of a cone within which the fragment traverses may provide a qualitative measure of the extent of flexibility. By this criterion, monomeric and dimeric IgA's of the same subclass appear to be qualitatively similar in flexibility.

Fluorescence decay kinetics of pyrene in membrane vesicles

The fluorescence decay kinetics of pyrene incorporated into artificial and natural membrane vesicles has been studied by pulse fluorimetry. The emission of monomeric pyrene and its excimer embedded in sonicated liposomes prepared from dipalmitoylphosphatidylcholine and a mixture of this phospholipid and dipalmitoylphosphatidylserine follows a multiple exponential decay law at temperatures both below and above their thermal transitions (10--48 degrees C). When pyrene is incorporated into fragmented skeletal sarcoplasmic reticulum vesicles, the emission decay exhibits similar multiple exponential character. The decay of the monomer in the phospholipid vesicles can be adequately described by three exponential terms. The experimental decays observed with both types of vesicles deviate significantly from a previously proposed model in which departure of the decay of pyrene monomer from monoexponentiality is qualitatively related to a time dependence in the diffuslipid vesicles can be adequately described by three exponential terms. The experimental decays observed with both types of vesicles deviate significantly from a previously proposed model in which departure of the decay of pyrene monomer from monoexponentiality is qualitatively related to a time dependence in the diffuslipid vesicles can be adequately described by three exponential terms. The experimental decays observed with both types of vesicles deviate significantly from a previously proposed model in which departure of the decay of pyrene monomer from monoexponentiality is qualitatively related to a time dependence in the diffusion-controlled formation of excimers from ground state and excited monomers. It is suggested that the observed decays are compatible with a reaction scheme involving excited state interaction.

The properties of immune complex-forming systems. A new theoretical approach

A new mathematical model for antigen-antibody interactions has been developed. The new model is based on the assumption that the formation of complexes between a bivalent antibody and a multivalent antigen is determined thermodynamically by the concentrations and valences of antigen as well as antibody, together with one association constant which is common to all mutual interactions. Formulae have been derived for calculation of the distributions of compositionally different antigen-antibody complexes either from knowledge of equilibrium concentrations of free antigen and antibody, or from knowledge of total amounts of antigen and antibody in the system. A computer program for these calculation is described. The model is found to yield precise predictions of the formation of soluble immune complexes, as studied by zonal centrifugation. It is found through use of the model that 'complex formation' as such differs in binding characteristics from adsorption, especially for high concentrations of antigens and antibodies. 'Complex formation' implies that association constants estimated through a Sips plot method will vary with antibody concentration, and that certain curvatures of the lines in a Sips plot reflect inherent properties of complex-forming systems.