Infectious Disorders - Drug Targets (Formerly Current Drug Targets - Infectious Disorders) - Online First
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Streptococcal Toxic Shock Syndrome (STSS) Secondary to Monoarticular Septic Arthritis Leading to Multiorgan Failure in a Patient without Underlying Comorbidities: Emphasizing Early Diagnosis and Management Strategies
Authors: Awad Chady, Chong Brandon, Samaniego Michelle, Omar Fahad and Omar AsadAvailable online: 29 January 2025More LessBackgroundStreptococcal Toxic Shock Syndrome (STSS) is a life-threatening condition caused by bacterial toxins. The STSS triad encompasses high fever, hypotensive shock, and a “sunburn-like” rash with desquamation. STSS, like Toxic Shock Syndrome (TSS), is a rare complication of streptococcal infections caused by Group A Streptococcus (GAS), Streptococcal pyogenes (S. pyogenes). Staphylococcus aureus is the most frequently isolated bacterial species associated with TSS. Risk factors for STSS include older age, skin wounds, recent viral infection with open sores, recent surgery, nasal packing, use of tampons or other devices, such as menstrual cups/contraceptive sponges/diaphragms, or any other chronic illness, like diabetes or alcohol/drug abuse. Our case presents a patient who did not have any of these risk factors.
Case PresentationA 25-year-old male was admitted to the Intensive Care Unit (ICU) after requiring intubation with mechanical ventilation and pressor support in the setting of septic shock. Septic arthritis was suspected, and blood and bone cultures were positive for S. pyogenes. Arthrocentesis of the affected knee (with fluid analysis and cytology) was positive for Streptococcal pyogenes. Infectious disease was consulted and the patient was empirically started on antibiotics. Kidney function continued to worsen, requiring hemodialysis. He no longer demonstrated brainstem reflexes, which prompted neurology consultation to rule out central nervous system dissemination.
Superantigens are pyrogenic exotoxins secreted by different strains of S. pyogenes and are responsible for the many symptoms of STSS that patients present with. Throat infections by the bacteria, leading to streptococcal pharyngitis, are mediated by toxin release and known to cause scarlet fever and, very rarely, STSS. The post-infectious non-pyogenic, non-suppurative syndromes of GAS are autoimmune in nature, which include rheumatic fever, acute glomerulonephritis, and very rarely, reactive arthritis. This cross-reactivity of antibodies with body tissue via a mechanism of molecular mimicry can follow streptococcal infections, like streptococcal pharyngitis. Renal disease can also occur after a localized skin infection, also known as streptococcal impetigo.
Despite the relationship of STSS with throat infections, there seem to be no reported cases of STSS secondary to septic arthritis in adult patients with no pertinent past medical history or other risk factors that could contribute to the condition.
ConclusionStreptococcal septic arthritis is an uncommon orthopedic emergency with high morbidity and mortality that requires emergent medical management. Septic arthritis needs to be treated with systemic antibiotics and joint aspiration, also known as arthrocentesis, which may be required more than once for complete recovery and avoidance of joint destruction. STSS is a very rare complication of streptococcal septic arthritis and monitoring of organ failure and hemodynamic instability is paramount for patient’s management and survival.
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A Clinical Multicenter Trial of Recombinant Human Interferon Gamma in Tuberculosis (GAM2022) Experience with the Use of Human Recombinant Interferon Gamma in TB Practice
Available online: 27 January 2025More LessBackgroundIn this article, we present the results of a multicenter clinical trial of IFN-γ in patients with drug-susceptible and drug-resistant pulmonary Tuberculosis (TB) in routine clinical practice.
ObjectiveThis study aimed to confirm the efficacy and safety of IFN-γ administered to patients with TB.
MethodsAll patients were diagnosed with TB after being tested by bacterioscopic and molecular genetic methods and had no contraindications to standard chemotherapy.
ResultsRecombinant human IFN-γ proved high efficacy in multi-center clinical trials in routine TB practice.
ConclusionThe results show that IFN-γ is efficient and safe in the treatment of pulmonary tuberculosis.
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Exploring the Potential Use of Withania somnifera in Leprosy and Lepra Reactions: A Molecular Docking Approach
Available online: 30 December 2024More LessIntroductionWithania somnifera (Ashwagandha) is a traditional herb that is currently commercially available for treating a variety of illnesses. By evaluating and verifying docking affinity scores, it is possible to explore the potential of the plant for treating leprosy and lepra-reaction as off-label use.
MethodsThe sitoindosides were used as ligands along with thalidomide in docking against targets, such as M. leprae, TNF-Alpha, and Interleukin-6 in order to determine the potential for inhibitory concentration and docking affinity.
ResultsAccording to the study, good binding energy values varied from -7 to -11 Kcal/mol. Sitoindoside IX had the highest binding affinity and important binding interactions, such as hydrogen bonding, when compared to Thalidomide and Sitoindoside X against all three receptors.
ConclusionThe present study confirmed that the Sitoindoside IX and X are a better fit for treating patients with leprosy. These findings are highly intriguing and suggest that this herb should be investigated further to validate these findings in leprosy.
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Antioxidant Nutraceuticals: Their Adjunct Role in the Management of COVID-19 Infections and Post-COVID Syndrome
Available online: 30 December 2024More LessThe COVID-19 epidemic in recent years has been produced by various coronavirus strains that nearly destroyed world health policies and economics. Emerging viral strains exacerbated the pandemic. Huge investments have been made in preventative vaccines to combat the disease, but the genetic instability of these viruses has hampered their usefulness. However, in addition to traditional therapeutic approaches, nutraceuticals have been considered efficacious in preventing and or treating COVID-19 and post-COVID syndrome. In this context, nutraceuticals such as vitamins or dietary supplements including multiple vitamins and minerals and propolis have been widely studied for their significant impact on viral respiratory diseases like SARS-CoV-2 and COVID-19. Some of these nutraceuticals having antioxidant, anti-inflammatory, and immune-modulatory properties have been highly recommended for use as an adjunct option to moderate the adverse effects associated with the COVID-19 pandemic. In this review, we intend to present the recent understanding and converse scientific implications for the use of nutraceutical antioxidants such as vitamins, minerals, probiotics, and polyphenols like bee propolis, in the management of viral respiratory diseases and post-COVID-19 syndrome. Future challenges and limitations regarding the use and bioavailability of these ingredients, and dose-response studies are further emphasized.
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Exploration of Phytochemicals as Anti-biofilm Agents Against Pathogenic Bacteria: Their Potential and Challenges
Available online: 30 December 2024More LessMulticellular surface-attached populations of bacteria embedded in the extracellular matrix are known as biofilms. Bacteria generally preferred to grow as biofilms. Quorum sensing (QS), detection of density of cell population through gene regulation, has been found to play an important role in the production of biofilms. Biofilm formation can increase the severity of infections that can lead to morbidity or mortality. Bacteria living within biofilms have a higher pattern of adaptive resistance to antibiotics. Antibiotic resistance is a barrier in the treatment of biofilms-induced acute to chronic infections such as post-surgery infections, surgery-associated wound infections, endocarditis, joint infections, burn-related wound infections occurred, ventilator-associated pneumonia, etc. So it is urgent to discover or find out potent new drugs in fight against infectious diseases such as biofilms-associated infections. Medicinal plants or herbs are a rich source for fighting with biofilms-mediated infections. Phytochemicals have exhibited significant effects in the prevention of biofilms formation against different bacteria that are causing infections. Purified compounds such as berberine, tetrandrine, embelin, xanthorrhizol, bakuchiol, etc., exhibited promising biofilm inhibition actions against different pathogenic bacteria. Plant extracts that contain several phytochemicals are evaluated for its biofilm’s inhibition property, and have shown significant potential in biofilm formation. Antibiofilm agents act by distinct mechanisms such as inhibiting the adherence of biofilms in a surface, preventing the biofilm formations, disrupting the matured biofilms, etc. This study is intended to reiterate about possibilities of plant extracts and purified compounds in the treatment of the prevention of bacterial biofilms-related infections.
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Herbal Medicine for the Management of Wounds: A Systematic Review of Clinical Studies
Available online: 26 December 2024More LessBackgroundCuts and wounds are unfortunate yet inevitable events. Traditional remedies have historically harnessed various plants for wound healing, undergoing clinical and pre-clinical scrutiny. Hence, this systematic review focuses on clinically researched herbal formulations for wound healing.
MethodologyFollowing Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, databases like Google Scholar, Web of Science, PubMed, Scopus, J-gate, and Ayush Research Portal were meticulously searched for clinical trials involving wound-targeting herbal formulations, alongside a comprehensive hunt for preclinical plant data.
ResultsAmong 623 screened documents, 26 published clinical trials spotlighting herbal wound healing formulations were identified. All studies showcased significant wound healing progress, with some surpassing standard betadine treatment. Only one study reported an adverse effect. Within the 26 formulations, 45 distinct plant species were employed, with 35 exhibiting wound healing attributes like antimicrobial, anti-inflammatory, and antioxidant activities scientifically. Enhanced collagen content, stabilized fibers, activated fibroblast cells, increased total protein, elevated growth factors, hydroxyproline, hexosamine, and tissue protein demonstrate the efficacy of plants, such as Hypericum perforatum, Centella asiatica, and Calendula officinalis in wound healing.
ConclusionThe findings of the current study indicated that medicinal plants are effective and safe agents for the treatment of wounds, though larger, well-designed trials are needed for definitive role confirmation.
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A Case Study of Intradural Extramedullary Spinal Schwannoma and Multiple Thoracic Vertebral Haemangiomas Following COVID-19 Infection and Vaccination: Insights from MRI Imaging
Available online: 20 December 2024More LessIntroductionSpinal schwannomas are benign intradural extramedullary tumors of Schwann cells, while hemangiomas are common benign vascular tumors found in the vertebral column.
Case RepresentationThis case study presents a 32-year-old male who developed both a spinal schwannoma and multiple thoracic vertebral haemangiomas following a COVID-19 infection and subsequent vaccination. The patient reported intermittent lumbar and thigh pain over 6-8 months. Magnetic resonance imaging (MRI) confirmed an intradural extramedullary schwannoma at the L5 vertebra and multiple thoracic haemangiomas at the T6-T7 levels. The schwannoma was surgically resected, and pathology confirmed the diagnosis. Postoperatively, the patient’s symptoms improved significantly, with no complications.
ConclusionThis case raises questions about a possible link between COVID-19 and these spinal conditions. Further research is warranted to explore the potential association between viral infection, vaccination, and tumor development.
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Intensification of Invasive Fungal Infections and Exploration of Effective Antifungal Drug Delivery Formulations: A Detailed Review
Authors: Shrikant Mahesh Sharma, Rupali Sharma and Pankaj ChandrateyaAvailable online: 20 December 2024More LessInvasive fungal infections (IFIs) pose a significant global health threat, particularly among immunocompromised individuals. These infections can lead to severe illness and death, placing a significant financial burden on healthcare systems. Fungi were not previously considered a substantial risk to human health, but this perception changed with the rise of the HIV epidemic. The emergence of drug-resistant fungal strains further complicates the management of these infections, highlighting the urgent need for effective antifungal therapies. Innovative approaches in antifungal drug delivery formulations. This article explores the role of effective antifungal drug delivery formulations in combating the rise of IFIs. These formulations, ranging from lipid-based systems like liposomes and lipid emulsions to polymeric nanoparticles and microparticles, offer several advantages over conventional drug delivery methods. Optimizing these formulations may improve drug efficacy, reduce the risk of drug resistance, and enhance patient outcomes. Furthermore, advancements in nanotechnology and targeted drug delivery systems hold promise in overcoming existing limitations and expanding the scope of antifungal therapies.
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Annual SZ: An Alternative Immunotherapy for COVID-19 and Long COVID
Available online: 20 December 2024More LessSince the outbreak of coronavirus disease 2019 (COVID-19) in late 2019 and early 2020, the identification of drugs to control severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its symptoms has been a pressing focus of research. Cytokine storm and acute respiratory distress syndrome (ARDS) are the leading causes of mortality following infection. In this review, we discuss immune pathogenesis and four medications, including Remdesivir, Tocilizumab, Dexamethasone, and Annual SZ for COVID-19. A comparison of the effectiveness and therapeutic usage of drugs as reported in clinical trials and reports was made at different disease levels as well. Clinical studies indicate that Annual SZ with mild side effects was more affordable and might be more effective than other medications. Additionally, Annual SZ was capable of reducing the levels of pro-inflammatory cytokines as well as viral attachment and RNA replication.
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Repercussion of SARS-CoV-2 on the Sexual Function in Males: An Updated Review
Available online: 20 December 2024More LessSARS-CoV-2, also called coronavirus causes SARS-CoV-2 or severe acute respiratory syndrome, a highly transmissible disease that has rapidly spread worldwide, straining healthcare systems and leading to a substantial number of fatalities. Interestingly, SARS-CoV-2 has revealed a gender difference, with males dying at a greater rate and with more severe cases than women. It's worth noting that the male reproductive system might be particularly susceptible to damage during periods of moderate to severe sickness, which has been linked to cases of orchitis and erectile dysfunction. Furthermore, SARS-CoV-2 virus particles have been found in the tissues of the testes and penile of both living patients who have recovered from the virus and in post-mortem analyses of males who have died from it. For males who have recovered from SARS-CoV-2, sexual transmission is not a big concern, even though moderate to severe infections may have detrimental effects on male reproductive health. This includes the depletion of germ cells and Leydig cells that leads to a decrease in the formation of sperm, potentially decreasing the release of male sex hormones. These adverse effects may result in issues such as infertility and sexual dysfunction, which are of growing concern for couples looking to conceive or those in need of assisted reproduction. Numerous investigations have examined SARS-CoV-2's effects on male reproductive health from a variety of perspectives. The purpose of this review is to give a general summary of how SARS-CoV-2 has affected male reproductive health.
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The Severity of COVID-19 in Systemic Lupus Erythematosus Patient
Authors: Kishor R. Danao, Vijayshri V. Rokde and Ujwala N. MahajanAvailable online: 20 December 2024More LessAs of early October 2020, the COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, resulted in approximately 35 million cases and one million fatalities worldwide. Systemic lupus erythematosus (SLE) is an autoimmune disease marked by the generation of pathogenic autoantibodies and a lack of tolerance to nuclear self-antigens. Hypocomplementemia, or an abnormal blood complement deficit, is a reliable predictor of infection in SLE patients. Moreover, it has been found that immunoglobulin (Ig), particularly IgG and IgM, is lowered in SLE patients, which may be a factor in their heightened susceptibility to infection. Bloodstream autoantibodies, lymphopenia, aberrant T cells, proinflammatory cytokines, and impaired regulatory systems all lead to an immune response that is aberrant in lupus patients. SLE patients exhibit impaired CD8 T cell responses, including abnormal phagocytosis and chemotaxis. Recent study has shown that COVID-19 infections significantly boost type I interferon responses. Patients with SLE and Covid-19 infection typically get immune-suppressing drugs viz corticosteroids, Janus kinase inhibitors (JAK), and tocilizumab, which improve their immune systems and diminution susceptible to Covid-19 infections.
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Therapeutic Potential of Emodin: A Mini-Review of its Anti-Biofilm and Antimicrobial Effects
Authors: Samane Teymouri, Maryam Pourhajibagher and Abbas BahadorAvailable online: 20 December 2024More LessThe resistance of biofilms to antimicrobial agents presents numerous challenges. The formation of biofilms leads to enhanced resistance to adverse environmental conditions, as well as to antimicrobial agents. Natural compounds have been of interest as potential therapeutic agents. Emodin, a natural anthraquinone compound, has recently attracted attention for its potential as a broad-spectrum antimicrobial agent. This ability could potentially help combat biofilm-associated infections and enhance the effectiveness of antimicrobial therapies. This review was carried out to evaluate the effects of emodin on microbial biofilms, determine its effectiveness in inhibiting and reducing biofilm formation, eradicate biofilms, and examine its antimicrobial effects. Our study shows that the use of emodin as an additional therapeutic agent in combating microbial biofilms holds considerable promise. As researchers continue to investigate how emodin interacts with microbial biofilms, there is excitement about the potential applications of this natural compound in addressing biofilm-related issues. However, it is suggested to pay more attention to evaluating the effects of emodin on microbial biofilms in future studies
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In vitro Anti-biofilm and Anti-adhesion Effects of Lactic Acid Bacteria-derived Biosurfactants against Streptococcus mutans
Authors: Maryam Pourhajibagher and Abbas BahadorAvailable online: 20 December 2024More LessIntroductionBiosurfactants are naturally occurring compounds with various applications, biodegradable, non-toxic, and effective in different conditions. This study focuses on the extraction and evaluation of biosurfactants produced by five strains of lactic acid bacteria (LAB) for their potential to inhibit biofilm formation and adhesion by Streptococcus mutans.
MethodsThe strains of LAB-producing biosurfactants such as Lactobacillus salivarius, L. acidophilus, L. plantarum, L. casei, and L. rhamnosus were confirmed by the hemolysis test. The presence of biosurfactants derived from LAB strains and their molecular composition were confirmed, and their cellular toxicity, minimum inhibitory concentration (MIC), and minimum bactericidal concentration (MBC) were investigated. Ultimately, the anti-biofilm and anti-adhesive activities of LAB-derived biosurfactants against S. mutans were determined. Eventually, the effect of biosurfactants on the changes in gene expression associated with biofilm formation of S. mutans was assessed.
All the LAB strains used in this study were biosurfactant producers. The LAB-derived biosurfactants exhibited no cytotoxicity towards the human gingival fibroblast (HGF) cell line. According to the results, the lowest and highest MIC values were observed in the biosurfactants derived from L. rhamnosus and L. plantarum at 0.78 mg/mL and 6.25 mg/mL, respectively. The MBC values for the biosurfactants derived from L. rhamnosus, L. casei, L. salivarius, L. acidophilus, and L. plantarum were 3.12, 3.12, 6.25, 12.5, and 12.5 mg/mL, respectively. The LAB-derived biosurfactants at MBC concentrations exhibited significant inhibitory effects on biofilm formation and adhesion of S. mutans (P<0.05) The highest anti-biofilm and anti-adhesion activities were attributed to the biosurfactants derived from L. plantarum, which were not significantly different from the 0.2% chlorhexidine as a positive control group (P>0.05). Moreover, all biosurfactants could significantly decrease the gene expression level of gtfB (P>0.05).
ResultsThe study found that LAB-derived biosurfactants exhibit significant anti-adhesion and anti-biofilm activities against S. mutans without any observed cellular toxicity towards HGF cells.
ConclusionThese promising bioactive compounds can be utilized as natural antimicrobial agents and biofilm inhibitors to prevent microbial biofilm formation and adhesion in various dental applications, offering a safe and effective alternative for controlling dental biofilms and improving oral health outcomes.
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Antimicrobial Resistance of Environmental V. cholerae Non-O1/O139 Isolates: Systematic Review and Meta-analysis
Available online: 22 October 2024More LessBackgroundThe understanding of the antibiotic resistance status of environmental nonO1/nonO139 V. cholerae [NOVC] in relation to other illnesses, which can vary in severity from mild to life-threatening, is limited. However, it is important to note that NOVC-related infections are increasing and serve as a significant illustration of emerging human diseases associated with climate change. The primary objective of the present study was to assess the rates of resistance observed in environmental NOVC isolates across various years, and regions, and their resistance rates.
MethodsWe performed a systematic search of Scopus, PubMed, Web of Science, and EMBASE databases [until May 2024] following PRISMA guidelines. All statistical analyses were carried out using the statistical package R.
ResultsOur analysis included a total of 34 studies. According to the meta-regression, chloramphenicol, rifampicin, ciprofloxacin, nalidixic acid, cotrimoxazole, kanamycin, trimethoprim, amoxicillin/clavulanic acid, and tetracycline resistance rate increased over time. The lowest resistance rates were observed in Austria [amoxicillin; 0.6%], the United States [kanamycin; 0.1% and tetracycline; 0.1%], Morocco [polymyxin B; 12%], and Spain [trimethoprim; 0.3%]. Conversely, the highest resistance rates were found in Spain [amoxicillin; 61%], Indonesia [kanamycin and tetracycline; 94.9%], India [polymyxin B; 97.8%], and Morocco [trimethoprim; 48.9%].
ConclusionThe meta-analysis showed significant variability in antibiotic resistance patterns among environmental NOVC isolates across time and regions, emphasizing the need for targeted, time-specific, and country-specific approaches to address antibiotic resistance globally.
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