Arboviral encephalitis remains a major public health concern in tropical Asia, where the etiology of a substantial proportion of central nervous system infections remains undetermined despite endemic circulation of dengue virus (DENV) and Japanese encephalitis virus. Laboratory confirmation is frequently absent in clinically suspected encephalitis. Perera et al recently published a study in World Journal of Virology , highlight this diagnostic gap by identifying DENV infection in 6.06% of encephalitis cases, including molecular evidence of DENV-3 neuroinvasion. These findings add to the growing evidence that DENV can cause encephalitis and meningoencephalitis across age groups. However, encephalitis in endemic settings is etiologically heterogeneous, and dengue represents only one of several infectious and immune-mediated contributors. Neurological dengue is likely under-recognized due to overlapping clinical presentations and limited diagnostic capacity. The identification of DENV-3 is noteworthy given its recurrent association with neurological disease. Limited concordance between reverse transcription polymerase chain reaction and immunoglobulin M assays reflects challenges related to viral kinetics, timing of specimen collection, and flaviviral serological cross-reactivity. Strengthening surveillance through integrated molecular and serological diagnostic strategies, including multiplex polymerase chain reaction and metagenomic next-generation sequencing, is essential to reduce undiagnosed encephalitis and improve clinical management and public health preparedness in tropical Asia.
BACKGROUND Emergency repair of strangulated hernias in elderly patients with active respiratory viral infections is high risk and poorly described. This case reports the first emergency robotic-assisted transabdominal preperitoneal (r-TAPP) repair performed in an elderly patient with active influenza A infection, highlighting surgical and infection-control adaptations enabling safe outcomes. CASE SUMMARY An 80-year-old male with significant comorbidities presented with a strangulated left inguinal hernia and confirmed influenza A (H3N2) infection, associated with abdominal pain, bowel obstruction, and mild hypoxaemia. Emergency robotic r-TAPP repair was performed using targeted modifications, including ultra-low-pressure pneumoperitoneum, ultra-low particulate air filtration, and lung-protective ventilation. Operative time was 85 minutes with minimal blood loss. The patient was extubated immediately postoperatively, experienced no complications, and was discharged on postoperative day two. Antiviral therapy was continued without respiratory deterioration or nosocomial transmission. CONCLUSION Emergency robotic-assisted repair of strangulated hernia can be safely performed in selected elderly patients with active respiratory viral infection when appropriate surgical, anaesthetic, and infection-control strategies are applied.
Machupo virus (MACV), classified within the Mammarenavirus genus of the Arenaviridae family, serves as the causative agent of Bolivian hemorrhagic fever (BHF), a life-threatening zoonosis primarily confined to rural regions of Bolivia’s Beni Department. First identified in 1959 during epidemics in San Joaquín, this bisegmented, ambisense, single-stranded RNA virus exhibits 20%-35% case-fatality rates, with highest lethality among children under 5 and adults over 55. The vesper mouse (Calomys callosus ) acts as the principal reservoir, sustaining lifelong asymptomatic infections and shedding virus through excreta, facilitating human spillover via aerosol inhalation, contaminated food, or direct contact-predominant in agrarian settings. Clinically, BHF follows a 5-21 days incubation with initial nonspecific febrile prodrome (fever, myalgia, prostration) evolving into hemorrhagic diathesis (petechiae, mucosal bleeds), neurological signs (tremors, delirium), leukopenia/thrombocytopenia, and shock. Pathogenesis hinges on transferrin receptor 1-mediated endothelial tropism, type I interferon suppression (NP/Z), and cytokine storms, recapitulated in guinea pig/primate models. Designated Centers for Disease Control and Prevention Category A and biosafety level (BSL)-4, MACV constrains research; diagnostics demand reverse transcription polymerase chain reaction, enzyme-linked immunosorbent assay, or isolation in maximum containment. Supportive therapy prevails, augmented by off-label ribavirin (preclinical efficacy) and convalescent plasma; Candid 1 (Junín-attenuated) cross-protects informally. This review details MACV’s genomic organization (L/S segments encoding L/Z, NP/GPC), epidemiology, etiology, and advances: Reverse genetics for antivirals, GP-specific mAbs (100% guinea pig survival), multi-epitope vaccines, and high-throughput screening entry inhibitors. One health imperatives-rodent control, artificial intelligence surveillance, and Bolivian BSL-3 expansion-counter ecological drivers like deforestation. Amid climate, prioritizing global collaborations will forge resilient countermeasures, leveraging MACV as a sentinel for new world arenavirus threats.
As global strategies shift toward expanding treatment eligibility for chronic hepatitis B, ensuring long-term adherence is critical. Block et al recently published a study in World Journal of Virology, challenging the conventional focus on economic barriers and revealing that compromised physical functioning is a significantly more potent predictor of non-adherence than financial affordability. This finding exposes a profound “clinical discordance”: Patients may achieve viral suppression yet suffer from residual fatigue and functional impairment, potentially driven by immune exhaustion or metabolic comorbidities. We argue that this symptom burden serves as a functional blockade to daily persistence. Therefore, clinical care must evolve from “adherence policing” to active symptom management. Integrating patient-reported outcomes and addressing physical deficits are essential strategies to safeguard the efficacy of antiviral regimens in the elimination era.
BACKGROUND Peer supporters are instrumental for the successful navigation of prevention of mother-to-child human immunodeficiency virus (HIV) transmission services, including maternal viral load suppression and early infant HIV diagnosis. These outcomes are critical for the elimination of mother-to-child HIV transmission. We assessed the impact of continuous quality improvement (CQI) services on assignment to peer supporters and undetection of the viruses among pregnant women living with HIV (WLHIV) and mother-to-child transmission of HIV (MTCT) rates among HIV exposed babies in Rwanda. AIM To assess the impact of CQI services on assignment to peer supporters and undetection of the viruses among pregnant WLHIV and MTCT rates among HIV exposed babies in Rwanda. METHODS Between 2021 and 2022, CQI services were implemented in 18 of the 38 healthcare facilities included in this analysis. Healthcare workers in 18 facilities used CQI approaches to key predictors of, and contributors related to, the implementation of the prevention of MTCT (PMTCT) program to improve maternal and infant outcomes. This was a secondary data analysis that explored the association between CQI and assignment to peer supporters, undetection of the virus, and MTCT rates. To assess the impact of CQI on these outcomes, a multivariable logistic regression model was used to compute adjusted odds ratios (aOR) and corresponding 95% confidence intervals (CI). RESULTS A total of 1145 mother-baby pairs were included, of whom 558 (48.7%) were from facilities that implemented CQI. At the end of evaluation, 1043 (91.0%) either completed 24-months of follow-up or remained in care in the same facilities. Of 102 not available at the evaluation, 84 were transferred out, and 18 were dead or lost to follow-up. Overall, 405 (35.4%) women were assigned to peer supporters, 1004 (87.7%) had undetectable viruses, and 8 (0.7%) infants were infected with HIV. Compared to women from non-CQI facilities, those from CQI implementing facilities had 32% higher odds of being assigned to peer supporters (aOR = 1.32; 95%CI: 1.02-1.71). Similarly, disclosing HIV status (aOR = 1.53; 95%CI: 1.10-2.14) and a higher number of health care workers per 1000 active patients (> 4 vs ≤ 4) (aOR = 1.34; 95%CI: 1.05-1.75) were associated with higher odds of being linked to peer supporters. Having a formal education was associated with reduced odds of being linked to peer supporters compared to those with no education. Compared to women from non-CQI facilities, those from CQI implementing facilities had 51% higher odds of having undetectable viruses (aOR = 1.51; 95%CI: 1.05-2.18). CQI was associated with fewer transferred out compared to non-CQI facilities (6.0% vs 8.8%; P = 0.07). CONCLUSION Nearly 3 in 10 pregnant WLHIV in Rwanda were linked to peer support to support the successful navigation of PMTCT services, and CQI increased this linkage and aided the achievement of undetectable viruses. Implementing CQI and promoting HIV status disclosure is critical to facilitate peer support linkage and improve maternal and infant outcomes.
BACKGROUND Human metapneumovirus (hMPV) is an important cause of acute respiratory tract infection worldwide, but its impact during pregnancy has not been systematically characterized. AIM To synthesize available evidence on maternal, obstetric and neonatal outcomes of hMPV infection in pregnancy. METHODS Following PRISMA 2020 guidelines, a comprehensive search of PubMed/MEDLINE, EMBASE, Scopus, Web of Science and Google Scholar from inception to November 2025 identified studies reporting laboratory-confirmed hMPV infection in pregnant women. Eligible designs included case reports, case series and observational studies; however, the available evidence consisted predominantly of case reports and small case series, with only two prospective cohort studies contributing population-level data. Given anticipated heterogeneity, findings were synthesized narratively. RESULTS Seven studies met inclusion criteria, comprising two prospective community-based cohorts and five case reports/series. Across studies, approximately 50-60 women had laboratory-confirmed antenatal hMPV infection after exclusion of postpartum-only cases and accounting for non-overlapping cohorts. In community cohorts from Nepal and Thailand, hMPV accounted for a modest but non-trivial proportion of symptomatic antenatal respiratory illnesses, most of which were mild to moderate, self-limited, and did not require hospitalization or intensive care. In contrast, case-based reports described severe pneumonia and acute respiratory distress syndrome (ARDS) in women—typically in the second or third trimester-with underlying comorbidities such as asthma, morbid obesity, diabetes, chronic kidney disease or hypertensive disorders; no maternal deaths were reported. Obstetric outcomes were generally reassuring, although one cohort demonstrated an increased risk of small-for-gestational-age infants after antenatal hMPV infection, while evidence for preterm birth and other major complications remained limited and inconsistent. Neonatal outcomes were mostly favorable, with live births, gestational age and birthweight distributions comparable to uninfected pregnancies, and no confirmed congenital hMPV infections. CONCLUSION hMPV is an under-recognized cause of respiratory illness in pregnancy, usually resulting in mild disease but occasionally associated with severe pneumonia and ARDS in women with comorbidities. A possible association with fetal growth restriction has been reported; however, given the predominance of case reports and small cohort data, causality cannot be inferred for obstetric outcomes. Evidence for other adverse maternal and neonatal outcomes remains limited and inconsistent.
Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated alcohol-related liver disease (MetALD) have emerged as increasingly important sources of morbidity among people living with human immunodeficiency virus (HIV). Advances in antiretroviral therapy have substantially improved life expectancy in people living with HIV (PLWH), but have also unmasked a growing burden of metabolic comorbidities which contribute to steatotic liver disease. Recent shifts in nomenclature and the introduction of MetALD emphasize metabolic dysfunction and graded alcohol exposure as central drivers of disease and are particularly relevant to PLWH, a population in whom overlapping metabolic and behavioral risk factors are common. Epidemiologic studies demonstrate that MASLD affects approximately one-third to one-half of PLWH worldwide, often occurring at younger ages and lower body mass index thresholds than in HIV-negative individuals. Emerging data further highlight the synergistic contribution of metabolic dysfunction and alcohol use to accelerated fibrosis progression in PLWH. Pathophysiologic mechanisms linking HIV infection to MASLD and MetALD include chronic immune activation and systemic inflammation, antiretroviral therapy-associated metabolic effects, altered adipose tissue distribution, gut-liver axis dysregulation, and alcohol-metabolic synergy. This review synthesizes contemporary evidence on the definitions, epidemiology, pathogenesis, clinical assessment, and management of MASLD and MetALD in PLWH.
Soluble human leukocyte antigen-G (sHLA-G), a non-classical major histocompatibility complex class I molecule, arises either through proteolytic cleavage of membrane-bound isoforms or via secretion of soluble isoforms. sHLA-G exerts potent immunosuppressive effects, facilitating immune escape of cancer cells within the tumor microenvironment by inhibiting the cytotoxic activity of natural killer cells, cytotoxic T lymphocytes, and other immune effectors. Emerging evidence indicates that aberrant expression of sHLA-G contributes to tumor progression in virus-associated malignancies, including human papillomavirus-driven cervical cancer and hepatitis B virus/hepatitis C virus-related hepatocellular carcinoma. sHLA-G is detectable in various body fluids, including plasma and serum, highlighting its potential as both a diagnostic and prognostic biomarker as well as a therapeutic target.
The monkeypox virus (MPXV) belongs to the Poxviridae family and has emerged as a global problem for public health since May 2022. Both innate and adaptive immunity are crucial for preventing MPXV infections. Understanding the interaction between the innate and adaptive immune systems and MPXV could be critical in developing novel treatments. This review presents an update on the host antiviral innate and adaptive immune responses against four zoonosis poxvirus, including mouse kidney parvovirus, cowpox virus, variola virus, and vaccinia virus. The effect of APOBEC3 variants on viral immune escape and the underlying mechanisms were also explored. The possible mechanisms of the effects of human immunodeficiency virus and monkeypox co-infection in the clinical setting were also analysed in the hope of providing a basis for clinical drug development and treatment.
BACKGROUND Hepatitis B virus remains an important occupational risk for healthcare trainees. Objective serology can verify protection and inform pre-placement clearance policies. AIM To assess hepatitis B vaccination status, occupational exposure, and serological protection among health sciences students in Albania. METHODS Cross-sectional study (April-June 2024) at the University of Vlore. Students completed a structured questionnaire (n = 152); a consenting subset provided blood samples for hepatitis B surface antigen and anti-hepatitis B surface antibody (HBs) testing (n = 134). Group comparisons used χ 2/Fisher’s exact tests and multivariable logistic regression for seroprotection (anti-HBs ≥ 10 IU/L). RESULTS All tested participants were hepatitis B surface antigen negative (n = 134). Overall, 86.6% had protective anti-HBs (≥ 10 IU/L), including 76.2% with titers > 100 IU/L; 13.4% had anti-HBs < 10 IU/L. Needlestick/sharps injuries were reported during training, supporting the need for standardized clearance and reporting pathways. CONCLUSION Most students had serological protection, but a meaningful minority lacked protective titers. Universities and training sites should implement pre-placement HB clearance with documented vaccination, mandatory anti-HBs testing, and structured catch-up/booster pathways.
Viral infections of the ocular surface significantly contribute to morbidity and visual impairment globally. The herpes simplex virus (HSV), adenovirus, cytomegalovirus (CMV), and human papillomavirus (HPV) are predominant pathogens impacting the cornea and conjunctiva, resulting in recurrent illness, epidemic outbreaks, and virus-associated neoplasia. Progress in virology, immunology, and molecular diagnostics has enhanced comprehension of host-virus interactions and introduced novel therapeutic opportunities. A narrative literature review was performed utilizing PubMed, Scopus, and Web of Science, encompassing papers published from 2000 to 2025, with a specific focus on research from 2020 onwards. Eligible publications were peer-reviewed clinical and experimental investigations, together with reviews that focused on epidemiology, etiology, diagnostic methodologies, and therapeutic alternatives. Research indicates that HSV keratitis is the predominant infectious cause of corneal blindness in high-income nations, although adenovirus persists in instigating epidemics of keratoconjunctivitis in the absence of licensed antiviral treatments. CMV keratitis, previously confined to immunocompromised persons, is now acknowledged in immunocompetent patients as a causative agent of corneal endotheliitis. HPV is associated with ocular surface squamous neoplasia, especially in areas with elevated ultraviolet exposure and high human immunodeficiency virus prevalence. Innovative molecular diagnostics, innovative antiviral agents, immunomodulatory approaches, and immunization initiatives signify significant progress that could enhance preventative and therapeutic results.
BACKGROUND:The coronavirus disease 2019 (COVID-19) pandemic has had profound physical, psychological, and social consequences, with lasting effects on health-related quality of life (HRQoL) among people with a history of COVID-19. AIM:To synthesize the current evidence on HRQoL and long-term health outcomes among people with a history of COVID-19 in India. METHODS:We incorporated studies from India reporting post-COVID HRQoL outcomes using validated instruments, including the 5-level EuroQol 5-Dimensional questionnaire, the EuroQol Visual Analogue Scale, the Short Form-36 Health Survey, the World Health Organization Quality of Life-Brief Version, and the European Health Interview Survey-Quality of Life. Pooled mean 5-level EuroQol 5-Dimensional questionnaire scores with 95%CIs were calculated for HRQoL. Adjusted odds ratios were pooled for comorbidity, disease severity, intensive care unit admission, age, sex, and vaccination status using random-effects models. RESULTS:Three studies (n = 1526) reported EuroQol instruments, with the 5-level EuroQol 5-Dimensional questionnaire utility scores suitable for quantitative pooling. The pooled mean utility was 0.83 (95%CI: 0.75-0.92), although heterogeneity was high because the included studies represented clinically distinct populations. Across all studies, several determinants were consistently associated with impaired HRQoL. Older adults (≥ 60 years) had higher odds of poor HRQoL [pooled odds ratio (OR) = 1.83, 95%CI: 1.43-2.35], and females were more likely to experience impaired HRQoL (pooled OR = 1.74, 95%CI: 1.44-2.10), whereas males had a lower risk (pooled OR = 0.58, 95%CI: 0.48-0.70). Being unvaccinated increased the likelihood of persistent symptoms or reduced HRQoL (pooled OR = 1.60, 95%CI: 1.21-2.14). Comorbidity (pooled OR = 1.94, 95%CI: 1.43-2.63) and severe acute COVID-19 or intensive care unit admission (pooled OR = 2.77, 95%CI: 2.13-3.59) were also strongly associated with poorer HRQoL Six additional studies utilizing disparate instruments (EuroQol Visual Analogue Scale, Short Form-36 Health Survey, World Health Organization Quality of Life-Brief Version, European Health Interview Survey-Quality of Life) were excluded from quantitative synthesis due to measurement heterogeneity. CONCLUSION:Post-COVID HRQoL in people with a history of COVID-19 in India is suboptimal, with greater impairment observed among older adults, females, patients with comorbidities or severe disease, and unvaccinated individuals. These findings highlight the need for targeted rehabilitation and preventive strategies.
BACKGROUND:In tropical Asia, arbovirus-induced encephalitis continues to be a serious public health issue. Encephalitis is caused by wide range of neurotropic pathogens, and flaviviruses are one of the main causative agents in the area. Sri Lanka reports a considerable number of central nervous system infections annually. Both dengue and Japanese encephalitis are endemic, and cases of Zika and West Nile virus infections were reported occasionally in Sri Lanka. Although reported number of Japanese encephalitis cases has reduced in the past, aetiological diagnosis in majority of encephalitis cases is still unknown. AIM:To detect dengue virus (DENV) infections in individuals in the central region of Sri Lanka who were clinically suspected of having encephalitis. METHODS:A retrospective observational analysis was conducted on 99 cerebrospinal fluid samples received to a virology laboratory from patients in the central part of Sri Lanka who were clinically suspected of having encephalitis. Samples were analyzed using reverse transcriptase polymerase chain reaction (RT-PCR) with universal flavivirus primers to detect flaviviral RNA followed by DENV serotyping real-time RT-PCR, and an immunoglobulin M (IgM) detection enzyme-linked immunosorbent assay to detect IgM antibodies indicative of a possible recent DENV infection. RESULTS:DENV aetiology was detected in 6 (6.06%) cerebrospinal fluid samples, and all were confirmed as DENV infections. A single positive result (1.01%) was yielded through RT-PCR and was identified as DENV serotype 3. Serology testing detected 05 (5.05%) anti-dengue IgM positives and further investigation indicated probable DENV aetiology. Among positives 02 (33.33%) were children (aged less than 14 years), and rest were adults. CONCLUSION:These findings underscore the presence of DENV-associated central nervous system infections and highlight the need for broader surveillance and more advanced diagnostic approaches in the future.
Between 2021 and 2023, approximately 400 pediatric cases of acute hepatitis of unknown etiology (AHUE) were reported in European countries and the United States. In 2023, three pediatric studies revealed that adeno-associated virus serotype 2 (AAV-2) infection was associated with AHUE. This article presents a summary and comparison of the results of metagenomic sequencing, viral whole-genome sequencing, virus-specific real-time polymerase chain reaction (PCR) and histological analysis of the liver, all of which were among the common investigative methods used in the three pediatric studies. All three pediatric studies revealed 80% or greater rates of positivity for AAV-2 in cases of AHUE according to metagenomic sequencing. Moreover, on the basis of PCR results, two studies revealed high AAV-2 positivity rates (96.4% and 81.2%) among cases of AHUE. These findings suggest that AAV-2 is a pathogen in AHUE. Coinfection with AAV-2 and one or more helper viruses (human adenovirus, human herpesvirus 6B, Epstein-Barr virus, etc.), high viral loads of AAV-2 in blood, anti-AAV-2 IgM and human leukocyte antigen typing could be candidate diagnostic criteria for AHUE. AAV-2 infection should be incorporated into clinical guidelines for the management of acute liver failure. Cidofovir can be administered if coinfection with AAV-2 and HAdV is detected.
Hepatitis C virus (HCV) infection, traditionally regarded as a hepatotropic disease, is increasingly recognized as a systemic condition with significant thrombotic implications. Chronic HCV induces a persistent proinflammatory and prothrombotic state that substantially elevates the risk of both venous and arterial events. Mechanistically, HCV drives endothelial dysfunction, enhances platelet activation, disrupts coagulation and fibrinolytic balance, and promotes immune-mediated vascular injury through cryoglobulinemia and chronic systemic inflammation. Clinical manifestations range from portal vein thrombosis and venous thromboembolism to coronary artery disease and ischemic stroke, highlighting the far-reaching consequences of virus-driven coagulopathy. Emerging evidence challenges the historical view of cirrhosis as a "naturally anticoagulated" state, instead describing a fragile hemostatic balance prone to both bleeding and thrombosis. Direct-acting antiviral therapy has transformed outcomes, not only achieving sustained virological response but also reversing systemic inflammation, improving endothelial function, and reducing thrombotic complications. However, patients with advanced fibrosis and comorbidities remain at elevated risk despite viral clearance, underscoring the need for ongoing surveillance. This minireview highlights the interplay between hepatic dysfunction, viral-induced inflammation, and cardiovascular sequelae in chronic HCV, emphasizing the importance of integrating thrombotic risk assessment into clinical care and research frameworks.
Acute respiratory infections (ARIs) are the main cause of morbidity and mortality worldwide, especially among children. The human bocavirus (HBoV) is a non-enveloped DNA virus that was recently identified as a respiratory pathogen associated with respiratory tract infections (RTIs), predominantly in infants and young children. It is also detected from the gastrointestinal tract in children. The prevalence of HBoV1 acute respiratory tract infection varies across age groups, ranging from 10.3% to 12.51% in individuals under 3 years of age. The spectrum of clinical presentation includes mild upper RTIs, acute exacerbation of asthma, bronchitis, bronchiolitis, pneumonia, and multi-organ failure. Although HBoV is often detected in patients with ARIs who have other respiratory viruses (17%-85%), recent studies have identified it as the sole aetiology for mild to severe ARIs. Children with pre-existing medical conditions infected with HBoV often have a risk of severe illness. HBoV infection is diagnosed primarily by detecting viral DNA in respiratory samples using molecular methods. Currently, there is no specific antiviral treatment for HBoV infections and the cases are managed symptomatically. General preventive measures used for the prevention of viral RTIs are applicable, as there is no effective vaccine against this virus. The HBoV has been implicated in RTIs, particularly in children, and has also been detected in cases of gastroenteritis. Despite its global prevalence, the exact pathogenic role of HBoV remains unclear due to frequent co-infections with other viruses. This mini-review discusses the virology, epidemiology, clinical manifestations, diagnosis, and potential treatment approaches related to HBoV infections.
This retrospective cohort study from Rwanda demonstrated the likelihood of maternal disclosure and peer support in preventing mother-to-child human immunodeficiency virus (HIV) transmission. High sustained maternal viral load suppression (91.0%) and exceptional infant testing uptake (100% at 6 weeks) correlated with a low 0.7% infant HIV incidence. To eliminate mother-to-child transmission of HIV, effective strategies must engage male partners in disclosure, reduce stigma, improve health literacy, and provide structural peer-support for enhancing adherence and mental health.
