Globally, there are an estimated 13.3 million cases of acute kidney injury (AKI) annually. Although infections are a common cause of AKI globally, most infection-associated AKI occurs in low- and lower-middle-income countries. There are marked differences in the etiology of infection-associated AKI across age groups, populations at risk, and geographic location. This article provides a global overview of different infections that are associated commonly with AKI, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), human immunodeficiency virus, malaria, dengue, leptospirosis, tick-borne illnesses, and viral hemorrhagic fevers. Further discussion focuses on infectious conditions associated with AKI including sepsis, diarrheal diseases and pregnancy, peripartum and neonatal AKI. This article also discusses the future of infection-associated AKI in the framework of climate change. It explores how increased investment in achieving the sustainable development goals may contribute to the International Society of Nephrology's 0 by 25 objective to curtail avoidable AKI-related fatalities by 2025. 

Infections and Acute Kidney Injury: A Global Perspective.

Adenovirus (ADV) may cause severe complications in hematopoietic stem cell transplant recipients, but disseminated ADV infections in patients who received chemotherapy alone for hematological malignancies are poorly understood due to the rarity of cases. Concomitant infection with Pneumocystis (PCP) is extremely rare. Despite being diagnostically challenging, a more specific workup needs to be initiated with a low threshold in patients who are exposed to agents with the potential to suppress T cells. We report a fatal case of disseminated ADV and drug‐resistant PCP pneumonia in a patient with mantle cell lymphoma who had only received combination chemotherapy. A 75‐year‐old man who was diagnosed with mantle cell lymphoma 10 months prior was admitted for mild hypoxic respiratory failure. Bendamustine, Rituximab, Cytarabine regimen had resulted in complete remission of his lymphoma, with the last cycle of chemotherapy administered 3 months prior to admission. CT of the chest revealed ground‐glass opacities concerning pneumonia. Initial laboratory tests were remarkable for mild leukopenia. The respiratory viral panel was only positive for ADV. He did not respond to empiric antibiotics for community‐acquired pneumonia and Trimethoprim / Sulfamethoxazole given later for positive Beta D Glucan (BDG) suggestive of Pneumocystis pneumonia. Then, he developed hemorrhagic cystitis, followed by liver and renal function derangement that prompted checking serum ADV viral load by polymerase chain reaction (PCR). This test took 1 week to return, with a viral load of 50, 000 copies/mL suggesting disseminated ADV infection. Despite initiation of Cidofovir, multi‐organ failure continued to progress, and the follow‐up viral load had doubled on Day 2. The patient passed away the same day shortly after transition to comfort care. T cell suppression seems to be a risk factor for disseminated ADV disease. Clinicians may need to maintain a low threshold to send serum quantitative ADV PCR when symptoms are not improved by antimicrobial treatment for more conventional infections in patients who received agents that are known to suppress T cells, such as Bendamustine.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/ccr3.7220

A case of fatal disseminated adenovirus and drug‐resistant Pneumocystis pneumonia in a patient who received chemotherapy for mantle cell lymphoma

Introduction This study sought to elucidate the long-term antibody responses to the Moderna mRNA-1273 COVID-19 vaccine within a Ugandan cohort, aiming to contribute to the sparse data on m-RNA vaccine immunogenicity in Sub-Saharan Africa. Methods We tracked the development and persistence of the elicited antibodies in 19 participants aged 18 to 67, who received two doses of the mRNA-1273 vaccine. A validated enzyme-linked immunosorbent assay (ELISA) was used to quantify SARS-CoV-2-specific IgG, IgM, and IgA antibodies against the spike (S) and nucleoproteins (N). The study’s temporal scope extended from the baseline to one year, capturing immediate and long-term immune responses. Statistical analyses were performed using the Wilcoxon test to evaluate changes in antibody levels across predetermined intervals with the Hochberg correction for multiple comparisons. Results Our results showed a significant initial rise in spike-directed IgG (S-IgG) and spike-directed IgA (S-IgA) levels, which remained elevated for the duration of the study. The S-IgG concentrations peaked 14 days afterboosting, while spike-directed IgM (S-IgM) levels were transient, aligning with their early response role. Notably, post-booster antibody concentrations did not significantly change. Prior S-IgG status influenced the post-priming S-IgA dynamics, with baseline S-IgG positive individuals maintaining higher S-IgA responses, a difference that did not reach statistical difference post-boost. Three instances of breakthrough infections: two among participants who exhibited baseline seropositivity for S-IgG, and one in a participant initially seronegative for S-IgG. Discussion In conclusion, the mRNA-1273 vaccine elicited robust and persistent S-IgG and S-IgA antibody responses, particularly after the first dose, indicating potential for long-term immunity. Prior viral exposure enhances post-vaccination S-IgA responses compared to naive individuals, which aligned with the prior-naïve, post-boost. The stable antibody levels observed post-booster dose, remaining high over an extended period, with no significant secondary rise, and no difference by baseline exposure, suggest that initial vaccination may sufficiently prime the immune system for prolonged protection in this population, allowing for potential to delay booster schedules as antibody responses remained high at the time of boosting. This finding calls for a reassessment of the booster dose scheduling in this demographic.

Sustained S-IgG and S-IgA antibodies to Moderna’s mRNA-1273 vaccine in a Sub-Saharan African cohort suggests need for booster timing reconsiderations

Background: While protective immunity against some viruses, such as coronaviruses, is relatively short-lived, healing from acute infections of many different viruses, such as those caused by yellow fever, polio, measles, and smallpox, can give cell-mediated and humoral immunity for a lifetime. The main element in the long-term prevention of reinfection by most viruses might be due to the specific antibodies generated by plasma cells. Aim: This study aims to estimate the levels of SARS-CoV-2 Anti-Spike S1 RBD IgM, IgA, and IgG in serum among people in Baghdad after one month of receiving the Pfizer-BioNTech vaccine, infected with the SARS-CoV-2 virus after vaccination and COVID-19 infected patients respectively. Methods: A total of 120 volunteers were enrolled in this study, which was conducted between the 1st of November 2022 and the 13th of January 2023, and they were divided into four groups, each group containing 30 individuals. The study groups were categorized after one month into vaccinated with the Pfizer-BioNTech vaccine (BNT162b2), infected with SARS-CoV-2 after Pfizer vaccination, COVID-19 patients, and control. Results: The study presented a significant difference where (P value < 0.05) in the serum levels of Anti-Spike S1 RBD IgM, IgA, and IgG for all groups compared to the control. Serum levels of S1 RBD IgM Anti-Spike of SARS-CoV-2 in all groups were significantly increased (P value >0.05) compared to each other. For Anti-Spike S1 RBD IgA and IgG, there was no significant difference (P value >0.05) between the COVID-19-infected patients group and those infected by SARS-CoV-2 after the Pfizer vaccination group. Positive correlations were found among Anti-Spike S1 RBD IgM, IgA, and IgG levels in the serum. Conclusions: Natural infection by SARS-CoV-2 or vaccination with Pfizer-BioNTech (BNT162b2) provides significant humoral Immunological protection.

Elevated Serum Levels of SARS-CoV-2 Anti-Spike S1 RBD IgM, IgG, and IgA in Pfizer-BioNTech Vaccinated, COVID-19 Infected, and COVID-19 Infected after Pfizer-BioNTech Vaccinated Individuals after One Month

Multiple drugs

Background
Measurements of IgG antibodies to wild-type SARS-CoV-2 antigens can assess vaccine efficacy, but the absolute risk of Omicron symptomatic infection at different IgG levels for children and adolescents remains uncertain, as well as the minimum effective antibody level. We sought to determine the relationship between the tertiles of IgG antibodies to wild-type SARS-CoV-2 antigens and children with symptomatic infection of the pandemic and duration to negative conversion in China for the first time.


Methods
A retrospective study was conducted, including 168 participants under 18 years old from the No.2 People's Hospital of Lanzhou, China, diagnosed with Omicron variant BA.2.38 between July 8, 2022, and August 2, 2022. We calculated odds ratios (OR) in univariate and multivariate regression to assess the association of symptomatic infection with the tertiles of IgG, respectively. Kaplan-Meier curves and Cox proportional hazards regression were used to evaluate the relationship between IgG level and negative conversion time.


Results
The average age of the 168 children included in this study was 7.2 (4.7) years old, 133 (79.2%) were symptomatic patients, and the average negative conversion time was 12.2 (3.5) days. The participants with high IgG levels were less likely to become symptomatic, had a shorter turnaround time, and had higher values of IgM and nucleic acid CT. Compared to those with the lowest tertile of IgG, patients with the highest tertile had a 91% lower risk of developing a symptomatic infection after fully adjusting for confounders (OR = 0.09, 95% CI, 0.02-0.36, p = 0.001). There's no robust relationship between IgG level and negative conversion time in multivariate Cox regression.


Conclusion
The risk of developing a symptomatic infection can be predicted independently by tertiles of IgG antibodies to wild-type SARS-CoV-2 antigens. High IgG levels can inhibit viral replication, vastly reduce the risk of symptomatic infections and promote a virus-negative conversion, especially when IgG quantitative detection was ≥3.44 S/CO, a potential threshold for protection and booster strategy in the future. More data and research are needed in the future to validate the predictive models.

Association between levels of IgG antibodies from vaccines and Omicron symptomatic infection among children and adolescents in China.

Clinical and Humoral Immune Response Characterization of SARS-CoV-2 Omicron BA.2.38 Infection in Pediatric Patients

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A case of fatal disseminated adenovirus and drug‐resistant Pneumocystis pneumonia in a patient who received chemotherapy for mantle cell lymphoma

Association between levels of IgG antibodies from vaccines and Omicron symptomatic infection among children and adolescents in China.

Clinical and Humoral Immune Response Characterization of SARS-CoV-2 Omicron BA.2.38 Infection in Pediatric Patients