Agents of infection
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Agents of Infection: A Comprehensive Overview
Infectious Agents and Vascular Disease
Infectious agents play a significant role in the pathogenesis of vascular diseases. Various pathogens, including herpesviruses, parvovirus B19, hepatitis viruses, human immunodeficiency virus (HIV), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Treponema pallidum, Mycobacterium tuberculosis, Pseudomonas aeruginosa, Staphylococcus aureus, and Candida albicans, have been linked to vascular complications. These pathogens can disrupt vascular homeostasis and functionality through mechanisms such as dysregulation of vasomotor function, thromboembolic complications, initiation and progression of atherosclerosis, and recruitment of inflammatory cells and molecules.
Safety of Targeted and Biological Therapies
Interleukins, Immunoglobulins, and Complement Factors
Patients receiving interleukin-targeted therapies, such as IL-1 and IL-5 agents, face a moderate risk of infection. IL-6/IL-6 receptor-targeted agents are associated with risks similar to anti-tumor necrosis factor-α (TNF-α) agents. IL-12/23-targeted agents require screening for latent tuberculosis and antiviral prophylaxis for hepatitis B surface antigen-positive patients. IL-17-targeted therapies may lead to mucocutaneous candidiasis, and C5-targeted agents significantly increase the risk of infections from encapsulated bacteria, necessitating preventive measures like meningococcal vaccination.
Lymphoid and Myeloid Cell Surface Antigens
Agents targeting CD19, CD20, and CD52 increase the risk of various infections, including severe respiratory tract infections, hepatitis B virus reactivation, and varicella-zoster virus infection. Preventive strategies include screening for chronic infections and providing antiviral prophylaxis. CD22, CD30, CD33, CD38, CD40, SLAMF-7, and CCR4-targeted therapies also pose infection risks, with specific recommendations for prophylaxis and monitoring to mitigate these risks .
Anti-Tumor Necrosis Factor-α Agents
Anti-TNF-α therapies are linked to a higher risk of active tuberculosis and other serious infections. Screening for latent tuberculosis and chronic hepatitis B virus infection is recommended before initiating therapy. Preventive measures, including vaccinations and antiviral prophylaxis, are crucial to reduce the risk of reactivation of latent infections.
Emerging Yeast Pathogens
The incidence of infections caused by non-traditional yeast pathogens has increased. Common yeast pathogens include Candida albicans, Candida tropicalis, Candida glabrata, Candida parapsilosis, and Cryptococcus neoformans. Emerging pathogens such as Malassezia furfur, Trichosporon beigelii, and Rhodotorula species are increasingly recognized, particularly in immunocompromised patients. These pathogens exhibit varied antifungal susceptibilities, necessitating comprehensive species identification and susceptibility testing for effective management.
Antiviral Agents from Marine Natural Products
Marine natural products are a promising source of new antiviral agents. These agents are crucial in combating drug-resistant infectious diseases, including HIV, hepatitis B and C, influenza, and respiratory syncytial virus. The continuous search for novel anti-infective agents is essential to address the evolving resistance of pathogens to current treatments.
Bacterial Resistance to Antimicrobial Agents
Bacterial resistance to antimicrobial agents is a growing public health concern. Mechanisms of resistance include active efflux of antimicrobials, reduced drug entry, enzymatic degradation of drugs, biofilm formation, and altered drug targets. Understanding these mechanisms is vital for developing strategies to overcome resistance and restore the efficacy of antimicrobial therapies.
Immunomodulatory Agents in Infection Control
Immunomodulatory agents have emerged as promising therapies for infectious diseases. Agents such as granulocyte colony-stimulating factor (G-CSF), interferons, and synthetic cytosine phosphate-guanosine (CpG) oligodeoxynucleotides are being used or investigated for their potential to enhance the immune response against infections. These agents offer an adjunct approach to traditional antimicrobial therapies, particularly in the context of rising antibiotic resistance.
Conclusion
Infectious agents are diverse and impact various aspects of human health, from vascular diseases to systemic infections. The development and implementation of targeted therapies, preventive strategies, and novel antimicrobial agents are crucial in managing and mitigating the risks associated with these pathogens. Continuous research and innovation are essential to stay ahead of emerging infectious threats and resistance mechanisms.
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