Impaired renal functions have been reported with Hepatitis E virus (HEV) infections, especially with genotypes 3 and 4. These complications were reported during the acute and chronic phases of infection. HEV genotype 1 causes acute infection, and the effect of HEV-1 infections on renal functions is not known. We examined the kidney function parameters in the serum of HEV-1 patients (AHE, n = 31) during the acute phase of infection. All of the included patients developed an acute self-limiting course of infection, without progression to fulminant hepatic failure. We compared the demographic, laboratory, and clinical data between AHE patients with normal kidney function parameters and those with abnormal renal parameters. Out of 31 AHE patients, 5 (16%) had abnormal kidney function tests (KFTs) during the acute phase of infection. Three patients had abnormal serum urea and creatinine, and two patients had either abnormal urea or creatinine. Four out of five patients had an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m². AHE patients with abnormal KFTs were older and had a lower level of albumin, but a slightly elevated alanine transaminase (ALT) compared to AHE patients with normal KFTs. There were no significant differences between the two groups in terms of age, sex, liver transaminase levels, and the viral load. Similarly, the clinical presentations were comparable in both groups. Interestingly, these KFTs in patients with abnormal renal parameters returned to normal levels at the recovery. The serum creatinine level was not correlated with patients’ age or liver transaminase levels, but it was significantly negatively correlated with albumin level. In conclusion, this study is the first report that evaluated KFTs in patients during the acute phase of HEV-1 infections. Impaired KFTs in some AHE patients resolved at convalescence. KFTs and renal complications should be monitored during HEV-1 infections.

Wastewater monitoring is an effective approach for assessing public health, providing insight into circulating pathogens and their associated antimicrobial resistance genes. Klebsiella pneumoniae, a clinically and environmentally significant opportunistic pathogen, was investigated in this study. 120 wastewater samples were collected from various sources, and the isolates were analyzed for antimicrobial susceptibility using the Kirby-Bauer disk diffusion method against 11 antibiotics, in addition to PCR-based detection of β-lactamase and virulence genes. Among 81 K. pneumoniae isolates from different wastewater sources, 51% were resistant to at least one antibiotic, with hospital wastewater being the main source of resistant strains (74.2%), followed by community wastewater (50%), WWTP influent (35%), and effluent (21.4%). Resistance was most frequent to ampicillin/sulbactam (35.8%), whereas gentamicin showed the highest efficacy (4.9%). Multidrug resistance was observed in 53.7% of resistant isolates, primarily in samples from hospitals (69.6%) and WWTP influents (57.1%). ESBL producers accounted for 67.5% of isolates, while 32.5% co-produced ESBLs and carbapenemases. The bla_SHV gene was detected in all isolates (100%), while bla_OXA-48 (22.5%) was the most common carbapenemase gene. Almost all isolates (98.8%) possessed at least one virulence gene, with mrkD (96.3%) and entB (79.0%) being the most detected. Additionally, 86.5% of the isolates carried two or more virulence genes. Notably, no hypervirulent strains were observed. Overall, wastewater from diverse sources constitutes a significant reservoir of multidrug-resistant and virulent K. pneumoniae strains. Their environmental release poses a considerable public health risk, highlighting the urgent need for improved wastewater management and continuous microbial surveillance.

Dendritic cells (DCs) play a crucial role in controlling viral infections. Little is known about the changes in frequencies of the DC subsets in patients with chronic hepatitis C (CHC), particularly in the era of interferon-free regimens. We aimed to evaluate the impact of sofosbuvir/daclatasvir on the frequency of different peripheral DC subsets, the expression of the inhibitory CD200R and its ligand CD200 on DC, and their relation to the treatment outcome. A total of 1000 patients with CHC were enrolled and treated with a fixed oral dose of 400 mg of sofosbuvir and 60 mg of daclatasvir for 12 weeks. A total of 940 patients achieved sustained virologic response (SVR), and only 60 patients were non-responders (NRs). The frequencies of the peripheral plasmacytoid (pDC) and myeloid (mDCs) subsets and their surface expressions of CD200R and CD200 molecules were analyzed using flow cytometry. This analysis included 60 non-responders (NR group), 60 randomly selected sustained virologic responders (SVR group) at baseline, and at the end of treatment, and 60 healthy controls. HCV infection was associated with a down-regulation in the frequency of mDC, compared to healthy controls. In addition, mDC in HCV-infected patients showed lower levels of CD200R. However, neither the pDC frequency nor their CD200R expression was significantly altered. Interestingly, by the end of therapy, the frequencies of circulating mDCs and CD200R⁺mDC increased significantly in the SVR group and were even comparable to healthy controls. The levels of these cells were not normalized in the NR group. Percentages of mDCs and CD200R⁺mDC subsets showed good prognostic accuracy for predicting virologic response to therapy. Our results showed that HCV infection was associated with modulation of the mDC frequency and their surface expression of CD200R. Successful daclatasvir and sofosbuvir combined therapy was associated with the normalization of the percentages of mDC and CD200R⁺mDC.