SARS-CoV-2 infection in an advanced rheumatoid arthritis patient Dear Editor, In late 2019, pneumonia due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, which has immediately spread around the world. The major clinical manifestations of COVID-19 include a range from asymptomatic presentation to acute respiratory distress syndrome (ARDS) (1). Rheumatoid arthritis (RA) patients usually manage with immunosuppressive agents; hence, they are at a higher risk of infections (2). However, limited data are available about the severe case of COVID-19 in RA patients (3-7). Here, we present a complicated case of SARS-CoV-2 infection in a female RA patient.

Introduction Human immunodeficiency virus (HIV/AIDS) infected patients have a higher risk of opportunistic infections (OIs) depending on their immunological status, especially CD4 + cell count. Toxoplasma gondii, hepatitis C virus (HCV), and hepatitis B virus (HBV) are important OIs among Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) patients. However, little is known about co‐infection of these pathogens among HIV‐infected individuals and their correlation with the patient's CD4 + cell count. Hence, this study aimed to investigate the serological and molecular status of T. gondii infection among HIV‐infected individuals who had co‐infection with HBV and HCV infections. Methods A total of 100 HIV/AIDS patients in two cities in the southwest of Iran was tested for T. gondii Immunoglobulin G (IgG) and Immunoglobulin M (IgM) antibodies as well as DNA detection by polymerase chain reaction (PCR) targeting the RE gene. HBV and HCV were detected by hepatitis B surface antigen (HBsAg) test, hepatitis C antibody (HCV Ab) test, and Real‐Time PCR. The number of CD4 + cell counts was determined by Flow cytometry. Results Anti‐T. gondii IgG was positive in 22% of the patients, but anti‐T. gondii IgM and PCR were negative in all samples. HBV and HCV were positive in 8% and 33% of the patients, respectively. Co‐infections were as followed: HIV + HCV (16%), HIV + HCV + T. gondii (11%), HIV + T. gondii (5%), HIV + HBV (1%), HIV + HBV + T. gondii (1%), HIV + HBV + HCV (1%), and HIV + HBV + HCV + T. gondii (5%). A significant decline in CD4 + cell counts was found in such co‐infection groups (HIV + T. gondii, HIV + HCV + T. gondii, and HIV + HBV + HCV + T. gondii) compared with the HIV mono‐infection group. Conclusions Our study showed that co‐infections of T. gondii, HCV, and HBV were common among HIV‐infected patients and co‐infections had a negative correlation with CD4 + cell counts of the patients.

Background Toxoplasma gondii and Neospora caninum are important protozoan parasites with worldwide distribution among warm-blooded animals. Moreover, T. gondii is a zoonotic parasite that infects humans. Poultries are important intermediated hosts of T. gondii and N. caninum. However, little is known about the contamination of poultry eggs with these parasites. We aimed to investigate the molecular frequency of T. gondii and N. caninum among the eggs of chicken, domestic duck, and quail from three different geographic regions of Iran. T. gondii and N. caninum were detected by PCR targeting the RE and Nc5 genes, respectively. Findings Overall contamination rates with T. gondii and N. caninum were 10.7 and 5.9%, respectively. The overall contamination rates of T. gondii among chicken, duck, and quail were 12.2, 15.5, and 4.4%, respectively; while N. caninum was detected in 11.1, 3.3, and 1.1% of the same samples, respectively. The contamination rates were increased with increasing humidity across three different regions. Conclusions Taken together, this study indicates the contamination of poultry eggs with T. gondii and N. caninum. The possibility of egg-born transmission of T. gondii should not be neglected by consuming raw soft-boiled eggs. Furthermore, contamination of poultry eggs could be an indicator for environmental contamination by these parasites.