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Infections that are unusually severe or caused by opportunistic pathogens are a hallmark of primary immunodeficiency (PID). Anti-cytokine autoantibodies (ACA) are an emerging cause of acquired immunodeficiency mimicking PID. Nocardia spp. are Gram-positive bacteria generally inducing disseminated infections in immunocompromised patients, but seldom also occurring in apparently immunocompetent hosts. Anti-GM-CSF autoantibodies are associated with autoimmune pulmonary alveolar proteinosis (PAP). In those patients, an increased incidence of disseminated nocardiosis and cryptococcosis has been observed. It is unclear whether the PAP or the autoantibodies predispose to the infection. We report an apparently immunocompetent woman presenting with disseminated nocardiosis without any evidence of PAP. Clinical data and radiological images were retrospectively collected. Lymphocyte populations were analyzed by flow cytometry. Anti-GM-CSF autoantibodies were measured by ELISA. A 55-year-old otherwise healthy woman presented with cerebral and pulmonary abscesses. Personal and familial history of infections or autoimmunity were negative. After extensive examinations, a final diagnosis of disseminated nocardiosis was made. Immunologic investigations including neutrophilic function and IFN-γ/IL-12 circuitry failed to identify a PID. Whole-exome sequencing did not find pathogenic variants associated with immunodeficiency. Serum anti-GM-CSF autoantibodies were positive. There were no clinical or instrumental signs of PAP. Trimethoprim-sulfamethoxazole and imipenem were administered, with progressive improvement and recovery of the infectious complication. We identified anti-GM-CSF autoantibodies as the cause of disseminated nocardiosis in a previously healthy and apparently immunocompetent adult. This case emphasizes the importance of including ACA in the differential diagnosis of PID, especially in previously healthy adults. Importantly, anti-GM-CSF autoantibodies can present with disseminated nocardiosis without PAP., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

In light of global change, research on ecosystem dynamics and the related environmental policies are increasingly required to face with the inherent polarization in areas with low and high human pressure. Differential levels of human pressure are hypothesized to reflect development paths toward ecological stability of local systems vis à vis socioeconomic resilience. To delineate the latent nexus between socioeconomic development paths and ecological stability of local systems, we proposed a multidimensional, diachronic analysis of 28 indicators of territorial disparities, and ecological stability in 206 homogeneous administrative units of Czech Republic over almost 30 years (1990-2018). Mixing time-invariant factors with time-varying socio-environmental attributes, a dynamic factor analysis investigated the latent relationship between ecosystem functions, environmental pressures, and the background socioeconomic characteristics of the selected spatial units. We identified four geographical gradients in Czech Republic (namely elevation, economic agglomeration, demographic structure, and soil imperviousness) at the base of territorial divides associated with the increased polarization in areas with low and high human pressure. The role of urbanization, agriculture, and loss of natural habitats reflective of rising human pressure was illustrated along the selected gradients. Finally, policy implications of the (changing) geography of ecological disturbances and local development paths in Czech Republic were briefly discussed., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

A short-term issue that has been occasionally investigated in the current literature is if (and, eventually, how) population dynamics (directly or indirectly) driven by COVID-19 pandemic have contributed to enlarge regional divides in specific demographic processes and dimensions. To verify this assumption, our study run an exploratory multivariate analysis of ten indicators representative of different demographic phenomena (fertility, mortality, nuptiality, internal and international migration) and the related population outcomes (natural balance, migration balance, total growth). We developed a descriptive analysis of the statistical distribution of the ten demographic indicators using eight metrics that assess formation (and consolidation) of spatial divides, controlling for shifts over time in both central tendency, dispersion, and distributional shape regimes. All indicators were made available over 20 years (2002-2021) at a relatively detailed spatial scale (107 NUTS-3 provinces) in Italy. COVID-19 pandemic exerted an impact on Italian population because of intrinsic (e.g. a particularly older population age structure compared with other advanced economies) and extrinsic (e.g. the early start of the pandemic spread compared with the neighboring European countries) factors. For such reasons, Italy may represent a sort of 'worst' demographic scenario for other countries affected by COVID-19 and the results of this empirical study can be informative when delineating policy measures (with both economic and social impact) able to mitigate the effect of pandemics on demographic balance and improve the adaptation capacity of local societies to future pandemic's crises., Competing Interests: Conflict of interestThe authors have no competing interests to declare that are relevant to the content of this article., (© The Author(s), under exclusive licence to Springer Nature B.V. 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Earlier studies relating form and functions of cities address an intriguing and complex research issue, especially for specific urban typologies. Although with inherent differences on a local scale, Mediterranean cities represent diversified settlement morphologies and multifaceted socioeconomic contexts. The present study investigates the socioeconomic structure at the base of rapid development of a large Mediterranean agglomeration (Athens, Greece). Results of a multivariate analysis of the spatial distribution of average (per-capita) declared income and non-parametric correlations of contextual indicators suggest that the characteristic socio-spatial structure of the 1970s and the 1980s in Athens had slightly changed in recent times. A remarkable segregation in wealthy and disadvantaged communities - well beyond the urban-rural divide usually observed in Mediterranean regions - consolidated in recent decades. Despite economic transformations shaping urban design and infrastructural networks, persistent disparities between affluent and economically depressed neighborhoods still characterize the socio-spatial structure of contemporary Athens., Competing Interests: Conflicts of interest/Competing interestsThe authors declare no conflict of interest., (© The Author(s) 2022.)

Purpose: SARS-CoV-2 infection in immunocompromised hosts is challenging, and prolonged viral shedding can be a common complication in these patients. We describe the clinical, immunological, and virological course of a patient with eosinophilic granulomatosis with polyangiitis, who developed the status of long-term asymptomatic SARS-CoV-2 carrier for more than 7 months., Methods: Over the study period, the patient underwent 20 RT-PCR tests for SARS-CoV-2 detection on nasopharyngeal swabs. In addition, viral cultures and genetic investigation of SARS-CoV-2 were performed. As for immunological assessment, serological and specific T-cell testing was provided at different time points., Results: Despite the patient showing a deep drug-induced B and T adaptive immunity impairment, he did not experience COVID-19 progression to severe complications, and the infection remained asymptomatic during the follow-up period, but he was not able to achieve viral clearance for more than 7 months. The infection was finally cleared by SARS-CoV-2-specific monoclonal antibody treatment, after that remdesivir and convalescent plasma failed in this scope. The genetic investigations evidenced that the infection was sustained by multiple viral subpopulations that had apparently evolved intra-host during the infection., Conclusion: Our case suggests that people with highly impaired B- and T-cell adaptive immunity can prevent COVID-19 progression to severe complications, but they may not be able to clear SARS-CoV-2 infection. Immunocompromised hosts with a long-term infection may play a role in the emergence of viral variants., (© 2022. The Author(s).)

Background and Purpose: Waning immunity and the surge of SARS-CoV-2 variants are responsible for breakthrough infections, i.e., infections in fully vaccinated individuals. Although the majority of vaccinated infected subjects report mild or no symptoms, some others require hospitalization. The clinical and immunological features of vaccinated hospitalized COVID-19 patients are currently unknown., Methods: Twenty-nine unvaccinated and 36 vaccinated hospitalized COVID-19 patients were prospectively enrolled and clinical and laboratory data were gathered. Immunophenotyping of leukocytes' subsets, T and B cell SARS-CoV-2-specific responses were evaluated via flow cytometry. Anti-IFN-α autoantibodies were measured via ELISA., Results: Despite vaccinated patients were older and with more comorbidities, unvaccinated subjects showed higher levels of pro-inflammatory markers, more severe disease, and increased mortality rate. Accordingly, they presented significant alterations in the circulating leukocyte composition, typical of severe COVID-19. Vaccinated patients displayed higher levels of anti-Spike IgGs and Spike-specific B cells. Of all participants, survivors showed higher levels of anti-Spike IgGs and Spike-specific CD4+ T cells than non-survivors. At hospital admission, 6 out of 65 patients (9.2%) displayed high serum concentrations of autoantibodies targeting IFN-α. Remarkably, 3 were unvaccinated and eventually died, while the other 3 were vaccinated and survived., Conclusion: Despite more severe pre-existing clinical conditions, vaccinated patients have good outcome. A rapid activation of anti-SARS-CoV-2-specific immunity is fundamental for the resolution of the infection. Therefore, prior immunization through vaccination provides a significant contribution to prevention of disease worsening and can even overcome the presence of high-risk factors (i.e., older age, comorbidities, anti-IFN-α autoantibodies)., (© 2022. The Author(s).)

Vulnerability to land degradation in Mediterranean Europe increased substantially in the last decades because of the latent interplay of climate and land-use change, progressive soil deterioration, and rising human pressure. The present study provides a quantitative evaluation of the intrinsic change over time in the level of vulnerability to land degradation over a representative Mediterranean area (Italy) using a normative indicator, the percentage of land classified as 'critical' in total area. This indicator derives from a spatially explicit elaboration of the ESA (Environmental Sensitive Area) Index (ESAI), a standard methodology of land classification considering different levels of vulnerability to degradation at a particularly refined spatial scale (1 km 2 ). This indicator was calculated over a relatively long time interval (1960-2010) and aggregated at the geographical scale of administrative regions in Italy, a relevant domain in the implementation of the National Action Plan (NAP) to combat desertification and the adoption of individual Regional Action Plans (RAP). A significant - but spatially heterogeneous - increase in 'critical' land was observed in Italy, leading to distinctive dynamics in northern/central regions and southern regions. Climate aridity and anthropogenic pressure leveraged the sudden vulnerability in some marginal land of Northern Italy - a region classified as unexposed to desertification risk - paralleling the levels observed in some districts of Southern Italy, an 'affected' region to desertification risk. These results suggest a re-thinking of mitigation policies proposed in the Italian NAP and a redesign of the RAPs toward place-specific adaptation measures, especially in the 'less exposed' Northern Italian region., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

The present work investigates the increase of confirmed cases of West Nile virus and the relationship between weather-related patterns and the geographical expansion of West Nile virus in Greece, with a special focus on West Attica, Central Greece, a semi-arid, ecologically fragile Mediterranean area. Using data from the European Environment Agency, European Drought Observatory of Joint Research Centre, the pairwise relationship between surface air temperature anomalies, precipitation anomalies, soil moisture index anomalies, and the fraction of absorbed photosynthetically active radiation anomalies (fAPAR) was evaluated during summer time of 2018, a particularly intense virus outbreak. The empirical results of this study indicate that total precipitation during 2018 was extremely high, nearly 500% above the average. These conditions contributed to the increase of soil moisture index anomaly and fAPAR, creating an ideal microenvironment (wet soils and green pastures) for mosquito breeding. This phenomenon was directly associated with a drastic outbreak of West Nile virus cases in the area, compared with earlier years. Our results indicate how unusually high values of summer precipitation may have contributed (both through direct and indirect ecological channels) to the rapid spread of the West Nile virus in West Attica, causing a significant number of confirmed cases and fatalities. Climate change may bring forth other issues aside from natural disasters, including-but not limited to-virus expansion.

Shifts in government priorities in response to the 2007 global recession have affected wildfire management and natural disaster funding arrangements, leading to a reduced effectiveness of fire suppression actions and increasing fire vulnerability. Our study investigates the role of local socioeconomic contexts on fire suppression effectiveness under economic expansion and recession in a Mediterranean region (Attica, Greece) strongly affected by 2007 crisis and displaying a persistently high density of peri-urban wildfires. Basic characteristics of wildfires (spatial distribution, intensity, and land use preferences) were investigated in the study area over two consecutive 8-year time intervals characterized by economic expansion (2000-2007) and recession (2008-2015). An integrated approach based on multivariate statistics and artificial neural networks was implemented to evaluate latent relationships between fire suppression time, wildfire characteristics, and socioeconomic dynamics. Controlling for wildfires' characteristics over the two time intervals, fire time length increased under crisis-mainly for small and medium-sized fires-possibly as an indirect response to reduced effectiveness of forest land management. Local contexts and political decisions influenced by economic downturns are relevant factors shaping wildfires' severity in the Mediterranean region. With recession, local contexts vulnerable to wildfires require more effective fire prevention measures, sustainable forest management, and regional planning.

Little is known about composition, diversity, and abundance of microbial communities in environments affected by primary soil salinization, such as coastal lagoon systems. The main objective of this study was to investigate the impact of lagoon salinity, soil type, and land-use on inland soil and groundwater quality, and soil microbial community structure, diversity, and gene abundance, as evaluated by T-RFLP (terminal-restriction fragment length polymorphism) and qPCR (quantitative polymerase-chain-reaction). For this purpose, four sites oriented along a groundwater salinity gradient (Fogliano lagoon, central Italy) were studied under different recreational, grazing, and land-use conditions. Spatial variability in groundwater attributes was observed depending on salinity and soil electrical conductivity, both influenced by salt intrusion. A comparison of community abundance and number of phylotypes of bacteria, archaea, and fungi across varying soil depths pointed out marked differences across soils characterized by different soil type, land-use, and salinity. The latter significantly affected the microbial population richness and diversity and showed a dominance in terms of bacteria species. Our study provides a comprehensive overview of the spatial relationship between soil microbial community and soil degradation processes along a relatively underexplored environmental gradient in a coastal system, coming to the conclusion that salinity acts differently as a driver of microbial community structure in comparison with other saline environments.

Topsoil organic carbon (TOC) and soil organic carbon (SOC) are fundamental in the carbon cycle influencing soil functions and attributes. Many factors have effects on soil carbon content such as climate, parent material, land topography and the human action including agriculture, which sometimes caused a severe loss in soil carbon content. This has resulted in a significant differentiation in TOC or SOC at the continental scale due to the different territorial and socioeconomic conditions. The present study proposes an exploratory data analysis assessing the relationship between the spatial distribution of soil organic carbon and selected socioeconomic attributes at the local scale in Italy with the aim to provide differentiated responses for a more sustainable use of land. A strengths, weaknesses, opportunities and threats (SWOT) analysis contributed to understand the effectiveness of local communities responses for an adequate comprehension of the role of soil as carbon sink.