1.
Med J Aust. 2020 Mar 30. doi: 10.5694/mja2.50566. [Epub ahead of print]
A case of toxigenic, pharyngeal diphtheria in Australia.
Author information
- 1
- Sunshine Coast Hospital and Health Service, Sunshine Coast, QLD.
- 2
- Griffith University, Sunshine Coast, QLD.
- 3
- Forensic and Scientific Services, Brisbane, QLD.
KEYWORDS:
Communicable diseases; Disease transmission, infectious; Respiratory tract infections; Travel medicine; Vaccine preventable disease
2.
J Infect Dis. 2020 Mar 30. pii: jiaa050. doi: 10.1093/infdis/jiaa050. [Epub ahead of print]
Low Sensitivity of BinaxNOW RSV in Infants.
Zuurbier RP1,2, Bont LJ1, Langedijk AC1, Hamer M1, Korsten K1, Drysdale SB3, Snape MD3, Robinson H3, Pollard AJ3, Martinón-Torres F4,5, Rodríguez-Tenreiro Sánchez C4, Gómez-Carballa A4,5, Dacosta-Urbieta AI4,5, Heikkinen T6, Cunningham S7, van Houten MA2, Wildenbeest JG1; RESCEU Investigators.
Abstract
BACKGROUND:
Respiratory syncytial virus (RSV) is a major cause of hospitalization in infants. Early detection of RSV can optimize clinical management and minimize use of antibiotics. BinaxNOW RSV (BN) is a rapid antigen detection test that is widely used. We aimed to validate the sensitivity of BN in hospitalized and nonhospitalized infants against the gold standard of molecular diagnosis.
METHODS:
We evaluated the performance of BN in infants with acute respiratory tract infections with different degrees of disease severity. Diagnostic accuracy of BN test results were compared with molecular diagnosis as reference standard.
RESULTS:
One hundred sixty-two respiratory samples from 148 children from October 2017 to February 2019 were studied. Sixty-six (40.7%) samples tested positive for RSV (30 hospitalizations, 31 medically attended episodes not requiring hospitalization, and 5 nonmedically attended episodes). Five of these samples tested positive with BN, leading to an overall sensitivity of BN of 7.6% (95% confidence interval [CI], 3.3%-16.5%) and a specificity of 100% (95% CI, 96.2%-100%). Sensitivity was low in all subgroups.
CONCLUSIONS:
We found a low sensitivity of BN for point-of-care detection of RSV infection. BinaxNOW RSV should be used and interpreted with caution.
© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.
KEYWORDS:
antigen detection; birth cohort; diagnosis; point-of-care test; respiratory syncytial virus
3.
Lancet Infect Dis. 2020 Mar 27. pii: S1473-3099(20)30200-0. doi: 10.1016/S1473-3099(20)30200-0. [Epub ahead of print]
Clinical and virological data of the first cases of COVID-19 in Europe: a case series.
Lescure FX1, Bouadma L2, Nguyen D3, Parisey M4, Wicky PH2, Behillil S5, Gaymard A6, Bouscambert-Duchamp M6, Donati F5, Le Hingrat Q7, Enouf V8, Houhou-Fidouh N9, Valette M6, Mailles A10, Lucet JC11, Mentre F12, Duval X13, Descamps D7, Malvy D3, Timsit JF2, Lina B6, van-der-Werf S5, Yazdanpanah Y14.
Abstract
BACKGROUND:
On Dec 31, 2019, China reported a cluster of cases of pneumonia in people at Wuhan, Hubei Province. The responsible pathogen is a novel coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report the relevant features of the first cases in Europe of confirmed infection, named coronavirus disease 2019 (COVID-19), with the first patient diagnosed with the disease on Jan 24, 2020.
METHODS:
In this case series, we followed five patients admitted to Bichat-Claude Bernard University Hospital (Paris, France) and Pellegrin University Hospital (Bordeaux, France) and diagnosed with COVID-19 by semi-quantitative RT-PCR on nasopharyngeal swabs. We assessed patterns of clinical disease and viral load from different samples (nasopharyngeal and blood, urine, and stool samples), which were obtained once daily for 3 days from hospital admission, and once every 2 or 3 days until patient discharge. All samples were refrigerated and shipped to laboratories in the National Reference Center for Respiratory Viruses (The Institut Pasteur, Paris, and Hospices Civils de Lyon, Lyon, France), where RNA extraction, real-time RT-PCR, and virus isolation and titration procedures were done.
FINDINGS:
The patients were three men (aged 31 years, 48 years, and 80 years) and two women (aged 30 years and 46 years), all of Chinese origin, who had travelled to France from China around mid-January, 2020. Three different clinical evolutions are described: (1) two paucisymptomatic women diagnosed within a day of exhibiting symptoms, with high nasopharyngeal titres of SARS-CoV-2 within the first 24 h of the illness onset (5·2 and 7·4 log10 copies per 1000 cells, respectively) and viral RNA detection in stools; (2) a two-step disease progression in two young men, with a secondary worsening around 10 days after disease onset despite a decreasing viral load in nasopharyngeal samples; and (3) an 80-year-old man with a rapid evolution towards multiple organ failure and a persistent high viral load in lower and upper respiratory tract with systemic virus dissemination and virus detection in plasma. The 80-year-old patient died on day 14 of illness (Feb 14, 2020); all other patients had recovered and been discharged by Feb 19, 2020.
INTERPRETATION:
We illustrated three different clinical and biological types of evolution in five patients infected with SARS-CoV-2 with detailed and comprehensive viral sampling strategy. We believe that these findings will contribute to a better understanding of the natural history of the disease and will contribute to advances in the implementation of more efficient infection control strategies.
FUNDING:
REACTing (Research & Action Emerging Infectious Diseases).
Copyright © 2020 Elsevier Ltd. All rights reserved.
4.
Explore (NY). 2020 Feb 26. pii: S1550-8307(20)30085-9. doi: 10.1016/j.explore.2020.02.004. [Epub ahead of print]
Effects of winter sea bathing on psychoneuroendocrinoimmunological parameters.
Abstract
CONTEXT:
Many people claim winter sea bathing gives them energy and health. According to the psychoneuroendocrinoimmunology (PNEI) paradigm, the stress response elicited by cold water immersion could indeed induce several beneficial psychophysical alterations.
OBJECTIVE:
To determine the effects of winter sea bathing on psychological wellbeing, stress and immune markers.
DESIGN:
A cross-sectional study.
PARTICIPANTS:
228 people, between 19 and 88 years, including 107 winter sea bathers and 121 controls.
MAIN OUTCOME MEASURES:
A battery of questionnaires was administered to assess sociodemographic characteristics, self-perception of mental and physical heath, the number, duration and intensity of Upper Respiratory Tract Infections (URTIs) in the last year, and Big Five personality traits. 17 winter sea bathers and 15 controls (mean age 67 years) were further examined to evaluate physiological health, underwent one ear-nose-throat (ENT) examination, and provided saliva samples for measurements of biological markers (cortisol, sIgA, IL-1β, IL-6).
RESULTS:
Winter sea bathing was associated with lower levels of self-reported stress and higher wellbeing. The ENT examinations did not reveal signs of URTIs in winter sea bathers, who exhibited significantly higher levels of salivary sIgA compared to controls. Neither salivary IL-1β nor cortisol levels were significantly different between the two groups.
CONCLUSIONS:
Winter sea bathers (even the elderly) had a perception of higher wellbeing and reported better health: thus, they appeared to take advantage of potential distress (cold water exposure) to improve their health.
Copyright © 2020. Published by Elsevier Inc.
KEYWORDS:
Cortisol; Personality; Psychoneuroendocrinoimmunology; Stress response; Wellbeing; Winter sea bathing
5.
Endoscopy. 2020 Apr;52(4):312-314. doi: 10.1055/a-1128-4313. Epub 2020 Mar 25.
Suggestions for infection prevention and control in digestive endoscopy during current 2019-nCoV pneumonia outbreak in Wuhan, Hubei province, China.
Comment on
- Reaction to Letter from Zhang et al. [Endoscopy. 2020]
6.
JAMA. 2020 Mar 24;323(12):1131-1132. doi: 10.1001/jama.2020.2025.
US Emergency Legal Responses to Novel Coronavirus: Balancing Public Health and Civil Liberties.
7.
JAMA. 2020 Mar 24;323(12):1129-1130. doi: 10.1001/jama.2020.1960.
Preparation for Possible Sustained Transmission of 2019 Novel Coronavirus: Lessons From Previous Epidemics.
8.
Clin Exp Rheumatol. 2020 Mar-Apr;38(2):175-180. Epub 2020 Mar 24.
COVID-19: the new challenge for rheumatologists.
Comment on
- COVID-19, cytokines and immunosuppression: what can we learn from severe acute respiratory syndrome? [Clin Exp Rheumatol. 2020]
- Therapies used in rheumatology with relevance to coronavirus disease 2019. [Clin Exp Rheumatol. 2020]
9.
JAMA Netw Open. 2020 Mar 2;3(3):e204006. doi: 10.1001/jamanetworkopen.2020.4006.
Exercising Heart and Head in Managing Coronavirus Disease 2019 in Wuhan.
Comment on
10.
PLoS One. 2020 Jan 14;15(1):e0223033. doi: 10.1371/journal.pone.0223033. eCollection 2020.
Whole genome sequence analysis reveals the broad distribution of the RtxA type 1 secretion system and four novel putative type 1 secretion systems throughout the Legionella genus.
Brown CL1,2, Garner E1,3, Jospin G4, Coil DA4, Schwake DO5, Eisen JA4,6, Mukhopadhyay B2, Pruden AJ1.
Abstract
Type 1 secretion systems (T1SSs) are broadly distributed among bacteria and translocate effectors with diverse function across the bacterial cell membrane. Legionella pneumophila, the species most commonly associated with Legionellosis, encodes a T1SS at the lssXYZABD locus which is responsible for the secretion of the virulence factor RtxA. Many investigations have failed to detect lssD, the gene encoding the membrane fusion protein of the RtxA T1SS, in non-pneumophila Legionella, which has led to the assumption that this system is a virulence factor exclusively possessed by L. pneumophila. Here we discovered RtxA and its associated T1SS in a novel Legionella taurinensis strain, leading us to question whether this system may be more widespread than previously thought. Through a bioinformatic analysis of publicly available data, we classified and determined the distribution of four T1SSs including the RtxA T1SS and four novel T1SSs among diverse Legionella spp. The ABC transporter of the novel Legionella T1SS Legionella repeat protein secretion system shares structural similarity to those of diverse T1SS families, including the alkaline protease T1SS in Pseudomonas aeruginosa. The Legionella bacteriocin (1-3) secretion systems T1SSs are novel putative bacteriocin transporting T1SSs as their ABC transporters include C-39 peptidase domains in their N-terminal regions, with LB2SS and LB3SS likely constituting a nitrile hydratase leader peptide transport T1SSs. The LB1SS is more closely related to the colicin V T1SS in Escherichia coli. Of 45 Legionella spp. whole genomes examined, 19 (42%) were determined to possess lssB and lssD homologs. Of these 19, only 7 (37%) are known pathogens. There was no difference in the proportions of disease associated and non-disease associated species that possessed the RtxA T1SS (p = 0.4), contrary to the current consensus regarding the RtxA T1SS. These results draw into question the nature of RtxA and its T1SS as a singular virulence factor. Future studies should investigate mechanistic explanations for the association of RtxA with virulence.
- PMID:
- 31935215
- PMCID:
- PMC6959600
- DOI:
- 10.1371/journal.pone.0223033
- [Indexed for MEDLINE]
11.
BMC Health Serv Res. 2020 Jan 13;20(1):35. doi: 10.1186/s12913-019-4884-5.
An evaluation of the Zambia influenza sentinel surveillance system, 2011-2017.
Abstract
BACKGROUND:
Over the past decade, influenza surveillance has been established in several African countries including Zambia. However, information on the on data quality and reliability of established influenza surveillance systems in Africa are limited. Such information would enable countries to assess the performance of their surveillance systems, identify shortfalls for improvement and provide evidence of data reliability for policy making and public health interventions.
METHODS:
We used the Centers for Disease Control and Prevention guidelines to evaluate the performance of the influenza surveillance system (ISS) in Zambia during 2011-2017 using 9 attributes: (i) data quality and completeness, (ii) timeliness, (iii) representativeness, (iv) flexibility, (v) simplicity, (vi) acceptability, (vii) stability, (viii) utility, and (ix) sustainability. Each attribute was evaluated using pre-defined indicators. For each indicator we obtained the proportion (expressed as percentage) of the outcome of interest over the total. A scale from 1 to 3 was used to provide a score for each attribute as follows: < 60% (as obtained in the calculation above) scored 1 (weak performance); 60-79% scored 2 (moderate performance); ≥80% scored 3 (good performance). An overall score for each attribute and the ISS was obtained by averaging the scores of all evaluated attributes.
RESULTS:
The overall mean score for the ISS in Zambia was 2.6. Key strengths of the system were the quality of data generated (score: 2.9), its flexibility (score: 3.0) especially to monitor viral pathogens other than influenza viruses, its simplicity (score: 2.8), acceptability (score: 3.0) and stability (score: 2.6) over the review period and its relatively low cost ($310,000 per annum). Identified weaknesses related mainly to geographic representativeness (score: 2.0), timeliness (score: 2.5), especially in shipment of samples from remote sites, and sustainability (score: 1.0) in the absence of external funds.
CONCLUSIONS:
The system performed moderately well in our evaluation. Key improvements would include improvements in the timeliness of samples shipments and geographical coverage. However, these improvements would result in increased cost and logistical complexity. The ISSS in Zambia is largely reliant on external funds and the acceptability of maintaining the surveillance system through national funds would require evaluation.
KEYWORDS:
Evaluation; Influenza; Surveillance; Zambia
- PMID:
- 31931793
- PMCID:
- PMC6958603
- DOI:
- 10.1186/s12913-019-4884-5
- [Indexed for MEDLINE]
12.
Infect Dis Poverty. 2019 Dec 3;8(1):99. doi: 10.1186/s40249-019-0603-z.
The role of active case finding in reducing patient incurred catastrophic costs for tuberculosis in Nepal.
Gurung SC1, Dixit K1, Rai B1, Caws M1,2, Paudel PR3, Dhital R1, Acharya S1, Budhathoki G1, Malla D1, Levy JW3, van Rest J3, Lönnroth K4, Viney K4,5, Ramsay A6, Wingfield T2,7, Basnyat B8, Thapa A9, Squire B2, Wang D2, Mishra G1,2, Shah K10, Shrestha A10, de Siqueira-Filha NT11,12.
Abstract
BACKGROUND:
The World Health Organization (WHO) End TB Strategy has established a milestone to reduce the number of tuberculosis (TB)- affected households facing catastrophic costs to zero by 2020. The role of active case finding (ACF) in reducing patient costs has not been determined globally. This study therefore aimed to compare costs incurred by TB patients diagnosed through ACF and passive case finding (PCF), and to determine the prevalence and intensity of patient-incurred catastrophic costs in Nepal.
METHODS:
The study was conducted in two districts of Nepal: Bardiya and Pyuthan (Province No. 5) between June and August 2018. One hundred patients were included in this study in a 1:1 ratio (PCF: ACF, 25 consecutive ACF and 25 consecutive PCF patients in each district). The WHO TB patient costing tool was applied to collect information from patients or a member of their family regarding indirect and direct medical and non-medical costs. Catastrophic costs were calculated based on the proportion of patients with total costs exceeding 20% of their annual household income. The intensity of catastrophic costs was calculated using the positive overshoot method. The chi-square and Wilcoxon-Mann-Whitney tests were used to compare proportions and costs. Meanwhile, the Mantel Haenszel test was performed to assess the association between catastrophic costs and type of diagnosis.
RESULTS:
Ninety-nine patients were interviewed (50 ACF and 49 PCF). Patients diagnosed through ACF incurred lower costs during the pre-treatment period (direct medical: USD 14 vs USD 32, P = 0.001; direct non-medical: USD 3 vs USD 10, P = 0.004; indirect, time loss: USD 4 vs USD 13, P < 0.001). The cost of the pre-treatment and intensive phases combined was also lower for direct medical (USD 15 vs USD 34, P = 0.002) and non-medical (USD 30 vs USD 54, P = 0.022) costs among ACF patients. The prevalence of catastrophic direct costs was lower for ACF patients for all thresholds. A lower intensity of catastrophic costs was also documented for ACF patients, although the difference was not statistically significant.
CONCLUSIONS:
ACF can reduce patient-incurred costs substantially, contributing to the End TB Strategy target. Other synergistic policies, such as social protection, will also need to be implemented to reduce catastrophic costs to zero among TB-affected households.
KEYWORDS:
Case finding; Catastrophic cost; Cost; Nepal; Patient-incurred cost; Tuberculosis
- PMID:
- 31791412
- PMCID:
- PMC6889665
- DOI:
- 10.1186/s40249-019-0603-z
- [Indexed for MEDLINE]
13.
Sci Total Environ. 2020 Feb 10;703:134727. doi: 10.1016/j.scitotenv.2019.134727. Epub 2019 Oct 31.
Latitudes mediate the association between influenza activity and meteorological factors: A nationwide modelling analysis in 45 Japanese prefectures from 2000 to 2018.
Abstract
BACKGROUND:
Cold and dry conditions were well-documented as a major determinant of influenza seasonality in temperate countries but the association may not be consistent when the climate in temperate areas is closer to that in sub-tropical areas. We hypothesized latitudes may mediate the association between influenza activity and meteorological factors in 45 Japanese prefectures.
METHODS:
We used the weekly incidence of influenza-like illness of 45 prefectures from 2000 to 2018 as a proxy for influenza activity in Japan, a temperate country lying off the east coast of Asia. A combination of generalized additive model and distributed lag nonlinear model was adopted to investigate the associations between meteorological factors (average temperature, relative humidity, total rainfall, and actual vapour pressure, a proxy for absolute humidity) and the influenza incidence. Kendall's tau b (τ) and Spearman correlation coefficient (rs) between latitude and the adjusted relative risk (ARR) of each meteorological factor were also assessed.
RESULTS:
A higher vapour pressure was significantly associated with a lower influenza risk but the ARR strongly weakened along with a lower latitude (τ = -0.23, p-value = 0.02; rs = -0.33, p-value = 0.03). Lower temperature and lower relatively humidity were significantly associated with higher influenza risks in over 65% and around 40% of the prefectures respectively but the strength and significance of the correlations between their ARRs and latitude were weaker than that from vapour pressure.
CONCLUSION:
Even though the range of latitudes in Japan is small (26°N-43°N), the relationships between meteorological factors and influenza activity were mediated by the latitude. Our study echoed absolute humidity played a more important role in relating influenza risk, but we on the other hand showed its effect on influenza activity could be hampered in a low-latitude temperate region, which have a warmer climate. These findings thus offer a high-resolution characterization of the role of meteorological factors on influenza seasonality.
Copyright © 2019 Elsevier B.V. All rights reserved.
KEYWORDS:
Humidity; Influenza; Japan; Latitude; Temperature
14.
Acta Med Acad. 2019 Aug;48(2):140-146. doi: 10.5644/ama2006-124.252.
Comparative Study of the Efficacy of the Lysozyme, Benzydamine and Chlorhexidine Oral Spray in the Treatment of Acute Tonsillopharyngitis - Results of a Pilot Study.
Golac-Guzina N1, Novaković Z1, Sarajlić Z2, Šukalo A3, Džananović J3, Glamočlija U4, Kapo B3, Čordalija V5, Mehić M6.
Abstract
OBJECTIVE:
Lysozyme is a natural antimicrobial and immunomodulatory enzyme, which is produced as a host response to infectious agents. The objective of this study was to compare the efficacy and safety of lysozyme-based versus benzydamine and chlorhexidinebased oral spray in patients with an acute tonsillopharyngitis associated with a common cold.
PATIENTS AND METHODS:
A prospective twoarm pilot study (lysozyme/cetylpyridinium/lidocaine spray versus: benzydamine spray-arm 1; chlorhexidine/lidocaine spray-arm 2) was conducted in the primary health care unit. Efficacy was evaluated by the patient's self-assessment of pain, difficulty in swallowing and the throat swelling, by using the visual analog scale (VAS) at baseline and three follow-up visits. Safety was evaluated by the assessment of the frequency and severity of adverse effects.
RESULTS:
Lysozyme-based spray reduced pain faster than benzydamine-based spray and slower than chlorhexidine-based spray. Lysozyme-based and chlorhexidinebased sprays similarly reduced difficulty in swallowing, but were faster than benzydamine-based spray. Similar effects on the reduction of throat swelling were seen in all treated groups. All tested products showed proper safety and were well tolerated, with no serious adverse events reported.
CONCLUSIONS:
The lysozyme-based oral spray was shown to be effective and safe in the reduction of pain, difficulty in swallowing and throat swelling in patients with acute tonsillopharyngitis associated with a common cold. Lysozyme-based oral spray (containing natural compound with advantages of influencing immune system and preventing recurrences) had similar activity to benzydamine and chlorhexidine-based oral antiseptic sprays.
Copyright © 2019 by Academy of Sciences and Arts of Bosnia and Herzegovina.
KEYWORDS:
Antiseptics; Lysozyme; Sore Throat
15.
Int J Mol Sci. 2019 Nov 4;20(21). pii: E5493. doi: 10.3390/ijms20215493.
Maintenance of Type 2 Response by CXCR6-Deficient ILC2 in Papain-Induced Lung Inflammation.
Abstract
Innate lymphoid cells (ILC) are important players of early immune defenses in situations like lymphoid organogenesis or in case of immune response to inflammation, infection and cancer. Th1 and Th2 antagonism is crucial for the regulation of immune responses, however mechanisms are still unclear for ILC functions. ILC2 and NK cells were reported to be both involved in allergic airway diseases and were shown to be able to interplay in the regulation of the immune response. CXCR6 is a common chemokine receptor expressed by all ILC, and its deficiency affects ILC2 and ILC1/NK cell numbers and functions in lungs in both steady-state and inflammatory conditions. We determined that the absence of a specific ILC2 KLRG1+ST2- subset in CXCR6-deficient mice is probably dependent on CXCR6 for its recruitment to the lung under inflammation. We show that despite their decreased numbers, lung CXCR6-deficient ILC2 are even more activated cells producing large amount of type 2 cytokines that could drive eosinophilia. This is strongly associated to the decrease of the lung Th1 response in CXCR6-deficient mice.
KEYWORDS:
CXCR6; ILC immunity; Immunology; Lung inflammation
16.
J Nutr Sci Vitaminol (Tokyo). 2019;65(5):390-398. doi: 10.3177/jnsv.65.390.
Poor Vitamin D Status in Active Pulmonary Tuberculosis Patients and Its Correlation with Leptin and TNF-α.
Wang Q1, Ma A1, Gao T1, Liu Y2, Ren L3, Han L3, Wei B1, Liu Q1, Dong C1, Mu Y1, Li D1, Kok FJ4, Schouten EG4.
Abstract
Vitamin D deficiency (VDD) is common in tuberculosis (TB) and may be implicated in the etiology of the disease and in its clinical course. The aim of this study was to investigate the association between leptin, inflammatory markers and VD status in TB patients, stratified for presence or absence of diabetes mellitus (DM). Two hundred ninety-nine TB patients were recruited from October 2015 to August 2016. Also, 91 normal controls were included. The information including socio-demographics, dietary intake and living habits was obtained by face-to-face interview. Serum concentrations of leptin and TNF-α, CRP and IL-6 were compared between TB patients with and without severe VDD (SVDD). Pearson's correlation was used to analyze the association between TNF-α, leptin and 25-hydroxyvitamin D (25(OH)D). A significantly higher prevalence of VDD and SVDD was observed in TB patients compared with normal controls (93.0% vs 70.3%, 65.9% vs 3.3% respectively). Concentration of leptin was significantly lower, while TNF-α higher in TB patients with SVDD compared to those without (p<0.05). After adjustment for confounders, leptin was positively associated with 25(OH)D (r=0.210, p=0.002) with similar correlation in TB patients with DM (r=0.240, p=0.020). A negative association between TNF-α and 25(OH)D was observed (r=-0.197, p=0.003), which was significant only in the subgroup without DM (r=-0.304, p=0.001). Our findings indicate that a higher VD status in TB patients may be related to higher immune activity and less serious tissue damage, and that this relation is different according to presence or absence of DM co-morbidity.
KEYWORDS:
TNF-α; co-morbidity; diabetes; immune activity; inflammatory markers; leptin; serum 25(OH)D; tuberculosis
17.
Afr Health Sci. 2019 Jun;19(2):2091-2099. doi: 10.4314/ahs.v19i2.33.
Predictors of recurrent TB in sputum smear and culture positive adults: a prospective cohort study.
Abstract
OBJECTIVE:
To explore simple inexpensive non-culture based predictors of recurrent pulmonary tuberculosis (PTB).
SETTING AND STUDY POPULATION:
HIV-infected and uninfected adults with the first episode of smear positive, culture-confirmed pulmonary tuberculosis in a high tuberculosis burden country.
DESIGN:
A nested prospective cohort study of participants with pulmonary tuberculosis (PTB) presenting to a hospital out-patient clinic.
RESULTS:
A total of 630 TB culture confirmed participants were followed up for eighteen months of which 57 (9%) developed recurrent recurrent TB. On univariate analysis,4.7% low grade(1+) pre-treatment sputum smear participants developed recurrent tuberculosis Vs 8.8% with high grade(3+) smears (OR=0.31,95%CI: 0.10-0.93, p=0.037).On multivariate analysis: participants with extensive fibro-cavitation had a high risk of recurrent TB Vs minimal end of treatment fibro-cavitation (18%Vs12%, OR=2.3,95%CI:1.09-4.68, p=0.03). Weight gain with HIV infection was assosciated with a high risk of recurrent TB Vs weight gain with no HIV infection(18%Vs 6%, OR=6.8,95%CI:165-27.83, p=0.008) where as weight gain with a low pre-treatment high bacillary burden was assosciated with a low risk of recurrent TB Vs weight gain with a high pre-treatmentbacillary burden(6.5%Vs7.9%, OR=0.2,95%CI:0.05-0.79, p=0.02).
CONCLUSION:
Extensive end of treatment pulmonary fibro-cavitation, high pre-treatment bacillary burden with no weight gain and HIV infection could be reliable predictors of recurrent tuberculosis.
© 2019 Muzanyi et al.
KEYWORDS:
Grade; cavities; fibrosis; weight
18.
Afr Health Sci. 2019 Jun;19(2):2073-2081. doi: 10.4314/ahs.v19i2.31.
Bacterial etiology in early re-admission patients with acute exacerbation of chronic obstructive pulmonary disease.
Abstract
BACKGROUND:
Repeatedly hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are often exposed to more antibiotics, but the distribution of pathogenic bacteria in these patients is poorly understood. The objectives of this study were to analyze the distribution of pathogenic bacteria and the risk factors associated with multidrug-resistant (MDR) bacteria infection in early re-admission patients with AECOPD.
METHODS:
We retrospectively reviewed charts for patients with AECOPD admitted to our hospital between January 2011 and November 2012. The early re-admission group and non-early readmission group were determined by whether patients were readmitted within 31 days after discharge. Detection of potentially pathogenic microorganisms (PPMs) and MDR bacteria were analyzed. Logistic regression analysis was performed to identify independent risk factors for MDR bacteria infection.
RESULTS:
PPMs were isolated from 230 (32.0%) cases of respiratory tract specimens; MDR bacteria accounted for 24.7% (57/230). Pseudomonas aeruginosa (43.7%), Klebsiella pneumoniae (15.6%), and Acinetobacter baumannii (12.5%) were the top three PPMs in the early readmission group, while the top three PPMs in the non-early readmission group were K. pneumoniae (23.7%), P. aeruginosa (21.2%), and Streptococcus pneumoniae (17.1%). Multivariate analysis showed that use of antibiotics within 2 weeks (odds ratio [OR] 8.259, 95% confidence interval [CI] 3.056-22.322, p = 0.000) was the independent risk factor for MDR bacteria infection.
CONCLUSION:
Non-fermentative Gram-negative bacilli (NFGNB) and enterobacteria were the predominant bacteria in early readmission patients with AECOPD. The detection rate of MDR bacteria was high which was related to the use of antibiotics within 2 weeks before admission in these patients.
© 2019 Lin et al.
KEYWORDS:
AECOPD; bacteria; multidrug-resistant (MDR); re-admission; risk factors
19.
Dev Period Med. 2019;23(3):159-162.
Pneumocystis pneumonia: still a serious disease in children.
Abstract
Pneumocystis carinii pneumonia is a common opportunistic respiratory infection among children with human immunodeficiency virus and a weakened immune system. The primary infection in immunocompetent patients may be asymptomatic, whereas fever, shortness of breath, night sweats, nonproductive (dry) cough, pneumonia, progressive respiratory distress and apnea are cardinal symptoms of full-blown pneumocystis pneumonia. The diagnosis can be confirmed by histochemical staining of biological specimens or, recently, by polymerase chain reaction. International recommendations indicate that the drug of choice is the intravenously administered trimethoprim-sulfamethoxazole combination. Early diagnosis and appropriate treatment reduce the mortality of the disease. This article briefly highlights the epidemiology of Pneumocystis pneumonia, its diagnosis and therapeutic options in the pediatric population.
KEYWORDS:
Pneumocystis pneumonia; children; symptoms; treatment
20.
Ther Adv Respir Dis. 2019 Jan-Dec;13:1753466619878555. doi: 10.1177/1753466619878555.
Tailored combined cytomegalovirus management in lung transplantation: a retrospective analysis.
Solidoro P1, Patrucco F2, Libertucci D1, Verri G1, Sidoti F3, Curtoni A3, Boffini M4, Simonato E4, Rinaldi M4, Cavallo R3, Costa C3.
Abstract
BACKGROUND:
There is no univocal prophylactic regimen to prevent cytomegalovirus (CMV) infection/disease in lung transplantation (LT) recipients. The aim of this study is to evaluate short-term clinical outcomes of a tailored combined CMV management approach.
METHODS:
After 1-year follow up, 43 LT patients receiving combined CMV prophylaxis with antiviral agents and CMV-specific IgG were evaluated in a retrospective observational study. Systemic and lung viral infections were investigated by molecular methods on a total of 1134 whole blood and 167 bronchoalveolar lavage (BAL) and biopsy specimens. CMV immunity was assessed by ELISPOT assay. Clinical and therapeutic data were also evaluated.
RESULTS:
We found 2/167 cases of CMV pneumonia (1.2%), both in the donor-positive/recipient-positive (D+/R+) population, and 51/167 cases of CMV pulmonary infection (BAL positivity 30.5%). However, only 32/167 patients (19.1%) were treated due to their weak immunological response at CMV ELISPOT assay. Viremia ⩾100,000 copies/mL occurred in 33/1134 specimens (2.9%). Regarding CMV-serological matching (D/R), the D+/R- population had more CMV viremia episodes (p < 0.05) and fewer viremia-free days (p < 0.001).
CONCLUSIONS:
Compared to previous findings, our study shows a lower incidence of CMV pneumonia and viremia despite the presence of a substantial CMV load. In addition, our findings further confirm the D+/R- group to be a high-risk population for CMV viremia. Overall, a good immunological response seems to protect patients from CMV viremia and pneumonia but not from CMV alveolar replication. The reviews of this paper are available via the supplemental material section.
KEYWORDS:
CMV ELISPOT; CMV pulmonary infection; CMV viremia; cytomegalovirus; lung transplant; prophylaxis
- PMID:
- 31566097
- PMCID:
- PMC6769221
- DOI:
- 10.1177/1753466619878555
- [Indexed for MEDLINE]
21.
J Hosp Infect. 2019 Dec;103(4):441-446. doi: 10.1016/j.jhin.2019.08.022. Epub 2019 Sep 5.
A service evaluation of simultaneous near-patient testing for influenza, respiratory syncytial virus, Clostridium difficile and norovirus in a UK district general hospital.
Abstract
BACKGROUND:
The Cepheid® GeneXpert® (GXP) can simultaneously test for norovirus (NV), Clostridium difficile (CD), influenza A/B (IFA/B) and respiratory syncytial virus (RSV).
AIM:
To compare centralized multiplex polymerase chain reaction (PCR) testing with localized GXP testing at a district general hospital.
METHODS:
From December 2017 to December 2018, samples received at Whipps Cross University Hospital (WCUH) were first tested at the local laboratory before transport centrally to the Royal London Hospital (RLH). At the RLH, a non-proprietary multiplex reverse transcriptase (RT) PCR assay was performed, which also tested for gastrointestinal or respiratory pathogens not tested for by the GXP.
FINDINGS:
A total of 1111 stool and respiratory samples were processed at both sites; 591 were respiratory and 520 were stool samples. Compared to centralized testing, the GXP gave sensitivity, specificity, and NPV all in excess of 97%, with the exception of RSV. The RSV assay had a sensitivity of 66.7% (95% confidence interval (CI) 24.1, 94.0) but an NPV of 99.7% (95% CI 98.6, 99.9). At the RLH, 65 (5.9%) additional respiratory or gastrointestinal viruses were detected, predominantly rhinovirus 35 (3.2%) and adenovirus 11 (1.0%). Compared to centralized testing, the median time saved for local respiratory and gastrointestinal sample testing was 19 h and 46 min and 17 h and 6 min, respectively.
CONCLUSIONS:
Local GXP testing compared to centralized multiplex PCR testing for IF, NV and CD, demonstrated sensitivities, specificities and NPV between 95% and 100%. Turnaround times were faster, enabling quicker infection prevention and control decision making. In our local setting (WCUH), the GXP demonstrated the potential to reduce NV and IFA/B outbreaks.
Copyright © 2019 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
KEYWORDS:
Cepheid; Clostridium difficile; GeneXpert; Infection prevention; Influenza; Norovirus; RSV
22.
J Hosp Infect. 2019 Nov;103(3):358-360. doi: 10.1016/j.jhin.2019.08.003. Epub 2019 Aug 6.
Lessons learnt from influenza POCT implementation in an acute medical unit.
23.
J Paediatr Child Health. 2019 Aug;55(8):1001-1002. doi: 10.1111/jpc.14539.
High flow nasal cannula and the use for bronchiolitis: Is the use for every case?
Comment on
- Ten years of severe respiratory syncytial virus infections in a tertiary paediatric intensive care unit. [J Paediatr Child Health. 2020]
24.
PLoS One. 2019 Jul 25;14(7):e0220346. doi: 10.1371/journal.pone.0220346. eCollection 2019.
Factors associated with atypical radiological findings of pulmonary tuberculosis.
Goto A1,2, Komiya K1,2, Kan T1,2, Honjo K1,2, Uchida S1,2, Takikawa S1, Yoshimatsu T1, Fujimoto K3, Johkoh T4, Kadota JI2.
Abstract
BACKGROUND:
Unusual radiological images may delay diagnosis of pulmonary tuberculosis. This study aimed to analyze the risk factors for an atypical radiological image in patients with pulmonary tuberculosis.
METHODS:
We retrospectively analyzed data from patients admitted to one hospital from January 2013 to December 2016 for sputum smear-positive lung tuberculosis who underwent chest computed tomography (CT) on admission. Patients whose sputum cultures were positive for general bacteria were excluded. Patient characteristics and laboratory data were compared between patients with cavity and those without and between patients with upper predominant lung involvement and those without.
RESULTS:
This study included 94 (93%) of 101 patients who underwent chest CT. The non-cavity group was older, had a greater number of females, had a lower C-reactive protein (CRP) level, and had a lower glomerular filtration rate. Multivariate analysis showed that a low CRP level (OR 0.808; 95% CI 0.674-0.967; p = 0.020) significantly predicted non-cavity pulmonary tuberculosis. The non-upper predominant lung involvement group was older and had a greater number of females, poorer performance status, a higher CRP level, and a lower serum albumin level. A poor performance status (OR 2.155; 95% CI 1.257-3.693; p = 0.005) was found to significantly predict pulmonary tuberculosis with non-upper predominant lung distributions.
CONCLUSIONS:
A low CRP level and poor performance status were associated with non-cavity and non-upper predominant lung distribution, respectively, in patients with pulmonary tuberculosis. Tuberculosis patients with these characteristics may present unusual chest images.
- PMID:
- 31344108
- PMCID:
- PMC6657914
- DOI:
- 10.1371/journal.pone.0220346
- [Indexed for MEDLINE]
25.
Pulm Med. 2019 Jun 17;2019:6838439. doi: 10.1155/2019/6838439. eCollection 2019.
Role of Convex Probe Endobronchial Ultrasound in the Diagnosis and Treatment of Nonmalignant Diseases.
Abstract
Here we present a comprehensive review of the literature concerning the utility of convex probe endobronchial ultrasound (CP-EBUS) in the diagnosis and treatment of nonmalignant conditions and discuss the associated complications. CP-EBUS has been conventionally used for the staging of lung cancer and sampling of mediastinal and hilar nodes. However, its application is not limited to malignant conditions, and it is gaining acceptance as a diagnostic modality of choice for nonmalignant conditions such as tuberculosis, sarcoidosis, pulmonary embolism, thyroid lesions, and cysts. Moreover, its therapeutic value allows for extended applications such as mediastinal and thyroid cyst drainage, fiducial marker placement for radiation therapy, and transbronchial needle injection. The noninvasiveness, low complication rate, high diagnostic yield, and satisfactory sensitivity and specificity values are the main attributes that lend credence to the use of CP-EBUS as a standalone primary diagnostic and therapeutic tool in pulmonary medicine in the foreseeable future.
26.
J Hosp Infect. 2019 Nov;103(3):360-361. doi: 10.1016/j.jhin.2019.07.001. Epub 2019 Jul 4.
Seasonal respiratory virus testing in management of adult cystic fibrosis patients.
27.
Clin Physiol Funct Imaging. 2019 Nov;39(6):393-398. doi: 10.1111/cpf.12590. Epub 2019 Jul 24.
Measurement of airway inflammation in current smokers by positron emission tomography.
Abstract
BACKGROUND:
Accumulation of activated neutrophilic leucocytes is known to increase uptake of 18 F-fluorodeoxyglucose (18 F-FDG) into lung tissue. Available evidence suggests that smokers and subjects with chronic obstructive pulmonary disease (COPD) have neutrophilic inflammation in peripheral airways. The aim of this study was to examine whether current smokers have higher lung tissue uptake of 18 F-FDG than never-smokers when correcting for air fraction of the lungs.
METHODS:
We prospectively recruited 33 current smokers and 33 never-smokers among subjects referred for diagnosis or staging of cancer, other than lung cancer, with combined positron emission tomography/computed tomography (PET/CT) with 18 F-FDG. Subjects with focal 18 F-FDG uptake or focal CT abnormalities in the lungs were excluded. The lungs were segmented in the CT image, and lung density measured. 18 F-FDG uptake was measured in the corresponding volume and corrected for air fraction.
RESULTS:
Lung uptake of 18 F-FDG, corrected for air fraction, was 12·5 and 8 per cent higher in the right and left lungs, respectively, in current smokers than in never-smokers (P<0·05). Conclusion Abnormal lung tissue uptake of 18 F-FDG may be masked by reduced lung density if the uptake is not related to air fraction. Increased uptake of 18 F-FDG in lung tissue in current smokers relative to never-smokers may reflect inflammation in peripheral airways. Measurements of 18 F-FDG uptake in the lung tissue may be useful for animal and human studies of airways disease in COPD and the relation between airway and systemic inflammation.
© 2019 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.
KEYWORDS:
chronic obstructive pulmonary disease; computed tomography; lung density; positron emission tomography
28.
Biomol Concepts. 2019 Jun 17;10(1):91-98. doi: 10.1515/bmc-2019-0011.
Evaluation of Quality of Life in Terms of Sinonasal Symptoms in Children with Cystic Fibrosis.
Abstract
Objective Sinusitis is a common complaint in children with cystic fibrosis. However, the actual prevalence of chronic rhinosinusitis and its effect on the quality of life of children have not been well considered. Therefore, the objective of this study was to determine the effect of sinonasal quality of life in children with cystic fibrosis. Materials and methods This study was a diagnostic study performed on 80 children with cystic fibrosis ranging from 2 to 20 years old, who were referred to the cystic fibrosis clinic of Masih Daneshvari Hospital from 2017-2018. The questionnaires used in this study were chronic rhinosinusitis screening questionnaire based on the European task force and the evaluation of the sinonasal quality of life was based on the SN-5 survey. Results Of the 80 patients with fibrosis from 2 to 20 years old who were recruited in the study, 41 patients were female (51.3%) and 39 were male (48.8%). In 61 cases (76.3%), there was no chronic rhinosinusitis and 19 cases (23.8%) had chronic rhinosinusitis. The mean SN-5 score in 19 patients with chronic rhinosinusitis was 3.4105 and the mean score of patients without rhinosinusitis was 1.8426, with a P-value of 0.000. The mean SN-5 score was significant between the two groups. In patients with nasal congestion, there was a significant difference in quality of life factors such as sinus infection, nasal obstruction, and allergy symptoms (P<0.001). In patients with facial pain, there was a significant difference in quality of life factors such as sinus infection, nasal obstruction, allergic symptoms, and physical activity limitation (P <0.001). There was also a significant difference in the quality of life factors such as sinus infection, nasal obstruction, and allergy symptoms in patients with postnasal drip (P <0.001). Conclusion In children with cystic fibrosis, the quality of life of sinonasal has a significant relationship with absence of chronic rhinosinusitis. This study showed that children with chronic renosinusitis have significantly lower quality of sinonasal life than children with chronic rhinosinusitis. The results demonstrated that quality of life scores in sinus infections, nasal obstruction, and allergy symptoms were significantly higher in patients with chronic rhinosinusitis than in those without chronic rhinosinusitis. The findings of this study are important for improving children's health related quality of life, as it leads to promoting communication between the patient and the health care provider, identifying overlooked problems, monitoring the progress of the disease and the burden of treatment, and promoting interventions in the daily life of patients.
KEYWORDS:
Child; Cystic fibrosis; Quality of life; Sinusitis
29.
J Paediatr Child Health. 2019 Jun;55(6):728. doi: 10.1111/jpc.14463.
National guidelines for bronchiolitis.
Comment on
- Evaluation of national guidelines for bronchiolitis: AGREEments and controversies. [J Paediatr Child Health. 2019]
30.
Pulm Med. 2019 Mar 20;2019:2905615. doi: 10.1155/2019/2905615. eCollection 2019.
Sputum Smear Positive Pulmonary Tuberculosis Diagnostic Dropout Rate in Public Health Facilities, Addis Ababa, Ethiopia.
Desalegn DM1,2, Kitila KT1,2, Taddese BD1,2, Hailu TK2, Dinku TT1,2, Asferie KD1,2, Balcha HM1,2, Gebeyehu CS1,2, Medhin G3.
Abstract
BACKGROUND:
Prolonged laboratory diagnostic process of tuberculosis can lead to failure to complete the diagnosis and increase dropout rate of smear positive pulmonary tuberculosis (PTB) cases. This implies such dropout patients without completing diagnosis are critical as infected individuals remain untreated in the community, providing more opportunities for transmission of the disease and adversely affecting the epidemic. The aim of this research is to determine the level of smear positive PTB diagnosis dropout rate of spot-morning-spot sputum microscopy diagnosis method in public health facilities, in Addis Ababa, Ethiopia.
METHODS:
Retrospective review of patient documents in 13 public health facilities' TB laboratory in Addis Ababa was conducted from October 2011 to March 2016. Data was computerized using Epi-info software and analysed using SPSS version 20.0 software. Descriptive numerical summaries were used to present the findings. Association between the dropout rate and demographic variables was assessed by Chi-square (X2). Bivariate model using Odds Ratio (OR) with a 95% Confidence Interval (CI) was calculated. P-Value less than 0.05 was taken as statistically significant.
RESULTS:
Of 41,884 presumptive TB patients registered during the 53 months for laboratory investigation, 5.9% were positive for the first spot sputum smear microscopy. Among these positive cases, 142 (5.8%) and 298 (12.1%) did not come back to the laboratory to submitted early morning and second spot sputum specimens, respectively. The diagnostic dropout for morning sputum specimen in hospitals was 5.6% (58/1039) and in health centres was 5.9% (84/1424). However, higher proportion of dropout for second spot sputum specimen in hospitals was 16.4% (170/1039), compared to the health centres, 8.9% (128/1424). Diagnostic dropout of sputum smear microscopy had no significant association with sociodemographic variable (P value >0.05), while it had significant association with facility type (P value <0.05).
CONCLUSION:
In this study smear positive pulmonary tuberculosis diagnostic dropout rate was high compared to WHO reported for the new strategy shift implying the importance of shifting to same-day approach. Hence, shifting from conventional to same day is crucial to minimize the TB diagnostic dropout rate in the study area and other similar settings. Further research is needed/recommended in the local setting to compare the yield and dropout rates between same-day and conventional sputum smear microscopy approach.
31.
Expert Opin Biol Ther. 2019 Jun;19(6):491-500. doi: 10.1080/14712598.2019.1610382. Epub 2019 May 7.
An evaluation of mepolizumab for the treatment of severe asthma.
Abstract
Introduction: Asthma is considered one of the most common chronic conditions globally, characterized by variable airflow obstruction and symptoms. Severe asthma is diagnosed when asthma control requires high-intensity therapy or continues to remain uncontrolled despite treatment. Eosinophilic inflammation is known to be perpetuated by the activity of IL-5 in a proportion of severe asthma subjects, and targeting IL-5 may offer a therapeutic option. Areas covered: In this review, we discuss the role and pathogenesis of IL-5 and eosinophils in asthma and rationale of antagonizing IL-5 in severe eosinophilic asthma. Mepolizumab is the first of three anti-IL-5 biologics licensed in 2015 for use in this subgroup of patients. We discuss clinical and real-life studies leading up to its approval and post-marketing outcomes in terms of efficacy and safety to-date, as well as its pros and cons. Expert opinion: IL-5 antagonism has paved the way for an additional personalized therapeutic opportunity for use in severe asthma with eosinophilic inflammation, though there is limited evidence on the long-term implications of suppressing/depleting eosinophils and the duration for which they should be administered.
KEYWORDS:
Severe asthma; anti-Il-5 therapies; biologics; eosinophilic asthma; mepolizumab
32.
AJNR Am J Neuroradiol. 2019 May;40(5):855-861. doi: 10.3174/ajnr.A6037. Epub 2019 Apr 18.
The Black Turbinate Sign, A Potential Diagnostic Pitfall: Evaluation of the Normal Enhancement Patterns of the Nasal Turbinates.
Abstract
BACKGROUND AND PURPOSE:
Lack of enhancement of a nasal turbinate on MR imaging, known as the black turbinate, has been reported as a finding highly suggestive of invasive fungal rhinosinusitis in immunocompromised patients. Our purpose was to investigate the normal enhancement pattern of nasal turbinates and to determine whether a black turbinate occurs in patients without invasive fungal rhinosinusitis and, if so, to distinguish differentiating features from pathologic enhancement.
MATERIALS AND METHODS:
We examined patient medical records and available MR imaging, which included most nasal turbinates in more than 1 sequence. Imaging was performed with contrast, either with or without fat saturation, in patients without invasive fungal rhinosinusitis. All MR images were evaluated for a turbinate enhancement pattern and the presence of nonenhancing areas.
RESULTS:
After we applied the exclusion criteria, 75 MR images from each group, with and without fat saturation, were included. Overall, the frequency of observed nonenhancing portions of turbinates, ie, black turbinates, was 30%. Most observed black turbinates were located in the posterior portion of inferior turbinates. Tiny areas of nonenhancement within turbinates were also a common finding.
CONCLUSIONS:
A black turbinate is not uncommon on MR images in immunocompetent patients who have no chance of having invasive fungal rhinosinusitis. Benign turbinate nonenhancement improves over subsequent series, has preserved thin peripheral enhancement, and often has thin internal septa. Knowledge of this normal pattern of nasal turbinate enhancement can aid in the differentiation of the benign black turbinate in immunocompetent patients from the pathologic black turbinate seen in patients with invasive fungal rhinosinusitis.
© 2019 by American Journal of Neuroradiology.
- PMID:
- 31000527
- PMCID:
- PMC7053906
- [Available on 2020-05-01]
- DOI:
- 10.3174/ajnr.A6037
- [Indexed for MEDLINE]
33.
Pediatr Allergy Immunol. 2019 Aug;30(5):547-552. doi: 10.1111/pai.13055. Epub 2019 May 20.
Hypersensitivity reactions to antiepileptic drugs in children.
Atanasković-Marković M1,2, Janković J2, Tmušić V2, Gavrović-Jankulović M3, Ćirković Veličković T3,4,5,6, Nikolić D1,2, Škorić D1,2.
Abstract
BACKGROUND:
Antiepileptic drugs (AEDs) can cause hypersensitivity reactions in children. These reactions are mainly cutaneous, self-limiting, and benign, but life-threatening severe cutaneous adverse reactions can occur. Infections can lead to skin eruptions and mimic drug hypersensitivity reactions, if a drug is taken at the same time. The aims of our study were to confirm or rule out the diagnosis of hypersensitivity reactions to AEDs in children and to detect an infection which mimics these reactions.
METHODS:
A prospective survey was conducted in a group of 100 children with histories of hypersensitivity reactions to AEDs by performing patch tests, delayed-reading intradermal test, and, in case of negative results, challenge test. In all children, a study was performed to detect infections by viruses or Mycoplasma pneumoniae.
RESULTS:
Maculopapular exanthema and delayed-appearing urticaria were the most reported hypersensitivity reactions to AEDs. Sixty-six (66%) of 100 children had confirmed hypersensitivity reactions to AEDs. Fifty-nine children had positive patch test. No children had positive challenge tests. The most common AEDs causing hypersensitivity reactions were carbamazepine (45.4%) and lamotrigine (43.6%). Thirty-two children had positive tests for viruses or M pneumoniae, and nine of them had also a positive allergy work-up.
CONCLUSION:
Considering that there are no specific tests to distinguish between a viral infection and hypersensitivity reactions to AEDs in the acute phase, a diagnostic work-up should be performed in all children with suspected hypersensitivity reactions to AEDs, as well as infectious agent study, to remove a false label of hypersensitivity.
© 2019 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.
KEYWORDS:
antiepileptic drugs; children; hypersensitivity reactions; non-immediate reactions
34.
Ann Rheum Dis. 2019 Sep;78(9):1283-1284. doi: 10.1136/annrheumdis-2019-215187. Epub 2019 Mar 23.
Optimal time between the last methotrexate administration and seasonal influenza vaccination in rheumatoid arthritis: post hoc analysis of a randomised clinical trial.
KEYWORDS:
discontinuation; influenza; methotrexate; rheumatoid arthritis; vaccination
35.
J Immunother Cancer. 2019 Feb 22;7(1):53. doi: 10.1186/s40425-019-0535-y.
Influenza vaccination and myocarditis among patients receiving immune checkpoint inhibitors.
Awadalla M1, Golden DLA2, Mahmood SS3, Alvi RM2, Mercaldo ND2, Hassan MZO2, Banerji D2, Rokicki A2, Mulligan C2, Murphy SPT2, Jones-O'Connor M2, Cohen JV4, Heinzerling LM5, Armanious M6, Sullivan RJ4, Damrongwatanasuk R6, Chen CL7, Gupta D7, Kirchberger MC5, Moslehi JJ8, Shah SP9, Ganatra S9, Thavendiranathan P10, Rizvi MA11, Sahni G12, Lyon AR13, Tocchetti CG14, Mercurio V14, Thuny F15, Ederhy S16, Mahmoudi M17, Lawrence DP4, Groarke JD18, Nohria A18, Fradley MG6, Reynolds KL4, Neilan TG2,19.
Abstract
BACKGROUND:
Influenza vaccination (FV) is recommended for patients with cancer. Recent data suggested that the administration of the FV was associated with an increase in immune-related adverse events (irAEs) among patients on immune checkpoint inhibitors (ICIs). Myocarditis is an uncommon but serious complication of ICIs and may also result from infection with influenza. There are no data testing the relationship between FV and the development of myocarditis on ICIs.
METHODS:
Patients on ICIs who developed myocarditis (n = 101) (cases) were compared to ICI-treated patients (n = 201) without myocarditis (controls). A patient was defined as having the FV if they were administered the FV from 6 months prior to start of ICI to anytime during ICI therapy. Alternate thresholds for FV status were also tested. The primary comparison of interest was the rate of FV between cases and controls. Patients with myocarditis were followed for major adverse cardiac events (MACE), defined as the composite of cardiogenic shock, cardiac arrest, hemodynamically significant complete heart block and cardiovascular death.
RESULTS:
The FV was administered to 25% of the myocarditis cases compared to 40% of the non-myocarditis ICI-treated controls (p = 0.01). Similar findings of lower rates of FV administration were noted among myocarditis cases when alternate thresholds were tested. Among the myocarditis cases, those who were vaccinated had 3-fold lower troponin levels when compared to unvaccinated cases (FV vs. No FV: 0.12 [0.02, 0.47] vs. 0.40 [0.11, 1.26] ng/ml, p = 0.02). Within myocarditis cases, those administered the FV also had a lower rate of other irAEs when compared to unvaccinated cases (36 vs. 55% p = 0.10) including lower rates of pneumonitis (12 vs. 36%, p = 0.03). During follow-up (175 [IQR 89, 363] days), 47% of myocarditis cases experienced a MACE. Myocarditis cases who received the FV were at a lower risk of cumulative MACE when compared to unvaccinated cases (24 vs. 59%, p = 0.002).
CONCLUSION:
The rate of FV among ICI-related myocarditis cases was lower than controls on ICIs who did not develop myocarditis. In those who developed myocarditis related to an ICI, there was less myocardial injury and a lower risk of MACE among those who were administered the FV.
KEYWORDS:
Cancer; Cardiovascular disease; Immune checkpoint inhibitors; Immune-related adverse events; Influenza vaccination; Major adverse cardiac events; Myocarditis
- PMID:
- 30795818
- PMCID:
- PMC6387531
- DOI:
- 10.1186/s40425-019-0535-y
- [Indexed for MEDLINE]
36.
Pediatr Allergy Immunol. 2019 Aug;30(5):503-510. doi: 10.1111/pai.13040. Epub 2019 Mar 18.
Interleukin-33 in the developing lung-Roles in asthma and infection.
Abstract
It has become increasingly clear that interleukin-33 (IL-33) plays a crucial role in initiation of type 2 immunity. The last decade of intense research has uncovered multiple mechanisms through which IL-33 targets key effector cells of the allergic immune response. Recently, IL-33 has been implicated in shaping the immune system of the lungs early in life, at a time which is crucial in the subsequent development of allergic asthma. In this review, we will address the current literature describing the role of IL-33 in the healthy and diseased lung. In particular, we will focus on the evidence for IL-33 in the development of immune responses in the lung, including the role of IL-33-responsive immune cells that may explain susceptibility to allergic sensitization at a young age and the association between genetic variants of IL-33 and asthma in humans. Finally, we will indicate areas for potential therapeutic modulation of the IL-33 pathway.
© 2019 John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.
KEYWORDS:
airborne viruses; development of asthma; early intervention; immune mechanisms; respiratory epithelium
37.
Braz J Infect Dis. 2018 Nov - Dec;22(6):462-471. doi: 10.1016/j.bjid.2018.10.280. Epub 2018 Dec 5.
Assessing and screening for T-cell epitopes from Mycobacterium tuberculosis RD2 proteins for the diagnosis of active tuberculosis.
Abstract
The Region of D eletion 2 (RD2) of Mycobacterium tuberculosis encodes reserved antigens that contribute to bacterial virulence. Among these antigens, Rv1983, Rv1986, Rv1987, and Rv1989c have been shown to be immunodominant in infected cattle; however, their diagnostic utility has not been evaluated in humans. In this study, we screened 87 overlapping synthetic peptides encoded by five RD2 proteins for diagnosing tuberculosis epitopes in 50 active tuberculosis (TB) cases, 31 non-tuberculosis patients and 36 healthy individuals. A pool of promising epitopes was then assessed for their diagnostic value in 233 suspected TB patients using a whole blood IFN-γ release assay. Only 10 peptides were recognized by more than 10% of active tuberculosis patients. The IFN-γ release responses to Rv1986-P9, P15, P16, Rv1988-P4, P11, and Rv1987-P11 were significantly higher in the active TB group than in the control groups (p<0.05). The whole blood IFN-γ release assay based on these epitopes yielded a sensitivity of 51% and a specificity of 85% in diagnosing active tuberculosis, and the corresponding results using the T-SPOT.TB assay were 76% and 75%, respectively. In conclusion, these results suggest that the six epitopes from the RD2 of M. tuberculosis have potential diagnostic value in TB.
Copyright © 2018. Published by Elsevier España, S.L.U.
KEYWORDS:
Diagnostic antigen; Mycobacterium tuberculosis; T-cell epitope
38.
Acad Pediatr. 2019 Mar;19(2):177-185. doi: 10.1016/j.acap.2018.09.013. Epub 2018 Sep 27.
Developing Resident-Sensitive Quality Measures: Engaging Stakeholders to Inform Next Steps.
Schumacher DJ1, Martini A2, Holmboe E3, Varadarajan K2, Busari J4, van der Vleuten C5, Carraccio C6.
Abstract
OBJECTIVE:
Despite the need for quality measures relevant to the work residents complete, few attempts have been made to address this gap. Resident-sensitive quality measures (RSQMs) can help fill this void. This study engaged resident and supervisor stakeholders to develop and inform next steps in creating such measures.
METHODS:
Two separate nominal group techniques (NGTs), one with residents and one with faculty and fellow supervisors, were used to generate RSQMs for 3 specific illnesses (asthma, bronchiolitis, and closed head injury) as well as general care for the pediatric emergency department. Two separate Delphi processes were then used to prioritize identified RSQMs. The measures produced by each group were compared side by side, illuminating similarities and differences that were explored through focus groups with residents and supervisors. These focus groups also probed future settings in which to develop RSQMs.
RESULTS:
In the NGT and Delphi groups, residents and supervisors placed considerable focus on measures in 3 areas across the illnesses of interest: 1) appropriate medication dosing, 2) documentation, and 3) information provided at patient discharge. Focus groups highlighted hospital medicine and general pediatrics as priority areas for developing future RSQMs but also noted contextual variables that influence the application of similar measures in different settings. Residents and supervisors had both similar as well as unique insights into developing RSQMs.
CONCLUSIONS:
This study continues to pave the path forward in developing future RSQMs by exploring specific settings, measures, and stakeholders to consider when undertaking this work.
Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
KEYWORDS:
outcomes-based assessment; quality care; resident assessment
39.
Aktuelle Urol. 2018 Sep;49(5):389. doi: 10.1055/a-0677-9654. Epub 2018 Sep 5.
Die Rolle der Uterosakral-Ligamente.
[Article in German]
[No authors listed]
Comment on
- Influenza vaccination for all pregnant women? So far the less biased evidence does not favour it. [Hum Vaccin Immunother. 2019]
40.
Curr Res Transl Med. 2019 Feb;67(1):28-30. doi: 10.1016/j.retram.2018.02.001. Epub 2018 Mar 7.
X-linked hyper-IgM syndrome associated with pulmonary manifestations: A very rare case of functional mutation in CD40L gene in Iran.
Abstract
Hyper IgM (HIGM) syndromes are a complex of primary immunodeficiency disorders. A 4-years-old boy with recurrent fever and chills, dyspnea, sort throat for a month was admitted to emergency department. In the current case, whole exome sequencing followed by Sanger sequencing were employed in order to screen probable functional mutations. Molecular analysis revealed a functional mutation across the CD40L gene (NM_000074: exon5: c.T464C) resulted in amino acid change p.L155P attributed to X-linked hyper IgM syndrome. The findings of the current study signify the critical role of microbial infection as well as XHIGM screening, particularly in those children cases with respiratory symptoms.
Copyright © 2018 Elsevier Masson SAS. All rights reserved.
KEYWORDS:
CD40 ligand; Hyper IgM syndrome; Whole exome sequencing
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