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Chen MH, Abernathy E, Icenogle JP, Perelygina LM. Improved diagnostic and multiplex RT-qPCR for detecting rubella viral RNA. J Virol Methods 2022; 306:114555. [PMID: 35654258 DOI: 10.1016/j.jviromet.2022.114555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/19/2022] [Accepted: 05/27/2022] [Indexed: 11/18/2022]
Abstract
An examination of the nucleic acid sequence alignment of 48 full-length rubella virus genomes revealed that the 5' terminus of the genome is more conserved than the commonly used detection windows for rubella virus RNA located in the E1 protein coding region, suggesting that the 5' terminus could be a target for improving detection of all rubella virus genotypes. Two candidate primer sets were tested and the window between nucleotides (nts) 98 and 251 was found to have the greatest analytical sensitivity for detection of different genotypes. The new method had a limit of detection of four copies of rubella RNA per reaction with high specificity. The average coefficient variation of Ct was 2.2%. Concordance between the new method and currently used method, based on testing 251 clinical specimens collected from a rubella outbreak, was 99.4%. The assay was further improved upon by the incorporation of detection of both rubella virus RNA and mRNA from a cellular reference gene in a multiplex format. The multiplex format did not reduce the sensitivity or the reproducibility of rubella RNA detection and, of 60 specimens tested, the concordance between the single target and multiplex assays was 85.0%. To assess the utility of the multiplex assay for molecular surveillance, 62 rubella IgM positive serum samples from a rubella outbreak were tested, and eleven tested positive using the multiplex method while none were positive using the method targeting E1. These results show that the assay based on the new detection window near the 5' terminus of the genome can improve the detection of rubella virus for the purpose of molecular surveillance and case confirmation, with the added benefit of improved efficiency due to multiplexing.
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Affiliation(s)
- Min-Hsin Chen
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | - Emily Abernathy
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Joseph P Icenogle
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Ludmila M Perelygina
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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2
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Wanat KA, Perelygina L, Chen MH, Hao L, Abernathy E, Bender NR, Shields BE, Wilson BD, Crosby D, Routes J, Samimi SS, Haun PL, Sokumbi O, Icenogle JP, Sullivan KE, Rosenbach M, Drolet BA. Association of Persistent Rubella Virus With Idiopathic Skin Granulomas in Clinically Immunocompetent Adults. JAMA Dermatol 2022; 158:626-633. [PMID: 35338705 DOI: 10.1001/jamadermatol.2022.0828] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Vaccine-derived and wild-type rubella virus (RuV) has been identified within granulomas in patients with inborn errors of immunity, but has not been described in granulomas of healthy adults. Objective To determine the association between RuV and atypical granulomatous inflammation in immune-competent adults. Design, Setting, and Participants This case series, conducted in US academic dermatology clinics from January 2019 to January 2021, investigated the presence of RuV in skin specimens using RuV immunofluorescent staining of paraffin-embedded tissue sections, real-time reverse-transcription polymerase chain reaction, whole-genome sequencing with phylogenetic analyses, and cell culture by the US Centers for Disease Control and Prevention. Rubella immunoglobulin G, immunoglobulin M enzyme-linked immunoassay, and viral neutralization assays were performed for the sera of immunocompetent individuals with treatment refractory cutaneous granulomas and histopathology demonstrating atypical palisaded and necrotizing granulomas. Clinical immune evaluation was performed. Main Outcomes and Measures Identification, genotyping, and culture of vaccine-derived and wild-type RuV within granulomatous dermatitis of otherwise clinically immune competent adults. Results Of the 4 total immunocompetent participants, 3 (75%) were women, and the mean (range) age was 61.5 (49.0-73.0) years. The RuV capsid protein was detected by immunohistochemistry in cutaneous granulomas. The presence of RuV RNA was confirmed by real-time reverse-transcription polymerase chain reaction in fresh-frozen skin biopsies and whole-genome sequencing. Phylogenetic analysis of the RuV sequences showed vaccine-derived RuV in 3 cases and wild-type RuV in 1. Live RuV was recovered from the affected skin in 2 participants. Immunology workup results demonstrated no primary immune deficiencies. Conclusions and Relevance The case series study results suggest that RuV (vaccine derived and wild type) can persist for years in cutaneous granulomas in clinically immunocompetent adults and is associated with atypical (palisaded and necrotizing type) chronic cutaneous granulomas. These findings represent a potential paradigm shift in the evaluation, workup, and management of atypical granulomatous dermatitis and raises questions regarding the potential transmissibility of persistent live RuV.
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Affiliation(s)
| | | | - Min-Hsin Chen
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - LiJuan Hao
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily Abernathy
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Bridget E Shields
- University of Wisconsin, Madison.,Assistant Section Editor, JAMA Dermatology
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3
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Provost J, Labetoulle M, Bouthry E, Haigh O, Leleu I, Kobal A, Mouriaux F, Barreau E, Vauloup-Fellous C, Rousseau A. Rubella virus-associated uveitis: The essentiality of aqueous humor virological analysis. Eur J Ophthalmol 2022; 32:3489-3497. [PMID: 35285294 DOI: 10.1177/11206721221087562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIMS / BACKGROUND Rubella virus-associated uveitis (RVAU) classically presents with the clinical features of Fuchs uveitis syndrome (FUS). We report a series RVAU, and discuss the relevance of available diagnostic strategies, and how vaccination could potentially prevent disease. METHODS We retrospectively included patients with RV-positive aqueous humor (AH) with RT-PCR and/or intraocular RV-IgG production, between January 2014 and December 2019. RV-IgG titers from AH and serum were compared with other virus-specific IgG titers (VZV and/or CMV and/or HSV-1), to determine the derived Goldmann-Witmer coefficient (GWC'). Clinical findings at presentation and during follow-up are reported, as well as the anti-RV vaccination status. RESULTS All 13 included patients demonstrated intraocular synthesis of RV-IgG (median GWC': 9.5; 3.2-100). RV-RNA was detected in one patient while PCR results were negative for other HSV1, VZV and CMV. The mean delay in diagnosis was 13 ± 12.6 years, with an initial presentation of FUS in only 3 patients (23%). Only four patients had been vaccinated, but all after the recommended age. CONCLUSION As RVAU is a pleiomorphic entity, virological analysis (RV RT-PCR and GWC') of aqueous humor is essential to improve the diagnosis and management of this entity. Improper vaccination against RV appears to be implicated in RVAU.
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Affiliation(s)
- Julien Provost
- Department of Ophthalmology, Bicêtre Hospital, 26930Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, France
| | - Marc Labetoulle
- Department of Ophthalmology, Bicêtre Hospital, 26930Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, & U1184, IMVA-HB, CEA, France
| | - Elise Bouthry
- Department of Virology, Hôpital Paul Brousse, 26930Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, INSERM U1193, France
| | - Oscar Haigh
- Department of Immunology of Viral, Auto-immune bacterial and hematological Diseases, U1184, IMVA-HB, CEA, France
| | - Igor Leleu
- Department of Ophthalmology, 55862Centre Hospitalier National d'Ophtalmologie des XV-XX, France
| | - Alfred Kobal
- Department of Ophthalmology, 55862Centre Hospitalier National d'Ophtalmologie des XV-XX, France
| | - Frédéric Mouriaux
- Department of Ophthalmology, Rennes University Hospital, Rennes, France
| | - Emmanuel Barreau
- Department of Ophthalmology, Bicêtre Hospital, 26930Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, France
| | - Christelle Vauloup-Fellous
- Department of Virology, Hôpital Paul Brousse, 26930Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, INSERM U1193, France
| | - Antoine Rousseau
- Department of Ophthalmology, Bicêtre Hospital, 26930Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, & U1184, IMVA-HB, CEA, France
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4
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Perelygina L, Faisthalab R, Abernathy E, Chen MH, Hao L, Bercovitch L, Bayer DK, Noroski LM, Lam MT, Cicalese MP, Al-Herz W, Nanda A, Hajjar J, Vanden Driessche K, Schroven S, Leysen J, Rosenbach M, Peters P, Raedler J, Albert MH, Abraham RS, Rangarjan HG, Buchbinder D, Kobrynski L, Pham-Huy A, Dhossche J, Cunningham Rundles C, Meyer AK, Theos A, Atkinson TP, Musiek A, Adeli M, Derichs U, Walz C, Krüger R, von Bernuth H, Klein C, Icenogle J, Hauck F, Sullivan KE. Rubella Virus Infected Macrophages and Neutrophils Define Patterns of Granulomatous Inflammation in Inborn and Acquired Errors of Immunity. Front Immunol 2022; 12:796065. [PMID: 35003119 PMCID: PMC8728873 DOI: 10.3389/fimmu.2021.796065] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/30/2021] [Indexed: 01/08/2023] Open
Abstract
Rubella virus (RuV) has recently been found in association with granulomatous inflammation of the skin and several internal organs in patients with inborn errors of immunity (IEI). The cellular tropism and molecular mechanisms of RuV persistence and pathogenesis in select immunocompromised hosts are not clear. We provide clinical, immunological, virological, and histological data on a cohort of 28 patients with a broad spectrum of IEI and RuV-associated granulomas in skin and nine extracutaneous tissues to further delineate this relationship. Combined immunodeficiency was the most frequent diagnosis (67.8%) among patients. Patients with previously undocumented conditions, i.e., humoral immunodeficiencies, a secondary immunodeficiency, and a defect of innate immunity were identified as being susceptible to RuV-associated granulomas. Hematopoietic cell transplantation was the most successful treatment in this case series resulting in granuloma resolution; steroids, and TNF-α and IL-1R inhibitors were moderately effective. In addition to M2 macrophages, neutrophils were identified by immunohistochemical analysis as a novel cell type infected with RuV. Four patterns of RuV-associated granulomatous inflammation were classified based on the structural organization of granulomas and identity and location of cell types harboring RuV antigen. Identification of conditions that increase susceptibility to RuV-associated granulomas combined with structural characterization of the granulomas may lead to a better understanding of the pathogenesis of RuV-associated granulomas and discover new targets for therapeutic interventions.
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Affiliation(s)
- Ludmila Perelygina
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA, United States
| | - Raeesa Faisthalab
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA, United States
| | - Emily Abernathy
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA, United States
| | - Min-Hsin Chen
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA, United States
| | - LiJuan Hao
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA, United States
| | - Lionel Bercovitch
- Department of Dermatology, Hasbro Children's Hospital and Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Diana K Bayer
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States
| | - Lenora M Noroski
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Michael T Lam
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Maria Pia Cicalese
- Pediatric Immunohematology and Bone Marrow Transplantation Unit and San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Istituto di Ricovero e Cura a Carattere Scientifico (National Institute for Research and Treatment) (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Waleed Al-Herz
- Department of Pediatrics, Kuwait University, Kuwait City, Kuwait.,Allergy and Clinical Immunology Unit, Department of Pediatrics, Al-Sabah Hospital, Kuwait City, Kuwait
| | - Arti Nanda
- Pediatric Dermatology Unit, As'ad Al-Hamad Dermatology Center, Al-sabah Hospital, Kuwait City, Kuwait
| | - Joud Hajjar
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Koen Vanden Driessche
- Department of Pediatrics, Queen Mathilde Mother and Child Centre, Antwerp University Hospital, Antwerp, Belgium
| | - Shari Schroven
- Department of Pediatrics, Queen Mathilde Mother and Child Centre, Antwerp University Hospital, Antwerp, Belgium
| | - Julie Leysen
- Department of Dermatology, Queen Mathilde Mother and Child Centre, Antwerp University Hospital, Antwerp, Belgium
| | - Misha Rosenbach
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Philipp Peters
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Johannes Raedler
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Michael H Albert
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Roshini S Abraham
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, United States
| | - Hemalatha G Rangarjan
- Department of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children's Hospital, Columbus, OH, United States
| | - David Buchbinder
- Department of Hematology, Children's Hospital of Orange County, Orange, CA, United States.,Department of Pediatrics, University of California at Irvine, Orange, CA, United States
| | - Lisa Kobrynski
- Allergy/Immunology Section, Emory University, Atlanta, GA, United States
| | - Anne Pham-Huy
- Department of Pediatrics, University of Ottawa and Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Julie Dhossche
- Department of Dermatology, Oregon Health and Science University, Portland, OR, United States
| | - Charlotte Cunningham Rundles
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Anna K Meyer
- Department of Pediatrics, National Jewish Health, Denver, CO, United States
| | - Amy Theos
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - T Prescott Atkinson
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Amy Musiek
- Division of Dermatology, Washington University School of Medicine, St. Louis, MO, United States
| | - Mehdi Adeli
- Division of Immunology and Allergy, Sidra Medicine and Hamad Medical Corporation, Doha, Qatar
| | - Ute Derichs
- Center for Pediatric and Adolescent Medicine, University Medical Hospital Mainz, Mainz, Germany
| | - Christoph Walz
- Institute of Pathology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Renate Krüger
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Horst von Bernuth
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Labor Berlin GmbH, Department of Immunology, Berlin, Germany
| | - Christoph Klein
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Joseph Icenogle
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA, United States
| | - Fabian Hauck
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Kathleen E Sullivan
- Division of Allergy Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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5
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Abstract
Purpose: to summarize the origin and very recent history of the use of metagenomic sequencing for the diagnosis of infectious uveitis, convey the technique as described by one of the primary institutions experimenting with the technology, and present recent successful applications of the technology as well as potential advantages and pitfalls compared to other current diagnostic tools.Methods: review of peer-reviewed literature concerning metagenomic sequencing for the diagnosis of infectious uveitis.Conclusion: compared to existing diagnostic methods, metagenomic deep sequencing is a sensitive, unbiased, and comprehensive technique with great potential for diagnosing the causative pathogens of cases of infectious uveitis. However, many issues remain to be addressed in the process of developing this technology, including but not limited to the potentially overwhelming amount of information generated, definition of diagnostic thresholds, demonstration of validity, contamination, and cost.
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Affiliation(s)
- Lianna Valdes
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston, MA, USA
| | - Paulo Bispo
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston, MA, USA
| | - Lucia Sobrin
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston, MA, USA
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6
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von Hofsten J, Ringlander J, Norberg P, Zetterberg M, Andersson M, Lindh M, Bergström T. Deep Sequencing of Varicella-Zoster Virus in Aqueous Humor From a Patient With Acute Retinal Necrosis Presenting With Acute Glaucoma. Open Forum Infect Dis 2020; 7:ofaa198. [PMID: 32587876 PMCID: PMC7305702 DOI: 10.1093/ofid/ofaa198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/22/2020] [Indexed: 11/16/2022] Open
Abstract
We report a case of acute retinal necrosis presenting with acute glaucoma preceding inflammatory signs by several days. High-throughput sequencing on aqueous humor revealed a low-level diversity in the viral genome comparable to diversity seen in cutaneous vesicles in contrast to high diversity in encephalitis.
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Affiliation(s)
- Joanna von Hofsten
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Ophthalmology, Halland Hospital Halmstad, Halmstad, Sweden
| | - Johan Ringlander
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Sweden
| | - Peter Norberg
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Sweden
| | - Madeleine Zetterberg
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Gothenburg, Sweden
| | - Maria Andersson
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Sweden
| | - Magnus Lindh
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Sweden
| | - Tomas Bergström
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Sweden
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7
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Touhami S, Vanier A, Rosati A, Bojanova M, Benromdhane B, Lehoang P, Rozenberg F, Bodaghi B. Predictive Factors of Intraocular Pressure Level Evolution Over Time and Glaucoma Severity in Fuchs' Heterochromic Iridocyclitis. Invest Ophthalmol Vis Sci 2019; 60:2399-2405. [PMID: 31157832 DOI: 10.1167/iovs.18-24597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the clinical and virologic-associated and predictive factors of intraocular pressure (IOP) evolution over time and its severity in Fuchs' heterochromic iridocyclitis (FHC). Methods Consecutive patients with both clinical FHC and intraocular synthesis of rubella virus (RV)-specific antibodies were included in this study. Specific ocular production of RV antibodies was confirmed using the quotient of serum/aqueous humor ratio of RV IgGs (Crv) and control antiviral IgGs (Cctl), using quantitative serology methods. Epidemiologic, clinical, biological, and virologic data at referral were collected and correlated with IOP values over time, occurrence, and severity of glaucoma. Results Sixty-eight eyes of 68 patients were included. Mean age at diagnosis was 40.7 ± 11.1 years. Mean follow-up was 4.3 ± 4.3 years. Mean baseline Crv and Cctl values were 12.34 ± 14.67 and 216.70 ± 98.4, respectively. Mean baseline IOP was 17.2 ± 7.2 mm Hg (range, 9-40) and 15.6 ± 5.6 (range, 3-30) 5 years after referral. The predictive factors for pejorative IOP evolution over time and glaucoma severity were male sex (P = 0.03) and decreased Crv (P = 0.04) and presence of iris nodules (P < 0.001) and decreased Cctl (P = 0.02), respectively. Diagnostic delay was associated with increased likelihood of undergoing glaucoma surgery (P = 0.02). Conclusions Time to diagnosis, male sex, presence of iris nodules at baseline, and decreased Crv and Cctl ratios were associated with increased likelihood of pejorative IOP evolution over time. Given the aggressiveness of glaucoma in FHC, these results provide interesting insight into what category of patients should need the closest screening.
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Affiliation(s)
- Sara Touhami
- Ophthalmology Department, Reference Center in Rare Diseases, Département Hospitalo Universitaire Sight Restore, Hôpital Pitié Salpêtrière, University Paris VI, Paris, France
| | - Antoine Vanier
- Inserm, University Bretagne Loire, University of Nantes, University of Tours, Unité Mixte de Recherche, U1246 Sciences Philosophie Histoire, Nantes, France
| | - Alessandra Rosati
- Ophthalmology Unit, Dipartimento di Neuroscienze Salute Mentale e Organi di Senso, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Magdalena Bojanova
- Virology Department, Hôpital Cochin, Paris Descartes University, Paris, France
| | - Bouchra Benromdhane
- Ophthalmology Department, Reference Center in Rare Diseases, Département Hospitalo Universitaire Sight Restore, Hôpital Pitié Salpêtrière, University Paris VI, Paris, France
| | - Phuc Lehoang
- Ophthalmology Department, Reference Center in Rare Diseases, Département Hospitalo Universitaire Sight Restore, Hôpital Pitié Salpêtrière, University Paris VI, Paris, France
| | - Flore Rozenberg
- Virology Department, Hôpital Cochin, Paris Descartes University, Paris, France
| | - Bahram Bodaghi
- Ophthalmology Department, Reference Center in Rare Diseases, Département Hospitalo Universitaire Sight Restore, Hôpital Pitié Salpêtrière, University Paris VI, Paris, France
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8
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Gonzales JA, Hinterwirth A, Shantha J, Wang K, Zhong L, Cummings SL, Qian Y, Wilson MR, Acharya NR, Doan T. Association of Ocular Inflammation and Rubella Virus Persistence. JAMA Ophthalmol 2019; 137:435-438. [PMID: 30589932 PMCID: PMC6439711 DOI: 10.1001/jamaophthalmol.2018.6185] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 11/01/2018] [Indexed: 12/14/2022]
Abstract
Importance Metagenomic deep sequencing (MDS) demonstrates that persistent and active rubella virus (RV) infection is associated with Fuchs heterochromic iridocyclitis (FHI). Objective To assess the utility of MDS in identifying RV infection in patients with uveitis. Design, Setting, and Participants This case series assessed 6 patients diagnosed by MDS with RV-associated uveitis at a tertiary uveitis referral center in the United States. Exposures Prior RV infection. Main Outcomes and Measures Clinical examination findings, slitlamp photography, corneal confocal imaging, and infectious pathogen genome obtained from RNA sequencing. Results Six white men (age range, 36-61 years) were diagnosed with RV-associated uveitis by MDS. Three patients exhibited iris heterochromia associated with their uveitis in classic FHI fashion. The other 3 patients had less classic FHI features and exhibited anterior vitritis. Three patients had in vivo corneal confocal microscopy, with 2 demonstrating stellate keratic precipitates in addition to endothelial infiltration, spotlike holes, and enlarged intercellular boundaries. Of these 3 patients, 1 patient exhibited polymorphism and polymegathism of the endothelial cells. Conclusions and Relevance These findings suggest that persistent RV infection is associated with recurrent or chronic anterior or anterior-intermediate uveitis as well as corneal endothelial cell damage. Ophthalmologists should consider RV infection as a potential cause of hypertensive anterior and intermediate uveitis.
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Affiliation(s)
- John A. Gonzales
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
| | - Armin Hinterwirth
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Jessica Shantha
- Department of Ophthalmology, Emory University, Atlanta, Georgia
| | - Kaidi Wang
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
| | - Lina Zhong
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Susie L. Cummings
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Ying Qian
- Department of Ophthalmology, Kaiser Permanente, Oakland, California
| | - Michael R. Wilson
- Weill Institute for Neurosciences, University of California, San Francisco
- Department of Neurology, University of California, San Francisco
| | - Nisha R. Acharya
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
| | - Thuy Doan
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
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9
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Bankamp B, Hickman C, Icenogle JP, Rota PA. Successes and challenges for preventing measles, mumps and rubella by vaccination. Curr Opin Virol 2019; 34:110-116. [PMID: 30852425 DOI: 10.1016/j.coviro.2019.01.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/21/2018] [Accepted: 01/16/2019] [Indexed: 01/13/2023]
Abstract
The measles, mumps and rubella (MMR) vaccine has an outstanding safety record and is highly efficacious. High coverage with MMR has led to the elimination of endemic measles, rubella, and congenital rubella syndrome in the US. The biggest challenges to global measles and rubella control and elimination are insufficient vaccination coverage globally and increasing hesitancy. Despite high two dose coverage rates, mumps has made a resurgence in the US and other countries. Mumps outbreaks have occurred primarily in close contact, high-density settings and most cases had received a second dose 10 or more years previously. Waning humoral immunity and antigenic variation of circulating wild-type mumps strains may play a role in the mumps resurgence.
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Affiliation(s)
- Bettina Bankamp
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Carole Hickman
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Joseph P Icenogle
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Paul A Rota
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
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10
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Perelygina L, Buchbinder D, Dorsey MJ, Eloit M, Hauck F, Hautala T, Moshous D, Uriarte I, Deripapa E, Icenogle J, Sullivan KE. Outcomes for Nitazoxanide Treatment in a Case Series of Patients with Primary Immunodeficiencies and Rubella Virus-Associated Granuloma. J Clin Immunol 2019; 39:112-117. [PMID: 30680653 DOI: 10.1007/s10875-019-0589-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/02/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Nitazoxanide was recently reported as having in vitro effectiveness against the rubella virus. Immunodeficiency-related vaccine-derived rubella occurs in some patients who have an inherited immunodeficiency and who received the MMR vaccine. This study investigated the in vivo effectiveness of nitazoxanide therapy. METHODS This is a retrospective analysis of seven patients treated with nitazoxanide as salvage therapy for immunodeficiency-related vaccine-derived rubella infection. The patients were recruited from an ongoing rubella detection surveillance project. RESULTS Seven patients with persistent rubella were treated with nitazoxanide and one demonstrated significant clinical improvement. Two additional patients exhibited diminished viral capsid production with one patient having transient slowing of progression. The cohort overall generally had low T cell counts and had a high burden of comorbidities. There were three deaths. Two deaths were from PML and one was related to hematopoietic stem cell transplantation. CONCLUSIONS Nitazoxanide has limited in vivo anti-viral effects for immunodeficiency-related vaccine-derived rubella. Most patients did not exhibit clinical improvement.
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Affiliation(s)
- Ludmila Perelygina
- Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA
| | - David Buchbinder
- Division of Hematology, CHOC Children's Hospital, Orange, CA, USA
| | - Morna J Dorsey
- Department of Pediatrics, Division of Allergy, Immunology, and Blood and Marrow Transplant, Benioff Children's Hospital, University of California, San Francisco, 1975 4th Street, San Francisco, CA, 94158, USA
| | - Marc Eloit
- Institut Pasteur, Laboratory of Pathogen Discovery, Biology of Infection Unit, Inserm U1117, Paris, France
| | - Fabian Hauck
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Timo Hautala
- Research Unit of Internal Medicine, University of Oulu and Oulu University Hospital, Kajaanintie 50, 90220, Oulu, Finland
| | - Despina Moshous
- Department of Pediatric Immunology, Hematology and Rheumatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Necker Children's Hospital, Paris, France.,Laboratory "Genome Dynamics in The Immune System," INSERM UMR1163, Université Paris Descartes Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Ignacio Uriarte
- Immunology Unit, The Child's and Mother Hospital, Vitorio Tetamanti, High School of Medicine, Mar del Plata National University, Castelli 2450 Mar del Plata, 7600, Buenos Aires, Argentina
| | - Elena Deripapa
- Department of Immunology, Center for Pediatric Hematology, Oncology, Immunology, Moscow, Russia
| | - Joseph Icenogle
- Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA
| | - Kathleen E Sullivan
- Division of Allergy Immunology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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11
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Inhibition of rubella virus replication by the broad-spectrum drug nitazoxanide in cell culture and in a patient with a primary immune deficiency. Antiviral Res 2017; 147:58-66. [PMID: 28974385 PMCID: PMC7127570 DOI: 10.1016/j.antiviral.2017.09.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/25/2017] [Accepted: 09/29/2017] [Indexed: 12/20/2022]
Abstract
Persistent rubella virus (RV) infection has been associated with various pathologies such as congenital rubella syndrome, Fuchs's uveitis, and cutaneous granulomas in patients with primary immune deficiencies (PID). Currently there are no drugs to treat RV infections. Nitazoxanide (NTZ) is an FDA-approved drug for parasitic infections, and has been recently shown to have broad-spectrum antiviral activities. Here we found that empiric 2-month therapy with oral NTZ was associated in the decline/elimination of RV antigen from lesions in a PID patient with RV positive granulomas, while peginterferon treatment had no effect. In addition, we characterized the effects of NTZ on cell culture models of persistent RV infection. NTZ significantly inhibited RV replication in a primary culture of human umbilical vein endothelial cells (HUVEC) and Vero and A549 epithelial cell lines in a dose dependent manner with an average 50% inhibitory concentration of 0.35 μg/ml (1.1 μM). RV strains representing currently circulating genotypes were inhibited to a similar extent. NTZ affected early and late stages of infection by inhibiting synthesis of cellular and RV RNA and interfering with intracellular trafficking of the RV surface glycoproteins, E1 and E2. These results suggest a potential application of NTZ for the treatment of persistent rubella infections, but more studies are required.
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12
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Neven B, Pérot P, Bruneau J, Pasquet M, Ramirez M, Diana JS, Luzi S, Corre-Catelin N, Chardot C, Moshous D, Leclerc Mercier S, Mahlaoui N, Aladjidi N, Le Bail B, Lecuit M, Bodemer C, Molina TJ, Blanche S, Eloit M. Cutaneous and Visceral Chronic Granulomatous Disease Triggered by a Rubella Virus Vaccine Strain in Children With Primary Immunodeficiencies. Clin Infect Dis 2016; 64:83-86. [PMID: 27810866 DOI: 10.1093/cid/ciw675] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 09/22/2016] [Indexed: 11/12/2022] Open
Abstract
Persistence of rubella live vaccine has been associated with chronic skin granuloma in 3 children with primary immunodeficiency. We describe 6 additional children with these findings, including 1 with visceral extension to the spleen.
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Affiliation(s)
- Bénédicte Neven
- Sorbonne Paris Cité, Paris Descartes University, Institut Imagine.,Paediatric Haemato-Immunology Unit.,National Reference Centre for Primary Immune Deficiencies
| | - Philippe Pérot
- Biology of Infection Unit, Laboratory of Pathogen Discovery, Inserm U1117.,Biomics, Centre d'Innovation et de Recherche Technologique
| | | | - Marlene Pasquet
- Hematology and Immunology Pediatric Department, CHU Toulouse, Center of Research in Cancerology of Toulouse, Team 16, Institut Universitaire du Cancer de Toulouse-Oncopole
| | - Marie Ramirez
- Biology of Infection Unit, Laboratory of Pathogen Discovery, Inserm U1117
| | - Jean-Sébastien Diana
- Sorbonne Paris Cité, Paris Descartes University, Institut Imagine.,Paediatric Haemato-Immunology Unit
| | | | - Nicole Corre-Catelin
- Investigation Clinique et Accès aux Ressources Biologiques, Institut Pasteur, Paris
| | | | - Despina Moshous
- Sorbonne Paris Cité, Paris Descartes University, Institut Imagine.,Paediatric Haemato-Immunology Unit.,National Reference Centre for Primary Immune Deficiencies
| | | | - Nizar Mahlaoui
- Paediatric Haemato-Immunology Unit.,National Reference Centre for Primary Immune Deficiencies
| | - Nathalie Aladjidi
- Pediatric Oncology Hematology Unit/CEREVANCE/CIC 1401, Inserm Centre d'Investigation Clinique Plurithématique, University Hospital of Bordeaux, Pediatric Hospital
| | - Brigitte Le Bail
- Department of Pathology, Hôpital des Enfants-Hôpital Pellegrin, Bordeaux, France
| | - Marc Lecuit
- Sorbonne Paris Cité, Paris Descartes University, Institut Imagine.,Department of Infectious Diseases, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris.,National Reference Centre for Primary Immune Deficiencies.,Biology of Infection Unit, Laboratory of Pathogen Discovery, Inserm U1117
| | | | - Thierry Jo Molina
- Sorbonne Paris Cité, Paris Descartes University, Institut Imagine.,Department of Pathology
| | - Stéphane Blanche
- Sorbonne Paris Cité, Paris Descartes University, Institut Imagine.,Paediatric Haemato-Immunology Unit.,National Reference Centre for Primary Immune Deficiencies
| | - Marc Eloit
- Biology of Infection Unit, Laboratory of Pathogen Discovery, Inserm U1117
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13
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Doan T, Wilson MR, Crawford ED, Chow ED, Khan LM, Knopp KA, O’Donovan BD, Xia D, Hacker JK, Stewart JM, Gonzales JA, Acharya NR, DeRisi JL. Illuminating uveitis: metagenomic deep sequencing identifies common and rare pathogens. Genome Med 2016; 8:90. [PMID: 27562436 PMCID: PMC4997733 DOI: 10.1186/s13073-016-0344-6] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 08/05/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Ocular infections remain a major cause of blindness and morbidity worldwide. While prognosis is dependent on the timing and accuracy of diagnosis, the etiology remains elusive in ~50 % of presumed infectious uveitis cases. The objective of this study is to determine if unbiased metagenomic deep sequencing (MDS) can accurately detect pathogens in intraocular fluid samples of patients with uveitis. METHODS This is a proof-of-concept study, in which intraocular fluid samples were obtained from five subjects with known diagnoses, and one subject with bilateral chronic uveitis without a known etiology. Samples were subjected to MDS, and results were compared with those from conventional diagnostic tests. Pathogens were identified using a rapid computational pipeline to analyze the non-host sequences obtained from MDS. RESULTS Unbiased MDS of intraocular fluid produced results concordant with known diagnoses in subjects with (n = 4) and without (n = 1) uveitis. Samples positive for Cryptococcus neoformans, Toxoplasma gondii, and herpes simplex virus 1 as tested by a Clinical Laboratory Improvement Amendments-certified laboratory were correctly identified with MDS. Rubella virus was identified in one case of chronic bilateral idiopathic uveitis. The subject's strain was most closely related to a German rubella virus strain isolated in 1992, one year before he developed a fever and rash while living in Germany. The pattern and the number of viral identified mutations present in the patient's strain were consistent with long-term viral replication in the eye. CONCLUSIONS MDS can identify fungi, parasites, and DNA and RNA viruses in minute volumes of intraocular fluid samples. The identification of chronic intraocular rubella virus infection highlights the eye's role as a long-term pathogen reservoir, which has implications for virus eradication and emerging global epidemics.
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Affiliation(s)
- Thuy Doan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA USA
| | - Michael R. Wilson
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA USA
- Department of Neurology, University of California San Francisco, San Francisco, CA USA
| | - Emily D. Crawford
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA USA
- Howard Hughes Medical Institute, Chevy Chase, MD USA
| | - Eric D. Chow
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA USA
| | - Lillian M. Khan
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA USA
| | - Kristeene A. Knopp
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA USA
| | - Brian D. O’Donovan
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA USA
| | - Dongxiang Xia
- California Department of Public Health, Richmond, CA USA
| | - Jill K. Hacker
- California Department of Public Health, Richmond, CA USA
| | - Jay M. Stewart
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA USA
| | - John A. Gonzales
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA USA
| | - Nisha R. Acharya
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA USA
| | - Joseph L. DeRisi
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA USA
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