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Cortese I, Norato G, Harrington PR, Usher T, Mainardi I, Martin-Blondel G, Cinque P, Major EO, Sheikh V. Biomarkers for progressive multifocal leukoencephalopathy: emerging data for use of JC virus DNA copy number in clinical trials. Lancet Neurol 2024; 23:534-544. [PMID: 38631769 DOI: 10.1016/s1474-4422(24)00099-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 04/19/2024]
Abstract
Progressive multifocal leukoencephalopathy is a rare but devastating demyelinating disease caused by the JC virus (JCV), for which no therapeutics are approved. To make progress towards addressing this unmet medical need, innovations in clinical trial design are needed. Quantitative JCV DNA in CSF has the potential to serve as a valuable biomarker of progressive multifocal leukoencephalopathy disease and treatment response in clinical trials to expedite therapeutic development, as do neuroimaging and other fluid biomarkers such as neurofilament light chain. Specifically, JCV DNA in CSF could be used in clinical trials as an entry criterion, stratification factor, or predictor of clinical outcomes. Insights from the investigation of candidate biomarkers for progressive multifocal leukoencephalopathy might inform approaches to biomarker development for other rare diseases.
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Affiliation(s)
- Irene Cortese
- Experimental Immunotherapeutics Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
| | - Gina Norato
- Clinical Trials Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Patrick R Harrington
- Division of Antivirals, Office of Infectious Diseases, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Therri Usher
- Division of Biometrics IV, Office of Biostatistics, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Ilaria Mainardi
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Guillaume Martin-Blondel
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), INSERM UMR1291-CNRS UMR5051, Université Toulouse III, Toulouse, France
| | - Paola Cinque
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eugene O Major
- Laboratory of Molecular Medicine and Neuroscience, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Virginia Sheikh
- Division of Antivirals, Office of Infectious Diseases, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
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2
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Milburn J, Suresh R, Doyle R, Jarvis JN. The diagnosis of central nervous system infections in resource-limited settings and the use of novel and molecular diagnostic platforms to improve diagnosis. Expert Rev Mol Diagn 2024; 24:219-230. [PMID: 38369939 DOI: 10.1080/14737159.2024.2317414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/07/2024] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Central nervous system infections (CNSI) disproportionately affect individuals in low-resource settings where diagnosis is challenging; large proportions of patients never receive a confirmed microbiological diagnosis resulting in inadequate management and high mortality. The epidemiology of CNSI varies globally and conventional diagnostics deployed in resource-limited settings have significant limitations, with an urgent need for improved diagnostic strategies. AREAS COVERED This review describes molecular platforms and other novel diagnostics used in the diagnosis of CNSI that are applicable to resource-limited settings. An extensive literature search of Medline and PubMed was performed. The emphasis is on investigations targeting infections of relevance to resource-limited settings either due to variation in regional CNSI epidemiology or due to increased prevalence in patients with immunosuppression. This includes commercially available multiplex PCR platforms, mycobacterial PCR platforms, and rapid diagnostics tests. To offer a framework for the optimal implementation in clinical settings, existing evidence highlighting the advantages and limitations of available platforms is reviewed. EXPERT OPINION The implementation of molecular platforms and other novel diagnostics has the potential to transform CNSI diagnosis in resource-limited settings, with several examples of successful rollout of novel diagnostics such as Xpert MTB/RIF Ultra and cryptococcal antigen testing.
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Affiliation(s)
- James Milburn
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Clinical Research, Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Rachita Suresh
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Ronan Doyle
- Department of Clinical Research, Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Joseph N Jarvis
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Clinical Research, Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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3
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Rocchi A, Sariyer IK, Berger JR. Revisiting JC virus and progressive multifocal leukoencephalopathy. J Neurovirol 2023; 29:524-537. [PMID: 37659983 DOI: 10.1007/s13365-023-01164-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/10/2023] [Accepted: 07/27/2023] [Indexed: 09/04/2023]
Abstract
Since its definition 65 years ago, progressive multifocal leukoencephalopathy (PML) has continued to devastate a growing population of immunosuppressed patients despite major advances in our understanding of the causative JC virus (JCV). Unless contained by the immune system, JCV lyses host oligodendrocytes collateral to its life cycle, leading to demyelination, neurodegeneration, and death. Novel treatments have stagnated in the absence of an animal model while current antiviral agents fail to address the now ubiquitous polyomavirus. In this review, we highlight the established pathogenesis by which JCV infection progresses to PML, highlighting major challenges that must be overcome to eliminate the underlying virus and, therefore, the debilitating disease.
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Affiliation(s)
- Angela Rocchi
- Department of Microbiology, Immunology and Inflammation, Center for Neurovirology and Gene Editing, Temple University Lewis Katz School of Medicine, Philadelphia, PA, 19140, USA
| | - Ilker K Sariyer
- Department of Microbiology, Immunology and Inflammation, Center for Neurovirology and Gene Editing, Temple University Lewis Katz School of Medicine, Philadelphia, PA, 19140, USA.
| | - Joseph R Berger
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3400 Convention Avenue, Philadelphia, PA, 19104, USA.
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4
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Chiu CY, Amenta E, Chavez V, Fukuta Y, Hasbun R. Undetectable JC virus CSF PCR in patients with JC virus-induced progressive multifocal leukoencephalopathy. J Neurovirol 2023; 29:94-99. [PMID: 36723823 DOI: 10.1007/s13365-023-01113-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/15/2022] [Accepted: 01/05/2023] [Indexed: 02/02/2023]
Abstract
The diagnosis of progressive multifocal leukoencephalopathy (PML) is based on a combination of clinical, radiographic, and laboratory findings. However, negative JC polyomavirus (JCPyV) PCR in CSF does not always rule out JCPyV-related PML. In this narrative review, we sought to examine the characteristic of biopsy-proven PML in patients with undetectable JCPyV CSF PCR and provide alternative approaches in this scenario.
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Affiliation(s)
- Chia-Yu Chiu
- Division of Infectious Diseases, Department of Internal Medicine, The University of Texas Health Science Center at Houston, 6431 Fannin St, STE MSB 2112, Houston, TX, USA.
| | - Eva Amenta
- Section of Infectious Diseases, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Violeta Chavez
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Yuriko Fukuta
- Section of Infectious Diseases, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Rodrigo Hasbun
- Division of Infectious Diseases, Department of Internal Medicine, The University of Texas Health Science Center at Houston, 6431 Fannin St, STE MSB 2112, Houston, TX, USA
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5
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Villani LA, Stulberg EL, Abbatemarco JR, Davidson CJ, Kadish R, Renner DR, Soldan MMP, Rose JW, Clardy SL, Greenlee JE. Biopsy-proven PML in an HIV-negative patient with discoid lupus: Failure to detect JC virus in CSF. Clin Neurol Neurosurg 2021; 209:106843. [PMID: 34461360 PMCID: PMC10590808 DOI: 10.1016/j.clineuro.2021.106843] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 01/20/2023]
Abstract
We present a case of a 58-year-old man with a history of severe discoid lupus erythematosus and acute encephalopathy and incoordination. Antinuclear antibody testing was weakly positive but all other laboratory tests for systemic lupus erythematosus were negative and serum quantitative immunoglobulins and lymphocytes were normal. MRI brain showed T2/FLAIR hyperintensities within the bilateral parietal and temporal lobes with involvement of subcortical U fibers. CSF PCR was negative for varicella-zoster virus, herpes simplex, JCV and BK virus. However, JCV antibody index was elevated (3.88; reference: < 0.2). Right parietal brain biopsy was consistent with JCV infection and diagnostic of progressive multifocal leukoencephalopathy (PML). To the best of our knowledge, this is the first reported case of PML in a patient with discoid lupus without other traditional risk factors for the disease and highlights the need for clinical vigilance in this patient population.
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Affiliation(s)
- Linda A Villani
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Eric L Stulberg
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | | | | | - Robert Kadish
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - David R Renner
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - M Mateo Paz Soldan
- Department of Neurology, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - John W Rose
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Stacey L Clardy
- Department of Neurology, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - John E Greenlee
- Department of Neurology, University of Utah, Salt Lake City, UT, USA.
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6
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Hu CQ, Su JW, Wang MY, Guo YZ, Xu LJ, Tao R, Xie YR, Huang Y, Zhu B. Sequencing and analysis of John Cunningham polyomavirus DNA from acquired immunodeficiency syndrome patients with progressive multifocal leukoencephalopathy. Chin Med J (Engl) 2020; 133:2887-2889. [PMID: 33273343 PMCID: PMC10631578 DOI: 10.1097/cm9.0000000000001225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Cai-Qin Hu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China
| | - Jun-Wei Su
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China
| | - Meng-Yan Wang
- Xixi Hospital of Hangzhou, Hangzhou, Zhejiang 310023, China
| | - Yong-Zheng Guo
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China
| | - Li-Jun Xu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China
| | - Ran Tao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China
| | - Yi-Rui Xie
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China
| | - Ying Huang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China
| | - Biao Zhu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China
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Solis M, Guffroy A, Lersy F, Soulier E, Gallais F, Renaud M, Douiri N, Argemi X, Hansmann Y, De Sèze J, Kremer S, Fafi-Kremer S. Inadequate Immune Humoral Response against JC Virus in Progressive Multifocal Leukoencephalopathy Non-Survivors. Viruses 2020; 12:v12121380. [PMID: 33276614 PMCID: PMC7761562 DOI: 10.3390/v12121380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/17/2020] [Accepted: 11/29/2020] [Indexed: 11/16/2022] Open
Abstract
JC virus (JCV) causes progressive multifocal leukoencephalopathy (PML) in immunosuppressed patients. There is currently no effective specific antiviral treatment and PML management relies on immune restoration. Prognosis markers are crucially needed in this disease because of its high mortality rate. In this work, we investigated the compartmentalization of JCV strains as well as the humoral neutralizing response in various matrices to further understand the pathophysiology of PML and define markers of survival. Four patients were included, of which three died in the few months following PML onset. Cerebrospinal fluid (CSF) viral loads were the highest, with plasma samples having lower viral loads and urine samples being mostly negative. Whether at PML onset or during follow-up, neutralizing antibody (NAb) titers directed against the same autologous strain (genotype or mutant) were the highest in plasma, with CSF titers being on average 430-fold lower and urine titers 500-fold lower at the same timepoint. Plasma NAb titers against autologous genotype or mutant were lower in non-survivor patients, though no neutralization “blind spot” was observed. The surviving patient was followed up until nine months after PML onset and presented, at that time, an increase in neutralizing titers, from 38-fold against the autologous genotype to around 200-fold against PML mutants. Our results suggest that patients’ humoral neutralizing response against their autologous strain may play a role in PML outcome, with survivors developing high NAb titers in both plasma and CSF.
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Affiliation(s)
- Morgane Solis
- Virology Laboratory, Strasbourg University Hospitals, 67000 Strasbourg, France; (M.S.); (F.G.)
- INSERM UMR-S 1109 LabEx TRANSPLANTEX, Strasbourg University, 67000 Strasbourg, France;
| | - Aurélien Guffroy
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases, Strasbourg University Hospitals, 67000 Strasbourg, France;
| | - François Lersy
- Service d’Imagerie 2, Strasbourg University Hospitals, 67000 Strasbourg, France; (F.L.); (S.K.)
| | - Eric Soulier
- INSERM UMR-S 1109 LabEx TRANSPLANTEX, Strasbourg University, 67000 Strasbourg, France;
| | - Floriane Gallais
- Virology Laboratory, Strasbourg University Hospitals, 67000 Strasbourg, France; (M.S.); (F.G.)
- INSERM UMR-S 1109 LabEx TRANSPLANTEX, Strasbourg University, 67000 Strasbourg, France;
| | - Mathilde Renaud
- Neurology Department, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg University Hospitals, 67000 Strasbourg, France; (M.R.); (J.D.S.)
| | - Nawal Douiri
- Department of Infectious Diseases, Strasbourg University Hospitals, 67000 Strasbourg, France; (N.D.); (X.A.); (Y.H.)
| | - Xavier Argemi
- Department of Infectious Diseases, Strasbourg University Hospitals, 67000 Strasbourg, France; (N.D.); (X.A.); (Y.H.)
| | - Yves Hansmann
- Department of Infectious Diseases, Strasbourg University Hospitals, 67000 Strasbourg, France; (N.D.); (X.A.); (Y.H.)
| | - Jérôme De Sèze
- Neurology Department, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg University Hospitals, 67000 Strasbourg, France; (M.R.); (J.D.S.)
- Clinical Investigation Center, INSERM 1434, Strasbourg University Hospitals, 67000 Strasbourg, France
| | - Stéphane Kremer
- Service d’Imagerie 2, Strasbourg University Hospitals, 67000 Strasbourg, France; (F.L.); (S.K.)
- Engineering Science, Computer Science and Imaging Laboratory (ICube), Integrative Multimodal Imaging in Healthcare, UMR 7357, University of Strasbourg-CNRS, 67000 Strasbourg, France
| | - Samira Fafi-Kremer
- Virology Laboratory, Strasbourg University Hospitals, 67000 Strasbourg, France; (M.S.); (F.G.)
- INSERM UMR-S 1109 LabEx TRANSPLANTEX, Strasbourg University, 67000 Strasbourg, France;
- Correspondence: ; Tel.: +33-3-69-55-14-38; Fax: +33-3-68-85-37-50
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8
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Bianchi A, Ragonese P, Banco MA, Realmuto S, Vazzoler G, Portera E, La Tona G, Salemi G. Four cases of progressive multifocal leukoencephalopathy in iatrogenic immunocompromised patients. eNeurologicalSci 2020; 19:100243. [PMID: 32478179 PMCID: PMC7248236 DOI: 10.1016/j.ensci.2020.100243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/03/2020] [Indexed: 11/06/2022] Open
Abstract
Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system (CNS) caused by John Cunningham Virus (JCV). We report four PML cases in immunocompromised patients, respectively treated with (1) Natalizumab, (2) Rituximab, (3) autologous stem-cell transplantation, and (4) Tacrolimus. All patients underwent neurological examination, magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), JCV-DNA research on biological samples, and lymphocytes subpopulation study. All cases presented with motor, behavioural, and cognitive disorders. Visual, sensitive, and cerebellar deficits developed in three cases. MRI revealed widespread progressive demyelinating areas with active borders; three patients presented contrast enhancement. One patient developed inflammatory reconstitution syndrome (IRIS). At MRS, all cases presented decreased N-acetyl-aspartate (NAA) and three cases showed increased choline (Cho). In one patient, plasma and urine tested positive for JCV-DNA, while cerebrospinal fluid (CSF) analysis confirmed JCV in two patients. The fourth patient had a low JCV-DNA blood titer and brain biopsy showed subacute necrosis. Two patients had abnormal lymphocyte subpopulations. Three patients underwent therapy with Mirtazapine, one of whom received Mefloquine in add-on. No clinical response was registered. Clinical onset, MRI and MRS were highly suggestive of PML in all patients, despite three cases presented contrast enhancement. In three cases JCV-DNA detection in biological samples confirmed the diagnosis. The fourth patient fulfilled diagnosis of “presumptive PML”. Our data confirm the importance to complete the diagnostic workup despite the presence of findings not completely consistent with classical PML. We hypothesize that atypical characteristics could due to the clinical conditions leading to PML. Four cases of PML in iatrogenic immunocompromised patients. Clinical presentation was typical for PML. Diagnostic findings were not completely consistent with classical PML. Atypical findings do not exclude diagnosis when clinical data are highly suggestive. It is necessary to improve the diagnostic and therapeutic management of patients.
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Affiliation(s)
- Alessia Bianchi
- Department of Biomedicine, Neuroscience & Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Paolo Ragonese
- Department of Biomedicine, Neuroscience & Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Maria Aurelia Banco
- Department of Biomedicine, Neuroscience & Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Sabrina Realmuto
- Department of Biomedicine, Neuroscience & Advanced Diagnostic, University of Palermo, Palermo, Italy.,Clinic of Neurology and Stroke Unite, Centre of Neuroimmunology, AOOR Villa Sofia-Cervello, Palermo, Italy
| | - Giulia Vazzoler
- Department of Biomedicine, Neuroscience & Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Erika Portera
- Department of Biomedicine, Neuroscience & Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Giuseppe La Tona
- Department of Biomedicine, Neuroscience & Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neuroscience & Advanced Diagnostic, University of Palermo, Palermo, Italy
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9
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JC virus DNA in cerebrospinal fluid: insight into clinical significance. Diagn Microbiol Infect Dis 2020; 97:115017. [DOI: 10.1016/j.diagmicrobio.2020.115017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 02/08/2020] [Indexed: 11/17/2022]
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10
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Lokhandwala S, Sendowski M, Grafe M, Rakita RM, Kapnadak SG. Progressive Behavior Changes and Brain Lesions in a Lung Transplant Recipient. Clin Infect Dis 2020; 68:887-889. [PMID: 30766993 DOI: 10.1093/cid/ciy404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sharukh Lokhandwala
- Divison of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle.,Divison of Epidemiology, University of Washington School of Public Health, Seattle
| | | | - Marjorie Grafe
- Division of Neuropathology, Oregon Health and Science University, Portland
| | - Robert M Rakita
- Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle
| | - Siddhartha G Kapnadak
- Divison of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle
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11
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Kamminga S, van der Meijden E, de Brouwer C, Feltkamp M, Zaaijer H. Prevalence of DNA of fourteen human polyomaviruses determined in blood donors. Transfusion 2019; 59:3689-3697. [PMID: 31633816 PMCID: PMC6916541 DOI: 10.1111/trf.15557] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/24/2019] [Accepted: 09/24/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Human polyomaviruses (HPyVs), like herpesviruses, cause persistent infection in a large part of the population. In immunocompromised and elderly patients, PyVs cause severe diseases such as nephropathy (BK polyomavirus [BKPyV]), progressive multifocal leukoencephalopathy (JC polyomavirus [JCPyV]), and skin cancer (Merkel cell polyomavirus [MCPyV]). Like cytomegalovirus, donor‐derived PyV can cause disease in kidney transplant recipients. Possibly blood components transmit PyVs as well. To study this possibility, as a first step we determined the presence of PyV DNA in Dutch blood donations. STUDY DESIGN AND METHODS Blood donor serum samples (n = 1016) were analyzed for the presence of DNA of 14 HPyVs using HPyV species‐specific quantitative polymerase chain reaction (PCR) procedures. PCR‐positive samples were subjected to confirmation by sequencing. Individual PCR findings were compared with the previously reported PyV serostatus. RESULTS MC polyomavirus DNA was detected in 39 donors (3.8%), JCPyV and TS polyomavirus (TSPyV) DNA in five donors (both 0.5%), and HPyV9 DNA in four donors (0.4%). BKPyV, WU polyomavirus (WUPyV), HPyV6, MW polyomavirus (MWPyV), and LI polyomavirus (LIPyV) DNA was detected in one or two donors. Amplicon sequencing confirmed the expected product for BKPyV, JCPyV, WUPyV, MCPyV, HPyV6, TSPyV, MWPyV, HPyV9, and LIPyV. For JCPyV a significant association was observed between detection of viral DNA and the level of specific IgG antibodies. CONCLUSION In 5.4% of Dutch blood donors PyV DNA was detected, including DNA from pathogenic PyVs such as JCPyV. As a next step, the infectivity of PyV in donor blood and transmission via blood components to immunocompromised recipients should be investigated.
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Affiliation(s)
- Sergio Kamminga
- Department of Blood-borne Infections, Sanquin Research, Amsterdam, Netherlands.,Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
| | - Els van der Meijden
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
| | - Caroline de Brouwer
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
| | - Mariet Feltkamp
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
| | - Hans Zaaijer
- Department of Blood-borne Infections, Sanquin Research, Amsterdam, Netherlands
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12
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An unusual case of PML in HIV patient presenting with diplopia. Neurol Sci 2018; 40:1081-1082. [PMID: 30515605 DOI: 10.1007/s10072-018-3665-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/28/2018] [Indexed: 01/20/2023]
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