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Manuelpillai B, Zendt M, Chang-Rabley E, Ricotta EE. Stuck in pandemic uncertainty: a review of the persistent effects of COVID-19 infection in immune-deficient people. Clin Microbiol Infect 2024; 30:1007-1011. [PMID: 38552795 PMCID: PMC11254561 DOI: 10.1016/j.cmi.2024.03.027] [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: 01/17/2024] [Revised: 03/04/2024] [Accepted: 03/23/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND People who are immune-deficient/disordered (IDP) are underrepresented in COVID-19 studies. Specifically, there is limited research on post-SARS-CoV-2 infection outcomes, including viral persistence and long-term sequelae in these populations. OBJECTIVES This review aimed to examine the published literature on the occurrence of persistent SARS-CoV-2 positivity, relapse, reinfections, variant coinfection, and post-acute sequelae of COVID-19 in IDP. Although the available literature largely centred on those with secondary immunodeficiencies, studies on people with inborn errors of immunity are also included. SOURCES PubMed was searched using medical subject headings terms to identify relevant articles from the last 4 years. Articles on primary and secondary immunodeficiencies were chosen, and a special emphasis was placed on including articles that studied people with inborn errors of immunity. The absence of extensive cohort studies including these individuals has limited most articles in this review to case reports, whereas the articles focusing on secondary immunodeficiencies include larger cohort, case-control, and cross-sectional studies. Articles focusing solely on HIV/AIDS were excluded. CONTENT Scientific literature suggests that IDP of any age are more likely to experience persistent SARS-CoV-2 infections. Although adult IDP exhibits a higher rate of post-acute sequelae of COVID-19, milder COVID-19 infections in children may reduce their risk of experiencing post-acute sequelae of COVID-19. Reinfections and coinfections may occur at a slightly higher rate in IDP than in the general population. IMPLICATIONS Although IDP experience increased viral persistence and inter-host evolution, it is unlikely that enough evidence can be generated at the population-level to support or refute the hypothesis that infections in IDP are significantly more likely to result in variants of concern than infections in the general population. Additional research on the relationship between viral persistence and the rate of long-term sequelae in IDP could inform the understanding of the immune response to SARS-CoV-2 in IDP and the general population.
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Affiliation(s)
- Bevin Manuelpillai
- Rollins School of Public Health, Emory University, Atlanta, GA, USA; Epidemiology and Data Management Unit, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Mackenzie Zendt
- Epidemiology and Data Management Unit, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Emma Chang-Rabley
- Epidemiology and Data Management Unit, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Emily E Ricotta
- Epidemiology and Data Management Unit, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
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Harris CE, Vaidya V, Lan Z, Klompas M, Rhee C, Baden LR, Baker MA. SARS-CoV-2 Polymerase Chain Reaction Cycle Threshold Trends in Patients Who Are Immunocompromised and Implications for Isolation Precautions. Open Forum Infect Dis 2024; 11:ofae367. [PMID: 39077053 PMCID: PMC11285146 DOI: 10.1093/ofid/ofae367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/26/2024] [Indexed: 07/31/2024] Open
Abstract
Among 495 patients who were immunocompromised and tested positive for SARS-CoV-2, polymerase chain reaction cycle thresholds remained <33 beyond 20 days more frequently in patients with hematologic malignancies, particularly those receiving B-cell-depleting or Bruton tyrosine kinase inhibitor therapy, as compared with those with solid organ malignancy (26% vs 5%).
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Affiliation(s)
- Courtney E Harris
- Division of Infectious Disease, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Vineeta Vaidya
- Infection Control Department, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Zhou Lan
- Center for Clinical Investigation, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Klompas
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Chanu Rhee
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lindsey R Baden
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Meghan A Baker
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Rodríguez-Sabogal IA, Cabrera R, Marin D, Lopez L, Aguilar Y, Gomez G, Peña-Valencia K, Riaño W, Vélez L, Keynan Y, Rueda ZV. Does the Recovery of Respiratory Viruses Impact Pulmonary Function at Baseline and 1-, 6-, and 12-Month Follow-Up in People Living with HIV and Pneumonia? Viruses 2024; 16:344. [PMID: 38543710 PMCID: PMC10974101 DOI: 10.3390/v16030344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/10/2024] [Accepted: 02/21/2024] [Indexed: 05/23/2024] Open
Abstract
The frequency of respiratory viruses in people living with HIV (PLHIV) and their impact on lung function remain unclear. We aimed to determine the frequency of respiratory viruses in bronchoalveolar lavage and induced sputum samples in PLHIV and correlate their presence with lung function. A prospective cohort of adults hospitalized in Medellín between September 2016 and December 2018 included three groups: group 1 = people diagnosed with HIV and a diagnosis of community-acquired pneumonia (CAP), group 2 = HIV, and group 3 = CAP. People were followed up with at months 1, 6, and 12. Clinical, microbiological, and spirometric data were collected. Respiratory viruses were detected by multiplex RT-PCR. Sixty-five patients were included. At least 1 respiratory virus was identified in 51.9%, 45.1%, and 57.1% of groups 1, 2 and 3, respectively. Among these, 89% of respiratory viruses were detected with another pathogen, mainly Mycobacterium tuberculosis (40.7%) and Pneumocystis jirovecii (22.2%). The most frequent respiratory virus was rhinovirus (24/65, 37%). On admission, 30.4% of group 1, 16.6% of group 2, and 50% of group 3 had airflow limitation, with alteration in forced expiratory volume at first second in both groups with pneumonia compared to HIV. Respiratory viruses are frequent in people diagnosed with HIV, generally coexisting with other pathogens. Pulmonary function on admission was affected in patients with pneumonia, improving significantly in the 1st, 6th, and 12th months after CAP onset.
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Affiliation(s)
- Iván Arturo Rodríguez-Sabogal
- School of Medicine, Universidad de Antioquia, Medellin 050010, Colombia; (I.A.R.-S.); (W.R.); (L.V.)
- Infectious Diseases Section, Hospital Universitario San Vicente Fundación, Medellin 050010, Colombia
| | - Ruth Cabrera
- Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin 050031, Colombia; (R.C.); (D.M.); (L.L.); (Y.A.)
- Grupo Biología de Sistemas, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin 050031, Colombia
| | - Diana Marin
- Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin 050031, Colombia; (R.C.); (D.M.); (L.L.); (Y.A.)
- Grupo de Investigación en Salud Pública, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin 050031, Colombia;
| | - Lucelly Lopez
- Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin 050031, Colombia; (R.C.); (D.M.); (L.L.); (Y.A.)
- Grupo de Investigación en Salud Pública, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin 050031, Colombia;
| | - Yudy Aguilar
- Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin 050031, Colombia; (R.C.); (D.M.); (L.L.); (Y.A.)
- Grupo Investigador de Problemas en Enfermedades Infecciosas—GRIPE, Facultad de Medicina, Universidad de Antioquia, Medellin 050010, Colombia
| | - Gustavo Gomez
- Pulmonologist Section, Hospital Universitario San Vicente Fundacion, Medellin 050010, Colombia;
| | - Katherine Peña-Valencia
- Grupo de Investigación en Salud Pública, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin 050031, Colombia;
- Escuela de Microbiología, Universidad de Antioquia, Medellín 050010, Colombia
- Grupo Bacterias & Cancer, School of Medicine, Universidad de Antioquia, Medellin 050010, Colombia
| | - Will Riaño
- School of Medicine, Universidad de Antioquia, Medellin 050010, Colombia; (I.A.R.-S.); (W.R.); (L.V.)
- Grupo de Investigación en Salud Pública, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin 050031, Colombia;
| | - Lázaro Vélez
- School of Medicine, Universidad de Antioquia, Medellin 050010, Colombia; (I.A.R.-S.); (W.R.); (L.V.)
- Infectious Diseases Section, Hospital Universitario San Vicente Fundación, Medellin 050010, Colombia
- Grupo Investigador de Problemas en Enfermedades Infecciosas—GRIPE, Facultad de Medicina, Universidad de Antioquia, Medellin 050010, Colombia
| | - Yoav Keynan
- Department of Medical Microbiology and Infectious Disease, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
| | - Zulma Vanessa Rueda
- Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin 050031, Colombia; (R.C.); (D.M.); (L.L.); (Y.A.)
- Grupo de Investigación en Salud Pública, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin 050031, Colombia;
- Department of Medical Microbiology and Infectious Disease, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
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Tiew HW, Tan JWP, Teo CHY. Delayed organising pneumonia in an immunocompromised host after a mild COVID-19 infection. BMJ Case Rep 2023; 16:16/5/e254737. [PMID: 37192779 DOI: 10.1136/bcr-2023-254737] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
Organising pneumonia after a mild COVID-19 infection has been increasingly reported and poses a diagnostic challenge to physicians especially in immunocompromised patients. We report a patient with a background of lymphoma in remission on rituximab who presented with prolonged and persistent fever after recovering from a mild COVID-19 infection. The initial workup showed bilateral lower zone lung consolidation; however, the infective and autoimmune workup were unremarkable. Subsequently, a bronchoscopy with transbronchial lung biopsy confirmed the diagnosis of organising pneumonia. A tapering glucocorticoid regimen was commenced with prompt resolution of the patient's clinical symptoms, and subsequent resolution of biochemical markers and radiological lung changes 3 months later. This case highlights the importance of early recognition of the diagnosis of organising pneumonia in immunocompromised populations after a mild COVID-19 infection as it shows promising response to glucocorticoid therapy.
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Affiliation(s)
- Han Wei Tiew
- General Medicine, Tan Tock Seng Hospital, Singapore, Singapore
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Ambadapoodi RS, Arnold FW, Chariker JH, Glynn A, Lauer W, Marimuthu S, Rouchka EC, Smith ML, Wolf LA. Persistent SARS-CoV-2 Infection in a Multiple Sclerosis Patient on Ocrelizumab: A Case Report. RESEARCH SQUARE 2023:rs.3.rs-2768759. [PMID: 37066424 PMCID: PMC10104259 DOI: 10.21203/rs.3.rs-2768759/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
A 44-year-old female patient with multiple sclerosis (MS) treated with ocrelizumab was hospitalized with SARS-CoV-2 pneumonia three times over the course of five months, eventually expiring. Viral sequencing of samples from her first and last admissions suggests a single persistent SARS-CoV-2 infection. We hypothesize that her immunocompromised state, due to MS treatment with an immunosuppressive monoclonal antibody, prevented her from achieving viral clearance.
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Affiliation(s)
| | - Forest W. Arnold
- Division of Infectious Diseases, School of Medicine, University of Louisville, Louisville, KY
| | - Julia H. Chariker
- Neuroscience Training Department, University of Louisville, Louisville, KY
| | - Alex Glynn
- Division of Infectious Diseases, School of Medicine, University of Louisville, Louisville, KY
| | - William Lauer
- Department of Biochemistry and Molecular Genetics, University of Louisville, Louisville, KY
| | - Subathra Marimuthu
- Division of Infectious Diseases, School of Medicine, University of Louisville, Louisville, KY
| | - Eric C. Rouchka
- Department of Biochemistry and Molecular Genetics, University of Louisville, Louisville, KY
| | - Melissa L. Smith
- Department of Biochemistry and Molecular Genetics, University of Louisville, Louisville, KY
| | - Leslie A. Wolf
- Division of Infectious Diseases, School of Medicine, University of Louisville, Louisville, KY
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A Case of a Malignant Lymphoma Patient Persistently Infected with SARS-CoV-2 for More than 6 Months. Medicina (B Aires) 2023; 59:medicina59010108. [PMID: 36676732 PMCID: PMC9864643 DOI: 10.3390/medicina59010108] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/25/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by severe acute respiratory syndrome 2 (SARS-CoV-2). There are many unknowns regarding the handling of long-term SARS-CoV-2 infections in immunocompromised patients. Here, we describe the lethal disease course in a SARS-CoV-2-infected patient during Bruton's tyrosine kinase inhibitor therapy. We performed whole-genome analysis using samples obtained during the course of the disease in a 63-year-old woman who was diagnosed with intraocular malignant lymphoma of the right eye in 2012. She had received treatment since the diagnosis. An autologous transplant was performed in 2020, but she experienced a worsening of the primary disease 26 days before she was diagnosed with a positive SARS-CoV-2 RT-PCR. Tirabrutinib was administered for the primary disease. A cluster of COVID-19 infections occurred in the hematological ward while the patient was hospitalized, and she became infected on day 0. During the course of the disease, she experienced repeated remission exacerbations of COVID-19 pneumonia and eventually died on day 204. SARS-CoV-2 whole-viral sequencing revealed that the patient shed the virus long-term. Viral infectivity studies confirmed infectious virus on day 189, suggesting that the patient might be still infectious. This case report describes the duration and viral genetic evaluation of a patient with malignant lymphoma who developed SARS-CoV-2 infection during Bruton's tyrosine kinase inhibitor therapy and in whom the infection persisted for over 6 months.
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7
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Kronbichler A, Anders HJ. mRNA COVID-19 Vaccines and Their Risk to Induce a Relapse of Glomerular Diseases. J Am Soc Nephrol 2022; 33:2128-2131. [PMID: 36332972 PMCID: PMC9731639 DOI: 10.1681/asn.2022091078] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Hans-Joachim Anders
- Renal Division, Department of Medicine IV, Hospital of the Ludwig Maximilian University, Munich, Germany
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8
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Berger B, Hazzan M, Kamar N, Francois H, Matignon M, Greze C, Gatault P, Frimat L, Westeel PF, Goutaudier V, Snanoudj R, Colosio C, Sicard A, Bertrand D, Mousson C, Bamoulid J, Thierry A, Anglicheau D, Couzi L, Chemouny JM, Duveau A, Moal V, Le Meur Y, Blancho G, Tourret J, Malvezzi P, Mariat C, Rerolle JP, Bouvier N, Caillard S, Thaunat O. Absence of Mortality Differences Between the First and Second COVID-19 Waves in Kidney Transplant Recipients. Kidney Int Rep 2022; 7:2617-2629. [PMID: 36159445 PMCID: PMC9489985 DOI: 10.1016/j.ekir.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/05/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction SARS-CoV-2 pandemic evolved in 2 consecutive waves during 2020. Improvements in the management of COVID-19 led to a reduction in mortality rates among hospitalized patients during the second wave. Whether this progress benefited kidney transplant recipients (KTRs), a population particularly vulnerable to severe COVID-19, remained unclear. Methods In France, 957 KTRs were hospitalized for COVID-19 in 2020 and their data were prospectively collected into the French Solid Organ Transplant (SOT) COVID registry. The presentation, management, and outcomes of the 359 KTRs diagnosed during the first wave were compared to those of the 598 of the second wave. Results Baseline comorbidities were similar between KTRs of the 2 waves. Maintenance immunosuppression was reduced in most patients but withdrawal of antimetabolite (73.7% vs. 58.4%, P < 0.001) or calcineurin inhibitor (32.1% vs. 16.6%, P < 0.001) was less frequent during the second wave. Hydroxychloroquine and azithromycin that were commonly used during the first wave (21.7% and 30.9%, respectively) but were almost abandoned during the second wave. In contrast, the use of high dose corticosteroids doubled (19.5% vs. 41.6%, P < 0.001). Despite these changing trends in COVID-19 management, 60-day mortality was not statistically different between the 2 waves (25.3% vs. 23.9%; Log Rank, P = 0.48) and COVID-19 hospitalization period was not associated with death due to COVID-19 in multivariate analysis (Hazard ratio 0.89, 95% confidence interval 0.67-1.17, P = 0.4). Conclusion We conclude that changing of therapeutic trends during 2020 did not reduce COVID-19 related mortality among KTRs. Our data indirectly support the importance of vaccination and neutralizing monoclonal anti-SARS-CoV-2 antibodies to protect KTRS from severe COVID-19.
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Affiliation(s)
- Bastien Berger
- Department of Transplantation, Nephrology and Clinical Immunology, Edouard Herriot Hospital, Hospices civils de Lyon, Lyon, France
| | - Marc Hazzan
- Department of Nephrology and Transplantation, University of Lille, Lille, France
| | - Nassim Kamar
- Department of Nephrology and Transplantation, University of Toulouse, Toulouse, France
| | - Hélène Francois
- Department of Nephrology and Renal Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - Marie Matignon
- Department of Nephrology and Renal Transplantation, Assistance Publique-Hôpitaux de Paris, Institut Francilien de Recherche en Néphrologie et Transplantation IFRNT, Groupe Hospitalier Henri-Mondor/Albert-Chenevier, Université Paris-Est-Créteil, Département Hospitalo-Universitaire, Virus-Immunité-Cancer, Institut Mondor de Recherche Biomédicale, Equipe 21, INSERM U 955, Créteil, France
| | - Clarisse Greze
- Department of Nephrology and Transplantation, Hôpital Bichat, Paris, France
| | - Philippe Gatault
- Department of Nephrology and Transplantation, University of Tours, Tours, France
| | - Luc Frimat
- Department of Nephrology, University of Lorraine, CHRU-Nancy, Vandoeuvre, France, INSERM CIC-EC CIE6, Nancy, France
| | - Pierre F. Westeel
- Department of Nephrology and Transplantation, University of Amiens, Amiens, France
| | - Valentin Goutaudier
- Department of Nephrology and Transplantation, University of Montpellier, Montpellier, France
| | - Renaud Snanoudj
- Nephrology and Renal Transplantation Department, Hôpital Foch, Paris, France
| | - Charlotte Colosio
- Department of Nephrology and Transplantation, University of Reims, Reims, France
| | - Antoine Sicard
- Service de Néphrologie-Dialyse-Transplantation, Hôpital Pasteur 2, CHU de Nice, Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
| | - Dominique Bertrand
- Department of Nephrology and Transplantation, University of Rouen, Rouen, France
| | - Christiane Mousson
- Department of Nephrology and Transplantation, University of Dijon, Dijon, France
| | - Jamal Bamoulid
- Department of Nephrology, University of Besançon, Besançon, France
| | - Antoine Thierry
- Department of Nephrology and Transplantation, University of Poitiers, Poitiers, France
| | - Dany Anglicheau
- Service de Néphrologie et Transplantation Adultes, Hôpital Universitaire Necker- APHP Centre-Université de Paris INEM INSERM U 1151 - CNRS UMR 8253, Paris, France
| | - Lionel Couzi
- Service de Néphrologie-Transplantation-Dialyse-Aphérèse, Hôpital Pellegrin, CHU de Bordeaux Pellegrin, Unité Mixte de Recherche “ImmunoConcEpT” 5164 - Université de Bordeaux, Bordeaux, France
| | - Jonathan M. Chemouny
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, CIC-P 1414, Rennes, France
| | - Agnes Duveau
- Department of Nephrology and Transplantation, University of Angers, Angers, France
| | - Valerie Moal
- Centre de Néphrologie et Transplantation Rénale, Aix Marseille Université, Hôpitaux Universitaires de Marseille, Hôpital Conception, Marseille, France
| | - Yannick Le Meur
- Department of Nephrology, CHU de Brest, UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, Labex IGO, Brest, France
| | - Gilles Blancho
- Department of Nephrology and Transplantation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jérôme Tourret
- Nephrology and Renal Transplantation Department, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié Salpétrière, Paris, France
| | - Paolo Malvezzi
- Department of Nephrology, University of Grenoble, Grenoble, France
| | - Christophe Mariat
- Department of Nephrology and Transplantation, University of St Etienne, St Etienne, France
| | - Jean-Philippe Rerolle
- Department of Nephrology and Transplantation, University of Limoges, Limoges, France
| | - Nicolas Bouvier
- Department of Nephrology and Transplantation, University of Caen, Caen, France
| | - Sophie Caillard
- Department of Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France
- INSERM, IRM UMR-S 1109, University of Strasbourg, Strasbourg, France
| | - Olivier Thaunat
- Department of Transplantation, Nephrology and Clinical Immunology, Edouard Herriot Hospital, Hospices civils de Lyon, Lyon, France
- CIRI, INSERM U1111, University Claude Bernard Lyon I, Lyon, France
- Claude Bernard University (Lyon 1), Villeurbanne, France
| | - the French Solid Organ Transplant (SOT) COVID Registry34
- Department of Transplantation, Nephrology and Clinical Immunology, Edouard Herriot Hospital, Hospices civils de Lyon, Lyon, France
- Department of Nephrology and Transplantation, University of Lille, Lille, France
- Department of Nephrology and Transplantation, University of Toulouse, Toulouse, France
- Department of Nephrology and Renal Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
- Department of Nephrology and Renal Transplantation, Assistance Publique-Hôpitaux de Paris, Institut Francilien de Recherche en Néphrologie et Transplantation IFRNT, Groupe Hospitalier Henri-Mondor/Albert-Chenevier, Université Paris-Est-Créteil, Département Hospitalo-Universitaire, Virus-Immunité-Cancer, Institut Mondor de Recherche Biomédicale, Equipe 21, INSERM U 955, Créteil, France
- Department of Nephrology and Transplantation, Hôpital Bichat, Paris, France
- Department of Nephrology and Transplantation, University of Tours, Tours, France
- Department of Nephrology, University of Lorraine, CHRU-Nancy, Vandoeuvre, France, INSERM CIC-EC CIE6, Nancy, France
- Department of Nephrology and Transplantation, University of Amiens, Amiens, France
- Department of Nephrology and Transplantation, University of Montpellier, Montpellier, France
- Nephrology and Renal Transplantation Department, Hôpital Foch, Paris, France
- Department of Nephrology and Transplantation, University of Reims, Reims, France
- Service de Néphrologie-Dialyse-Transplantation, Hôpital Pasteur 2, CHU de Nice, Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
- Department of Nephrology and Transplantation, University of Rouen, Rouen, France
- Department of Nephrology and Transplantation, University of Dijon, Dijon, France
- Department of Nephrology, University of Besançon, Besançon, France
- Department of Nephrology and Transplantation, University of Poitiers, Poitiers, France
- Service de Néphrologie et Transplantation Adultes, Hôpital Universitaire Necker- APHP Centre-Université de Paris INEM INSERM U 1151 - CNRS UMR 8253, Paris, France
- Service de Néphrologie-Transplantation-Dialyse-Aphérèse, Hôpital Pellegrin, CHU de Bordeaux Pellegrin, Unité Mixte de Recherche “ImmunoConcEpT” 5164 - Université de Bordeaux, Bordeaux, France
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, CIC-P 1414, Rennes, France
- Department of Nephrology and Transplantation, University of Angers, Angers, France
- Centre de Néphrologie et Transplantation Rénale, Aix Marseille Université, Hôpitaux Universitaires de Marseille, Hôpital Conception, Marseille, France
- Department of Nephrology, CHU de Brest, UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, Labex IGO, Brest, France
- Department of Nephrology and Transplantation, Centre Hospitalier Universitaire de Nantes, Nantes, France
- Nephrology and Renal Transplantation Department, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié Salpétrière, Paris, France
- Department of Nephrology, University of Grenoble, Grenoble, France
- Department of Nephrology and Transplantation, University of St Etienne, St Etienne, France
- Department of Nephrology and Transplantation, University of Limoges, Limoges, France
- Department of Nephrology and Transplantation, University of Caen, Caen, France
- Department of Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France
- INSERM, IRM UMR-S 1109, University of Strasbourg, Strasbourg, France
- CIRI, INSERM U1111, University Claude Bernard Lyon I, Lyon, France
- Claude Bernard University (Lyon 1), Villeurbanne, France
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Veličković J, Vukičević TA, Spurnić AR, Lazić I, Popović B, Bogdanović I, Raičević S, Marić D, Berisavac I. Case report: Nocardial brain abscess in a persistently SARS-CoV-2 PCR positive patient with systemic lupus erythematosus. Front Med (Lausanne) 2022; 9:973817. [PMID: 36059827 PMCID: PMC9434960 DOI: 10.3389/fmed.2022.973817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/01/2022] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease (COVID-19) in immunocompromised patients represents a major challenge for diagnostics, surveillance, and treatment. Some individuals remain SARS-CoV-2 PCR-positive for a prolonged period. The clinical and epidemiological significance of this phenomenon is not well understood. We report a case of a patient with a history of systemic lupus erythematosus (SLE) who has been persistently SARS-CoV-2 PCR positive for 9 months, with multiple thromboembolic complications, and development of nocardial brain abscess successfully treated with surgery and antibiotics.
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Affiliation(s)
- Jelena Veličković
- COVID Hospital Batajnica, University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana Adžić Vukičević
- COVID Hospital Batajnica, University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Radovanović Spurnić
- COVID Hospital Batajnica, University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Igor Lazić
- Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Bojana Popović
- COVID Hospital Batajnica, University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan Bogdanović
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Savo Raičević
- Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Dragana Marić
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Pulmonology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ivana Berisavac
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Neurology, University Clinical Center of Serbia, Belgrade, Serbia
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10
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Considerations regarding Interpretation of Positive SARS-CoV-2 Molecular Results with Late Cycle Threshold Values. J Clin Microbiol 2022; 60:e0050122. [PMID: 35658526 PMCID: PMC9491168 DOI: 10.1128/jcm.00501-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
COVID-19 disease lies on a spectrum, ranging from completely asymptomatic to mild disease to severe and critical disease. Studies have shown that prolonged shedding or sporadic detection of SARS-CoV-2 RNA can occur long after symptom resolution. Adding to these clinical complexities is the demand for testing for SARS-CoV-2 at all stages of diseases, frequently driven by screening of asymptomatic persons, something that traditionally has not been performed for other viral respiratory diseases. This can lead to positive results from nucleic acid amplification tests (NAATs), such as RT-PCR, with late cycle threshold (CT) values near the test’s limit of detection. In this commentary, we review unique attributes of COVID-19 and causes of NAAT late CT values. We provide interpretation considerations as well as strategies to aid in test interpretation.
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11
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Roberts SC, Palacios CF, Grubaugh ND, Alpert T, Ott IM, Breban MI, Martinello RA, Smith C, Davis MW, Mcmanus D, Tirmizi S, Topal JE, Azar MM, Malinis M. An outbreak of SARS-CoV-2 on a transplant unit in the early vaccination era. Transpl Infect Dis 2021; 24:e13782. [PMID: 34969164 DOI: 10.1111/tid.13782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 11/29/2022]
Abstract
Solid organ transplant recipients are at increased risk of COVID-19 associated morbidity and mortality. We describe the first nosocomial outbreak investigation on an immunocompromised inpatient unit aided by SARS-CoV-2 whole genome sequencing. Two patients were identified as potential index cases; one presented with diarrhea and the other tested positive on hospital day 18 after developing hypoxemia and subsequently testing positive for SARS-CoV-2. Following identification of the SARS-CoV-2 cluster, the unit was closed to new admissions, and the remaining patients and staff members underwent surveillance SARS-CoV-2 testing. Four additional patients and four staff members tested positive for SARS-CoV-2. Asymptomatic patients with COVID-19 were treated with bamlanivimab and all were alive at discharge. The unit was then re-opened with no additional positives reported since the initial outbreak. Preventing SARS-CoV-2 outbreaks in transplant units poses unique challenges as patients may have atypical presentations of COVID-19. Immunocompromised patients who test positive for SARS-CoV-2 while asymptomatic may benefit from monoclonal antibody therapy to prevent disease progression. All hospital staff members working with immunocompromised patients should be promptly encouraged to receive SARS-CoV-2 vaccination. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Scott C Roberts
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine.,Department of Infection Prevention, Yale New Haven Health
| | - Carlo Foppiano Palacios
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine
| | - Nathan D Grubaugh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health
| | - Tara Alpert
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health
| | - Isabel M Ott
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health
| | - Mallery I Breban
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health
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- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine
| | - Richard A Martinello
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine.,Department of Infection Prevention, Yale New Haven Health.,Department of Pediatrics, Yale School of Medicine
| | - Cindy Smith
- Department of Infection Prevention, Yale New Haven Health
| | | | - Dayna Mcmanus
- Department of Pharmacy Services, Yale New Haven Hospital
| | - Samad Tirmizi
- Department of Pharmacy Services, Yale New Haven Hospital
| | - Jeffrey E Topal
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health
| | - Marwan M Azar
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine
| | - Maricar Malinis
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine
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12
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Dolan SA, Mulcahy Levy J, Moss A, Pearce K, Butler M, Jung S, Dominguez SR, Mwangi E, Maloney K, Rao S. SARS-CoV-2 persistence in immunocompromised children. Pediatr Blood Cancer 2021; 68:e29277. [PMID: 34453477 PMCID: PMC8661864 DOI: 10.1002/pbc.29277] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES We evaluated the length of time immunocompromised children (ICC) remain positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), identified factors associated with viral persistence, and determined cycle threshold (CT ) values of children with viral persistence as a surrogate of viral load. METHODS We conducted a retrospective cohort study of ICC at a pediatric hospital from March 2020 to March 2021. Immunocompromised status was defined as primary, secondary, or acquired due to medical comorbidities/immunosuppressive treatment. The primary outcome was time to first of two consecutive negative SARS-CoV-2 polymerase chain reaction (PCR) tests at least 24 hours apart. Testing of sequential clinical specimens from the same subject was conducted using the Centers for Disease Control (CDC) 2019-nCoV real-time reverse transcriptase (RT)-PCR Diagnostic Panel assay. Descriptive statistics, Kaplan-Meier curve median event times and log-rank tests were used to compare outcomes between groups. RESULTS Ninety-one children met inclusion criteria. Median age was 15.5 years (interquartile range [IQR] 8-18), 64% were male, 58% were White, and 43% were Hispanic/Latinx. Most (67%) were tested in outpatient settings and 58% were asymptomatic. The median time to two negative tests was 42 days (IQR 25.0-55.0), with no differences in median time by illness presentation or level of immunosuppression. Seven children had more than one sample available for repeat testing, and five of seven (71%) children had initial CT values of <30 (moderate to high viral load); four children had CT values of <30, 3-4 weeks later, suggesting persistent moderate to high viral loads. CONCLUSIONS Most ICC with SARS-CoV-2 infection had mild disease, with prolonged viral persistence >6 weeks and moderate to high viral load.
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Affiliation(s)
- Susan A. Dolan
- Department of EpidemiologyChildren's Hospital ColoradoAuroraColoradoUSA
| | - Jean Mulcahy Levy
- Department of Pediatrics (Center for Cancer and Blood Disorders)University of Colorado School of Medicine and Children's Hospital ColoradoAuroraColoradoUSA,Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital ColoradoAuroraColoradoUSA,Department of PharmacologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Angela Moss
- Children's Hospital Colorado and Adult and Child Center for Health Outcomes Research and Delivery ScienceUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Kelly Pearce
- Department of EpidemiologyChildren's Hospital ColoradoAuroraColoradoUSA
| | - Molly Butler
- Department of Pathology and Laboratory MedicineChildren's Hospital ColoradoAuroraColoradoUSA
| | - Sarah Jung
- Department of Pathology and Laboratory MedicineChildren's Hospital ColoradoAuroraColoradoUSA
| | - Samuel R. Dominguez
- Department of Pediatrics (Infectious Diseases), University of Colorado School of Medicine and Children's Hospital ColoradoAuroraColoradoUSA
| | - Eric Mwangi
- Department of Pathology and Laboratory MedicineChildren's Hospital ColoradoAuroraColoradoUSA
| | - Kelly Maloney
- Department of Pediatrics (Center for Cancer and Blood Disorders)University of Colorado School of Medicine and Children's Hospital ColoradoAuroraColoradoUSA
| | - Suchitra Rao
- Department of Pediatrics (Infectious Diseases and Hospital Medicine and Epidemiology)University of Colorado School of Medicine and Children's Hospital ColoradoAuroraColoradoUSA
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13
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Dęborska-Materkowska D, Kamińska D. The Immunology of SARS-CoV-2 Infection and Vaccines in Solid Organ Transplant Recipients. Viruses 2021; 13:1879. [PMID: 34578460 PMCID: PMC8473113 DOI: 10.3390/v13091879] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 12/12/2022] Open
Abstract
Since its outbreak in December 2019, the coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), led to an enormous rise in scientific response with an excess of COVID-19-related studies on the pathogenesis and potential therapeutic approaches. Solid organ transplant (SOT) recipients are a heterogeneous population with long-lasting immunosuppression as a joining element. Immunocompromised patients are a vulnerable population with a high risk of severe infections and an increased infection-related mortality rate. It was postulated that the hyperinflammatory state due to cytokine release syndrome during severe COVID-19 could be alleviated by immunosuppressive therapy in SOT patients. On the other hand, it was previously established that T cell-mediated immunity, which is significantly weakened in SOT recipients, is the main component of antiviral immune responses. In this paper, we present the current state of science on COVID-19 immunology in relation to solid organ transplantation with prospective therapeutic and vaccination strategies in this population.
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Affiliation(s)
- Dominika Dęborska-Materkowska
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Nowogrodzka 59, 02-006 Warsaw, Poland;
| | - Dorota Kamińska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
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