1
|
Liu Y, Deng C. Case Report: Visceral Leishmaniasis Falsely Diagnosed as Viral Hepatitis C Without Febrile Symptoms. Infect Drug Resist 2024; 17:2009-2014. [PMID: 38800583 PMCID: PMC11122169 DOI: 10.2147/idr.s456984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/17/2024] [Indexed: 05/29/2024] Open
Abstract
Background Visceral leishmaniasis (VL), also known as kala-azar, is caused by an intracellular parasite transmitted to humans by the bite of a sand fly, and with the source of the infection mainly being dogs. The main features of the disease are irregular fever, weight loss, hepatosplenomegaly and anaemia. Diagnosis relies mainly on bone marrow aspiration tests to find Leishman-Donovan(LD) bodies. And we report the case without febrile symptoms and hepatitis C virus antibody was probably false positive. Case Presentation The case was a 74-year-old male residing in Yangquan City, Shanxi Province, a VL endemic area. He presented with generalised malaise, hepatosplenomegaly and scarring pigmentation on the skin as a result of scratching. Laboratory tests showed pancytopenia, positive hepatitis C virus antibody (HCV-Ab), positive direct anti-human globulin test (DAT), positive anti-cardiolipin antibody IgG, IgM (+), and increased immunoglobulin IgG. Symptomatic treatments such as hepatoprotection and blood transfusion were given, but the patient's symptoms still persisted and his spleen and liver further enlarged. Further repeat tests were performed and found to be negative for hepatitis C virus antibodies and antigens. The patient was eventually found to be infected with Leishmania protozoa by rk39 rapid diagnostic test and metagenomic next-generation sequencing(mNGS). And the patient quickly relieved after one course of treatment with sodium stibogluconate. Conclusion Patients with VL may cause abnormalities in the immune system, leading to false positives for various antibodies without clear febrile symptoms, resulting in misdiagnosis or delayed diagnosis. It is important to consider VL in cases where there is a significant hepatosplenomegaly with a relevant epidemiological history. If the diagnosis cannot be confirmed through bone marrow aspiration and the patient is not suitable for splenic aspiration, the rk39 test can be used for initial exclusion and further verified through mNGS.
Collapse
Affiliation(s)
- Yuanli Liu
- The First Clinical Medical School, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Chunqing Deng
- Department of Infectious Diseases, The First Hospital, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| |
Collapse
|
2
|
Schillie S, Wester C, Osborne M, Wesolowski L, Ryerson AB. CDC Recommendations for Hepatitis C Screening Among Adults - United States, 2020. MMWR Recomm Rep 2020; 69:1-17. [PMID: 32271723 PMCID: PMC7147910 DOI: 10.15585/mmwr.rr6902a1] [Citation(s) in RCA: 303] [Impact Index Per Article: 75.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Hepatitis C virus (HCV) infection is a major source of morbidity and mortality in the United States. HCV is transmitted primarily through parenteral exposures to infectious blood or body fluids that contain blood, most commonly through injection drug use. No vaccine against hepatitis C exists and no effective pre- or postexposure prophylaxis is available. More than half of persons who become infected with HCV will develop chronic infection. Direct-acting antiviral treatment can result in a virologic cure in most persons with 8-12 weeks of all-oral medication regimens. This report augments (i.e., updates and summarizes) previously published recommendations from CDC regarding testing for HCV infection in the United States (Smith BD, Morgan RL, Beckett GA, et al. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965. MMWR Recomm Rec 2012;61[No. RR-4]). CDC is augmenting previous guidance with two new recommendations: 1) hepatitis C screening at least once in a lifetime for all adults aged ≥18 years, except in settings where the prevalence of HCV infection is <0.1% and 2) hepatitis C screening for all pregnant women during each pregnancy, except in settings where the prevalence of HCV infection is <0.1%. The recommendation for HCV testing that remains unchanged is regardless of age or setting prevalence, all persons with risk factors should be tested for hepatitis C, with periodic testing while risk factors persist. Any person who requests hepatitis C testing should receive it, regardless of disclosure of risk, because many persons might be reluctant to disclose stigmatizing risks.
Collapse
Affiliation(s)
- Sarah Schillie
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Carolyn Wester
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Melissa Osborne
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Laura Wesolowski
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - A. Blythe Ryerson
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| |
Collapse
|
3
|
Sims DB, Kataria R, Rangasamy S, Jorde UP. Seroreversion of positive anti-hepatitis C virus antibodies in left ventricular assist device recipients: Now you see them, now you don't. Artif Organs 2019; 43:791-795. [PMID: 30725485 DOI: 10.1111/aor.13433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/05/2019] [Accepted: 01/28/2019] [Indexed: 01/04/2023]
Abstract
The clinical significance of positive anti-hepatitis C virus (anti-HCV) antibody tests in recipients of left ventricular assist devices remains unclear. In light of emerging evidence suggesting the possibility of persistent low-level HCV infection in patients with positive anti-HCV antibody test but negative HCV ribonucleic acid, it is very important to distinguish the truly false positive HCV antibodies, in recipients of continuous flow left ventricular assist devices, from those suggestive of a prior clinically resolved infection or one where a low-level viremia may have persisted. We conducted a retrospective analysis of left ventricular assist device recipients at our institution. While the total incidence of positive HCV antibody with concomitantly negative HCV ribonucleic acid test (19.2%) was in keeping with the incidences reported in prior cross-sectional studies, we longitudinally followed our patients and observed a 100% seroreversion. Seroreversion, which has not been reported in other studies, occurred either during continued left ventricular assist device support (10 out of 26) or after heart transplant (7 out of 26). Hundred percent seroreversion strongly suggested that the anti-HCV antibodies were truly false positive.
Collapse
Affiliation(s)
- Daniel B Sims
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Rachna Kataria
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Sabarivinoth Rangasamy
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ulrich P Jorde
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| |
Collapse
|
4
|
de Vera ME, Volk ML, Ncube Z, Blais S, Robinson M, Allen N, Evans R, Weissman J, Baron P, Kore A, Bratton C, Garnett G, Hoang T, Wai P, Villicana R. Transplantation of hepatitis C virus (HCV) antibody positive, nucleic acid test negative donor kidneys to HCV negative patients frequently results in seroconversion but not HCV viremia. Am J Transplant 2018; 18:2451-2456. [PMID: 30040178 DOI: 10.1111/ajt.15031] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/06/2018] [Accepted: 07/18/2018] [Indexed: 01/25/2023]
Abstract
Anecdotal reports have suggested that transplantation of hepatitis C virus (HCV) antibody positive (Ab+)/nucleic acid test negative (NAT-) donor kidneys into HCV negative recipients is not associated with HCV transmission. We reviewed our center's outcomes of 32 HCV negative patients who received kidney allografts from 25 donors who were HCV Ab+/NAT-. The mean recipient age was 56.9 ± 12.1 years and the mean donor age was 41.5 ± 14 years, with a median Kidney Donor Profile Index (KDPI) of 68%. Twelve donors (48%) met Public Health Service (PHS) increased risk status. All patients received antithymocyte globulin induction followed by tacrolimus, mycophenolate mofetil, and steroid maintenance immunosuppression. With a mean follow-up posttransplant of 10 ± 2.7 months, 1- and 3- month serum creatinine levels were 1.7 ± 0.8 and 1.3 ± 0.4, respectively, and patient and graft survival rates were 100% and 97%, respectively. Fourteen patients (44%) seroconverted and became HCV Ab+ posttransplant. However, all 32 patients were HCV RNA negative at 1- and 3- months posttransplant, and 27 and 8 patients tested at 6- and 12-months posttransplant, respectively, remain HCV RNA negative. In conclusion, transplantation of HCV Ab+/NAT- kidneys to HCV negative recipients frequently causes HCV Ab seroconversion but not HCV viremia.
Collapse
Affiliation(s)
- Michael E de Vera
- Transplant Institute (Transplant Surgery), Loma Linda University Health, Loma Linda, CA, USA
| | - Michael L Volk
- Transplant Institute (Transplant Hepatology), Loma Linda University Health, Loma Linda, CA, USA
| | - Ziphezinhle Ncube
- Transplant Institute (Transplant Surgery), Loma Linda University Health, Loma Linda, CA, USA
| | - Shawna Blais
- Transplant Institute (Transplant Surgery), Loma Linda University Health, Loma Linda, CA, USA
| | - Melissa Robinson
- Transplant Institute (Transplant Surgery), Loma Linda University Health, Loma Linda, CA, USA
| | - Nancy Allen
- Transplant Institute (Transplant Surgery), Loma Linda University Health, Loma Linda, CA, USA
| | - Ryan Evans
- Transplant Institute (Transplant Surgery), Loma Linda University Health, Loma Linda, CA, USA
| | - Jill Weissman
- School of Pharmacy, Loma Linda University Health, Loma Linda, CA, USA
| | - Pedro Baron
- Transplant Institute (Transplant Surgery), Loma Linda University Health, Loma Linda, CA, USA
| | - Arputharaj Kore
- Transplant Institute (Transplant Surgery), Loma Linda University Health, Loma Linda, CA, USA
| | - Charles Bratton
- Transplant Institute (Transplant Surgery), Loma Linda University Health, Loma Linda, CA, USA
| | - Gwendolyn Garnett
- Transplant Institute (Transplant Surgery), Loma Linda University Health, Loma Linda, CA, USA
| | - Thanh Hoang
- Transplant Institute (Transplant Nephrology), Loma Linda University Health, Loma Linda, CA, USA
| | - Philip Wai
- Transplant Institute (Transplant Surgery), Loma Linda University Health, Loma Linda, CA, USA
| | - Rafael Villicana
- Transplant Institute (Transplant Nephrology), Loma Linda University Health, Loma Linda, CA, USA
| |
Collapse
|
5
|
Kiely P, Hoad VC, Wood EM. False positive viral marker results in blood donors and their unintended consequences. Vox Sang 2018; 113:530-539. [PMID: 29974475 DOI: 10.1111/vox.12675] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/29/2018] [Accepted: 06/06/2018] [Indexed: 12/15/2022]
Abstract
False positive (FP) viral marker results in blood donors continue to pose many challenges. Informing donors of FP results and subsequent deferral can result in stress and anxiety for donors and additional complexity and workload for blood services. Donor management strategies need to balance the requirement to minimise donor anxiety and inconvenience while maintaining sufficiency of supply. Decisions about how and when to inform donors of FP results and determine deferral periods can be difficult as FP results, while often transitory, can take up to several years to resolve. Additional complexities include the interpretation of indeterminate serological confirmatory testing without detectable viral RNA or non-discriminated NAT results with concomitant anti-HBc reactivity - both may be due to FP results, but the former may also represent past infection and the later may represent occult hepatitis B infection. In this review we discuss strategies to minimise indeterminate serological confirmatory results, possible donor deferral policies and the impact on donors when notified of FP results. We also provide some new data from Australia that address the challenge of interpreting non-discriminated NAT results with concomitant anti-HBc reactivity. Ultimately, the challenge is for each blood service to develop appropriate strategies for donor management, taking into account local information and requirements.
Collapse
Affiliation(s)
- Philip Kiely
- Australian Red Cross Blood Service, Melbourne, Victoria, Australia
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Veronica C Hoad
- Australian Red Cross Blood Service, Perth, Western Australia, Australia
| | - Erica M Wood
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
6
|
Minamoto GY, Lee D, Colovai A, Levy D, Vasovic L, Roach KW, Shuter J, Goldstein D, D'Alessandro D, Jorde UP, Muggia VA. False positive hepatitis C antibody test results in left ventricular assist device recipients: increased risk with age and transfusions. J Thorac Dis 2017; 9:205-210. [PMID: 28203425 DOI: 10.21037/jtd.2017.01.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Left ventricular assist devices (LVADs) have been successfully used in patients with heart failure. However, LVADs may trigger immune activation, leading to higher frequencies of autoantibodies. We describe the clinical, epidemiological, and laboratory characteristics of LVAD recipients with false positive hepatitis C (FPHC) serology among 39 consecutive adult LVAD recipients who bridged to heart transplantation from January 2007 to January 2013 at Montefiore Medical Center. FPHC patients were identified as those with post-LVAD positive hepatitis C ELISA antibody tests and negative confirmatory testing with hepatitis C RNA PCR and/or radioimmunoblot assay. Ten (26%) patients previously seronegative for hepatitis C were found to have FPHC after device placement. Of the 39 patients, 32 had HeartMate II devices. The mean age at LVAD placement was 55 years. FPHC correlated with older age at the time of LVAD implantation and with receipt of packed red blood cell transfusions, but not with gender, fresh frozen plasma transfusions, panel reactive antibodies, globulin fraction, rheumatoid factor, or anticardiolipin antibodies. Clinicians should be aware of this increased risk of FPHC in older LVAD patients and those more heavily transfused in order to avoid unnecessary apprehension and possible delay in transplantation. Further studies should be done to evaluate the possible relationship between transfused blood products and immunomodulation.
Collapse
Affiliation(s)
- Grace Y Minamoto
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
| | - Doreen Lee
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
| | - Adriana Colovai
- Department of Surgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dana Levy
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ljiljana Vasovic
- Department of Pathology, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
| | - Keith W Roach
- Department of Medicine, Weill Medical College of Cornell University, New York, NY, USA
| | - Jonathan Shuter
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
| | - Daniel Goldstein
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
| | - David D'Alessandro
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ulrich P Jorde
- Division of Cardiology, Department of Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
| | - Victoria A Muggia
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
7
|
Heinrichs A, Antoine M, Steensels D, Montesinos I, Delforge ML. HCV false positive immunoassays in patients with LVAD: A potential trap! J Clin Virol 2016; 78:44-6. [PMID: 26985592 DOI: 10.1016/j.jcv.2016.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/03/2016] [Accepted: 03/07/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Left ventricular assist devices (LVAD) are a therapeutic choice for patients with advanced heart failure prior cardiac transplantation. Patients with a LVAD implant are frequently monitored for hepatitis C virus (HCV) as a positive result may be an exclusion criterion for transplantation. OBJECTIVES To determine the rate of false positive results with immunoassays for HCV antibodies in a LVAD population. STUDY DESIGN Between June 2011 and January 2015, HCV antibody testing using a chemiluminescent immunoassay (CLIA) (Liaison, Diasorin) was performed for 32 patients prior and post LVAD implantation. A HCV reactive result by CLIA was repeated and further tested by an enzyme linked fluorescent assay (ELFA) (VIDAS, bioMérieux). For patients with a positive HCV CLIA and ELFA test, immunoblot and HCV RNA detection were performed. RESULTS Prior to LVAD implantation, all patients showed a negative HCV serology. After LVAD implantation, 19 patients (59%) had positive results for HCV antibody using CLIA and ELFA technologies. The HCV immunoblot was negative for 17 patients and indeterminate for two patients. For 15 patients, HCV RNA detection was performed and was undetectable. Actually, no HCV infections were observed among those who were tested for HCV RNA. CONCLUSIONS HCV serological tests routinely used in our laboratories are not reliable in patients with cardiac devices. A positive CLIA and/or ELFA reaction in patients with a LVAD should be confirmed by HCV immunoblot and by HCV RNA PCR detection in order to rule out a HCV infection.
Collapse
Affiliation(s)
- Amélie Heinrichs
- Microbiology Department, ULB-Hôpital Erasme, Route de Lennik 808, 1070 Brussels, Belgium.
| | - Martine Antoine
- Cardiac Surgery Department, ULB-Hôpital Erasme, Route de Lennik 808, 1070 Brussels, Belgium
| | - Deborah Steensels
- Microbiology Department, ULB-Hôpital Erasme, Route de Lennik 808, 1070 Brussels, Belgium
| | - Isabel Montesinos
- Microbiology Department, ULB-Hôpital Erasme, Route de Lennik 808, 1070 Brussels, Belgium
| | - Marie-Luce Delforge
- Microbiology Department, ULB-Hôpital Erasme, Route de Lennik 808, 1070 Brussels, Belgium
| |
Collapse
|