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Filardo TD, Crooke SN, Bankamp B, Raines K, Mathis AD, Lanzieri TM, Beard RS, Perelygina L, Sugerman DE, Rota PA. Measles and Rubella Diagnostic and Classification Challenges in Near- and Post-Elimination Countries. Vaccines (Basel) 2024; 12:697. [PMID: 38932426 PMCID: PMC11209053 DOI: 10.3390/vaccines12060697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Measles and rubella are vaccine-preventable viral diseases and can be prevented by safe, highly effective vaccination with measles- and rubella-containing vaccines. Given the myriad causes of febrile exanthems, laboratory surveillance for both measles and rubella is important to document the incidence of these diseases and to track the progress and maintenance of elimination in near- and post-elimination settings. Diagnostic challenges can hinder effective surveillance and classification challenges can hinder efforts to demonstrate achievement or maintenance of elimination. In this report, we review diagnostic and classification challenges for measles and rubella in near- and post-elimination settings.
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Affiliation(s)
- Thomas D. Filardo
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (S.N.C.); (B.B.); (K.R.); (A.D.M.); (T.M.L.); (R.S.B.); (L.P.); (D.E.S.); (P.A.R.)
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Landry ML, Hassan S, Rottmann BG, Pesak SJ, Ordazzo M, Skrzyniarz M, Deponte S, Peaper DR. Performance of two modified two-tier algorithms for the serologic diagnosis of Lyme disease. J Clin Microbiol 2024; 62:e0013924. [PMID: 38597655 PMCID: PMC11077974 DOI: 10.1128/jcm.00139-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/15/2024] [Indexed: 04/11/2024] Open
Abstract
We compared the performance of a new modified two-tier testing (MTTT) platform, the Diasorin Liaison chemiluminescent immunoassay (CLIA), to the Zeus enzyme-linked immunoassay (ELISA) MTTT and to Zeus ELISA/Viramed immunoblot standard two-tier testing (STTT) algorithm. Of 537 samples included in this study, 91 (16.9%) were positive or equivocal by one or more screening tests. Among these 91 samples, only 57 samples were concordant positive by first-tier screening tests, and only 19 of 57 were concordant by the three second-tier methods. For IgM results, positive percent agreement (PPA) was 68.1% for Diasorin versus 89.4% for Zeus compared to immunoblot. By contrast, the PPA for IgG for both Diasorin and Zeus was 100%. Using a 2-out-of-3 consensus reference standard, the PPAs for IgM were 75.6%, 97.8%, and 95.6% for Diasorin, Zeus, and immunoblot, respectively. The difference between Zeus MTTT and Diasorin MTTT for IgM detection was significant (P = 0.0094). PPA for both Diasorin and Zeus MTTT IgG assays was 100% but only 65.9% for immunoblot STTT (P = 0.0005). In total, second-tier positive IgM and/or IgG results were reported for 57 samples by Diasorin MTTT, 63 by Zeus MTTT, and 54 by Viramed STTT. While Diasorin CLIA MTTT had a much more rapid, automated, and efficient workflow, Diasorin MTTT was less sensitive for the detection of IgM than Zeus MTTT and STTT including in 5 early Lyme cases that were IgM negative but IgG positive. IMPORTANCE The laboratory diagnosis of Lyme disease relies upon the detection of antibodies to Borrelia species. Standard two tier testing (STTT) methods rely upon immunoblots which have clinical and technical limitations. Modified two-tier testing (MTTT) methods have recently become available and are being widely adopted. There are limited independent data available assessing the performance of MTTT and STTT methods.
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Affiliation(s)
- Marie L. Landry
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sajjad Hassan
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Bruce G. Rottmann
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | | | | | - David R. Peaper
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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Zhao HD, Qian HB, Wang ZK, Ren RK, Yu TB, Liu HL. Patient with suspected co-infection of hemorrhagic fever with renal syndrome and malaria: a case report. Front Med (Lausanne) 2024; 11:1341015. [PMID: 38751985 PMCID: PMC11094318 DOI: 10.3389/fmed.2024.1341015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/10/2024] [Indexed: 05/18/2024] Open
Abstract
Background Hemorrhagic fever with renal syndrome (HFRS) is a natural epidemic disease that can be caused by the Hantaan virus (HTNV). Malaria is caused by plasmodium and can be transmitted by a mosquito bite. The similar manifestations shared by these disorders pose a challenge for clinicians in differential diagnosis, in particular, coupled with a false-positive serological test. Case presentation A 46-year-old man was admitted for fever and chills for over 10 days and was suspected of being co-infected with HFRS and malaria due to a history of travel to malaria-endemic areas and a positive HTNV-immunoglobulin M (IgM) test. Although leukocytosis, thrombocytopenia, renal injury, lymphocytosis, overexpression of interleukin-6, and procalcitonin were observed during the hospitalization, the hypotensive, oliguria, and polyuria phases of the HFRS course were not observed. Instead, typical symptoms of malaria were found, including a progressive decrease in erythrocytes and hemoglobin levels with signs of anemia. Furthermore, because the patient had no history of exposure to HFRS endemic areas, exposure to an HTNV-infected rodent, or a positive HTNV-IgG test, and false serological tests of IgM can be caused by various factors, the HFRS coinfection with malaria was ruled out. Conclusion Misdiagnosis can be easily induced by a false serological test, in particular the IgM test which can be influenced by various factors. A combination of health history, epidemiology, physical examination, precise application of specific examinations involving tests of conventional laboratory parameters as well as well-accepted methods such as the immunochromatographic (ICG) test, real-time reverse transcription-polymerase chain reaction (PCR), and Western blot (WB), and acquaintance with disorders with similar manifestations will contribute to the precise diagnosis in clinical treatment.
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Affiliation(s)
- Han-Dong Zhao
- Central Laboratory of Virology, Shaanxi Provincial Hospital of Infectious Diseases, The Eighth Hospital Affiliated to Medical College of Xi’an Jiaotong University, Xi’an, China
- Clinical Laboratory Center, Shaanxi Provincial Hospital of Infectious Diseases, The Eighth Hospital Affiliated to Medical College of Xi’an Jiaotong University, Xi’an, China
| | - Hong-Bo Qian
- Clinical Laboratory Center, Shaanxi Provincial Hospital of Infectious Diseases, The Eighth Hospital Affiliated to Medical College of Xi’an Jiaotong University, Xi’an, China
| | - Ze-Kun Wang
- Department of Radiology, Shaanxi Provincial Hospital of Infectious Diseases, The Eighth Hospital Affiliated to Medical College of Xi’an Jiaotong University, Xi’an, China
| | - Rui-Kang Ren
- Network and Information Center, Shaanxi Provincial Hospital of Infectious Diseases, The Eighth Hospital Affiliated to Medical College of Xi’an Jiaotong University, Xi’an, China
| | - Tong-Bo Yu
- Clinical Laboratory Center, Shaanxi Provincial Hospital of Infectious Diseases, The Eighth Hospital Affiliated to Medical College of Xi’an Jiaotong University, Xi’an, China
| | - Hong-Li Liu
- Clinical Laboratory Center, Xi’an People’s Hospital (Xi’an Fourth Hospital) Guang-Ren Hospital Affiliated to Xi’an Jiaotong University Health Science Center, Xi’an, China
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Lapuente D, Winkler TH, Tenbusch M. B-cell and antibody responses to SARS-CoV-2: infection, vaccination, and hybrid immunity. Cell Mol Immunol 2024; 21:144-158. [PMID: 37945737 PMCID: PMC10805925 DOI: 10.1038/s41423-023-01095-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 10/13/2023] [Indexed: 11/12/2023] Open
Abstract
The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2019 prompted scientific, medical, and biotech communities to investigate infection- and vaccine-induced immune responses in the context of this pathogen. B-cell and antibody responses are at the center of these investigations, as neutralizing antibodies (nAbs) are an important correlate of protection (COP) from infection and the primary target of SARS-CoV-2 vaccine modalities. In addition to absolute levels, nAb longevity, neutralization breadth, immunoglobulin isotype and subtype composition, and presence at mucosal sites have become important topics for scientists and health policy makers. The recent pandemic was and still is a unique setting in which to study de novo and memory B-cell (MBC) and antibody responses in the dynamic interplay of infection- and vaccine-induced immunity. It also provided an opportunity to explore new vaccine platforms, such as mRNA or adenoviral vector vaccines, in unprecedented cohort sizes. Combined with the technological advances of recent years, this situation has provided detailed mechanistic insights into the development of B-cell and antibody responses but also revealed some unexpected findings. In this review, we summarize the key findings of the last 2.5 years regarding infection- and vaccine-induced B-cell immunity, which we believe are of significant value not only in the context of SARS-CoV-2 but also for future vaccination approaches in endemic and pandemic settings.
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Affiliation(s)
- Dennis Lapuente
- Institut für klinische und molekulare Virologie, Universitätsklinikum Erlangen und Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Schlossgarten 4, 91054, Erlangen, Germany
| | - Thomas H Winkler
- Department of Biology, Division of Genetics, Nikolaus-Fiebiger-Center for Molecular Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
- Medical Immunology Campus Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Schlossplatz 1, 91054, Erlangen, Germany.
| | - Matthias Tenbusch
- Institut für klinische und molekulare Virologie, Universitätsklinikum Erlangen und Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Schlossgarten 4, 91054, Erlangen, Germany
- Medical Immunology Campus Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Schlossplatz 1, 91054, Erlangen, Germany
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Pereira GM, Manuli ER, Coulon L, Côrtes MF, Ramundo MS, Dromenq L, Larue-Triolet A, Raymond F, Tourneur C, Lázari CDS, Brasil P, Filippis AMBD, Paranhos-Baccalà G, Banz A, Sabino EC. Performance Evaluation of VIDAS ® Diagnostic Assays Detecting Anti-Chikungunya Virus IgM and IgG Antibodies: An International Study. Diagnostics (Basel) 2023; 13:2306. [PMID: 37443699 DOI: 10.3390/diagnostics13132306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/26/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
Chikungunya (CHIK) is a debilitating mosquito-borne disease with an epidemiology and early clinical symptoms similar to those of other arboviruses-triggered diseases such as dengue or Zika. Accurate and rapid diagnosis of CHIK virus (CHIKV) infection is therefore challenging. This international study evaluated the performance of the automated VIDAS® anti-CHIKV IgM and IgG assays compared to that of manual competitor IgM and IgG ELISA for the detection of anti-CHIKV IgM and IgG antibodies in 660 patients with suspected CHIKV infection. Positive and negative agreements of the VIDAS® CHIKV assays with ELISA ranged from 97.5% to 100.0%. The sensitivity of the VIDAS® CHIKV assays evaluated in patients with a proven CHIKV infection confirmed reported kinetics of anti-CHIKV IgM and IgG response, with a positive detection of 88.2-100.0% for IgM ≥ 5 days post symptom onset and of 100.0% for IgG ≥ 11 days post symptom onset. Our study also demonstrated the superiority of ELISA and VIDAS® assays over rapid diagnostic IgM/IgG tests. The analytical performance of VIDAS® anti-CHIKV IgM and IgG assays was excellent, with a high precision (coefficients of variation ≤ 7.4%) and high specificity (cross-reactivity rate ≤ 2.9%). This study demonstrates the suitability of the automated VIDAS® anti-CHIKV IgM and IgG assays to diagnose CHIKV infections and supports its applicability for epidemiological surveillance and differential diagnosis in regions endemic for CHIKV.
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Affiliation(s)
- Geovana M Pereira
- Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Erika R Manuli
- Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
- Faculdade de Medicina da Universidade Municipal de São Caetano do Sul, São Paulo 09521-160, Brazil
- Laboratório de Investigação Médica/Parasitologia LIM/46, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | | | - Marina F Côrtes
- Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Mariana S Ramundo
- Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | | | | | | | | | - Carolina Dos Santos Lázari
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Patricia Brasil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Fiocruz, Rio de Janeiro 21040-360, Brazil
| | - Ana Maria Bispo de Filippis
- Laboratório de Arbovírus e Vírus Hemorrágicos, Instituto Oswaldo Cruz/Fiocruz, Rio de Janeiro 21040-360, Brazil
| | - Glaucia Paranhos-Baccalà
- Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
- bioMérieux, 69280 Marcy l'Etoile, France
| | - Alice Banz
- bioMérieux, 69280 Marcy l'Etoile, France
| | - Ester C Sabino
- Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
- Faculdade de Medicina da Universidade Municipal de São Caetano do Sul, São Paulo 09521-160, Brazil
- Laboratório de Investigação Médica/Parasitologia LIM/46, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
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Weidung B, Josefsson M, Lyttkens P, Olsson J, Elgh F, Lind L, Kilander L, Lövheim H. Longitudinal Effects of Herpesviruses on Multiple Cognitive Outcomes in Healthy Elderly Adults. J Alzheimers Dis 2023:JAD221116. [PMID: 37334589 PMCID: PMC10357165 DOI: 10.3233/jad-221116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
BACKGROUND Herpesviruses have been proposed to be involved in Alzheimer's disease development as potentially modifiable pathology triggers. OBJECTIVE To investigate associations of serum antibodies for herpes simplex virus (HSV)-1 and cytomegalovirus (CMV) and anti-herpesvirus treatment with cognitive outcomes in relation to interactions with APOE ɛ4. METHODS The study included 849 participants in the population-based Prospective Investigation of the Vasculature in Uppsala Seniors study. Cognitive performance at the ages of 75 and 80 years was assessed using the Mini-Mental State Examination (MMSE), trail-making test (TMT) A and B, and 7-minute screening test (7MS). RESULTS Anti- HSV-1 IgG positivity was associated cross-sectionally with worse performance on the MMSE, TMT-A, TMT-B, 7MS, enhanced free recall, and verbal fluency tests (p = 0.016, p = 0.016, p < 0.001, p = 0.001, p = 0.033, and p < 0.001, respectively), but not orientation or clock drawing. Cognitive scores did not decline over time and longitudinal changes did not differ according to HSV-1 positivity. Anti- CMV IgG positivity was not associated cross-sectionally with cognition, but TMT-B scores declined more in anti- CMV IgG carriers. Anti- HSV-1 IgG interacted with APOE ɛ4 in association with worse TMT-A and better enhanced cued recall. Anti- HSV IgM interacted with APOE ɛ4 and anti-herpesvirus treatment in association with worse TMT-A and clock drawing, respectively. CONCLUSION These findings indicate that HSV-1 is linked to poorer cognition in cognitively healthy elderly adults, including impairments in executive function, memory, and expressive language. Cognitive performance did not decline over time, nor was longitudinal decline associated with HSV-1.
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Affiliation(s)
- Bodil Weidung
- Department of Public Health and Caring Sciences, Section of Clinical Geriatrics, Uppsala University, Uppsala, Sweden
| | - Maria Josefsson
- Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden
| | - Peter Lyttkens
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Jan Olsson
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Fredrik Elgh
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Lars Lind
- Department of Medical Sciences, Acute and Internal Medicine, Uppsala University, Uppsala, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences, Section of Clinical Geriatrics, Uppsala University, Uppsala, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Division of Geriatic Medicine, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå university, Umeå, Sweden
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Lilley CM, Borys E, Picken MM. Adenovirus-Associated Acute Interstitial Nephritis With Graft Survival and Novel Follow-Up Biopsy Findings Including Karyomegaly: A Case Series. Cureus 2023; 15:e38452. [PMID: 37273386 PMCID: PMC10234624 DOI: 10.7759/cureus.38452] [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] [Accepted: 04/30/2023] [Indexed: 06/06/2023] Open
Abstract
Adenoviral infections in post-transplant patients have been described in multiple organ systems, most classically the lung, liver, and alimentary tract. In the genitourinary tract, hemorrhagic cystitis is most frequently observed. Clinically apparent renal involvement with adenovirus is rare, and adenovirus-associated interstitial nephritis (AAIN) is an uncommon cause of renal allograft failure. Here, we present three cases of AAIN in patients who, after prompt diagnosis and treatment adjustment, experienced a return of allograft function. All patients were on standard triple therapy with tacrolimus levels within the target range at the time of biopsy. None of the patients had respiratory symptoms, and despite diarrhea, colon biopsies were negative. Only case one had positive adenovirus serology (IgG only) and case three had positive urine; two patients had leukopenia without neutropenia. Renal biopsies showed a characteristic granulomatous tubulocentric mixed lymphocytic and neutrophilic infiltrate. Adenovirus immunohistochemistry (IHC) showed strong staining in the tubular epithelium (nuclear and cytoplasmic) while staining for polyomavirus was negative. A follow-up biopsy two months after the diagnosis of AAIN in one patient revealed persistent cytopathic effects with negative adenoviral IHC staining while a biopsy at one year in another patient showed glomerular and tubulointerstitial scarring. AAIN is an uncommon but important etiology to consider in cases of acute renal allograft dysfunction. Although the presenting symptoms for AAIN are nonspecific, hematuria is frequently noted. Adenovirus IHC should be considered in cases with granulomatous inflammation associated with necrosis and mixed inflammatory infiltrate. As demonstrated in this single-institution case series, prompt diagnosis can result in the preservation of the renal allograft. Lasting cytopathic effects after adenoviral infection should also be considered in patients with a history, or potential history, of AAIN.
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Affiliation(s)
- Cullen M Lilley
- Department of Pathology, Loyola University Chicago Stritch School of Medicine, Maywood, USA
| | - Ewa Borys
- Department of Pathology, Loyola University Medical Center, Maywood, USA
| | - Maria M Picken
- Department of Pathology, Loyola University Medical Center, Maywood, USA
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Cleveland DW, Anderson CC, Brissette CA. Borrelia miyamotoi: A Comprehensive Review. Pathogens 2023; 12:267. [PMID: 36839539 PMCID: PMC9967256 DOI: 10.3390/pathogens12020267] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
Borrelia miyamotoi is an emerging tick-borne pathogen in the Northern Hemisphere and is the causative agent of Borrelia miyamotoi disease (BMD). Borrelia miyamotoi is vectored by the same hard-bodied ticks as Lyme disease Borrelia, yet phylogenetically groups with relapsing fever Borrelia, and thus, has been uniquely labeled a hard tick-borne relapsing fever Borrelia. Burgeoning research has uncovered new aspects of B. miyamotoi in human patients, nature, and the lab. Of particular interest are novel findings on disease pathology, prevalence, diagnostic methods, ecological maintenance, transmission, and genetic characteristics. Herein, we review recent literature on B. miyamotoi, discuss how findings adapt to current Borrelia doctrines, and briefly consider what remains unknown about B. miyamotoi.
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Affiliation(s)
| | | | - Catherine A. Brissette
- Department of Biomedical Sciences, University of North Dakota, Grand Forks, ND 58202, USA
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Acute Pancreatitis Associated with Atypical Bacterial Pneumonia: Systematic Literature Review. J Clin Med 2022; 11:jcm11237248. [PMID: 36498822 PMCID: PMC9736890 DOI: 10.3390/jcm11237248] [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: 11/03/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Extra-pulmonary features sometimes occur in association with atypical bacterial pneumonia and include neurologic manifestations, diarrhea, rashes, altered liver enzymes, or kidney injury, among other conditions. Acute pancreatitis has been associated with atypical pneumonias since 1973. METHODS We performed a systematic review of the literature in the Excerpta Medica, National Library of Medicine, and Web of Science databases. We retained 27 reports published between 1973 and 2022 describing subjects with an otherwise unexplained pancreatitis temporally associated with an atypical pneumonia. RESULTS The reports included 33 subjects (19 males, and 14 females; 8 children and 25 adults) with acute pancreatitis temporally associated with atypical pneumonia caused by Mycoplasma pneumoniae (n = 18), Legionella species (n = 14), or Coxiella burnetii (n = 1). Approximately 90% of patients (n = 29) concurrently presented with respiratory and pancreatic diseases. No cases associated with Chlamydophila pneumoniae, Chlamydophila psittaci, or Francisella species were found. CONCLUSIONS Acute pancreatitis has been associated with various infectious agents. The present review documents the association with atypical pneumonia induced by Mycoplasma pneumoniae, Legionella species, and Coxiella burnetii.
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Hoey J, Solomon JL, Kim B, Carsons S, Nusbaum J. Melanoma differentiation-associated gene 5 amyopathic dermatomyositis following an acute Mycoplasma pneumoniae infection: a case report. J Med Case Rep 2022; 16:401. [PMID: 36316755 PMCID: PMC9623992 DOI: 10.1186/s13256-022-03616-z] [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: 05/05/2022] [Accepted: 09/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A previously healthy young male of Southeast Asian descent presented with 6 weeks of fevers, cough, mucocutaneous ulcers, arthritis, and myalgias. Initial workup revealed positive Mycoplasma pneumoniae immunoglobulin M, and the patient was treated with antibiotics without relief of symptoms. Rheumatologic workup revealed highly positive melanoma differentiation-associated gene 5 antibody. Viral infections are thought to potentially trigger loss of self tolerance, and prompt the autoimmunity cascade that can result in conditions such as dermatomyositis. To our knowledge, this is the first case report demonstrating a non-viral infection, specifically Mycoplasma pneumoniae, as the inciting infectious trigger for the anti-melanoma differentiation-associated gene 5 dermatomyositis subtype. CASE PRESENTATION A 20-year-old southeast Asian-American male with no significant past medical history presented with symptoms of intermittent fevers, nonproductive cough, dry eyes, oral ulcers, rash, arthritis, and myalgias. The patient was noted to have erythematous papules across the bilateral hands along the lateral digits and palms, as well as synovitis involving the bilateral hands and feet. Immunoglobulin M antibodies were positive for Mycoplasma pneumoniae. The patient was diagnosed with mycoplasma pneumonia. The patient did not respond to a course of antibiotics, leading to rheumatological testing that found highly positive melanoma differentiation-associated gene 5 autoantibody. Muscle enzyme and electromyography testing were normal, indicating clinically amyopathic disease. Methylprednisolone was initiated, with resolution of fevers and improvement of arthritis and myalgias. The cutaneous lesions on the digits and palms improved. CONCLUSIONS This patient presented with symptoms of fever, cough, oral ulcers, rashes, and arthritis, and blood work demonstrated the presence of immunoglobulin M antibodies to Mycoplasma pneumoniae. Despite antibiotic treatment for the presumed diagnosis of Mycoplasma pneumoniae infection, the patient did not improve, prompting rheumatological workup and revealing melanoma differentiation-associated gene 5 autoantibodies. This case suggests that infections, other than viral, can trigger the autoinflammatory cascade, leading to the development of amyopathic melanoma differentiation-associated gene 5 dermatomyositis.
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Affiliation(s)
- Jessica Hoey
- Division of Rheumatology, Allergy, and Immunology, NYU Long Island School of Medicine, Mineola, NY USA
| | - Jenny Lue Solomon
- grid.281603.e0000 0001 0228 085XDepartment of Internal Medicine, NYU Langone Hospital, Long Island, Mineola, NY USA
| | - Brandon Kim
- grid.281603.e0000 0001 0228 085XDepartment of Internal Medicine, NYU Langone Hospital, Long Island, Mineola, NY USA
| | - Steven Carsons
- Division of Rheumatology, Allergy, and Immunology, NYU Long Island School of Medicine, Mineola, NY USA
| | - Julie Nusbaum
- Division of Rheumatology, Allergy, and Immunology, NYU Long Island School of Medicine, Mineola, NY USA
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Binder RA, Fujimori GF, Forconi CS, Reed GW, Silva LS, Lakshmi PS, Higgins A, Cincotta L, Dutta P, Salive MC, Mangolds V, Anya O, Calvo Calle JM, Nixon T, Tang Q, Wessolossky M, Wang Y, Ritacco DA, Bly CS, Fischinger S, Atyeo C, Oluoch PO, Odwar B, Bailey JA, Maldonado-Contreras A, Haran JP, Schmidt AG, Cavacini L, Alter G, Moormann AM. SARS-CoV-2 Serosurveys: How Antigen, Isotype and Threshold Choices Affect the Outcome. J Infect Dis 2022; 227:371-380. [PMID: 36314635 PMCID: PMC9891417 DOI: 10.1093/infdis/jiac431] [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: 07/13/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Evaluating the performance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serological assays and clearly articulating the utility of selected antigens, isotypes, and thresholds is crucial to understanding the prevalence of infection within selected communities. METHODS This cross-sectional study, implemented in 2020, screened PCRconfirmed coronavirus disease 2019 patients (n 86), banked prepandemic and negative samples (n 96), healthcare workers and family members (n 552), and university employees (n 327) for antiSARS-CoV-2 receptor-binding domain, trimeric spike protein, and nucleocapsid protein immunoglobulin (Ig)G and IgA antibodies with a laboratory-developed enzyme-linked immunosorbent assay and tested how antigen, isotype and threshold choices affected the seroprevalence outcomes. The following threshold methods were evaluated: (i) mean 3 standard deviations of the negative controls; (ii) 100 specificity for each antigen-isotype combination; and (iii) the maximal Youden index. RESULTS We found vastly different seroprevalence estimates depending on selected antigens and isotypes and the applied threshold method, ranging from 0.0 to 85.4. Subsequently, we maximized specificity and reported a seroprevalence, based on more than one antigen, ranging from 9.3 to 25.9. CONCLUSIONS This study revealed the importance of evaluating serosurvey tools for antigen-, isotype-, and threshold-specific sensitivity and specificity, to interpret qualitative serosurvey outcomes reliably and consistently across studies.
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Affiliation(s)
- Raquel A Binder
- Correspondence: Raquel A. Binder, University of Massachusetts Chan Medical School, Worcester, MA 01605 ()
| | | | | | - George W Reed
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Leandro S Silva
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Priya Saikumar Lakshmi
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Amanda Higgins
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Lindsey Cincotta
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Protiva Dutta
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Marie-Claire Salive
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Virginia Mangolds
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Otuwe Anya
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - J Mauricio Calvo Calle
- Department of Pathology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Thomas Nixon
- Horae Gene Therapy Center, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Qiushi Tang
- Horae Gene Therapy Center, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Mireya Wessolossky
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Yang Wang
- MassBiologics, University of Massachusetts Medical School, Boston, Massachusetts, USA
| | - Dominic A Ritacco
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Courtney S Bly
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | | | - Caroline Atyeo
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
| | - Peter O Oluoch
- Department of Microbiology and Physiological Systems, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Boaz Odwar
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Jeffrey A Bailey
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Ana Maldonado-Contreras
- Department of Microbiology and Physiological Systems, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA,Department of Microbiology and Physiological Systems, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Aaron G Schmidt
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA,Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Lisa Cavacini
- MassBiologics, University of Massachusetts Medical School, Boston, Massachusetts, USA
| | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
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12
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Calibrating Hepatitis E Virus Serological Assays Using Asymptomatic Specimens Obtained in Japan. Microbiol Spectr 2022; 10:e0214622. [PMID: 36125314 PMCID: PMC9603090 DOI: 10.1128/spectrum.02146-22] [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: 12/31/2022] Open
Abstract
This study aimed to calibrate hepatitis E virus (HEV) serological assays. We optimized the previously developed in-house HEV antibody enzyme-linked immunosorbent assay (ELISA) by setting the cutoff with an in-house serological performance panel consisting of broad HEV antibody titers and subtracting nonspecific background values for anti-HEV IgM, IgA, and IgG. We also compared the assay's performance with that of commercial serological assay kits (four kits for IgM, one for IgA, and two for IgG). Although all serological assays readily detected HEV antibodies at high titers in the symptomatic hepatitis E population, considerable variations between assays were observed in the asymptomatic population. The in-house ELISA showed a higher sensitivity for HEV IgM, IgA, and IgG than the commercial kits and detected the seroconversion of HEV IgM and IgG earlier when testing a commercially available HEV seroconversion panel. The low sensitivity of the commercial kits was due to the high setting of the original cutoff, which was demonstrated by receiver operating characteristic analysis. However, the corrected cutoff value reduced assay specificity. Background subtraction is essential to achieve high specificity because the in-house ELISA without background subtraction reduced its specificity. These results indicate that asymptomatic specimens and background subtraction contribute to the optimization of HEV serological assays. IMPORTANCE Accurate diagnosis of hepatitis E virus (HEV) infection is essential for public health surveillance and for preventing HEV-contaminated blood transfusion. Anti-HEV IgM or IgA is used as a reliable marker of recent HEV infection. However, considerable variability in the sensitivity and specificity of HEV antibody detection is observed among several commercially available assay kits. In addition, none of the HEV antibody detection methods have been approved by the U.S. Food and Drug Administration (FDA). Here, we show that the in-house enzyme-linked immunosorbent assay (ELISA) could detect HEV IgM and IgA more sensitively than commercial kits in the asymptomatic population. We also suggest that the assay performance of commercial kits might be improved by optimizing the cutoff and reducing nonspecific background noise. A sensitive serological (IgM or IgA) assay in addition to HEV RNA testing will contribute to accurate diagnosis of acute HEV infection because HEV RNA-positive duration is relatively short.
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13
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Primary HSV-2 Infection Complicated by Radiculomyelitis in a Young Immunocompetent Female Patient with Inherited Chromosomally Integrated HHV-6: A Case Report. Viruses 2022; 14:v14091979. [PMID: 36146785 PMCID: PMC9500849 DOI: 10.3390/v14091979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background: HSV-1, HSV-2 and VZV are alpha Herpesviruses, neurotropic viruses that are associated with various neurologic complications upon primary infection or reactivation. Cases of myelitis and radiculomyelitis are rare and appropriate etiologic diagnoses can be tricky. Case presentation: Here we describe the case of a young immunocompetent woman who developed painful and extended vesicular genital lesions, with subsequent radiculomyelitis. HSV-1/-2 PCRs in the cerebrospinal fluid were misleadingly negative, whereas HHV-6 PCR was positive. Positive anti-HSV-2 IgM and IgG in serum was consistent with HSV-2 primary infection. On the other hand, the detection of HHV-6 DNA was explained by inherited chromosomally integrated HHV-6. The clinical course was favorable with high-dose IV acyclovir and corticosteroids. Conclusion: HSV-2-related radiculomyelitis is a rare clinical entity, which can be difficult to diagnose. In this case report, the causative virus was not detected in the patient’s CSF, whereas HHV-6 DNA, non-pathogenic in this situation, was paradoxically positive. The diagnosis was based on the clinical features typical for HSV-2 primary infection, confirmed by the serology results. The delay between the genital lesions and the appearance of the radiculomyelitis, along with the absence of HSV-2 detection in the CSF, suggests a possible immuno-mediated physiopathological process. As for the HHV-6 DNA detection in the patient’s CSF, it was explained by inherited chromosomally integrated HHV-6. This case illustrates how both negative and positive clinical virology results need careful interpretation according to the clinical findings.
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14
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Carson KJ, Tucker HR, Howard K, Hales M, Bryant PW, St. George K, Kulas KE, Lee WT. Evaluation of Measles IgM Antibody Detection Assays During the 2018-2019 Outbreak in New York State. Diagn Microbiol Infect Dis 2022; 104:115741. [DOI: 10.1016/j.diagmicrobio.2022.115741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/02/2022] [Accepted: 05/29/2022] [Indexed: 11/29/2022]
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15
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Plazas MI, Marín JS, Torres E, Londoño JC, Celis-Giraldo D, Marín JEG. FREQUENCY OF NATURAL ANTIBODIES AND CONCORDANCE ANALYSIS FOR ANTI-TOXOPLASMA IgM TESTS IN COLOMBIAN SERA OF PREGNANT WOMEN. Diagn Microbiol Infect Dis 2022; 103:115733. [DOI: 10.1016/j.diagmicrobio.2022.115733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/13/2022] [Accepted: 05/21/2022] [Indexed: 11/03/2022]
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16
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Wright WF, Yenokyan G, Simner PJ, Carroll KC, Auwaerter PG. Geographic Variation of Infectious Disease Diagnoses Among Patients with Fever of Unknown Origin (FUO) – A Systematic Review and Meta-analysis. Open Forum Infect Dis 2022; 9:ofac151. [PMID: 35450085 PMCID: PMC9017373 DOI: 10.1093/ofid/ofac151] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/18/2022] [Indexed: 11/12/2022] Open
Abstract
Background Fever of unknown origin (FUO) investigations yield a substantial number of patients with infectious diseases. This systematic review and meta-analysis aimed to quantify more common FUO infectious diseases etiologies and to underscore geographic variation. Methods Four databases (PubMed, Embase, Scopus, and Web of Science) were searched for prospective studies reporting FUO rates among adult patients from 1 January 1997 to 31 March 2021. The pooled proportion for infectious diseases etiology was estimated using the random-effects meta-analysis model. Results Nineteen prospective studies were included with 2667 total cases. No studies were available for Africa or the Americas. Overall, 37.0% (95.0% confidence interval [CI], 30.0%–44.0%) of FUO patients had an infectious disease etiology. Infections were more likely from Southeastern Asia (pooled proportion, 0.49 [95% CI, .43–.55]) than from Europe (pooled proportion, 0.31 [95% CI, .22–.41]). Among specifically reported infectious diseases (n = 832), Mycobacterium tuberculosis complex predominated across all geographic regions (n = 285 [34.3%]), followed by brucellosis (n = 81 [9.7%]), endocarditis (n = 62 [7.5%]), abscesses (n = 61 [7.3%]), herpesvirus (eg, cytomegalovirus and Epstein-Barr virus) infections (n = 60 [7.2%]), pneumonia (n = 54 [6.5%]), urinary tract infections (n = 54 [6.5%]), and enteric fever (n = 40 [4.8%]). Conclusions FUO patients from Southeastern Asia were more likely to have an infectious diseases etiology when compared to other regions. The predominant factor for this finding appears to be differences in disease prevalence among various geographical locations or other factors such as access to timely care and diagnosis. Noting epidemiological disease factors in FUO investigations could improve diagnostic yields and clinical outcomes.
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Affiliation(s)
- William F Wright
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gayane Yenokyan
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Patricia J Simner
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Karen C Carroll
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul G Auwaerter
- The Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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17
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Vandervore L, Van Mieghem E, Nowé V, Schouwers S, Steger C, Abrams P, Schaeren JV, Meskal A, Vandamme T. False positive Herpes Simplex IgM serology in COVID-19 patients correlates with SARS-CoV-2 IgM/IgG seropositivity. Diagn Microbiol Infect Dis 2022; 103:115653. [PMID: 35228129 PMCID: PMC8802144 DOI: 10.1016/j.diagmicrobio.2022.115653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/23/2021] [Accepted: 01/21/2022] [Indexed: 12/31/2022]
Abstract
Differentiating COVID-19 from other causes of viral pneumonia, like herpes simplex (HSV), can be complicated by shared clinical and laboratory features. Viral pneumonia is mostly diagnosed based on molecular or serological techniques. Serological immunoassay interferences, often attributed to concurrent appearance of heterologous (viral) immunoglobulins, is well-known, but has not been studied in COVID-19 patients. Following false positive HSV immunoglobulin M (IgM) results in our index patient, 25 other COVID-19 patients were tested for HSV-1/2 IgM with the chemiluminescent Liaison assay and Euroimmun enzyme-linked immunosorbent assay. Forty-five percent of COVID-19 patients tested positive for HSV IgM with Liaison. No HSV indices were positive with Euroimmun enzyme-linked immunosorbent assay, suggesting immunoassay interference. Significant correlation between HSV IgM and SARS-CoV-2 IgM/IgG positivity was found. Adding 0.5% polyvinylpyrrolidone, inhibiting non-specific solid-phase adsorption, abolished interference in 22% of false positive cases, suggesting interference caused by solid-phase reactive IgM. Hence, serologic immunoassay results should be interpreted with caution in COVID-19 patients.
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18
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Idris OO, Kolawole OM. Seroprevalence and molecular characterization of human respiratory syncytial virus and human adenovirus among children in Ado-Ekiti, Nigeria. J Med Virol 2021; 94:2548-2557. [PMID: 34816447 DOI: 10.1002/jmv.27473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 11/19/2021] [Indexed: 11/10/2022]
Abstract
In children, the respiratory syncytial virus and adenovirus majorly cause acute respiratory infections. The study evaluated the seroprevalence and conducted the molecular characterization of human respiratory syncytial virus (HRSV) and human adenovirus (HAdV) among children. Venous blood, nasopharyngeal, and oropharyngeal swabs were collected from children presenting with acute respiratory infections in a tertiary health facility in Ado-Ekiti, Nigeria. A serological investigation was carried out on the sera samples for the detection of anti-HRSV immunoglobulin M (IgM), anti-HRSV IgG, anti-HAdV IgM, and anti-HAdV IgG using ELISA (enzyme-linked immunosorbent assay) kits. The amplification and sequencing of HRSV and HAdV were carried out using specific primer pairs that targeted the glycoprotein (G) gene of HRSV and the hexon gene of HAdV, respectively. The seroprevalence of HRSV IgG and IgM was 73% and 7.5%, respectively, while the seroprevalence of HAdV IgG and IgM was 98.5% and 8.5%, respectively. The age of enrolled children, presence of fever, and cough were associated (p < 0.05) with the infection. HRSV subtype B (HRSV-B) (13.3%), and species of HAdV (Mastadenovirus B and C) (11.7%) were detected among the studied population. There was no viral coinfection with both HRSV and HAdV. In infancy and early childhood, HRSV-B, HAdV species B and C are common etiologic agents of respiratory infections as reported in this study. Further studies on molecular characterization of respiratory tract viruses including circulating respiratory syncytial virus and adenovirus are hereby advocated.
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Affiliation(s)
- Olayinka O Idris
- Department of Microbiology, Faculty of Life Sciences, Infectious Diseases and Environmental Health Research Group, University of Ilorin, Ilorin, Nigeria.,Department of Biological Sciences, College of Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Olatunji M Kolawole
- Department of Microbiology, Faculty of Life Sciences, Infectious Diseases and Environmental Health Research Group, University of Ilorin, Ilorin, Nigeria
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19
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Qin H, Peng J, Liu L, Wu J, Pan L, Huang X, Huang M, Qiu H, Du B. A Retrospective Paired Comparison Between Untargeted Next Generation Sequencing and Conventional Microbiology Tests With Wisely Chosen Metagenomic Sequencing Positive Criteria. Front Med (Lausanne) 2021; 8:686247. [PMID: 34692715 PMCID: PMC8526841 DOI: 10.3389/fmed.2021.686247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives: To evaluate the performance of metagenomic next generation sequencing (mNGS) using adequate criteria for the detection of pathogens in lower respiratory tract (LRT) samples with a paired comparison to conventional microbiology tests (CMT). Methods: One hundred sixty-seven patients were reviewed from four different intensive care units (ICUs) in mainland China during 2018 with both mNGS and CMT results of LRT samples available. The reads per million ratio (RPMsample/RPMnon−template−control ratio) and standardized strictly mapped reads number (SDSMRN) were the two criteria chosen for identifying positive pathogens reported from mNGS. A McNemar test was used for a paired comparison analysis between mNGS and CMT. Results: One hundred forty-nine cases were counted into the final analysis. The RPMsample/RPMNTC ratio criterion performed better with a higher accuracy for bacteria, fungi, and virus than SDSMRN criterion [bacteria (RPMsample/RPMNTC ratio vs. SDSMRN), 65.1 vs. 55.7%; fungi, 75.8 vs. 71.1%; DNA virus, 86.3 vs. 74.5%; RNA virus, 90.9 vs. 81.8%]. The mNGS was also superior in bacteria detection only if an SDSMRN ≥3 was used as a positive criterion with a paired comparison to culture [SDSMRN positive, 92/149 (61.7%); culture positive, 54/149 (36.2%); p < 0.001]; however, it was outperformed with significantly more fungi and DNA virus identification when choosing both criteria for positive outliers [fungi (RPMsample/RPMNTC ratio vs. SDSMRN vs. culture), 23.5 vs. 29.5 vs. 8.7%, p < 0.001; DNA virus (RPMsample/RPMNTC ratio vs. SDSMRN vs. PCR), 14.1 vs. 20.8 vs. 11.8%, p < 0.05]. Conclusions: Metagenomic next generation sequencing may contribute to revealing the LRT infection etiology in hospitalized groups of potential fungal infections and in situations with less access to the multiplex PCR of LRT samples from the laboratory by choosing a wise criterion like the RPMsample/RPMNTC ratio.
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Affiliation(s)
- Hanyu Qin
- State Key Laboratory of Complex, Severe and Rare Disease, Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jinmin Peng
- State Key Laboratory of Complex, Severe and Rare Disease, Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Ling Liu
- Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Jing Wu
- Department of Intensive Care Unit, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lingai Pan
- Department of Critical Care Medicine, Sichuan Provincial Hospital, University of Electronic Science and Technology of China, Chengdu, China.,Sichuan Translational Medicine Research Hospital, Chinese Academy of Sciences, Chengdu, China
| | - Xiaobo Huang
- Department of Critical Care Medicine, Sichuan Provincial Hospital, University of Electronic Science and Technology of China, Chengdu, China.,Sichuan Translational Medicine Research Hospital, Chinese Academy of Sciences, Chengdu, China
| | - Man Huang
- Department of Intensive Care Unit, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haibo Qiu
- Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Bin Du
- State Key Laboratory of Complex, Severe and Rare Disease, Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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20
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Mendes JJ, Paiva JA, Gonzalez F, Mergulhão P, Froes F, Roncon R, Gouveia J. Update of the recommendations of the Sociedade Portuguesa de Cuidados Intensivos and the Infection and Sepsis Group for the approach to COVID-19 in Intensive Care Medicine. Rev Bras Ter Intensiva 2021; 33:487-536. [PMID: 35081236 PMCID: PMC8889599 DOI: 10.5935/0103-507x.0103-507x-rbti-20210080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/20/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The Sociedade Portuguesa de Cuidados Intensivos and the Infection and Sepsis Group have previously issued health service and management recommendations for critically ill patients with COVID-19. Due to the evolution of knowledge, the panel of experts was again convened to review the current evidence and issue updated recommendations. METHODS A national panel of experts who declared that they had no conflicts of interest regarding the development of the recommendations was assembled. Operational questions were developed based on the PICO methodology, and a rapid systematic review was conducted by consulting different bibliographic sources. The panel determined the direction and strength of the recommendations using two Delphi rounds, conducted in accordance with the principles of the GRADE system. A strong recommendation received the wording "is recommended", and a weak recommendation was written as "is suggested." RESULTS A total of 48 recommendations and 30 suggestions were issued, covering the following topics: diagnosis of SARS-CoV-2 infection, coinfection and superinfection; criteria for admission, cure and suspension of isolation; organization of services; personal protective equipment; and respiratory support and other specific therapies (antivirals, immunomodulators and anticoagulation). CONCLUSION These recommendations, specifically oriented to the Portuguese reality but that may also apply to Portuguese-speaking African countries and East Timor, aim to support health professionals in the management of critically ill patients with COVID-19. They will be continuously reviewed to reflect the progress of our understanding and the treatment of this pathology.
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Affiliation(s)
- João João Mendes
- Sociedade Portuguesa de Cuidados Intensivos - Lisboa,
Portugal
- Department of Intensive Care Medicine, Hospital Prof. Doutor
Fernando da Fonseca EPE - Lisboa, Portugal
| | - José Artur Paiva
- College of Specialties of Intensive Care Medicine, Ordem dos
Médicos- Lisboa, Portugal
- Infection and Sepsis Group - Lisboa, Portugal
- Department of Intensive Care Medicine, Centro Hospitalar
Universitário de São João EPE, Faculdade de Medicina da Universidade do Porto -
Porto, Portugal
| | - Filipe Gonzalez
- Sociedade Portuguesa de Cuidados Intensivos - Lisboa,
Portugal
- Department of Intensive Care Medicine, Hospital Garcia de Orta EPE -
Lisboa, Portugal
| | - Paulo Mergulhão
- Sociedade Portuguesa de Cuidados Intensivos - Lisboa,
Portugal
- Infection and Sepsis Group - Lisboa, Portugal
- Polyvalent Intensive Care Unit, Hospital Lusíadas Porto - Porto,
Portugal
| | - Filipe Froes
- Medical-Surgical Intensive Care Unit, Hospital de Pulido Valente,
Centro Hospitalar Universitário de Lisboa Norte EPE - Lisboa, Portugal
| | - Roberto Roncon
- Department of Intensive Care Medicine, Centro Hospitalar
Universitário de São João EPE, Faculdade de Medicina da Universidade do Porto -
Porto, Portugal
| | - João Gouveia
- Sociedade Portuguesa de Cuidados Intensivos - Lisboa,
Portugal
- Department of Intensive Care Medicine, Centro Hospitalar
Universitário de Lisboa Norte EPE - Lisboa, Portugal
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21
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Tan Y, Chen L. Sustained false-positive results for hepatitis A virus immunoglobulin M: A case report and literature review. Open Med (Wars) 2021; 16:1311-1317. [PMID: 34568578 PMCID: PMC8424969 DOI: 10.1515/med-2021-0336] [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: 05/30/2021] [Revised: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 11/17/2022] Open
Abstract
Hepatitis A virus immunoglobulin M (HAV-IgM) is often used to diagnose acute hepatitis A virus (HAV) infection serologically. However, false-positive test results can interfere with the diagnosis. A 56-year-old woman was readmitted to the hospital owing to abnormal liver function tests for the last 18 months. She had been diagnosed with acute HAV and was hospitalized in isolation based on a positive HAV-IgM test 18 months ago. Regular follow-up after discharge showed abnormal liver function and an elevated level of antinuclear antibodies and immunoglobulin G. For the last 15 days, the patient had fatigue, decreased appetite, and yellow urine, signaling recrudescence. Liver function tests were also abnormal. Liver biopsy revealed histological changes consistent with typical autoimmune hepatitis. After 2 months of methylprednisolone treatment, liver function returned to normal, and HAV-IgM turned negative. The diagnosis of acute HAV in nonendemic areas requires a comprehensive analysis of epidemic history, clinical characteristics, etiology, etc.
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Affiliation(s)
- Youwen Tan
- Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, No. 300, Daijiamen, Runzhou Distinct, Zhenjiang 212003, China
| | - Li Chen
- Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang 212003, China
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22
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Breedon AME, Saldanha RJ, Salisbury RL, Metzger DE, Werry MP, McPherson CJ, Irvin AP, Davis CM, Bogner CA, Braddock AM, Salter CE, Grigsby CC, Hart CR, Pangburn HA. COVID-19 Seroprevalence and Active Infection in an Asymptomatic Population. Front Med (Lausanne) 2021; 8:749732. [PMID: 34589507 PMCID: PMC8473750 DOI: 10.3389/fmed.2021.749732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/20/2021] [Indexed: 12/15/2022] Open
Abstract
In response to the COVID-19 pandemic, immediate and scalable testing solutions are needed to direct return to full capacity planning in the general public and across the Department of Defense (DoD). To fully understand the extent to which a population has been affected by COVID-19, active monitoring approaches require an estimation of overall seroprevalence in addition to accurate, affordable, and rapid tests to detect current SARS-CoV-2 infection. In this study, researchers in the Air Force Research Laboratory's 711th Human Performance Wing, Airman Systems Directorate evaluated the performance of various testing methods for the detection of SARS-CoV-2 antibodies and viral RNA in asymptomatic adults working at Wright-Patterson Air Force Base and the surrounding area during the period of 23 July 2020-23 Oct 2020. Altogether, there was a seroprevalance of 3.09% and an active infection rate of 0.5% (determined via the testing of saliva samples) amongst individuals tested, both of which were comparable to local and national averages at the time. This work also presents technical and non-technical assessments of various testing strategies as compared to the gold standard approaches (e.g., lateral flow assays vs. ELISA and RT-LAMP vs. RT-PCR) in order to explore orthogonal supply chains and fieldability. Exploration and validation of multiple testing strategies will allow the DoD and other workforces to make informed responses to COVID-19 and future pandemics.
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Affiliation(s)
- Amy M. E. Breedon
- Air Force Research Laboratory, 711th Human Performance Wing, Wright-Patterson Air Force Base, OH, United States
- UES, Inc., Integrative Health & Performance Sciences Division, Dayton, OH, United States
| | - Roland J. Saldanha
- Air Force Research Laboratory, 711th Human Performance Wing, Wright-Patterson Air Force Base, OH, United States
| | - Richard L. Salisbury
- Air Force Research Laboratory, 711th Human Performance Wing, Wright-Patterson Air Force Base, OH, United States
| | - David E. Metzger
- Air Force Research Laboratory, 711th Human Performance Wing, Wright-Patterson Air Force Base, OH, United States
- UES, Inc., Integrative Health & Performance Sciences Division, Dayton, OH, United States
| | - Michael P. Werry
- Air Force Research Laboratory, 711th Human Performance Wing, Wright-Patterson Air Force Base, OH, United States
| | - Craig J. McPherson
- Air Force Research Laboratory, 711th Human Performance Wing, Wright-Patterson Air Force Base, OH, United States
- UES, Inc., Integrative Health & Performance Sciences Division, Dayton, OH, United States
| | - Adam P. Irvin
- Air Force Research Laboratory, 711th Human Performance Wing, Wright-Patterson Air Force Base, OH, United States
| | - Christina M. Davis
- Air Force Research Laboratory, 711th Human Performance Wing, Wright-Patterson Air Force Base, OH, United States
- UES, Inc., Integrative Health & Performance Sciences Division, Dayton, OH, United States
| | - Charles A. Bogner
- Air Force Research Laboratory, 711th Human Performance Wing, Wright-Patterson Air Force Base, OH, United States
| | - Amber M. Braddock
- Air Force Research Laboratory, 711th Human Performance Wing, Wright-Patterson Air Force Base, OH, United States
- UES, Inc., Integrative Health & Performance Sciences Division, Dayton, OH, United States
| | - Charles E. Salter
- Air Force Research Laboratory, 711th Human Performance Wing, Wright-Patterson Air Force Base, OH, United States
| | - Claude C. Grigsby
- Air Force Research Laboratory, 711th Human Performance Wing, Wright-Patterson Air Force Base, OH, United States
| | - Corey R. Hart
- Air Force Research Laboratory, 711th Human Performance Wing, Wright-Patterson Air Force Base, OH, United States
| | - Heather A. Pangburn
- Air Force Research Laboratory, 711th Human Performance Wing, Wright-Patterson Air Force Base, OH, United States
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23
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Yan J, He YS, Song Y, Chen XY, Liu HB, Rao CY. False positive anti-hepatitis A virus immunoglobulin M in autoimmune hepatitis/primary biliary cholangitis overlap syndrome: A case report. World J Clin Cases 2021; 9:6464-6468. [PMID: 34435013 PMCID: PMC8362578 DOI: 10.12998/wjcc.v9.i22.6464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 04/30/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Autoimmune hepatitis (AIH) is an immune-mediated liver disease affecting all age groups. Associations between hepatitis A virus (HAV) and AIH have been described for many years. Herein, we report a case of an AIH/primary biliary cholangitis (PBC) overlap syndrome with anti-HAV immunoglobulin M (IgM) false positivity.
CASE SUMMARY A 55-year-old man was admitted with manifestations of anorexia and jaundice along with weakness. He had marked transaminitis and hyperbilirubinemia. Viral serology was positive for HAV IgM and negative for others. Autoantibody screening was positive for anti-mitochondria antibody but negative for others. Abdominal ultrasound imaging was normal. He was diagnosed with acute hepatitis A. After symptomatic treatment, liver function tests gradually recovered. Several months later, his anti-HAV IgM positivity persisted and transaminase and bilirubin levels were also more than 10 times above of the upper limit of normal. Liver histology was prominent, and HAV RNA was negative. Therefore, AIH/primary biliary cholangitis (PBC) overlap syndrome diagnosis was made based on the “Paris Criteria”. The patient was successfully treated by immunosuppression.
CONCLUSION This case highlights that autoimmune diseases or chronic or acute infections, may cause a false-positive anti-HAV IgM result because of cross-reacting antibodies. Therefore, the detection of IgM should not be the only method for the diagnosis of acute HAV infection. HAV nucleic acid amplification tests should be employed to confirm the diagnosis.
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Affiliation(s)
- Jun Yan
- Department of Hepatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China
| | - Yan-Sha He
- Department of Hepatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China
| | - Yi Song
- Department of Hepatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China
| | - Xin-Yu Chen
- Department of Hepatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China
| | - Hua-Bao Liu
- Department of Hepatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China
| | - Chun-Yan Rao
- Department of Hepatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China
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24
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Drummer HE, Van H, Klock E, Zheng S, Wei Z, Boo I, Center RJ, Li F, Bhat P, Ffrench R, Lau JS, McMahon J, Laeyendecker O, Fernandez RE, Manabe YC, Klein SL, Quinn TC, Anderson DA. Dimeric IgA is a specific biomarker of recent SARS-CoV-2 infection. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.06.28.21259671. [PMID: 34230936 PMCID: PMC8259913 DOI: 10.1101/2021.06.28.21259671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Current tests for SARS-CoV-2 antibodies (IgG, IgM, IgA) cannot differentiate recent and past infections. We describe a point of care, lateral flow assay for SARS-CoV-2 dIgA based on the highly selective binding of dIgA to a chimeric form of secretory component (CSC), that distinguishes dIgA from monomeric IgA. Detection of specific dIgA uses a complex of biotinylated SARS-CoV-2 receptor binding domain and streptavidin-colloidal gold. SARS-CoV-2-specific dIgA was measured both in 112 cross-sectional samples and a longitudinal panel of 362 plasma samples from 45 patients with PCR-confirmed SARS-CoV-2 infection, and 193 discrete pre-COVID-19 or PCR-negative patient samples. The assay demonstrated 100% sensitivity from 11 days post-symptom onset, and a specificity of 98.2%. With an estimated half-life of 6.3 days, dIgA provides a unique biomarker for the detection of recent SARS-CoV-2 infections with potential to enhance diagnosis and management of COVID-19 at point-of-care.
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25
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Ramadori G. Albumin Infusion in Critically Ill COVID-19 Patients: Hemodilution and Anticoagulation. Int J Mol Sci 2021; 22:ijms22137126. [PMID: 34281177 PMCID: PMC8268290 DOI: 10.3390/ijms22137126] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/21/2021] [Accepted: 06/28/2021] [Indexed: 02/07/2023] Open
Abstract
Hypercoagulation is one of the major risk factors for ICU treatment, mechanical ventilation, and death in critically ill patients infected with SARS-CoV-2. At the same time, hypoalbuminemia is one risk factor in such patients, independent of age and comorbidities. Especially in patients with severe SARS-CoV-2-infection, albumin infusion may be essential to improve hemodynamics and to reduce the plasma level of the main marker of thromboembolism, namely, the D-dimer plasma level, as suggested by a recent report. Albumin is responsible for 80% of the oncotic pressure in the vessels. This is necessary to keep enough water within the systemic circulatory system and for the maintenance of sufficient blood pressure, as well as for sufficient blood supply for vital organs like the brain, lungs, heart, and kidney. The liver reacts to a decrease in oncotic pressure with an increase in albumin synthesis. This is normally possible through the use of amino acids from the proteins introduced with the nutrients reaching the portal blood. If these are not sufficiently provided with the diet, amino acids are delivered to the liver from muscular proteins by systemic circulation. The liver is also the source of coagulation proteins, such as fibrinogen, fibronectin, and most of the v WF VIII, which are physiological components of the extracellular matrix of the vessel wall. While albumin is the main negative acute-phase protein, fibrinogen, fibronectin, and v WF VIII are positive acute-phase proteins. Acute illnesses cause the activation of defense mechanisms (acute-phase reaction) that may lead to an increase of fibrinolysis and an increase of plasma level of fibrinogen breakdown products, mainly fibrin and D-dimer. The measurement of the plasma level of the D-dimer has been used as a marker for venous thromboembolism, where a fourfold increase of the D-dimer plasma level was used as a negative prognostic marker in critically ill SARS-CoV-2 hospitalized patients. Increased fibrinolysis can take place in ischemic peripheral sites, where the mentioned coagulation proteins can become part of the provisional clot (e.g., in the lungs). Although critically ill SARS-CoV-2-infected patients are considered septic shock patients, albumin infusions have not been considered for hemodynamic resuscitation and as anticoagulants. The role of coagulation factors as provisional components of the extracellular matrix in case of generalized peripheral ischemia due to hypoalbuminemia and hypovolemia is discussed in this review.
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Affiliation(s)
- Giuliano Ramadori
- Internal Medicine University Clinic, University of Göttingen, Göttingen, Germany Robert-Koch-Strasse 40, 37075 Göttingen, Germany
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26
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Comparison of PCR with Serology for Detecting Acute Hepatitis A Virus Infection. JOURNAL OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASES 2021. [DOI: 10.52547/jommid.9.2.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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27
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Schulte-Spechtel U, Berth M, Lauseker-Hao Y, Meyer-Schlinkmann K, Bohnert M, Jochum S, Schuhmann K. Analytical performance evaluation of the Elecsys Epstein-Barr virus immunoassay panel. Diagn Microbiol Infect Dis 2021; 101:115443. [PMID: 34304105 DOI: 10.1016/j.diagmicrobio.2021.115443] [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: 03/02/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 11/27/2022]
Abstract
We evaluated the analytical performance of the Elecsys® Epstein-Barr virus (EBV) immunoassay panel for the in vitro detection of EBV immunoglobulin M (IgM), EBV viral capsid antigen immunoglobulin G (VCA IgG), and EBV nuclear antigen immunoglobulin G (EBNA IgG). Relative sensitivity/specificity were assessed using 1,734 human blood samples (1,068 residual samples from routine EBV testing; 467 presumed acute infection; 199 presumed seronegative) tested with the Elecsys EBV and 2 comparator panels (ARCHITECT EBV; Liaison EBV). EBV infection status was defined by majority approach. The three panels demonstrated comparable relative sensitivities/specificities, ranging between values (%) of 98.3-99.5 / 96.9-97.4 (EBV IgM); 96.3-98.4 / 98.4-98.7 (EBV VCA IgG); and 98.1-99.5 / 99.1-99.5 (EBV EBNA IgG). The Elecsys EBV IgM assay demonstrated superior analytical specificity in samples containing potential interferents. Utilizing the Elecsys EBV panel for the EBNA-first approach showed 97.5% overall agreement versus the majority approach in samples with clear EBV status.
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Affiliation(s)
| | - Mario Berth
- Algemeen Medisch Laboratorium, Antwerp, Belgium
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28
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Documentation of a false positive Lyme disease serologic test in a patient with untreated Babesia microti infection carries implications for accurately determining the frequency of Lyme disease coinfections. Diagn Microbiol Infect Dis 2021; 101:115429. [PMID: 34133997 DOI: 10.1016/j.diagmicrobio.2021.115429] [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: 03/04/2021] [Revised: 04/27/2021] [Accepted: 05/09/2021] [Indexed: 11/20/2022]
Abstract
Although many infections may potentially cause a false positive Borrelia burgdorferi antibody test, particularly for IgM antibody, babesiosis is not regarded as an infection that does this. A patient with untreated babesiosis is described here who developed transient IgM seropositivity for antibodies to B. burgdorferi. Thus, the diagnosis of Lyme disease coinfection in patients with active babesiosis, as in patients with human granulocytic anaplasmosis, is more convincingly accomplished if an objective clinical manifestation of Lyme disease is present, such as an erythema migrans skin lesion.
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29
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Abstract
COVID-19, caused by the SARS-CoV-2 virus, has developed into a global health crisis, causing over 2 million deaths and changing people's daily life the world over. Current main-stream diagnostic methods in the laboratory include nucleic acid PCR tests and direct viral antigen tests for detecting active infections, and indirect human antibody tests specific to SARS-CoV-2 to detect prior exposure. In this Perspective, we briefly describe the PCR and antigen tests and then focus mainly on existing antibody tests and their limitations including inaccuracies and possible causes of unreliability. False negatives in antibody immunoassays can arise from assay formats, selection of viral antigens and antibody types, diagnostic testing windows, individual variance, and fluctuation in antibody levels. Reasons for false positives in antibody immunoassays mainly involve antibody cross-reactivity from other viruses, as well as autoimmune disease. The spectrum bias has an effect on both the false negatives and false positives. For assay developers, not only improvement of assay formats but also selection of viral antigens and isotopes of human antibodies need to be carefully considered to improve sensitivity and specificity. For clinicians, the factors influencing the accuracy of assays must be kept in mind to test patients using currently imperfect but available tests with smart tactics and realistic interpretation of the test results.
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Affiliation(s)
- Guoqiang Liu
- Medical College, Jiaxing
University, 118 Jiahang Road, Jiaxing, Zhejiang Province,
China
- Department of Chemistry, University of
Connecticut, 55 North Eagleville Road, Storrs, Connecticut 06269,
United States
| | - James F. Rusling
- Department of Chemistry, University of
Connecticut, 55 North Eagleville Road, Storrs, Connecticut 06269,
United States
- Department of Surgery and Neag Cancer Center,
UConn Health, Farmington, Connecticut 06232, United
States
- Institute of Materials Science,
University of Connecticut, 97 North Eagleville Road, Storrs,
Connecticut 0626, United States
- School of Chemistry, National University
of Ireland Galway, University Road, Galway,
Ireland
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30
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Alam MA, Hasan MR, Anzar N, Suleman S, Narang J. Diagnostic approaches for the rapid detection of Zika virus–A review. Process Biochem 2021. [DOI: 10.1016/j.procbio.2020.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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31
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Reifert J, Kamath K, Bozekowski J, Lis E, Horn EJ, Granger D, Theel ES, Shon J, Sawyer JR, Daugherty PS. Serum Epitope Repertoire Analysis Enables Early Detection of Lyme Disease with Improved Sensitivity in an Expandable Multiplex Format. J Clin Microbiol 2021; 59:e01836-20. [PMID: 33148704 PMCID: PMC8111119 DOI: 10.1128/jcm.01836-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/27/2020] [Indexed: 12/25/2022] Open
Abstract
Widely employed diagnostic antibody serology for Lyme disease, known as standard two-tier testing (STTT), exhibits insufficient sensitivity in early Lyme disease, yielding many thousands of false-negative test results each year. Given this problem, we applied serum antibody repertoire analysis (SERA), or next-generation sequencing (NGS)-based serology, to discover IgG and IgM antibody epitope motifs capable of detecting Lyme disease-specific antibodies with high sensitivity and specificity. Iterative motif discovery and bioinformatic analysis of epitope repertoires from subjects with Lyme disease (n = 264) and controls (n = 391) yielded a set of 28 epitope motifs representing 20 distinct IgG antibody epitopes and a set of 38 epitope motifs representing 21 distinct IgM epitopes, which performed equivalently in a large validation cohort of STTT-positive samples. In a second validation set from subjects with clinically defined early Lyme disease (n = 119) and controls (n = 257), the SERA Lyme IgG and IgM assay exhibited significantly improved sensitivity relative to STTT (77% versus 62%; Z-test; P = 0.013) and improved specificity (99% versus 97%). Early Lyme disease subjects exhibited significantly fewer reactive epitopes (Mann-Whitney U test; P < 0.0001) relative to subjects with Lyme arthritis. Thus, SERA Lyme IgG and M panels provided increased accuracy in early Lyme disease in a readily expandable multiplex assay format.
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Affiliation(s)
| | | | | | - Ewa Lis
- Serimmune Inc., Goleta, California, USA
| | | | - Dane Granger
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester Minnesota, USA
| | - Elitza S Theel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester Minnesota, USA
| | - John Shon
- Serimmune Inc., Goleta, California, USA
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32
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Springer A, Glass A, Probst J, Strube C. Tick-borne zoonoses and commonly used diagnostic methods in human and veterinary medicine. Parasitol Res 2021; 120:4075-4090. [PMID: 33459849 PMCID: PMC8599405 DOI: 10.1007/s00436-020-07033-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/21/2020] [Indexed: 12/20/2022]
Abstract
Around the world, human health and animal health are closely linked in terms of the One Health concept by ticks acting as vectors for zoonotic pathogens. Animals do not only maintain tick cycles but can either be clinically affected by the same tick-borne pathogens as humans and/or play a role as reservoirs or sentinel pathogen hosts. However, the relevance of different tick-borne diseases (TBDs) may vary in human vs. veterinary medicine, which is consequently reflected by the availability of human vs. veterinary diagnostic tests. Yet, as TBDs gain importance in both fields and rare zoonotic pathogens, such as Babesia spp., are increasingly identified as causes of human disease, a One Health approach regarding development of new diagnostic tools may lead to synergistic benefits. This review gives an overview on zoonotic protozoan, bacterial and viral tick-borne pathogens worldwide, discusses commonly used diagnostic techniques for TBDs, and compares commercial availability of diagnostic tests for humans vs. domestic animals, using Germany as an example, with the aim of highlighting existing gaps and opportunities for collaboration in a One Health framework.
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Affiliation(s)
- Andrea Springer
- Institute for Parasitology, Centre for Infection Medicine, University of Veterinary Medicine Hannover, Buenteweg 17, 30559, Hanover, Germany
| | - Antje Glass
- Institute for Parasitology, Centre for Infection Medicine, University of Veterinary Medicine Hannover, Buenteweg 17, 30559, Hanover, Germany
| | - Julia Probst
- Institute for Parasitology, Centre for Infection Medicine, University of Veterinary Medicine Hannover, Buenteweg 17, 30559, Hanover, Germany
| | - Christina Strube
- Institute for Parasitology, Centre for Infection Medicine, University of Veterinary Medicine Hannover, Buenteweg 17, 30559, Hanover, Germany.
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33
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Péré H, Mboumba Bouassa RS, Tonen-Wolyec S, Podglajen I, Veyer D, Bélec L. Analytical performances of five SARS-CoV-2 whole-blood finger-stick IgG-IgM combined antibody rapid tests. J Virol Methods 2021; 290:114067. [PMID: 33476707 PMCID: PMC7813505 DOI: 10.1016/j.jviromet.2021.114067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/12/2020] [Accepted: 01/12/2021] [Indexed: 12/18/2022]
Abstract
Facing the ongoing pandemic caused by SARS-CoV-2, there is an urgent need for serological assays identifying individuals previously infected by coronavirus disease 2019 (COVID-19), including rapid diagnostic tests (RDTs). We herein compared five new CE-IVD-labeled commercially available SARS-CoV-2 whole-blood finger-stick IgG/IgM combined RDTs, in parallel according to the manufacturers’ instructions, with two serum panels obtained from 48 patients with confirmed COVID-19 (panel I) and from a group of 52 patients randomly selected, for whom serum samples collected before the COVID-19 epidemic (from October 1 to November 30, 2019) were negative for SARS-CoV-2 IgG (panel II). We found a sensitivity of 95.8 %, 91.6 %, 92.3 %, 97.9 % and 91.4 %, and a specificity of 98.1 %, 86.5 %, 100 %, 98.1 % and 84.6 %, for BIOSYNEX COVID-19 BSS (IgG/IgM) (Biosynex Swiss SA, Freiburg, Switzerland), Humasis COVID-19 IgG/IgM Test (Humasis Co., Ltd., Gyneonggi, Republic of Korea), LYHER COVID-19 IgM/IgG Rapid Test (Medakit Ltd, Hong Kong, China), SIENNA™ COVID-19 (IgG/IgM) Rapid Test Cassette (Salofa Oy, Salo, Finland) and NG-BIOTECH COVID-19 (IgG/IgM) (NG-Biotech, Guipry, France), respectively. Commercially available SARS-CoV-2 IgG/IgM combined RDTs have a sufficient sensitivity for identifying individuals with past SARS-CoV-2 infection, but some RDTs may lack of specificity, with risk of false positivity mainly for the IgM band.
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Affiliation(s)
- Hélène Péré
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM U970, PARCC, Hôpital Européen Georges Pompidou, Faculté de Médecine, Centre Université de Paris, Paris, France; Service de Microbiologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Sorbonne Paris Cité, Paris, France
| | - Ralph-Sydney Mboumba Bouassa
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; Ecole Doctorale Régionale D'Afrique Centrale en Infectiologie Tropicale, Franceville, Gabon
| | - Serge Tonen-Wolyec
- Ecole Doctorale Régionale D'Afrique Centrale en Infectiologie Tropicale, Franceville, Gabon; Faculty of Medicine and Pharmacy, University of Kisangani, Kisangani, the Democratic Republic of the Congo
| | - Isabelle Podglajen
- Service de Microbiologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Sorbonne Paris Cité, Paris, France
| | - David Veyer
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; Service de Microbiologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurent Bélec
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; Service de Microbiologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Sorbonne Paris Cité, Paris, France.
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34
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Humble RM, Merrill AE, Ford BA, Diekema DJ, Krasowski MD. Practical Considerations for Implementation of SARS-CoV-2 Serological Testing in the Clinical Laboratory: Experience at an Academic Medical Center. Acad Pathol 2021; 8:23742895211002802. [PMID: 33889715 PMCID: PMC8040556 DOI: 10.1177/23742895211002802] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 01/16/2021] [Accepted: 02/06/2021] [Indexed: 12/19/2022] Open
Abstract
Molecular techniques, especially reverse transcriptase polymerase chain reaction (RT-PCR), have been the gold standard for the diagnosis of acute severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Serological tests for SARS-CoV-2 have been widely used for serosurveys, epidemiology, and identification of potential convalescent plasma donors. However, the clinical role of serologic testing is still limited and evolving. In this report, we describe the experience of selecting, validating, and implementing SARS-CoV-2 serologic testing for clinical purposes at an academic medical center in a rural state. Successful implementation involved close collaboration between pathology, infectious diseases, and outpatient clinics. The most common clinician concerns were appropriateness/utility of testing, patient charges/insurance coverage, and assay specificity. In analyzing test utilization, serologic testing in the first month after go-live was almost entirely outpatient and appeared to be strongly driven by patient interest (including health care workers and others in high-risk occupations for exposure to SARS-CoV-2), with little evidence that the results impacted clinical decision-making. Test volumes for serology declined steadily through October 31, 2020, with inpatient ordering assuming a steadily higher percentage of the total. In a 5-month period, SARS-CoV-2 serology test volumes amounted to only 1.3% of that of reverse transcriptase polymerase chain reaction. Unlike reverse transcriptase polymerase chain reaction, supply chain challenges and reagent availability were not major issues for serology testing. We also discuss the most recent challenge of requirements for SARS-CoV-2 testing in international travel protocols. Overall, our experience at an academic medical center shows that SARS-CoV-2 serology testing assumed a limited clinical role.
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Affiliation(s)
- Robert M. Humble
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Anna E. Merrill
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Bradley A. Ford
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Daniel J. Diekema
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Matthew D. Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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35
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Imborek KL, Krasowski MD, Natvig P, Merrill AE, Diekema DJ, Ford BA. Experience With Pretravel Testing for SARS-CoV-2 at an Academic Medical Center. Acad Pathol 2021; 8:23742895211010247. [PMID: 33997275 PMCID: PMC8110896 DOI: 10.1177/23742895211010247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/16/2021] [Accepted: 03/21/2021] [Indexed: 12/13/2022] Open
Abstract
International travel has been a significant factor in the coronavirus disease 2019 pandemic. Many countries and airlines have implemented travel restrictions to limit the spread of the causative agent, severe acute respiratory syndrome coronavirus-2. A common requirement has been a negative reverse-transcriptase polymerase chain reaction performed by a clinical laboratory within 48 to 72 hours of departure. A more recent travel mandate for severe acute respiratory syndrome coronavirus-2 immunoglobulin M serology testing was instituted by the Chinese government on October 29, 2020. Pretravel testing for severe acute respiratory syndrome coronavirus-2 raises complications in terms of cost, turnaround time, and follow-up of positive results. In this report, we describe the experience of a multidisciplinary collaboration to develop a workflow for pretravel severe acute respiratory syndrome coronavirus-2 reverse-transcriptase polymerase chain reaction and immunoglobulin M serology testing at an academic medical center. The workflow primarily involved self-payment by patients and preferred retrieval of results by the patient through the electronic health record patient portal (Epic MyChart). A total of 556 unique patients underwent pretravel reverse-transcriptase polymerase chain reaction testing, with 13 (2.4%) having one or more positive results, a rate similar to that for reverse-transcriptase polymerase chain reaction testing performed for other protocol-driven asymptomatic screening (eg, inpatient admissions, preprocedural) at our medical center. For 5 of 13 reverse-transcriptase polymerase chain reaction positive samples, the traveler had clinical history, prior reverse-transcriptase polymerase chain reaction positive, and high cycle thresholds values on pretravel testing consistent with remote infection and minimal transmission risk. Severe acute respiratory syndrome coronavirus-2 immunoglobulin M was performed on only 24 patients but resulted in 2 likely false positives. Overall, our experience at an academic medical center shows the challenge with pretravel severe acute respiratory syndrome coronavirus-2 testing.
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Affiliation(s)
- Katherine L. Imborek
- Department of Family Medicine, University of Iowa Hospitals and
Clinics, IA, USA
| | | | - Paul Natvig
- Division of Student Life, Student Health, University of Iowa, IA,
USA
| | - Anna E. Merrill
- Department of Pathology, University of Iowa Hospitals and
Clinics, IA, USA
| | - Daniel J. Diekema
- Department of Pathology, University of Iowa Hospitals and
Clinics, IA, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Hospitals and
Clinics, IA, USA
| | - Bradley A. Ford
- Department of Pathology, University of Iowa Hospitals and
Clinics, IA, USA
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36
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Matsuda Y, Hiramitsu T, Li XK, Watanabe T. Characteristics of Immunoglobulin M Type Antibodies of Different Origins from the Immunologic and Clinical Viewpoints and Their Application in Controlling Antibody-Mediated Allograft Rejection. Pathogens 2020; 10:pathogens10010004. [PMID: 33374617 PMCID: PMC7822424 DOI: 10.3390/pathogens10010004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/19/2020] [Accepted: 12/20/2020] [Indexed: 12/25/2022] Open
Abstract
Antibody-mediated allograft rejection (AMR) hinders patient prognosis after organ transplantation. Current studies concerning AMR have mainly focused on the diagnostic value of immunoglobulin G (IgG)-type donor-specific antihuman leukocyte antigen antibodies (DSAs), primarily because of their antigen specificity, whereas the clinical significance of immunoglobulin M (IgM)-type DSAs has not been thoroughly investigated in the context of organ transplantation because of their nonspecificity against antigens. Although consensus regarding the clinical significance and role of IgM antibodies is not clear, as discussed in this review, recent findings strongly suggest that they also have a huge potential in novel diagnostic as well as therapeutic application for the prevention of AMR. Most serum IgM antibodies are known to comprise natural antibodies with low affinity toward antigens, and this is derived from B-1 cells (innate B cells). However, some of the serum IgM-type antibodies reportedly also produced by B-2 cells (conventional B cells). The latter are known to have a high affinity for donor-specific antigens. In this review, we initially discuss how IgM-type antibodies of different origins participate in the pathology of various diseases, directly or through cell surface receptors, complement activation, or cytokine production. Then, we discuss the clinical applicability of B-1 and B-2 cell-derived IgM-type antibodies for controlling AMR with reference to the involvement of IgM antibodies in various pathological conditions.
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Affiliation(s)
- Yoshiko Matsuda
- Division of Transplant Immunology, National Research Institute for Child Health and Development, Tokyo 157-8535, Japan;
- Department of Advanced Technology for Transplantation, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
- Correspondence:
| | - Takahisa Hiramitsu
- Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross-Hospital, Aichi 466-8650, Japan;
| | - Xiao-kang Li
- Division of Transplant Immunology, National Research Institute for Child Health and Development, Tokyo 157-8535, Japan;
| | - Takeshi Watanabe
- Laboratory of Immunology, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto 606-8507, Japan;
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Xu G, Emanuel AJ, Nadig S, Mehrotra S, Caddell BA, Curry SR, Nolte FS, Babic N. Evaluation of Orthogonal Testing Algorithm for Detection of SARS-CoV-2 IgG Antibodies. Clin Chem 2020; 66:1531-1537. [PMID: 32894753 PMCID: PMC7499512 DOI: 10.1093/clinchem/hvaa210] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/27/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody testing is an important tool in assessment of pandemic progress, contact tracing, and identification of recovered coronavirus disease 2019 (COVID-19) patients. We evaluated an orthogonal testing algorithm (OTA) to improve test specificity in these use cases. METHODS A two-step OTA was applied where individuals who initially tested positive were tested with a second test. The first-line test, detecting IgG antibodies to the viral nucleocapsid protein, was validated in 130 samples and the second-line test, detecting IgG antibodies to the viral spike protein in 148 samples. The OTA was evaluated in 4333 clinical patient specimens. The seropositivity rates relative to the SARS-CoV-2 PCR positivity rates were evaluated from our entire patient population data (n = 5102). RESULTS The first-line test resulted in a clinical sensitivity of 96.4% (95% CI; 82.3% to 99.4%), and specificity of 99.0% (95% CI; 94.7% to 99.8%), whereas the second-line test had a sensitivity of 100% (95% CI; 87.1% to 100%) and specificity of 98.4% (95% CI; 94.2% to 99.5%). Using the OTA, 78/98 (80%) of initially positive SARS-CoV-2 IgG results were confirmed with a second-line test, while 11/42 (26%) of previously diagnosed COVID-19 patients had no detectable antibodies as long as 94 days post PCR diagnosis. CONCLUSION Our results show that an OTA can be used to identify patients who require further follow-up due to potential SARS CoV-2 IgG false positive results. In addition, serological testing may not be sufficiently sensitive to reliably detect prior COVID-19 infection.
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Affiliation(s)
- Gang Xu
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC
| | - Anthony J Emanuel
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC
| | - Satish Nadig
- Department of Surgery, Microbiology and Immunology, Medical University of South Carolina, Charleston, SC
| | - Shikhar Mehrotra
- Department of Surgery, Microbiology and Immunology, Medical University of South Carolina, Charleston, SC
| | - Brittany A Caddell
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC
| | - Scott R Curry
- Division of Infectious Diseases, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Frederick S Nolte
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC
| | - Nikolina Babic
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC
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Stieber F, Howard J, Rao SN, Kawamura LM, Manissero D, Love J, Yang M, Uchiyama R, Parsons S, Miller C, Douwes H, McDonald A, Fairburn L, Boyle J. First performance report of QIAreach™ Anti-SARS-CoV-2 Total Test, an innovative nanoparticle fluorescence digital detection platform. J Clin Virol 2020; 133:104681. [PMID: 33160178 PMCID: PMC7833412 DOI: 10.1016/j.jcv.2020.104681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 12/23/2022]
Abstract
In 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a global pandemic. Disease diagnosis, appropriate clinical management and infection control are all important factors in controlling the spread of SARS-CoV-2. The QIAreach™ Anti-SARS-CoV-2 Total Test (Anti-CoV2) is a rapid, qualitative serological test, using proprietary nanoparticle fluorescence technology to detect total antibody (IgA, IgM, and IgG) against SARS-CoV-2. Here we report the results of the US Food and Drug Administration (FDA) clinical agreement study. Thirty positive plasma or serum samples were taken from consenting individuals with polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection ≥14 days from symptom onset. Seventy-five samples from before the believed circulation of SARS-CoV-2 (November 1, 2019) were used to assess specificity. Positive percent agreement (PPA) and negative percent agreement (NPA) were calculated along with the corresponding exact two-sided 95 % confidence intervals (CI) using an FDA Emergency Use Authorized PCR test as the reference method. Anti-CoV2 was shown to have 100 % sensitivity (PPA; 95 % CI 88.4-100 %) and 100 % specificity (NPA; 95 % CI 95.2-100 %). Against 157 pre-pandemic samples, no cross-reactivity was observed with seasonal coronaviruses or other respiratory pathogens tested. Additionally, no interference was observed when samples were spiked with: conjugated bilirubin 0.4 mg/ml; unconjugated bilirubin 0.4 mg/ml; hemoglobin 5 mg/ml; prednisolone 0.12 mg/ml; triglycerides 15 mg/ml. In conclusion, Anti-CoV2 provides accurate qualitative detection of total antibodies against SARS-CoV-2.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Sean Parsons
- Ellume Limited, East Brisbane, Queensland, Australia
| | - Chris Miller
- Ellume Limited, East Brisbane, Queensland, Australia
| | | | | | - Luke Fairburn
- Ellume Limited, East Brisbane, Queensland, Australia
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Singh T, Heston SM, Langel SN, Blasi M, Hurst JH, Fouda GG, Kelly MS, Permar SR. Lessons From COVID-19 in Children: Key Hypotheses to Guide Preventative and Therapeutic Strategies. Clin Infect Dis 2020; 71:2006-2013. [PMID: 32382748 PMCID: PMC7239258 DOI: 10.1093/cid/ciaa547] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/05/2020] [Indexed: 12/22/2022] Open
Abstract
The current pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), reveals a peculiar trend of milder disease and lower case fatality in children compared with adults. Consistent epidemiologic evidence of reduced severity of infection in children across different populations and countries suggests there are underlying biological differences between children and adults that mediate differential disease pathogenesis. This presents a unique opportunity to learn about disease-modifying host factors from pediatric populations. Our review summarizes the current knowledge of pediatric clinical disease, role in transmission, risks for severe disease, protective immunity, as well as novel therapies and vaccine trials for children. We then define key hypotheses and areas for future research that can use the pediatric model of disease, transmission, and immunity to develop preventive and therapeutic strategies for people of all age groups.
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Affiliation(s)
- Tulika Singh
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, USA.,Department of Molecular Genetics and Microbiology, Duke University, Durham, North Carolina, USA.,Duke Children's Health and Discovery Initiative, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sarah M Heston
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Stephanie N Langel
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, USA.,Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Maria Blasi
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, USA.,Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Jillian H Hurst
- Duke Children's Health and Discovery Initiative, Duke University School of Medicine, Durham, North Carolina, USA.,Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Genevieve G Fouda
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, USA.,Department of Molecular Genetics and Microbiology, Duke University, Durham, North Carolina, USA.,Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Matthew S Kelly
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Sallie R Permar
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, USA.,Department of Molecular Genetics and Microbiology, Duke University, Durham, North Carolina, USA.,Duke Children's Health and Discovery Initiative, Duke University School of Medicine, Durham, North Carolina, USA.,Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
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Mboumba Bouassa RS, Péré H, Tonen-Wolyec S, Longo JDD, Moussa S, Mbopi-Keou FX, Mossoro-Kpinde CD, Grésenguet G, Veyer D, Bélec L. Unexpected high frequency of unspecific reactivities by testing pre-epidemic blood specimens from Europe and Africa with SARS-CoV-2 IgG-IgM antibody rapid tests points to IgM as the Achilles heel. J Med Virol 2020; 93:2196-2203. [PMID: 33107601 DOI: 10.1002/jmv.26628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/12/2020] [Accepted: 10/23/2020] [Indexed: 12/15/2022]
Abstract
We aimed to evaluate the rates of false-positive test results of three rapid diagnostic tests (RDTs) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific immunoglobulin G (IgG) and IgM detection. Two serum panels from patients hospitalized in Paris, France, and from patients living in Bangui, Central African Republic, acquired before the 2019 COVID-19 outbreak, were tested by 3 CE IVD-labeled RDTs for SARS-CoV-2 serology (BIOSYNEX® COVID-19 BSS [IgG/IgM]; SIENNA™ COVID-19 IgG/IgM Rapid Test Cassette; NG-Test® IgG-IgM COVID-19). Detectable IgG or IgM reactivities could be observed in 31 (3.43%) of the 902 IgG and IgM bands of the 3 RDTs used with all pre-epidemic sera. The frequencies of IgG/IgM reactivities were similar for European (3.20%) and African (3.55%) sera. IgM reactivities were observed in 9 European and 14 African sera, while IgG reactivity was observed in only 1 African serum (15.1% vs. 0.66%). The test NG-Test® IgG-IgM COVID-19 showed the highest rates of IgG or IgM reactivities (6.12% [18/294]), while the test BIOSYNEX® COVID-19 BSS (IgG/IgM) showed the lowest rate (1.36% [4/294]). Some combinations of 2 RDTs in series allowed decreasing significantly the risk of false-positive test results. Our observations point to the risk of false-positive reactivities when using currently available RDT for SARS-CoV-2 serological screening, especially for the IgM band, even if the test is CE IVD-labeled and approved by national health authorities, and provide the rational basis for confirmatory testing by another RDT in case of positive initial screening.
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Affiliation(s)
- Ralph-Sydney Mboumba Bouassa
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,Ecole Doctorale Régionale D'Afrique Centrale en Infectiologie Tropicale, Franceville, Gabon
| | - Hélène Péré
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Sorbonne Paris Cité, INSERM U970, PARCC, Paris, France
| | - Serge Tonen-Wolyec
- Ecole Doctorale Régionale D'Afrique Centrale en Infectiologie Tropicale, Franceville, Gabon.,Faculty of Medicine and Pharmacy, University of Kisangani, Kisangani, Democratic Republic of the Congo
| | - Jean De Dieu Longo
- Centre National des Maladies Sexuellement Transmissibles et du SIDA of Bangui, Bangui, Central African Republic.,Faculté des Sciences de la Santé, Université de Bangui, Bangui, Central African Republic
| | - Sandrine Moussa
- Institut Pasteur de Bangui, Bangui, Central African Republic
| | - Francois-Xavier Mbopi-Keou
- The University of Yaounde I, Yaounde, Cameroon.,The Institute for the Development of Africa (The-IDA), Yaounde, Cameroon.,UNAIDS Scientific and Technical Advisory Committee (STAC) and The Board of Health Innovation Exchange, Geneva, Switzerland
| | - Christian Diamant Mossoro-Kpinde
- Faculté des Sciences de la Santé, Université de Bangui, Bangui, Central African Republic.,Laboratoire National de Biologie Clinique et de Santé Publique, Bangui, Central African Republic
| | - Gérard Grésenguet
- Faculté des Sciences de la Santé, Université de Bangui, Bangui, Central African Republic
| | - David Veyer
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurent Bélec
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Sorbonne Paris Cité, INSERM U970, PARCC, Paris, France
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A high-throughput Anti-SARS-CoV-2 IgG testing platform for COVID-19. J Virol Methods 2020; 287:114009. [PMID: 33152411 PMCID: PMC7605757 DOI: 10.1016/j.jviromet.2020.114009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Serology tests for detecting the antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can identify previous infection and help to confirm the presence of current infection. OBJECTIVE The aim of this study was to evaluate the performances of a newly developed high throughput immunoassay for anti-SARS-CoV-2 IgG antibody detection. RESULTS Clinical agreement studies were performed in 107 COVID-19 patient serum samples and 226 negative donor serum/plasma samples. Positive percent agreement (PPA) was 46.15 % (95 % CI: 19.22 % ∼74.87 %), 61.54 % (95 % CI: 31.58 % ∼86.14 %), and 97.53 % (95 % CI: 91.36 % ∼99.70 %) for samples collected on 0-7 days, 8-14 days, and ≥15 days from symptom onset, respectively. Negative Percent Agreement (NPA) was 98.23 % (95 % CI: 95.53 % ∼99.52 %). No cross-reactivity was observed to patient samples positive for IgG antibodies against the following pathogens: HIV, HAV, HBV, RSV, CMV, EBV, Rubella, Influenza A, and Influenza B. Hemoglobin (200 mg/dL), bilirubin (2 mg/dL) and EDTA (10 mM) showed no significant interfering effect on this assay. CONCLUSION An anti-SARS-CoV-2 IgG antibody assay with high sensitivity and specificity has been developed. With the high throughput, this assay will speed up anti-SARS-CoV-2 IgG testing.
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Williams KM, Wang H, Paulsen MJ, Thakore AD, Rieck M, Lucian HJ, Grady F, Hironaka CE, Chien AJ, Farry JM, Shin HS, Jaatinen KJ, Eskandari A, Stapleton LM, Steele AN, Cohen JE, Woo YJ. Safety of photosynthetic Synechococcus elongatus for in vivo cyanobacteria-mammalian symbiotic therapeutics. Microb Biotechnol 2020; 13:1780-1792. [PMID: 32476224 PMCID: PMC7533327 DOI: 10.1111/1751-7915.13596] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/10/2020] [Accepted: 04/30/2020] [Indexed: 12/12/2022] Open
Abstract
The cyanobacterium Synechococcus elongatus (SE) has been shown to rescue ischaemic heart muscle after myocardial infarction by photosynthetic oxygen production. Here, we investigated SE toxicity and hypothesized that systemic SE exposure does not elicit a significant immune response in rats. Wistar rats intravenously received SE (n = 12), sterile saline (n = 12) or E. coli lipopolysaccharide (LPS, n = 4), and a subset (8 SE, 8 saline) received a repeat injection 4 weeks later. At baseline, 4 h, 24 h, 48 h, 8 days and 4 weeks after injection, clinical assessments, blood cultures, blood counts, lymphocyte phenotypes, liver function tests, proinflammatory cytokines and immunoglobulins were assessed. Across all metrics, SE rats responded comparably to saline controls, displaying no clinically significant immune response. As expected, LPS rats exhibited severe immunological responses. Systemic SE administration does not induce sepsis or toxicity in rats, thereby supporting the safety of cyanobacteria-mammalian symbiotic therapeutics using this organism.
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Affiliation(s)
- Kiah M. Williams
- Department of Cardiothoracic SurgeryStanford University300 Pasteur Drive, Falk Cardiovascular Research BuildingStanfordCA94305USA
| | - Hanjay Wang
- Department of Cardiothoracic SurgeryStanford University300 Pasteur Drive, Falk Cardiovascular Research BuildingStanfordCA94305USA
| | - Michael J. Paulsen
- Department of Cardiothoracic SurgeryStanford University300 Pasteur Drive, Falk Cardiovascular Research BuildingStanfordCA94305USA
| | - Akshara D. Thakore
- Department of Cardiothoracic SurgeryStanford University300 Pasteur Drive, Falk Cardiovascular Research BuildingStanfordCA94305USA
| | - Mary Rieck
- Beckman Center for Molecular and Genetic MedicineStanford UniversityStanfordCAUSA
| | - Haley J. Lucian
- Department of Cardiothoracic SurgeryStanford University300 Pasteur Drive, Falk Cardiovascular Research BuildingStanfordCA94305USA
| | - Frederick Grady
- Department of Cardiothoracic SurgeryStanford University300 Pasteur Drive, Falk Cardiovascular Research BuildingStanfordCA94305USA
| | - Camille E. Hironaka
- Department of Cardiothoracic SurgeryStanford University300 Pasteur Drive, Falk Cardiovascular Research BuildingStanfordCA94305USA
| | - Athena J. Chien
- Department of Cardiothoracic SurgeryStanford University300 Pasteur Drive, Falk Cardiovascular Research BuildingStanfordCA94305USA
| | - Justin M. Farry
- Department of Cardiothoracic SurgeryStanford University300 Pasteur Drive, Falk Cardiovascular Research BuildingStanfordCA94305USA
| | - Hye Sook Shin
- Department of Cardiothoracic SurgeryStanford University300 Pasteur Drive, Falk Cardiovascular Research BuildingStanfordCA94305USA
| | - Kevin J. Jaatinen
- Department of Cardiothoracic SurgeryStanford University300 Pasteur Drive, Falk Cardiovascular Research BuildingStanfordCA94305USA
| | - Anahita Eskandari
- Department of Cardiothoracic SurgeryStanford University300 Pasteur Drive, Falk Cardiovascular Research BuildingStanfordCA94305USA
| | - Lyndsay M. Stapleton
- Department of Cardiothoracic SurgeryStanford University300 Pasteur Drive, Falk Cardiovascular Research BuildingStanfordCA94305USA
- Department of BioengineeringStanford UniversityStanfordCAUSA
| | - Amanda N. Steele
- Department of Cardiothoracic SurgeryStanford University300 Pasteur Drive, Falk Cardiovascular Research BuildingStanfordCA94305USA
- Department of BioengineeringStanford UniversityStanfordCAUSA
| | - Jeffrey E. Cohen
- Department of Cardiothoracic SurgeryStanford University300 Pasteur Drive, Falk Cardiovascular Research BuildingStanfordCA94305USA
| | - Y. Joseph Woo
- Department of Cardiothoracic SurgeryStanford University300 Pasteur Drive, Falk Cardiovascular Research BuildingStanfordCA94305USA
- Department of BioengineeringStanford UniversityStanfordCAUSA
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Nierhaus A, Berlot G, Kindgen-Milles D, Müller E, Girardis M. Best-practice IgM- and IgA-enriched immunoglobulin use in patients with sepsis. Ann Intensive Care 2020; 10:132. [PMID: 33026597 PMCID: PMC7538847 DOI: 10.1186/s13613-020-00740-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 09/06/2020] [Indexed: 12/20/2022] Open
Abstract
Background Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Despite treatment being in line with current guidelines, mortality remains high in those with septic shock. Intravenous immunoglobulins represent a promising therapy to modulate both the pro- and anti-inflammatory processes and can contribute to the elimination of pathogens. In this context, there is evidence of the benefits of immunoglobulin M (IgM)- and immunoglobulin A (IgA)-enriched immunoglobulin therapy for sepsis. This manuscript aims to summarize current relevant data to provide expert opinions on best practice for the use of an IgM- and IgA-enriched immunoglobulin (Pentaglobin) in adult patients with sepsis. Main text Sepsis patients with hyperinflammation and patients with immunosuppression may benefit most from treatment with IgM- and IgA-enriched immunoglobulin (Pentaglobin). Patients with hyperinflammation present with phenotypes that manifest throughout the body, whilst the clinical characteristics of immunosuppression are less clear. Potential biomarkers for hyperinflammation include elevated procalcitonin, interleukin-6, endotoxin activity and C-reactive protein, although thresholds for these are not well-defined. Convenient biomarkers for identifying patients in a stage of immune-paralysis are still matter of debate, though human leukocyte antigen–antigen D related expression on monocytes, lymphocyte count and viral reactivation have been proposed. The timing of treatment is potentially more critical for treatment efficacy in patients with hyperinflammation compared with patients who are in an immunosuppressed stage. Due to the lack of evidence, definitive dosage recommendations for either population cannot be made, though we suggest that patients with hyperinflammation should receive an initial bolus at a rate of up to 0.6 mL (30 mg)/kg/h for 6 h followed by a continuous maintenance rate of 0.2 mL (10 mg)/kg/hour for ≥ 72 h (total dose ≥ 0.9 g/kg). For immunosuppressed patients, dosage is more conservative (0.2 mL [10 mg]/kg/h) for ≥ 72 h, without an initial bolus (total dose ≥ 0.72 g/kg). Conclusions Two distinct populations that may benefit most from Pentaglobin therapy are described in this review. However, further clinical evidence is required to strengthen support for the recommendations given here regarding timing, duration and dosage of treatment.
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Affiliation(s)
- Axel Nierhaus
- University Medical Center Hamburg, Hamburg, Germany. .,Dep. of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Plebani M, Padoan A, Negrini D, Carpinteri B, Sciacovelli L. Diagnostic performances and thresholds: The key to harmonization in serological SARS-CoV-2 assays? Clin Chim Acta 2020; 509:1-7. [PMID: 32485157 PMCID: PMC7261100 DOI: 10.1016/j.cca.2020.05.050] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The evaluation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) specific antibody (Ab) assay performances is of the utmost importance in establishing and monitoring virus spread in the community. In this study focusing on IgG antibodies, we compare reliability of three chemiluminescent (CLIA) and two enzyme linked immunosorbent (ELISA) assays. METHODS Sera from a total of 271 subjects, including 64 reverse transcription-polymerase chain reaction (RT-PCR) confirmed SARS-CoV-2 patients were tested for specific Ab using Maglumi (Snibe), Liaison (Diasorin), iFlash (Yhlo), Euroimmun (Medizinische Labordiagnostika AG) and Wantai (Wantai Biological Pharmacy) assays. Diagnostic sensitivity and specificity, positive and negative likelihood ratios were evaluated using manufacturers' and optimized thresholds. RESULTS Optimized thresholds (Maglumi 2 kAU/L, Liaison 6.2 kAU/L and iFlash 15.0 kAU/L) allowed us to achieve a negative likelihood ratio and an accuracy of: 0.06 and 93.5% for Maglumi; 0.03 and 93.1% for Liaison; 0.03 and 91% for iFlash. Diagnostic sensitivities and specificities were above 93.8% and 85.9%, respectively for all CLIA assays. Overall agreement was 90.3% (Cohen's kappa = 0.805 and SE = 0.041) for CLIA, and 98.4% (Cohen's kappa = 0.962 and SE = 0.126) for ELISA. CONCLUSIONS The results obtained indicate that, for CLIA assays, it might be possible to define thresholds that improve the negative likelihood ratio. Thus, a negative test result enables the identification of subjects at risk of being infected, who should then be closely monitored over time with a view to preventing further viral spread. Redefined thresholds, in addition, improved the overall inter-assay agreement, paving the way to a better harmonization of serologic tests.
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Affiliation(s)
- Mario Plebani
- Department of Laboratory Medicine, University Hospital of Padova, Italy; Department of Medicine-DIMED, University of Padova, Italy.
| | - Andrea Padoan
- Department of Laboratory Medicine, University Hospital of Padova, Italy; Department of Medicine-DIMED, University of Padova, Italy
| | - Davide Negrini
- Department of Medicine-DIMED, University of Padova, Italy
| | | | - Laura Sciacovelli
- Department of Laboratory Medicine, University Hospital of Padova, Italy
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Mahmood R, Mohamed K, Saeed N, Al-Banaa K, Zimmerman J, Big C. The vagaries of IgM: a case report of EBV infection with concomitantly false-positive IgM for CMV, VZV, and HSV. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2020. [DOI: 10.1186/s43162-020-00006-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Serum IgM (immunoglobulin M) testing is commonly used to diagnose acute viral infections. However, most clinicians are unaware of the vagaries of IgM testing, including antigenic cross-reactivity between multiple viruses and risk misdiagnosis.
Case presentation
We report a case of infectious mononucleosis with concomitantly positive IgM for EBV, CMV, VZV, and HSV.
A 26-year-old man presented with acute infectious mononucleosis picture. His blood work showed a total bilirubin level of 7.7 mg/dl, ALT 1077 U/L, AST 806 U/L, ALP 325 U/L, and INR 1.0. Monospot was positive; peripheral blood smear showed atypical lymphocytes; however, because EBV infectious mononucleosis does not typically cause elevation of liver enzymes over 1000, other etiologies were explored. Tests for hepatitis A, B, C, HIV, ANA, and ASMA returned negative. IgM for EBV-VCA, CMV, HSV, and VZV all returned positive, and the diagnosis of EBV IM was called into question. Subsequent tests of CMV and HSV PCR for viral load were negative (VZV was not clinically suspected), and later on, EBV-EBNA returned negative and EBV-VCA IgM and IgG returned positive, confirming the diagnosis of acute EBV infection.
Conclusion
We believe that IgM seropositivity can result from cross-reactivity among several viruses (especially herpes viruses), and although often relied on, a positive IgM should not serve as the sole determinant for diagnosis of acute viral infections.
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Osbak KK, Tsoumanis A, De Baetselier I, Van Esbroek M, Smet H, Kenyon CR, Crucitti T. Role of IgM testing in the diagnosis and post-treatment follow-up of syphilis: a prospective cohort study. BMJ Open 2020; 10:e035838. [PMID: 32958482 PMCID: PMC7507855 DOI: 10.1136/bmjopen-2019-035838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The diagnosis of repeat syphilis and its follow-up remains challenging. We aimed to investigate if IgM testing may assist in the diagnosis of syphilis reinfection/relapse and its treatment follow-up. METHODS This substudy was conducted in the context of a syphilis biomarker discovery study (ClinicalTrials.gov Nr: NCT02059525). Sera were collected from 120 individuals with a new diagnosis of syphilis (72 with repeat infections) and 30 syphilis negative controls during a cohort study investigating syphilis biomarkers conducted at a sexually transmitted infection/HIV clinic in Antwerp, Belgium. Syphilis was diagnosed based on a simultaneous positive treponemal and non-treponemal assay result and/or positive serum PCR targeting polA. Specimens collected at visit of diagnosis, and 3 and 6 months post-treatment were tested by two enzyme immunoassays (EIAs), recomWell (Mikrogen; MI) and Euroimmun (EU), to detect anti-treponemal IgM. Baseline specimens were also tested for anti-treponemal IgM using a line immunoassay (LIA) recomLine (MI). Quantitative kinetic decay curves were constructed from the longitudinal quantitative EIA results. RESULTS An overall sensitivity for the diagnosis of syphilis of 59.8% (95% CI: 50.3%-68.7%), 75.0% (95% CI: 66.1%-82.3%) and 63.3% (95% CI: 54.8%-72.6%) was obtained for the EU, MI EIAs and MI LIA, respectively. When only considering repeat syphilis, the diagnostic sensitivity decreased to 45.7% (95% CI: 33.9%-58.0%), 63.9% (95% CI: 51.7%-74.6%) and 47.2% (95% CI: 35.5%-59.3%), respectively. IgM seroreverted in most cases 6 months after treatment. Post-treatment IgM concentrations decreased almost 30% faster for initial syphilis compared with repeat infection. The IgM EIAs and IgM LIA agreed from fairly to moderately (Cohen's kappa (κ): 0.36 (EU EIA); κ: 0.53 (MI EIA); κ: 0.40 (MI LIA)) with the diagnosis of syphilis. CONCLUSIONS IgM detection was not a sensitive method to diagnose syphilis and was even poorer in the diagnosis of syphilis repeat infections.
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Affiliation(s)
- Kara K Osbak
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Achilleas Tsoumanis
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Irith De Baetselier
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marjan Van Esbroek
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Hilde Smet
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Chris R Kenyon
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Medicine, Groote Schuur Hospital, Observatory, South Africa
| | - Tania Crucitti
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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The Brief Case: Secondary Measles and the Pitfalls of Diagnostic Testing. J Clin Microbiol 2020; 58:58/9/e01938-19. [DOI: 10.1128/jcm.01938-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Rosenfeld N, Tasher D, Ovadia A, Abiri S, Dalal I. Kawasaki disease with a concomitant primary Epstein - Barr virus infection. Pediatr Rheumatol Online J 2020; 18:65. [PMID: 32787862 PMCID: PMC7425362 DOI: 10.1186/s12969-020-00459-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/03/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Kwasaki disease (KD) is the leading cause of acquired heart disease in children in most developed countries. The cause of KD remains unknown. The presumed theory is that KD occurs due to one or more infectious agents who evoke an abnormal immunological response in susceptible individuals. Epstein - Barr virus (EBV) infection has been considered as a suspected causative agent because of the potential effect on the immune system. CASE PRESENTATION A previously healthy 19 month old boy presented with a 6 day history of fever accompanied by a diffuse macular erythematous rash that appeared 1 day after. The physical examination on admission revealed bilateral non-suppurative conjunctivitis, dry fissured and injected lips without "strawberry" tongue, diffuse macular rash on the trunk, face and limbs, swelling of the hands and feet, and right cervical lymphadenopathy (2 cm in diameter). Following fulfillment of all the clinical criteria, the diagnosis of KD was made and treatment with IVIG 2 g/Kg was administered along with oral aspirin (80 mg/ kg/day). However, despite the treatment, he remained febrile for an additional 2 days with persistent clinical manifestations. Therefore, he received a second 2 g/kg IVIG course with a favorable response. On the 14th day of illness the patient became febrile again and was readmitted. Blood examinations revealed remarkable leukocytosis up to 35.7 X 109/L with 87.3% lymphocytes and the blood smear revealed atypical lymphocytes and monocytes. The liver enzymes were elevated. The serology for infectious mononucleosis from his first admission revealed: IgM CMV (+), IgG CMV (-); IgM VCA EBV (+) IgG VCA EBV (-), IgG EBNA (-). To confirm infectious mononucleosis following the administration of 2 doses of IVIG, serum EBV PCR was performed and was positive (1.6X 103 cp/ml). CONCLUSIONS We describe here a case of KD with a concomitant primary EBV infection. To the best of our knowledge, this is the first case in western country that describes KD with acute EBV infection as confirmed by PCR. The case we described stands as a contribution in favor of the possible role of EBV in the development of KD.
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Affiliation(s)
- Nataly Rosenfeld
- Department of Paediatrics, Edith Wolfson Medical Center, Halochamim 62, Holon, Israel.
| | - Diana Tasher
- grid.414317.40000 0004 0621 3939Department of Paediatrics, Edith Wolfson Medical Center, Halochamim 62, Holon, Israel
| | - Adi Ovadia
- grid.414317.40000 0004 0621 3939Department of Paediatrics, Edith Wolfson Medical Center, Halochamim 62, Holon, Israel
| | - Shirly Abiri
- grid.414317.40000 0004 0621 3939Department of Paediatrics, Edith Wolfson Medical Center, Halochamim 62, Holon, Israel
| | - Ilan Dalal
- grid.414317.40000 0004 0621 3939Department of Paediatrics, Edith Wolfson Medical Center, Halochamim 62, Holon, Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel- Aviv University, Tel- Aviv, Israel
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McAulay K, Bryan A, Greninger AL, Grill F, Lake D, Kaleta EJ, Grys TE. Retrospective clinical evaluation of 4 lateral flow assays for the detection of SARS-CoV-2 IgG. Diagn Microbiol Infect Dis 2020; 98:115161. [PMID: 32947206 PMCID: PMC7395943 DOI: 10.1016/j.diagmicrobio.2020.115161] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/24/2020] [Accepted: 07/25/2020] [Indexed: 02/03/2023]
Abstract
In a Clinical Laboratory Improvement Amendments laboratory setting, we evaluated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG detection with 4 lateral flow immunoassays [LFIAs; 2 iterations from BTNX Inc. (n = 457) and 1 each from ACON Laboratories (n = 200) and SD BIOSENSOR (n = 155)]. In a cohort of primarily hospitalized, reverse-transcription polymerase chain reaction-confirmed coronavirus disease 2019 cases, sensitivity at ≥14 days from symptom onset was: BTNX kit 1, 95%; BTNX kit 2, 91%; ACON, 95%; and SD, 92%. All assays showed good concordance with the Abbott SARS-CoV-2 IgG assay at ≥14 days from symptom onset: BTNX kit 1, 99%; BTNX kit 2, 94%; ACON, 99%; and SD, 100%. Specificity, measured using specimens collected prior to SARS-CoV-2 circulation in the United States and "cross-reactivity challenge" specimens, was 98% for BTNX kit 1 and ACON and 100% for BTNX kit 2 and SD. These results suggest that LFIAs may provide adequate results for rapid detection of SARS-CoV-2.
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Affiliation(s)
- Kathrine McAulay
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, USA
| | - Andrew Bryan
- Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Alexander L Greninger
- Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, WA, USA; Vaccine and Infectious Disease Division, Fred Hutchison Cancer Research Center, Seattle, WA, USA
| | - Francisca Grill
- School of Life Sciences, Arizona State University, Tempe, AZ, USA
| | - Douglas Lake
- School of Life Sciences, Arizona State University, Tempe, AZ, USA
| | - Erin J Kaleta
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, USA
| | - Thomas E Grys
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, USA.
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Farnsworth CW, Anderson NW. SARS-CoV-2 Serology: Much Hype, Little Data. Clin Chem 2020; 66:875-877. [PMID: 32343775 PMCID: PMC7197624 DOI: 10.1093/clinchem/hvaa107] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Christopher W Farnsworth
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis Missouri, MO
| | - Neil W Anderson
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis Missouri, MO
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