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Frasca F, Sorrentino L, Fracella M, D’Auria A, Coratti E, Maddaloni L, Bugani G, Gentile M, Pierangeli A, d’Ettorre G, Scagnolari C. An Update on the Entomology, Virology, Pathogenesis, and Epidemiology Status of West Nile and Dengue Viruses in Europe (2018-2023). Trop Med Infect Dis 2024; 9:166. [PMID: 39058208 PMCID: PMC11281579 DOI: 10.3390/tropicalmed9070166] [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: 04/17/2024] [Revised: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
In recent decades, increases in temperature and tropical rainfall have facilitated the spread of mosquito species into temperate zones. Mosquitoes are vectors for many viruses, including West Nile virus (WNV) and dengue virus (DENV), and pose a serious threat to public health. This review covers most of the current knowledge on the mosquito species associated with the transmission of WNV and DENV and their geographical distribution and discusses the main vertebrate hosts involved in the cycles of WNV or DENV. It also describes virological and pathogenic aspects of WNV or DENV infection, including emerging concepts linking WNV and DENV to the reproductive system. Furthermore, it provides an epidemiological analysis of the human cases of WNV and DENV reported in Europe, from 1 January 2018 to 31 December 2023, with a particular focus on Italy. The first autochthonous cases of DENV infection, with the most likely vector being Aedes albopictus, have been observed in several European countries in recent years, with a high incidence in Italy in 2023. The lack of treatments and effective vaccines is a serious challenge. Currently, the primary strategy to prevent the spread of WNV and DENV infections in humans remains to limit the spread of mosquitoes.
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Affiliation(s)
- Federica Frasca
- Laboratory of Virology, Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (L.S.); (M.F.); (A.D.); (E.C.); (M.G.); (A.P.); (C.S.)
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (L.M.); (G.B.); (G.d.)
| | - Leonardo Sorrentino
- Laboratory of Virology, Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (L.S.); (M.F.); (A.D.); (E.C.); (M.G.); (A.P.); (C.S.)
| | - Matteo Fracella
- Laboratory of Virology, Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (L.S.); (M.F.); (A.D.); (E.C.); (M.G.); (A.P.); (C.S.)
| | - Alessandra D’Auria
- Laboratory of Virology, Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (L.S.); (M.F.); (A.D.); (E.C.); (M.G.); (A.P.); (C.S.)
| | - Eleonora Coratti
- Laboratory of Virology, Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (L.S.); (M.F.); (A.D.); (E.C.); (M.G.); (A.P.); (C.S.)
| | - Luca Maddaloni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (L.M.); (G.B.); (G.d.)
| | - Ginevra Bugani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (L.M.); (G.B.); (G.d.)
| | - Massimo Gentile
- Laboratory of Virology, Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (L.S.); (M.F.); (A.D.); (E.C.); (M.G.); (A.P.); (C.S.)
| | - Alessandra Pierangeli
- Laboratory of Virology, Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (L.S.); (M.F.); (A.D.); (E.C.); (M.G.); (A.P.); (C.S.)
| | - Gabriella d’Ettorre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (L.M.); (G.B.); (G.d.)
| | - Carolina Scagnolari
- Laboratory of Virology, Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (L.S.); (M.F.); (A.D.); (E.C.); (M.G.); (A.P.); (C.S.)
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Walker CW. What is causing this patient's diffuse rash? JAAPA 2024; 37:47-49. [PMID: 38916370 DOI: 10.1097/01.jaa.0000000000000045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Affiliation(s)
- Clay W Walker
- Clay W. Walker practices in family medicine at the Mayo Clinic in Phoenix, Ariz., and is an adjunct faculty member in the PA programs at Southern Illinois University in Carbondale, Ill., Rush University in Chicago, Ill., A.T. Still University in Mesa, Ariz., and Franklin Pierce University in Rindge, N.H. The author has disclosed no potential conflicts of interest, financial or otherwise
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Crivei LA, Vata A, Teodor D, Porea D, Cozma AP, Anita A, Oslobanu LE, Morosan S, Savuta G. An Assessment of West Nile and Usutu Viruses' Seroprevalence in Hospitalized Patients: A Preliminary Study on Flavivirus Exposure in Eastern Romania. Pathogens 2024; 13:133. [PMID: 38392871 PMCID: PMC10892458 DOI: 10.3390/pathogens13020133] [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: 12/03/2023] [Revised: 01/12/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024] Open
Abstract
WNV and USUV are closely related epornitic flaviviruses transmitted by Culex mosquitoes which can cause febrile and neurodegenerative disease in humans. The impact of both viruses on public health has increased in the recent decades. AIM The aim of the study was to evaluate the seroprevalence of WNV and USUV in hospitalized patients from eastern Romania who did not show symptoms corresponding to the case definition. METHODS Human blood samples from the hospitalized patients were collected in 2015 and from April to September 2019 in Iasi County, Romania. The samples were screened by ELISA for anti-WNV IgG, IgM, and anti-USUV IgG antibodies. RESULTS A cumulative seroprevalence of 3.4% was recorded for anti-WNV IgG antibodies and 9.1% for anti-WNV IgM. No sample was positive for anti-USUV antibodies. CONCLUSION The cumulative seroprevalence observed provides support for the consideration of WNV as being endemic in the east of Romania. The absence of anti-USUV antibodies may be related to cross-reactivity and cohort size, thus, USUV should be considered in clinical practice and become an objective for active surveillance in Romania.
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Affiliation(s)
- Luciana Alexandra Crivei
- Regional Center of Advanced Research for Emerging Diseases, Zoonoses and Food Safety, Department of Public Health, Faculty of Veterinary Medicine, Iași University of Life Sciences, 700490 Iași, Romania; (D.P.); (A.A.); (L.E.O.); (G.S.)
| | - Andrei Vata
- “Sf. Parascheva” Infectious Diseases Hospital of Iasi, 700490 Iasi, Romania; (A.V.); (D.T.)
- Department of Infectious Diseases, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700490 Iași, Romania
| | - Danut Teodor
- “Sf. Parascheva” Infectious Diseases Hospital of Iasi, 700490 Iasi, Romania; (A.V.); (D.T.)
| | - Daniela Porea
- Regional Center of Advanced Research for Emerging Diseases, Zoonoses and Food Safety, Department of Public Health, Faculty of Veterinary Medicine, Iași University of Life Sciences, 700490 Iași, Romania; (D.P.); (A.A.); (L.E.O.); (G.S.)
- Laboratories and Research Stations Department, Danube Delta National Institute for Research and Development, 820112 Tulcea, Romania
| | - Andreea Paula Cozma
- Faculty of Veterinary Medicine, Iași University of Life Sciences, 700490 Iași, Romania; (A.P.C.); (S.M.)
| | - Adriana Anita
- Regional Center of Advanced Research for Emerging Diseases, Zoonoses and Food Safety, Department of Public Health, Faculty of Veterinary Medicine, Iași University of Life Sciences, 700490 Iași, Romania; (D.P.); (A.A.); (L.E.O.); (G.S.)
- Faculty of Veterinary Medicine, Iași University of Life Sciences, 700490 Iași, Romania; (A.P.C.); (S.M.)
| | - Luanda Elena Oslobanu
- Regional Center of Advanced Research for Emerging Diseases, Zoonoses and Food Safety, Department of Public Health, Faculty of Veterinary Medicine, Iași University of Life Sciences, 700490 Iași, Romania; (D.P.); (A.A.); (L.E.O.); (G.S.)
- Faculty of Veterinary Medicine, Iași University of Life Sciences, 700490 Iași, Romania; (A.P.C.); (S.M.)
| | - Serban Morosan
- Faculty of Veterinary Medicine, Iași University of Life Sciences, 700490 Iași, Romania; (A.P.C.); (S.M.)
- Faculté de Médecine, Sorbonne Université, UMS 28, Inserm, 75013 Paris, France
| | - Gheorghe Savuta
- Regional Center of Advanced Research for Emerging Diseases, Zoonoses and Food Safety, Department of Public Health, Faculty of Veterinary Medicine, Iași University of Life Sciences, 700490 Iași, Romania; (D.P.); (A.A.); (L.E.O.); (G.S.)
- Faculty of Veterinary Medicine, Iași University of Life Sciences, 700490 Iași, Romania; (A.P.C.); (S.M.)
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Lee HJ, Zhao Y, Fleming I, Mehta S, Wang X, Wyk BV, Ronca SE, Kang H, Chou CH, Fatou B, Smolen KK, Levy O, Clish CB, Xavier RJ, Steen H, Hafler DA, Love JC, Shalek AK, Guan L, Murray KO, Kleinstein SH, Montgomery RR. Early cellular and molecular signatures correlate with severity of West Nile virus infection. iScience 2023; 26:108387. [PMID: 38047068 PMCID: PMC10692672 DOI: 10.1016/j.isci.2023.108387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/04/2023] [Accepted: 10/27/2023] [Indexed: 12/05/2023] Open
Abstract
Infection with West Nile virus (WNV) drives a wide range of responses, from asymptomatic to flu-like symptoms/fever or severe cases of encephalitis and death. To identify cellular and molecular signatures distinguishing WNV severity, we employed systems profiling of peripheral blood from asymptomatic and severely ill individuals infected with WNV. We interrogated immune responses longitudinally from acute infection through convalescence employing single-cell protein and transcriptional profiling complemented with matched serum proteomics and metabolomics as well as multi-omics analysis. At the acute time point, we detected both elevation of pro-inflammatory markers in innate immune cell types and reduction of regulatory T cell activity in participants with severe infection, whereas asymptomatic donors had higher expression of genes associated with anti-inflammatory CD16+ monocytes. Therefore, we demonstrated the potential of systems immunology using multiple cell-type and cell-state-specific analyses to identify correlates of infection severity and host cellular activity contributing to an effective anti-viral response.
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Affiliation(s)
- Ho-Joon Lee
- Department of Genetics and Yale Center for Genome Analysis, Yale School of Medicine, New Haven, CT 06520, USA
| | - Yujiao Zhao
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Ira Fleming
- The Institute of Medical Science and Engineering, Department of Chemistry, and Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA 02139, USA
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
- The Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
| | - Sameet Mehta
- Department of Genetics and Yale Center for Genome Analysis, Yale School of Medicine, New Haven, CT 06520, USA
| | - Xiaomei Wang
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Brent Vander Wyk
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Shannon E. Ronca
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA
| | - Heather Kang
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Chih-Hung Chou
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Benoit Fatou
- Department of Pathology, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Kinga K. Smolen
- Department of Pathology, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Ofer Levy
- Department of Infectious Disease, Precision Vaccines Program, Boston Children’s Hospital, and Harvard Medical School, Boston, MA 02115, USA
| | - Clary B. Clish
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Ramnik J. Xavier
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
- Center for Computational and Integrative Biology and Department of Molecular Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Hanno Steen
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA
| | - David A. Hafler
- Departments of Neurology and Immunobiology, Yale School of Medicine, New Haven, CT 06510, USA
| | - J. Christopher Love
- The Institute of Medical Science and Engineering, Department of Chemistry, and Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA 02139, USA
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
- The Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
| | - Alex K. Shalek
- The Institute of Medical Science and Engineering, Department of Chemistry, and Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA 02139, USA
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
- The Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
| | - Leying Guan
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06520, USA
| | - Kristy O. Murray
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA
| | - Steven H. Kleinstein
- Department of Pathology, Yale School of Medicine, New Haven, CT 06520, USA
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT 06520, USA
| | - Ruth R. Montgomery
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
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Bloch KC, Glaser C, Gaston D, Venkatesan A. State of the Art: Acute Encephalitis. Clin Infect Dis 2023; 77:e14-e33. [PMID: 37485952 DOI: 10.1093/cid/ciad306] [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: 02/01/2023] [Indexed: 07/25/2023] Open
Abstract
Encephalitis is a devastating neurologic disease often complicated by prolonged neurologic deficits. Best practices for the management of adult patients include universal testing for a core group of etiologies, including herpes simplex virus (HSV)-1, varicella zoster virus (VZV), enteroviruses, West Nile virus, and anti-N-methyl-D-aspartate receptor (anti-NMDAR) antibody encephalitis. Empiric acyclovir therapy should be started at presentation and in selected cases continued until a second HSV-1 polymerase chain reaction test is negative. Acyclovir dose can be increased for VZV encephalitis. Supportive care is necessary for other viral etiologies. Patients in whom no cause for encephalitis is identified represent a particular challenge. Management includes repeat brain magnetic resonance imaging, imaging for occult malignancy, and empiric immunomodulatory treatment for autoimmune conditions. Next-generation sequencing (NGS) or brain biopsy should be considered. The rapid pace of discovery regarding autoimmune encephalitis and the development of advanced molecular tests such as NGS have improved diagnosis and outcomes. Research priorities include development of novel therapeutics.
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Affiliation(s)
- Karen C Bloch
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carol Glaser
- California Department of Public Health, Richmond, California, USA
| | - David Gaston
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arun Venkatesan
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
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Schwarz ER, Long MT. Comparison of West Nile Virus Disease in Humans and Horses: Exploiting Similarities for Enhancing Syndromic Surveillance. Viruses 2023; 15:1230. [PMID: 37376530 DOI: 10.3390/v15061230] [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: 04/18/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
West Nile virus (WNV) neuroinvasive disease threatens the health and well-being of horses and humans worldwide. Disease in horses and humans is remarkably similar. The occurrence of WNV disease in these mammalian hosts has geographic overlap with shared macroscale and microscale drivers of risk. Importantly, intrahost virus dynamics, the evolution of the antibody response, and clinicopathology are similar. The goal of this review is to provide a comparison of WNV infection in humans and horses and to identify similarities that can be exploited to enhance surveillance methods for the early detection of WNV neuroinvasive disease.
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Affiliation(s)
- Erika R Schwarz
- Montana Veterinary Diagnostic Laboratory, MT Department of Livestock, Bozeman, MT 59718, USA
| | - Maureen T Long
- Department of Comparative, Diagnostic, & Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610, USA
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Hort HM, Ibaraki M, Schwartz FW. Temporal and Spatial Synchronicity in West Nile Virus Cases Along the Central Flyway, USA. GEOHEALTH 2023; 7:e2022GH000708. [PMID: 37181010 PMCID: PMC10171186 DOI: 10.1029/2022gh000708] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 03/18/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023]
Abstract
This study of West Nile virus (WNV) examined the possibility of avian transmission to explain synchronicity in the year-to-year variability of WNV case numbers from Texas northward to the Dakotas, and reasons for the large case numbers on the northern Great Plains. We determined correlation coefficients between annual disease incidence per 100,000 people among states within the Great Plains Region, as well as the Central Flyway. There was spatial and temporal synchronicity, as evidenced by Pearson "r," with values along the core of the Central Flyway (Oklahoma, Kansas, Nebraska, and South Dakota) varying between 0.69 and 0.79. Correlations for North Dakota (r = 0.6), however, were affected by local conditions. The concept of relative amplification is helpful in explaining why northerly states along the Central Flyway have larger annual case numbers per 100,000 than Texas but preserve the temporal signal. States differed in their capacity for amplifying the temporal signal in case numbers. For example, Nebraska, South Dakota, and North Dakota case numbers were commonly amplified relative to Texas, with Oklahoma and Kansas deamplified. Relative amplification factors for all states increased as a function of increasing case numbers in Texas. Thus, increased numbers of initially infected birds in Texas likely led to the rapid intensification of the zoonotic cycle as compared to more typical years. The study also confirmed the importance of winter weather in locally modulating disease cases. North Dakota appeared most impacted by these factors to the extent of reducing WNV case numbers in colder years and years with deep snow.
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Affiliation(s)
| | - M. Ibaraki
- School of Earth SciencesThe Ohio State UniversityColumbusOHUSA
| | - F. W. Schwartz
- School of Earth SciencesThe Ohio State UniversityColumbusOHUSA
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Lesteberg KE, Araya P, Waugh KA, Chauhan L, Espinosa JM, Beckham JD. Severely ill and high-risk COVID-19 patients exhibit increased peripheral circulation of CD62L+ and perforin+ T cells. Front Immunol 2023; 14:1113932. [PMID: 36817450 PMCID: PMC9932815 DOI: 10.3389/fimmu.2023.1113932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction The emergence of SARS-CoV-2, which causes COVID-19, has led to over 400 million reported cases worldwide. COVID-19 disease ranges from asymptomatic infection to severe disease and may be impacted by individual immune differences. Methods We used multiparameter flow cytometry to compare CD4+ and CD8+ T cell responses in severe (ICU admitted) and non-severe (admitted to observational unit) hospitalized COVID-19 patients. Results We found that patients with severe COVID- 19 had greater frequencies of CD4+ T cells expressing CD62L compared to non-severe patients and greater frequencies of perforin+ CD8+ T cells compared to recovered patients. Furthermore, greater frequencies of CD62L+ CD4+ and CD8+ T cells were seen in severely ill diabetic patients compared to non-severe and non-diabetic patients, and increased CD62L+ CD4+ T cells were also seen in severely ill patients with hypertension. Discussion This is the first report to show that CD62L+ T cells and perforin+ T cells are associated with severe COVID-19 illness and are significantly increased in patients with high-risk pre-existing conditions including older age and diabetes. These data provide a potential biological marker for severe COVID-19.
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Affiliation(s)
- Kelsey E. Lesteberg
- Department of Medicine, Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Paula Araya
- Linda Crnic Institute for Down Syndrome, University of Colorado School of Medicine, Aurora, CO, United States
| | - Katherine A. Waugh
- Linda Crnic Institute for Down Syndrome, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Pharmacology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Lakshmi Chauhan
- Department of Medicine, Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, United States
| | - Joaquin M. Espinosa
- Linda Crnic Institute for Down Syndrome, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Pharmacology, University of Colorado School of Medicine, Aurora, CO, United States
| | - J. David Beckham
- Department of Medicine, Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Medicine, Rocky Mountain VA Medical Center, Aurora, CO, United States
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CRIVEI LA, MOUTAILLER S, GONZALEZ G, LOWENSKI S, CRIVEI IC, POREA D, ANITA DC, RATOI IA, ZIENTARA S, OSLOBANU LE, TOMAZATOS A, SAVUTA G, LECOLLINET S. Detection of West Nile Virus Lineage 2 in Eastern Romania and First Identification of Sindbis Virus RNA in Mosquitoes Analyzed using High-Throughput Microfluidic Real-Time PCR. Viruses 2023; 15:186. [PMID: 36680227 PMCID: PMC9860827 DOI: 10.3390/v15010186] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
The impact of mosquito-borne diseases on human and veterinary health is being exacerbated by rapid environmental changes caused mainly by changing climatic patterns and globalization. To gain insight into mosquito-borne virus circulation from two counties in eastern and southeastern Romania, we have used a combination of sampling methods in natural, urban and peri-urban sites. The presence of 37 mosquito-borne viruses in 16,827 pooled mosquitoes was analyzed using a high-throughput microfluidic real-time PCR assay. West Nile virus (WNV) was detected in 10/365 pools of Culex pipiens (n = 8), Culex modestus (n = 1) and Aedes vexans (n = 1) from both studied counties. We also report the first molecular detection of Sindbis virus (SINV) RNA in the country in one pool of Culex modestus. WNV infection was confirmed by real-time RT-PCR (10/10) and virus isolation on Vero or C6/36 cells (four samples). For the SINV-positive pool, no cytopathic effectwas observed after infection of Vero or C6/36 cells, but no amplification was obtained in conventional SINV RT-PCR. Phylogenetic analysis of WNV partial NS5 sequences revealed that WNV lineage 2 of theCentral-Southeast European clade, has a wider circulation in Romania than previously known.
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Affiliation(s)
- Luciana Alexandra CRIVEI
- Regional Center of Advanced Research for Emerging Diseases, Zoonoses and Food Safety, Iași University of Life Sciences, 700490 Iași, Romania
| | - Sara MOUTAILLER
- ANSES, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR BIPAR, Laboratoire de Santé Animale, 94700 Maisons-Alfort, France
| | - Gaëlle GONZALEZ
- ANSES, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR VIROLOGIE, Laboratoire de Santé Animale, 94700 Maisons-Alfort, France
| | - Steeve LOWENSKI
- ANSES, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR VIROLOGIE, Laboratoire de Santé Animale, 94700 Maisons-Alfort, France
| | - Ioana Cristina CRIVEI
- Regional Center of Advanced Research for Emerging Diseases, Zoonoses and Food Safety, Iași University of Life Sciences, 700490 Iași, Romania
| | - Daniela POREA
- Regional Center of Advanced Research for Emerging Diseases, Zoonoses and Food Safety, Iași University of Life Sciences, 700490 Iași, Romania
| | - Dragoș Constantin ANITA
- Regional Center of Advanced Research for Emerging Diseases, Zoonoses and Food Safety, Iași University of Life Sciences, 700490 Iași, Romania
| | - Ioana Alexandra RATOI
- Regional Center of Advanced Research for Emerging Diseases, Zoonoses and Food Safety, Iași University of Life Sciences, 700490 Iași, Romania
| | - Stéphan ZIENTARA
- ANSES, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR VIROLOGIE, Laboratoire de Santé Animale, 94700 Maisons-Alfort, France
| | - Luanda Elena OSLOBANU
- Regional Center of Advanced Research for Emerging Diseases, Zoonoses and Food Safety, Iași University of Life Sciences, 700490 Iași, Romania
| | - Alexandru TOMAZATOS
- Department of Arbovirology, Bernhard Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany
| | - Gheorghe SAVUTA
- Regional Center of Advanced Research for Emerging Diseases, Zoonoses and Food Safety, Iași University of Life Sciences, 700490 Iași, Romania
| | - Sylvie LECOLLINET
- ANSES, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR VIROLOGIE, Laboratoire de Santé Animale, 94700 Maisons-Alfort, France
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Moreno-Reina C, Martínez-Moya M, Piñero-González de la Peña P, Caro-Domínguez P. Neuroinvasive disease due to West Nile virus: Clinical and imaging findings associated with a re-emerging pathogen. RADIOLOGIA 2022; 64:473-483. [PMID: 36243447 DOI: 10.1016/j.rxeng.2021.06.007] [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: 12/12/2020] [Accepted: 06/21/2021] [Indexed: 06/16/2023]
Abstract
The West Nile virus (WNV) is an arbovirus than can infect human beings and cause severe neuroinvasive disease. Taking the outbreak that occurred in Spain in 2020 as a reference, this article reviews the clinical and imaging findings for neuroinvasive disease due to WNV. We collected demographic, clinical, laboratory, and imaging (CT and MRI) variables for 30 patients with WNV infection diagnosed at our center. The main clinical findings were fever, headache, and altered levels of consciousness. Neuroimaging studies, especially MRI, are very useful in the diagnosis and follow-up of these patients. The most common imaging findings were foci of increased signal intensity in the thalamus and brainstem in T2-weighted sequences; we illustrate these findings in cases from our hospital.
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Affiliation(s)
- C Moreno-Reina
- Unidad de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - M Martínez-Moya
- Unidad de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - P Caro-Domínguez
- Unidad de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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11
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Onisâi M, Vlădăreanu AM, Iordan I, Bumbea H, Găman M, Ciufu C, Voican I, Cîșleanu D, Vasile D, Marinescu C, Nicolescu A, Spînu A, Nistor R, Alexandru A. Primary, secondary or less frequent causes of immune thrombocytopenia: A case report. Exp Ther Med 2021; 22:1096. [PMID: 34504550 DOI: 10.3892/etm.2021.10530] [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: 03/01/2021] [Accepted: 03/31/2021] [Indexed: 01/16/2023] Open
Abstract
Primary immune thrombocytopenia (ITP) is characterized by isolated low platelet count and it is a diagnosis of exclusion, contrasting to secondary ITP. Therefore, a positive diagnosis is difficult and requires extensive investigation. Some of the underlying conditions that are associated with ITP are lymphoproliferative disorders and infections, especially viral ones. In the present study, the case of a patient diagnosed with diffuse large B-cell lymphoma, who received chemotherapy and autologous hematopoietic stem cell transplantation is presented. After a complete remission of four years, the patient presented with sudden intense hemorrhagic syndrome and severely decreased platelet count. The most frequent causes of secondary ITP were excluded, including lymphoma relapse, and intravenous corticosteroids were started. However, shortly after hospital admission, the patient developed neuro-psychiatric anomalies, fever and pancytopenia, and West-Nile encephalitis was diagnosed. Although the initial development was favorable, he started to complain of progressive severe muscle weakness and eventually succumbed to infectious complications in the setting of prolonged hospitalization, corticotherapy, and immobilization.
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Affiliation(s)
- Minodora Onisâi
- Hematology Clinic, Emergency University Hospital, 050098 Bucharest, Romania.,Department of Hematology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ana-Maria Vlădăreanu
- Hematology Clinic, Emergency University Hospital, 050098 Bucharest, Romania.,Department of Hematology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Iuliana Iordan
- Hematology Clinic, Emergency University Hospital, 050098 Bucharest, Romania.,Department of Hematology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Horia Bumbea
- Hematology Clinic, Emergency University Hospital, 050098 Bucharest, Romania.,Department of Hematology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Mihaela Găman
- Hematology Clinic, Emergency University Hospital, 050098 Bucharest, Romania.,Department of Hematology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Cristina Ciufu
- Hematology Clinic, Emergency University Hospital, 050098 Bucharest, Romania.,Department of Hematology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Irina Voican
- Hematology Clinic, Emergency University Hospital, 050098 Bucharest, Romania
| | - Diana Cîșleanu
- Hematology Clinic, Emergency University Hospital, 050098 Bucharest, Romania.,Department of Hematology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Daniela Vasile
- Hematology Clinic, Emergency University Hospital, 050098 Bucharest, Romania.,Department of Hematology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Cristina Marinescu
- Hematology Clinic, Emergency University Hospital, 050098 Bucharest, Romania.,Department of Hematology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Anca Nicolescu
- Hematology Clinic, Emergency University Hospital, 050098 Bucharest, Romania
| | - Andreea Spînu
- Hematology Clinic, Emergency University Hospital, 050098 Bucharest, Romania.,Department of Hematology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Raluca Nistor
- Neurology Clinic, Emergency University Hospital, 050098 Bucharest, Romania.,Department of Neurology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Adrian Alexandru
- Department of Plastic Reconstructive Surgery, Emergency University Hospital, 050098 Bucharest, Romania.,Department of Plastic Surgery, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
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12
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Moreno-Reina C, Martínez-Moya M, Piñero-González de la Peña P, Caro-Domínguez P. Neuroinvasive disease due to West Nile virus: clinical and imaging findings associated with a re-emerging pathogen. RADIOLOGIA 2021; 64:S0033-8338(21)00114-4. [PMID: 34325916 DOI: 10.1016/j.rx.2021.06.003] [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: 12/12/2020] [Revised: 05/10/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Abstract
The West Nile virus (WNV) is an arbovirus than can infect human beings and cause severe neuroinvasive disease. Taking the outbreak that occurred in Spain in 2020 as a reference, this article reviews the clinical and imaging findings for neuroinvasive disease due to WNV. We collected demographic, clinical, laboratory, and imaging (CT and MRI) variables for 30 patients with WNV infection diagnosed at our center. The main clinical findings were fever, headache, and altered levels of consciousness. Neuroimaging studies, especially MRI, are very useful in the diagnosis and follow-up of these patients. The most common imaging findings were foci of increased signal intensity in the thalamus and brainstem in T2-weighted sequences; we illustrate these findings in cases from our hospital.
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Affiliation(s)
- C Moreno-Reina
- Unidad de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - M Martínez-Moya
- Unidad de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | - P Caro-Domínguez
- Unidad de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España
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13
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Maximova OA, Sturdevant DE, Kash JC, Kanakabandi K, Xiao Y, Minai M, Moore IN, Taubenberger J, Martens C, Cohen JI, Pletnev AG. Virus infection of the CNS disrupts the immune-neural-synaptic axis via induction of pleiotropic gene regulation of host responses. eLife 2021; 10:e62273. [PMID: 33599611 PMCID: PMC7891934 DOI: 10.7554/elife.62273] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 01/15/2021] [Indexed: 12/19/2022] Open
Abstract
Treatment for many viral infections of the central nervous system (CNS) remains only supportive. Here we address a remaining gap in our knowledge regarding how the CNS and immune systems interact during viral infection. By examining the regulation of the immune and nervous system processes in a nonhuman primate model of West Nile virus neurological disease, we show that virus infection disrupts the homeostasis of the immune-neural-synaptic axis via induction of pleiotropic genes with distinct functions in each component of the axis. This pleiotropic gene regulation suggests an unintended off-target negative impact of virus-induced host immune responses on the neurotransmission, which may be a common feature of various viral infections of the CNS.
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Affiliation(s)
- Olga A Maximova
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of HealthBethesdaUnited States
| | - Daniel E Sturdevant
- Research Technologies Branch, Genomics Unit, National Institute of Allergy and Infectious Diseases, National Institutes of HealthHamiltonUnited States
| | - John C Kash
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of HealthBethesdaUnited States
| | - Kishore Kanakabandi
- Research Technologies Branch, Genomics Unit, National Institute of Allergy and Infectious Diseases, National Institutes of HealthHamiltonUnited States
| | - Yongli Xiao
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of HealthBethesdaUnited States
| | - Mahnaz Minai
- Infectious Disease Pathogenesis Section, Comparative Medicine Branch, National Institute of Allergy and Infectious Diseases, National Institutes of HealthBethesdaUnited States
| | - Ian N Moore
- Infectious Disease Pathogenesis Section, Comparative Medicine Branch, National Institute of Allergy and Infectious Diseases, National Institutes of HealthBethesdaUnited States
| | - Jeff Taubenberger
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of HealthBethesdaUnited States
| | - Craig Martens
- Research Technologies Branch, Genomics Unit, National Institute of Allergy and Infectious Diseases, National Institutes of HealthHamiltonUnited States
| | - Jeffrey I Cohen
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of HealthBethesdaUnited States
| | - Alexander G Pletnev
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of HealthBethesdaUnited States
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14
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Cahill ME, Loeb M, Dewan AT, Montgomery RR. In-Depth Analysis of Genetic Variation Associated with Severe West Nile Viral Disease. Vaccines (Basel) 2020; 8:E744. [PMID: 33302579 PMCID: PMC7768385 DOI: 10.3390/vaccines8040744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 01/04/2023] Open
Abstract
West Nile virus (WNV) is a mosquito-borne virus which causes symptomatic disease in a minority of infected humans. To identify novel genetic variants associated with severe disease, we utilized data from an existing case-control study of WNV and included population controls for an expanded analysis. We conducted imputation and gene-gene interaction analysis in the largest and most comprehensive genetic study conducted to date for West Nile neuroinvasive disease (WNND). Within the imputed West Nile virus dataset (severe cases n = 381 and asymptomatic/mild controls = 441), we found novel loci within the MCF.2 Cell Line Derived Transforming Sequence Like (MCF2L) gene (rs9549655 and rs2297192) through the individual loci analyses, although none reached statistical significance. Incorporating population controls from the Wisconsin Longitudinal Study on Aging (n = 9012) did not identify additional novel variants, a possible reflection of the cohort's inclusion of individuals who could develop mild or severe WNV disease upon infection. Many of the top gene-gene interaction results were intergenic, with currently undefined biological roles, highlighting the need for further investigation into these regions and other identified gene targets in severe WNND. Further studies including larger sample sizes and more diverse populations reflective of those at risk are needed to fully understand the genetic architecture of severe WNDD and provide guidance on viable targets for therapeutic and vaccine development.
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Affiliation(s)
- Megan E. Cahill
- Center for Perinatal, Pediatric and Environmental Epidemiology, Department of Chronic Disease Epidemiology, Yale School of Public Health, 1 Church Street, New Haven, CT 06510, USA; (M.E.C.); (A.T.D.)
| | - Mark Loeb
- 3208 Michael DeGroote Centre for Learning & Discovery, Division of Clinical Pathology, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Andrew T. Dewan
- Center for Perinatal, Pediatric and Environmental Epidemiology, Department of Chronic Disease Epidemiology, Yale School of Public Health, 1 Church Street, New Haven, CT 06510, USA; (M.E.C.); (A.T.D.)
| | - Ruth R. Montgomery
- Department of Internal Medicine, Yale School of Medicine, 300 Cedar Street, New Haven, CT 06520, USA
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15
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Hazeldine J, Lord JM. Immunesenescence: A Predisposing Risk Factor for the Development of COVID-19? Front Immunol 2020; 11:573662. [PMID: 33123152 PMCID: PMC7573102 DOI: 10.3389/fimmu.2020.573662] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/28/2020] [Indexed: 01/08/2023] Open
Abstract
Bearing a strong resemblance to the phenotypic and functional remodeling of the immune system that occurs during aging (termed immunesenescence), the immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of Coronavirus disease 2019 (COVID-19), is characterized by an expansion of inflammatory monocytes, functional exhaustion of lymphocytes, dysregulated myeloid responses and the presence of highly activated senescent T cells. Alongside advanced age, male gender and pre-existing co-morbidities [e.g., obesity and type 2 diabetes (T2D)] are emerging as significant risk factors for COVID-19. Interestingly, immunesenescence is more profound in males when compared to females, whilst accelerated aging of the immune system, termed premature immunesenescence, has been described in obese subjects and T2D patients. Thus, as three distinct demographic groups with an increased susceptibility to COVID-19 share a common immune profile, could immunesenescence be a generic contributory factor in the development of severe COVID-19? Here, by focussing on three key aspects of an immune response, namely pathogen recognition, elimination and resolution, we address this question by discussing how immunesenescence may weaken or exacerbate the immune response to SARS-CoV-2. We also highlight how aspects of immunesenescence could render potential COVID-19 treatments less effective in older adults and draw attention to certain therapeutic options, which by reversing or circumventing certain features of immunesenescence may prove to be beneficial for the treatment of groups at high risk of severe COVID-19.
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Affiliation(s)
- Jon Hazeldine
- Medical Research Council-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Janet M. Lord
- Medical Research Council-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- National Institute for Health Research Birmingham Biomedical Research Centre, University Hospital Birmingham National Health Service Foundation Trust and University of Birmingham, Birmingham, United Kingdom
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16
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Clinical Characteristics and Outcome of West Nile Virus Infection in Patients with Lymphoid Neoplasms: An Italian Multicentre Study. Hemasphere 2020; 4:e395. [PMID: 32647801 PMCID: PMC7306307 DOI: 10.1097/hs9.0000000000000395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/07/2020] [Indexed: 01/01/2023] Open
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17
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Karki S, Brown WM, Uelmen J, Ruiz MO, Smith RL. The drivers of West Nile virus human illness in the Chicago, Illinois, USA area: Fine scale dynamic effects of weather, mosquito infection, social, and biological conditions. PLoS One 2020; 15:e0227160. [PMID: 32437363 PMCID: PMC7241786 DOI: 10.1371/journal.pone.0227160] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/09/2020] [Indexed: 11/19/2022] Open
Abstract
West Nile virus (WNV) has consistently been reported to be associated with human cases of illness in the region near Chicago, Illinois. However, the number of reported cases of human illness varies across years, with intermittent outbreaks. Several dynamic factors, including temperature, rainfall, and infection status of vector mosquito populations, are responsible for much of these observed variations. However, local landscape structure and human demographic characteristics also play a key role. The geographic and temporal scales used to analyze such complex data affect the observed associations. Here, we used spatial and statistical modeling approaches to investigate the factors that drive the outcome of WNV human illness on fine temporal and spatial scales. Our approach included multi-level modeling of long-term weekly data from 2005 to 2016, with weekly measures of mosquito infection, human illness and weather combined with more stable landscape and demographic factors on the geographical scale of 1000m hexagons. We found that hot weather conditions, warm winters, and higher MIR in earlier weeks increased the probability of an area of having a WNV human case. Higher population and the proportion of urban light intensity in an area also increased the probability of observing a WNV human case. A higher proportion of open water sources, percentage of grass land, deciduous forests, and housing built post 1990 decreased the probability of having a WNV case. Additionally, we found that cumulative positive mosquito pools up to 31 weeks can strongly predict the total annual human WNV cases in the Chicago region. This study helped us to improve our understanding of the fine-scale drivers of spatiotemporal variability of human WNV cases.
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Affiliation(s)
- Surendra Karki
- Department of Pathobiology, University of Illinois, Urbana-Champaign, Urbana, Illinois, United States of America
| | - William M. Brown
- Department of Pathobiology, University of Illinois, Urbana-Champaign, Urbana, Illinois, United States of America
| | - John Uelmen
- Department of Pathobiology, University of Illinois, Urbana-Champaign, Urbana, Illinois, United States of America
| | - Marilyn O’Hara Ruiz
- Department of Pathobiology, University of Illinois, Urbana-Champaign, Urbana, Illinois, United States of America
| | - Rebecca Lee Smith
- Department of Pathobiology, University of Illinois, Urbana-Champaign, Urbana, Illinois, United States of America
- * E-mail:
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18
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Pierson TC, Diamond MS. The continued threat of emerging flaviviruses. Nat Microbiol 2020; 5:796-812. [PMID: 32367055 DOI: 10.1038/s41564-020-0714-0] [Citation(s) in RCA: 496] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/27/2020] [Indexed: 12/18/2022]
Abstract
Flaviviruses are vector-borne RNA viruses that can emerge unexpectedly in human populations and cause a spectrum of potentially severe diseases including hepatitis, vascular shock syndrome, encephalitis, acute flaccid paralysis, congenital abnormalities and fetal death. This epidemiological pattern has occurred numerous times during the last 70 years, including epidemics of dengue virus and West Nile virus, and the most recent explosive epidemic of Zika virus in the Americas. Flaviviruses are now globally distributed and infect up to 400 million people annually. Of significant concern, outbreaks of other less well-characterized flaviviruses have been reported in humans and animals in different regions of the world. The potential for these viruses to sustain epidemic transmission among humans is poorly understood. In this Review, we discuss the basic biology of flaviviruses, their infectious cycles, the diseases they cause and underlying host immune responses to infection. We describe flaviviruses that represent an established ongoing threat to global health and those that have recently emerged in new populations to cause significant disease. We also provide examples of lesser-known flaviviruses that circulate in restricted areas of the world but have the potential to emerge more broadly in human populations. Finally, we discuss how an understanding of the epidemiology, biology, structure and immunity of flaviviruses can inform the rapid development of countermeasures to treat or prevent human infections as they emerge.
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Affiliation(s)
- Theodore C Pierson
- Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, the National Institutes of Health, Bethesda, MD, USA.
| | - Michael S Diamond
- Departments of Medicine, Molecular Microbiology, Pathology & Immunology, Andrew M. and Jane M. Bursky Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, MO, USA.
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19
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Savopoulos C, Pilalas D, Kaiafa GD, Panagiotou G, Grammenou MC, Kouskouras K, Tegos T, Psomas E, Papa A, Foroglou N, Hatzitolios AI. West Nile virus neuroinvasive disease. QJM 2020; 113:125-126. [PMID: 31593223 DOI: 10.1093/qjmed/hcz255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 09/25/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Savopoulos
- From the First Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - D Pilalas
- From the First Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - G D Kaiafa
- From the First Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - G Panagiotou
- From the First Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - M-C Grammenou
- From the First Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | | | - T Tegos
- First Department of Neurology, AHEPA University Hospital, Medical School, Aristotle University, Thessaloniki, Greece
| | - E Psomas
- From the First Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - A Papa
- Department of Microbiology, Medical School, Aristotle University, Thessaloniki, Greece
| | - N Foroglou
- First Department of Neurosurgery, AHEPA University Hospital, Medical School, Aristotle University, Thessaloniki, Greece
| | - A I Hatzitolios
- From the First Propedeutic Department of Internal Medicine, Thessaloniki, Greece
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20
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Obaidat MM, Stringer AP, Roess AA. Seroprevalence, risk factors and spatial distribution of West Nile virus in Jordan. Trans R Soc Trop Med Hyg 2020; 113:24-30. [PMID: 30299511 DOI: 10.1093/trstmh/try111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/07/2018] [Indexed: 11/13/2022] Open
Abstract
Background This is the first countrywide study of the seroprevalence, risk factors and spatial distribution of West Nile virus (WNV) in Jordan. Methods A cross-sectional sample of 801 participants was administered a comprehensive questionnaire survey and tested for WNV immunoglobulin G antibodies. Results The point seroprevalence rate for WNV infection was 8.61% (95% confidence interval 6.8 to 10.8). Multivariate regression analysis demonstrated that sex, age, climate, income and drinking water source were significantly associated with seropositivity (p≤0.05). Males had 1.73 greater odds of infection compared with females. Compared with 15 to 29-year-olds, adults 30-49 y old and adults ≥50 y old had 2.0 and 3.1 greater odds of infection, respectively. Individuals living in the Jordan Valley and Badia had 22.2 and 7.2 times greater odds of infection, respectively, compared with individuals living in the highlands. Households with an income of <US$750/month had 1.8 greater odds of infection compared with those with higher household incomes. Individuals using spring lakes as a drinking water source had 5.1 greater odds of infection than people who used water from any other source. Conclusions This study demonstrates that WNV is circulating in Jordan and should be considered as a differential diagnosis in medical cases presenting with nervous system symptoms, especially for older populations living in the Jordan Valley and Badia areas.
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Affiliation(s)
- Mohammad M Obaidat
- Department of Veterinary Pathology and Public Health, Faculty of Veterinary Medicine, Jordan University of Science and Technology, Ar-Ramtha, Irbid, Jordan
| | - Andrew P Stringer
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Amira A Roess
- Department of Global Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue NW, Washington, DC, USA
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21
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Encephalopathic Presentation of West Nile Virus Neuroinvasive Disease Confounded by Concomitant History of Acute Alcohol Withdrawal. Adv Emerg Nurs J 2019; 41:316-321. [PMID: 31687995 DOI: 10.1097/tme.0000000000000266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
West Nile neuroinvasive disease (WNND) is a rare and severe manifestation of West Nile virus (WNV) infection that occurs in less than 1% of infected persons. It should be considered in patients who present with fever, neurological symptoms, and a history of recent outdoor activity where mosquitoes were active. This article highlights a case of a 55-year-old man whose history and symptoms of WNND were confounded with an alternate diagnosis, acute alcohol withdrawal. An overview of WNV infections, and important historical clues and objective findings characteristic of neuroinvasive disease, is discussed to increase readers' knowledge of WNV and awareness of when to consider WNND in the diagnostic differential.
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22
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West Nile Virus Encephalitis in Haematological Setting: Report of Two Cases and a Brief Review of the Literature. Mediterr J Hematol Infect Dis 2019; 11:e2019033. [PMID: 31205637 PMCID: PMC6548214 DOI: 10.4084/mjhid.2019.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/03/2019] [Indexed: 01/01/2023] Open
Abstract
West Nile virus is a zoonotic agent causing life-threatening encephalitis in a proportion of infected patients. Older age, immunosuppression, and mutations in specific host genes (e.g., CCR5 delta-32 mutation) predispose to neuroinvasive infection. We report on two cases of severe West Nile encephalitis in recently-treated, different-aged, chronic lymphocytic leukemia patients. Both patients developed high-grade fever associated with severe neurological impairment. The younger one harboured germ-line CCR5 delta-32 mutation, which might have played a role in the pathogenesis of its neuroinvasive manifestations.
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23
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Kolawole OM, Adelaiye G, Ogah JI. Emergence and Associated Risk Factors of Vector Borne West Nile Virus Infection in Ilorin, Nigeria. J Arthropod Borne Dis 2018; 12:341-350. [PMID: 30918903 PMCID: PMC6423457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 08/05/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND West Nile Virus (WNV) is a mosquito-borne viral pathogen that is the causative agent of West Nile fever and encephalitis. Diagnostic tools for WNV infection in Nigeria are not well established hence the current prevalence rate of WNV infection in Nigeria is unknown. We aimed to establish the serological prevalence of WNV infection in febrile patients in Ilorin, Nigeria in 2016, and to assess the risk factors associated with the acquisition of the virus. METHODS This was a cross-sectional study involving the screening of subjects presenting with febrile illnesses. While specific IgM ELISA was used to determine the seroprevalence, a closed-ended questionnaire was used to ascertain the risk factors associated with this viral infection. RESULTS Fifteen (7.5%) of the respondents were positive for WNV infection. Subjects living in areas in close proximity to trees and bushes (P= 0.011) and stagnant water (P= 0.001) were at a higher risk of having WNV infection. Other risk factors associated with WNV among the respondents include the none use of insecticide (P= 0.001), sitting out at night (P= 0.044), HIV positivity (P= 0.003) and having an organ transplant (P= 0.002). CONCLUSION This study clearly shows a considerable WNV infection in Ilorin, with the presence of factors that can promulgate an outbreak, hence a need for further surveillance in the study area.
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24
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Radu RA, Terecoasă EO, Ene A, Băjenaru OA, Tiu C. Opsoclonus-Myoclonus Syndrome Associated With West-Nile Virus Infection: Case Report and Review of the Literature. Front Neurol 2018; 9:864. [PMID: 30386288 PMCID: PMC6198716 DOI: 10.3389/fneur.2018.00864] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/25/2018] [Indexed: 12/29/2022] Open
Abstract
Opsoclonus-myoclonus syndrome (OMS) is a very rare condition with different autoimmune, infectious and paraneoplastic aetiologies or in most cases idiopathic. We report the case of a 75-year-old woman who was admitted in our department in early fall for altered mental status, opsoclonus, multifocal myoclonus, truncal titubation and generalized tremor, preceded by a 5 day prodrome consisting of malaise, nausea, fever and vomiting. Brain computed tomography and MRI scans showed no significant abnormalities and cerebrospinal fluid changes consisted of mildly increased protein content and number of white cells. Work-up for paraneoplastic and autoimmune causes of OMS was negative but serologic tests identified positive IgM and IgG antibodies against West Nile virus (WNV). The patient was treated with Dexamethasone and Clonazepam with progressive improvement of mental status, myoclonus, opsoclonus and associated neurologic signs. Six months after the acute illness she had complete recovery. To our knowledge this is the 14th case of WNV associated OMS reported in the literature so far. We briefly describe the clinical course of the other reported cases together with the different treatment strategies that have been employed.
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Affiliation(s)
- Răzvan Alexandru Radu
- Department of Neurology, University Emergency Hospital Bucharest, Bucharest, Romania.,Department of Clinical Neurosciences, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Elena Oana Terecoasă
- Department of Neurology, University Emergency Hospital Bucharest, Bucharest, Romania.,Department of Clinical Neurosciences, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Amalia Ene
- Department of Neurology, University Emergency Hospital Bucharest, Bucharest, Romania
| | - Ovidiu Alexandru Băjenaru
- Department of Neurology, University Emergency Hospital Bucharest, Bucharest, Romania.,Department of Clinical Neurosciences, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Cristina Tiu
- Department of Neurology, University Emergency Hospital Bucharest, Bucharest, Romania.,Department of Clinical Neurosciences, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
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25
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Lesteberg KE, Beckham JD. Immunology of West Nile Virus Infection and the Role of Alpha-Synuclein as a Viral Restriction Factor. Viral Immunol 2018; 32:38-47. [PMID: 30222521 DOI: 10.1089/vim.2018.0075] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
West Nile virus (WNV) is a single-stranded RNA flavivirus and is a major cause of viral encephalitis worldwide. Experimental models of WNV infection in mice are commonly used to define acute neuroinflammatory responses in the brain. Alpha-synuclein (Asyn) is a protein of primarily neuronal origin and is a major cause of Parkinson's disease (PD), a disorder characterized by loss of dopaminergic neurons. Both WNV and PD pathologies are largely mediated by inflammation of the central nervous system (neuroinflammation) and have overlapping inflammatory pathways. In this review, we highlight the roles of the immune system in both diseases while comparing and contrasting both protective and pathogenic roles of immune cells and their effector proteins. Additionally, we review the current literature showing that Asyn is an important mediator of the immune response with diverging roles in PD (pathogenic) and WNV disease (neuroprotective).
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Affiliation(s)
- Kelsey E Lesteberg
- 1 Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine , Aurora, Colorado
| | - John David Beckham
- 1 Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine , Aurora, Colorado.,2 Division of Neuroimmunology and Neurological Infections, Department of Neurology, University of Colorado School of Medicine , Aurora, Colorado.,3 Veterans Administration, Eastern Colorado Health System , Denver, Colorado
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26
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Cahill ME, Conley S, DeWan AT, Montgomery RR. Identification of genetic variants associated with dengue or West Nile virus disease: a systematic review and meta-analysis. BMC Infect Dis 2018; 18:282. [PMID: 29929468 PMCID: PMC6014009 DOI: 10.1186/s12879-018-3186-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 06/07/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Dengue and West Nile viruses are highly cross-reactive and have numerous parallels in geography, potential vector host (Aedes family of mosquitoes), and initial symptoms of infection. While the vast majority (> 80%) of both dengue and West Nile virus infections result in asymptomatic infections, a minority of individuals experience symptomatic infection and an even smaller proportion develop severe disease. The mechanisms by which these infections lead to severe disease in a subset of infected individuals is incompletely understood, but individual host differences including genetic factors and immune responses have been proposed. We sought to identify genetic risk factors that are associated with more severe disease outcomes for both viruses in order to shed light on possible shared mechanisms of resistance and potential therapeutic interventions. METHODS We applied a search strategy using four major databases (Medline, PubMed, Embase, and Global Health) to find all known genetic associations identified to date with dengue or West Nile virus disease. Here we present a review of our findings and a meta-analysis of genetic variants identified. RESULTS We found genetic variations that are significantly associated with infections of these viruses. In particular we found variation within the OAS1 (meta-OR = 0.83, 95% CI: 0.69-1.00) and CCR5 (meta-OR = 1.29, 95% CI: 1.08-1.53) genes is significantly associated with West Nile virus disease, while variation within MICB (meta-OR = 2.35, 95% CI: 1.68-3.29), PLCE1 (meta-OR = 0.55, 95% CI: 0.42-0.71), MBL2 (meta-OR = 1.54, 95% CI: 1.02-2.31), and IFN-γ (meta-OR = 2.48, 95% CI: 1.30-4.71), is associated with dengue disease. CONCLUSIONS Despite substantial heterogeneity in populations studied, genes examined, and methodology, significant associations with genetic variants were found across studies within both diseases. These gene associations suggest a key role for immune mechanisms in susceptibility to severe disease. Further research is needed to elucidate the role of these genes in disease pathogenesis and may reveal additional genetic factors associated with disease severity.
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Affiliation(s)
- Megan E Cahill
- Yale University School of Public Health, New Haven, CT, USA
| | | | - Andrew T DeWan
- Yale University School of Public Health, New Haven, CT, USA
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27
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Popescu CP, Florescu SA, Cotar AI, Badescu D, Ceianu CS, Zaharia M, Tardei G, Codreanu D, Ceausu E, Ruta SM. Re-emergence of severe West Nile virus neuroinvasive disease in humans in Romania, 2012 to 2017-implications for travel medicine. Travel Med Infect Dis 2018; 22:30-35. [PMID: 29544774 DOI: 10.1016/j.tmaid.2018.03.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 02/25/2018] [Accepted: 03/11/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND In Romania, after a major outbreak in 1996, West Nile neuroinvasive disease (WNND) was reported only in a limited number of cases annually. During 2016-2017, a significant increase in the number of WNND cases was reported at the national level, associated with high mortality rates. METHODS A retrospective analysis of all cases confirmed with WNND, hospitalized during 2012-2017 in a single tertiary facility from Bucharest was performed in order to determine the annual prevalence and mortality rate and the risk factors associated with a severe outcome. RESULTS 47 cases were confirmed as WNND. The mortality rate was 25.5%, all death occurred during 2016-2017. Coma, confusion, obtundation, sleepiness and depressed deep tendon reflexes were symptoms predicting a severe outcome. In a univariate analysis age (p < 0.001), associated cancers (p = 0.012) and low levels of chloride in the CSF (p = 0.008) were risk factors for mortality. In a multinomial logistic analysis, age older than 75 years remained the only independent predictor of death in WNND. CONCLUSIONS The increase in both the number and the mortality rate of WNND cases suggest a changing pattern of WNV infection in Romania. Public health authorities and clinicians should be aware of the risk of severe WNV infection in travelers returning from Romania.
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Affiliation(s)
- Corneliu Petru Popescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania; ESCMID Study Group for Infectious Diseases of the Brain, Basel, Switzerland; ESCMID Study Group for Infections in Travellers and Migrants, Basel, Switzerland.
| | - Simin Aysel Florescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Ani Ioana Cotar
- Laboratory for Vector-Borne Infections, Cantacuzino National Institute for Research, Bucharest, Romania
| | - Daniela Badescu
- Laboratory for Vector-Borne Infections, Cantacuzino National Institute for Research, Bucharest, Romania
| | - Cornelia Svetlana Ceianu
- Laboratory for Vector-Borne Infections, Cantacuzino National Institute for Research, Bucharest, Romania
| | - Mihaela Zaharia
- Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania; ESCMID Study Group for Infectious Diseases of the Brain, Basel, Switzerland; ESCMID Study Group for Infections in Travellers and Migrants, Basel, Switzerland
| | - Gratiela Tardei
- Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Daniel Codreanu
- Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Emanoil Ceausu
- Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Simona Maria Ruta
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Stefan S Nicolau Institute of Virology, Bucharest, Romania
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28
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Barber BE, Grigg MJ, William T, Piera KA, Boyle MJ, Yeo TW, Anstey NM. Effects of Aging on Parasite Biomass, Inflammation, Endothelial Activation, Microvascular Dysfunction and Disease Severity in Plasmodium knowlesi and Plasmodium falciparum Malaria. J Infect Dis 2017; 215:1908-1917. [PMID: 28863470 DOI: 10.1093/infdis/jix193] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/15/2017] [Indexed: 02/06/2023] Open
Abstract
Background In populations pauci-immune to malaria, risk of severe malaria increases with age. This is particularly apparent in Plasmodium knowlesi malaria. However, pathophysiological mechanisms underlying knowlesi malaria, and of the age-related increase in risk of severe malaria in general, are poorly understood. Methods In Malaysian patients aged ≥12 years with severe (n = 47) and nonsevere (n = 99) knowlesi malaria, severe (n = 21) and nonsevere (n = 109) falciparum malaria, and healthy controls (n = 50), we measured parasite biomass, systemic inflammation (interleukin 6 [IL-6]), endothelial activation (angiopoietin-2), and microvascular function, and evaluated the effects of age. Results Plasmodium knowlesi parasitemia correlated with age (Spearman's correlation coefficient [rs] = 0.36; P < .0001). In knowlesi malaria, IL-6, angiopoietin-2, and microvascular dysfunction were increased in severe compared to nonsevere disease, and all correlated with age, independent of parasitemia. In falciparum malaria, angiopoietin-2 increased with age, independent of parasite biomass (histidine-rich protein 2 [HRP2]). Independent risk factors for severe malaria included parasitemia and angiopoietin-2 in knowlesi malaria, and HRP2, angiopoietin-2, and microvascular dysfunction in falciparum malaria. Conclusions Parasite biomass, endothelial activation, and microvascular dysfunction are associated with severe disease in knowlesi malaria and likely contribute to pathogenesis. The association of each of these processes with aging may account for the greater severity of malaria observed in older adults in low-endemic regions.
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Affiliation(s)
- Bridget E Barber
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Northern Territory, Australia.,Infectious Diseases Society, Sabah-Menzies School of Health Research Clinical Research Unit, Queen Elizabeth Hospital
| | - Matthew J Grigg
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Northern Territory, Australia.,Infectious Diseases Society, Sabah-Menzies School of Health Research Clinical Research Unit, Queen Elizabeth Hospital
| | - Timothy William
- Infectious Diseases Society, Sabah-Menzies School of Health Research Clinical Research Unit, Queen Elizabeth Hospital.,Jesselton Medical Centre, Kota Kinabalu, Sabah, Malaysia
| | - Kim A Piera
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Northern Territory, Australia
| | - Michelle J Boyle
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Northern Territory, Australia.,Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia
| | - Tsin W Yeo
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Northern Territory, Australia.,Infectious Diseases Society, Sabah-Menzies School of Health Research Clinical Research Unit, Queen Elizabeth Hospital.,Lee Kong Chian School of Medicine, Nanyang Technological University.,Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Nicholas M Anstey
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Northern Territory, Australia.,Infectious Diseases Society, Sabah-Menzies School of Health Research Clinical Research Unit, Queen Elizabeth Hospital
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29
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Allen J, Conard J, Wang M. A Fatal Case of Neuroinvasive West Nile Virus Infection in an Immunocompromised Host. Spartan Med Res J 2017; 2:5967. [PMID: 33655115 PMCID: PMC7746072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 06/15/2017] [Indexed: 09/16/2024] Open
Abstract
The neuroinvasive form of West Nile disease is an uncommon manifestation of the viral infection. To date, documented cases in Michigan of neuroinvasive decompensation from this virus have been rare. Evaluation requires a broad differential diagnosis and treatment options are still quite limited. Objective evaluations entailing physical exam and radiographic and laboratory changes are nonspecific. Serologic testing of cerebrospinal fluid by enzyme immunoassay remains the gold standard for diagnosis. However, IgM antibodies typically do not develop until after the fourth to seventh day of symptom onset. This retrospective case report presents an immunocompromised male patient in his mid-70s in whom neuroinvasive West Nile virus was diagnosed postmortem. All information was obtained from the patient's electronic health record. This patient's immunocompromised state at the time of West Nile exposure made him more susceptible to neuroinvasive disease progression and ultimately influenced the outcome. Prior to withdrawing care, the patient was treated for methicillin sensitive staphylococcus aureus (MSSA) cellulitis and Type 1 Herpes Simplex virus. In this case, neuroinvasive West Nile virus was a less likely diagnosis given the patient's physical exam findings and the context of more likely alternative explanations for his cognitive decline. Treatment options for neuroinvasive forms of West Nile virus are still supportive and would not have altered the patient's hospital course. This case report demonstrates that clinicians must maintain an ongoing index of suspicion for infection in warmer climates where West Nile is becoming more prevalent. Given some patients' obscure physical exam findings and radiographic imaging results, a thorough history with laboratory conformation is required for a more conclusive diagnosis.
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Affiliation(s)
- Justin Allen
- Lakeland Health Internal Medicine Resident, PGY 3, Saint Joseph, M
| | - Jennifer Conard
- Lakeland Health Internal Medicine Resident, PGY 3, Saint Joseph, MI
| | - Michael Wang
- Lakeland Health IM Residency Program Director and Attending Physician Infectious Diseases, Saint Joseph, MI
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30
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Layton DS, Choudhary A, Bean AGD. Breaking the chain of zoonoses through biosecurity in livestock. Vaccine 2017; 35:5967-5973. [PMID: 28826750 DOI: 10.1016/j.vaccine.2017.07.110] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/24/2017] [Accepted: 07/31/2017] [Indexed: 12/14/2022]
Abstract
Increases in global travel, trade and urbanisation are leading to greater incidence of zoonotic disease, and livestock are often a key link in the spread of disease to humans. As such, livestock vaccination strategies, as a part of broader biosecurity solutions, are critical to both animal and human health. Importantly, approaches that restrict infectious agents in livestock, not only protects their economic value but should reduce the potential for spill over infections in humans. Biosecurity solutions to livestock health can take a number of different forms and are generally heavily weighted towards prevention of infection rather than treatment. Therefore, vaccination can provide an effective component of a strategic approach, particularly as production economics dictate the use of cost effective solutions. Furthermore, in an evolving global environment there is a need for vaccines that accommodate for lower socioeconomic and rapidly emerging zoonotics.
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Affiliation(s)
- Daniel S Layton
- CSIRO Health and Biosecurity, Australian Animal Health Laboratories, Geelong, Australia
| | - Anupma Choudhary
- CSIRO Health and Biosecurity, Australian Animal Health Laboratories, Geelong, Australia
| | - Andrew G D Bean
- CSIRO Health and Biosecurity, Australian Animal Health Laboratories, Geelong, Australia.
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31
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Molony RD, Malawista A, Montgomery RR. Reduced dynamic range of antiviral innate immune responses in aging. Exp Gerontol 2017; 107:130-135. [PMID: 28822811 PMCID: PMC5815956 DOI: 10.1016/j.exger.2017.08.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/11/2017] [Accepted: 08/12/2017] [Indexed: 01/04/2023]
Abstract
The worldwide population aged ≥ 65 years is increasing and the average life span is expected to increase another 10 years by 2050. This extended lifespan is associated with a progressive decline in immune function and a paradoxical state of low-grade, chronic inflammation that may contribute to susceptibility to viral infection, and reduced responses to vaccination. Here we review the effects of aging on innate immune responses to viral pathogens including elements of recognition, signaling, and production of inflammatory mediators. We specifically focus on age-related changes in key pattern recognition receptor signaling pathways, converging on altered cytokine responses, including a notable impairment of antiviral interferon responses. We highlight an emergent change in innate immunity that arises during aging – the dampening of the dynamic range of responses to multiple sources of stimulation – which may underlie reduced efficiency of immune responses in aging. We review the effects of aging on innate antiviral immunity, including recognition, signaling, and cytokine responses. Lower Toll-like receptor expression leads to impaired signaling and responses upon activation of these sensors. Effects of aging on cytosolic nucleic acid sensing receptors and inflammasomes remains incompletely characterized. In aging the dynamic range of innate immunity is compressed, with increased basal activation of many signaling pathways. Interferon production is impaired with age, which may lead to the increased viral susceptibility of older persons.
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Affiliation(s)
- Ryan D Molony
- Departments of Immunobiology, Yale University School of Medicine, New Haven, CT 06520, United States
| | - Anna Malawista
- Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, United States
| | - Ruth R Montgomery
- Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, United States; Human Translational Immunology, Yale University School of Medicine, New Haven, CT 06520, United States.
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32
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Sullivan KE, Bassiri H, Bousfiha AA, Costa-Carvalho BT, Freeman AF, Hagin D, Lau YL, Lionakis MS, Moreira I, Pinto JA, de Moraes-Pinto MI, Rawat A, Reda SM, Reyes SOL, Seppänen M, Tang MLK. Emerging Infections and Pertinent Infections Related to Travel for Patients with Primary Immunodeficiencies. J Clin Immunol 2017; 37:650-692. [PMID: 28786026 PMCID: PMC5693703 DOI: 10.1007/s10875-017-0426-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/21/2017] [Indexed: 12/18/2022]
Abstract
In today's global economy and affordable vacation travel, it is increasingly important that visitors to another country and their physician be familiar with emerging infections, infections unique to a specific geographic region, and risks related to the process of travel. This is never more important than for patients with primary immunodeficiency disorders (PIDD). A recent review addressing common causes of fever in travelers provides important information for the general population Thwaites and Day (N Engl J Med 376:548-560, 2017). This review covers critical infectious and management concerns specifically related to travel for patients with PIDD. This review will discuss the context of the changing landscape of infections, highlight specific infections of concern, and profile distinct infection phenotypes in patients who are immune compromised. The organization of this review will address the environment driving emerging infections and several concerns unique to patients with PIDD. The first section addresses general considerations, the second section profiles specific infections organized according to mechanism of transmission, and the third section focuses on unique phenotypes and unique susceptibilities in patients with PIDDs. This review does not address most parasitic diseases. Reference tables provide easily accessible information on a broader range of infections than is described in the text.
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Affiliation(s)
- Kathleen E Sullivan
- Division of Allergy and Immunology, The Children's Hospital of Philadelphia, 3615 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Hamid Bassiri
- Division of Infectious Diseases and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3501 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Ahmed A Bousfiha
- Clinical Immunology Unit, Infectious Department, Hopital d'Enfant Abderrahim Harouchi, CHU Ibn Rochd, Laboratoire d'Immunologie Clinique, d'Inflammation et d'Allergie LICIA, Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, Morocco
| | - Beatriz T Costa-Carvalho
- Department of Pediatrics, Federal University of São Paulo, Rua dos Otonis, 725, São Paulo, SP, 04025-002, Brazil
| | - Alexandra F Freeman
- NIAID, NIH, Building 10 Room 12C103, 9000 Rockville, Pike, Bethesda, MD, 20892, USA
| | - David Hagin
- Division of Allergy and Immunology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, University of Tel Aviv, 6 Weizmann St, 64239, Tel Aviv, Israel
| | - Yu L Lau
- Department of Paediatrics & Adolescent Medicine, The University of Hong Kong, Rm 106, 1/F New Clinical Building, Pok Fu Lam, Hong Kong.,Queen Mary Hospital, 102 Pokfulam Road, Pok Fu Lam, Hong Kong
| | - Michail S Lionakis
- Fungal Pathogenesis Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy & Infectious Diseases (NIAID), National Institutes of Health (NIH), 9000 Rockville Pike, Building 10, Room 11C102, Bethesda, MD, 20892, USA
| | - Ileana Moreira
- Immunology Unit, Hospital de Niños Ricardo Gutiérrez, Gallo 1330, 1425, Buenos Aires, Argentina
| | - Jorge A Pinto
- Division of Immunology, Department of Pediatrics, Federal University of Minas Gerais, Av. Alfredo Balena 190, room # 161, Belo Horizonte, MG, 30130-100, Brazil
| | - M Isabel de Moraes-Pinto
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Federal University of São Paulo, Rua Pedro de Toledo, 781/9°andar, São Paulo, SP, 04039-032, Brazil
| | - Amit Rawat
- Pediatric Allergy and Immunology, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shereen M Reda
- Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Saul Oswaldo Lugo Reyes
- Immunodeficiencies Research Unit, National Institute of Pediatrics, Av Iman 1, Torre de Investigacion, Piso 9, Coyoacan, 04530, Mexico City, Mexico
| | - Mikko Seppänen
- Harvinaissairauksien yksikkö (HAKE), Rare Disease Center, Helsinki University Hospital (HUH), Helsinki, Finland
| | - Mimi L K Tang
- Murdoch Children's Research Institute, The Royal Children's Hospital, University of Melbourne, Melbourne, Australia
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33
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Montgomery RR. Age-related alterations in immune responses to West Nile virus infection. Clin Exp Immunol 2016; 187:26-34. [PMID: 27612657 DOI: 10.1111/cei.12863] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2016] [Indexed: 12/25/2022] Open
Abstract
West Nile virus (WNV) is the most important causative agent of viral encephalitis worldwide and an important public health concern in the United States due to its high prevalence, severe disease, and the absence of effective treatments. Infection with WNV is mainly asymptomatic, but some individuals develop severe, possibly fatal, neurological disease. Individual host factors play a role in susceptibility to WNV infection, including genetic polymorphisms in key anti-viral immune genes, but age is the most well-defined risk factor for susceptibility to severe disease. Ageing is associated with distinct changes in immune cells and a decline in immune function leading to increased susceptibility to infection and reduced responses to vaccination. WNV is detected by pathogen recognition receptors including Toll-like receptors (TLRs), which show reduced expression and function in ageing. Neutrophils, monocyte/macrophages and dendritic cells, which first recognize and respond to infection, show age-related impairment of many functions relevant to anti-viral responses. Natural killer cells control many viral infections and show age-related changes in phenotype and functional responses. A role for the regulatory receptors Mertk and Axl in blood-brain barrier permeability and in facilitating viral uptake through phospholipid binding may be relevant for susceptibility to WNV, and age-related up-regulation of Axl has been noted previously in human dendritic cells. Understanding the specific immune parameters and mechanisms that influence susceptibility to symptomatic WNV may lead to a better understanding of increased susceptibility in elderly individuals and identify potential avenues for therapeutic approaches: an especially relevant goal, as the world's populating is ageing.
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Affiliation(s)
- R R Montgomery
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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34
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Tabachnick WJ. Ecological effects on arbovirus-mosquito cycles of transmission. Curr Opin Virol 2016; 21:124-131. [PMID: 27693828 DOI: 10.1016/j.coviro.2016.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/14/2016] [Indexed: 10/20/2022]
Abstract
Mosquitoes transmit many viruses to a variety of hosts. Cycles of mosquito borne arbovirus transmission are the result of complex interactions between the mosquito, the arbovirus and the host that are influenced by genetic variations in a variety of traits in each that are all influenced by many environmental factors. R0, the basic reproduction number or mean number of individuals infected from a single infected individual, is a measure of mosquito borne arbovirus transmission. Understanding the causes for the distribution of R0 in any transmission cycle is a daunting challenge due to the lack of information on the genetic and environmental variances that influence R0. Information about the major factors influencing R0 for specific transmission cycles is essential to develop efficient and effective strategies to reduce transmission in different cycles and locations.
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Affiliation(s)
- Walter J Tabachnick
- Florida Medical Entomology Laboratory, Department of Entomology and Nematology, University of Florida, IFAS, 200 9th St., SE, Vero Beach, FL, USA.
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35
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Lenhard T, Ott D, Jakob NJ, Pham M, Bäumer P, Martinez-Torres F, Meyding-Lamadé U. Predictors, Neuroimaging Characteristics and Long-Term Outcome of Severe European Tick-Borne Encephalitis: A Prospective Cohort Study. PLoS One 2016; 11:e0154143. [PMID: 27111657 PMCID: PMC4844156 DOI: 10.1371/journal.pone.0154143] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 04/09/2016] [Indexed: 12/30/2022] Open
Abstract
Background and Objectives Tick-borne encephalitis (TBE) still represents a considerable medical and health economic problem in Europe and entails a potential threat to travellers. The aim of this study was to characterise the conditions of severe TBE by precisely recording its clinical variants, the related neuroimaging features, and the variant-specific long-term outcome and by identifying predictors for severe courses. Methods A cohort of 111 TBE patients (median age 51, range 17–75 years; 42% females) was analysed prospectively. Data were acquired from the department of neurology, University Hospital Heidelberg, and the infectious diseases registry of the Robert-Koch institute Berlin. Neurological status was ascertained by protocol at admission and discharge and the degree of disability was scored using the modified RANKIN Scale (mRS; clinical score addressing neurological disability, range from 0, healthy to 6, dead) at admission and at follow-up. Follow-up examination was conducted by means of a telephone interview. To identify independent predictors for severe TBE and functional outcome, modelled logistic regression was performed. MRI changes were correlated with infection variants. To assess alpha-motor neuron injury patterns, we used high-resolution magnetic resonance neurography (hrMRN). Analyses were performed at the Department of Neurology, University Hospital, University of Heidelberg from April 2004 through September 2014 Results Acute course: 3.6% of patients died during the acute infection. All patients with a lethal course suffered from meningoencephaloradiculitis (MER, 14.4% of the cohort), which is associated with a significantly higher risk of requiring intensive care (p = 0.004) and mechanical ventilation (p<0.001) than menigoencephalitis (ME, 27.9% of the cohort). At admission, both MER and ME groups were severely affected, with the MER group having a statistically higher mRS score (median of 5 in the MER groups versus 4 in the ME group; p<0.001). Long-term outcome: outcome for MER was considerably worse (median mRS = 4) than for ME (mRS = 1, p<0.0001) and meningitis (mRS = 0, 57.7% of the cohort). Risk factors: advanced age (p<0.001) and male gender (p = 0.043) are independent risk factors for a severe infection course. Furthermore, we identified pre-existing diabetes mellitus (p = 0.024) as an independent risk factor for MER. In MER, alpha-motor neuron injury accounts for the poor prognosis confirmed by hrMRN. Conclusion and Relevance These data provide critical information for neurologists and other health professionals to use in evaluating TBEV patients who live in or travel to endemic areas. This information can be used to classify clinical presentation and estimate infection-associated complications and individual prognosis. Furthermore, the risk for severe, disabling infections in older patients should prompt general practitioners to recommend and encourage vaccination to those patients living in or travelling to endemic areas.
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Affiliation(s)
- Thorsten Lenhard
- Neuroinfectious Diseases Group, Department of Neurology, University Hospital of Heidelberg, Heidelberg, Germany
- * E-mail:
| | - Daniela Ott
- Neuroinfectious Diseases Group, Department of Neurology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Nurith J. Jakob
- Neuroinfectious Diseases Group, Department of Neurology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Mirko Pham
- Department of Neuroradiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Philipp Bäumer
- Department of Neuroradiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Francisco Martinez-Torres
- Neuroinfectious Diseases Group, Department of Neurology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Uta Meyding-Lamadé
- Department of Neurology, Krankenhaus Nordwest Frankfurt, Frankfurt, Germany
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Abstract
West Nile virus (WNV) can cause severe neuroinvasive disease in humans and currently no vaccine or specific treatments are available. As aging is the most prominent risk factor for WNV, age-related immune dysregulation likely plays an essential role in host susceptibility to infection with WNV. In this review, we summarize recent findings in effects of aging on immune responses to WNV infection. In particular, we focus on the age-dependent dysregulation of innate immune cell types-neutrophils, macrophages, and dendritic cells-in response to WNV infection, as well as age-related alterations in NK cells and γδ T cells that may associate with increased WNV susceptibility in older people. We also highlight two advanced technologies, i.e., mass cytometry and microRNA profiling, which significantly contribute to systems-level study of immune dysregulation in aging and should facilitate new discoveries for therapeutic intervention against WNV.
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Affiliation(s)
- Yi Yao
- Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, CT, 06520, USA
| | - Ruth R Montgomery
- Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, CT, 06520, USA.
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Tsioris K, Gupta NT, Ogunniyi AO, Zimnisky RM, Qian F, Yao Y, Wang X, Stern JNH, Chari R, Briggs AW, Clouser CR, Vigneault F, Church GM, Garcia MN, Murray KO, Montgomery RR, Kleinstein SH, Love JC. Neutralizing antibodies against West Nile virus identified directly from human B cells by single-cell analysis and next generation sequencing. Integr Biol (Camb) 2015; 7:1587-97. [PMID: 26481611 PMCID: PMC4754972 DOI: 10.1039/c5ib00169b] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
West Nile virus (WNV) infection is an emerging mosquito-borne disease that can lead to severe neurological illness and currently has no available treatment or vaccine. Using microengraving, an integrated single-cell analysis method, we analyzed a cohort of subjects infected with WNV - recently infected and post-convalescent subjects - and efficiently identified four novel WNV neutralizing antibodies. We also assessed the humoral response to WNV on a single-cell and repertoire level by integrating next generation sequencing (NGS) into our analysis. The results from single-cell analysis indicate persistence of WNV-specific memory B cells and antibody-secreting cells in post-convalescent subjects. These cells exhibited class-switched antibody isotypes. Furthermore, the results suggest that the antibody response itself does not predict the clinical severity of the disease (asymptomatic or symptomatic). Using the nucleotide coding sequences for WNV-specific antibodies derived from single cells, we revealed the ontogeny of expanded WNV-specific clones in the repertoires of recently infected subjects through NGS and bioinformatic analysis. This analysis also indicated that the humoral response to WNV did not depend on an anamnestic response, due to an unlikely previous exposure to the virus. The innovative and integrative approach presented here to analyze the evolution of neutralizing antibodies from natural infection on a single-cell and repertoire level can also be applied to vaccine studies, and could potentially aid the development of therapeutic antibodies and our basic understanding of other infectious diseases.
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Affiliation(s)
- Konstantinos Tsioris
- Department of Chemical Engineering, Koch Institute of Integrative Cancer Research, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Bldg. 76-253, Cambridge, MA 02139, USA.
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38
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Non-native and native organisms moving into high elevation and high latitude ecosystems in an era of climate change: new challenges for ecology and conservation. Biol Invasions 2015. [DOI: 10.1007/s10530-015-1025-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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39
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Barzon L, Pacenti M, Sinigaglia A, Berto A, Trevisan M, Palù G. West Nile virus infection in children. Expert Rev Anti Infect Ther 2015; 13:1373-86. [PMID: 26325613 DOI: 10.1586/14787210.2015.1083859] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
West Nile virus (WNV) is an emerging flavivirus responsible for an increasing number of outbreaks of neuroinvasive disease in North America, Europe, and neighboring countries. Almost all WNV infections in humans are transmitted through the bite of infected mosquitoes. Transmission during pregnancy and through breastfeeding has been reported, but the risk seems to be very low. West Nile disease in children is less common (1-5% of all WNV cases) and associated with milder symptoms and better outcome than in elderly individuals, even though severe neuroinvasive disease and death have been reported also among children. However, the incidence of WNV infection and disease in children is probably underestimated and the disease spectrum is not fully understood because of lack of reporting and underdiagnosis in children. Infection is diagnosed by detection of WNV-specific antibodies in serum and WNV RNA in plasma and urine. Since no effective WNV-specific drugs are available, therapy is mainly supportive.
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Affiliation(s)
- Luisa Barzon
- a 1 Department of Molecular Medicine, University of Padova, via A. Gabelli 63, 35121 Padova, Italy
| | - Monia Pacenti
- b 2 Microbiology and Virology Unit, Padova University Hospital, via Giustiniani 2, 35128 Padova, Italy
| | | | - Alessandro Berto
- a 1 Department of Molecular Medicine, University of Padova, via A. Gabelli 63, 35121 Padova, Italy
| | - Marta Trevisan
- a 1 Department of Molecular Medicine, University of Padova, via A. Gabelli 63, 35121 Padova, Italy
| | - Giorgio Palù
- a 1 Department of Molecular Medicine, University of Padova, via A. Gabelli 63, 35121 Padova, Italy
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