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Kapadia RK, Staples JE, Gill CM, Fischer M, Khan E, Laven JJ, Panella A, Velez JO, Hughes HR, Brault A, Pastula DM, Gould CV. Severe Arboviral Neuroinvasive Disease in Patients on Rituximab Therapy: A Review. Clin Infect Dis 2023; 76:1142-1148. [PMID: 36103602 PMCID: PMC10011006 DOI: 10.1093/cid/ciac766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/02/2022] [Accepted: 09/09/2022] [Indexed: 11/12/2022] Open
Abstract
With increasing use of rituximab and other B-cell depleting monoclonal antibodies for multiple indications, infectious complications are being recognized. We summarize clinical findings of patients on rituximab with arboviral diseases identified through literature review or consultation with the Centers for Disease Control and Prevention. We identified 21 patients on recent rituximab therapy who were diagnosed with an arboviral disease caused by West Nile, tick-borne encephalitis, eastern equine encephalitis, Cache Valley, Jamestown Canyon, and Powassan viruses. All reported patients had neuroinvasive disease. The diagnosis of arboviral infection required molecular testing in 20 (95%) patients. Median illness duration was 36 days (range, 12 days to 1 year), and 15/19 (79%) patients died from their illness. Patients on rituximab with arboviral disease can have a severe or prolonged course with an absence of serologic response. Patients should be counseled about mosquito and tick bite prevention when receiving rituximab and other B-cell depleting therapies.
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Affiliation(s)
- Ronak K Kapadia
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado, USA
- Division of Neurology, Department of Clinical Neurosciences, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - J Erin Staples
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Christine M Gill
- University of Iowa, Carver College of Medicine, Department of Neurology, Iowa City, Iowa, USA
| | - Marc Fischer
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Ezza Khan
- Hunterdon Infectious Disease Specialists, Flemington, New Jersey, USA
| | - Janeen J Laven
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Amanda Panella
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Jason O Velez
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Holly R Hughes
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Aaron Brault
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Daniel M Pastula
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado, USA
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Carolyn V Gould
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
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Rutland JW, Delman BN, Gill CM, Zhu C, Shrivastava RK, Balchandani P. Emerging Use of Ultra-High-Field 7T MRI in the Study of Intracranial Vascularity: State of the Field and Future Directions. AJNR Am J Neuroradiol 2020; 41:2-9. [PMID: 31879330 DOI: 10.3174/ajnr.a6344] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/15/2019] [Indexed: 12/23/2022]
Abstract
Cerebrovascular disease is a major source of mortality that commonly requires neurosurgical intervention. MR imaging is the preferred technique for imaging cerebrovascular structures, as well as regions of pathology that include microbleeds and ischemia. Advanced MR imaging sequences such as time-of-flight, susceptibility-weighted imaging, and 3D T2-weighted sequences have demonstrated excellent depiction of arterial and venous structures with and without contrast administration. While the advantages of 3T compared with 1.5T have been described, the role of ultra-high-field (7T) MR imaging in neurovascular imaging remains poorly understood. In the present review, we examine emerging neurosurgical applications of 7T MR imaging in vascular imaging of diverse conditions and discuss current limitations and future directions for this technique.
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Affiliation(s)
- J W Rutland
- From the Translational and Molecular Imaging Institute (J.W.R., B.N.D., P.B.)
- Departments of Neurosurgery (J.W.R., C.M.G., R.K.S.)
| | - B N Delman
- From the Translational and Molecular Imaging Institute (J.W.R., B.N.D., P.B.)
- Diagnostic, Molecular, and Interventional Radiology (B.N.D.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - C M Gill
- Departments of Neurosurgery (J.W.R., C.M.G., R.K.S.)
| | - C Zhu
- Department of Radiology and Biomedical Imaging (C.Z.), University of California San Francisco, San Francisco, California
| | | | - P Balchandani
- From the Translational and Molecular Imaging Institute (J.W.R., B.N.D., P.B.)
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Gill CM, Kapadia RK, Beckham JD, Piquet AL, Tyler KL, Pastula DM. Usutu virus disease: a potential problem for North America? J Neurovirol 2019; 26:149-154. [PMID: 31858483 DOI: 10.1007/s13365-019-00818-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 09/07/2019] [Accepted: 11/18/2019] [Indexed: 11/27/2022]
Abstract
Usutu virus is an emerging mosquito-borne flavivirus initially identified in South Africa in 1959 that is now circulating throughout parts of Africa, Europe, and the Middle East. It is closely related to West Nile virus, and has similar vectors, amplifying bird hosts, and epidemiology. Usutu virus infection can occur in humans and may be asymptomatic or cause systemic (e.g., fever, rash, and hepatitis) or neuroinvasive (e.g., meningitis and encephalitis) disease. Given few reported cases, the full clinical spectrum is not known. No anti-viral treatment is available, but it can be largely prevented by avoiding mosquito bites. Because of similar mosquitoes, birds, and climate to Europe, the potential for introduction to North America is possible.
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Affiliation(s)
- Christine M Gill
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Mail Stop B182, Research Complex 2, 12700 East 19th Ave., Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Ronak K Kapadia
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Mail Stop B182, Research Complex 2, 12700 East 19th Ave., Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - J David Beckham
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Mail Stop B182, Research Complex 2, 12700 East 19th Ave., Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Amanda L Piquet
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Mail Stop B182, Research Complex 2, 12700 East 19th Ave., Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Kenneth L Tyler
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Mail Stop B182, Research Complex 2, 12700 East 19th Ave., Anschutz Medical Campus, Aurora, CO, 80045, USA
- Department of Immunology-Microbiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel M Pastula
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Mail Stop B182, Research Complex 2, 12700 East 19th Ave., Anschutz Medical Campus, Aurora, CO, 80045, USA.
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
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Gill CM, Beckham JD, Piquet AL, Tyler KL, Pastula DM. Five Emerging Neuroinvasive Arboviral Diseases: Cache Valley, Eastern Equine Encephalitis, Jamestown Canyon, Powassan, and Usutu. Semin Neurol 2019; 39:419-427. [PMID: 31533182 DOI: 10.1055/s-0039-1687839] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
There are many arthropod-borne viruses (arboviruses) capable of neuroinvasion, with West Nile virus being one of the most well known. In this review, we highlight five rarer emerging or reemerging arboviruses capable of neuroinvasion: Cache Valley, eastern equine encephalitis, Jamestown Canyon, Powassan, and Usutu viruses. Cache Valley and Jamestown Canyon viruses likely circulate throughout most of North America, while eastern equine encephalitis and Powassan viruses typically circulate in the eastern half. Usutu virus is not currently circulating in North America, but has the potential to be introduced in the future given similar climate, vectors, and host species to Europe (where it has been circulating). Health care providers should contact their state or local health departments with any questions regarding arboviral disease surveillance, diagnosis, treatment, or prevention. To prevent neuroinvasive arboviral diseases, use of insect repellent and other mosquito and tick bite prevention strategies are key.
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Affiliation(s)
- Christine M Gill
- Neuro-Infectious Diseases Group, Division of Infectious Diseases, Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado
| | - J David Beckham
- Neuro-Infectious Diseases Group, Division of Infectious Diseases, Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado
| | - Amanda L Piquet
- Neuro-Infectious Diseases Group, Division of Infectious Diseases, Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado
| | - Kenneth L Tyler
- Neuro-Infectious Diseases Group, Division of Infectious Diseases, Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel M Pastula
- Neuro-Infectious Diseases Group, Division of Infectious Diseases, Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado.,Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
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