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Baksh SN, Heath SL, Fukuta Y, Shade D, Meisenberg B, Bloch EM, Tobian AAR, Spivak ES, Patel B, Gerber J, Raval JS, Forthal D, Paxton J, Mosnaim G, Anjan S, Blair J, Cachay E, Currier J, Das P, Huaman M, Sutcliffe C, Yarava A, Casadevall A, Sullivan D, Hanley D, Gebo KA. Symptom Duration and Resolution With Early Outpatient Treatment of Convalescent Plasma for Coronavirus Disease 2019: A Randomized Trial. J Infect Dis 2023; 227:1266-1273. [PMID: 36722044 PMCID: PMC10226658 DOI: 10.1093/infdis/jiad023] [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: 09/15/2022] [Revised: 01/20/2023] [Accepted: 01/26/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) convalescent plasma (CCP) reduces hospitalizations among outpatients treated early after symptom onset. It is unknown whether CCP reduces time to symptom resolution among outpatients. METHODS We evaluated symptom resolution at day 14 by trial arm using an adjusted subdistribution hazard model, with hospitalization as a competing risk. We also assessed the prevalence of symptom clusters at day 14 between treatments. Clusters were defined based on biologic clustering, impact on ability to work, and an algorithm. RESULTS Among 1070 outpatients followed up after transfusion, 381 of 538 (70.8%) receiving CCP and 381 of 532 (71.6%) receiving control plasma were still symptomatic (P = .78) at day 14. Associations between CCP and symptom resolution by day 14 did not differ significantly from those in controls after adjustment for baseline characteristics (adjusted subdistribution hazard ratio, 0.99; P = .62). The most common cluster consisted of cough, fatigue, shortness of breath, and headache and was found in 308 (57.2%) and 325 (61.1%) of CCP and control plasma recipients, respectively (P = .16). CONCLUSIONS In this trial of outpatients with early COVID-19, CCP was not associated with faster resolution of symptoms compared with control. Overall, there were no differences by treatment in the prevalence of each symptom or symptom clusters at day 14. CLINICAL TRIALS REGISTRATION NCT04373460.
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Affiliation(s)
- Sheriza N Baksh
- Department of Epidemiology Bloomberg Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Sonya L Heath
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yuriko Fukuta
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - David Shade
- Department of Epidemiology Bloomberg Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Barry Meisenberg
- Department of Medicine and Research Institute of Luminis Health, Annapolis, Maryland, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Emily S Spivak
- Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, Utah, USA
| | - Bela Patel
- Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - Jonathan Gerber
- Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, Massachusetts, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Donald Forthal
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, California, USA
| | - James Paxton
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan, USA
| | - Giselle Mosnaim
- Department of Medicine Northshore University Health System, Division of Allergy and Immunology, Evanston, Illinois, USA
| | - Shweta Anjan
- Department of Medicine, Division of Infectious Diseases, University of Miami, Miami, Florida, USA
| | - Janis Blair
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Phoenix, Phoenix, Arizona, USA
| | - Edward Cachay
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, La Jolla, California, USA
| | - Judith Currier
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, California, USA
| | - Piyali Das
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Moises Huaman
- Department of Medicine, Division of Infectious Diseases, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Catherine Sutcliffe
- Department of Epidemiology Bloomberg Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Anusha Yarava
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Arturo Casadevall
- Departments of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David Sullivan
- Departments of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel Hanley
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly A Gebo
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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2
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Shoham S, Bloch EM, Casadevall A, Hanley D, Lau B, Gebo K, Cachay E, Kassaye SG, Paxton JH, Gerber J, Levine AC, Naeim A, Currier J, Patel B, Allen ES, Anjan S, Appel L, Baksh S, Blair PW, Bowen A, Broderick P, Caputo CA, Cluzet V, Elena MC, Cruser D, Ehrhardt S, Forthal D, Fukuta Y, Gawad AL, Gniadek T, Hammel J, Huaman MA, Jabs DA, Jedlicka A, Karlen N, Klein S, Laeyendecker O, Karen L, McBee N, Meisenberg B, Merlo C, Mosnaim G, Park HS, Pekosz A, Petrini J, Rausch W, Shade DM, Shapiro JR, Singleton RJ, Sutcliffe C, Thomas DL, Yarava A, Zand M, Zenilman JM, Tobian AA, Sullivan DJ. Transfusing Convalescent Plasma as Post-Exposure Prophylaxis Against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection: A Double-Blinded, Phase 2 Randomized, Controlled Trial. Clin Infect Dis 2023; 76:e477-e486. [PMID: 35579509 PMCID: PMC9129191 DOI: 10.1093/cid/ciac372] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/18/2022] [Accepted: 05/10/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The efficacy of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) convalescent plasma (CCP) for preventing infection in exposed, uninfected individuals is unknown. CCP might prevent infection when administered before symptoms or laboratory evidence of infection. METHODS This double-blinded, phase 2 randomized, controlled trial (RCT) compared the efficacy and safety of prophylactic high titer (≥1:320 by Euroimmun ELISA) CCP with standard plasma. Asymptomatic participants aged ≥18 years with close contact exposure to a person with confirmed coronavirus disease 2019 (COVID-19) in the previous 120 hours and negative SARS-CoV-2 test within 24 hours before transfusion were eligible. The primary outcome was new SARS-CoV-2 infection. RESULTS In total, 180 participants were enrolled; 87 were assigned to CCP and 93 to control plasma, and 170 transfused at 19 sites across the United States from June 2020 to March 2021. Two were excluded for screening SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) positivity. Of the remaining 168 participants, 12/81 (14.8%) CCP and 13/87 (14.9%) control recipients developed SARS-CoV-2 infection; 6 (7.4%) CCP and 7 (8%) control recipients developed COVID-19 (infection with symptoms). There were no COVID-19-related hospitalizations in CCP and 2 in control recipients. Efficacy by restricted mean infection free time (RMIFT) by 28 days for all SARS-CoV-2 infections (25.3 vs 25.2 days; P = .49) and COVID-19 (26.3 vs 25.9 days; P = .35) was similar for both groups. CONCLUSIONS Administration of high-titer CCP as post-exposure prophylaxis, although appearing safe, did not prevent SARS-CoV-2 infection. CLINICAL TRIALS REGISTRATION NCT04323800.
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Affiliation(s)
| | | | | | | | - Bryan Lau
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Mosaic Consulting Ltd., Israel
| | | | - Edward Cachay
- Department of Medicine, Division of Infectious Diseases
| | - Seble G. Kassaye
- Division of Infectious Diseases/Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - James H. Paxton
- Department of Emergency Medicine Wayne State University, Detroit, Michigan, USA
| | - Jonathan Gerber
- Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worchester, Massachusetts, USA
| | - Adam C Levine
- Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, Rhode Island, USA
| | - Arash Naeim
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, California, USA
| | - Judith Currier
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, California, USA
| | - Bela Patel
- Department of Medicine, Division Critical Care Medicine, University of Texas Health, Houston, Texas, USA
| | - Elizabeth S. Allen
- Department of Pathology, University of California, San Diego, San Diego, California, USA
| | - Shweta Anjan
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Sheriza Baksh
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Mosaic Consulting Ltd., Israel
| | | | | | | | | | - Valerie Cluzet
- Vassar Brothers Medical Center, Nuvance Health, Poughkeepsie, New York, USA
| | | | | | - Stephan Ehrhardt
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Mosaic Consulting Ltd., Israel
| | - Donald Forthal
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, California, USA
| | - Yuriko Fukuta
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | | | - Thomas Gniadek
- Department of Pathology, Northshore University Health System, Evanston, Illinois, USA
| | | | - Moises A. Huaman
- Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati, Ohio, USA
| | - Douglas A. Jabs
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | - Sabra Klein
- Department of Molecular Microbiology and Immunology
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, USA
| | | | | | | | | | | | - Han-Sol Park
- Department of Molecular Microbiology and Immunology
| | | | - Joann Petrini
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, USA
| | - William Rausch
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, USA
| | - David M. Shade
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Mosaic Consulting Ltd., Israel
| | | | | | - Catherine Sutcliffe
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Mosaic Consulting Ltd., Israel
| | | | | | - Martin Zand
- Department of Medicine, University of Rochester, Rochester, New York, USA
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3
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Sironi M, Cagliani R, Biasin M, Lo Caputo S, Saulle I, Forni D, Real LM, Pineda JA, Exposito A, Saez ME, Sinangil F, Forthal D, Caruz A, Clerici M. No association of a risk variant for severe COVID-19 with HIV protection in three cohorts of highly exposed individuals. PNAS Nexus 2022; 1:pgac138. [PMID: 36741450 PMCID: PMC9896871 DOI: 10.1093/pnasnexus/pgac138] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/21/2022] [Indexed: 02/07/2023]
Abstract
An extended haplotype on chromosome 3 is the major genetic risk factor for severe COVID-19. The risk haplotype, which was inherited from Neanderthals, decreases the expression of several cytokine receptors, including CCR5. Recently, a study based on three general population cohorts indicated that the minor allele of one of the variants in the haplotype (rs17713054) protects against HIV infection. We thus expected this allele to be over-represented in highly exposed individuals who remain uninfected (exposed seronegative individuals, ESN). To perform a meta-analysis, we genotyped rs17713054 in three ESN cohorts of European ancestry exposed to HIV through different routes. No evidence of association was detected in the single cohorts. The meta-analysis also failed to detect any effect of the variant on protection from HIV-1. The same results were obtained in a Cox-regression analysis for the time to seroconversion. An in-vitro infection assay did not detect differences in viral replication as a function of rs17713054 genotype status. We conclude that the rs17713054 minor allele is not associated with the ESN phenotype and does not modulate HIV infection in vitro.
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Affiliation(s)
| | | | - Mara Biasin
- Laboratory of Immunobiology, Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, 20157 Milan, Italy
| | - Sergio Lo Caputo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Irma Saulle
- Laboratory of Immunobiology, Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, 20157 Milan, Italy
| | - Diego Forni
- Scientific Institute IRCCS E. MEDEA, Bioinformatics, Bosisio Parini, 23842 Lecco, Italy
| | - Luis Miguel Real
- Unidad de Enfermedades Infecciosas y Microbiología Clínica. Hospital Universitario de Valme, 41014 Sevilla, Spain,Departamento de Especialidades Quirúrgicas, Bioquímica e Inmunología. Facultad de Medicina. Universidad de Málaga, 29010 Málaga, Spain,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
| | - Juan Antonio Pineda
- Unidad de Enfermedades Infecciosas y Microbiología Clínica. Hospital Universitario de Valme, 41014 Sevilla, Spain,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain,Departamento de Medicina. Facultad de Medicina. Universidad de Sevilla. Instituto de Biomedicina de Sevilla (IBiS), 41013 Sevilla, Spain
| | - Almudena Exposito
- Unidad de Inmunogenética, Genética, Departamento de Biología Experimental, Universidad de Jaén, 23071 Jaén, Spain
| | | | - Faruk Sinangil
- Global Solutions for Infectious Diseases, Lafayette, 94549 CA, USA
| | - Donald Forthal
- Division of Infectious Diseases, Department of Medicine, University of California, Irvine School of Medicine, Irvine, 92697 CA, USA
| | - Antonio Caruz
- Unidad de Inmunogenética, Genética, Departamento de Biología Experimental, Universidad de Jaén, 23071 Jaén, Spain
| | - Mario Clerici
- Department of Physiopathology and Transplantation, University of Milan, 20122 Milan, Italy,Don C. Gnocchi Foundation ONLUS, IRCCS, 20133 Milan, Italy
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4
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Bloch EM, Tobian AAR, Shoham S, Hanley DF, Gniadek TJ, Cachay ER, Meisenberg BR, Kafka K, Marshall C, Heath SL, Shenoy A, Paxton JH, Levine A, Forthal D, Fukuta Y, Huaman MA, Ziman A, Adamski J, Gerber J, Cruser D, Kassaye SG, Mosnaim GS, Patel B, Metcalf RA, Anjan S, Reisler RB, Yarava A, Lane K, McBee N, Gawad A, Raval JS, Zand M, Abinante M, Broderick PB, Casadevall A, Sullivan D, Gebo KA. How do I implement an outpatient program for the administration of convalescent plasma for COVID-19? Transfusion 2022; 62:933-941. [PMID: 35352362 PMCID: PMC9086144 DOI: 10.1111/trf.16871] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/14/2022] [Accepted: 03/19/2022] [Indexed: 11/30/2022]
Abstract
Convalescent plasma, collected from donors who have recovered from a pathogen of interest, has been used to treat infectious diseases, particularly in times of outbreak, when alternative therapies were unavailable. The COVID-19 pandemic revived interest in the use of convalescent plasma. Large observational studies and clinical trials that were executed during the pandemic provided insight into how to use convalescent plasma, whereby high levels of antibodies against the pathogen of interest and administration early within the time course of the disease are critical for optimal therapeutic effect. Several studies have shown outpatient administration of COVID-19 convalescent plasma (CCP) to be both safe and effective, preventing clinical progression in patients when administered within the first week of COVID-19. The United States Food and Drug Administration expanded its emergency use authorization (EUA) to allow for the administration of CCP in an outpatient setting in December 2021, at least for immunocompromised patients or those on immunosuppressive therapy. Outpatient transfusion of CCP and infusion of monoclonal antibody therapies for a highly transmissible infectious disease introduces nuanced challenges related to infection prevention. Drawing on our experiences with the clinical and research use of CCP, we describe the logistical considerations and workflow spanning procurement of qualified products, infrastructure, staffing, transfusion, and associated management of adverse events. The purpose of this description is to facilitate the efforts of others intent on establishing outpatient transfusion programs for CCP and other antibody-based therapies.
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Affiliation(s)
- Evan M. Bloch
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Aaron A. R. Tobian
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious DiseasesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Daniel F. Hanley
- Department of NeurologyBrain Injury Outcomes Division, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Thomas J. Gniadek
- Department of PathologyNorthshore University Health SystemEvanstonIllinoisUSA
| | - Edward R. Cachay
- Department of Medicine, Division of Infectious DiseasesUniversity of CaliforniaSan DiegoCaliforniaUnited States
| | | | - Kimberly Kafka
- Department of PediatricsJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Christi Marshall
- Department of NeurologyBrain Injury Outcomes Division, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Sonya L. Heath
- Department of Medicine, Division of Infectious DiseasesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Aarthi Shenoy
- Department of Medicine, Division of Hematology and OncologyMedstar Washington Hospital CenterWashingtonDistrict of ColumbiaUSA
| | - James H. Paxton
- Department of Emergency MedicineWayne State UniversityDetroitMichiganUSA
| | - Adam Levine
- Department of Emergency MedicineRhode Island Hospital/Brown UniversityProvidenceRhode IslandUSA
| | - Donald Forthal
- Department of Medicine, Division of Infectious DiseasesUniversity of CaliforniaIrvineCaliforniaUnited States
| | - Yuriko Fukuta
- Department of Medicine, Section of Infectious DiseasesBaylor College of MedicineHoustonTexasUSA
| | - Moises A. Huaman
- Department of Medicine, Division of Infectious DiseasesUniversity of CincinnatiCincinnatiOhioUSA
| | - Alyssa Ziman
- Department of PathologyUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Jill Adamski
- Department of Laboratory MedicineMayo Clinic HospitalPhoenixArizonaUSA
| | - Jonathan Gerber
- Department of Medicine, Division of Hematology and OncologyUniversity of MassachusettsWorchesterMassachusettsUSA
| | - Daniel Cruser
- Nuvance Health Vassar Brothers Medical CenterPoughkeepsieNew YorkUSA
| | - Seble G. Kassaye
- Department of Medicine, Division of Infectious DiseasesMedstar Georgetown University HospitalWashingtonDistrict of ColumbiaUSA
| | - Giselle S. Mosnaim
- Division of Allergy and Immunology, Department of MedicineNorthshore University Health SystemEvanstonIllinoisUSA
| | - Bela Patel
- Department of Medicine, Divisions of Pulmonary and Critical Care MedicineUniversity of Texas Health Science CenterHoustonTexasUSA
| | - Ryan A. Metcalf
- Department of Medicine, Division of Infectious DiseasesUniversity of UtahSalt Lake CityUtahUSA
| | - Shweta Anjan
- Department of Medicine, Division of Infectious DiseasesUniversity of Miami, Miller School of MedicineMiamiFloridaUSA
| | | | - Anusha Yarava
- Department of NeurologyBrain Injury Outcomes Division, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Karen Lane
- Department of NeurologyBrain Injury Outcomes Division, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Nichol McBee
- Department of NeurologyBrain Injury Outcomes Division, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Amy Gawad
- Department of NeurologyBrain Injury Outcomes Division, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Jay S. Raval
- Department of PathologyUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Martin Zand
- Department of MedicineUniversity of RochesterRochesterNew YorkUSA
| | | | | | - Arturo Casadevall
- Departments of Molecular Microbiology and ImmunologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - David Sullivan
- Departments of Molecular Microbiology and ImmunologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Kelly A. Gebo
- Department of Medicine, Division of Infectious DiseasesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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5
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Meza G, Galián F, Jaimes-Bernal C, Márquez FJ, Sinangil F, Scagnolari C, Real LM, Forthal D, Caruz A. IFNL4 genotype influences the rate of HIV-1 seroconversion in men who have sex with men. Virulence 2022; 13:757-763. [PMID: 35481423 PMCID: PMC9067526 DOI: 10.1080/21505594.2022.2066612] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Individuals lacking interferon lambda 4 (IFNL4) protein due to a common null mutation (rs368234815) in the IFNL4 gene display higher resistance against several infections. The influence of IFNL4 on HIV-1 infection is still under discussion and conflicting results have been reported. This study intended to corroborate or refute the association of the null allele of IFNL4 and HIV-1 predisposition in a cohort of men who have sex with men (MSM). IFNL4 null genotype was assessed on 619 HIV-1-seronegative MSM who were followed for 36 months during a trial of a prophylactic vaccine against HIV-1. Of those, 257 individuals seroconverted during this period. A logistic regression model was constructed including demographic and IFNL4 genotype. In addition, a meta-analysis using data from the current study and other European populations was conducted. The null IFNL4 genotypes were correlated with lower HIV-1 seroconversion (Adjusted OR = 0.4 [95%CI: 0.2–0.8], P = 0.008) and longer time to seroconversion (889 vs. 938 days, P= 0.01). These results were validated by a meta-analysis incorporating data from other European populations and the result yielded a significant association of the IFNL4 null genotype under a dominant model with a lower probability of HIV-1 infection (OR=0.4 [95% CI: 0.3-0.6]; P= 1.3 x 10E-5).
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Affiliation(s)
- Giovanna Meza
- Departamento de Biología Experimental, Unidad de Inmunogenetica, Universidad de Jaén, Jaén, Spain.,Universidad de Ciencias Aplicadas y Ambientales, Facultad de Ciencia y Tecnología, Bogotá, Colombia
| | - Fátima Galián
- Departamento de Biología Experimental, Unidad de Inmunogenetica, Universidad de Jaén, Jaén, Spain
| | - Claudia Jaimes-Bernal
- Departamento de Biología Experimental, Unidad de Inmunogenetica, Universidad de Jaén, Jaén, Spain.,Universidad de Boyaca, Facultad de Ciencias de la Salud, Tunja, Colombia
| | - Francisco J Márquez
- Departamento de Biología Experimental, Unidad de Inmunogenetica, Universidad de Jaén, Jaén, Spain
| | - Faruk Sinangil
- Global Solutions for Infectious Diseases, Lafayette, CA, USA
| | - Carolina Scagnolari
- Department of Molecular Medicine, Laboratory of Virology, Institut Pasteur Italia, SApienza University of Rome, Rome, Italy
| | - Luis Miguel Real
- de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario de Valme, Sevilla, Spain.,Inmunología, Universidad de MálagaDepartamento de Especialidades Quirúrgicas, Bioquímica e , Málaga Spain
| | - Donald Forthal
- Division of Infectious Diseases, Department of Medicine, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Antonio Caruz
- Departamento de Biología Experimental, Unidad de Inmunogenetica, Universidad de Jaén, Jaén, Spain
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6
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Shoham S, Bloch EM, Casadevall A, Hanley D, Lau B, Gebo K, Cachay E, Kassaye SG, Paxton JH, Gerber J, Levine AC, Currier J, Patel B, Allen ES, Anjan S, Appel L, Baksh S, Blair PW, Bowen A, Broderick P, Caputo CA, Cluzet V, Cordisco ME, Cruser D, Ehrhardt S, Forthal D, Fukuta Y, Gawad AL, Gniadek T, Hammel J, Huaman MA, Jabs DA, Jedlicka A, Karlen N, Klein S, Laeyendecker O, Lane K, McBee N, Meisenberg B, Merlo C, Mosnaim G, Park HS, Pekosz A, Petrini J, Rausch W, Shade DM, Shapiro JR, Singleton JR, Sutcliffe C, Thomas DL, Yarava A, Zand M, Zenilman JM, Tobian AA, Sullivan D. Randomized controlled trial transfusing convalescent plasma as post-exposure prophylaxis against SARS-CoV-2 infection. medRxiv 2021:2021.12.13.21267611. [PMID: 34931202 PMCID: PMC8687473 DOI: 10.1101/2021.12.13.21267611] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The efficacy of SARS-CoV-2 convalescent plasma (CCP) for preventing infection in exposed, uninfected individuals is unknown. We hypothesized that CCP might prevent infection when administered before symptoms or laboratory evidence of infection. METHODS This double-blinded, phase 2 randomized, controlled trial (RCT) compared the efficacy and safety of prophylactic high titer (≥1:320) CCP with standard plasma. Asymptomatic participants aged ≥18 years with close contact exposure to a person with confirmed COVID-19 in the previous 120 hours and negative SARS-CoV-2 test within 24 hours before transfusion were eligible. The primary outcome was development of SARS-CoV-2 infection. RESULTS 180 participants were enrolled; 87 were assigned to CCP and 93 to control plasma, and 170 transfused at 19 sites across the United States from June 2020 to March 2021. Two were excluded for SARS-CoV-2 RT-PCR positivity at screening. Of the remaining 168 participants, 12/81 (14.8%) CCP and 13/87 (14.9%) control recipients developed SARS-CoV-2 infection; 6 (7.4%) CCP and 7 (8%) control recipients developed COVID-19 (infection with symptoms). There were no COVID-19-related hospitalizations in CCP and 2 in control recipients. There were 28 adverse events in CCP and 58 in control recipients. Efficacy by restricted mean infection free time (RMIFT) by 28 days for all SARS-CoV-2 infections (25.3 vs. 25.2 days; p=0.49) and COVID-19 (26.3 vs. 25.9 days; p=0.35) were similar for both groups. CONCLUSION In this trial, which enrolled persons with recent exposure to a person with confirmed COVID-19, high titer CCP as post-exposure prophylaxis appeared safe, but did not prevent SARS-CoV-2 infection. TRIAL REGISTRATION Clinicaltrial.gov number NCT04323800 .
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7
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Costales JK, Lee H, Quan KA, Madey KM, McArthur K, Gohil SK, Huang SS, Forthal D, Park S. 306. Association of Antibiotic Use and Development Secondary Infection from Clostridium difficile, Multidrug-Resistant Bacteria, and Candida in Hospitalized Patients with History of COVID-19. Open Forum Infect Dis 2021. [PMCID: PMC8644050 DOI: 10.1093/ofid/ofab466.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background There is increasing evidence that patients hospitalized with COVID-19 receive unnecessary antibiotics. The consequences of antibiotic overuse as it relates to antimicrobial resistance and development of secondary infections remains uncertain. The objective of this study is to compare antibiotic prescription patterns in patients with a history of COVID-19 to those without a history of COVID-19 and determine if there are differences in the frequency of secondary infections from Clostridioides difficile (C. difficile), multidrug-resistant (MDR) bacteria, and candida infections. Methods This study is a single-center, retrospective cohort study of 18,757 adults hospitalized during the COVID-19 pandemic from March 1, 2020 to March 31, 2021. Patients were stratified as COVID-19 positive, throughout all hospitalizations subsequent to the date of initial positivity, or COVID-19 negative. Differences in antibiotic practice patterns between the two groups were quantified using days of therapy per 1000 patient days (DOT/1000 PD). The frequency of C. difficile infection, MDR-bacteria, and candida infections were assessed among the two groups. Results During the 12-month study period, on average, the COVID-19 positive group received 21.81% more antibiotics than COVID-19 negative patients, with up to 56.15% increase seen in the first month of the pandemic (Table 1, Figure 1) The COVID-19 positive group had an increased frequency of Candidemia (0.73% versus 0.18%, p< .00001) and decreased isolation of ESBL organisms (1.17% versus 1.87%, p< 0.01416) compared to the COVID-19 negative group. There were no significant differences in frequency of C. difficile infection, isolation of other MDR-organisms, or Candida auris between the two groups. (Table 2) Table 1. Antibiotic days of therapy in COVID-19 positive and COVID-19 negative patients. ![]()
Figure 1. Antibiotic days of therapy in total cohort, COVID-19 positive, and COVID-19 negative patients. ![]()
Table 2. Frequency of secondary infections in COVID-19 positive and COVID-19 negative patients ![]()
Conclusion Patients with a history of COVID-19 infection received an average of 21.81% more antibiotics, have higher rates of candidemia, but lower rates of ESBL infection than those without a history of COVID-19 infection. The potential increase in antibiotic exposure could account for the increase in candidemia in patients with a history of COVID-19. Future studies include investigating the decrease in ESBL infections seen, perhaps due to receipt of broad antibiotics in COVID-19 patients that target ESBL bacteria. Disclosures Shruti K. Gohil, MD, MPH, Medline (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Molnycke (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Susan S. Huang, MD, MPH, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)
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Affiliation(s)
| | | | | | - Keith M Madey
- University of California Irvine Medical Center, Lakewood, California
| | | | | | | | - Donald Forthal
- University of California, Irvine School of Medicine, Irvine, California
| | - Steven Park
- University of California, Irvine, Irvine, CA
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8
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Gohil SK, Quan KA, Madey KM, King-Adelsohn S, Tjoa T, Tifrea D, Crews BO, Monuki ES, Khan S, Schubl SD, Bittencourt CE, Detweiler N, Chang W, Willis L, Khusbu U, Saturno A, Rezk SA, Figueroa C, Jain A, Assis R, Felgner P, Edwards R, Hsieh L, Forthal D, Wilson WC, Stamos MJ, Huang SS. Infection prevention strategies are highly protective in COVID-19 units while main risks to healthcare professionals come from coworkers and the community. Antimicrob Resist Infect Control 2021; 10:163. [PMID: 34809702 PMCID: PMC8608236 DOI: 10.1186/s13756-021-01031-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/27/2021] [Indexed: 11/19/2022] Open
Abstract
Background Early evaluations of healthcare professional (HCP) COVID-19 risk occurred during insufficient personal protective equipment and disproportionate testing, contributing to perceptions of high patient-care related HCP risk. We evaluated HCP COVID-19 seropositivity after accounting for community factors and coworker outbreaks. Methods Prior to universal masking, we conducted a single-center retrospective cohort plus cross-sectional study. All HCP (1) seen by Occupational Health for COVID-like symptoms (regardless of test result) or assigned to (2) dedicated COVID-19 units, (3) units with a COVID-19 HCP outbreak, or (4) control units from 01/01/2020 to 04/15/2020 were offered serologic testing by an FDA-authorized assay plus a research assay against 67 respiratory viruses, including 11 SARS-CoV-2 antigens. Multivariable models assessed the association of demographics, job role, comorbidities, care of a COVID-19 patient, and geocoded socioeconomic status with positive serology. Results Of 654 participants, 87 (13.3%) were seropositive; among these 60.8% (N = 52) had never cared for a COVID-19 patient. Being male (OR 1.79, CI 1.05–3.04, p = 0.03), working in a unit with a HCP-outbreak unit (OR 2.21, CI 1.28–3.81, p < 0.01), living in a community with low owner-occupied housing (OR = 1.63, CI = 1.00–2.64, p = 0.05), and ethnically Latino (OR 2.10, CI 1.12–3.96, p = 0.02) were positively-associated with COVID-19 seropositivity, while working in dedicated COVID-19 units was negatively-associated (OR 0.53, CI = 0.30–0.94, p = 0.03). The research assay identified 25 additional seropositive individuals (78 [12%] vs. 53 [8%], p < 0.01). Conclusions Prior to universal masking, HCP COVID-19 risk was dominated by workplace and community exposures while working in a dedicated COVID-19 unit was protective, suggesting that infection prevention protocols prevent patient-to-HCP transmission. Article summary Prior to universal masking, HCP COVID-19 risk was dominated by workplace and community exposures while working in a dedicated COVID-19 unit was protective, suggesting that infection prevention protocols prevent patient-to-HCP transmission. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-01031-5.
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Affiliation(s)
- Shruti K Gohil
- Epidemiology and Infection Prevention Program, Irvine Health (UC Irvine Health), University of California, Irvine, USA. .,Division of Infectious Diseases, Department of Medicine, Irvine School of Medicine, University of California, 100 Theory, Suite 120, Irvine, CA, 92617, USA.
| | - Kathleen A Quan
- Epidemiology and Infection Prevention Program, Irvine Health (UC Irvine Health), University of California, Irvine, USA
| | - Keith M Madey
- Epidemiology and Infection Prevention Program, Irvine Health (UC Irvine Health), University of California, Irvine, USA
| | | | - Tom Tjoa
- Division of Infectious Diseases, Department of Medicine, Irvine School of Medicine, University of California, 100 Theory, Suite 120, Irvine, CA, 92617, USA
| | - Delia Tifrea
- Pathology and Laboratory Medicine, UCI Health, Newport Beach, USA
| | - Bridgit O Crews
- Pathology and Laboratory Medicine, UCI Health, Newport Beach, USA
| | - Edwin S Monuki
- Pathology and Laboratory Medicine, UCI Health, Newport Beach, USA
| | - Saahir Khan
- Division of Infectious Diseases, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Sebastian D Schubl
- Department of Surgery, Irvine School of Medicine, University of California, Irvine, USA
| | | | - Neil Detweiler
- Pathology and Laboratory Medicine, UCI Health, Newport Beach, USA
| | - Wayne Chang
- Division of Occupational and Environmental Medicine, Irvine School of Medicine, University of California, Irvine, USA
| | - Lynn Willis
- Epidemiology and Infection Prevention Program, Irvine Health (UC Irvine Health), University of California, Irvine, USA
| | - Usme Khusbu
- Epidemiology and Infection Prevention Program, Irvine Health (UC Irvine Health), University of California, Irvine, USA
| | - Antonella Saturno
- Epidemiology and Infection Prevention Program, Irvine Health (UC Irvine Health), University of California, Irvine, USA
| | - Sherif A Rezk
- Pathology and Laboratory Medicine, UCI Health, Newport Beach, USA
| | - Cesar Figueroa
- Department of Surgery, Irvine School of Medicine, University of California, Irvine, USA
| | - Aarti Jain
- Department of Physiology and Biophysics, University of California, Irvine, USA
| | - Rafael Assis
- Department of Physiology and Biophysics, University of California, Irvine, USA
| | - Philip Felgner
- Department of Physiology and Biophysics, University of California, Irvine, USA
| | - Robert Edwards
- Pathology and Laboratory Medicine, UCI Health, Newport Beach, USA
| | - Lanny Hsieh
- Division of Infectious Diseases, Department of Medicine, Irvine School of Medicine, University of California, 100 Theory, Suite 120, Irvine, CA, 92617, USA
| | - Donald Forthal
- Division of Infectious Diseases, Department of Medicine, Irvine School of Medicine, University of California, 100 Theory, Suite 120, Irvine, CA, 92617, USA
| | | | - Michael J Stamos
- Department of Surgery, Irvine School of Medicine, University of California, Irvine, USA
| | - Susan S Huang
- Epidemiology and Infection Prevention Program, Irvine Health (UC Irvine Health), University of California, Irvine, USA.,Division of Infectious Diseases, Department of Medicine, Irvine School of Medicine, University of California, 100 Theory, Suite 120, Irvine, CA, 92617, USA
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9
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Abstract
This review focuses on adaptive immune responses against SARS-CoV-2, the coronavirus that causes COVID-19. A great deal of work has been accomplished in a very short period of time to describe adaptive immune responses and to ascertain their roles in determining the course of infection. As with other viral infections, SARS-CoV-2 elicits both antibody and T-cell responses. Whereas antibody responses are likely effective in preventing infection and may participate in controlling infection once established, it is less clear whether or not they play a role in pathogenesis. T cells are likely involved in controlling established infection, but a pathogenic role is also possible. Longer term evaluation is necessary to determine the durability of protective immune responses.
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Affiliation(s)
- Donald Forthal
- Division of Infectious Diseases, Department of Medicine, Department of Molecular Biology and Biochemistry, University of California, Irvine School of Medicine and School of Biological Sciences, United States.
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10
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Kwon YJ, Forthal D. COVID-19: An unprecedented challenge and an opportunity for change. Adv Drug Deliv Rev 2021; 171:48-49. [PMID: 33524417 PMCID: PMC7845530 DOI: 10.1016/j.addr.2021.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Young Jik Kwon
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, USA; Department of Chemical and Biomolecular Engineering, The Henry Samueli School of Engineering, University of California, Irvine, USA; Department of Biomedical Engineering, The Henry Samueli School of Engineering, University of California, Irvine, USA; Department of Molecular Biology and Biochemistry, School of Biological Sciences, University of California, Irvine, USA.
| | - Donald Forthal
- Department of Molecular Biology and Biochemistry, School of Biological Sciences, University of California, Irvine, USA; Division of Infectious Diseases, Department of Medicine, University of California, Irvine, USA
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11
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Cooper DM, Guay-Woodford L, Blazar BR, Bowman S, Byington CL, Dome J, Forthal D, Konstan MW, Kuppermann N, Liem RI, Ochoa ER, Pollock BH, Price OA, Ramsey BW, Ross LF, Sokol RJ, Wright RJ. Reopening Schools Safely: The Case for Collaboration, Constructive Disruption of Pre-Coronavirus 2019 Expectations, and Creative Solutions. J Pediatr 2020; 223:183-185. [PMID: 32445649 PMCID: PMC7239776 DOI: 10.1016/j.jpeds.2020.05.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Dan M. Cooper
- Institute for Clinical and Translational Science, University of California at Irvine, School of Medicine, Irvine, CA,Reprint requests: Dan M. Cooper, MD, Institute for Clinical and Translational Sciences, 843 Health Sciences Rd, Hewitt Hall 1113, Irvine, CA 92697
| | - Lisa Guay-Woodford
- Children's National Research Institute, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Bruce R. Blazar
- University of Minnesota Medical School, Pediatrics, Minneapolis, Minnesota
| | - Scott Bowman
- Irvine Unified School District. California State University, Los Angeles, Irvine, California
| | - Carrie L. Byington
- University of California Health, Office of the President, Oakland, California
| | - Jeffrey Dome
- Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, D.C
| | - Donald Forthal
- University of California, Irvine School of Medicine & School of Biological Sciences, Center for Cancer and Blood Disorders, Washington, D.C
| | | | - Nathan Kuppermann
- University of California, Davis School of Medicine, Pediatrics and Emergency Medicine, Sacramento, California
| | - Robert I. Liem
- Ann & Robert H. Lurie Children's Hospital of Chicago, Pediatrics, Chicago, Illinois
| | - Eduardo R. Ochoa
- University of Arkansas for Medical Sciences College of Medicine, Community Pediatrics, Little Rock, Arkansas
| | - Brad H. Pollock
- University of California, Davis School of Medicine & Clinical Translational Science Center, Public Health Sciences, Sacramento, California
| | - Olga Acosta Price
- University of Washington School of Medicine, Prevention and Community Health, Washington, DC
| | - Bonnie W. Ramsey
- George Washington University Milken Institute School of Public Health, Center for Clinical and Translational Research, Seattle, Washington
| | - Lainie Friedman Ross
- University of Chicago MacLean Center for Clinical Medical Ethics & Institute for Translational Medicine, Pediatrics, Chicago, Illinois
| | - Ronald J. Sokol
- University of Colorado School of Medicine, Colorado Clinical and Translational Sciences Institute, Aurora, Colorado
| | - Rosalind J. Wright
- Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, Pediatrics, New York, New York
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12
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Speiser L, Hsieh L, Huang SS, Bittencourt C, Forthal D. Brucellosis Presenting as Cholecystitis: A Case Report and Literature Review. Open Forum Infect Dis 2019; 6:ofz334. [PMID: 31660329 PMCID: PMC6765347 DOI: 10.1093/ofid/ofz334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/12/2019] [Indexed: 12/03/2022] Open
Abstract
Brucellosis is a zoonotic disease endemic to much of the world. It most often presents with nonspecific symptoms and is a well known cause of undulant fever. Focal forms occur less frequently, with osteoarticular complications being the most common. In this study, we describe a rare case of brucellosis presenting as cholecystitis.
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13
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Chinn J, Runge A, Dinicu A, Chang J, Ziogas A, Maher J, Naaseh A, Lucas A, Zezoff D, White K, Bera K, Crawford E, Cooper E, Bernstein M, Hari A, Tewari S, Rutaisire E, Forthal D, Pearre D, Tewari KS. Feasibility of visual inspection with acetic acid (VIA) screening for cervical cancer in Tanzania with emphasis on special populations. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.5527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5527 Background: Following the report that VIA screening reduced cervical cancer mortality by 31% in India (ASCO LBA2 2013; Shastri SS, et al JNCI 2014), the W.H.O. endorsed VIA guidelines for Africa, where the global disease burden is highest. In Tanzania, cervical cancer is a major source of morbidity and mortality, with nearly 10,000 new cases and 7,000 deaths annually. Due to lack of resources, therapies are limited and patient outcomes are further confounded by the relatively high prevalence of concurrent HIV infection. We report on the feasibility of VIA screening in Tanzania with emphasis on unique populations. Methods: Our two 5-day VIA screen-and-treat workshops in Buzuruga and Sangabuye Health Centres in Mwanza, Tanzania were approved by the University of California, Irvine IRB and local health authorities. Participants were recruited from surrounding communities and offered free cervical VIA screening, cryotherapy when indicated, and HIV rapid testing. Acetowhite lesions and/or abnormal vascular markings were VIA+. Chi-square and Fisher exact tests were performed with statistical significance assigned at 0.05. Results: During July 2018, 825 of 917 registered participants underwent VIA screening and 25.1% (n=207) were VIA+. 147 VIA+ non-pregnant women received same day cryotherapy and 15 (1.8%) with lesions suspicious for cancer were referred to Bugando Medical Center. In the subanalysis of 64 HIV+ patients (23 diagnosed at the workshops, 41 with prior diagnosis on ART), HIV infection was not associated with VIA positivity (p=0.497). Additionally, a non-significant trend of higher VIA+ screens among newly diagnosed untreated HIV patients (27.7%) vs patients with known HIV on ART (17.5%) was observed (p=0.556). Conclusions: VIA screening for cervical cancer, while feasible in Tanzania, will require follow-up and repetitive screening. Although cervical cancer is an AIDS-defining illness, lack of correlation between HIV infection and VIA-positivity may reflect the availability of W.H.O.-subsidized ART in sub-Saharan Africa to attenuate HPV-mediated neoplastic transformation, as previously reported by others. Further study of this phenomenon is warranted.
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Affiliation(s)
- Justine Chinn
- University of California, Irvine School of Medicine, Irvine, CA
| | - Ava Runge
- University of California, Irvine School of Medicine, Irvine, CA
| | - Andreea Dinicu
- University of California, Irvine School of Medicine, Irvine, CA
| | - Jenny Chang
- Department of Epidemiology, University of California, Irvine, Irvine, CA
| | - Argyrios Ziogas
- Department of Epidemiology, University of California, Irvine, Irvine, CA
| | - Justine Maher
- University of California, Irvine School of Medicine, Irvine, CA
| | - Ariana Naaseh
- University of California, Irvine School of Medicine, Irvine, CA
| | - Alexa Lucas
- University of California, Irvine School of Medicine, Irvine, CA
| | - Danielle Zezoff
- University of California, Irvine School of Medicine, Newport Beach, CA
| | - Kayla White
- University of California, Irvine School of Medicine, Irvine, CA
| | - Kevin Bera
- University of California, Irvine School of Medicine, Irvine, CA
| | | | - Emma Cooper
- University of California, Irvine School of Medicine, Irvine, CA
| | - Megan Bernstein
- University of California, Irvine School of Medicine, Irvine, CA
| | - Anjali Hari
- University of California, Los Angeles, Los Angeles, CA
| | | | - Eugen Rutaisire
- Buzuruga Health Center, Mwanza, Tanzania, United Republic of
| | - Donald Forthal
- University of California, Irvine Institute for Immunology, Irvine, CA
| | - Diana Pearre
- The Division of Gynecologic Oncology at the University of California, Irvine, Orange, CA
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14
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Abstract
Interactions between IgG Fc and its receptors (FcγRs) have been shown to augment broadly neutralizing Ab-mediated (BnAb-mediated) protection from simian-human immunodeficiency virus (SHIV) challenge. In the current issue of the JCI, Parsons and collaborators compared the BnAb PGT121 with a version engineered to have impaired FcγR binding for their ability to protect macaques from an intravenous challenge with SHIV-infected cells as well as to treat already infected animals. Unexpectedly, and in contrast to previous studies, both versions of the Ab were equally able to prevent infection and decrease viral loads in infected animals. Thus, FcγR engagement does not always improve the in vivo antiviral activity of BnAbs.
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Affiliation(s)
- Donald Forthal
- Division of Infectious Diseases, Department of Medicine, School of Medicine.,Department of Molecular Biology and Biochemistry, School of Biological Sciences, University of California, Irvine, Irvine, California, USA
| | - Andrés Finzi
- Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal.,Centre de Recherche du CHUM, Montreal, Quebec, Canada
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15
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Rosenberg Y, Sack M, Montefiori D, Forthal D, Mao L, Hernandez-Abanto S, Urban L, Landucci G, Fischer R, Jiang X. Rapid high-level production of functional HIV broadly neutralizing monoclonal antibodies in transient plant expression systems. PLoS One 2013; 8:e58724. [PMID: 23533588 PMCID: PMC3606348 DOI: 10.1371/journal.pone.0058724] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 02/05/2013] [Indexed: 11/19/2022] Open
Abstract
Passive immunotherapy using anti-HIV broadly neutralizing monoclonal antibodies (mAbs) has shown promise as an HIV treatment, reducing mother-to-child-transmission (MTCT) of simian/human immunodeficiency virus (SHIV) in non-human primates and decreasing viral rebound in patients who ceased receiving anti-viral drugs. In addition, a cocktail of potent mAbs may be useful as mucosal microbicides and provide an effective therapy for post-exposure prophylaxis. However, even highly neutralizing HIV mAbs used today may lose their effectiveness if resistance occurs, requiring the rapid production of new or engineered mAbs on an ongoing basis in order to counteract the viral resistance or the spread of a certain HIV-1 clade in a particular region or patient. Plant-based expression systems are fast, inexpensive and scalable and are becoming increasingly popular for the production of proteins and monoclonal antibodies. In the present study, Agrobacterium-mediated transient transfection of plants, utilizing two species of Nicotiana, have been tested to rapidly produce high levels of an HIV 89.6PΔ140env and several well-studied anti-HIV neutralizing monoclonal antibodies (b12, 2G12, 2F5, 4E10, m43, VRC01) or a single chain antibody construct (m9), for evaluation in cell-based viral inhibition assays. The protein-A purified plant-derived antibodies were intact, efficiently bound HIV envelope, and were equivalent to, or in one case better than, their counterparts produced in mammalian CHO or HEK-293 cells in both neutralization and antibody dependent viral inhibition assays. These data indicate that transient plant-based transient expression systems are very adaptable and could rapidly generate high levels of newly identified functional recombinant HIV neutralizing antibodies when required. In addition, they warrant detailed cost-benefit analysis of prolonged incubation in plants to further increase mAb production.
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Affiliation(s)
- Yvonne Rosenberg
- PlantVax Corporation, Rockville, Maryland, United States of America.
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16
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Miller CJ, Genescà M, Abel K, Montefiori D, Forthal D, Bost K, Li J, Favre D, McCune JM. Antiviral antibodies are necessary for control of simian immunodeficiency virus replication. J Virol 2007; 81:5024-35. [PMID: 17329327 PMCID: PMC1900210 DOI: 10.1128/jvi.02444-06] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [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: 11/06/2006] [Accepted: 02/21/2006] [Indexed: 01/01/2023] Open
Abstract
To better define the role of B cells in the control of pathogenic simian immunodeficiency virus (SIV) replication, six rhesus monkeys were depleted of B cells by intravenous infusion of rituximab (anti-CD20) 28 days and 7 days before intravaginal SIVmac239 inoculation and every 21 days thereafter until AIDS developed. Although the blood and tissues were similarly depleted of B cells, anti-SIV immunoglobulin G (IgG) antibody responses were completely blocked in only three of the six animals. In all six animals, levels of viral RNA (vRNA) in plasma peaked at 2 weeks and declined by 4 weeks postinoculation (PI). However, the three animals prevented from making an anti-SIV antibody response had significantly higher plasma vRNA levels through 12 weeks PI (P = 0.012). The remaining three B-cell-depleted animals made moderate anti-SIV IgG antibody responses, maintained moderate plasma SIV loads, and showed an expected rate of disease progression, surviving to 24 weeks PI without developing AIDS. In contrast, all three of the B-cell-depleted animals prevented from making anti-SIV IgG responses developed AIDS by 16 weeks PI (P = 0.0001). These observations indicate that antiviral antibody responses are critical in maintaining effective control of SIV replication at early time points postinfection.
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Affiliation(s)
- Christopher J Miller
- Center for Comparative Medicine, California National Primate Research Center, University of California, Davis, Davis, California 95616, USA.
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17
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Reddy SV, Kurihara N, Menaa C, Landucci G, Forthal D, Koop BA, Windle JJ, Roodman GD. Osteoclasts formed by measles virus-infected osteoclast precursors from hCD46 transgenic mice express characteristics of pagetic osteoclasts. Endocrinology 2001; 142:2898-905. [PMID: 11416009 DOI: 10.1210/endo.142.7.8255] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Pagetic osteoclasts (OCLs) are abnormal in size and contain paramyxoviral-like nuclear inclusions that cross-react with antibodies to measles virus (MV). However, the role that MV infection plays in Paget's disease is unknown, because no animal model of Paget's disease is available. Therefore, we targeted a cellular MV receptor, human CD46 (hCD46), to cells in the OCL lineage in transgenic mice using the mouse tartrate-resistant acid phosphatase (TRAP) gene promoter. In vitro infection of OCL precursors from hCD46 transgenic mice with MV significantly increased OCL formation in bone marrow cultures. The numbers of TRAP-positive mononuclear cells and CFU-GM, the earliest identifiable OCL precursor, were also significantly increased. MV-infected OCLs formed from hCD46 marrow were increased in size, contained markedly increased numbers of nuclei, and had increased bone-resorbing capacity per OCL compared with OCLs formed from marrow of nontransgenic littermates. Furthermore, IL-6 and 24-hydroxylase messenger RNA expression levels were increased in MV-infected hCD46 transgenic mouse bone marrow cultures. Treatment of MV-infected hCD46 marrow cultures with a neutralizing antibody to IL-6 blocked the increased OCL formation seen in these cultures. These data demonstrate that MV infection of OCL precursors results in OCLs that have many features of pagetic OCLs, that the enhanced OCL formation is in part mediated by increased IL-6 expression induced by MV infection, and suggest that the hCD46 transgenic mouse may be a useful model for examining the effects of MV infection on OCL formation in vivo.
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Affiliation(s)
- S V Reddy
- Department of Medicine/Hematology, University of Texas Health Science Center, San Antonio, Texas 78229, USA
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18
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Dunne MW, Bozzette S, McCutchan JA, Dubé MP, Sattler FR, Forthal D, Kemper CA, Havlir D. Efficacy of azithromycin in prevention of Pneumocystis carinii pneumonia: a randomised trial. California Collaborative Treatment Group. Lancet 1999; 354:891-5. [PMID: 10489947 DOI: 10.1016/s0140-6736(98)10328-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Azithromycin in combination with sulphonamides is active against Pneumocystis carinii pneumonia (PCP) in animals. We assessed the clinical efficacy of azithromycin for PCP prophylaxis in human beings. METHODS We identified HIV-1-infected patients with PCP during a prospective randomised trial comparing azithromycin, rifabutin, and the two drugs in combination for prevention of disseminated Mycobacterim avium infection. Patients had CD4-cell counts less than 100/microL at entry and received PCP prophylaxis according to the standard practice of their clinician. Analysis was by intention to treat. FINDINGS Patients receiving azithromycin, either alone (n=233) or in combination with rifabutin (n=224), had a 45% lower risk of developing PCP than those receiving rifabutin alone (n=236; p=0.008). Compared with rifabutin alone, hazard ratio for azithromycin was 0.54 (95% CI 0.32-0.94), for azithromycin plus rifabutin was 0.55 (0.32-0.94), and for regimens containing azithromycin was 0.55 (0.35-0.86). The most common side-effects involved the gastrointestinal tract with dose-limiting toxicities, and were mainly seen in patients receiving combination therapy. INTERPRETATION Azithromycin as prophylaxis for M. avium complex disease provides additional protection against P. carinii over and above that of standard PCP prophylaxis. Use of azithromycin is beneficial only as primary prophylaxis.
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Affiliation(s)
- M W Dunne
- Pfizer Central Research, Groton, CT 06340, USA.
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Havlir DV, Haubrich R, Hwang J, Dunne MW, Currier J, Forthal D, Torriani F, Richman DD, McCutchan JA. Human immunodeficiency virus replication in AIDS patients with Mycobacterium avium complex bacteremia: a case control study. California Collaborative Treatment Group. J Infect Dis 1998; 177:595-9. [PMID: 9498437 DOI: 10.1086/514220] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The development of opportunistic infections and the administration of vaccines have been associated with transient increases of human immunodeficiency virus (HIV) RNA plasma levels in HIV-infected patients. To determine the relationship between Mycobacterium avium complex (MAC) bacteremia and HIV RNA levels, HIV RNA levels in patients who developed MAC bacteremia (cases) were compared with levels in patients who remained free of MAC disease (controls). Cases and controls were matched for CD4 cell count, prophylaxis against MAC disease, antiretroviral therapy, and duration of follow-up. Mean baseline HIV RNA levels were 4.8 log10 copies/mL in cases and 4.6 log10 copies/mL in controls (P = 0.22). HIV RNA levels increased by a median of 0.4 log in cases but not controls at the time of MAC bacteremia (P = 0.01). In AIDS patients, the onset of MAC bacteremia is associated with a modest but significant increase in serum HIV RNA levels. Increased HIV replication may contribute to the higher mortality associated with MAC bacteremia.
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Affiliation(s)
- D V Havlir
- University of California, San Diego, USA.
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McDougall B, Nymark MH, Landucci G, Forthal D, Robinson WE. Predominance of detrimental humoral immune responses to HIV-1 in AIDS patients with CD4 lymphocyte counts less than 400/mm3. Scand J Immunol 1997; 45:103-11. [PMID: 9010507 DOI: 10.1046/j.1365-3083.1997.d01-374.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The humoral immune response to human immunodeficiency virus type 1 (HIV-1) was studied in 25 AIDS patients with CD4 lymphocyte counts of less than 400/mm3. Humoral immune responses against tissue culture adapted strains of HIV-1, and two limited-passage patient isolates were investigated. Total anti-HIV antibody levels were not significantly different between different individuals. Neutralizing titres against HIVLA1 and HIVSF2 were 10- to 100-fold higher than against clinical isolates. The complement-mediated, antibody-dependent enhancement of HIV-1 infection titre was high (mean 1:14,000). Antibody-complement mediated cytotoxicity of both HIVLA1 and HIVSF2 was ineffective using human complement as a complement source. The antibody-dependent, cell-mediated cytotoxicity (ADCC) activity varied against the four isolates with tissue culture-adapted strains being more susceptible than clinical isolates. Finally, an ADCC effector cell function, natural killer or NK activity, was measured for all 25 patients, and NK activity of patients was decreased by nearly 75% compared to uninfected individuals. In summary, beneficial humoral immune responses are low in HIV-1 infected individuals with CD4 counts of less than 400/mm3 if the in vitro assay system is constructed to best mimic the in vivo situation. These results suggest that the lack of functional antibody responses to HIV may play an important role in viral pathogenesis.
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Affiliation(s)
- B McDougall
- Department of Pathology, University of California, Irvine 92697-4800, USA
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Bozzette SA, Forthal D, Sattler FR, Kemper C, Richman DD, Tilles JG, Leedom J, McCutchan JA. The tolerance for zidovudine plus thrice weekly or daily trimethoprim-sulfamethoxazole with and without leucovorin for primary prophylaxis in advanced HIV disease. California Collaborative Treatment Group. Am J Med 1995; 98:177-82. [PMID: 7847434 DOI: 10.1016/s0002-9343(99)80401-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Trimethoprim-sulfamethoxazole (TMP/SMX) is the preferred agent for prophylaxis of Pneumocystis carinii pneumonia (PCP) in patients with HIV infection, but frequent adverse events limit its usefulness. Intermittent dosing and supplementation with leucovorin have been tried in attempts to improve tolerance. We evaluated these strategies in persons with advanced HIV disease. METHOD One hundred seven patients were enrolled. All had HIV infection, < 200 CD4+ lymphocytes per mm3, and no history of PCP. Fifty-two were randomized to TMP/SMX twice daily (BID); of these, 26 were randomized to leucovorin with each dose. Fifty-five patients were randomized to TMP/SMX (BID) 3 times per week; of these, 27 were randomized to leucovorin with each dose. All patients took zidovudine concurrently. RESULTS The 24-week risk of discontinuation due to protocol-defined limiting toxicity was 24% with thrice-weekly TMP/SMX versus 42% with daily TMP/SMX (risk ratio 0.4; 95% CI 0.2 to 1.0). The risks of discontinuation for any reason were 41% and 59% (risk ratio 0.4; 95% CI 0.2 to 0.8). Clinical toxicity, such as headache and gastrointestinal distress, accounted for the observed difference in tolerance between dosing regimens. The 24-week risk of discontinuation due to protocol-defined toxicity was 33% in both the leucovorin and non-leucovorin groups (risk ratio 1.1; 95% CI 0.5 to 2.5). The risks of discontinuation for any reason were 53% and 47% (risk ratio 0.8; 95% CI 0.3 to 1.7). CONCLUSION Intermittent therapy with TMP/SMX BID thrice weekly is better tolerated than daily BID therapy. Leucovorin use does not improve tolerance for chronic TMP/SMX dosing in AIDS, even among patients taking tablets daily.
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Affiliation(s)
- S A Bozzette
- Department of Medicine, University of California San Diego, La Jolla
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Larsen RA, Bozzette SA, Jones BE, Haghighat D, Leal MA, Forthal D, Bauer M, Tilles JG, McCutchan JA, Leedom JM. Fluconazole combined with flucytosine for treatment of cryptococcal meningitis in patients with AIDS. Clin Infect Dis 1994; 19:741-5. [PMID: 7803641 DOI: 10.1093/clinids/19.4.741] [Citation(s) in RCA: 154] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Treatment of cryptococcal meningitis with amphotericin B or fluconazole is often unsuccessful; in only 35%-40% of cases do CSF cultures become negative by 10 weeks after initiation of such therapy. We conducted a prospective, open-label clinical trial involving persons with AIDS to determine whether the rate of clinical success would improve when fluconazole (400 mg daily) was combined with flucytosine (150 mg/kg daily). At the conclusion of 10 weeks of therapy, 75% (95% confidence interval, 58%-87%) of 32 subjects' CSF cultures were negative. The Kaplan-Meier estimate of clinical success at 10 weeks was 63% (95% confidence interval, 48%-82%). The median time to negativity of the CSF culture was 23 days. Toxic side effects that were sufficiently severe to lead to the withdrawal of flucytosine were observed in nine subjects (28%). In this pilot study of fluconazole combined with flucytosine, the rate of clinical success at 10 weeks was greater than that previously reported with regard to the use of fluconazole alone or amphotericin B alone.
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Affiliation(s)
- R A Larsen
- Los Angeles County-University of Southern California Medical Center
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Aarnaes SL, Blanding J, Speier S, Forthal D, de la Maza LM, Peterson EM. Comparison of the ProSpecT and Color Vue enzyme-linked immunoassays for the detection of Cryptosporidium in stool specimens. Diagn Microbiol Infect Dis 1994; 19:221-5. [PMID: 7851085 DOI: 10.1016/0732-8893(94)90035-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Two enzyme-linked immunosorbent assays, the ProSpecT (Al-exon, Sunnyvale, CA, USA) and the Color Vue (Seradyn, Indianapolis, IN, USA) were compared for their ability to detect Cryptosporidium in 236 formalin-fixed stool specimens using the Merifluor C/G (Meridian, Cincinnati, OH, USA) stain as the reference method. The initial sensitivities of the ProSpecT and the Color Vue were 96.0% and 76.0%, which upon repeat testing of all discrepancies remained at 96.0% for the ProSpecT and decreased to 72.0% for the Color Vue. There were 25 (11%) specimens positive by the reference method. Initially, there were five false positive specimens by the ProSpecT, only one of which remained positive on retesting. The specificity of the Color Vue was 100% for the initial and repeated results, whereas the ProspecT had an initial specificity of 97.6% that increased to 99.5% upon repeat testing. The enzyme-linked immunosorbent assays offered the advantages of objectivity, batch testing, and, in the case of the ProSpecT, an acceptable sensitivity.
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Affiliation(s)
- S L Aarnaes
- Department of Pathology, University of California Irvine Medical Center, Orange 92668
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Abstract
Ceftazidime was prospectively evaluated in the treatment of bacterial meningitis in 19 pediatric patients. Haemophilus influenzae type b (HIB) was the etiologic agent in 17 patients, and Streptococcus pneumonia and Neisseria meningitidis were the etiologic agents in one patient each. Ceftazidime was administered intravenously in a dosage of 150 mg/kg/day divided into eight hourly doses for a mean of 15 days (range, 14 to 22 days) for H. influenzae type b meningitis. The clinical and microbiologic response was appropriate in all cases. The mean ceftazidime CSF concentration was 6.7 micrograms/ml at approximately 2 hours following iv infusions. This concentration was 16- to greater than 100-fold the minimal bactericidal concentration determined for the isolated pathogens. These preliminary observations support ceftazidime as a candidate cephalosporin for the treatment of bacterial meningitis caused by H. influenzae. Additional study is required to further define its role in meningitis caused by S. pneumoniae and N. meningitidis.
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Abstract
Changes of serum albumin levels were studied in 20 patients with end-stage renal disease who had undergone renal transplantation. Serum albumin concentrations steadily decreased from a normal pretransplantal value to its lowest level eight to 29 days after transplantation. This was followed by a gradual increase toward pretransplant values by the fourth and fifth weeks after transplantation. Although the hypoalbuminemia was slightly more severe and its recovery somewhat slower in the group with failing grafts than those with functioning grafts, the differences were not statistically significant. The decrease in serum albumin level after transplantation was accompanied by a parallel reduction in serum globulin concentration. However, in contrast to albumin levels, a subsequent increase in serum globulin concentration was not observed during the five-week study period.
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