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Agrati C, Cossarizza A, Mazzotta V, Grassi G, Casetti R, De Biasi S, Pinnetti C, Gili S, Mondi A, Cristofanelli F, Lo Tartaro D, Notari S, Maffongelli G, Gagliardini R, Gibellini L, Aguglia C, Lanini S, D'Abramo A, Matusali G, Fontana C, Nicastri E, Maggi F, Girardi E, Vaia F, Antinori A. Immunological signature in human cases of monkeypox infection in 2022 outbreak: an observational study. Lancet Infect Dis 2023; 23:320-330. [PMID: 36356606 PMCID: PMC9761565 DOI: 10.1016/s1473-3099(22)00662-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND An unprecedented global monkeypox outbreak started in May, 2022. No data are yet available about the dynamics of the immune response against monkeypox virus. The aim of this study was to describe kinetics of T-cell response, inflammatory profile, and pox-specific T-cell induction in patients with laboratory-confirmed monkeypox. METHODS 17 patients with laboratory-confirmed monkeypox admitted at the Lazzaro Spallanzani National Institute for Infectious Diseases (Rome, Italy), from May 19, to July 7, 2022, were tested for differentiation and activation profile of CD4 and CD8 T (expression of CD38, PD-1, and CD57 assessed by flow cytometry), frequency of pox-specific T cells (by standard interferon-γ ELISpot), and release of interleukin (IL)-1β, IL-6, IL-8, and tumour necrosis factor (TNF) in plasma (by ELISA). All patients were tested 10-12 days after symptoms onset. In a subgroup of nine patients with a laboratory-confirmed monkeypox, the kinetics of the immune response were analysed longitudinally according to timing from symptoms onset and compared with ten healthy donors (ie, health-care workers recruited from the same institution). FINDINGS Among the 17 patients, ten were HIV negative and seven HIV positive, all with good viro-immunological status. On days 0-3 from symptom onset, patients with laboratory-confirmed monkeypox were characterised by a statistically significant reduction in CD4+ T cells (p=0·0011) and a concurrent increase of CD8+ T cells (p=0·0057) compared with healthy donors. A lower proportion of naive (CD45RA+CD27+) CD4+ T cells was observed in six (67%) of nine patients and a concomitant higher proportion of effector memory (CD45RA-CD27-) CD4+ T cells in all patients; this skewed immune profile tended to normalise over time. A similar differentiated profile was also observed in CD8+ T cells with a consistent expansion of terminally differentiated CD8+ T cells. Patients with monkeypox had a higher proportion of CD4+CD38+ and CD38+CD8+ T-cells than healthy donors, which normalised after 12-20 days from symptom onset. The expression of PD-1 and CD57 on CD4+ and CD8+ T-cells showed kinetics similar to that observed for CD38. Furthermore, the inflammatory cytokines (IL-1β, IL-6, IL-8, and TNF) were higher in patients with monkeypox than in healthy donors and, although they decreased over time, they remained elevated after recovery. Almost all patients (15 [94%] of 16) developed a pox-specific Th1 response. No differences in immune cells profile were observed between patients with and without HIV, whereas paucysimptomatic patients (without systemic symptoms, with less than five skin lesions, and no other mucosal localisation of monkeypox) showed a less perturbed immune profile early after symptom onset. INTERPRETATION Our data showed the immunological signature of monkeypox virus infection, characterised by an early expansion of activated effector CD4+ and CD8+ T cells that persisted over time. Almost all patients, even regardless of HIV infection, developed a poxvirus-specific Th1 cell response. These results might have implications on the expected immunogenicity of monkeypox vaccination, suggesting that it might not be necessary to vaccinate people who have already been infected. FUNDING Italian Ministry of Health. TRANSLATION For the Italian translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Chiara Agrati
- Laboratory of Cellular Immunology and Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Andrea Cossarizza
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy; National Institute for Cardiovascular Research, Bologna, Italy
| | - Valentina Mazzotta
- Clinical and Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy.
| | - Germana Grassi
- Laboratory of Cellular Immunology and Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Rita Casetti
- Laboratory of Cellular Immunology and Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Sara De Biasi
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Carmela Pinnetti
- Clinical and Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Simona Gili
- Laboratory of Cellular Immunology and Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Annalisa Mondi
- Clinical and Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Flavia Cristofanelli
- Laboratory of Cellular Immunology and Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Domenico Lo Tartaro
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefania Notari
- Laboratory of Cellular Immunology and Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Gaetano Maffongelli
- Clinical and Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Roberta Gagliardini
- Clinical and Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Lara Gibellini
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Camilla Aguglia
- Clinical and Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Simone Lanini
- Clinical and Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Alessandra D'Abramo
- Clinical and Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Giulia Matusali
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Carla Fontana
- Laboratoy of Microbiology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Emanuele Nicastri
- Clinical and Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Fabrizio Maggi
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Enrico Girardi
- Scientific Direction, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Francesco Vaia
- General Direction, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Andrea Antinori
- Clinical and Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
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2
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Mastrorosa I, Gagliardini R, Segala FV, Mondi A, Lorenzini P, Cerva C, Taddei E, Bai F, Vergori A, Marcantonio N, Pinnetti C, Cicalini S, Murri R, Mazzotta V, Camici M, Mosti S, Bini T, Maffongelli G, Beccacece A, Milozzi E, Iannetta M, Lamonica S, Fusto M, Plazzi MM, Ottou S, Lichtner M, Fantoni M, Andreoni M, Sarmati L, Cauda R, Girardi E, Nicastri E, D'Arminio Monforte A, Palmieri F, Cingolani A, Vaia F, Antinori A. Sarilumab plus standard of care vs standard of care for the treatment of severe COVID-19: a phase 3, randomized, open-labeled, multi-center study (ESCAPE study). EClinicalMedicine 2023; 57:101895. [PMID: 36936403 PMCID: PMC9999914 DOI: 10.1016/j.eclinm.2023.101895] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Among interleukin-6 inhibitors suggested for use in COVID-19, there are few robust evidences for the efficacy of sarilumab. Herein, we evaluated the efficacy and safety of sarilumab in severe COVID-19. METHODS In this phase 3, open-labeled, randomized clinical trial, conducted at 5 Italian hospitals, adults with severe COVID-19 pneumonia (excluding mechanically ventilated) were randomized 2:1 to receive intravenous sarilumab (400 mg, repeatable after 12 h) plus standard of care (SOC) (arm A) or to continue SOC (arm B). Randomization was web-based. As post-hoc analyses, the participants were stratified according to baseline inflammatory parameters. The primary endpoint was analysed on the modified Intention-To-Treat population, including all the randomized patients who received any study treatment (sarilumab or SOC). It was time to clinical improvement of 2 points on a 7-points ordinal scale, from baseline to day 30. We used Kaplan Meier method and log-rank test to compare the primary outcome between two arms, and Cox regression stratified by clinical center and adjusted for severity of illness, to estimate the hazard ratio (HR). The trial was registered with EudraCT (2020-001390-76). FINDINGS Between May 2020 and May 2021, 191 patients were assessed for eligibility, of whom, excluding nine dropouts, 176 were assigned to arm A (121) and B (55). At day 30, no significant differences in the primary endpoint were found (88% [95% CI 81-94] in arm A vs 85% [74-93], HR 1.07 [0.8-1.5] in arm B; log-rank p = 0.50). After stratifying for inflammatory parameters, arm A showed higher probability of improvement than B without statistical significance in the strata with C reactive protein (CRP) < 7 mg/dL (88% [77-96] vs 79% [63-91], HR 1.55 [0.9-2.6]; log-rank p = 0.049) and in the strata with lymphocytes <870/mmc (90% [79-96]) vs (73% [55-89], HR 1.53 [0.9-2.7]; log-rank p = 0.058). Overall, 39/121 (32%) AEs were reported in arm A and 14/55 (23%) in B (p = 0.195), while serious AEs were 22/121 (18%) and 7/55 (11%), respectively (p = 0.244). There were no treatment-related deaths. INTERPRETATION The efficacy of sarilumab in severe COVID-19 was not demonstrated both in the overall and in the stratified for severity analysis population. Exploratory analyses suggested that subsets of patients with lower CRP values or lower lymphocyte counts might have had benefit with sarilumab treatment, but this finding would require replication in other studies. The relatively low rate of concomitant corticosteroid use, could partially explain our results. FUNDING This study was supported by INMI "Lazzaro Spallanzani" Ricerca Corrente Linea 1 on emerging and reemerging infections, funded by Italian Ministry of Health.
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Affiliation(s)
- Ilaria Mastrorosa
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
- Corresponding author. Clinical Department of Infectious Diseases and Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Via Portuense 292, 00149, Roma, Italy.
| | - Roberta Gagliardini
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Annalisa Mondi
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Patrizia Lorenzini
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Carlotta Cerva
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Eleonora Taddei
- Fondazione Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesca Bai
- ASST Santi Paolo e Carlo, University of Milan, Italy
| | - Alessandra Vergori
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Negri Marcantonio
- Fondazione Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Carmela Pinnetti
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Stefania Cicalini
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Rita Murri
- Fondazione Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Valentina Mazzotta
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Marta Camici
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Silvia Mosti
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Teresa Bini
- ASST Santi Paolo e Carlo, University of Milan, Italy
| | - Gaetano Maffongelli
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessia Beccacece
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Eugenia Milozzi
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Silvia Lamonica
- Fondazione Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Marisa Fusto
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Sandrine Ottou
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Massimo Fantoni
- Fondazione Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - Roberto Cauda
- Fondazione Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Enrico Girardi
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Fabrizio Palmieri
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Antonella Cingolani
- Fondazione Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Vaia
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
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Mazzotta V, Scorzolini L, Falasca L, Lionetti R, Aguglia C, Kontogiannis D, Colombo D, Colavita F, De Palo MG, Carletti F, Mondi A, Pinnetti C, Maffongelli G, Garbuglia AR, Baldini F, Corpolongo A, Maggi F, D'Offizi G, Girardi E, Vaia F, Nicastri E, Del Nonno F, Antinori A. Lymphofollicular lesions associated with monkeypox (Mpox) virus proctitis. Int J Infect Dis 2023; 130:48-51. [PMID: 36858309 PMCID: PMC10013572 DOI: 10.1016/j.ijid.2023.02.021] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 03/02/2023] Open
Abstract
In the recent 2022 monkeypox (Mpox) global outbreak, cases have been mostly documented among men who have sex with men. Proctitis was reported in almost 14% of cases. In this study, four Mpox-confirmed cases requiring hospitalizations for severe proctitis were characterized by clinical, virological, microbiological, endoscopic, and histological aspects. The study showed the presence of lymphofollicular lesions associated with Mpox virus rectal infection for the first time.
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Affiliation(s)
- Valentina Mazzotta
- Clinical and Research Infectious Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Laura Scorzolini
- Clinical and Research Infectious Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Laura Falasca
- Laboratory of Electron Microscopy, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy.
| | - Raffaella Lionetti
- Infectious Diseases Hepatology Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Camilla Aguglia
- Clinical and Research Infectious Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Dimitra Kontogiannis
- Clinical and Research Infectious Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Daniele Colombo
- Pathology Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Francesca Colavita
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Grazia De Palo
- Infectious Diseases Hepatology Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabrizio Carletti
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Annalisa Mondi
- Clinical and Research Infectious Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Carmela Pinnetti
- Clinical and Research Infectious Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gaetano Maffongelli
- Clinical and Research Infectious Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Anna Rosa Garbuglia
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesco Baldini
- Clinical and Research Infectious Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Angela Corpolongo
- Clinical and Research Infectious Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabrizio Maggi
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gianpiero D'Offizi
- Infectious Diseases Hepatology Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Enrico Girardi
- Scientific Direction, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesco Vaia
- General Direction, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Emanuele Nicastri
- Clinical and Research Infectious Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Franca Del Nonno
- Pathology Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Andrea Antinori
- Clinical and Research Infectious Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
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4
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Giancola ML, Corpolongo A, Comandini UV, Del Nonno F, Montalbano M, Petrone A, Carrara S, Mariano A, Beccacece A, Maffongelli G, Nicastri E. Severe drug-induced liver injury (DILI) associated with benznidazole therapy for Chagas' disease. J Antimicrob Chemother 2022; 77:3515-3517. [PMID: 36173378 DOI: 10.1093/jac/dkac310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/19/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- Maria Letizia Giancola
- Clinical Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani', IRCCS-Via Portuense, 292, Italy
| | - Angela Corpolongo
- Clinical Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani', IRCCS-Via Portuense, 292, Italy
| | - Ubaldo Visco Comandini
- Clinical Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani', IRCCS-Via Portuense, 292, Italy
| | - Franca Del Nonno
- Clinical Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani', IRCCS-Via Portuense, 292, Italy
| | - Marzia Montalbano
- Clinical Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani', IRCCS-Via Portuense, 292, Italy
| | - Ada Petrone
- Clinical Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani', IRCCS-Via Portuense, 292, Italy
| | - Stefania Carrara
- Clinical Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani', IRCCS-Via Portuense, 292, Italy
| | - Andrea Mariano
- Clinical Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani', IRCCS-Via Portuense, 292, Italy
| | - Alessia Beccacece
- Clinical Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani', IRCCS-Via Portuense, 292, Italy
| | - Gaetano Maffongelli
- Clinical Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani', IRCCS-Via Portuense, 292, Italy
| | - Emanuele Nicastri
- Clinical Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani', IRCCS-Via Portuense, 292, Italy
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5
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D'Abramo A, Vita S, Colavita F, Cimini E, Haggiag S, Maffongelli G, Valli MB, Bevilacqua N, Corpolongo A, Giancola ML, Maggi F, Agrati C, Nicastri E. The first case of meningitis associated with SARS-CoV-2 BA.2 variant infection with persistent viremia. Int J Infect Dis 2022; 124:38-40. [PMID: 36108959 PMCID: PMC9468051 DOI: 10.1016/j.ijid.2022.09.011] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/30/2022] [Accepted: 09/08/2022] [Indexed: 11/04/2022] Open
Abstract
Severe neurological disorders and vascular events during COVID-19 have been described. Here, we describe the first case of a female patient infected with the SARS-CoV-2 BA.2 Omicron variant of concern with meningitis with newly diagnosed central demyelinating disease.
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Affiliation(s)
- Alessandra D'Abramo
- National Institute of Infectious Diseases Lazzaro Spallanzani, Institute of Hospitalization and Scientific Care, Rome, Italy
| | - Serena Vita
- National Institute of Infectious Diseases Lazzaro Spallanzani, Institute of Hospitalization and Scientific Care, Rome, Italy.
| | - Francesca Colavita
- National Institute of Infectious Diseases Lazzaro Spallanzani, Institute of Hospitalization and Scientific Care, Rome, Italy
| | - Eleonora Cimini
- National Institute of Infectious Diseases Lazzaro Spallanzani, Institute of Hospitalization and Scientific Care, Rome, Italy
| | - Shalom Haggiag
- Department of Neurology, San Camillo-Forlanini, Rome, Italy
| | - Gaetano Maffongelli
- National Institute of Infectious Diseases Lazzaro Spallanzani, Institute of Hospitalization and Scientific Care, Rome, Italy
| | - Maria Beatrice Valli
- National Institute of Infectious Diseases Lazzaro Spallanzani, Institute of Hospitalization and Scientific Care, Rome, Italy
| | - Nazario Bevilacqua
- National Institute of Infectious Diseases Lazzaro Spallanzani, Institute of Hospitalization and Scientific Care, Rome, Italy
| | - Angela Corpolongo
- National Institute of Infectious Diseases Lazzaro Spallanzani, Institute of Hospitalization and Scientific Care, Rome, Italy
| | - Maria Letizia Giancola
- National Institute of Infectious Diseases Lazzaro Spallanzani, Institute of Hospitalization and Scientific Care, Rome, Italy
| | - Fabrizio Maggi
- National Institute of Infectious Diseases Lazzaro Spallanzani, Institute of Hospitalization and Scientific Care, Rome, Italy
| | - Chiara Agrati
- National Institute of Infectious Diseases Lazzaro Spallanzani, Institute of Hospitalization and Scientific Care, Rome, Italy
| | - Emanuele Nicastri
- National Institute of Infectious Diseases Lazzaro Spallanzani, Institute of Hospitalization and Scientific Care, Rome, Italy
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6
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Lapa D, Carletti F, Mazzotta V, Matusali G, Pinnetti C, Meschi S, Gagliardini R, Colavita F, Mondi A, Minosse C, Scorzolini L, Cicalini S, Maffongelli G, Specchiarello E, Camici M, Bettini A, Baldini F, Francalancia M, Mizzoni K, Garbuglia AR, Nicastri E, Girardi E, Antinori A, Vaia F, Maggi F. Monkeypox virus isolation from a semen sample collected in the early phase of infection in a patient with prolonged seminal viral shedding. The Lancet Infectious Diseases 2022; 22:1267-1269. [PMID: 35931095 PMCID: PMC9629691 DOI: 10.1016/s1473-3099(22)00513-8] [Citation(s) in RCA: 122] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 12/25/2022]
Affiliation(s)
- Daniele Lapa
- Laboratory of Virology, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Fabrizio Carletti
- Laboratory of Virology, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Valentina Mazzotta
- Clinical and Research Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Giulia Matusali
- Laboratory of Virology, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Carmela Pinnetti
- Clinical and Research Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Silvia Meschi
- Laboratory of Virology, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Roberta Gagliardini
- Clinical and Research Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Francesca Colavita
- Laboratory of Virology, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy.
| | - Annalisa Mondi
- Clinical and Research Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Claudia Minosse
- Laboratory of Virology, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Laura Scorzolini
- Clinical and Research Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Stefania Cicalini
- Clinical and Research Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Gaetano Maffongelli
- Clinical and Research Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Eliana Specchiarello
- Laboratory of Virology, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Marta Camici
- Clinical and Research Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Aurora Bettini
- Laboratory of Virology, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Francesco Baldini
- Clinical and Research Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Massimo Francalancia
- Laboratory of Virology, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Klizia Mizzoni
- Laboratory of Virology, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Anna Rosa Garbuglia
- Laboratory of Virology, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Emanuele Nicastri
- Clinical and Research Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Enrico Girardi
- Scientific Direction, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Andrea Antinori
- Clinical and Research Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Francesco Vaia
- General Direction, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Fabrizio Maggi
- Laboratory of Virology, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
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D'Abramo A, Vita S, Maffongelli G, Beccacece A, Agrati C, Cimini E, Colavita F, Giancola ML, Cavasio A, Nicastri E. Clinical Management of Patients With B-Cell Depletion Agents to Treat or Prevent Prolonged and Severe SARS-COV-2 Infection: Defining a Treatment Pathway. Front Immunol 2022; 13:911339. [PMID: 35711444 PMCID: PMC9196078 DOI: 10.3389/fimmu.2022.911339] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/29/2022] [Indexed: 12/22/2022] Open
Abstract
Introduction Immunocompromised patients with B-cell depletion agents are at risk for persistence and/or severe SARS-COV-2 infection. We describe a case series of 21 COVID-19 patients under B cell depletion therapy, mostly treated with a combined therapy based on intravenous remdesevir (RDV) and steroid associated with SARS-CoV-2 monoclonal antibodies against Spike glycoprotein and/or hyper-immune convalescent plasma. Methods This is a single-center longitudinal study. We retrospectively enrolled a total number of 21 B-cell depleted consecutive hospitalized patients with COVID-19 at the Lazzaro Spallanzani National Institute for Infectious Diseases, Rome, Italy, from November 2020 to December 2021. Demographic characteristics, medical history, clinical presentation, treatment, adverse drug reactions, and clinical and virological outcome were collected for all patients. In a subgroup, we explore immune T cells activation, T cells specific anti-SARS-COV-2 response, and neutralizing antibodies. Results Twenty-one inpatients with B-cell depletion and SARS-COV-2 infection were enrolled. A median of 1 B cells/mm3 was detected. Eighteen patients presented hypogammaglobulinemia. All patients presented interstitial pneumonia treated with intravenous RDV and steroids. Sixteen patients were treated with monoclonal antibodies against SARS-CoV-2 Spike protein, four patients were treated with SARS-CoV-2 hyper-immune convalescent plasma infusion, and three patients received both treatments. A variable kinetic of T cell activation returning to normal levels at Day 30 after immunotherapy infusion was observed. All treated patients recovered. Conclusion In COVID-19 immunosuppressed subjects, it is mandatory to establish a prompt, effective, and combined multi-target therapy including oxygen, antiviral, steroid, and antibody-based therapeutics, tailored to the patient’s clinical needs.
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Affiliation(s)
- Alessandra D'Abramo
- National Institute for Infectious Diseases "Lazzaro Spallanzani" (IRCCS), Rome, Italy
| | - Serena Vita
- National Institute for Infectious Diseases "Lazzaro Spallanzani" (IRCCS), Rome, Italy
| | - Gaetano Maffongelli
- National Institute for Infectious Diseases "Lazzaro Spallanzani" (IRCCS), Rome, Italy
| | - Alessia Beccacece
- National Institute for Infectious Diseases "Lazzaro Spallanzani" (IRCCS), Rome, Italy
| | - Chiara Agrati
- National Institute for Infectious Diseases "Lazzaro Spallanzani" (IRCCS), Rome, Italy
| | - Eleonora Cimini
- National Institute for Infectious Diseases "Lazzaro Spallanzani" (IRCCS), Rome, Italy
| | - Francesca Colavita
- National Institute for Infectious Diseases "Lazzaro Spallanzani" (IRCCS), Rome, Italy
| | | | - Alessandro Cavasio
- Clinical Infectious Diseases, Department of System Medicine, Tor Vergata University, Rome, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases "Lazzaro Spallanzani" (IRCCS), Rome, Italy
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8
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Farroni C, Picchianti-Diamanti A, Aiello A, Nicastri E, Laganà B, Agrati C, Castilletti C, Meschi S, Colavita F, Cuzzi G, Casetti R, Grassi G, Petrone L, Vanini V, Salmi A, Repele F, Altera AMG, Maffongelli G, Corpolongo A, Salemi S, Di Rosa R, Nalli G, Sesti G, Vaia F, Puro V, Goletti D. Kinetics of the B- and T-Cell Immune Responses After 6 Months From SARS-CoV-2 mRNA Vaccination in Patients With Rheumatoid Arthritis. Front Immunol 2022; 13:846753. [PMID: 35309297 PMCID: PMC8924958 DOI: 10.3389/fimmu.2022.846753] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/02/2022] [Indexed: 12/16/2022] Open
Abstract
ObjectiveTo assess the kinetics of the humoral and cell-mediated responses after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in rheumatoid arthritis (RA) patients treated with different immunosuppressive therapies.MethodsFollowing vaccine completed schedule, health care workers (HCWs, n = 49) and RA patients (n = 35) were enrolled at 5 weeks (T1) and 6 months (T6) after the first dose of BNT162b2-mRNA vaccination. Serological response was assessed by quantifying anti-receptor-binding domain (RBD)-specific immunoglobulin G (IgG) and SARS-CoV-2 neutralizing antibodies, while cell-mediated response was assessed by a whole-blood test quantifying the interferon (IFN)-γ response to spike peptides. B-cell phenotype and IFN-γ-specific T-cell responses were evaluated by flow cytometry.ResultsAfter 6 months, anti-RBD antibodies were still detectable in 91.4% of RA patients, although we observed a significant reduction of the titer in patients under Cytotoxic T-Lymphocyte Antigen 4 (CTLA-4)-Ig [median: 16.4 binding antibody units (BAU)/ml, interquartile range (IQR): 11.3–44.3, p < 0.0001] or tumor necrosis factor (TNF)-α inhibitors (median: 26.5 BAU/ml, IQR: 14.9–108.8, p = 0.0034) compared to controls (median: 152.7 BAU/ml, IQR: 89.3–260.3). All peripheral memory B-cell (MBC) subpopulations, in particular, the switched IgG+ MBCs (CD19+CD27+IgD-IgM-IgG+), were significantly reduced in RA subjects under CTLA-4-Ig compared to those in HCWs (p = 0.0012). In RA patients, a significantly reduced anti-RBD IgG titer was observed at T6 vs. T1, mainly in those treated with CTLA-4-Ig (p = 0.002), interleukin (IL)-6 inhibitors (p = 0.015), and disease-modifying antirheumatic drugs (DMARDs) ± corticosteroids (CCSs) (p = 0.015). In contrast, a weak nonsignificant reduction of the T-cell response was reported at T6 vs. T1. T-cell response was found in 65.7% of the RA patients at T6, with lower significant magnitude in patients under CTLA-4-Ig compared to HCWs (p < 0.0001). The SARS-CoV-2 IFN-γ-S-specific T-cell response was mainly detected in the CD4+ T-cell compartment.ConclusionsIn this study, in RA patients after 6 months from COVID-19 vaccination, we show the kinetics, waning, and impairment of the humoral and, to a less extent, of the T-cell response. Similarly, a reduction of the specific response was also observed in the controls. Therefore, based on these results, a booster dose of the vaccine is crucial to increase the specific immune response regardless of the immunosuppressive therapy.
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Affiliation(s)
- Chiara Farroni
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Andrea Picchianti-Diamanti
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, Rome, Italy
| | - Alessandra Aiello
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Emanuele Nicastri
- Clinical Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Bruno Laganà
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, Rome, Italy
| | - Chiara Agrati
- Laboratory of Cellular Immunology, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Concetta Castilletti
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Silvia Meschi
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Francesca Colavita
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Gilda Cuzzi
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Rita Casetti
- Laboratory of Cellular Immunology, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Germana Grassi
- Laboratory of Cellular Immunology, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Linda Petrone
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Valentina Vanini
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Unità Operativa Semplice (UOS) Professioni Sanitarie Tecniche, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Andrea Salmi
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Federica Repele
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Anna Maria Gerarda Altera
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Gaetano Maffongelli
- Clinical Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Angela Corpolongo
- Clinical Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Simonetta Salemi
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, Rome, Italy
| | - Roberta Di Rosa
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, Rome, Italy
| | - Gabriele Nalli
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, Rome, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, Rome, Italy
| | - Francesco Vaia
- Unità Operativa Complessa (UOC) Direzione Sanitaria, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Vincenzo Puro
- Unità Operativa Complessa (UOC) Emerging Infections and Centro di Riferimento AIDS (CRAIDS), National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Delia Goletti
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- *Correspondence: Delia Goletti,
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Maffongelli G, Bevilacqua N, Vita S, Bartoli TA, Corpolongo A, Benvenuto D, Chiriaco T, Spiga G, Ribaldi S, Zirretta V, Ippolito G, Lauria FN, Vaia F, Nicastri E. Telemedicine During COVID-19 Pandemic: Lesson Learned from the Lazio Region Infectious Diseases and Emergency Department Network. J Med Syst 2022; 46:105. [PMID: 36473993 PMCID: PMC9726758 DOI: 10.1007/s10916-022-01887-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/02/2022] [Indexed: 12/13/2022]
Abstract
Telemedicine and teleconsultation can be powerful and useful tools for patients to hamper the physical barriers to access to health care services during COVID-19 pandemic. We describe the teleconsultation (TC) model in the Lazio Region. It uses a hub-and-spoke network system on geographic regional basis using a web based digital platform, termed ADVICE with the aim to connect regional Emergency Departments (EDs) and Infectious Diseases (ID) acute and critical care settings for patients with acute ID syndrome. Between January 2020 and June 2021, the ADVICE platform received 18.686 TCs: of them, 10838 requests (58%) were for ID TCs in 7996 patients, followed by 2555(13%) requests for trauma, 2286(12%) for acute complex syndrome and 1681 (8%) for Stroke TCs. Three quarter of ID TCs were requested for SARS-COV-2 infection, followed by sepsis management in 7% and tuberculosis in 6%. In 5416 TCs, 68%, diagnostic investigations and therapeutic prescriptions were recommended before admission, in 1941 TCs, 24%, the recommendation was patient admission and in 608 TCs, 7%, was to discharge patient at home. Telemedicine have ensured high-profile consultations for ID patients and during COVID-19 the use of this resource optimized clinical patient management.
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Affiliation(s)
- Gaetano Maffongelli
- National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS via Portuense 292, 00149 Rome, Italy
| | - Nazario Bevilacqua
- National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS via Portuense 292, 00149 Rome, Italy
| | - Serena Vita
- National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS via Portuense 292, 00149 Rome, Italy
| | - Tommaso Ascoli Bartoli
- National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS via Portuense 292, 00149 Rome, Italy
| | - Angela Corpolongo
- National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS via Portuense 292, 00149 Rome, Italy
| | - Domenico Benvenuto
- National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS via Portuense 292, 00149 Rome, Italy
| | | | | | | | | | - Giuseppe Ippolito
- National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS via Portuense 292, 00149 Rome, Italy
| | - Francesco Nicola Lauria
- National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS via Portuense 292, 00149 Rome, Italy
| | - Francesco Vaia
- National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS via Portuense 292, 00149 Rome, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS via Portuense 292, 00149 Rome, Italy
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Picchianti-Diamanti A, Aiello A, Laganà B, Agrati C, Castilletti C, Meschi S, Farroni C, Lapa D, Najafi Fard S, Cuzzi G, Cimini E, Grassi G, Vanini V, Di Rosa R, Salemi S, Nalli G, Salmi A, Repele F, Altera AMG, Maffongelli G, Palazzolo C, Vita S, Leone S, Puro V, Capobianchi MR, Ippolito G, Nicastri E, Goletti D. ImmunosuppressiveTherapies Differently Modulate Humoral- and T-Cell-Specific Responses to COVID-19 mRNA Vaccine in Rheumatoid Arthritis Patients. Front Immunol 2021; 12:740249. [PMID: 34594343 PMCID: PMC8477040 DOI: 10.3389/fimmu.2021.740249] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/17/2021] [Indexed: 01/03/2023] Open
Abstract
Objective To assess in rheumatoid arthritis (RA) patients, treated with different immunosuppressive therapies, the induction of SARS-CoV-2-specific immune response after vaccination in terms of anti-region-binding-domain (RBD)-antibody- and T-cell-specific responses against spike, and the vaccine safety in terms of clinical impact on disease activity. Methods Health care workers (HCWs) and RA patients, having completed the BNT162b2-mRNA vaccination in the last 2 weeks, were enrolled. Serological response was evaluated by quantifying anti-RBD antibodies, while the cell-mediated response was evaluated by a whole-blood test quantifying the interferon (IFN)-γ-response to spike peptides. FACS analysis was performed to identify the cells responding to spike stimulation. RA disease activity was evaluated by clinical examination through the DAS28crp, and local and/or systemic clinical adverse events were registered. In RA patients, the ongoing therapeutic regimen was modified during the vaccination period according to the American College of Rheumatology indications. Results We prospectively enrolled 167 HCWs and 35 RA patients. Anti-RBD-antibodies were detected in almost all patients (34/35, 97%), although the titer was significantly reduced in patients under CTLA-4-inhibitors (median: 465 BAU/mL, IQR: 103-1189, p<0.001) or IL-6-inhibitors (median: 492 BAU/mL, IQR: 161-1007, p<0.001) compared to HCWs (median: 2351 BAU/mL, IQR: 1389-3748). T-cell-specific response scored positive in most of RA patients [24/35, (69%)] with significantly lower IFN-γ levels in patients under biological therapy such as IL-6-inhibitors (median: 33.2 pg/mL, IQR: 6.1-73.9, p<0.001), CTLA-4-inhibitors (median: 10.9 pg/mL, IQR: 3.7-36.7, p<0.001), and TNF-α-inhibitors (median: 89.6 pg/mL, IQR: 17.8-224, p=0.002) compared to HCWs (median: 343 pg/mL, IQR: 188-756). A significant correlation between the anti-RBD-antibody titer and spike-IFN-γ-specific T-cell response was found in RA patients (rho=0.432, p=0.009). IFN-γ T-cell response was mediated by CD4+ and CD8+ T cells. Finally, no significant increase in disease activity was found in RA patients following vaccination. Conclusion This study showed for the first time that antibody-specific and whole-blood spike-specific T-cell responses induced by the COVID-19 mRNA-vaccine were present in the majority of RA patients, who underwent a strategy of temporary suspension of immunosuppressive treatment during vaccine administration. However, the magnitude of specific responses was dependent on the immunosuppressive therapy administered. In RA patients, BNT162b2 vaccine was safe and disease activity remained stable.
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Affiliation(s)
- Andrea Picchianti-Diamanti
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, Rome, Italy
| | - Alessandra Aiello
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Bruno Laganà
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, Rome, Italy
| | - Chiara Agrati
- Laboratory of Cellular Immunology, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Concetta Castilletti
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Silvia Meschi
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Chiara Farroni
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Daniele Lapa
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Saeid Najafi Fard
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Gilda Cuzzi
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Eleonora Cimini
- Laboratory of Cellular Immunology, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Germana Grassi
- Laboratory of Cellular Immunology, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Valentina Vanini
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
- Unità Operativa Semplice (UOS) Professioni Sanitarie Tecniche, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Roberta Di Rosa
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, Rome, Italy
| | - Simonetta Salemi
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, Rome, Italy
| | - Gabriele Nalli
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, Rome, Italy
| | - Andrea Salmi
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Federica Repele
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Anna Maria Gerarda Altera
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Gaetano Maffongelli
- Clinical Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Claudia Palazzolo
- Clinical Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Serena Vita
- Clinical Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Sara Leone
- UOC Emerging Infections and Centro di Riferimento AIDS (CRAIDS), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Vincenzo Puro
- UOC Emerging Infections and Centro di Riferimento AIDS (CRAIDS), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Maria Rosaria Capobianchi
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Giuseppe Ippolito
- Scientific Direction, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Emanuele Nicastri
- Clinical Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Delia Goletti
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
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D'Abramo A, Vita S, Maffongelli G, Mariano A, Agrati C, Castilletti C, Goletti D, Ippolito G, Nicastri E. Prolonged and severe SARS-CoV-2 infection in patients under B-cell-depleting drug successfully treated: A tailored approach. Int J Infect Dis 2021; 107:247-250. [PMID: 33901654 PMCID: PMC8065233 DOI: 10.1016/j.ijid.2021.04.068] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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] [Received: 03/18/2021] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 12/27/2022] Open
Abstract
Prolonged B-cell depletion due to anti-CD20 monoclonal antibody (mAbs) therapy impairs the adaptive immune response, causing severe manifestations during COronaVIrus Disease-2019 (COVID-19). The cases of two patients under anti-CD20 therapy who experienced prolonged and severe COVID-19 successfully treated with mAbs against Severe Acute Respiratory Syndrome-CoV-2 spike proteins are reported.
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Affiliation(s)
- Alessandra D'Abramo
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, via Portuense 292, 00149, Rome, Italy
| | - Serena Vita
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, via Portuense 292, 00149, Rome, Italy
| | - Gaetano Maffongelli
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, via Portuense 292, 00149, Rome, Italy.
| | - Andrea Mariano
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, via Portuense 292, 00149, Rome, Italy
| | - Chiara Agrati
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, via Portuense 292, 00149, Rome, Italy
| | - Concetta Castilletti
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, via Portuense 292, 00149, Rome, Italy
| | - Delia Goletti
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, via Portuense 292, 00149, Rome, Italy
| | - Giuseppe Ippolito
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, via Portuense 292, 00149, Rome, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, via Portuense 292, 00149, Rome, Italy
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- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, via Portuense 292, 00149, Rome, Italy
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Mondi A, Lorenzini P, Castilletti C, Gagliardini R, Lalle E, Corpolongo A, Valli MB, Taglietti F, Cicalini S, Loiacono L, Di Gennaro F, D'Offizi G, Palmieri F, Nicastri E, Agrati C, Petrosillo N, Ippolito G, Vaia F, Girardi E, Capobianchi MR, Antinori A, Zito S, Abbonizio MA, Abdeddaim A, Agostini E, Agrati C, Albarello F, Amadei G, Amendola A, Antinori A, Antonica MA, Antonini M, Bartoli TA, Baldini F, Barbaro R, Bartolini B, Bellagamba R, Benigni M, Bevilacqua N, Biava G, Bibas M, Bordi L, Bordoni V, Boumis E, Branca M, Buonomo R, Busso D, Camici M, Campioni P, Canichella F, Capobianchi MR, Capone A, Caporale C, Caraffa E, Caravella I, Carletti F, Castilletti C, Cataldo A, Cerilli S, Cerva C, Chiappini R, Chinello P, Cianfarani MA, Ciaralli C, Cimaglia C, Cinicola N, Ciotti V, Cicalini S, Colavita F, Corpolongo A, Cristofaro M, Curiale S, D'Abramo A, Dantimi C, De Angelis A, De Angelis G, De Palo MG, De Zottis F, Di Bari V, Di Lorenzo R, Di Stefano F, D'Offizi G, Donno D, Evangelista F, Faraglia F, Farina A, Ferraro F, Fiorentini L, Frustaci A, Fusetti M, Galati V, Gagliardini R, Gallì P, Garotto G, Gaviano I, Tekle SG, Giancola ML, Giansante F, Giombini E, Granata G, Greci MC, Grilli E, Grisetti S, Gualano G, Iacomi F, Iaconi M, Iannicelli G, Inversi C, Ippolito G, Lalle E, Lamanna ME, Lanini S, Lapa D, Lepore L, Libertone R, Lionetti R, Liuzzi G, Loiacono L, Lucia A, Lufrani F, Macchione M, Maffongelli G, Marani A, Marchioni L, Mariano A, Marini MC, Maritti M, Mastrobattista A, Mastrorosa I, Matusali G, Mazzotta V, Mencarini P, Meschi S, Messina F, Micarelli S, Mogavero G, Mondi A, Montalbano M, Montaldo C, Mosti S, Murachelli S, Musso M, Nardi M, Navarra A, Nicastri E, Nocioni M, Noto P, Noto R, Oliva A, Onnis I, Ottou S, Palazzolo C, Pallini E, Palmieri F, Palombi G, Pareo C, Passeri V, Pelliccioni F, Penna G, Petrecchia A, Petrone A, Petrosillo N, Pianura E, Pinnetti C, Pisciotta M, Piselli P, Pittalis S, Pontarelli A, Proietti C, Puro V, Ramazzini PM, Rianda A, Rinonapoli G, Rosati S, Rubino D, Rueca M, Ruggeri A, Sacchi A, Sampaolesi A, Sanasi F, Santagata C, Scarabello A, Scarcia S, Schininà V, Scognamiglio P, Scorzolini L, Stazi G, Strano G, Taglietti F, Taibi C, Taloni G, Nardi T, Tonnarini R, Topino S, Tozzi M, Vaia F, Vairo F, Valli MB, Vergori A, Vincenzi L, Visco-Comandini U, Vita S, Vittozzi P, Zaccarelli M, Zanetti A, Zito S. Risk and predictive factors of prolonged viral RNA shedding in upper respiratory specimens in a large cohort of COVID-19 patients admitted to an Italian reference hospital. Int J Infect Dis 2021; 105:532-539. [PMID: 33676001 PMCID: PMC7927669 DOI: 10.1016/j.ijid.2021.02.117] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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] [Received: 11/16/2020] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 12/15/2022] Open
Abstract
Background Limited data are available about the predictors and outcomes associated with prolonged SARS-CoV-2 RNA shedding (VS). Methods A retrospective study including COVID-19 patients admitted to an Italian hospital between March 1 and July 1, 2020. Predictors of viral clearance (VC) and prolonged VS from the upper respiratory tract were assessed by Poisson regression and logistic regression analyses. The causal relation between VS and clinical outcomes was evaluated through an inverse probability weighted Cox model. Results The study included 536 subjects. The median duration of VS from symptoms onset was 18 days. The estimated 30-day probability of VC was 70.2%. Patients with comorbidities, lymphopenia at hospital admission, or moderate/severe respiratory disease had a lower chance of VC. The development of moderate/severe respiratory failure, delayed hospital admission after symptoms onset, baseline comorbidities, or D-dimer >1000 ng/mL at admission independently predicted prolonged VS. The achievement of VC doubled the chance of clinical recovery and reduced the probability of death/mechanical ventilation. Conclusions Respiratory disease severity, comorbidities, delayed hospital admission and inflammatory markers negatively predicted VC, which resulted to be associated with better clinical outcomes. These findings highlight the importance of prompt hospitalization of symptomatic patients, especially where signs of severity or comorbidities are present.
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Affiliation(s)
- Annalisa Mondi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Patrizia Lorenzini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Concetta Castilletti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Roberta Gagliardini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy.
| | - Eleonora Lalle
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Angela Corpolongo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Beatrice Valli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabrizio Taglietti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Stefania Cicalini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Laura Loiacono
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesco Di Gennaro
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gianpiero D'Offizi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabrizio Palmieri
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Chiara Agrati
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Nicola Petrosillo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giuseppe Ippolito
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesco Vaia
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Enrico Girardi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Andrea Antinori
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Sara Zito
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Amina Abdeddaim
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Elisabetta Agostini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Chiara Agrati
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabrizio Albarello
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gioia Amadei
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra Amendola
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Mario Antonini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Francesco Baldini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Raffaella Barbaro
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Barbara Bartolini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Rita Bellagamba
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Martina Benigni
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Nazario Bevilacqua
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gianluigi Biava
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Michele Bibas
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Licia Bordi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Veronica Bordoni
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Evangelo Boumis
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Marta Branca
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Rosanna Buonomo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Donatella Busso
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Marta Camici
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Paolo Campioni
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Flaminia Canichella
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Alessandro Capone
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Cinzia Caporale
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Emanuela Caraffa
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Ilaria Caravella
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabrizio Carletti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Concetta Castilletti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Adriana Cataldo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Stefano Cerilli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Carlotta Cerva
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Roberta Chiappini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Pierangelo Chinello
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Carmine Ciaralli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Claudia Cimaglia
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Nicola Cinicola
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Veronica Ciotti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Stefania Cicalini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesca Colavita
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Angela Corpolongo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Massimo Cristofaro
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Salvatore Curiale
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra D'Abramo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Cristina Dantimi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessia De Angelis
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giada De Angelis
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Grazia De Palo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Federico De Zottis
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Virginia Di Bari
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Rachele Di Lorenzo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Federica Di Stefano
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gianpiero D'Offizi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Davide Donno
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Francesca Faraglia
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Anna Farina
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Federica Ferraro
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Lorena Fiorentini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Frustaci
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Matteo Fusetti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Vincenzo Galati
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Roberta Gagliardini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Paola Gallì
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gabriele Garotto
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Ilaria Gaviano
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | | | - Filippo Giansante
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Emanuela Giombini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Guido Granata
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Cristina Greci
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Elisabetta Grilli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Susanna Grisetti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gina Gualano
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabio Iacomi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Marta Iaconi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Carlo Inversi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giuseppe Ippolito
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Eleonora Lalle
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Elena Lamanna
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Simone Lanini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Daniele Lapa
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Luciana Lepore
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Raffaella Libertone
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Raffaella Lionetti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giuseppina Liuzzi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Laura Loiacono
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Lucia
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Franco Lufrani
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Manuela Macchione
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gaetano Maffongelli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra Marani
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Luisa Marchioni
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Mariano
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Micaela Maritti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Ilaria Mastrorosa
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giulia Matusali
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Valentina Mazzotta
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Paola Mencarini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Silvia Meschi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesco Messina
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Sibiana Micarelli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giulia Mogavero
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Annalisa Mondi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Marzia Montalbano
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Chiara Montaldo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Silvia Mosti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Silvia Murachelli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Musso
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Michela Nardi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Assunta Navarra
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Martina Nocioni
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Pasquale Noto
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Roberto Noto
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra Oliva
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Ilaria Onnis
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Sandrine Ottou
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Claudia Palazzolo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Emanuele Pallini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabrizio Palmieri
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giulio Palombi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Carlo Pareo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Virgilio Passeri
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Federico Pelliccioni
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giovanna Penna
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Antonella Petrecchia
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Ada Petrone
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Nicola Petrosillo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Elisa Pianura
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Carmela Pinnetti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Pisciotta
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Pierluca Piselli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Silvia Pittalis
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Agostina Pontarelli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Costanza Proietti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Vincenzo Puro
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Alessia Rianda
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gabriele Rinonapoli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Silvia Rosati
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Dorotea Rubino
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Martina Rueca
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alberto Ruggeri
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra Sacchi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Francesco Sanasi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Carmen Santagata
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Silvana Scarcia
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Vincenzo Schininà
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Paola Scognamiglio
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Laura Scorzolini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giulia Stazi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giacomo Strano
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabrizio Taglietti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Chiara Taibi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giorgia Taloni
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Tetaj Nardi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Roberto Tonnarini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Simone Topino
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Martina Tozzi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesco Vaia
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesco Vairo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Beatrice Valli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra Vergori
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Laura Vincenzi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Serena Vita
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Pietro Vittozzi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Mauro Zaccarelli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Antonella Zanetti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Sara Zito
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
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- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
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Mazzarelli A, Giancola ML, Farina A, Marchioni L, Rueca M, Gruber CEM, Bartolini B, Ascoli Bartoli T, Maffongelli G, Capobianchi MR, Ippolito G, Di Caro A, Nicastri E, Pazienza V. 16S rRNA gene sequencing of rectal swab in patients affected by COVID-19. PLoS One 2021; 16:e0247041. [PMID: 33596245 PMCID: PMC7888592 DOI: 10.1371/journal.pone.0247041] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [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: 09/16/2020] [Accepted: 01/31/2021] [Indexed: 12/23/2022] Open
Abstract
COronaVIrus Disease-2019 (COVID-19) is a pandemic respiratory infection caused by a new betacoronavirus, the Severe Acute Respiratory Syndrome-CoronaVirus-2 (SARS-CoV-2). Few data are reported on the gut microbiota in COVID-19 patients. 16S rRNA gene sequencing was performed to reveal an altered composition of the gut microbiota in patients with COVID-19 pneumonia admitted in intensive care unit (ICU) (i-COVID19), or in infectious disease wards (w-COVID19) as compared to controls (CTRL). i-COVID19 patients showed a decrease of Chao1 index as compared to CTRL and w-COVID19 patients indicating that patients in ICU displayed a lower microbial richness while no change was observed as for Shannon Index. At the phylum level, an increase of Proteobacteria was detected in w-COVID19 patients as compared to CTRL. A decrease of Fusobacteria and Spirochetes has been found, with the latter decreased in i-COVID19 patients as compared to CTRL. Significant changes in gut microbial communities in patients with COVID-19 pneumonia with different disease severity compared to CTRL have been identified. Our preliminary data may provide valuable information and promising biomarkers for the diagnosis of the disease and, when validated in larger cohort, it could facilitate the stratification of patients based on the microbial signature.
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Affiliation(s)
- Antonio Mazzarelli
- National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Maria Letizia Giancola
- National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Anna Farina
- National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Luisa Marchioni
- National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Martina Rueca
- National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | | | - Barbara Bartolini
- National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Tommaso Ascoli Bartoli
- National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Gaetano Maffongelli
- National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | | | - Giuseppe Ippolito
- National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Antonino Di Caro
- National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Rome, Italy
- * E-mail:
| | - Emanuele Nicastri
- National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Valerio Pazienza
- Division of Gastroenterology, Fondazione-IRCCS “Casa Sollievo della Sofferenza” Hospital, S. Giovanni Rotondo (FG), Italy
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14
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Palazzolo C, Maffongelli G, D'Abramo A, Lepore L, Mariano A, Vulcano A, Bartoli TA, Bevilacqua N, Giancola ML, Di Rosa E, Nicastri E. Legionella pneumonia: increased risk after COVID-19 lockdown? Italy, May to June 2020. ACTA ACUST UNITED AC 2020; 25. [PMID: 32734857 PMCID: PMC7393852 DOI: 10.2807/1560-7917.es.2020.25.30.2001372] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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] [Indexed: 11/20/2022]
Abstract
We report a case of Legionella pneumonia in a dishwasher of a restaurant in Rome, Italy, just after the end of the lockdown that was in place to control the SARS-CoV-2 epidemic. The case highlights the importance of strict monitoring of water and air systems immediately before reopening business or public sector buildings, and the need to consider Legionella infections among the differential diagnosis of respiratory infections after lockdown due to the ongoing COVID-19 pandemic.
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Affiliation(s)
- Claudia Palazzolo
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Gaetano Maffongelli
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Alessandra D'Abramo
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Luciana Lepore
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Andrea Mariano
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Antonella Vulcano
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | | | - Nazario Bevilacqua
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | | | | | - Emanuele Nicastri
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
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15
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Palazzolo C, Maffongelli G, D'Abramo A, Lepore L, Mariano A, Vulcano A, Bartoli TA, Bevilacqua N, Giancola ML, Di Rosa E, Nicastri E. Authors' response: importance of a careful investigation to avoid attributing Legionnaires' disease cases to an incorrect source of infection. Euro Surveill 2020; 25:2001570. [PMID: 32856588 PMCID: PMC7453682 DOI: 10.2807/1560-7917.es.2020.25.34.2001570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/27/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Claudia Palazzolo
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Gaetano Maffongelli
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Alessandra D'Abramo
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Luciana Lepore
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Andrea Mariano
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Antonella Vulcano
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | | | - Nazario Bevilacqua
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | | | | | - Emanuele Nicastri
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
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16
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Campogiani L, Cerva C, Maffongelli G, Teti E, Pupo L, Vaccarini S, Cantonetti M, Pennica A, Andreoni M, Sarmati L. Remission of an HHV8-related extracavitary primary effusion lymphoma in an HIV-positive patient during antiretroviral treatment containing dolutegravir. AIDS Res Ther 2019; 16:15. [PMID: 31351487 PMCID: PMC6660660 DOI: 10.1186/s12981-019-0230-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 07/17/2019] [Indexed: 12/12/2022] Open
Abstract
Background Human herpes virus 8 (HHV8) is the causative agent of Kaposi’s sarcoma and has been associated with an increasing number of hematologic diseases such as primary effusion lymphoma (PEL) (both classic and extracavitary form), multicentric Castleman disease and the germinotropic lymphoproliferative disorder. PEL is a rare B cell non-Hodgkin lymphoma that primarily affects immunocompromised patients; aggressive chemotherapy and antiretroviral therapy (ART) with protease inhibitors have been used, with poor results. We present a case of extracavitary PEL in an HIV-infected patient, regressed after ART initiation. Case presentation A 42-year-old male was admitted to the emergency room because of several months of malaise, fever and progressive deterioration of the general conditions. On physical examination soft non-painful subcutaneous masses were palpable at retronuchal, retroauricolar and thoracic regions. HIV serology resulted positive: HIV plasma viremia was 782,270 copies/mL, CD4 103 cells/mL. The excision of one of the masses, metabolically active at a positron emission tomography (PET-CT) scan, revealed an HHV8-related extracavitary PEL. HHV8 plasma viremia was 44,826 copies/mL. ART with tenofovir alafenamide/emtricitabine/dolutegravir was started together with ganciclovir for cytomegalovirus chorioretinitis. The progressive disappearance of the masses was seen after 6 weeks of ART, and a PET-CT scan resulted completely negative at 3 months. After 19 months of ART the patient was in remission of PEL, HIV viremia was undetectable (< 20 copies/mL), CD4 count was 766 cells/mL and HHV8 viremia was undetectable. Conclusions In this clinical case, the complete regression of PEL has been achieved after the immune recovery, as a consequence of ART introduction, without chemotherapy. It cannot be excluded that ganciclovir, used for the treatment of CMV chorioretinitis, may have contributed to the control of HHV8 replication. Whether to try or not a conservative approach in HIV-infected PEL patients must be carefully evaluated, considering the patient’s characteristics and the prognostic factors.
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17
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Mengoli C, Basso M, Andreis S, Scaggiante R, Cruciani M, Ferretto R, Panese S, Manfrin V, Francisci D, Schiaroli E, Maffongelli G, Sarmati L, Andreoni M, Baldelli F, Palu' G, Parisi SG. Role of pretreatment variables on plasma HIV RNA value at the sixth month of antiretroviral therapy including all first line drugs in HIV naïve patients: A path analysis approach. PLoS One 2019; 14:e0213160. [PMID: 30856186 PMCID: PMC6411145 DOI: 10.1371/journal.pone.0213160] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 02/15/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND AIMS We investigated the conditioning roles of viral tropism and other variables on plasma HIV RNA levels after 6 months of combination antiretroviral therapy (cART) in an HIV-infected Italian naïve population using regression tree, random forest regression, and path analysis (PA). Patients in this multicenter observational study were treated with all antiviral drugs that are currently recommended as first-line therapies. METHODS Adult patients with chronic HIV infection were enrolled at the beginning of first-line cART (T0). The main variables were age, gender, tropism, "lcd4_0" and "lcd4_6" (log10 CD4+counts at T0 and after 6 months of cART, respectively), and "lrna0" (log10 HIV RNA at T0). Regression tree and random forest analyses were applied. The predictive effect on lrna6 (log10-transformed plasma HIV RNA after 6 months of cART) was also investigated via PA (x4->lcd4_0->lrna0->lrna6) with a treatment selection step included as a dependent (mediator) variable for each third drug and, as predictive covariates, age, female, x4_10, x4_5, lcd4_0, and lrna0. Tropism was assessed in plasma using the Geno2pheno algorithm with 2 false positive rate (FPR) cut-offs: 5% (x4_5) and 10% (x4_10). RESULTS The study included 571 subjects (21% x4_10 and 10.7% x4_5). The only important predictor of lrna6 was lrna0, and a positive indirect effect of bearing X4 virus in plasma was suggested. A significant direct positive effect of protease inhibitors on lrna6 was found (p = 0.022), and a significant negative effect of integrase strand transfer inhibitor (INSTI) was also detected (p = 0.003 for FPR ≤ 5% and p = 0.01 for FPR < 10%). PA predicted mean residual viremias of 40 copies/mL without INSTI and 3 copies/mL with INSTI. CONCLUSIONS PA indicated a possible indirect role of HIV tropism on lrna6 with both FPR < 10% and ≤ 5%. Patients treated with INSTI had a predicted residual viremia of 3 copies/mL.
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Affiliation(s)
- Carlo Mengoli
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Monica Basso
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Samantha Andreis
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Renzo Scaggiante
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | | | - Roberto Ferretto
- Clinical Infectious Diseases, Santorso Hospital, Santorso (VI), Italy
| | - Sandro Panese
- Clinical Infectious Diseases, Mestre Hospital, Venezia, Italy
| | - Vinicio Manfrin
- Clinical Infectious Diseases, Vicenza Hospital, Vicenza, Italy
| | | | | | | | - Loredana Sarmati
- Clinical Infectious Diseases, Tor Vergata University, Roma, Italy
| | - Massimo Andreoni
- Clinical Infectious Diseases, Tor Vergata University, Roma, Italy
| | - Franco Baldelli
- Clinical Infectious Diseases, University of Perugia, Perugia, Italy
| | - Giorgio Palu'
- Department of Molecular Medicine, University of Padova, Padova, Italy
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18
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Sterrantino G, Borghi V, Callegaro AP, Bruzzone B, Saladini F, Maggiolo F, Maffongelli G, Andreoni M, De Gennaro M, Gianotti N, Bagnarelli P, Vergori A, Antinori A, Zazzi M, Zaccarelli M. Prevalence of predicted resistance to doravirine in HIV-1-positive patients after exposure to non-nucleoside reverse transcriptase inhibitors. Int J Antimicrob Agents 2019; 53:515-519. [PMID: 30769200 DOI: 10.1016/j.ijantimicag.2019.02.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/29/2019] [Accepted: 02/06/2019] [Indexed: 11/17/2022]
Abstract
This study investigated the prevalence of doravirine (DOR) resistance mutations in non-nucleoside reverse transcriptase inhibitor (NNRTI)-experienced patients. DOR resistance was assessed in samples from NNRTI-experienced patients who underwent genotypic testing for virological failure from the Antiretroviral Response Cohort Analysis (ARCA) database. Intermediate DOR resistance was defined as detection of any of V106A/M, Y188C/H, V108I, and K103N+P225H. High-level DOR resistance was defined as detection of any of Y188L, M230L, G190E, V106A/M+F227L, and V106A/M+L234I. Overall, 6893 patients were included in the study: 64.2% had experienced efavirenz (EFV), 54.4% nevirapine (NVP), 6.8% etravirine (ETR), 7.7% rilpivirine (RPV) and 0.7% delavirdine. Among NNRTI-experienced patients, 12.7% and 6.1% of subjects had intermediate and high-level DOR resistance, respectively. The most common DOR resistance mutation was Y188L. In multivariable analysis, previous EFV use (OR = 1.52, 95% CI 1.15-2.02) and ETR use (OR = 1.91, 95% CI 1.34-2.73) were associated with detection of high-level DOR resistance, whilst RPV use was associated with a lower probability of high-level DOR resistance (OR = 0.39, 95% CI 0.22-0.71). Moreover, EFV use (OR = 1.76, 95% CI 1.19-2.58) and ETR use (OR = 1.72, 95% CI 1.10-2.68) were associated with detection of the Y188L mutation, whereas RPV use was not (OR = 0.16, 95% CI 0.05-0.50). In Italy, DOR resistance is uncommon among NNRTI-experienced patients, confirming a distinguishing resistance pattern within NNRTIs. However, previous EFV and ETR experience poses a higher risk of DOR resistance. These results support the use of DOR in NNRTI-experienced patients.
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Affiliation(s)
- Gaetana Sterrantino
- Tropical and Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Università degli studi di Firenze, Largo Brambilla 3, 50134 Florence, Italy.
| | - Vanni Borghi
- Department of Infectious Diseases, Università di Modena, Modena, Italy
| | - Anna Paola Callegaro
- Microbiology and Virology Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Bianca Bruzzone
- Hygiene Unit, Azienda Ospedaliera-Universitaria San Martino, Genoa, Italy
| | - Francesco Saladini
- Department of Medical Biotechnologies, Università di Siena, Siena, Italy
| | - Franco Maggiolo
- Department of Infectious Diseases, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | | | - Massimo Andreoni
- Department of Infectious Diseases, Università di Tor Vergata, Rome, Italy
| | | | - Nicola Gianotti
- Department of Infectious Diseases, Ospedale San Raffaele, Milan, Italy
| | - Patrizia Bagnarelli
- Virology Unit, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Alessandra Vergori
- Clinical Department, Istituto Nazionale per le Malattie Infettive 'Lazzaro Spallanzani', IRCCS, Rome, Italy
| | - Andrea Antinori
- Clinical Department, Istituto Nazionale per le Malattie Infettive 'Lazzaro Spallanzani', IRCCS, Rome, Italy
| | - Maurizio Zazzi
- Department of Medical Biotechnologies, Università di Siena, Siena, Italy
| | - Mauro Zaccarelli
- Clinical Department, Istituto Nazionale per le Malattie Infettive 'Lazzaro Spallanzani', IRCCS, Rome, Italy
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19
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Fabeni L, Alteri C, Di Carlo D, Orchi N, Carioti L, Bertoli A, Gori C, Forbici F, Continenza F, Maffongelli G, Pinnetti C, Vergori A, Mondi A, Ammassari A, Borghi V, Giuliani M, De Carli G, Pittalis S, Grisetti S, Pennica A, Mastroianni CM, Montella F, Cristaudo A, Mussini C, Girardi E, Andreoni M, Antinori A, Ceccherini-Silberstein F, Perno CF, Santoro MM. Dynamics and phylogenetic relationships of HIV-1 transmitted drug resistance according to subtype in Italy over the years 2000-14. J Antimicrob Chemother 2018; 72:2837-2845. [PMID: 29091206 DOI: 10.1093/jac/dkx231] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/09/2017] [Indexed: 11/14/2022] Open
Abstract
Background Transmitted drug-resistance (TDR) remains a critical aspect for the management of HIV-1-infected individuals. Thus, studying the dynamics of TDR is crucial to optimize HIV care. Methods In total, 4323 HIV-1 protease/reverse-transcriptase sequences from drug-naive individuals diagnosed in north and central Italy between 2000 and 2014 were analysed. TDR was evaluated over time. Maximum-likelihood and Bayesian phylogenetic trees with bootstrap and Bayesian-probability supports defined transmission clusters. Results Most individuals were males (80.2%) and Italian (72.1%), with a median (IQR) age of 37 (30-45) years. MSM accounted for 42.2% of cases, followed by heterosexuals (36.4%). Non-B subtype infections accounted for 30.8% of the overall population and increased over time (<2005-14: 19.5%-38.5%, P < 0.0001), particularly among Italians (<2005-14: 6.5%-28.8%, P < 0.0001). TDR prevalence was 8.8% and increased over time in non-B subtypes (<2005-14: 2%-7.1%, P = 0.018). Overall, 467 transmission clusters (involving 1207 individuals; 27.9%) were identified. The prevalence of individuals grouping in transmission clusters increased over time in both B (<2005-14: 12.9%-33.5%, P = 0.001) and non-B subtypes (<2005-14: 18.4%-41.9%, P = 0.006). TDR transmission clusters were 13.3% within the overall cluster observed and dramatically increased in recent years (<2005-14: 14.3%-35.5%, P = 0.005). This recent increase was mainly due to non-B subtype-infected individuals, who were also more frequently involved in large transmission clusters than those infected with a B subtype [median number of individuals in transmission clusters: 7 (IQR 6-19) versus 4 (3-4), P = 0.047]. Conclusions The epidemiology of HIV transmission changed greatly over time; the increasing number of transmission clusters (sometimes with drug resistance) shows that detection and proper treatment of the multi-transmitters is a major target for controlling HIV spread.
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Affiliation(s)
- L Fabeni
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - C Alteri
- University of Rome Tor Vergata, Rome, Italy
| | - D Di Carlo
- University of Rome Tor Vergata, Rome, Italy
| | - N Orchi
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - L Carioti
- University of Rome Tor Vergata, Rome, Italy
| | - A Bertoli
- University of Rome Tor Vergata, Rome, Italy
| | - C Gori
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - F Forbici
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - F Continenza
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | | | - C Pinnetti
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - A Vergori
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - A Mondi
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - A Ammassari
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - V Borghi
- Modena University Hospital, Modena, Italy
| | - M Giuliani
- San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - G De Carli
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - S Pittalis
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - S Grisetti
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | | | | | - F Montella
- S. Giovanni Addolorata Hospital, Rome, Italy
| | - A Cristaudo
- San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - C Mussini
- Modena University Hospital, Modena, Italy
| | - E Girardi
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - M Andreoni
- University Hospital Tor Vergata, Rome, Italy
| | - A Antinori
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | | | - C F Perno
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
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20
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Cerva C, Maffongelli G, Svicher V, Salpini R, Colagrossi L, Battisti A, Mariotti B, Cerretti R, Cudillo L, Sarmati L. Hepatitis B reactivation characterized by HBsAg negativity and anti-HbsAg antibodies persistence in haematopoietic stem cell transplanted patient after lamivudine withdrawal. BMC Infect Dis 2017; 17:566. [PMID: 28806922 PMCID: PMC5557326 DOI: 10.1186/s12879-017-2672-6] [Citation(s) in RCA: 9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 08/07/2017] [Indexed: 12/11/2022] Open
Abstract
Background HBV reactivation is associated with high mortality rates in hematopoietic stem cell transplantation (HSCT) and prophylactic lamivudine (LMV) treatment is suggested to prevent this phenomenon. However, the duration of LMV treatment in HSCT patients is not fully defined and the time of immune recovery is considered the best parameter for a drug to be safely interrupted. In patients undergoing allogeneic HSCT, the time of immune recovery is not easy to define and may take years after transplantation and prolonged LMV treatments, which can lead to drug-resistant viral strains. Case presentation An anti-HBc-positive hematological patient who was undergoing prolonged immunosuppression and who experienced HBV reactivation 3 months after the suspension of a prolonged LMV prophylaxis is described. HBV-DNA matching an atypical serological profile characterized by HbsAg negativity and anti-HBs positivity was detected in the patient. The genotypic analysis of the HBV strain identified T127P, F170FL and S204R mutations of HbsAg, which can hinder HBsAg recognition in a diagnostic assay. Conclusions HBV reactivation in the HSCT host can be sustained by HBsAg viral variants with characteristics of altered immunogenicity that cannot be detected by usual laboratory tests. This clinical case description suggests the importance of screening for serum HBV-DNA levels in the diagnosis of HBV reactivation and monitoring HBV-DNA after prophylaxis suspension, particularly in HSCT subjects who have undergone prolonged periods of LMV treatment.
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Affiliation(s)
- C Cerva
- Clinical Infectious Disease, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - G Maffongelli
- Clinical Infectious Disease, Department of Systems Medicine, Tor Vergata University, Rome, Italy.
| | - V Svicher
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - R Salpini
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - L Colagrossi
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - A Battisti
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - B Mariotti
- Department of Hematology, Stem Cell Transplant Unit, Tor Vergata University, Rome, Italy
| | - R Cerretti
- Department of Hematology, Stem Cell Transplant Unit, Tor Vergata University, Rome, Italy
| | - L Cudillo
- Department of Hematology, Stem Cell Transplant Unit, Tor Vergata University, Rome, Italy
| | - L Sarmati
- Clinical Infectious Disease, Department of Systems Medicine, Tor Vergata University, Rome, Italy
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21
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Ricciardi A, Gentilotti E, Coppola L, Maffongelli G, Cerva C, Malagnino V, Mari A, Di Veroli A, Berrilli F, Apice F, Toschi N, Di Cave D, Parisi SG, Andreoni M, Sarmati L. Infectious disease ward admission positively influences P. jiroveci pneumonia (PjP) outcome: A retrospective analysis of 116 HIV-positive and HIV-negative immunocompromised patients. PLoS One 2017; 12:e0176881. [PMID: 28505159 PMCID: PMC5432209 DOI: 10.1371/journal.pone.0176881] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 04/18/2017] [Indexed: 01/15/2023] Open
Abstract
P. jiroveci (Pj) causes a potentially fatal pneumonia in immunocompromised patients and the factors associated with a bad outcome are poorly understood. A retrospective analysis on Pj pneumonia (PjP) cases occurring in Tor Vergata University Hospital, Italy, during the period 2011–2015. The patients’ demographic, clinical and radiological characteristics and the Pj genotypes were considered. The study population included 116 patients, 37.9% of whom had haematological malignancy or underwent haematological stem cell transplantation (HSCT), 22.4% had HIV infection, 16.4% had chronic lung diseases (CLD), 7.8% had a solid cancer, and 3.4% underwent a solid organ transplant (SOT). The remaining 12.1% had a miscellaneous other condition. At univariate analysis, being older than 60 years was significantly correlated with a severe PjP (OR [95%CI] 2.52 [0.10–5.76]; p = 0.031) and death (OR [95%CI] 2.44 [1.05–5.70]; p = 0.036), while a previous trimethoprim/sulfamethoxazole (TMP/SMX) prophylaxis were significantly associated with a less severe pneumonia (OR[95%CI] 0.35 [0.15–0.84], p = 0.023); moreover, death due to PjP was significantly more frequent in patients with CLD (OR[95%CI] 3.26 [1.17–9.05]; p = 0.019) while, admission to the Infectious Diseases Unit was significantly associated with fewer deaths (OR[95%CI] 0.10 [0.03–0.36], p = 0.002). At multivariate analysis, a better PjP outcome was observed in patients taking TMP/SMX prophylaxis and that were admitted to the Infectious Diseases Unit (OR[95%CI] 0.27 [0.07–1.03], p = 0.055, OR[95%CI] 0.16 [0.05–0.55]; p = 0.004, respectively). In conclusion, in our study population, TMP/SMX prophylaxis and infectious disease specialist approach were variables correlated with a better PjP outcome.
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Affiliation(s)
| | | | - Luigi Coppola
- Infectious Diseases, Tor Vergata University, Rome, Italy
| | | | - Carlotta Cerva
- Infectious Diseases, Tor Vergata University, Rome, Italy
| | | | - Alessia Mari
- Respiratory Diseases Unit, Tor Vergata University, Rome, Italy
| | - Ambra Di Veroli
- Department of Haematology, Tor Vergata University, Rome, Italy
| | - Federica Berrilli
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Fabiana Apice
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Nicola Toschi
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging and Harvard Medical School, Boston, MA, United States of America
| | - David Di Cave
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Saverio Giuseppe Parisi
- Department of Molecular Medicine, University of Padua, Padua, Italy, Clinical Microbiology and Virology Unit, Padua University Hospital, Padua, Italy
| | | | - Loredana Sarmati
- Infectious Diseases, Tor Vergata University, Rome, Italy
- * E-mail:
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22
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Mengoli C, Andreis S, Scaggiante R, Cruciani M, Bosco O, Ferretto R, Leoni D, Maffongelli G, Basso M, Torti C, Sarmati L, Andreoni M, Palù G, Parisi SG. Structural equation modelling of viral tropism reveals its impact on achieving viral suppression within 6 months in treatment-naive HIV-1-infected patients after combination antiretroviral therapy. J Antimicrob Chemother 2016; 72:220-226. [PMID: 27605599 DOI: 10.1093/jac/dkw348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/19/2016] [Accepted: 07/25/2016] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To evaluate the role of pre-treatment co-receptor tropism of plasma HIV on the achievement of viral suppression (plasma HIV RNA 1.69 log10 copies/mL) at the sixth month of combination antiretroviral therapy (cART) in a cohort of naive patients using, for the first time in this context, a path analysis (PA) approach. PATIENTS AND METHODS Adult patients with chronic infection by subtype B HIV-1 were consecutively enrolled from the start of first-line cART (T0). Genotypic analysis of viral tropism was performed on plasma and interpreted using the bioinformatic tool Geno2pheno, with a false positive rate of 10%. A Bayesian network starting from the viro-immunological data at T0 and at the sixth month of treatment (T1) was set up and this model was evaluated using a PA approach. RESULTS A total of 262 patients (22.1% bearing an X4 virus) were included; 178 subjects (67.9%) achieved viral suppression. A significant positive indirect effect of bearing X4 virus in plasma at T0 on log10 HIV RNA at T1 was detected (P = 0.009), the magnitude of this effect was, however, over 10-fold lower than the direct effect of log10 HIV RNA at T0 on log10 HIV RNA at T1 (P = 0.000). Moreover, a significant positive indirect effect of bearing an X4 virus on log10 HIV RNA at T0 (P = 0.003) was apparent. CONCLUSIONS PA overcame the limitations implicit in common multiple regression analysis and showed the possible role of pre-treatment viral tropism at the recommended threshold on the outcome of plasma viraemia in naive patients after 6 months of therapy.
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Affiliation(s)
- Carlo Mengoli
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Samantha Andreis
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | | | | | | | | | - Davide Leoni
- Clinical Infectious Diseases, Tor Vergata University, Rome, Italy
| | | | - Monica Basso
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Carlo Torti
- Unit of Infectious Diseases, University 'Magna Graecia', Catanzaro, Italy
| | - Loredana Sarmati
- Clinical Infectious Diseases, Tor Vergata University, Rome, Italy
| | - Massimo Andreoni
- Clinical Infectious Diseases, Tor Vergata University, Rome, Italy
| | - Giorgio Palù
- Department of Molecular Medicine, University of Padova, Padova, Italy
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23
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Armenia D, Di Carlo D, Maffongelli G, Borghi V, Alteri C, Forbici F, Bertoli A, Gori C, Giuliani M, Nicastri E, Zaccarelli M, Pinnetti C, Cicalini S, D'Offizi G, Ceccherini-Silberstein F, Mussini C, Antinori A, Andreoni M, Perno CF, Santoro MM. Virological response and resistance profile in HIV-1-infected patients starting darunavir-containing regimens. HIV Med 2016; 18:21-32. [PMID: 27353061 DOI: 10.1111/hiv.12388] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We evaluated the virological response in patients starting a regimen based on darunavir/ritonavir (DRV/r), which is currently the most widely used ritonavir-boosted protease inhibitor. METHODS Data from 206 drug-naïve and 327 PI-experienced patients starting DRV/r 600/100 mg twice daily (DRV600) or 800/100 mg once daily (DRV800) were examined. The probabilities of virological success (VS) and virological rebound (VR) were evaluated in survival analyses. Baseline DRV/r resistance and its evolution at failure were also examined. RESULTS DRV600 was preferentially administered in patients with complex requirements (older age, higher viraemia, lower CD4 cell count and DRV/PI resistance) compared with DRV800. By 12 months, the probability of achieving VS was 93.2% and 84.3% in drug-naïve and PI-experienced patients, respectively. The higher the baseline viraemia, the longer was the time required to achieve VS, both in drug-naïve patients [>500 000 HIV-1 RNA copies/mL: median [interquartile range (IQR)] 6.1 (5.1-10.3) months; 100 000-500 000 copies/mL: median (IQR) 4.9 (3.8-6.1) months; <100 000 copies/mL: median (IQR) 3.9 (3.5-4.8) months; P < 0.001] and in PI-experienced patients [≥100 000 copies/mL: median (IQR) 7.2 (5.7-11.6) months; <100 000 copies/mL: median (IQR) 2.8 (2.4-3.3) months; P < 0.001]. In PI-experienced patients, the probability of VR was higher for higher viraemia levels (22.3% for ≥100 000 copies/ml vs. 9.7% for <100 000 copies/mL; P = 0.007). Baseline resistance did not affect the virological response. At failure, a high percentage of patients maintained virus susceptible to all PIs (drug-naïve: 95%; PI-experienced: 80%). Despite being used more often in patients with more complex requirements, DRV600 performed as well as DRV800. CONCLUSIONS In clinical practice, use of DRV/r (with its flexible dosage) results in high rates of virological response. These data support the use of PI/r in patients whose characteristics require potent drugs with a high genetic barrier.
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Affiliation(s)
- D Armenia
- Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - D Di Carlo
- Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - G Maffongelli
- Infectious Diseases Division, University Hospital Tor Vergata, Rome, Italy
| | - V Borghi
- Infectious Diseases Division, Modena University Hospital, Modena, Italy
| | - C Alteri
- Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - F Forbici
- Antiretroviral Therapy Monitoring Unit, L Spallanzani Hospital, Rome, Italy
| | - A Bertoli
- Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy.,Molecular Virology Division, University Hospital Tor Vergata, Rome, Italy
| | - C Gori
- Antiretroviral Therapy Monitoring Unit, L Spallanzani Hospital, Rome, Italy
| | - M Giuliani
- Infectious Dermatology Unit, San Gallicano Hospital, Rome, Italy
| | - E Nicastri
- Infectious Diseases Division, L Spallanzani Hospital, Rome, Italy
| | - M Zaccarelli
- Infectious Diseases Division, L Spallanzani Hospital, Rome, Italy
| | - C Pinnetti
- Infectious Diseases Division, L Spallanzani Hospital, Rome, Italy
| | - S Cicalini
- Infectious Diseases Division, L Spallanzani Hospital, Rome, Italy
| | - G D'Offizi
- Infectious Diseases Division, L Spallanzani Hospital, Rome, Italy
| | | | - C Mussini
- Infectious Diseases Division, Modena University Hospital, Modena, Italy
| | - A Antinori
- Infectious Diseases Division, L Spallanzani Hospital, Rome, Italy
| | - M Andreoni
- Infectious Diseases Division, University Hospital Tor Vergata, Rome, Italy
| | - C F Perno
- Antiretroviral Therapy Monitoring Unit, L Spallanzani Hospital, Rome, Italy
| | - M M Santoro
- Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
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24
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Ricciardi A, Sordillo P, Ceccarelli L, Maffongelli G, Calisti G, Di Pietro B, Caracciolo CR, Schillaci O, Pellegrino A, Chiariello L, Andreoni M, Sarmati L. 18-Fluoro-2-deoxyglucose positron emission tomography-computed tomography: an additional tool in the diagnosis of prosthetic valve endocarditis. Int J Infect Dis 2014; 28:219-24. [PMID: 25093540 DOI: 10.1016/j.ijid.2014.04.028] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 04/20/2014] [Accepted: 04/26/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES To evaluate the role of 18-fluoro-2-deoxyglucose positron emission tomography-computed tomography ((18)F-FDG-PET-CT) in the diagnosis of infectious endocarditis (IE). METHODS We retrospectively examined 27 consecutive patients who were admitted to the Infectious Diseases Department of Tor Vergata University Hospital between 2009 and 2013 with a suspicion of IE. The final IE diagnosis was defined according to the modified Duke criteria, and the microbiological and diagnostic results were collected for each patient. RESULTS Twenty out of 27 patients had a suspected prosthetic valve endocarditis (PVE) and seven had a suspected native valve endocarditis (NVE). Twenty-five out of 27 patients (92%) had a confirmed diagnosis of IE (18/25 PVE and 7/25 NVE); 16 had a positive echocardiography evaluation and 16 had positive (18)F-FDG-PET-CT findings. Echocardiography showed a higher sensitivity as a diagnostic tool for the detection of IE compared to (18)F-FDG-PET-CT (80% vs. 55%). However, a greater number of PVE had positive (18)F-FDG-PET-CT results compared to those with positive echocardiography findings (11/13 vs. 9/13), and overall 89% (16/18) of confirmed PVE resulted (18)F-FDG-PET-CT positive. Analyzing only the cases who underwent transoesophageal echocardiography, (18)F-FDG-PET-CT showed a sensitivity of 85% in PVE (vs. 69% for echocardiography and 77% for the Duke criteria). All seven patients with NVE had a positive echocardiography and negative (18)F-FDG-PET-CT findings (p<0.001). CONCLUSIONS The results of this study further highlight the limitations of echocardiography in the diagnosis of PVE and the potential advantages of (18)F-FDG-PET-CT in these cases.
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Affiliation(s)
- Alessandra Ricciardi
- Clinical Infectious Diseases, Tor Vergata University, V. Montpellier 1, 00133, Rome, Italy
| | - Pasquale Sordillo
- Clinical Infectious Diseases, Tor Vergata University, V. Montpellier 1, 00133, Rome, Italy
| | - Laura Ceccarelli
- Clinical Infectious Diseases, Tor Vergata University, V. Montpellier 1, 00133, Rome, Italy
| | - Gaetano Maffongelli
- Clinical Infectious Diseases, Tor Vergata University, V. Montpellier 1, 00133, Rome, Italy
| | - Giorgio Calisti
- Department of Virology, Royal Free London NHS Foundation Trust, London, UK
| | - Barbara Di Pietro
- Department of Biopathology and Diagnostic Imaging, Tor Vergata University, Rome, Italy
| | | | - Orazio Schillaci
- Department of Biopathology and Diagnostic Imaging, Tor Vergata University, Rome, Italy
| | | | | | - Massimo Andreoni
- Clinical Infectious Diseases, Tor Vergata University, V. Montpellier 1, 00133, Rome, Italy
| | - Loredana Sarmati
- Clinical Infectious Diseases, Tor Vergata University, V. Montpellier 1, 00133, Rome, Italy.
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Svicher V, Alteri C, Montano M, Nori A, D'Arrigo R, Andreoni M, Angarano G, Antinori A, Antonelli G, Allice T, Bagnarelli P, Baldanti F, Bertoli A, Borderi M, Boeri E, Bon I, Bruzzone B, Barresi R, Calderisi S, Callegaro AP, Capobianchi MR, Gargiulo F, Castelli F, Cauda R, Ceccherini-Silberstein F, Clementi M, Chirianni A, Colafigli M, D'Arminio Monforte A, De Luca A, Di Biagio A, Di Nicuolo G, Di Perri G, Di Santo F, Fadda G, Galli M, Gennari W, Ghisetti V, Costantini A, Gori A, Gulminetti R, Leoncini F, Maffongelli G, Maggiolo F, Maserati R, Mazzotta F, Meini G, Micheli V, Monno L, Mussini C, Nozza S, Paolucci S, Palù G, Parisi S, Parruti G, Pignataro AR, Quirino T, Re MC, Rizzardini G, Sanguinetti M, Santangelo R, Scaggiante R, Sterrantino G, Turriziani O, Vatteroni ML, Viscoli C, Vullo V, Zazzi M, Lazzarin A, Perno CF. Genotypic testing on HIV-1 DNA as a tool to assess HIV-1 co-receptor usage in clinical practice: results from the DIVA study group. Infection 2013; 42:61-71. [PMID: 24146352 PMCID: PMC3906530 DOI: 10.1007/s15010-013-0510-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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] [Received: 03/11/2013] [Accepted: 07/16/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE We have developed a sequencing assay for determining the usage of the genotypic HIV-1 co-receptor using peripheral blood mononuclear cell (PBMC) DNA in virologically suppressed HIV-1 infected patients. Our specific aims were to (1) evaluate the efficiency of V3 sequences in B versus non-B subtypes, (2) compare the efficiency of V3 sequences and tropism prediction using whole blood and PBMCs for DNA extraction, (3) compare the efficiency of V3 sequences and tropism prediction using a single versus a triplicate round of amplification. RESULTS The overall rate of successful V3 sequences ranged from 100 % in samples with >3,000 copies HIV-1 DNA/10(6) PBMCs to 60 % in samples with <100 copies total HIV-1 DNA /10(6) PBMCs. Analysis of 143 paired PBMCs and whole-blood samples showed successful V3 sequences rates of 77.6 % for PBMCs and 83.9 % for whole blood. These rates are in agreement with the tropism prediction obtained using the geno2pheno co-receptor algorithm, namely, 92.1 % with a false-positive rate (FPR) of 10 or 20 % and of 96.5 % with an FPR of 5.75 %. The agreement between tropism prediction values using single versus triplicate amplification was 98.2 % (56/57) of patients using an FPR of 20 % and 92.9 % (53/57) using an FPR of 10 or 5.75 %. For 63.0 % (36/57) of patients, the FPR obtained via the single amplification procedure was superimposable to all three FPRs obtained by triplicate amplification. CONCLUSIONS Our results show the feasibility and consistency of genotypic testing on HIV-1 DNA tropism, supporting its possible use for selecting patients with suppressed plasma HIV-1 RNA as candidates for CCR5-antagonist treatment. The high agreement between tropism prediction by single and triple amplification does not support the use of triplicate amplification in clinical practice.
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Affiliation(s)
- V Svicher
- Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
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Ricciardi A, Chiariello G, Sordillo P, Nardi P, Maffongelli G, Pellegrino A, Cesta N, Chiariello L, Andreoni M. P01 INFECTIVE ENDOCARDITIS: EPIDEMIOLOGICAL AND THERAPEUTIC ASPECTS IN AN URBAN POPULATION – ROME, ITALY. RETROSPECTIVE STUDY. Int J Antimicrob Agents 2013. [DOI: 10.1016/s0924-8579(13)70025-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sarmati L, Parisi SG, Montano M, Andreis S, Scaggiante R, Galgani A, Viscione M, Maffongelli G, Ricciardi A, Andreoni C, Boros S, Palu G, Andreoni M. Nevirapine use, prolonged antiretroviral therapy and high CD4 nadir values are strongly correlated with undetectable HIV-DNA and -RNA levels and CD4 cell gain. J Antimicrob Chemother 2012; 67:2932-8. [DOI: 10.1093/jac/dks331] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Svicher V, Alteri C, Montano M, D'Arrigo R, Andreoni M, Angarano G, Antinori A, Antonelli G, Allice T, Bagnarelli P, Baldanti F, Bertoli A, Borderi M, Boeri E, Bon I, Bruzzone B, Callegaro AP, Capobianchi MR, Carosi G, Cauda R, Ceccherini-Silberstein F, Clementi M, Chirianni A, Colafigli M, D'Arminio Monforte A, De Luca A, Di Biagio A, Di Nicuolo G, Di Perri G, Di Pietro M, Di Santo F, Fabeni L, Fadda G, Galli M, Gennari W, Ghisetti V, Giacometti A, Gori C, Gori A, Gulminetti R, Leoncini F, Maffongelli G, Maggiolo F, Manca G, Gargiulo F, Martinelli C, Maserati R, Mazzotta F, Meini G, Micheli V, Monno L, Mussini C, Narciso P, Nozza S, Paolucci S, Pal G, Parisi S, Parruti G, Pignataro AR, Pollicita M, Quirino T, Re MC, Rizzardini G, Santangelo R, Scaggiante R, Sterrantino G, Turriziani O, Vatteroni ML, Vecchi L, Viscoli C, Vullo V, Zazzi M, Lazzarini A, Perno CF. Performance of genotypic tropism testing on proviral DNA in clinical practice: results from the DIVA study group. New Microbiol 2012; 35:17-25. [PMID: 22378549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 11/10/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The DIVA study is aimed at setting up a standardized genotypic tropism-testing on proviral-DNA for the routine clinical diagnostic-laboratory. METHODS Twelve local centres and 5 reference centres (previously cross-validated) were identified. For inter-center validation-procedure, 60 peripheral-blood mononuclear cells (PBMCs) aliquots from 45 HAART-treated patients were randomly chosen for population V3 sequencing on proviral-DNA at local HIV centre and at reference-laboratory. Viral tropism was predicted by Geno2Pheno algorithm (False Positive Rate [FPR] = 20%) as proposed by the European-Guidelines. Quantification of total HIV-1 DNA was based on a method described by Viard (2004). RESULTS Quantification of HIV-1 DNA was available for 35/45 (77.8%) samples, and gave a median value of 598 (IQR:252- 1,203) copies/10 PBMCs. A total of 56/60 (93.3%) samples were successfully amplified by both the reference and the local virological centers. The overall concordance of tropism prediction between local and reference centers was 54/56 (96.4%). Results of tropism prediction by local centers were: 33/54 (61.1%) R5 and 21/54 (38.9%) X4/DM. CONCLUSION There was high concordance in the genotypic tropism prediction based on proviral DNA among different virological centers throughout Italy. Our results are in line with other European studies, and support the use of genotypic tropism testing on proviral DNA in patients with suppressed plasma HIV-1 RNA candidate to CCR5-antagonist treatment.
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Affiliation(s)
- Valentina Svicher
- Department of Experimental Medicine, University of Rome, Roma, Italy
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Ceccarelli L, Calisti G, Delle Rose D, Ricciardi A, Maffongelli G, Sordillo P, Sarmati L, Andreoni M. Dapsone hypersensitivity syndrome complicated by Scedosporium apiospermum pneumonia in an immunocompetent patient. Infection 2011; 40:459-62. [PMID: 22124953 DOI: 10.1007/s15010-011-0225-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 11/10/2011] [Indexed: 10/15/2022]
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Sarmati L, Beltrame A, Dori L, Maffongelli G, Cudillo L, De Angelis G, Picardi A, Ottaviani L, Cefalo MG, Venditti A, Amadori S, Arcese W, Andreoni M. Procalcitonin is a reliable marker of severe systemic infection in neutropenic haematological patients with mucositis. Am J Hematol 2010; 85:380-3. [PMID: 20425801 DOI: 10.1002/ajh.21685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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