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Brusosa M, Ruiz S, Monge I, Solano MT, Rosiñol L, Esteve J, Carreras E, Marcos MÁ, Riu G, Carcelero E, Martinez C, Fernández-Avilés F, Rovira M, Suárez-Lledó M, Salas MQ. Impact of letermovir prophylaxis in CMV reactivation and disease after allogenic hematopoietic cell transplantation: a real-world, observational study. Ann Hematol 2024; 103:609-621. [PMID: 37957371 DOI: 10.1007/s00277-023-05542-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/05/2023] [Indexed: 11/15/2023]
Abstract
Letermovir for CMV prevention in CMV-seropositive adults undergoing allo-HCT was implemented at our program in 2021. This study investigates the results from the use of letermovir. The study includes all the 140 CMV-seropositive patients who underwent an allo-HCT during the years 2020, 2021, and 2022 at our institution. Thirty-eight (27.4%) of these patients received letermovir, administered from day + 7 to day + 100 and restarted if patients were on treatment with steroids. The day + 180 and 1-year cumulative incidences of CMV reactivation were 5.3% and 12.1% for patients who received letermovir and 52.9% and 53.9% for those who did not (P < 0.001) (HR 0.19, P < 0.001). Four (10.5%) of these thirty-eight patients had a CMV reactivation, but only 2 (5.3%) cases occurred during the administration of letermovir. During the first year after allo-HCT, 13 (9.2%) patients had CMV disease; the day + 180 and 1-year cumulative incidences were 2.6% and 6.0% for patients who received letermovir and 9.9% and 12.3% for those who did not (P = 0.254) (HR 1.01, P = 0.458). Two (4.2%) of the patients included in the letermovir group had CMV disease, but both of them after letermovir discontinuation. Letermovir induced a protective effect on CMV reactivation risk, but its use was not associated with a significant reduction of CMV disease. The fact that the CMV disease in patients who received letermovir occurred after the discontinuation of the drug, questions whether CMV prophylaxis should be used in patients with high risk for CMV reactivation or disease.
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Affiliation(s)
| | - Sonia Ruiz
- Pharmacy Clinic Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Inés Monge
- Pharmacy Clinic Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - María Teresa Solano
- Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hematopoietic Transplantation Unit, Hospital Clínic de Barcelona, C/ Villarroel 190, 08036, Barcelona, CP, Spain
| | - Laura Rosiñol
- University of Barcelona, Barcelona, Spain
- Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hematopoietic Transplantation Unit, Hospital Clínic de Barcelona, C/ Villarroel 190, 08036, Barcelona, CP, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Jordi Esteve
- University of Barcelona, Barcelona, Spain
- Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hematopoietic Transplantation Unit, Hospital Clínic de Barcelona, C/ Villarroel 190, 08036, Barcelona, CP, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Enric Carreras
- Fundació I Institut de Recerca Josep Carreras Contra La Leucèmia, Barcelona, Spain
| | - M Ángeles Marcos
- Department of Microbiology, Hospital Clínic-ISGlobal, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Gisela Riu
- Pharmacy Clinic Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Esther Carcelero
- Pharmacy Clinic Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Carmen Martinez
- University of Barcelona, Barcelona, Spain
- Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hematopoietic Transplantation Unit, Hospital Clínic de Barcelona, C/ Villarroel 190, 08036, Barcelona, CP, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Francesc Fernández-Avilés
- University of Barcelona, Barcelona, Spain
- Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hematopoietic Transplantation Unit, Hospital Clínic de Barcelona, C/ Villarroel 190, 08036, Barcelona, CP, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Montserrat Rovira
- University of Barcelona, Barcelona, Spain
- Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hematopoietic Transplantation Unit, Hospital Clínic de Barcelona, C/ Villarroel 190, 08036, Barcelona, CP, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - María Suárez-Lledó
- University of Barcelona, Barcelona, Spain
- Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hematopoietic Transplantation Unit, Hospital Clínic de Barcelona, C/ Villarroel 190, 08036, Barcelona, CP, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - María Queralt Salas
- University of Barcelona, Barcelona, Spain.
- Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hematopoietic Transplantation Unit, Hospital Clínic de Barcelona, C/ Villarroel 190, 08036, Barcelona, CP, Spain.
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
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2
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Herrera S, Aguado JM, Candel FJ, Cordero E, Domínguez-Gil B, Fernández-Ruiz M, Los Arcos I, Len Ò, Marcos MÁ, Muñez E, Muñoz P, Rodríguez-Goncer I, Sánchez-Céspedes J, Valerio M, Bodro M. Executive summary of the consensus statement of the group for the study of infection in transplantation and other immunocompromised host (GESITRA-IC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) on the treatment of SARS-CoV-2 infection in solid organ transplant recipients. Transplant Rev (Orlando) 2023; 37:100788. [PMID: 37591117 DOI: 10.1016/j.trre.2023.100788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/04/2023] [Accepted: 08/06/2023] [Indexed: 08/19/2023]
Affiliation(s)
- Sabina Herrera
- Department of Infectious Diseases, Hospital Clínic, IDIBAPS (Institut D'Investigacions Biomèdiques Agust Pi I Sunyer), Universitat de Barcelona, Barcelona, Spain
| | - Jose M Aguado
- Infectious Diseases Unit, Hospital Universitario 12 de Octubre (Madrid), Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Francisco Javier Candel
- Clinical Microbiology & Infectious Diseases, Transplant Coordination, Hospital Clínico Universitario San Carlos, Madrid 28040, Spain; Department of Clinical Microbiology and Infectious Diseases, Hospital Clínico San Carlos, Madrid, Spain
| | - Elisa Cordero
- Infectious Diseases Unit, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina Sevilla, Sevilla, Spain
| | | | - Mario Fernández-Ruiz
- Infectious Diseases Unit, Hospital Universitario 12 de Octubre (Madrid), Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Ibai Los Arcos
- Infectious Diseases Department, Hospital Universitari Vall D'Hebron, Barcelona, Spain
| | - Òscar Len
- Infectious Diseases Department, Hospital Universitari Vall D'Hebron, Barcelona, Spain
| | | | - Elena Muñez
- Infectious Diseases Unit, Internal Medicine Department, University Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Patricia Muñoz
- Department of Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, 9 Madrid, Spain
| | - Isabel Rodríguez-Goncer
- Infectious Diseases Unit, Hospital Universitario 12 de Octubre (Madrid), Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Javier Sánchez-Céspedes
- Infectious Diseases Unit, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina Sevilla, Sevilla, Spain
| | - Maricela Valerio
- Department of Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, 9 Madrid, Spain
| | - Marta Bodro
- Department of Infectious Diseases, Hospital Clínic, IDIBAPS (Institut D'Investigacions Biomèdiques Agust Pi I Sunyer), Universitat de Barcelona, Barcelona, Spain.
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López-Medrano F, Alfayate S, Carratalà J, Chamorro-Camazón J, Cordero E, Cruz-Cañete M, Fernández-Prada M, García-Cenoz M, Marcos MÁ, Melón S, Moreno-Millán N, Onieva-García MÁ, de Lejarazu RO, Pérez-Martín JJ, Rodríguez-García J, Schwarz-Chavarri G, Tagarro-García A, van Esso-Arbolave D, Viasus D, Pumarola T. Executive summary - Diagnosis, treatment and prophylaxis of influenza virus infection - Consensus statement of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Pediatric Infectious Diseases (SEIP), the Spanish Association of Vaccinology (AEV), the Spanish Society of Family and Community Medicine (SEMFYC) and the Spanish Society of Preventive Medicine, Public Health and Health Management (SEMPSPGS). Aten Primaria 2023; 55:102629. [PMID: 37119776 PMCID: PMC10154965 DOI: 10.1016/j.aprim.2023.102629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 05/01/2023] Open
Abstract
The influenza virus has accompanied humans since time immemorial, in the form of annual epidemics and occasional pandemics. It is a respiratory infection with multiple repercussions on people's lives at an individual and social level, as well as representing a significant burden on the health system. This Consensus Document arises from the collaboration of various Spanish scientific societies involved in influenza virus infection. The conclusions drawn are based on the highest quality evidence available in the scientific literature and, failing that, on the opinion of the experts convened. The Consensus Document addresses the clinical, microbiological, therapeutic, and preventive aspects (with respect to the prevention of transmission and in relation to vaccination) of influenza, for both adult and pediatric populations. This Consensus Document aims to help facilitate the clinical, microbiological, and preventive approach to influenza virus infection and, consequently, to reduce its important consequences on the morbidity and mortality of the population.
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Affiliation(s)
- Francisco López-Medrano
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación del Hospital 12 de Octubre (imas12), School of Medicine, Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain.
| | - Santiago Alfayate
- Department of Pediatrics, Unit of Infectious Diseases, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Institute for Biomedical Research (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
| | - Judith Chamorro-Camazón
- Department of Preventive Medicine and Hospital Hygiene, Complejo Hospitalario Navarra, IdiSNA, Pamplona, Spain
| | - Elisa Cordero
- Department of Medicine, School of Medicine, University of Sevilla, Sevilla, Spain; Infectious Diseases, Microbiology and Preventive Medicine, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville (IBiS), /CSIC/University of Sevilla, Sevilla, Spain; Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Cruz-Cañete
- Department of Pediatrics, Agencia Sanitaria del Alto Guadalquivir, Hospital de Montilla, Córdoba, Spain
| | - María Fernández-Prada
- Department of Preventive Medicine and Public Health, Vital Álvarez Buylla Hospital, Mieres, Asturias, Spain
| | - Manuel García-Cenoz
- Public Health Institute of Navarra, IdiSNA, CIBER de Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain
| | - M Ángeles Marcos
- Department of Microbiology, Hospital Clinic-ISGlobal, University of Barcelona, Barcelona, Spain
| | - Santiago Melón
- Department of Microbiology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Nemesio Moreno-Millán
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Barcelona, Member of Grupo de Enfermedades Infecciosas PAPPS-semFYC, Spain
| | | | - Raúl Ortiz de Lejarazu
- National Influenza Centre (GISRS, WHO), Hospital Clínico Universitario and School of Medicine, University of Valladolid, Spain
| | - Jaime Jesús Pérez-Martín
- Médico Especialista en Medicina Preventiva y Salud Pública, Steering Committee Spanish Vaccinology Association, Spain
| | - Juan Rodríguez-García
- Preventive Medicine Department. University Hospital Son Espases, School of Medicine, Universitat de les Illes Balears, Mallorca, Spain
| | - Germán Schwarz-Chavarri
- San Blas Primary Care Center, Conselleria de Sanitat, Comunidad Valenciana, Member of Grupo de Enfermedades Infecciosas PAPPS-semFYC, Spain
| | - Alfredo Tagarro-García
- Department of Pediatrics, Infanta Sofía University Hospital. Infanta Sofia University Hospital and Henares University Hospital Foundation for Biomedical Research and Innovation (FIIB HUIS HHEN), Madrid, Spain; Fundación de Investigación Biomédica Hospital 12 de Octubre. Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain; RITIP (Translational Research Network in Pediatric Infectious Diseases), Universidad Europea de Madrid, Spain
| | | | - Diego Viasus
- Department of Medicine, Division of Health Sciences, Universidad del Norte, and Hospital Universidad del Norte, Barranquilla, Colombia
| | - Tomàs Pumarola
- Department of Microbiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
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Soldevila N, Basile L, Martínez A, Torner N, Marcos MÁ, Mosquera MM, Antón A, Andrés C, Rius C, Pumarola T, Domínguez Á. Surveillance of influenza B severe hospitalized cases during ten seasons in Catalonia. Does the lineage make a difference? J Med Virol 2022; 94:4417-4424. [PMID: 35593301 DOI: 10.1002/jmv.27876] [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: 03/07/2022] [Revised: 05/07/2022] [Accepted: 05/17/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Influenza B viruses circulates in two lineages (B/Victoria and B/Yamagata). Although classically affecting children, recently it has shown high rate of infection and increased hospitalization in the elderly. OBJECTIVE To describe and analyze the clinical and epidemiological characteristics of severe hospitalized laboratory confirmed influenza B virus (SHLCI-B) cases in Catalonia associated to mismatch from Influenza B virus strain included in the trivalent influenza vaccine (TIV). METHODS SHLCI-B registered by the influenza sentinel surveillance system of Catalonia (PIDIRAC) during ten surveillance seasons from 2010 to 2020. Variables age, comorbidities, vaccination status were recorded. Vaccine effectiveness was estimated as (1-OR) for intensive care unit (ICU) admission. Statistical significance was established at p <0.05. RESULTS A total of 1159 SHLCI-B were registered, of these 68.2% (791) corresponded to the 2017-18 season; 21.8% (253) were admitted to ICU and 13.8% (160) were exitus; 62.5% (725) cases occurred in those aged > 64 years; most frequent risk factor was cardiovascular disease (35.1%, 407) followed by chronic pulmonary obstructive disease-COPD (24.6%, 285) and diabetes (24.1%, 279). In 4 seasons, the predominant circulating lineage was B/Victoria, in 2 seasons the B/Yamagata lineage and 4 seasons had no IBV activity. Four seasons presented discordance with the strain included within the TIV. Vaccine effectiveness (VE) to prevent ICU admission was 31% (95% CI: 4-51%; p=0.03); being 29% (95%CI: -3%, 51%) in discordant and 43% (95% CI:-43%, 77%) in concordant seasons. Significant differences were observed in the number of affected aged > 64 years (OR=2.5; 95% CI: 1.9-3.4; p <0.001) and in patients with heart disease (OR = 2.40 95% CI: 1.7-3.4; p <0.001), COPD (OR = 1.6 95% CI: 1.1-2.3; p = 0.01) and diabetes (OR = 1.5 95% CI: 1.1-2.1; p = 0.04) between discordant and concordant seasons. CONCLUSIONS The increase in hospitalization rate in people> 64 years of age and those presenting comorbidities in seasons with circulating influenza B virus belonging to a lineage discordant with the strain included in the TIV and the decrease of VE to prevent ICU admissions evidences the vital need to administer the quadrivalent influenza vaccine regardless of the findings of predominant circulation in the previous season. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Núria Soldevila
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Luca Basile
- Public Health Agency of Catalonia, Barcelona, Spain
| | - Ana Martínez
- Public Health Agency of Catalonia, Barcelona, Spain.,Ciber Epidemiology and Public Health CIBERESP, Instituto de Salud Carlos III, Madrid
| | - Núria Torner
- Department of Medicine, University of Barcelona, Barcelona, Spain.,Ciber Epidemiology and Public Health CIBERESP, Instituto de Salud Carlos III, Madrid
| | | | - MMar Mosquera
- Department of Microbiology, Hospital Clínic of Barcelona
| | - Andrés Antón
- Respiratory Viruses Unit, Microbiology Department, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid
| | - Cristina Andrés
- Respiratory Viruses Unit, Microbiology Department, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid
| | - Cristina Rius
- Ciber Epidemiology and Public Health CIBERESP, Instituto de Salud Carlos III, Madrid.,Public Health Agency of Barcelona, Barcelona, Spain
| | - Tomàs Pumarola
- Respiratory Viruses Unit, Microbiology Department, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid
| | - Ángela Domínguez
- Department of Medicine, University of Barcelona, Barcelona, Spain.,Ciber Epidemiology and Public Health CIBERESP, Instituto de Salud Carlos III, Madrid
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Montagud-Marrahi E, Cucchiari D, Cuadrado-Payán E, Cofan F, Torregrosa JV, Ventura-Aguiar P, Revuelta I, Bodro M, Piñeiro GJ, Esforzado N, Campistol JM, Oppenheimer F, Marcos MÁ, Bayés B, Moreno A, Diekmann F. SARS-CoV-2 Infection After Full Vaccination in Kidney Transplant Recipients. Transplantation 2021; 105:e278-e279. [PMID: 34406187 PMCID: PMC8612844 DOI: 10.1097/tp.0000000000003927] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Enrique Montagud-Marrahi
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - David Cucchiari
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Elena Cuadrado-Payán
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Frederic Cofan
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Josep-Vicens Torregrosa
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Pedro Ventura-Aguiar
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Ignacio Revuelta
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Marta Bodro
- Department of Infectious Diseases, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Gaston J. Piñeiro
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Nuria Esforzado
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Josep M. Campistol
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Federico Oppenheimer
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M. Ángeles Marcos
- Virology Division, Microbiology Department, Biomedical Diagnosis Center, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Beatriu Bayés
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Asunción Moreno
- Department of Infectious Diseases, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Fritz Diekmann
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Red de Investigación Renal (REDINREN), Madrid, Spain
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6
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Machuca I, Aguado R, Veloza L, Marcos MÁ. Absence of maternal HHV-6-specific T-cell response in the setting of human Herpesvirus-6 chromosomal integration: Potential impact on congenital infection. Enferm Infecc Microbiol Clin 2020; 39:104-106. [PMID: 32439137 DOI: 10.1016/j.eimc.2020.04.003] [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: 01/09/2020] [Revised: 04/06/2020] [Accepted: 04/14/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Isabel Machuca
- Clinical Unit of Infectious Diseases, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofía University Hospital/University of Cordoba, Cordoba, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD12/0015 and RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - Rocío Aguado
- Clinical Unit of Infectious Diseases, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofía University Hospital/University of Cordoba, Cordoba, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD12/0015 and RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Veloza
- Department of Pathology, Clínic Hospital, Barcelona, Spain
| | - M Ángeles Marcos
- Microbiology Unit, Clínic Hospital, University of Barcelona, ISGLOBAL Institute for Global Health, Barcelona, Spain.
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7
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Nicolás D, Suárez A, Ambrosioni J, Manzardo C, Ligero C, Costa J, Fernández E, Marcos MÁ, Plana M, Mosquera MM, Sánchez-Palomino S, Gatell JM, Miró JM. Prevalence, clinical characteristics and outcome of severe primary HIV-1 infection: A prospective cohort study. Int J Infect Dis 2019; 88:73-79. [PMID: 31401201 DOI: 10.1016/j.ijid.2019.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/31/2019] [Accepted: 08/03/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Severe cases of primary HIV infection have been described in patients presenting with neurological involvement, AIDS defining events or other life-threatening events. These severe forms have not been fully studied. OBJECTIVES To determine the prevalence and characteristics of severe PHI in a hospital-based cohort of primary HIV infection, and the response to the early initiation of antiretroviral therapy (ART) at 12 months. METHODS Every patient with PHI attending Hospital Clínic of Barcelona (1997-2015) was evaluated. Severe PHI was defined using clinical, analytical and immunological criteria. Chi-squared test was used for categorical variables and Student's t-test for quantitative variables. RESULTS 33% of 224 PHI patients (95% CI: 26.84%-39.16%) had a severe PHI. These patients had more symptoms, abnormal analytical parameters and hospital admissions. The severe PHI group had a significantly higher viral load although no differences were observed at 12 months in terms of viral suppression or CD4 count recovery. None died during PHI. CONCLUSIONS Up to one third of patients in our cohort presented with a severe PHI, which was associated with higher hospitalization rates and higher plasma HIV RNA viral load. However, severe forms were not associated to a worse clinical, immunological or virological outcome at 12 months.
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Affiliation(s)
- David Nicolás
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Antoni Suárez
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Juan Ambrosioni
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Christian Manzardo
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Carmen Ligero
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Josep Costa
- Microbiology Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Emma Fernández
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - M Ángeles Marcos
- Microbiology Service, Hospital Clinic, University of Barcelona, Institute for Global Health, (ISGlobal), Barcelona, Spain.
| | - Montserrat Plana
- Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, IDIBAPS, Hospital Clínic, University of Barcelona, Spain.
| | - María Mar Mosquera
- Microbiology Service, Hospital Clinic, University of Barcelona, Institute for Global Health, (ISGlobal), Barcelona, Spain.
| | - Sonsoles Sánchez-Palomino
- Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, IDIBAPS, Hospital Clínic, University of Barcelona, Spain.
| | - Jose M Gatell
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - José M Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
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8
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Nicolás D, Ambrosioni J, de Lazzari E, Suarez A, Manzardo C, Agüero F, Mosquera MM, Costa J, Ligero C, Marcos MÁ, Sánchez-Palomino S, Fernández E, Plana M, Yerly S, Gatell JM, Miró JM. Epidemiological changes of acute/recent human immunodeficiency virus type 1 infection in Barcelona, Spain (1997-2015): a prospective cohort study. Clin Microbiol Infect 2018; 25:878-884. [PMID: 30472421 DOI: 10.1016/j.cmi.2018.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 07/17/2018] [Revised: 10/25/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe the epidemiology of acute/recent human immunodeficiency virus (HIV) infection over two decades in Barcelona (Spain). METHODS Prospective, single-centre cohort including all patients with an acute/recent HIV infection (<180 days) since 1997. Patients were stratified into four periods. Phylogenetic analysis was performed to determine clusters of transmission. RESULTS A total of 346 consecutive acute/recently infected patients were included. The annual proportion of recent infections among total new HIV diagnoses increased over time from 1% (29 out of 1964) to 8% (112 out of 1474) (p <0.001). Proportion of men who have sex with men (MSM) in the cohort increased from 62% (18 out of 29) to 89% (100 out of 112) (p <0.001). The proportion of migrants showed a non-significant increasing trend (24% (7 of 29) to 40% (45 of 112)) likewise the non-B subtype (0% to 22% (22 of 112)). The mean time from infection to diagnosis was 53.6 days (interquartile range (IQR) 50-57), comparable among all periods. Mean time from infection to treatment decreased over the years from 575 (IQR 467-683) to 471 (IQR 394-549) days (p <0.001) without significant differences between migrants and non-migrants (133 (IQR 71-411) versus 208 (IQR 90-523) days p 0.089). Almost 50% (152 of 311) of recently infected individuals were included in a cluster of transmission, and 92% (137 of 149) of them were MSM. CONCLUSION The MSM population has progressively grown within acutely/recently infected patients in Barcelona, and is frequently involved in transmission clusters. Although the time between diagnosis and treatment has been reduced, the time between infection and diagnosis still needs to be shortened.
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Affiliation(s)
- D Nicolás
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J Ambrosioni
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - E de Lazzari
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A Suarez
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - C Manzardo
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - F Agüero
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M M Mosquera
- Laboratory of Virology, Microbiology Service, Hospital Clinic Barcelona, CIBERehd, University of Barcelona, Barcelona, Spain
| | - J Costa
- Laboratory of Virology, Microbiology Service, Hospital Clinic Barcelona, CIBERehd, University of Barcelona, Barcelona, Spain
| | - C Ligero
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M Á Marcos
- Laboratory of Virology, Microbiology Service, Hospital Clinic Barcelona, CIBERehd, University of Barcelona, Barcelona, Spain
| | - S Sánchez-Palomino
- Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - E Fernández
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M Plana
- Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - S Yerly
- Laboratory of Virology, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - J M Gatell
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J M Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
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9
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Nicolás D, Ambrosioni J, Sued O, Brunet M, López-Diéguez M, Manzardo C, Agüero F, Tuset M, Plana M, Guardo AC, Mosquera MM, Muñoz-Fernández MÁ, Caballero M, Marcos MÁ, Gatell JM, de Lazzari E, Gallart T, Miró JM. Cyclosporine A in addition to standard ART during primary HIV-1 infection: pilot randomized clinical trial. J Antimicrob Chemother 2017; 72:829-836. [PMID: 27999018 DOI: 10.1093/jac/dkw462] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 10/02/2016] [Indexed: 11/12/2022] Open
Abstract
Background Initiating ART during acute/recent HIV-1 infection reduces viral reservoir formation. It has been proposed that, during this phase, the size of the viral reservoir could be further reduced by the association of immunomodulatory therapy with ART. Contradictory results have emerged, however, from two trials evaluating the impact on immune recovery and the viral reservoir of adding cyclosporine A to ART during primary HIV-1 infection. Patients and methods Twenty patients with acute/recent HIV-1 infection were randomized to receive ART alone (tenofovir, emtricitabine and lopinavir/ritonavir) or associated with 8 weeks of cyclosporine A (0.3-0.6 mg/kg twice daily). The impact on viral load, immune response and integrated and non-integrated DNA viral reservoir at 0, 8 and 36 weeks of treatment was evaluated. Results The estimated median time from HIV-1 infection to ART onset was 63 days (IQR 53; 79.5) with 90% of patients at Fiebig V stage. No significant differences were observed in viral load decay, CD4 T cell recovery, immune response markers or the evolution of integrated DNA at week 8 (end of cyclosporine A) and week 36 between groups. However, non-integrated DNA significantly increased in the cyclosporine A arm between weeks 0 and 36. Cyclosporine A was well tolerated. Conclusions Adding cyclosporine A to ART during acute/recent infection did not improve immune recovery. However, unintegrated DNA increased in the cyclosporine A group, suggesting an anti-integration effect, a point warranting further research (ClinicalTrials.gov Identifier: NCT00979706).
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Affiliation(s)
- David Nicolás
- Infectious Diseases Service, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Juan Ambrosioni
- Infectious Diseases Service, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Omar Sued
- Infectious Diseases Service, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Mercé Brunet
- Pharmacology and Toxicology Department, Biomedical Diagnostic Center, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - María López-Diéguez
- Infectious Diseases Service, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Christian Manzardo
- Infectious Diseases Service, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Fernando Agüero
- Infectious Diseases Service, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Montserrat Tuset
- Pharmacy Department, Hospital Clinic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Montserrat Plana
- Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Alberto C Guardo
- Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - María Mar Mosquera
- Department of Clinical Microbiology, Hospital Clínic, Barcelona, Spain/ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - M Ángeles Muñoz-Fernández
- Laboratorio InmunoBiología Molecular, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Spanish HIV-HGM Biobank, Networking Research Center on Bioengineering, Biomaterials & Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Miguel Caballero
- Otorhinolaryngology Department, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - M Ángeles Marcos
- Department of Clinical Microbiology, Hospital Clínic, Barcelona, Spain/ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - José M Gatell
- Infectious Diseases Service, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Elisa de Lazzari
- Fundació Clinic per a la Recerca Biomèdica, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Teresa Gallart
- Immunology Department, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - José M Miró
- Infectious Diseases Service, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Balcells C, Botet F, Gayete S, Marcos MÁ, Dorronsoro I, de Alba C, Figueras-Aloy J. Vertically transmitted cytomegalovirus infection in newborn preterm infants. J Perinat Med 2016; 44:485-90. [PMID: 26845714 DOI: 10.1515/jpm-2015-0325] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 01/06/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the epidemiology of congenital and acquired cytomegalovirus (CMV) infections in preterm infants and to analyze the efficacy of breast milk freezing in decreasing the vertical transmission rate of CMV. STUDY DESIGN During 2013 and 2014, preterm newborns who weighed ≤1500 g and were admitted to 22 Spanish neonatal units were included and screened for CMV infection according to the Spanish Neonatology Society recommendations. Each hospital treated the breast milk according to its own protocols. RESULTS Among the 1236 preterm neonates included, 10 had a congenital infection (0.8%) and 49 had an acquired infection (4.0%) (82% demonstrated positive PCR-CMV in breast milk). The neonates who received only frozen milk presented less frequently with acquired infection (1.2%) than those fed fresh milk (5.5%) (RR=0.22; 95% CI 0.05-0.90; P=0.017). The newborns who received bank milk followed by frozen or fresh breast milk more frequently had an acquired infection (2.1% or 2.2%, respectively) than those fed only frozen breast milk. CONCLUSIONS The incidence of congenital CMV infection in our sample is low, as described in the literature. To reduce acquired CMV infection, freezing breast milk might be an advisable procedure for preterm neonates born from seropositive mothers, either from the beginning of lactation or after a period of bank milk administration.
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Nicolás D, Ambrosioni J, Paredes R, Marcos MÁ, Manzardo C, Moreno A, Miró JM. Infection with human retroviruses other than HIV-1: HIV-2, HTLV-1, HTLV-2, HTLV-3 and HTLV-4. Expert Rev Anti Infect Ther 2015; 13:947-63. [PMID: 26112187 DOI: 10.1586/14787210.2015.1056157] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
HIV-1 is the most prevalent retrovirus, with over 30 million people infected worldwide. Nevertheless, infection caused by other human retroviruses like HIV-2, HTLV-1, HTLV-2, HTLV-3 and HTLV-4 is gaining importance. Initially confined to specific geographical areas, HIV-2, HTLV-1 and HTLV-2 are becoming a major concern in non-endemic countries due to international migration flows. Clinical manifestations of retroviruses range from asymptomatic carriers to life-threatening conditions, such as AIDS in HIV-2 infection or adult T-cell lymphoma/leukemia or tropical spastic paraparesis in HTLV-1 infection. HIV-2 is naturally resistant to some antiretrovirals frequently used to treat HIV-1 infection, but it does have effective antiretroviral therapy options. Unfortunately, HTLV still has limited therapeutic options. In this article, we will review the epidemiological, clinical, diagnostic, pathogenic and therapeutic aspects of infections caused by these human retroviruses.
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Affiliation(s)
- David Nicolás
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
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12
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López-Medrano F, Cordero E, Gavaldá J, Cruzado JM, Marcos MÁ, Pérez-Romero P, Sabé N, Gómez-Bravo MÁ, Delgado JF, Cabral E, Carratalá J. Executive summary. Management of influenza infection in solid-organ transplant recipients: consensus statement of the Group for the Study of Infection in Transplant Recipients (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Network for Research in Infectious Diseases (REIPI). Enferm Infecc Microbiol Clin 2013; 31:528-34. [PMID: 23528340 DOI: 10.1016/j.eimc.2013.01.014] [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: 01/23/2013] [Accepted: 01/25/2013] [Indexed: 10/27/2022]
Abstract
Solid organ transplant (SOT) recipients are at greater risk than the general population for complications and mortality from influenza infection. We have conducted a systematic review to assess the management and prevention of influenza infection in SOT recipients. Recommendations are provided about the procurement of organs from donors with influenza infection. We highlight the importance of the possibility of influenza infection in any SOT recipient presenting upper or lower respiratory symptoms, including pneumonia. The importance of early antiviral treatment of SOT recipients with suspected or confirmed influenza infection and the necessity of annual influenza vaccination are emphasized. The microbiological techniques for diagnosis of influenza infection are reviewed. Guidelines for the use of antiviral prophylaxis are provided. Recommendations for household contacts of SOT recipients with influenza infection and health care workers are also included. Antiviral dose adjustment guidelines are presented for cases of impaired renal function and for pediatric populations.
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Affiliation(s)
- Francisco López-Medrano
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica 12 de Octubre (i+12), Departamento de Medicina, Universidad Complutense, Madrid, Spain.
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13
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López-Medrano F, Cordero E, Gavaldá J, Cruzado JM, Marcos MÁ, Pérez-Romero P, Sabé N, Gómez-Bravo MÁ, Delgado JF, Cabral E, Carratalá J. Management of influenza infection in solid-organ transplant recipients: consensus statement of the Group for the Study of Infection in Transplant Recipients (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Network for Research in Infectious Diseases (REIPI). Enferm Infecc Microbiol Clin 2013; 31:526.e1-526.e20. [PMID: 23528341 DOI: 10.1016/j.eimc.2013.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 01/23/2013] [Accepted: 01/25/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Solid organ transplant (SOT) recipients are at greater risk than the general population for complications and mortality from influenza infection. METHODS Researchers and clinicians with experience in SOT infections have developed this consensus document in collaboration with several Spanish scientific societies and study networks related to transplant management. We conducted a systematic review to assess the management and prevention of influenza infection in SOT recipients. Evidence levels based on the available literature are given for each recommendation. This article was written in accordance with international recommendations on consensus statements and the recommendations of the Appraisal of Guidelines for Research and Evaluation II (AGREE II). RESULTS Recommendations are provided on the procurement of organs from donors with suspected or confirmed influenza infection. We highlight the importance of the possibility of influenza infection in any SOT recipient presenting upper or lower respiratory symptoms, including pneumonia. The importance of early antiviral treatment of SOT recipients with suspected or confirmed influenza infection and the necessity of annual influenza vaccination are emphasized. The microbiological techniques for diagnosis of influenza infection are reviewed. Guidelines for the use of antiviral prophylaxis in inpatients and outpatients are provided. Recommendations for household contacts of SOT recipients with influenza infection and health care workers in close contact with transplant patients are also included. Finally antiviral dose adjustment guidelines are presented for cases of impaired renal function and for pediatric populations. CONCLUSIONS The latest scientific information available regarding influenza infection in the context of SOT is incorporated into this document.
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Affiliation(s)
- Francisco López-Medrano
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica 12 de Octubre (i+12), Departamento de Medicina, Universidad Complutense, Madrid, Spain.
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de Ory F, Avellón A, Echevarría JE, Sánchez-Seco MP, Trallero G, Cabrerizo M, Casas I, Pozo F, Fedele G, Vicente D, Pena MJ, Moreno A, Niubo J, Rabella N, Rubio G, Pérez-Ruiz M, Rodríguez-Iglesias M, Gimeno C, Eiros JM, Melón S, Blasco M, López-Miragaya I, Varela E, Martinez-Sapiña A, Rodríguez G, Marcos MÁ, Gegúndez MI, Cilla G, Gabilondo I, Navarro JM, Torres J, Aznar C, Castellanos A, Guisasola ME, Negredo AI, Tenorio A, Vázquez-Morón S. Viral infections of the central nervous system in Spain: a prospective study. J Med Virol 2012; 85:554-62. [PMID: 23239485 DOI: 10.1002/jmv.23470] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2012] [Indexed: 11/10/2022]
Abstract
The aim of the study was to determine the incidence of viruses causing aseptic meningitis, meningoencephalitis, and encephalitis in Spain. This was a prospective study, in collaboration with 17 Spanish hospitals, including 581 cases (CSF from all and sera from 280): meningitis (340), meningoencephalitis (91), encephalitis (76), febrile syndrome (7), other neurological disorders (32), and 35 cases without clinical information. CSF were assayed by PCR for enterovirus (EV), herpesvirus (herpes simplex [HSV], varicella-zoster [VZV], cytomegalovirus [CMV], Epstein-Barr [EBV], and human herpes virus-6 [HHV-6]), mumps (MV), Toscana virus (TOSV), adenovirus (HAdV), lymphocytic choriomeningitis virus (LCMV), West Nile virus (WNV), and rabies. Serology was undertaken when methodology was available. Amongst meningitis cases, 57.1% were characterized; EV was the most frequent (76.8%), followed by VZV (10.3%) and HSV (3.1%; HSV-1: 1.6%; HSV-2: 1.0%, HSV non-typed: 0.5%). Cases due to CMV, EBV, HHV-6, MV, TOSV, HAdV, and LCMV were also detected. For meningoencephalitis, 40.7% of cases were diagnosed, HSV-1 (43.2%) and VZV (27.0%) being the most frequent agents, while cases associated with HSV-2, EV, CMV, MV, and LCMV were also detected. For encephalitis, 27.6% of cases were caused by HSV-1 (71.4%), VZV (19.1%), or EV (9.5%). Other positive neurological syndromes included cerebellitis (EV and HAdV), seizures (HSV), demyelinating disease (HSV-1 and HHV-6), myelopathy (VZV), and polyradiculoneuritis (HSV). No rabies or WNV cases were identified. EVs are the most frequent cause of meningitis, as is HSV for meningoencephalitis and encephalitis. A significant number of cases (42.9% meningitis, 59.3% meningoencephalitis, 72.4% encephalitis) still have no etiological diagnosis.
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Affiliation(s)
- F de Ory
- National Centre for Microbiology, Majadahonda, Spain.
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15
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Cervera C, Fernández-Ruiz M, Valledor A, Linares L, Antón A, Ángeles Marcos M, Sanclemente G, Hoyo I, Cofán F, Ricart MJ, Pérez-Villa F, Navasa M, Pumarola T, Moreno A. Epidemiology and risk factors for late infection in solid organ transplant recipients. Transpl Infect Dis 2011; 13:598-607. [PMID: 21535336 DOI: 10.1111/j.1399-3062.2011.00646.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Information concerning the risk factors and outcome of late infection (LI) after solid organ transplantation (SOT) still remains scarce. METHODS We prospectively analyzed all patients undergoing SOT from July 2003 to March 2008, who survived the first 6 months after surgery and with a minimum 1-year follow-up. Risk factors associated with the development of bacterial and cytomegalovirus (CMV) LI and survival were identified. RESULTS Overall, 942 SOT recipients (491 kidney, 280 liver, 65 heart, and 106 double transplants) were included. During the study period 147 patients (15.6%) developed 276 episodes of LI (incidence rate, 0.43 per 1000 transplantation-days). Bacteria were the most prevalent etiology (88.0%). Primary sources of infection included urinary tract (36.9%), intra-abdominal (16.7%), and sepsis without source (13.4%). Independent risk factors for late bacterial infection were: age (hazard ratio [HR] [per year] 1.0; 95% confidence interval [CI]: 1.0-1,0), female gender (HR 1.7; 95%CI: 1.1-2.6), anti-hepatitis C virus (HCV) positive serostatus (HR 1.8; 95%CI: 1.1-3.0), chronic allograft dysfunction (HR 3.2; 95%CI: 1.7-6.1), early CMV disease (HR 2.2; 95%CI 1.2-4.1), and early bacterial infection (HR 2.5; 95%CI 1.6-3.8). The occurrence of chronic allograft dysfunction was an independent risk factor for late CMV disease (HR 6.5; 95%CI: 1.7-24.6), whereas immunosuppression based on mammalian target of rapamycin inhibitors protected against the development of late CMV disease (HR 0.3; 95%CI: 0.1-1.0). Cox model selected anti-HCV positive serostatus (adjusted HR [aHR] 2.67; 95%CI: 1.27-5.59), age (aHR [per year] 1.06; 95%CI: 1.02-1.10), and the occurrence of LI (aHR 9.12; 95%CI: 3.90-21.33) as independent factors for mortality. CONCLUSIONS LI did not constitute an uncommon complication in our cohort, and patients at risk may benefit from close clinical monitoring.
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Affiliation(s)
- C Cervera
- Department of Infectious Diseases-CIBERHED, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
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