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Demolder S, Schaevers V, Lagrou K, De Munter P, Beeckmans H, Verleden GM, Godinas L, Dupont LJ, Van Bleyenbergh P, Lorent N, Vos R. COVID-19 Outcomes in Lung Transplant Recipients Following Pre-Exposure Prophylaxis With Tixagevimab-Cilgavimab During the Omicron BA.5 Surge: A Single Center Analysis. Transpl Int 2024; 37:12061. [PMID: 38328617 PMCID: PMC10847296 DOI: 10.3389/ti.2024.12061] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 01/09/2024] [Indexed: 02/09/2024]
Abstract
Lung transplant (LTx) recipients are at high risk for COVID-19 related morbidity and mortality. Data regarding pre-exposure prophylaxis (PrEP) with tixagevimab-cilgavimab in this population are scarce. We therefore evaluated COVID-19 breakthrough infections and COVID-19 related complications after PrEP in a retrospective single-center study, including 264 LTx recipients who received PrEP between June 2022 and December 2022, when Omicron BA.5 was the dominant circulating SARS-CoV-2 variant. PrEP was indicated for fully vaccinated patients with poor seroconversion (anti-S <260 BAU/mL). COVID-19 breakthrough infection after PrEP occurred in 11.0% within the first 3 months, increasing to 17.4% within 6 months. Hospitalization rate rose from 27.6% to 52.9% (p = 0.046), while ICU admissions and COVID-19 mortality remained low, respectively occurring in 6.5% and 4.3% of patients with breakthrough infection within 6 months. COVID-19 breakthrough infection and associated hospitalization remained an important problem during the Omicron BA.5 surge in fully vaccinated LTx recipients with deficient seroconversion, despite PrEP with tixagevimab-cilgavimab. However, ICU admissions and COVID-19 mortality were low. Waning of neutralizing effects of PrEP and changing circulating SARS-CoV-2 variants may explain increases in COVID-19 infections and hospitalizations over time after PrEP, highlighting the need for novel, long-term effective PrEP strategies in these high-risk patients.
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Affiliation(s)
- Saartje Demolder
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | | | - Katrien Lagrou
- Department of Laboratory Medicine and National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Paul De Munter
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Hanne Beeckmans
- Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Geert M. Verleden
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Laurent Godinas
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Lieven J. Dupont
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | | | - Natalie Lorent
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Robin Vos
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
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Ruythooren F, Ghijselings S, Cools J, Depypere M, De Munter P, Metsemakers WJ, Vles G. Should treatment decisions in septic arthritis of the native hip joint be based on the route of infection? J Bone Jt Infect 2023; 8:209-218. [PMID: 38039332 PMCID: PMC10655073 DOI: 10.5194/jbji-8-209-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 08/21/2023] [Indexed: 12/03/2023] Open
Abstract
Background: Surgical management of septic arthritis (SA) of the hip aims at treating the infection by either preserving, resecting or replacing the joint. In some cases, joint preservation should be attempted, whereas other cases would benefit from immediate joint resection or replacement. Prognostic factors have been proposed to guide decision-making. We hypothesized that most of these factors can be simplified to three subgroups based on the route of infection: contiguous spreading, direct inoculation or hematogenous seeding. Methods: A total of 41 patients have been treated surgically for SA of the native hip at our tertiary hospital during the last 16 years. Medical records were studied, and various patient and disease characteristics were collated. Results: Significant differences between (1) level of fitness, (2) condition of the hip joint, (3) micro-organisms and (4) chance of femoral head preservation were found for patients with SA of the native hip resulting from the three aforementioned subgroups. Femoral head resection was necessary at one point in 85 % of patients. Patients with hematogenous infections of undamaged hips had a reasonable chance (53 %) of avoiding joint resection or replacement. Hip arthroplasty was performed on 46.3 % of patients, with an infection rate of 10.5 %. Conclusion: Patients with SA of the native hip resulting from contiguous spreading, hematogenous seeding or direct inoculation differ significantly and should be considered distinct clinical entities. Route of infection is directly related to the chance of femoral head preservation and should, therefore, guide decision-making. Only patients with hematogenous infection to a previously healthy hip had the possibility of femoral head preservation.
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Affiliation(s)
- Fred Ruythooren
- Department of Orthopaedic Surgery, University Hospitals Leuven - Gasthuisberg, Leuven, Belgium
- Institute for Orthopaedic Research and Training (IORT), Catholic University Leuven, Leuven, Belgium
| | - Stijn Ghijselings
- Department of Orthopaedic Surgery, University Hospitals Leuven - Gasthuisberg, Leuven, Belgium
- Institute for Orthopaedic Research and Training (IORT), Catholic University Leuven, Leuven, Belgium
| | - Jordi Cools
- Department of Orthopaedic Surgery, University Hospitals Leuven - Gasthuisberg, Leuven, Belgium
- Institute for Orthopaedic Research and Training (IORT), Catholic University Leuven, Leuven, Belgium
| | - Melissa Depypere
- Department of Laboratory Medicine, University Hospitals Leuven - Gasthuisberg, Leuven, Belgium
| | - Paul De Munter
- Department of General Internal Medicine, University Hospitals Leuven - Gasthuisberg, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Laboratory for Clinical Infectious and Inflammatory Disorders, KU Leuven, Leuven, Belgium
| | - Willem-Jan Metsemakers
- Department of Traumatology, University Hospitals Leuven - Gasthuisberg, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - George Vles
- Department of Orthopaedic Surgery, University Hospitals Leuven - Gasthuisberg, Leuven, Belgium
- Institute for Orthopaedic Research and Training (IORT), Catholic University Leuven, Leuven, Belgium
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Van Praet JT, Serrien B, Ausselet N, Darcis G, Demeester R, De Munter P, De Scheerder MA, Goffard JC, Libois A, Messiaen P, Yombi JC, Van Beckhoven D. Dynamics of Weight Change After Initiation of Contemporaneous Antiretroviral Therapy in Treatment-Naive HIV-1 Infected Patients: Results From the Belgian HIV Cohort 2015-2021. J Acquir Immune Defic Syndr 2023; 93:e4-e5. [PMID: 36787727 DOI: 10.1097/qai.0000000000003175] [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] [Indexed: 02/16/2023]
Affiliation(s)
- Jens T Van Praet
- Department of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ben Serrien
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | | | - Gilles Darcis
- Department of Infectious Diseases and General Internal Medicine, University Hospital of Liège, Liège, Belgium
| | - Rémy Demeester
- HIV Reference Centre, University Hospital of Charleroi, Lodelinsart, Belgium
| | - Paul De Munter
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of General Internal Medicine, UZ Leuven, Leuven, Belgium
| | | | - Jean-Christophe Goffard
- HIV Reference Centre, Internal Medicine, Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Agnès Libois
- Department of Infectious Diseases, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Peter Messiaen
- Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Jean Cyr Yombi
- Department of Internal Medicine and Infectious Disease, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Breukers J, Ven K, Struyfs C, Ampofo L, Rutten I, Imbrechts M, Pollet F, Van Lent J, Kerstens W, Noppen S, Schols D, De Munter P, Thibaut HJ, Vanhoorelbeke K, Spasic D, Declerck P, Cammue BPA, Geukens N, Thevissen K, Lammertyn J. FLUIDOT: A Modular Microfluidic Platform for Single-Cell Study and Retrieval, with Applications in Drug Tolerance Screening and Antibody Mining. Small Methods 2023; 7:e2201477. [PMID: 36642827 DOI: 10.1002/smtd.202201477] [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] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/21/2022] [Indexed: 06/17/2023]
Abstract
Advancements in lab-on-a-chip technologies have revolutionized the single-cell analysis field. However, an accessible platform for in-depth screening and specific retrieval of single cells, which moreover enables studying diverse cell types and performing various downstream analyses, is still lacking. As a solution, FLUIDOT is introduced, a versatile microfluidic platform incorporating customizable microwells, optical tweezers and an interchangeable cell-retrieval system. Thanks to its smart microfluidic design, FLUIDOT is straightforward to fabricate and operate, rendering the technology widely accessible. The performance of FLUIDOT is validated and its versatility is subsequently demonstrated in two applications. First, drug tolerance in yeast cells is studied, resulting in the discovery of two treatment-tolerant populations. Second, B cells from convalescent COVID-19 patients are screened, leading to the discovery of highly affine, in vitro neutralizing monoclonal antibodies against SARS-CoV-2. Owing to its performance, flexibility, and accessibility, it is foreseen that FLUIDOT will enable phenotypic and genotypic analysis of diverse cell samples and thus elucidate unexplored biological questions.
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Affiliation(s)
- Jolien Breukers
- Department of Biosystems, Biosensors group, KU Leuven, Willem de Croylaan 42, Leuven, 3001, Belgium
- LISCO, KU Leuven Institute for Single Cell Omics, ON4 Herestraat 49, Leuven, 3000, Belgium
| | - Karen Ven
- Department of Biosystems, Biosensors group, KU Leuven, Willem de Croylaan 42, Leuven, 3001, Belgium
- LISCO, KU Leuven Institute for Single Cell Omics, ON4 Herestraat 49, Leuven, 3000, Belgium
- MabMine: KU Leuven Single B Cell Mining Platform, KU Leuven, ON2 Herestraat 49, 3000, Leuven, Belgium
| | - Caroline Struyfs
- Centre of Microbial and Plant Genetics, KU Leuven, Kasteelpark Arenberg 20, Leuven, 3001, Belgium
| | - Louanne Ampofo
- Department of Biosystems, Biosensors group, KU Leuven, Willem de Croylaan 42, Leuven, 3001, Belgium
- MabMine: KU Leuven Single B Cell Mining Platform, KU Leuven, ON2 Herestraat 49, 3000, Leuven, Belgium
- PharmAbs, The KU Leuven Antibody Center, KU Leuven, ON 2 Herestraat 49, Leuven, 3000, Belgium
- Laboratory for Therapeutic and Diagnostic Antibodies, KU Leuven, ON2 Herestraat 49, Leuven, 3000, Belgium
| | - Iene Rutten
- Department of Biosystems, Biosensors group, KU Leuven, Willem de Croylaan 42, Leuven, 3001, Belgium
- LISCO, KU Leuven Institute for Single Cell Omics, ON4 Herestraat 49, Leuven, 3000, Belgium
| | - Maya Imbrechts
- MabMine: KU Leuven Single B Cell Mining Platform, KU Leuven, ON2 Herestraat 49, 3000, Leuven, Belgium
- PharmAbs, The KU Leuven Antibody Center, KU Leuven, ON 2 Herestraat 49, Leuven, 3000, Belgium
- Laboratory for Therapeutic and Diagnostic Antibodies, KU Leuven, ON2 Herestraat 49, Leuven, 3000, Belgium
| | - Francesca Pollet
- Department of Biosystems, Biosensors group, KU Leuven, Willem de Croylaan 42, Leuven, 3001, Belgium
| | - Julie Van Lent
- Department of Biosystems, Biosensors group, KU Leuven, Willem de Croylaan 42, Leuven, 3001, Belgium
| | - Winnie Kerstens
- Translational Platform Virology and Chemotherapy, Rega Institute, KU Leuven, Rega - Herestraat 49, Leuven, 3000, Belgium
| | - Sam Noppen
- Laboratory of Virology and Chemotherapy, Rega Institute, KU Leuven, Rega - Herestraat 49, Leuven, 3000, Belgium
| | - Dominique Schols
- Laboratory of Virology and Chemotherapy, Rega Institute, KU Leuven, Rega - Herestraat 49, Leuven, 3000, Belgium
| | - Paul De Munter
- Department of Internal Medicine, University Hospitals Leuven, UZ Herestraat 49, Leuven, 3000, Belgium
- Laboratory for Clinical Infectious and Inflammatory Disorders, KU Leuven, UZ Herestraat 49, Leuven, 3000, Belgium
| | - Hendrik Jan Thibaut
- Translational Platform Virology and Chemotherapy, Rega Institute, KU Leuven, Rega - Herestraat 49, Leuven, 3000, Belgium
| | - Karen Vanhoorelbeke
- MabMine: KU Leuven Single B Cell Mining Platform, KU Leuven, ON2 Herestraat 49, 3000, Leuven, Belgium
- PharmAbs, The KU Leuven Antibody Center, KU Leuven, ON 2 Herestraat 49, Leuven, 3000, Belgium
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Etienne Sabbelaan 53, Kortrijk, 8500, Belgium
| | - Dragana Spasic
- Department of Biosystems, Biosensors group, KU Leuven, Willem de Croylaan 42, Leuven, 3001, Belgium
| | - Paul Declerck
- MabMine: KU Leuven Single B Cell Mining Platform, KU Leuven, ON2 Herestraat 49, 3000, Leuven, Belgium
- PharmAbs, The KU Leuven Antibody Center, KU Leuven, ON 2 Herestraat 49, Leuven, 3000, Belgium
- Laboratory for Therapeutic and Diagnostic Antibodies, KU Leuven, ON2 Herestraat 49, Leuven, 3000, Belgium
| | - Bruno P A Cammue
- Centre of Microbial and Plant Genetics, KU Leuven, Kasteelpark Arenberg 20, Leuven, 3001, Belgium
| | - Nick Geukens
- MabMine: KU Leuven Single B Cell Mining Platform, KU Leuven, ON2 Herestraat 49, 3000, Leuven, Belgium
- PharmAbs, The KU Leuven Antibody Center, KU Leuven, ON 2 Herestraat 49, Leuven, 3000, Belgium
- Laboratory for Therapeutic and Diagnostic Antibodies, KU Leuven, ON2 Herestraat 49, Leuven, 3000, Belgium
| | - Karin Thevissen
- Centre of Microbial and Plant Genetics, KU Leuven, Kasteelpark Arenberg 20, Leuven, 3001, Belgium
| | - Jeroen Lammertyn
- Department of Biosystems, Biosensors group, KU Leuven, Willem de Croylaan 42, Leuven, 3001, Belgium
- LISCO, KU Leuven Institute for Single Cell Omics, ON4 Herestraat 49, Leuven, 3000, Belgium
- MabMine: KU Leuven Single B Cell Mining Platform, KU Leuven, ON2 Herestraat 49, 3000, Leuven, Belgium
- LIMNI, KU Leuven Institute for Micro- and Nanoscale Integration, Celestijnenlaan 200F, Leuven, 3001, Belgium
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5
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Janssens E, Flamaing J, Vandermeulen C, Peetermans WE, Desmet S, De Munter P. The 20-valent pneumococcal conjugate vaccine (PCV20): expected added value. Acta Clin Belg 2023; 78:78-86. [PMID: 35171752 DOI: 10.1080/17843286.2022.2039865] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Currently existing pneumococcal vaccines have contributed to a major reduction in pneumococcal disease. However, there remains an unmet need for vaccine coverage of serotypes not included in PCV13 to further reduce the burden of disease. The objective of this review is to assess the potential impact of implementation of the investigational 20-valent pneumococcal conjugate vaccine (PCV20) in the childhood and adult immunization programme in Belgium and Europe. METHODS A literature search was conducted to identify publications and surveillance reports concerning the effectiveness and safety of pneumococcal vaccines, epidemiological data on pneumococcal disease or serotype distribution dynamics after introduction of systematic vaccination. RESULTS Serotypes included in PCV20 currently account for the majority of pneumococcal disease in Belgium and Europe. In Belgium, PCV20-serotypes accounted for 71.4% of invasive pneumococcal disease (IPD) cases across all age groups in 2019, of which 39.2% were caused by PCV20-non-PCV13-serotypes. In Europe, these seven serotypes accounted for 37,6% of IPD cases in 2018. PCV20 has proven to be well tolerated in vaccine-naïve adults and elicits a substantial immune response against all serotypes included. CONCLUSION Due to serotype replacement following the introduction of PCV7 and PCV13, a considerable proportion of pneumococcal disease is currently caused by PCV20-serotypes. PCV20 has the potential of preventing more pneumococcal disease in children and the adult population at risk than the existing conjugate vaccines. The available evidence on safety and immunogenicity of PCV20 is promising, but further research is needed to provide data about vaccine effectiveness, immune response duration and replacement phenomenon after introduction of PCV20.
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Affiliation(s)
- Esther Janssens
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Johan Flamaing
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Public Health & Primary Care, KU Leuven, Leuven, Belgium
| | - Corinne Vandermeulen
- Department of Public Health & Primary Care, KU Leuven, Leuven, Belgium.,Leuven University Vaccinology Centre, Leuven, Belgium
| | - Willy E Peetermans
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Stefanie Desmet
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,National Reference Centre for Streptococcus Pneumoniae, University Hospitals Leuven, Leuven, Belgium
| | - Paul De Munter
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium
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6
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Khan M, Clijsters M, Choi S, Backaert W, Claerhout M, Couvreur F, Van Breda L, Bourgeois F, Speleman K, Klein S, Van Laethem J, Verstappen G, Dereli AS, Yoo SJ, Zhou H, Dan Do TN, Jochmans D, Laenen L, Debaveye Y, De Munter P, Gunst J, Jorissen M, Lagrou K, Meersseman P, Neyts J, Thal DR, Topsakal V, Vandenbriele C, Wauters J, Mombaerts P, Van Gerven L. Anatomical barriers against SARS-CoV-2 neuroinvasion at vulnerable interfaces visualized in deceased COVID-19 patients. Neuron 2022; 110:3919-3935.e6. [PMID: 36446381 PMCID: PMC9647025 DOI: 10.1016/j.neuron.2022.11.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/26/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022]
Abstract
Can SARS-CoV-2 hitchhike on the olfactory projection and take a direct and short route from the nose into the brain? We reasoned that the neurotropic or neuroinvasive capacity of the virus, if it exists, should be most easily detectable in individuals who died in an acute phase of the infection. Here, we applied a postmortem bedside surgical procedure for the rapid procurement of tissue, blood, and cerebrospinal fluid samples from deceased COVID-19 patients infected with the Delta, Omicron BA.1, or Omicron BA.2 variants. Confocal imaging of sections stained with fluorescence RNAscope and immunohistochemistry afforded the light-microscopic visualization of extracellular SARS-CoV-2 virions in tissues. We failed to find evidence for viral invasion of the parenchyma of the olfactory bulb and the frontal lobe of the brain. Instead, we identified anatomical barriers at vulnerable interfaces, exemplified by perineurial olfactory nerve fibroblasts enwrapping olfactory axon fascicles in the lamina propria of the olfactory mucosa.
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Affiliation(s)
- Mona Khan
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany
| | - Marnick Clijsters
- Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, KU Leuven, Leuven, Belgium
| | - Sumin Choi
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany
| | - Wout Backaert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium
| | - Michiel Claerhout
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Floor Couvreur
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Laure Van Breda
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Florence Bourgeois
- Department of Otorhinolaryngology, Head and Neck Surgery, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Kato Speleman
- Department of Otorhinolaryngology, Head and Neck Surgery, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Sam Klein
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Johan Van Laethem
- Department of Infectious Diseases, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gill Verstappen
- Department of Otorhinolaryngology - Head and Neck Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Seung-Jun Yoo
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany; Department of Life Science, College of Natural Sciences, Hanyang University, Seoul, Republic of Korea
| | - Hai Zhou
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany
| | - Thuc Nguyen Dan Do
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, KU Leuven, Leuven, Belgium
| | - Dirk Jochmans
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, KU Leuven, Leuven, Belgium
| | - Lies Laenen
- Department of Laboratory Medicine & National Reference Center for Respiratory Pathogens, University Hospitals Leuven, Leuven, Belgium
| | - Yves Debaveye
- Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, KU Leuven, Leuven, Belgium
| | - Paul De Munter
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Laboratory for Clinical Infectious and Inflammatory Disorders, KU Leuven, Leuven, Belgium
| | - Jan Gunst
- Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, KU Leuven, Leuven, Belgium
| | - Mark Jorissen
- Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, KU Leuven, Leuven, Belgium; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Katrien Lagrou
- Department of Laboratory Medicine & National Reference Center for Respiratory Pathogens, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Bacteriology and Mycology, KU Leuven, Leuven, Belgium
| | - Philippe Meersseman
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Laboratory for Clinical Infectious and Inflammatory Disorders, KU Leuven, Leuven, Belgium
| | - Johan Neyts
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, KU Leuven, Leuven, Belgium
| | - Dietmar Rudolf Thal
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Neuropathology, Department of Imaging & Pathology and Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Vedat Topsakal
- Department of Otorhinolaryngology - Head and Neck Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Christophe Vandenbriele
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Joost Wauters
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Laboratory for Clinical Infectious and Inflammatory Disorders, KU Leuven, Leuven, Belgium
| | - Peter Mombaerts
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany.
| | - Laura Van Gerven
- Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, KU Leuven, Leuven, Belgium; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium.
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Imbrechts M, Maes W, Ampofo L, Van den Berghe N, Calcoen B, Van Looveren D, Kerstens W, Rasulova M, Vercruysse T, Noppen S, Abdelnabi R, Foo C, Hollevoet K, Maes P, Zhang X, Jochmans D, Ven K, Lammertyn J, Vanhoorelbeke K, Callewaert N, De Munter P, Schols D, Thibaut HJ, Neyts J, Declerck P, Geukens N. Potent neutralizing anti-SARS-CoV-2 human antibodies cure infection with SARS-CoV-2 variants in hamster model. iScience 2022; 25:104705. [PMID: 35813873 PMCID: PMC9250818 DOI: 10.1016/j.isci.2022.104705] [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: 12/10/2021] [Revised: 03/15/2022] [Accepted: 06/28/2022] [Indexed: 12/01/2022] Open
Abstract
Treatment with neutralizing monoclonal antibodies (mAbs) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) contributes to COVID-19 management. Unfortunately, SARS-CoV-2 variants escape several of these recently approved mAbs, highlighting the need for additional discovery and development. In a convalescent patient with COVID-19, we identified six mAbs, classified in four epitope groups, that potently neutralized SARS-CoV-2 D614G, beta, gamma, and delta infection in vitro, with three mAbs neutralizing omicron as well. In hamsters, mAbs 3E6 and 3B8 potently cured infection with SARS-CoV-2 Wuhan, beta, and delta when administered post-viral infection at 5 mg/kg. Even at 0.2 mg/kg, 3B8 still reduced viral titers. Intramuscular delivery of DNA-encoded 3B8 resulted in in vivo mAb production of median serum levels up to 90 μg/mL, and protected hamsters against delta infection. Overall, our data mark 3B8 as a promising candidate against COVID-19, and highlight advances in both the identification and gene-based delivery of potent human mAbs.
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Affiliation(s)
- Maya Imbrechts
- KU Leuven, PharmAbs: the KU Leuven Antibody Center, Herestraat 49 box 820, 3000 Leuven, Belgium
- KU Leuven, Department Pharmaceutical and Pharmacological Sciences, Laboratory for Therapeutic and Diagnostic Antibodies, 3000 Leuven, Belgium
- KU Leuven, MabMine: KU Leuven Single B Cell Mining Platform, Herestraat 49 box 820, 3000 Leuven, Belgium
| | - Wim Maes
- KU Leuven, PharmAbs: the KU Leuven Antibody Center, Herestraat 49 box 820, 3000 Leuven, Belgium
- KU Leuven, MabMine: KU Leuven Single B Cell Mining Platform, Herestraat 49 box 820, 3000 Leuven, Belgium
- KU Leuven Campus Kortrijk, IRF Life Sciences, Laboratory for Thrombosis Research, 3000 Leuven, Belgium
| | - Louanne Ampofo
- KU Leuven, PharmAbs: the KU Leuven Antibody Center, Herestraat 49 box 820, 3000 Leuven, Belgium
- KU Leuven, MabMine: KU Leuven Single B Cell Mining Platform, Herestraat 49 box 820, 3000 Leuven, Belgium
| | - Nathalie Van den Berghe
- KU Leuven, Department Pharmaceutical and Pharmacological Sciences, Laboratory for Therapeutic and Diagnostic Antibodies, 3000 Leuven, Belgium
| | - Bas Calcoen
- KU Leuven Campus Kortrijk, IRF Life Sciences, Laboratory for Thrombosis Research, 3000 Leuven, Belgium
| | - Dominique Van Looveren
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Translational Platform Virology and Chemotherapy (TPVC), KU Leuven, Leuven, Belgium
| | - Winnie Kerstens
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Translational Platform Virology and Chemotherapy (TPVC), KU Leuven, Leuven, Belgium
| | - Madina Rasulova
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Translational Platform Virology and Chemotherapy (TPVC), KU Leuven, Leuven, Belgium
| | - Thomas Vercruysse
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Translational Platform Virology and Chemotherapy (TPVC), KU Leuven, Leuven, Belgium
| | - Sam Noppen
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, 3000 Leuven, Belgium
| | - Rana Abdelnabi
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, 3000 Leuven, Belgium
- GVN, Global Virus Network
| | - Caroline Foo
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, 3000 Leuven, Belgium
- GVN, Global Virus Network
| | - Kevin Hollevoet
- KU Leuven, PharmAbs: the KU Leuven Antibody Center, Herestraat 49 box 820, 3000 Leuven, Belgium
- KU Leuven, Department Pharmaceutical and Pharmacological Sciences, Laboratory for Therapeutic and Diagnostic Antibodies, 3000 Leuven, Belgium
| | - Piet Maes
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, 3000 Leuven, Belgium
- GVN, Global Virus Network
| | - Xin Zhang
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, 3000 Leuven, Belgium
- GVN, Global Virus Network
| | - Dirk Jochmans
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, 3000 Leuven, Belgium
- GVN, Global Virus Network
| | - Karen Ven
- KU Leuven, MabMine: KU Leuven Single B Cell Mining Platform, Herestraat 49 box 820, 3000 Leuven, Belgium
- KU Leuven, Department of Biosystems, Biosensors Group, 3000 Leuven, Belgium
| | - Jeroen Lammertyn
- KU Leuven, MabMine: KU Leuven Single B Cell Mining Platform, Herestraat 49 box 820, 3000 Leuven, Belgium
- KU Leuven, Department of Biosystems, Biosensors Group, 3000 Leuven, Belgium
| | - Karen Vanhoorelbeke
- KU Leuven, PharmAbs: the KU Leuven Antibody Center, Herestraat 49 box 820, 3000 Leuven, Belgium
- KU Leuven, MabMine: KU Leuven Single B Cell Mining Platform, Herestraat 49 box 820, 3000 Leuven, Belgium
- KU Leuven Campus Kortrijk, IRF Life Sciences, Laboratory for Thrombosis Research, 3000 Leuven, Belgium
| | - Nico Callewaert
- AZ Groeninge Hospital Clinical Laboratory, 8500 Kortrijk, Belgium
| | - Paul De Munter
- Department of Internal Medicine, University Hospitals Leuven, 3000 Leuven, Belgium
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Laboratory for Clinical Infectious and Inflammatory Disorders, 3000 Leuven, Belgium
| | - Dominique Schols
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, 3000 Leuven, Belgium
| | - Hendrik Jan Thibaut
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Translational Platform Virology and Chemotherapy (TPVC), KU Leuven, Leuven, Belgium
| | - Johan Neyts
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, 3000 Leuven, Belgium
- Molecular Vaccinology and Vaccine Discovery, 3000 Leuven, Belgium
- GVN, Global Virus Network
| | - Paul Declerck
- KU Leuven, PharmAbs: the KU Leuven Antibody Center, Herestraat 49 box 820, 3000 Leuven, Belgium
- KU Leuven, Department Pharmaceutical and Pharmacological Sciences, Laboratory for Therapeutic and Diagnostic Antibodies, 3000 Leuven, Belgium
- KU Leuven, MabMine: KU Leuven Single B Cell Mining Platform, Herestraat 49 box 820, 3000 Leuven, Belgium
| | - Nick Geukens
- KU Leuven, PharmAbs: the KU Leuven Antibody Center, Herestraat 49 box 820, 3000 Leuven, Belgium
- KU Leuven, MabMine: KU Leuven Single B Cell Mining Platform, Herestraat 49 box 820, 3000 Leuven, Belgium
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8
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Staels F, Lorenzetti F, De Keukeleere K, Willemsen M, Gerbaux M, Neumann J, Tousseyn T, Pasciuto E, De Munter P, Bossuyt X, Gijsbers R, Liston A, Humblet-Baron S, Schrijvers R. A Novel Homozygous Stop Mutation in IL23R Causes Mendelian Susceptibility to Mycobacterial Disease. J Clin Immunol 2022; 42:1638-1652. [PMID: 35829840 DOI: 10.1007/s10875-022-01320-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/28/2022] [Accepted: 06/27/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Mendelian susceptibility to mycobacterial disease (MSMD) is caused by inborn errors of IFN-γ immunity. The most frequent genetic defects are found in IL12 or a subunit of its receptor. IL23R deficiency in MSMD has only been reported once, in two pediatric patients from the same kindred with isolated disseminated Bacille Calmette-Guérin disease. We evaluated the impact of a homozygous stop mutation in IL23R (R381X), identified by whole exome sequencing, in an adult patient with disseminated non-tuberculous mycobacterial disease. METHODS We performed functional validation of the R381X mutation by evaluating IL23R expression and IL-23 signaling (STAT3 phosphorylation, IFN-γ production) in primary cells (PBMCs, EBV-B cells) and cell lines (HeLa) with or without back-complementation of wild-type IL23R. RESULTS We report on a 48-year-old male with disseminated non-tuberculous mycobacterial disease. We identified and characterized a homozygous loss-of-function stop mutation underlying IL23R deficiency, resulting in near absent expression of membrane bound IL23R. IL23R deficiency was characterized by impaired IL-23-mediated IFN-γ secretion in CD4+, CD8+ T, and mucosal-associated invariant T (MAIT) cells, and low frequencies of circulating Th17 (CD3+CD45RA-CCR4+CXCR3-RORγT+), Th1* (CD45RA-CCR4-CXCR3+RORγT+), and MAIT (CD3+CD8+Vα7.2+CD161+) cells. Although the patient did not have a history of recurrent fungal infections, impaired Th17 differentiation and blunted IL-23-mediated IL-17 secretion in PBMCs were observed. CONCLUSION We demonstrate that impaired IL-23 immunity caused by a homozygous R381X mutation in IL23R underlies MSMD, corroborating earlier findings with a homozygous p.C115Y IL23R mutation. Our report further supports a model of redundant contribution of IL-23- to IL-17-mediated anti-fungal immunity.1.
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Affiliation(s)
- Frederik Staels
- Department of Microbiology, Immunology and Transplantation, Laboratory of Adaptive Immunology, KU Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium
| | - Flaminia Lorenzetti
- Department of Microbiology, Immunology and Transplantation, Laboratory of Adaptive Immunology, KU Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium
| | - Kerstin De Keukeleere
- Department of Microbiology, Immunology and Transplantation, Laboratory of Adaptive Immunology, KU Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium
| | - Mathijs Willemsen
- Department of Microbiology, Immunology and Transplantation, Laboratory of Adaptive Immunology, KU Leuven, Leuven, Belgium
- VIB Center for Brain and Disease Research, Leuven, Belgium
| | - Margaux Gerbaux
- Department of Microbiology, Immunology and Transplantation, Laboratory of Adaptive Immunology, KU Leuven, Leuven, Belgium
| | - Julika Neumann
- Department of Microbiology, Immunology and Transplantation, Laboratory of Adaptive Immunology, KU Leuven, Leuven, Belgium
- VIB Center for Brain and Disease Research, Leuven, Belgium
| | - Thomas Tousseyn
- Department of Imaging and Pathology, Laboratory for Translational Cell and Tissue Research, KU Leuven, Leuven, Belgium
| | - Emanuela Pasciuto
- Department of Microbiology, Immunology and Transplantation, Laboratory of Adaptive Immunology, KU Leuven, Leuven, Belgium
- VIB Center for Brain and Disease Research, Leuven, Belgium
- Department of Neurosciences, Laboratory for the Research of Neurodegenerative Diseases, KU Leuven, Leuven, Belgium
| | - Paul De Munter
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Xavier Bossuyt
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical and Diagnostic Immunology, KU Leuven, Leuven, Belgium
| | - Rik Gijsbers
- Department of Pharmaceutical and Pharmacological Sciences, Laboratory for Viral Vector Technology and Gene Therapy, KU Leuven, Leuven, Belgium
- Leuven Viral Vector Core, KU Leuven, Leuven, Belgium
| | - Adrian Liston
- Department of Microbiology, Immunology and Transplantation, Laboratory of Adaptive Immunology, KU Leuven, Leuven, Belgium
- VIB Center for Brain and Disease Research, Leuven, Belgium
- Laboratory of Lymphocyte Signaling and Development, Babraham Institute, Cambridge, UK
| | - Stephanie Humblet-Baron
- Department of Microbiology, Immunology and Transplantation, Laboratory of Adaptive Immunology, KU Leuven, Leuven, Belgium
| | - Rik Schrijvers
- Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium.
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium.
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9
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Engelen MM, Vandenbriele C, Spalart V, Martens CP, Vandenberk B, Sinonquel P, Lorent N, De Munter P, Willems R, Wauters J, Wilmer A, Dauwe D, Gunst J, Guler I, Janssens S, Martinod K, Pieters G, Peerlinck K, Verhamme P, Vanassche T. Thromboprophylaxis in COVID‐19: Weight and severity adjusted intensified dosing. Res Pract Thromb Haemost 2022; 6:e12683. [PMID: 35415384 PMCID: PMC8980774 DOI: 10.1002/rth2.12683] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 12/22/2022] Open
Abstract
Background Aims Methods Results Conclusion
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Affiliation(s)
- Matthias M. Engelen
- Department of Cardiovascular Diseases University Hospitals Leuven Leuven Belgium
- Center for Molecular and Vascular Biology Department of Cardiovascular Sciences KU Leuven Leuven Belgium
| | - Christophe Vandenbriele
- Department of Cardiovascular Diseases University Hospitals Leuven Leuven Belgium
- Center for Molecular and Vascular Biology Department of Cardiovascular Sciences KU Leuven Leuven Belgium
| | - Valérie Spalart
- Department of Cardiovascular Diseases University Hospitals Leuven Leuven Belgium
- Center for Molecular and Vascular Biology Department of Cardiovascular Sciences KU Leuven Leuven Belgium
| | - Caroline P. Martens
- Center for Molecular and Vascular Biology Department of Cardiovascular Sciences KU Leuven Leuven Belgium
| | - Bert Vandenberk
- Department of Cardiovascular Diseases University Hospitals Leuven Leuven Belgium
| | - Pieter Sinonquel
- Department of Gastro‐enterology and Hepatology University Hospitals Leuven Leuven Belgium
- Department of Translational Research in Gastrointestinal Diseases (TARGID) KU Leuven Leuven Belgium
| | - Natalie Lorent
- Department of Respiratory Diseases University Hospitals Leuven Leuven Belgium
| | - Paul De Munter
- Department of General Internal Medicine University Hospitals Leuven Leuven Belgium
- Department of Microbiology, Immunology and Transplantation KU Leuven Leuven Belgium
| | - Rik Willems
- Department of Cardiovascular Diseases University Hospitals Leuven Leuven Belgium
- Division of Clinical Cardiology, Department of Cardiovascular Sciences KU Leuven Leuven Belgium
| | - Joost Wauters
- Medical Intensive Care Unit Department of General Internal Medicine University Hospitals Leuven Leuven Belgium
| | - Alexander Wilmer
- Medical Intensive Care Unit Department of General Internal Medicine University Hospitals Leuven Leuven Belgium
| | - Dieter Dauwe
- Department of Intensive Care Medicine University Hospitals Leuven Leuven Belgium
| | - Jan Gunst
- Department of Intensive Care Medicine University Hospitals Leuven Leuven Belgium
- Laboratory of Intensive Care Medicine Department of Cellular and Molecular Medicine KU Leuven Leuven Belgium
| | - Ipek Guler
- Leuven Biostatistics and Statistical Bioinformatics Centre (L‐BioStat) KU Leuven Leuven Belgium
| | - Stefan Janssens
- Department of Cardiovascular Diseases University Hospitals Leuven Leuven Belgium
| | - Kimberly Martinod
- Center for Molecular and Vascular Biology Department of Cardiovascular Sciences KU Leuven Leuven Belgium
| | - Griet Pieters
- Department of Cardiovascular Diseases University Hospitals Leuven Leuven Belgium
| | - Kathelijne Peerlinck
- Department of Cardiovascular Diseases University Hospitals Leuven Leuven Belgium
- Center for Molecular and Vascular Biology Department of Cardiovascular Sciences KU Leuven Leuven Belgium
| | - Peter Verhamme
- Department of Cardiovascular Diseases University Hospitals Leuven Leuven Belgium
- Center for Molecular and Vascular Biology Department of Cardiovascular Sciences KU Leuven Leuven Belgium
| | - Thomas Vanassche
- Department of Cardiovascular Diseases University Hospitals Leuven Leuven Belgium
- Center for Molecular and Vascular Biology Department of Cardiovascular Sciences KU Leuven Leuven Belgium
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10
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Steels S, Van Elslande J, De Munter P, Bossuyt X. Transient Increase of Pre-existing Anti-IFN-α2 Antibodies Induced by SARS-CoV-2 Infection. J Clin Immunol 2022; 42:742-745. [PMID: 35296990 PMCID: PMC8926884 DOI: 10.1007/s10875-022-01235-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/20/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Sophie Steels
- Department of Laboratory Medicine, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - Jan Van Elslande
- Department of Laboratory Medicine, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - Paul De Munter
- Laboratory for Clinical Infectious and Inflammatory Disorders, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Xavier Bossuyt
- Department of Laboratory Medicine, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
- Clinical and Diagnostic Immunology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
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11
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Uyttebroek S, Chen B, Onsea J, Ruythooren F, Debaveye Y, Devolder D, Spriet I, Depypere M, Wagemans J, Lavigne R, Pirnay JP, Merabishvili M, De Munter P, Peetermans WE, Dupont L, Van Gerven L, Metsemakers WJ. Safety and efficacy of phage therapy in difficult-to-treat infections: a systematic review. The Lancet Infectious Diseases 2022; 22:e208-e220. [DOI: 10.1016/s1473-3099(21)00612-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/26/2021] [Accepted: 09/10/2021] [Indexed: 12/11/2022]
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12
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Van De Sijpe G, Quintens C, Walgraeve K, Van Laer E, Penny J, De Vlieger G, Schrijvers R, De Munter P, Foulon V, Casteels M, Van der Linden L, Spriet I. Overall performance of a drug-drug interaction clinical decision support system: quantitative evaluation and end-user survey. BMC Med Inform Decis Mak 2022; 22:48. [PMID: 35193547 PMCID: PMC8864797 DOI: 10.1186/s12911-022-01783-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 11/15/2021] [Accepted: 02/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical decision support systems are implemented in many hospitals to prevent medication errors and associated harm. They are however associated with a high burden of false positive alerts and alert fatigue. The aim of this study was to evaluate a drug-drug interaction (DDI) clinical decision support system in terms of its performance, uptake and user satisfaction and to identify barriers and opportunities for improvement. METHODS A quantitative evaluation and end-user survey were performed in a large teaching hospital. First, very severe DDI alerts generated between 2019 and 2021 were evaluated retrospectively. Data collection comprised alert burden, override rates, the number of alert overrides reviewed by pharmacists and the resulting pharmacist recommendations as well as their acceptance rate. Second, an e-survey was carried out among prescribers to assess satisfaction, usefulness and relevance of DDI alerts as well as reasons for overriding. RESULTS A total of 38,409 very severe DDI alerts were generated, of which 88.2% were overridden by the prescriber. In 3.2% of reviewed overrides, a recommendation by the pharmacist was provided, of which 79.2% was accepted. False positive alerts were caused by a too broad screening interval and lack of incorporation of patient-specific characteristics, such as QTc values. Co-prescribing of a non-vitamin K oral anticoagulant and a low molecular weight heparin accounted for 49.8% of alerts, of which 92.2% were overridden. In 88 (1.1%) of these overridden alerts, concurrent therapy was still present. Despite the high override rate, the e-survey revealed that the DDI clinical decision support system was found useful by prescribers. CONCLUSIONS Identified barriers were the lack of DDI-specific screening intervals and inclusion of patient-specific characteristics, both leading to a high number of false positive alerts and risk for alert fatigue. Despite these barriers, the added value of the DDI clinical decision support system was recognized by prescribers. Hence, integration of DDI-specific screening intervals and patient-specific characteristics is warranted to improve the performance of the DDI software.
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Affiliation(s)
- Greet Van De Sijpe
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium. .,Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
| | - Charlotte Quintens
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium.,Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | | | - Eva Van Laer
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - Jens Penny
- Department of Information Technology, University Hospitals Leuven, Leuven, Belgium
| | - Greet De Vlieger
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Rik Schrijvers
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Paul De Munter
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Veerle Foulon
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Minne Casteels
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Lorenz Van der Linden
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium.,Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Isabel Spriet
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium.,Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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13
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Vermeersch S, Demeester RP, Ausselet N, Callens S, De Munter P, Florence E, Goffard JC, Henrard S, Lacor P, Messiaen P, Libois A, Seyler L, Uurlings F, Vandecasteele SJ, Van Wijngaerden E, Yombi JC, Annemans L, De Wit S. A public health value-based healthcare paradigm for HIV. BMC Health Serv Res 2022; 22:13. [PMID: 34974833 PMCID: PMC8722062 DOI: 10.1186/s12913-021-07371-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/25/2021] [Accepted: 12/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background HIV patients face considerable acute and chronic healthcare needs and battling the HIV epidemic remains of the utmost importance. By focusing on health outcomes in relation to the cost of care, value-based healthcare (VBHC) proposes a strategy to optimize quality of care and cost-efficiency. Its implementation may provide an answer to the increasing pressure to optimize spending in healthcare while improving patient outcomes. This paper describes a pragmatic value-based healthcare framework for HIV care. Methods A value-based HIV healthcare framework was developed during a series of roundtable discussions bringing together 16 clinical stakeholder representatives from the Belgian HIV reference centers and 2 VBHC specialists. Each round of discussions was focused on a central question translating a concept or idea to the next level of practical implementation: 1) how can VBHC principles be translated into value-based HIV care drivers; 2) how can these value-based HIV care divers be translated into value-based care objectives and activities; and 3) how can value-based HIV care objectives and activities be translated into value-based care indicators. Value drivers were linked to concrete objectives and activities using a logical framework approach. Finally, specific, measurable, and acceptable structure, process and outcomes indicators were defined to complement the framework. Results Our framework identifies 4 core value areas where HIV care would benefit most from improvements: Prevention, improvement of the cascade of care, providing patient-centered HIV care and sustaining a state-of-the-art HIV disease management context. These 4 core value areas were translated into 12 actionable core value objectives. For each objective, example activities were proposed. Indicators are suggested for each level of the framework (outcome indicators for value areas and objectives, process indicators for suggested activities). Conclusions This framework approach outlines how to define a patient- and public health centered value-based HIV care paradigm. It proposes how to translate core value drivers to practical objectives and activities and suggests defining indicators that can be used to track and improve the framework’s implementation in practice.
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Affiliation(s)
| | - Rémy P Demeester
- HIV Reference Centre, University Hospital of Charleroi, Charleroi, Belgium
| | | | - Steven Callens
- Department General Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Paul De Munter
- Department of Microbiology Immunology, Transplantation and HIV Reference Centre, University Hospital Leuven, Leuven, Belgium
| | - Eric Florence
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jean-Christophe Goffard
- HIV Reference Centre, Internal Medicine, C.U.B. Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Sophie Henrard
- HIV Reference Centre, Internal Medicine, C.U.B. Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Patrick Lacor
- HIV Reference Centre, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Peter Messiaen
- Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium
| | - Agnès Libois
- Division of Infectious Diseases, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Lucie Seyler
- HIV Reference Centre, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Françoise Uurlings
- HIV Reference Centre, Infectious Diseases Department, Liège University Hospital, Liege, Belgium
| | - Stefaan J Vandecasteele
- Department of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge Oostende AV, Brugge, Belgium
| | - Eric Van Wijngaerden
- Department of Microbiology Immunology, Transplantation and HIV Reference Centre, University Hospital Leuven, Leuven, Belgium
| | - Jean-Cyr Yombi
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Lieven Annemans
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Stéphane De Wit
- Division of Infectious Diseases, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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14
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Khan M, Yoo SJ, Clijsters M, Backaert W, Vanstapel A, Speleman K, Lietaer C, Choi S, Hether TD, Marcelis L, Nam A, Pan L, Reeves JW, Van Bulck P, Zhou H, Bourgeois M, Debaveye Y, De Munter P, Gunst J, Jorissen M, Lagrou K, Lorent N, Neyrinck A, Peetermans M, Thal DR, Vandenbriele C, Wauters J, Mombaerts P, Van Gerven L. Visualizing in deceased COVID-19 patients how SARS-CoV-2 attacks the respiratory and olfactory mucosae but spares the olfactory bulb. Cell 2021; 184:5932-5949.e15. [PMID: 34798069 PMCID: PMC8564600 DOI: 10.1016/j.cell.2021.10.027] [Citation(s) in RCA: 208] [Impact Index Per Article: 69.3] [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: 06/29/2021] [Revised: 09/01/2021] [Accepted: 10/25/2021] [Indexed: 12/28/2022]
Abstract
Anosmia, the loss of smell, is a common and often the sole symptom of COVID-19. The onset of the sequence of pathobiological events leading to olfactory dysfunction remains obscure. Here, we have developed a postmortem bedside surgical procedure to harvest endoscopically samples of respiratory and olfactory mucosae and whole olfactory bulbs. Our cohort of 85 cases included COVID-19 patients who died a few days after infection with SARS-CoV-2, enabling us to catch the virus while it was still replicating. We found that sustentacular cells are the major target cell type in the olfactory mucosa. We failed to find evidence for infection of olfactory sensory neurons, and the parenchyma of the olfactory bulb is spared as well. Thus, SARS-CoV-2 does not appear to be a neurotropic virus. We postulate that transient insufficient support from sustentacular cells triggers transient olfactory dysfunction in COVID-19. Olfactory sensory neurons would become affected without getting infected.
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Affiliation(s)
- Mona Khan
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany
| | - Seung-Jun Yoo
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany
| | - Marnick Clijsters
- Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, KU Leuven, Leuven, Belgium
| | - Wout Backaert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Unit, KU Leuven, Leuven, Belgium
| | - Arno Vanstapel
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Kato Speleman
- Department of Otorhinolaryngology, Head and Neck Surgery, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Charlotte Lietaer
- Department of Otorhinolaryngology, Head and Neck Surgery, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Sumin Choi
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany
| | | | - Lukas Marcelis
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Andrew Nam
- NanoString Technologies Inc., Seattle, WA, USA
| | - Liuliu Pan
- NanoString Technologies Inc., Seattle, WA, USA
| | | | - Pauline Van Bulck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Hai Zhou
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany
| | - Marc Bourgeois
- Department of Anesthesiology and Intensive Care Medicine, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Yves Debaveye
- Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, KU Leuven, Leuven, Belgium
| | - Paul De Munter
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Laboratory for Clinical Infectious and Inflammatory Disorders, KU Leuven, Leuven, Belgium
| | - Jan Gunst
- Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, KU Leuven, Leuven, Belgium
| | - Mark Jorissen
- Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, KU Leuven, Leuven, Belgium; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Katrien Lagrou
- Department of Laboratory Medicine and National Reference Centre for Respiratory Pathogens, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Bacteriology and Mycology, KU Leuven, Leuven, Belgium
| | - Natalie Lorent
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Arne Neyrinck
- Department of Anesthesia, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Marijke Peetermans
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Laboratory for Clinical Infectious and Inflammatory Disorders, KU Leuven, Leuven, Belgium
| | - Dietmar Rudolf Thal
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, Laboratory of Neuropathology and Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Christophe Vandenbriele
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Joost Wauters
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Laboratory for Clinical Infectious and Inflammatory Disorders, KU Leuven, Leuven, Belgium
| | - Peter Mombaerts
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany.
| | - Laura Van Gerven
- Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, KU Leuven, Leuven, Belgium; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Unit, KU Leuven, Leuven, Belgium.
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15
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Vandenberk B, Engelen MM, Van De Sijpe G, Vermeulen J, Janssens S, Vanassche T, Verhamme P, De Munter P, Lorent N, Willems R. Repolarization abnormalities on admission predict 1-year outcome in COVID-19 patients. Int J Cardiol Heart Vasc 2021; 37:100912. [PMID: 34751251 PMCID: PMC8565995 DOI: 10.1016/j.ijcha.2021.100912] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 10/29/2021] [Indexed: 12/26/2022]
Abstract
Background ECG abnormalities in COVID-19 have been widely reported, however data after discharge is limited. The aim was to describe ECG abnormalities on admission and following recovery of COVID-19, and their associated mortality. Methods All patients hospitalized in a tertiary care hospital between March 7th and July 1st 2020 with COVID-19 were included in a retrospective registry. The first ECG on admission was collected, together with an ECG after hospital discharge in the absence of acute pathology. Automated measures and clinical ECG interpretations were collected. Multivariate Cox regression analysis was performed to predict 1-year all-cause mortality. Results In total 420 patients were included, of which 83 patients (19.8%) died during the 1-year follow-up period. Repolarization abnormalities were present in 189 patients (45.0%). The extent of repolarization abnormalities was an independent predictor of 1-year all-cause mortality (HR per region 1.30, 95%CI 1.04–1.64) together with age (/year HR 1.06, 95%CI 1.04–1.08), heart rate (/bpm HR 1.02, 95%CI 1.01–1.03), neurological disorders (HR 2.41, 95%CI 1.47–3.93), active cancer (HR 2.75, 95%CI 1.57–4.82), CRP (per 10 mg/L HR 1.05, 95%CI 1.02–1.08) and eGFR (per 10 mg/L HR 0.90, 95%CI 0.83–0.98). In 245 patients (68.1%) an ECG post discharge was available. New repolarization abnormalities were more frequent in patients who died after discharge (4.7% versus 41.7%, p < 0.001) and 8 (3.3%) had new ventricular conduction defects, none of whom died during follow-up. Conclusions The presence and extent of repolarization abnormalities predicted outcome in patients with COVID-19. New repolarization abnormalities after discharge were associated with post-discharge mortality.
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Affiliation(s)
- Bert Vandenberk
- Department of Cardiovascular Sciences, KU Leuven, Belgium.,Libin Cardiovascular Institute, University of Calgary, Canada.,Cardiology, University Hospitals Leuven, Belgium
| | - Matthias M Engelen
- Department of Cardiovascular Sciences, KU Leuven, Belgium.,Cardiology, University Hospitals Leuven, Belgium
| | - Greet Van De Sijpe
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
| | | | - Stefan Janssens
- Department of Cardiovascular Sciences, KU Leuven, Belgium.,Cardiology, University Hospitals Leuven, Belgium
| | - Thomas Vanassche
- Department of Cardiovascular Sciences, KU Leuven, Belgium.,Cardiology, University Hospitals Leuven, Belgium
| | - Peter Verhamme
- Department of Cardiovascular Sciences, KU Leuven, Belgium.,Cardiology, University Hospitals Leuven, Belgium
| | - Paul De Munter
- General Internal Medicine, University Hospitals Leuven, Belgium.,Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium
| | - Natalie Lorent
- Respiratory Diseases, University Hospitals Leuven, Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, KU Leuven, Belgium.,Cardiology, University Hospitals Leuven, Belgium
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16
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Lemmens L, Geelen H, Depypere M, De Munter P, Verhaegen F, Zimmerli W, Nijs S, Debeer P, Metsemakers WJ. Management of periprosthetic infection after reverse shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:2514-2522. [PMID: 33895302 DOI: 10.1016/j.jse.2021.04.014] [Citation(s) in RCA: 15] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/29/2021] [Accepted: 04/04/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Periprosthetic shoulder infection (PSI) remains a devastating complication after reverse shoulder arthroplasty (RSA). Currently, scientific data related to the management of PSI are limited, and the optimal strategy and related clinical outcomes remain unclear. Guidelines from the Infectious Diseases Society of America for the management of periprosthetic joint infection are mainly based on data from patients after hip and knee arthroplasty. The aim of this study was to evaluate whether these guidelines are also valid for patients with PSI after RSA. In addition, the functional outcome according to the surgical intervention was assessed. METHODS An RSA database was retrospectively reviewed to identify infections after primary and revision RSAs, diagnosed between 2004 and 2018. Data collected included age, sex, indication for RSA, causative pathogen, surgical and antimicrobial treatment, functional outcome, and recurrence. RESULTS Thirty-six patients with a PSI were identified. Surgical treatment was subdivided into débridement and implant retention (DAIR) (n = 6, 17%); 1-stage revision (n = 1, 3%); 2-stage revision (n = 16, 44%); multiple-stage revision (>2 stages) (n = 7, 19%); definitive spacer implantation (n = 2, 6%); and resection arthroplasty (n = 4, 11%). The most common causative pathogens were Staphylococcus epidermidis (n = 11, 31%) and Cutibacterium acnes (n = 9, 25%). Recurrence was diagnosed in 4 patients (11%), all of whom were initially treated with a DAIR approach. The median follow-up period was 36 months (range, 24-132 months). CONCLUSION PSI is typically caused by low-virulence pathogens, which often are diagnosed with a delay, resulting in chronic infection at the time of surgery. Our results indicate that treatment of patients with chronic PSI with DAIR has a high recurrence rate. In addition, implant exchange (ie, 1- and 2-stage exchange) does not compromise the functional result as compared with implant retention. Thus, patients with chronic PSI should be treated with implant exchange. Future research should further clarify which surgical strategy (ie, 1-stage vs. 2-stage exchange) has a better outcome overall.
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Affiliation(s)
- Laura Lemmens
- Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Hans Geelen
- Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Melissa Depypere
- Department of Clinical Biology, University Hospitals Leuven, Leuven, Belgium
| | - Paul De Munter
- Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Filip Verhaegen
- Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Werner Zimmerli
- Interdisciplinary Unit for Orthopaedic Infections, Kantonsspital Baselland, Liestal, Switzerland
| | - Stefaan Nijs
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, University of Leuven, Leuven, Belgium
| | - Philippe Debeer
- Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, University of Leuven, Leuven, Belgium
| | - Willem-Jan Metsemakers
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, University of Leuven, Leuven, Belgium.
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17
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Akalay S, Vanassche T, De Munter P. Tigecycline-induced life-threatening coagulopathy in a patient with a Mycobacterium abscess: a case report and step-by-step diagnostic approach. Acta Clin Belg 2021; 76:410-414. [PMID: 32255411 DOI: 10.1080/17843286.2020.1747197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Tigecycline is a broad-spectrum antibiotic that is indicated in the treatment of complicated intra-abdominal infections and complicated skin and skin and soft-tissue infections. We report the case of a 53-year old kidney transplant patient with a severe Mycobacterium abscess who developed life-threatening coagulopathy after initiation of tigecycline therapy. Further analysis revealed a severe hypofibrinogenemia. A few case reports previously described an association between tigecycline and prolongation of clotting time. Our case confirms an uncommon yet possibly life-threatening side-effect of tigecycline. Medical practitioners should be aware of this potential coagulopathy and we recommend routine monitoring of coagulation parameters in patients receiving tigecycline.
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18
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Boey L, Curinckx A, Roelants M, Derdelinckx I, Van Wijngaerden E, De Munter P, Vos R, Kuypers D, Van Cleemput J, Vandermeulen C. Immunogenicity and Safety of the 9-Valent Human Papillomavirus Vaccine in Solid Organ Transplant Recipients and Adults Infected With Human Immunodeficiency Virus (HIV). Clin Infect Dis 2021; 73:e661-e671. [PMID: 33373429 DOI: 10.1093/cid/ciaa1897] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 11/11/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The burden of human papillomavirus (HPV) in human immunodeficiency virus (HIV)-infected persons and solid organ transplant (SOT) recipients is high. Clinical trials on HPV vaccines in persons living with HIV and particularly in SOT recipients have been sparse to date, included low numbers of participants, and none of them assessed the 9-valent HPV (9vHPV) vaccine. We investigated the immunogenicity with respect to HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58 and the safety of the 9vHPV vaccine in persons living with HIV and recipients of a kidney, lung, or heart transplant. METHODS This is a phase III investigator-initiated study in 100 persons living with HIV (age 18-45 years) and 171 SOT recipients (age 18-55 years). The 9vHPV vaccine was administered at day 1, month 2, and month 6. Primary outcome was seroconversion rates to the 9vHPV types at month 7. Secondary outcomes were geometric mean titers (GMTs) and frequency of adverse events (AEs). RESULTS All HIV-infected participants seroconverted for all HPV types, but seroconversion ranged from 46% for HPV45 to 72% for HPV58 in SOT recipients. GMTs ranged from 180 to 2985 mMU/mL in HIV-positive participants and from 17 to 170 mMU/mL in SOT recipients, depending on the HPV type. Injection-site AEs occurred in 62% of participants but were mostly mild or moderate in intensity. None of the reported serious adverse events were deemed vaccine related. No patients died during the study. CONCLUSIONS Immunogenicity of the 9vHPV vaccine is high in persons living with HIV but suboptimal in SOT recipients. The vaccine is safe and well tolerated in both groups.
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Affiliation(s)
- Lise Boey
- Leuven University Vaccinology Centre, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Ans Curinckx
- Leuven University Vaccinology Centre, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Mathieu Roelants
- Leuven University Vaccinology Centre, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Inge Derdelinckx
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.,Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Eric Van Wijngaerden
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.,Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Paul De Munter
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.,Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Robin Vos
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium, and Department CHROMETA (Chronic Diseases, Metabolism and Aging), BREATHE (Laboratory of Respiratory Diseases and Thoracic Surgery), KU Leuven, Leuven, Belgium
| | - Dirk Kuypers
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.,Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | | | - Corinne Vandermeulen
- Leuven University Vaccinology Centre, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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19
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Onsea J, Uyttebroek S, Chen B, Wagemans J, Lood C, Van Gerven L, Spriet I, Devolder D, Debaveye Y, Depypere M, Dupont L, De Munter P, Peetermans WE, van Noort V, Merabishvili M, Pirnay JP, Lavigne R, Metsemakers WJ. Bacteriophage Therapy for Difficult-to-Treat Infections: The Implementation of a Multidisciplinary Phage Task Force ( The PHAGEFORCE Study Protocol). Viruses 2021; 13:1543. [PMID: 34452408 PMCID: PMC8402896 DOI: 10.3390/v13081543] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 12/22/2022] Open
Abstract
In times where only a few novel antibiotics are to be expected, antimicrobial resistance remains an expanding global health threat. In case of chronic infections caused by therapy-resistant pathogens, physicians have limited therapeutic options, which are often associated with detrimental consequences for the patient. This has resulted in a renewed interest in alternative strategies, such as bacteriophage (phage) therapy. However, there are still important hurdles that currently impede the more widespread implementation of phage therapy in clinical practice. First, the limited number of good-quality case series and clinical trials have failed to show the optimal application protocol in terms of route of administration, frequency of administration, treatment duration and phage titer. Second, there is limited information on the systemic effects of phage therapy. Finally, in the past, phage therapy has been applied intuitively in terms of the selection of phages and their combination as parts of phage cocktails. This has led to an enormous heterogeneity in previously published studies, resulting in a lack of reliable safety and efficacy data for phage therapy. We hereby present a study protocol that addresses these scientific hurdles using a multidisciplinary approach, bringing together the experience of clinical, pharmaceutical and molecular microbiology experts.
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Affiliation(s)
- Jolien Onsea
- Department of Trauma Surgery, University Hospitals Leuven, 3000 Leuven, Belgium; (B.C.); (W.-J.M.)
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Saartje Uyttebroek
- Department of Otorhinolaryngology, University Hospitals Leuven, 3000 Leuven, Belgium; (S.U.); (L.V.G.)
- Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, KU Leuven, 3000 Leuven, Belgium
| | - Baixing Chen
- Department of Trauma Surgery, University Hospitals Leuven, 3000 Leuven, Belgium; (B.C.); (W.-J.M.)
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Jeroen Wagemans
- Department of Biosystems, Laboratory of Gene Technology, KU Leuven, 3000 Leuven, Belgium; (J.W.); (C.L.); (R.L.)
| | - Cédric Lood
- Department of Biosystems, Laboratory of Gene Technology, KU Leuven, 3000 Leuven, Belgium; (J.W.); (C.L.); (R.L.)
- Center of Microbial and Plant Genetics, KU Leuven, 3000 Leuven, Belgium;
| | - Laura Van Gerven
- Department of Otorhinolaryngology, University Hospitals Leuven, 3000 Leuven, Belgium; (S.U.); (L.V.G.)
- Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, KU Leuven, 3000 Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, 3000 Leuven, Belgium
| | - Isabel Spriet
- Pharmacy Department, University Hospitals Leuven, 3000 Leuven, Belgium; (I.S.); (D.D.)
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, 3000 Leuven, Belgium
| | - David Devolder
- Pharmacy Department, University Hospitals Leuven, 3000 Leuven, Belgium; (I.S.); (D.D.)
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, 3000 Leuven, Belgium
| | - Yves Debaveye
- Department of Intensive Care Medicine, University Hospitals Leuven, 3000 Leuven, Belgium;
| | - Melissa Depypere
- Department of Laboratory Medicine, University Hospitals Leuven, 3000 Leuven, Belgium;
- Laboratory of Clinical Bacteriology and Mycology, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium
| | - Lieven Dupont
- Department of Pneumology, University Hospitals Leuven, 3000 Leuven, Belgium;
| | - Paul De Munter
- Department of Internal Medicine, University Hospitals Leuven, 3000 Leuven, Belgium; (P.D.M.); (W.E.P.)
- Laboratory for Clinical Infectious and Inflammatory Disorders, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium
| | - Willy E. Peetermans
- Department of Internal Medicine, University Hospitals Leuven, 3000 Leuven, Belgium; (P.D.M.); (W.E.P.)
- Laboratory for Clinical Infectious and Inflammatory Disorders, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium
| | - Vera van Noort
- Center of Microbial and Plant Genetics, KU Leuven, 3000 Leuven, Belgium;
- Institute of Biology, Leiden University, 2333 BE Leiden, The Netherlands
| | - Maia Merabishvili
- Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, 1120 Brussels, Belgium; (M.M.); (J.-P.P.)
| | - Jean-Paul Pirnay
- Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, 1120 Brussels, Belgium; (M.M.); (J.-P.P.)
| | - Rob Lavigne
- Department of Biosystems, Laboratory of Gene Technology, KU Leuven, 3000 Leuven, Belgium; (J.W.); (C.L.); (R.L.)
| | - Willem-Jan Metsemakers
- Department of Trauma Surgery, University Hospitals Leuven, 3000 Leuven, Belgium; (B.C.); (W.-J.M.)
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
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20
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Liesenborghs L, Spriet I, Jochmans D, Belmans A, Gyselinck I, Teuwen LA, ter Horst S, Dreesen E, Geukens T, Engelen MM, Landeloos E, Geldhof V, Ceunen H, Debaveye B, Vandenberk B, Van der Linden L, Jacobs S, Langendries L, Boudewijns R, Dan Do TN, Chiu W, Wang X, Zhang X, Weynand B, Vanassche T, Devos T, Meyfroidt G, Janssens W, Vos R, Vermeersch P, Wauters J, Verbeke G, De Munter P, Kaptein SJ, Rocha-Pereira J, Delang L, Van Wijngaerden E, Neyts J, Verhamme P. Corrigendum to "itraconazole for COVID-19: Preclinical studies and a proof-of-concept randomized clinical trial Laurens". EBioMedicine 2021; 69:103454. [PMID: 34186486 PMCID: PMC8233477 DOI: 10.1016/j.ebiom.2021.103454] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Laurens Liesenborghs
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
- The Outbreak Research Team, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Corresponding author at: Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.
| | - Isabel Spriet
- Pharmacy Department University Hospitals Leuven and Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
| | - Dirk Jochmans
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Ann Belmans
- KU Leuven University of Leuven & Universiteit Hasselt, I-BioStat, Leuven, Belgium
| | - Iwein Gyselinck
- Department of Respiratory Diseases, UZ Leuven and CHROMETA, Research group BREATHE, KU Leuven, Leuven, Belgium
| | - Laure-Anne Teuwen
- Laboratory of Angiogenesis and Vascular Metabolism, Center for Cancer Biology, VIB, Department of Oncology, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - Sebastiaan ter Horst
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Erwin Dreesen
- Clinical Pharmacology and Pharmacotherapy Unit, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
| | - Tatjana Geukens
- Department of Oncology, Laboratory for Translational Breast Cancer Research, KU Leuven, Belgium
| | | | - Ewout Landeloos
- Department of Oncology, Laboratory for molecular Cancer biology, VIB-KU Leuven, Belgium
| | - Vincent Geldhof
- Laboratory of Angiogenesis and Vascular Metabolism, Center for Cancer Biology, VIB, Department of Oncology, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - Helga Ceunen
- Department of General Internal Medicine, UZ Leuven and Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium
| | - Barbara Debaveye
- Department of Cardiovascular Sciences, UZ and KU Leuven, Belgium
| | - Bert Vandenberk
- Department of Cardiovascular Sciences, UZ and KU Leuven, Belgium
| | - Lorenz Van der Linden
- Pharmacy Department University Hospitals Leuven and Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
| | - Sofie Jacobs
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Lana Langendries
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Robbert Boudewijns
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Thuc Nguyen Dan Do
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Winston Chiu
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Xinyu Wang
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Xin Zhang
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Birgit Weynand
- Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Belgium
| | - Thomas Vanassche
- Department of Cardiovascular Sciences, UZ and KU Leuven, Belgium
| | - Timothy Devos
- Department of Hematology, UZ Leuven and Department of Microbiology, Immunology and Transplantation, Laboratory of Molecular Immunology (Rega Institute), KU Leuven, Belgium
| | - Geert Meyfroidt
- Department and Laboratory of Intensive Care Medicine, UZ and KU Leuven, Belgium
| | - Wim Janssens
- Department of Respiratory Diseases, UZ Leuven and CHROMETA, Research group BREATHE, KU Leuven, Leuven, Belgium
| | - Robin Vos
- Department of Respiratory Diseases, UZ Leuven and CHROMETA, Research group BREATHE, KU Leuven, Leuven, Belgium
| | - Pieter Vermeersch
- Department of Cardiovascular Sciences and Clinical Department of Laboratory Medicine, KU Leuven, Belgium
| | - Joost Wauters
- Medical Intensive Care Unit, UZ Leuven and Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium
| | - Geert Verbeke
- KU Leuven University of Leuven & Universiteit Hasselt, I-BioStat, Leuven, Belgium
| | - Paul De Munter
- Department of General Internal Medicine, UZ Leuven and Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium
| | - Suzanne J.F. Kaptein
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Joana Rocha-Pereira
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Leen Delang
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Eric Van Wijngaerden
- Department of General Internal Medicine, UZ Leuven and Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium
- Corresponding author at: Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.
| | - Johan Neyts
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Peter Verhamme
- Department of Cardiovascular Sciences, UZ and KU Leuven, Belgium
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21
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Liesenborghs L, Spriet I, Jochmans D, Belmans A, Gyselinck I, Teuwen LA, ter Horst S, Dreesen E, Geukens T, Engelen MM, Landeloos E, Geldhof V, Ceunen H, Debaveye B, Vandenberk B, Van der Linden L, Jacobs S, Langendries L, Boudewijns R, Do TND, Chiu W, Wang X, Zhang X, Weynand B, Vanassche T, Devos T, Meyfroidt G, Janssens W, Vos R, Vermeersch P, Wauters J, Verbeke G, De Munter P, Kaptein SJ, Rocha-Pereira J, Delang L, Van Wijngaerden E, Neyts J, Verhamme P. Itraconazole for COVID-19: preclinical studies and a proof-of-concept randomized clinical trial. EBioMedicine 2021; 66:103288. [PMID: 33752127 PMCID: PMC7979145 DOI: 10.1016/j.ebiom.2021.103288] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 11/25/2020] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The antifungal drug itraconazole exerts in vitro activity against SARS-CoV-2 in Vero and human Caco-2 cells. Preclinical and clinical studies are required to investigate if itraconazole is effective for the treatment and/or prevention of COVID-19. METHODS Due to the initial absence of preclinical models, the effect of itraconazole was explored in a clinical, proof-of-concept, open-label, single-center study, in which hospitalized COVID-19 patients were randomly assigned to standard of care with or without itraconazole. Primary outcome was the cumulative score of the clinical status until day 15 based on the 7-point ordinal scale of the World Health Organization. In parallel, itraconazole was evaluated in a newly established hamster model of acute SARS-CoV-2 infection and transmission, as soon as the model was validated. FINDINGS In the hamster acute infection model, itraconazole did not reduce viral load in lungs, stools or ileum, despite adequate plasma and lung drug concentrations. In the transmission model, itraconazole failed to prevent viral transmission. The clinical trial was prematurely discontinued after evaluation of the preclinical studies and because an interim analysis showed no signal for a more favorable outcome with itraconazole: mean cumulative score of the clinical status 49 vs 47, ratio of geometric means 1.01 (95% CI 0.85 to 1.19) for itraconazole vs standard of care. INTERPRETATION Despite in vitro activity, itraconazole was not effective in a preclinical COVID-19 hamster model. This prompted the premature termination of the proof-of-concept clinical study. FUNDING KU Leuven, Research Foundation - Flanders (FWO), Horizon 2020, Bill and Melinda Gates Foundation.
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Affiliation(s)
- Laurens Liesenborghs
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
- The Outbreak Research Team, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Isabel Spriet
- Pharmacy Department University Hospitals Leuven and Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
| | - Dirk Jochmans
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Ann Belmans
- KU Leuven – University of Leuven & Universiteit Hasselt, I-BioStat, Leuven, Belgium
| | - Iwein Gyselinck
- Department of Respiratory Diseases, UZ Leuven and CHROMETA, Research group BREATHE, KU Leuven, Leuven, Belgium
| | - Laure-Anne Teuwen
- Laboratory of Angiogenesis and Vascular Metabolism, Center for Cancer Biology, VIB, Department of Oncology, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - Sebastiaan ter Horst
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Erwin Dreesen
- Clinical Pharmacology and Pharmacotherapy Unit, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
| | - Tatjana Geukens
- Department of Oncology, Laboratory for Translational Breast Cancer Research, KU Leuven, Belgium
| | | | - Ewout Landeloos
- Department of Oncology, Laboratory for molecular Cancer biology, VIB-KU Leuven, Belgium
| | - Vincent Geldhof
- Laboratory of Angiogenesis and Vascular Metabolism, Center for Cancer Biology, VIB, Department of Oncology, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - Helga Ceunen
- Department of General Internal Medicine, UZ Leuven and Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium
| | - Barbara Debaveye
- Department of Cardiovascular Sciences, UZ and KU Leuven, Belgium
| | - Bert Vandenberk
- Department of Cardiovascular Sciences, UZ and KU Leuven, Belgium
| | - Lorenz Van der Linden
- Pharmacy Department University Hospitals Leuven and Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
| | - Sofie Jacobs
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Lana Langendries
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Robbert Boudewijns
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Thuc Nguyen Dan Do
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Winston Chiu
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Xinyu Wang
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Xin Zhang
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Birgit Weynand
- Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Belgium
| | - Thomas Vanassche
- Department of Cardiovascular Sciences, UZ and KU Leuven, Belgium
| | - Timothy Devos
- Department of Hematology, UZ Leuven and Department of Microbiology, Immunology and Transplantation, Laboratory of Molecular Immunology (Rega Institute), KU Leuven, Belgium
| | - Geert Meyfroidt
- Department and Laboratory of Intensive Care Medicine, UZ and KU Leuven, Belgium
| | - Wim Janssens
- Department of Respiratory Diseases, UZ Leuven and CHROMETA, Research group BREATHE, KU Leuven, Leuven, Belgium
| | - Robin Vos
- Department of Respiratory Diseases, UZ Leuven and CHROMETA, Research group BREATHE, KU Leuven, Leuven, Belgium
| | - Pieter Vermeersch
- Department of Cardiovascular Sciences and Clinical Department of Laboratory Medicine, KU Leuven, Belgium
| | - Joost Wauters
- Medical Intensive Care Unit, UZ Leuven and Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium
| | - Geert Verbeke
- KU Leuven – University of Leuven & Universiteit Hasselt, I-BioStat, Leuven, Belgium
| | - Paul De Munter
- Department of General Internal Medicine, UZ Leuven and Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium
| | - Suzanne J.F. Kaptein
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Joana Rocha-Pereira
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Leen Delang
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Eric Van Wijngaerden
- Department of General Internal Medicine, UZ Leuven and Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium
| | - Johan Neyts
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Peter Verhamme
- Department of Cardiovascular Sciences, UZ and KU Leuven, Belgium
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22
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de Azambuja E, Brandão M, Wildiers H, Laenen A, Aspeslagh S, Fontaine C, Collignon J, Lybaert W, Verheezen J, Rutten A, Vuylsteke P, Goeminne JC, Demey W, Van Beckhoven D, Deblonde J, Rottey S, Geukens T, Punie K, Bafort K, Belkhir L, Bossuyt N, Colombie V, Daubresse C, Dauby N, De Munter P, Delmarcelle D, Delvallee M, Demeester R, Delefortrie Q, Dugernier T, Holemans X, Louviaux I, Machurot P, Minette P, Mokrane S, Nachtergal C, Noirhomme S, Piérard D, Rossi C, Schirvel C, Sermijn E, Staelens F, Triest F, Van Beckhoven D, Van Goethem N, Van Praet J, Vanhoenacker A, Verstraete R, Willems E, Wyndham-Thomas C. Impact of solid cancer on in-hospital mortality overall and among different subgroups of patients with COVID-19: a nationwide, population-based analysis. ESMO Open 2020; 5:e000947. [PMID: 32978251 PMCID: PMC7520811 DOI: 10.1136/esmoopen-2020-000947] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/15/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cancer seems to have an independent adverse prognostic effect on COVID-19-related mortality, but uncertainty exists regarding its effect across different patient subgroups. We report a population-based analysis of patients hospitalised with COVID-19 with prior or current solid cancer versus those without cancer. METHODS We analysed data of adult patients registered until 24 May 2020 in the Belgian nationwide database of Sciensano. The primary objective was in-hospital mortality within 30 days of COVID-19 diagnosis among patients with solid cancer versus patients without cancer. Severe event occurrence, a composite of intensive care unit admission, invasive ventilation and/or death, was a secondary objective. These endpoints were analysed across different patient subgroups. Multivariable logistic regression models were used to analyse the association between cancer and clinical characteristics (baseline analysis) and the effect of cancer on in-hospital mortality and on severe event occurrence, adjusting for clinical characteristics (in-hospital analysis). RESULTS A total of 13 594 patients (of whom 1187 with solid cancer (8.7%)) were evaluable for the baseline analysis and 10 486 (892 with solid cancer (8.5%)) for the in-hospital analysis. Patients with cancer were older and presented with less symptoms/signs and lung imaging alterations. The 30-day in-hospital mortality was higher in patients with solid cancer compared with patients without cancer (31.7% vs 20.0%, respectively; adjusted OR (aOR) 1.34; 95% CI 1.13 to 1.58). The aOR was 3.84 (95% CI 1.94 to 7.59) among younger patients (<60 years) and 2.27 (95% CI 1.41 to 3.64) among patients without other comorbidities. Severe event occurrence was similar in both groups (36.7% vs 28.8%; aOR 1.10; 95% CI 0.95 to 1.29). CONCLUSIONS This population-based analysis demonstrates that solid cancer is an independent adverse prognostic factor for in-hospital mortality among patients with COVID-19. This adverse effect was more pronounced among younger patients and those without other comorbidities. Patients with solid cancer should be prioritised in vaccination campaigns and in tailored containment measurements.
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Affiliation(s)
- Evandro de Azambuja
- Department of Medical Oncology, Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B), Brussels, Belgium.
| | - Mariana Brandão
- EPI Unit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Hans Wildiers
- Department of General Medical Oncology and Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Annouschka Laenen
- Interuniversity Centre for Biostatistics and Statistical Bioinformatics, KU Leuven, Leuven, Belgium
| | | | | | | | - Willem Lybaert
- Department of Medical Oncology, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Jolanda Verheezen
- Department of Medical Oncology, St. Trudo Hospital, Sint-Truiden, Belgium
| | - Annemie Rutten
- Department of Medical Oncology, GZA Ziekenhuizen, Campus Sint-Augustinus, Wilrijk, Belgium
| | - Peter Vuylsteke
- Department of Medical Oncology, UCLouvain, CHU-UCL Namur, Namur, Belgium; Department of Internal Medicine, University of Botswana, Gaborone, Botswana
| | | | - Wim Demey
- Department of Medical Oncology, AZ Klina, Brasschaat, Belgium
| | | | | | - Sylvie Rottey
- Department of Medical Oncology, Gent University Hospital, Gent, Belgium
| | - Tatjana Geukens
- Laboratory for Translational Breast Cancer Research, KU Leuven, Leuven, Belgium
| | - Kevin Punie
- Department of General Medical Oncology and Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
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23
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Onsea J, Soentjens P, Djebara S, Merabishvili M, Depypere M, Spriet I, De Munter P, Debaveye Y, Nijs S, Vanderschot P, Wagemans J, Pirnay JP, Lavigne R, Metsemakers WJ. Bacteriophage Application for Difficult-to-treat Musculoskeletal Infections: Development of a Standardized Multidisciplinary Treatment Protocol. Viruses 2019; 11:v11100891. [PMID: 31548497 PMCID: PMC6832313 DOI: 10.3390/v11100891] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [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: 08/24/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 12/19/2022] Open
Abstract
Bacteriophage therapy has recently attracted increased interest, particularly in difficult-to-treat infections. Although it is not a novel concept, standardized treatment guidelines are currently lacking. We present the first steps towards the establishment of a "multidisciplinary phage task force" (MPTF) and a standardized treatment pathway, based on our experience of four patients with severe musculoskeletal infections. After review of their medical history and current clinical status, a multidisciplinary team found four patients with musculoskeletal infections eligible for bacteriophage therapy within the scope of Article 37 of the Declaration of Helsinki. Treatment protocols were set up in collaboration with phage scientists and specialists. Based on the isolated pathogens, phage cocktails were selected and applied intraoperatively. A draining system allowed postoperative administration for a maximum of 10 days, 3 times per day. All patients received concomitant antibiotics and their clinical status was followed daily during phage therapy. No severe side-effects related to the phage application protocol were noted. After a single course of phage therapy with concomitant antibiotics, no recurrence of infection with the causative strains occurred, with follow-up periods ranging from 8 to 16 months. This study presents the successful outcome of bacteriophage therapy using a standardized treatment pathway for patients with severe musculoskeletal infection. A multidisciplinary team approach in the form of an MPTF is paramount in this process.
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Affiliation(s)
- Jolien Onsea
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium.
- Department of Trauma Surgery, University Hospitals Leuven, 3000 Leuven, Belgium.
| | - Patrick Soentjens
- Centre for Infectious Diseases, Queen Astrid Military Hospital, 1120 Brussels, Belgium.
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium.
| | - Sarah Djebara
- Centre for Infectious Diseases, Queen Astrid Military Hospital, 1120 Brussels, Belgium.
| | - Maia Merabishvili
- Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, 1120 Brussels, Belgium.
| | - Melissa Depypere
- Department of Laboratory Medicine, University Hospitals Leuven, 3000 Leuven, Belgium.
| | - Isabel Spriet
- Pharmacy Department, University Hospitals Leuven, 3000 Leuven, Belgium.
| | - Paul De Munter
- Department of General Internal Medicine, University Hospitals Leuven, 3000 Leuven, Belgium.
- Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium.
| | - Yves Debaveye
- Department of Intensive Care Medicine, University Hospitals Leuven, 3000 Leuven, Belgium.
| | - Stefaan Nijs
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium.
- Department of Trauma Surgery, University Hospitals Leuven, 3000 Leuven, Belgium.
| | - Paul Vanderschot
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium.
- Department of Trauma Surgery, University Hospitals Leuven, 3000 Leuven, Belgium.
| | - Jeroen Wagemans
- Laboratory of Gene Technology, KU Leuven, 3001 Leuven, Belgium.
| | - Jean-Paul Pirnay
- Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, 1120 Brussels, Belgium.
| | - Rob Lavigne
- Laboratory of Gene Technology, KU Leuven, 3001 Leuven, Belgium.
| | - Willem-Jan Metsemakers
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium.
- Department of Trauma Surgery, University Hospitals Leuven, 3000 Leuven, Belgium.
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De Munter P, Derdelinckx I, Peetermans WE, Fieuws S, Vanderschueren S, Van Wijngaerden E. Incidence and risk factors of fever in a contemporary cohort of HIV-patients with good access to antiretroviral therapy. Acta Clin Belg 2017; 72:226-231. [PMID: 27383579 DOI: 10.1080/17843286.2016.1206240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/21/2022]
Abstract
OBJECTIVE To study incidence and to determine risk factors of fever in a contemporary cohort of HIV-infected patients with access to antiretroviral therapy. METHODS Prospective study in a cohort of HIV-infected patients in Belgium from 2009 to 2013. RESULTS 759 patients were followed for a total of 2136 patient years. The incidence of fever was low, with an incidence rate of 0.103 (95% CI 0.078; 0.135) febrile episodes per patient per year for temperature 38.3 °C or higher measured by a health care provider. Gender, age, ethnicity, and calendar year of measurement were no significant risk factors for fever in univariable analysis, but recent HIV diagnosis, prior AIDS, nadir CD4 cell count, last CD4 cell count, and viral load were, as were use of antiretroviral therapy, recent start of antiretroviral therapy and recent switch of antiretroviral therapy. Recent stop of antiretroviral therapy was no significant risk factor. In multivariable analysis prior AIDS, last CD4 and viral load remained significant risk factors, but use of antiretroviral therapy not. CONCLUSION In this contemporary cohort, incidence of fever was low but CD4 cell count less than 200/mm³ remained associated with the highest incidence of fever.
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Affiliation(s)
- Paul De Munter
- Department of General Internal Medicine, University Hospitals Leuven & Department of Microbiology and Immunology, KU Leuven – University of Leuven, Leuven, Belgium
| | - Inge Derdelinckx
- Department of General Internal Medicine, University Hospitals Leuven & Department of Microbiology and Immunology, KU Leuven – University of Leuven, Leuven, Belgium
| | - Willy E. Peetermans
- Department of General Internal Medicine, University Hospitals Leuven & Department of Microbiology and Immunology, KU Leuven – University of Leuven, Leuven, Belgium
| | - Steffen Fieuws
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven and Universiteit Hasselt, Leuven, Belgium
| | - Steven Vanderschueren
- Department of General Internal Medicine, University Hospitals Leuven & Department of Microbiology and Immunology, KU Leuven – University of Leuven, Leuven, Belgium
| | - Eric Van Wijngaerden
- Department of General Internal Medicine, University Hospitals Leuven & Department of Microbiology and Immunology, KU Leuven – University of Leuven, Leuven, Belgium
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Abstract
OBJECTIVES Q fever is a global zoonosis that can cause both acute and chronic infections in humans through aerogenic transmission. Although Q fever was discovered already 80 years ago, this infectious disease remains largely unknown. We studied a case series in a Belgian tertiary care hospital. METHODS A laboratory and file query at our department was performed to detect patients who were newly diagnosed with Q fever from 01 January 2005 to 01 October 2014. RESULTS In total, 10 acute Q fever and 5 chronic Q fever infections were identified. An aspecific flu-like illness was the prevailing manifestation of acute Q fever, while this was infective endocarditis in chronic Q fever cases. Noteworthy are the high percentage of myocarditis cases in the acute setting and one case of amyloidosis as a manifestation of chronic Q fever. No evolution from acute to chronic Q fever was noted; overall outcome for both acute and chronic Q fever was favourable with a 94% survival rate. DISCUSSION Q fever is an infectious disease characterised by a variable clinical presentation. Detection requires correct assessment of the clinical picture in combination with a laboratory confirmation. Treatment and follow-up are intended to avoid a negative outcome.
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26
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De Munter P, Derdelinckx I, Peetermans WE, Vanderschueren S, Van Wijngaerden E. Clinical presentation, causes and outcome of febrile episodes in a prospective cohort of HIV-infected patients. Infect Dis (Lond) 2016; 49:65-70. [PMID: 27564977 DOI: 10.1080/23744235.2016.1216655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Fever was frequently caused by opportunistic conditions in HIV-patients in the early years of the epidemic. Little is known about diagnostic spectrum and outcome of febrile episodes in patients with good access to antiretroviral therapy. METHODS We prospectively studied clinical presentation, diagnosis and outcome of febrile episodes in a contemporary cohort of HIV-patients with good access to antiretroviral therapy. Fever was defined as temperature 38.3 °C or higher, measured by a health care provider. RESULTS We found 220 febrile episodes in 146 patients. In 25.9% of episodes the patient had a CD4 less than 200/mm³ and in 78.6% the patient was on antiretroviral therapy. There were multiple episodes in 44 patients. A diagnosis was established in 91.8%. Infection accounted for 82.3%, mainly respiratory tract infections, viral syndromes and abdominal infections. Malignancy, drug reactions and inflammatory conditions accounted together for less than 12% of episodes. Fifteen percent were attributed to opportunistic conditions. Episodes in patients with CD4 less than 200 were less likely to be caused by infection, but more likely to be caused by malignancy, drug reactions and opportunistic conditions. In 6.4% the patient died within six months after the onset of fever. Risk factors for death at six months in multivariable analysis were higher age and lower CD4. CONCLUSIONS HIV-patients with access to antiretroviral therapy present with fever mostly due to conditions common in the general population. HIV-patients with low CD4 remain at risk for fever due to opportunistic conditions and death.
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Affiliation(s)
- Paul De Munter
- a Department of Microbiology and Immunology , KU Leuven - University of Leuven , Leuven , Belgium.,b Department of General Internal Medicine , University Hospitals Leuven , Leuven , Belgium
| | - Inge Derdelinckx
- a Department of Microbiology and Immunology , KU Leuven - University of Leuven , Leuven , Belgium.,b Department of General Internal Medicine , University Hospitals Leuven , Leuven , Belgium
| | - Willy E Peetermans
- a Department of Microbiology and Immunology , KU Leuven - University of Leuven , Leuven , Belgium.,b Department of General Internal Medicine , University Hospitals Leuven , Leuven , Belgium
| | - Steven Vanderschueren
- a Department of Microbiology and Immunology , KU Leuven - University of Leuven , Leuven , Belgium.,b Department of General Internal Medicine , University Hospitals Leuven , Leuven , Belgium
| | - Eric Van Wijngaerden
- a Department of Microbiology and Immunology , KU Leuven - University of Leuven , Leuven , Belgium.,b Department of General Internal Medicine , University Hospitals Leuven , Leuven , Belgium
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Declercq S, De Munter P, Derdelinckx I, Verhaegen J, Peetermans WE, Vanderschueren S, Van Wijngaerden E. Characteristics, causes, and outcome of 54 episodes of bloodstream infections in a cohort of HIV patients. Infect Dis (Lond) 2015; 47:611-7. [PMID: 25875395 DOI: 10.3109/23744235.2015.1033002] [Citation(s) in RCA: 9] [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] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients infected with human immunodeficiency virus (HIV) have an increased risk for bloodstream infections (BSIs). Published recent data on characteristics, etiology, and outcome of BSIs in HIV patients in high income countries are scarce. METHODS Blood cultures from 2001 to 2011 from adult HIV patients were retrieved. Blood cultures considered to be contamination based on isolates and clinical context were excluded. Clinical and microbiological characteristics of BSIs and patients were described, those of community-acquired and nosocomial episodes were compared, and risk factors for 6-month mortality were analyzed. RESULTS We found 54 episodes of true BSI in 46 patients. Demographics were similar to those of the source cohort of all patients followed between 2001 and 2011. In 63% there was prior AIDS, in 91% a CD4 nadir below 200/mm(3), and in 72% a latest CD4 count < 200/mm(3). In 13% of patients BSI preceded a new HIV diagnosis within 1 week. Main causative microorganisms were coagulase-negative staphylococci (26%), Streptococcus pneumoniae (20%), and Enterococcus spp. (13%). The most frequent diagnoses were pneumonia (28%) and catheter-related BSI (CRBSI) (28%); 56% of episodes were nosocomial. The 1-month mortality rate was 17%, with a cause of death apparently unrelated to the BSI in five of nine episodes. The 6-month mortality was 28%. Factors of co-morbidity or immunodeficiency other than HIV were significantly associated with 6-month mortality. CONCLUSIONS BSIs in HIV-infected patients occur predominantly in patients with advanced HIV infection. Community-acquired bacteremic pneumococcal pneumonia and nosocomial staphylococcal CRBSIs are the main causes. Mortality following BSI is high, and seems to be driven by underlying complicated HIV infection.
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Affiliation(s)
- Steven Declercq
- Department of General Internal Medicine, University Hospitals Leuven
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Cnops L, Gerard M, Vandenberg O, Van den Wijngaert S, Heyndrickx L, Willems E, Demeulemeester K, De Clerck H, Dediste A, Callens S, De Munter P, Vlieghe E, Bottieau E, Wuillaume F, Van Esbroeck M, Ariën KK. Risk of Misinterpretation of Ebola Virus PCR Results After rVSV ZEBOV–GP Vaccination. Clin Infect Dis 2015; 60:1725-6. [DOI: 10.1093/cid/civ131] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Pineda-Peña AC, Schrooten Y, Vinken L, Ferreira F, Li G, Trovão NS, Khouri R, Derdelinckx I, De Munter P, Kücherer C, Kostrikis LG, Nielsen C, Littsola K, Wensing A, Stanojevic M, Paredes R, Balotta C, Albert J, Boucher C, Gomez-Lopez A, Van Wijngaerden E, Van Ranst M, Vercauteren J, Vandamme AM, Van Laethem K. Trends and predictors of transmitted drug resistance (TDR) and clusters with TDR in a local Belgian HIV-1 epidemic. PLoS One 2014; 9:e101738. [PMID: 25003369 PMCID: PMC4086934 DOI: 10.1371/journal.pone.0101738] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [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: 02/15/2014] [Accepted: 06/10/2014] [Indexed: 11/23/2022] Open
Abstract
We aimed to study epidemic trends and predictors for transmitted drug resistance (TDR) in our region, its clinical impact and its association with transmission clusters. We included 778 patients from the AIDS Reference Center in Leuven (Belgium) diagnosed from 1998 to 2012. Resistance testing was performed using population-based sequencing and TDR was estimated using the WHO-2009 surveillance list. Phylogenetic analysis was performed using maximum likelihood and Bayesian techniques. The cohort was predominantly Belgian (58.4%), men who have sex with men (MSM) (42.8%), and chronically infected (86.5%). The overall TDR prevalence was 9.6% (95% confidence interval (CI): 7.7-11.9), 6.5% (CI: 5.0-8.5) for nucleoside reverse transcriptase inhibitors (NRTI), 2.2% (CI: 1.4-3.5) for non-NRTI (NNRTI), and 2.2% (CI: 1.4-3.5) for protease inhibitors. A significant parabolic trend of NNRTI-TDR was found (p = 0.019). Factors significantly associated with TDR in univariate analysis were male gender, Belgian origin, MSM, recent infection, transmission clusters and subtype B, while multivariate and Bayesian network analysis singled out subtype B as the most predictive factor of TDR. Subtype B was related with transmission clusters with TDR that included 42.6% of the TDR patients. Thanks to resistance testing, 83% of the patients with TDR who started therapy had undetectable viral load whereas half of the patients would likely have received a suboptimal therapy without this test. In conclusion, TDR remained stable and a NNRTI up-and-down trend was observed. While the presence of clusters with TDR is worrying, we could not identify an independent, non-sequence based predictor for TDR or transmission clusters with TDR that could help with guidelines or public health measures.
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Affiliation(s)
- Andrea-Clemencia Pineda-Peña
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- Clinical and Molecular Infectious Diseases Group, Faculty of Sciences and Mathematics, Universidad del Rosario, Bogotá, Colombia
| | - Yoeri Schrooten
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- AIDS Reference Laboratory, University Hospitals Leuven, Leuven, Belgium
| | - Lore Vinken
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Fossie Ferreira
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Guangdi Li
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Nídia Sequeira Trovão
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Ricardo Khouri
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Inge Derdelinckx
- Clinical Infectious and Inflammatory Disorders, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Paul De Munter
- Clinical Infectious and Inflammatory Disorders, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | | | | | - Kirsi Littsola
- National Institute of health and welfare, Helsinki, Finland
| | - Annemarie Wensing
- Department of Virology, University Medical Center Utrecht, The Netherlands
| | - Maja Stanojevic
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | | | | | - Jan Albert
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Charles Boucher
- Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Arley Gomez-Lopez
- Clinical and Molecular Infectious Diseases Group, Faculty of Sciences and Mathematics, Universidad del Rosario, Bogotá, Colombia
| | - Eric Van Wijngaerden
- Clinical Infectious and Inflammatory Disorders, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Marc Van Ranst
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- AIDS Reference Laboratory, University Hospitals Leuven, Leuven, Belgium
| | - Jurgen Vercauteren
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Anne-Mieke Vandamme
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- Centro de Malária e outras Doenças Tropicais and Unidade de Microbiologia, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Kristel Van Laethem
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- AIDS Reference Laboratory, University Hospitals Leuven, Leuven, Belgium
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Debeuckelaere C, De Munter P, Van Bleyenbergh P, De Wever W, Van Assche G, Rutgeerts P, Vermeire S. Tuberculosis infection following anti-TNF therapy in inflammatory bowel disease, despite negative screening. J Crohns Colitis 2014; 8:550-7. [PMID: 24295645 DOI: 10.1016/j.crohns.2013.11.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 11/07/2013] [Accepted: 11/08/2013] [Indexed: 12/15/2022]
Abstract
We present two patients with inflammatory bowel disease who, despite negative tuberculosis screening, developed a de novo tuberculosis infection after the start of anti tumor necrosis factor alpha treatment. We discuss current screening methods and their limitations, the approach after positive screening and the timing to resume anti-TNFα treatment after TB infection. We shortly mention the immune reconstitution inflammatory syndrome (IRIS), described in a few cases after the stop of anti-TNFalpha while treating the tuberculosis infection. We conclude with some remaining questions concerning tuberculosis in IBD patients.
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Affiliation(s)
- Celine Debeuckelaere
- Department of Internal Medicine, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Paul De Munter
- Department of Infectious Diseases, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Pascal Van Bleyenbergh
- Department of Respiratory Division, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Walter De Wever
- Department of Radiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Gert Van Assche
- Department of Gastroenterology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Paul Rutgeerts
- Department of Gastroenterology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Severine Vermeire
- Department of Gastroenterology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
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Libin P, Beheydt G, Deforche K, Imbrechts S, Ferreira F, Van Laethem K, Theys K, Carvalho AP, Cavaco-Silva J, Lapadula G, Torti C, Assel M, Wesner S, Snoeck J, Ruelle J, De Bel A, Lacor P, De Munter P, Van Wijngaerden E, Zazzi M, Kaiser R, Ayouba A, Peeters M, de Oliveira T, Alcantara LCJ, Grossman Z, Sloot P, Otelea D, Paraschiv S, Boucher C, Camacho RJ, Vandamme AM. RegaDB: community-driven data management and analysis for infectious diseases. Bioinformatics 2013; 29:1477-80. [PMID: 23645815 PMCID: PMC3661054 DOI: 10.1093/bioinformatics/btt162] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Summary: RegaDB is a free and open source data management and analysis environment for infectious diseases. RegaDB allows clinicians to store, manage and analyse patient data, including viral genetic sequences. Moreover, RegaDB provides researchers with a mechanism to collect data in a uniform format and offers them a canvas to make newly developed bioinformatics tools available to clinicians and virologists through a user friendly interface. Availability and implementation: Source code, binaries and documentation are available on http://rega.kuleuven.be/cev/regadb. RegaDB is written in the Java programming language, using a web-service-oriented architecture. Contact:pieter.libin@rega.kuleuven.be
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Affiliation(s)
- Pieter Libin
- Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.
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Vanderschueren S, Hermans F, De Munter P, Knockaert D. Adult-onset Still's disease: still a diagnosis of exclusion. A nested case-control study in patients with fever of unknown origin. Clin Exp Rheumatol 2012; 30:514-519. [PMID: 22510428] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 11/28/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Several sets of criteria have been proposed to classify adult-onset Still's disease (AOSD), those of Yamaguchi being the most commonly used. The Yamaguchi criteria demand the exclusion of other conditions. A clinical scale, recently proposed by Crispin et al., but not yet validated, would allow a positive diagnosis of AOSD in a majority of patients, without the need of thorough diagnostic procedures. METHODS From a database of 447 patients with classical fever of unknown origin (FUO), collected over a 10-year period (2000-2009) at a general internal medicine department of a university hospital, 22 patients with AOSD according to the Yamaguchi criteria were extracted and compared with 44 controls, matched to index year. Clinical and laboratory parameters were recorded. Sensitivity, specificity and accuracy of the Yamaguchi criteria and of the clinical score were assessed. RESULTS Lower age, joint symptoms, rash, throat ache, neutrophilic leukocytosis, and elevated erythrocyte sedimentation rate were the principal characteristics supporting a diagnosis of AOSD in patients with FUO. Sensitivity, specificity, and accuracy of the Yamaguchi criteria were 95% or more. The clinical scale, while being specific (98%), lacked sensitivity (55%) and had lower accuracy (83%). CONCLUSIONS In patients with FUO, the Yamaguchi criteria are a time honored and reliable guide to a diagnosis of AOSD. The clinical scale may serve to rule in, rather than to rule out, AOSD. In many patients, Still's disease is still a diagnosis of exclusion.
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Thai S, Koole O, Un P, Ros S, De Munter P, Van Damme W, Jacques G, Colebunders R, Lynen L. Five-year experience with scaling-up access to antiretroviral treatment in an HIV care programme in Cambodia. Trop Med Int Health 2009; 14:1048-58. [DOI: 10.1111/j.1365-3156.2009.02334.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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34
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Van Laethem K, Schrooten Y, Covens K, Dekeersmaeker N, De Munter P, Van Wijngaerden E, Van Ranst M, Vandamme AM. A genotypic assay for the amplification and sequencing of integrase from diverse HIV-1 group M subtypes. J Virol Methods 2008; 153:176-81. [PMID: 18706932 DOI: 10.1016/j.jviromet.2008.07.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 07/14/2008] [Accepted: 07/17/2008] [Indexed: 10/21/2022]
Abstract
Recently, the Food and Drug Administration (FDA) of the USA approved the first integrase inhibitor for inclusion in treatment regimens of HIV-1 patients failing their current regimens with multi-drug resistant strains. However, treatment failure has been observed during integrase inhibitor-containing therapy. Several mutational pathways have been described with signature mutations at integrase positions 66, 92, 148 and 155. Therefore, a genotypic assay for the amplification and sequencing of HIV-1 integrase was developed. The assay displayed a detection limit of 10 HIV-1 III(B) RNA copies/ml plasma. As the HIV-1 pandemic is characterised by a large genetic diversity, the new assay was evaluated on a panel of 74 genetically divergent samples belonging to the following genetic forms A, B, C, D, F, G, J, CRF01-AE, CRF02-AG, CRFF03-AB, CRF12-BF and CRF13-cpx. Their viral load ranged from 178 until >500,000 RNA copies/ml. The amplification and sequencing was successful for 70 samples (a success rate of 95%). The four failures were most probably due to low viral load or poor quality of RNA and not to subtype issues. Some of the sequences obtained from integrase inhibitor-naïve patients displayed polymorphisms at integrase positions associated with resistance: 74IV, 138D, 151I, 157Q and 163AE. The relevance of these polymorphisms in the absence of the signature mutations remains unclear.
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Affiliation(s)
- Kristel Van Laethem
- Rega Institute for Medical Research, Katholieke Universiteit Leuven, Leuven, Belgium.
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De Munter P, Peetermans W, Declerck D. [Prevention of endocarditis: changes in the recommendations]. Rev Belge Med Dent (1984) 2008; 63:29-35. [PMID: 18754537] [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] [Indexed: 05/26/2023]
Abstract
Guidelines for the prophylaxis of infective endocarditis have historically evolved and have been based on limited medical evidence. New data suggest that infectious endocarditis is much more likely to result from frequent exposure to random bacteremias associated with daily activities than from bacteremia caused by a dental, gastrointestinal (GI) or genitourinary (GU) tract procedure, that prophylaxis may prevent an exceedingly small number of cases of endocarditis in patients who undergo a dental, GI tract or GU tract procedure and that the risk of antibiotic-associated adverse events may exceed the benefit from prophylactic antibiotic therapy. Based on these data the 2007 guidelines of the American Heart Association radically limit the indications for endocarditis prophylaxis. In its new consensus guidelines, the UZ Leuven restricts candidates for endocarditis prophylaxis to patients with cardiac conditions with an increased risk for infectious endocarditis and the highest risk of an adverse outcome. Prophylaxis is indicated in these patients in case of dental procedures that involve manipulation of gingival tissue, periapical region or in case of perforation of the mucosa. Daily oral hygiene and regular evaluation and treatment by a dentist are essential in the prevention of infectious endocarditis. The publication of these guidelines intends to stimulate discussion in order to develop uniform Belgian guidelines.
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Affiliation(s)
- Paul De Munter
- Service de Médecine Interne Générale, Cliniques Universitaires Leuven
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Van Laethem K, De Munter P, Schrooten Y, Verbesselt R, Van Ranst M, Van Wijngaerden E, Vandamme AM. No response to first-line tenofovir+lamivudine+efavirenz despite optimization according to baseline resistance testing: impact of resistant minority variants on efficacy of low genetic barrier drugs. J Clin Virol 2007; 39:43-7. [PMID: 17369083 DOI: 10.1016/j.jcv.2007.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Revised: 02/02/2007] [Accepted: 02/05/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Resistance testing has been implemented into clinical guidelines as it has shown some beneficial effect on subsequent therapy response. CASE REPORT Routine population-based genotypic resistance testing for a newly diagnosed HIV-1 patient revealed the presence of resistance mutations M41L, V179D and T215E within reverse transcriptase and no mutations within protease. Four weeks after initiation of the combination tenofovir+lamivudine+efavirenz, no response was observed despite good adherence to therapy and efavirenz drug levels in the therapeutic range. Retrospective single genome sequencing of the baseline sample revealed the presence of minority viral variants with additional mutations: a mutation conferring resistance to lamivudine (M184IV), a thymidine associated mutation (K219R) and mutations possibly associated with non-nucleoside reverse transcriptase resistance (F227S, M230IV). CONCLUSIONS This case illustrates that undetected drug-resistant minority variants can reduce the efficacy of a normally very potent first-line regimen tenofovir+lamivudine+efavirenz. The presence of drug-resistance mutations at diagnosis should be considered as a warning sign against the use of low genetic barrier drugs in first-line regimens, even when these drugs are considered to be active according to routine resistance testing.
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Affiliation(s)
- Kristel Van Laethem
- Rega Institute for Medical Research, Katholieke Universiteit Leuven, Minderbroedersstraat 10, 3000 Leuven, Belgium.
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Lynen L, Teav S, Vereecken C, De Munter P, An S, Jacques G, Kestens L. Validation of Primary CD4 Gating as an Affordable Strategy for Absolute CD4 Counting in Cambodia. J Acquir Immune Defic Syndr 2006; 43:179-85. [PMID: 16940854 DOI: 10.1097/01.qai.0000242447.82403.c2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To validate primary CD4 gating in lysed whole blood for absolute CD4 counts in fresh and aged blood using an affordable compact volumetric commercial flow cytometer. DESIGN Comparison of CD4 counts between the FACSCount and the 2-parameter CyFlow SL Green. METHODS One hundred twenty fresh blood samples from patients likely to be infected with HIV were simultaneously run on a FACSCount at the Pasteur Institute of Cambodia and on a CyFlow SL Green at the Sihanouk Hospital Center of Hope (SHCH), Phnom Penh, Cambodia. Intra- and interrun precision was assessed using 2 blood samples. Stability of CD4 counting in blood stored up to 96 hours at room temperature was assessed using 27 blood samples. RESULTS CD4 counts on the CyFlow SL Green and on the FACSCount correlated well apart from a relative bias (R = 0.993, bias of -9.5%, 95% confidence interval [CI]: -11.8% to -7.1%, limits of agreement: -32.5% to 13.6%). Intra- and interrun variability ranged from 3% to 5% and from 5% to 6%, respectively. CD4 counts on aged blood using the CyFlow SL Green showed an interassay variability of <10%. CONCLUSIONS Primary CD4 gating in lysed whole blood using the CyFlow SL Green is an affordable and precise method for CD4 counting. Because the fluorescence (FL) and light scatter signals have to be analyzed manually, however, intensive training of the technician and/or operator is imperative.
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Affiliation(s)
- Lut Lynen
- Clinical and Microbiology Department, Institute of Tropical Medicine, Antwerp, Belgium
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Lynen L, Thai S, De Munter P, Leang B, Sokkab A, Schrooten W, Huyst V, Kestens L, Jacques G, Colebunders R, Menten J, van den Ende J. The Added Value of a CD4 Count to Identify Patients Eligible for Highly Active Antiretroviral Therapy Among HIV-Positive Adults in Cambodia. J Acquir Immune Defic Syndr 2006; 42:322-4. [PMID: 16688095 DOI: 10.1097/01.qai.0000221682.37316.d5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In a retrospective study of 648 persons with HIV infection in Cambodia, we determined the sensitivity, specificity, and accuracy of the 2003 World Health Organization (WHO) criteria to start antiretroviral treatment based on clinical criteria alone or based on a combination of clinical symptoms and the total lymphocyte count. As a reference test, we used the 2003 WHO criteria, including the CD4 count. The 2003 WHO clinical criteria had a sensitivity of 96%, a specificity of 57%, and an accuracy of 89% to identify patients who need highly active antiretroviral therapy (HAART). In our clinic, with a predominance of patients with advanced disease, the 2003 WHO clinical criteria alone was a good predictor of those needing HAART. A total lymphocyte count as an extra criterion did not improve the accuracy. Nine percent of patients were wrongly identified to be in need of HAART. Among them, almost 50% had a CD4 count of more than 500 cells/muL, and 73% had weight loss of more than 10% as a stage-defining condition. Our data suggest that, in settings with limited access to CD4 count testing, it might be useful to target this test to patients in WHO stage 3 whose staging is based on weight loss alone, to avoid unnecessary treatment.
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Affiliation(s)
- Lut Lynen
- Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium
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Rijnders BJA, Vandecasteele SJ, Van Wijngaerden E, De Munter P, Peetermans WE. Use of semiautomatic treatment advice to improve compliance with Infectious Diseases Society of America guidelines for treatment of intravascular catheter-related infection: a before-after study. Clin Infect Dis 2003; 37:980-3. [PMID: 13130411 DOI: 10.1086/378067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2003] [Accepted: 06/01/2003] [Indexed: 11/03/2022] Open
Abstract
In a large university hospital, the rate of noncompliance with the Infectious Diseases Society of America guidelines for treatment of catheter-related bloodstream infection (CRBSI) was 44% during 52 consecutively observed episodes of CRBSI. To decrease noncompliance, the physicians who provided care to the next 46 patients with CRBSI received standardized treatment advice by electronic mail. This simple and not labor-intensive intervention decreased guideline noncompliance from 44% to 15% (P<.01).
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Affiliation(s)
- Bart J A Rijnders
- Department of Internal Medicine and Infectious Diseases, Universitaire Ziekenhuizen Leuven, Leuven, Belgium.
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