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Pérez Marín M, Decosterd LA, Andre P, Buclin T, Mercier T, Murray K, Rizzi M, Meylan P, Jaton-Ogay K, Opota O, Gengler C, Perez MH, Natterer J, Asner SA. Compassionate Use of Letermovir in a 2-Year-Old Immunocompromised Child With Resistant Cytomegalovirus Disease. J Pediatric Infect Dis Soc 2020; 9:96-99. [PMID: 31183500 DOI: 10.1093/jpids/piz033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 05/06/2019] [Indexed: 11/14/2022]
Abstract
Little information on the efficacy and pharmacokinetics of letermovir among immunocompromised children is currently available. We describe here the use of letermovir in a 2-year-old immunocompromised child with ganciclovir-resistant cytomegalovirus disease who required extracorporeal membrane oxygenation. Detailed information on therapeutic-drug-monitoring measures and dosage adjustments for letermovir is provided.
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Affiliation(s)
- Maria Pérez Marín
- Pediatric Intensive Care Unit, University Hospital Center and University of Lausanne, Switzerland
| | - Laurent Arthur Decosterd
- Service of Clinical Pharmacology, University Hospital Center and University of Lausanne, Switzerland
| | - Pascal Andre
- Service of Clinical Pharmacology, University Hospital Center and University of Lausanne, Switzerland
| | - Thierry Buclin
- Service of Clinical Pharmacology, University Hospital Center and University of Lausanne, Switzerland
| | - Thomas Mercier
- Service of Clinical Pharmacology, University Hospital Center and University of Lausanne, Switzerland
| | - Kristina Murray
- Pediatric Infectious Diseases and Vaccinology Unit, Woman-Mother-Child Department, University Hospital Center and University of Lausanne, Switzerland
| | - Mattia Rizzi
- Pediatric Hematology-Oncology Unit, University Hospital Center and University of Lausanne, Switzerland
| | - Pascal Meylan
- Institute of Microbiology, Department of Laboratories, University Hospital Center and University of Lausanne, Switzerland
| | - Katia Jaton-Ogay
- Institute of Microbiology, Department of Laboratories, University Hospital Center and University of Lausanne, Switzerland
| | - Onya Opota
- Institute of Microbiology, Department of Laboratories, University Hospital Center and University of Lausanne, Switzerland
| | - Carole Gengler
- Department of Pathology, University Hospital Center and University of Lausanne, Switzerland
| | - Marie-Hélène Perez
- Pediatric Intensive Care Unit, University Hospital Center and University of Lausanne, Switzerland
| | - Julia Natterer
- Pediatric Intensive Care Unit, University Hospital Center and University of Lausanne, Switzerland
| | - Sandra Andrea Asner
- Pediatric Infectious Diseases and Vaccinology Unit, Woman-Mother-Child Department, University Hospital Center and University of Lausanne, Switzerland.,Infectious Diseases Service, Department of Medicine, University Hospital Center and University of Lausanne, Switzerland
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Fouriki A, Fougère Y, De Camaret C, Blanchard Rohner G, Grazioli S, Wagner N, Relly C, Pachlopnik Schmid J, Trück J, Kottanatu L, Perez E, Perez MH, Schaffner D, Asner SA, Hofer M. Case Report: Case Series of Children With Multisystem Inflammatory Syndrome Following SARS-CoV-2 Infection in Switzerland. Front Pediatr 2020; 8:594127. [PMID: 33469522 PMCID: PMC7813982 DOI: 10.3389/fped.2020.594127] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/23/2020] [Indexed: 12/21/2022] Open
Abstract
Since the beginning of the severe SARS-CoV-2 pandemic, an increasing number of countries reported cases of a systemic hyperinflammatory condition defined as multi-system inflammatory syndrome in children (MIS-C). The clinical features of MIS-C can be an overlap of Kawasaki Disease (KD), Toxic Shock Syndrome (TSS), Macrophage Activation Syndrome (MAS), or have often an acute abdominal presentation. Intravenous immunoglobulin (IVIG) is recommended as first line therapy in KD. Recent evidence suggests intravenous immunoglobulins (IVIG) resistance in some cases of SARS-CoV-2 related MIS-C, thereby questioning the benefit of immunomodulators such as IL-1 or IL-6 blocking agents. We report on a cohort of 6 Swiss children with SARS-CoV2 related MIS-C presenting with clinical features compatible with Incomplete KD and Toxic Shock Syndrome associated to a cytokine storm. Serum cytokine profile investigations showed increased IL1RA levels (8 to 22-fold) in 5 of the 6 patients (one patient had not been tested), whereas, IL-6 serum levels were increased only in the 3 patients of the 6 who were tested. With exception of one patient who had only benefited by Anakinra, all patients received at least one dose of IVIG. One patient has only received Anakinra with favorable evolution, and three patients had also a steroid treatment. In addition to all this anti-inflammatory medication two patients have also received one dose of anti-IL6. In conclusion, our case series reports on clinical and laboratory findings of most of Swiss cases with MIS-C and suggests the use of Anakinra as an alternative to steroids in these children, most of whom presented with high IL-1RA levels.
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Affiliation(s)
- Athina Fouriki
- Pediatric Immuno-Rheumatology of Western Switzerland, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.,Pediatric Immuno-Rheumatology, Department of Paediatrics, University Hospital, Geneva, Switzerland
| | - Yves Fougère
- Pediatric Infectious Diseases and Vaccinology Unit, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Caroline De Camaret
- Pediatric Immuno-Rheumatology of Western Switzerland, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.,Pediatric Immuno-Rheumatology, Department of Paediatrics, University Hospital, Geneva, Switzerland
| | - Géraldine Blanchard Rohner
- Pediatric Immunology and Vaccinology Unit, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Serge Grazioli
- Division of Neonatal and Pediatric Intensive Care, Department of Paediatrics, Gynecology and Obstetrics, Geneva University Hospital, Geneva, Switzerland
| | - Noémie Wagner
- Pediatric Infectious Diseases Unit, Department of Paediatrics, Gynecology and Obstetrics, Geneva University Hospital, Geneva, Switzerland
| | - Christa Relly
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | | | - Johannes Trück
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland.,Pediatric Immunology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Lisa Kottanatu
- Pediatric Infectious Diseases, Pediatric Institute of Southern Switzerland, Regional Hospital of Bellinzona, Bellinzona, Switzerland
| | | | - Marie-Helene Perez
- Pediatric Intensive Care Unit, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Damien Schaffner
- Pediatric Cardiology Unit, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Sandra Andrea Asner
- Pediatric Infectious Diseases and Vaccinology Unit, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Michael Hofer
- Pediatric Immuno-Rheumatology of Western Switzerland, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.,Pediatric Immuno-Rheumatology, Department of Paediatrics, University Hospital, Geneva, Switzerland
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Kobas M, Bickle Graz M, Truttmann AC, Giannoni E, Meylan P, Asner SA. Erratum to: Clinical characteristics, audiological and neurodevelopmental outcomes of newborns with congenital cytomegalovirus infection. Swiss Med Wkly 2019; 149:w20075. [DOI: 10.4414/smw.2019.20075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Kobas M, Bickle Graz M, Truttmann AC, Giannoni E, Meylan P, Asner SA. Clinical characteristics, audiological and neurodevelopmental outcomes of newborns with congenital cytomegalovirus infection. Swiss Med Wkly 2018; 148:w14627. [PMID: 29894555 DOI: 10.4414/smw.2018.14627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Congenital cytomegalovirus (cCMV) infections are the leading nongenetic cause of congenital sensorineural hearing loss (SNHL); however the true impact of cCMV infections remains unknown. AIMS OF THE STUDY (1) To identify the number of asymptomatic and symptomatic cCMV infections diagnosed between 1999 and 2014 at the Lausanne University Hospital; (2) to describe the audiological and neurodevelopmental outcomes of infants with cCMV infection; and (3) to compare clinical outcomes between infants born to mothers with primary versus nonprimary infection. METHODS This was a single-centre, observational, exploratory, retrospective study of newborns diagnosed with cCMV infection at the Lausanne University Hospital between 1999 and 2014. RESULTS Fifty newborns with cCMV infection were identified; 39 (78%) were symptomatic at birth, of whom 29 (74%) were neurologically symptomatic. Twelve children (24%) presented with subsequent abnormal audiological and/or neurodevelopmental outcomes. Newborns born to mothers with a nonprimary infection were more often symptomatic at birth than those born to mothers with a primary infection. CONCLUSIONS All infants with subsequent SNHL or abnormal neurodevelopment were symptomatic at birth. Similar long-term neurodevelopmental and audiological outcomes were observed in infants born to mothers with a primary and nonprimary infection.
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Affiliation(s)
- Manuela Kobas
- Faculty of Biology and Medicine, University of Lausanne, Switzerland
| | - Myriam Bickle Graz
- Follow-up Unit, Clinic of Neonatology, Department Woman-Mother-Child, Lausanne University Hospital, Switzerland / Clinic of Neonatology, Department Woman-Mother-Child, Lausanne University Hospital, Switzerland
| | - Anita Carmen Truttmann
- Clinic of Neonatology, Department Woman-Mother-Child, Lausanne University Hospital, Switzerland
| | - Eric Giannoni
- Clinic of Neonatology, Department Woman-Mother-Child, Lausanne University Hospital, Switzerland
| | - Pascal Meylan
- Institute of Microbiology, Department of Laboratories, Lausanne University Hospital, Switzerland / Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Switzerland
| | - Sandra Andrea Asner
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Switzerland / Paediatric Infectious Diseases and Vaccinology Unit, Department Woman-Mother-Child, Lausanne University Hospital, Switzerland
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Asner SA, Morré SA, Bochud PY, Greub G. Host factors and genetic susceptibility to infections due to intracellular bacteria and fastidious organisms. Clin Microbiol Infect 2014; 20:1246-53. [PMID: 25366416 DOI: 10.1111/1469-0691.12806] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/24/2014] [Accepted: 10/24/2014] [Indexed: 12/14/2022]
Abstract
While genetic polymorphisms play a paramount role in tuberculosis (TB), less is known about their contribution to the severity of diseases caused by other intracellular bacteria and fastidious microorganisms. We searched electronic databases for observational studies reporting on host factors and genetic predisposition to infections caused by intracellular fastidious bacteria published up to 30 May 2014. The contribution of genetic polymorphisms was documented for TB. This includes genetic defects in the mononuclear phagocyte/T helper cell type 1 (Th1) pathway contributing to disseminated TB disease in children and genome-wide linkage analysis (GWAS) in reactivated pulmonary TB in adults. Similarly, experimental studies supported the role of host genetic factors in the clinical presentation of illnesses resulting from other fastidious intracellular bacteria. These include IL-6 -174G/C or low mannose-binding (MBL) polymorphisms, which are incriminated in chronic pulmonary conditions triggered by C. pneumoniae, type 2-like cytokine secretion polymorphisms, which are correlated with various clinical patterns of M. pneumoniae infections, and genetic variation in the NOD2 gene, which is an indicator of tubal pathology resulting from Chamydia trachomatis infections. Monocyte/macrophage migration and T lymphocyte recruitment defects are corroborated to ineffective granuloma formation observed among patients with chronic Q fever. Similar genetic polymorphisms have also been suggested for infections caused by T. whipplei although not confirmed yet. In conclusion, this review supports the paramount role of genetic factors in clinical presentations and severity of infections caused by intracellular fastidious bacteria. Genetic predisposition should be further explored through such as exome sequencing.
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Affiliation(s)
- S A Asner
- Service of Infectious Diseases, Department of Internal Medicine, University Hospital Center, Lausanne, Switzerland; Unit of Pediatric Infectious Diseases and Vaccinology, Department of Paediatrics, University Hospital Center, Lausanne, Switzerland
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