Cytomegalovirus infection as an underestimated trigger for checkpoint inhibitor-related pneumonitis in lung cancer: a retrospective study

Objectives Checkpoint inhibitor-related pneumonitis (CIP) is a rare but potentially fatal complication of immune checkpoint inhibitors (ICIs). At present, the mechanism of CIP is not completely clear. Cytomegalovirus (CMV) infection is widespread in the population. Chemotherapy and radiotherapy can lead to the reactivation of CMV. We aimed to investigate the association between CMV infection and CIP. Materials and methods We retrospectively identified all lung cancer patients treated with ICIs at our institute from January 2016 to May 2020. The association between the development of CIP and CMV infection status was analyzed. Results Among 251 cases analyzed, 29 (11.6%) patients with CIP were identified, of whom 12 (4.78%) cases had grade 3–4 CIP. All 12 patients with grade 3–4 pneumonitis were CMV-IgG-positive, indicating a previous CMV infection. Except for one CMV-DNA-positive patient, the other patients were CMV-DNA-negative. All but one patient was CMV pp65 antigen-positive, indicating an early reactivation of the virus. The histological features of CMV pneumonia were not found in all available lung tissues, including lung transplantation pathology in one patient and lung biopsies in three patients. Except for one patient who received delayed antiviral therapy, the symptoms improved after glucocorticoid combined with antiviral therapy. Conclusions The use of ICIs can restore the immune function and cause an immune response to CMV antigen while the infection is still latent. Our study suggests that CIP may be an immune reconstitution syndrome associated with CMV infection. CMV infection may represent a potentially important trigger for CIP. Patients with severe CIP should be vigilant against CMV infection. The early use of glucocorticoid combined with antiviral therapy is pivotal to good prognosis (AU)

Riesgo de reactivación de la hepatitis B asociado al tratamiento con corticoides frente a SARS-CoV-2 (COVID-19) / Risk of hepatitis B reactivation associated with treatment against SARS-CoV-2 (COVID-19) with corticosteroids

No disponible

Quimioterapia y reactivación oculta del VHB en pacientes de hemodiálisis / Chemotherapy and occult reactivation of HBV in hemodialysis patients

No disponible

Riesgo de reactivación de infección por virus hepatitis B en pacientes con psoriasis en tratamiento con secukinumab: una serie de 4 casos / Risk of Hepatitis B Virus Reactivation in Patients on Secukinumab for Psoriasis: A Series of 4 Cases

No disponible

Reactivación silenciosa del virus de la hepatitis B en paciente que reinicia diálisis tras trasplante renal. ¿Cómo podemos prevenirlo o anticiparlo en el diagnóstico? / Reactivation of hepatitis B virus in patient that rests dialysis after renal transplantation. How can we prevent it or anticipate it in diagnosis?

No disponible

Controversias sobre el tratamiento con IECA/ARA-II y Covid-19 / Controversy regarding ACE inhibitors / ARBs in Covid-19

No disponible

¿Cuándo puede ser útil buscar VHB oculto en pacientes en hemodiálisis? / When can it be useful to look for occult HBV in hemodialysis patients?

No disponible

Reactivación de la hepatitis B asociada a agentes inmunodepresores y a quimioterapia. Historia natural, factores de riesgo y recomendaciones para prevenirla / Reactivation of hepatitis B associated with immunosuppressants and chemotherapy. Natural history, risk factors and recommendations for prevention

A pesar de que el riesgo de reactivación de la hepatitis B en los pacientes tratados con inmunosupresores es conocido desde hace años y de la existencia de recomendaciones, los datos procedentes de algunas encuestas indican que el estudio del perfil serológico de la infección por el VHB antes de iniciar el tratamiento inmunosupresor no es una práctica universal. Teniendo en cuenta las consecuencias graves que puede comportar la reactivación de la infección por el VHB, creemos que es necesario divulgar la importancia de este problema entre los profesionales sanitarios que prescriben estos tratamientos así como de las recomendaciones a seguir. De hecho, en los últimos años, es cada vez más frecuente el empleo de quimioterapia e inmunosupresores potentes en pacientes con procesos neoplásicos y en patología no neoplásica de diversas especialidades, aumentando la población de pacientes con riesgo de reactivación del VHB

Although the risk of reactivation of hepatitis B in patients treated with immunosuppressants has been known for years and, if there are recommendations, data from some surveys indicate that the study of the serological profile of HBV infection before starting immunosuppressive treatment is not universal practice. Taking into account the serious consequences that the reactivation of the infection with HBV may entail, we believe that it is necessary to disclose the importance of this problem among the health professionals who prescribe these treatments as well as the recommendations to be followed. In fact, in recent years, the use of chemotherapy and potent immunosuppressants in patients with neoplastic processes and in non-neoplastic pathology of various specialties has been increasingly frequent, increasing the population of patients at risk of reactivation of HBV

Hepatitis B en pacientes con hepatitis C tratados con agentes antivirales directos / Hepatitis B virus in patients with chronic hepatitis C treated with direct antiviral agents

Introducción: se han comunicado casos de reactivación de virus de la hepatitis B (VHB) en pacientes con virus de la hepatitis C (VHC) tratados con agentes antivirales directos (AAD). Objetivos y métodos: los objetivos del presente estudio son: a) conocer la prevalencia de la coinfección VHB/VHC en pacientes VHC tratados con AAD en la Comunidad de Madrid (CM) y determinar la incidencia y relevancia clínica de la reactivación del VHB; y b) conocer las tasas de cribado del VHB en pacientes VHC en nuestra comunidad. Se evaluaron 1.337 pacientes VHC consecutivos tratados con AAD en dos hospitales del sur de la CM desde enero de 2015 hasta junio de 2017. Resultados: nueve de los 1.337 (0,67%) presentaban HBsAg positivo y 356 (26,6%) presentaban algún marcador de infección VHB pasada. Dos de los cuatro (50%) pacientes HBsAg positivo sin tratamiento desarrollaron reactivación virológica VHB pero no bioquímica. De los 356 con patrón de infección VHB pasada, el 100% presentó transaminasas normales al finalizar el tratamiento y durante el seguimiento. La tasa de cribado VHB ascendió al 92,9% de la cohorte. Conclusiones: la prevalencia de infección VHB (HBsAg positivos) en pacientes con hepatitis crónica por VHC en la zona sur de la CM es baja. La reactivación del VHB en pacientes HBsAg positivo que reciben AAD es frecuente, pero sin relevancia clínica. En nuestro medio existe una alta tasa de cribado del VHB en pacientes con VHC candidatos a recibir AAD

Introduction: cases of hepatitis B virus (HBV) reactivation have been reported in patients with hepatitis C virus (HCV) treated with direct antiviral agents (DAA). Objectives and methods: the main objectives of the present study are: a) to determine the prevalence of HBV/HCV coinfection in HCV patients treated with DAAs in the Autonomous Community of Madrid (CM) and also to determine the incidence and clinical relevance of HBV reactivation; and b) to determine the HBV screening rates in HCV patients in our region. For that purpose, 1,337 HCV patients were consecutively treated with DAAs in two hospitals located in South CM between January 2015 and June 2017. Results: nine of the 1,337 (0.67%) participants were HBsAg positive and 356 (26.6%) had previous HBV infection markers. Two of the four (50%) HBsAg positive patients with untreated HBV developed a virological reactivation, but not a biochemical reaction. Of the 356 patients with previous HBV infection markers, all had normal transaminases at the end of treatment and during follow-up. The HBV screening rate amounted to 92.9% of the cohort. Conclusions: the prevalence of HBV (HBsAg positive) infection in patients with chronic hepatitis C in the southern area of the CM is low. HBV reactivation in HBsAg positive patients treated with DAAs is common, although without clinical relevance. In our region, there is a high rate of HBV screening in patients with HCV that are likely treated with DAAs

Reactivation of Hepatitis B virus in kidney transplant recipients with previous clinically resolved infection: A single-center experience / Reactivación del virus de la hepatitis B en receptores de trasplante renal con infección previa resuelta clínicamente: una experiencia de un solo centro

BACKGROUND: Hepatitis B virus (HBV) reactivation in kidney transplant recipients (KTR) involves important morbidity and mortality. Despite being more common in patients who are HBsAg-positive, it may occur in patients with clinically resolved infection (HBsAg-negative and anti-HBc-positive), in whom the presence of the protective anti-HB antibody is thought to decrease the risk of reactivation. Data regarding reactivation rates in this population are scarce. OBJECTIVE: To retrospectively evaluate the risk of HBV reactivation in KTR with previously resolved infection. MATERIAL AND METHODS: Retrospective cohort study including patients who underwent a kidney transplant between January 1994 and December 2014 with resolved HBV infection at the time of transplantation (anti-HBc seropositivity without detectable HBsAg, with or without anti-HB-positive antibodies and normal liver enzymes). RESULTS: Out of 966 patients, 95 patients with evidence of resolved HBV infection were analyzed, of which 86 had a titer of anti-HBs >10 mIU/ml. Mean follow-up time was 93 months; 12 patients had lost anti-HBs. Two patients showed evidence of reactivation. Risk factors associated with loss of anti-HBs were elderly age (>60) and occurrence of acute graft rejection (p < 0.05). CONCLUSION: The risk of HBV reactivation in KTR with previously resolved infection is not negligible at 2%. Elderly age and acute rejection were associated with loss of anti-HBs, and these patients may benefit from closer monitoring of HBV DNA levels. Routine serology and/or HBV viral load monitoring in HBsAg-negative, anti-HBc-positive patients is recommended and should be emphasized in these patients

INTRODUCCIÓN: La reactivación del virus de la hepatitis B (VHB) en receptores de trasplante renal (RTR) supone una importante morbilidad y mortalidad. A pesar de ser más frecuente en pacientes con HBsAg positivo, puede suceder en pacientes con infección clínicamente resuelta (HBsAg-negativo y anti-HBc-positivo). En estos casos, la presencia del anticuerpo protector anti-HBs parece disminuir el riesgo de reactivación. Existen escasos datos relativos a las tasas de reactivación en esta población. OBJETIVOS: Evaluación retrospectiva del riesgo de reactivación del VHB en RTR con infección previa resuelta. MATERIAL Y MÉTODOS: Estudio de cohorte retrospectivo, incluyendo RTR entre enero de 1994 y diciembre de 2014, con infección VHB resuelta en el momento del trasplante (anti-HBc seropositivo, HBsAg indetectable, con o sin anticuerpo anti-HBs e enzimas hepáticas normales). RESULTADOS: De un total de 966, 95 pacientes con evidencia de infección VHB resuelta fueron analizados; 86 tenían un título de anti-HBs > 10 mIU/ml. El tiempo medio de seguimiento fue de 93 meses, 12 pacientes habían perdido anti-HBs. Dos pacientes tuvieron evidencia de reactivación. Los factores de riesgo asociados a la pérdida de anti-HBs fueron la edad avanzada (> 60) y la evidencia de rechazo agudo del injerto (p < 0,05). CONCLUSIÓN: El riesgo de reactivación del VHB en RTR con infección previamente resuelta (2%) no es despreciable. La edad avanzada y el rechazo agudo están asociados a la pérdida de anti-HBs, y estos pacientes podrían beneficiarse de una vigilancia de los niveles de DNA del VHB. Las serologías de rutina y/o la monitorización de la carga viral en pacientes HBsAg-negativo, anti-HBc-positivo está recomendado y debería ser enfatizado en estos pacientes

Dermatitis granulomatosa postherpética en un paciente tratado con nivolumab / Postherpetic Granulomatous Dermatitis in a Man Treated With Nivolumab

No disponible

Reactivación del virus de la hepatitis B tras el cese de la profilaxis con entecavir en un paciente con leucemia linfoblástica tipo Burkitt tratado con rituximab / Hepatitis B virus reactivation after cessation of prophylaxis with entecavir in a patient with Burkitt type acute lymphoblastic leukaemia treated with rituximab

No disponible

Mieloradiculitis por reactivación del virus Epstein-Barr en paciente con Linfoma de Hodking / Myeloradiculitis due to Epstein-Barr virus reactivation in a Hodgkin's lymphoma patient

No disponible

Importancia del despistaje del virus de la hepatitis B en los pacientes hematológicos / Importance of hepatitis B virus screening in hematological patients

No disponible

Reactivación del virus de la hepatitis B en pacientes tratados con rituximab: incidencia y factores de riesgo / Hepatitis B virus reactivation in rituximab-treated patients: incidence and risk factors

La reactivación del virus de la hepatitis B en pacientes tratados con quimioterapia es una complicación conocida. La incidencia y los factores de riesgo aún no están bien definidos. El objetivo de nuestro estudio es determinar la incidencia y los factores de riesgo de la reactivación del virus de la hepatitis B en pacientes tratados con rituximab (RTX), e investigar si la dosis acumulada de RTX es un factor de riesgo independiente para la reactivación del virus de la hepatitis B. Se revisaron de forma retrospectiva 320 pacientes tratados con RTX en nuestro hospital, de los cuales 42 (13,12%) tenían marcadores serológicos de hepatitis B. Durante el seguimiento, 9 (21%) de los 42 pacientes con marcadores serológicos del virus de la hepatitis B presentaron una reactivación. Los factores de riesgo para la reactivación del virus de la hepatitis B fueron la presencia de HBsAg positivo (p < 0,05), anti-HBc aislado (p < 0,05), el linfoma de la zona marginal y linfoma de células del manto (p < 0,05) y la mediana de la dosis de rituximab tendió a ser mayor en los pacientes que presentaron reactivación (p = 0,06)

Hepatitis B virus (HBV) reactivation after chemotherapy regimens is a well-known complication. The incidence and risk factors for HBV reactivation remain to be elucidated. We aimed to determine the incidence and risk factors for HBV reactivation in patients receiving rituximab, and the potential role of the cumulative rituximab dose in HBV reactivation. We retrospectively reviewed 320 patients receiving rituximab in our hospital. Of these, 42 (13.12%) had serological markers of hepatitis B. During follow-up, 21% (9/42) had HBV reactivation. Risk factors for reactivation were HBsAg positivity (p < 0.05), isolated anti-HBc positivity (p < 0.05), marginal zone lymphoma, and Mantle cell lymphoma (p < 0.05). The median rituximab dose tended to be higher in patients with reactivation (p = 0.06)

Las células natural killer y su papel en la respuesta inmunitaria durante la infección por el virus de la inmunodeficiencia humana tipo-1 / Natural killer cells and their role in the immune response during Human immunodeficiency virus type-1 infection

Durante la infección por el virus de la inmunodeficiencia humana tipo-1 (VIH-1) se presentan alteraciones en la frecuencia, el fenotipo y la función de las células NK, lo cual reduce su capacidad antiviral y se correlaciona con el incremento de la carga viral y la progresión a sida. Sin embargo, los estudios en individuos que presentan resistencia natural al VIH-1 han mostrado que estas células intervienen en el control de la replicación viral, con efectos antivirales directos y con la activación de células dendríticas, otro componente de la inmunidad innata. A pesar de que estos linfocitos no poseen receptores antigénicos específicos, recientemente se ha reportado su capacidad para responder a péptidos del VIH-1. Aunque el mecanismo no está completamente elucidado, es indudable que este hallazgo abre un nuevo panorama en el estudio de nuevas alternativas terapéuticas o preventivas contra la infección por VIH-1 que involucren a las células NK (AU)

During human immunodeficiency virus type-1 (HIV-1) infection there are several changes in the frequency, phenotype and function of NK cells, altering their antiviral response. This is correlated with increased viral loads, and AIDS progression. However, studies in individuals with natural resistance to HIV-1 infection have shown that NK cells are very important incontrolling viral replication, not only for their antiviral activity, but also because of their effects on the activity of other innate immune cells, such as dendritic cells. NK cells do not have antigen receptors, but it has been recently reported that they can specifically respond to HIV-1 peptides. Although the mechanism is not fully elucidated, this finding open more options in the study of new therapeutic or preventative strategies against HIV-1 infection (AU)

Prácticas de cribado del virus de la hepatitis B previo a las terapias de riesgo de reactivación vírica en diferentes especialidades médicas. Proyecto HEBRA / Screening practices for hepatitis B virus prior to viral reactivation risk therapies among different medical specialties. HEBRA Project

No disponible

Induction, structural characterization, and genome sequence of Lv1, a prophage from a human vaginal Lactobacillus jensenii strain

The prophage Lv1, harbored by a vaginal Lactobacillus jensenii isolate, was induced by several different anticancer, antimicrobial, and antiseptic agents, suggesting that they contribute to the adverse vaginal effects associated with their therapeutic use. Of special interest with respect to its novelty was the inducing effect of nonoxynol-9, a non-ionic detergent commonly used as a spermicide. The Lv1 genome consists of a 38,934-bp dsDNA molecule with cohesive ends, in which 48 ORFs were recognized, and is organized into functional modules. Lv1 belongs to the family Siphoviridae and, more precisely, to the proposed Sfi21-like genus. The capsid-tail junction of the Lv1 virions is fragile such that most particles become disrupted, suggesting that the virus is defective and thus unable to generate fertile progeny. However, genome analysis did not provide evidence of the defective nature of the prophage, other than the finding that its genome is shorter than those of other, related, phages. Further analysis indicated that prophage Lv1 suffered deletions in its right half to the extent that it no longer fulfill the minimum packaging limits, thereby generating the observed unstable particles (AU)

No disponible

Reactivación de la hepatitis B en un paciente HBsAg negativo/antiHBc positivo con linfoma B que recibió quimioterapia con rituximab / Hepatitis B reactivation in an HbsAg-negative/anti-HBc-positive patient with B-cell non-Hodgkin lymphoma receiving chemotherapy with rituximab

La reactivación de la infección por el VHB en pacientes con infección resuelta se detecta en pocas ocasiones, usualmente asociado a un tratamiento inmunosupresor y conlleva una morbilidad y mortalidad altas. Se ha publicado en la literatura médica algunos casos de reactivación de la infección por el VHB asociada al empleo de rituximab y nosotros presentamos otro paciente, con un linfoma no Hodgkin B, que tras recibir quimioterapia en combinación con rituximab sufrió una reactivación seguida de fallo hepático. Se revisa y comenta la literatura más reciente en relación a este tema (AU)

Reactivation of hepatitis B virus infection in patients with resolved infection is rare and is usually associated with immunosuppressive therapy. Morbidity and mortality are high. Some cases of hepatitis B reactivation associated with the use of rituximab have previously been published. We present the case of a patient with B-cell non-Hodgkin lymphoma receiving combination chemotherapy with rituximab who showed hepatitis B reactivation followed by liver failure. The most recent literature on this topic is reviewed and discussed (AU)

Bacteriophage induction versus vaginal homeostasis: role of H2O2 in the selection of Lactobacillus defective prophages

Vaginal disorders associated with systemic chemotherapy arise by direct inhibition of the resident microbiota (dominated by lactobacilli) or, possibly, by induction of prophages harbored in their genomes, leading to cell lysis. In the present study, proficient Lactobacillus phages could not be isolated from vaginal exudates. However, lysogeny appeared to be widespread, although about half of the strains harbored prophage sequences that were not responsive to SOS activation. In other cases, prophage induction was achieved, but viable phages were not generated, despite the fact that the induced supernatants of some strains were bactericidal. In one case, this activity was accompanied by the production of a bacteriophage subsequently identified as a member of the family Siphoviridae (isometric capsid and long non-contractile tail). Most of the lactobacilli tested generated hydrogen peroxide, which acted as an inducer of the SOS response, suggesting that H2O2 selects for strains that harbor SOS-insensitive, defective prophages, which are thus unable to promote vaginal lactobacilli phage-induced lysis (AU)

No disponible