RESUMO
BACKGROUND: To evaluate the enterovirus (EV)-positivity rate in respiratory samples collected from children ≤15 years hospitalized with severe acute respiratory infections (SARIs) and to describe the epidemiologic and molecular characteristics of EVs. METHODS: Respiratory samples were collected from 2468 children hospitalized with SARI at a university and research hospital in Milan (September 1, 2014 to August 31, 2017). EV and EV-D68 RNA were detected using a commercial multiplex and a specific real-time RT-PCR assay, respectively. The EV-D68-negative samples were then characterized by partial sequencing of the VP1 gene. RESULTS: EV-RNA was detected in 9% (222/2468) of SARI cases, 77% were children ≤3 years, almost 13% of whom required intensive care. EVs circulated all-year-round in 2 distinct epidemic waves (May-August and November-December). An EV-D68 outbreak, responsible for 14.8% of EV-positive-SARIs, occurred in 2016 and 5 newly emerging EV types were identified. Twenty-two EV types were detected and remarkable heterogeneity was observed in species distribution and between different pediatric age groups. CONCLUSIONS: This study showed that EV-positivity rate for our SARI series was 9%. The molecular detection and characterization of EVs allowed for the rapid detection of an EV-D68 outbreak and revealed the presence of emerging EV types that may pose a public health threat. The lack of routine screening and EV characterization in respiratory tract infections hampers the assessment of their epidemiologic and molecular features.
Assuntos
Enterovirus Humano D/genética , Infecções por Enterovirus/epidemiologia , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/virologia , Doença Aguda/epidemiologia , Adolescente , Proteínas do Capsídeo/genética , Criança , Pré-Escolar , Surtos de Doenças , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Itália/epidemiologia , Masculino , FilogeniaRESUMO
Short-term administration of the entry inhibitor myrcludex-B (MyrB) has been shown to be safe and effective in phase II studies in patients coinfected with hepatitis B virus (HBV) and hepatitis delta virus (HDV). However, its effectiveness and safety are unknown during long-term and high-dose treatment of patients with compensated cirrhosis in real-life settings. Herein, we describe the first 3 European patients with HDV-related compensated cirrhosis who were treated with MyrB 10â¯mg/day for 48â¯weeks as a compassionate therapy. Liver function tests, bile acids, and virological markers were monitored every 4â¯weeks. HBV/HDV-specific T cell quantity (up to 48 and 36â¯weeks) and HBV RNA levels were also assessed in 2 cases. During MyrB treatment, HDV RNA levels progressively declined from 4.4 and 5.6 logs IU/ml to undetectability in 2 cases, and from 6.8 log copies/ml to 500 copies/ml for the other patient. Alanine aminotransferase normalised after 20, 12 and 28â¯weeks, respectively. A significant improvement in features of portal hypertension, liver function tests and alpha-fetoprotein levels were documented in 2 cases. In the male patient with histological and clinical stigmata of autoimmune hepatitis, IgG and immunoglobulins rapidly normalised. No significant changes in HBV surface antigen levels and circulating HBV/HDV-specific T cells were demonstrated; HBV DNA and HBV RNA levels remained undetectable throughout the study period. MyrB was well tolerated; patients remained fully asymptomatic despite a significant increase of bile acids. In conclusion, this report shows excellent safety and effectiveness of a 48-week course of MyrB 10â¯mg/day, combined with tenofovir disoproxil fumarate, for the treatment of HDV-related compensated cirrhosis.
Assuntos
Vírus da Hepatite B , Hepatite B Crônica , Hepatite D , Vírus Delta da Hepatite , Lipopeptídeos , Cirrose Hepática , Tenofovir , Idoso , Antivirais/administração & dosagem , Antivirais/efeitos adversos , Coinfecção/tratamento farmacológico , Relação Dose-Resposta a Droga , Monitoramento de Medicamentos/métodos , Quimioterapia Combinada , Duração da Terapia , Feminino , Vírus da Hepatite B/efeitos dos fármacos , Vírus da Hepatite B/genética , Vírus da Hepatite B/isolamento & purificação , Hepatite B Crônica/sangue , Hepatite B Crônica/fisiopatologia , Hepatite B Crônica/terapia , Hepatite D/sangue , Hepatite D/fisiopatologia , Hepatite D/terapia , Hepatite D/virologia , Vírus Delta da Hepatite/efeitos dos fármacos , Vírus Delta da Hepatite/genética , Vírus Delta da Hepatite/isolamento & purificação , Humanos , Lipopeptídeos/administração & dosagem , Cirrose Hepática/sangue , Cirrose Hepática/terapia , Cirrose Hepática/virologia , Testes de Função Hepática/métodos , Masculino , Pessoa de Meia-Idade , Gravidade do Paciente , RNA Viral/isolamento & purificação , Tenofovir/administração & dosagem , Tenofovir/efeitos adversos , Resultado do TratamentoRESUMO
Between September and October 2018, an enterovirus D68 (EV-D68) outbreak occurred in patients hospitalised with severe acute respiratory infection in northern Italy; 21 laboratory-confirmed cases were reported. Phylogenetic analysis revealed that 16/20 of the EV-D68 sequences belonged to a divergent group within the sub-clade D1. Since its upsurge, EV-D68 has undergone rapid evolution with the emergence of new viral variants, emphasising the need for molecular surveillance that include outpatients with respiratory illness.
Assuntos
Enterovirus Humano D/genética , Enterovirus Humano D/isolamento & purificação , Infecções por Enterovirus/diagnóstico , Infecções por Enterovirus/virologia , Infecções Respiratórias/virologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteínas do Capsídeo/genética , Criança , Pré-Escolar , Surtos de Doenças , Enterovirus Humano D/classificação , Infecções por Enterovirus/epidemiologia , Feminino , Humanos , Lactente , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Dados de Sequência Molecular , Filogenia , Infecções Respiratórias/epidemiologia , Análise de Sequência de DNA , Adulto JovemRESUMO
Hepatitis E virus (HEV) is a feco-orally transmitted pathogen and one of the most common cause of acute hepatitis worldwide. Recent studies in developed countries suggested that a direct human-to-human contact such as for sexually transmitted diseases may play a significant role in the HEV spread. The aim of this study was to investigate the seroprevalence of HEV and HAV in a group of MSM, including subjects HIV, and Treponema infected, in Milan, Italy. The overall anti HEV IgG seroprevalence in MSM was 10.2% (65/636), instead in the control group the detection rate was 5.2% (15/288) (P < 0.05); the anti HAV seroprevalence was 42.8% in MSM, when in the control group the positivity rate was 29.2% (P < 0.05). The rate of coinfection HEV/HAV was 14.6% in MSM and 1% in control group (P < 0.05). In the future, sexual history, HIV status, and STI risk might address specific investigations to prevent spread of pathogens such HEV in MSM, before becoming a substantial public health problem like for HAV outbreaks.