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1.
Nat Commun ; 13(1): 4489, 2022 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-35927279

RESUMO

Immunocompromised patients are predisposed to severe COVID-19. Here we compare homotypic and heterotypic humoral and cellular immune responses to Omicron BA.1 in organ transplant patients across a diverse clinical spectrum. We perform variant-specific pseudovirus neutralization assays for D614G, and Omicron-BA.1, -BA.2, and Delta variants. We also measure poly-and monofunctional T-cell responses to BA.1 and ancestral SARS-CoV-2 peptide pools. We identify that partially or fully-vaccinated transplant recipients after infection with Omicron BA.1 have the greatest BA.1 neutralizing antibody and BA.1-specific polyfunctional CD4+ and CD8+ T-cell responses, with potent cross-neutralization against BA.2. In these patients, the magnitude of the BA.1-directed response is comparable to immunocompetent triple-vaccinated controls. A subset of patients with pre-Omicron infection have heterotypic responses to BA.1 and BA.2, whereas uninfected transplant patients with three doses of vaccine demonstrate the weakest comparative responses. These results have implications for risk of infection, re-infection, and disease severity among immune compromised hosts with Omicron infection.


Assuntos
COVID-19 , Vacinas Virais , Anticorpos Neutralizantes , Anticorpos Antivirais , Humanos , Imunidade Celular , Hospedeiro Imunocomprometido , SARS-CoV-2
2.
Clin J Oncol Nurs ; 26(4): 367-373, 2022 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-35939727

RESUMO

BACKGROUND:  Patients with cancer are highly vulnerable to COVID-19 because of immunosuppression from diseases and treatments. Emerging data characterize the impact of COVID-19 vaccines related to cancer malignancies and treatments. OBJECTIVES:  This article provides a clinical foundation on the immune response to the COVID-19 vaccine associated with the impact of cancer and its related treatments. It reviews strategies for vaccine scheduling, Centers for Disease Control and Prevention recommendations, and nursing considerations when administering the vaccine to immunosuppressed patients. METHODS:  Research studies about immune responses to COVID-19 vaccines among immunosuppressed patients with hematologic and solid tumor malignancies were summarized. FINDINGS:  Studies about the humoral immune responses of patients with cancer to COVID-19 vaccines help guide vaccination planning for this population. Critical nursing considerations for patients with cancer receiving COVID-19 vaccination are integral to the provision of optimal clinical oncology care during the pandemic.


Assuntos
COVID-19 , Neoplasias , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Humanos , Hospedeiro Imunocomprometido , Neoplasias/tratamento farmacológico , Pandemias , Vacinação
3.
Front Cell Infect Microbiol ; 12: 937481, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35923801

RESUMO

The second wave of coronavirus disease 2019 (COVID-19) caused severe infections with high mortality. An increase in the cases of COVID-19-associated mucormycosis (CAM) was reported predominantly in India. Commonly present in immunocompromised individuals, mucormycosis is often a life-threatening condition. Confounding factors and molecular mechanisms associated with CAM are still not well understood, and there is a need for careful research in this direction. In this review, a brief account of the diagnosis, management, and advancement in drug discovery for mucormycosis has been provided. Here, we summarize major factors that dictate the occurrence of mucormycosis in COVID-19 patients through the analysis of published literature and case reports. Major predisposing factors to mucormycosis appear to be uncontrolled diabetes, steroid therapy, and certain cancers. At the molecular level, increased levels of iron in COVID-19 might contribute to mucormycosis. We have also discussed the potential role and regulation of iron metabolism in COVID-19 patients in establishing fungal growth. Other factors including diabetes prevalence and fungal spore burden in India as contributing factors have also been discussed.


Assuntos
COVID-19 , Diabetes Mellitus , Mucormicose , COVID-19/complicações , Humanos , Hospedeiro Imunocomprometido , Índia/epidemiologia , Mucormicose/diagnóstico , Mucormicose/tratamento farmacológico , Mucormicose/epidemiologia
5.
J Natl Compr Canc Netw ; 20(7): 800-807.e1, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35830888

RESUMO

BACKGROUND: Immune-related adverse events (irAEs) often require treatment with high-dose systemic steroids (SS) and other immunosuppressive agents (ISAs). NCCN Guidelines recommend prophylactic antibiotics for Pneumocystis jirovecii pneumonia (PJP) for patients receiving prolonged SS/ISAs. However, there is a paucity of evidence regarding the incidence of opportunistic infections (OIs) and non-OIs and the role of prophylactic antibiotics in patients on SS/ISAs for irAEs. METHODS: A retrospective analysis was conducted of patients treated using immune checkpoint inhibitor (ICI) therapy at 5 MedStar Health hospitals from January 2011 to April 2018. OIs were defined per the Infectious Diseases Society of America guidelines for the prevention and treatment of OIs in patients with HIV. The study cohort included patients who received ≥20 mg daily of a prednisone equivalent for ≥4 weeks to manage irAEs. RESULTS: The study cohort identified 112 (15%) of 758 total patients treated using ICIs. Baseline characteristics included the following: median age was 64 years, 74% (n=82) of patients were White, 89% (n=100) had an ECOG performance status ≤1, 61% (n=68) had melanoma, 19% (n=21) had non-small cell lung cancer, 45% (n=50) were treated using an anti-PD-(L)1 ICI, and 33% (n=37) were treated using an anti-PD-1/anti-CTLA-4 combination. The median starting SS dose was 100 mg of a prednisone equivalent, and 25% of patients required additional ISAs, with infliximab (n=15) and mycophenolate mofetil (n=9) being the most common. We found that 20% (n=22) of patients developed any infection, including 7% (n=8) with OIs (oral candidiasis [n=4], nondisseminated varicella zoster infection [n=2], PJP [n=1], and Listeria monocytogenes endophthalmitis [n=1]) and 13% (n=14) with non-OIs (most common: Clostridium difficile and pneumonia [n=5 each]). PJP prophylaxis with sulfamethoxazole/trimethoprim was given to 13% (n=14) patients, of whom 43% (n=6) developed OIs/non-OIs. CONCLUSIONS: Our study highlights the fundamental issues for patients on ICI therapy who require SS/ISAs for irAEs: the degree of immunosuppression and the relative risk of OI. We noted a low incidence of OIs overall and breakthrough infections despite PJP prophylaxis. We question whether PJP prophylaxis is efficacious or necessary. Prospective trials are required to answer these questions.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Infecções Oportunistas , Pneumocystis carinii , Pneumonia por Pneumocystis , Antibacterianos , Antibioticoprofilaxia/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Humanos , Hospedeiro Imunocomprometido , Neoplasias Pulmonares/tratamento farmacológico , Pessoa de Meia-Idade , Infecções Oportunistas/epidemiologia , Infecções Oportunistas/etiologia , Infecções Oportunistas/prevenção & controle , Pneumonia por Pneumocystis/tratamento farmacológico , Pneumonia por Pneumocystis/epidemiologia , Pneumonia por Pneumocystis/etiologia , Prednisona/uso terapêutico , Estudos Prospectivos , Estudos Retrospectivos
6.
Am J Case Rep ; 23: e936278, 2022 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-35879878

RESUMO

BACKGROUND Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection that commonly occurs in immunocompromised patients, especially those with HIV. Early diagnosis and prompt treatment are important because PJP is a potentially life-threatening infection. However, the diagnosis of PJP in the early stage can be challenging due to various factors. Furthermore, the early presentation of PJP, which includes normal chest radiograph and examination findings along with the subacute presentation of PJP in patients with HIV, makes an early diagnosis of the disease even more challenging for doctors. CASE REPORT In this case report, we present the case of a 39-year-old man who had normal chest X-ray findings during the initial stage of his presentation. Coupled with non-disclosure of HIV status, these led to a delay in PJP diagnosis. The diagnosis of PJP with underlying HIV was later supported by the patient's clinical features, initial blood investigations, and presence of high-risk sexual activity. The diagnosis was confirmed when the PJP polymerase chain reaction test from the respiratory sample was positive. He was successfully treated with oral trimethoprim-sulfamethoxazole. However, he subsequently developed rare adverse effects of drug-induced immune hemolytic anemia, which was diagnosed based on the presence of hemolytic anemia and recent exposure to a new drug. Trimethoprim-sulfamethoxazole was promptly discontinued, which resulted in symptom improvement. CONCLUSIONS This case report aims to create awareness among primary care doctors to be vigilant of the PJP diagnosis and its nonspecific presentations as well as to the rare adverse effects of medications to treat PJP.


Assuntos
Anemia Hemolítica , Infecções por HIV , Pneumocystis carinii , Pneumonia por Pneumocystis , Adulto , Anemia Hemolítica/induzido quimicamente , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Hospedeiro Imunocomprometido , Masculino , Pneumonia por Pneumocystis/diagnóstico por imagem , Pneumonia por Pneumocystis/tratamento farmacológico , Radiografia , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos
7.
Pan Afr Med J ; 41: 318, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35865834

RESUMO

COVID-19 which first raised its deadly head in December 2019, has now engulfed the entire planet with its fire and fury. Mankind has been literally held to ransom by this micro-beast which has caused so much pain, sorrow and suffering, leaving behind scores of people dead and millions sick and gasping for air (quite literally!) The whole world is in disarray since the past 16 months, and now a new deadly superadded fungal infection has appeared in COVID-19 patients, in parts of the Indian subcontinent; namely mucormycosis, the deadly "black fungus." This persistent, unrelenting fungal infection which is relatively resistant to conventional anti-fungal treatment, sometimes requires radical, extensive surgical intervention in order to stem the spread of infection to vital organs such as the heart, brain, orbital spaces and spleen. mucormycosis has been increasingly seen to occur in COVID-19 patients who are immunocompromised and have uncontrolled diabetes mellitus as a comorbidity. Commonly seen forms of mucormycosis in COVID-19 patients include, Rhinocerebral mucormycosis and Pulmonary mucormycosis, with some patients also developing the cutaneous form, while some manifesting the more serious disseminated form of mucormycosis.


Assuntos
COVID-19 , Mucormicose , Encéfalo , Fungos , Humanos , Hospedeiro Imunocomprometido , Mucormicose/diagnóstico , Mucormicose/epidemiologia
8.
BMJ Case Rep ; 15(7)2022 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-35787508

RESUMO

A male adult in his mid-40s with end-stage renal disease (ESRD) on haemodialysis, with history of splenectomy and sarcoidosis, developed septic arthritis of the knee. Excision and drainage was performed and empiric antibiotics were initiated. Cultures were initially negative without clinical improvement. Eventually, the aerobic synovial fluid culture grew Cryptococcus neoformans (formerly Cryptococcus neoformans var. grubii). The patient was treated with liposomal amphotericin B and then switched to fluconazole until the infection resolved. This case highlights the less well-recognised association between cryptococcal arthritis and immunodeficiency states like ESRD, splenectomy and sarcoidosis.


Assuntos
Artrite Infecciosa , Cryptococcus neoformans , Falência Renal Crônica , Sarcoidose , Humanos , Hospedeiro Imunocomprometido , Masculino , Diálise Renal , Esplenectomia
9.
BMC Infect Dis ; 22(1): 654, 2022 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-35902817

RESUMO

BACKGROUND: The rapid course of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic calls for fast implementation of clinical trials to assess the effects of new treatment and prophylactic interventions. Building trial platforms embedded in existing data infrastructures is an ideal way to address such questions within well-defined subpopulations. METHODS: We developed a trial platform building on the infrastructure of two established national cohort studies: the Swiss human immunodeficiency virus (HIV) Cohort Study (SHCS) and Swiss Transplant Cohort Study (STCS). In a pilot trial, termed Corona VaccinE tRiAL pLatform (COVERALL), we assessed the vaccine efficacy of the first two licensed SARS-CoV-2 vaccines in Switzerland and the functionality of the trial platform. RESULTS: Using Research Electronic Data Capture (REDCap), we developed a trial platform integrating the infrastructure of the SHCS and STCS. An algorithm identifying eligible patients, as well as baseline data transfer ensured a fast inclusion procedure for eligible patients. We implemented convenient re-directions between the different data entry systems to ensure intuitive data entry for the participating study personnel. The trial platform, including a randomization algorithm ensuring balance among different subgroups, was continuously adapted to changing guidelines concerning vaccination policies. We were able to randomize and vaccinate the first trial participant the same day we received ethics approval. Time to enroll and randomize our target sample size of 380 patients was 22 days. CONCLUSION: Taking the best of each system, we were able to flag eligible patients, transfer patient information automatically, randomize and enroll the patients in an easy workflow, decreasing the administrative burden usually associated with a trial of this size.


Assuntos
Vacinas contra COVID-19 , COVID-19 , COVID-19/prevenção & controle , Estudos de Coortes , Humanos , Hospedeiro Imunocomprometido , SARS-CoV-2 , Resultado do Tratamento
10.
Curr Opin Infect Dis ; 35(4): 302-311, 2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-35849520

RESUMO

PURPOSE OF REVIEW: Double-stranded DNA (dsDNA) viruses remain important causes of morbidity and mortality after allogeneic hematopoietic cell transplantation (HCT). As treatment options are limited, adoptive therapy with virus-specific T cells (VST) is promising in restoring immunity and thereby preventing and treating virus infections. Here we review current evidence and recent advances in the field of VST for dsDNA viruses in allogeneic HCT recipients. RECENT FINDINGS: Four different protocols for VST generation are currently used in clinical trials, and various products including multivirus-specific and off-the-shelf products are under investigation for prophylaxis, preemptive therapy or treatment. Data from nearly 1400 dsDNA-VST applications in allogeneic HCT patients have been published and demonstrated its safety. Although Epstein-Barr virus, cytomegalovirus, and adenovirus-specific T-cell therapy studies have predominated over the past 25 years, additional human herpes viruses were added to multivirus-specific T cells over the last decade and clinical evidence for polyomavirus-specific VST has just recently emerged. Response rates of around 70-80% have been reported, but cautious interpretation is warranted as data are predominantly from phase 1/2 studies and clinical efficacy needs to be confirmed in phase 3 studies. SUMMARY: Investigation on the 'ideal' composition of VST is ongoing. Several products recently entered phase 3 trials and may allow widespread clinical use in the near future.


Assuntos
Infecções por Vírus Epstein-Barr , Transplante de Células-Tronco Hematopoéticas , Infecções por Vírus Epstein-Barr/terapia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Herpesvirus Humano 4 , Humanos , Hospedeiro Imunocomprometido , Transplantados
11.
Ther Umsch ; 79(6): 307-311, 2022 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-35903827

RESUMO

Vaccination and Vaccination Response in Immunodeficiency Abstract. Vaccination of patients with immunodeficiencies is challenging. A lack of increase in vaccine antibody titers or vaccine-induced infections may indicate primary immunodeficiency. All vaccines against SARS-CoV-2 licensed in Switzerland can be administered to immunocompromised patients.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Hospedeiro Imunocomprometido , COVID-19/prevenção & controle , Vacinas contra COVID-19/administração & dosagem , Humanos , SARS-CoV-2 , Suíça , Vacinação
12.
Viruses ; 14(7)2022 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-35891439

RESUMO

Human adenovirus (HAdV) can often lead to fulminant hepatitis in immunocompromised patients, mostly after reactivation of HAdV. Different risk factors, e.g., transplantation and chemotherapy, increase the risk of developing a HAdV hepatitis. We retrospectively analyzed three patients who showed the characteristics of a HAdV hepatitis observed in disseminated disease. In addition to PCR, diagnosis could be proven by pathology, CT scan, and markedly elevated transaminases. All patients had a hemato-oncologic underlying disease. Two had received a stem-cell transplant, and one was under chemotherapy including rituximab. Despite therapy with cidofovir, all patients died. As the incidence of HAdV hepatitis is low, diagnosis may be easily overlooked. No treatment approaches have yet been established. HAdV hepatitis should be considered as a differential diagnosis, especially when risk factors are present. To avoid dissemination, treatment should be initiated as soon as possible.


Assuntos
Infecções por Adenoviridae , Infecções por Adenovirus Humanos , Adenovírus Humanos , Hepatite Viral Humana , Necrose Hepática Massiva , Infecções por Adenovirus Humanos/diagnóstico , Infecções por Adenovirus Humanos/tratamento farmacológico , Infecções por Adenovirus Humanos/patologia , Adenovírus Humanos/genética , Humanos , Hospedeiro Imunocomprometido , Estudos Retrospectivos
13.
Ann Parasitol ; 68(2): 399-403, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35842846

RESUMO

Cystoisospora belli is an obligate intracellular coccidian parasite known to cause chronic persistent diarrhoea in immunocompromised individuals such as human immunodeficiency virus (HIV) infection, long term corticosteroid therapy, cancer chemotherapy and solid organ transplant recipients. Trichuris trichiura is a soil transmitted helminth, which predominantly causes asymptomatic or mild infections but heavy worm load can sometimes lead to chronic diarrhoea, tenesmus or rectal prolapse. We report a case of co-infection with Cystoisospora belli and Trichuris trichiura in an adult patient causing intractable diarrhea, which led to the unraveling of a severely compromised immune status in the patient enabling an appropriate therapeutic approach and further management.


Assuntos
Coinfecção , Infecções por HIV , Adulto , Animais , Coinfecção/complicações , Diarreia/parasitologia , Infecções por HIV/complicações , Humanos , Hospedeiro Imunocomprometido , Trichuris
14.
Emerg Infect Dis ; 28(8): 1681-1685, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35876734

RESUMO

We report 2 cases of Spiroplasma ixodetis infection in an immunocompetent patient and an immunocompromised patient who had frequent tick exposure. Fever, thrombocytopenia, and increased liver aminotransferase levels raised the suspicion of anaplasmosis, but 16S rRNA PCR and Sanger sequencing yielded a diagnosis of spiroplasmosis. Both patients recovered after doxycycline treatment.


Assuntos
Anaplasmose , Picadas de Carrapatos , Carrapatos , Anaplasmose/diagnóstico , Animais , Humanos , Hospedeiro Imunocomprometido , RNA Ribossômico 16S/genética , Spiroplasma , Suécia
15.
R I Med J (2013) ; 105(6): 20-23, 2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-35881994

RESUMO

Human babesiosis is an emerging infectious disease with a progressively rising number of cases in the Northeast over the last few decades. We report a case of fatal babesiosis in a 48-year-old male without significant risk factors for a severe presentation. Clinicians should be aware that even in patients without the classic risk factors of asplenia, advanced age, and immunocompromised status for severe presentations of babesiosis, a deadly case can present. There is a need for further research regarding optimal treatment options for severe babesiosis considering the questionable efficacy of red blood cell exchange (RCE) transfusion in patients who do not improve on the current first-line antimicrobials.


Assuntos
Babesiose , Babesiose/diagnóstico , Babesiose/tratamento farmacológico , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade
16.
Virulence ; 13(1): 1242-1251, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-35891618

RESUMO

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern have been emerging. However, knowledge of temporal and spatial dynamics of SARS-CoV-2 is limited. This study characterized SARS-CoV-2 evolution in immunosuppressed patients with long-term SARS-CoV-2 shedding for 73-250 days, without specific treatment. We conducted whole-genome sequencing of 27 serial samples, including 26 serial samples collected from various anatomic sites of two patients and the first positive sample from patient 2's mother. We analysed the intrahost temporal dynamics and genomic diversity of the viral population within different sample types. Intrahost variants emerging during infection showed diversity between individual hosts. Remarkably, N501Y, P681R, and E484K, key substitutions within spike protein, emerged in vivo during infection and became the dominant population. P681R, which had not yet been detected in the publicly available genome in Korea, appeared within patient 1 during infection. Mutually exclusive substitutions at residues R346 (R346S and R346I) and E484 (E484K and E484A) of spike protein and continuous turnover of these substitutions occurred. Unique genetic changes were observed in urine samples. A household transmission from patient 2 to his mother, at least 38 days after the diagnosis, was characterized. Viruses may differently mutate and adjust to the host selective pressure, which could enable the virus to replicate efficiently for fitness in each host. Intrahost variants could be candidate variants likely to spread to the population eventually. Our findings may provide new insights into the dynamics of SARS-CoV-2 in response to interactions between the virus and host.


Assuntos
COVID-19 , Hospedeiro Imunocomprometido , SARS-CoV-2 , Eliminação de Partículas Virais , COVID-19/transmissão , Humanos , Mutação , SARS-CoV-2/genética , Glicoproteína da Espícula de Coronavírus/genética , Sequenciamento Completo do Genoma
17.
Dtsch Med Wochenschr ; 147(13): 840-850, 2022 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-35785782

RESUMO

The number of immunosuppressed patients continues to increase worldwide. The main reasons are the demographic development and improved long-term survival, also for patients under immunosuppression. A major cause of hospitalization and mortality among these patients are infections. Their management, including prevention and adequate treatment, plays a crucial role in survival and quality of life, but also with regard to economic factors.Infection management in immunocompromised patients faces new challenges today. Not only the increasing number, but also new groups of patients at risk and an increasingly aging and comorbid population pose problems for the treating physicians. While cancer medicine is no longer determined solely by radiotherapy and chemotherapy, new targeted substances are playing an increasingly important role. In addition, new targeted substances complicate adequate infection prophylaxis due to potential interactions. The worldwide increase in antibiotic-resistant pathogens complicates treatment of bacterial infections, which is associated with increased mortality, especially in the immunocompromised patient population. Further, the disruption of the microbiome shows negative antibiotic-associated effects. Hence the reasonable use of anti-infectives in prophylaxis and therapy is of great importance.There are many recommendations and guidelines for clinicians regarding the management of infections in immunocompromised patients. Overlaps of infectiology, hygiene as well as hematology and oncology sometimes lead to different recommendations. This article provides an overview of the currently existing evidence and guidelines for infection management in immunosuppressed patients.


Assuntos
Infecções Bacterianas , Neoplasias , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Humanos , Hospedeiro Imunocomprometido , Neoplasias/tratamento farmacológico , Qualidade de Vida
18.
BMJ Open ; 12(7): e060425, 2022 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-35777878

RESUMO

OBJECTIVES: To determine whether spontaneous reporting rates of myocarditis and pericarditis differed in immunocompromised patients compared with the whole population overall, and in terms of demographics, vaccine dose and time-to-onset. DESIGN: Systematic review of spontaneously reported data from the European Union/European Economic Area (EU/EEA), the USA and the UK. DATA SOURCES: EudraVigilance (EU/EEA), Vaccine Adverse Event Reporting System (VAERS; USA) and the Medicines and Healthcare products Regulatory Agency (UK) spontaneous reporting databases were searched from date of vaccine launch to 1 December 2021. ELIGIBILITY CRITERIA: Publicly available spontaneous reporting data for 'myocarditis' and 'pericarditis' from EU/EEA and USA following COVID-19 messenger RNA vaccines. Reports with comorbidities or concurrent medication indicative of transplantation, HIV infection or cancer ('immunocompromised' population) were compared with each overall database population. DATA EXTRACTION AND SYNTHESIS: Two researchers extracted data. Spontaneously reported events of myocarditis and pericarditis were presented for immunocompromised populations for each data source, stratified by age, sex, dose and time-to-onset (where available). Seriousness of each event was determined according to the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) Guideline E2A definition. Proportional reporting ratio (PRR) was calculated. RESULTS: There were 178 reports of myocarditis and pericarditis among immunocompromised individuals overall. Seriousness was comparable between the immunocompromised and overall populations in both databases. No trends in age or sex were observed among immunocompromised individuals. Most reports followed a second vaccine dose and occurred within 14 days. The frequency of reporting was similar to the wider population (PRR=1.36 (95% CI=0.89 to 1.82) for VAERS population). CONCLUSIONS: Myocarditis and pericarditis following COVID-19 vaccination are very rare, and benefits of COVID-19 vaccination continue to outweigh any perceived risks. Reporting rates of myocarditis and pericarditis were similar in immunocompromised individuals, however defining characteristics differed compared with the whole population; therefore, continued monitoring of adverse events following vaccination remains vital to understand differences between population subgroups.


Assuntos
Vacinas contra COVID-19 , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Humanos , Hospedeiro Imunocomprometido , Miocardite/epidemiologia , Pericardite/epidemiologia , Transplantados
19.
Front Cell Infect Microbiol ; 12: 924007, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35782144

RESUMO

Emerging infectious disease has become the center of attention since the outbreak of COVID-19. For the coronavirus, bats are suspected to be the origin of the pandemic. Consequently, the spotlight has fallen on zoonotic diseases, and the focus now expands to organisms other than viruses. Microsporidia is a single-cell organism that can infect a wide range of hosts such as insects, mammals, and humans. Its pathogenicity differs among species, and host immunological status plays an important role in infectivity and disease severity. Disseminated disease from microsporidiosis can be fatal, especially among patients with a defective immune system. Recently, there were two Trachipleistophora hominis, a microsporidia species which can survive in insects, case reports in Thailand, one patient had disseminated microsporidiosis. This review gathered data of disseminated microsporidiosis and T. hominis infections in humans covering the biological and clinical aspects. There was a total of 22 cases of disseminated microsporidiosis reports worldwide. Ten microsporidia species were identified. Maximum likelihood tree results showed some possible correlations with zoonotic transmissions. For T. hominis, there are currently eight case reports in humans, seven of which had Human Immunodeficiency Virus (HIV) infection. It is observed that risks are higher for the immunocompromised to acquire such infections, however, future studies should look into the entire life cycle, to identify the route of transmission and establish preventive measures, especially among the high-risk groups.


Assuntos
COVID-19 , Microsporídios , Microsporidiose , Animais , Humanos , Hospedeiro Imunocomprometido , Mamíferos , Microsporidiose/epidemiologia , Zoonoses/epidemiologia
20.
MMWR Morb Mortal Wkly Rep ; 71(27): 878-884, 2022 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-35797216

RESUMO

Immunocompromised persons are at increased risk for severe COVID-19-related outcomes, including intensive care unit (ICU) admission and death (1). Data on adults aged ≥18 years hospitalized with laboratory-confirmed COVID-19 from 10 U.S. states in the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) were analyzed to assess associations between immunocompromise and ICU admission and in-hospital death during March 1, 2020-February 28, 2022. Associations of COVID-19 vaccination status with ICU admission and in-hospital death were also examined during March 1, 2021-February 28, 2022. During March 1, 2020-February 28, 2022, among a sample of 22,345 adults hospitalized for COVID-19, 12.2% were immunocompromised. Among unvaccinated patients, those with immunocompromise had higher odds of ICU admission (adjusted odds ratio [aOR] = 1.26; 95% CI = 1.08-1.49) and in-hospital death (aOR = 1.34; 95% CI = 1.05-1.70) than did nonimmunocompromised patients. Among vaccinated patients,* those with immunocompromise had higher odds of ICU admission (aOR = 1.40; 95% CI = 1.01-1.92) and in-hospital death (aOR = 1.87; 95% CI = 1.28-2.75) than did nonimmunocompromised patients. During March 1, 2021-February 28, 2022, among nonimmunocompromised patients, patients who were vaccinated had lower odds of death (aOR = 0.58; 95% CI = 0.39-0.86) than did unvaccinated patients; among immunocompromised patients, odds of death between vaccinated and unvaccinated patients did not differ. Immunocompromised persons need additional protection from COVID-19 and using multiple known COVID-19 prevention strategies,† including nonpharmaceutical interventions, up-to-date vaccination of immunocompromised persons and their close contacts,§ early testing, and COVID-19 prophylactic (Evusheld) and early antiviral treatment,¶ can help prevent hospitalization and subsequent severe COVID-19 outcomes among immunocompromised persons.


Assuntos
COVID-19 , Adolescente , Adulto , COVID-19/terapia , Vacinas contra COVID-19 , Mortalidade Hospitalar , Hospitalização , Humanos , Hospedeiro Imunocomprometido
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