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1.
Methods Mol Biol ; 2244: 1-18, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33555579

RESUMO

Human cytomegalovirus (HCMV) is a betaherpesvirus with a global seroprevalence of 60-90%. HCMV is the leading cause of congenital infections and poses a great health risk to immunocompromised individuals. Although HCMV infection is typically asymptomatic in the immunocompetent population, infection can result in mononucleosis and has also been associated with the development of certain cancers, as well as chronic inflammatory diseases such as various cardiovascular diseases. In immunocompromised patients, including AIDS patients, transplant recipients, and developing fetuses, HCMV infection is associated with increased rates of morbidity and mortality. Currently there is no vaccine for HCMV and there is a need for new pharmacological treatments. Ongoing research seeks to further define the complex aspects of HCMV pathogenesis, which could potentially lead to the generation of new therapeutics to mitigate the disease states associated with HCMV infection. The following chapter reviews the advancements in our understanding of HCMV pathogenesis in the immunocompetent and immunocompromised hosts.


Assuntos
Infecções por Citomegalovirus/imunologia , Citomegalovirus/metabolismo , Citomegalovirus/fisiologia , Citomegalovirus/genética , Citomegalovirus/patogenicidade , DNA Viral/genética , Humanos , Hospedeiro Imunocomprometido/imunologia , Estudos Soroepidemiológicos
5.
Muscle Nerve ; 63(3): 294-303, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33471383

RESUMO

The clinical course of neuromuscular disorders (NMDs) can be affected by infections, both in immunocompetent individuals, and in those with reduced immunocompetence due to immunosuppressive/immunomodulating therapies. Infections and immunizations may also trigger NMDs. There is a potential for reduced efficacy of immunizations in patients with reduced immunocompetence. The recent vaccination program for coronavirus disease-2019 (COVID-19) raises several questions regarding the safety and efficacy of this vaccine in individuals with NMDs. In this Practice Topic article, we address the role of vaccine-preventable infections in NMDs and the safety and efficacy of immunization in individuals with NMDs, with emphasis on vaccination against COVID-19.


Assuntos
/uso terapêutico , Imunossupressores/efeitos adversos , Doenças Neuromusculares/terapia , Doenças Preveníveis por Vacina/prevenção & controle , /complicações , /imunologia , Síndrome de Guillain-Barré/epidemiologia , Síndrome de Guillain-Barré/etiologia , Humanos , Imunocompetência/imunologia , Hospedeiro Imunocomprometido/imunologia , Fatores Imunológicos/efeitos adversos , Doenças Neuromusculares/epidemiologia , Doenças Neuromusculares/imunologia , Vacinas Atenuadas/uso terapêutico , Vacinas de Produtos Inativados/uso terapêutico
7.
Eur Rev Med Pharmacol Sci ; 24(24): 13089-13097, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33378062

RESUMO

OBJECTIVE: Recently, two influential articles that reported the association of (hydroxy)chloroquine or angiotensin converting enzyme (ACE) inhibitors and coronavirus disease 2019 (COVID-19) mortality were retracted due to significant methodological issues. Therefore, we aimed to analyze the same clinical issues through an improved research method and to find out the differences from the retracted papers. We systematically reviewed pre-existing literature, and compared the results with those of the retracted papers to gain a novel insight. MATERIALS AND METHODS: We extracted common risk factors identified in two retracted papers, and conducted relevant publication search until June 26, 2020 in PubMed. Then, we analyzed the risk factors for COVID-19 mortality and compared them to those of the retracted papers. RESULTS: Our systematic review demonstrated that most demographic and clinical risk factors for COVID-19 mortality were similar to those of the retracted papers. However, while the retracted paper indicated that both (hydroxy)chloroquine monotherapy and combination therapy with macrolide were associated with higher risk of mortality, our study showed that only combination therapy of hydroxychloroquine and macrolide was associated with higher risk of mortality (odds ratio 2.33; 95% confidence interval 1.63-3.34). In addition, our study demonstrated that use of ACE inhibitors or angiotensin receptor blockers (ARBs) was associated with reduced risk of mortality (0.77; 0.65-0.91). CONCLUSIONS: When analyzing the same clinical issues with the two retracted papers through a systematic review of randomized controlled trials and relevant cohort studies, we found out that (hydroxy)chloroquine monotherapy was not associated with higher risk of mortality, and that the use of ACE inhibitors or ARBs was associated with reduced risk of mortality in COVID-19 patients.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Inibidores Enzimáticos/uso terapêutico , Hidroxicloroquina/uso terapêutico , Retratação de Publicação como Assunto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Fatores Etários , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , /epidemiologia , Doença da Artéria Coronariana/epidemiologia , Bases de Dados Factuais , Diabetes Mellitus/epidemiologia , Quimioterapia Combinada , Insuficiência Cardíaca/epidemiologia , Humanos , Hipertensão/epidemiologia , Hospedeiro Imunocomprometido/imunologia , Disseminação de Informação , Macrolídeos/uso terapêutico , Obesidade/epidemiologia , Escores de Disfunção Orgânica , Fatores de Proteção , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Fumar/epidemiologia
8.
Medicine (Baltimore) ; 99(50): e23213, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327239

RESUMO

Cryptococcosis caused by Cryptococcus gattii, is a life threatening fungal infection with recently increasing prevalence. C. gattii is a species complex comprising multiple independent species. However, many biological characteristics and clinical features of cryptococcosis due to C. gattii are relatively less well defined. In this paper, we identify two cases of C. gattii infection, and laboratory findings of genotype VGI and VGII in two groups of apparently immunocompetent Chinese individuals respectively. Upon detailed review of all 35 cases of C. gattii infections, it was observed that C. gattii can cause debilitating illness in both immunocompetent and immunocompromised individuals. Cryptococcosis due to C. gattii is a serious systemic fungal infection, with pulmonary central nervous system tropism. Epidemiologically, C. gattii infection is not only restricted in tropical and subtropical regions, but also in other geographical settings.


Assuntos
Infecções Fúngicas do Sistema Nervoso Central/diagnóstico , Criptococose/diagnóstico , Criptococose/microbiologia , Cryptococcus gattii/genética , Administração Intravenosa , Adolescente , Adulto , Idoso , Anfotericina B/administração & dosagem , Anfotericina B/uso terapêutico , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Grupo com Ancestrais do Continente Asiático/genética , Infecções Fúngicas do Sistema Nervoso Central/líquido cefalorraquidiano , Infecções Fúngicas do Sistema Nervoso Central/epidemiologia , Infecções Fúngicas do Sistema Nervoso Central/microbiologia , Criptococose/líquido cefalorraquidiano , Criptococose/tratamento farmacológico , Quimioterapia Combinada , Feminino , Flucitosina/administração & dosagem , Flucitosina/uso terapêutico , Genótipo , Geografia , Humanos , Hospedeiro Imunocomprometido/imunologia , Masculino , Pessoa de Meia-Idade , Prevalência , Recidiva , Punção Espinal/métodos , Resultado do Tratamento , Recusa do Paciente ao Tratamento , Adulto Jovem
9.
Int J Med Sci ; 17(18): 2974-2986, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33173418

RESUMO

In the ongoing COVID-19 pandemic, all COVID-19 patients are naïve patients as it is the first-time humans have been exposed to the SARS-CoV-2 virus. As with exposure to many viruses, individuals with pre-existing, compromised immune systems may be at increased risk of developing severe symptoms and/or dying because of (SARS-CoV-2) infection. To learn more about such individuals, we conducted a search and review of published reports on the clinical characteristics and outcomes of COVID-19 patients with pre-existing, compromised immune systems. Here we present our review of patients who possess pre-existing primary antibody deficiency (PAD) and those who are organ transplant recipients on maintenance immunosuppressants. Our review indicates different clinical outcomes for the patients with pre-existing PAD, depending on the underlying causes. For organ transplant recipients, drug-induced immune suppression alone does not appear to enhance COVID-19 mortality risk - rather, advanced age, comorbidities, and the development of secondary complications appears required.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Doenças do Sistema Imunitário/complicações , Doenças do Sistema Imunitário/diagnóstico , Hospedeiro Imunocomprometido , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Betacoronavirus/imunologia , Betacoronavirus/fisiologia , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Humanos , Hospedeiro Imunocomprometido/imunologia , Imunossupressores/uso terapêutico , Mortalidade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Doenças da Imunodeficiência Primária/complicações , Doenças da Imunodeficiência Primária/diagnóstico , Doenças da Imunodeficiência Primária/imunologia , Doenças da Imunodeficiência Primária/mortalidade , Prognóstico , Transplantados/estatística & dados numéricos
10.
BMJ Case Rep ; 13(10)2020 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-33130585

RESUMO

Infection with SARS-CoV-2 represents a great source of concern and a new threat for immunocompromised patients. Limited studies are available on COVID-19 in immunocompromised children. This case series aimed to evaluate the clinical and laboratory characteristics, management and outcomes of COVID-19 in five children immunocompromised due to different underlying conditions. All had mild symptoms or were asymptomatic at presentation. All had a benign course of illness. No changes or delays in their treatment regimens occurred, and none experienced a relapse of the original disease, developed severe COVID-19 or died. However, these cases showed a prolonged duration of virus shedding. This report suggests that immunocompromised paediatric patients may not be at a higher risk of developing severe COVID-19. However, further studies are required to elaborate on the pathogenesis of COVID-19 in this vulnerable group.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Hospedeiro Imunocomprometido/imunologia , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Síndrome Respiratória Aguda Grave/diagnóstico , Fatores Etários , Criança , Pré-Escolar , Terapia Combinada , Infecções por Coronavirus/terapia , Feminino , Humanos , Masculino , Pandemias/estatística & dados numéricos , Pneumonia Viral/terapia , Prognóstico , Medição de Risco , Amostragem , Síndrome Respiratória Aguda Grave/epidemiologia , Síndrome Respiratória Aguda Grave/terapia , Índice de Gravidade de Doença , Fatores Sexuais , Resultado do Tratamento
11.
Transplant Proc ; 52(9): 2637-2641, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33012543

RESUMO

Here we report a single-center cohort of 6 patients (4 kidney only, and 2 simultaneous liver/kidney transplants) diagnosed with COVID-19 at a median of 1.9 years (range = 0.2-9.3 years) post transplant. Five (of 6) patients required inpatient admission, 2 patients (mortality = 33%) died. Among those with mortality, an increased concentration of inflammatory biomarkers (interleukin-6 and C-reactive protein) was noted with a lack of response to interleukin-6 blockade, remdesivir, and/or convalescent plasma. None of the kidney-only transplants (4/6; 67%) had elevation in plasma donor-derived cell-free DNA above the previously published cut-off of 1%, suggesting absence of significant allo-immune injury. Four (of 5) admitted patients had detectable SARS-CoV-2 (severe acute respiratory syndrome-coronavirus 2) in blood on samples obtained at/during hospitalization. Of the 4 discharged patients, 2 patients with undetectable virus on repeat nasopharyngeal swabs had seroconversion with positive SARS-CoV-2 IgG formation at 30 to 48 days post infection. One patient had prolonged shedding of virus on nasopharyngeal swab at 28 days post discharge despite lack of symptoms. In this preliminary report, we find that immunocompromised transplant patients had higher rates of RNAemia (67%) than reported in the general population (15%), seeming absence of allo-immune injury despite systemic inflammation, and formation of IgG overtime after recovery from infection.


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/imunologia , Hospedeiro Imunocomprometido/imunologia , Transplante de Rim/efeitos adversos , Pneumonia Viral/imunologia , Complicações Pós-Operatórias/imunologia , Adulto , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Imunização Passiva , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/virologia , Viremia/imunologia , Viremia/mortalidade , Viremia/virologia
12.
BMJ Case Rep ; 13(10)2020 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-33012717

RESUMO

We present a case of COVID-19 in an immunocompetent patient with risk factors for severe disease who recovered after prolonged swab positivity of 61 days postsymptom onset without significant respiratory and organ dysfunction. We discuss the reasons behind her prolonged swab positivity in the context of current SARS-CoV-2 knowledge, document the trend in her inflammatory response and swab results, and discuss the implications swab positivity had on her isolation and recovery.


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/imunologia , Hospedeiro Imunocomprometido/imunologia , Pneumonia Viral/imunologia , Eliminação de Partículas Virais/imunologia , Idoso , Infecções por Coronavirus/terapia , Feminino , Humanos , Pandemias , Pneumonia Viral/terapia , Tempo , Carga Viral/imunologia
13.
J Allergy Clin Immunol Pract ; 8(10): 3247-3250, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32971311

RESUMO

NASA implements required medical tests and clinical monitoring to ensure the health and safety of its astronauts. These measures include a pre-launch quarantine to mitigate the risk of infectious diseases. During space missions, most astronauts experience perturbations to their immune system that manifest as a detectable secondary immunodeficiency. On return to Earth, after the stress of re-entry and landing, astronauts would be most vulnerable to infectious disease. In April 2020, a crew returned from International Space Station to NASA Johnson Space Center in Houston, Texas, during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Post-flight quarantine protocols (both crew and contacts) were enhanced to protect this crew from SARS-CoV-2. In addition, specific additional clinical monitoring was performed to determine post-flight immunocompetence. Given that coronavirus disease 2019 (COVID-19) prognosis is more severe for the immunocompromised, a countermeasures protocol for spaceflight suggested by an international team of scientists could benefit terrestrial patients with secondary immunodeficiency.


Assuntos
Astronautas , Infecções por Coronavirus/prevenção & controle , Hospedeiro Imunocomprometido/imunologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Quarentena/métodos , Voo Espacial , Estresse Fisiológico/imunologia , Betacoronavirus , Contagem de Linfócito CD4 , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD8-Positivos/imunologia , Infecções por Coronavirus/imunologia , Suplementos Nutricionais , Terapia por Exercício , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Humanos , Imunoglobulina G/uso terapêutico , Interleucina-2/uso terapêutico , Política Organizacional , Pneumonia Viral/imunologia , Quarentena/organização & administração , Astronave , Texas , Estados Unidos , United States National Aeronautics and Space Administration
14.
Stroke ; 51(10): 3156-3168, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32897811

RESUMO

Understanding the relationship between infection and stroke has taken on new urgency in the era of the coronavirus disease 2019 (COVID-19) pandemic. This association is not a new concept, as several infections have long been recognized to contribute to stroke risk. The association of infection and stroke is also bidirectional. Although infection can lead to stroke, stroke also induces immune suppression which increases risk of infection. Apart from their short-term effects, emerging evidence suggests that poststroke immune changes may also adversely affect long-term cognitive outcomes in patients with stroke, increasing the risk of poststroke neurodegeneration and dementia. Infections at the time of stroke may also increase immune dysregulation after the stroke, further exacerbating the risk of cognitive decline. This review will cover the role of acute infections, including respiratory infections such as COVID-19, as a trigger for stroke; the role of infectious burden, or the cumulative number of infections throughout life, as a contributor to long-term risk of atherosclerotic disease and stroke; immune dysregulation after stroke and its effect on the risk of stroke-associated infection; and the impact of infection at the time of a stroke on the immune reaction to brain injury and subsequent long-term cognitive and functional outcomes. Finally, we will present a model to conceptualize the many relationships among chronic and acute infections and their short- and long-term neurological consequences. This model will suggest several directions for future research.


Assuntos
Aterosclerose/epidemiologia , Infecções/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/fisiopatologia , Aterosclerose/imunologia , Aterosclerose/fisiopatologia , Bacteriemia/epidemiologia , Bacteriemia/imunologia , Bacteriemia/fisiopatologia , Betacoronavirus , Doença Crônica , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/fisiopatologia , Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/imunologia , Infecções por Citomegalovirus/fisiopatologia , Endotélio/fisiopatologia , Infecções por HIV/epidemiologia , Infecções por HIV/imunologia , Infecções por HIV/fisiopatologia , Humanos , Hospedeiro Imunocomprometido/imunologia , Infecções/imunologia , Infecções/fisiopatologia , Inflamação/imunologia , Influenza Humana/epidemiologia , Influenza Humana/imunologia , Influenza Humana/fisiopatologia , Pandemias , Ativação Plaquetária , Agregação Plaquetária , Pneumonia/epidemiologia , Pneumonia/imunologia , Pneumonia/fisiopatologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Pneumonia Viral/fisiopatologia , Prognóstico , Fatores de Risco , Acidente Vascular Cerebral/imunologia , Trombose/epidemiologia , Trombose/imunologia , Infecção pelo Vírus da Varicela-Zoster/epidemiologia , Infecção pelo Vírus da Varicela-Zoster/imunologia , Infecção pelo Vírus da Varicela-Zoster/fisiopatologia
15.
Transplant Proc ; 52(9): 2607-2613, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32773284

RESUMO

The concerns generated by coronavirus disease 2019 (COVID-19) pandemic are having profound impact on solid organ transplantation (SOT). Non-pharmaceutical interventions (NPI) are currently the only measures available to contain COVID-19 in the general population and in more vulnerable recipients of any organ transplant. In this cross-sectional case control study from a patient survey undertaken in 2 transplant centers (TxC) in the Kingdom of Saudi Arabia and Italy, we aimed to appraise awareness of the NPI implemented by respective these governments. We have also evaluated the impact of COVID-19 on our kidney transplant (KT) recipients and a control group of kidney living donors (KLD). In our series, there were zero cases of COVID-19 among 111 KT recipients and 70 KLD of the control group. Demography, transplant type, immunosuppression regimes, and, importantly, the different COVID-19 prevalence in the 2 regions of the TxC did not appear to influence incidence of COVID-19 in our KT recipients. The absence of COVID-19 cases in our series was unexpected. Our findings suggest that awareness of NPI is associated with a successful containment of COVID-19 in vulnerable, immunosuppressed KT recipients.


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/epidemiologia , Hospedeiro Imunocomprometido/imunologia , Transplante de Rim/efeitos adversos , Pneumonia Viral/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Estudos de Casos e Controles , Infecções por Coronavirus/imunologia , Estudos Transversais , Feminino , Humanos , Incidência , Itália/epidemiologia , Doadores Vivos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/imunologia , Complicações Pós-Operatórias/imunologia , Complicações Pós-Operatórias/virologia , Prevalência , Arábia Saudita/epidemiologia , Coleta de Tecidos e Órgãos/efeitos adversos , Obtenção de Tecidos e Órgãos/estatística & dados numéricos
16.
Transplant Proc ; 52(9): 2620-2625, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32798002

RESUMO

Kidney transplant recipients who develop symptoms consistent with coronavirus disease 2019 (COVID-19) are bringing unique challenges to health care professionals. Telemedicine has surged dramatically since the pandemic in effort to maintain patient care and reduce the risk of COVID-19 exposure to patients, health care workers, and the public. Herein we present reports of 3 kidney transplant recipients with COVID-19 who were managed using telemedicine via synchronous video visits integrated with an electronic medical record system, from home to inpatient settings. We demonstrate how telemedicine helped assess, diagnose, triage, and treat patients with COVID-19 while avoiding a visit to an emergency department or outpatient clinic. While there is limited information about the duration of viral shedding for immunosuppressed patients, our findings underscore the importance of using telemedicine in the follow-up care for kidney transplant recipients with COVID-19 who have recovered from symptoms but might have persistently positive nucleic acid tests. Our experience emphasizes the opportunities of telemedicine in the management of kidney transplant recipients with COVID-19 and in the maintenance of uninterrupted follow-up care for such immunosuppressed patients with prolonged viral shedding. Telemedicine may help increase access to care for kidney transplant recipients during and beyond the pandemic as it offers a prompt, safe, and convenient platform in the delivery of care for these patients. Yet, to advance the practice of telemedicine in the field of kidney transplantation, barriers to increasing the widespread implementation of telemedicine should be removed, and research studies are needed to assess the effectiveness of telemedicine in the care of kidney transplant recipients.


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/terapia , Transplante de Rim/efeitos adversos , Pneumonia Viral/terapia , Complicações Pós-Operatórias/terapia , Telemedicina/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/imunologia , Feminino , Humanos , Hospedeiro Imunocomprometido/imunologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/imunologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/imunologia
18.
Mult Scler Relat Disord ; 45: 102439, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32769063

RESUMO

BACKGROUND: Development of long-term immunologic memory relies upon humoral and cellular immune responses. Vaccinations aim to stimulate these responses against pathogens. Several studies have evaluated the impact of multiple sclerosis disease-modifying therapies on immune response to vaccines. Findings from these studies have important implications for people with multiple sclerosis who require vaccination and are using disease-modifying therapies. METHODS: Searches using PubMed and other engines were conducted in May 2020 to collect studies evaluating the impact of various disease-modifying therapies on immune responses to vaccination. RESULTS: Several studies demonstrated preserved immune responses in people treated with beta-interferons to multiple vaccine types. Limited data suggest vaccine responses to be preserved with dimethyl fumarate treatment, as well. Vaccine responses were reduced to varying degrees in those treated with glatiramer acetate, teriflunomide, sphingosine-1-phosphate receptor modulators, and natalizumab. The timing of vaccination played an important role in those treated with alemtuzumab. Humoral vaccine responses were significantly impaired by B cell depleting anti-CD20 monoclonal antibody therapies, particularly to a neoantigen. Data are lacking on vaccine responses in patients with multiple sclerosis taking cladribine and high-dose corticosteroids. Notably, the majority of these studies have focused on humoral responses, with few examining cellular immune responses to vaccination. CONCLUSIONS: Prior investigations into the effects of individual disease-modifying therapies on immune responses to existing vaccines can serve as a guide to expected responses to a SARS-CoV-2 vaccine. Responses to any vaccination depend on the vaccine type, the type of response (recall versus response to a novel antigen), and the impact of the individual disease-modifying therapy on humoral and cellular immunity in response to that vaccine type. When considering a given therapy, clinicians should weigh its efficacy against MS for the individual patient versus potential impact on responses to vaccinations that may be needed in the future.


Assuntos
Infecções por Coronavirus/prevenção & controle , Hospedeiro Imunocomprometido/efeitos dos fármacos , Hospedeiro Imunocomprometido/imunologia , Esclerose Múltipla/imunologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Vacinas Virais/imunologia , Betacoronavirus/imunologia , Infecções por Coronavirus/imunologia , Humanos , Imunossupressores/uso terapêutico , Esclerose Múltipla/tratamento farmacológico , Pneumonia Viral/imunologia
19.
J Am Soc Nephrol ; 31(10): 2413-2423, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32847984

RESUMO

BACKGROUND: COVID-19 has been associated with high morbidity and mortality in kidney transplant recipients. However, risk factors for COVID-19 disease in patients with kidney transplants remain poorly defined. METHODS: We enrolled patients who underwent kidney transplantation and were actively followed up in two hospitals in Paris on March 1st, 2020. Patients were screened for baseline and transplant characteristics, functional parameters, comorbidities, and immunosuppressive therapies. COVID-19 disease was assessed. Patients were followed up during the pandemic until April 30th, 2020 by the COVID-19 SLS KT survey program, including teleconsulting, at-home monitoring for patients with COVID-19, and a dedicated phone hotline platform. RESULTS: Among 1216 patients with kidney transplants enrolled, 66 (5%) patients were identified with COVID-19 disease, which is higher than the incidence observed in the general population in France (0.3%). Their mean age was 56.4±12.5 years, and 37 (56%) patients were men. The following factors were independently associated with COVID-19 disease: non-White ethnicity (adjusted odds ratio [OR], 2.17; 95% confidence interval [95% CI], 1.23 to 3.78; P=0.007), obesity (OR, 2.19; 95% CI, 1.19 to 4.05; P=0.01), asthma and chronic pulmonary disease (OR, 3.09; 95% CI, 1.49 to 6.41; P=0.002), and diabetes (OR, 3.33; 95% CI, 1.92 to 5.77; P<0.001). The mortality rate related to COVID-19 disease was 1% in the overall study population and 24% in COVID-19-positive patients. CONCLUSIONS: Patients with kidney transplants display a high risk of mortality. Non-White ethnicity and comorbidities such as obesity, diabetes, asthma, and chronic pulmonary disease were associated with higher risk of developing COVID-19 disease. It is imperative that policy makers urgently ensure the integration of such risk factors on response operations against COVID-19.


Assuntos
Comorbidade , Infecções por Coronavirus/epidemiologia , Hospedeiro Imunocomprometido/imunologia , Falência Renal Crônica/cirurgia , Transplante de Rim/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Pneumonia Viral/epidemiologia , Adulto , Idoso , Estudos de Coortes , Infecções por Coronavirus/prevenção & controle , Feminino , França , Humanos , Incidência , Controle de Infecções/organização & administração , Falência Renal Crônica/epidemiologia , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Estudos Prospectivos , Medição de Risco , Análise de Sobrevida , Transplantados/estatística & dados numéricos
20.
Crit Rev Oncol Hematol ; 153: 103059, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32711241

RESUMO

The novel coronavirus respiratory illness (COVID-19) is a public health emergency of global concern. Patients with cancer are at high risk of infections, due to an overall immunocompromised status. However, this connection is not straightforward for coronavirus (CoV) infection, in which the host immune response is the main driver of tissue damage. We performed a thorough review of data on CoV pathogenesis and morbidity rate in cancer patients, through the analysis of the previous CoV pandemics. Considering the interaction between CoV and the host immune system, cancer patients receiving immunotherapy might be more at risk for an aberrant immune response in case of infection, and might therefore deserve additional precautions. The limited available data do not allow us to provide practical indications for the management of cancer patients in this critical situation. Efforts should be made to prospectively collect data, to identify effective interventions to guide treatment decision.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Hospedeiro Imunocomprometido/imunologia , Neoplasias/imunologia , Pneumonia Viral/epidemiologia , Betacoronavirus/imunologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Feminino , Humanos , Sistema Imunitário , Masculino , Neoplasias/complicações , Neoplasias/epidemiologia , Neoplasias/terapia , Pandemias , Pneumonia Viral/imunologia , Pneumonia Viral/virologia
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