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1.
Am J Case Rep ; 23: e935059, 2022 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-34999671

RESUMO

BACKGROUND Blastomycosis is a rare opportunistic disease caused by inhalation of the fungus Blastomyces dermatitidis. Blastomycosis can occur in all individuals but is most commonly seen in immunocompromised hosts. If left untreated or not caught early enough, blastomycosis can progress to fulminant multilobar pneumonia, acute respiratory distress syndrome (ARDS), and even death. CASE REPORT A 74-year-old immunocompromised man in northeast Ohio presented to the Emergency Department with shortness of breath and hemoptysis. The patient had a negative evaluation for a gastrointestinal bleed and was found to have significant blood collection in the larynx and trachea. A bronchoscopy demonstrated right upper lobe hemorrhage and an infection with Blastomyces species. The patient was started on amphotericin B 5 mg/kg every 24 h for severe blastomycosis. The patient continued to have pulmonary hemorrhage and progressed to multilobar pneumonia and ARDS. Ultimately, the patient died due to respiratory distress after being hospitalized for 5 days. CONCLUSIONS Blastomycosis can present with multiple clinical manifestations, including pulmonary hemorrhage, in severe disease. Diagnostic delay of blastomycosis is common owing to a nonspecific patient presentation. Blastomycosis is an opportunistic infection; therefore, the fungus can be more commonly seen within immunocompromised hosts. The combination of diagnostic delay and immunocompromised hosts leads to an increased mortality rate from blastomycosis infections.


Assuntos
Blastomicose , Idoso , Blastomyces , Blastomicose/diagnóstico , Diagnóstico Tardio , Hemoptise , Humanos , Hospedeiro Imunocomprometido , Masculino
2.
Cancer Control ; 29: 10732748211070720, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35001670

RESUMO

Data is limited on the immunogenicity of the COVID-19 two-vaccination series among patients with hematologic malignancies and current guidelines do not recommend routine monitoring for post-vaccine antibodies. However, we describe three patients who developed severe or critical COVID-19 infections six months after vaccination. This highlights the importance of routine testing of COVID-19 IgG Spike, semi-quantitative antibodies post-vaccination, particularly among immunocompromised patients.


Assuntos
Anticorpos Antivirais/imunologia , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/imunologia , COVID-19/prevenção & controle , Neoplasias Hematológicas/epidemiologia , Adulto , Idoso , Anticorpos Antivirais/análise , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , SARS-CoV-2
3.
BMC Infect Dis ; 22(1): 25, 2022 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-34983425

RESUMO

BACKGROUND: Herpes simplex virus (HSV)-1 is a highly prevalent, non-oncogenic virus that has higher morbidity in immunocompromised hosts. Its most common clinical manifestation is superficial ulceration of the integument or mucus membranes. CASE PRESENTATION: A 65-year-old woman with a history of acute myelogenous leukemia treated with allogenic peripheral blood stem cell transplant presented for resection of an ulcerated buccal squamous cell carcinoma. We report a case of HSV-1-infected malignant cells discovered on histopathological examination of the carcinoma specimen ultimately treated with valacyclovir. CONCLUSIONS: HSV-1 is not considered an oncogenic virus itself but may increase risk of malignant progression. Cancer cells are vulnerable to superimposed viral infections, including HSV-1, which likely led to the findings in this case.


Assuntos
Carcinoma de Células Escamosas , Herpes Simples , Herpesvirus Humano 1 , Idoso , Feminino , Herpes Simples/diagnóstico , Herpes Simples/tratamento farmacológico , Humanos , Hospedeiro Imunocomprometido , Valaciclovir
4.
Artigo em Inglês | MEDLINE | ID: mdl-34759018

RESUMO

BACKGROUND AND OBJECTIVES: To investigate whether children receiving immunosuppressive therapies for neuroimmunologic disorders had (1) increased susceptibility to SARS-CoV2 infection or to develop more severe forms of COVID-19; (2) increased relapses or autoimmune complications if infected; and (3) changes in health care delivery during the pandemic. METHODS: Patients with and without immunosuppressive treatment were recruited to participate in a retrospective survey evaluating the period from March 14, 2020, to March 30, 2021. Demographics, clinical features, type of immunosuppressive treatment, suspected or confirmed COVID-19 in the patients or cohabitants, and changes in care delivery were recorded. RESULTS: One hundred fifty-three children were included: 84 (55%) female, median age 13 years (interquartile range [8-16] years), 79 (52%) on immunosuppressive treatment. COVID-19 was suspected or confirmed in 17 (11%) (all mild), with a frequency similar in patients with and without immunosuppressive treatment (11/79 [14%] vs 6/74 [8%], p = 0.3085). The frequency of neurologic relapses was similar in patients with (18%) and without (21%) COVID-19. Factors associated with COVID-19 included having cohabitants with COVID-19 (p < 0.001) and lower blood levels of vitamin D (p = 0.039). Return to face-to-face schooling or mask type did not influence the risk of infection, although 43(28%) children had contact with a classmate with COVID-19. Clinic visits changed from face to face to remote for 120 (79%) patients; 110 (92%) were satisfied with the change. DISCUSSION: In this cohort of children with neuroimmunologic disorders, the frequency of COVID-19 was low and not affected by immunosuppressive therapies. The main risk factors for developing COVID-19 were having cohabitants with COVID-19 and low vitamin D levels.


Assuntos
COVID-19/complicações , COVID-19/imunologia , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/imunologia , SARS-CoV-2/imunologia , Adolescente , COVID-19/prevenção & controle , COVID-19/virologia , Criança , Atenção à Saúde/organização & administração , Atenção à Saúde/estatística & dados numéricos , Feminino , Humanos , Imunossupressores/uso terapêutico , Masculino , Máscaras/estatística & dados numéricos , Máscaras/virologia , Doenças do Sistema Nervoso/virologia , Pandemias , Recidiva , Estudos Retrospectivos , Vitamina D/sangue
5.
J Eur Acad Dermatol Venereol ; 36 Suppl 1: 6-10, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34855246

RESUMO

The incidence of cutaneous squamous cell carcinoma (cSCC) is rapidly increasing. A growing part of this patient group is formed by immunocompromised patients, for example organ-transplant recipients (OTR). Although over 90% of the cSCC show a relatively harmless clinical behaviour, there is also a chance of developing advanced cSCC and metastases. Locally advanced cSCC are defined as cSCC that have locally advanced progression and are no longer amenable to surgery or radiation therapy. Better understanding of the clinical behaviour of cSCC is essential to discriminate between low- and high-risk cSCC. Staging systems are important and have recently been improved. Genetic characterisation of SCC will likely become an important tool to help distinguish low and high-risk cSCC with an increased potential to metastasise in the near future. Available treatments for high-risk and advanced cSCC include surgery, radiotherapy, chemotherapy and targeted therapy with epidermal growth factor receptors inhibitors. Anti-PD-1 antibodies show promising results with response rates of up to 50% in both locally advanced and metastatic cSCC but, in its present form, is not suitable for OTR.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Cutâneas , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Humanos , Hospedeiro Imunocomprometido , Estadiamento de Neoplasias , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapia
6.
J Med Virol ; 94(1): 99-109, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34570905

RESUMO

A severe pandemic of Coronavirus Disease (COVID-19) has been sweeping the globe since 2019, and this time, it did not stop, with frequent mutations transforming into virulent strains, for instance, B.1.1.7, B.1.351, and B.1.427. In recent months, a fungal infection, mucormycosis has emerged with more fatal responses and significantly increased mortality rate. To measure the severity and potential alternative approaches against black fungus coinfection in COVID-19 patients, PubMed, Google Scholar, World Health Organization (WHO) newsletters, and other online resources, based on the cases reported and retrospective observational analysis were searched from the years 2015-2021. The studies reporting mucormycosis with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) coinfection and/or demonstrating potential risk factors, such as a history of diabetes mellitus or suppressed immune system were included, and reports published in non-English language were excluded. More than 20 case reports and observational studies on black fungus coinfection in COVID-19 patients were eligible for inclusion. The results indicated that diabetes mellitus, hyperglycemic, and immunocompromised COVID-19 patients with mucormycosis were at a higher risk. We found that it was prudent to assess the potential risk factors and severity of invasive mycosis via standardized diagnostic and clinical settings. Large-scale studies need to be conducted to identify early biomarkers and optimization of diagnostic methods has to be established per population and geographical variation. This will not only help clinicians around the world to detect the coinfection in time but also will prepare them for future outbreaks of other potential pandemics.


Assuntos
COVID-19/epidemiologia , Coinfecção/epidemiologia , Mucormicose/epidemiologia , Mucormicose/mortalidade , SARS-CoV-2/isolamento & purificação , Diabetes Mellitus/patologia , Humanos , Hiperglicemia/patologia , Hospedeiro Imunocomprometido/fisiologia , Mucorales/crescimento & desenvolvimento , Mucorales/isolamento & purificação , Mucormicose/patologia , Estudos Retrospectivos , Fatores de Risco
7.
J Med Virol ; 94(1): 417-423, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34581458

RESUMO

A 36-year-old male with diffuse large B-cell lymphoma on maintenance rituximab therapy presented to the emergency department with high fever and fatigue. A chest X-ray showed a lobar infiltrate, 40 days before admission the patient suffered from a mild coronavirus disease 2019 (COVID-19) infection and fully recovered. PCR nasopharyngeal swab was negative for COVID-19. Comprehensive biochemical, radiological, and pathological evaluation including 18-fluorodeoxyglucose positron emission tomography with computed tomography and transbronchial lung biopsy found no pathogen or lymphoma recurrence. Treatment for pneumonia with antibiotic and antifungal agents was nonbeneficial. A diagnosis of secondary organizing pneumonia (OP) was made after pneumonia migration and a rapid response to corticosteroids. OP secondary to a viral respiratory infection has been well described. Raising awareness for post-COVID-19 OP has therapeutic and prognostic importance because those patients benefit from steroid therapy. We believe the condition described here is underdiagnosed and undertreated by doctors worldwide. Because of the ongoing global pandemic we are now encountering a new kind of patient, patients that have recovered from COVID-19. We hope that this case may contribute to gaining more knowledge about this growing patient population.


Assuntos
Corticosteroides/uso terapêutico , COVID-19/terapia , Pneumonia em Organização Criptogênica/diagnóstico , Pneumonia em Organização Criptogênica/tratamento farmacológico , Adulto , Antineoplásicos Imunológicos/uso terapêutico , Pneumonia em Organização Criptogênica/patologia , Humanos , Hospedeiro Imunocomprometido/imunologia , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Masculino , Nasofaringe/virologia , Tomografia por Emissão de Pósitrons , Rituximab/uso terapêutico , SARS-CoV-2
8.
Emerg Infect Dis ; 28(1): 219-223, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34932935

RESUMO

We report a transfusion-transmitted hepatitis A virus infection in an immunocompromised patient in France, detected shortly after a transfusion of pathogen-reduced pooled platelets. This case raises questions about the efficacy of donor screening methods. Additional safety measures, such as routine donation screening, should be considered.


Assuntos
Vírus da Hepatite A , Torque teno virus , Doadores de Sangue , Transfusão de Sangue , Vírus da Hepatite A/genética , Humanos , Hospedeiro Imunocomprometido , Programas de Rastreamento
9.
Oncol Rep ; 47(1)2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34779494

RESUMO

The incidence of cancer, which is the second leading cause of mortality globally, continues to increase, although continued efforts are being made to identify effective treatments with fewer side­effects. Previous studies have reported that chronic microinflammation, which occurs in diseases, including diabetes, along with weakened immune systems, may ultimately lead to cancer development. Chemotherapy, radiotherapy and surgery are the mainstream approaches to treatment; however, they all lead to immune system weakness, which in turn increases the metastatic spread. The aim of the present review was to provide evidence of a biological response modifier ß­glucan [ß­glucan vaccine adjuvant approach to treating cancer via immune enhancement (B­VACCIEN)] and its beneficial effects, including vaccine­adjuvant potential, balancing metabolic parameters (including blood glucose and lipid levels), increasing peripheral blood cell cytotoxicity against cancer and alleviating chemotherapy side effects in animal models. This suggests its value as a potential strategy to provide long­term prophylaxis in immunocompromised individuals or genetically prone to cancer.


Assuntos
/administração & dosagem , Hospedeiro Imunocomprometido/imunologia , Neoplasias/imunologia , Neoplasias/prevenção & controle , beta-Glucanas/imunologia , Animais , Humanos
11.
Blood Cancer J ; 11(12): 202, 2021 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-34907159

RESUMO

There is evidence of reduced SARS-CoV-2 vaccine effectiveness in patients with hematological malignancies. We hypothesized that tumor and treatment-related immunosuppression can be depicted in peripheral blood, and that immune profiling prior to vaccination can help predict immunogenicity. We performed a comprehensive immunological characterization of 83 hematological patients before vaccination and measured IgM, IgG, and IgA antibody response to four viral antigens at day +7 after second-dose COVID-19 vaccination using multidimensional and computational flow cytometry. Health care practitioners of similar age were the control group (n = 102). Forty-four out of 59 immune cell types were significantly altered in patients; those with monoclonal gammopathies showed greater immunosuppression than patients with B-cell disorders and Hodgkin lymphoma. Immune dysregulation emerged before treatment, peaked while on-therapy, and did not return to normalcy after stopping treatment. We identified an immunotype that was significantly associated with poor antibody response and uncovered that the frequency of neutrophils, classical monocytes, CD4, and CD8 effector memory CD127low T cells, as well as naive CD21+ and IgM+D+ memory B cells, were independently associated with immunogenicity. Thus, we provide novel immune biomarkers to predict COVID-19 vaccine effectiveness in hematological patients, which are complementary to treatment-related factors and may help tailoring possible vaccine boosters.


Assuntos
Biomarcadores/sangue , Vacinas contra COVID-19 , COVID-19/imunologia , Neoplasias Hematológicas/complicações , Hospedeiro Imunocomprometido/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2
12.
Rev Peru Med Exp Salud Publica ; 38(3): 463-466, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34932749

RESUMO

Cerebral nocardia infections is a rare entity, which has been mainly reported in immunosuppressed patients. Currently, there are no clinical guidelines for first-line treatment. Our case refers to an older immunocompetent adult, with encephalopathy and left hemiparesis, associated with lesions compatible with multiple brain abscess and suggestive of infectious etiology. He initially received treatment for tuberculosis, bacterial abscess, and toxoplasmosis, without a favorable clinical response. An empirical treatment for nocardiosis started, by using meropenem and trimethoprim / sulfamethoxazole, and clinical and imaging improvement was achieved. The occurrence of adverse events forces the temporary use of alternative medications. We highlight some criteria for including nocardiosis in the differential diagnosis in cases of multiple brain abscess and mention laboratory diagnostic methods and drugs to initiate empirical treatment.


Assuntos
Abscesso Encefálico , Nocardiose , Nocardia , Adulto , Antibacterianos/uso terapêutico , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/tratamento farmacológico , Humanos , Hospedeiro Imunocomprometido , Masculino , Nocardiose/diagnóstico , Nocardiose/tratamento farmacológico , Peru
13.
BMC Infect Dis ; 21(1): 1250, 2021 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-34906094

RESUMO

BACKGROUND: Bacterial infective endocarditis caused by Proteus mirabilis is rare and there are few cases in the literature. The natural history and treatment of this disease is not as clear but presumed to be associated with complicated urinary tract infection (cUTI). CASE PRESENTATION: A 65-year-old female with a history of rheumatoid arthritis, factor V Leiden hypercoagulability, and prior saddle pulmonary embolism presented to the emergency department following a mechanical fall. Computed Tomography showed evidence of acute/subacute splenic emboli. Complicated UTI was likely secondary to a ureteral stone. Blood and urine cultures also grew out P. mirabilis. Transthoracic echocardiography revealed a mobile echogenic density on the anterior mitral valve (MV) leaflet consistent with a vegetation. The patient underwent MV replacement, and P. mirabilis was isolated from the surgically removed valve. CONCLUSIONS: We hypothesize that the patient's immunocompromised status following steroid and Janus Kinase inhibitor usage for rheumatoid arthritis contributed to Gram-negative bacteremia following P. mirabilis UTI, ultimately seeding the native MV. Additional studies with larger numbers of Proteus endocarditis cases are needed to investigate an association between immunosuppression and Proteus species endocarditis.


Assuntos
Endocardite , Proteus mirabilis , Idoso , Antibacterianos/uso terapêutico , Endocardite/diagnóstico por imagem , Endocardite/tratamento farmacológico , Feminino , Humanos , Hospedeiro Imunocomprometido , Valva Mitral/diagnóstico por imagem
15.
Semin Respir Crit Care Med ; 42(6): 839-858, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34918325

RESUMO

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was first identified as a novel coronavirus in Wuhan, Hubei province, central China, in December 2019, and is responsible for the 2019-to-present pandemic. According to the most recent data released by the World Health Organization, more than 200 million people have been infected by SARS-CoV-2 so far, and more than 4 million people died worldwide. Although our knowledge on SARS-CoV-2 and COVID-19 is constantly growing, data on COVID-19 in immunocompromised patients are still limited. The aim of the present systematic review is to describe clinical picture, disease severity, proposed treatment regimen, and response to vaccination in patients with different types and severity of immunosuppression.


Assuntos
COVID-19/imunologia , COVID-19/fisiopatologia , Hospedeiro Imunocomprometido/imunologia , SARS-CoV-2/imunologia , SARS-CoV-2/patogenicidade , COVID-19/mortalidade , COVID-19/terapia , Vacinas contra COVID-19/imunologia , Humanos , Tolerância Imunológica
16.
Front Immunol ; 12: 803742, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34950155

RESUMO

Immunocompromised patients are considered high-risk and prioritized for vaccination against COVID-19. We aimed to analyze B-cell subsets in these patients to identify potential predictors of humoral vaccination response. Patients (n=120) suffering from hematologic malignancies or other causes of immunodeficiency and healthy controls (n=79) received a full vaccination series with an mRNA vaccine. B-cell subsets were analyzed prior to vaccination. Two independent anti-SARS-CoV-2 immunoassays targeting the receptor-binding domain (RBD) or trimeric S protein (TSP) were performed three to four weeks after the second vaccination. Seroconversion occurred in 100% of healthy controls, in contrast to 67% (RBD) and 82% (TSP) of immunocompromised patients, while only 32% (RBD) and 22% (TSP) achieved antibody levels comparable to those of healthy controls. The number of circulating CD19+IgD+CD27- naïve B cells was strongly associated with antibody levels (ρ=0.761, P<0.001) and the only independent predictor for achieving antibody levels comparable to healthy controls (OR 1.07 per 10-µL increase, 95%CI 1.02-1.12, P=0.009). Receiver operating characteristic analysis identified a cut-off at ≥61 naïve B cells per µl to discriminate between patients with and without an optimal antibody response. Consequently, measuring of naïve B cells in immunocompromised hematologic patients could be useful in predicting their humoral vaccination response.


Assuntos
Subpopulações de Linfócitos B/imunologia , Vacinas contra COVID-19/imunologia , COVID-19/prevenção & controle , Hospedeiro Imunocomprometido/imunologia , Imunogenicidade da Vacina/imunologia , Adulto , Idoso , Anticorpos Neutralizantes/imunologia , Anticorpos Antivirais/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Vacinas Sintéticas/imunologia , /imunologia
18.
Front Immunol ; 12: 760249, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34925330

RESUMO

Background: The humoral and cellular immune responses to SARS-COV-2 vaccination remain to be elucidated in hemodialysis (HD) patients and kidney transplant recipients (KTRs), considering their baseline immunosuppressed status. The aim of our study was to assess the associations of vaccine-induced antibody responses with circulating lymphocytes sub-populations and their respective patterns of alterations in maintenance HD patients and KTRs. Materials and Methods: We included 34 HD patients and 54 KTRs who received two doses of the mRNA-vaccine BNT162b2. Lymphocyte subpopulations were analyzed by flow cytometry before vaccination (T0), before the second vaccine dose (T1) and 2 weeks after the second dose (T2). The anti-SARS-CoV2 antibody response was assessed at T1 and at T2. Results: 31 HD patients (91.8%) and 16 KTRs (29.6%) became seropositive at T2. HD patients who became seropositive following the first dose displayed higher CD19+ B lymphocytes compared to their seronegative HD counterparts. A positive correlation was established between CD19+ B cells counts and antibody titers at all time-points in both groups (p < 0.001). KTRs showed higher naïve CD4+CD45RA+ T helper cells compared to HD patients at baseline and T2 whereas HD patients displayed higher memory CD45RO+ T cells compared to KTRs at T2. The naïve CD4+CD45RA to memory CD4+CD45RO+ T helper cells fraction was negatively associated with antibody production in both groups. Conclusions: Our study provides a potential conceptual framework for monitoring vaccination efficacy in HD patients and KTRs considering the correlation established between CD19+ B cells, generation of memory CD4+ T helper cells and anti SARS-CoV2 antibody response to vaccination.


Assuntos
Formação de Anticorpos/imunologia , Linfócitos B/imunologia , Linfócitos T CD4-Positivos/imunologia , Imunidade Humoral , Hospedeiro Imunocomprometido , Memória Imunológica , Linfócitos B/metabolismo , Biomarcadores , Linfócitos T CD4-Positivos/metabolismo , COVID-19/imunologia , COVID-19/virologia , Vacinas contra COVID-19/imunologia , Feminino , Humanos , Imunofenotipagem , Transplante de Rim , Contagem de Linfócitos , Masculino , Diálise Renal , SARS-CoV-2/imunologia
19.
Front Immunol ; 12: 780594, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34925359

RESUMO

Background: Dialysis patients are at high risk for a severe clinical course after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Safety and early immune responses after mRNA-based vaccination have been reported mostly in patients on hemodialysis (HD), whereas reports of peritoneal dialysis (PD) patients remain rare. Methods: In this retrospective observational study, 39 PD patients had received two doses of the mRNA-1273 Moderna® vaccine. We analyzed SARS-CoV-2 Spike (S) antibody titers 4 weeks after each dose of mRNA-1273 and report local and systemic side effects in PD patients that occurred within one week after each mRNA-1273 dose. Using a quantile regression model we examined factors that might influence SARS-CoV-2 S antibody levels in PD patients. Results: Four weeks after the first dose of mRNA-1273 vaccine 33 of 39 (84.6%) PD patients seroconverted and presented with 6.62 U/mL (median; IQR 1.57-22.5) anti-SARS-CoV-2 S antibody titers. After the second dose, 38 of 39 (97.4%) PD patients developed anti-SARS-CoV-2 S antibodies and titers increased significantly (median 968 U/mL; IQR 422.5-2500). Pain at the injection site was the most common local adverse event (AE) (71%). Systemic AEs occurring after the first dose were mostly fatigue (33%) and headache (20%). No severe systemic AEs were reported after the first injection. After the second dose the incidence and the severity of the systemic AEs increased. The most common systemic AEs were: fatigue (40.5%), headache (22.5%), joint pain (20%), myalgia (17.5%) and fever (13%). Lower Davies Comorbidity Score (p=0.04) and shorter dialysis vintage (p=0.017) were associated with higher antibody titers after the first dose. Patients with higher antibody titers after the first dose tended to have higher antibody titers after the second dose (p=1.53x10-05). Conclusions: Peritoneal dialysis patients in this cohort had a high seroconversion rate of 97.4%, showed high antibody titers after full vaccination and tolerated the anti-SARS-CoV-2 mRNA-1273 vaccine well without serious adverse events.


Assuntos
/imunologia , Formação de Anticorpos/imunologia , COVID-19/imunologia , Interações Hospedeiro-Patógeno/imunologia , Hospedeiro Imunocomprometido , Diálise Peritoneal , SARS-CoV-2/imunologia , /administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antivirais , COVID-19/prevenção & controle , Estudos de Coortes , Comorbidade , Feminino , Humanos , Imunogenicidade da Vacina , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vacinação
20.
Artigo em Inglês | MEDLINE | ID: mdl-34769913

RESUMO

OBJECTIVE: to describe a single-center experience of Pneumocystis jirovecii pneumonia (PJP) in non-HIV patients recovering from COVID-19. METHODS: We report the cases of five non-HIV patients with COVID-19 who also developed PJP at a University Hospital. RESULTS: With the exception of one subject, who experienced an atypical and prolonged course of COVID-19, all the patients developed PJP after the clinical resolution of COVID-19 pneumonia. All but one patient had no pre-existing immunosuppressive conditions or other risk factors for PJP development at COVID-19 diagnosis. Nonetheless, following the course of COVID-19 infection, all the patients fulfilled at least one host factor for PJP; indeed, all the patients had received at least 2 weeks of high-dose steroids and three out of five had a CD4+ cell count <200/mm3. CONCLUSIONS: The use of corticosteroids for COVID-19 respiratory impairment seems to be the most common risk factor for PJP, together with viral-induced and iatrogenic lymphopenia. The worsening in respiratory function and the characteristic radiological picture during or after COVID-19 pneumonia should raise the suspicion of PJP, even in immunocompetent patients. PJP primary chemoprophylaxis can be considered in selected high-risk COVID-19 patients, but further studies are needed.


Assuntos
COVID-19 , Pneumocystis carinii , Pneumonia por Pneumocystis , Teste para COVID-19 , Humanos , Hospedeiro Imunocomprometido , Pneumonia por Pneumocystis/tratamento farmacológico , SARS-CoV-2
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