Posts filed under ‘Biológicos’

The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak.

Journal of Autoimmunuty February 2020 

Rothan HA1, Byrareddy SN2.

Abstract

Coronavirus disease (COVID-19) is caused by SARS-COV2 and represents the causative agent of a potentially fatal disease that is of great global public health concern. Based on the large number of infected people that were exposed to the wet animal market in Wuhan City, China, it is suggested that this is likely the zoonotic origin of COVID-19. Person-to-person transmission of COVID-19 infection led to the isolation of patients that were subsequently administered a variety of treatments. Extensive measures to reduce person-to-person transmission of COVID-19 have been implemented to control the current outbreak. Special attention and efforts to protect or reduce transmission should be applied in susceptible populations including children, health care providers, and elderly people. In this review, we highlights the symptoms, epidemiology, transmission, pathogenesis, phylogenetic analysis and future directions to control the spread of this fatal disease.

FULL TEXT

https://www.sciencedirect.com/science/article/pii/S0896841120300469?via%3Dihub

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April 2, 2020 at 7:59 pm

Development and validation of the HScore, a score for the diagnosis of reactive hemophagocytic syndrome.

Arthritis Rheumatol. september 2014 V.66 N.9 P.2613-20.   

Fardet L1, Galicier L, Lambotte O, Marzac C, Aumont C, Chahwan D, Coppo P, Hejblum G.

Abstract

OBJECTIVE:

Because it has no unique clinical, biologic, or histologic features, reactive hemophagocytic syndrome may be difficult to distinguish from other diseases such as severe sepsis or hematologic malignancies. This study was undertaken to develop and validate a diagnostic score for reactive hemophagocytic syndrome.

METHODS:

A multicenter retrospective cohort of 312 patients who were judged by experts to have reactive hemophagocytic syndrome (n = 162), were judged by experts to not have reactive hemophagocytic syndrome (n = 104), or in whom the diagnosis of reactive hemophagocytic syndrome was undetermined (n = 46) was used to construct and validate the reactive hemophagocytic syndrome diagnostic score, called the HScore. Ten explanatory variables were evaluated for their association with the diagnosis of hemophagocytic syndrome, and logistic regression was used to calculate the weight of each criterion included in the score. Performance of the score was assessed using developmental and validation data sets.

RESULTS:

Nine variables (3 clinical [i.e., known underlying immunosuppression, high temperature, organomegaly], 5 biologic [i.e., triglyceride, ferritin, serum glutamic oxaloacetic transaminase, and fibrinogen levels, cytopenia], and 1 cytologic [i.e., hemophagocytosis features on bone marrow aspirate]) were retained in the HScore. The possible number of points assigned to each variable ranged from 0-18 for known underlying immunosuppression to 0-64 for triglyceride level. The median HScore was 230 (interquartile range [IQR] 203-257) for patients with a positive diagnosis of reactive hemophagocytic syndrome and 125 (IQR 91-150) for patients with a negative diagnosis. The probability of having hemophagocytic syndrome ranged from <1% with an HScore of ≤90 to >99% with an HScore of ≥250.

CONCLUSION:

The HScore can be used to estimate an individual’s risk of having reactive hemophagocytic syndrome. This scoring system is freely available online (http://saintantoine.aphp.fr/score/).

FULL TEXT

https://onlinelibrary.wiley.com/doi/full/10.1002/art.38690

PDF

https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.38690

April 2, 2020 at 7:57 pm

Letter COVID-19 – consider cytokine storm syndromes and immunosuppression.

Lancet. March 16, 2020 V.395 N.10229 P.1033-1034.

PDF

https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2930628-0

April 2, 2020 at 7:54 pm

Real-world efficacy of bezlotoxumab for prevention of recurrent Clostridium difficile infection: a retrospective study of 46 patients in five university hospitals in Finland

European Journal of Clinical Microbiology & Infectious Diseases October 2019 V.38 N.10 P.1947–1952

Reports on real-world experience on efficacy of bezlotoxumab (BEZ) has been lacking thus far. We retrospectively studied the efficacy and safety of BEZ in preventing the recurrence of Clostridium difficile infection (CDI) in five university hospitals in Finland. Seventy-three percent of our 46 patients remained free of recurrence in the following 3 months and the performance remained as 71% effective also among immunocompromised patients. In severe CDI, BEZ prevented recurrence in 63% of cases. From our study patients, 78% had three or more known risk factors for recurrence of CDI. Eight of our patients were waiting for fecal microbiota transplantation but after stopping the antibiotics that were continued to prevent recurrence of CDI and after receiving BEZ, all remained free of recurrence and did not need the procedure. Success with BEZ as an adjunctive treatment in preventing recurrence of CDI in high-risk patients may be rated as high. Among a subgroup of our patients, those already evaluated to be in need of fecal microbiota transplantation, BEZ seems to be an alternative option.

FULL TEXT

https://link.springer.com/article/10.1007/s10096-019-03630-y?wt_mc=alerts.TOCjournals&utm_source=toc&utm_medium=email&utm_campaign=toc_10096_38_10

PDF

https://link.springer.com/content/pdf/10.1007%2Fs10096-019-03630-y.pdf

November 12, 2019 at 3:45 pm

Bezlotoxumab for Prevention of Recurrent Clostridium difficile Infection in Patients at Increased Risk for Recurrence

Clinical Infectious Diseases September 1, 2018 V.67 N.5 P.649–656

Dale N Gerding; Ciaran P Kelly; Galia Rahav; Christine Lee; Erik R Dubberke …

Subgroup analyses from MODIFY confirmed that prior Clostridium difficile infection (CDI), age ≥65 years, infection with 027/078/244 strain, compromised immunity, and severe CDI are risk factors for recurrent CDI. Bezlotoxumab reduced CDI recurrence in participants with ≥1 risk factor compared with placebo.

Background

Bezlotoxumab is a human monoclonal antibody against Clostridium difficile toxin B indicated to prevent C. difficile infection (CDI) recurrence (rCDI) in adults at high risk for rCDI. This post hoc analysis of pooled monocolonal antibodies for C.difficile therapy (MODIFY) I/II data assessed bezlotoxumab efficacy in participants with characteristics associated with increased risk for rCDI.

Methods

The analysis population was the modified intent-to-treat population who received bezlotoxumab or placebo (n = 1554) by risk factors for rCDI that were prespecified in the statistical analysis plan: age ≥65 years, history of CDI, compromised immunity, severe CDI, and ribotype 027/078/244. The proportion of participants with rCDI in 12 weeks, fecal microbiota transplant procedures, 30-day all cause and CDI-associated hospital readmissions, and mortality at 30 and 90 days after randomization were presented.

Results

The majority of enrolled participants (75.6%) had ≥1 risk factor; these participants were older and a higher proportion had comorbidities compared with participants with no risk factors. The proportion of placebo participants who experienced rCDI exceeded 30% for each risk factor compared with 20.9% among those without a risk factor, and the rCDI rate increased with the number of risk factors (1 risk factor: 31.3%; ≥3 risk factors: 46.1%). Bezlotoxumab reduced rCDI, fecal microbiota transplants, and CDI-associated 30-day readmissions in participants with risk factors for rCDI.

Conclusions

The risk factors prespecified in the MODIFY statistical analysis plan are appropriate to identify patients at high risk for rCDI. While participants with ≥3 risk factors had the greatest reduction of rCDI with bezlotoxumab, those with 1 or 2 risk factors may also benefit.

Clinical Trials Registration NCT01241552 (MODIFY I) and NCT01513239 (MODIFY II).

FULL TEXT

https://academic.oup.com/cid/article/67/5/649/4925796

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September 2, 2018 at 10:33 am

Clostridium difficile Lives Up to Its Name: The Need for Systematic Approaches for Treatment and Prevention of Future Recurrence

Infectious Diseases in Clinical Practice March 2018 V.26 N.2 P.57-59

Editorial Comment

Roshdy, Danya; Jaffa, Rupal; Pillinger, Kelly E

La infección por Clostridium difficile (CDI) representa una carga significativa para el sistema de atención de la salud de los EEUU. lo que provoca 29,000 muertes y 4.800 millones de dólares en costos de atención médica excedentes anuales.

C. difficile fue el patógeno reportado con mayor frecuencia en una encuesta reciente de prevalencia multiestatal de las infecciones asociadas al cuidado de la salud, con tasas por cada 1000 altas en aumento. La infección por C. difficile afecta a los pacientes en una variedad de entornos, incluidos hospitales, hogares de ancianos y la comunidad.

Por lo tanto, el CDI ahora ha sido identificado como una amenaza urgente por los Centros para el Control y la Prevención de Enfermedades, lo que destaca la necesidad de un mayor control y estrategias de prevención….

FULL TEXT

https://journals.lww.com/infectdis/Fulltext/2018/03000/Clostridium_difficile_Lives_Up_to_Its_Name__The.1.aspx

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March 31, 2018 at 12:48 pm

High risk for invasive meningococcal disease among patients receiving eculizumab (Soliris) despite receipt of meningococcal vaccine

Morbidity and Mortalality Weekly Report July 14,  2017 V.66 N.27 P.734-737.

Lucy A. McNamara, PhD1; Nadav Topaz, MSc1; Xin Wang, PhD1; Susan Hariri, PhD1; LeAnne Fox, MD1; Jessica R. MacNeil, MPH1

Use of eculizumab (Soliris, Alexion Pharmaceuticals), a terminal complement inhibitor, is associated with a 1,000-fold to 2,000-fold increased incidence of meningococcal disease (1). Administration of meningococcal vaccines is recommended for patients receiving eculizumab before beginning treatment (2,3).

Sixteen cases of meningococcal disease were identified in eculizumab recipients in the United States during 2008–2016; among these, 11 were caused by nongroupable Neisseria meningitidis.

Fourteen patients had documentation of receipt of at least 1 dose of meningococcal vaccine before disease onset.

Because eculizumab recipients remain at risk for meningococcal disease even after receipt of meningococcal vaccines, some health care providers in the United States as well as public health agencies in other countries recommend antimicrobial prophylaxis for the duration of eculizumab treatment; a lifelong course of treatment is expected for many patients.

Heightened awareness, early care seeking, and rapid treatment of any symptoms consistent with meningococcal disease are essential for all patients receiving eculizumab treatment, regardless of meningococcal vaccination or antimicrobial prophylaxis status….

PDF

https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6627e1.pdf

July 27, 2017 at 8:12 am

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