Clinical Immunology Communications最新文献

As long as there is only symptomatic treatment against thick-borne encephalitis (TBE) available, vaccination is considered the only prevention against infection.

The national vaccination recommendations prescribe a booster vaccination every 5 years after a basic vaccination has been carried out. This study deals with the question if antibodies in sufficient concentration exist or not when the last immunization had been five years ago.

The TBE titer was determined in 168 subjects using indirect ELISA and the vaccination history was collected.

The results show that 97.3 % of the participants have a sufficient titer 5 years after the last booster vaccination. The time period since the last booster and the type of the vaccine influence the antibody level the most. In conclusion, it was found that by controlling the titer, it is possible to postpone a booster vaccination, if the immunization is still sufficient.

Management of Systemic lupus erythematosus is challenging due to its varied manifestations, relapses and problems associated with immunosuppressive therapy. This challenge is compounded in resource limited countries due to additional factors such as poor access to health care, limited income, out of pocket expenses for medical care and lack of financial independence of women. In the current review some of these issues have been highlighted in context of India, the most populous country of the world with current annual per capita income of around 2000 dollars.

Systemic lupus erythematosus (SLE) affects more severely non-White populations, which is also the case in Latin America; this is the result of a combination of genetic and non-genetic factors. Among the non-genetic factors, a limited income and a low educational level impact negatively on the course and outcome of the disease; in addition, lack of access to healthcare services deprives patients from the opportunity of being managed by specialists, making the availability of the newest drugs practically impossible. Taking together, these factors reduce the probability of patients achieving good outcomes, like remission, less damage accrual, a better survival and a better health-related quality of life, among others. Several strategies have been proposed to reduce these disparities, including peer education, educational activities for patients and primary care physicians, improving healthcare networks and generating cost-effectiveness analyses.

We report a case of an adult female with disseminated tuberculosis, cytomegalovirus viraemia and haemophagocytic-lymphohistiocystosis syndrome associated with neutralizing anti- interferon gamma (IFNγ) autoantibodies demonstrated by absent IFNγ stimulated STAT1 phosphorylation in the presence of patient sera. A brief review of immunodeficiency caused by anti-IFNγ autoantibodies is also described.

Goal of health policies is to protect and promote the health of communities. We examined COVID-19 policy outcomes of the 50 US states according to policymaker assumptions over time. With daily cumulative population mortality chosen as an indicator to evaluate and score outcomes of individual health policies, Hawaii had the best score and Arizona has the worst score. Our policy outcome analysis tool could identify and quantify policymakers’ faulty assumptions against COVID-19, and concludes that the more COVID-19 deaths, the greater the economic loss.

The acute respiratory distress syndrome (ARDS) is a common cause of respiratory failure in critically ill patients and is defined by the acute onset of noncardiogenic pulmonary edema, hypoxemia, and the need for mechanical ventilation. ARDS occurs most often in the setting of pneumonia, sepsis, aspiration of gastric contents or severe trauma, and is present in ∼10% of all intensive care unit patients worldwide. Pathologic specimens from patients with ARDS most frequently reveal diffuse alveolar damage, and laboratory studies have demonstrated both alveolar epithelial and lung endothelial injury, resulting in accumulation of protein-rich inflammatory edema fluid in the alveolar space. The current therapeutic regimen is comprised of supportive measures such as lung protective ventilation, restrictive fluid management, paralyzing drugs, and prone positioning. Although vast improvements have been made in ARDS-treatment during the last five decades, mortality among patients with severe ARDS remains at an unacceptable rate of 45%.This article reviews the evolution of the currently used definition, established pathophysiological mechanism, highlights the current best clinical practice to treat ARDS, gives a brief outlook on cutting edge trends in ARDS research and closes with an expert opinion on the subject. The ongoing digital revolution will help to individualize ARDS-treatment and will therefore presumably improve survival and quality of life.

Objectives

Elderly become more susceptible to lower respiratory tract infections, resulting in antibiotic prescriptions. Immunoglobulins (Ig) play an important role in host defense and protection against infections. Therefore, we aimed to investigate whether lower Ig levels are a risk factor for antibiotic use in the general elderly population.

Methods

After exclusion of current antibiotic users, Cox proportional-hazards regression models were performed to investigate the effect of stable serum IgM, IgG and IgA levels on time to first antibiotic prescription within the Rotterdam Study. Regression models were adjusted for age, sex, body mass index, smoking status and diabetes. We introduced quadratic terms and additionally categorized Igs to explore and quantify potential non-linearity of the association. The restricted cubic splines technique was used to plot the natural log of the hazard across Ig level.

Results

In total, 8,639 participants were included (mean age 64 years, 57% female, medium follow-up 3.2 years). No significant association between IgM and time to antibiotic prescription was observed. IgG and IgA levels (in g/L) showed a U-shaped relationship with time to antibiotic prescription (linear IgG HR 0.959, 95% CI 0.930–0.989; quadratic IgG² HR 1.002, 95% CI 1.000–1.003; linear IgA HR 0.949, 95% CI 0.910–0.990; quadratic IgA² HR 1.009, 95% CI 1.004–1.013).

Conclusion

Both low and high IgG and IgA levels were associated with a higher incidence of antibiotic prescriptions in stable middle-aged and older individuals. Increased awareness for the potential increased infection risk when persons have low or high Ig levels, even within the reference ranges, is needed.

Cutaneous T-cell lymphoma (CTCL) serves as an umbrella term for numerous lymphomas that reside in or recirculate through the skin. One such systemic lymphoma is Sézary Syndrome (SS). Although SS is not as common in Skin of Color (SOC), minority patients presenting with the condition do have a different presentation than their White counterparts. In this graphical review, we provide an overview of SS immunopathogenesis and varying presentations. Additionally, a summary of current treatment options is provided, highlighting ongoing clinical trials and opportunities to include SOC patients to promote health equity. SOC patients often have poorer prognosis due to biological differences and health disparities resulting in delayed diagnosis. This exemplifies the potential advantages and promising solutions of precision medicine implementation. To this end, the impact and benefits of precision medicine are summarized.

Mycosis fungoides (MF) is the most common subtype of Cutaneous T-Cell Lymphoma (CTCL). Patients with Skin of Color (SOC) may be disproportionately impacted by MF due to delayed diagnoses, limited research, and treatment differences. In this graphical review, we provide an overview of MF immunopathogenesis and demonstrate how it manifests differently in SOC patients. We also provide our hypothesis for why the disease process can result in a myriad of clinical presentations in SOC patients. Last, we provide a summary of current treatment options, highlighting ongoing clinical trials and opportunities to include SOC patients to promote health equity.

The newly discovered SARS-CoV-2 Omicron (B.1.1.529) variant is the most antigenically unique SARS-CoV-2 variant of concern to date, which is presently prevalent across most of the world. According to a number of studies, the Omicron variant causes a restricted immune response after infection. A critical component of study is determining the efficacy of Omicron-induced immunity and if it is cross-protective against other variants.