Journal of clinical virology plus最新文献

Background

Very limited literature on the clinical course of COVID-19 among liver transplant recipients (LT) is available from India. The present study aimed to evaluate the clinical and mutational profile of SARS-CoV-2 among LT.

Methodology

This was a retrospective study including LT cases in whom SARS-CoV-2 RT-PCR testing was requested between April 2020 and December 2022. Detailed mutational analysis was performed by comparing LT COVID-19 positive study group i.e. LT-CoV(+) with two control groups. One including COVID-19 positive with underlying chronic liver disease (CLD) i.e. CLD-CoV(+) and other including COVID-19 positive outpatients without any underlying LD i.e. NLD-CoV(+)

Results

Among 213 cases, 48 (22.5 %) were positive [LT-CoV(+)] and the remaining 165 (77.5 %) were negative [LT-CoV(-)] for SARS-CoV-2. Of these, 49 % had mild, 14 % moderate and 37 % had severe COVID-19. Mortality was recorded in 11 (23 %) cases, the majority being non-vaccinated. Severe COVID-19 with intensive care requirement was significantly higher among recipients with >5 years since transplant compared to recipients with ≤5 years (p = 0.02). Among 40 samples subjected to whole genome sequencing, 19 (47.5 %) were Delta, 15 (37.5 %) Omicron, and 6 (15 %) were other variants. COVID-19 severity was significantly higher in LT-CoV(+/D) with no significant difference in mortality (p = 0.122). No significant differences in mutational load and in fraction of deleterious mutations were observed between LT-/CLD-/NLD-CoV(+) groups for either Delta or Omicron.

Conclusion

An overall fatality rate of 23 % was recorded among LT recipients. Longer duration since transplant was associated with severe clinical course. However, no significant difference in mutation load between studied groups was observed.

Background

This study aimed to evaluate the impact of remdesivir, alone or in combination with corticosteroids, on the time to death in COVID-19 patients.

Methods

This retrospective cohort study was conducted between March 20, 2020, and March 18, 2021, on 5318 patients with confirmed COVID-19 at three tertiary educational hospitals in Tehran, Iran. The treated group consisted of COVID-19 patients who received remdesivir, either alone or in combination with corticosteroids, while the untreated group included infected patients who did not receive these treatments. The two groups were matched by propensity score matching method, which adjusted for 92 confounding factors such as demographic, sign and symptom, clinical, and treatment-related factors, to provide balanced covariates between the treated and untreated groups.

Results

Of the 4,322 patients, 791 received remdesivir alone and 694 received remdesivir combined with corticosteroids. Among the patients who received remdesivir, 456 were male, and the mean (±standard deviation) age was 59.52±16.49 with a median hospitalization stay of 8 (interquartile range: 5–13) days. After applying the nearest neighbor propensity score matching method, there were no significant differences found in the hazard of death between patients who received remdesivir alone and those who did not receive treatment (hazard ratio: 0.94; 95 % confidence interval: 0.76, 1.16). In addition, the combination of remdesivir and corticosteroids was not associated with a reduced hazard of death (hazard ratio: 1.00; 95 % confidence interval: 0.80, 1.26). The median hospitalization stay was significantly longer in the group treated with remdesivir (alone/combined with corticosteroids) compared to the untreated group, both before and after matching.

Conclusion

No association was observed between remdesivir treatment (alone/combined with corticosteroids) and a reduced hazard of death among COVID-19 patients. However, longer hospitalization stays were observed in patients receiving remdesivir, either alone or in combination with corticosteroids, compared to the untreated group.

Objective

To investigate the efficacy and safety of intravenous peramivir compared to oral oseltamivir for pediatric influenza by a method of meta-analysis.

Methods

Clinical trials involving intravenous peramivir versus oral oseltamivir therapy in children with influenza were searched from six databases until July 2023. Data were processed using Stata 15.0 software.

Results

Seven published articles were identified in this review. The combined results exhibited that the clinical effective rate in the peramivir group (76.09 %) was higher than that in the oseltamivir group (58.85 %) (RR= 1.12, 95 %CI: 1.01∼1.24, P = 0.038). The incidence of adverse reactions in the peramivir group (13.31 %) was lower than that in the oseltamivir group (17.34 %) (RR= 0.77, 95 %CI: 0.61–0.96, P = 0.023). Compared with the oseltamivir group, the peramivir group had lower recovery time of body temperature (WMD= -19.81, 95 %CI: -27.58∼-12.04, P < 0.001).

Conclusion

Compared with oral oseltamivir, intravenous peramivir has better efficacy and higher safety for pediatric influenza.

Introduction

Since its identification in April 2009, influenza A(H1N1)pdm09 virus has continued to cause significant outbreaks of respiratory tract infections, including pandemics in humans. In the course of its evolution, the virus has acquired many mutations that cause increased disease severity. Regular molecular surveillance of the virus is essential to mark the evolutionary changes that may cause a shift in viral behavior.

Methods

Twenty-five (H1N1)pdm09 isolates from Huzhou, China, in 2023 were randomly selected for whole-genome sequencing along with analysis of nucleotide and amino acid sequence identity, average genetic distance, antigen variation sites, receptor binding sites, pathogenicity, potential glycosylation sites, and drug resistance gene sites.

Results

The 25 (H1N1)pdm09 strains and representative 2023–2024 northern hemisphere vaccine strain A/Wisconsin/67/2022 showed nucleotide and amino acid similarity of 98.41 %–99.22 % and 98.41 %–99.36 %, respectively. This virus belongs to the 6B1A.5a.2a evolutionary lineage. There were 19 amino acid variations in hemagglutinin (HA) protein. Substitutions S137P and R142K occurred in the epitope Ca2 cluster. A total of 13 amino acids were mutated in neuraminidase (NA) protein, and 9 key protease active sites and amino acid sites related to NA inhibitor (NAI) resistance were not mutated. Five amino acid sites of matrix-2 (M2) protein associated with drug resistance were not replaced, but amino acid 31 of M2 protein was shown to be N in the 2023 pandemic strain (H1N1)pdm09 and vaccine strain A/Wisconsin/67/2022. There were seven and eight potential glycosylation sites for HA protein and NA protein, respectively. Compared with the vaccine strains, there were no new or missing potential glycosylation sites in the 25 (H1N1)pdm09 influenza virus isolates. No multiple continuous alkaline amino acids were found in the HA cleavage site of the 25 isolates.

Conclusions

The recommended vaccine strain A/Wisconsin/67/2022 has good prevention potential against the current circulating influenza (H1N1)pdm09. At present, NAIs have good therapeutic and preventive effects against (H1N1)pdm09 circulating in Huzhou, China, but the virus is naturally resistant to amantadines. At present, the (H1N1)pdm09 strain circulating in Huzhou, China, is characterized by low pathogenicity. However, regular molecular surveillance of (H1N1)pdm09 is important to monitor the behavior of the virus in terms of increases in virulence, drug resistance, and emergence of novel strains.

Rapid laboratory testing is essential to detect HSV in the lower respiratory tract to allow rapid treatment decisions. We evaluated the clinical performance of the Simplexa HSV 1 & 2 Direct assay in bronchoalveolar lavage. This assay is highly sensitive and specific in detecting HSV-1 and HSV-2 in bronchoalveolar lavage.

Background

To evaluate disease severity for coronavirus disease of 2019 (COVID-19), seasonal influenza (FLU) is often used as a control group for comparison. However, evidence regarding outpatients without risk factors for severe disease is insufficient to consider future treatment policies for these patients.

Objectives

To compare the risk of severe disease in patients without risk factors for severe disease who are diagnosed with COVID-19 or FLU.

Study design

This was a retrospective study analyzing a health insurance claims database (data collection: COVID-19, January 2020 through August 2022; FLU, October 2017 through September 2019). Outcome measures were incidences of severe events of hospitalization, respiratory and heart rate monitoring, oxygen therapy, ventilator use, and intensive care unit admission (within 28 days from diagnosis), and death (within the following month).

Results

Data from 575,293 patients were included in the COVID-19 group and from 1,095,698 patients in the FLU group, without risk factors. Adjusted odds ratios for all study outcomes were significantly higher for patients with COVID-19 than with FLU (>3 times greater odds ratio for all severe events). For the population aged ≥18 years, there was also a significantly higher risk for all severe events with COVID-19 versus FLU. The incidence of severe events with COVID-19 among the population aged <18 years was greatly reduced (versus ≥18 years), and risk for severe events was not significantly different with COVID-19 versus FLU.

Conclusions

These findings suggest that the medical need for specific treatment for patients with COVID-19 may be as high as for FLU.

Background

Tenofovir disoproxil fumarate (TDF) as first-line therapy for chronic HBV infection is related to nephrotoxicity. Tenofovir alafenamide fumarate (TAF) has been approved with a similar virological and serological response, but lower toxicity. TAF is available for older patients, with bone or kidney impairment.

Methods

The primary objective was the evaluation of renal function modification in patients who are switching from TDF to TAF; secondary objective was the use of urinary concentration of tenofovir (TFV) as early marker of renal function improvement or worsening.

Retrospective study including all HBV patients treated with TDF or TAF. Two groups were selected: patients who are switched from TDF to TAF and who continued with TDF. Follow-up was six months.

Results

42 subjects were included; 17 were in TAF group (40 %) and 25 in TDF group (60 %). In TDF group, no estimated glomerular filtration rate (eGFR) improvement was observed, while in TAF group increased by 9 ml/min (p < 0.001). Urinary TFV levels increased by 3 ng/mL in TDF group and decreased by 4.5 ng/mL in TAF group (p < 0.001). The relationship between the eGFR and urinary TFV resulted in reverse proportionality (R² = -0.740, p = 0.001) between the two variables. In multivariate analysis eGFR (β = 0.880, p = 0.043) and pretreatment wit adefovir dipivoxil (ADV) resulted significantly related to TFV urinary excretion.

Conclusions

Switching from TDF to TAF lead to significant improvement in eGFR and lower toxicity (estimated with TFV urinary excretion) at six months of follow-up. ADV pretreatment should be considered as adjunctive risk factor for nephrotoxicity independently from age and eGFR.

Background

EBV DNA monitoring is currently the main strategy to identify renal transplant recipients potentially at risk of EBV complications. EBV miRNA expression is markedly altered in different disease presentations associated with EBV. We performed a longitudinal assessment of the impact of rituximab on circulating EBV miRNA in 3 paediatric kidney transplant recipients.

Methods

Forty-two miRNAs encoded within 2 EBV open reading frames (BART and BHRF) were examined over a 28-month period using miRNA qPCR custom panels. EBV DNA was measured using qPCR and lymphocyte subsets were measured by flow cytometry.

Results

Patients were 3 years post kidney transplant and received cycles of rituximab infusions. Treatment with rituximab caused an immediate depletion of the circulating B cells and reduced the expression of the miRNAs and EBV DNA levels. About 4 months post treatment, as the circulating B cells repopulated, EBV miRNAs levels increased. A total of 29 plasma samples were studied and between 4 and 34 EBV miRNAs were detected. A significant correlation was observed between the numbers of EBV miRNAs expressed and the EBV DNA level (r = 0.63, p = 0.001).

Conclusion

We provide an in-depth longitudinal assessment of the impact of rituximab on specific circulating EBV miRNA expression in three paediatric kidney transplant recipients. Rituximab treatment resulted in the reduction of EBV miRNA expression and EBV DNA viral loads. Larger studies are required to determine whether EBV miRNA levels could be useful biomarkers to predict transplant recipients at risk of developing post-transplant lymphoproliferative disease.

Despite tremendous biotechnological and therapeutic advances, hepatitis B virus (HBV) and hepatitis C virus (HCV) still constitute a significant global health challenge. With Nigeria known to be a high HBV and HCV burden country, increasing knowledge about viral hepatitis in rural and urban settings, combined with testing and vaccination for unexposed individuals, could be an effective strategy to eliminate these viruses in Nigeria. Therefore, we undertook this prospective study to determine the level of knowledge and epidemiology of HBV and HCV in selected communities and towns in Enugu North geopolitical zone. In this study, 52.3 % of the participants admitted to having previously heard about hepatitis B and/or C. Also 71.2 % of the research participants had no prior vaccination against HBV. Based on our findings, the prevalence rate of HBV is 2.8 % and that of HCV is 0 %. With only the HBsAg marker detected using the five-panel test kits, five of our fourteen samples are designated as being in the acute phase. Another three had HBsAg and HBeAg present and were therefore classified as being either in the late acute or chronic phase. We also recorded a single case of waned immunity to HBV. Further studies to determine viral DNA levels and other new seromarkers is recommended along with vaccination of unvaccinated individuals.