Oral shedding of CMV and HSV-1 in hematopoietic stem cell transplantation patients

Prevalence of Viral Infections and Serious Complications in Pediatric Hematopoietic Stem Cell Transplant Patients: A Ten-Year Single-Institution Retrospective Study

Background

Pediatric hematopoietic stem cell transplant (pHSCT) patients are at risk for many life-threatening post-transplant complications, notably relapse, graft-versus-host disease (GvHD), and infection.

Methods

This retrospective study reviewed 10 years of pHSCT at a single institution, assessing for risk factors for post-transplantation viral infections (herpes simplex virus (HSV), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpes virus 6 (HHV6), adenovirus (ADNV), and human polyoma virus 1 (BK virus)), and characterizing adverse infectious outcomes.

Results

Overall, 139 patients received 151 transplants. With respect to graft source: 73 (48.3%) were bone marrow, 67 (44.4%) umbilical cord blood (UCB), and 11 (7.2%) peripheral blood stem cells (PBSCs). Forty-one deaths occurred, for an overall mortality rate of 29.5%. The overall incidence of post-transplant viral infections was 47.7% (n = 72). Incidence of post-transplant infection varied by virus type: 3.97% HSV, 0.67% VZV, 3.97% EBV, 24.5% CMV, 14.5% HHV6, 12.6% ADNV, and 12.6% BK virus. Viral encephalitis, though relatively uncommon, was primarily caused by HHV6 and more common in UCB transplants. Overall, cell source and donor source were identified with statistically significant correlation to both risk of infection and mortality.

Conclusions

Post-transplant viral infection remains as a serious adverse event in pediatric patients, and thus prospective studies should be performed to implement early intervention and more aggressive treatment in select high-risk patients. More studies specifically addressing infection risks in cord blood transplants and risk factors for post-transplant viral encephalitis are warranted.

Hematopoietic stem cell transplantation and the noncytomegalovirus herpesviruses

Although hematopoietic stem cell transplantation (HSCT) and other cellular therapies have significantly improved outcomes in the management of multiple hematological and nonhematological malignancies, the resulting impairment in humoral and cellular response increases the risk for opportunistic infection as an undesirable side effect. With their ability to establish latent infection and reactivate when the host immune system is at its weakest point, the Herpesviridae family constitutes a significant proportion of these opportunistic pathogens. Despite recent advancements in preventing and managing herpesvirus infections, they continue to be a common cause of significant morbidity and mortality in transplanted patients. Herein, we aim to provide and update on herpesvirus other than cytomegalovirus (CMV) affecting recipients of HSCT and other cellular therapies.

Oral microbial changes and oral disease management before and after the treatment of hematological malignancies: a narrative review

OBJECTIVES

Patients with hematological malignancies have dynamic changes in oral microbial communities before and after treatment. This narrative review describes the changes in oral microbial composition and diversity, and discusses an oral microbe-oriented strategy for oral disease management.

MATERIALS AND METHODS

A literature search was performed in PubMed/Medline, Web of Science, and Embase for articles published between 1980 and 2022. Any articles on the changes in oral microbial communities in patients with hematological malignancies and their effects on disease progression and prognosis were included.

RESULTS

Oral sample detection and oral microbial sequencing analysis of patients with hematological malignancies showed a correlation between changes in oral microbial composition and diversity and disease progression and prognosis. The possible pathogenic mechanism of oral microbial disorders is the impairment of mucosal barrier function and microbial translocation. Probiotic strategies, antibiotic strategies, and professional oral care strategies targeting the oral microbiota can effectively reduce the risk of oral complications and the grade of severity in patients with hematological malignancies.

CLINICAL RELEVANCE

This review provides dentists and hematologists with a comprehensive understanding of the host-microbe associated with hematologic malignancies and oral disease management advice.

Mitigation of SARS-CoV-2 transmission at a large public university

In Fall 2020, universities saw extensive transmission of SARS-CoV-2 among their populations, threatening health of the university and surrounding communities, and viability of in-person instruction. Here we report a case study at the University of Illinois at Urbana-Champaign, where a multimodal "SHIELD: Target, Test, and Tell" program, with other non-pharmaceutical interventions, was employed to keep classrooms and laboratories open. The program included epidemiological modeling and surveillance, fast/frequent testing using a novel low-cost and scalable saliva-based RT-qPCR assay for SARS-CoV-2 that bypasses RNA extraction, called covidSHIELD, and digital tools for communication and compliance. In Fall 2020, we performed >1,000,000 covidSHIELD tests, positivity rates remained low, we had zero COVID-19-related hospitalizations or deaths amongst our university community, and mortality in the surrounding Champaign County was reduced more than 4-fold relative to expected. This case study shows that fast/frequent testing and other interventions mitigated transmission of SARS-CoV-2 at a large public university.

Lack of direct association between oral mucosal lesions and SARS-CoV- 2 in a cohort of patients hospitalised with COVID-19

Background

COVID-19 is a disease affecting various human organs and systems, in which the virus seeks to interact with angiotensin-converting enzyme 2 receptors. These receptors are present in the oral cavity, but the direct relationship between such an interaction and possible oral manifestations of COVID-19 is still unclear.

Aim

The present study evaluated oral manifestations in a cohort of COVID-19 patients during the period of hospitalisation.

Methods

In total, 154 patients presenting moderate-to-severe forms of COVID-19 had their oral mucosa examined twice a week until the final outcome, either discharge or death. The oral alterations observed in the patients were grouped into Group 1 (pre-existing conditions and opportunistic oral lesions) and Group 2 (oral mucosal changes related to hospitalization).

Results

Oral lesions found in the patients of Group 1 are not suggestive of SARS-CoV-2 infection as they are mainly caused by opportunistic infections. On the other hand, oral alterations found in the patients of Group 2 were statistically (P < 0.001) related to intubation and longer period of hospitalisation.

Conclusion

It is unlikely that ulcerative lesions in the oral cavity are a direct manifestation of SARS-CoV-2 or a marker of COVID-19 progression.