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Hodson DZ, Etoundi YM, Parikh S, Boum Y. Striving towards true equity in global health: A checklist for bilateral research partnerships. PLOS Glob Public Health 2023; 3:e0001418. [PMID: 36963065 PMCID: PMC10021183 DOI: 10.1371/journal.pgph.0001418] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Interest in "global health" among schools of medicine, public health, and other health disciplines in high-income countries (HIC) continues to rise. Persistent power imbalances, racism, and maintenance of colonialism/neocolonialism plague global health efforts, including global health scholarship. Scholarly projects conducted in low- and middle-income countries (LMIC) by trainees at these schools in HIC often exacerbate these problems. Drawing on published literature and shared experiences, we review key inequalities within each phase of research, from design through implementation and analysis/dissemination, and make concrete and practical recommendations to improve equity at each stage. Key problems facing global health scholarship include HIC-centric nature of global health organizations, paucity of funding directly available for LMIC investigators and trainees, misplaced emphasis on HIC selected issues rather than local solutions to local problems, the dominance of English language in the scientific literature, and exploitation of LMIC team members. Four key principles lie at the foundation of all our recommendations: 1) seek locally derived and relevant solutions to global health issues, 2) create paired collaborations between HIC and LMIC institutions at all levels of training, 3) provide funding for both HIC and LMIC team members, 4) assign clear roles and responsibilities to value, leverage, and share the strengths of all team members. When funding for global health research is predicated upon more ethical and equitable collaborations, the nature of global health collaborations will evolve to be more ethical and equitable. Therefore, we propose the Douala Equity Checklist as a 20-item tool HIC and LMIC institutions can use throughout the conduct of global health projects to ensure more equitable collaborations.
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Affiliation(s)
- Daniel Z Hodson
- Yale School of Medicine, New Haven, CT, United States of America
| | - Yannick Mbarga Etoundi
- Douala Military Hospital, Douala, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Sunil Parikh
- Yale School of Medicine, New Haven, CT, United States of America
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States of America
| | - Yap Boum
- Epicentre, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Science, University of Yaoundé I, Yaoundé, Cameroon
- Institut Pasteur of Bangui, Bangui, Central African Republic
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2
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Lapidus S, Liu F, Casanovas-Massana A, Dai Y, Huck JD, Lucas C, Klein J, Filler RB, Strine MS, Sy M, Deme AB, Badiane AS, Dieye B, Ndiaye IM, Diedhiou Y, Mbaye AM, Diagne CT, Vigan-Womas I, Mbengue A, Sadio BD, Diagne MM, Moore AJ, Mangou K, Diallo F, Sene SD, Pouye MN, Faye R, Diouf B, Nery N, Costa F, Reis MG, Muenker MC, Hodson DZ, Mbarga Y, Katz BZ, Andrews JR, Campbell M, Srivathsan A, Kamath K, Baum-Jones E, Faye O, Sall AA, Vélez JCQ, Cappello M, Wilson M, Ben-Mamoun C, Tedder R, McClure M, Cherepanov P, Somé FA, Dabiré RK, Moukoko CEE, Ouédraogo JB, Boum Y, Shon J, Ndiaye D, Wisnewski A, Parikh S, Iwasaki A, Wilen CB, Ko AI, Ring AM, Bei AK. Plasmodium infection is associated with cross-reactive antibodies to carbohydrate epitopes on the SARS-CoV-2 Spike protein. Sci Rep 2022; 12:22175. [PMID: 36550362 PMCID: PMC9778468 DOI: 10.1038/s41598-022-26709-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Sero-surveillance can monitor and project disease burden and risk. However, SARS-CoV-2 antibody test results can produce false positive results, limiting their efficacy as a sero-surveillance tool. False positive SARS-CoV-2 antibody results are associated with malaria exposure, and understanding this association is essential to interpret sero-surveillance results from malaria-endemic countries. Here, pre-pandemic samples from eight malaria endemic and non-endemic countries and four continents were tested by ELISA to measure SARS-CoV-2 Spike S1 subunit reactivity. Individuals with acute malaria infection generated substantial SARS-CoV-2 reactivity. Cross-reactivity was not associated with reactivity to other human coronaviruses or other SARS-CoV-2 proteins, as measured by peptide and protein arrays. ELISAs with deglycosylated and desialated Spike S1 subunits revealed that cross-reactive antibodies target sialic acid on N-linked glycans of the Spike protein. The functional activity of cross-reactive antibodies measured by neutralization assays showed that cross-reactive antibodies did not neutralize SARS-CoV-2 in vitro. Since routine use of glycosylated or sialated assays could result in false positive SARS-CoV-2 antibody results in malaria endemic regions, which could overestimate exposure and population-level immunity, we explored methods to increase specificity by reducing cross-reactivity. Overestimating population-level exposure to SARS-CoV-2 could lead to underestimates of risk of continued COVID-19 transmission in sub-Saharan Africa.
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Affiliation(s)
- Sarah Lapidus
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Feimei Liu
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Arnau Casanovas-Massana
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Yile Dai
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, 06510, USA
| | - John D Huck
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Carolina Lucas
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Jon Klein
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Renata B Filler
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, 06510, USA
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Madison S Strine
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, 06510, USA
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Mouhamad Sy
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
- Laboratory of Parasitology and Mycology, Aristide le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Awa B Deme
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
- Laboratory of Parasitology and Mycology, Aristide le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Aida S Badiane
- Laboratory of Parasitology and Mycology, Aristide le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Baba Dieye
- Laboratory of Parasitology and Mycology, Aristide le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Ibrahima Mbaye Ndiaye
- Laboratory of Parasitology and Mycology, Aristide le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Younous Diedhiou
- Laboratory of Parasitology and Mycology, Aristide le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Amadou Moctar Mbaye
- Laboratory of Parasitology and Mycology, Aristide le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Cheikh Tidiane Diagne
- DiaTROPIX Rapid Diagnostic Tests Facility, Institut Pasteur de Dakar, Dakar, Senegal
| | - Inés Vigan-Womas
- Pôle Immunophysiopathologie et Maladies Infectieuses, Institut Pasteur de Dakar, Dakar, Senegal
| | - Alassane Mbengue
- G4-Malaria Experimental Genetic Approaches and Vaccines, Pôle Immunophysiopathologie et Maladies Infectieuses, Institut Pasteur de Dakar, Dakar, Senegal
| | - Bacary D Sadio
- Pôle Virologie, Institut Pasteur de Dakar, Dakar, Senegal
| | | | - Adam J Moore
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Khadidiatou Mangou
- G4-Malaria Experimental Genetic Approaches and Vaccines, Pôle Immunophysiopathologie et Maladies Infectieuses, Institut Pasteur de Dakar, Dakar, Senegal
| | - Fatoumata Diallo
- G4-Malaria Experimental Genetic Approaches and Vaccines, Pôle Immunophysiopathologie et Maladies Infectieuses, Institut Pasteur de Dakar, Dakar, Senegal
| | - Seynabou D Sene
- G4-Malaria Experimental Genetic Approaches and Vaccines, Pôle Immunophysiopathologie et Maladies Infectieuses, Institut Pasteur de Dakar, Dakar, Senegal
| | - Mariama N Pouye
- G4-Malaria Experimental Genetic Approaches and Vaccines, Pôle Immunophysiopathologie et Maladies Infectieuses, Institut Pasteur de Dakar, Dakar, Senegal
| | - Rokhaya Faye
- Pôle Immunophysiopathologie et Maladies Infectieuses, Institut Pasteur de Dakar, Dakar, Senegal
| | - Babacar Diouf
- Pôle Immunophysiopathologie et Maladies Infectieuses, Institut Pasteur de Dakar, Dakar, Senegal
| | - Nivison Nery
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brazil
- Department of Internal Medicine, Yale Occupational and Environmental Medicine Program, Yale School of Medicine, New Haven, CT, USA
| | - Federico Costa
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, BA, Brazil
| | - Mitermayer G Reis
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, BA, Brazil
- Faculty of Medicine, Federal University of Bahia, Salvador, Brazil
| | - M Catherine Muenker
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Daniel Z Hodson
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
| | | | - Ben Z Katz
- Division of Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Melissa Campbell
- Yale Center for Clinical Investigation, Yale School of Medicine, New Haven, CT, USA
| | - Ariktha Srivathsan
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
| | | | | | - Ousmane Faye
- Pôle Virologie, Institut Pasteur de Dakar, Dakar, Senegal
| | | | - Juan Carlos Quintero Vélez
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
- Grupo de Investigación Ciencias Veterinarias Centauro, University of Antioquia, Medellín, Colombia
- Grupo de Investigación Microbiología Básica y Aplicada, University of Antioquia, Medellín, Colombia
| | - Michael Cappello
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Michael Wilson
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Choukri Ben-Mamoun
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Richard Tedder
- Department of Infectious Disease, Imperial College London, St Mary's Campus, London, W2 1PG, UK
- South London Specialist Virology Centre, Kings College Hospital NHS Foundation Trust, London, UK
| | - Myra McClure
- Department of Infectious Disease, Imperial College London, St Mary's Campus, London, W2 1PG, UK
| | - Peter Cherepanov
- Department of Infectious Disease, Imperial College London, St Mary's Campus, London, W2 1PG, UK
- Chromatin Structure and Mobile DNA Laboratory, The Francis Crick Institute, London, NW1 1AT, UK
- Crick COVID19 Consortium, Francis Crick Institute, London, NW1 1AT, UK
| | - Fabrice A Somé
- Institut de Recherche en Sciences de La Santé (IRSS)/Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Roch K Dabiré
- Institut de Recherche en Sciences de La Santé (IRSS)/Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Carole Else Eboumbou Moukoko
- Department of Biological Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, 2701, BP, Cameroon
- Malaria Research Unit, Center Pasteur Cameroon, Yaoundé, Cameroon
| | - Jean Bosco Ouédraogo
- Institut de Recherche en Sciences de La Santé (IRSS)/Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Yap Boum
- Médecins Sans Frontières, University of Yaoundé and Epicentre, Yaoundé, Cameroon
| | | | - Daouda Ndiaye
- Laboratory of Parasitology and Mycology, Aristide le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Adam Wisnewski
- Department of Internal Medicine, Yale Occupational and Environmental Medicine Program, Yale School of Medicine, New Haven, CT, USA
| | - Sunil Parikh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Akiko Iwasaki
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, 06510, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Craig B Wilen
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Albert I Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, BA, Brazil
| | - Aaron M Ring
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Amy K Bei
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA.
- Laboratory of Parasitology and Mycology, Aristide le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal.
- G4-Malaria Experimental Genetic Approaches and Vaccines, Pôle Immunophysiopathologie et Maladies Infectieuses, Institut Pasteur de Dakar, Dakar, Senegal.
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Hodson DZ, Repetti GG, Hoesterey DT, Jeon Y, Bachour K, Mempin RL, Wang TS, Levine M. A 77-Year-Old Woman With Capillary Hypoxia and Perioral Cyanosis. Chest 2022; 162:e295-e299. [PMID: 36494128 PMCID: PMC9773228 DOI: 10.1016/j.chest.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 05/26/2022] [Accepted: 06/05/2022] [Indexed: 12/12/2022] Open
Abstract
CASE PRESENTATION A 77-year-old woman with asthma, hypothyroidism, irritable bowel syndrome, overactive bladder, and multiple rheumatologic conditions was sent from the clinic to the ED for evaluation of hypoxia. In the clinic, she reported dizziness without shortness of breath and was noted to have perioral cyanosis with an oxygen saturation measured by pulse oximetry (Spo2) of 80%. She was given a nonrebreather mask delivering oxygen at 8 L/min, but the Spo2 remained at 77% to 82%. In the ED, the patient reported intermittent shortness of breath, 2 to 3 days of mild left lower extremity swelling, and a brief episode of lightheadedness earlier in the day that had since resolved. She denied fevers/chills, upper respiratory symptoms, and chest pain. She had been referred to the pulmonology clinic 3 years earlier to evaluate mild hypoxia with Spo2 readings in the low 90% range, but pulmonary function testing failed to identify an etiology. There was no history of VTE. Her rheumatologic conditions included osteoarthritis, rheumatoid arthritis, Sjögren's syndrome, and fibromyalgia.
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Affiliation(s)
- Daniel Z. Hodson
- Division of Internal Medicine-Pediatrics, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA,CORRESPONDENCE TO: Daniel Z. Hodson, MD
| | - Giuliana G. Repetti
- Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Daniel T. Hoesterey
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Yejoo Jeon
- Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Kinan Bachour
- Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Roberto L. Mempin
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Tisha S. Wang
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Michael Levine
- Department of Emergency Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
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4
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Hodson DZ, Mbarga Etoundi Y, Mbatou Nghokeng N, Mohamadou Poulibe R, Magne Djoko S, Goodwin J, Cheteug Nguesta G, Nganso T, Armstrong JN, Andrews JJ, Zhang E, Wade M, Eboumbou Moukoko CE, Boum Y, Parikh S. Clinical characteristics of Plasmodium falciparum infection among symptomatic patients presenting to a major urban military hospital in Cameroon. Malar J 2022; 21:298. [PMID: 36273147 PMCID: PMC9588226 DOI: 10.1186/s12936-022-04315-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/10/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Urban malaria has received insufficient attention in the literature. The prevalence and clinical characteristics of Plasmodium falciparum infection amongst patients presenting with suspected malaria were investigated at a major urban hospital in Douala, Cameroon with a particular focus on anaemia. METHODS A cross-sectional, 18-week demographic and clinical survey was conducted of patients presenting to the Emergency Department of Douala Military Hospital with suspected malaria, largely defined by the presence or recent history of fever. Venous samples were tested for P. falciparum using rapid diagnostic tests and PCR, and anaemia was defined by haemoglobin level according to WHO definitions. Likelihood ratios (LR), odds ratios (OR), and population attributable risk percent (PARP) were calculated. RESULTS Participants were ages 8 months to 86 years, 51% were women (257/503), and all districts of Douala were represented. Overall, 38.0% (n = 189/497) were anaemic, including 5.2% (n = 26/497) with severe anaemia. Anaemia prevalence was significantly higher (OR: 2.20, 95% CI 1.41-3.45) among children < 15 years (53.1%, n = 52/98) compared to adults (34%, n = 133/392). Plasmodium falciparum was detected in 37.2% by nested PCR. Among all participants, several factors were associated with clinically significant LR for P. falciparum infection, including age 10-14 years (positive LR: 3.73), living in the island district of Douala VI (positive LR: 3.41), travel to any of three northern regions (positive LR: 5.11), and high fever > 40 °C at presentation (positive LR: 4.83). Among all participants, 8.7% of anaemia was associated with P. falciparum infection, while the PARP was 33.2% among those < 15 years of age and 81.0% among 10-14-year-olds. CONCLUSIONS The prevalence of P. falciparum infection in the urban hospital was high. Mirroring trends in many rural African settings, older children had the highest positivity rate for P. falciparum infection. Anaemia was also common in all age groups, and for those 10-14 years of age, 80% of the risk for anaemia was associated with P. falciparum infection. Malaria rates in major urban population centres can be high, and more research into the multifactorial causes of anaemia across the age spectrum are needed.
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Affiliation(s)
| | - Yannick Mbarga Etoundi
- Douala Military Hospital, Douala, Cameroon
- Douala Military Hospital School of Nursing, Douala, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | | | | | | | - Justin Goodwin
- Yale School of Medicine, New Haven, USA
- Yale School of Public Health, New Haven, USA
| | - Glwadys Cheteug Nguesta
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Malaria Research Service, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Tatiana Nganso
- Malaria Research Service, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | | | | | | | | | - Carole Else Eboumbou Moukoko
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Malaria Research Service, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Yap Boum
- Epicentre, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon
| | - Sunil Parikh
- Yale School of Medicine, New Haven, USA.
- Yale School of Public Health, New Haven, USA.
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Glick LR, Hodson DZ, Sharma S, Savarimuthu S. Cardiac tamponade as the initial presentation of autoimmune polyglandular syndrome Type 2: a case report. Eur Heart J Case Rep 2022; 6:ytac145. [PMID: 35528129 PMCID: PMC9071554 DOI: 10.1093/ehjcr/ytac145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/21/2021] [Accepted: 03/31/2022] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Cardiac tamponade is a rare but serious manifestation of autoimmune polyglandular syndrome Type 2 (APS 2). Patients often present with symptoms of thyroid dysfunction and adrenal insufficiency, but the insidious onset of the disease may lead to delayed diagnosis, which can progress rapidly to haemodynamic instability requiring urgent intervention.
Case summary
A 39-year-old previously healthy male was admitted with cardiac tamponade complicated by cardiac arrest requiring emergent pericardiocentesis. An extensive work up revealed primary adrenal insufficiency and Hashimoto’s thyroiditis. His positive autoantibodies to thyroid peroxidase and 21-hydroxylase combined with rapid improvement with initiation of corticosteroids and levothyroxine confirmed a diagnosis of APS 2.
Discussion
Although this disease is often difficult to diagnose given its vague symptoms, it should be considered in the differential diagnosis for young patients presenting with pericardial effusion or cardiac tamponade of unknown origin. Early diagnosis and management are critical and often result in rapid improvement after appropriate treatment.
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Affiliation(s)
- Laura R. Glick
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Corresponding author. Tel: +1 203 215 4987,
| | - Daniel Z. Hodson
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Shreyak Sharma
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Stella Savarimuthu
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
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6
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Affiliation(s)
- Daniel Z Hodson
- Section of Emergency Ultrasound, Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Samuel W Reinhardt
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Christopher L Moore
- Section of Emergency Ultrasound, Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
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7
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Lapidus S, Liu F, Casanovas-Massana A, Dai Y, Huck JD, Lucas C, Klein J, Filler RB, Strine MS, Sy M, Deme AB, Badiane AS, Dieye B, Ndiaye IM, Diedhiou Y, Mbaye AM, Diagne CT, Vigan-Womas I, Mbengue A, Sadio BD, Diagne MM, Moore AJ, Mangou K, Diallo F, Sene SD, Pouye MN, Faye R, Diouf B, Nery N, Costa F, Reis M, Muenker MC, Hodson DZ, Mbarga Y, Katz BZ, Andrews JR, Campbell M, Srivathsan A, Kamath K, Baum-Jones E, Faye O, Sall AA, Quintero Vélez JC, Cappello M, Wilson M, Ben-Mamoun C, Somé FA, Dabiré RK, Moukoko CEE, Ouédraogo JB, Boum Y, Shon J, Ndiaye D, Wisnewski A, Parikh S, Iwasaki A, Wilen CB, Ko AI, Ring AM, Bei AK. Plasmodium infection induces cross-reactive antibodies to carbohydrate epitopes on the SARS-CoV-2 Spike protein. medRxiv 2021:2021.05.10.21256855. [PMID: 34013301 PMCID: PMC8132281 DOI: 10.1101/2021.05.10.21256855] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Individuals with acute malaria infection generated high levels of antibodies that cross-react with the SARS-CoV-2 Spike protein. Cross-reactive antibodies specifically recognized the sialic acid moiety on N-linked glycans of the Spike protein and do not neutralize in vitro SARS-CoV-2. Sero-surveillance is critical for monitoring and projecting disease burden and risk during the pandemic; however, routine use of Spike protein-based assays may overestimate SARS-CoV-2 exposure and population-level immunity in malaria-endemic countries.
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Affiliation(s)
- Sarah Lapidus
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, 06510, USA
| | - Feimei Liu
- Yale School of Medicine, Department of Immunobiology, New Haven, CT, 06510, USA
| | - Arnau Casanovas-Massana
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, 06510, USA
| | - Yile Dai
- Yale School of Medicine, Department of Immunobiology, New Haven, CT, 06510, USA
| | - John D. Huck
- Yale School of Medicine, Department of Immunobiology, New Haven, CT, 06510, USA
| | - Carolina Lucas
- Yale School of Medicine, Department of Immunobiology, New Haven, CT, 06510, USA
| | - Jon Klein
- Yale School of Medicine, Department of Immunobiology, New Haven, CT, 06510, USA
| | - Renata B. Filler
- Yale School of Medicine, Department of Immunobiology, New Haven, CT, 06510, USA,Yale School of Medicine, Department of Laboratory Medicine, New Haven, CT, 06510, USA
| | - Madison S. Strine
- Yale School of Medicine, Department of Immunobiology, New Haven, CT, 06510, USA,Yale School of Medicine, Department of Laboratory Medicine, New Haven, CT, 06510, USA
| | - Mouhamad Sy
- Cheikh Anta Diop University, Aristide le Dantec Hospital, Laboratory of Parasitology and Mycology, Dakar, Senegal
| | - Awa B. Deme
- Cheikh Anta Diop University, Aristide le Dantec Hospital, Laboratory of Parasitology and Mycology, Dakar, Senegal
| | - Aida S. Badiane
- Cheikh Anta Diop University, Aristide le Dantec Hospital, Laboratory of Parasitology and Mycology, Dakar, Senegal
| | - Baba Dieye
- Cheikh Anta Diop University, Aristide le Dantec Hospital, Laboratory of Parasitology and Mycology, Dakar, Senegal
| | - Ibrahima Mbaye Ndiaye
- Cheikh Anta Diop University, Aristide le Dantec Hospital, Laboratory of Parasitology and Mycology, Dakar, Senegal
| | - Younous Diedhiou
- Cheikh Anta Diop University, Aristide le Dantec Hospital, Laboratory of Parasitology and Mycology, Dakar, Senegal
| | - Amadou Moctar Mbaye
- Cheikh Anta Diop University, Aristide le Dantec Hospital, Laboratory of Parasitology and Mycology, Dakar, Senegal
| | - Cheikh Tidiane Diagne
- DiaTROPIX Rapid Diagnostic Tests Facility, Institut Pasteur de Dakar, Dakar, Senegal
| | - Inés Vigan-Womas
- Pôle Immunophysiopathologie et Maladies Infectieuses, Institut Pasteur de Dakar, Dakar, Senegal
| | - Alassane Mbengue
- G4 - Malaria Experimental Genetic Approaches & Vaccines, Pôle Immunophysiopathologie et Maladies Infectieuses, Institut Pasteur de Dakar, Dakar, Senegal
| | | | | | - Adam J. Moore
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, 06510, USA
| | - Khadidiatou Mangou
- G4 - Malaria Experimental Genetic Approaches & Vaccines, Pôle Immunophysiopathologie et Maladies Infectieuses, Institut Pasteur de Dakar, Dakar, Senegal
| | - Fatoumata Diallo
- G4 - Malaria Experimental Genetic Approaches & Vaccines, Pôle Immunophysiopathologie et Maladies Infectieuses, Institut Pasteur de Dakar, Dakar, Senegal
| | - Seynabou D. Sene
- G4 - Malaria Experimental Genetic Approaches & Vaccines, Pôle Immunophysiopathologie et Maladies Infectieuses, Institut Pasteur de Dakar, Dakar, Senegal
| | - Mariama N. Pouye
- G4 - Malaria Experimental Genetic Approaches & Vaccines, Pôle Immunophysiopathologie et Maladies Infectieuses, Institut Pasteur de Dakar, Dakar, Senegal
| | - Rokhaya Faye
- Pôle Immunophysiopathologie et Maladies Infectieuses, Institut Pasteur de Dakar, Dakar, Senegal
| | - Babacar Diouf
- Pôle Immunophysiopathologie et Maladies Infectieuses, Institut Pasteur de Dakar, Dakar, Senegal
| | - Nivison Nery
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brazil,Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, BA, Brazil
| | - Federico Costa
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, 06510, USA,Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brazil,Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, BA, Brazil
| | - Mitermayer Reis
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, 06510, USA,Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brazil,Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, BA, Brazil
| | - M. Catherine Muenker
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, 06510, USA
| | - Daniel Z. Hodson
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, 06510, USA
| | | | - Ben Z. Katz
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Jason R. Andrews
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Melissa Campbell
- Yale Center for Clinical Investigation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ariktha Srivathsan
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, 06510, USA
| | | | | | - Ousmane Faye
- Pôle Virologie, Institut Pasteur de Dakar, Dakar, Senegal
| | | | - Juan Carlos Quintero Vélez
- Grupo de Investigación Ciencias Veterinarias Centauro, Universidad de Antioquia, Medellin, Colombia,Grupo de Investigación Ciencias Veterinarias Centauro, University of Antioquia, Medellín, Colombia,Grupo de Investigación Microbiología Básica y Aplicada, University of Antioquia, Medellín, Colombia
| | - Michael Cappello
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Michael Wilson
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Choukri Ben-Mamoun
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Fabrice A. Somé
- Institut de Recherche en Sciences de La Santé (IRSS)/Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Roch K. Dabiré
- Institut de Recherche en Sciences de La Santé (IRSS)/Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Carole Else Eboumbou Moukoko
- Department of Biological Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, BP 2701 Douala, Cameroon,Malaria Research Unit, Center Pasteur Cameroon, Yaoundé, Cameroon
| | - Jean Bosco Ouédraogo
- Institut de Recherche en Sciences de La Santé (IRSS)/Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Yap Boum
- University of Yaoundé and Epicentre, Médecins Sans Frontières
| | | | - Daouda Ndiaye
- Cheikh Anta Diop University, Aristide le Dantec Hospital, Laboratory of Parasitology and Mycology, Dakar, Senegal
| | - Adam Wisnewski
- Yale Occupational and Environmental Medicine Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sunil Parikh
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, 06510, USA
| | - Akiko Iwasaki
- Yale School of Medicine, Department of Immunobiology, New Haven, CT, 06510, USA
| | - Craig B. Wilen
- Yale School of Medicine, Department of Immunobiology, New Haven, CT, 06510, USA
| | - Albert I. Ko
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, 06510, USA,Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, BA, Brazil
| | - Aaron M. Ring
- Yale School of Medicine, Department of Immunobiology, New Haven, CT, 06510, USA
| | - Amy K. Bei
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, 06510, USA,Cheikh Anta Diop University, Aristide le Dantec Hospital, Laboratory of Parasitology and Mycology, Dakar, Senegal,G4 - Malaria Experimental Genetic Approaches & Vaccines, Pôle Immunophysiopathologie et Maladies Infectieuses, Institut Pasteur de Dakar, Dakar, Senegal,
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8
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Hodson DZ, Griffin M, Mahoney D, Raghavendra P, Ahmad T, Turner J, Wilson FP, Tang WHW, Rao VS, Collins SP, Mullens W, Testani JM. Natriuretic Response Is Highly Variable and Associated With 6-Month Survival: Insights From the ROSE-AHF Trial. JACC Heart Fail 2020; 7:383-391. [PMID: 31047017 DOI: 10.1016/j.jchf.2019.01.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/11/2019] [Accepted: 01/14/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study sought to describe sodium excretion in acute decompensated heart failure (ADHF) clearly and to evaluate the prognostic ability of urinary sodium and fluid-based metrics. BACKGROUND Sodium retention drives volume overload, with fluid retention largely a passive, secondary phenomenon. However, parameters (urine output, body weight) used to monitor therapy in ADHF measure fluid rather than sodium balance. Thus, the accuracy of fluid-based metrics hinges on the contested assumption that urinary sodium content is consistent. METHODS Patients enrolled in the ROSE-AHF (Renal Optimization Strategies Evaluation-Acute Heart Failure) trial with 24-h sodium excretion available were studied (n = 316). Patients received protocol-driven high-dose loop diuretic therapy. RESULTS Sodium excretion through the first 24 h was highly variable (range 0.12 to 19.8 g; median 3.63 g, interquartile range: 1.85 to 6.02 g) and was not correlated with diuretic agent dose (r = 0.06; p = 0.27). Greater sodium excretion was associated with reduced mortality in a univariate model (hazard ratio: 0.80 per doubling of sodium excretion; 95% confidence interval: 0.66 to 0.95; p = 0.01), whereas gross urine output (p = 0.43), net fluid balance (p = 0.87), and weight change (p = 0.11) were not. Sodium excretion of less than the prescribed dietary sodium intake (2 g), even in the setting of a negative net fluid balance, portended a worse prognosis (hazard ratio: 2.02; 95% confidence interval: 1.17 to 3.46; p = 0.01). CONCLUSIONS In patients hospitalized with ADHF who were receiving high-dose loop diuretic agents, sodium concentration and excretion were highly variable. Sodium excretion was strongly associated with 6-month mortality, whereas traditional fluid-based metrics were not. Poor sodium excretion, even in the context of fluid loss, portends a worse prognosis.
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Affiliation(s)
- Daniel Z Hodson
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Matthew Griffin
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Devin Mahoney
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Parinita Raghavendra
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Tariq Ahmad
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jeffrey Turner
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - F Perry Wilson
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Veena S Rao
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost Limburg, Genk-Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University Diepenbeek, Belgium
| | - Jeffrey M Testani
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.
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9
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Cox ZL, Fleming J, Ivey-Miranda J, Griffin M, Mahoney D, Jackson K, Hodson DZ, Thomas D, Gomez N, Rao VS, Testani JM. Mechanisms of Diuretic Resistance Study: design and rationale. ESC Heart Fail 2020; 7:4458-4464. [PMID: 32893505 PMCID: PMC7754741 DOI: 10.1002/ehf2.12949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/08/2020] [Accepted: 07/14/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Diuretic resistance is a common complication impairing decongestion during hospitalization for acute decompensated heart failure (ADHF). The current understanding of diuretic resistance mechanisms in ADHF is based upon extrapolations from other disease states and healthy volunteers. However, accumulating evidence suggests that the dominant mechanisms in other populations have limited influence on diuretic response in ADHF. Additionally, the ability to rapidly and reliably diagnose diuretic resistance is inadequate using currently available tools. AIMS The Mechanisms of Diuretic Resistance (MDR) Study is designed to rigorously investigate the mechanisms of diuretic resistance and develop tools to rapidly predict diuretic response in a prospective cohort hospitalized with ADHF. METHODS Study assessments occur serially during the ADHF hospitalization and after discharge. Each assessment includes a supervised 6-hour urine collection with baseline blood and timed spot urine collections following loop diuretic administration. Patient characteristics, medications, physical exam findings, and both in-hospital and post-discharge HF outcomes are collected. Patients with diuretic resistance are eligible for a randomized sub-study comparing an increased loop diuretic dose with combination diuretic therapy of loop diuretic plus chlorothiazide. CONCLUSIONS The Mechanisms of Diuretic Resistance Study will establish a prospective patient cohort and biorepository to investigate the mechanisms of diuretic resistance and urine biomarkers to rapidly predict loop diuretic resistance.
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Affiliation(s)
- Zachary L Cox
- Department of Pharmacy Practice, Lipscomb University College of Pharmacy, Nashville, TN, USA.,Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James Fleming
- Yale University School of Medicine, New Haven, CT, USA
| | - Juan Ivey-Miranda
- Yale University School of Medicine, New Haven, CT, USA.,Hospital de Cardiologia, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Devin Mahoney
- Yale University School of Medicine, New Haven, CT, USA
| | | | | | - Daniel Thomas
- Yale University School of Medicine, New Haven, CT, USA
| | - Nicole Gomez
- Yale University School of Medicine, New Haven, CT, USA
| | - Veena S Rao
- Yale University School of Medicine, New Haven, CT, USA
| | - Jeffrey M Testani
- Yale University School of Medicine, New Haven, CT, USA.,Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
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