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Orru' S, Bierbaum S, Enk A, Hengel H, Hoffelner M, Huzly D, Keller-Stanislawski B, Mahler V, Mockenhaupt M, Oberle D. Skin manifestations after immunisation with an adjuvanted recombinant zoster vaccine, Germany, 2020. Euro Surveill 2023; 28:2300261. [PMID: 38099347 PMCID: PMC10831415 DOI: 10.2807/1560-7917.es.2023.28.50.2300261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/19/2023] [Indexed: 12/17/2023] Open
Abstract
BackgroundShortly after the launch of a novel adjuvanted recombinant zoster vaccine (RZV), Shingrix, cases of suspected herpes zoster (HZ) or zoster-like skin reactions following immunisation were reported.AimWe aimed to investigate if these skin manifestations after administration of RZV could be HZ.MethodsBetween April and October 2020, general practitioners (GP) reporting a suspected case of HZ or zoster-like skin manifestation after RZV vaccination to the Paul-Ehrlich-Institut, the German national competent authority, were invited to participate in the study. The GP took a sample of the skin manifestation, photographed it and collected patient information on RZV vaccination and the suspected adverse event. We analysed all samples by PCR for varicella-zoster virus (VZV) and herpes-simplex virus (HSV) and genotyped VZV-positive samples. In addition, cases were independently assessed by two dermatologists.ResultsEighty eligible cases were enrolled and 72 could be included in the analysis. Of the 72 cases, 45 were female, 33 were 60-69 years old, 32 had skin symptoms in the thoracic and 27 in the cervical dermatomes. Twenty-seven samples tested PCR positive for VZV (all genotyped as wild-type, WT), three for HSV-1 and five for HSV-2.ConclusionIt may be difficult to distinguish HZ, without a PCR result, from other zoster-like manifestations. In this study, VZV-PCR positive dermatomal eruptions occurring in the first weeks after immunisation with RZV were due to WT VZV, which is not unexpected as HZ is a common disease against which the vaccine is unlikely to provide full protection at this time.
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Affiliation(s)
- Stefano Orru'
- Division of Safety of Biomedicines and Diagnostics, Paul-Ehrlich-Institut, Langen, Germany
| | - Sibylle Bierbaum
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Microbiology, Virology and Hygiene, Institute of Virology, Medical Center, University of Freiburg, Freiburg, Germany
- German Consulting Laboratory for HSV and VZV, Medical Center, University of Freiburg, Freiburg, Germany
| | - Alexander Enk
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Hartmut Hengel
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Microbiology, Virology and Hygiene, Institute of Virology, Medical Center, University of Freiburg, Freiburg, Germany
- German Consulting Laboratory for HSV and VZV, Medical Center, University of Freiburg, Freiburg, Germany
| | - Marcus Hoffelner
- Division of Safety of Biomedicines and Diagnostics, Paul-Ehrlich-Institut, Langen, Germany
| | - Daniela Huzly
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Microbiology, Virology and Hygiene, Institute of Virology, Medical Center, University of Freiburg, Freiburg, Germany
- German Consulting Laboratory for HSV and VZV, Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Vera Mahler
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - Maja Mockenhaupt
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Dokumentationszentrum schwerer Hautreaktionen (dZh), Department of Dermatology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Doris Oberle
- Division of Safety of Biomedicines and Diagnostics, Paul-Ehrlich-Institut, Langen, Germany
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Barsch F, Peters V, Morath O, Krumnau O, Maier P, Huzly D, Prettin S, Deibert P. Trends in the numbers of SARS-CoV-2 infections among students: a prospective cohort study comparing students in sports boarding schools with students in day schools during early COVID-19 pandemic. Front Public Health 2023; 11:1223748. [PMID: 38035288 PMCID: PMC10682161 DOI: 10.3389/fpubh.2023.1223748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction During the first months of the COVID pandemic it emerged that facilities where people gather or live together in cohorts, such as nursing homes or schools, were particularly at high risk for becoming hotspots of virus transmission. German political and health institutions responded with far-reaching interventions and preventive strategies to protect the population from infection with SARS-CoV-2. In this context, it remains unclear whether boarding schools for sports particularly pose a risk of infection to their residents. Methods In a single-center prospective cohort study, numbers of SARS-CoV-2 infections of students in sports boarding schools (n = 11) vs. students attending regular day schools (n = 22) in the region Freiburg/Hochschwarzwald in Germany were investigated over a period from October 2020 to January 2021 via regular virus and antibody screening (German Clinical Trials Register; Study ID: DRKS00021909). In addition, individual and behavioral risk factors for infection were stratified via questionnaire, which provide an indication of cohort specific risk factors for infection and the success of the implementation of hygiene concepts, as well as other infection prevention strategies, within the respective facilities. Results Regarding SARS-CoV-2 infection numbers, the screening detected no significant group difference between sports boarding schools vs. day schools. Discussion The study results provide indications that sports boarding schools did not pose an increased risk of infection, assuming that the facilities prevent virus transmissions with appropriate preventive strategies and hygiene measures. In future pandemic scenarios larger-scale and multicenter studies are necessary to achieve more comprehensive epidemiological data in this field.
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Affiliation(s)
- Friedrich Barsch
- Department of Medicine, Medical Center University of Freiburg, Faculty of Medicine, Institute for Exercise and Occupational Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Vera Peters
- Department of Medicine, Medical Center University of Freiburg, Faculty of Medicine, Institute for Exercise and Occupational Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Oliver Morath
- Department of Medicine, Medical Center University of Freiburg, Faculty of Medicine, Institute for Exercise and Occupational Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Oliver Krumnau
- Department of Medicine, Medical Center University of Freiburg, Faculty of Medicine, Institute for Exercise and Occupational Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Philipp Maier
- Department of Medicine, Medical Center University of Freiburg, Faculty of Medicine, Institute for Exercise and Occupational Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Daniela Huzly
- Freiburg University Medical Center, Faculty of Medicine, Institute of Virology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Stephan Prettin
- Department of Medicine, Medical Center University of Freiburg, Faculty of Medicine, Institute for Exercise and Occupational Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Peter Deibert
- Department of Medicine, Medical Center University of Freiburg, Faculty of Medicine, Institute for Exercise and Occupational Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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Vollmer-Raschdorf S, Rashidi-Alavijeh J, Voigt S, Hengel H, Borchardt B, Huzly D, Hüßler EM, In der Schmitten J, Halenius A, Willuweit K, Botzenhardt S, Trilling M, Boettler T, Dehnen D. Tiza- Titre increase and enhanced immunity through an adjuvanted, recombinant herpes zoster subunit v accine in patients with liver cirrhosis and post-liver transplantation: a study protocol for a prospective cohort study. BMJ Open 2023; 13:e074461. [PMID: 37918931 PMCID: PMC10626838 DOI: 10.1136/bmjopen-2023-074461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Shingrix, an effective adjuvanted, recombinant herpes zoster vaccine (RZV), has been available since 2018. Immunocompromised patients are known to be predisposed to vaccine failure. In-vitro testing of immunological surrogates of vaccine protection could be instrumental for monitoring vaccination success. So far, no test procedure is available for vaccine responses to RZV that could be used on a routine basis. METHODS AND ANALYSIS This is a single-centre, three-arm, parallel, longitudinal cohort study aspiring to recruit a total of 308 patients (103 with a liver cirrhosis Child A/B, 103 after liver transplantation (both ≥50 years), 102 immunocompetent patients (60-70 years)). Blood samples will be taken at seven data collection points to determine varicella zoster virus (VZV) and glycoprotein E (gE)-specific IgG and T cell responses. The primary study outcome is to measure and compare responses after vaccination with RZV depending on the type and degree of immunosuppression using gE-specific antibody detection assays. As a secondary outcome, first, the gE-specific CD4+ T cell response of the three cohorts will be compared and, second, the gE-VZV antibody levels will be compared with the severity of possible vaccination reactions. The tertiary outcome is a potential association between VZV immune responses and clinical protection against shingles. ETHICS AND DISSEMINATION Ethical approval was issued on 07/11/2022 by the Ethics Committee Essen, Germany (number 22-10805-BO). Findings will be published in peer-reviewed open-access journals and presented at local, national and international conferences. TRIAL REGISTRATION NUMBER German Clinical Trials Registry (number DRKS00030683).
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Affiliation(s)
| | - Jassin Rashidi-Alavijeh
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sebastian Voigt
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hartmut Hengel
- Institute of Virology, Freiburg University Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Consulting Laboratory for HSV and VZV, Medical Center-University of Freiburg, Freiburg, Germany
| | - Benjamin Borchardt
- Institute of General Practice, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Daniela Huzly
- Institute of Virology, Freiburg University Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Consulting Laboratory for HSV and VZV, Medical Center-University of Freiburg, Freiburg, Germany
| | - Eva-Maria Hüßler
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jürgen In der Schmitten
- Institute of General Practice, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Anne Halenius
- Institute of Virology, Freiburg University Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Willuweit
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Suzan Botzenhardt
- West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Mirko Trilling
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Tobias Boettler
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dorothea Dehnen
- Institute of General Practice, Medical Faculty, University of Duisburg-Essen, Essen, Germany
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Jaki L, Weigang S, Kern L, Kramme S, Wrobel AG, Grawitz AB, Nawrath P, Martin SR, Dähne T, Beer J, Disch M, Kolb P, Gutbrod L, Reuter S, Warnatz K, Schwemmle M, Gamblin SJ, Neumann-Haefelin E, Schnepf D, Welte T, Kochs G, Huzly D, Panning M, Fuchs J. Total escape of SARS-CoV-2 from dual monoclonal antibody therapy in an immunocompromised patient. Nat Commun 2023; 14:1999. [PMID: 37037847 PMCID: PMC10085998 DOI: 10.1038/s41467-023-37591-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 03/22/2023] [Indexed: 04/12/2023] Open
Abstract
Monoclonal antibodies (mAbs) directed against the spike of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are effective therapeutic options to combat infections in high-risk patients. Here, we report the adaptation of SARS-CoV-2 to the mAb cocktail REGN-COV in a kidney transplant patient with hypogammaglobulinemia. Following mAb treatment, the patient did not clear the infection. During viral persistence, SARS-CoV-2 acquired three novel spike mutations. Neutralization and mouse protection analyses demonstrate a complete viral escape from REGN-COV at the expense of ACE-2 binding. Final clearance of the virus occurred upon reduction of the immunosuppressive regimen and total IgG substitution. Serology suggests that the development of highly neutralizing IgM rather than IgG substitution aids clearance. Our findings emphasise that selection pressure by mAbs on SARS-CoV-2 can lead to development of escape variants in immunocompromised patients. Thus, modification of immunosuppressive therapy, if possible, might be preferable to control and clearance of the viral infection.
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Affiliation(s)
- Lena Jaki
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Weigang
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lisa Kern
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefanie Kramme
- Institute for Infection Prevention and Hospital Epidemiology, Freiburg University Medical Center, University of Freiburg, Freiburg, Germany
| | - Antoni G Wrobel
- The Structural Biology of Disease Processes Laboratory, The Francis Crick Institute, London, UK
| | - Andrea B Grawitz
- Institute for Clinical Chemistry and Laboratory Medicine, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp Nawrath
- The Structural Biology of Disease Processes Laboratory, The Francis Crick Institute, London, UK
| | - Stephen R Martin
- The Structural Biology of Disease Processes Laboratory, The Francis Crick Institute, London, UK
| | - Theo Dähne
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julius Beer
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Miriam Disch
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp Kolb
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lisa Gutbrod
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sandra Reuter
- Institute for Infection Prevention and Hospital Epidemiology, Freiburg University Medical Center, University of Freiburg, Freiburg, Germany
| | - Klaus Warnatz
- Department of Rheumatology and Clinical Immunology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Chronic Immunodeficiency (CCI), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Schwemmle
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Steven J Gamblin
- The Structural Biology of Disease Processes Laboratory, The Francis Crick Institute, London, UK
| | - Elke Neumann-Haefelin
- Renal Division, Department of Medicine, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Schnepf
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Welte
- Renal Division, Department of Medicine, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Friedrich Miescher Institute for Biomedical Research, Basel, Switzerland
| | - Georg Kochs
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniela Huzly
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marcus Panning
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Jonas Fuchs
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Luxenburger H, Reeg DB, Lang-Meli J, Reinscheid M, Eisner M, Bettinger D, Oberhardt V, Salimi Alizei E, Wild K, Graeser A, Karl V, Sagar, Emmerich F, Klein F, Panning M, Huzly D, Bengsch B, Boettler T, Elling R, Thimme R, Hofmann M, Neumann-Haefelin C. Boosting compromised SARS-CoV-2-specific immunity with mRNA vaccination in liver transplant recipients. J Hepatol 2023; 78:1017-1027. [PMID: 36804404 PMCID: PMC10019593 DOI: 10.1016/j.jhep.2023.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/10/2023] [Accepted: 02/04/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND & AIMS Liver transplant recipients (LTRs) demonstrate a reduced response to COVID-19 mRNA vaccination; however, a detailed understanding of the interplay between humoral and cellular immunity, especially after a third (and fourth) vaccine dose, is lacking. METHODS We longitudinally compared the humoral, as well as CD4+ and CD8+ T-cell, responses between LTRs (n = 24) and healthy controls (n = 19) after three (LTRs: n = 9 to 16; healthy controls: n = 9 to 14 per experiment) to four (LTRs: n = 4; healthy controls: n = 4) vaccine doses, including in-depth phenotypical and functional characterization. RESULTS Compared to healthy controls, development of high antibody titers required a third vaccine dose in most LTRs, while spike-specific CD8+ T cells with robust recall capacity plateaued after the second vaccine dose, albeit with a reduced frequency and epitope repertoire compared to healthy controls. This overall attenuated vaccine response was linked to a reduced frequency of spike-reactive follicular T helper cells in LTRs. CONCLUSION Three doses of a COVID-19 mRNA vaccine induce an overall robust humoral and cellular memory response in most LTRs. Decisions regarding additional booster doses may thus be based on individual vaccine responses as well as evolution of novel variants of concern. IMPACT AND IMPLICATIONS Due to immunosuppressive medication, liver transplant recipients (LTR) display reduced antibody titers upon COVID-19 mRNA vaccination, but the impact on long-term immune memory is not clear. Herein, we demonstrate that after three vaccine doses, the majority of LTRs not only exhibit substantial antibody titers, but also a robust memory T-cell response. Additional booster vaccine doses may be of special benefit for a small subset of LTRs with inferior vaccine response and may provide superior protection against evolving novel viral variants. These findings will help physicians to guide LTRs regarding the benefit of booster vaccinations.
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Affiliation(s)
- Hendrik Luxenburger
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; IMM-PACT, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - David B Reeg
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julia Lang-Meli
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; IMM-PACT, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Reinscheid
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Miriam Eisner
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency (CCI), University Medical Center, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany; Center for Pediatrics and Adolescent Medicine, University Medical Center, 79106, Freiburg, Germany
| | - Dominik Bettinger
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Valerie Oberhardt
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elahe Salimi Alizei
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Wild
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anne Graeser
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Vivien Karl
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Sagar
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Florian Emmerich
- Institute for Transfusion Medicine and Gene Therapy, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Florian Klein
- Institute of Virology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany; Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany; German Center for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Marcus Panning
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniela Huzly
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bertram Bengsch
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - Tobias Boettler
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Roland Elling
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency (CCI), University Medical Center, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany; Center for Pediatrics and Adolescent Medicine, University Medical Center, 79106, Freiburg, Germany
| | - Robert Thimme
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Maike Hofmann
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Christoph Neumann-Haefelin
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Huzly E, Steinmann D, Kramme S, Panning M, Huzly D. SARS-CoV-2 rapid antigen tests for health care workers—assessment of benefit by means of a questionnaire. Deutsches Ärzteblatt international 2023; 120:170-171. [PMID: 37106550 DOI: 10.3238/arztebl.m2022.0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/09/2022] [Accepted: 12/29/2022] [Indexed: 01/27/2023]
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Zhang Z, Rafei-Shamsabadi D, Lehr S, Buettner N, Diehl R, Huzly D, Pinato DJ, Thimme R, Meiss F, Bengsch B. Incidence and severity of immune-related hepatitis after dual checkpoint therapy is linked to younger age independent of herpes virus immunity. J Transl Med 2022; 20:582. [PMID: 36503532 PMCID: PMC9743538 DOI: 10.1186/s12967-022-03755-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/04/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND AIMS Dual immune checkpoint blockade (ICB) therapy can result in immune-related-adverse events (irAE) such as ICB-hepatitis. An expansion of effector-memory (TEM) CD4 T cells associated with antiviral immunity against herpesviridae was implicated in ICB-hepatitis. Notably, these memory subsets are frequently associated with age. Here, we sought to understand baseline patient, immune and viral biomarkers associated with the development of ICB-hepatitis to identify currently lacking baseline predictors and test if an expansion of TEM or positive serology against herpesviridae can predict ICB-hepatitis. METHODS A discovery (n = 39) and validation cohort (n = 67) of patients with advanced melanoma undergoing anti-PD-1&anti-CTLA4 combination therapy (total n = 106) were analyzed for baseline clinical characteristics, occurrence of irAE and oncological outcomes alongside serological status for CMV, EBV and HSV. Immune populations were profiled by high-parametric flow cytometry (n = 29). RESULTS ICB-hepatitis occurred in 59% of patients within 100 days; 35.9% developed severe (CTCAE 3-4) hepatitis. Incidence of ICB-hepatitis was higher in the younger (< 55y: 85.7%) compared to older (> = 55y: 27.8%) age group (p = 0.0003), occured earlier in younger patients (p < 0.0001). The association of younger age with ICB-Hepatitis was also observed in the validation cohort (p = 0.0486). Incidence of ICB-hepatitis was also associated with additional non-hepatic irAE (p = 0.018), but neither positive IgG serostatus for CMV, EBV or HSV nor TEM subsets despite an association of T cell subsets with age. CONCLUSION Younger age more accurately predicts ICB-hepatitis after anti-PD-1&anti-CTLA4 checkpoint therapy at baseline compared to herpes virus serology or TEM subsets. Younger patients should be carefully monitored for the development of ICB-hepatitis.
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Affiliation(s)
- Zhen Zhang
- grid.7708.80000 0000 9428 7911Faculty of Medicine, Clinic for Internal Medicine II, Gastroenterology, Hepatology, Endocrinology, and Infectious Disease, University Medical Center Freiburg, Freiburg, Germany
| | - David Rafei-Shamsabadi
- grid.7708.80000 0000 9428 7911Faculty of Medicine, Department of Dermatology and Venereology, University Medical Center Freiburg, Freiburg, Germany
| | - Saskia Lehr
- grid.7708.80000 0000 9428 7911Faculty of Medicine, Department of Dermatology and Venereology, University Medical Center Freiburg, Freiburg, Germany
| | - Nico Buettner
- grid.7708.80000 0000 9428 7911Faculty of Medicine, Clinic for Internal Medicine II, Gastroenterology, Hepatology, Endocrinology, and Infectious Disease, University Medical Center Freiburg, Freiburg, Germany
| | - Rebecca Diehl
- grid.7708.80000 0000 9428 7911Faculty of Medicine, Department of Dermatology and Venereology, University Medical Center Freiburg, Freiburg, Germany
| | - Daniela Huzly
- grid.5963.9Institute of Virology, Faculty of Medicine, Freiburg University Medical Center, University of Freiburg, Freiburg, Germany
| | - David J Pinato
- grid.413629.b0000 0001 0705 4923Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK ,grid.16563.370000000121663741Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Robert Thimme
- grid.7708.80000 0000 9428 7911Faculty of Medicine, Clinic for Internal Medicine II, Gastroenterology, Hepatology, Endocrinology, and Infectious Disease, University Medical Center Freiburg, Freiburg, Germany
| | - Frank Meiss
- grid.7708.80000 0000 9428 7911Faculty of Medicine, Department of Dermatology and Venereology, University Medical Center Freiburg, Freiburg, Germany
| | - Bertram Bengsch
- grid.7708.80000 0000 9428 7911Faculty of Medicine, Clinic for Internal Medicine II, Gastroenterology, Hepatology, Endocrinology, and Infectious Disease, University Medical Center Freiburg, Freiburg, Germany ,grid.5963.9Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany ,grid.7497.d0000 0004 0492 0584Partner Site Freiburg, German Cancer Consortium (DKTK), Heidelberg, Germany
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8
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Johnston M, Ceren Ates H, Glatz RT, Mohsenin H, Schmachtenberg R, Göppert N, Huzly D, Urban GA, Weber W, Dincer C. Multiplexed biosensor for point-of-care COVID-19 monitoring: CRISPR-powered unamplified RNA diagnostics and protein-based therapeutic drug management. Mater Today (Kidlington) 2022; 61:129-138. [PMID: 36405570 PMCID: PMC9643339 DOI: 10.1016/j.mattod.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/24/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
In late 2019 SARS-CoV-2 rapidly spread to become a global pandemic, therefore, measures to attenuate chains of infection, such as high-throughput screenings and isolation of carriers were taken. Prerequisite for a reasonable and democratic implementation of such measures, however, is the availability of sufficient testing opportunities (beyond reverse transcription PCR, the current gold standard). We, therefore, propose an electrochemical, microfluidic multiplexed polymer-based biosensor in combination with CRISPR/Cas-powered assays for low-cost and accessible point-of-care nucleic acid testing. In this study, we simultaneously screen for and identify SARS-CoV-2 infections (Omicron-variant) in clinical specimens (Sample-to-result time: ∼30 min), employing LbuCas13a, whilst bypassing reverse transcription as well as target amplification of the viral RNA (LODs of 2,000 and 7,520 copies/µl for the E and RdRP genes, respectively, and 50 copies/ml for combined targets), both of which are necessary for detection via PCR and other isothermal methods. In addition, we demonstrate the feasibility of combining synthetic biology-driven assays based on different classes of biomolecules, in this case protein-based ß-lactam antibiotic detection, on the same device. The programmability of the effector and multiplexing capacity (up to six analytes) of our platform, in combination with a miniaturized measurement setup, including a credit card sized near field communication (NFC) potentiostat and a microperistaltic pump, provide a promising on-site tool for identifying individuals infected with variants of concern and monitoring their disease progression alongside other potential biomarkers or medication clearance.
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Affiliation(s)
- Midori Johnston
- Department of Microsystems Engineering (IMTEK), University of Freiburg, Freiburg, Germany
- FIT Freiburg Center for Interactive Materials and Bioinspired Technologies, University of Freiburg, Freiburg, Germany
| | - H Ceren Ates
- Department of Microsystems Engineering (IMTEK), University of Freiburg, Freiburg, Germany
- FIT Freiburg Center for Interactive Materials and Bioinspired Technologies, University of Freiburg, Freiburg, Germany
| | - Regina T Glatz
- Department of Microsystems Engineering (IMTEK), University of Freiburg, Freiburg, Germany
- FIT Freiburg Center for Interactive Materials and Bioinspired Technologies, University of Freiburg, Freiburg, Germany
| | - Hasti Mohsenin
- Faculty of Biology and Signalling Research Centers BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - Rosanne Schmachtenberg
- Faculty of Biology and Signalling Research Centers BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - Nathalie Göppert
- Institute of Virology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniela Huzly
- Institute of Virology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gerald A Urban
- Department of Microsystems Engineering (IMTEK), University of Freiburg, Freiburg, Germany
- Freiburg Materials Research Center, University of Freiburg, Freiburg, Germany
| | - Wilfried Weber
- Faculty of Biology and Signalling Research Centers BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - Can Dincer
- Department of Microsystems Engineering (IMTEK), University of Freiburg, Freiburg, Germany
- FIT Freiburg Center for Interactive Materials and Bioinspired Technologies, University of Freiburg, Freiburg, Germany
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9
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Meyer T, Ihorst G, Bartsch I, Zeiser R, Wäsch R, Bertz H, Finke J, Huzly D, Wehr C. Cellular and Humoral SARS-CoV-2 Vaccination Responses in 192 Adult Recipients of Allogeneic Hematopoietic Cell Transplantation. Vaccines (Basel) 2022; 10:1782. [PMID: 36366291 PMCID: PMC9699205 DOI: 10.3390/vaccines10111782] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 09/29/2023] Open
Abstract
To determine factors influencing the vaccination response against SARS-CoV-2 is of importance in recipients of allogeneic hematopoietic cell transplantation (allo-HCT) as they display an increased mortality after SARS-CoV-2 infection, an increased risk of extended viral persistence and reduced vaccination response. Real-life data on anti-SARS-CoV-2-S1-IgG titers (n = 192) and IFN-γ release (n = 110) of allo-HCT recipients were obtained using commercially available, validated assays after vaccination with either mRNA (Comirnaty™, Pfizer-BioNTech™, NY, US and Mainz, Germany or Spikevax™, Moderna™, Cambridge, Massachusetts, US) or vector-based vaccines (Vaxzevria™,AstraZeneca™, Cambridge, UK or Janssen COVID-19 vaccine™Johnson/Johnson, New Brunswick, New Jersey, US), or after a heterologous protocol (vector/mRNA). Humoral response (78% response rate) was influenced by age, time after transplantation, the usage of antithymocyte globulin (ATG) and ongoing immunosuppression, specifically corticosteroids. High counts of B cells during the vaccination period correlated with a humoral response. Only half (55%) of participants showed a cellular vaccination response. It depended on age, time after transplantation, ongoing immunosuppression with ciclosporin A, chronic graft-versus-host disease (cGvHD) and vaccination type, with vector-based protocols favoring a response. Cellular response failure correlated with a higher CD8+ count and activated/HLA-DR+ T cells one year after transplantation. Our data provide the basis to assess both humoral and cellular responses after SARS-CoV2 vaccination in daily practice, thereby opening up the possibility to identify patients at risk.
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Affiliation(s)
- Thomas Meyer
- Department of Medicine I/Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Ingrid Bartsch
- Department of Medicine I/Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Robert Zeiser
- Department of Medicine I/Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Ralph Wäsch
- Department of Medicine I/Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Hartmut Bertz
- Department of Medicine I/Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Jürgen Finke
- Department of Medicine I/Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Daniela Huzly
- Institute of Virology, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Claudia Wehr
- Department of Medicine I/Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany
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10
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Kemming J, Gundlach S, Panning M, Huzly D, Huang J, Lütgehetmann M, Pischke S, Schulze Zur Wiesch J, Emmerich F, Llewellyn-Lacey S, Price DA, Tanriver Y, Warnatz K, Boettler T, Thimme R, Hofmann M, Fischer N, Neumann-Haefelin C. Mechanisms of CD8+ T-cell failure in chronic hepatitis E virus infection. J Hepatol 2022; 77:978-990. [PMID: 35636577 DOI: 10.1016/j.jhep.2022.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND & AIMS In immunosuppressed patients, persistent HEV infection is common and may lead to cirrhosis and liver failure. HEV clearance depends on an effective virus-specific CD8+ T-cell response; however, the knowledge gap around HEV-specific CD8+ T-cell epitopes has hindered analysis of the mechanisms of T-cell failure in persistent infection. METHODS We comprehensively studied HEV-specific CD8+ T-cell responses in 46 patients with self-limiting (n = 34) or chronic HEV infection (n = 12), by epitope-specific expansion, functional testing, ex vivo peptide HLA class I tetramer multi-parametric staining, and viral sequence analysis. RESULTS We identified 25 HEV-specific CD8+ T-cell epitopes restricted by 9 different HLA class I alleles. In self-limiting HEV infection, HEV-specific CD8+ T cells were vigorous, contracted after resolution of infection, and formed functional memory responses. In contrast, in chronic infection, the HEV-specific CD8+ T-cell response was diminished, declined over time, and displayed phenotypic features of exhaustion. However, improved proliferation of HEV-specific CD8+ T cells, increased interferon-γ production and evolution of a memory-like phenotype were observed upon reduction of immunosuppression and/or ribavirin treatment and were associated with viral clearance. In 1 patient, mutational viral escape in a targeted CD8+ T-cell epitope contributed to CD8+ T-cell failure. CONCLUSION Chronic HEV infection is associated with HEV-specific CD8+ T-cell exhaustion, indicating that T-cell exhaustion driven by persisting antigen recognition also occurs in severely immunosuppressed hosts. Functional reinvigoration of virus-specific T cells is at least partially possible when antigen is cleared. In a minority of patients, viral escape also contributes to HEV-specific CD8+ T-cell failure and thus needs to be considered in personalized immunotherapeutic approaches. LAY SUMMARY Hepatitis E virus (HEV) infection is usually cleared spontaneously (without treatment) in patients with fully functioning immune systems. In immunosuppressed patients, chronic HEV infection is common and can progress rapidly to cirrhosis and liver failure. Herein, we identified the presence of HEV-specific CD8+ T cells (a specific type of immune cell that can target HEV) in immunosuppressed patients, but we show that these cells do not function properly. This dysfunction appears to play a role in the development of chronic HEV infection in vulnerable patients.
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Affiliation(s)
- Janine Kemming
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Swantje Gundlach
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | - Marcus Panning
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniela Huzly
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jiabin Huang
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | - Sven Pischke
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany; Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julian Schulze Zur Wiesch
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany; Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Emmerich
- Institute for Transfusion Medicine and Gene Therapy, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sian Llewellyn-Lacey
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - David A Price
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom; Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Yakup Tanriver
- Department of Medicine IV (Nephrology and Primary Care), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Warnatz
- Department of Rheumatology and Clinical Immunology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Boettler
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Robert Thimme
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maike Hofmann
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nicole Fischer
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | - Christoph Neumann-Haefelin
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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11
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Haddad A, Janda A, Renk H, Stich M, Frieh P, Kaier K, Lohrmann F, Nieters A, Willems A, Huzly D, Dulovic A, Schneiderhan-Marra N, Jacobsen EM, Fabricius D, Zernickel M, Stamminger T, Bode SFN, Himpel T, Remppis J, Engel C, Peter A, Ganzenmueller T, Hoffmann GF, Haase B, Kräusslich HG, Müller B, Franz AR, Debatin KM, Tönshoff B, Henneke P, Elling R. Long COVID symptoms in exposed and infected children, adolescents and their parents one year after SARS-CoV-2 infection: A prospective observational cohort study. EBioMedicine 2022; 84:104245. [PMID: 36155957 PMCID: PMC9495281 DOI: 10.1016/j.ebiom.2022.104245] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/24/2022] [Accepted: 08/15/2022] [Indexed: 11/15/2022] Open
Abstract
Background Long COVID in children and adolescents remains poorly understood due to a lack of well-controlled studies with long-term follow-up. In particular, the impact of the family context on persistent symptoms following SARS-CoV-2 infection remains unknown. We examined long COVID symptoms in a cohort of infected children, adolescents, and adults and their exposed but non-infected household members approximately 1 year after infection and investigated clustering of persistent symptoms within households. Methods 1267 members of 341 households (404 children aged <14 years, 140 adolescents aged 14-18 years and 723 adults) were categorized as having had either a SARS-CoV-2 infection or household exposure to SARS-CoV-2 without infection, based on three serological assays and history of laboratory-confirmed infection. Participants completed questionnaires assessing the presence of long COVID symptoms 11-12 months after infection in the household using online questionnaires. Findings The prevalence of moderate or severe persistent symptoms was statistically significantly higher in infected than in exposed women (36.4% [95% CI: 30.7–42.4%] vs 14.2% [95% CI: 8.7–21.5%]), infected men (22.9% [95% CI: 17.9–28.5%] vs 10.3% [95% CI: 5.8–16.9%]) and infected adolescent girls (32.1% 95% CI: 17.2–50.5%] vs 8.9% [95%CI: 3.1–19.8%]). However, moderate or severe persistent symptoms were not statistically more common in infected adolescent boys aged 14–18 (9.7% [95% CI: 2.8–23.6%] or in infected children <14 years (girls: 4.3% [95% CI: 1.2–11.0%]; boys: 3.7% [95% CI: 1.1–9.6%]) than in their exposed counterparts (adolescent boys: 0.0% [95% CI: 0.0–6.7%]; girls < 14 years: 2.3% [95% CI: 0·7–6·1%]; boys < 14 years: 0.0% [95% CI: 0.0–2.0%]). The number of persistent symptoms reported by individuals was associated with the number of persistent symptoms reported by their household members (IRR=1·11, p=·005, 95% CI [1.03–1.20]). Interpretation In this controlled, multi-centre study, infected men, women and adolescent girls were at increased risk of negative outcomes 11-12 months after SARS-CoV-2 infection. Amongst non-infected adults, prevalence of negative outcomes was also high. Prolonged symptoms tended to cluster within families, suggesting family-level interventions for long COVID could prove useful. Funding Ministry of Science, Research and the Arts, Baden-Württemberg, Germany.
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Affiliation(s)
- Anneke Haddad
- Center for Pediatrics and Adolescent Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Aleš Janda
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm University, Germany
| | - Hanna Renk
- University Children's Hospital Tuebingen, Tuebingen, Germany
| | - Maximilian Stich
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Pauline Frieh
- Center for Pediatrics and Adolescent Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Florens Lohrmann
- Center for Pediatrics and Adolescent Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany; Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; IMM-PACT Clinician Scientist Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexandra Nieters
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anna Willems
- Center for Pediatrics and Adolescent Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniela Huzly
- Institute of Virology, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Alex Dulovic
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | | | - Eva-Maria Jacobsen
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm University, Germany
| | - Dorit Fabricius
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm University, Germany
| | - Maria Zernickel
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm University, Germany
| | | | - Sebastian F N Bode
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm University, Germany
| | - Theda Himpel
- University Children's Hospital Tuebingen, Tuebingen, Germany
| | | | - Corinna Engel
- Centre for Paediatric Clinical Studies, University Children's Hospital Tübingen, Tübingen, Germany
| | - Andreas Peter
- Institute for Clinical Chemistry and Pathobiochemistry, University Hospital Tübingen, Tübingen, Germany
| | - Tina Ganzenmueller
- Institute for Medical Virology and Epidemiology of Viral Diseases, University Hospital Tübingen, Tübingen, Germany
| | | | - Bettina Haase
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Georg Kräusslich
- Department of Infectious Diseases, Virology, Heidelberg University, Heidelberg, Germany
| | - Barbara Müller
- Department of Infectious Diseases, Virology, Heidelberg University, Heidelberg, Germany
| | - Axel R Franz
- University Children's Hospital Tuebingen, Tuebingen, Germany; Centre for Paediatric Clinical Studies, University Children's Hospital Tübingen, Tübingen, Germany
| | - Klaus-Michael Debatin
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm University, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Philipp Henneke
- Center for Pediatrics and Adolescent Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany; Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Roland Elling
- Center for Pediatrics and Adolescent Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany; Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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12
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Ankerhold J, Giese S, Kolb P, Maul-Pavicic A, Voll RE, Göppert N, Ciminski K, Kreutz C, Lother A, Salzer U, Bildl W, Welsink T, Morgenthaler NG, Grawitz AB, Emmerich F, Steinmann D, Huzly D, Schwemmle M, Hengel H, Falcone V. Circulating multimeric immune complexes contribute to immunopathology in COVID-19. Nat Commun 2022; 13:5654. [PMID: 36163132 PMCID: PMC9513013 DOI: 10.1038/s41467-022-32867-z] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 08/22/2022] [Indexed: 01/08/2023] Open
Abstract
A dysregulated immune response with high levels of SARS-CoV-2 specific IgG antibodies characterizes patients with severe or critical COVID-19. Although a robust IgG response is considered to be protective, excessive triggering of activating Fc-gamma-receptors (FcγRs) could be detrimental and cause immunopathology. Here, we document excessive FcγRIIIA/CD16A activation in patients developing severe or critical COVID-19 but not in those with mild disease. We identify two independent ligands mediating extreme FcγRIIIA/CD16A activation. Soluble circulating IgG immune complexes (sICs) are detected in about 80% of patients with severe and critical COVID-19 at levels comparable to active systemic lupus erythematosus (SLE) disease. FcγRIIIA/CD16A activation is further enhanced by afucosylation of SARS-CoV-2 specific IgG. Utilizing cell-based reporter systems we provide evidence that sICs can be formed prior to a specific humoral response against SARS-CoV-2. Our data suggest a cycle of immunopathology driven by an early formation of sICs in predisposed patients. These findings suggest a reason for the seemingly paradoxical findings of high antiviral IgG responses and systemic immune dysregulation in severe COVID-19. The involvement of circulating sICs in the promotion of immunopathology in predisposed patients opens new possibilities for intervention strategies to mitigate critical COVID-19 progression. During viral infections high levels of antibodies can form soluble immune complexes (sICs) with antigen and trigger Fcγ receptors (FcγR) leading to increased immunopathology. Here the authors measure FcγRs activation by sICs and consider how these may lead to excessive immunopathology during severe SARS-CoV-2 infection.
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Affiliation(s)
- Jakob Ankerhold
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Sebastian Giese
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Philipp Kolb
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Andrea Maul-Pavicic
- Department of Rheumatology and Clinical Immunology, Freiburg University Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.,Center for Chronic Immunodeficiency (CCI), Freiburg University Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, Freiburg University Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.,Center for Chronic Immunodeficiency (CCI), Freiburg University Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Nathalie Göppert
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Kevin Ciminski
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Clemens Kreutz
- Institute of Medical Biometry and Statistics, Freiburg University Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Achim Lother
- Department of Cardiology and Angiology I, University Heart Center, Freiburg University Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.,Institute of Experimental and Clinical Pharmacology and Toxicology, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.,Interdisciplinary Medical Intensive Care, Freiburg University Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Ulrich Salzer
- Department of Rheumatology and Clinical Immunology, Freiburg University Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.,Center for Chronic Immunodeficiency (CCI), Freiburg University Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Wolfgang Bildl
- Institute of Physiology II, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Tim Welsink
- InVivo BioTech Services GmbH, Hennigsdorf, Germany
| | | | - Andrea Busse Grawitz
- Institute of Clinical Chemistry and Laboratory Medicine, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Florian Emmerich
- Institute for Transfusion Medicine and Gene Therapy, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Steinmann
- Occupational Medical Service, Freiburg University Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Daniela Huzly
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Martin Schwemmle
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Hartmut Hengel
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.
| | - Valeria Falcone
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.
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13
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Arnold F, Huzly D, Tanriver Y, Welte T. Response to SARS-CoV-2 vaccines in patients receiving B-cell modulating antibodies for renal autoimmune disease. BMC Infect Dis 2022; 22:734. [PMID: 36104663 PMCID: PMC9472190 DOI: 10.1186/s12879-022-07722-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background Effective SARS-CoV-2 vaccination in patients receiving treatment with B-cell depleting agents is challenging. Information on vaccination responses in these patients are a valuable tool to develop efficient vaccination regimens. Methods In this single-center retrospective observational study, we report the humoral and cellular response in 34 patients receiving anti-CD20 antibody treatment for renal immune disease. Results After base immunization with SARS-CoV-2-vaccines, 92.0% developed a cellular, 32.4% a humoral response. Humoral immunity correlated with B-cell counts and the timespan between anti-CD20 antibody treatment and vaccination. All patients with > 21/µl B-cells, or > 197 days after treatment showed humoral response. Conclusions Adequate timing of SARS-CoV-2-vaccinations after anti-CD20 antibody treatment and CD19 measurements are crucial to generate immunity. Awaiting partial B-cell recovery by postponing regularly scheduled anti-CD20 treatment should be considered in patients with stable immune disease. Trial registration: This study has been retrospectively registered in the German Clinical Trials Register (DRKS00027049) on 29/10/2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07722-7.
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14
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Zbinden A, Ries J, Redli PM, Shah C, Glauser A, Goslings D, Huzly D, Böni J, Gottschalk J, Frey BM. Prevalence of Occult Hepatitis B Virus Infection in Blood Donors with Negative ID-NAT in Switzerland. Transfus Med Hemother 2022; 49:338-345. [PMID: 36654973 PMCID: PMC9768291 DOI: 10.1159/000525480] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/11/2022] [Accepted: 06/05/2022] [Indexed: 01/21/2023] Open
Abstract
Introduction Screening of hepatitis B surface antigen (HBsAg) and individual-donation nucleic acid amplification testing (ID-NAT) of blood donors have become standard to detect hepatitis B virus (HBV) infection. However, there is still a residual risk of HBV transmission by blood components of donors suffering from occult HBV infection (OBI). Therefore, many countries implemented universal testing of anti-HBV core antigen (anti-HBc) antibodies in order to increase blood safety. In Switzerland, anti-HBc testing is not part of the routine blood donor-screening repertoire. Therefore, we sought to assess prevalence of donors with OBI in a Swiss blood donor collective. Methods Blood donations were prospectively investigated for the presence of anti-HBc antibodies during two time periods (I: all donors, March 2017; II: first-time donors only, April 2017 until February 2018). Anti-HBc-positive findings were confirmed by an anti-HBc neutralization test. Discarded plasma samples of anti-HBc-confirmed positive donors were ultracentrifuged and subsequently retested by regular HBV-ID-NAT to search for traces of HBV. Results During time period I, 78 (1.6%) individuals out of 4,923 donors were confirmed anti-HBc-positive. Sixty-nine (88%) anti-HBc-positive samples were available and processed by ultracentrifugation followed by repeat HBV-ID-NAT. Four samples (5.8%) were found positive for HBV DNA. Sixty-five (94.2%) samples remained HBV NAT-negative upon ultracentrifugation. During time period II, 56 (0.9%) donor samples out of 6,509 exhibited anti-HBc-confirmed positive. Fifty-five (98%) samples could be reassessed by HBV-ID-NAT upon ultracentrifugation. Three (5.5%) samples contained HBV DNA and 52 (94.5%) samples remained HBV NAT-negative. Conclusion Overall, we detected 7 viremic OBI carriers among 11,432 blood donors, which tested negative for HBV by standard HBV-ID-NAT and HBsAg screening. In contrast, OBI carriers showed positive anti-HBc findings which could be confirmed in 83.8% of the cases. Thus, OBI might be missed by the current HBV screening process of Swiss blood donors. We suggest to review current HBV screening algorithm. Extended donor screening by anti-HBc testing may unmask OBI carriers and contribute to blood safety for the recipient of blood products.
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Affiliation(s)
- Andrea Zbinden
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Judith Ries
- Blood Transfusion Service SRC Zurich, Swiss Red Cross, Zürich, Switzerland
| | - Patrick M. Redli
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Cyril Shah
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Andreas Glauser
- Blood Transfusion Service SRC Zurich, Swiss Red Cross, Zürich, Switzerland,*Andrea Zbinden,
| | - David Goslings
- Blood Transfusion Service SRC Zurich, Swiss Red Cross, Zürich, Switzerland
| | - Daniela Huzly
- Institute of Virology, Department for Medical Microbiology and Hygiene, University of Freiburg, Freiburg im Breisgau, Germany
| | - Jürg Böni
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Jochen Gottschalk
- Blood Transfusion Service SRC Zurich, Swiss Red Cross, Zürich, Switzerland
| | - Beat M. Frey
- Blood Transfusion Service SRC Zurich, Swiss Red Cross, Zürich, Switzerland,**Beat M. Frey,
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15
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Morath O, Barsch F, Lazaro A, Huzly D, Deibert P. Case Report: Assessing COVID-19 Transmission in Professional Volleyball in Germany, September to December 2020: An Epidemiological Study. Front Sports Act Living 2022; 4:827005. [PMID: 35774381 PMCID: PMC9237641 DOI: 10.3389/fspor.2022.827005] [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: 12/01/2021] [Accepted: 05/25/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction The SARS-CoV-2 pandemic poses extraordinary challenges in all fields of daily life. The WHO recommended social distancing guidelines and person-to-person contact was strongly discouraged to contain transmission. Team-based sports were questioned and widely debated. However, there is a lack of available evidence on the risk of in-game SARS-CoV-2 transmission. We aim to derive new insights regarding the risk of SARS-CoV2 infection during team sports and provide current opinion on how to behave during training and competition. Methods We report on six competitive male volleyball players (national level) of the same team who were infected with COVID-19. The mode of transmission and potential virus spreading within the team was investigated. The entire course of infection was documented by detailed medical history of the players and RT-PCR tests confirmed suspected infections. Serological testing was performed to establish the antibody status of the team. Results The investigation did not show strong evidence of viral transmission within the team during sporting activities. Only two players with PCR-proven infection hat detectable antibodies in two antibody assays. Conclusion Private and social gatherings can spread infection into team sports. Clearly defined test strategies and strict adherence to standard COVID-19 hygiene guidelines during sports seasons cannot be overemphasized.
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Affiliation(s)
- Oliver Morath
- Department of Medicine, Faculty of Medicine, Institute of Exercise and Occupational Medicine, Medical Center-University of Freiburg, Freiburg, Germany
- *Correspondence: Oliver Morath
| | - Friedrich Barsch
- Department of Medicine, Faculty of Medicine, Institute of Exercise and Occupational Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - Adhara Lazaro
- Department of Medicine, Faculty of Medicine, Institute of Exercise and Occupational Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - Daniela Huzly
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Deibert
- Department of Medicine, Faculty of Medicine, Institute of Exercise and Occupational Medicine, Medical Center-University of Freiburg, Freiburg, Germany
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16
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Fomenko A, Weibel S, Moezi H, Menger K, Schmucker C, Metzendorf MI, Motschall E, Falcone V, Huzly D, Panning M, Rücker G, Hengel H. Assessing severe acute respiratory syndrome coronavirus 2 infectivity by reverse-transcription polymerase chain reaction: A systematic review and meta-analysis. Rev Med Virol 2022; 32:e2342. [PMID: 35366033 PMCID: PMC9111068 DOI: 10.1002/rmv.2342] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 12/19/2022]
Abstract
The cornerstone of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) detection is reverse‐transcription polymerase chain reaction (RT‐PCR) of viral RNA. As a surrogate assay SARS‐CoV‐2 RNA detection does not necessarily imply infectivity. Only virus isolation in permissive cell culture systems can indicate infectivity. Here, we review the evidence on RT‐PCR performance in detecting infectious SARS‐CoV‐2. We searched for any studies that used RT‐PCR and cell culture to determine infectious SARS‐CoV‐2 in respiratory samples. We assessed (i) diagnostic accuracy of RT‐PCR compared to cell culture as reference test, (ii) performed meta‐analysis of positive predictive values (PPV) and (iii) determined the virus isolation probabilities depending on cycle threshold (Ct) or log10 genome copies/ml using logistic regression. We included 55 studies. There is substantial statistical and clinical heterogeneity. Seven studies were included for diagnostic accuracy. Sensitivity ranged from 90% to 99% and specificity from 29% to 92%. In meta‐analysis, the PPVs varied across subgroups with different sampling times after symptom onset, with 1% (95% confidence interval [CI], 0%–7%) in sampling beyond 10 days and 27% (CI, 19%–36%) to 46% (CI, 33%–60%) in subgroups that also included earlier samples. Estimates of virus isolation probability varied between 6% (CI, 0%–100%) and 50% (CI, 0%–100%) at a Ct value of 30 and between 0% (CI, 0%–22%) and 63% (CI, 0%–100%) at 5 log10 genome copies/ml. Evidence on RT‐PCR performance in detecting infectious SARS‐CoV‐2 in respiratory samples was limited. Major limitations were heterogeneity and poor reporting. RT‐PCR and cell culture protocols need further standardisation.
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Affiliation(s)
- Alexey Fomenko
- Institute of Virology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Stephanie Weibel
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Helia Moezi
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Kristina Menger
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Christine Schmucker
- Institute for Evidence in Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Edith Motschall
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Valeria Falcone
- Institute of Virology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Daniela Huzly
- Institute of Virology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Marcus Panning
- Institute of Virology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Gerta Rücker
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Hartmut Hengel
- Institute of Virology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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17
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Huzly D, Panning M, Smely F, Enders M, Komp J, Falcone V, Steinmann D. Accuracy and real life performance of a novel interferon-γ release assay for the detection of SARS-CoV2 specific T cell response. J Clin Virol 2022; 148:105098. [PMID: 35134681 PMCID: PMC8806708 DOI: 10.1016/j.jcv.2022.105098] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 10/29/2021] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The reliable detection of T cell response to COVID-19 or COVID-19 vaccination is important for individual patient care and for monitoring the immune response e.g. in COVID-19 vaccine trials in a standardized fashion. OBJECTIVES AND STUDY DESIGN We used blood samples from health care workers (HCW) with or without history of COVID-19 to define test accuracy of a novel interferon-γ release assay (IGRA). For a real-life performance evaluation, we analysed interferon-γ response to complete COVID-19 vaccination in HCW receiving homologous or heterologous vaccination regimens and in patients receiving immunosuppressive or immune modulating therapies. RESULTS The assay had a specificity of 100%. Sensitivity of the IGRA to detect past infection was 72.2% after infection more than 5 months ago and 93.8% after COVID-19 up to 5 months ago. Quantitative results showed significant differences between first and second vaccine dose, but no difference between homologous and heterologous vaccination regimen. Immunocompromised patients often had no immune response or isolated T cell or antibody response to complete vaccination. CONCLUSIONS The novel IGRA proved to be a highly specific tool to detect SARS-CoV-2 specific T cell response to COVID-19 as well as COVID-19 vaccination, with sensitivity getting lower over time. In perspective, it may serve as a standardized tool in COVID-19 vaccine trials and in clinical care of immunosuppressed patients.
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Affiliation(s)
- Daniela Huzly
- Institute of Virology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Marcus Panning
- Institute of Virology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Franziska Smely
- Institute of Virology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Enders
- Laboratory Prof. Gisela Enders and Colleagues, Stuttgart, Germany
| | - Johanna Komp
- Institute of Microbiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Valeria Falcone
- Institute of Virology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Steinmann
- Occupational Medical Service, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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18
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Renk H, Dulovic A, Seidel A, Becker M, Fabricius D, Zernickel M, Junker D, Groß R, Müller J, Hilger A, Bode SFN, Fritsch L, Frieh P, Haddad A, Görne T, Remppis J, Ganzemueller T, Dietz A, Huzly D, Hengel H, Kaier K, Weber S, Jacobsen EM, Kaiser PD, Traenkle B, Rothbauer U, Stich M, Tönshoff B, Hoffmann GF, Müller B, Ludwig C, Jahrsdörfer B, Schrezenmeier H, Peter A, Hörber S, Iftner T, Münch J, Stamminger T, Groß HJ, Wolkewitz M, Engel C, Liu W, Rizzi M, Hahn BH, Henneke P, Franz AR, Debatin KM, Schneiderhan-Marra N, Janda A, Elling R. Robust and durable serological response following pediatric SARS-CoV-2 infection. Nat Commun 2022; 13:128. [PMID: 35013206 PMCID: PMC8748910 DOI: 10.1038/s41467-021-27595-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [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: 08/26/2021] [Accepted: 11/22/2021] [Indexed: 02/07/2023] Open
Abstract
The quality and persistence of children's humoral immune response following SARS-CoV-2 infection remains largely unknown but will be crucial to guide pediatric SARS-CoV-2 vaccination programs. Here, we examine 548 children and 717 adults within 328 households with at least one member with a previous laboratory-confirmed SARS-CoV-2 infection. We assess serological response at 3-4 months and 11-12 months after infection using a bead-based multiplex immunoassay for 23 human coronavirus antigens including SARS-CoV-2 and its Variants of Concern (VOC) and endemic human coronaviruses (HCoVs), and additionally by three commercial SARS-CoV-2 antibody assays. Neutralization against wild type SARS-CoV-2 and the Delta VOC are analysed in a pseudotyped virus assay. Children, compared to adults, are five times more likely to be asymptomatic, and have higher specific antibody levels which persist longer (96.2% versus 82.9% still seropositive 11-12 months post infection). Of note, symptomatic and asymptomatic infections induce similar humoral responses in all age groups. SARS-CoV-2 infection occurs independent of HCoV serostatus. Neutralization responses of children and adults are similar, although neutralization is reduced for both against the Delta VOC. Overall, the long-term humoral immune response to SARS-CoV-2 infection in children is of longer duration than in adults even after asymptomatic infection.
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Affiliation(s)
- Hanna Renk
- University Children's Hospital Tübingen, Tübingen, Germany
| | - Alex Dulovic
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Alina Seidel
- Institute of Molecular Virology, Ulm University Medical Center, Ulm, Germany
| | - Matthias Becker
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Dorit Fabricius
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm University, Ulm, Germany
| | - Maria Zernickel
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm University, Ulm, Germany
| | - Daniel Junker
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Rüdiger Groß
- Institute of Molecular Virology, Ulm University Medical Center, Ulm, Germany
| | - Janis Müller
- Institute of Molecular Virology, Ulm University Medical Center, Ulm, Germany
| | - Alexander Hilger
- Center for Pediatrics and Adolescent Medicine, Medical Center Freiburg, Germany and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian F N Bode
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm University, Ulm, Germany
| | - Linus Fritsch
- Center for Pediatrics and Adolescent Medicine, Medical Center Freiburg, Germany and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Pauline Frieh
- Center for Pediatrics and Adolescent Medicine, Medical Center Freiburg, Germany and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anneke Haddad
- Center for Pediatrics and Adolescent Medicine, Medical Center Freiburg, Germany and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tessa Görne
- Center for Pediatrics and Adolescent Medicine, Medical Center Freiburg, Germany and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Tina Ganzemueller
- Institute for Medical Virology and Epidemiology of Viral Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Andrea Dietz
- Institute of Virology, Ulm University Medical Center, Ulm, Germany
| | - Daniela Huzly
- Institute of Virology, Medical Center Freiburg, Germany and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hartmut Hengel
- Institute of Virology, Medical Center Freiburg, Germany and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Medical Center Freiburg, Germany and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Susanne Weber
- Institute of Medical Biometry and Statistics, Medical Center Freiburg, Germany and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Eva-Maria Jacobsen
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm University, Ulm, Germany
| | - Philipp D Kaiser
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Bjoern Traenkle
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Ulrich Rothbauer
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Maximilian Stich
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Georg F Hoffmann
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Barbara Müller
- Department of Infectious Diseases, Virology, Heidelberg University Hospital, Heidelberg, Germany
| | - Carolin Ludwig
- Institute of Transfusion Medicine, Ulm University, Ulm, Germany
- Institute for Clinical Transfusion Medicine and Immunogenetics, Ulm, Germany
- German Red Cross Blood Transfusion Service, Baden-Württemberg-Hessen, Germany
| | - Bernd Jahrsdörfer
- Institute of Transfusion Medicine, Ulm University, Ulm, Germany
- Institute for Clinical Transfusion Medicine and Immunogenetics, Ulm, Germany
- German Red Cross Blood Transfusion Service, Baden-Württemberg-Hessen, Germany
| | - Hubert Schrezenmeier
- Institute of Transfusion Medicine, Ulm University, Ulm, Germany
- Institute for Clinical Transfusion Medicine and Immunogenetics, Ulm, Germany
- German Red Cross Blood Transfusion Service, Baden-Württemberg-Hessen, Germany
| | - Andreas Peter
- Institute for Clinical Chemistry and Pathobiochemistry, University Hospital Tübingen, Tübingen, Germany
| | - Sebastian Hörber
- Institute for Clinical Chemistry and Pathobiochemistry, University Hospital Tübingen, Tübingen, Germany
| | - Thomas Iftner
- Institute for Medical Virology and Epidemiology of Viral Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Jan Münch
- Institute of Molecular Virology, Ulm University Medical Center, Ulm, Germany
| | | | | | - Martin Wolkewitz
- Institute of Medical Biometry and Statistics, Medical Center Freiburg, Germany and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Corinna Engel
- University Children's Hospital Tübingen, Tübingen, Germany
- Center for Pediatric Clinical Studies, University Hospital Tübingen, Tübingen, Germany
| | - Weimin Liu
- Department of Microbiology and Department of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Marta Rizzi
- Department of Rheumatology and Clinical Immunology, Medical Center Freiburg, Germany and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Beatrice H Hahn
- Department of Microbiology and Department of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Philipp Henneke
- Center for Pediatrics and Adolescent Medicine, Medical Center Freiburg, Germany and Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute for Immunodeficiency, Medical Center Freiburg, Germany and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Axel R Franz
- University Children's Hospital Tübingen, Tübingen, Germany
- Center for Pediatric Clinical Studies, University Hospital Tübingen, Tübingen, Germany
| | - Klaus-Michael Debatin
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm University, Ulm, Germany
| | | | - Ales Janda
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm University, Ulm, Germany
| | - Roland Elling
- Center for Pediatrics and Adolescent Medicine, Medical Center Freiburg, Germany and Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- Institute for Immunodeficiency, Medical Center Freiburg, Germany and Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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19
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Stich M, Elling R, Renk H, Janda A, Garbade SF, Müller B, Kräusslich HG, Fabricius D, Zernickel M, Meissner P, Huzly D, Grulich-Henn J, Haddad A, Görne T, Spielberger B, Fritsch L, Nieters A, Hengel H, Dietz AN, Stamminger T, Ganzenmueller T, Ruetalo N, Peter A, Remppis J, Iftner T, Jeltsch K, Waterboer T, Franz AR, Hoffmann GF, Engel C, Debatin KM, Tönshoff B, Henneke P. Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 in Households with Children, Southwest Germany, May-August 2020. Emerg Infect Dis 2021; 27:3009-3019. [PMID: 34695369 PMCID: PMC8632156 DOI: 10.3201/eid2712.210978] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Resolving the role of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in households with members from different generations is crucial for containing the current pandemic. We conducted a large-scale, multicenter, cross-sectional seroepidemiologic household transmission study in southwest Germany during May 11-August 1, 2020. We included 1,625 study participants from 405 households that each had ≥1 child and 1 reverse transcription PCR-confirmed SARS-CoV-2-infected index case-patient. The overall secondary attack rate was 31.6% and was significantly higher in exposed adults (37.5%) than in children (24.6%-29.2%; p = <0.015); the rate was also significantly higher when the index case-patient was >60 years of age (72.9%; p = 0.039). Other risk factors for infectiousness of the index case-patient were SARS-CoV-2-seropositivity (odds ratio [OR] 27.8, 95% CI 8.26-93.5), fever (OR 1.93, 95% CI 1.14-3.31), and cough (OR 2.07, 95% CI 1.21-3.53). Secondary infections in household contacts generate a substantial disease burden.
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Affiliation(s)
| | | | | | | | - Sven F. Garbade
- Heidelberg University Hospital, Heidelberg, Germany (M. Stich, S.F. Garbade, B. Müller, H.-G. Kräusslich, J. Grulich-Henn, K. Jeltsch, G.F. Hoffmann, B. Tönshoff)
- University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany (R. Elling, D. Huzly, A. Haddad, T. Görne, B. Spielberger, L. Fritsch, A. Nieters, H. Hengel, P. Henneke)
- University Hospital and Faculty of Medicine Tübingen, Tübingen, Germany (H. Renk, T. Ganzenmueller, N. Ruetalo, A. Peter, J. Remppis, T. Iftner, A.R. Franz, C. Engel)
- Ulm University Medical Center, Ulm, Germany (A. Janda, D. Fabricius, M. Zernickel, P. Meissner, A.N. Dietz, T. Stamminger, K.-M. Debatin)
- German Cancer Research Center (DKFZ), Heidelberg (T. Waterboer)
| | - Barbara Müller
- Heidelberg University Hospital, Heidelberg, Germany (M. Stich, S.F. Garbade, B. Müller, H.-G. Kräusslich, J. Grulich-Henn, K. Jeltsch, G.F. Hoffmann, B. Tönshoff)
- University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany (R. Elling, D. Huzly, A. Haddad, T. Görne, B. Spielberger, L. Fritsch, A. Nieters, H. Hengel, P. Henneke)
- University Hospital and Faculty of Medicine Tübingen, Tübingen, Germany (H. Renk, T. Ganzenmueller, N. Ruetalo, A. Peter, J. Remppis, T. Iftner, A.R. Franz, C. Engel)
- Ulm University Medical Center, Ulm, Germany (A. Janda, D. Fabricius, M. Zernickel, P. Meissner, A.N. Dietz, T. Stamminger, K.-M. Debatin)
- German Cancer Research Center (DKFZ), Heidelberg (T. Waterboer)
| | - Hans-Georg Kräusslich
- Heidelberg University Hospital, Heidelberg, Germany (M. Stich, S.F. Garbade, B. Müller, H.-G. Kräusslich, J. Grulich-Henn, K. Jeltsch, G.F. Hoffmann, B. Tönshoff)
- University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany (R. Elling, D. Huzly, A. Haddad, T. Görne, B. Spielberger, L. Fritsch, A. Nieters, H. Hengel, P. Henneke)
- University Hospital and Faculty of Medicine Tübingen, Tübingen, Germany (H. Renk, T. Ganzenmueller, N. Ruetalo, A. Peter, J. Remppis, T. Iftner, A.R. Franz, C. Engel)
- Ulm University Medical Center, Ulm, Germany (A. Janda, D. Fabricius, M. Zernickel, P. Meissner, A.N. Dietz, T. Stamminger, K.-M. Debatin)
- German Cancer Research Center (DKFZ), Heidelberg (T. Waterboer)
| | - Dorit Fabricius
- Heidelberg University Hospital, Heidelberg, Germany (M. Stich, S.F. Garbade, B. Müller, H.-G. Kräusslich, J. Grulich-Henn, K. Jeltsch, G.F. Hoffmann, B. Tönshoff)
- University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany (R. Elling, D. Huzly, A. Haddad, T. Görne, B. Spielberger, L. Fritsch, A. Nieters, H. Hengel, P. Henneke)
- University Hospital and Faculty of Medicine Tübingen, Tübingen, Germany (H. Renk, T. Ganzenmueller, N. Ruetalo, A. Peter, J. Remppis, T. Iftner, A.R. Franz, C. Engel)
- Ulm University Medical Center, Ulm, Germany (A. Janda, D. Fabricius, M. Zernickel, P. Meissner, A.N. Dietz, T. Stamminger, K.-M. Debatin)
- German Cancer Research Center (DKFZ), Heidelberg (T. Waterboer)
| | - Maria Zernickel
- Heidelberg University Hospital, Heidelberg, Germany (M. Stich, S.F. Garbade, B. Müller, H.-G. Kräusslich, J. Grulich-Henn, K. Jeltsch, G.F. Hoffmann, B. Tönshoff)
- University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany (R. Elling, D. Huzly, A. Haddad, T. Görne, B. Spielberger, L. Fritsch, A. Nieters, H. Hengel, P. Henneke)
- University Hospital and Faculty of Medicine Tübingen, Tübingen, Germany (H. Renk, T. Ganzenmueller, N. Ruetalo, A. Peter, J. Remppis, T. Iftner, A.R. Franz, C. Engel)
- Ulm University Medical Center, Ulm, Germany (A. Janda, D. Fabricius, M. Zernickel, P. Meissner, A.N. Dietz, T. Stamminger, K.-M. Debatin)
- German Cancer Research Center (DKFZ), Heidelberg (T. Waterboer)
| | - Peter Meissner
- Heidelberg University Hospital, Heidelberg, Germany (M. Stich, S.F. Garbade, B. Müller, H.-G. Kräusslich, J. Grulich-Henn, K. Jeltsch, G.F. Hoffmann, B. Tönshoff)
- University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany (R. Elling, D. Huzly, A. Haddad, T. Görne, B. Spielberger, L. Fritsch, A. Nieters, H. Hengel, P. Henneke)
- University Hospital and Faculty of Medicine Tübingen, Tübingen, Germany (H. Renk, T. Ganzenmueller, N. Ruetalo, A. Peter, J. Remppis, T. Iftner, A.R. Franz, C. Engel)
- Ulm University Medical Center, Ulm, Germany (A. Janda, D. Fabricius, M. Zernickel, P. Meissner, A.N. Dietz, T. Stamminger, K.-M. Debatin)
- German Cancer Research Center (DKFZ), Heidelberg (T. Waterboer)
| | - Daniela Huzly
- Heidelberg University Hospital, Heidelberg, Germany (M. Stich, S.F. Garbade, B. Müller, H.-G. Kräusslich, J. Grulich-Henn, K. Jeltsch, G.F. Hoffmann, B. Tönshoff)
- University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany (R. Elling, D. Huzly, A. Haddad, T. Görne, B. Spielberger, L. Fritsch, A. Nieters, H. Hengel, P. Henneke)
- University Hospital and Faculty of Medicine Tübingen, Tübingen, Germany (H. Renk, T. Ganzenmueller, N. Ruetalo, A. Peter, J. Remppis, T. Iftner, A.R. Franz, C. Engel)
- Ulm University Medical Center, Ulm, Germany (A. Janda, D. Fabricius, M. Zernickel, P. Meissner, A.N. Dietz, T. Stamminger, K.-M. Debatin)
- German Cancer Research Center (DKFZ), Heidelberg (T. Waterboer)
| | - Jürgen Grulich-Henn
- Heidelberg University Hospital, Heidelberg, Germany (M. Stich, S.F. Garbade, B. Müller, H.-G. Kräusslich, J. Grulich-Henn, K. Jeltsch, G.F. Hoffmann, B. Tönshoff)
- University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany (R. Elling, D. Huzly, A. Haddad, T. Görne, B. Spielberger, L. Fritsch, A. Nieters, H. Hengel, P. Henneke)
- University Hospital and Faculty of Medicine Tübingen, Tübingen, Germany (H. Renk, T. Ganzenmueller, N. Ruetalo, A. Peter, J. Remppis, T. Iftner, A.R. Franz, C. Engel)
- Ulm University Medical Center, Ulm, Germany (A. Janda, D. Fabricius, M. Zernickel, P. Meissner, A.N. Dietz, T. Stamminger, K.-M. Debatin)
- German Cancer Research Center (DKFZ), Heidelberg (T. Waterboer)
| | - Anneke Haddad
- Heidelberg University Hospital, Heidelberg, Germany (M. Stich, S.F. Garbade, B. Müller, H.-G. Kräusslich, J. Grulich-Henn, K. Jeltsch, G.F. Hoffmann, B. Tönshoff)
- University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany (R. Elling, D. Huzly, A. Haddad, T. Görne, B. Spielberger, L. Fritsch, A. Nieters, H. Hengel, P. Henneke)
- University Hospital and Faculty of Medicine Tübingen, Tübingen, Germany (H. Renk, T. Ganzenmueller, N. Ruetalo, A. Peter, J. Remppis, T. Iftner, A.R. Franz, C. Engel)
- Ulm University Medical Center, Ulm, Germany (A. Janda, D. Fabricius, M. Zernickel, P. Meissner, A.N. Dietz, T. Stamminger, K.-M. Debatin)
- German Cancer Research Center (DKFZ), Heidelberg (T. Waterboer)
| | - Tessa Görne
- Heidelberg University Hospital, Heidelberg, Germany (M. Stich, S.F. Garbade, B. Müller, H.-G. Kräusslich, J. Grulich-Henn, K. Jeltsch, G.F. Hoffmann, B. Tönshoff)
- University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany (R. Elling, D. Huzly, A. Haddad, T. Görne, B. Spielberger, L. Fritsch, A. Nieters, H. Hengel, P. Henneke)
- University Hospital and Faculty of Medicine Tübingen, Tübingen, Germany (H. Renk, T. Ganzenmueller, N. Ruetalo, A. Peter, J. Remppis, T. Iftner, A.R. Franz, C. Engel)
- Ulm University Medical Center, Ulm, Germany (A. Janda, D. Fabricius, M. Zernickel, P. Meissner, A.N. Dietz, T. Stamminger, K.-M. Debatin)
- German Cancer Research Center (DKFZ), Heidelberg (T. Waterboer)
| | - Benedikt Spielberger
- Heidelberg University Hospital, Heidelberg, Germany (M. Stich, S.F. Garbade, B. Müller, H.-G. Kräusslich, J. Grulich-Henn, K. Jeltsch, G.F. Hoffmann, B. Tönshoff)
- University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany (R. Elling, D. Huzly, A. Haddad, T. Görne, B. Spielberger, L. Fritsch, A. Nieters, H. Hengel, P. Henneke)
- University Hospital and Faculty of Medicine Tübingen, Tübingen, Germany (H. Renk, T. Ganzenmueller, N. Ruetalo, A. Peter, J. Remppis, T. Iftner, A.R. Franz, C. Engel)
- Ulm University Medical Center, Ulm, Germany (A. Janda, D. Fabricius, M. Zernickel, P. Meissner, A.N. Dietz, T. Stamminger, K.-M. Debatin)
- German Cancer Research Center (DKFZ), Heidelberg (T. Waterboer)
| | - Linus Fritsch
- Heidelberg University Hospital, Heidelberg, Germany (M. Stich, S.F. Garbade, B. Müller, H.-G. Kräusslich, J. Grulich-Henn, K. Jeltsch, G.F. Hoffmann, B. Tönshoff)
- University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany (R. Elling, D. Huzly, A. Haddad, T. Görne, B. Spielberger, L. Fritsch, A. Nieters, H. Hengel, P. Henneke)
- University Hospital and Faculty of Medicine Tübingen, Tübingen, Germany (H. Renk, T. Ganzenmueller, N. Ruetalo, A. Peter, J. Remppis, T. Iftner, A.R. Franz, C. Engel)
- Ulm University Medical Center, Ulm, Germany (A. Janda, D. Fabricius, M. Zernickel, P. Meissner, A.N. Dietz, T. Stamminger, K.-M. Debatin)
- German Cancer Research Center (DKFZ), Heidelberg (T. Waterboer)
| | - Alexandra Nieters
- Heidelberg University Hospital, Heidelberg, Germany (M. Stich, S.F. Garbade, B. Müller, H.-G. Kräusslich, J. Grulich-Henn, K. Jeltsch, G.F. Hoffmann, B. Tönshoff)
- University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany (R. Elling, D. Huzly, A. Haddad, T. Görne, B. Spielberger, L. Fritsch, A. Nieters, H. Hengel, P. Henneke)
- University Hospital and Faculty of Medicine Tübingen, Tübingen, Germany (H. Renk, T. Ganzenmueller, N. Ruetalo, A. Peter, J. Remppis, T. Iftner, A.R. Franz, C. Engel)
- Ulm University Medical Center, Ulm, Germany (A. Janda, D. Fabricius, M. Zernickel, P. Meissner, A.N. Dietz, T. Stamminger, K.-M. Debatin)
- German Cancer Research Center (DKFZ), Heidelberg (T. Waterboer)
| | - Hartmut Hengel
- Heidelberg University Hospital, Heidelberg, Germany (M. Stich, S.F. Garbade, B. Müller, H.-G. Kräusslich, J. Grulich-Henn, K. Jeltsch, G.F. Hoffmann, B. Tönshoff)
- University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany (R. Elling, D. Huzly, A. Haddad, T. Görne, B. Spielberger, L. Fritsch, A. Nieters, H. Hengel, P. Henneke)
- University Hospital and Faculty of Medicine Tübingen, Tübingen, Germany (H. Renk, T. Ganzenmueller, N. Ruetalo, A. Peter, J. Remppis, T. Iftner, A.R. Franz, C. Engel)
- Ulm University Medical Center, Ulm, Germany (A. Janda, D. Fabricius, M. Zernickel, P. Meissner, A.N. Dietz, T. Stamminger, K.-M. Debatin)
- German Cancer Research Center (DKFZ), Heidelberg (T. Waterboer)
| | - Andrea N. Dietz
- Heidelberg University Hospital, Heidelberg, Germany (M. Stich, S.F. Garbade, B. Müller, H.-G. Kräusslich, J. Grulich-Henn, K. Jeltsch, G.F. Hoffmann, B. Tönshoff)
- University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany (R. Elling, D. Huzly, A. Haddad, T. Görne, B. Spielberger, L. Fritsch, A. Nieters, H. Hengel, P. Henneke)
- University Hospital and Faculty of Medicine Tübingen, Tübingen, Germany (H. Renk, T. Ganzenmueller, N. Ruetalo, A. Peter, J. Remppis, T. Iftner, A.R. Franz, C. Engel)
- Ulm University Medical Center, Ulm, Germany (A. Janda, D. Fabricius, M. Zernickel, P. Meissner, A.N. Dietz, T. Stamminger, K.-M. Debatin)
- German Cancer Research Center (DKFZ), Heidelberg (T. Waterboer)
| | - Thomas Stamminger
- Heidelberg University Hospital, Heidelberg, Germany (M. Stich, S.F. Garbade, B. Müller, H.-G. Kräusslich, J. Grulich-Henn, K. Jeltsch, G.F. Hoffmann, B. Tönshoff)
- University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany (R. Elling, D. Huzly, A. Haddad, T. Görne, B. Spielberger, L. Fritsch, A. Nieters, H. Hengel, P. Henneke)
- University Hospital and Faculty of Medicine Tübingen, Tübingen, Germany (H. Renk, T. Ganzenmueller, N. Ruetalo, A. Peter, J. Remppis, T. Iftner, A.R. Franz, C. Engel)
- Ulm University Medical Center, Ulm, Germany (A. Janda, D. Fabricius, M. Zernickel, P. Meissner, A.N. Dietz, T. Stamminger, K.-M. Debatin)
- German Cancer Research Center (DKFZ), Heidelberg (T. Waterboer)
| | - Tina Ganzenmueller
- Heidelberg University Hospital, Heidelberg, Germany (M. Stich, S.F. Garbade, B. Müller, H.-G. Kräusslich, J. Grulich-Henn, K. Jeltsch, G.F. Hoffmann, B. Tönshoff)
- University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany (R. Elling, D. Huzly, A. Haddad, T. Görne, B. Spielberger, L. Fritsch, A. Nieters, H. Hengel, P. Henneke)
- University Hospital and Faculty of Medicine Tübingen, Tübingen, Germany (H. Renk, T. Ganzenmueller, N. Ruetalo, A. Peter, J. Remppis, T. Iftner, A.R. Franz, C. Engel)
- Ulm University Medical Center, Ulm, Germany (A. Janda, D. Fabricius, M. Zernickel, P. Meissner, A.N. Dietz, T. Stamminger, K.-M. Debatin)
- German Cancer Research Center (DKFZ), Heidelberg (T. Waterboer)
| | - Natalia Ruetalo
- Heidelberg University Hospital, Heidelberg, Germany (M. Stich, S.F. Garbade, B. Müller, H.-G. Kräusslich, J. Grulich-Henn, K. Jeltsch, G.F. Hoffmann, B. Tönshoff)
- University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany (R. Elling, D. Huzly, A. Haddad, T. Görne, B. Spielberger, L. Fritsch, A. Nieters, H. Hengel, P. Henneke)
- University Hospital and Faculty of Medicine Tübingen, Tübingen, Germany (H. Renk, T. Ganzenmueller, N. Ruetalo, A. Peter, J. Remppis, T. Iftner, A.R. Franz, C. Engel)
- Ulm University Medical Center, Ulm, Germany (A. Janda, D. Fabricius, M. Zernickel, P. Meissner, A.N. Dietz, T. Stamminger, K.-M. Debatin)
- German Cancer Research Center (DKFZ), Heidelberg (T. Waterboer)
| | - Andreas Peter
- Heidelberg University Hospital, Heidelberg, Germany (M. Stich, S.F. Garbade, B. Müller, H.-G. Kräusslich, J. Grulich-Henn, K. Jeltsch, G.F. Hoffmann, B. Tönshoff)
- University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany (R. Elling, D. Huzly, A. Haddad, T. Görne, B. Spielberger, L. Fritsch, A. Nieters, H. Hengel, P. Henneke)
- University Hospital and Faculty of Medicine Tübingen, Tübingen, Germany (H. Renk, T. Ganzenmueller, N. Ruetalo, A. Peter, J. Remppis, T. Iftner, A.R. Franz, C. Engel)
- Ulm University Medical Center, Ulm, Germany (A. Janda, D. Fabricius, M. Zernickel, P. Meissner, A.N. Dietz, T. Stamminger, K.-M. Debatin)
- German Cancer Research Center (DKFZ), Heidelberg (T. Waterboer)
| | - Jonathan Remppis
- Heidelberg University Hospital, Heidelberg, Germany (M. Stich, S.F. Garbade, B. Müller, H.-G. Kräusslich, J. Grulich-Henn, K. Jeltsch, G.F. Hoffmann, B. Tönshoff)
- University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany (R. Elling, D. Huzly, A. Haddad, T. Görne, B. Spielberger, L. Fritsch, A. Nieters, H. Hengel, P. Henneke)
- University Hospital and Faculty of Medicine Tübingen, Tübingen, Germany (H. Renk, T. Ganzenmueller, N. Ruetalo, A. Peter, J. Remppis, T. Iftner, A.R. Franz, C. Engel)
- Ulm University Medical Center, Ulm, Germany (A. Janda, D. Fabricius, M. Zernickel, P. Meissner, A.N. Dietz, T. Stamminger, K.-M. Debatin)
- German Cancer Research Center (DKFZ), Heidelberg (T. Waterboer)
| | - Thomas Iftner
- Heidelberg University Hospital, Heidelberg, Germany (M. Stich, S.F. Garbade, B. Müller, H.-G. Kräusslich, J. Grulich-Henn, K. Jeltsch, G.F. Hoffmann, B. Tönshoff)
- University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany (R. Elling, D. Huzly, A. Haddad, T. Görne, B. Spielberger, L. Fritsch, A. Nieters, H. Hengel, P. Henneke)
- University Hospital and Faculty of Medicine Tübingen, Tübingen, Germany (H. Renk, T. Ganzenmueller, N. Ruetalo, A. Peter, J. Remppis, T. Iftner, A.R. Franz, C. Engel)
- Ulm University Medical Center, Ulm, Germany (A. Janda, D. Fabricius, M. Zernickel, P. Meissner, A.N. Dietz, T. Stamminger, K.-M. Debatin)
- German Cancer Research Center (DKFZ), Heidelberg (T. Waterboer)
| | - Kathrin Jeltsch
- Heidelberg University Hospital, Heidelberg, Germany (M. Stich, S.F. Garbade, B. Müller, H.-G. Kräusslich, J. Grulich-Henn, K. Jeltsch, G.F. Hoffmann, B. Tönshoff)
- University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany (R. Elling, D. Huzly, A. Haddad, T. Görne, B. Spielberger, L. Fritsch, A. Nieters, H. Hengel, P. Henneke)
- University Hospital and Faculty of Medicine Tübingen, Tübingen, Germany (H. Renk, T. Ganzenmueller, N. Ruetalo, A. Peter, J. Remppis, T. Iftner, A.R. Franz, C. Engel)
- Ulm University Medical Center, Ulm, Germany (A. Janda, D. Fabricius, M. Zernickel, P. Meissner, A.N. Dietz, T. Stamminger, K.-M. Debatin)
- German Cancer Research Center (DKFZ), Heidelberg (T. Waterboer)
| | - Tim Waterboer
- Heidelberg University Hospital, Heidelberg, Germany (M. Stich, S.F. Garbade, B. Müller, H.-G. Kräusslich, J. Grulich-Henn, K. Jeltsch, G.F. Hoffmann, B. Tönshoff)
- University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany (R. Elling, D. Huzly, A. Haddad, T. Görne, B. Spielberger, L. Fritsch, A. Nieters, H. Hengel, P. Henneke)
- University Hospital and Faculty of Medicine Tübingen, Tübingen, Germany (H. Renk, T. Ganzenmueller, N. Ruetalo, A. Peter, J. Remppis, T. Iftner, A.R. Franz, C. Engel)
- Ulm University Medical Center, Ulm, Germany (A. Janda, D. Fabricius, M. Zernickel, P. Meissner, A.N. Dietz, T. Stamminger, K.-M. Debatin)
- German Cancer Research Center (DKFZ), Heidelberg (T. Waterboer)
| | - Axel R. Franz
- Heidelberg University Hospital, Heidelberg, Germany (M. Stich, S.F. Garbade, B. Müller, H.-G. Kräusslich, J. Grulich-Henn, K. Jeltsch, G.F. Hoffmann, B. Tönshoff)
- University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany (R. Elling, D. Huzly, A. Haddad, T. Görne, B. Spielberger, L. Fritsch, A. Nieters, H. Hengel, P. Henneke)
- University Hospital and Faculty of Medicine Tübingen, Tübingen, Germany (H. Renk, T. Ganzenmueller, N. Ruetalo, A. Peter, J. Remppis, T. Iftner, A.R. Franz, C. Engel)
- Ulm University Medical Center, Ulm, Germany (A. Janda, D. Fabricius, M. Zernickel, P. Meissner, A.N. Dietz, T. Stamminger, K.-M. Debatin)
- German Cancer Research Center (DKFZ), Heidelberg (T. Waterboer)
| | - Georg Friedrich Hoffmann
- Heidelberg University Hospital, Heidelberg, Germany (M. Stich, S.F. Garbade, B. Müller, H.-G. Kräusslich, J. Grulich-Henn, K. Jeltsch, G.F. Hoffmann, B. Tönshoff)
- University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany (R. Elling, D. Huzly, A. Haddad, T. Görne, B. Spielberger, L. Fritsch, A. Nieters, H. Hengel, P. Henneke)
- University Hospital and Faculty of Medicine Tübingen, Tübingen, Germany (H. Renk, T. Ganzenmueller, N. Ruetalo, A. Peter, J. Remppis, T. Iftner, A.R. Franz, C. Engel)
- Ulm University Medical Center, Ulm, Germany (A. Janda, D. Fabricius, M. Zernickel, P. Meissner, A.N. Dietz, T. Stamminger, K.-M. Debatin)
- German Cancer Research Center (DKFZ), Heidelberg (T. Waterboer)
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Weigang S, Fuchs J, Zimmer G, Schnepf D, Kern L, Beer J, Luxenburger H, Ankerhold J, Falcone V, Kemming J, Hofmann M, Thimme R, Neumann-Haefelin C, Ulferts S, Grosse R, Hornuss D, Tanriver Y, Rieg S, Wagner D, Huzly D, Schwemmle M, Panning M, Kochs G. Within-host evolution of SARS-CoV-2 in an immunosuppressed COVID-19 patient as a source of immune escape variants. Nat Commun 2021; 12:6405. [PMID: 34737266 PMCID: PMC8568958 DOI: 10.1038/s41467-021-26602-3] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [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: 04/23/2021] [Accepted: 10/15/2021] [Indexed: 02/06/2023] Open
Abstract
The origin of SARS-CoV-2 variants of concern remains unclear. Here, we test whether intra-host virus evolution during persistent infections could be a contributing factor by characterizing the long-term SARS-CoV-2 infection dynamics in an immunosuppressed kidney transplant recipient. Applying RT-qPCR and next-generation sequencing (NGS) of sequential respiratory specimens, we identify several mutations in the viral genome late in infection. We demonstrate that a late viral isolate exhibiting genome mutations similar to those found in variants of concern first identified in UK, South Africa, and Brazil, can escape neutralization by COVID-19 antisera. Moreover, infection of susceptible mice with this patient’s escape variant elicits protective immunity against re-infection with either the parental virus and the escape variant, as well as high neutralization titers against the alpha and beta SARS-CoV-2 variants, B.1.1.7 and B.1.351, demonstrating a considerable immune control against such variants of concern. Upon lowering immunosuppressive treatment, the patient generated spike-specific neutralizing antibodies and resolved the infection. Our results suggest that immunocompromised patients could be a source for the emergence of potentially harmful SARS-CoV-2 variants. Here, in a longitudinal case study, Weigang et al. demonstrate that evolution of SARS-CoV-2 within a persistently infected immunosuppressed patient can result in the emergence of novel variants with reduced sensitivity to antibody neutralization.
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Affiliation(s)
- Sebastian Weigang
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jonas Fuchs
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gert Zimmer
- Institute of Virology and Immunology, Bern & Mittelhäusern, Switzerland, and Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Daniel Schnepf
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lisa Kern
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julius Beer
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hendrik Luxenburger
- Department of Medicine II, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jakob Ankerhold
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Valeria Falcone
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Janine Kemming
- Department of Medicine II, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maike Hofmann
- Department of Medicine II, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Robert Thimme
- Department of Medicine II, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Neumann-Haefelin
- Department of Medicine II, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Svenja Ulferts
- Institute of Experimental and Clinical Pharmacology and Toxicology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Robert Grosse
- Institute of Experimental and Clinical Pharmacology and Toxicology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Hornuss
- Division of Infectious Diseases, Dept. Med. II, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Yakup Tanriver
- Division of Nephrology, Dept. Med. IV, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Dept. Med. II, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dirk Wagner
- Division of Infectious Diseases, Dept. Med. II, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniela Huzly
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Schwemmle
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marcus Panning
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Georg Kochs
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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21
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Tönshoff B, Müller B, Elling R, Renk H, Meissner P, Hengel H, Garbade SF, Kieser M, Jeltsch K, Grulich-Henn J, Euler J, Stich M, Chobanyan-Jürgens K, Zernickel M, Janda A, Wölfle L, Stamminger T, Iftner T, Ganzenmueller T, Schmitt C, Görne T, Laketa V, Olberg S, Plaszczyca A, Cortese M, Bartenschlager R, Pape C, Remme R, Huzly D, Panning M, Weigang S, Giese S, Ciminski K, Ankerhold J, Kochs G, Schwemmle M, Handgretinger R, Niemeyer CM, Engel C, Kern WV, Hoffmann GF, Franz AR, Henneke P, Debatin KM, Kräusslich HG. Prevalence of SARS-CoV-2 Infection in Children and Their Parents in Southwest Germany. JAMA Pediatr 2021; 175:586-593. [PMID: 33480966 PMCID: PMC7823424 DOI: 10.1001/jamapediatrics.2021.0001] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 12/02/2020] [Indexed: 01/12/2023]
Abstract
Importance School and daycare closures were enforced as measures to confine the novel coronavirus disease 2019 (COVID-19) pandemic, based on the assumption that young children may play a key role in severe acute respiratory coronavirus 2 (SARS-CoV-2) spread. Given the grave consequences of contact restrictions for children, a better understanding of their contribution to the COVID-19 pandemic is of great importance. Objective To describe the rate of SARS-CoV-2 infections and the seroprevalence of SARS-CoV-2 antibodies in children aged 1 to 10 years, compared with a corresponding parent of each child, in a population-based sample. Design, Setting, and Participants This large-scale, multicenter, cross-sectional investigation (the COVID-19 BaWü study) enrolled children aged 1 to 10 years and a corresponding parent between April 22 and May 15, 2020, in southwest Germany. Exposures Potential exposure to SARS-CoV-2. Main Outcomes and Measures The main outcomes were infection and seroprevalence of SARS-CoV-2. Participants were tested for SARS-CoV-2 RNA from nasopharyngeal swabs by reverse transcription-polymerase chain reaction and SARS-CoV-2 specific IgG antibodies in serum by enzyme-linked immunosorbent assays and immunofluorescence tests. Discordant results were clarified by electrochemiluminescence immunoassays, a second enzyme-linked immunosorbent assay, or an in-house Luminex-based assay. Results This study included 4964 participants: 2482 children (median age, 6 [range, 1-10] years; 1265 boys [51.0%]) and 2482 parents (median age, 40 [range, 23-66] years; 615 men [24.8%]). Two participants (0.04%) tested positive for SARS-CoV-2 RNA. The estimated SARS-CoV-2 seroprevalence was low in parents (1.8% [95% CI, 1.2-2.4%]) and 3-fold lower in children (0.6% [95% CI, 0.3-1.0%]). Among 56 families with at least 1 child or parent with seropositivity, the combination of a parent with seropositivity and a corresponding child with seronegativity was 4.3 (95% CI, 1.19-15.52) times higher than the combination of a parent who was seronegative and a corresponding child with seropositivity. We observed virus-neutralizing activity for 66 of 70 IgG-positive serum samples (94.3%). Conclusions and Relevance In this cross-sectional study, the spread of SARS-CoV-2 infection during a period of lockdown in southwest Germany was particularly low in children aged 1 to 10 years. Accordingly, it is unlikely that children have boosted the pandemic. This SARS-CoV-2 prevalence study, which appears to be the largest focusing on children, is instructive for how ad hoc mass testing provides the basis for rational political decision-making in a pandemic.
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Affiliation(s)
- Burkhard Tönshoff
- Department of Pediatrics I, University Children’s Hospital Heidelberg, Heidelberg, Germany
| | - Barbara Müller
- Department of Infectious Diseases, Virology, Heidelberg University, Heidelberg, Germany
| | - Roland Elling
- Center for Pediatrics and Adolescent Medicine, University Medical Centre and Faculty of Medicine Freiburg, Freiburg im Breisgau, Germany
- Institute for Immunodeficiency, University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany
| | - Hanna Renk
- University Children’s Hospital Tübingen, Tübingen, Germany
| | - Peter Meissner
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm, Germany
| | - Hartmut Hengel
- Institute of Virology, University Medical Centre and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Sven F. Garbade
- Department of Pediatrics I, University Children’s Hospital Heidelberg, Heidelberg, Germany
| | - Meinhard Kieser
- Institute for Medical Biometry and Informatics, Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Kathrin Jeltsch
- Department of Pediatrics I, University Children’s Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen Grulich-Henn
- Department of Pediatrics I, University Children’s Hospital Heidelberg, Heidelberg, Germany
| | - Julia Euler
- Department of Pediatrics I, University Children’s Hospital Heidelberg, Heidelberg, Germany
| | - Maximilian Stich
- Department of Pediatrics I, University Children’s Hospital Heidelberg, Heidelberg, Germany
| | - Kristine Chobanyan-Jürgens
- Department of Pediatrics I, University Children’s Hospital Heidelberg, Heidelberg, Germany
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, Heidelberg, Germany
- Pediatric Clinical-Pharmacological Trial Centre (paedKliPS), University Hospital Heidelberg, Heidelberg, Germany
| | - Maria Zernickel
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm, Germany
| | - Aleš Janda
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm, Germany
| | - Lena Wölfle
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm, Germany
| | | | - Thomas Iftner
- Institute for Medical Virology, University Hospital of Tübingen, Tübingen, Germany
| | - Tina Ganzenmueller
- Institute for Medical Virology, University Hospital of Tübingen, Tübingen, Germany
| | - Christian Schmitt
- Center for Pediatrics and Adolescent Medicine, University Medical Centre and Faculty of Medicine Freiburg, Freiburg im Breisgau, Germany
| | - Tessa Görne
- Center for Pediatrics and Adolescent Medicine, University Medical Centre and Faculty of Medicine Freiburg, Freiburg im Breisgau, Germany
| | - Vibor Laketa
- Department of Infectious Diseases, Virology, Heidelberg University, Heidelberg, Germany
| | - Sylvia Olberg
- Department of Infectious Diseases, Virology, Heidelberg University, Heidelberg, Germany
| | - Anna Plaszczyca
- Department of Infectious Diseases, Molecular Virology, Heidelberg University, Heidelberg, Germany
| | - Mirko Cortese
- Department of Infectious Diseases, Molecular Virology, Heidelberg University, Heidelberg, Germany
| | - Ralf Bartenschlager
- Department of Infectious Diseases, Molecular Virology, Heidelberg University, Heidelberg, Germany
| | - Constantin Pape
- Heidelberg Collaboratory for Image Processing, Interdisciplinary Centre for Scientific Computing, Heidelberg University, Heidelberg, Germany
- European Molecular Biology Laboratory, Heidelberg, Heidelberg, Germany
| | - Roman Remme
- Heidelberg Collaboratory for Image Processing, Interdisciplinary Centre for Scientific Computing, Heidelberg University, Heidelberg, Germany
| | - Daniela Huzly
- Institute of Virology, University Medical Centre and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Marcus Panning
- Institute of Virology, University Medical Centre and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Sebastian Weigang
- Institute of Virology, University Medical Centre and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Sebastian Giese
- Institute of Virology, University Medical Centre and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Kevin Ciminski
- Institute of Virology, University Medical Centre and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Jakob Ankerhold
- Institute of Virology, University Medical Centre and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Georg Kochs
- Institute of Virology, University Medical Centre and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Martin Schwemmle
- Institute of Virology, University Medical Centre and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Charlotte M. Niemeyer
- Center for Pediatrics and Adolescent Medicine, University Medical Centre and Faculty of Medicine Freiburg, Freiburg im Breisgau, Germany
| | - Corinna Engel
- Centre for Paediatric Clinical Studies at the University Children’s Hospital Tübingen, Tübingen, Germany
| | - Winfried V. Kern
- Department of Medicine II, Division of Infectious Diseases and Travel Medicine, University Medical Centre Freiburg, Freiburg, Germany
| | | | - Axel R. Franz
- Centre for Paediatric Clinical Studies at the University Children’s Hospital Tübingen, Tübingen, Germany
| | - Philipp Henneke
- Center for Pediatrics and Adolescent Medicine, University Medical Centre and Faculty of Medicine Freiburg, Freiburg im Breisgau, Germany
- Institute for Immunodeficiency, University Medical Centre and Faculty of Medicine Freiburg, Freiburg, Germany
| | - Klaus-Michael Debatin
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm, Germany
| | - Hans-Georg Kräusslich
- Department of Infectious Diseases, Virology, Heidelberg University, Heidelberg, Germany
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22
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Groß M, Speckmann C, May A, Gajardo-Carrasco T, Wustrau K, Maier SL, Panning M, Huzly D, Agaimy A, Bryceson YT, Choo S, Chow CW, Dückers G, Fasth A, Fraitag S, Gräwe K, Haxelmans S, Holzinger D, Hudowenz O, Hübschen JM, Khurana C, Kienle K, Klifa R, Korn K, Kutzner H, Lämmermann T, Ledig S, Lipsker D, Meeths M, Naumann-Bartsch N, Rascon J, Schänzer A, Seidl M, Tesi B, Vauloup-Fellous C, Vollmer-Kary B, Warnatz K, Wehr C, Neven B, Vargas P, Sepulveda FE, Lehmberg K, Schmitt-Graeff A, Ehl S. Rubella vaccine-induced granulomas are a novel phenotype with incomplete penetrance of genetic defects in cytotoxicity. J Allergy Clin Immunol 2021; 149:388-399.e4. [PMID: 34033843 DOI: 10.1016/j.jaci.2021.05.007] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/19/2021] [Accepted: 05/05/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Rubella virus-induced granulomas have been described in patients with various inborn errors of immunity. Most defects impair T-cell immunity, suggesting a critical role of T cells in rubella elimination. However, the molecular mechanism of virus control remains elusive. OBJECTIVE This study sought to understand the defective effector mechanism allowing rubella vaccine virus persistence in granulomas. METHODS Starting from an index case with Griscelli syndrome type 2 and rubella skin granulomas, this study combined an international survey with a literature search to identify patients with cytotoxicity defects and granuloma. The investigators performed rubella virus immunohistochemistry and PCR and T-cell migration assays. RESULTS This study identified 21 patients with various genetically confirmed cytotoxicity defects, who presented with skin and visceral granulomas. Rubella virus was demonstrated in all 12 accessible biopsies. Granuloma onset was typically before 2 years of age and lesions persisted from months to years. Granulomas were particularly frequent in MUNC13-4 and RAB27A deficiency, where 50% of patients at risk were affected. Although these proteins have also been implicated in lymphocyte migration, 3-dimensional migration assays revealed no evidence of impaired migration of patient T cells. Notably, patients showed no evidence of reduced control of concomitantly given measles, mumps, or varicella live-attenuated vaccine or severe infections with other viruses. CONCLUSIONS This study identified lymphocyte cytotoxicity as a key effector mechanism for control of rubella vaccine virus, without evidence for its need in control of live measles, mumps, or varicella vaccines. Rubella vaccine-induced granulomas are a novel phenotype with incomplete penetrance of genetic disorders of cytotoxicity.
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Affiliation(s)
- Miriam Groß
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany; Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Carsten Speckmann
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany; Center for Pediatrics and Adolescent Medicine, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Annette May
- Institute for Surgical Pathology, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Tania Gajardo-Carrasco
- Molecular Basis of Altered Immune Homeostasis Laboratory, Institut National de la Santé et de la Recherche Médicale (INSERM), Unite Mixte de Recherche (UMR) 1163, Paris, France; Imagine Institute, Université de Paris, Paris, France
| | - Katharina Wustrau
- Division of Pediatric Stem Cell Transplantation and Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Lena Maier
- Division of Pediatric Stem Cell Transplantation and Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcus Panning
- Institute of Virology, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Daniela Huzly
- Institute of Virology, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Yenan T Bryceson
- Department of Medicine, Center for Hematology and Regenerative Medicine, Karolinska Institutet, Stockholm, Sweden; Broegelmann Research Laboratory, Department of Clinical Sciences, University of Bergen, Bergen, Norway
| | - Sharon Choo
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, Australia
| | - C W Chow
- Department of Anatomical Pathology, The Royal Children's Hospital, Melbourne, Australia
| | - Gregor Dückers
- Helios Klinikum Krefeld, Zentrum für Kinder- und Jugendmedizin, Krefeld, Germany
| | - Anders Fasth
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden
| | - Sylvie Fraitag
- Department of Pathology, Necker-Enfants Malades Hospital, Paris, France
| | - Katja Gräwe
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | | | - Dirk Holzinger
- Department of Pediatric Hematology-Oncology, University of Duisburg-Essen, Essen, Germany
| | - Ole Hudowenz
- Department of Rheumatology, Immunology, Osteology, and Physical Medicine, Campus Kerckhoff of Justus-Liebig-University Gießen, Bad Nauheim, Germany
| | - Judith M Hübschen
- World Health Organization European Regional Reference Laboratory for Measles and Rubella, Luxembourg Institute of Health, Department of Infection and Immunity, Esch-sur-Alzette, Luxembourg
| | - Claudia Khurana
- Department of Pediatric Hematology and Oncology, Children's Center Bethel, University Hospital Ostwestfalen-Lippe (OWL)/University Bielefeld, Bielefeld, Germany
| | - Korbinian Kienle
- Max Planck Institute of Immunobiology and Epigenetics, Freiburg, Germany
| | - Roman Klifa
- Immunology and Pediatric Hematology Department, Assistance Publique-Hôpitaux de Paris (AH-PH), Paris, France
| | - Klaus Korn
- Institute of Virology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Tim Lämmermann
- Max Planck Institute of Immunobiology and Epigenetics, Freiburg, Germany
| | - Svea Ledig
- Division of Pediatric Stem Cell Transplantation and Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dan Lipsker
- Faculté de Médecine, Université de Strasbourg and Clinique Dermatologique, Hôpitaux Universitaires, Strasbourg, France
| | - Marie Meeths
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Theme of Children's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Nora Naumann-Bartsch
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - Jelena Rascon
- Center for Pediatric Oncology and Hematology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania; Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Anne Schänzer
- Institute of Neuropathology, Justus Liebig University Gießen, Gießen, Germany
| | - Maximilian Seidl
- Institute for Surgical Pathology, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany; Institute of Pathology, Heinrich Heine University and University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Bianca Tesi
- Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Genetics, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
| | - Christelle Vauloup-Fellous
- AP-HP, Hôpital Paul-Brousse, Department of Virology, World Health Organization Rubella National Reference Laboratory, Groupe de Recherche sur les Infections pendant la Grossesse, University Paris Saclay, INSERM U1193, Villejuif, France
| | - Beate Vollmer-Kary
- Institute for Surgical Pathology, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Klaus Warnatz
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany; Center for Chronic Immunodeficiency, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Claudia Wehr
- Center for Chronic Immunodeficiency, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany; Department of Medicine I, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Bénédicte Neven
- Imagine Institute, Université de Paris, Paris, France; Pediatric Hematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Laboratory of Immunogenetics of Pediatric Autoimmunity, INSERM UMR 1163, Imagine Institute, Université de Paris, Paris, France
| | - Pablo Vargas
- Institut Curie, Centre National de la Recherche Scientifique (CNRS) UMR 144 and Institut Pierre-Gilles de Gennes, and INSERM U932 Immunité et Cancer, Institut Curie, Paris Sciences et Lettres Research University, Paris, France
| | - Fernando E Sepulveda
- Molecular Basis of Altered Immune Homeostasis Laboratory, Institut National de la Santé et de la Recherche Médicale (INSERM), Unite Mixte de Recherche (UMR) 1163, Paris, France; Imagine Institute, Université de Paris, Paris, France; Centre National de la Recherche Scientifique (CNRS), Paris, France
| | - Kai Lehmberg
- Division of Pediatric Stem Cell Transplantation and Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Annette Schmitt-Graeff
- Center for Chronic Immunodeficiency, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Stephan Ehl
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany.
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23
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Luppa PB, Rabenau HF, Gässler N, Huzly D, Nauck M, Reischl U, Schoerner C, Zeichhardt H. Rational clinical use of near-patient analytical systems for molecular detection of infectious agents. J LAB MED 2021. [DOI: 10.1515/labmed-2021-0035] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Tests for diagnosing infectious diseases (ID-POCT) play a special role among the available point-of-care testing (POCT) methods.
Methods
A systematic literature search was performed in PubMed. Based on this literature review and our own experience, aspects associated with using molecular biological methods in the diagnostic amplification of pathogen DNA/RNA (nucleic acid testing = NAT) and/or signal amplification were discussed in an interdisciplinary manner. This resulted in the following recommendations for the near-patient use of NAT methods.
Results
Due to the current rise in the use of near-patient NAT testing (e.g., using disposable cartridges), recommendations are made for their implementation and appropriate clinical use in the hospital setting. Particular emphasis is placed on the analytical quality of the results. Furthermore, internal best-practice rules and selection criteria are proposed to ensure rapid diagnosis. Equally important are a medically valid interpretation of results and compliance with hygiene requirements. These recommendations emphasize that near-patient NAT should always be procured in conjunction with a (preferably) multidisciplinary institution responsible for POCT and knowledge of the test specifications and risks, as well as quality assurance need to be in place before they are carried out.
Conclusions
These recommendations are intended to improve patient safety and to avoid economically questionable expenditures.
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Affiliation(s)
- Peter B. Luppa
- Institute of Clinical Chemistry and Pathobiochemistry, University Hospital rechts der Isar der Technischen Universität München , Munich , Germany
| | - Holger F. Rabenau
- Institute of Medical Virology, Universitätsklinikum Frankfurt/Main , Frankfurt/Main , Germany
| | - Norbert Gässler
- Center for Laboratory Diagnostics, St. Bernward Hospital , Hildesheim , Germany
| | - Daniela Huzly
- Institute of Virology, Universitätsklinikum Freiburg , Freiburg , Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, Universitätsmedizin Greifswald , Greifswald , Germany
| | - Udo Reischl
- Institute of Clinical Microbiology and Hygiene, Universitätsklinikum Regensburg , Regensburg , Germany
| | - Christoph Schoerner
- Microbiology Institute – Clinical Microbiology, Immunology and Hygiene, Universitätsklinikum Erlangen , Erlangen , Germany
| | - Heinz Zeichhardt
- IQVD GmbH – Institut für Qualitätssicherung in der Virusdiagnostik , Berlin , Germany
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24
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Schulien I, Kemming J, Oberhardt V, Wild K, Seidel LM, Killmer S, Sagar, Daul F, Salvat Lago M, Decker A, Luxenburger H, Binder B, Bettinger D, Sogukpinar O, Rieg S, Panning M, Huzly D, Schwemmle M, Kochs G, Waller CF, Nieters A, Duerschmied D, Emmerich F, Mei HE, Schulz AR, Llewellyn-Lacey S, Price DA, Boettler T, Bengsch B, Thimme R, Hofmann M, Neumann-Haefelin C. Characterization of pre-existing and induced SARS-CoV-2-specific CD8 + T cells. Nat Med 2020; 27:78-85. [PMID: 33184509 DOI: 10.1038/s41591-020-01143-2] [Citation(s) in RCA: 240] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/22/2020] [Indexed: 12/14/2022]
Abstract
Emerging data indicate that SARS-CoV-2-specific CD8+ T cells targeting different viral proteins are detectable in up to 70% of convalescent individuals1-5. However, very little information is currently available about the abundance, phenotype, functional capacity and fate of pre-existing and induced SARS-CoV-2-specific CD8+ T cell responses during the natural course of SARS-CoV-2 infection. Here, we define a set of optimal and dominant SARS-CoV-2-specific CD8+ T cell epitopes. We also perform a high-resolution ex vivo analysis of pre-existing and induced SARS-CoV-2-specific CD8+ T cells, applying peptide-loaded major histocompatibility complex class I (pMHCI) tetramer technology. We observe rapid induction, prolonged contraction and emergence of heterogeneous and functionally competent cross-reactive and induced memory CD8+ T cell responses in cross-sectionally analyzed individuals with mild disease following SARS-CoV-2 infection and three individuals longitudinally assessed for their T cells pre- and post-SARS-CoV-2 infection. SARS-CoV-2-specific memory CD8+ T cells exhibited functional characteristics comparable to influenza-specific CD8+ T cells and were detectable in SARS-CoV-2 convalescent individuals who were seronegative for anti-SARS-CoV-2 antibodies targeting spike (S) and nucleoprotein (N). These results define cross-reactive and induced SARS-CoV-2-specific CD8+ T cell responses as potentially important determinants of immune protection in mild SARS-CoV-2 infection.
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Affiliation(s)
- Isabel Schulien
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Janine Kemming
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Valerie Oberhardt
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Katharina Wild
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Chemistry and Pharmacy, University of Freiburg, Freiburg, Germany
| | - Lea M Seidel
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany.,SGBM - Spemann Graduate School of Biology and Medicine, University of Freiburg, Freiburg, Germany.,Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - Saskia Killmer
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sagar
- Max Planck Institute of Immunobiology and Epigenetics, Freiburg, Germany
| | - Franziska Daul
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Marilyn Salvat Lago
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Annegrit Decker
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hendrik Luxenburger
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,IMM-PACT, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Benedikt Binder
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,IMM-PACT, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominik Bettinger
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Berta-Ottenstein Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Oezlem Sogukpinar
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Siegbert Rieg
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marcus Panning
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniela Huzly
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Schwemmle
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Georg Kochs
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cornelius F Waller
- Department of Haematology, Oncology & Stem Cell Transplantation, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexandra Nieters
- Center for Biobanking-FREEZE-Biobanking, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Duerschmied
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Florian Emmerich
- Institute for Transfusion Medicine and Gene Therapy, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Henrik E Mei
- German Rheumatism Research Center Berlin (DRFZ), Berlin, Germany
| | | | - Sian Llewellyn-Lacey
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - David A Price
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK.,Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
| | - Tobias Boettler
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Berta-Ottenstein Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bertram Bengsch
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - Robert Thimme
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Maike Hofmann
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Christoph Neumann-Haefelin
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Schramm MA, Venhoff N, Wagner D, Thiel J, Huzly D, Craig-Mueller N, Panning M, Hengel H, Kern WV, Voll RE. COVID-19 in a Severely Immunosuppressed Patient With Life-Threatening Eosinophilic Granulomatosis With Polyangiitis. Front Immunol 2020; 11:2086. [PMID: 32983161 PMCID: PMC7484740 DOI: 10.3389/fimmu.2020.02086] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/31/2020] [Accepted: 07/31/2020] [Indexed: 12/30/2022] Open
Abstract
Immunosuppressive therapies increase the susceptibility of patients to infections. The current pandemic with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compels clinicians to develop recommendations for successful clinical management and surveillance of immunocompromised patients at high risk for severe disease progression. With only few case studies published on SARS-CoV-2 infection in patients with rheumatic diseases, we report a 25-year-old male who developed moderate coronavirus disease 2019 (COVID-19) with fever, mild dyspnea, and no major complications despite having received high-dose prednisolone, cyclophosphamide, and rituximab for the treatment of highly active, life-threatening eosinophilic granulomatosis with polyangiitis (EGPA).
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Affiliation(s)
- Markus A Schramm
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dirk Wagner
- Division of Infectious Diseases, Department of Internal Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jens Thiel
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniela Huzly
- Institute of Virology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nils Craig-Mueller
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marcus Panning
- Institute of Virology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hartmut Hengel
- Institute of Virology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Internal Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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26
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Weinmayr LM, Kanz D, Eckenweiler M, Bormann T, Huzly D, Bardutzky J, Harloff A. Acute tick-borne encephalitis during pregnancy - An alarming combination. Ticks Tick Borne Dis 2020; 11:101512. [PMID: 32993932 DOI: 10.1016/j.ttbdis.2020.101512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/25/2020] [Accepted: 07/10/2020] [Indexed: 11/30/2022]
Abstract
We report on a pregnant patient who contracted tick-borne encephalitis (TBE) during her second trimester in an endemic region in Southern Germany. The patient presented with typical symptoms including fever and headache, and TBE infection was confirmed by positive blood and cerebrospinal fluid (CSF) testing. During acute infection there was no evidence of pregnancy complications, and the mother recovered well. We performed a clinical follow-up examination of both mother and child eight months after the diagnosis of TBE, which revealed no signs of sequelae. This case study presents rare evidence of TBE infection during pregnancy and may provide guidance for both physicians as well as mothers-to-be dealing with TBE.
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Affiliation(s)
- L M Weinmayr
- Department of Neurology and Clinical Neurophysiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - D Kanz
- Department of Neurology and Clinical Neurophysiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - M Eckenweiler
- Department of Neuropediatrics and Muscle Disorders, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - T Bormann
- Department of Neurology and Clinical Neurophysiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - D Huzly
- Institute of Virology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - J Bardutzky
- Department of Neurology and Clinical Neurophysiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - A Harloff
- Department of Neurology and Clinical Neurophysiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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27
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Eis-Hübinger AM, Hönemann M, Wenzel JJ, Berger A, Widera M, Schmidt B, Aldabbagh S, Marx B, Streeck H, Ciesek S, Liebert UG, Huzly D, Hengel H, Panning M. Ad hoc laboratory-based surveillance of SARS-CoV-2 by real-time RT-PCR using minipools of RNA prepared from routine respiratory samples. J Clin Virol 2020; 127:104381. [PMID: 32344319 PMCID: PMC7175872 DOI: 10.1016/j.jcv.2020.104381] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [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: 04/09/2020] [Accepted: 04/19/2020] [Indexed: 01/22/2023]
Abstract
A laboratory-based surveillance tool for SARS-CoV-2 was established. It consists of minipool testing of nucleic acid preparations. Limit of detection was 48 copies per reaction (95 % confidence interval: 33–184). A protocol was distributed among five German university hospitals. The approach proved its principle and one COVID-19 case was detected in 70 minipools.
Background A novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in China in late 2019 and subsequently caused a pandemic. Surveillance is important to better appreciate this evolving pandemic and to longitudinally monitor the effectiveness of public health measures. Objectives We aimed to provide a rapid, easy to establish and costeffective laboratory-based surveillance tool for SARS-CoV-2. Study design: We used minipools of RNA prepared from nucleic acid extractions of routine respiratory samples. We technically validated the assay and distributed the protocol within an informal network of five German university laboratories. Results We tested a total of 70 minipools resembling 700 samples shortly before the upsurge of cases in Germany from 17.02.2020 to 10.03.2020. One minipool reacted positive and after resolution one individual sample tested SARS-CoV-2 positive. This sample was from a hospitalized patient not suspected of having contracted SARS-CoV-2. Conclusions Our approach of a laboratory-based surveillance for SARSCoV-2 using minipools proved its concept is easily adaptable and resource-saving. It might assist not only public health laboratories in SARS-CoV-2 surveillance.
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Affiliation(s)
- Anna M Eis-Hübinger
- Institute of Virology, University of Bonn, Faculty of Medicine, Bonn, Germany
| | - Mario Hönemann
- Institute of Virology, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Jürgen J Wenzel
- Institute of Clinical Microbiology and Hygiene, Regensburg University Hospital, Regensburg, Germany
| | - Annemarie Berger
- Institute of Medical Virology, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Marek Widera
- Institute of Medical Virology, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Barbara Schmidt
- Institute of Clinical Microbiology and Hygiene, Regensburg University Hospital, Regensburg, Germany
| | - Souhaib Aldabbagh
- Institute of Virology, University of Bonn, Faculty of Medicine, Bonn, Germany
| | - Benjamin Marx
- Institute of Virology, University of Bonn, Faculty of Medicine, Bonn, Germany
| | - Hendrik Streeck
- Institute of Virology, University of Bonn, Faculty of Medicine, Bonn, Germany
| | - Sandra Ciesek
- Institute of Medical Virology, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Uwe G Liebert
- Institute of Virology, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Daniela Huzly
- Institute of Virology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hartmut Hengel
- Institute of Virology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marcus Panning
- Institute of Virology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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28
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Kempster SL, Almond N, Dimech W, Grangeot-Keros L, Huzly D, Icenogle J, El Mubarak HS, Mulders MN, Nübling CM. WHO international standard for anti-rubella: learning from its application. The Lancet Infectious Diseases 2020; 20:e17-e19. [DOI: 10.1016/s1473-3099(19)30274-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/30/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
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29
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Venhoff N, Thiel J, Rizzi M, Venhoff A, Rauer S, Endres D, Hentze C, Staniek J, Huzly D, Voll RE, Salzer U, Hottenrott T. The MRZ-Reaction and Specific Autoantibody Detection for Differentiation of ANA-Positive Multiple Sclerosis From Rheumatic Diseases With Cerebral Involvement. Front Immunol 2019; 10:514. [PMID: 30941143 PMCID: PMC6433788 DOI: 10.3389/fimmu.2019.00514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/10/2019] [Accepted: 02/26/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: Rheumatic diseases with involvement of the central nervous system (RDwCNS) may mimic multiple sclerosis (MS). Inversely, up to 60% of MS-patients have antinuclear autoantibodies (ANAs) and may be misdiagnosed as RDwCNS. The detection of antibodies against extractable nuclear antigens (ENA) and oligoclonal bands (OCB) are established valuable diagnostic tools in the differential diagnosis of RDwCNS and MS. The MRZ-reaction (MRZR) is defined by three antibody indices (AIs) against neurotropic viruses and is frequently positive in MS. To investigate the added value of MRZR combined with testing for antibodies against ENAs and OCB detection to distinguish RDwCNS from ANA positive MS. Methods: MRZR was evaluated in RDwCNS (n = 40) and 68 ANA positive MS-patients. Two stringency levels, MRZR-1 and MRZR-2 (at least one respectively two of three AIs positive) were applied. Autoantibody testing included ANA plus ENA and anti-dsDNA antibodies, antiphospholipid antibodies, and anti-neutrophil cytoplasmic antibodies. Results: Most of the RDwCNS patients (n = 32; 80%) suffered from systemic lupus erythematosus. Within the RDwCNS group 20% had a positive MRZR-1 and 8.5% a positive MRZR-2 compared to 80.9 and 60%, respectively within the MS-group (p < 0.0001 for both comparisons). Oligoclonal bands were found in 28.6% of the RDwCNS patients and 94.3% of the MS-patients (p < 0.0001). Conversely, autoantibodies to specific nuclear antigens or phospholipids were found more frequently in RDwCNS. A positive MRZR in conjunction with the absence of ENA autoantibodies distinguished MS from RDwCNS with high specificity (97.5%). Conclusions: We suggest combining MRZR, OCBs, and specific autoantibody diagnostics to differentiate RDwCNS from MS.
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Affiliation(s)
- Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Jens Thiel
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Marta Rizzi
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Ana Venhoff
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Sebastian Rauer
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Carolin Hentze
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Julian Staniek
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Daniela Huzly
- Faculty of Medicine, Institute of Virology, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Ulrich Salzer
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Tilman Hottenrott
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
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30
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Amon E, Huzly D, Kalbhenn J, Hettich I, Kotter E, Bansbach J. Abdominal pain, unconsciousness, and skin rash after lung transplantation. Transpl Infect Dis 2018; 20:e12993. [PMID: 30187615 DOI: 10.1111/tid.12993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/06/2018] [Accepted: 08/21/2018] [Indexed: 11/28/2022]
Abstract
Long-term success of lung transplantation is limited by allograft dysfunction and frequent infections. Varicella zoster virus infection (VZV) is one of the most common opportunistic infections among solid organ transplantation recipients. However the occurrence of visceral involvement or disseminated disease, as seen after bone marrow transplantation, is rare. We report a case of a 59-year-old woman who underwent double-lung transplantation with a fatal visceral and disseminated varicella zoster virus infection.
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Affiliation(s)
- Elisa Amon
- Faculty of Medicine, Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany
| | - Daniela Huzly
- Faculty of Medicine, Institute of Virology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Johannes Kalbhenn
- Faculty of Medicine, Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany
| | - Ina Hettich
- Faculty of Medicine, Department of Pneumology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Elmar Kotter
- Faculty of Medicine, Department of Radiology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Joachim Bansbach
- Faculty of Medicine, Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany
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Hottenrott T, Schorb E, Fritsch K, Dersch R, Berger B, Huzly D, Rauer S, Tebartz van Elst L, Endres D, Stich O. The MRZ reaction and a quantitative intrathecal IgG synthesis may be helpful to differentiate between primary central nervous system lymphoma and multiple sclerosis. J Neurol 2018; 265:1106-1114. [DOI: 10.1007/s00415-018-8779-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 01/04/2023]
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Hottenrott T, Dersch R, Berger B, Endres D, Huzly D, Thiel J, Rauer S, Stich O, Salzer U, Venhoff N. The MRZ reaction helps to distinguish rheumatologic disorders with central nervous involvement from multiple sclerosis. BMC Neurol 2018; 18:14. [PMID: 29386006 PMCID: PMC5793342 DOI: 10.1186/s12883-018-1018-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 07/01/2017] [Accepted: 01/18/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Some rheumatologic disorders may initially manifest with central nervous system (CNS) affection, mimicking the clinical, magnetic resonance imaging, and cerebrospinal fluid findings of multiple sclerosis (MS). The MRZ reaction (MRZR), composed of the three respective antibody indices (AIs) against measles, rubella, and varicella zoster virus, has been found positive frequently in MS patients. However, it is unclear whether the MRZR is helpful to distinguish rheumatologic disorders with CNS involvement (RDwCNS) from MS. METHODS The MRZR was evaluated in patients with RDwCNS (n = 23), MS (n = 46; age and sex matched to patients with RDwCNS), and other inflammatory autoimmune neurological diseases affecting the CNS (OIND; n = 48). Both the stringency levels that have been used in previous MRZR studies, MRZR-1 (≥ 1 of 3 AIs positive) and MRZR-2 (≥ 2 of 3 AIs positive), were applied. RESULTS There was no statistically significant difference in the prevalence of positive MRZR between patients with RDwCNS (MRZR-1: 13.0% and MRZR-2: 8.7%, respectively) and OIND (MRZR-1: 22.9% and MRZR-2: 8.3%, respectively). Compared to these two study cohorts, the MS group exhibited significantly higher prevalences of positive MRZR (MRZR-1: 82.6%, MRZR-2: 63.0%; p < 0.005 each). CONCLUSIONS Considering the high specificity of MRZR-2 for MS found in this study, MRZR-2 can be a useful diagnostic tool for distinguishing MS from RDwCNS or OIND.
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Affiliation(s)
- Tilman Hottenrott
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center - University of Freiburg, Breisacher Strasse 64, D-79106, Freiburg, Germany.
| | - Rick Dersch
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center - University of Freiburg, Breisacher Strasse 64, D-79106, Freiburg, Germany
| | - Benjamin Berger
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center - University of Freiburg, Breisacher Strasse 64, D-79106, Freiburg, Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, Hauptstraße 5, D-79104, Freiburg, Germany
| | - Daniela Huzly
- Institute of Virology, University Medical Center Freiburg, Hermann-Herder-Strasse 11, D-79104, Freiburg, Germany
| | - Jens Thiel
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Hugstetter Strasse 55, D-79106, Freiburg, Germany
| | - Sebastian Rauer
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center - University of Freiburg, Breisacher Strasse 64, D-79106, Freiburg, Germany
| | - Oliver Stich
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center - University of Freiburg, Breisacher Strasse 64, D-79106, Freiburg, Germany
| | - Ulrich Salzer
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Hugstetter Strasse 55, D-79106, Freiburg, Germany
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Hugstetter Strasse 55, D-79106, Freiburg, Germany
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Endres D, Huzly D, Dersch R, Stich O, Berger B, Schuchardt F, Perlov E, Venhoff N, Hellwig S, Fiebich BL, Erny D, Hottenrott T, Tebartz van Elst L. Do patients with schizophreniform and bipolar disorders show an intrathecal, polyspecific, antiviral immune response? A pilot study. Fluids Barriers CNS 2017; 14:34. [PMID: 29212505 PMCID: PMC5719745 DOI: 10.1186/s12987-017-0082-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 10/31/2017] [Indexed: 02/06/2023] Open
Abstract
Background We previously described inflammatory cerebrospinal fluid (CSF) alterations in a subgroup of patients with schizophreniform disorders and the synthesis of polyspecific intrathecal antibodies against different neurotropic infectious pathogens in some patients with bipolar disorders. Consequently, we have measured the prevalence of a positive MRZ reaction (MRZR)—a marker for a polyspecific, antiviral, intrathecal, humoral immune response composed of three antibody indices for the neurotropic viruses of measles (M), rubella (R), and varicella zoster (Z)—in these patients. Methods We analyzed paired CSF and serum samples of 39 schizophreniform and 39 bipolar patients. For comparison, we used a group of 48 patients with other inflammatory neurological disorders (OIND) and a cohort of 203 multiple sclerosis (MS) patients. Results We found a positive MRZR in two patients with schizophreniform disorders (5.1%); both suffered from schizodepressive disorders without any other signs suggestive of MS. None of the bipolar patients (0%) and four members of the OIND group (8.3%) showed a positive MRZR. In the MS cohort, a positive MRZR was found significantly more frequently [in 99 patients (48.8%)] than in the other patient groups (p > 0.001). In summary, we did not find a positive MRZR in a relevant subgroup of patients with schizophreniform or bipolar disorders. Conclusions Our results indicate that the MRZR is highly specific to MS. Nevertheless, two schizodepressive patients also had a positive MRZR. This finding corresponds to the few MRZR-positive patients with OIND or other autoimmune disorders with central nervous involvement, implicating that the MRZR specificity for MS is high, but not 100%.
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Affiliation(s)
- Dominique Endres
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Daniela Huzly
- Institute for Virology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rick Dersch
- Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Oliver Stich
- Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Benjamin Berger
- Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Florian Schuchardt
- Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Evgeniy Perlov
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sabine Hellwig
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernd L Fiebich
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Erny
- Institute of Neuropathology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tilman Hottenrott
- Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Klotz D, Joellenbeck M, Winkler K, Kunze M, Huzly D, Hentschel R. High-temperature short-time pasteurisation of human breastmilk is efficient in retaining protein and reducing the bacterial count. Acta Paediatr 2017; 106:763-767. [PMID: 28135766 DOI: 10.1111/apa.13768] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 11/22/2016] [Accepted: 01/25/2017] [Indexed: 12/29/2022]
Abstract
AIM Milk banks are advised to use Holder pasteurisation to inactivate the cytomegalovirus, but the process adversely affects the bioactive properties of human breastmilk. This study explored the antibacterial efficacy of an alternative high-temperature short-time (HTST) treatment of human breastmilk and its effect on marker proteins, compared with the Holder method. METHODS Breastmilk samples were obtained from 27 mothers with infants in a German neonatal intensive care unit. The samples were either heated to 62°C for five seconds using HTST or processed using Holder pasteurisation, at 63 ± 0.5°C for 30 minutes. Immunoglobulin A, lactoferrin, lysozyme, alkaline phosphatase and bile salt-stimulated lipase concentrations and bacterial colony-forming units/mL were measured before and after heating. RESULTS HTST-treated samples retained higher rates of immunoglobulin A (95% versus 83%), alkaline phosphatase (6% versus 0%) and bile salt-stimulated lipase (0.8% versus 0.4%) than Holder pasteurisation samples (all p < 0.01), but not lactoferrin (32% versus 20%, p = 0.18) and lysozyme (72% versus 65%, p = 1). No difference in antibacterial efficacy was noted between the two groups (p = 0.29). CONCLUSION Using the HTST treatment protocol retained some of the bioactive properties of human breastmilk and appeared to have similar antibacterial efficacy to Holder pasteurisation.
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Affiliation(s)
- Daniel Klotz
- Division of Neonatology; Center for Pediatrics; Medical Center - University of Freiburg; Freiburg Germany
- Faculty of Medicine; University of Freiburg; Freiburg Germany
| | - Mirjam Joellenbeck
- Division of Neonatology; Center for Pediatrics; Medical Center - University of Freiburg; Freiburg Germany
- Faculty of Medicine; University of Freiburg; Freiburg Germany
| | - Karl Winkler
- Institute for Clinical Chemistry and Laboratory Medicine; Medical Center - University of Freiburg; Freiburg Germany
| | - Mirjam Kunze
- Department of Obstetrics and Gynecology; Medical Center - University of Freiburg; Freiburg Germany
| | - Daniela Huzly
- Institute of Virology; Medical Center - University of Freiburg; Freiburg Germany
| | - Roland Hentschel
- Division of Neonatology; Center for Pediatrics; Medical Center - University of Freiburg; Freiburg Germany
- Faculty of Medicine; University of Freiburg; Freiburg Germany
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Heyd R, Eis-Hübinger AM, Berger A, Bierbaum S, Pietzonka S, Wenzel JJ, Huzly D, Keppler OT, Panning M. Retrospective analysis of clinical and virological parameters of influenza cases at four university hospitals in Germany, 2015. Infection 2017; 45:349-354. [PMID: 28316058 DOI: 10.1007/s15010-017-1008-1] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 03/13/2017] [Indexed: 02/05/2023]
Abstract
We conducted a retrospective observational study at four German university hospitals of patients with laboratory-confirmed influenza in 2014/2015. Overall, a fatality rate of 8% was observed. Significantly more A(H1N1)pdm09 patients were admitted to ICU compared to those with A(H3N2). However, fatal outcome was not significantly increased among A(H1N1)pdm09 cases. Nosocomial infections were seen in 17% of cases. Systematic collection of data from hospitals will complement national influenza surveillance.
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Affiliation(s)
- Robert Heyd
- Institute of Clinical Microbiology and Hygiene, Regensburg University Medical Centre, Regensburg, Germany
| | | | - Annemarie Berger
- Institute for Medical Virology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Sibylle Bierbaum
- Institute for Virology, Medical Center - University of Freiburg, Hermann-Herder-Str. 11, 79014, Freiburg, Germany
| | - Sandra Pietzonka
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany
| | - Jürgen J Wenzel
- Institute of Clinical Microbiology and Hygiene, Regensburg University Medical Centre, Regensburg, Germany
| | - Daniela Huzly
- Institute for Virology, Medical Center - University of Freiburg, Hermann-Herder-Str. 11, 79014, Freiburg, Germany
| | - Oliver T Keppler
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany.,Max von Pettenkofer-Institut, Virology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Marcus Panning
- Institute for Virology, Medical Center - University of Freiburg, Hermann-Herder-Str. 11, 79014, Freiburg, Germany.
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Huzly D, Hanselmann I, Schmidt-Chanasit J, Panning M. High specificity of a novel Zika virus ELISA in European patients after exposure to different flaviviruses. ACTA ACUST UNITED AC 2017; 21:30203. [PMID: 27126052 DOI: 10.2807/1560-7917.es.2016.21.16.30203] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/21/2016] [Indexed: 11/20/2022]
Abstract
The current Zika virus (ZIKV) epidemic in the Americas caused an increase in diagnostic requests in European countries. Here we demonstrate high specificity of the Euroimmun anti-ZIKV IgG and IgM ELISA tests using putative cross-reacting sera of European patients with antibodies against tick-borne encephalitis virus, dengue virus, yellow fever virus and hepatitis C virus. This test may aid in counselling European travellers returning from regions where ZIKV is endemic.
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Affiliation(s)
- Daniela Huzly
- Institute for Virology, Medical Center - University of Freiburg, Freiburg, Germany
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Affiliation(s)
- Barbara Miernik
- Department of Dermatology and Venerology, University Medical Centre, Hauptstraße 7, D-79104 Freiburg, Germany.
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Hottenrott T, Dersch R, Berger B, Rauer S, Huzly D, Stich O. The MRZ reaction in primary progressive multiple sclerosis. Fluids Barriers CNS 2017; 14:2. [PMID: 28166789 PMCID: PMC5294835 DOI: 10.1186/s12987-016-0049-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 11/09/2016] [Accepted: 12/29/2016] [Indexed: 11/17/2022] Open
Abstract
Background The MRZ reaction (MRZR), composed of the three antibody indices (AI) against measles, rubella and varicella zoster virus and found positive in the majority of relapsing-remitting multiple sclerosis (RRMS) patients, is absent in other inflammatory neurological diseases (OIND). So far, it has been uncertain whether its differential diagnostic promise extends to patients with primary-progressive multiple sclerosis (PPMS). Objective To investigate the prevalence of MRZR in PPMS compared to RRMS and OIND patients. Methods MRZR was assessed in patients with PPMS (n = 103), RRMS (n = 100) and OIND (n = 48). Both stringency levels for MRZR testing, MRZR-1 (≥1 AI positive) and MRZR-2 (≥2 AI positive), were applied. Results Prevalence of positive MRZR-1 was 83.5% in PPMS and 67.8% in RRMS (p < 0.05). A positive MRZR-2 was found in 54.4% of PPMS and in 43.0% of RRMS patients (not significant). Compared to both MS subgroups, OIND patients exhibit lower frequencies of positive MRZR (MRZR-1: 22.9%, MRZR-2: 8.3%; p < 0.0001 each). Conclusion Positive MRZR was at least as frequent in PPMS as in RRMS and much less frequent in OIND, confirming its promise as a potentially useful diagnostic tool for distinguishing both MS course types from OIND.
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Affiliation(s)
- Tilman Hottenrott
- Department of Neurology and Neurophysiology, University Medical Center Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany.
| | - Rick Dersch
- Department of Neurology and Neurophysiology, University Medical Center Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany
| | - Benjamin Berger
- Department of Neurology and Neurophysiology, University Medical Center Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany
| | - Sebastian Rauer
- Department of Neurology and Neurophysiology, University Medical Center Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany.,Ravo Diagnostika GmbH, Oltmannsstrasse 5, 79100, Freiburg, Germany
| | - Daniela Huzly
- University Medical Center Freiburg, Institute of Virology, Hermann-Herder-Strasse 11, 79104, Freiburg, Germany
| | - Oliver Stich
- Department of Neurology and Neurophysiology, University Medical Center Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany
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39
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Rabenau HF, Bannert N, Berger A, Donoso Mantke O, Eberle J, Enders M, Fickenscher H, Grunert HP, Gürtler L, Heim A, Huzly D, Kaiser R, Korn K, Nick S, Kücherer C, Nübling M, Obermeier M, Panning M, Zeichhardt H. [Not Available]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 58:1025. [PMID: 26275568 DOI: 10.1007/s00103-015-2214-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Holger F Rabenau
- Nationales Referenzzentrum für Retroviren, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
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Hottenrott T, Dersch R, Berger B, Rauer S, Eckenweiler M, Huzly D, Stich O. The intrathecal, polyspecific antiviral immune response in neurosarcoidosis, acute disseminated encephalomyelitis and autoimmune encephalitis compared to multiple sclerosis in a tertiary hospital cohort. Fluids Barriers CNS 2015; 12:27. [PMID: 26652013 PMCID: PMC4677451 DOI: 10.1186/s12987-015-0024-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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: 09/11/2015] [Accepted: 11/11/2015] [Indexed: 11/30/2022] Open
Abstract
Background A polyspecific, intrathecal humoral immune response against the neurotropic viruses, measles, rubella and varicella zoster virus, called “MRZ reaction” (MRZR), is present in the majority of patients with multiple sclerosis (MS). Neurosarcoidosis (NS) and acute disseminated encephalomyelitis (ADEM) are important clinical differential diagnoses of MS. Autoimmune encephalitis (AIE) represents a well characterized autoimmune CNS disorder with intrathecal antibody synthesis. The aim of this study was to investigate the specificity of MRZR for MS in patients with NS, ADEM and AIE for the first time, and to compare it with the diagnostic value of oligoclonal bands (OCB). Patients and methods Twenty-two patients with NS, 17 with AIE, 8 with ADEM and 33 with MS serving as controls were analyzed for OCB and MRZR by calculation of the antibody index (AI) for each virus. MRZR was considered as positive if at least two AIs were ≥1.5. Results A positive MRZR was statistically significantly less frequent in NS (9 %), AIE (11 %) and ADEM (0 %) compared to MS patients (70 %; p < 0.001 each). The specificity of MRZR for MS was 92 % in the study cohort. In comparison to MRZR, the OCB showed a higher sensitivity (100 %), but a lower specificity (69 %) for MS. Conclusion These results indicate that MRZR seems to be the most specific available CSF marker of MS.
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Affiliation(s)
- Tilman Hottenrott
- Department of Neurology and Neurophysiology, University Medical Center Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany.
| | - Rick Dersch
- Department of Neurology and Neurophysiology, University Medical Center Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany.
| | - Benjamin Berger
- Department of Neurology and Neurophysiology, University Medical Center Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany.
| | - Sebastian Rauer
- Department of Neurology and Neurophysiology, University Medical Center Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany. .,ravo Diagnostika GmbH, Oltmannsstrasse 5, 79100, Freiburg, Germany.
| | - Matthias Eckenweiler
- Department of Neuropediatrics and Muscle Disorders, University Medical Center Freiburg, Mathildenstrasse 1, 79106, Freiburg, Germany.
| | - Daniela Huzly
- Institute of Virology, University Medical Center Freiburg, Hermann-Herder-Strasse 11, 79104, Freiburg, Germany.
| | - Oliver Stich
- Department of Neurology and Neurophysiology, University Medical Center Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany.
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Huzly D, Kurz S, Ebner W, Dettenkofer M, Panning M. Characterisation of nosocomial and community-acquired influenza in a large university hospital during two consecutive influenza seasons. J Clin Virol 2015; 73:47-51. [PMID: 26540462 PMCID: PMC7185613 DOI: 10.1016/j.jcv.2015.10.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 07/27/2015] [Revised: 09/29/2015] [Accepted: 10/21/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Nosocomial influenza is increasingly recognized as an important public health threat causing considerable morbidity and mortality each year. However, data on nosocomial influenza is usually collected during outbreaks only and clinical information of nosocomial influenza is sparsely available. OBJECTIVES To systematically analyse the distribution of nosocomial and community-acquired influenza and epidemiological characteristics in a tertiary care unit in two consecutive seasons. STUDY DESIGN A retrospective observational study was conducted to identify and characterise cases of nosocomial and community-acquired influenza at Freiburg University hospital from 1 January 2013 to 30 April 2014. A validated multiplex RT-PCR to detect influenza virus and other respiratory pathogens was used throughout. Clinical information was retrieved from the hospital-based information system. RESULTS Overall, 218 patients with laboratory-confirmed influenza were included (179 in the first, 39 patients in the second season). A rate of 20% of nosocomial influenza was observed throughout. A fatal outcome was recorded for 9% of nosocomial cases, which were mainly associated with influenza virus A(H1N1)pdm09. Nosocomial influenza occurred in all age groups, but fatalities were only observed in patients ≥18 years. Patients with nosocomial influenza were significantly older, underwent therapy for blood malignancies and immunosuppressive regimens more frequently, and received solid organ transplantation more often compared to community-acquired patients. CONCLUSIONS Despite the different distribution of virus subtypes and epidemiological properties between both influenza seasons, the rate of nosocomial cases remained similar. Systematic detection and targeted prevention measures seem mandatory to minimize nosocomial influenza.
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Affiliation(s)
- Daniela Huzly
- Institute for Virology, Medical Center-University of Freiburg, Freiburg, Germany
| | - Sven Kurz
- Department for Environmental Health Sciences and Hospital Infection Control, Medical Center-University of Freiburg, Freiburg, Germany
| | - Winfried Ebner
- Department for Environmental Health Sciences and Hospital Infection Control, Medical Center-University of Freiburg, Freiburg, Germany
| | - Markus Dettenkofer
- Department for Environmental Health Sciences and Hospital Infection Control, Medical Center-University of Freiburg, Freiburg, Germany
| | - Marcus Panning
- Institute for Virology, Medical Center-University of Freiburg, Freiburg, Germany.
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Goldacker S, Witte T, Huzly D, Schlesier M, Peter HH, Warnatz K. Analysis of specific IgG titers against tick-borne encephalitis in patients with primary antibody deficiency under immunoglobulin substitution therapy: impact of plasma donor origin. Front Immunol 2015; 5:675. [PMID: 25601868 PMCID: PMC4283645 DOI: 10.3389/fimmu.2014.00675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 10/17/2014] [Accepted: 12/15/2014] [Indexed: 11/25/2022] Open
Abstract
Immunoglobulin (Ig) replacement therapy is effective in reducing infections in patients with primary antibody deficiency (PAD). Diversity of specific antibodies is achieved by pooling plasma from over 1000 donors usually of a given geographic region. However, there is no agreement with regard to an optimal vaccination schedule for plasma donors. Especially for tick-borne encephalitis (TBE), regional vaccination rates differ widely among populations due to the epidemiology of the disease. We analyzed specific antibody titers against TBE in comparison to total IgG levels in 162 serum samples collected from 110 PAD patients substituted with polyvalent intravenous IgG or subcutaneous IgG. Some patients received different IgG products over time leading to a total number of 122 different patient-IgG product combinations. Positive TBE-specific IgG levels were detected in 35 cases when measured by standard ELISA and could be confirmed by demonstration of neutralizing antibodies in 31 cases. The detection of specific antibody levels correlated with the geographic origin of the IgG preparations. No titers were detectable in patients substituted with IgG products from North-American donors, whereas variable degrees of anti-TBE titers were observed in patients receiving products from different European countries. We suggest considering the patients' personal risk for TBE when selecting an appropriate Ig preparation. These data support regional plasma donation in order to address the diverse local infection profile.
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Affiliation(s)
- Sigune Goldacker
- Center for Chronic Immunodeficiency, University Medical Center and University of Freiburg, Freiburg, Germany
| | - Torsten Witte
- Clinic for Immunology and Rheumatology, Hannover Medical School, Hannover, Germany
| | - Daniela Huzly
- Institute for Medical Microbiology & Hygiene, University Medical Center Freiburg, Freiburg, Germany
| | - Michael Schlesier
- Center for Chronic Immunodeficiency, University Medical Center and University of Freiburg, Freiburg, Germany
| | - Hans-Hartmut Peter
- Center for Chronic Immunodeficiency, University Medical Center and University of Freiburg, Freiburg, Germany
| | - Klaus Warnatz
- Center for Chronic Immunodeficiency, University Medical Center and University of Freiburg, Freiburg, Germany
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Bettinger D, Schorb E, Huzly D, Panning M, Schmitt-Graeff A, Kurz P, Bertz H, Finke J, Brass V, Thimme R, Hasselblatt P. Chronic hepatitis E virus infection following allogeneic hematopoietic stem cell transplantation: an important differential diagnosis for graft versus host disease. Ann Hematol 2014; 94:359-60. [PMID: 25015055 DOI: 10.1007/s00277-014-2163-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/04/2014] [Indexed: 01/25/2023]
Affiliation(s)
- Dominik Bettinger
- Department of Medicine II, University Hospital Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
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Hage E, Huzly D, Ganzenmueller T, Beck R, Schulz TF, Heim A. A human adenovirus species B subtype 21a associated with severe pneumonia. J Infect 2014; 69:490-9. [PMID: 24975176 DOI: 10.1016/j.jinf.2014.06.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/16/2014] [Accepted: 06/20/2014] [Indexed: 12/19/2022]
Abstract
Between 2005 and 2013 six severe pneumonia cases (all requiring mechanical ventilation, two fatal outcomes) caused by human adenovirus type 21 (HAdV-B21) were observed in Germany. So far, HAdV-B21 was mainly associated with non-severe upper and lower respiratory tract infections. However, a few highly virulent HAdV types, e.g. HAdV-B14p1, were previously associated with severe, fatal pneumonia. Complete genomic sequences of the German HAdV-B21 pneumonia isolates formed a single phylogenetic cluster with very high sequence identity (≥ 99.897%). Compared to the HAdV-B21 prototype (only 99.319% identity), all isolates had a unique 15 amino acid deletion and a 2 amino acid insertion in the RGD loop of the penton base which may affect binding to the secondary receptor on the host cells. Moreover, a recombinant E4 gene region derived of HAdV-B3 was identified by bootscan analysis. Thus, the highly virulent, pneumotropic HAdV-B21 was denominated as subtype 21a. Surprisingly, there was 99.963% identity with agent Y/SIBU97 (only 13.4 kb available in GenBank of the 35.4 kb genome) which was associated with 10 fatalities due to cardiopulmonary failure in Sarawak, Malaysia, in 1997. In conclusion, a HAdV-B21 subtype (21a) associated with severe pneumonia in Germany was phylogenetically linked to an adenovirus isolated in Malaysia.
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Affiliation(s)
- Elias Hage
- Institut für Virologie, Medizinische Hochschule, Hannover, Germany
| | - Daniela Huzly
- Institut für Virologie, Albert-Ludwigs-Universität, Freiburg, Germany
| | | | - Robert Beck
- Institut für Medizinische Virologie, Universitätsklinikum Tübingen, Germany
| | - Thomas F Schulz
- Institut für Virologie, Medizinische Hochschule, Hannover, Germany; Deutsches Zentrum Infektionsforschung, Hannover und Braunschweig, Germany
| | - Albert Heim
- Institut für Virologie, Medizinische Hochschule, Hannover, Germany; Netzwerk Atemwegsinfektionen des Robert-Koch-Institutes, Adenovirus Konsiliarlabor, Germany.
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Huzly D, Umhau M, Bettinger D, Cathomen T, Emmerich F, Hasselblatt P, Hengel H, Herzog R, Kappert O, Maassen S, Schorb E, Schulz-Huotari C, Thimme R, Unmüssig R, Wenzel JJ, Panning M. Transfusion-transmitted hepatitis E in Germany, 2013. Euro Surveill 2014; 19. [DOI: 10.2807/1560-7917.es2014.19.21.20812] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The reported IgG seroprevalence against hepatitis E virus (HEV) in German blood donations is 6.8%, and HEV RNA detected in 0.08%, but documented evidence for HEV transmission is lacking. We identified two donations from a single donor containing 120 IU HEV RNA/mL plasma and 490 IU/mL. An infectious dose of 7,056 IU HEV RNA was transmitted via apheresis platelets to an immunosuppressed patient who developed chronic HEV. Further, transmission was probable in an immunocompetent child.
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Affiliation(s)
- D Huzly
- Institute for Virology, University Medical Center, Freiburg, Germany
| | - M Umhau
- Institute for Cell and Gene Therapy, University Medical Center, Freiburg, Germany
| | - D Bettinger
- Department of Medicine II, University Medical Center, Freiburg, Germany
| | - T Cathomen
- Institute for Cell and Gene Therapy, University Medical Center, Freiburg, Germany
| | - F Emmerich
- Institute for Cell and Gene Therapy, University Medical Center, Freiburg, Germany
| | - P Hasselblatt
- Department of Medicine II, University Medical Center, Freiburg, Germany
| | - H Hengel
- Institute for Virology, University Medical Center, Freiburg, Germany
| | - R Herzog
- Institute for Cell and Gene Therapy, University Medical Center, Freiburg, Germany
| | - O Kappert
- Public Health Office, Freiburg, Germany
| | - S Maassen
- Public Health Office, Freiburg, Germany
| | - E Schorb
- Department of Medicine I, University Medical Center, Freiburg, Germany
| | - C Schulz-Huotari
- Institute for Cell and Gene Therapy, University Medical Center, Freiburg, Germany
| | - R Thimme
- Department of Medicine II, University Medical Center, Freiburg, Germany
| | | | - J J Wenzel
- Institute of Clinical Microbiology and Hygiene, Regensburg University Medical Center, Regensburg, Germany
| | - M Panning
- Institute for Virology, University Medical Center, Freiburg, Germany
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Panning M, Huzly D, Hengel H, V. Kern W, Dettenkofer M. The crucial role of molecular diagnostics. Dtsch Arztebl Int 2014; 111:10. [PMID: 24565272 PMCID: PMC3948014 DOI: 10.3238/arztebl.2014.0010a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Marcus Panning
- *Institut für Virologie, Department für Medizinische Mikrobiologie und Hygiene Universitätsklinikum Freiburg
| | | | | | - Winfried V. Kern
- **Abteilung Infektiologie, Department Innere Medizin Universitätsklinikum Freiburg
| | - Markus Dettenkofer
- *** Institut für Umweltmedizin und Krankenhaushygiene Universitätsklinikum Freiburg
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Otto C, Huzly D, Kemna L, Hüttel A, Benk C, Rieg S, Ploenes T, Werner M, Kayser G. Acute fibrinous and organizing pneumonia associated with influenza A/H1N1 pneumonia after lung transplantation. BMC Pulm Med 2013; 13:30. [PMID: 23683442 PMCID: PMC3662564 DOI: 10.1186/1471-2466-13-30] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [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: 08/08/2012] [Accepted: 05/08/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Immunocompromised patients, particularly after lung transplantation, are at high risk to develop atypical forms of pulmonary infections including influenza A/H1N1. Acute Fibrinous and Organizing Pneumonia (AFOP) is a special histological pattern in acute respiratory failure with high mortality. CASE PRESENTATION We describe a 66-year-old woman with double lung transplantation in August 2009 due to end stage pulmonary fibrosis. After prolonged weaning and subsequent promising course, she developed atypical pneumonia with diffuse pulmonary infiltrates in both lungs in January 2010. Infection with influenza A/H1N1 virus was verified. The patient rapidly suffered from respiratory insufficiency and died eight days after this diagnosis. The post-mortem revealed especially in the lower parts of the lungs the classical histological pattern of pure AFOP. Molecular analyses of lung tissue were positive for influenza A/H1N1. CONCLUSION To our knowledge we present the first case of AFOP triggered by viral infection, here proven to be influenza virus A/H1N1. Thus, also in the setting of viral infection the highly deadly differential diagnosis of AFOP must be considered.
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Affiliation(s)
- Claudia Otto
- Institute of Pathology, University Medical Center Freiburg, Breisacher Strasse 115a, Freiburg, D-79106, Germany
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Falcone V, Bierbaum S, Kern W, Kontny U, Bertz H, Huzly D, Panning M. Influenza virus A(H1N1)pdm09 hemagglutinin polymorphism and associated disease in southern Germany during the 2010/11 influenza season. Arch Virol 2013; 158:1297-303. [PMID: 23397331 PMCID: PMC7087040 DOI: 10.1007/s00705-013-1610-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 11/07/2012] [Accepted: 12/06/2012] [Indexed: 01/03/2023]
Abstract
A novel influenza A virus emerged in early 2009 to cause the first influenza pandemic of the 21(st) century. Understanding the evolution of influenza virus is crucial to determine pathogenesis, vaccine efficacy, and resistance to antiviral drugs. In this study, we investigated the molecular evolution of influenza virus A(H1N1)pdm09 in the 2010/11 influenza season in southern Germany by sequence analysis of the influenza virus hemagglutinin gene from 25 patients with mild, moderate, and severe disease. Phylogenetic analysis revealed co-circulation of different genetic groups. The D222G mutation, which had previously been observed in severe cases, was not detected. Immunocompromised patients were not affected more severely than non-immunocompromised patients (p>0.05), although longer shedding was observed in some of them. Interestingly, additional mutations and potential glycosylation sites were detected in samples from the lower respiratory tract in two patients, but not in the corresponding upper respiratory tract specimens. The H275Y mutation in the influenza virus neuraminidase gene, known to confer resistance to the neuraminidase inhibitor oseltamivir, was detected in one patient.
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Affiliation(s)
- Valeria Falcone
- Department of Virology, Institute for Medical Microbiology and Hygiene, University Medical Center, Hermann-Herder Str. 11, 79104 Freiburg, Germany
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Falcone V, Panning M, Strahm B, Vraetz T, Bierbaum S, Neumann-Haefelin D, Huzly D. Prolonged KI polyomavirus infection in immunodeficient child. Emerg Infect Dis 2012; 18:706-8. [PMID: 22469436 PMCID: PMC3309672 DOI: 10.3201/eid1804.111588] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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