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Gáspár Z, Szabó BG, Andrikovics H, Ceglédi A, Rajmon M, Ábrahám A, Várnai Z, Kiss-Dala N, Szlávik J, Sinkó J, Vályi-Nagy I, Lakatos B. Secondary infections and long-term outcomes among hospitalized elderly and non-elderly patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and treated with baricitinib: a comparative study from the national centre of Hungary. GeroScience 2024; 46:2863-2877. [PMID: 38367195 PMCID: PMC11009165 DOI: 10.1007/s11357-024-01099-y] [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] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 02/03/2024] [Indexed: 02/19/2024] Open
Abstract
Baricitinib is considered a first-line treatment for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected adult patients with an associated cytokine storm syndrome (CSS). Our objective was to compare rates of secondary infections and long-term outcomes of elderly and non-elderly patients who received baricitinib for COVID-19. We conducted a single-centre observational study between November 2020 and September 2023, focusing on hospitalized adult SARS-CoV-2 patients with CSS, categorized as elderly (≥ 65 years) and non-elderly (< 65 years). Enrolment, severity stratification, and diagnosis of infectious complications followed predefined criteria. Outcomes of all-cause mortality and rates of non-severe and severe secondary infections were assessed at 1-year post-treatment initiation. Kaplan-Meier analysis was performed for survival analysis. In total, 490 patients were enrolled (median age 65 ± 23 (21-100) years (years, median ± IQR, min-max); 49.18% elderly; 59.59% male). Elderly patients were admitted to the hospital significantly earlier (7 ± 5 days vs. 8 ± 4 days; p = 0.02), experienced a higher occurrence of severe COVID-19 (121/241, 50.21% vs. 98/249, 39.36%; p = 0.02), and required the use of non-invasive ventilation at baseline (167/225, 74.22% vs. 153/236, 64.83%; p = 0.03). At 1 year, all-cause mortality was significantly higher in the elderly subgroup (111/241, 46.06% vs. 29/249, 11.65%; p < 0.01). At 90 days and 1 year, rates of any severe secondary infection were also more prevalent among the elderly (56/241, 23.24% vs. 37/249 14.86%; p = 0.02 and 58/241, 24.07% vs. 39/249, 15.66%; p = 0.02). In conclusion, elderly SARS-CoV-2-infected patients experience a more severe clinical course, higher secondary infection rates, and increased risk for long-term mortality, regardless of immunomodulatory therapy.
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Affiliation(s)
- Zsófia Gáspár
- National Institute of Haematology and Infectious Diseases, Central Hospital of Southern Pest, Albert Flórián Street 5-7., 1097, Budapest, Hungary
- School of PhD Studies, Semmelweis University, Üllői Street 26., 1085, Budapest, Hungary
| | - Bálint Gergely Szabó
- National Institute of Haematology and Infectious Diseases, Central Hospital of Southern Pest, Albert Flórián Street 5-7., 1097, Budapest, Hungary.
- School of PhD Studies, Semmelweis University, Üllői Street 26., 1085, Budapest, Hungary.
- Departmental Group of Infectious Diseases, Department of Internal Medicine and Haematology, Semmelweis University, Üllői Street 26., 1085, Budapest, Hungary.
| | - Hajnalka Andrikovics
- School of PhD Studies, Semmelweis University, Üllői Street 26., 1085, Budapest, Hungary
- Laboratory of Molecular Genetics, National Institute of Haematology and Infectious Diseases, Central Hospital of Southern Pest, Albert Flórián Street 5-7., 1097, Budapest, Hungary
- Department of Transfusion Medicine, Semmelweis University, Üllői Street 26., 1085, Budapest, Hungary
| | - Andrea Ceglédi
- National Institute of Haematology and Infectious Diseases, Central Hospital of Southern Pest, Albert Flórián Street 5-7., 1097, Budapest, Hungary
| | - Martin Rajmon
- Faculty of Medicine, Semmelweis University, Üllői Street 26., 1085, Budapest, Hungary
| | - Anita Ábrahám
- National Institute of Haematology and Infectious Diseases, Central Hospital of Southern Pest, Albert Flórián Street 5-7., 1097, Budapest, Hungary
| | - Zsuzsanna Várnai
- National Institute of Haematology and Infectious Diseases, Central Hospital of Southern Pest, Albert Flórián Street 5-7., 1097, Budapest, Hungary
| | - Noémi Kiss-Dala
- National Institute of Haematology and Infectious Diseases, Central Hospital of Southern Pest, Albert Flórián Street 5-7., 1097, Budapest, Hungary
- School of PhD Studies, Semmelweis University, Üllői Street 26., 1085, Budapest, Hungary
| | - János Szlávik
- National Institute of Haematology and Infectious Diseases, Central Hospital of Southern Pest, Albert Flórián Street 5-7., 1097, Budapest, Hungary
| | - János Sinkó
- National Institute of Haematology and Infectious Diseases, Central Hospital of Southern Pest, Albert Flórián Street 5-7., 1097, Budapest, Hungary
- Departmental Group of Infectious Diseases, Department of Internal Medicine and Haematology, Semmelweis University, Üllői Street 26., 1085, Budapest, Hungary
| | - István Vályi-Nagy
- National Institute of Haematology and Infectious Diseases, Central Hospital of Southern Pest, Albert Flórián Street 5-7., 1097, Budapest, Hungary
| | - Botond Lakatos
- National Institute of Haematology and Infectious Diseases, Central Hospital of Southern Pest, Albert Flórián Street 5-7., 1097, Budapest, Hungary
- School of PhD Studies, Semmelweis University, Üllői Street 26., 1085, Budapest, Hungary
- Departmental Group of Infectious Diseases, Department of Internal Medicine and Haematology, Semmelweis University, Üllői Street 26., 1085, Budapest, Hungary
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Gopcsa L, Réti M, Andrikovics H, Bobek I, Bekő G, Bogyó J, Ceglédi A, Dobos K, Giba-Kiss L, Jankovics I, Kis O, Lakatos B, Mathiász D, Meggyesi N, Miskolczi G, Németh N, Paksi M, Riczu A, Sinkó J, Szabó B, Szilvási A, Szlávik J, Tasnády S, Reményi P, Vályi-Nagy I. Effective virus-specific T-cell therapy for high-risk SARS-CoV-2 infections in hematopoietic stem cell transplant recipients: initial case studies and literature review. GeroScience 2024; 46:1083-1106. [PMID: 37414968 PMCID: PMC10828167 DOI: 10.1007/s11357-023-00858-7] [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] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023] Open
Abstract
The COVID-19 pandemic has exacerbated mortality rates among immunocompromised patients, accentuating the need for novel, targeted therapies. Transplant recipients, with their inherent immune vulnerabilities, represent a subgroup at significantly heightened risk. Current conventional therapies often demonstrate limited effectiveness in these patients, calling for innovative treatment approaches. In immunocompromised transplant recipients, several viral infections have been successfully treated by adoptive transfer of virus-specific T-cells (VST). This paper details the successful application of SARS-CoV-2-specific memory T-cell therapy, produced by an interferon-γ cytokine capture system (CliniMACS® Prodigy device), in three stem cell transplant recipients diagnosed with COVID-19 (case 1: alpha variant, cases 2 and 3: delta variants). These patients exhibited persistent SARS-CoV-2 PCR positivity accompanied by bilateral pulmonary infiltrates and demonstrated only partial response to standard treatments. Remarkably, all three patients recovered and achieved viral clearance within 3 to 9 weeks post-VST treatment. Laboratory follow-up investigations identified an increase in SARS-CoV-2-specific T-cells in two of the cases. A robust anti-SARS-CoV-2 S (S1/S2) IgG serological response was also recorded, albeit with varying titers. The induction of memory T-cells within the CD4 + compartment was confirmed, and previously elevated interleukin-6 (IL-6) and IL-8 levels normalized post-VST therapy. The treatment was well tolerated with no observed adverse effects. While the need for specialized equipment and costs associated with VST therapy present potential challenges, the limited treatment options currently available for COVID-19 within the allogeneic stem cell transplant population, combined with the risk posed by emerging SARS-CoV-2 mutations, underscore the potential of VST therapy in future clinical practice. This therapeutic approach may be particularly beneficial for elderly patients with multiple comorbidities and weakened immune systems.
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Affiliation(s)
- László Gopcsa
- Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, 1 Nagyvárad Square, P.B. 1097, Budapest, Hungary.
| | - Marienn Réti
- Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, 1 Nagyvárad Square, P.B. 1097, Budapest, Hungary
| | - Hajnalka Andrikovics
- Laboratory of Molecular Genetics, Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Ilona Bobek
- Department of Intensive Care Unit, Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Gabriella Bekő
- Department of Central Laboratory, Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Judit Bogyó
- Hungarian National Blood Transfusion Service, Karolina Út 19-21, 1113, Budapest, Hungary
| | - Andrea Ceglédi
- Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, 1 Nagyvárad Square, P.B. 1097, Budapest, Hungary
| | - Katalin Dobos
- Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, 1 Nagyvárad Square, P.B. 1097, Budapest, Hungary
| | - Laura Giba-Kiss
- Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, 1 Nagyvárad Square, P.B. 1097, Budapest, Hungary
| | - István Jankovics
- National Public Health and Medical Officer Service, Albert Florian Út 2-6, 1097, Budapest, Hungary
| | - Orsolya Kis
- Department of Intensive Care Unit, Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Botond Lakatos
- Department of Infectious Diseases, Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Dóra Mathiász
- Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, 1 Nagyvárad Square, P.B. 1097, Budapest, Hungary
| | - Nóra Meggyesi
- Laboratory of Molecular Genetics, Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Gottfried Miskolczi
- Department of Central Laboratory, Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Noémi Németh
- Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, 1 Nagyvárad Square, P.B. 1097, Budapest, Hungary
| | - Melinda Paksi
- Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, 1 Nagyvárad Square, P.B. 1097, Budapest, Hungary
| | - Alexandra Riczu
- Department of Infectious Diseases, Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - János Sinkó
- Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, 1 Nagyvárad Square, P.B. 1097, Budapest, Hungary
| | - Bálint Szabó
- Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, 1 Nagyvárad Square, P.B. 1097, Budapest, Hungary
| | - Anikó Szilvási
- Hungarian National Blood Transfusion Service, Karolina Út 19-21, 1113, Budapest, Hungary
| | - János Szlávik
- Department of Infectious Diseases, Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Szabolcs Tasnády
- Department of Central Laboratory, Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Péter Reményi
- Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, 1 Nagyvárad Square, P.B. 1097, Budapest, Hungary
| | - István Vályi-Nagy
- Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, 1 Nagyvárad Square, P.B. 1097, Budapest, Hungary
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Gáspár Z, Szabó BG, Ábrahám A, Várnai Z, Kiss-Dala N, Szlávik J, Sinkó J, Vályi-Nagy I, Lakatos B. Outcomes of high-risk adult outpatients treated with early remdesivir therapy during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) omicron era: experiences from the national centre of Hungary. Naunyn Schmiedebergs Arch Pharmacol 2023; 396:1857-1862. [PMID: 36892627 PMCID: PMC9995722 DOI: 10.1007/s00210-023-02456-y] [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] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/28/2023] [Indexed: 03/10/2023]
Abstract
Emerging evidence suggests that remdesivir might improve clinical outcome of high-risk outpatients with coronavirus disease 2019 (COVID-19). Our aim was to evaluate characteristics and outcomes of nonhospitalised adults diagnosed with COVID-19 and treated with early remdesivir therapy during the omicron wave. A single-centre prospective cohort study was performed among adult patients between February and June 2022, during the circulation of phylogenetic assignment of named global outbreak (PANGO) subvariants BA.2, BA.4, and BA.5 in Hungary. Patients were enrolled based on pre-defined criteria. Clinical characteristics (demography, comorbidities, vaccination status, imaging, treatment, and disease course) and outcomes (COVID-19 related hospitalisation, oxygen supplementation, intensive care support, and all-cause death) were assessed at 28 days post-treatment. A subgroup analysis of patients with and without active haematological malignancies was also carried out. Altogether, 127 patients were enrolled: 51.2% (65/127) were female with a median age of 59 (IQR: 22, range: 21‒92) years, and 48.8% (62/127) had active haematological malignancy. At 28 days post-treatment, 7.1% (9/127) of patients required COVID-19-related hospitalisation, 2.4% (3/127) required oxygen supplementation, 1.6% (2/127) required intensive care, and 0.8% (1/127) died due to a non-COVID-19-related secondary infection at the intensive care unit, all with haematological malignancies. Early remdesivir treatment might be a feasible strategy among high-risk outpatients with COVID-19 during the omicron wave.
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Affiliation(s)
- Zsófia Gáspár
- School of PhD Studies, Semmelweis University, Üllői Street 26., 1085, Budapest, Hungary
- National Institute of Haematology and Infectious Diseases, South Pest Central Hospital, Albert Flórián Street 5-7., 1097, Budapest, Hungary
| | - Bálint Gergely Szabó
- School of PhD Studies, Semmelweis University, Üllői Street 26., 1085, Budapest, Hungary.
- Departmental Group of Infectious Diseases, Department of Internal Medicine and Haematology, Semmelweis University, Albert Flórián Street 5-7., 1097, Budapest, Hungary.
- National Institute of Haematology and Infectious Diseases, South Pest Central Hospital, Albert Flórián Street 5-7., 1097, Budapest, Hungary.
| | - Anita Ábrahám
- National Institute of Haematology and Infectious Diseases, South Pest Central Hospital, Albert Flórián Street 5-7., 1097, Budapest, Hungary
| | - Zsuzsanna Várnai
- National Institute of Haematology and Infectious Diseases, South Pest Central Hospital, Albert Flórián Street 5-7., 1097, Budapest, Hungary
| | - Noémi Kiss-Dala
- School of PhD Studies, Semmelweis University, Üllői Street 26., 1085, Budapest, Hungary
- National Institute of Haematology and Infectious Diseases, South Pest Central Hospital, Albert Flórián Street 5-7., 1097, Budapest, Hungary
| | - János Szlávik
- National Institute of Haematology and Infectious Diseases, South Pest Central Hospital, Albert Flórián Street 5-7., 1097, Budapest, Hungary
| | - János Sinkó
- School of PhD Studies, Semmelweis University, Üllői Street 26., 1085, Budapest, Hungary
- Departmental Group of Infectious Diseases, Department of Internal Medicine and Haematology, Semmelweis University, Albert Flórián Street 5-7., 1097, Budapest, Hungary
- National Institute of Haematology and Infectious Diseases, South Pest Central Hospital, Albert Flórián Street 5-7., 1097, Budapest, Hungary
| | - István Vályi-Nagy
- National Institute of Haematology and Infectious Diseases, South Pest Central Hospital, Albert Flórián Street 5-7., 1097, Budapest, Hungary
| | - Botond Lakatos
- School of PhD Studies, Semmelweis University, Üllői Street 26., 1085, Budapest, Hungary
- Departmental Group of Infectious Diseases, Department of Internal Medicine and Haematology, Semmelweis University, Albert Flórián Street 5-7., 1097, Budapest, Hungary
- National Institute of Haematology and Infectious Diseases, South Pest Central Hospital, Albert Flórián Street 5-7., 1097, Budapest, Hungary
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Szabó BG, Reményi P, Tasnády S, Korózs D, Gopcsa L, Réti M, Várkonyi A, Sinkó J, Lakatos B, Szlávik J, Bekő G, Bobek I, Vályi-Nagy I. Extracorporeal Photopheresis as a Possible Therapeutic Approach for Adults with Severe and Critical COVID-19 Non-Responsive to Standard Treatment: A Pilot Investigational Study. J Clin Med 2023; 12:5000. [PMID: 37568402 PMCID: PMC10420323 DOI: 10.3390/jcm12155000] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/08/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Background: The optimal approach for adult patients hospitalized with severe and critical coronavirus disease 2019 (COVID-19), non-responsive to antiviral and immunomodulatory drugs, is not well established. Our aim was to evaluate feasibility and safety of extracorporeal photopheresis (ECP) in this setting. Methods: A prospective, single-center investigational study was performed between 2021 and 2022 at a tertiary referral center for COVID-19. Patients diagnosed with COVID-19 were screened, and cases with severe or critical disease fulfilling pre-defined clinical and biochemical criteria of non-response for >5 days, despite remdesivir, dexamethasone and immunomodulation (tocilizumab, baricitinib, ruxolitinib), were consecutively enrolled. After patient inclusion, two ECP sessions on two consecutive days per week for 2 weeks were applied. Patients were followed-up per protocol from study inclusion, and clinical, virological and radiological outcomes were assessed at the end of treatment (EOT) +28 days. Results: A total of seven patients were enrolled. At inclusion, four out of seven (57.1%) were admitted to the ICU, all patients had ongoing cytokine storm. Additionally, 3/7 (42.9%) had radiological progression on chest CT. At EOT+28 days, 2/7 (28.6%) patients died due to non-ECP-related causes. Among the survivors, no additional requirement for intensive care unit admission or radiological progression was observed, and invasive mechanical ventilation could be weaned off in 1/5 (20.0%). All patients achieved whole-blood SARS-CoV-2 RNAemia clearance, while 3/7 (42.9%) no longer showed detectable respiratory SARS-CoV-2 RNA. According to immune biomarker profiling, ECP mainly facilitated a decrease in plasma IL-6 and IL-17A levels, as well as the physiological regeneration of peripheral blood immunocyte subpopulations, notably CD8+/CD45RO+ memory T-cells. No safety signals were identified. Conclusions: ECP appears to be a safe and feasible option for adults hospitalized with severe or critical COVID-19 who do not respond to pharmacological interventions. Further trial data are warranted to assess its optimal use. Trial registration: ClinicalTrials.gov NCT05882331 (retrospectively registered).
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Affiliation(s)
- Bálint Gergely Szabó
- Departmental Group of Infectious Diseases, Department of Haematology and Internal Medicine, Semmelweis University, H-1097 Budapest, Hungary
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Florian út 5–7., H-1097 Budapest, Hungary
| | - Péter Reményi
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Florian út 5–7., H-1097 Budapest, Hungary
| | - Szabolcs Tasnády
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Florian út 5–7., H-1097 Budapest, Hungary
| | - Dorina Korózs
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Florian út 5–7., H-1097 Budapest, Hungary
| | - László Gopcsa
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Florian út 5–7., H-1097 Budapest, Hungary
| | - Marienn Réti
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Florian út 5–7., H-1097 Budapest, Hungary
| | - Andrea Várkonyi
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Florian út 5–7., H-1097 Budapest, Hungary
| | - János Sinkó
- Departmental Group of Infectious Diseases, Department of Haematology and Internal Medicine, Semmelweis University, H-1097 Budapest, Hungary
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Florian út 5–7., H-1097 Budapest, Hungary
| | - Botond Lakatos
- Departmental Group of Infectious Diseases, Department of Haematology and Internal Medicine, Semmelweis University, H-1097 Budapest, Hungary
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Florian út 5–7., H-1097 Budapest, Hungary
| | - János Szlávik
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Florian út 5–7., H-1097 Budapest, Hungary
| | - Gabriella Bekő
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Florian út 5–7., H-1097 Budapest, Hungary
| | - Ilona Bobek
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Florian út 5–7., H-1097 Budapest, Hungary
| | - István Vályi-Nagy
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Florian út 5–7., H-1097 Budapest, Hungary
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Szabó BG, Czél E, Nagy I, Korózs D, Petrik B, Marosi B, Gáspár Z, Rajmon M, Di Giovanni M, Vályi-Nagy I, Sinkó J, Lakatos B, Bobek I. Clinical and Microbiological Outcomes and Follow-Up of Secondary Bacterial and Fungal Infections among Critically Ill COVID-19 Adult Patients Treated with and without Immunomodulation: A Prospective Cohort Study. Antibiotics (Basel) 2023; 12:1196. [PMID: 37508292 PMCID: PMC10376198 DOI: 10.3390/antibiotics12071196] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/14/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Nearly 10% of COVID-19 cases will require admission to the intensive care unit (ICU). Our aim was to assess the clinical and microbiological outcomes of secondary infections among critically ill COVID-19 adult patients treated with/without immunomodulation. METHODS A prospective observational cohort study was performed between 2020 and 2022 at a single ICU. The diagnosis and severity classification were established by the ECDC and WHO criteria, respectively. Eligible patients were included consecutively at admission, and followed for +30 days post-inclusion. Bloodstream-infections (BSIs), ventilator-associated bacterial pneumonia (VAP), and COVID-19-associated invasive pulmonary aspergillosis (CAPA) were defined according to international guidelines. Patient stratification was performed by immunomodulatory therapy administration (dexamethasone, tocilizumab, baricitinib/ruxolitinib). The primary outcome was any microbiologically confirmed major infectious complication, secondary outcomes were invasive mechanical ventilation (IMV) requirement and all-cause mortality. RESULTS Altogether, 379 adults were included. At baseline, 249/379 (65.7%) required IMV and 196/379 (51.7%) had a cytokine storm. At +30 days post-inclusion, the rate of any microbiologically confirmed major infectious complication was 151/379 (39.8%), IMV requirement and all-cause mortality were 303/379 (79.9%) and 203/379 (53.6%), respectively. There were no statistically significant outcome differences after stratification. BSI, VAP, and CAPA episodes were mostly caused by Enterococcus faecalis (27/124, 22.1%), Pseudomonas aeruginosa (26/91, 28.6%), and Aspergillus fumigatus (20/20, 100%), respectively. Concerning the primary outcome, Kaplan-Meier analysis showed similar probability distributions between the treatment subgroups (118/299, 39.5% vs. 33/80, 41.3%, log-rank p = 0.22), and immunomodulation was not retained as its independent predictor in multivariate logistic regression. CONCLUSIONS Secondary infections among critically ill COVID-19 adult patients represent a relevant burden, probably irrespective of immunomodulatory treatment.
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Affiliation(s)
- Bálint Gergely Szabó
- Division of Infectology, Department of Haematology and Internal Medicine, Semmelweis University, Albert Florian ut 5-7, H-1097 Budapest, Hungary
- Doctoral School of Clinical Medicine, Semmelweis University, Ulloi ut 26, H-1085 Budapest, Hungary
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Albert Florian ut 5-7, H-1097 Budapest, Hungary
| | - Eszter Czél
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Albert Florian ut 5-7, H-1097 Budapest, Hungary
| | - Imola Nagy
- Faculty of Medicine, Semmelweis University, Ulloi ut 26, H-1085 Budapest, Hungary
| | - Dorina Korózs
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Albert Florian ut 5-7, H-1097 Budapest, Hungary
- Faculty of Medicine, Semmelweis University, Ulloi ut 26, H-1085 Budapest, Hungary
| | - Borisz Petrik
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Albert Florian ut 5-7, H-1097 Budapest, Hungary
- Faculty of Medicine, Semmelweis University, Ulloi ut 26, H-1085 Budapest, Hungary
| | - Bence Marosi
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Albert Florian ut 5-7, H-1097 Budapest, Hungary
- Faculty of Medicine, Semmelweis University, Ulloi ut 26, H-1085 Budapest, Hungary
| | - Zsófia Gáspár
- Doctoral School of Clinical Medicine, Semmelweis University, Ulloi ut 26, H-1085 Budapest, Hungary
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Albert Florian ut 5-7, H-1097 Budapest, Hungary
- Faculty of Medicine, Semmelweis University, Ulloi ut 26, H-1085 Budapest, Hungary
| | - Martin Rajmon
- Faculty of Medicine, Semmelweis University, Ulloi ut 26, H-1085 Budapest, Hungary
| | - Márk Di Giovanni
- Faculty of Medicine, Semmelweis University, Ulloi ut 26, H-1085 Budapest, Hungary
| | - István Vályi-Nagy
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Albert Florian ut 5-7, H-1097 Budapest, Hungary
| | - János Sinkó
- Division of Infectology, Department of Haematology and Internal Medicine, Semmelweis University, Albert Florian ut 5-7, H-1097 Budapest, Hungary
- Doctoral School of Clinical Medicine, Semmelweis University, Ulloi ut 26, H-1085 Budapest, Hungary
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Albert Florian ut 5-7, H-1097 Budapest, Hungary
| | - Botond Lakatos
- Division of Infectology, Department of Haematology and Internal Medicine, Semmelweis University, Albert Florian ut 5-7, H-1097 Budapest, Hungary
- Doctoral School of Clinical Medicine, Semmelweis University, Ulloi ut 26, H-1085 Budapest, Hungary
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Albert Florian ut 5-7, H-1097 Budapest, Hungary
| | - Ilona Bobek
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Albert Florian ut 5-7, H-1097 Budapest, Hungary
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6
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Lakatos B, Szabó BG, Bobek I, Kiss-Dala N, Gáspár Z, Riczu A, Petrik B, Farkas BF, Sebestyén G, Gopcsa L, Bekő G, Sinkó J, Reményi P, Szlávik J, Mathiász D, Vályi-Nagy I. Baricitinib vs tocilizumab treatment for hospitalized adult patients with severe COVID-19 and associated cytokine storm: a prospective, investigational, real-world study. Int J Infect Dis 2022; 125:233-240. [PMID: 36328291 PMCID: PMC9621622 DOI: 10.1016/j.ijid.2022.10.037] [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: 08/31/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Our aim was to compare outcomes of hospitalized adults with severe COVID-19 and cytokine storm treated with tocilizumab or baricitinib. METHODS A prospective, investigational, real-world study was performed from April 2020 to April 2021 at our center. COVID-19 severity was classified by World Health Organization criteria, and cytokine storm was documented along predefined criteria. Eligible patients were enrolled at diagnosis if they fulfilled a priori inclusion criteria and received standard-of-care plus tocilizumab or baricitinib for >48 hours. Patients were followed per protocol for 28 days post-diagnosis. The primary outcome was all-cause mortality; secondary outcomes were invasive mechanical ventilation and major infectious complications. RESULTS Of 463 patients, 102/463 (22.1%) received tocilizumab, and 361/463 (77.9%) baricitinib. Baseline characteristics were balanced. At 28 days, there was no difference in all-cause mortality (22/102, 21.6% vs 64/361, 17.7%; P-value = 0.38). Requirement for invasive mechanical ventilation was more frequent after tocilizumab (52/102, 50.9% vs 96/361, 26.6%; P <0.01), rate of major infectious complications was similar (32/102, 31.4% vs 96/361, 26.6%; P-value = 0.34). In logistic regression, the immunomodulatory drug was not retained as a predictor of all-cause mortality. Kaplan-Meier analysis revealed statistically similar survival distributions. CONCLUSION All-cause mortality was similar between adults treated with baricitinib or tocilizumab for severe COVID-19 with cytokine storm.
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Affiliation(s)
- Botond Lakatos
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary,Semmelweis University, Department of Internal Medicine and Hematology, Division of Infectology, Budapest, Hungary,Corresponding author at: Botond Lakatos, H-1097 Albert Florian ut 5-7., Budapest, Hungary, Tel: +36203104163
| | - Bálint Gergely Szabó
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary,Semmelweis University, Department of Internal Medicine and Hematology, Division of Infectology, Budapest, Hungary
| | - Ilona Bobek
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Noémi Kiss-Dala
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary,Semmelweis University, Doctoral School of Clinical Medicine, Budapest, Hungary
| | - Zsófia Gáspár
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary,Semmelweis University, Doctoral School of Clinical Medicine, Budapest, Hungary
| | - Alexandra Riczu
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Borisz Petrik
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | | | - Gabriella Sebestyén
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - László Gopcsa
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Gabriella Bekő
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - János Sinkó
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Péter Reményi
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - János Szlávik
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Dóra Mathiász
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - István Vályi-Nagy
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
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7
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Vancea S, Balázs-Bécsi I, Imre J, Török B, Lungu-Flustur M, Sinkó J. 3,5-Dimethoxyphenol identification from urine by GC-MS after a lethal intoxication with Taxus baccata: A case report. Toxicologie Analytique et Clinique 2022. [DOI: 10.1016/j.toxac.2022.06.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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8
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Stemler J, de Jonge N, Skoetz N, Sinkó J, Brüggemann RJ, Busca A, Ben-Ami R, Ráčil Z, Piechotta V, Lewis R, Cornely OA. Antifungal prophylaxis in adult patients with acute myeloid leukaemia treated with novel targeted therapies: a systematic review and expert consensus recommendation from the European Hematology Association. The Lancet Haematology 2022; 9:e361-e373. [DOI: 10.1016/s2352-3026(22)00073-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 12/24/2022]
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9
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Gopcsa L, Bobek I, Bekő G, Lakatos B, Molnár E, Réti M, Reményi P, Sinkó J, Szlávik J, Tatai G, Vályi-Nagy I. Common points of therapeutic intervention in COVID-19 and in allogeneic hematopoietic stem cell transplantation associated severe cytokine release syndrome. Acta Microbiol Immunol Hung 2021; 68:240-255. [PMID: 34797216 DOI: 10.1556/030.2021.01620] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 10/22/2021] [Indexed: 11/19/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) and coronavirus disease 2019 (COVID-19) infection can both lead to severe cytokine release syndrome (sCRS) resulting in critical illness and death. In this single institution, preliminary comparative case-series study we compared clinical and laboratory co-variates as well as response to tocilizumab (TCZ)-based therapy of 15 allogeneic-HSCT- and 17 COVID-19-associated sCRS patients. Reaction to a TCZ plus posttransplant cyclophosphamide (PTCY) consolidation therapy in the allogeneic-HSCT-associated sCRS group yielded significantly inferior long-term outcome as compared to TCZ-based therapy in the COVID-19-associated group (P = 0.003). We report that a TCZ followed by consolidation therapy with a Janus kinase/signal transducer and activator of transcription (JAK/STAT) inhibitor given to 4 out of 8 critically ill COVID-19 patients resulted in their complete recovery. Non-selective JAK/STAT inhibitors influencing the action of several cytokines exhibit a broader effect than TCZ alone in calming down sCRS. Serum levels of cytokines and chemokines show similar changes in allogeneic-HSCT- and COVID-19-associated sCRS with marked elevation of interleukin-6 (IL-6), regulated upon activation normal T-cell expressed and secreted (RANTES), monocyte chemoattractant protein-1 (MCP-1) and interferon γ-induced protein 10 kDa (IP-10) levels. In addition, levels of IL-5, IL-10, IL-15 were also elevated in allogeneic-HSCT-associated sCRS. Our multi-cytokine expression data indicate that the pathophysiology of allogeneic-HSCT and COVID-19-associated sCRS are similar therefore the same clinical grading system and TCZ-based treatment approaches can be applied. TCZ with JAK/STAT inhibitor consolidation therapy might be highly effective in COVID-19 sCRS patients.
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Affiliation(s)
- László Gopcsa
- 1Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, Department of Hematology and Stem Cell Transplantation, Albert Florian ut 5-7, H-1097, Budapest, Hungary
| | - Ilona Bobek
- 2Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, Department of Intensive Care Unit, Albert Florian ut 5-7, H-1097, Budapest, Hungary
| | - Gabriella Bekő
- 3Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, Department of Central Laboratory, Albert Florian ut 5-7, H-1097, Budapest, Hungary
| | - Botond Lakatos
- 4Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, Department of Infectious Diseases, Albert Florian ut 5-7, H-1097, Budapest, Hungary
| | - Eszter Molnár
- 2Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, Department of Intensive Care Unit, Albert Florian ut 5-7, H-1097, Budapest, Hungary
| | - Marienn Réti
- 1Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, Department of Hematology and Stem Cell Transplantation, Albert Florian ut 5-7, H-1097, Budapest, Hungary
| | - Péter Reményi
- 1Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, Department of Hematology and Stem Cell Transplantation, Albert Florian ut 5-7, H-1097, Budapest, Hungary
| | - János Sinkó
- 1Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, Department of Hematology and Stem Cell Transplantation, Albert Florian ut 5-7, H-1097, Budapest, Hungary
| | - János Szlávik
- 4Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, Department of Infectious Diseases, Albert Florian ut 5-7, H-1097, Budapest, Hungary
| | - Gábor Tatai
- 1Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, Department of Hematology and Stem Cell Transplantation, Albert Florian ut 5-7, H-1097, Budapest, Hungary
| | - István Vályi-Nagy
- 1Central Hospital of Southern-Pest, National Institute of Hematology and Infectious Diseases, Department of Hematology and Stem Cell Transplantation, Albert Florian ut 5-7, H-1097, Budapest, Hungary
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10
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Merkely B, Szabó AJ, Kosztin A, Berényi E, Sebestyén A, Lengyel C, Merkely G, Karády J, Várkonyi I, Papp C, Miseta A, Betlehem J, Burián K, Csóka I, Vásárhelyi B, Ludwig E, Prinz G, Sinkó J, Hankó B, Varga P, Fülöp GÁ, Mag K, Vokó Z. Novel coronavirus epidemic in the Hungarian population, a cross-sectional nationwide survey to support the exit policy in Hungary. GeroScience 2020; 42:1063-1074. [PMID: 32677025 PMCID: PMC7366154 DOI: 10.1007/s11357-020-00226-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [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: 06/24/2020] [Accepted: 07/01/2020] [Indexed: 01/08/2023] Open
Abstract
After months of restrictive containment efforts to fight the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) epidemic, European countries are planning to reopen. To support the process, we conducted a cross-sectional survey among the Hungarian population to estimate the prevalence of infectious cases and prior SARS-CoV-2 exposure. A representative sample (n = 17,787) for the Hungarian population of 14 years or older living in private households (n = 8,283,810) was selected. The study was performed within 16 days after 50 days of restrictions, when the number of confirmed cases was stable low. Naso- and oropharyngeal smears and blood samples were collected for PCR and antibody testing. The testing was accompanied by a questionnaire about symptoms, comorbidities, and contacts. Design-based prevalence estimates were calculated. In total, 10,474 individuals (67.7% taken into account a sample frame error of 2315) of the selected sample participated in the survey. Of the tested individuals, 3 had positive PCR and 69 had positive serological test. Population estimate of the number of SARS-CoV-2 infection and seropositivity were 2421 and 56,439, respectively, thus active infection rate (2.9/10,000) and the prevalence of prior SARS-CoV-2 exposure (68/10,000) was low. Self-reported loss of smell or taste and body aches were significantly more frequent among those with SARS-CoV-2. In this representative, cross-sectional survey of the Hungarian population with a high participation rate, the overall active infection rate was low in sync with the prevalence of prior SARS-CoV-2 exposure. We demonstrated a potential success of containment efforts, supporting an exit strategy. NCT04370067, 30.04.2020.
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Affiliation(s)
- Béla Merkely
- Heart and Vascular Center, Semmelweis University, 68 Városmajor St, Budapest, 1122, Hungary.
| | - Attila J Szabó
- I. Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Annamária Kosztin
- Heart and Vascular Center, Semmelweis University, 68 Városmajor St, Budapest, 1122, Hungary
| | - Ervin Berényi
- Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Andor Sebestyén
- Institute for Health Insurance, Faculty of Health Sciences, Clinical Centre, University of Pécs, 48-as tér 1, Pécs, 7622, Hungary
| | - Csaba Lengyel
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Gergő Merkely
- Semmelweis University, Budapest, Hungary.,Orthopedic Department, Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Júlia Karády
- Heart and Vascular Center, Semmelweis University, 68 Városmajor St, Budapest, 1122, Hungary.,Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - István Várkonyi
- Kenézy Gyula Teaching Hospital, University of Debrecen, Egyetem tér 1, Debrecen, 4032, Hungary
| | - Csaba Papp
- Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Attila Miseta
- Department of Laboratory Medicine, Clinical Centre, Medical School, University of Pécs, Pécs, Hungary
| | - József Betlehem
- Institute of Emergency Care and Pedagogy of Health, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Katalin Burián
- Institute of Clinical Microbiology, Department of Medical Microbiology and Immunobiology, University of Szeged, Szeged, Hungary
| | - Ildikó Csóka
- Institute of Pharmaceutical Technology and Regulatory Affairs, University of Szeged, Szeged, Hungary
| | - Barna Vásárhelyi
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Endre Ludwig
- Department of Infectology, Semmelweis University, Budapest, Hungary.,Central Hospital of Southern Pest, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Gyula Prinz
- Department of Infectology, Semmelweis University, Budapest, Hungary
| | - János Sinkó
- Department of Infectology, Semmelweis University, Budapest, Hungary.,Central Hospital of Southern Pest, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Balázs Hankó
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
| | | | - Gábor Áron Fülöp
- Heart and Vascular Center, Semmelweis University, 68 Városmajor St, Budapest, 1122, Hungary
| | - Kornélia Mag
- Hungarian Central Statistical Office, Budapest, Hungary
| | - Zoltán Vokó
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
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11
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Bobek I, Gopcsa L, Réti M, Bekő G, Hancz L, Lakatos B, Molnár E, Nagy S, Reményi P, Sebestyén G, Sinkó J, Szlávik J, Szolnoky M, Vályi-Nagy I. Successful administration of convalescent plasma in critically ill COVID-19 patients in Hungary: the first two cases. Orv Hetil 2020; 161:1111-1121. [PMID: 32564002 DOI: 10.1556/650.2020.31901] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION At present, neither specific curative treatment nor vaccines for novel coronavirus 2019 (COVID-19) are available. There is an urgent need to look for alternative strategies for COVID-19 treatment especially in the case of severe and/or critically ill patients with cytokine release syndrome (CRS). AIM Convalescent plasma proved to increase survival rates in other severe viral infections. Therefore, convalescent plasma could be a promising treatment option for severe COVID-19 patients. METHOD In our article, we present the first two critically ill Hungarian patients with COVID-19 infection treated with convalescent fresh frozen plasma. RESULTS At the time of plasma therapy both patients were on mechanical ventilation and received antiviral agents and a full scale of supportive care. Each patient received 3 × 200 mL of convalescent plasma of recently recovered donors with sufficient novel anti-coronavirus IgG titers. Subsequent to convalescent plasma infusion, oxygenization improved and inflammatory markers decreased in both individuals. As compared to pretransfusion, lymphocyte counts increased and interleukin-6 level lessened. Both patients were weaned from mechanical ventilation within 2 weeks of treatment. No severe adverse effects were observed. CONCLUSIONS Our experience indicates that convalescent plasma therapy is well tolerated and could potentially improve clinical outcomes. Optimal dose and timing as well as precise assessment of clinical benefit of convalescent plasma therapy will need further investigation in larger, well-controlled trials. This is the first report of the successful use of convalescent plasma in the treatment of critically ill patients with COVID-19 infection in Hungary. Orv Hetil. 2020; 161(27): 1111-1121.
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Affiliation(s)
- Ilona Bobek
- Intenzív Terápiás Osztály,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Budapest
| | - László Gopcsa
- Hematológiai és Őssejt-transzplantációs Osztály,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Budapest, Albert Flórián út 5-7., 1097
| | - Marienn Réti
- Hematológiai és Őssejt-transzplantációs Osztály, Apheresis és Őssejt-feldolgozó Részleg,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Budapest
| | - Gabriella Bekő
- Központi Laboratórium,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Budapest
| | - Lilla Hancz
- Intenzív Terápiás Osztály,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Budapest
| | - Botond Lakatos
- Infektológiai Osztály,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Budapest
| | - Eszter Molnár
- Intenzív Terápiás Osztály,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Budapest
| | | | - Péter Reményi
- Hematológiai és Őssejt-transzplantációs Osztály,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Budapest, Albert Flórián út 5-7., 1097
| | - Gabriella Sebestyén
- Intenzív Terápiás Osztály,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Budapest
| | - János Sinkó
- Hematológiai és Őssejt-transzplantációs Osztály,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Budapest, Albert Flórián út 5-7., 1097
| | - János Szlávik
- Infektológiai Osztály,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Budapest
| | | | - István Vályi-Nagy
- Intenzív Terápiás Osztály,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Budapest.,Infektológiai Osztály,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Budapest
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12
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Lakatos B, Gopcsa L, Gondos E, Riczu A, Várnai Z, Nagy É, Molnár E, Bekő G, Bobek I, Reményi P, Szlávik J, Sinkó J, Vályi-Nagy I. Anti-cytokine therapy in novel coronavirus disease (COVID-19) – the first administration of tocilizumab in Hungary at a department of infectology. Orv Hetil 2020; 161:1070-1077. [PMID: 32541085 DOI: 10.1556/650.2020.31899] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/19/2022]
Abstract
During the past few months, a pandemic originating from China named new coronavirus disease (COVID-19) has shown how vulnerable the world is. To date, no medication supported by randomized clinical trials has been approved for the treatment of COVID-19. At the time of writing of this paper, severe acute respiratory syndrome caused by coronavirus-2 (SARS-CoV-2) has been responsible - according to modest estimations - for around 4 million of infections and 300 000 deaths. Unveiling details of patomechanism, in fatal cases the role of immune dysregulation, namely cytokine release syndrome (CRS) has been discovered. Based on the current knowledge, interleukin-6 (IL6) plays a pivotal role in COVID-19 associated CRS. Case reports and result of small case series suggest efficacy of an IL6 inhibitor monoclonal antibody (tocilizumab) in treating CRS. Authors describe a case and review recent knowledge on the treatment of COVID-19. To our knowledge, the first case of severe COVID-19-associated cytokine storm syndrome - treated succesfully with IL6 monoclocal antibody at a Hungarian department of infectology - is presented here. Orv Hetil. 2020; 161(26): 1070-1077.
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Affiliation(s)
- Botond Lakatos
- Infektológiai Osztály,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet Budapest, Albert Flórián út 5-7., 1097
| | - László Gopcsa
- Hematológiai Osztály,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet Budapest
| | - Enikő Gondos
- Gyermekintenzív Osztály,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet Budapest
| | - Alexandra Riczu
- Infektológiai Osztály,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet Budapest, Albert Flórián út 5-7., 1097
| | - Zsuzsa Várnai
- Infektológiai Osztály,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet Budapest, Albert Flórián út 5-7., 1097
| | - Éva Nagy
- Infektológiai Osztály,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet Budapest, Albert Flórián út 5-7., 1097
| | - Eszter Molnár
- Intenzív Terápiás Osztály,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet Budapest
| | - Gabriella Bekő
- Központi Laboratórium,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet Budapest
| | - Ilona Bobek
- Intenzív Terápiás Osztály,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet Budapest
| | - Péter Reményi
- Hematológiai Osztály,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet Budapest
| | - János Szlávik
- Infektológiai Osztály,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet Budapest, Albert Flórián út 5-7., 1097
| | - János Sinkó
- Hematológiai Osztály,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet Budapest
| | - István Vályi-Nagy
- Hematológiai Osztály,Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet Budapest
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13
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Lakatos B, Szabó H, Csordás K, Tatai G, Nikolova R, Csomor J, Reményi P, Masszi T, Vályi-Nagy I, Sinkó J. [Epidemiology of early infections after autologous hematopoietic stem cell transplantation. Analysis of data from 699 patients treated in a Hungarian centre]. Orv Hetil 2020; 161:103-109. [PMID: 31928060 DOI: 10.1556/650.2020.31638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction: Autologous hemopoietic stem cell transplantation remains a promising therapy in certain malignant and non-malignant conditions. The procedure, however, will increase the risk of complications, most notably early and late infections. Aim: To analyze the frequency and spectrum of pathogens in early (<+100 days) post-transplant infections and to evaluate risk factors for mortality. Method: Prospectively collected data from 699 patients undergoing autologous hemopoietic stem cell transplantation between 2007 and 2014 at our center were retrospectively reviewed and analyzed. Results: The median age of 699 patients was 56 (interquartile range: 43-62) years, 54% (376) were male. 25 patients have been transferred to other centers and 19 patients were lost to follow up. Neutropenic fever occurred in 69.8% (488) of patients. In addition, 102 infectious episodes in 96 patients were identified. Most commonly bacteremia occurred (49 episodes) with a median onset of 7 (5-11) days. The majority (33/49) of bacteremias have been observed during the pre-engraftment period. Their incidence proved to be higher in patients with malignant lymphoma compared to individuals with plasma cell disorders (p = 0.0005, OR: 2.41, 95% CI: 1.49-3.99). 12 episodes of viral infections and 8 cases of proven or probable invasive mycoses have been identified. Among the 655 patients with complete follow up, 16 in-hospital deaths (2.4%) occurred, 8 of them were associated with infections. Survival was adversely affected by early infections (p = 0.0001). Conclusion: In autologous stem cell transplantation, microbiologically unconfirmed neutropenic fever is common. Documented early bacteremia, however, is infrequent. Lymphoma patients have a significantly higher chance to develop bloodstream infections compared to individuals with plasma cell disorders. Early infections decrease the chance of survival; thus, an effective prophylaxis and therapy remains of paramount importance. Orv Hetil. 2020; 161(3): 103-109.
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Affiliation(s)
- Botond Lakatos
- Országos Hematológiai és Infektológiai Intézet, Infektológiai Osztály, Dél-pesti Centrumkórház Budapest
| | - Helga Szabó
- Radiológiai és Onkoterápiás Klinika, Semmelweis Egyetem Budapest
| | - Katalin Csordás
- Országos Hematológiai és Infektológiai Intézet, Gyermekhematológiai és Őssejt-transzplantációs Osztály, Dél-pesti Centrumkórház Budapest
| | - Gábor Tatai
- Általános Orvostudományi Kar, Semmelweis Egyetem Budapest
| | - Radka Nikolova
- Országos Hematológiai és Infektológiai Intézet, Mikrobiológiai Laboratórium, Dél-pesti Centrumkórház Budapest
| | - Judit Csomor
- Általános Orvostudományi Kar, I. Patológiai és Kísérleti Rákkutató Intézet, Semmelweis Egyetem Budapest
| | - Péter Reményi
- Országos Hematológiai és Infektológiai Intézet, Hematológiai Osztály, Dél-pesti Centrumkórház Budapest, Albert Flórián út 5-7., 1097
| | - Tamás Masszi
- Általános Orvostudományi Kar, III. Belgyógyászati Klinika, Semmelweis Egyetem Budapest
| | - István Vályi-Nagy
- Országos Hematológiai és Infektológiai Intézet, Hematológiai Osztály, Dél-pesti Centrumkórház Budapest, Albert Flórián út 5-7., 1097
| | - János Sinkó
- Országos Hematológiai és Infektológiai Intézet, Hematológiai Osztály, Dél-pesti Centrumkórház Budapest, Albert Flórián út 5-7., 1097
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14
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Sinkó J. Amphotericin B-deoxycholate as first-line antifungal therapy in critically ill patients: a word of caution. Intensive Care Med 2019; 46:562-563. [PMID: 31848652 DOI: 10.1007/s00134-019-05880-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2019] [Indexed: 11/27/2022]
Affiliation(s)
- János Sinkó
- Department of Hematology and HSCT, National Institute of Hematology and Infectology, South-Pest Central Hospital, 5-7 Albert F u, Budapest, 1097, Hungary.
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15
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Tasnády S, Karászi É, Szederjesi A, Bihari G, Juhász Z, Hardi A, Kriván G, Kállay K, Reményi P, Sinkó J, Mikala G, Réti M, Masszi T. Identification of the best-suited donor for generating virus-specific T cells. Vox Sang 2019; 115:18-26. [PMID: 31667887 DOI: 10.1111/vox.12857] [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: 06/19/2019] [Revised: 10/06/2019] [Accepted: 10/09/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Administration of virus-specific T cells (VSTs) is a viable antiviral treatment strategy after allogeneic HSCT, even if conventional therapies fail. Third-party donors are often chosen for the generation of the VST product. The eligibility of the donor has to be tested in a rigorous donor screening procedure, since the isolation technology only targets pre-existing VSTs. MATERIALS AND METHODS In a period of 3 years, we performed 32 VST treatments for 28 patients. Targeting four different viruses, 284 healthy individuals underwent 417 donor screening procedures. VSTs were counted by flow cytometry detecting interferon-gamma (IFN-γ) producing T cells. Generation of the VSTs was performed from leukapheresis products in a fully automated and closed system using magnetic cell separation. RESULTS The mean circulating VST frequencies ranged from 0·006% to 0·328%. The average yield of viable VSTs in the product was 1·83·106 cells, while the average VST dose calculated for the patient's body weight was 4·63·104 /kg. The mean purity - percentage of VSTs within the T cells - of all T-cell products was 62·9%. Correlation was identified between the frequency of the VSTs in the peripheral blood of the donor and the VST numbers of the end product; the strongest correlation was seen for CMV. CONCLUSION This paper focuses on the T-cell donors, highlighting some key points on the donor selection process. Based on the findings in connection with the CMV therapies, peripheral VST seems to be the best predictor of the VST content of the final product administered to the patient.
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Affiliation(s)
- Szabolcs Tasnády
- National Institute of Hematology and Infectious Diseases, Central Hospital of Southern Pest, Budapest, Hungary
| | - Éva Karászi
- National Institute of Hematology and Infectious Diseases, Central Hospital of Southern Pest, Budapest, Hungary
| | - Attila Szederjesi
- Third Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - György Bihari
- Third Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Zsófia Juhász
- National Institute of Hematology and Infectious Diseases, Central Hospital of Southern Pest, Budapest, Hungary
| | - Apor Hardi
- National Institute of Hematology and Infectious Diseases, Central Hospital of Southern Pest, Budapest, Hungary
| | - Gergely Kriván
- National Institute of Hematology and Infectious Diseases, Central Hospital of Southern Pest, Budapest, Hungary
| | - Krisztián Kállay
- National Institute of Hematology and Infectious Diseases, Central Hospital of Southern Pest, Budapest, Hungary
| | - Péter Reményi
- National Institute of Hematology and Infectious Diseases, Central Hospital of Southern Pest, Budapest, Hungary
| | - János Sinkó
- National Institute of Hematology and Infectious Diseases, Central Hospital of Southern Pest, Budapest, Hungary
| | - Gábor Mikala
- National Institute of Hematology and Infectious Diseases, Central Hospital of Southern Pest, Budapest, Hungary
| | - Marienn Réti
- National Institute of Hematology and Infectious Diseases, Central Hospital of Southern Pest, Budapest, Hungary
| | - Tamás Masszi
- Third Department of Internal Medicine, Semmelweis University, Budapest, Hungary
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16
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Sinkó J. [Current treatment modalities of immunocompromised patients with cytomegalovirus infection. II. Therapeutic options and management strategies]. Orv Hetil 2019; 160:363-369. [PMID: 30829057 DOI: 10.1556/650.2019.31320] [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] [Indexed: 11/19/2022]
Abstract
Although cytomegalovirus is one of the most prevalent viral pathogens on the globe, in immunocompetent individuals infected with cytomegalovirus usually no specific antiviral therapy is required. In the case of impaired T-cell mediated immunity, however, latent infection can reactivate and occasionally a viral disease with organ involvement develops. The number of actually available anti-cytomegalovirus drugs is low, for prophylaxis or treatment ganciclovir, valganciclovir, foscarnet or cidofovir can be administered. The clinical use of these drugs is primarily hampered by their toxicity. In search for new treatment options, only letermovir, a terminase complex inhibitor compound showed appropriate activity and tolerability. In a placebo-controlled clinical trial on prophylactic letermovir in stem cell transplant patients, administration of the active compound resulted in a significant decrease in human cytomegalovirus reactivations as well as in prolonged survival. No toxicity affecting clinical use has been observed. For management of patients being at high risk for cytomegalovirus reactivation, appropriate antiviral strategy should be followed. Antiviral prophylaxis or diagnostics-guided pre-emptive therapy seem to be the most suitable options. Orv Hetil. 2019; 160(10): 363-369.
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Affiliation(s)
- János Sinkó
- Hematológiai és Őssejt-transzplantációs Osztály, Dél-Pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet Budapest, Albert Flórián u 5-7., 1097
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17
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Sinkó J. [Current treatment modalities of immunocompromised patients with cytomegalovirus infection. I. Epidemiological and clinical perspectives]. Orv Hetil 2019; 160:83-92. [PMID: 30640526 DOI: 10.1556/650.2019.31287] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Human cytomegalovirus is a DNA virus with a global prevalence of 40-100%. In humans, primary infection is followed by a lifelong latent persistent phase. Even in individuals developing adequate specific immunity, interactions with the resident virus do probably occur. Clinically significant problems, however, appear primarily in immunocompromised hosts. As a result of an impaired T-cell mediated immunity, viral reactivation as well as a viral disease resulting in organ damage can develop. Most severely affected are HIV positive persons in AIDS stage and individuals undergoing solid organ or stem cell transplantation. As vital functions and survival may adversely be affected by cytomegalovirus reactivation and disease, it is of paramount significance to evaluate evident risk factors. Viral reactivation and organ specific disease can be detected by several methods based on conventional and molecular biological and histological diagnostic techniques. An up-to-date management of affected patient groups requires a meticulous assessment of the possible risk for cytomegalovirus infection and development of an adequate antiviral strategy. Orv Hetil. 2019; 160(3): 83-92.
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Affiliation(s)
- János Sinkó
- Hematológiai és Őssejt-transzplantációs Osztály, Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet Budapest, Albert Flórián u 5-7., 1097
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18
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Kassa C, Reményi P, Sinkó J, Kállay K, Kertész G, Kriván G. Successful nivolumab therapy in an allogeneic stem cell transplant child with post-transplant lymphoproliferative disorder. Pediatr Transplant 2018; 22:e13302. [PMID: 30345623 DOI: 10.1111/petr.13302] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 07/05/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
Primary CNS PTLD is an extremely rare complication after allogeneic HSCT. At our centre, an 11-year-old patient developed nausea, vomiting, and diplopy on day +82 following HSCT. On brain MRI, multiple white matter lesions were seen. Histology showed a diffuse large B-cell lymphoma with high load of EBV in tissue. Despite stopping immunosuppression, treatment with EBV-specific cytotoxic T cells, systemic rituximab, HD-MTX, and intrathecal chemotherapy, progression was observed. With a combination of HD-MTX and cytarabine, only a partial response could be achieved. Having all conventional modalities not only failed but resulted in significant toxicity, a salvage monotherapy with biweekly nivolumab has been instituted. The starting dose was 1.1 mg/kg, later escalated to 2.2 mg/kg. After 8 months of nivolumab therapy, PET-CT showed complete metabolic remission. Subsequently, the patient has been switched to a maintenance dosage of 1.1 mg/kg. No cytopenias, graft failure, GvHD, or any other alloimmune complications were seen during nivolumab therapy. In conclusion, nivolumab may be considered as an effective and safe option for CNS PTLD therapy when all other modalities have failed.
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Affiliation(s)
- Csaba Kassa
- Department of Pediatric Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Péter Reményi
- Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - János Sinkó
- Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Krisztián Kállay
- Department of Pediatric Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Gabriella Kertész
- Department of Pediatric Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Gergely Kriván
- Department of Pediatric Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
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19
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Ullmann AJ, Aguado JM, Arikan-Akdagli S, Denning DW, Groll AH, Lagrou K, Lass-Flörl C, Lewis RE, Munoz P, Verweij PE, Warris A, Ader F, Akova M, Arendrup MC, Barnes RA, Beigelman-Aubry C, Blot S, Bouza E, Brüggemann RJM, Buchheidt D, Cadranel J, Castagnola E, Chakrabarti A, Cuenca-Estrella M, Dimopoulos G, Fortun J, Gangneux JP, Garbino J, Heinz WJ, Herbrecht R, Heussel CP, Kibbler CC, Klimko N, Kullberg BJ, Lange C, Lehrnbecher T, Löffler J, Lortholary O, Maertens J, Marchetti O, Meis JF, Pagano L, Ribaud P, Richardson M, Roilides E, Ruhnke M, Sanguinetti M, Sheppard DC, Sinkó J, Skiada A, Vehreschild MJGT, Viscoli C, Cornely OA. Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect 2018; 24 Suppl 1:e1-e38. [PMID: 29544767 DOI: 10.1016/j.cmi.2018.01.002] [Citation(s) in RCA: 780] [Impact Index Per Article: 130.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 02/06/2023]
Abstract
The European Society for Clinical Microbiology and Infectious Diseases, the European Confederation of Medical Mycology and the European Respiratory Society Joint Clinical Guidelines focus on diagnosis and management of aspergillosis. Of the numerous recommendations, a few are summarized here. Chest computed tomography as well as bronchoscopy with bronchoalveolar lavage (BAL) in patients with suspicion of pulmonary invasive aspergillosis (IA) are strongly recommended. For diagnosis, direct microscopy, preferably using optical brighteners, histopathology and culture are strongly recommended. Serum and BAL galactomannan measures are recommended as markers for the diagnosis of IA. PCR should be considered in conjunction with other diagnostic tests. Pathogen identification to species complex level is strongly recommended for all clinically relevant Aspergillus isolates; antifungal susceptibility testing should be performed in patients with invasive disease in regions with resistance found in contemporary surveillance programmes. Isavuconazole and voriconazole are the preferred agents for first-line treatment of pulmonary IA, whereas liposomal amphotericin B is moderately supported. Combinations of antifungals as primary treatment options are not recommended. Therapeutic drug monitoring is strongly recommended for patients receiving posaconazole suspension or any form of voriconazole for IA treatment, and in refractory disease, where a personalized approach considering reversal of predisposing factors, switching drug class and surgical intervention is also strongly recommended. Primary prophylaxis with posaconazole is strongly recommended in patients with acute myelogenous leukaemia or myelodysplastic syndrome receiving induction chemotherapy. Secondary prophylaxis is strongly recommended in high-risk patients. We strongly recommend treatment duration based on clinical improvement, degree of immunosuppression and response on imaging.
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Affiliation(s)
- A J Ullmann
- Department of Infectious Diseases, Haematology and Oncology, University Hospital Würzburg, Würzburg, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J M Aguado
- Infectious Diseases Unit, University Hospital Madrid, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - S Arikan-Akdagli
- Department of Medical Microbiology, Hacettepe University Medical School, Ankara, Turkey; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - D W Denning
- The National Aspergillosis Centre, Wythenshawe Hospital, Mycology Reference Centre Manchester, Manchester University NHS Foundation Trust, ECMM Excellence Centre of Medical Mycology, Manchester, UK; The University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; European Confederation of Medical Mycology (ECMM)
| | - A H Groll
- Department of Paediatric Haematology/Oncology, Centre for Bone Marrow Transplantation, University Children's Hospital Münster, Münster, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - K Lagrou
- Department of Microbiology and Immunology, ECMM Excellence Centre of Medical Mycology, University Hospital Leuven, Leuven, Belgium; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - C Lass-Flörl
- Institute of Hygiene, Microbiology and Social Medicine, ECMM Excellence Centre of Medical Mycology, Medical University Innsbruck, Innsbruck, Austria; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - R E Lewis
- Infectious Diseases Clinic, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; ESCMID Fungal Infection Study Group (EFISG)
| | - P Munoz
- Department of Medical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias - CIBERES (CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - P E Verweij
- Department of Medical Microbiology, Radboud University Medical Centre, Centre of Expertise in Mycology Radboudumc/CWZ, ECMM Excellence Centre of Medical Mycology, Nijmegen, Netherlands; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - A Warris
- MRC Centre for Medical Mycology, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - F Ader
- Department of Infectious Diseases, Hospices Civils de Lyon, Lyon, France; Inserm 1111, French International Centre for Infectious Diseases Research (CIRI), Université Claude Bernard Lyon 1, Lyon, France; European Respiratory Society (ERS)
| | - M Akova
- Department of Medicine, Section of Infectious Diseases, Hacettepe University Medical School, Ankara, Turkey; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - M C Arendrup
- Department Microbiological Surveillance and Research, Statens Serum Institute, Copenhagen, Denmark; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - R A Barnes
- Department of Medical Microbiology and Infectious Diseases, Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK; European Confederation of Medical Mycology (ECMM)
| | - C Beigelman-Aubry
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; European Respiratory Society (ERS)
| | - S Blot
- Department of Internal Medicine, Ghent University, Ghent, Belgium; Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Australia; European Respiratory Society (ERS)
| | - E Bouza
- Department of Medical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias - CIBERES (CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - R J M Brüggemann
- Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Centre of Expertise in Mycology Radboudumc/CWZ, ECMM Excellence Centre of Medical Mycology, Nijmegen, Netherlands; ESCMID Fungal Infection Study Group (EFISG)
| | - D Buchheidt
- Medical Clinic III, University Hospital Mannheim, Mannheim, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J Cadranel
- Department of Pneumology, University Hospital of Tenon and Sorbonne, University of Paris, Paris, France; European Respiratory Society (ERS)
| | - E Castagnola
- Infectious Diseases Unit, Istituto Giannina Gaslini Children's Hospital, Genoa, Italy; ESCMID Fungal Infection Study Group (EFISG)
| | - A Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India; European Confederation of Medical Mycology (ECMM)
| | - M Cuenca-Estrella
- Instituto de Salud Carlos III, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - G Dimopoulos
- Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece; European Respiratory Society (ERS)
| | - J Fortun
- Infectious Diseases Service, Ramón y Cajal Hospital, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J-P Gangneux
- Univ Rennes, CHU Rennes, Inserm, Irset (Institut de Recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J Garbino
- Division of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - W J Heinz
- Department of Infectious Diseases, Haematology and Oncology, University Hospital Würzburg, Würzburg, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - R Herbrecht
- Department of Haematology and Oncology, University Hospital of Strasbourg, Strasbourg, France; ESCMID Fungal Infection Study Group (EFISG)
| | - C P Heussel
- Diagnostic and Interventional Radiology, Thoracic Clinic, University Hospital Heidelberg, Heidelberg, Germany; European Confederation of Medical Mycology (ECMM)
| | - C C Kibbler
- Centre for Medical Microbiology, University College London, London, UK; European Confederation of Medical Mycology (ECMM)
| | - N Klimko
- Department of Clinical Mycology, Allergy and Immunology, North Western State Medical University, St Petersburg, Russia; European Confederation of Medical Mycology (ECMM)
| | - B J Kullberg
- Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Centre of Expertise in Mycology Radboudumc/CWZ, ECMM Excellence Centre of Medical Mycology, Nijmegen, Netherlands; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - C Lange
- International Health and Infectious Diseases, University of Lübeck, Lübeck, Germany; Clinical Infectious Diseases, Research Centre Borstel, Leibniz Center for Medicine & Biosciences, Borstel, Germany; German Centre for Infection Research (DZIF), Tuberculosis Unit, Hamburg-Lübeck-Borstel-Riems Site, Lübeck, Germany; European Respiratory Society (ERS)
| | - T Lehrnbecher
- Division of Paediatric Haematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany; European Confederation of Medical Mycology (ECMM)
| | - J Löffler
- Department of Infectious Diseases, Haematology and Oncology, University Hospital Würzburg, Würzburg, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - O Lortholary
- Department of Infectious and Tropical Diseases, Children's Hospital, University of Paris, Paris, France; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J Maertens
- Department of Haematology, ECMM Excellence Centre of Medical Mycology, University Hospital Leuven, Leuven, Belgium; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - O Marchetti
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland; Department of Medicine, Ensemble Hospitalier de la Côte, Morges, Switzerland; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Centre of Expertise in Mycology Radboudumc/CWZ, ECMM Excellence Centre of Medical Mycology, Nijmegen, Netherlands; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - L Pagano
- Department of Haematology, Universita Cattolica del Sacro Cuore, Roma, Italy; European Confederation of Medical Mycology (ECMM)
| | - P Ribaud
- Quality Unit, Pôle Prébloc, Saint-Louis and Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - M Richardson
- The National Aspergillosis Centre, Wythenshawe Hospital, Mycology Reference Centre Manchester, Manchester University NHS Foundation Trust, ECMM Excellence Centre of Medical Mycology, Manchester, UK; The University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - E Roilides
- Infectious Diseases Unit, 3rd Department of Paediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece; Hippokration General Hospital, Thessaloniki, Greece; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - M Ruhnke
- Department of Haematology and Oncology, Paracelsus Hospital, Osnabrück, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - M Sanguinetti
- Institute of Microbiology, Fondazione Policlinico Universitario A. Gemelli - Università Cattolica del Sacro Cuore, Rome, Italy; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - D C Sheppard
- Division of Infectious Diseases, Department of Medicine, Microbiology and Immunology, McGill University, Montreal, Canada; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J Sinkó
- Department of Haematology and Stem Cell Transplantation, Szent István and Szent László Hospital, Budapest, Hungary; ESCMID Fungal Infection Study Group (EFISG)
| | - A Skiada
- First Department of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - M J G T Vehreschild
- Department I of Internal Medicine, ECMM Excellence Centre of Medical Mycology, University Hospital of Cologne, Cologne, Germany; Centre for Integrated Oncology, Cologne-Bonn, University of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF) partner site Bonn-Cologne, Cologne, Germany; European Confederation of Medical Mycology (ECMM)
| | - C Viscoli
- Ospedale Policlinico San Martino and University of Genova (DISSAL), Genova, Italy; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - O A Cornely
- First Department of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece; German Centre for Infection Research (DZIF) partner site Bonn-Cologne, Cologne, Germany; CECAD Cluster of Excellence, University of Cologne, Cologne, Germany; Clinical Trials Center Cologne, University Hospital of Cologne, Cologne, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM); ESCMID European Study Group for Infections in Compromised Hosts (ESGICH).
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Abstract
In antithymocyte globulin (ATG) treated patients occasionally bradycardia has been noticed. Therefore, we retrospectively analyzed the occurrence of bradycardia in ATG-treated children. Using medical records between 2007 and 2012 we identified children undergoing a combined therapy with ATG and glucocorticoids (ATG group, n = 22). The incidence of bradycardia was compared to that registered in children treated with glucocorticoids alone (glucocorticoid alone group, n = 21). Heart rates (HR) were registered before and on days 0-3, 4-7 and 8-14 after the ATG or steroid administration. The rate of bradycardic episodes was higher during ATG therapy than in the steroid alone group, while severe bradycardia occurred only in the ATG group (97 versus 32, p = 0.0037, and 13 versus 0, p = 0.0029, respectively). There was an interaction between the time and treatment group on HR (p = 0.046). Heart rates in ATG and steroid alone groups differed significantly on day 0-3 and day 4-7 (p = 0.046, p = 0.006, respectively). Within the ATG group HR was lower on days 4-7 compared to the days before and the days 8-14 values (p < 0.001, 95%CI: 0.020-0.074). These findings indicate that transient asymptomatic bradycardia is probably more common with ATG therapy than previously reported. HR should be closely monitored during and after ATG therapy.
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Affiliation(s)
- Krisztián Kállay
- Pediatric Hematology and Stem Cell Transplantation Unit, United St. István and St. László Hospital, Albert Flórián street 5-7, Budapest, H-1097, Hungary.
| | - Dávid Zakariás
- Pediatric Hematology and Stem Cell Transplantation Unit, United St. István and St. László Hospital, Albert Flórián street 5-7, Budapest, H-1097, Hungary
| | - Katalin Csordás
- Pediatric Hematology and Stem Cell Transplantation Unit, United St. István and St. László Hospital, Albert Flórián street 5-7, Budapest, H-1097, Hungary
| | - Gábor Benyó
- Pediatric Hematology and Stem Cell Transplantation Unit, United St. István and St. László Hospital, Albert Flórián street 5-7, Budapest, H-1097, Hungary
| | - Csaba Kassa
- Pediatric Hematology and Stem Cell Transplantation Unit, United St. István and St. László Hospital, Albert Flórián street 5-7, Budapest, H-1097, Hungary
| | - János Sinkó
- Pediatric Hematology and Stem Cell Transplantation Unit, United St. István and St. László Hospital, Albert Flórián street 5-7, Budapest, H-1097, Hungary
| | - Anita Stréhn
- Pediatric Hematology and Stem Cell Transplantation Unit, United St. István and St. László Hospital, Albert Flórián street 5-7, Budapest, H-1097, Hungary
| | - Orsolya Horváth
- Pediatric Hematology and Stem Cell Transplantation Unit, United St. István and St. László Hospital, Albert Flórián street 5-7, Budapest, H-1097, Hungary
| | - Barna Vásárhelyi
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Gergely Kriván
- Pediatric Hematology and Stem Cell Transplantation Unit, United St. István and St. László Hospital, Albert Flórián street 5-7, Budapest, H-1097, Hungary
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21
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Horváth O, Kállay K, Csuka D, Mező B, Sinkovits G, Kassa C, Stréhn A, Csordás K, Sinkó J, Prohászka Z, Kriván G. Early Increase in Complement Terminal Pathway Activation Marker sC5b-9 Is Predictive for the Development of Thrombotic Microangiopathy after Stem Cell Transplantation. Biol Blood Marrow Transplant 2018; 24:989-996. [PMID: 29339271 DOI: 10.1016/j.bbmt.2018.01.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 10/13/2017] [Accepted: 01/08/2018] [Indexed: 12/17/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT)-associated thrombotic microangiopathy (TA-TMA) is a multifactorial complication, and its prediction is largely unresolved. Our aim was to analyze changes of complement profile after HSCT to identify potential markers of TA-TMA development. Thirty-three consecutive pediatric patients (9.6 ± 4.4 years old) who underwent allogeneic HSCT due to malignant (n = 17) or nonmalignant (n = 16) indications were included in this study. Graft-versus-host disease (GVHD) was diagnosed using Glucksberg criteria, viral reactivation was monitored, 5 different TA-TMA diagnostic criteria were applied, and all important clinical and laboratory parameters of TA-TMA activity were registered. Complement pathway activities, components and terminal pathway activation marker (sC5b-9) levels were systematically measured before transplantation and on days 28, 56, and 100 after HSCT. During the first 100 days after HSCT, 1 of 33 patients died (day 50, multiple organ failure), whereas 10 subjects met the criteria for TA-TMA, typically on day 61 (range, 16 to 98 days). TA-TMA was preceded by acute GVHD in 3 of 10 patients, by viral reactivation in 2 of 10, or by both in 4 of 10 cases. Baseline sC5b-9 levels did not differ in patients without (200 [interquartile range, 144 to 266] ng/mL), or with (208 [interquartile range, 166 to 271] ng/mL) subsequent TA-TMA; however, on day 28 significant differences were observed (201 [interquartile range, 185 to 290] ng/mL versus 411 [interquartile range, 337 to 471] ng/mL; P = .004). Importantly, all 10 patients with TMA showed increase in sC5b-9 level from baseline level to day 28, whereas in patients without TMA the same tendency was observed for only 9 of 23 patients (P = .031). No additional complement parameters were closely associated with the development of TA-TMA. Development of TA-TMA occurred in 30% of our patients, typically after GVHD and/or viral reactivation. However, early raise of sC5b-9 activation marker was predictive for later development of TA-TMA, and should therefore be considered as an alarming sign necessitating a careful monitoring of all TA-TMA activity markers. Further studies enrolling a higher number of patients are necessary to determine if terminal pathway activation is an independent predictor of TA-TMA.
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Affiliation(s)
- Orsolya Horváth
- Department of Pediatric Hematology and Stem Cell Transplantation, United St.István and St. László Hospital, Budapest, Hungary; Doctoral School of Medicine, Semmelweis University, Budapest, Hungary.
| | - Krisztián Kállay
- Department of Pediatric Hematology and Stem Cell Transplantation, United St.István and St. László Hospital, Budapest, Hungary
| | - Dorottya Csuka
- Research Laboratory, IIIrd Department of Internal Medicine, and MTA-SE Research Group of Immunology and Hematology, Hungarian Academy of Sciences and Semmelweis University, Budapest, Hungary
| | - Blanka Mező
- Research Laboratory, IIIrd Department of Internal Medicine, and MTA-SE Research Group of Immunology and Hematology, Hungarian Academy of Sciences and Semmelweis University, Budapest, Hungary
| | - György Sinkovits
- Research Laboratory, IIIrd Department of Internal Medicine, and MTA-SE Research Group of Immunology and Hematology, Hungarian Academy of Sciences and Semmelweis University, Budapest, Hungary
| | - Csaba Kassa
- Department of Pediatric Hematology and Stem Cell Transplantation, United St.István and St. László Hospital, Budapest, Hungary
| | - Anita Stréhn
- Department of Pediatric Hematology and Stem Cell Transplantation, United St.István and St. László Hospital, Budapest, Hungary
| | - Katalin Csordás
- Department of Pediatric Hematology and Stem Cell Transplantation, United St.István and St. László Hospital, Budapest, Hungary
| | - János Sinkó
- Department of Hematology and Stem Cell Transplantation, United St. István and St. László Hospital, Budapest, Hungary
| | - Zoltán Prohászka
- Research Laboratory, IIIrd Department of Internal Medicine, and MTA-SE Research Group of Immunology and Hematology, Hungarian Academy of Sciences and Semmelweis University, Budapest, Hungary
| | - Gergely Kriván
- Department of Pediatric Hematology and Stem Cell Transplantation, United St.István and St. László Hospital, Budapest, Hungary
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22
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Sinkó J. Antibiotikumokkal szemben ellenálló Gram-negatív baktériumok okozta súlyos fertőzések a klinikus szemével. A Birodalom visszavág?. Orv Hetil 2017; 158:1528-1534. [DOI: 10.1556/650.2017.30858] [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: 11/19/2022]
Abstract
Abstract: In our days, growing incidence of antibiotic resistant bacteria has become an eminent public health problem. For survival Gram-negative species possess several different tools to withstand antibiotics: they produce degrading and modifying enzymes, decrease their permeability or expel drug molecules. An increasing proportion of severe nosocomial infections are caused by strains resistant to several antimicrobials (multiresistant, extensively resistant or panresistant species). Development of new antibiotic compounds may serve as a possible solution to this problem. Ceftolozane-tazobactam is a new beta-lactam+beta-lactamase-inhibitor combination resistant to most extended spectrum beta-lactamase enzymes showing excellent anti-Pseudomonas activity. It is also effective against strains when beta-lactam resistance is related to porin loss or efflux pump activity. The spectrum of ceftazidime-avibactam also includes carbapenemase-(KPC)-producing Enterobacteriaceae. In addition to novel therapy, an effective infection control system together with the prudent use of antimicrobials (antimicrobial stewardship) is of paramount importance. Orv Hetil. 2017; 158(39): 1528–1534.
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Affiliation(s)
- János Sinkó
- Hematológiai és Őssejt-transzplantációs Osztály, Egyesített Szent István és Szent László Kórház Budapest, Albert F. u. 5–7., 1097
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23
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Horváth O, Prohászka Z, Kállay K, Kassa C, Stréhn A, Csordás K, Sinkó J, Kriván G. [Changes in diagnostic criteria of thrombotic microangiopathy after stem cell transplantation]. Orv Hetil 2017; 158:1043-1050. [PMID: 28670985 DOI: 10.1556/650.2017.30786] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hematopoietic stem cell transplantation associated thrombotic microangiopathy is a multifactorial complication, and has variable incidence in study populations due to different diagnostic criteria. The diversity of activity parameters, like elevated laktát-dehidrogenáz, hematological parameters and kidney function are not specific variables after stem cell transplantation. Dysregulation of the classical and alternative pathway can play an important role in the pathomechanism of thrombotic microangiopathy, but the understanding of the role of complement activation under transplantation conditions requires further investigation. Monitoring of complement parameters, including terminal complement pathway activation complex during transplantation may help physicians to improve diagnostic strategy, to evaluate therapeutical options and to predict and follow up efficacy of complement blockade methods and supportive therapy. This review focuses on the development of diagnostic criteria and therapeutical options in thrombotic microangiopathy, and presents some preliminary findings while using different diagnostic criteria in pediatric patients. Orv Hetil. 2017; 158(27): 1043-1050.
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Affiliation(s)
- Orsolya Horváth
- Doktori Iskola, Semmelweis Egyetem Budapest.,Gyermekhematológiai és Őssejt-transzplantációs Osztály, Egyesített Szent István és Szent László Kórház Budapest, Albert Flórián út 5-7. 11/4A, 1097
| | - Zoltán Prohászka
- Általános Orvostudományi Kar, III. Belgyógyászati Klinika, Semmelweis Egyetem Budapest
| | - Krisztián Kállay
- Gyermekhematológiai és Őssejt-transzplantációs Osztály, Egyesített Szent István és Szent László Kórház Budapest, Albert Flórián út 5-7. 11/4A, 1097
| | - Csaba Kassa
- Gyermekhematológiai és Őssejt-transzplantációs Osztály, Egyesített Szent István és Szent László Kórház Budapest, Albert Flórián út 5-7. 11/4A, 1097
| | - Anita Stréhn
- Gyermekhematológiai és Őssejt-transzplantációs Osztály, Egyesített Szent István és Szent László Kórház Budapest, Albert Flórián út 5-7. 11/4A, 1097
| | - Katalin Csordás
- Gyermekhematológiai és Őssejt-transzplantációs Osztály, Egyesített Szent István és Szent László Kórház Budapest, Albert Flórián út 5-7. 11/4A, 1097
| | - János Sinkó
- Hematológiai és Őssejt-transzplantációs Osztály, Egyesített Szent István és Szent László Kórház Budapest
| | - Gergely Kriván
- Gyermekhematológiai és Őssejt-transzplantációs Osztály, Egyesített Szent István és Szent László Kórház Budapest, Albert Flórián út 5-7. 11/4A, 1097
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24
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Jakó B, Sinkó J. Case report. Role of the Methylene Tetrahydrofolate Reductase (MTHFR) Gene Mutation in Acute Myocardial Infarction. Journal Of Cardiovascular Emergencies 2017. [DOI: 10.1515/jce-2017-0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
This is a case report of a 36-year-old male who was diagnosed with acute inferior and right ventricular myocardial infarction and treated with percutaneous coronary angioplasty with a drug-eluting stent in the right coronary artery. A profile test for thrombophilia was performed for methylene tetrahydrofolate reductase (MTHFR) gene mutation; the test was positive for a heterozygous mutation - C677C and 1298A. The patient received a long-term treatment with folic acid supplements, taken daily. This case report shows that medical doctors should have an outside-the-box approach for the diagnosis and therapeutic management of young patients who present with acute cardiovascular events. If the patient in question does not present clear cardiovascular risk factors for acute myocardial ischemia, the clinician should seek for possible causes, thus leading to several benefits in the management and secondary prevention of such cases.
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Affiliation(s)
- Beáta Jakó
- Emergency County Hospital, Miercurea Ciuc , Romania
| | - János Sinkó
- Emergency County Hospital, Miercurea Ciuc , Romania
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25
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Sinkó J. [Invasive fungal infections in patients with haematological malignancies]. Magy Onkol 2017; 61:75-80. [PMID: 28273191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/04/2016] [Indexed: 06/06/2023]
Abstract
Invasive fungal diseases represent an ever changing field within infectology, profoundly affecting daily clinical activities of specialists in haematology. The dynamic development seen in oncohaematology creates novel risk groups of patients, consequently necessitating a re-evaluation of principles in antifungal therapy from time to time. Not even in 2017 may achievements of fungal diagnostics and therapy become a substitute for clinical thinking and adaptation of general guidelines according to local experience. For antifungal management all centres should elaborate appropriate strategies. By creating and operating a multidisciplinary team, decision making can effectively be supported.
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Affiliation(s)
- János Sinkó
- Hematológiai és Õssejt-transzplantációs Osztály, Egyesített Szent István és Szent László Kórház, Budapest, Hungary.
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26
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Sinkó J, Sulyok M, Denning DW. Burden of serious fungal diseases in Hungary. Mycoses 2016; 58 Suppl 5:29-33. [PMID: 26449504 DOI: 10.1111/myc.12385] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/18/2015] [Accepted: 05/20/2015] [Indexed: 12/11/2022]
Abstract
Valid data on the prevalence of serious fungal diseases are difficult to derive as in most countries these conditions are not reportable infections. To assess the burden of these infections in Hungary prevalence estimates from international peer-reviewed papers and population statistics were utilised. In the intensive care unit (ICU) population at least 370 cases of serious yeast and 52 mould infections can be expected yearly. The total number of candidaemia cases may be as high as 1110 annually. In patients with acute leukaemia and recipients of haematopoietic stem cell and solid organ transplants the predicted incidence is more than 55 every year. Recurrent vulvovaginal candidiasis--though not a life-threatening condition--can adversely affect the quality of life of more than 177,000 Hungarian women. According to organisation for economic co-operation and development (OECD), 4.7% of total population older than 15 will suffer from chronic obstructive pulmonary disease (COPD) and 4.4% from asthma, adding another very broad risk group to the aforementioned categories susceptible for mycotic complications. Here more than 17,000 can have severe asthma with fungal sensitisation (SAFS) and more than 13,000 are at risk for developing allergic bronchopulmonary aspergillosis (ABPA). The incidence of dermatomycoses and other superficial fungal infections is even more difficult to assess but--according to international estimations--can affect around 14.3% of the total population. More than 1.6 million Hungarians may suffer from fungal diseases annually, with 33,000 cases being life threatening or very serious. This is an under-recognised problem of special importance for public health.
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Affiliation(s)
- János Sinkó
- Szent István and Szent László Hospital, Budapest, Hungary
| | - Mihály Sulyok
- Szent István and Szent László Hospital, Budapest, Hungary
| | - David W Denning
- The University of Manchester, Manchester Academic Health Sciences Centre and the National Aspergillosis Centre, Manchester, UK
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27
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Erdélyi M, Sinkó J, Kákonyi R, Kelemen A, Rees E, Varga D, Szabó G. Origin and compensation of imaging artefacts in localization-based super-resolution microscopy. Methods 2015; 88:122-32. [PMID: 26036838 DOI: 10.1016/j.ymeth.2015.05.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 01/14/2015] [Revised: 04/10/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022] Open
Abstract
Interpretation of high resolution images provided by localization-based microscopy techniques is a challenge due to imaging artefacts that can be categorized by their origin. They can be introduced by the optical system, by the studied sample or by the applied algorithms. Some artefacts can be eliminated via precise calibration procedures, others can be reduced only below a certain value. Images studied both theoretically and experimentally are qualified either by pattern specific metrics or by a more general metric based on fluorescence correlation spectroscopy.
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Affiliation(s)
- M Erdélyi
- Department of Optics and Quantum Electronics, University of Szeged, Szeged, Dóm tér 9, 6720, Hungary.
| | - J Sinkó
- Department of Optics and Quantum Electronics, University of Szeged, Szeged, Dóm tér 9, 6720, Hungary
| | - R Kákonyi
- Department of Optics and Quantum Electronics, University of Szeged, Szeged, Dóm tér 9, 6720, Hungary
| | - A Kelemen
- Department of Applied Informatics, University of Szeged, Boldogasszony sgt. 6, 6725, Hungary
| | - E Rees
- Department of Chemical Engineering and Biotechnology, University of Cambridge, New Museums Site, Pembroke Street, Cambridge CB2 3RA, UK
| | - D Varga
- Department of Optics and Quantum Electronics, University of Szeged, Szeged, Dóm tér 9, 6720, Hungary
| | - G Szabó
- Department of Optics and Quantum Electronics, University of Szeged, Szeged, Dóm tér 9, 6720, Hungary
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28
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Kriván G, Szabó D, Kállay K, Benyó G, Kassa C, Sinkó J, Goda V, Arató A, Veres G. [Successful autologous haematopoietic stem cell transplantation in severe, therapy-resistant childhood Crohn's disease. Report on the first case in Hungary]. Orv Hetil 2014; 155:789-92. [PMID: 24819188 DOI: 10.1556/oh.2014.29892] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The biological therapy of Crohn's disease, such as infliximab is a powerful approach in the therapy of inflammatory bowel diseases. However, in some patients with aggressive disease course, even a combined immunosuppressive therapy will not result in permanent remission. Hematopoietic stem cell transplantation has emerged as a new potential therapeutic tool for inflammatory bowel diseases. The authors report the case of a 15-year-old boy with severe Crohn's disease resistant to combined immunosuppressive therapy. After a 3-years course of unsuccessful conventional therapy including infliximab, autologous hematopoietic stem cell transplantation was performed which resulted in a complete remission. One year after transplantation the patient has relapsed, but he could be treated effectively with conventional therapy regiments. To the best of knowledge of the authors, this is the first report in Hungary presenting hematopoietic stem cell therapy in patient with severe Crohn's disease.
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Affiliation(s)
- Gergely Kriván
- Egyesített Szent István és Szent László Kórház Budapest Albert Flórián u. 5-7. 1097
| | - Dolóresz Szabó
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Gyermekgyógyászati Klinika Budapest
| | - Krisztián Kállay
- Egyesített Szent István és Szent László Kórház Budapest Albert Flórián u. 5-7. 1097
| | - Gábor Benyó
- Egyesített Szent István és Szent László Kórház Budapest Albert Flórián u. 5-7. 1097
| | - Csaba Kassa
- Egyesített Szent István és Szent László Kórház Budapest Albert Flórián u. 5-7. 1097
| | - János Sinkó
- Egyesített Szent István és Szent László Kórház Budapest Albert Flórián u. 5-7. 1097
| | - Vera Goda
- Egyesített Szent István és Szent László Kórház Budapest Albert Flórián u. 5-7. 1097
| | - András Arató
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Gyermekgyógyászati Klinika Budapest
| | - Gábor Veres
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Gyermekgyógyászati Klinika Budapest
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29
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Akan H, Antia VP, Kouba M, Sinkó J, Tănase AD, Vrhovac R, Herbrecht R. Preventing invasive fungal disease in patients with haematological malignancies and the recipients of haematopoietic stem cell transplantation: practical aspects. J Antimicrob Chemother 2014; 68 Suppl 3:iii5-16. [PMID: 24155144 DOI: 10.1093/jac/dkt389] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Invasive fungal disease (IFD), predominantly aspergillosis, is associated with significant morbidity and mortality in immunocompromised patients, especially those with haematological malignancies and recipients of allogeneic haematopoietic stem cell transplantation. There has been a great deal of scientific debate as to the effectiveness of antifungal prophylaxis in preventing infection in different patient groups and in which patients it is an appropriate management option. Deciding on an appropriate prophylaxis regimen for IFD is challenging as the incidence varies among different patient groups, due to the varied nature of their underlying haematological disease, and in different regions and centres. Attempts have been made to define risk factors and include them in treatment protocols. Impaired immune status of the patient, especially neutropenia, is a key risk factor for IFD and can sometimes be related to specific polymorphisms of genes controlling innate immunity. Risk factors also vary according to the type of fungal pathogen. Consequently, prophylaxis needs to be tailored to individual patient groups. Furthermore, the choice of antifungal agent for prophylaxis depends on the potential for drug-drug interactions with the patients' concomitant medications. Additional challenges are optimal timing of antifungal prophylaxis, when to change from prophylaxis to antifungal treatment and how to prevent recurrence of IFD. This article considers the use of antifungal prophylaxis for patients at risk of IFD in daily clinical practice, with clinical profiles that may be distinct from those covered by guidelines, and aims to provide practical advice for treatment of these patient groups.
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Affiliation(s)
- Hamdi Akan
- Department of Hematology, Ankara University Medical Faculty, Ankara, Turkey
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Abstract
Twelve months after the WHO launched its global campaign to safeguard current antimicrobial medicines for future generations, antifungal stewardship initiatives were a major focus for the 2012 European Congress of Clinical Microbiology and Infectious Diseases, in London, UK. Speakers from Europe, North and South America and Asia reported significant variations in fungal epidemiology and resistance, and demonstrated the value of multidisciplinary infectious disease advisory teams in monitoring local trends and making recommendations about the most appropriate antifungal treatment.
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Affiliation(s)
- János Sinkó
- Department of Hematology & HSCT, St István & St László Hospital, 5–7 Gyáli u.,1097, Budapest, Hungary
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31
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Kállay K, Liptai Z, Benyó G, Kassa C, Goda V, Sinkó J, Tóth A, Kriván G. Successful unrelated umbilical cord blood transplantation in Lesch-Nyhan syndrome. Metab Brain Dis 2012; 27:193-6. [PMID: 22350962 DOI: 10.1007/s11011-012-9279-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 09/15/2011] [Accepted: 02/01/2012] [Indexed: 10/28/2022]
Abstract
Lesch-Nyhan syndrome (LNS) is a chronic, progressive neurodevelopmental disorder causing motor and behavioral dysfunction due to decreased synthesis of the enzyme hypoxantine-guanine phosphoribosyltransferase (HPRT). Affected boys have mental retardation, delayed development, extrapyramidal motor disturbances and self-injuring behavior. As hematopoietic stem cell transplantation (HSCT) has been shown to be effective in several neurodevelopmental inborn errors, we hypothesized that it could be favorable in LNS as well. Following a myeloablative conditioning regimen (busulphan 3.2 mg/kg/day for 4 days, cyclophosphamide 60 mg/kg/day for 2 days with ATG Thymoglobin 2.5 mg/kg/day for 4 days) an unrelated umbilical cord blood unit was transfused at the age of 2 years. The graft was a 6/6 HLA-matched at HLA-A, B loci by antigen level, and at DRB1 by allelic level typing. Infused total nucleated cell dose was 3.6 × 10e7 per kilogram body weight. Serum HPRT levels reached normal values by the end of the sixth month post transplant. Slow neurodevelopmental improvement seen during the three-year follow-up and the missing self-injuring behavior can be considered as a proof for the presence of enzyme-competent cells behind the blood-brain barrier.
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Affiliation(s)
- Krisztián Kállay
- Pediatric Hematology and Stem Cell Transplantation Unit, United St. István and St. László Hospital, Budapest, Hungary.
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32
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Sinkó J. [Treatment and prevention of infections in cancer patients with neutropenia]. Magy Onkol 2011; 55:155-163. [PMID: 21918740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 07/12/2011] [Indexed: 05/31/2023]
Abstract
Prognosis of malignant diseases is significantly influenced by infectious morbidity and mortality. Thus, up to date management of cancer patients, in addition to other supportive care modalities, should also incorporate diagnostic methods and therapy of infections. In order to improve outcome, patients developing febrile neutropenia following antitumour treatment should be adequately informed regarding the risk of infections. At the same time, centres responsible for cancer patient care should set up written protocols for basic workup and empirical antibiotic therapy. Here general characteristics of neutropenic infections developing in solid tumour patients are outlined and key points for risk assessment are highlighted. In addition, options and limits of anti-infective therapy as well as prophylaxis of infections are reviewed. Importance of a fully functional institutional infection control system and multidisciplinary patient management is also emphasised.
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Affiliation(s)
- János Sinkó
- Fõvárosi Önkormányzat Egyesített Szent István és Szent László Kórház - Rendelõintézet, Budapest, Hungary.
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Sinkó J, Cser V, Konkoly Thege M, Masszi T. Gram-negative bacteremia in neutropenic patients with hematologic disorders. Experiences with prophylactic use of fluoroquinolones. Orv Hetil 2011; 152:1063-7. [DOI: 10.1556/oh.2011.29150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Gram-negative bacteremia remains a severe complication of neutropenia with a high mortality rate. For high-risk patients prophylactic use of fluoroquinolones is recommended as a preventive strategy. Aims: To study the effect of fluoroquinolone prophylaxis on Gram-negative bacteremia. Methods: In the retrospective survey Gram-negative bacteremic episodes occurring in a centre for hematology and stem cell transplantation were studied. Data from the year before and after instituting prophylaxis were compared with regard to the incidence of blood stream infections, spectrum of pathogens, rate of fluoroquinolone resistance and all cause mortality of affected patient population. Results: Only a slight decrease in the incidence of Gram-negative bacteremia was seen (ARR: 0.024) after the introduction of fluoroquinolone prophylaxis. Spectrum of pathogens remained unchanged. However, the proportion of fluoroquinolone resistant Gram-negative isolates increased markedly (from 24% to 59%, p = 0.001), especially fluoroquinolone resistant E. coli strains became more prevalent (from 16% to 75%, p<0.001). All cause mortality at 7 and 30 days remained the same or increased insignificantly. Conclusions: With the current epidemiological background none of the expected benefits from the fluoroquinolone prophylaxis could be proven, whereas, the rate of fluoroquinolone resistance increased markedly. A reconsideration of present prophylactic strategies is suggested. Orv. Hetil., 2011, 152, 1063–1067.
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Affiliation(s)
- János Sinkó
- Fővárosi Önkormányzat Egyesített Szent István és Szent László Kórház-Rendelőintézet (ESZSZK) I. Belgyógyászat-Hematológiai Osztály Budapest Gyáli út 5–7. 1097
| | - Viktória Cser
- Fővárosi Önkormányzat Egyesített Szent István és Szent László Kórház-Rendelőintézet (ESZSZK) Mikrobiológiai Laboratórium Budapest
| | - Marianne Konkoly Thege
- Fővárosi Önkormányzat Egyesített Szent István és Szent László Kórház-Rendelőintézet (ESZSZK) Mikrobiológiai Laboratórium Budapest
| | - Tamás Masszi
- Fővárosi Önkormányzat Egyesített Szent István és Szent László Kórház-Rendelőintézet (ESZSZK) Hematológiai és Őssejt-transzplantációs Osztály Budapest
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Sinkó J, Bryan J. Managing invasive fungal infection in hematopoietic stem-cell transplantation. Future Microbiol 2010; 5:1309-14. [PMID: 20860477 DOI: 10.2217/fmb.10.88] [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: 11/21/2022] Open
Abstract
Reduced intensity conditioning regimens and a wider range of donor sources, including cord blood, mean that more patients can be offered potentially curative allogeneic hematopoietic stem cell transplantation than ever before. Although these modalities aim to reduce procedure-related morbidity and mortality, their potential benefit may be overshadowed by a changing spectrum of problems related to the immunocompromised status of affected patients. Acute or chronic extensive graft-versus-host disease, which occasionally emerges in the late post-transplant period, and prolonged neutropenia due to delayed engraftment still carry a substantial risk of invasive fungal and other infections. As a result, advances in antifungal prophylaxis and pre-emptive treatment were widely reported at the 36th Annual Meeting of the European Group for Blood and Marrow Transplantation attended this year by approximately 3800 delegates.
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Affiliation(s)
- János Sinkó
- St István & St László Hospital, Budapest, Hungary.
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Kriván G, Erdős M, Kállay K, Benyó G, Tóth Á, Sinkó J, Goda V, Tóth B, Maródi L. Successful umbilical cord blood stem cell transplantation in a child with WHIM syndrome. Eur J Haematol 2010; 84:274-5. [DOI: 10.1111/j.1600-0609.2009.01368.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Egyed M, Rajnics P, Kollár B, Sinkó J, Zsoldos E, Repa I. Severe hemolytic anemia and acute psychosis caused by Clostridium perfringens sepsis. Med Sci Monit 2008; 14:CS13-CS16. [PMID: 18301361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Clostridium perfringens septicaemia with massive hemolysis is well known. The infection induced acute hemolytic attack frequently occur in chronic corpuscular hemolytic anemias. Alterations in mental status are common in septic patients. CASE REPORT The case of a 39-year-old woman with a history of chronic corpuscular hemolytic anemia, experiencing weakness, pallor, somnolence is presented. Hypothermia and an acute paranoid psychotic episode subsequently developed in the hospital. C. perfringens sepsis was detected from blood cultures. The patient was cured by penicillin and clindamycin. Her symptoms disappeared and there was total resolution of toxic encephalopathy according to the brain MRI after 6 weeks. CONCLUSION This report discusses the possible explanation of clostridial sepsis the role of brain MRI in the sepsis-induced organic psychosyndromes and underlines the need for obtain blood cultures in hypothermia suggestive to sepsis.
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Affiliation(s)
- Miklós Egyed
- Department of Internal Medicine, Division of Hematology, Kaposi Mór Teaching Hospital, Hungary
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Csomor J, Sinkó J, Sápi Z, Ráthonyi E, Timár B, Fekete S. P072 Mediastinal germ cell tumor and acute myeloid leukemia. Blood Rev 2007. [DOI: 10.1016/s0268-960x(07)70150-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sinkó J. I12 Serious infections in onco-hematology and hematopoietic stem cell transplantation. Anti-infective treatment strategies. Blood Rev 2007. [DOI: 10.1016/s0268-960x(07)70013-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sinkó J, Csomor J, Nikolova R, Lueff S, Kriván G, Reményi P, Bátai A, Masszi T. Invasive fungal disease in allogeneic hematopoietic stem cell transplant recipients: an autopsy-driven survey. Transpl Infect Dis 2007; 10:106-9. [PMID: 17605727 DOI: 10.1111/j.1399-3062.2007.00264.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Invasive mycoses are pre-eminent causes of morbidity and mortality in the allogeneic stem cell transplant setting. In spite of novel diagnostic modalities, the timely and specific identification of invasive mycoses still remains challenging. We analyzed the case history of 97 consecutive patients receiving 103 allogeneic stem cell transplants between January 2003 and October 2006 performed by a single team at 2 transplant centers in Budapest, Hungary. All patients with febrile neutropenia not responding to broad-spectrum antibacterial therapy received amphotericin B deoxycholate empirically. In cases of proven or probable invasive aspergillosis, intravenous voriconazole was instituted. Patients who failed to improve on initial therapy were treated with an antifungal combination, while responders were switched to oral voriconazole. A total of 38 patients died following allografting. Both centers had an autopsy rate of 100% due to central health care regulations. An infectious cause of death could be identified in 15 cases, invasive fungal disease being the most prevalent and accounting for 10 fatalities. Six patients died of invasive aspergillosis, while invasive candidiasis and mucormycosis led to a fatal outcome in 2 cases each. Despite the regular use of galactomannan antigen detections and imaging, an ante mortem diagnosis of proven/probable invasive fungal disease could only be established in 4 of 10 autopsy-verified cases (aspergillosis: 3, candidiasis: 1, mucormycosis: 0). In the remaining 6 patients, deep mycoses were missed clinically and were revealed only by postmortem histology. Present diagnostic and therapeutic strategies still seem to be suboptimal for the management of invasive fungal diseases in the high-risk allogeneic stem cell transplant population.
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Affiliation(s)
- J Sinkó
- Department of Bone Marrow Transplantation, Szent László Hospital, Budapest, Hungary.
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Kriván G, Sinkó J, Nagy IZ, Goda V, Reményi P, Bátai A, Lueff S, Kapás B, Réti M, Tremmel A, Masszi T. Successful combined antifungal salvage therapy with liposomal amphothericin B and caspofungin for invasive Aspergillus flavus infection in a child following allogeneic bone marrow transplantation. Acta Biomed 2006; 77 Suppl 2:17-21. [PMID: 16918062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The emergence of new antifungal compounds with alternative mechanisms of action and improved tolerability has opened up new therapeutic possibilities for the use of combined antifungal treatment in life-threatening systemic fungal infections. A case report of an 8-year-old allogeneic stem cell transplant recipient who developed a central venous catheter tunnel infection caused by Aspergillus flavus is presented here. In spite of conventional and subsequent liposomal amphotericin B therapy the infection progressed rapidly and the necrosis extended further to the thoracic wall, pleura and the right lung. Combined treatment consisting of liposomal amphotericin B and caspofungin was instituted. After 30 days of dual therapy the deep fungal infection resolved and the extensive soft tissue defect showed scarring. One year post-transplant, the patient is well, with normal bone marrow function and full donor chimerism. Although there is limited clinical data on the effectiveness of echinocandins in pediatric patients with documented invasive fungal infections, this case report shows that combining liposomal amphotericin B with caspofungin could be advantageous.
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Affiliation(s)
- Gergely Kriván
- Bone Marrow Transplantation Unit, Szent László Hospital, Budapest, Hungary.
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Csomor J, Nikolova R, Sinkó J, Reményi P, Szabó Z. [Mucormycosis]. Orv Hetil 2004; 145:2507-13. [PMID: 15662750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Over recent years the clinical importance of invasive fungal infections has significantly increased. Mucormycosis refers to a rare, life threatening, opportunistic disease caused by filamentous fungi of the order Mucorales. Most frequently mucormycosis occurs in patients with ketoacidotic diabetes and in neutropenic patients with acute leukaemia. This study of fifteen patients was conducted to evaluate the clinical characteristics of invasive mucormycosis, and goal was also to propose for an early diagnosis and management as survival can only be improved by aggressive surgery and antifungal therapy. In a retrospective analysis of the biopsy and autopsy records of the Department of Pathology at Szent László Hospital between 1992-2003 were evaluated fifteen histologically documented cases of mucormycosis. The underlying diseases were hematological malignancy with neutropenia in ten cases, chronic leukaemia with neutropenia, chronic leukaemia with latent diabetes mellitus and diabetes mellitus one case each. Three cases did not belong to any typical risk group. An in vivo diagnosis was made only in four patients with a rhinocerebral manifestation. Radical necrectomy and long-term antifungal therapy cured two of them. Two patients died of a generalised infection despite therapy. None of the systemic infections could be cured. The diagnosis was made post mortem in eleven patients. Selected clinical forms of mucormycosis are illustrated with short case reports.
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Affiliation(s)
- Judit Csomor
- Fovárosi Szt. László Kórház, Patológiai Osztály, Budapest
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Sinkó J, Csomor J, Nikolova R. [Invasive fungal infection in malignant hematologic diseases]. Orv Hetil 1998; 139:409-12. [PMID: 9524423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In patients with hematological malignancies invasive mycoses occur frequently. In this retrospective study autopsy and histopathology material of 171 patients with hematological malignancy who had died between 1994 and 1996 at the 1st Department of Internal Medicine (Hematology), St. László Hospital, Budapest was analysed. In cases with invasive fungal infection post mortem results were compared to clinical and microbiological data. Through the three years' period an invasive mycosis could be confirmed in 33 patients by autopsy. Aspergillosis occurred in 21, candidiasis in 11, other fungal infections in 2 cases, a double infection was seen in 1 patient. The incidence was 19.2% (in invasive candidiasis: 6.4%, in aspergillosis 12.2%). Invasive aspergillosis most frequently was seen in the lung (71%), while candidiasis occurred mainly in the intestinal tract (42%). Cultures for mycology were collected from the autopsy material of 9 patients, of which 8 gave positive results. A previous fungal colonisation results was confirmed in 23 patients, but based on colonisation conclusions rarely could be driven concerning the species causing invasive infection. Sensitivity of Aspergillus antigen and antibody tests was 45 and 50%, respectively. Predisposing factors for invasive aspergillosis and candidiasis were similar, except for duration of neutropenia (24 vs. 12 days, p < 0.004). The antifungal drug most frequently used was amphotericin B. We observed a persisting infection in invasive pulmonary aspergillosis and chronic disseminated candidiasis in spite of the administration of a cumulative dosis of 1-2 g. Most frequently Aspergillus infections--primarily that of the lung--can be seen. Presence of invasive mycoses can usually be confirmed in vivo, but an early diagnosis still remains unsolved.
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Affiliation(s)
- J Sinkó
- I. Belgyógyászat (Haematologia), Fövárosi Szt. László Kórház Budapest
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