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Blanco Y, Escudero D, Lleixà C, Llufriu S, Egri N, García RR, Alba M, Aguilar E, Artola M, Aldea Novo M, Alvarez S, Caballero E, Cabrera-Maqueda JM, Fonseca E, Guasp M, Hernando A, Martinez-Hernandez E, Olivé-Cirera G, Lopez-Contreras J, Martín-Aguilar L, Martinez-Martinez L, Rombauts A, Rodés M, Sabater L, Sepulveda M, Solana E, Tejada-Illa C, Vidal-Fernández N, Vilella A, Fortuny C, Armangué T, Dalmau JO, Querol L, Saiz A. mRNA COVID-19 Vaccination Does Not Exacerbate Symptoms or Trigger Neural Antibody Responses in Multiple Sclerosis. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200163. [PMID: 37679040 PMCID: PMC10484689 DOI: 10.1212/nxi.0000000000200163] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/17/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND AND OBJECTIVE In people with multiple sclerosis (pwMS), concern for potential disease exacerbation or triggering of other autoimmune disorders contributes to vaccine hesitancy. We assessed the humoral and T-cell responses to SARS-CoV-2 after mRNA vaccination, changes in disease activity, and development of antibodies against central or peripheral nervous system antigens. METHODS This was a prospective 1-year longitudinal observational study of pwMS and a control group of patients with other inflammatory neurologic disorders (OIND) who received an mRNA vaccine. Blood samples were obtained before the first dose (T1), 1 month after the first dose (T2), 1 month after the second dose (T3), and 6 (T4), 9 (T5), and 12 (T6) months after the first dose. Patients were assessed for the immune-specific response, annualized relapse rate (ARR), and antibodies to onconeuronal, neural surface, glial, ganglioside, and nodo-paranodal antigens. RESULTS Among 454 patients studied, 390 had MS (22 adolescents) and 64 OIND; the mean (SD) age was 44 (14) years; 315 (69%) were female; and 392 (87%) were on disease-modifying therapies. Antibodies to the receptor-binding domain were detected in 367 (86%) patients at T3 and 276 (83%) at T4. After a third dose, only 13 (22%) of 60 seronegative patients seroconverted, and 255 (92%) remained seropositive at T6. Cellular responses were present in 381 (93%) patients at T3 and in 235 (91%) patients at T6 including all those receiving anti-CD20 therapies and in 79% of patients receiving fingolimod. At T3 (429 patients) or T6 (395 patients), none of the patients had developed CNS autoantibodies. Seven patients had neural antibodies that were already present before immunization (3 adult patients with MS had MOG-IgG, 2 with MG and 1 with MS had neuronal cell surface antibodies [unknown antigen], and 1 with MS had myelin antibody reactivity [unknown antigen]. Similarly, no antibodies against PNS antigens were identified at T3 (427 patients). ARR was lower in MS and not significantly different in patients with OIND. Although 182 (40%) patients developed SARS-CoV-2 infection, no cases of severe COVID-19 or serious adverse events occurred. DISCUSSION In this study, mRNA COVID-19 vaccination was safe and did not exacerbate the autoimmune disease nor triggered neural autoantibodies or immune-mediated neurologic disorders. The outcome of patients who developed SARS-CoV-2 infection was favorable.
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Affiliation(s)
- Yolanda Blanco
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Domingo Escudero
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Cinta Lleixà
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Sara Llufriu
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Natalia Egri
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Raquel Ruiz García
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Mercedes Alba
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Esther Aguilar
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Montse Artola
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Marta Aldea Novo
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Silvia Alvarez
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Eva Caballero
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Jose Maria Cabrera-Maqueda
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Elianet Fonseca
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Mar Guasp
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Ana Hernando
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Eugenia Martinez-Hernandez
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Gemma Olivé-Cirera
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Joaquin Lopez-Contreras
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Lorena Martín-Aguilar
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Laura Martinez-Martinez
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Alexander Rombauts
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Maria Rodés
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Lidia Sabater
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Maria Sepulveda
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Elisabeth Solana
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Clara Tejada-Illa
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Nuria Vidal-Fernández
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Anna Vilella
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Claudia Fortuny
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Thaís Armangué
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Josep O Dalmau
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Luis Querol
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Albert Saiz
- From the Neuroimmunology and Multiple Sclerosis Unit (Y.B., D.E., S.L., R.R.G., M.A., S.A., J.M.C.-M., M.G., A.H., E.M.-H., M.S., T.A., J.D., A.S.), Hospital Clinic de Barcelona, and Universitat de Barcelona; Neurommunology Program, Fundació de Recerca Clinic Barcelona-IDIBAPS (Y.B., S.L., R.R.G., M.A., E.A., M.A., E.C., J.M.C.-M., E.F., M.G., E.M.-H., G.O.-C., M.R., L.S., M.S., E.S., T.A., J.D., A.S.), Barcelona; Neuromuscular Diseases Unit, Neurology Department (C.L., L.M.-A., C.T.-I., N.V.-F., L.Q.), Hospital de Sant Pau, Barcelona; Centro para la Investigación en Red en Enfermedades Raras (CIBERER) (C.L., M.G., C.T.-I., J.D., L.Q.), Madrid; Department of Immunology (N.E., R.R.G.), Hospital Clinic de Barcelona; Department of Preventive Medicine and Epidemiology (M.A., A.V.), Hospital Clinic de Barcelona, Spain; Department of Neurology (E.F.), School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Barcelona; Infectious Diseases Unit, Department of Internal Medicine, (J.L.-C., A.R.) Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Immunology Department (L.M.-M.), Sant Pau, Institut de Recerca del Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona; Department of Pediatrics, and Infectious Diseases Department (C.F.), Institut de Recerca Pediàtrica Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona; Pediatric Neuroimmunology Unit, Department of Neurology (S.J.D.), Sant Joan de Déu Children´s Hospital (T.A), University of Barcelona, Spain; Department of Neurology, (J.D.) Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
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García-García A, Pérez de Diego R, Flores C, Rinchai D, Solé-Violán J, Deyà-Martínez À, García-Solis B, Lorenzo-Salazar JM, Hernández-Brito E, Lanz AL, Moens L, Bucciol G, Almuqamam M, Domachowske JB, Colino E, Santos-Perez JL, Marco FM, Pignata C, Bousfiha A, Turvey SE, Bauer S, Haerynck F, Ocejo-Vinyals JG, Lendinez F, Prader S, Naumann-Bartsch N, Pachlopnik Schmid J, Biggs CM, Hildebrand K, Dreesman A, Cárdenes MÁ, Ailal F, Benhsaien I, Giardino G, Molina-Fuentes A, Fortuny C, Madhavarapu S, Conway DH, Prando C, Schidlowski L, Martínez de Saavedra Álvarez MT, Alfaro R, Rodríguez de Castro F, Meyts I, Hauck F, Puel A, Bastard P, Boisson B, Jouanguy E, Abel L, Cobat A, Zhang Q, Casanova JL, Alsina L, Rodríguez-Gallego C. Humans with inherited MyD88 and IRAK-4 deficiencies are predisposed to hypoxemic COVID-19 pneumonia. J Exp Med 2023; 220:e20220170. [PMID: 36880831 PMCID: PMC9998661 DOI: 10.1084/jem.20220170] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 11/11/2022] [Accepted: 01/30/2023] [Indexed: 03/08/2023] Open
Abstract
X-linked recessive deficiency of TLR7, a MyD88- and IRAK-4-dependent endosomal ssRNA sensor, impairs SARS-CoV-2 recognition and type I IFN production in plasmacytoid dendritic cells (pDCs), thereby underlying hypoxemic COVID-19 pneumonia with high penetrance. We report 22 unvaccinated patients with autosomal recessive MyD88 or IRAK-4 deficiency infected with SARS-CoV-2 (mean age: 10.9 yr; 2 mo to 24 yr), originating from 17 kindreds from eight countries on three continents. 16 patients were hospitalized: six with moderate, four with severe, and six with critical pneumonia, one of whom died. The risk of hypoxemic pneumonia increased with age. The risk of invasive mechanical ventilation was also much greater than in age-matched controls from the general population (OR: 74.7, 95% CI: 26.8-207.8, P < 0.001). The patients' susceptibility to SARS-CoV-2 can be attributed to impaired TLR7-dependent type I IFN production by pDCs, which do not sense SARS-CoV-2 correctly. Patients with inherited MyD88 or IRAK-4 deficiency were long thought to be selectively vulnerable to pyogenic bacteria, but also have a high risk of hypoxemic COVID-19 pneumonia.
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Affiliation(s)
- Ana García-García
- Pediatric Allergy and Clinical Immunology Dept., Clinical Immunology and Primary Immunodeficiencies Unit, Hospital Sant Joan de Déu, Barcelona, Barcelona, Spain
- Study Group for Immune Dysfunction Diseases in Children, Institut de Recerca Sant Joan de Déu, Barcelona, Barcelona, Spain
- Clinical Immunology Unit, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - Rebeca Pérez de Diego
- Laboratory of Immunogenetics of Human Diseases, IdiPAZ Institute for Health Research, La Paz Hospital, Madrid, Spain
| | - Carlos Flores
- Genomics Division, Instituto Tecnológico y de Energías Renovables, Santa Cruz de Tenerife, Spain
- Research Unit, Hospital Universitario N.S. de Candelaria, Santa Cruz de Tenerife, Spain
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Dept. of Clinical Sciences, University Fernando Pessoa Canarias, Las Palmas de Gran Canaria, Spain
| | - Darawan Rinchai
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, USA
| | - Jordi Solé-Violán
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Dept. of Clinical Sciences, University Fernando Pessoa Canarias, Las Palmas de Gran Canaria, Spain
- Dept. of Intensive Care Medicine, University Hospital of Gran Canaria Dr. Negrin, Canarian Health System, Las Palmas de Gran Canaria, Spain
| | - Àngela Deyà-Martínez
- Pediatric Allergy and Clinical Immunology Dept., Clinical Immunology and Primary Immunodeficiencies Unit, Hospital Sant Joan de Déu, Barcelona, Barcelona, Spain
- Study Group for Immune Dysfunction Diseases in Children, Institut de Recerca Sant Joan de Déu, Barcelona, Barcelona, Spain
- Clinical Immunology Unit, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - Blanca García-Solis
- Laboratory of Immunogenetics of Human Diseases, IdiPAZ Institute for Health Research, La Paz Hospital, Madrid, Spain
| | - José M. Lorenzo-Salazar
- Genomics Division, Instituto Tecnológico y de Energías Renovables, Santa Cruz de Tenerife, Spain
| | - Elisa Hernández-Brito
- Dept. of Immunology, University Hospital of Gran Canaria Dr. Negrin, Canarian Health System, Las Palmas de Gran Canaria, Spain
| | - Anna-Lisa Lanz
- Dept. of Pediatrics, Division of Pediatric Immunology and Rheumatology, Dr. von Hauner Children’s Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Leen Moens
- Laboratory for Inborn Errors of Immunity, Dept. of Microbiology, Immunology and Transplantation KU Leuven, Leuven, Belgium
| | - Giorgia Bucciol
- Laboratory for Inborn Errors of Immunity, Dept. of Microbiology, Immunology and Transplantation KU Leuven, Leuven, Belgium
- Dept. of Pediatrics, Childhood Immunology, UZ Leuven, Leuven, Belgium
| | - Mohamed Almuqamam
- Dept. of Pediatrics, Drexel University College of Medicine, St Christopher’s Hospital for Children, Philadelphia, PA, USA
| | | | - Elena Colino
- Unidad de Enfermedades Infecciosas, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Juan Luis Santos-Perez
- Unidad de Gestión Clínica de Pediatría y Cirugía Pediátrica, Hospital Virgen de las Nieves-IBS, Granada, Spain
| | - Francisco M. Marco
- Dept. of Immunology, Alicante University General Hospital Doctor Balmis, Alicante, Spain
- Alicante Institute for Health and Biomedical Research, Alicante, Spain
| | - Claudio Pignata
- Dept. of Translational Medical Sciences, Section of Pediatrics, Federico II University, Naples, Italy
| | - Aziz Bousfiha
- Dept. of Pediatric Infectious Diseases and Clinical Immunology, Ibn Rushd University Hospital, Casablanca, Morocco
- Clinical Immunology, Autoimmunity and Inflammation Laboratory, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Stuart E. Turvey
- Dept. of Paediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, Canada
| | - Stefanie Bauer
- Clinic for Children and Adolescents. Dept. of Hematology and Oncology. University Clinic Erlangen, Erlangen, Germany
| | - Filomeen Haerynck
- Dept. of Pediatric Immunology and Pulmonology, Centre for Primary Immune Deficiency Ghent, Ghent University Hospital, Ghent, Belgium
- Dept. of Internal Medicine and Pediatrics, PID Research Laboratory, Ghent University, Ghent, Belgium
| | | | - Francisco Lendinez
- Dept. of Pediatric Oncohematology, Hospital Materno Infantil Torrecárdenas, Almería, Spain
| | - Seraina Prader
- Division of Immunology and Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | - Nora Naumann-Bartsch
- Clinic for Children and Adolescents. Dept. of Hematology and Oncology. University Clinic Erlangen, Erlangen, Germany
| | - Jana Pachlopnik Schmid
- Division of Immunology and Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | - Catherine M. Biggs
- Dept. of Paediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, Canada
| | - Kyla Hildebrand
- Dept. of Paediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, Canada
| | | | - Miguel Ángel Cárdenes
- Dept. of Internal Medicine, Unit of Infectious Diseases, University Hospital of Gran Canaria Dr. Negrin, Canarian Health System, Las Palmas de Gran Canaria, Spain
| | - Fatima Ailal
- Dept. of Pediatric Infectious Diseases and Clinical Immunology, Ibn Rushd University Hospital, Casablanca, Morocco
- Clinical Immunology, Autoimmunity and Inflammation Laboratory, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Ibtihal Benhsaien
- Dept. of Pediatric Infectious Diseases and Clinical Immunology, Ibn Rushd University Hospital, Casablanca, Morocco
- Clinical Immunology, Autoimmunity and Inflammation Laboratory, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Giuliana Giardino
- Dept. of Translational Medical Sciences, Section of Pediatrics, Federico II University, Naples, Italy
| | | | - Claudia Fortuny
- Study Group for Immune Dysfunction Diseases in Children, Institut de Recerca Sant Joan de Déu, Barcelona, Barcelona, Spain
- Pediatric Infectious Diseases Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Madrid, Spain; Translational Research Network in Pediatric Infectious Diseases, Madrid, Spain
- Dept. of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, University of Barcelona, Barcelona, Spain
| | - Swetha Madhavarapu
- Dept. of Pediatrics, Drexel University College of Medicine, St Christopher’s Hospital for Children, Philadelphia, PA, USA
| | - Daniel H. Conway
- Dept. of Pediatrics, Drexel University College of Medicine, St Christopher’s Hospital for Children, Philadelphia, PA, USA
| | - Carolina Prando
- Instituto de Pesquisa Pelé Pequeno Príncipe, Faculdades Pequeno Príncipe, Hospital Pequeno Príncipe, Curitiba, Brazil
| | - Laire Schidlowski
- Instituto de Pesquisa Pelé Pequeno Príncipe, Faculdades Pequeno Príncipe, Hospital Pequeno Príncipe, Curitiba, Brazil
| | | | - Rafael Alfaro
- Dept. of Immunology, University Hospital of Gran Canaria Dr. Negrin, Canarian Health System, Las Palmas de Gran Canaria, Spain
| | - Felipe Rodríguez de Castro
- Dept. of Medical and Surgical Sciences, School of Medicine, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Dept. of Respiratory Diseases, University Hospital of Gran Canaria Dr. Negrin, Canarian Health System, Las Palmas de Gran Canaria, Spain
| | - Isabelle Meyts
- Laboratory for Inborn Errors of Immunity, Dept. of Microbiology, Immunology and Transplantation KU Leuven, Leuven, Belgium
- Dept. of Pediatrics, Childhood Immunology, UZ Leuven, Leuven, Belgium
| | - Fabian Hauck
- Dept. of Pediatrics, Division of Pediatric Immunology and Rheumatology, Dr. von Hauner Children’s Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anne Puel
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, USA
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- University Paris Cité, Imagine Institute, Paris, France
| | - Paul Bastard
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, USA
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- University Paris Cité, Imagine Institute, Paris, France
- Pediatric Hematology and Immunology Unit, Department of Pediatrics, Necker Hospital for Sick Children, AP-HP, Paris, France
| | - Bertrand Boisson
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, USA
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- University Paris Cité, Imagine Institute, Paris, France
| | - Emmanuelle Jouanguy
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, USA
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- University Paris Cité, Imagine Institute, Paris, France
| | - Laurent Abel
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, USA
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- University Paris Cité, Imagine Institute, Paris, France
| | - Aurélie Cobat
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- University Paris Cité, Imagine Institute, Paris, France
| | - Qian Zhang
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, USA
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- University Paris Cité, Imagine Institute, Paris, France
| | - Jean-Laurent Casanova
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, USA
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- University Paris Cité, Imagine Institute, Paris, France
- Department of Pediatrics, Necker Hospital for Sick Children, Paris, France
- Howard Hughes Medical Institute, New York, NY, USA
| | - Laia Alsina
- Pediatric Allergy and Clinical Immunology Dept., Clinical Immunology and Primary Immunodeficiencies Unit, Hospital Sant Joan de Déu, Barcelona, Barcelona, Spain
- Study Group for Immune Dysfunction Diseases in Children, Institut de Recerca Sant Joan de Déu, Barcelona, Barcelona, Spain
- Clinical Immunology Unit, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
- Dept. of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, University of Barcelona, Barcelona, Spain
| | - Carlos Rodríguez-Gallego
- Dept. of Clinical Sciences, University Fernando Pessoa Canarias, Las Palmas de Gran Canaria, Spain
- Dept. of Immunology, University Hospital of Gran Canaria Dr. Negrin, Canarian Health System, Las Palmas de Gran Canaria, Spain
- Dept. of Medical and Surgical Sciences, School of Medicine, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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3
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Monzó-Gallo P, Chumbita M, Lopera C, Aiello TF, Peyrony O, Bodro M, Herrera S, Sempere A, Fernández-Pittol M, Cuesta G, Simó S, Benegas M, Fortuny C, Mensa J, Soriano A, Puerta-Alcalde P, Marco F, Garcia-Vidal C. Real-life epidemiology and current outcomes of hospitalized adults with invasive fungal infections. Med Mycol 2023; 61:7067261. [PMID: 36861308 DOI: 10.1093/mmy/myad021] [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: 12/21/2022] [Revised: 02/07/2023] [Accepted: 02/28/2023] [Indexed: 03/03/2023] Open
Abstract
We aimed to describe the current epidemiology of both hosts with invasive fungal infections (IFIs) and causative fungi. And, detail outcomes of these infections at 12 weeks in a real-life cohort of hospitalized patients. The study was retrospective and observational to describe IFI diagnosed in a tertiary hospital (February 2017-December 2021). We included all consecutive patients meeting criteria for proven or probable IFI according to EORTC-MSG and other criteria. A total of 367 IFIs were diagnosed. 11.7% were breakthrough infections, and 56.4% were diagnosed in the intensive care unit. Corticosteroid use (41.4%) and prior viral infection (31.3%) were the most common risk factors for IFI. Lymphoma and pneumocystis pneumonia were the most common baseline and fungal diseases. Only 12% of IFI occurred in patients with neutropenia. Fungal cultures were the most important diagnostic tests (85.8%). The most frequent IFIs were candidemia (42.2%) and invasive aspergillosis (26.7%). Azole-resistant Candida strains and non-fumigatus Aspergillus infections represented 36.1% and 44.5% of the cases, respectively. Pneumocystosis (16.9%), cryptococcosis (4.6%), and mucormycosis (2.7%) were also frequent, as well as mixed infections (3.4%). Rare fungi accounted for 9.5% of infections. Overall, IFI mortality at 12 weeks was 32.2%; higher rates were observed for Mucorales (55.6%), Fusarium (50%), and mixed infections (60%). We documented emerging changes in both hosts and real-life IFI epidemiology. Physicians should be aware of these changes to suspect infections and be aggressive in diagnoses and treatments. Currently, outcomes for such clinical scenarios remain extremely poor.
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Affiliation(s)
- Patricia Monzó-Gallo
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Mariana Chumbita
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Carlos Lopera
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Tommaso Francesco Aiello
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Oliver Peyrony
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
- Emergency Department, Hôpital Saint Louis, Paris, France
| | - Marta Bodro
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Sabina Herrera
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Abiu Sempere
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Genoveva Cuesta
- Department of Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Silvia Simó
- Department of Pediatrics, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Mariana Benegas
- Department of Radiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Claudia Fortuny
- Department of Pediatrics, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Josep Mensa
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Pedro Puerta-Alcalde
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Francesc Marco
- Department of Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
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4
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García-García A, Fortuny C, Fumadó V, Jordan I, Ruiz-López L, González-Navarro EA, Egri N, Esteve-Solé A, Luo Y, Vlagea A, Cabedo MM, Launes C, Soler A, Codina A, Juan M, Pascal M, Deyà-Martínez A, Alsina L. Acute and long-term immune responses to SARS-CoV-2 infection in unvaccinated children and young adults with inborn errors of immunity. Front Immunol 2023; 14:1084630. [PMID: 36742319 PMCID: PMC9896004 DOI: 10.3389/fimmu.2023.1084630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/03/2023] [Indexed: 01/22/2023] Open
Abstract
Purpose To describe SARS-CoV-2 infection outcome in unvaccinated children and young adults with inborn errors of immunity (IEI) and to compare their specific acute and long-term immune responses with a sex-, age-, and severity-matched healthy population (HC). Methods Unvaccinated IEI patients up to 22 years old infected with SARS-CoV-2 were recruited along with a cohort of HC. SARS-CoV-2 serology and ELISpot were performed in the acute phase of infection (up to 6 weeks) and at 3, 6, 9, and 12 months. Results Twenty-five IEI patients (median age 14.3 years, min.-max. range 4.5-22.8; 15/25 males; syndromic combined immunodeficiencies: 48.0%, antibody deficiencies: 16.0%) and 17 HC (median age 15.3 years, min.-max. range 5.4-20.0; 6/17 males, 35.3%) were included. Pneumonia occurred in 4/25 IEI patients. In the acute phase SARS-CoV-2 specific immunoglobulins were positive in all HC but in only half of IEI in whom it could be measured (n=17/25): IgG+ 58.8% (10/17) (p=0.009); IgM+ 41.2% (7/17)(p<0.001); IgA+ 52.9% (9/17)(p=0.003). Quantitative response (index) was also lower compared with HC: IgG IEI (3.1 ± 4.4) vs. HC (3.5 ± 1.5)(p=0.06); IgM IEI (1.9 ± 2.4) vs. HC (3.9 ± 2.4)(p=0.007); IgA IEI (3.3 ± 4.7) vs. HC (4.6 ± 2.5)(p=0.04). ELISpots positivity was qualitatively lower in IEI vs. HC (S-ELISpot IEI: 3/11, 27.3% vs. HC: 10/11, 90.9%; p=0.008; N-ELISpot IEI: 3/9, 33.3% vs. HC: 11/11, 100%; p=0.002) and also quantitatively lower (S-ELISpot IEI: mean index 3.2 ± 5.0 vs. HC 21.2 ± 17.0; p=0.001; N-ELISpot IEI: mean index 9.3 ± 16.6 vs. HC: 39.1 ± 23.7; p=0.004). As for long term response, SARS-CoV-2-IgM+ at 6 months was qualitatively lower in IEI(3/8, 37.5% vs. 9/10 HC: 90.0%; p=0.043), and quantitatively lower in all serologies IgG, M, and A (IEI n=9, 1.1 ± 0.9 vs. HC n=10, 2.1 ± 0.9, p=0.03; IEI n=9, 1.3 ± 1.5 vs. HC n=10, 2.9 ± 2.8, p=0.02; and IEI n=9, 0.6 ± 0.5 vs. HC n=10, 1.7 ± 0.8, p=0.002 -respectively) but there were no differences at remaining time points. Conclusions Our IEI pediatric cohort had a higher COVID-19 pneumonia rate than the general age-range population, with lower humoral and cellular responses in the acute phase (even lower compared to the reported IEI serological response after SARS-CoV-2 vaccination), and weaker humoral responses at 6 months after infection compared with HC.
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Affiliation(s)
- Ana García-García
- Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain.,Department of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - Claudia Fortuny
- Department of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,Paediatric Infectious Diseases Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,CIBER of Epidemiology and Public Health, Madrid, Spain.,Translational Research Network in Paediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Victoria Fumadó
- Department of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,Paediatric Infectious Diseases Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,CIBER of Epidemiology and Public Health, Madrid, Spain.,Translational Research Network in Paediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Iolanda Jordan
- Department of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Translational Research Network in Paediatric Infectious Diseases (RITIP), Madrid, Spain.,Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Laura Ruiz-López
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain.,Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Natalia Egri
- Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Ana Esteve-Solé
- Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain.,Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - Yiyi Luo
- Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain.,Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - Alexandru Vlagea
- Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain.,Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Manel Monsonís Cabedo
- Department of Microbiology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Cristian Launes
- Department of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,Paediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain.,Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Aleix Soler
- Paediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Anna Codina
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Pathology Department and Biobank Department, Hospital Sant Joan de Deu, Esplugues de Llobregat, Barcelona, Spain
| | - Manel Juan
- Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain.,Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Immunotherapy Platform, Hospital Sant Joan de Déu-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Mariona Pascal
- Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain.,Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Spanish Network for Allergy - RETIC de Asma, Reacciones Adversas y Alérgicas (ARADYAL), Madrid, Spain
| | - Angela Deyà-Martínez
- Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain.,Department of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - Laia Alsina
- Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain.,Department of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain.,Immunotherapy Platform, Hospital Sant Joan de Déu-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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5
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Mele-Casas M, Launes C, de Sevilla MF, Hernandez-Garcia M, Pons-Tomas G, Bassat Q, Fumado V, Fortuny C, Garcia-Miquel A, Bonet-Carne E, Prats C, Ajanovic S, Cubells M, Claverol J, Penela-Sanchez D, Jou C, Arias S, Balanza N, Baro B, Millat-Martinez P, Alonso S, Alvarez-Lacalle E, Catala M, Cuadras D, Muñoz-Almagro C, Gratacos E, Jordan I, Garcia-Garcia JJ. Low transmission of SARS-CoV-2 derived from children in family clusters: An observational study of family households in the Barcelona Metropolitan Area, Spain. PLoS One 2022; 17:e0277754. [PMID: 36395194 PMCID: PMC9671318 DOI: 10.1371/journal.pone.0277754] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 11/02/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Family clusters offer a good opportunity to study viral transmission in a stable setting. We aimed to analyze the specific role of children in transmission of SARS-CoV-2 within households. METHODS A prospective, longitudinal, observational study, including children with documented acute SARS-CoV-2 infection attending 22 summer-schools in Barcelona, Spain, was performed. Moreover, other patients and families coming from other school-like environments that voluntarily accessed the study were also studied. A longitudinal follow-up (5 weeks) of the family clusters was conducted to determine whether the children considered to be primary cases were able to transmit the virus to other family members. The household reproduction number (Re*) and the secondary attack rate (SAR) were calculated. RESULTS 1905 children from the summer schools were screened for SARS-CoV-2 infection and 22 (1.15%) tested positive. Moreover, 32 additional children accessed the study voluntarily. Of these, 37 children and their 26 households were studied completely. In half of the cases (13/26), the primary case was considered to be a child and secondary transmission to other members of the household was observed in 3/13, with a SAR of 14.2% and a Re* of 0.46. Conversely, the SAR of adult primary cases was 72.2% including the kids that gave rise to the contact tracing study, and 61.5% without them, and the estimated Re* was 2.6. In 4/13 of the paediatric primary cases (30.0%), nasopharyngeal PCR was persistently positive > 1 week after diagnosis, and 3/4 of these children infected another family member (p<0.01). CONCLUSIONS Children may not be the main drivers of the infection in household transmission clusters in the study population. A prolonged positive PCR could be associated with higher transmissibility.
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Affiliation(s)
- Maria Mele-Casas
- Pediatric Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Cristian Launes
- Pediatric Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Mariona F. de Sevilla
- Pediatric Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- * E-mail:
| | - Maria Hernandez-Garcia
- Pediatric Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Gemma Pons-Tomas
- Pediatric Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Quique Bassat
- Pediatric Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ICREA, Pg. Lluís Companys 23, Barcelona, Spain
| | - Victoria Fumado
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Claudia Fortuny
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Aleix Garcia-Miquel
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
| | - Elisenda Bonet-Carne
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Universitat Politècnica de Catalunya, BarcelonaTech, Barcelona, Spain
| | - Clara Prats
- Department of Physics, Computational Biology and Complex Systems (BIOCOM-SC), Universitat Politècnica de Catalunya, Castelldefels, Spain
| | - Sara Ajanovic
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Marta Cubells
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Fundació Sant Joan de Déu, Barcelona, Spain
| | - Joana Claverol
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Fundació Sant Joan de Déu, Barcelona, Spain
| | - Daniel Penela-Sanchez
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Cristina Jou
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Department of Pathology and Biobank, Hospital Sant Joan de Déu, Barcelona, Spain
- CIBERER, Instituto de Salud Carlos III, Barcelona, Spain
| | - Sara Arias
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Nuria Balanza
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Barbara Baro
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | | | - Sergio Alonso
- Department of Physics, Computational Biology and Complex Systems (BIOCOM-SC), Universitat Politècnica de Catalunya, Castelldefels, Spain
| | - Enric Alvarez-Lacalle
- Department of Physics, Computational Biology and Complex Systems (BIOCOM-SC), Universitat Politècnica de Catalunya, Castelldefels, Spain
| | - Marti Catala
- Centre for Comparative Medicine and Bioimage (CMCiB), Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Daniel Cuadras
- Statistics Department, Fundació Sant Joan de Déu, Barcelona, Spain
| | - Carmen Muñoz-Almagro
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Eduard Gratacos
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- CIBERER, Instituto de Salud Carlos III, Barcelona, Spain
| | - Iolanda Jordan
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Juan Jose Garcia-Garcia
- Pediatric Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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6
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Mensa-Vilaró A, Vicente A, Español-Rego M, Antón J, Fabregat V, Fortuny C, González EA, Fumadó V, González-Roca E, Jou C, Plaza S, Mosquera JM, Yagüe J, Prat C, Pascal M, Juan M, Arostegui JI, Baselga E, Alsina L. Chilblains outbreak during COVID-19 pandemic: A Type-I interferonopathy? Pediatr Allergy Immunol 2022; 33:e13860. [PMID: 36282139 PMCID: PMC9874765 DOI: 10.1111/pai.13860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 09/05/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Anna Mensa-Vilaró
- Department of Immunology, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Asunción Vicente
- Department of Dermatology, Hospital Sant Joan de Déu, Esplugues, Spain
| | | | - Jordi Antón
- Department of Rheumatology, Hospital Sant Joan de Déu, Esplugues, Spain.,School of Medicine, Universitat de Barcelona, Barcelona, Spain.,Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - Claudia Fortuny
- Department of Pediatrics, Infectious Disease Unit, Hospital Sant Joan de Déu, Esplugues, Spain
| | | | - Victoria Fumadó
- Department of Pediatrics, Infectious Disease Unit, Hospital Sant Joan de Déu, Esplugues, Spain
| | | | - Cristina Jou
- Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Hospital Sant Joan de Déu, Barcelona, Spain.,Pathology Department and Biobank, Hospital Sant Joan de Déu, Esplugues, Spain
| | - Susana Plaza
- Department of Immunology, Hospital Clínic, Barcelona, Spain
| | | | - Jordi Yagüe
- Department of Immunology, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Carolina Prat
- Department of Dermatology, Hospital Sant Joan de Déu, Esplugues, Spain
| | - Mariona Pascal
- Department of Immunology, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Manel Juan
- Department of Immunology, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Juan I Arostegui
- Department of Immunology, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Eulalia Baselga
- Department of Dermatology, Hospital Sant Joan de Déu, Esplugues, Spain
| | - Laia Alsina
- School of Medicine, Universitat de Barcelona, Barcelona, Spain.,Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Hospital Sant Joan de Déu, Barcelona, Spain.,Department of Allergy and Clinical Immunology, Clinical Immunology and Primary Immunodeficiencies Unit, Hospital Sant Joan de Déu, Esplugues, Spain.,Clinical Immunology Unit, Hospital Sant Joan de Déu-Hospital Clínic, Barcelona, Spain
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7
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Torres-Fernandez D, Jiménez de Ory S, Fortuny C, Sainz T, Falcón D, Bernal E, Jiménez MC, Vilasaró MN, Epalza C, Navarro M, Ramos JT, Holguín Á, Prieto L. Integrase inhibitors in children and adolescents: clinical use and resistance. J Antimicrob Chemother 2022; 77:2784-2792. [PMID: 35971971 DOI: 10.1093/jac/dkac259] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although integrase inhibitor (INI)-based regimens are now the first-line choice for all people living with HIV, experience among children and adolescents is still scarce. We describe the characteristics and outcomes of a paediatric/adolescent cohort on INI-based ART. METHODS Retrospective analysis of HIV-infected patients below 18 years of age who started an INI-based regimen from 2007 to 2019, enrolled in the Spanish National Adult (CoRIS) and Paediatric (CoRISpe) cohorts. Resistance mutations were identified by the Stanford HIV Drug Resistance Database. RESULTS Overall, 318 INI-based regimens were implemented in 288 patients [53.8% female; median age at start of 14.3 years (IQR 12.0-16.3)]. Most were born in Spain (69.1%), vertically infected (87.7%) and treatment-experienced (92.7%). The most frequently prescribed INI was dolutegravir (134; 42.1%), followed by raltegravir (110; 34.6%) and elvitegravir (73; 23.0%). The median exposure was 2.0 years (IQR 1.1-3.0). The main reasons to start an INI-based therapy were treatment simplification (54.4%) and virological failure (34.3%). In total, 103 (32.4%) patients interrupted their regimen: 14.5% for simplification and 8.5% due to virological failure. Most subjects who received dolutegravir (85.8%) and elvitegravir (83.6%) did not interrupt their regimen and maintained undetectable viral load. There were only five virological failures with dolutegravir and three with elvitegravir. There were no interruptions related to adverse events. Seven patients with virological failure presented major resistance mutations to INIs; none of them were on dolutegravir. CONCLUSIONS INI-based regimens were effective and safe for HIV treatment in children and adolescents. Dolutegravir and elvitegravir presented an excellent profile, and most patients achieved and maintained viral suppression.
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Affiliation(s)
- David Torres-Fernandez
- Paediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Instituto de Investigación imas12, Madrid, Spain.,Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Santiago Jiménez de Ory
- Instituto de Investigación Sanitaria Gregorio Marañón (IisGM), Hospital Gregorio Marañón, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Claudia Fortuny
- Department of Paediatric Infectious Diseases, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.,Red de Investigación Traslacional en Infectología Pediátrica (RITIP)
| | - Talía Sainz
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain.,Red de Investigación Traslacional en Infectología Pediátrica (RITIP).,Department of Paediatric Infectious Diseases, Hospital Universitario La Paz and La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain.,Universidad Autonoma de Madrid (UAM), Madrid, Spain
| | - Dolores Falcón
- Red de Investigación Traslacional en Infectología Pediátrica (RITIP).,Department of Paediatric Infectious Diseases, Rheumatology and Immunodeficiency, Hospital Virgen del Rocío, Seville, Spain
| | - Enrique Bernal
- Hospital General Universitario Reina Sofía, Murcia, Spain
| | | | | | - Cristina Epalza
- Paediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Instituto de Investigación imas12, Madrid, Spain.,Universidad Complutense de Madrid (UCM), Madrid, Spain.,Red de Investigación Traslacional en Infectología Pediátrica (RITIP)
| | - Marisa Navarro
- Instituto de Investigación Sanitaria Gregorio Marañón (IisGM), Hospital Gregorio Marañón, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain.,Red de Investigación Traslacional en Infectología Pediátrica (RITIP).,Paediatric Infectious Diseases Unit, Hospital Gregorio Marañón, Madrid, Spain
| | - José Tomás Ramos
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain.,Red de Investigación Traslacional en Infectología Pediátrica (RITIP).,Hospital Clínico San Carlos, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - África Holguín
- Red de Investigación Traslacional en Infectología Pediátrica (RITIP).,HIV-1 Molecular Epidemiology Laboratory, Microbiology Department, Hospital Universitario Ramón y Cajal-IRYCIS, Madrid, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Luis Prieto
- Paediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Instituto de Investigación imas12, Madrid, Spain.,Universidad Complutense de Madrid (UCM), Madrid, Spain.,Red de Investigación Traslacional en Infectología Pediátrica (RITIP)
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8
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Dobaño C, Alonso S, Vidal M, Jiménez A, Rubio R, Santano R, Barrios D, Pons Tomas G, Melé Casas M, Hernández García M, Girona-Alarcón M, Puyol L, Baro B, Millat-Martínez P, Ajanovic S, Balanza N, Arias S, Rodrigo Melero N, Carolis C, García-Miquel A, Bonet-Carné E, Claverol J, Cubells M, Fortuny C, Fumadó V, Codina A, Bassat Q, Muñoz-Almagro C, Fernández de Sevilla M, Gratacós E, Izquierdo L, García-García JJ, Aguilar R, Jordan I, Moncunill G. Multiplex Antibody Analysis of IgM, IgA and IgG to SARS-CoV-2 in Saliva and Serum From Infected Children and Their Close Contacts. Front Immunol 2022; 13:751705. [PMID: 35154094 PMCID: PMC8828491 DOI: 10.3389/fimmu.2022.751705] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 08/01/2021] [Accepted: 01/06/2022] [Indexed: 12/12/2022] Open
Abstract
COVID-19 affects children to a lesser extent than adults but they can still get infected and transmit SARS-CoV-2 to their contacts. Field deployable non-invasive sensitive diagnostic techniques are needed to evaluate the infectivity dynamics of SARS-CoV-2 in pediatric populations and guide public health interventions, particularly if this population is not fully vaccinated. We evaluated the utility of high-throughput Luminex assays to quantify saliva IgM, IgA and IgG antibodies against five SARS-CoV-2 spike (S) and nucleocapsid (N) antigens in a contacts and infectivity longitudinal study in 122 individuals (52 children and 70 adults). We compared saliva versus serum/plasma samples in infected children and adults diagnosed by weekly RT-PCR over 35 days (n=62), and those who consistently tested negative over the same follow up period (n=60), in the Summer of 2020 in Barcelona, Spain. Saliva antibody levels in SARS-CoV-2 RT-PCR positive individuals were significantly higher than in negative individuals and correlated with those measured in sera/plasmas. Asymptomatic infected individuals had higher levels of anti-S IgG than symptomatic individuals, suggesting a protective anti-disease role for antibodies. Higher anti-S IgG and IgM levels in serum/plasma and saliva, respectively, in infected children compared to infected adults could also be related to stronger clinical immunity in them. Among infected children, males had higher levels of saliva IgG to N and RBD than females. Despite overall correlation, individual clustering analysis suggested that responses that may not be detected in blood could be patent in saliva, and vice versa. In conclusion, measurement of SARS-CoV-2-specific saliva antibodies should be considered as a complementary non-invasive assay to serum/plasma to determine COVID-19 prevalence and transmission in pediatric populations before and after vaccination campaigns.
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Affiliation(s)
- Carlota Dobaño
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red (CIBER) de Enfermedades Infecciosas, Madrid, Spain
| | - Selena Alonso
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Marta Vidal
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Alfons Jiménez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Rocío Rubio
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Rebeca Santano
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Diana Barrios
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Gemma Pons Tomas
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Spain
| | - María Melé Casas
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Spain
| | - María Hernández García
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Spain
| | - Mònica Girona-Alarcón
- Institut de Recerca Sant Joan de Déu, Esplugues, Spain.,Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Laura Puyol
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Barbara Baro
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - Sara Ajanovic
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Núria Balanza
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Sara Arias
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Natalia Rodrigo Melero
- Biomolecular Screening and Protein Technologies Unit, Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Carlo Carolis
- Biomolecular Screening and Protein Technologies Unit, Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Aleix García-Miquel
- Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
| | - Elisenda Bonet-Carné
- Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Universitat Politècnica de Catalunya, BarcelonaTech, Barcelona, Spain
| | - Joana Claverol
- Institut de Recerca Sant Joan de Déu, Esplugues, Spain.,Fundació Sant Joan de Déu, Barcelona, Spain
| | - Marta Cubells
- Institut de Recerca Sant Joan de Déu, Esplugues, Spain.,Fundació Sant Joan de Déu, Barcelona, Spain
| | - Claudia Fortuny
- Institut de Recerca Sant Joan de Déu, Esplugues, Spain.,Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Victoria Fumadó
- Institut de Recerca Sant Joan de Déu, Esplugues, Spain.,Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Anna Codina
- Biobank Hospital Sant Joan de Déu, Barcelona, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Carmen Muñoz-Almagro
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut de Recerca Sant Joan de Déu, Esplugues, Spain.,Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain.,Molecular Microbiology Department, Hospital Sant Joan de Déu, Esplugues, Spain
| | - Mariona Fernández de Sevilla
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Spain.,Institut de Recerca Sant Joan de Déu, Esplugues, Spain
| | - Eduard Gratacós
- Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Center for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - Luis Izquierdo
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red (CIBER) de Enfermedades Infecciosas, Madrid, Spain
| | - Juan José García-García
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Spain.,Institut de Recerca Sant Joan de Déu, Esplugues, Spain
| | - Ruth Aguilar
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Iolanda Jordan
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut de Recerca Sant Joan de Déu, Esplugues, Spain.,Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Gemma Moncunill
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red (CIBER) de Enfermedades Infecciosas, Madrid, Spain
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9
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Dobaño C, Alonso S, Fernández de Sevilla M, Vidal M, Jiménez A, Pons Tomas G, Jairoce C, Melé Casas M, Rubio R, Hernández García M, Ruiz-Olalla G, Girona-Alarcón M, Barrios D, Santano R, Mitchell RA, Puyol L, Mayer L, Chi J, Rodrigo Melero N, Carolis C, Garcia-Miquel A, Bonet-Carne E, Claverol J, Cubells M, Fortuny C, Fumadó V, Jou C, Muñoz-Almagro C, Izquierdo L, Bassat Q, Gratacós E, Aguilar R, García-García JJ, Moncunill G, Jordan I. Antibody conversion rates to SARS-CoV-2 in saliva from children attending summer schools in Barcelona, Spain. BMC Med 2021; 19:309. [PMID: 34809617 PMCID: PMC8608564 DOI: 10.1186/s12916-021-02184-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/09/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Surveillance tools to estimate viral transmission dynamics in young populations are essential to guide recommendations for school opening and management during viral epidemics. Ideally, sensitive techniques are required to detect low viral load exposures among asymptomatic children. We aimed to estimate SARS-CoV-2 infection rates in children and adult populations in a school-like environment during the initial COVID-19 pandemic waves using an antibody-based field-deployable and non-invasive approach. METHODS Saliva antibody conversion defined as ≥ 4-fold increase in IgM, IgA, and/or IgG levels to five SARS-CoV-2 antigens including spike and nucleocapsid constructs was evaluated in 1509 children and 396 adults by high-throughput Luminex assays in samples collected weekly in 22 summer schools and 2 pre-schools in 27 venues in Barcelona, Spain, from June 29th to July 31st, 2020. RESULTS Saliva antibody conversion between two visits over a 5-week period was 3.22% (49/1518) or 2.36% if accounting for potentially cross-reactive antibodies, six times higher than the cumulative infection rate (0.53%) assessed by weekly saliva RT-PCR screening. IgG conversion was higher in adults (2.94%, 11/374) than children (1.31%, 15/1144) (p=0.035), IgG and IgA levels moderately increased with age, and antibodies were higher in females. Most antibody converters increased both IgG and IgA antibodies but some augmented either IgG or IgA, with a faster decay over time for IgA than IgG. Nucleocapsid rather than spike was the main antigen target. Anti-spike antibodies were significantly higher in individuals not reporting symptoms than symptomatic individuals, suggesting a protective role against COVID-19. CONCLUSION Saliva antibody profiling including three isotypes and multiplexing antigens is a useful and user-friendlier tool for screening pediatric populations to detect low viral load exposures among children, particularly while they are not vaccinated and vulnerable to highly contagious variants, and to recommend public health policies during pandemics.
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Affiliation(s)
- Carlota Dobaño
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalonia, Spain. .,CIBER de Enfermedades Infecciosas, Madrid, Spain. .,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | - Selena Alonso
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Mariona Fernández de Sevilla
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut de Recerca Sant Joan de Déu, Esplugues, Barcelona, Spain.,Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
| | - Marta Vidal
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Alfons Jiménez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalonia, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Gemma Pons Tomas
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
| | - Chenjerai Jairoce
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - María Melé Casas
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
| | - Rocío Rubio
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - María Hernández García
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
| | - Gemma Ruiz-Olalla
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Mònica Girona-Alarcón
- Institut de Recerca Sant Joan de Déu, Esplugues, Barcelona, Spain.,Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Diana Barrios
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Rebeca Santano
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Robert A Mitchell
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Laura Puyol
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Leonie Mayer
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Jordi Chi
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Natalia Rodrigo Melero
- Biomolecular Screening and Protein Technologies Unit, Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Carlo Carolis
- Biomolecular Screening and Protein Technologies Unit, Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Aleix Garcia-Miquel
- Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
| | - Elisenda Bonet-Carne
- Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Universitat Politècnica de Catalunya, BarcelonaTech, Barcelona, Spain
| | - Joana Claverol
- Institut de Recerca Sant Joan de Déu, Esplugues, Barcelona, Spain.,Fundació Sant Joan de Déu, Barcelona, Spain
| | - Marta Cubells
- Institut de Recerca Sant Joan de Déu, Esplugues, Barcelona, Spain.,Fundació Sant Joan de Déu, Barcelona, Spain
| | - Claudia Fortuny
- Institut de Recerca Sant Joan de Déu, Esplugues, Barcelona, Spain.,Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Victoria Fumadó
- Institut de Recerca Sant Joan de Déu, Esplugues, Barcelona, Spain.,Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Cristina Jou
- Institut de Recerca Sant Joan de Déu, Esplugues, Barcelona, Spain.,Department of Pathology and Biobank Hospital Sant Joan de Déu, Barcelona, Spain.,CIBERER, Instituto de Salud Carlos III, Barcelona, Spain
| | - Carmen Muñoz-Almagro
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut de Recerca Sant Joan de Déu, Esplugues, Barcelona, Spain.,Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain.,Molecular Microbiology Department, Hospital Sant Joan de Déu, Esplugues, Barcelona, Spain
| | - Luis Izquierdo
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalonia, Spain.,CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalonia, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain
| | - Eduard Gratacós
- Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Center for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - Ruth Aguilar
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Juan José García-García
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut de Recerca Sant Joan de Déu, Esplugues, Barcelona, Spain.,Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
| | - Gemma Moncunill
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalonia, Spain.,CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Iolanda Jordan
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. .,Institut de Recerca Sant Joan de Déu, Esplugues, Barcelona, Spain. .,Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.
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10
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Deyà-Martínez A, García-García A, Gonzalez-Navarro EA, Yiyi L, Vlagea A, Jordan I, Fumadó V, Fortuny C, Español M, Launes C, Esteve-Solé A, Juan M, Pascal M, Alsina L. COVID-19 in children and young adults with moderate/severe inborn errors of immunity in a high burden area in pre-vaccine era. Clin Immunol 2021; 230:108821. [PMID: 34391937 PMCID: PMC8359496 DOI: 10.1016/j.clim.2021.108821] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/02/2021] [Accepted: 08/06/2021] [Indexed: 12/24/2022]
Abstract
Background Information regarding inborn error of immunity (IEI) as a risk factor for severe COVID-19 is scarce. We aimed to determine if paediatric patients with moderate/severe IEI got COVID-19 at the same level as the general population, and to describe COVID-19 expression. Material and methods We included patients with moderate/severe IEI aged 0–21 years old: cross-sectional study (June2020) to determine the prevalence of COVID-19; prospective study (January2020-January2021) including IEI patients with COVID-19. Assays used: nasopharyngeal swab SARS-CoV-2 PCR and SARS-CoV-2-specific immunoglobulins. Results Seven from sixty-five patients tested positive (prevalence: 10.7% (7%–13%)) after the first SARS-COV-2 wave and 13/15 patients diagnosed with COVID-19 had an asymptomatic/mild course. Conclusions In our area, prevalence of COVID-19 in moderate/severe IEI paediatric patients after the first wave was slightly higher than in the general population. The majority of patients presented a benign course, suggesting a possible protective factor related with age despite IEI.
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Affiliation(s)
- A Deyà-Martínez
- Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain; Universitat de Barcelona, Spain; Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain.
| | - A García-García
- Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain; Universitat de Barcelona, Spain; Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - E A Gonzalez-Navarro
- Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain; Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - L Yiyi
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain; Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - A Vlagea
- Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain; Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - I Jordan
- Universitat de Barcelona, Spain; Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain; CIBER of Epidemiology and Public Health, Madrid, Spain
| | - V Fumadó
- Universitat de Barcelona, Spain; Paediatric Infectious Diseases Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - C Fortuny
- Universitat de Barcelona, Spain; Paediatric Infectious Diseases Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain; CIBER of Epidemiology and Public Health, Madrid, Spain; Translational Research Network in Paediatric Infectious Diseases (RITIP), Madrid, Spain
| | - M Español
- Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain; Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - C Launes
- Universitat de Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain; Paediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain; CIBER of Epidemiology and Public Health, Madrid, Spain
| | - A Esteve-Solé
- Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain; Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - M Juan
- Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain; Immunotherapy Platform, Hospital Sant Joan de Déu-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - M Pascal
- Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain; Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain; Spanish Network for Allergy - RETIC de Asma, Reacciones adversas y Alérgicas (ARADYAL), Madrid, Spain.
| | - L Alsina
- Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain; Universitat de Barcelona, Spain; Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain; Immunotherapy Platform, Hospital Sant Joan de Déu-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
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11
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Esteve-Sole A, Anton J, Pino-Ramirez RM, Sanchez-Manubens J, Fumadó V, Fortuny C, Rios-Barnes M, Sanchez-de-Toledo J, Girona-Alarcón M, Mosquera JM, Ricart S, Launes C, de Sevilla MF, Jou C, Muñoz-Almagro C, González-Roca E, Vergara A, Carrillo J, Juan M, Cuadras D, Noguera-Julian A, Jordan I, Alsina L. Similarities and differences between the immunopathogenesis of COVID-19-related pediatric multisystem inflammatory syndrome and Kawasaki disease. J Clin Invest 2021; 131:144554. [PMID: 33497356 DOI: 10.1172/jci144554] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/20/2021] [Indexed: 12/30/2022] Open
Abstract
Multisystem inflammatory syndrome associated with the SARS-CoV-2 pandemic has recently been described in children (MIS-C), partially overlapping with Kawasaki disease (KD). We hypothesized that (a) MIS-C and prepandemic KD cytokine profiles may be unique and justify the clinical differences observed, and (b) SARS-CoV-2-specific immune complexes (ICs) may explain the immunopathology of MIS-C. Seventy-four children were included: 14 with MIS-C, 9 patients positive for SARS-CoV-2 by PCR without MIS-C (COVID), 14 with prepandemic KD, and 37 healthy controls (HCs). Thirty-four circulating cytokines were quantified in pretreatment serum or plasma samples and the presence of circulating SARS-CoV-2 ICs was evaluated in MIS-C patients. Compared with HCs, the MIS-C and KD groups showed most cytokines to be significantly elevated, with IFN-γ-induced response markers (including IFN-γ, IL-18, and IP-10) and inflammatory monocyte activation markers (including MCP-1, IL-1α, and IL-1RA) being the main triggers of inflammation. In linear discriminant analysis, MIS-C and KD profiles overlapped; however, a subgroup of MIS-C patients (MIS-Cplus) differentiated from the remaining MIS-C patients in IFN-γ, IL-18, GM-CSF, RANTES, IP-10, IL-1α, and SDF-1 and incipient signs of macrophage activation syndrome. Circulating SARS-CoV-2 ICs were not detected in MIS-C patients. Our findings suggest a major role for IFN-γ in the pathogenesis of MIS-C, which may be relevant for therapeutic management.
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Affiliation(s)
- Ana Esteve-Sole
- Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu (HSJD), Barcelona, Spain.,Clinical Immunology Unit, HSJD-Hospital Clínic de Barcelona (HCB), Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Jordi Anton
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain.,Pediatric Rheumatology Department and
| | | | - Judith Sanchez-Manubens
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Pediatric Rheumatology Department and.,Pediatric Rheumatology Department, Hospital Parc Tauli, Sabadell, Spain
| | - Victoria Fumadó
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain.,Infectious Diseases Department, HSJD, Barcelona, Spain
| | - Claudia Fortuny
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain.,Infectious Diseases Department, HSJD, Barcelona, Spain.,CIBER of Epidemiology and Public Health, Madrid, Spain.,Translational Research Network in Paediatric Infectious Diseases (RITIP), Madrid, Spain
| | | | - Joan Sanchez-de-Toledo
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Cardiology Department, HSJD, Barcelona, Spain.,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Juan Manuel Mosquera
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Pediatric Rheumatology Department and
| | - Silvia Ricart
- Universitat de Barcelona, Barcelona, Spain.,Pediatrics Department, HSJD, Barcelona, Spain
| | - Cristian Launes
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain.,Pediatrics Department, HSJD, Barcelona, Spain.,CIBER of Epidemiology and Public Health, Madrid, Spain
| | | | - Cristina Jou
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Pathology Department and Biobank, HSJD, Barcelona, Spain.,Center for the Biomedical Research on Rare Diseases (CIBERER), ISCIII, Madrid, Spain
| | - Carmen Muñoz-Almagro
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,CIBER of Epidemiology and Public Health, Madrid, Spain.,Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain.,Molecular Microbiology Department, HSJD, Barcelona, Spain
| | - Eva González-Roca
- Molecular Biology Core, and.,Department of Immunology, El Centro de Diagnóstico Biomédico (CDB), HCB-IDIBAPS, Barcelona, Spain
| | - Andrea Vergara
- Molecular Biology Core, and.,Microbiology Department, CDB, HCB, Barcelona, Spain
| | - Jorge Carrillo
- IrsiCaixa AIDS Research Institute, Hospital Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Manel Juan
- Clinical Immunology Unit, HSJD-Hospital Clínic de Barcelona (HCB), Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain.,Department of Immunology, El Centro de Diagnóstico Biomédico (CDB), HCB-IDIBAPS, Barcelona, Spain
| | - Daniel Cuadras
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Statistical Department, Fundació Sant Joan de Déu, Barcelona, Spain
| | - Antoni Noguera-Julian
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain.,Infectious Diseases Department, HSJD, Barcelona, Spain.,CIBER of Epidemiology and Public Health, Madrid, Spain.,Translational Research Network in Paediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Iolanda Jordan
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain.,CIBER of Epidemiology and Public Health, Madrid, Spain.,Pediatric Intensive Care Unit, and
| | - Laia Alsina
- Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu (HSJD), Barcelona, Spain.,Clinical Immunology Unit, HSJD-Hospital Clínic de Barcelona (HCB), Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
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12
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Jordan I, de Sevilla MF, Fumado V, Bassat Q, Bonet-Carne E, Fortuny C, Garcia-Miquel A, Jou C, Adroher C, Casas MM, Girona-Alarcon M, Garcia MH, Tomas GP, Ajanovic S, Arias S, Balanza N, Baro B, Millat-Martinez P, Varo R, Alonso S, Álvarez-Lacalle E, López D, Claverol J, Cubells M, Brotons P, Codina A, Cuadras D, Bruijning-Verhagen P, Faust S, Munro A, Muñoz-Almagro C, Català M, Prats C, Garcia-Garcia JJ, Gratacós E. Transmission of SARS-CoV-2 infection among children in summer schools applying stringent control measures in Barcelona, Spain. Clin Infect Dis 2021; 74:66-73. [PMID: 33709138 PMCID: PMC7989514 DOI: 10.1093/cid/ciab227] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Understanding the role of children in SARS-CoV-2 transmission is critical to guide decision-making for schools in the pandemic. We aimed to describe the transmission of SARS-CoV-2 among children and adult staff in summer schools. METHODS During July 2020 we prospectively recruited children and adult staff attending summer schools in Barcelona who had SARS-CoV-2 infection. Primary SARS-CoV-2 infections were identified through: (1) surveillance program in 22 summer schools' of 1905 participants, involving weekly saliva sampling for SARS-CoV-2 RT-PCR during 2-5 weeks; (2)cases identified through the Catalonian Health Surveillance System of children diagnosed with SARS-CoV-2 infection by nasopharyngeal RT-PCR. All centres followed prevention protocols: bubble groups, hand washing, facemasks and conducting activities mostly outdoors. Contacts of a primary case within the same bubble were evaluated by nasopharyngeal RT-PCR. Secondary attack rates and effective reproduction number in summer schools(R*) were calculated. RESULTS Among the over 2000 repeatedly screened participants, 30children and 9adults were identified as primary cases. A total of 253 close contacts of these primary cases were studied (median 9 (IQR 5-10) for each primary case), among which twelve new cases (4.7%) were positive for SARS-CoV-2. The R* was 0.3, whereas the contemporary rate in the general population from the same areas in Barcelona was 1.9. CONCLUSIONS The transmission rate of SARS-CoV-2 infection among children attending school-like facilities under strict prevention measures was lower than that reported for the general population. This suggests that under preventive measures schools are unlikely amplifiers of SARS-CoV-2 transmission and supports current recommendations for school opening.
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Affiliation(s)
- Iolanda Jordan
- Paediatric Intensive Care Unit. Hospital Sant Joan de Déu, University of Barcelona. Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, University of Barcelona. Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Victoria Fumado
- Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Quique Bassat
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Pediatric Service. Hospital Sant Joan de Déu, University of Barcelona. Barcelona, Spain.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ICREA, Pg. Lluís Companys 23, 08010 Barcelona, Spain
| | - Elisenda Bonet-Carne
- BCNatal
- Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Universitat Politècnica de Catalunya • BarcelonaTech
| | - Claudia Fortuny
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Aleix Garcia-Miquel
- BCNatal
- Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
| | - Cristina Jou
- Institut de Recerca Sant Joan de Déu, University of Barcelona. Barcelona, Spain.,Department of Pathology and Biobank Hospital Sant Joan de Deu.,CIBERER, Instituto de Salud Carlos III. Barcelona, Spain
| | - Cristina Adroher
- Deputy Director of Strategic Planning and Management Control- Hospital Sant Joan de Déu (Barcelona)
| | - María Melé Casas
- Pediatric Service. Hospital Sant Joan de Déu, University of Barcelona. Barcelona, Spain
| | - Mònica Girona-Alarcon
- Paediatric Intensive Care Unit. Hospital Sant Joan de Déu, University of Barcelona. Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, University of Barcelona. Barcelona, Spain
| | | | - Gemma Pons Tomas
- Pediatric Service. Hospital Sant Joan de Déu, University of Barcelona. Barcelona, Spain
| | - Sara Ajanovic
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Sara Arias
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Núria Balanza
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Bárbara Baro
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Pere Millat-Martinez
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Rosauro Varo
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Sergio Alonso
- Computational Biology and Complex Systems (BIOCOM-SC). Department of Physics. Universitat Politècnica de Catalunya, Castelldefels, Spain
| | - Enric Álvarez-Lacalle
- Computational Biology and Complex Systems (BIOCOM-SC). Department of Physics. Universitat Politècnica de Catalunya, Castelldefels, Spain
| | - Daniel López
- Computational Biology and Complex Systems (BIOCOM-SC). Department of Physics. Universitat Politècnica de Catalunya, Castelldefels, Spain
| | - Joana Claverol
- Institut de Recerca Sant Joan de Déu, University of Barcelona. Barcelona, Spain.,Fundació Sant Joan de Déu, Barcelona, Spain
| | - Marta Cubells
- Institut de Recerca Sant Joan de Déu, University of Barcelona. Barcelona, Spain.,Fundació Sant Joan de Déu, Barcelona, Spain
| | - Pedro Brotons
- Institut de Recerca Sant Joan de Déu, University of Barcelona. Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Anna Codina
- Institut de Recerca Sant Joan de Déu, University of Barcelona. Barcelona, Spain.,Department of Pathology and Biobank Hospital Sant Joan de Deu
| | - Daniel Cuadras
- Statistics Department, Fundació Sant Joan de Déu, Barcelona, Spain
| | - Patricia Bruijning-Verhagen
- Julius Centre for Health Sciences, department of infectious diseases epidemiology, University Medical Center Utrecht
| | - Saul Faust
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital NHS Foundation Trust; and Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Alasdair Munro
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital NHS Foundation Trust; and Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Carmen Muñoz-Almagro
- Institut de Recerca Sant Joan de Déu, University of Barcelona. Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Martí Català
- Comparative Medicine and Bioimage Centre of Catalonia (CMCiB), Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Clara Prats
- Computational Biology and Complex Systems (BIOCOM-SC). Department of Physics. Universitat Politècnica de Catalunya, Castelldefels, Spain
| | - Juan José Garcia-Garcia
- Institut de Recerca Sant Joan de Déu, University of Barcelona. Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Pediatric Service. Hospital Sant Joan de Déu, University of Barcelona. Barcelona, Spain
| | - Eduard Gratacós
- BCNatal
- Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Center for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
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13
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Marbán-Castro E, Goncé A, Fumadó V, Martínez MJ, López M, García-Otero L, Salazar L, Esteve C, Salvia D, Fortuny C, Eixarch E, Fuente-Moreno M, Pinazo MJ, Oliveira I, Rodríguez-Valero N, Requena-Méndez A, Camprubí D, Saco A, Castillo P, Vázquez A, de Ory F, Navero-Castillejos J, Casellas A, González R, Muñoz J, Gascón J, Ordi J, Menéndez C, Bardají A. Zika virus infection in pregnant travellers and impact on childhood neurodevelopment in the first two years of life: A prospective observational study. Travel Med Infect Dis 2021; 40:101985. [PMID: 33601028 DOI: 10.1016/j.tmaid.2021.101985] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The emergence of Zika virus (ZIKV) represents a threat with consequences on maternal and children's health. We aimed to assess the clinical and epidemiological characteristics of pregnant women returning from ZIKV affected areas, and the effects of maternal ZIKV infection on birth outcomes and children's health. METHODS This was a hospital-based prospective observational study conducted at the Hospital Clínic of Barcelona and Hospital Sant Joan de Déu, Barcelona, Spain, from January 2016 to February 2020. RESULTS One hundred and ninety-five pregnant women who had travelled to ZIKV affected areas during pregnancy were recruited. Four women (2.1%) had a confirmed ZIKV infection, 40 women (20.5%) a probable infection, and 151 (77.4%) were negative for ZIKV. Among the ZIKV confirmed cases, a pregnant woman suffered a miscarriage, highly plausible to be associated with ZIKV infection. Brain cysts and microcalcifications were detected in 7% of fetuses or infants from women with confirmed or probable ZIKV infection. Neurodevelopmental delay in the language function was found in 33.3% out of the 21 children evaluated. CONCLUSIONS These findings contribute to the understanding of ZIKV prevalence estimates, and the impact of maternal ZIKV infection on pregnancy outcomes and children's health. Results highlight the importance of long-term surveillance in pregnant travellers and their children.
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Affiliation(s)
| | - Anna Goncé
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Victoria Fumadó
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Department of Tropical Pathology and Imported Diseases, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Miguel J Martínez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Department of Clinical Microbiology, Hospital Clínic, Barcelona, Spain
| | - Marta López
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Laura García-Otero
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Laura Salazar
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Carolina Esteve
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Dolors Salvia
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Claudia Fortuny
- Department of Tropical Pathology and Imported Diseases, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Elisenda Eixarch
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | | | - María Jesús Pinazo
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Inés Oliveira
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - Ana Requena-Méndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Department of Global Public Health, Karolinska Institutet, Sweden
| | - Daniel Camprubí
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Adela Saco
- Department of Pathology, Hospital Clínic, Barcelona, Spain
| | - Paola Castillo
- Department of Pathology, Hospital Clínic, Barcelona, Spain
| | - Ana Vázquez
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando de Ory
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Aina Casellas
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Raquel González
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - José Muñoz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Joaquim Gascón
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jaume Ordi
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Department of Global Public Health, Karolinska Institutet, Sweden
| | - Clara Menéndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Azucena Bardají
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
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14
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GarcÍa-Otero L, LÓpez M, GoncÉ A, Fortuny C, Salazar L, Valenzuela-Alcaraz B, Guirado L, CÉsar S, GratacÓs E, Crispi F. Cardiac remodeling and hypertension in HIV uninfected infants exposed in utero to antiretroviral therapy. Clin Infect Dis 2021; 73:586-593. [PMID: 33471090 DOI: 10.1093/cid/ciab030] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We aimed to assess the postnatal pattern of cardiovascular remodeling associated with intrauterine exposure to maternal HIV and antiretroviral treatment (ART). METHODS Prospective cohort including 34 HIV-exposed uninfected (HEU) infants and 53 non-HIV-exposed infants evaluated from fetal life up to 6 months postnatally. A cardiovascular evaluation was performed including echocardiography, blood pressure and carotid intima media thickness (cIMT) measurement. RESULTS ART regimens during pregnancy included two nucleoside reverse transcriptase inhibitors (Abacavir+Lamivudine (32.4%), Emtricitabine+Tenofovir (41.2%) and Zidovudine+Lamivudine (20.6%)). At 6 months of age, HIV-exposed uninfected infants showed thicker myocardial walls (septal wall thickness mean 5.02 mm (SD 0.85) vs 3.98 mm (0.86); p<0.001) and relative systolic dysfunction with decreased mitral ring displacement (8.57 mm (2.03) vs 10.34 mm (1.84); p=0.002) and decreased tricuspid S' (9.71 cm/s (1.94) vs 11.54 cm/s (2.07); p=0.003) together with relative diastolic dysfunction showed by prolonged left isovolumic relaxation time (58.57 ms (13.79) vs 47.94 (7.39); p<0.001). Vascular assessment showed significantly higher systolic and diastolic blood pressure (102 mmHg (16.1) vs 80 mmHg (13.9); p<0.001 and 64 mmHg (14.4) vs 55 mmHg (10.2); p=0.045 respectively), with 50% of HIV-exposed children meeting criteria for hypertension vs 3.77% of the non-HIV-exposed group (p<0.001) and thicker mean cIMT in the HIV-exposed group (0.62 µm (0.09) vs 0.51 µm (0.09); p=0.015). CONCLUSIONS Subclinical cardiac impairment together with higher blood pressure and thicker cIMT were observed in HIV-exposed infants at 6 months of age. Half of them presented hypertension. Our findings support a possible increased cardiovascular risk in HIV uninfected infants exposed in utero to ART.
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Affiliation(s)
- Laura GarcÍa-Otero
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Marta LÓpez
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Anna GoncÉ
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Claudia Fortuny
- Pediatric Infectious Diseases Department, Hospital Sant Joan de Déu Barcelona, University of Barcelona, Barcelona, Spain
| | - Laura Salazar
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Brenda Valenzuela-Alcaraz
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Laura Guirado
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Sergi CÉsar
- Department of Pediatric Cardiology, Hospital Sant Joan de Déu Barcelona, University of Barcelona, Barcelona, Spain
| | - Eduard GratacÓs
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Fátima Crispi
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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15
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Wolf J, Kalocsai K, Fortuny C, Lazar S, Bosis S, Korczowski B, Petit A, Bradford D, Croos-Dabrera R, Incera E, Melis J, van Maanen R. Safety and Efficacy of Fidaxomicin and Vancomycin in Children and Adolescents with Clostridioides (Clostridium) difficile Infection: A Phase 3, Multicenter, Randomized, Single-blind Clinical Trial (SUNSHINE). Clin Infect Dis 2020; 71:2581-2588. [PMID: 31773143 PMCID: PMC7744996 DOI: 10.1093/cid/ciz1149] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 11/26/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Fidaxomicin, a narrow-spectrum antibiotic approved for Clostridioides (Clostridium) difficile infection (CDI) in adults, is associated with lower rates of recurrence than vancomycin; however, pediatric data are limited. This multicenter, investigator-blind, phase 3, parallel-group trial assessed the safety and efficacy of fidaxomicin in children. METHODS Patients aged <18 years with confirmed CDI were randomized 2:1 to 10 days of treatment with fidaxomicin (suspension or tablets, twice daily) or vancomycin (suspension or tablets, 4 times daily). Safety assessments included treatment-emergent adverse events. The primary efficacy end point was confirmed clinical response (CCR), 2 days after the end of treatment (EOT). Secondary end points included global cure (GC; CCR without CDI recurrence) 30 days after EOT (end of study; EOS). Plasma and stool concentrations of fidaxomicin and its active metabolite OP-1118 were measured. RESULTS Of 148 patients randomized, 142 were treated (30 <2 years old). The proportion of participants with treatment-emergent adverse events was similar with fidaxomicin (73.5%) and vancomycin (75.0%). Of 3 deaths in the fidaxomicin arm during the study, none were CDI or treatment related. The rate of CCR at 2 days after EOT was 77.6% (76 of 98 patients) with fidaxomicin and 70.5% (31 of 44) with vancomycin, whereas the rate of GC at EOS was significantly higher in participants receiving fidaxomicin (68.4% vs 50.0%; adjusted treatment difference, 18.8%; 95% confidence interval, 1.5%-35.3%). Systemic absorption of fidaxomicin and OP-1118 was minimal, and stool concentrations were high. CONCLUSIONS Compared with vancomycin, fidaxomicin was well tolerated and demonstrated significantly higher rates of GC in children and adolescents with CDI. CLINICAL TRIALS REGISTRATION NCT02218372.
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Affiliation(s)
- Joshua Wolf
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Krisztina Kalocsai
- Gyermekinfektológia, Dél-pesti Centrumkórház Országos Haematológiai és Infektológiai Intézet, Budapest, Hungary
| | - Claudia Fortuny
- Department of Paediatric Infectious Diseases, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Stefan Lazar
- Department of Pediatrics, Clinical Hospital for Infectious and Tropical Diseases “Dr. Victor Babeș,” Bucharest, Romania
| | - Samantha Bosis
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Bartosz Korczowski
- Department of Pediatrics and Pediatric Gastroenterology, University of Rzeszów, Rzeszów, Poland
| | - Arnaud Petit
- Department of Pediatric Hematology and Oncology, Hôpital Trousseau, HUEP, APHP, Paris, France
- Faculty of Medicine, Sorbonne Université, UMRS 938, GRC MyPAC, Paris, France
| | | | | | | | - Joost Melis
- Astellas Pharma B.V., Leiden, the Netherlands
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16
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Goncé A, Hawkins-Villarreal A, Salazar L, Guirado L, Marcos MA, Pascual Mancho J, Prats P, López M, Eixarch E, Salvia MD, Fortuny C, Figueras F. Maternal high-dose valacyclovir and its correlation with newborn blood viral load and outcome in congenital cytomegalovirus infection. J Matern Fetal Neonatal Med 2020; 35:4004-4008. [PMID: 33143511 DOI: 10.1080/14767058.2020.1843016] [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: 10/23/2022]
Abstract
BACKGROUND/OBJECTIVE Currently, there is no validated treatment for fetal cytomegalovirus (CMV). Two studies suggest that high-dose maternal valacyclovir decreases fetal viral load and improves outcomes in moderately-symptomatic fetuses. We offered valacyclovir in cases of fetal infection lacking ultrasound abnormalities or with non-severe infection. Maternal tolerability, fetal outcome and newborn blood viral load were evaluated in pregnancies of mothers receiving valacyclovir. STUDY DESIGN We performed a case series including 8 pregnancies with fetal CMV classified as unaffected/mildly-moderately affected. Mothers received valacyclovir (8 g/24h) from fetal infection diagnosis to delivery. Standard newborn evaluation was performed, and viremia was determined in the first 48 h of life and compared according to length of maternal treatment and presence/absence of prenatal anomalies. RESULTS Valacyclovir was administered at a median gestational age of 26.5 weeks (23.8-33.1) in 3 cases without fetal abnormalities, and 5 with mild/moderate abnormalities. Three were 3 first trimester primary infections, one non-primary infection, and in 4 the type of infection was unknown. Valacyclovir was well-tolerated. Fetal features did not progress. Three newborns were asymptomatic, and one was severely affected (bilateral chorioretinitis). The median newborn viral load (IQR) was 502 IU/mL (231-191781) with lower levels when maternal treatment was administered ≥10 weeks, and in cases without fetal abnormalities [median 234 IU/mL (228-711) vs. 4061 (292-510500) p = .18; and 234 IU/mL (228-379500) vs. 711 IU/mL (292-4061) p = .65, respectively], these differences being non-significant. CONCLUSIONS Fetal CMV lesions remained stable with high-dose maternal valacyclovir. Newborn viral load was unchanged despite treatment duration and fetal/neonatal abnormalities. SUMMARY Fetal cytomegalovirus lesions remained stable with high-dose maternal valacyclovir. Newborn viral load was unchanged despite treatment duration and fetal/newborn abnormalities.
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Affiliation(s)
- Anna Goncé
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu). Institut Clínic de Ginecología, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.,Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain
| | - Ameth Hawkins-Villarreal
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu). Institut Clínic de Ginecología, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.,Fetal Medicine Service, Obstetrics Department, Hospital "Santo Tomás", University of Panama, Panama City, Panamá. On behalf of the Iberoamerican Research Network in Translational, Molecular and Maternal Fetal Medicine, Barcelona, Spain
| | - Laura Salazar
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu). Institut Clínic de Ginecología, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Laura Guirado
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu). Institut Clínic de Ginecología, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Maria-Angeles Marcos
- Department of Clinical Microbiology, Hospital Clinic, University of Barcelona; Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Jara Pascual Mancho
- Department of Obstetrics, Prenatal Diagnosis, Miguel Servet University Hospital, Zaragoza, Spain
| | - Pilar Prats
- Obstetrics Service, Department of Obstetrics, Gynaecology and Reproduction, Institut Universitari Dexeus, Barcelona, Spain
| | - Marta López
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu). Institut Clínic de Ginecología, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.,Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain
| | - Elisenda Eixarch
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu). Institut Clínic de Ginecología, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.,Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain
| | - Maria-Dolors Salvia
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu). Institut Clínic de Ginecología, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Claudia Fortuny
- Department of Pediatric Infectious Diseases, Hospital Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain
| | - Francesc Figueras
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu). Institut Clínic de Ginecología, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.,Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain
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17
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Melé M, Henares D, Pino R, Asenjo S, Matamoros R, Fumadó V, Fortuny C, García-García JJ, Jordan I, Brotons P, Muñoz-Almagro C, de-Sevilla MF, Launes C. Low impact of SARS-CoV-2 infection among paediatric acute respiratory disease hospitalizations. J Infect 2020; 82:414-451. [PMID: 33098956 PMCID: PMC7577222 DOI: 10.1016/j.jinf.2020.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 11/22/2022]
Abstract
Objective This study describes the characteristics of children requiring admission with an acute lower-respiratory disease (ALRD) during the SARS-CoV-2 pandemics. Methods Epidemiological, clinical, and microbiological data from patients with ALRD (pneumonia, bronchiolitis, bronchospasm) admitted to a reference paediatric hospital in Spain during the pandemic peak (week 11–20/2020) were prospectively analysed. Results 110 patients were included. 7 were SARS-CoV-2(+) and they were older in comparison to SARS-CoV-2(-). Among SARS-CoV-2(+) patients, pneumonia was the main clinical diagnosis (6/7) and bronchospasm was absent. Only 1 of 29 infants diagnosed with bronchiolitis was SARS-CoV-2(+). Lower values of leucocytes, lymphocytes, neutrophils, and platelets and higher values of creatinine were found in SARS-CoV-2(+). Human-rhinovirus/enterovirus was the main detection (11/32). There were not differences in PICU admission rates between SARS-CoV-2(+) and (-). Conclusions Most of the ALRD episodes identified during the pandemics were not related to SARS-CoV-2 infection. SARS-CoV-2 was mainly found causing pneumonia in older children.
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Affiliation(s)
- Maria Melé
- Paediatrics Department, Hospital Sant Joan de Déu (HSJD), Barcelona, Spain
| | | | - Rosa Pino
- Paediatrics Department, Hospital Sant Joan de Déu (HSJD), Barcelona, Spain
| | - Silvia Asenjo
- Paediatrics Department, Hospital Sant Joan de Déu (HSJD), Barcelona, Spain
| | - Rocío Matamoros
- Paediatrics Department, Hospital Sant Joan de Déu (HSJD), Barcelona, Spain
| | - Victoria Fumadó
- Paediatric Infectious Diseases Department, HSJD, Barcelona, Spain; University of Barcelona, Barcelona, Spain; Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Claudia Fortuny
- Paediatric Infectious Diseases Department, HSJD, Barcelona, Spain; University of Barcelona, Barcelona, Spain; Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Juan-José García-García
- Paediatrics Department, Hospital Sant Joan de Déu (HSJD), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Iolanda Jordan
- University of Barcelona, Barcelona, Spain; Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Paediatric Intensive Care Unit, HSJD, Barcelona, Spain
| | - Pedro Brotons
- Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Paediatric Intensive Care Unit, HSJD, Barcelona, Spain
| | - Carmen Muñoz-Almagro
- Molecular Microbiology Department, HSJD, Barcelona, Spain; Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Universitat Internacional de Catalunya, Barcelona, Spain
| | - Mariona-Fernández de-Sevilla
- Paediatrics Department, Hospital Sant Joan de Déu (HSJD), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Cristian Launes
- Paediatrics Department, Hospital Sant Joan de Déu (HSJD), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
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18
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Martín-Nalda A, Fortuny C, Rey L, Bunney TD, Alsina L, Esteve-Solé A, Bull D, Anton MC, Basagaña M, Casals F, Deyá A, García-Prat M, Gimeno R, Juan M, Martinez-Banaclocha H, Martinez-Garcia JJ, Mensa-Vilaró A, Rabionet R, Martin-Begue N, Rudilla F, Yagüe J, Estivill X, García-Patos V, Pujol RM, Soler-Palacín P, Katan M, Pelegrín P, Colobran R, Vicente A, Arostegui JI. Severe Autoinflammatory Manifestations and Antibody Deficiency Due to Novel Hypermorphic PLCG2 Mutations. J Clin Immunol 2020; 40:987-1000. [PMID: 32671674 PMCID: PMC7505877 DOI: 10.1007/s10875-020-00794-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/20/2020] [Indexed: 01/28/2023]
Abstract
Autoinflammatory diseases (AIDs) were first described as clinical disorders characterized by recurrent episodes of seemingly unprovoked sterile inflammation. In the past few years, the identification of novel AIDs expanded their phenotypes toward more complex clinical pictures associating vasculopathy, autoimmunity, or immunodeficiency. Herein, we describe two unrelated patients suffering since the neonatal period from a complex disease mainly characterized by severe sterile inflammation, recurrent bacterial infections, and marked humoral immunodeficiency. Whole-exome sequencing detected a novel, de novo heterozygous PLCG2 variant in each patient (p.Ala708Pro and p.Leu845_Leu848del). A clear enhanced PLCγ2 activity for both variants was demonstrated by both ex vivo calcium responses of the patient's B cells to IgM stimulation and in vitro assessment of PLC activity. These data supported the autoinflammation and PLCγ2-associated antibody deficiency and immune dysregulation (APLAID) diagnosis in both patients. Immunological evaluation revealed a severe decrease of immunoglobulins and B cells, especially class-switched memory B cells, with normal T and NK cell counts. Analysis of bone marrow of one patient revealed a reduced immature B cell fraction compared with controls. Additional investigations showed that both PLCG2 variants activate the NLRP3-inflammasome through the alternative pathway instead of the canonical pathway. Collectively, the evidences here shown expand APLAID diversity toward more severe phenotypes than previously reported including dominantly inherited agammaglobulinemia, add novel data about its genetic basis, and implicate the alternative NLRP3-inflammasome activation pathway in the basis of sterile inflammation.
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Affiliation(s)
- Andrea Martín-Nalda
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain
| | - Claudia Fortuny
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Pediatrics, Hospital Sant Joan de Deu, Esplugues, Spain
- Institut de Recerca Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Spain
| | - Lourdes Rey
- Department of Pediatrics, Hospital Alvaro Cunqueiro, Vigo, Spain
| | - Tom D Bunney
- Institute of Structural and Molecular Biology, University College London, London, UK
| | - Laia Alsina
- Institut de Recerca Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Spain
- Department of Allergy and Clinical Immunology Clinical Immunology and Primary, Immunodeficiencies Unit, Hospital Sant Joan de Déu, Esplugues, Spain
- Clinical Immunology Unit, Hospital Sant Joan de Déu-Hospital Clínic, Barcelona, Spain
| | - Ana Esteve-Solé
- Institut de Recerca Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Spain
- Department of Allergy and Clinical Immunology Clinical Immunology and Primary, Immunodeficiencies Unit, Hospital Sant Joan de Déu, Esplugues, Spain
- Clinical Immunology Unit, Hospital Sant Joan de Déu-Hospital Clínic, Barcelona, Spain
| | - Daniel Bull
- ARUK Drug Discovery Institute, University College London, London, UK
| | - Maria Carmen Anton
- Department of Immunology-CDB (esc 4-pl 0), Hospital Clínic, Villarroel, 170, 08036, Barcelona, Spain
| | - María Basagaña
- Allergy Section, Hospital Universitari Germans Trias i Pujol, Autonomous University of Barcelona, Badalona, Spain
| | - Ferran Casals
- Genomics Core Facility, Experimental and Health Sciences Department, Universitat Pompeu Fabra, Barcelona, Spain
| | - Angela Deyá
- Institut de Recerca Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Spain
- Department of Allergy and Clinical Immunology Clinical Immunology and Primary, Immunodeficiencies Unit, Hospital Sant Joan de Déu, Esplugues, Spain
- Clinical Immunology Unit, Hospital Sant Joan de Déu-Hospital Clínic, Barcelona, Spain
| | - Marina García-Prat
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain
| | - Ramon Gimeno
- Department of Immunology, Hospital del Mar, Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Manel Juan
- Department of Immunology-CDB (esc 4-pl 0), Hospital Clínic, Villarroel, 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Helios Martinez-Banaclocha
- Instituto Murciano de Investigación Biosanitaria IMIB-Arrixaca, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Juan J Martinez-Garcia
- Instituto Murciano de Investigación Biosanitaria IMIB-Arrixaca, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Anna Mensa-Vilaró
- Department of Immunology-CDB (esc 4-pl 0), Hospital Clínic, Villarroel, 170, 08036, Barcelona, Spain
| | - Raquel Rabionet
- Institut de Recerca Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Spain
- Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, IBUB, IRJSD, CIBERER, Barcelona, Spain
| | - Nieves Martin-Begue
- Department of Pediatric Ophthalmology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Francesc Rudilla
- Histocompatibility and Immunogenetics Laboratory, Blood and Tissue Bank, Barcelona, Spain
- Transfusional Medicine Group, Vall d'Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Jordi Yagüe
- Department of Immunology-CDB (esc 4-pl 0), Hospital Clínic, Villarroel, 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Xavier Estivill
- Quantitative Genomic Medicine Laboratories (qGenomics), Esplugues del Llobregat, Barcelona, Catalonia, Spain
| | - Vicente García-Patos
- Department of Pediatric Dermatology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Ramon M Pujol
- Department of Dermatology, Hospital del Mar, Institut Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain
- Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Matilda Katan
- Institute of Structural and Molecular Biology, University College London, London, UK
| | - Pablo Pelegrín
- Instituto Murciano de Investigación Biosanitaria IMIB-Arrixaca, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Roger Colobran
- Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain
- Immunology Division, Department of Clinical and Molecular Genetics, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
- Department of Cell Biology, Physiology and Immunology, Autonomous University of Barcelona, Barcelona, Spain
| | - Asun Vicente
- Department of Pediatric Dermatology, Hospital Sant Joan de Deu, Esplugues, Spain
| | - Juan I Arostegui
- Department of Immunology-CDB (esc 4-pl 0), Hospital Clínic, Villarroel, 170, 08036, Barcelona, Spain.
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
- School of Medicine, Universitat de Barcelona, Barcelona, Spain.
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19
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Carrasco I, Sainz T, Frick MA, Jiménez de Ory S, Fortuny C, Burgos J, Montero M, Gavilán C, Falcón MD, Couceiro JA, Bernardino JI, Bisbal O, Guerrero C, Aldámiz-Echevarría MT, Berenguer J, Navarro ML. Response to direct-acting antivirals for hepatitis C treatment in vertically HIV/HCV co-infected patients. J Viral Hepat 2020; 27:955-958. [PMID: 32347645 DOI: 10.1111/jvh.13308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 11/06/2019] [Revised: 03/23/2020] [Accepted: 04/05/2020] [Indexed: 12/13/2022]
Abstract
Direct-acting antivirals (DAAs) for HCV treatment have improved tolerance and efficacy among adults, but experience in vertical transmission is scarce. In our vertically HIV/HCV co-infected youth cohort of 58 patients, DAA achieved excellent rates of cure among naïve and pretreated individuals. Treating vertically infected seems important as 29.6% displayed advanced fibrosis at treatment initiation.
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Affiliation(s)
- Itzíar Carrasco
- Hospital General Universitario Gregorio Marañón and Gregorio Marañón Research Institute (IiSGM), Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Talía Sainz
- Hospital Universitario La Paz and La Paz Research Institute (IdiPAZ), Madrid, Spain
| | | | - Santiago Jiménez de Ory
- Hospital General Universitario Gregorio Marañón and Gregorio Marañón Research Institute (IiSGM), Madrid, Spain
| | | | | | - Marta Montero
- Hospital Universitario y Politécnico de La Fe, Valencia, Spain
| | - César Gavilán
- Hospital San Juan de Alicante, Sant Joan d'Alacant, Spain
| | | | | | | | | | | | | | - Juan Berenguer
- Hospital General Universitario Gregorio Marañón and Gregorio Marañón Research Institute (IiSGM), Madrid, Spain
| | - María Luisa Navarro
- Hospital General Universitario Gregorio Marañón and Gregorio Marañón Research Institute (IiSGM), Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
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20
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Fernández-McPhee C, Sainz T, Mellado MJ, Noguera-Julian A, Otero C, Fortuny C, Soler-Palacín P, Falcón MD, Ramos Amador JT, Gavilán C, González-Tomé MI, Navarro ML. Effect of Hepatitis C Virus Coinfection on the Progression of Vertically Acquired Human Immunodeficiency Virus Infection During Childhood and Adolescence. J Pediatric Infect Dis Soc 2020; 9:232-235. [PMID: 30929024 DOI: 10.1093/jpids/piz008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/25/2019] [Indexed: 11/13/2022]
Abstract
Data for a total of 57 patients vertically coinfected with human immunodeficiency virus (HIV)/hepatitis C virus (HCV) and 365 HIV-monoinfected patients were compared until their transition to adult care. No differences regarding the dynamics of CD4 and/or CD8 T-cell counts during childhood were found. The coexistence of HCV does not increase the risk of disease progression in vertically HIV-infected patients.
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Affiliation(s)
- Carolina Fernández-McPhee
- Departments of Pediatric Infectious Diseases, University Hospital Gregorio Marañón and Gregorio Marañón Research Institute (IiSGM), Madrid.,Spain Universidad Complutense de Madrid, Spain
| | - Talía Sainz
- Department of Pediatric Infectious Diseases, University Hospital La Paz and La Paz Research Institute (IdiPAZ), Madrid, Spain
| | - María José Mellado
- Department of Pediatrics, Universidad Autonoma de Madrid, Madrid, Spain.,Department of Pediatric Infectious Diseases, Universidad Autónoma de Madrid, Spain
| | - Antoni Noguera-Julian
- Unit of infectious Diseases and Systemic Inflammatory Response and Hospital Sant Joan de Déu Research Institute, Barcelona, Spain.,Department of Pediatrics, Universidad de Barcelona, Barcelona Spain.,CIBER in Epidemiology and Public Health, CIBERESP, Madrid, Spain
| | - Carmen Otero
- Department of Pediatric Infectious Diseases, University Hospital La Fe, Valencia, Spain
| | - Claudia Fortuny
- Unit of infectious Diseases and Systemic Inflammatory Response and Hospital Sant Joan de Déu Research Institute, Barcelona, Spain.,Department of Pediatrics, Universidad de Barcelona, Barcelona Spain.,CIBER in Epidemiology and Public Health, CIBERESP, Madrid, Spain
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - María Dolores Falcón
- Pediatric Infectious Diseases, Immunology and Rheumatology Unit, University Hospital Virgen del Rocío, Sevilla, Spain.,Pediatric Infectious Diseases, Immunology and Rheumatology Unit, Instituto de Biomedicina de Sevilla (IBiS), Spain
| | - José Tomás Ramos Amador
- Department of Pediatrics, Hospital Clinico San Carlos and Hospital Clinico San Carlos Research Institute, Madrid, Spain.,Department of Pediatrics, Universidad Complutense de Madrid, Madrid, Spain
| | - César Gavilán
- Department of Pediatrics, University Hospital Sant Joan d'Alacant, Alicante, Spain
| | | | - María Luisa Navarro
- Departments of Pediatric Infectious Diseases, University Hospital Gregorio Marañón and Gregorio Marañón Research Institute (IiSGM), Madrid.,Spain Universidad Complutense de Madrid, Spain
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21
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Romaní J, Baselga E, Mitjà O, Riera-Martí N, Garbayo P, Vicente A, Casals M, Fumadó V, Fortuny C, Calzado S. Chilblain and Acral Purpuric Lesions in Spain during Covid Confinement: Retrospective Analysis of 12 Cases. Actas Dermosifiliogr (Engl Ed) 2020; 111:426-429. [PMID: 32402369 PMCID: PMC7174170 DOI: 10.1016/j.ad.2020.04.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 11/03/2022] Open
Affiliation(s)
- J Romaní
- Departamento de Dermatología, Consorci Sanitari Parc Taulí, Sabadell, Barcelona, España.
| | - E Baselga
- Departamento de Dermatología, Hospital Sant Joan de Deu, Barcelona, España
| | - O Mitjà
- Enfermedades Infecciosas y Salud Global, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - N Riera-Martí
- Enfermedades Infecciosas y Salud Global, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - P Garbayo
- Departamento de Dermatología, Consorci Sanitari Parc Taulí, Sabadell, Barcelona, España
| | - A Vicente
- Departamento de Dermatología, Hospital Sant Joan de Deu, Barcelona, España
| | - M Casals
- Departamento de Dermatología, Consorci Sanitari Parc Taulí, Sabadell, Barcelona, España
| | - V Fumadó
- Departamento de Enfermedades Infecciosas, Hospital Sant Joan de Deu, Barcelona, España
| | - C Fortuny
- Departamento de Enfermedades Infecciosas, Hospital Sant Joan de Deu, Barcelona, España
| | - S Calzado
- Departamento de Enfermedades Infecciosas, Consorci Sanitari Parc Taulí, Sabadell, Barcelona, España
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22
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Sainz T, Fernández McPhee C, Domínguez-Rodríguez S, Hierro L, Mellado MJ, Fortuny C, Falcón MD, Soler-Palacín P, Rojo P, Ramos JT, Gavilán C, Guerrero C, Díaz MDC, Jara P, Navarro ML. Longitudinal evolution of vertically HIV/HCV-co-infected vs HCV-mono-infected children. J Viral Hepat 2020; 27:61-67. [PMID: 31515866 DOI: 10.1111/jvh.13206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/18/2019] [Accepted: 07/14/2019] [Indexed: 12/26/2022]
Abstract
HIV co-infection has been suggested to play a deleterious role on the pathogenesis of liver fibrosis among vertically HCV-infected children. The aim of this study was to describe the longitudinal evolution of vertically acquired HIV/HCV co-infection in youths, in comparison with HCV infection alone. This was a retrospective, multicentre study including vertically HIV/HCV-co-infected patients and age- and sex-matched vertically HCV-mono-infected patients. Progression to advanced liver fibrosis, defined as F3 or more by elastography or METAVIR biopsy staging, and response to treatment were compared by means of univariate and multivariate regression analyses and Cox regression models. Sixty-seven co-infected patients were compared with 67 matched HCV-mono-infected patients. No progression to advanced liver disease was observed during the first decade. At a median age of 20.0 [19.0, 22.0] years, 26.7% co-infected vs 20% mono-infected had progressed to advanced fibrosis (P = .617). Peg-IFN/RBV for HCV treatment was given to 37.9% vs 86.6% (P-value < .001). At treatment initiation, co-infected patients were older (16.9 ± 4.1 vs 11.7 ± 4.5 years, P < .001), and 47.1% vs 7.1% showed advanced fibrosis (P < .003), with no differences in hard-to-treat genotype distribution. Sustained viral response was comparable between groups (43.5% vs 44.0%, P = .122). In vertically HIV/HCV-co-infected patients, the progression to liver fibrosis was rare during childhood. At the end of adolescence, over 25% of patients displayed advanced liver disease. Response to Peg-IFN/RBV was poor and comparable in both groups, supporting the need for fast access to early treatment with direct-acting antivirals against HCV for vertically co-infected patients.
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Affiliation(s)
- Talia Sainz
- Department of Pediatric Infectious Diseases, University Hospital La Paz, and La Paz Research Institute (IdiPAZ), Madrid, Spain.,TRaslational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Carolina Fernández McPhee
- TRaslational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain.,Department of Pediatric Infectious Diseases, University Hospital Gregorio Marañón and Gregorio Marañón Research Institute (IiSGM), Universidad Complutense de Madrid, Madrid, Spain
| | - Sara Domínguez-Rodríguez
- Department of Pediatric Infectious Diseases, University Hospital Doce de Octubre, and Doce de Octubre Research Institute (I+12), Madrid, Spain
| | - Loreto Hierro
- Department of Pediatric Hepatology, University Hospital La Paz, and La Paz Research Institute (IdiPAZ), Madrid, Spain
| | - María José Mellado
- TRaslational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain.,Department of Pediatric Infectious Diseases, University Hospital La Paz, La Paz Research Institute (IdiPAZ) and Universidad Autónoma de Madrid, Madrid, Spain
| | - Claudia Fortuny
- TRaslational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain.,Pediatric Infectious Diseases and Sistemic Inflammatory Response Unit, Sant Joan de Déu Hospital, University of Barcelona, Barcelona, Spain.,Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain.,Departament of Pediatrics, Universitat de Barcelona, Barcelona, Spain.,CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - María Dolores Falcón
- TRaslational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain.,Pediatric Infectious Diseases, Immunology and Rheumatology Unit, University Hospital Virgen del Rocío, and Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - Pere Soler-Palacín
- TRaslational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain.,Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pablo Rojo
- TRaslational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain.,Pediatric Infectious Diseases, University Hospital 12 de Octubre and Hospital 12 de Octubre Research Institute (i+12), Madrid, Spain
| | - José Tomás Ramos
- TRaslational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain.,Department of Pediatric Infectious Diseases, University Hospital Clínico San Carlos, and Universidad Complutense de Madrid, Madrid, Spain
| | - César Gavilán
- Department of Pediatrics, University Hospital Sant Joan d'Alacant, Alicante, Spain
| | - Carmelo Guerrero
- Department of Pediatrics, University Hospital Miguel Servet, Zaragoza, Spain
| | - Maria Del Carmen Díaz
- Department of Pediatric Infectious Diseases, University Hospital Doce de Octubre, and Doce de Octubre Research Institute (I+12), Madrid, Spain
| | - Paloma Jara
- Department of Pediatric Infectious Diseases, University Hospital Doce de Octubre, and Doce de Octubre Research Institute (I+12), Madrid, Spain
| | - María Luisa Navarro
- TRaslational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain.,Department of Pediatric Infectious Diseases, University Hospital Gregorio Marañón and Gregorio Marañón Research Institute (IiSGM), Universidad Complutense de Madrid, Madrid, Spain
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23
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Jiménez de Ory S, Ramos JT, Fortuny C, González-Tomé MI, Mellado MJ, Moreno D, Gavilán C, Menasalvas AI, Piqueras AI, Frick MA, Muñoz-Fernández MA, Navarro ML. Sociodemographic changes and trends in the rates of new perinatal HIV diagnoses and transmission in Spain from 1997 to 2015. PLoS One 2019; 14:e0223536. [PMID: 31647824 PMCID: PMC6812742 DOI: 10.1371/journal.pone.0223536] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 09/22/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND There are not enough nationwide studies on perinatal HIV transmission in connection with a combination of antiretroviral treatments in Spain. Our objectives were to study sociodemographic changes and trends in the rates of HIV diagnoses and perinatal transmission in Spain from 1997 to 2015. METHODS A retrospective study using data from Spanish Paediatric HIV Network (CoRISpe) and Spanish Minimum Basic Data Set (MDBS) was performed. HIV- diagnosed children between 1997 and 2015 were selected. Sociodemographic, clinical and immunovirological data of HIV-infected children and their mothers were studied in four calendar periods (P1: 1997-2000; P2: 2001-2005; P3: 2006-2010; P4: 2011-2015). Rates of perinatal HIV diagnoses and transmission from 1997 to 2015 were calculated. RESULTS A total of 532 HIV-infected children were included in this study. Of these children, 406 were Spanish (76.3%) and 126 immigrants (23.7%). A decrease in the number of HIV diagnoses, 203 (38.2%) children in the first (P1), 149 (28%) in the second (P2), 130 (24.4%) in the third (P3) and 50 (9.4%) in the fourth (P4) calendar periods was studied. The same decrease in the Spanish HIV-infected children (P1, 174 (46.6%), P2, 115 (30.8%), P3, 65 (17.4%) and P4, 19 (5.1%)) was monitored. However, an increase in the number of HIV diagnoses by sexual contact (P1: 0%; P2: 1.3%; P3: 4.6%; P4: 16%) was observed. The rates of new perinatal HIV diagnoses and perinatal transmission in Spanish children decreased from 0.167 to 0.005 per 100,000 inhabitants and 11.4% to 0.4% between 1997 and 2015, respectively. CONCLUSIONS A decline of perinatal HIV diagnoses and transmission was observed. However, an increase of teen-agers HIV diagnoses with sexual infection was studied. Public awareness campaigns directed to teen-agers are advisable to prevent HIV infection by sexual contact.
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Affiliation(s)
- Santiago Jiménez de Ory
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IisGM), CoRISpe, Madrid, Spain
| | - José Tomas Ramos
- Servicio de Pediatría, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Claudia Fortuny
- Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues del Llobregat, Spain
| | - María Isabel González-Tomé
- Servicio de Infecciosas Pediátricas, Hospital Universitario Doce de Octubre, Instituto de Investigación Hospital 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Maria José Mellado
- Pediatrics, Immunodeficiencies and Infectious Diseases Unit, Hospital Universitario La Paz, Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - David Moreno
- Department of Pediatrics, Regional Maternal-Child University Hospital, Malaga, Spain
- IBIMA Multidisciplinary Group for Pediatric Research, Malaga, Spain, Malaga University, Malaga, Spain
| | - César Gavilán
- Department of Paediatrics, University Clinical Hospital of San Juan de Alicante, San Juan de Alicante, Alicante, Spain
- Department of Paediatrics, Miguel Hernández University of Elche, Campus of Sant Joan d'Alacant, Alicante, Spain
| | | | - Ana Isabel Piqueras
- Department of Pediatric Surgery, and Department of Pediatrics, Hospital La Fe, Valencia, Spain
| | - M. Antoinette Frick
- Tropical Medicine and International Health Unit. Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Pediatrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Angeles Muñoz-Fernández
- Section Immunology, Laboratorio InmunoBiología Molecular, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain, Spanish HIV HGM BioBank, Madrid, Spain
| | - Maria Luisa Navarro
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Medical School, Universidad Complutense de Madrid, Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
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24
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Casas-Alba D, Valero-Rello A, Muchart J, Armangué T, Jordan I, Cabrerizo M, Molero-Luís M, Artuch R, Fortuny C, Muñoz-Almagro C, Launes C. Cerebrospinal Fluid Neopterin in Children With Enterovirus-Related Brainstem Encephalitis. Pediatr Neurol 2019; 96:70-73. [PMID: 30935719 DOI: 10.1016/j.pediatrneurol.2019.01.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 09/15/2018] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Enterovirus-A71 causes outbreaks of brainstem encephalitis, ranging from self-limited disease to acute flaccid paralysis. The aim of this study was to assess the role of cerebrospinal fluid (CSF) neopterin as a biomarker of disease severity in children with enterovirus-related brainstem encephalitis. METHODS A descriptive, prospective cohort study was conducted from April 2016 to March 2017 in a tertiary hospital. Pediatric patients with a diagnosis of brainstem encephalitis with or without myelitis due to enterovirus infection were enrolled. The final study group comprised a convenience sample including all patients with sufficient CSF volume for neopterin determination. The major variables considered in estimating the severity were the diagnosis of encephalomyelitis, the presence of lesions and extensive lesions on brain and spinal magnetic resonance imaging (MRI), hospital stay length greater than seven days, and sequelae at day 30. RESULTS Of 60 patients, CSF neopterin could be measured in 36. Median age was 26 months (interquartile range: 19 to 32). Thirty-three were diagnosed with brainstem encephalitis and three with encephalomyelitis. Enterovirus-A71 was the only identified genotype (25 of 25). CSF neopterin levels were elevated (>61 nmol/L) in 33 of 36 (92%), with a median of 347 nmol/L (interquartile range: 204 to 525). CSF neopterin was useful to distinguish patients with lesions on MRI (area under the receiver operating characteristic curve = 0.76; P = 0.02) and extensive lesions (area under the receiver operating characteristic curve = 0.76; P = 0.04). CONCLUSIONS This study suggests an association between CSF neopterin levels and the presence of inflammatory lesions on MRI.
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Affiliation(s)
- Dídac Casas-Alba
- Department of Pediatrics, Hospital Sant Joan de Deu (University of Barcelona), Barcelona, Spain; Pediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Ana Valero-Rello
- Pediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Deu, Barcelona, Spain; Department of Molecular Microbiology, Hospital Sant Joan de Deu (University of Barcelona), Barcelona, Spain
| | - Jordi Muchart
- Department of Diagnostic Imaging, Hospital Sant Joan de Deu (University of Barcelona), Barcelona, Spain
| | - Thaís Armangué
- Pediatric Neuroimmunology Unit, Department of Pediatric Neurology, Hospital Sant Joan de Deu (University of Barcelona), Barcelona, Spain; Neuroimmunology Program, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS)-Hospital Clinic (University of Barcelona), Barcelona, Spain; CIBER en Enfermedades Raras (CIBERER), Madrid, Spain
| | - Iolanda Jordan
- Pediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Deu, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Pediatric Intensive Care Unit, Hospital Sant Joan de Deu (University of Barcelona), Barcelona, Spain
| | - María Cabrerizo
- Enterovirus Unit, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Molero-Luís
- CIBER en Enfermedades Raras (CIBERER), Madrid, Spain; Department of Clinical Biochemistry, Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Rafael Artuch
- Department of Clinical Biochemistry, Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Claudia Fortuny
- Department of Pediatrics, Hospital Sant Joan de Deu (University of Barcelona), Barcelona, Spain; Pediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Deu, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carmen Muñoz-Almagro
- Pediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Deu, Barcelona, Spain; Department of Molecular Microbiology, Hospital Sant Joan de Deu (University of Barcelona), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Cristian Launes
- Department of Pediatrics, Hospital Sant Joan de Deu (University of Barcelona), Barcelona, Spain; Pediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Deu, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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25
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Bossacoma Busquets F, Noguera-Julian A, Sanchez E, Fortuny C. Dolutegravir plus abacavir/lamivudine works in adolescents, but size matters. J Antimicrob Chemother 2018; 72:2958-2960. [PMID: 29091219 DOI: 10.1093/jac/dkx235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ferran Bossacoma Busquets
- Pharmacy Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Spain
| | - Antoni Noguera-Julian
- Malalties infeccioses i resposta inflamatòria sistèmica en pediatria, Unitat d'Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain.,Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (Ciberesp), Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Emilia Sanchez
- Blanquerna School of Health Science, Universitat Ramon Llull, Padilla 332, 08025 Barcelona, Spain
| | - Claudia Fortuny
- Malalties infeccioses i resposta inflamatòria sistèmica en pediatria, Unitat d'Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain.,Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (Ciberesp), Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
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Wolf J, Kalocsai K, Fortuny C, Lazar S, Bosis S, Korczowski B, Petit A, Bradford D, Incera E, Melis J, Van Maanen R. LB12. Safety and Efficacy of Fidaxomicin and Vancomycin in Pediatric Patients with Clostridium difficile Infection: Phase III, Multicenter, Investigator-blind, Randomized, Parallel Group (SUNSHINE) Study. Open Forum Infect Dis 2018. [PMCID: PMC6253862 DOI: 10.1093/ofid/ofy229.2186] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Clostridium difficile infection (CDI), a common cause of antibiotic-associated diarrhea, leads to substantial healthcare burden. In children and young adults, the incidence of CDI is increasing. Fidaxomicin (FDX) is a narrow-spectrum macrocyclic antibiotic treatment for CDI in adults, but pediatric data are limited. The primary objective of our study was to investigate safety and efficacy of FDX and vancomycin (VAN) in children. Methods Patients aged <18 years with new laboratory-confirmed CDI and diarrhea (watery diarrhea for patients aged <2 years, and ≥3 unformed bowel movements in 24 hours for patients aged ≥2 years) were enrolled in a randomized, investigator-blinded study. Participants were randomized (2:1) to 10 days of treatment with either FDX (oral suspension 32 mg/kg/day or tablets 200 mg BID) or VAN (oral liquid 40 mg/kg/day or capsules 125 mg QID). Concurrent use of other antibiotic treatment for CDI was not permitted. Randomization was stratified by age group. The primary efficacy endpoint was confirmed clinical response (CCR) at Day 12 (absence of diarrhea for 2 consecutive days on treatment and remaining well until treatment discontinuation). Other efficacy endpoints were also evaluated. Results Of 142 patients in the full analysis set (FDX n = 98; VAN n = 44), 30 were aged <2 years, 48 were aged 2 to <6 years, 36 were aged 6 to <12 years and 28 were aged 12 to <18 years. At baseline, 28.6% of the FDX arm and 22.7% of the VAN arm had prior confirmed CDI. Overall, 73.5% of the FDX arm and 75.0% of the VAN arm had ≥1 treatment-emergent adverse event. There were three deaths in the FDX arm during the study and two deaths in the VAN arm after end of study (post-Day 40); none were related to treatment. There was a trend to improved CCR and other efficacy outcomes for FDX (figure) and this was statistically significant for global cure (adjusted difference 18.8%; 95% CI 1.5%, 35.3%). Conclusions There was a consistent trend for improved efficacy outcomes with FDX compared with VAN, as shown by the adjusted treatment differences, although the small sample size precluded conclusions on most outcome differences. Figure. ![]()
Disclosures J. Wolf, Astellas Pharma: Consultant and Non-Financial Support, Consulting fee and This study was initiated and sponsored by Astellas. Medical writing support was provided by Cello Health MedErgy and funded by Astellas. . K. Kalocsai, Astellas Pharma: Non-Financial Support, This study was initiated and sponsored by Astellas. Medical writing support was provided by Cello Health MedErgy and funded by Astellas. . C. Fortuny, Astellas Pharma: Non-Financial Support, This study was initiated and sponsored by Astellas. Medical writing support was provided by Cello Health MedErgy and funded by Astellas. . S. Lazar, Astellas Pharma: Non-Financial Support, This study was initiated and sponsored by Astellas. Medical writing support was provided by Cello Health MedErgy and funded by Astellas. . S. Bosis, Astellas Pharma: Non-Financial Support, This study was initiated and sponsored by Astellas. Medical writing support was provided by Cello Health MedErgy and funded by Astellas. . B. Korczowski, Astellas Pharma: Non-Financial Support, This study was initiated and sponsored by Astellas. Medical writing support was provided by Cello Health MedErgy and funded by Astellas. . A. Petit, Astellas Pharma: Non-Financial Support, This study was initiated and sponsored by Astellas. Medical writing support was provided by Cello Health MedErgy and funded by Astellas. . D. Bradford, Astellas Pharma: Employee and Non-Financial Support, Medical writing support was provided by Cello Health MedErgy and funded by Astellas. and Salary. E. Incera, Astellas Pharma: Employee of Iqvia, a CRO contracted by Astellas, Medical writing support was provided by Cello Health MedErgy and funded by Astellas. . J. Melis, Astellas Pharma: Employee and Non-Financial Support, Medical writing support was provided by Cello Health MedErgy and funded by Astellas. and Salary. R. Van Maanen, Astellas Pharma: Employee and Non-Financial Support, Medical writing support was provided by Cello Health MedErgy and funded by Astellas. and Salary.
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Affiliation(s)
- Joshua Wolf
- St. Jude Children’s Research Hospital, Memphis, TN
| | - Krisztina Kalocsai
- Dél-pesti Centrumkórház Országos Haematológiai és Infektológiai Intézet, Budapest, Hungary
| | | | - Stefan Lazar
- Clinical and Infectious Diseases “Dr. Victor Babeş” Hospital, Bucharest, Romania
| | - Samantha Bosis
- Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Arnaud Petit
- Hôpital Trousseau, HUEP, APHP, Paris, France
- Sorbonne Université, UMRS 938, GRC MyPAC, Paris, France
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Tagarro A, Chan M, Zangari P, Ferns B, Foster C, De Rossi A, Nastouli E, Muñoz-Fernández MA, Gibb D, Rossi P, Giaquinto C, Babiker A, Fortuny C, Freguja R, Cotugno N, Judd A, Noguera-Julian A, Navarro ML, Mellado MJ, Klein N, Palma P, Rojo P. Early and Highly Suppressive Antiretroviral Therapy Are Main Factors Associated With Low Viral Reservoir in European Perinatally HIV-Infected Children. J Acquir Immune Defic Syndr 2018; 79:269-276. [PMID: 30211778 PMCID: PMC6173292 DOI: 10.1097/qai.0000000000001789] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [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] [Indexed: 01/11/2023]
Abstract
BACKGROUND Future strategies aiming to achieve HIV-1 remission are likely to target individuals with small reservoir size. SETTING We retrospectively investigated factors associated with HIV-1 DNA levels in European, perinatally HIV-infected children starting antiretroviral therapy (ART) <6 months of age. METHODS Total HIV-1 DNA was measured from 51 long-term suppressed children aged 6.3 years (median) after initial viral suppression. Factors associated with log10 total HIV-1 DNA were analyzed using linear regression. RESULTS At ART initiation, children were aged median [IQR] 2.3 [1.2-4.1] months, CD4% 37 [24-45] %, CD8% 28 [18-36] %, log10 plasma viral load (VL) 5.4 [4.4-5.9] copies per milliliter. Time to viral suppression was 7.98 [4.6-19.3] months. After suppression, 13 (25%) children had suboptimal response [≥2 consecutive VL 50-400 followed by VL <50] and/or experienced periods of virological failure [≥2 consecutive VL ≥400 followed by VL <50]. Median total HIV-1 DNA was 43 [6195] copies/10 PBMC. Younger age at therapy initiation was associated with lower total HIV-1 DNA (adjusted coefficient [AC] 0.12 per month older, P = 0.0091), with a month increase in age at ART start being associated with a 13% increase in HIV DNA. Similarly, a higher proportion of time spent virally suppressed (AC 0.10 per 10% higher, P = 0.0022) and the absence of viral failure/suboptimal response (AC 0.34 for those with fail/suboptimal response, P = 0.0483) were associated with lower total HIV-1 DNA. CONCLUSIONS Early ART initiation and a higher proportion of time suppressed are linked with lower total HIV-1 DNA. Early ART start and improving adherence in perinatally HIV-1-infected children minimize the size of viral reservoir.
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Affiliation(s)
- Alfredo Tagarro
- Department of Pediatrics, Hospital 12 de Octubre, Fundación para la Investigación Biomédica del Hospital Universitario 12 de Octubre. Madrid, Spain
- Biomedical School. Uiversidad Europea de Madrid. Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Man Chan
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UK
| | - Paola Zangari
- Academic Department of Pediatrics (DPUO), Research Unit in Congenital and Perinatal Infection, Children's Hospital Bambino Gesù, Rome, Italy
| | | | | | - Anita De Rossi
- University of Padova, Section of Oncology and Immunology DiSCOG, Padova, Italy
| | - Eleni Nastouli
- UCL Great Ormond Sstreet Institute of Child Health, London UK
| | - María Angeles Muñoz-Fernández
- Immunology Section, InmunoBioloy Molecular Laboratory, Hospital General Universitario Gregorio Marañón, Spanish HIV HGM BioBank, IiSGM, Madrid, Spain
| | - Diana Gibb
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UK
| | - Paolo Rossi
- Academic Department of Pediatrics (DPUO), Research Unit in Congenital and Perinatal Infection, Children's Hospital Bambino Gesù, Rome, Italy
| | - Carlo Giaquinto
- Department of Women and Child Health, University of Padova, Padova, Italy
| | - Abdel Babiker
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UK
| | - Claudia Fortuny
- Malalties infeccioses i resposta inflamatòria sistèmica en pediatria. Unitat d'Infeccions, Servei de Pediatria. Institut de Recerca, Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain. Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain. CIBER de Epidemiología y Salud Pública Ciberesp, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Riccardo Freguja
- University of Padova, Section of Oncology and Immunology DiSCOG, Padova, Italy
| | - Nicola Cotugno
- Academic Department of Pediatrics (DPUO), Research Unit in Congenital and Perinatal Infection, Children's Hospital Bambino Gesù, Rome, Italy
| | - Ali Judd
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UK
| | - Antoni Noguera-Julian
- Malalties infeccioses i resposta inflamatòria sistèmica en pediatria. Unitat d'Infeccions, Servei de Pediatria. Institut de Recerca, Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain. Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain. CIBER de Epidemiología y Salud Pública Ciberesp, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - María Luisa Navarro
- Pediatric Infectious Diseases Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - María José Mellado
- Pediatrics, Immunodeficiencies and Infectious Diseases Unit, Hospital Universitario La Paz, Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Nigel Klein
- UCL Great Ormond Sstreet Institute of Child Health, London UK
| | - Paolo Palma
- Academic Department of Pediatrics (DPUO), Research Unit in Congenital and Perinatal Infection, Children's Hospital Bambino Gesù, Rome, Italy
| | - Pablo Rojo
- Department of Pediatrics, Hospital 12 de Octubre, Fundación para la Investigación Biomédica del Hospital Universitario 12 de Octubre. Madrid, Spain
- Medical School. Universidad Complutense de Madrid. Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
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Richarz NA, Fustà-Novell X, Fatsini-Blanch V, Fortuny C, González-Enseñat MA, Vicente A. Lichen striatus following scarlet fever in a 3-year-old female patient. Int J Dermatol 2018; 57:1118-1119. [DOI: 10.1111/ijd.13995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/04/2018] [Accepted: 03/17/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Nina A. Richarz
- Department of Dermatology; Hospital Sant Joan de Déu; Barcelona Spain
| | | | | | - Claudia Fortuny
- Department of Pediatrics; Hospital Sant Joan de Déu; Barcelona Spain
| | | | - Asunción Vicente
- Department of Dermatology; Hospital Sant Joan de Déu; Barcelona Spain
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Slogrove AL, Schomaker M, Davies MA, Williams P, Balkan S, Ben-Farhat J, Calles N, Chokephaibulkit K, Duff C, Eboua TF, Kekitiinwa-Rukyalekere A, Maxwell N, Pinto J, Seage G, Teasdale CA, Wanless S, Warszawski J, Wools-Kaloustian K, Yotebieng M, Timmerman V, Collins IJ, Goodall R, Smith C, Patel K, Paul M, Gibb D, Vreeman R, Abrams EJ, Hazra R, Van Dyke R, Bekker LG, Mofenson L, Vicari M, Essajee S, Penazzato M, Anabwani G, Q. Mohapi E, N. Kazembe P, Hlatshwayo M, Lumumba M, Goetghebuer T, Thorne C, Galli L, van Rossum A, Giaquinto C, Marczynska M, Marques L, Prata F, Ene L, Okhonskaia L, Rojo P, Fortuny C, Naver L, Rudin C, Le Coeur S, Volokha A, Rouzier V, Succi R, Sohn A, Kariminia A, Edmonds A, Lelo P, Ayaya S, Ongwen P, Jefferys LF, Phiri S, Mubiana-Mbewe M, Sawry S, Renner L, Sylla M, Abzug MJ, Levin M, Oleske J, Chernoff M, Traite S, Purswani M, Chadwick EG, Judd A, Leroy V. The epidemiology of adolescents living with perinatally acquired HIV: A cross-region global cohort analysis. PLoS Med 2018; 15:e1002514. [PMID: 29494593 PMCID: PMC5832192 DOI: 10.1371/journal.pmed.1002514] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 01/24/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Globally, the population of adolescents living with perinatally acquired HIV (APHs) continues to expand. In this study, we pooled data from observational pediatric HIV cohorts and cohort networks, allowing comparisons of adolescents with perinatally acquired HIV in "real-life" settings across multiple regions. We describe the geographic and temporal characteristics and mortality outcomes of APHs across multiple regions, including South America and the Caribbean, North America, Europe, sub-Saharan Africa, and South and Southeast Asia. METHODS AND FINDINGS Through the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER), individual retrospective longitudinal data from 12 cohort networks were pooled. All children infected with HIV who entered care before age 10 years, were not known to have horizontally acquired HIV, and were followed up beyond age 10 years were included in this analysis conducted from May 2016 to January 2017. Our primary analysis describes patient and treatment characteristics of APHs at key time points, including first HIV-associated clinic visit, antiretroviral therapy (ART) start, age 10 years, and last visit, and compares these characteristics by geographic region, country income group (CIG), and birth period. Our secondary analysis describes mortality, transfer out, and lost to follow-up (LTFU) as outcomes at age 15 years, using competing risk analysis. Among the 38,187 APHs included, 51% were female, 79% were from sub-Saharan Africa and 65% lived in low-income countries. APHs from 51 countries were included (Europe: 14 countries and 3,054 APHs; North America: 1 country and 1,032 APHs; South America and the Caribbean: 4 countries and 903 APHs; South and Southeast Asia: 7 countries and 2,902 APHs; sub-Saharan Africa, 25 countries and 30,296 APHs). Observation started as early as 1982 in Europe and 1996 in sub-Saharan Africa, and continued until at least 2014 in all regions. The median (interquartile range [IQR]) duration of adolescent follow-up was 3.1 (1.5-5.2) years for the total cohort and 6.4 (3.6-8.0) years in Europe, 3.7 (2.0-5.4) years in North America, 2.5 (1.2-4.4) years in South and Southeast Asia, 5.0 (2.7-7.5) years in South America and the Caribbean, and 2.1 (0.9-3.8) years in sub-Saharan Africa. Median (IQR) age at first visit differed substantially by region, ranging from 0.7 (0.3-2.1) years in North America to 7.1 (5.3-8.6) years in sub-Saharan Africa. The median age at ART start varied from 0.9 (0.4-2.6) years in North America to 7.9 (6.0-9.3) years in sub-Saharan Africa. The cumulative incidence estimates (95% confidence interval [CI]) at age 15 years for mortality, transfers out, and LTFU for all APHs were 2.6% (2.4%-2.8%), 15.6% (15.1%-16.0%), and 11.3% (10.9%-11.8%), respectively. Mortality was lowest in Europe (0.8% [0.5%-1.1%]) and highest in South America and the Caribbean (4.4% [3.1%-6.1%]). However, LTFU was lowest in South America and the Caribbean (4.8% [3.4%-6.7%]) and highest in sub-Saharan Africa (13.2% [12.6%-13.7%]). Study limitations include the high LTFU rate in sub-Saharan Africa, which could have affected the comparison of mortality across regions; inclusion of data only for APHs receiving ART from some countries; and unavailability of data from high-burden countries such as Nigeria. CONCLUSION To our knowledge, our study represents the largest multiregional epidemiological analysis of APHs. Despite probable under-ascertained mortality, mortality in APHs remains substantially higher in sub-Saharan Africa, South and Southeast Asia, and South America and the Caribbean than in Europe. Collaborations such as CIPHER enable us to monitor current global temporal trends in outcomes over time to inform appropriate policy responses.
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Affiliation(s)
| | - Amy L. Slogrove
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Michael Schomaker
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Mary-Ann Davies
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Paige Williams
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Suna Balkan
- Epicentre, Médecins Sans Frontières, Paris, France
| | | | - Nancy Calles
- Baylor International Pediatric AIDS Initiative, Texas Children’s Hospital-USA, Houston, Texas, United States of America
| | | | - Charlotte Duff
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Tanoh François Eboua
- Yopougon University Hospital, University Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | | | - Nicola Maxwell
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Jorge Pinto
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - George Seage
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Chloe A. Teasdale
- ICAP at Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Sebastian Wanless
- Baylor International Pediatric AIDS Initiative, Texas Children’s Hospital-USA, Houston, Texas, United States of America
| | - Josiane Warszawski
- Inserm (French Institute of Health and Medical Research), CESP UMR Villejuif, France
| | - Kara Wools-Kaloustian
- Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Marcel Yotebieng
- College of Public Health, Ohio State University, Columbus, Ohio, United States of America
| | - Venessa Timmerman
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Intira J. Collins
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Ruth Goodall
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Colette Smith
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Kunjal Patel
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Mary Paul
- Baylor International Pediatric AIDS Initiative, Texas Children’s Hospital-USA, Houston, Texas, United States of America
| | - Diana Gibb
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Rachel Vreeman
- Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Elaine J. Abrams
- ICAP at Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Rohan Hazra
- National Institute of Child Health and Human Development (NICHD), US National Institutes of Health, Rockville, Maryland, United States of America
| | - Russell Van Dyke
- Tulane University, New Orleans, Louisiana, United States of America
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Lynne Mofenson
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
| | | | | | | | - Gabriel Anabwani
- Baylor International Pediatric AIDS Initiative, Gaborone, Botswana
| | - Edith Q. Mohapi
- Baylor International Pediatric AIDS Initiative, Maseru, Lesotho
| | - Peter N. Kazembe
- Baylor International Pediatric AIDS Initiative, Lilongwe, Malawi
| | | | - Mwita Lumumba
- Baylor International Pediatric AIDS Initiative, Mbeya, Tanzania
| | | | - Claire Thorne
- Institute of Child Health, University College London, London, United Kingdom
| | - Luisa Galli
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Annemarie van Rossum
- Erasmus MC University Medical Center Rotterdam-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | | | - Magdalena Marczynska
- Medical University of Warsaw, Hospital of Infectious Diseases in Warsaw, Warsaw, Poland
| | | | | | | | - Liubov Okhonskaia
- Republican Hospital of Infectious Diseases, St Petersburg, Russian Federation
| | | | - Claudia Fortuny
- Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Lars Naver
- Karolinska University Hospital, Stockholm, Sweden
| | | | - Sophie Le Coeur
- Institut de Recherche pour le Développement (IRD) 174/PHPT, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Institut National d'Etudes Démograhiques (Ined), F-75020 Paris, France
| | - Alla Volokha
- Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | | | - Regina Succi
- Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Andrew Edmonds
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Patricia Lelo
- Pediatric Hospital Kalembe Lembe, Lingwala, Kinshasa, Democratic Republic of Congo
| | - Samuel Ayaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Patricia Ongwen
- Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Sam Phiri
- Lighthouse Trust Clinic, Lilongwe, Malawi
| | | | - Shobna Sawry
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Harriet Shezi Children’s Clinic, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Lorna Renner
- University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | | | - Mark J. Abzug
- University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - Myron Levin
- University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - James Oleske
- Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Miriam Chernoff
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Shirley Traite
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Murli Purswani
- Bronx-Lebanon Hospital Center (Icahn School of Medicine at Mount Sinai), Bronx, New York, United States of America
| | - Ellen G. Chadwick
- Feinberg School of Medicine, Northwestern University, Evanston, Illinois, United States of America
| | - Ali Judd
- MRC Clinical Trials Unit at University College London, London, United Kingdom
- * E-mail: (AJ); (VL)
| | - Valériane Leroy
- Inserm (French Institute of Health and Medical Research), UMR 1027 Université Toulouse 3, Toulouse, France
- * E-mail: (AJ); (VL)
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Jiménez de Ory S, González-Tomé MI, Fortuny C, Mellado MJ, Soler-Palacin P, Bustillo M, Ramos JT, Muñoz-Fernández MA, Navarro ML. New diagnoses of human immunodeficiency virus infection in the Spanish pediatric HIV Cohort (CoRISpe) from 2004 to 2013. Medicine (Baltimore) 2017; 96:e7858. [PMID: 28953612 PMCID: PMC5626255 DOI: 10.1097/md.0000000000007858] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Vertical human immunodeficiency virus (HIV) infection has decreased in industrialized countries in recent decades, but there are no studies on the mechanisms of HIV transmission among infected children in Spain. Our aim was to study the characteristics and trends of diagnoses of vertically HIV-infected children in Spain from 2004 to 2013.Vertically HIV-infected children were selected if they were diagnosed from 2004 to 2013, were aged 0 to 18 years old, and were included in the Cohort of the Spanish Pediatric HIV Network (CoRISpe). Demographic, clinical, immunological, and virological data at diagnosis were obtained. The rate of diagnoses of vertically HIV-infected children was calculated as the number of cases per 100,000 inhabitants. Obstetric data of mothers of Spanish children and prophylaxis at childbirth and postpartum were obtained.A total of 218 HIV-infected children were included in the study. Of this sample, 182 children (83.5%) were perinatally HIV infected, and 125 out of those 182 children (68.7%) were born in Spain. The vertically HIV-infected Spanish children were diagnosed earlier and were in better clinical and immunological condition at diagnosis than were foreign children. The rate of vertically HIV-infected children declined from 0.09 in 2004 to 0.03 in 2013 due to the decrease in the rate of children born in Spain (0.08 in 2004 vs 0.01 in 2013). A total of 60 out of 107 mothers (56.1%) of Spanish children were diagnosed at or after childbirth. However, this number declined between 2004 and 2013.The rate of new HIV diagnoses of vertically HIV-infected children decreased significantly between 2004 and 2013 from 0.09 to 0.03 per 100,000 inhabitants.
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Affiliation(s)
- Santiago Jiménez de Ory
- Sección Inmunología, Laboratorio InmunoBiología Molecular, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón
- Spanish Human Immunodeficiency Virus Hospital Gregorio Marañón BioBank (Spanish HIV HGM BioBank)
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN)
- Servicio de Pediatría, Hospital Clínico San Carlos
| | - María Isabel González-Tomé
- Servicio de Infecciosas Pediátricas, Hospital Universitario Doce de Octubre, Instituto de Investigación Hospital 12 de Octubre
| | - Claudia Fortuny
- Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues del Llobregat, Barcelona
| | - Maria Jose Mellado
- Servicio de Pediatría Hospitalaria y Enfermedades Infecciosas y Tropicales Pediátricas, Hospital Universitario Infantil La Paz and Hospital Carlos III
| | - Pere Soler-Palacin
- Unitat de Patologia Infecciosa i Immunodeficiències de Pediatria, Hospital Universitari Vall d’Hebron, Institut de Recerca Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona
| | - Matilde Bustillo
- Servicio de Pediatría, Unidad Infectología, Hospital Infantil Universitario Miguel Servet, Zaragoza
| | | | - Maria Angeles Muñoz-Fernández
- Sección Inmunología, Laboratorio InmunoBiología Molecular, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón
- Spanish Human Immunodeficiency Virus Hospital Gregorio Marañón BioBank (Spanish HIV HGM BioBank)
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN)
| | - Maria Luisa Navarro
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
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Batalla A, Vicente A, Bartrons J, Prada F, Fortuny C, González-Enseñat M. Cardiomyopathy in Patients With Hereditary Bullous Epidermolysis. Actas Dermo-Sifiliográficas (English Edition) 2017. [DOI: 10.1016/j.adengl.2017.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Casas-Alba D, de Sevilla MF, Valero-Rello A, Fortuny C, García-García JJ, Ortez C, Muchart J, Armangué T, Jordan I, Luaces C, Barrabeig I, González-Sanz R, Cabrerizo M, Muñoz-Almagro C, Launes C. Outbreak of brainstem encephalitis associated with enterovirus-A71 in Catalonia, Spain (2016): a clinical observational study in a children's reference centre in Catalonia. Clin Microbiol Infect 2017; 23:874-881. [PMID: 28344164 DOI: 10.1016/j.cmi.2017.03.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [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: 01/19/2017] [Revised: 03/15/2017] [Accepted: 03/18/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To describe the characteristics of an outbreak of brainstem encephalitis and encephalomyelitis related to enterovirus (EV) infection in Catalonia (Spain), a setting in which these manifestations were uncommon. METHODS Clinical and microbiological data were analysed from patients with neurological symptoms associated with EV detection admitted to a reference paediatric hospital between April and June 2016. RESULTS Fifty-seven patients were included. Median age was 27.7 months (p25-p75 17.1-37.6). Forty-one (72%) were diagnosed with brainstem encephalitis, seven (12%) with aseptic meningitis, six (11%) with encephalitis, and three (5%) with encephalomyelitis (two out of three with cardiopulmonary failure). Fever, lethargy, and myoclonic jerks were the most common symptoms. Age younger than 12 months, higher white-blood-cell count, and higher procalcitonin levels were associated with cardiopulmonary failure. Using a PAN-EV real-time PCR, EV was detected in faeces and/or nasopharyngeal aspirate in all the patients, but it was found in cerebrospinal fluid only in patients with aseptic meningitis. EV was genotyped in 47 out of 57 and EV-A71 was identified in 40 out of 47, being the only EV type found in patients with brainstem symptoms. Most of the detected EV-A71 strains were subgenogroup C1. Intravenous immunoglobulins were used in 34 patients. Eight cases (14%) were admitted to the intensive care unit. All the patients but three, those with encephalomyelitis, showed a good clinical course and had no significant sequelae. No deaths occurred. CONCLUSIONS The 2016 outbreak of brainstem encephalitis in Catalonia was associated with EV-A71 subgenogroup C1. Despite the clinical manifestations of serious disease, a favourable outcome was observed in the majority of patients.
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Affiliation(s)
- D Casas-Alba
- Department of Paediatrics, Hospital Sant Joan de Deu (University of Barcelona), Spain
| | - M F de Sevilla
- Department of Paediatrics, Hospital Sant Joan de Deu (University of Barcelona), Spain; Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | - A Valero-Rello
- Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; Department of Molecular Microbiology, Hospital Sant Joan de Deu, Spain
| | - C Fortuny
- Department of Paediatrics, Hospital Sant Joan de Deu (University of Barcelona), Spain; Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | - J-J García-García
- Department of Paediatrics, Hospital Sant Joan de Deu (University of Barcelona), Spain; Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | - C Ortez
- Department of Paediatric Neurology, Hospital Sant Joan de Deu (University of Barcelona), Spain
| | - J Muchart
- Department of Diagnostic Imaging, Hospital Sant Joan de Deu (University of Barcelona), Spain
| | - T Armangué
- Department of Paediatric Neurology, Hospital Sant Joan de Deu (University of Barcelona), Spain
| | - I Jordan
- Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Paediatric Intensive Care Unit, Hospital Sant Joan de Deu (University of Barcelona), Spain
| | - C Luaces
- Emergency Department, Hospital Sant Joan de Deu (University of Barcelona), Spain
| | - I Barrabeig
- Epidemiological Surveillance Unit of Health Region, Barcelona-South, Public Health Agency of Catalonia, Hospitalet de Llobregat, Spain
| | - R González-Sanz
- Enterovirus Unit, National Centre for Microbiology, Institute of Public Health "Carlos III", Madrid, Spain
| | - M Cabrerizo
- Enterovirus Unit, National Centre for Microbiology, Institute of Public Health "Carlos III", Madrid, Spain
| | - C Muñoz-Almagro
- Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Emergency Department, Hospital Sant Joan de Deu (University of Barcelona), Spain; School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - C Launes
- Department of Paediatrics, Hospital Sant Joan de Deu (University of Barcelona), Spain; Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain.
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Moreno S, Antela A, García F, Del Amo J, Boix V, Coll P, Fortuny C, Sirvent JLG, Gutiérrez F, Iribarren JA, Llibre JM, Quirós JCLBD, Losa JE, Lozano A, Meulbroek M, Olalla J, Pujol F, Pulido F, Crespo Casal M, García JG, Aldeguer JL, Molina JAP, Podzamczer Palter D, Román AR. Executive summary: Pre-exposure prophylaxis for prevention of HIV infection in adults in Spain: July 2016. Enferm Infecc Microbiol Clin 2017; 35:377-383. [PMID: 28236498 DOI: 10.1016/j.eimc.2016.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 10/27/2016] [Revised: 11/09/2016] [Accepted: 11/25/2016] [Indexed: 11/30/2022]
Abstract
Administration of antiretroviral drugs to individuals exposed to, but not infected by, HIV has been shown to reduce the risk of transmission. The efficacy of pre-exposure prophylaxis (PrEP) makes it obligatory to include it in an integral program of prevention of HIV transmission, together with other measures, such as use of the condom, training, counseling, and appropriate treatment of infected individuals. In this document, the AIDS Study Group (GeSIDA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica [SEIMC]) provides its views on this important subject. The available evidence on the usefulness of PrEP in the prevention of transmission of HIV is presented, and the components that should make up a PrEP program and whose development and implementation are feasible in Spain are set out.
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Affiliation(s)
| | - Antonio Antela
- Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Felipe García
- Hospital Clínic, Hospital Universitario Ramón y Cajal, IRYCIS , Barcelona, Spain
| | | | | | - Pep Coll
- IrsiCaixa, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | | | | | | | - Josep M Llibre
- Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | | | - Ana Lozano
- Hospital de Poniente, El Ejido, Almería, Spain
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Affiliation(s)
- A Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron Research Institute, Barcelona, Spain
| | - A Noguera-Julian
- Infectious Diseases Unit, Pediatrics Department, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain.,Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (Ciberesp), Spain
| | - C Fortuny
- Infectious Diseases Unit, Pediatrics Department, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain.,Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (Ciberesp), Spain
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Soriano-Arandes A, Noguera-Julian A, López-Lacort M, Soler-Palacín P, Mur A, Méndez M, Mayol L, Vallmanya T, Almeda J, Carnicer-Pont D, Casabona J, Fortuny C. Pregnancy as an opportunity to diagnose human-immunodeficiency virus immigrant women in Catalonia. Enferm Infecc Microbiol Clin 2016; 36:9-15. [PMID: 27609632 DOI: 10.1016/j.eimc.2016.07.011] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 07/13/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Mother-to-child transmission (MTCT) is relevant in the global epidemiology of human-immunodeficiency virus (HIV), as it represents the main route of infection in children. The study objectives were to determine the rate of HIV-MTCT and its epidemiological trend between the Spanish-born and immigrant population in Catalonia in the period 2000-2014. METHODS A prospective observational study of mother-child pairs exposed to HIV, treated in 12 hospitals in Catalonia in the period 2000-2014. HIV-MTCT rate was estimated using a Bayesian logistic regression model. R and WinBUGS statistical software were used. RESULTS The analysis included 909 pregnant women, 1,009 pregnancies, and 1,032 children. Data on maternal origin was obtained in 79.4% of women, of whom 32.7% were immigrants, with 53.0% of these from sub-Saharan Africa. The overall HIV-MTCT rate was 1.4% (14/1,023; 95% CI; 0.8-2.3). The risk of MTCT-HIV was 10-fold lower in women with good virological control (P=.01), which was achieved by two-thirds of them. The proportion of immigrants was significantly higher in the period 2008-2014 (P<.0001), for the HIV-diagnosis (P<.0001), and antiretroviral administration (P=.02) during pregnancy, and for undetectable viral load next to delivery (P<.001). There were no differences in the rate of MTCT-HIV among Spanish-born and immigrant women (P=.6). CONCLUSIONS There is a gradual increase in HIV pregnant immigrants in Catalonia. Although most immigrant women were diagnosed during pregnancy, the rate of MTCT-HIV was no different from the Spanish-born women.
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Affiliation(s)
- Antoni Soriano-Arandes
- Unidad de Enfermedades Infecciosas e Inmunodeficiencias Pediátricas, Servicio de Pediatría, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Antoni Noguera-Julian
- Unidad de Infectologia, Servei de Pediatria, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España
| | - Mónica López-Lacort
- FISABIO, Centro de Salud Pública de la Generalitat de Valencia, Valencia, España
| | - Pere Soler-Palacín
- Unidad de Enfermedades Infecciosas e Inmunodeficiencias Pediátricas, Servicio de Pediatría, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Antonio Mur
- Hospital Universitari del Mar, Universidad Autónoma de Barcelona, Barcelona, España
| | - María Méndez
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Lluís Mayol
- Hospital Universitari Josep Trueta, Girona, España
| | | | - Jesús Almeda
- Centre d'Estudis Epidemiològics sobre les ITS i SIDA de Catalunya (CEEISCAT), Catalunya, España
| | - Dolors Carnicer-Pont
- Centre d'Estudis Epidemiològics sobre les ITS i SIDA de Catalunya (CEEISCAT), Catalunya, España
| | - Jordi Casabona
- Centre d'Estudis Epidemiològics sobre les ITS i SIDA de Catalunya (CEEISCAT), Catalunya, España
| | - Claudia Fortuny
- Unidad de Infectologia, Servei de Pediatria, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España
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Caylà JA, Domínguez Á, Rodríguez Valín E, de Ory F, Vázquez A, Fortuny C. [Zika virus infection: a new public health emergency with great media impact]. Gac Sanit 2016; 30:468-471. [PMID: 27474488 DOI: 10.1016/j.gaceta.2016.05.015] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 05/24/2016] [Accepted: 05/24/2016] [Indexed: 10/21/2022]
Abstract
Infection with Zika virus (ZV) has become a new epidemic, with great impact on the media, and is having a strong effect in Latin American countries. Its possible association with microcephaly and Guillain-Barré syndrome prompted the World Health Organization (WHO) to declare on 1 February 2016 that this epidemic is a public health emergency of international concern. Epidemiological data show an increasing incidence in countries like Brazil and Colombia, and that the epidemic is still expanding in many other countries. Between January 2007 and 27 April 2016, the WHO detected transmission in 55 countries (in 42 of these, this was the first outbreak of Zika) and 1,198 microcephalies and other neurological disorders in Brazil. Also, during 2015-2016, 13 countries detected an increase in Guillain-Barré syndrome and/or confirmation of ZV associated with Guillain-Barré syndrome. Research has already demonstrated a causal relationship between microcephaly and other serious brain disorders in newborns and ZV infection in the mother. Clinically, many cases are asymptomatic and it can be difficult to distinguish this diagnosis from that of other arboviruses. Vector control in Spain is a priority because of the presence of the Aedes albopictus (tiger mosquito). Early diagnosis is recommended, as is avoiding travel to endemic areas and unprotected sex, and ensuring that the high political profile, which can prevent this epidemic from becoming a high prevalence endemic disease, does not cause us to forget about other health problems.
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Affiliation(s)
- Joan A Caylà
- Programa de Prevención, Vigilancia y Control de las Enfermedades Transmisibles (PREVICET) del CIBER de Epidemiología y Salud Pública (CIBERESP), España; Servicio de Epidemiología, Agència de Salut Pública de Barcelona, Barcelona, España.
| | - Ángela Domínguez
- Programa de Prevención, Vigilancia y Control de las Enfermedades Transmisibles (PREVICET) del CIBER de Epidemiología y Salud Pública (CIBERESP), España; Departament de Salut Pública, Facultad de Medicina, Universitat de Barcelona, Barcelona, España
| | - Elena Rodríguez Valín
- Programa de Prevención, Vigilancia y Control de las Enfermedades Transmisibles (PREVICET) del CIBER de Epidemiología y Salud Pública (CIBERESP), España; Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España
| | - Fernando de Ory
- Programa de Prevención, Vigilancia y Control de las Enfermedades Transmisibles (PREVICET) del CIBER de Epidemiología y Salud Pública (CIBERESP), España; Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, España
| | - Ana Vázquez
- Programa de Prevención, Vigilancia y Control de las Enfermedades Transmisibles (PREVICET) del CIBER de Epidemiología y Salud Pública (CIBERESP), España; Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, España
| | - Claudia Fortuny
- Programa de Prevención, Vigilancia y Control de las Enfermedades Transmisibles (PREVICET) del CIBER de Epidemiología y Salud Pública (CIBERESP), España; Unitat d'Infeccions, Hospital Sant Joan de Déu, Esplugues de Llobregat (Barcelona), España
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Gijón M, Bellusci M, Petraitiene B, Noguera-Julian A, Zilinskaite V, Sanchez Moreno P, Saavedra-Lozano J, Glikman D, Daskalaki M, Kaiser-Labusch P, Falup-Pecurariu O, Montagnani C, Prieto L, Gené A, Trumpulyte G, Kulecnikova I, Lepe JA, Cercenado E, Kudinsky R, Makri A, Huppertz HI, Bleotu L, Cocchi P, García-Hierro P, Vitkauskiene A, Fortuny C, Zukovskaja V, Neth O, Santos M, Rokney A, Petra M, Lixandru R, Galli L, Guillén S, Chaves F, Rojo Conejo P. Factors associated with severity in invasive community-acquired Staphylococcus aureus infections in children: a prospective European multicentre study. Clin Microbiol Infect 2016; 22:643.e1-6. [PMID: 27107685 DOI: 10.1016/j.cmi.2016.04.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [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: 01/25/2016] [Revised: 03/17/2016] [Accepted: 04/05/2016] [Indexed: 11/30/2022]
Abstract
Staphylococcus aureus is the main pathogen responsible for bone and joint infections worldwide and is also capable of causing pneumonia and other invasive severe diseases. Panton-Valentine leukocidin (PVL) and methicillin-resistant S. aureus (MRSA) have been studied as factors related with severity in these infections. The aims of this study were to describe invasive community-acquired S. aureus (CA-SA) infections and to analyse factors related to severity of disease. Paediatric patients (aged 0-16 years) who had a CA-SA invasive infection were prospectively recruited from 13 centres in 7 European countries. Demographic, clinical and microbiological data were collected. Severe infection was defined as invasive infection leading to death or admission to intensive care due to haemodynamic instability or respiratory failure. A total of 152 children (88 boys) were included. The median age was 7.2 years (interquartile range, 1.3-11.9). Twenty-six (17%) of the 152 patients had a severe infection, including 3 deaths (2%). Prevalence of PVL-positive CA-SA infections was 18.6%, and 7.8% of the isolates were MRSA. The multivariate analysis identified pneumonia (adjusted odds ratio (aOR) 13.39 (95% confidence interval (CI) 4.11-43.56); p 0.008), leukopenia at admission (<3000/mm(3)) (aOR 18.3 (95% CI 1.3-259.9); p 0.03) and PVL-positive infections (aOR 4.69 (95% CI 1.39-15.81); p 0.01) as the only factors independently associated with severe outcome. There were no differences in MRSA prevalence between severe and nonsevere cases (aOR 4.30 (95% CI 0.68- 28.95); p 0.13). Our results show that in European children, PVL is associated with more severe infections, regardless of methicillin resistance.
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Affiliation(s)
- M Gijón
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Bellusci
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - B Petraitiene
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Noguera-Julian
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - V Zilinskaite
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Sanchez Moreno
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Saavedra-Lozano
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - D Glikman
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Daskalaki
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Kaiser-Labusch
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - O Falup-Pecurariu
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - C Montagnani
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - L Prieto
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Gené
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - G Trumpulyte
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - I Kulecnikova
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J A Lepe
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E Cercenado
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - R Kudinsky
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Makri
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - H I Huppertz
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - L Bleotu
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Cocchi
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P García-Hierro
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Vitkauskiene
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - C Fortuny
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - V Zukovskaja
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - O Neth
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Santos
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Rokney
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Petra
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - R Lixandru
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - L Galli
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - S Guillén
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - F Chaves
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Rojo Conejo
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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García J, Fortuny C, Riaza L, Soler M, Bassa P, Riera E. Diagnosis by 18 F-FDG PET/CT of infective endocarditis, staging and monitoring of antibiotic treatment after transposition of surgically corrected great arteries. Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2016.01.006] [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: 11/28/2022]
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García JR, Fortuny C, Riaza L, Soler M, Bassa P, Riera E. Diagnosis by (18)F-FDG PET/CT of infective endocarditis, staging and monitoring of antibiotic treatment after transposition of surgically corrected great arteries. Rev Esp Med Nucl Imagen Mol 2015; 35:115-7. [PMID: 26654886 DOI: 10.1016/j.remn.2015.10.007] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/22/2015] [Accepted: 10/23/2015] [Indexed: 10/22/2022]
Abstract
Infective endocarditis is one of the leading causes of fever of unknown origin in those patients with intravascular catheters, prosthetic valves or cardiovascular implantable electronic devices. The diagnosis of infective endocarditis is made according to modified Duke criteria, which are based on blood culture and echocardiographic findings. Demonstration of vegetation with the transoesophageal echocardiography may be difficult in these cases with previous anatomical changes, especially in early phases. Positron emission tomography with (18)F-fluorodeoxyglucose ((18)F-FDG PET/CT) is well known to show an increased glucidic metabolism in malignant, inflammatory, and infectious processes. Thus, it provides useful functional imaging that enables the disease causing the fever of unknown origin to be detected well before structural changes are evident. Moreover, (18)F-FDG PET/CT helps to detect infectious extra-cardiac involvement, since the whole body is imaged with this technique. (18)F-FDG PET/CT may have an additional promising role for the monitoring of response to antimicrobial therapy in patients with established infective endocarditis, thus evaluating standard treatment outcome, as well as evaluating the need for alternative/intensified treatment options.
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Affiliation(s)
| | - C Fortuny
- Servicio Pediatría, Hospital Sant Joan de Deu, Esplugues de Llobregat, Barcelona, España
| | - L Riaza
- Servicio Radiología, Hospital Sant Joan de Deu, Esplugues de Llobregat, Barcelona, España
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Agüero F, Cofan F, Fortuny C, Lopez M, Manzardo C, Lonca M, Oppenheimer F, Moreno A, Campistol JM, Miro JM. Pregnancy in a renal transplant recipient with HIV-1 infection: a case report. Antivir Ther 2015; 21:267-71. [PMID: 26576517 DOI: 10.3851/imp3013] [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] [Accepted: 09/13/2015] [Indexed: 10/22/2022]
Abstract
We report the first case of a pregnancy in a renal transplant recipient with HIV infection. She underwent renal transplantation in 2005 and became pregnant in 2009. The patient underwent vaginal delivery and a healthy full-term, female baby was born. Almost 6 years after delivery, both mother and child were doing well. The management of concurrent renal transplantation, HIV infection and pregnancy was extremely challenging. Women with HIV infection who have undergone renal transplantation should be accurately informed of the potential health risks for them and their offspring. Multidisciplinary teams are mandatory in order to properly manage these patients.
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Affiliation(s)
- Fernando Agüero
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
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Martínez-Bonet M, Puertas MC, Fortuny C, Ouchi D, Mellado MJ, Rojo P, Noguera-Julian A, Muñoz-Fernández MA, Martinez-Picado J. Establishment and Replenishment of the Viral Reservoir in Perinatally HIV-1-infected Children Initiating Very Early Antiretroviral Therapy. Clin Infect Dis 2015; 61:1169-78. [PMID: 26063721 PMCID: PMC4560905 DOI: 10.1093/cid/civ456] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 05/21/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Combination antiretroviral therapy (cART) generally suppresses the replication of the human immunodeficiency virus type 1 (HIV-1) but does not cure the infection, because proviruses persist in stable latent reservoirs. It has been proposed that low-level proviral reservoirs might predict longer virologic control after discontinuation of treatment. Our objective was to evaluate the impact of very early initiation of cART and temporary treatment interruption on the size of the latent HIV-1 reservoir in vertically infected children. METHODS This retrospective study included 23 perinatally HIV-1-infected children who initiated very early treatment within 12 weeks after birth (n = 14), or early treatment between week 12 and 1 year (n = 9). We measured the proviral reservoir (CD4(+) T-cell-associated HIV-1 DNA) in blood samples collected beyond the first year of sustained virologic suppression. RESULTS There is a strong positive correlation between the time to initiation of cART and the size of the proviral reservoir. Children who initiated cART within the first 12 weeks of life showed a proviral reservoir 6-fold smaller than children initiating cART beyond this time (P < .01). Rapid virologic control after initiation of cART also limits the size of the viral reservoir. However, patients who underwent transient treatment interruptions showed a dramatic increase in the size of the viral reservoir after discontinuation. CONCLUSIONS Initiation of cART during the first 12 weeks of life in perinatally HIV-1-infected children limits the size of the viral reservoir. Treatment interruptions should be undertaken with caution, as they might lead to fast and irreversible replenishment of the viral reservoir.
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Affiliation(s)
- Marta Martínez-Bonet
- Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Gregorio Marañón
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN)
- Spanish HIV HGM BioBank
| | - Maria Carmen Puertas
- AIDS Research Institute IrsiCaixa, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Claudia Fortuny
- Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues del Llobregat
| | - Dan Ouchi
- AIDS Research Institute IrsiCaixa, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Maria José Mellado
- Servicio de Pediatría Hospitalaria y E. Infecciosas y Tropicales Pediátricas. Hospital Universitario Infantil LA PAZ- H. Carlos III, Madrid
| | - Pablo Rojo
- Servicio de Pediatría. Hospital 12 de Octubre, Madrid
| | - Antoni Noguera-Julian
- Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues del Llobregat
| | - Ma Angeles Muñoz-Fernández
- Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Gregorio Marañón
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN)
- Spanish HIV HGM BioBank
| | - Javier Martinez-Picado
- AIDS Research Institute IrsiCaixa, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
- Universitat de Vic – Universitat Central de Catalunya (UVic-UCC)
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
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Rousaud A, Fortuny C, Lonca M, Blanch J. Transferring HIV-infected Adolescents to an Adult Outpatient Clinic. Implementation of a Standardized Protocol. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30467-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Falcon-Neyra L, Benmarzouk-Hidalgo OJ, Madrid L, Noguera-Julian A, Fortuny C, Neth O, López-Cortés L. No differences of immune activation and microbial translocation among HIV-infected children receiving combined antiretroviral therapy or protease inhibitor monotherapy. Medicine (Baltimore) 2015; 94:e521. [PMID: 25789946 PMCID: PMC4602495 DOI: 10.1097/md.0000000000000521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
This is a cross-sectional study of 15 aviremic chronic HIV-infected children revealing no differences in immune activation (IA; HLA-DRCD38 CD4 and CD8 T cells, and sCD14) and microbial translocation (MT; lipopolysaccharides (LPS) and 16S rDNA) among HIV-infected patients under combined antiretroviral treatment (cART; n = 10) or ritonavir-boosted protease inhibitor monotherapy (mtPI/rtv; n = 5). In both cases, IA and MT were lower in healthy control children (n = 32). This observational study suggests that ritonavir boosted protease inhibitor monotherapy (mtPI/rtv) is not associated with an increased state of IA or MT as compared with children receiving cART.
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Affiliation(s)
- Lola Falcon-Neyra
- From the Unidad de Enfermedades Infecciosas e Inmunopatologias, Hospital Infantil Virgen del Rocio, Instituto de Biomedicina de Sevilla (LF-N, LM, ON); Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBiS), Sevilla (OJB-H, LL-C); ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; and Unitat d'Infectologia, Servei de Pediatria, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain (LM, AN-J, CF)
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Noyola DE, Alarcón A, Noguera-Julian A, Muntasell A, Muñoz-Almagro C, García J, Mur A, Fortuny C, López-Botet M. Dynamics of the NK-cell subset redistribution induced by cytomegalovirus infection in preterm infants. Hum Immunol 2015; 76:118-23. [PMID: 25636568 DOI: 10.1016/j.humimm.2015.01.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 10/23/2014] [Revised: 01/02/2015] [Accepted: 01/14/2015] [Indexed: 12/22/2022]
Abstract
Human cytomegalovirus (HCMV) infection promotes an expansion of NK-cells expressing the CD94/NKG2C receptor. We prospectively monitored the effects of HCMV on the NK-cell receptor (NKG2C, NKG2A, KIR, LILRB1) distribution in preterm infants. As compared to non-infected moderately preterm newborns (n=19, gestational age: 32-37 weeks), very preterm infants (n=5, gestational age: <32 weeks) suffering symptomatic postnatal HCMV infection displayed increased numbers of NKG2C+, KIR+ NK-cells, encompassed by a reduction of NKG2A+ NK-cells. A similar profile was observed in HCMV-negative newborns (n=4) with asymptomatic infection, during follow-up at ~4 and 10 months of age. Of note, viremia remained detectable in three symptomatic cases at ~10 months despite the persistent expansion of NKG2C+ NK-cells. Our study provides original insights on the dynamics of the imprint exerted by primary HCMV infection on the NK-cell compartment, revealing that the expansion of NKG2C+ NK-cells may be insufficient to control viral replication in very preterm infants.
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Affiliation(s)
- Daniel E Noyola
- Immunology Unit, Universitat Pompeu Fabra, Doctor Aiguader 88, 08003 Barcelona, Spain.
| | - Ana Alarcón
- Department of Neonatology, Hospital Sant Joan de Déu, Universitat de Barcelona, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain.
| | - Antoni Noguera-Julian
- Infectious Diseases Unit, Hospital Sant Joan de Déu, Pediatrics Department, Universitat de Barcelona, Spain
| | - Aura Muntasell
- Hospital del Mar Medical Research Institute (IMIM), Doctor Aiguader 88, 08003 Barcelona, Spain
| | | | - Jordi García
- Neonatal Unit, Pediatrics Department, Hospital del Mar, Universitat Autònoma de Barcelona, Passeig Marítim de la Barceloneta, 25-29, 08003 Barcelona, Spain
| | - Antonio Mur
- Neonatal Unit, Pediatrics Department, Hospital del Mar, Universitat Autònoma de Barcelona, Passeig Marítim de la Barceloneta, 25-29, 08003 Barcelona, Spain
| | - Claudia Fortuny
- Infectious Diseases Unit, Hospital Sant Joan de Déu, Pediatrics Department, Universitat de Barcelona, Spain
| | - Miguel López-Botet
- Immunology Unit, Universitat Pompeu Fabra, Doctor Aiguader 88, 08003 Barcelona, Spain; Hospital del Mar Medical Research Institute (IMIM), Doctor Aiguader 88, 08003 Barcelona, Spain.
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Byrne LC, Oztürk BE, Lee T, Fortuny C, Visel M, Dalkara D, Schaffer DV, Flannery JG. Retinoschisin gene therapy in photoreceptors, Müller glia or all retinal cells in the Rs1h-/- mouse. Gene Ther 2014; 21:585-92. [PMID: 24694538 PMCID: PMC4047144 DOI: 10.1038/gt.2014.31] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 01/28/2014] [Accepted: 02/25/2014] [Indexed: 01/21/2023]
Abstract
X-linked retinoschisis, a disease characterized by splitting of the retina, is caused by mutations in the retinoschisin gene, which encodes a secreted cell adhesion protein. Currently, there is no effective treatment for retinoschisis, though viral vector-mediated gene replacement therapies offer promise. We used intravitreal delivery of three different AAV vectors to target delivery of the RS1 gene to Müller glia, photoreceptors, or multiple cell types throughout the retina. Müller glia radially span the entire retina, are accessible from the vitreous, and remain intact throughout progression of the disease. However, photoreceptors, not glia, normally secrete retinoschisin. We compared the efficacy of rescue mediated by retinoschisin secretion from these specific subtypes of retinal cells in the Rs1h−/− mouse model of retinoschisis. Our results indicate that all three vectors deliver the RS1 gene, and that several cell types can secrete retinoschisin, leading to transport of the protein across the retina. The greatest long-term rescue was observed when photoreceptors produce retinoschisin. Similar rescue was observed with photoreceptor-specific or generalized expression, though photoreceptor secretion may contribute to rescue in the latter case. These results collectively point to the importance of cell targeting and appropriate vector choice in the success of retinal gene therapies.
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Affiliation(s)
- L C Byrne
- 1] Department of Molecular and Cellular Biology, The Helen Wills Neuroscience Institute, The University of California, Berkeley, CA, USA [2] Department of Chemical and Biomolecular Engineering, The Helen Wills Neuroscience Institute, The University of California, Berkeley, CA, USA [3] Department of Bioengineering, The Helen Wills Neuroscience Institute, The University of California, Berkeley, CA, USA
| | - B E Oztürk
- Department of Molecular and Cellular Biology, The Helen Wills Neuroscience Institute, The University of California, Berkeley, CA, USA
| | - T Lee
- Department of Molecular and Cellular Biology, The Helen Wills Neuroscience Institute, The University of California, Berkeley, CA, USA
| | - C Fortuny
- 1] Department of Molecular and Cellular Biology, The Helen Wills Neuroscience Institute, The University of California, Berkeley, CA, USA [2] Department of Vision Science, The University of California, Berkeley, CA, USA
| | - M Visel
- Department of Molecular and Cellular Biology, The Helen Wills Neuroscience Institute, The University of California, Berkeley, CA, USA
| | - D Dalkara
- 1] Department of Molecular and Cellular Biology, The Helen Wills Neuroscience Institute, The University of California, Berkeley, CA, USA [2] Department of Chemical and Biomolecular Engineering, The Helen Wills Neuroscience Institute, The University of California, Berkeley, CA, USA [3] Department of Bioengineering, The Helen Wills Neuroscience Institute, The University of California, Berkeley, CA, USA
| | - D V Schaffer
- 1] Department of Chemical and Biomolecular Engineering, The Helen Wills Neuroscience Institute, The University of California, Berkeley, CA, USA [2] Department of Bioengineering, The Helen Wills Neuroscience Institute, The University of California, Berkeley, CA, USA
| | - J G Flannery
- 1] Department of Molecular and Cellular Biology, The Helen Wills Neuroscience Institute, The University of California, Berkeley, CA, USA [2] Department of Vision Science, The University of California, Berkeley, CA, USA
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Vicente A, Pau-Charles I, González-Enseñat MA, Muñoz-Almagro C, Cañadas MP, Noguera-Julian A, Fortuny C. High-risk alpha-human papillomavirus types: Detection in HIV-infected children with acquired epidermodysplasia verruciformis. J Am Acad Dermatol 2013; 68:343-5. [DOI: 10.1016/j.jaad.2012.08.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 08/09/2012] [Accepted: 08/12/2012] [Indexed: 10/27/2022]
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de Jose MI, Jiménez de Ory S, Espiau M, Fortuny C, Navarro ML, Soler-Palacín P, Muñoz-Fernandez MA. A new tool for the paediatric HIV research: general data from the Cohort of the Spanish Paediatric HIV Network (CoRISpe). BMC Infect Dis 2013; 13:2. [PMID: 23282073 PMCID: PMC3544738 DOI: 10.1186/1471-2334-13-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 12/18/2012] [Indexed: 12/20/2022] Open
Abstract
There are approximately from 1,100 to 1,200 HIV-infected children in a follow-up in Spain. In 2008 an open, multicentral, retrospective and prospective Cohort of the Spanish Paediatric HIV Network (CoRISpe) was founded. The CoRISpe is divided into the node 1 and node 2 representing geographically almost the whole territory of Spain. Since 2008 seventy-five hospitals have been participating in the CoRISpe. All the retrospective data of the HIV-infected children have been kept in the CoRISpe since 1995 and prospective data since 2008. In this article we are going to present the notion of CoRISpe, its role, the structure, how the CoRISpe works and the process how a child is transferred from Paediatric to Adults Units. The main objective of the CoRISpe is to contribute to furthering scientific knowledge on paediatric HIV infection by providing demographic, sociopsychological, clinical and laboratory data from HIV-infected paediatric patients. Its aim is to enable high-quality research studies on HIV-infected children.
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Affiliation(s)
- Ma Isabel de Jose
- Servicio Infecciosas Infantil, Hospital Universitario “La Paz”, Paseo de la Castellana 26, Madrid, 128046, Spain
| | - Santiago Jiménez de Ory
- Laboratorio de Inmuno-Biología Molecular. Spanish HIV HGM BioBank. Hospital General Universitario “Gregorio Marañón” and Instituto de Investigación Sanitaria Gregorio Marañón, C/Dr. Esquerdo 46, Madrid, 28007, Spain
| | - Maria Espiau
- Unitat de Patologia Infecciosa i Immunodeficiències de Pediatria, Hospital Universitari Vall d` Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Claudia Fortuny
- Servicio Infecciosas Infantil, Hospital Sant Joan de Dèu, Esplugues de Llobregat, Barcelona, Spain
| | - Ma Luisa Navarro
- Sección de Enfermedades Infecciosas. Servicio de Pediatría. Hospital General Universitario “Gregorio Marañón”, Madrid, Spain
| | - Pere Soler-Palacín
- Unitat de Patologia Infecciosa i Immunodeficiències de Pediatria, Hospital Universitari Vall d` Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ma Angeles Muñoz-Fernandez
- Laboratorio de Inmuno-Biología Molecular. Spanish HIV HGM BioBank. Hospital General Universitario “Gregorio Marañón” and Instituto de Investigación Sanitaria Gregorio Marañón, C/Dr. Esquerdo 46, Madrid, 28007, Spain
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Noyola DE, Fortuny C, Muntasell A, Noguera-Julian A, Muñoz-Almagro C, Alarcón A, Juncosa T, Moraru M, Vilches C, López-Botet M. Influence of congenital human cytomegalovirus infection and the NKG2C genotype on NK-cell subset distribution in children. Eur J Immunol 2012; 42:3256-66. [PMID: 22965785 DOI: 10.1002/eji.201242752] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Revised: 08/11/2012] [Accepted: 09/06/2012] [Indexed: 12/22/2022]
Abstract
Human cytomegalovirus (HCMV) has been reported to reshape the NK-cell receptor (NKR) distribution, promoting an expansion of CD94/NKG2C(+) NK and T cells. The role of NK cells in congenital HCMV infection is ill-defined. Here we studied the expression of NKR (i.e., NKG2C, NKG2A, LILRB1, CD161) and the frequency of the NKG2C gene deletion in children with past congenital infection, both symptomatic (n = 15) and asymptomatic (n = 11), including as controls children with postnatal infection (n = 11) and noninfected (n = 20). The expansion of NKG2C(+) NK cells in HCMV-infected individuals appeared particularly marked and was associated with an increased number of LILRB1(+) NK cells in cases with symptomatic congenital infection. Increased numbers of NKG2C(+), NKG2A(+), and CD161(+) T cells were also associated to HCMV infection. The NKG2C deletion frequency was comparable in children with congenital HCMV infection and controls. Remarkably, the homozygous NKG2C(+/+) genotype appeared associated with increased absolute numbers of NKG2C(+) NK cells. Moreover, HCMV-infected NKG2C(+/+) children displayed higher absolute numbers of NKG2A(+) and total NK cells than NKG2C(+/-) individuals. Our study provides novel insights on the impact of HCMV infection on the homeostasis of the NK-cell compartment in children, revealing a modulatory influence of NKG2C copy number.
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Affiliation(s)
- Daniel E Noyola
- Department of Microbiology, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
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García M, Santiago JL, Terrón A, Hernández-Martín A, Vicente A, Fortuny C, De Lucas R, López JC, Cuadrado-Corrales N, Holguín A, Illera N, Duarte B, Sánchez-Jimeno C, Llames S, García E, Ayuso C, Martínez-Santamaría L, Castiglia D, De Luca N, Torrelo A, Mechan D, Baty D, Zambruno G, Escámez MJ, Del Río M. Two novel recessive mutations in KRT14 identified in a cohort of 21 Spanish families with epidermolysis bullosa simplex. Br J Dermatol 2012; 165:683-92. [PMID: 21623745 DOI: 10.1111/j.1365-2133.2011.10428.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Basal epidermolysis bullosa simplex (EBS) is a group of blistering genodermatoses mostly caused by mutations in the keratin genes, KRT5 and KRT14. Recessive mutations represent about 5% of all EBS mutations, being common and specific in populations with high consanguinity, where affected patients show severe phenotypes. OBJECTIVES To accomplish the first mutational analysis in patients of Spanish origin with EBS and to delineate a comprehensive genotype-phenotype correlation. METHODS Twenty-one EBS families were analysed. Immunofluorescence mapping at the dermoepidermal junction level was performed on skin biopsies from patients. Mutation screening of the entire coding sequences of KRT5 and KRT14 in genomic DNA was assessed by polymerase chain reaction and direct sequencing. RESULTS KRT5 or KRT14 causative mutations were identified in 18 of the 21 EBS families. A total of 14 different mutations were disclosed, of which 12 were dominant missense mutations and two truncating recessive mutations. Five of the 14 mutations were novel including three dominant in KRT5 (p.V186E, p.T321P and p.A428T) and two recessive in KRT14 (p.K116X and p.K250RfsX8). The two patients with EBS carrying homozygous recessive mutations were affected by severe phenotypes and belonged to consanguineous families. All five families with the EBS Dowling-Meara subtype carried recurrent mutations affecting the highly conserved ends of the α-helical rod domain of K5 and K14. The seven mutations associated with the localized EBS subtype were widely distributed along the KRT5 and KRT14 genes. Two families with mottled pigmentation carried the P25L mutation in KRT5, commonly associated with this subtype. CONCLUSIONS This study further confirms the genotype-phenotype correlation established for EBS in other ethnic groups, and is the first in a Mediterranean country (excluding Israel). This study adds two novel recessive mutations to the worldwide record to date, which includes a total of 14 mutations. As in previous reports, the recessive mutations resulted in a lack of keratin K14, giving rise to a generalized and severe presentation.
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Affiliation(s)
- M García
- Regenerative Medicine Unit, Epithelial Biomedicine Division, Basic Research Department, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, Av. Complutense 22, 28040 Madrid, Spain
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Picard C, von Bernuth H, Ghandil P, Chrabieh M, Levy O, Arkwright PD, McDonald D, Geha RS, Takada H, Krause JC, Creech CB, Ku CL, Ehl S, Maŕodi Ĺ, Al-Muhsen S, Al-Hajjar S, Al-Ghonaium A, Day-Good NK, Holland SM, Gallin J, Chapel H, Speert DP, Rodriguez-Gallego C, Colino E, Garty BZ, Roifman C, Hara T, Yoshikawa H, Nonoyama S, Domachowske J, Issekutz AC, Tang M, Smart J, Zitnik SE, Hoarau C, Kumararatne D, Thrasher A, Davies EG, Bethune C, Sirvent N, de Ricaud D, Camcioglu Y, Vasconcelos J, Guedes M, Vitor AB, Rodrigo C, AlmaŸan F, Ḿendez M, Aŕostegui JI, Alsina L, Fortuny C, Reichenbach J, Verbsky JW, Bossuyt X, Doffinger R, Abel L, Puel A, Casanova JL. Clinical features and outcome of patients with IRAK-4 and MyD88 deficiency. Medicine (Baltimore) 2010; 89:403-425. [PMID: 21057262 PMCID: PMC3103888 DOI: 10.1097/md.0b013e3181fd8ec3] [Citation(s) in RCA: 289] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Autosomal recessive interleukin-1 receptor-associated kinase (IRAK)-4 and myeloid differentiation factor (MyD)88 deficiencies impair Toll-like receptor (TLR)- and interleukin-1 receptor-mediated immunity. We documented the clinical features and outcome of 48 patients with IRAK-4 deficiency and 12 patients with MyD88 deficiency, from 37 kindreds in 15 countries.The clinical features of IRAK-4 and MyD88 deficiency were indistinguishable. There were no severe viral, parasitic, and fungal diseases, and the range of bacterial infections was narrow. Noninvasive bacterial infections occurred in 52 patients, with a high incidence of infections of the upper respiratory tract and the skin, mostly caused by Pseudomonas aeruginosa and Staphylococcus aureus, respectively. The leading threat was invasive pneumococcal disease, documented in 41 patients (68%) and causing 72 documented invasive infections (52.2%). P. aeruginosa and Staph. aureus documented invasive infections also occurred (16.7% and 16%, respectively, in 13 and 13 patients, respectively). Systemic signs of inflammation were usually weak or delayed. The first invasive infection occurred before the age of 2 years in 53 (88.3%) and in the neonatal period in 19 (32.7%) patients. Multiple or recurrent invasive infections were observed in most survivors (n = 36/50, 72%).Clinical outcome was poor, with 24 deaths, in 10 cases during the first invasive episode and in 16 cases of invasive pneumococcal disease. However, no death and invasive infectious disease were reported in patients after the age of 8 years and 14 years, respectively. Antibiotic prophylaxis (n = 34), antipneumococcal vaccination (n = 31), and/or IgG infusion (n = 19), when instituted, had a beneficial impact on patients until the teenage years, with no seemingly detectable impact thereafter.IRAK-4 and MyD88 deficiencies predispose patients to recurrent life-threatening bacterial diseases, such as invasive pneumococcal disease in particular, in infancy and early childhood, with weak signs of inflammation. Patients and families should be informed of the risk of developing life-threatening infections; empiric antibacterial treatment and immediate medical consultation are strongly recommended in cases of suspected infection or moderate fever. Prophylactic measures in childhood are beneficial, until spontaneous improvement occurs in adolescence.
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