Seroprevalence of Toscana and sandfly fever Sicilian viruses in humans and livestock animals from western Saudi Arabia

High seroprevalence rates of several phleboviruses have been reported in domestic animals and humans in sandfly-infested regions. Sandfly Fever Sicilian virus (SFSV) and Toscana virus (TOSV) are two of these viruses commonly transmitted by Phlebotomus sandflies. While SFSV can cause rapidly resolving mild febrile illness, TOSV could involve the central nervous system (CNS), causing diseases ranging from aseptic meningitis to meningoencephalitis. Sandfly-associated phleboviruses have not been investigated before in Saudi Arabia and are potential causes of infection given the prevalence of sandflies in the country. Here, we investigated the seroprevalence of SFSV and TOSV in the western region of Saudi Arabia in samples collected from blood donors, livestock animals, and animal handlers. An overall seroprevalence of 9.4% and 0.8% was found in humans for SFSV and TOSV, respectively. Seropositivity was significantly higher in non-Saudis compared to Saudis and increased significantly with age especially for SFSV. The highest seropositivity rate was among samples collected from animal handlers. Specifically, in blood donors, 6.4% and 0.7% tested positive for SFSV and TOSV nAbs, respectively. Animal handlers showed higher seroprevalence rates of 16% and 1% for anti-SFSV and anti-TOSV nAbs, respectively, suggesting that contact with livestock animals could be a risk factor. Indeed, sera from livestock animals showed seropositivity of 53.3% and 4.4% in cows, 27.5% and 7.8% in sheep, 2.2% and 0.0% in goats, and 10.0% and 2.3% in camels for SFSV and TOSV, respectively. Together, these results suggest that both SFSV and TOSV are circulating in the western region of Saudi Arabia in humans and livestock animals, albeit at different rates, and that age and contact with livestock animals could represent risk factors for infection with these viruses.

Efficient inactivation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in human apheresis platelet concentrates with amotosalen and ultraviolet A light

Objectives

The detection of SARS-CoV-2 RNA in blood and platelet concentrates from asymptomatic donors, and the detection of viral particles on the surface and inside platelets during in vitro experiments, raised concerns over the potential risk for transfusion-transmitted-infection (TTI). The objective of this study was to assess the efficacy of the amotosalen/UVA pathogen reduction technology for SARS-CoV-2 in human platelet concentrates to mitigate such potential risk.

Material and methods

Five apheresis platelet units in 100% plasma were spiked with a clinical SARS-CoV-2 isolate followed by treatment with amotosalen/UVA (INTERCEPT Blood System), pre- and posttreatment samples were collected as well as untreated positive and negative controls. The infectious viral titer was assessed by plaque assay and the genomic titer by quantitative RT-PCR. To exclude the presence of infectious particles post-pathogen reduction treatment below the limit of detection, three consecutive rounds of passaging on permissive cell lines were conducted.

Results

SARS-CoV-2 in platelet concentrates was inactivated with amotosalen/UVA below the limit of detection with a mean log reduction of > 3.31 ± 0.23. During three consecutive rounds of passaging, no viral replication was detected. Pathogen reduction treatment also inhibited nucleic acid detection with a log reduction of > 4.46 ± 0.51 PFU equivalents.

Conclusion

SARS-CoV-2 was efficiently inactivated in platelet concentrates by amotosalen/UVA treatment. These results are in line with previous inactivation data for SARS-CoV-2 in plasma as well as MERS-CoV and SARS-CoV-1 in platelets and plasma, demonstrating efficient inactivation of human coronaviruses.

Understanding the role of therapeutic plasma exchange in COVID-19: preliminary guidance and practices

BACKGROUND AND OBJECTIVES

Cytokine release syndrome in COVID-19 is due to a pathological inflammatory response of raised cytokines. Removal of these cytokines by therapeutic plasma exchange (TPE) prior to end-organ damage may improve clinical outcomes. This manuscript is intended to serve as a preliminary guidance document for application of TPE in patients with severe COVID-19.

MATERIAL AND METHODS

The available literature pertaining to the role of TPE for treatment of COVID-19 patients was reviewed to guide optimal management. It included indication, contraindication, optimal timing of initiation and termination of TPE, vascular access and anticoagulants, numbers and mode of procedures, outcome measures and adverse events.

RESULTS

Out of a total of 78 articles, only 65 were directly related to the topic. From these 65, only 32 were acceptable as primary source, while 33 were used as supporting references. TPE in critically ill COVID-19 patients may be classified under ASFA category III grade 2B. The early initiation of TPE for 1-1·5 patient's plasma volume with fresh frozen plasma, or 4-5% albumin or COVID-19 convalescent plasma as replacement fluids before multiorgan failure, has better chances of recovery. The number of procedures can vary from three to nine depending on patient response.

CONCLUSION

TPE in COVID-19 patients may help by removing toxic cytokines, viral particles and/or by correcting coagulopathy or restoring endothelial membrane. Severity score (SOFA & APACHE II) and cytokine levels (IL-6, C-reactive protein) can be used to execute TPE therapy and to monitor response in COVID-19 patients.

Role of interferon gamma in SARS-CoV-2-positive patients with parasitic infections

Background

By 27 June 2020, almost half a million people had died due to COVID-19 infections. The susceptibility and severity of infection vary significantly across nations. The contribution of chronic viral and parasitic infections to immune homeostasis remains a concern. By investigating the role of interferon (IFN)-γ, we conducted this study to understand the connection between the decrease in numbers and severity of COVID-19 cases within parasitic endemic regions. Our research included 375 patients referred to hospitals for diagnosis of COVID-19 infection. Patients were subjected to full investigations, in particular severe acute respiratory syndrome coronavirus-2 nucleic acid and Toxoplasma IgM and IgG antibody detection, stool examination, and quantitative IFN-γ measurement.

Results

The majority of the studied cases had chest manifestation either alone (54.7%) or in association with gastrointestinal (GIT) manifestations (19.7%), whereas 25.6% had GIT symptoms. We reported parasitic infections in 72.8% of mild COVID-19 cases and 20.7% of severe cases. Toxoplasma gondii, Cryptosporidium, Blastocyst, and Giardia were the most common parasitic infections among the COVID-19 cases studied.

Conclusion

The remarkable adaptation of human immune response to COVID-19 infection by parasitic infections with high levels of IFN-γ was observed in moderate cases compared with low levels in extreme cases. The potential therapeutic efforts aimed at the role of parasitic infection in immune system modulation are needed if this hypothesis is confirmed.

Amotosalen and ultraviolet A light treatment efficiently inactivates severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in human plasma

Background and objectives

During the ongoing pandemic of COVID‐19, SARS‐CoV‐2 RNA was detected in plasma and platelet products from asymptomatic blood donors, raising concerns about potential risk of transfusion transmission, also in the context of the current therapeutic approach utilizing plasma from convalescent donors. The objective of this study was to assess the efficacy of amotosalen/UVA light treatment to inactivate SARS‐CoV‐2 in human plasma to reduce the risk of potential transmission through blood transfusion.

Methods

Pools of three whole‐blood‐derived human plasma units (630–650 ml) were inoculated with a clinical SARS‐CoV‐2 isolate. Spiked units were treated with amotosalen/UVA light (INTERCEPT Blood System™) to inactivate SARS‐CoV‐2. Infectious titres and genomic viral load were assessed by plaque assay and real‐time quantitative PCR. Inactivated samples were subject to three successive passages on permissive tissue culture to exclude the presence of replication‐competent viral particles.

Results

Inactivation of infectious viral particles in spiked plasma units below the limit of detection was achieved by amotosalen/UVA light treatment with a mean log reduction of >3·32 ± 0·2. Passaging of inactivated samples on permissive tissue showed no viral replication even after 9 days of incubation and three passages, confirming complete inactivation. The treatment also inhibited NAT detection by nucleic acid modification with a mean log reduction of 2·92 ± 0·87 PFU genomic equivalents.

Conclusion

Amotosalen/UVA light treatment of SARS‐CoV‐2 spiked human plasma units efficiently and completely inactivated >3·32 ± 0·2 log of SARS‐CoV‐2 infectivity, showing that such treatment could minimize the risk of transfusion‐related SARS‐CoV‐2 transmission.

Seroprevalence of MERS-CoV in healthy adults in western Saudi Arabia, 2011-2016

Background

The Middle East respiratory syndrome coronavirus (MERS-CoV) is a newly recognized zoonotic coronavirus. Current evidence confirms the role of dromedaries in primary human infections but does not explain the sporadic community cases. However, asymptomatic or subclinical cases could represent a possible source of infection in the community.

Methods

Archived human sera (7461) collected between 2011 and 2016 from healthy adult blood donors from 50 different nationalities in the western part of Saudi Arabia were obtained for MERS-CoV seroprevalence investigation. Samples were tested for MERS-CoV S1-specific antibodies (Abs) by ELISA and confirmed by testing for neutralizing Abs (nAbs) using both pseudotyped and live virus neutralization assays.

Results

Out of 7461 samples, 174 sera from individuals with 18 different nationalities were ELISA positive (2.3%, 95% CI 2.0–2.7). Presence of nAbs was confirmed in 17 samples (0.23%, 95% CI 0.1–0.4) of which one sample exhibited positivity in both neutralization assays. Confirmed seropositivity was identified in young (15–44 years) men and women from Saudi Arabia, Egypt, Yemen, Pakistan, Palestine, Sudan, and India without significant preference.

Conclusions

An increasing trend of MERS-CoV seroprevalence was observed in the general population in western Saudi Arabia, suggesting that asymptomatic or mild infections might exist and act as an unrecognized source of infection. Seropositivity of individuals from different nationalities underscores the potential MERS exportation outside of the Arabian Peninsula. Thus, enhanced and continuous surveillance is highly warranted.

Amotosalen and ultraviolet A light efficiently inactivate MERS-coronavirus in human platelet concentrates

Objective

This study aimed to assess the efficacy of the INTERCEPT™ Blood System [amotosalen/ultraviolet A (UVA) light] to reduce the risk of Middle East respiratory syndrome‐Coronavirus (MERS‐CoV) transmission by human platelet concentrates.

Background

Since 2012, more than 2425 MERS‐CoV human cases have been reported in 27 countries. The infection causes acute respiratory disease, which was responsible for 838 deaths in these countries, mainly in Saudi Arabia. Viral genomic RNA was detected in whole blood, serum and plasma of infected patients, raising concerns of the safety of blood supplies, especially in endemic areas.

Methods

Four apheresis platelet units in 100% plasma were inoculated with a clinical MERS‐CoV isolate. Spiked units were then treated with amotosalen/UVA to inactivate MERS‐CoV. Infectious and genomic viral titres were quantified by plaque assay and quantitative real‐time reverse transcription polymerase chain reaction (RT‐qPCR). Inactivated samples were successively passaged thrice on Vero E6 cells to exclude the presence of residual replication‐competent viral particles in inactivated platelets.

Results

Complete inactivation of MERS‐CoV in spiked platelet units was achieved by treatment with Amotosalen/UVA light with a mean log reduction of 4·48 ± 0·3. Passaging of the inactivated samples in Vero E6 showed no viral replication even after nine days of incubation and three passages. Viral genomic RNA titration in inactivated samples showed titres comparable to those in pre‐treatment samples.

Conclusion

Amotosalen and UVA light treatment of MERS‐CoV‐spiked platelet concentrates efficiently and completely inactivated MERS‐CoV infectivity (>4 logs), suggesting that such treatment could minimise the risk of transfusion‐related MERS‐CoV transmission.

Development and validation of different indirect ELISAs for MERS-CoV serological testing

Since 2012, MERS-CoV has caused up to 2220 cases and 790 deaths in 27 countries with Saudi Arabia being the most affected country with ~83.1% of the cases and ~38.8% local death rate. Current serological assays such as microneutralization (MN), plaque reduction neutralization, immunofluorescence, protein microarray or pseudoparticle neutralization assays rely on handling of live MERS-CoV in high containment laboratories or need for expensive and special equipment and reagents and highly trained personnel which represent a technical hurdle for most laboratories in resource-limited MERS-CoV endemic countries. Here, we developed, compared and evaluated three different indirect ELISAs based on MERS-CoV nucleocapsid protein (N), spike (S) ectodomain (amino acids 1–1297) and S1 subunit (amino acids 1–725) and compared them with MN assay. The developed ELISAs were evaluated using large number of confirmed seropositive (79 samples) and seronegative (274 samples) MERS-CoV human serum samples. Both rS1- and rS-ELISAs maintained high sensitivity and specificity (≥90%) across a wider range of OD values compared to rN-ELISA. Moreover, rS1- and rS-based ELISAs showed better agreement and correlation with MN assay in contrast to rN-ELISA. Collectively, our data demonstrate that rS1-ELISA and rS-ELISA are more reliable than rN-ELISA and represent a suitable choice for seroepidemiological testing and surveillance in MERS-CoV endemic regions.

Inactivation of Middle East respiratory syndrome-coronavirus in human plasma using amotosalen and ultraviolet A light

BACKGROUND

Middle East respiratory syndrome‐coronavirus (MERS‐CoV) is a novel zoonotic pathogen. Although the potential for MERS‐CoV transmission through blood transfusion is not clear, MERS‐CoV was recognized as a pathogen of concern for the safety of the blood supply especially after its detection in whole blood, serum, and plasma of infected individuals. Here we investigated the efficacy of amotosalen and ultraviolet A light (UVA) to inactivate MERS‐CoV in fresh‐frozen plasma (FFP).

STUDY DESIGN AND METHODS

Pooled FFP units were spiked with a recent clinical MERS‐CoV isolate. Infectious and genomic viral titers were determined in plasma before and after inactivation with amotosalen/UVA treatment by plaque assay and reverse transcription–quantitative polymerase chain reaction, respectively. In addition, residual replicating or live virus after inactivation was examined by passaging in the permissive Vero E6 cells.

RESULTS

The mean MERS‐CoV infectious titer in pretreatment samples was 4.67 ± 0.25 log plaque‐forming units (pfu)/mL, which was reduced to undetectable levels after inactivation with amotosalen/UVA demonstrating a mean log reduction of more than 4.67 ± 0.25 pfu/mL. Furthermore, inoculation of inactivated plasma on Vero E6 cells did not result in any cytopathic effect (CPE) even after 7 days of incubation and three consecutive passages, nor the detection of MERS RNA compared to pretreatment samples which showed complete CPE within 2 to 3 days postinoculation and log viral RNA titer ranging from 9.48 to 10.22 copies/mL in all three passages.

CONCLUSION

Our data show that amotosalen/UVA treatment is a potent and effective way to inactivate MERS‐CoV infectious particles in FFP to undetectable levels and to minimize the risk of any possible transfusion‐related MERS‐CoV transmission.

The use of transfusion quality indicators as a tool for hemovigilance system implementation at a tertiary care center in Saudi Arabia

OBJECTIVES

To report 2-years experience of using transfusion-related quality indicators as a tool in hemovigilance system implementation. 

METHODS

The study was carried out between 2012 and 2013. Blood transfusion service data were prospectively collected at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Donor reactions, transfusion reactions, fresh frozen plasma (FFP) in-date wastage, incidents, and errors pertaining to orders, or requests were collected quarterly and prospectively and forwarded to the Hospital Transfusion Committee (HTC) for review. 

RESULTS

Donor population consisted of 23,132 donors. One hundred and forty-eight donor reactions were reported, resulting in a rate of 0.6%. Eighty-four transfusion reactions were reported and most were allergic reactions (79.7%). Errors or incidents were reported with approximately 0.3% of the total number of submitted samples/request forms. The FFP in-date wastage was 21.3% of the total FFP wastage. The HTC regularly reviewed the hemovigilance data and reporting; and safety improvements were implemented. 

CONCLUSION

The use of quality indicators as a tool for developing and implementing a hemovigilance system provided a better understanding of improvement areas for continuous progress in quality and safety, and is expected to enhance these features along the blood transfusion chain.

Red Blood Cell Alloimmunization in Sickle Cell Disease Patients in Jeddah, Saudi Arabia: A Pilot Study

The treatment of patients with sickle cell disease frequently requires transfusion of red blood cells. Complications due to alloimmunization of red blood cells antigen remain a major risk as a post transfusion effect. The objective of this study is to determine the frequency of red cell alloimmunization in Jeddah, Saudi Arabia. A retrospective cross-section study of sickle cell disease patients at King Abdulaziz University Hospital between 2012 and 2013 was performed. Demographic characteristics and transfusion history was recorded. Blood samples were analyzed for alloimmunization using immunohematological technique. A total of 234 sickle cell patients were analyzed, of which 30 (12.8%) showed alloantibodies. A total of 43 alloantibodies were found out of which 28 belonged to Rh group, eight belonged to Kell while three belonged to MNS group. Demographic and transfusion characteristics were analyzed between alloimmunized and nonalloimmunized sickle cell disease patients. The rate of alloimmunization in Jeddah, Saudi Arabia was 12.8%. There was significant difference observed between alloantibodies detection between transfused patients compared to non-transfused patients. The consequences of red blood cell alloimmunization are highly significant and therefore immune hematological testing is highly recommended.  

Breast cancer awareness and breast self-examination in Northern Saudi Arabia. A preliminary survey

OBJECTIVE

To elicit knowledge of breast cancer, perception of occurrence, and behavior in relation to breast self-examination (BSE).

METHODS

A cross-sectional survey was carried out at the Department of Pathology, Medical College, University of Hail, Hail, Kingdom of Saudi Arabia for local occupants from Hail city and its rural neighborhood between September 2010 and February 2012. A personal interview-administered descriptive questionnaire and both descriptive and inferential statistics were used.

RESULTS

A total of 1000 participants agreed to be involved, out of which 87.7% were females, 7.2% were males and 5.1% had undisclosed gender. The age range for participants was 12-66 years. Out of all participants, 44% did not know that breast cancer is an abnormal growth and 78% failed to recognise its multi-factorial nature, with Increased age being the least recognised single risk factor 4.8%. Scores showed that 61.5% had a low level of breast cancer related knowledge. Out of the participants who knew of someone who had breast cancer 73%, 50.1% said the disease was discovered at a Late stage mainly by Chance. Data for BSE indicated that 50.1% of female participants >16 years old did not practice BSE, and Fear was the main declared perceived reason.

CONCLUSION

This study demonstrates a low level of fundamental knowledge of breast cancer and fear to practice BSE.

Autoimmune thrombocytopenia. Is it a different disease or different aspects of a single disease?

OBJECTIVE

To evaluate the association between autoimmune thrombocytopenia with other autoimmune disorders, to show if they are different autoimmune diseases or one disease with different presentations at the same time, and to study the effect of treatment on platelet count in different thyroid condition.

METHODS

In this retrospective study, we included 141 patients with thrombocytopenic purpura. The result of thyroid function test, thyroid autoantibodies, Coombs' reactivity, anti-nuclear antibody, and double-stranded DNA were analyzed. This study was conducted in the Clinical Hematology Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia between June 2003 and August 2010.

RESULTS

There were 51 (36.2%) patients with laboratory evidence of autoimmune disease, 13 (9.2%) with hypothyroidism, and 6 (4.3%) with hyperthyroidism. In addition, 5 (3.5%) patients showed laboratory evidence of Evan syndrome and 3 (2.1%) patients had isolated positive thyroid antibodies. There was non-significant difference (p=0.61) in platelets count after one month of treatment of patients with different thyroid condition.

CONCLUSION

Immune thrombocytopenia is associated with evidence of different autoimmune disease or a combination of them, which may appear at presentation or during the course of disease giving evidence that they are different manifestations of a single disease. Screening patients for antithyroid antibodies would identify a patient at risk of developing overt thyroid disease. These patients may be further screened with a thyroid-stimulating hormone assay to detect subclinical thyroid disease.

Genotype and antiretroviral drug resistance of human immunodeficiency virus-1 in Saudi Arabia

OBJECTIVE

To analyze antiretroviral drug resistance and determine the genotype of human immunodeficiency virus (HIV)-1 in Saudi patients by sequencing an amplified region of the viral pol gene.

METHODS

This retrospective study analyzed data from plasma samples submitted for genotypic drug sensitivity monitoring. Samples were analyzed at the Special Infectious Agent Unit, King Fahd Medical Research Center of King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia from August 2004 to June 2009. The Viroseq2.5 kit (Celera/Abbott) was used with ABI Prism 3100 sequencer. All patients were Saudi nationals and were on antiretroviral therapy, some experiencing treatment failure.

RESULTS

Based on protease region (PR), genotypes of 63 samples were as follows: C:22, G:21, B:9, CRF02_AG:5, D:3, A:1, F:1, and J:1. Based on reverse transcriptase region (RT), genotypes were as follows: C:23, G:24, B:9, CRF02_AG: 2, D:2, A:1, and F:1. Antiretroviral susceptibility testing results were as follows: 52% of the isolates were susceptible to all 3 major classes of antiretroviral drugs used, 41% had mutations known to confer high level resistance to one or more of the nucleoside analogue reverse transcriptase inhibitors, 16% had mutations known to confer high level resistance to non-nucleoside analogues reverse transcriptase inhibitors, 13% had mutations known to confer high level resistance to one or more of the protease inhibitors (PI). Most isolates were susceptible to 2 or at least one class of antiretroviral, and only 3% of the isolates had resistance to several members of all 3 classes.

CONCLUSION

Antiretroviral resistance is not uncommon in Saudi patients on antiretroviral therapy.

Serologial screening of human T cell lymphotropic virus I and II (HTLV I/II) in blood banks by immunoblotting and enzyme-immuno assays: to demand or to defeat?

Human T cell lymphotropic virus I and II (HTLV I/II) has been recommended to be screened for blood donors since 1988, and it become a mandatory test to get college of american Pathologists (CAP) accreditation. The present study aimed at investigating the prevalence rate of HTLV I/II among Arab blood donors, to revise whether is its screening mandatory? Thirty-thousand (30,000) Arab donors along two years attending two central hospital blood banks in Jeddah. Antibodies to HTLV I/II have been screened using enzyme immunoassay (E.I.A) and immunoblotting assay (Western blot). Results revealed zero prevalence rate. Based upon this finding, no potential risk of HTLV I/II transmission among blood donors population exist. As screening for HTLV I/II is still mandatory, it could be done on pools of sera rather than on individual serum samples, after standardization of a pooling protocol, to fulfill coast-effectiveness and reduce the coasts by 90-95%.