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Clinical Infectious Diseases, 5.12.2023
Tilføjet 5.12.2023
AbstractMultidrug-resistant(MDR) tuberculosis in Southern Africa is of great concern, exacerbated by the spread of a clone harboring a mutation missed by Xpert Ultra. In Southern Mozambique, the presence of such mutation and rising cases of non-MDR isoniazid resistance highlights the need to ensure accurate detection of antimicrobial-resistance in the country.
Læs mere Tjek på PubMedClinical Infectious Diseases, 5.12.2023
Tilføjet 5.12.2023
AbstractBackgroundMetallo-β-lactamases (MBL)-producing Enterobacterales are increasing worldwide. Our aim was to describe clinical features, treatments and outcomes of infections by MBL-Enterobacterales.MethodsProspective observational study conducted in the Pisa University Hospital (Jan 2019-Oct 2022) including patients with MBL-producing Enterobacterales infections. The primary outcome measure was 30-day mortality. A multivariable Cox regression analysis was performed to identify factors associated with 30-day mortality. Adjusted hazard ratio (aHR) (95% confidence intervals, CI) were calculated.Results343 patients were included: 15 VIM- and 328 NDM-producing Enterobacterales infections. Overall, 199 (58%) were bloodstream infections, 60 (17.5%) hospital-acquired/ventilator-associated pneumonias, 60 (17.5%) complicated urinary tract infections, 13 (3.8%) intra-abdominal infections, 11 (3.2%) skin and soft tissue infections. Thirty-day mortality was 29.7%. Thirty-two patients did not receive in vitro active antibiotic therapy, 215/343 (62.7%) received ceftazidime-avibactam (CZA) plus aztreonam (ATM), 33/343 (9.6%) cefiderocol-containing regimens, 26/343 (7.6%) colistin-containing regimens and 37 (10.8%) other active antibiotics. On multivariable analysis, septic shock (aHR 3.57, 95% CI 2.05-6.23, p
Læs mere Tjek på PubMedClinical Infectious Diseases, 5.12.2023
Tilføjet 5.12.2023
AbstractBackgroundNeutropenia may limit use of valganciclovir treatment for cytomegalovirus (CMV) infection following hematopoietic cell transplant (HCT). A phase 2 study indicated efficacy of maribavir with fewer treatment-limiting toxicities than valganciclovir.MethodsIn this multicenter, double-blind, phase 3 study, patients with first asymptomatic CMV infection post-HCT were stratified and randomized 1:1 to maribavir 400 mg twice daily or valganciclovir (dose-adjusted for renal clearance) for 8 weeks with 12 weeks follow-up. Primary endpoint was confirmed CMV viremia clearance at week 8 (primary hypothesis of non-inferiority margin of 7.0%). Key secondary endpoint was a composite of the primary endpoint with no findings of CMV tissue-invasive disease at week 8, through week 16. Treatment-emergent adverse events (TEAEs) were assessed.ResultsAmong patients treated (273 maribavir; 274 valganciclovir), the primary endpoint of non-inferiority of maribavir was not met (maribavir, 69.6%; valganciclovir, 77.4%; adjusted difference [95% confidence interval (CI)]: −7.7% [−14.98, −0.36]; lower limit of 95% CI of treatment difference exceeded −7.0%). At week 16, 52.7% and 48.5% of patients treated (maribavir and valganciclovir, respectively) maintained CMV viremia clearance without tissue-invasive disease (adjusted difference [95% CI]: 4.4% [−3.91, 12.76]). With maribavir (versus valganciclovir), fewer patients experienced neutropenia (16.1% and 52.9%) or discontinued due to TEAEs (27.8% and 41.2%). Discontinuations were mostly due to neutropenia (maribavir, 4.0%; valganciclovir, 17.5%).ConclusionsAlthough non-inferiority of maribavir to valganciclovir for the primary endpoint was not achieved based on the prespecified non-inferiority margin, maribavir demonstrated comparable CMV viremia clearance during post-treatment follow-up, with fewer discontinuations due to neutropenia.Clinical trials registrationNCT02927067 [AURORA]
Læs mere Tjek på PubMedClinical Infectious Diseases, 5.12.2023
Tilføjet 5.12.2023
AbstractBackgroundTwo prefusion F protein-based vaccines, Arexvy and Abrysvo, have been authorized by the US Food and Drug Administration for protecting older adults against respiratory syncytial virus (RSV)-associated lower respiratory tract illness. We evaluated the health benefits and cost-effectiveness of these vaccines.MethodsWe developed a discrete-event simulation model, parameterized with the burden of RSV disease including outpatient care, hospitalization, and death for adults aged 60 years or older in the United States. Taking into account the costs associated with these RSV-related outcomes, we calculated the net monetary benefit using quality-adjusted life-year (QALY) gained as a measure of effectiveness and determined the range of price-per-dose (PPD) for Arexvy and Abrysvo vaccination programs to be cost-effective from a societal perspective.ResultsUsing a willingness-to-pay of $95 000 per QALY gained, we found that vaccination programs could be cost-effective for a PPD up to $127 with Arexvy and $118 with Abrysvo over the first RSV season. Achieving an influenza-like vaccination coverage of 66% for the population of older adults in the United States, the budget impact of these programs at the maximum PPD ranged from $6.48 to $6.78 billion. If the benefits of vaccination extend to a second RSV season as reported in clinical trials, we estimated a maximum PPD of $235 for Arexvy and $245 for Abrysvo, with 2-year budget impacts of $11.78 and $12.25 billion, respectively.ConclusionsVaccination of older adults would provide substantial direct health benefits by reducing outcomes associated with RSV-related illness in this population.
Læs mere Tjek på PubMedMalaria Journal, 5.12.2023
Tilføjet 5.12.2023
Abstract Background Plasmodium vivax has been more resistant to various control measures than Plasmodium falciparum malaria because of its greater transmissibility and ability to produce latent parasite forms. Therefore, developing P. vivax vaccines and therapeutic monoclonal antibodies (humAbs) remains a high priority. The Duffy antigen receptor for chemokines (DARC) expressed on erythrocytes is central to P. vivax invasion of reticulocytes. P. vivax expresses a Duffy binding protein (PvDBP) on merozoites, a DARC ligand, and the DARC: PvDBP interaction is critical for P. vivax blood stage malaria. Therefore, PvDBP is a leading vaccine candidate for P. vivax and a target for therapeutic human monoclonal antibodies (humAbs). Methods Here, the functional activity of humAbs derived from naturally exposed and vaccinated individuals are compared for the first time using easily cultured Plasmodium knowlesi (P. knowlesi) that had been genetically modified to replace its endogenous PkDBP orthologue with PvDBP to create a transgenic parasite, PkPvDBPOR. This transgenic parasite requires DARC to invade human erythrocytes but is not reticulocyte restricted. This model was used to evaluate the invasion inhibition potential of 12 humAbs (9 naturally acquired; 3 vaccine-induced) targeting PvDBP individually and in combinations using growth inhibition assays (GIAs). Results The PvDBP-specific humAbs demonstrated 70–100% inhibition of PkPvDBPOR invasion with the IC50 values ranging from 51 to 338 µg/mL for the 9 naturally acquired (NA) humAbs and 33 to 99 µg/ml for the 3 vaccine-induced (VI) humAbs. To evaluate antagonistic, additive, or synergistic effects, six pairwise combinations were performed using select humAbs. Of these combinations tested, one NA/NA (099100/094083) combination demonstrated relatively strong additive inhibition between 10 and 100 µg/mL; all combinations of NA and VI humAbs showed additive inhibition at concentrations below 25 µg/mL and antagonism at higher concentrations. None of the humAb combinations showed synergy. Invasion inhibition efficacy by some mAbs shown with PkPvDBPOR was closely replicated using P. vivax clinical isolates. Conclusion The PkPvDBPOR transgenic model is a robust surrogate of P. vivax to assess invasion and growth inhibition of human monoclonal Abs recognizing PvDBP individually and in combination. There was no synergistic interaction for growth inhibition with the humAbs tested here that target different epitopes or subdomains of PvDBP, suggesting little benefit in clinical trials using combinations of these humAbs.
Læs mere Tjek på PubMedHaiyun Yu, Lu Yang, Zhennan Han, Xiaoyu Zhou, Zihan Zhang, Tianli Sun, Fang Zheng, Jingzhi Yang, Fei Guan, Jungang Xie, Chaohong Liu
Journal of Medical Virology, 5.12.2023
Tilføjet 5.12.2023
Astrid von Mentzer, Ann-Mari Svennerholm
Trends in Microbiology, 5.12.2023
Tilføjet 5.12.2023
Colonization factors (CFs) are major virulence factors of enterotoxigenic Escherichia coli (ETEC). This pathogen is among the most common causes of bacterial diarrhea in children in low- and middle-income countries, travelers, and livestock. CFs are major candidate antigens in vaccines under development as preventive measures against ETEC infections in humans and livestock. Recent molecular studies have indicated that newly identified CFs on human ETEC are closely related to animal ETEC CFs. Increased knowledge of pathogenic mechanisms, immunogenicity, regulation, and expression of ETEC CFs, as well as the possible spread of animal ETEC to humans, may facilitate the future development of ETEC vaccines for humans and animals. Here, we present an updated review of CFs in ETEC.
Læs mere Tjek på PubMedVijay Shankar Balakrishnan
Lancet Infectious Diseases, 5.12.2023
Tilføjet 5.12.2023
Beneath the shimmering veneer of modern medicine exists an undeniable predicament—the fight against antimicrobial resistance (AMR). In what appears to be a documentary, Race against resistance: the life and death struggle to save antibiotics, the AMR Action Fund, a Venture Capitalists\' Fund that enables discoveries in the development of antimicrobials, brings us up to speed on the antimicrobial innovation pipeline. Premiered on 5 September on the YouTube channel of the BBC StoryWorks Commercial Productions, a BBC department making marketing materials on behalf of other organisations (in this case, the AMR Action Fund), this commercial content appears non-editorialised by the BBC.
Læs mere Tjek på PubMedGeorgia Bisbas
Lancet Infectious Diseases, 5.12.2023
Tilføjet 5.12.2023
“History has the power to shape not only what we remember, but what we forget.” In the final paragraph of the introduction to In Her Hands, Women\'s Fight Against AIDS in the United States, historian Emma Day perfectly sums up the message behind her book. Day seeks to readdress the narrative around women\'s fight against HIV/AIDS and the political systems that overlooked, mistreated, and maligned them during the 1980s epidemic of the disease. It is her intention to ensure that we remember the struggles that women faced with accuracy and in their entirety, as no one subgroup of sufferers should take precedence in the history books when we recall the scale and severity of this disease.
Læs mere Tjek på PubMedJames Wassil, Maggie Sisti, Jeff Fairman, Matthew Davis, Carlos Fierro, Sean Bennett, Derek Johnson, Thi-Sau Migone, Kien Nguyen, Paul Sauer, Michelle Currie, Sam Iki, Jakub K Simon
Lancet Infectious Diseases, 5.12.2023
Tilføjet 5.12.2023
VAX-24 had a safety profile similar to PCV20 at all doses, with the 2·2 μg dose showing increased serotype coverage with decreased carrier suppression.
Læs mere Tjek på PubMedMarc T. Valitutto, Ohnmar Aung, Kyaw Yan Naing Tun, Megan E. Vodzak, Dawn Zimmerman, Jennifer H. Yu, Ye Tun Win, Min Thein Maw, Wai Zin Thein, Htay Htay Win, Jasjeet Dhanota, Victoria Ontiveros, Brett Smith, Alexandre Tremeau-Bravard, Tracey Goldstein, Christine K. Johnson, Suzan Murray, Jonna Mazet
PLoS One Infectious Diseases, 5.12.2023
Tilføjet 5.12.2023
by Marc T. Valitutto, Ohnmar Aung, Kyaw Yan Naing Tun, Megan E. Vodzak, Dawn Zimmerman, Jennifer H. Yu, Ye Tun Win, Min Thein Maw, Wai Zin Thein, Htay Htay Win, Jasjeet Dhanota, Victoria Ontiveros, Brett Smith, Alexandre Tremeau-Bravard, Tracey Goldstein, Christine K. Johnson, Suzan Murray, Jonna Mazet
Læs mere Tjek på PubMedTomoko Fujitani, Mariko Harada Sassa, Zhaoqing Lyu, Yukiko Fujii, Kouji H. Harada
PLoS One Infectious Diseases, 5.12.2023
Tilføjet 5.12.2023
by Tomoko Fujitani, Mariko Harada Sassa, Zhaoqing Lyu, Yukiko Fujii, Kouji H. Harada Lignan polyphenols derived from plants are metabolized by bacteria in the gut to mammalian lignans, such as enterolactone (ENL) and enterodiol (END). Mammalian lignan intake has been reported to be associated with obesity and low blood glucose levels. However, the factors that are responsible for individual differences in the metabolic capacity for ENL and END are not well understood. In the present study, the effects of enterotypes of isoflavone metabolism, equol producers (EQP) and O-desmethylangolensin producers (O-DMAP), on lignan metabolism were examined. EQP was defined by urinary daidzein (DAI) and equol concentrations as log(equol/DAI) ≥ –1.42. O-DMAP was defined by urinary DAI and O-DMA concentrations as O-DMA/DAI > 0.018. Isoflavone and lignan concentrations in urine samples from 440 Japanese women were measured by gas chromatography-mass spectrometry. Metabolic enterotypes were determined from the urinary equol and O-DMA concentrations. Urinary END and ENL concentrations were compared in four groups, combinations of EQP (+/–) and O-DMAP (+/–). The urinary lignan concentration was significantly higher in the O-DMAP/EQP group (ENL: P
Læs mere Tjek på PubMedHamza Umer, Muhammad Salar Khan
PLoS One Infectious Diseases, 5.12.2023
Tilføjet 5.12.2023
by Hamza Umer, Muhammad Salar Khan Social distancing served as a principal strategy to curtail the spread of COVID-19. However, congregational activities in mosques made it challenging to practice social distancing and led to a rapid surge in virus infections in several Muslim countries. This study uses nationally representative cross-sectional data from Pakistan, a Muslim-majority country, to examine the relationship of practicing preventive measures (such as social distancing, wearing mask and hand washing) and mitigation measures (like avoid going to the market, social gatherings, healthcare seeking, use of public transport, and long-distance travel) with mosque visits by utilizing logistic regressions. The results show that individuals adhering to preventive and mitigation measures also avoid visiting mosques and other religious gatherings. From a policy perspective, these results suggest that the government of Pakistan can avoid direct religious confrontation when it needs to minimize mosque visits to curtail the spread of the virus by implementing preventive and mitigation measures.
Læs mere Tjek på PubMedPeter T. Tanksley, Matthew W. Logan, J. C. Barnes
PLoS One Infectious Diseases, 5.12.2023
Tilføjet 5.12.2023
by Peter T. Tanksley, Matthew W. Logan, J. C. Barnes History of incarceration is associated with an excess of morbidity and mortality. While the incarceration experience itself comes with substantive health risks (e.g., injury, psychological stress, exposure to infectious disease), most individuals eventually return from prison to the general population where they will be diagnosed with the same age-related conditions that drive mortality in the non-incarcerated population but at exaggerated rates. However, the interplay between history of incarceration as a risk factor and more traditional risk factors for age-related diseases (e.g., genetic risk factors) has not been studied. Here, we focus on cognitive impairment, a hallmark of neurodegenerative conditions like Alzheimer’s disease, as an age-related state that may be uniquely impacted by the confluence of environmental stressors (e.g., incarceration) and genetic risk factors. Using data from the Health and Retirement Study, we found that incarceration and APOE-ε4 genotype (i.e., the chief genetic risk factor for Alzheimer’s disease) both constituted substantive risk factors for cognitive impairment in terms of overall risk and earlier onset. The observed effects were mutually independent, however, suggesting that the risk conveyed by incarceration and APOE-ε4 genotype operate across different risk pathways. Our results have implications for the study of criminal-legal contact as a public health risk factor for age-related, neurodegenerative conditions.
Læs mere Tjek på PubMedYing XuYihui WangHalah WinnerHuijie YangRongze HeJie WangGuangming Zhong1Department of Immunology, Xiangya School of Medicine, Central South University, Changsha, Hunan, China2Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA, Sunny Shin
Infection and Immunity, 4.12.2023
Tilføjet 4.12.2023
Julie M. StrizkiJohn M. GasparJohn A. HoweBeth HutchinsHiroshi MohriManoj S. NairKeith C. KinekPhilip McKennaShih Lin GohNicholas Murgolo1Merck Research Laboratories (MRL), Merck & Co., Inc., Rahway, New Jersey, USA2Aaron Diamond AIDS Research Center, Columbia University Medical Center, New York, New York, USA, Miguel Angel Martinez
Antimicrobial Agents And Chemotherapy, 4.12.2023
Tilføjet 4.12.2023
BMC Infectious Diseases, 4.12.2023
Tilføjet 4.12.2023
Abstract Background The severity of coronavirus disease 2019 (COVID-19) infections has led to the development of several therapeutic agents, with tocilizumab becoming increasingly used to treat patients with COVID-19-related pneumonia. This study compared the use of tocilizumab treatment with the standard of care (SOC) to determine its efficacy against severe COVID-19-related pneumonia in Japan. Methods This retrospective cohort study was designed to evaluate the efficacy of tocilizumab in two different databases: the JA42434 single-arm study and COVID-19 Registry Japan (COVIREGI-JP), with a synthetic control group from the COVIREGI-JP cohort as a benchmark for the tocilizumab group. The study’s primary objective was to evaluate the efficacy of tocilizumab in treating severe COVID-19-related pneumonia compared to the SOC among patients included in the above two databases. The SOC group was extracted as the synthetic control group using exact matching and a propensity score matching in sequence per subject. As a secondary objective, the efficacy of tocilizumab compared to the SOC was evaluated exclusively among patients included in the COVIREGI-JP database. In each objective, the primary endpoint was defined as the time to discharge or the status of awaiting discharge. Results For the primary endpoint, the hazard ratio (HR) of the tocilizumab group against the SOC group was 1.070 (95% confidence interval [CI]: 0.565–2.028). The median time from Study Day 1 to discharge or the state of awaiting discharge was 15 days in the tocilizumab group and 16 days in the SOC group. The HRs for the secondary endpoints, namely, time to improvement in the clinical state, time to clinical failure, and time to recovery, were 1.112 (95% CI: 0.596–2.075), 0.628 (95% CI: 0.202–1.953), and 1.019 (95% CI: 0.555–1.871), respectively. Similarly, the HR of the primary endpoint for the secondary objective was 0.846 (95% CI: 0.582–1.230). Conclusions Tocilizumab did not demonstrate a positive effect on time to discharge or the state of awaiting discharge. Furthermore, no statistically significant differences in other clinical outcomes, such as time to improvement in the clinical state, time to clinical failure, and time to recovery, were observed among the groups.
Læs mere Tjek på PubMedManon LangAndré CarvalhoZeynep BaharogluDidier Mazel1Institut Pasteur, Université Paris Cité, CNRS UMR3525, Unité Plasticité du Génome Bactérien, Paris, France, Corrella S. Detweiler
Microbiology and Molecular Biology Reviews, 4.12.2023
Tilføjet 4.12.2023
Megan S. HillJack A. Gilbert1Department of Pediatrics, University of California San Diego School of Medicine, San Diego, California, USA2Center for Marine Biotechnology and Biomedicine, Scripps Institution of Oceanography, University of California San Diego, La Jolla, California, USA3Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA, Federico Rey
Microbiology and Molecular Biology Reviews, 4.12.2023
Tilføjet 4.12.2023
Susan K. AmundsenGerald R. Smith1Fred Hutchinson Cancer Center Seattle, Seattle, Washington, USA, Kumaran S. Ramamurthi
Microbiology and Molecular Biology Reviews, 4.12.2023
Tilføjet 4.12.2023
Tropical Medicine & International Health, 4.12.2023
Tilføjet 4.12.2023
Tropical Medicine &International Health, Volume 28, Issue 12, Page i-iv, December 2023.
Læs mere Tjek på PubMedRebecca Brehm, Annabelle South, Elizabeth C. George
Tropical Medicine & International Health, 4.12.2023
Tilføjet 4.12.2023
Atiene S. Sagay, Szu-Chia Hsieh, Yu-Ching Dai, Charlotte Ajeong Chang, Jerry Ogwuche, Olukemi O. Ige, Makshwar L. Kahansim, Beth Chaplin, Godwin Imade, Michael Elujoba, Michael Paul, Donald J. Hamel, Hideki Furuya, Ricardo Khoury, Viviane Sampaio Boaventura, Laíse de Moraes, Phyllis J. Kanki, Wei-Kung Wang
International Journal of Infectious Diseases, 4.12.2023
Tilføjet 4.12.2023
Chikungunya virus (CHIKV), a member of the genus Alphavirus of the family Togaviridae, is transmitted by Aedes aegypti and Aedes albopictus mosquitoes. Prior to 2005, there were 3 distinct genotypes of CHIKV: the East-Central-South African (ECSA), West African and Asian genotypes in different geographic locations (1). The Indian Ocean lineage arose from the ECSA in 2004-2007 and Asian genotype expanded in late 2013, spreading to the Americas with over 1.3 million suspected cases by April 2015 [1-3].
Læs mere Tjek på PubMedJournal of Infectious Diseases, 4.12.2023
Tilføjet 4.12.2023
AbstractBackgroundAntimalarial drug resistance surveillance and containment are crucial for countries aiming to eliminate malaria. Monitoring resistance evolution through studies before and after treatment policy changes is crucial.MethodA total of 939 P. falciparum-positive blood samples were collected between 2014 and 2015 across ten sites in India, categorized into four geographic clusters. PCR-amplified products were sequenced to identify point mutations at drug-resistance-conferring genes (Pfdhfr, Pfdhps, Pfmdr1, Pfk13).ResultTriple Pfdhfr mutants were found only in northeast India bordering Myanmar, while the wildtype was dominant in central India. Pfdhps wildtypes were prevalent in all areas, and no double mutants were found. Except in Northwest India, Pfmdr1 wildtype was dominant in all clusters. Nonsynonymous double mutations were only found in northwest India. Only synonymous mutations occurred in Pfk13. These were found in Central India at low frequency. The pattern of linkage disequilibrium and principal component analysis reflects low pressure for drug resistance and heterogeneity between the geographic clusters.ConclusionResistance levels were highest in Northeast India, close to the Myanmar border, where resistance is common. Primaquine has been widely used as a gametocidal and schizonticidal drug, has likely contributed to maintaining low drug resistance levels and preventing strong selection for resistance.
Læs mere Tjek på PubMedJournal of Infectious Diseases, 4.12.2023
Tilføjet 4.12.2023
AbstractBone and joint infections (BJIs) are difficult to treat and affect a growing number of patients, in which relapses are observed in 10-20% of the case. These relapses, which call for prolonged antibiotic treatment and increase resistance emergence risk, may originate from ill understood adaptation of the pathogen to the host. Here, we investigated three pairs of Escherichia coli strains from BJI cases and their relapses to unravel in-patient adaptation. Whole genome comparison presented evidence for positive selection and phenotypic characterization showed that biofilm formation remained unchanged, contrary to what is usually described in such cases. Although virulence was not modified, we identified the loss of two virulence factors contributing to immune system evasion in one of the studied strains. Other strategies, including global growth optimization and colicin production, likely allowed the strains to outcompete competitors. This work highlights the variety of strategies allowing in-patient adaptation in BJIs.
Læs mere Tjek på PubMedJournal of Infectious Diseases, 4.12.2023
Tilføjet 4.12.2023
AbstractBackgroundThe 2022-2023 United States influenza season had unusually early influenza activity with high hospitalization rates. Vaccine-matched A(H3N2) viruses predominated, with lower levels of A(H1N1)pdm09 activity also observed.MethodsUsing the test-negative design, we evaluated influenza vaccine effectiveness (VE) during the 2022-2023 season against influenza-A-associated emergency department/urgent care (ED/UC) visits and hospitalizations from October 2022-March 2023 among adults (age ≥18 years) with acute respiratory illness (ARI). VE was estimated by comparing odds of seasonal influenza vaccination among case-patients (influenza A test-positive by molecular assay) and controls (influenza test-negative), applying inverse-propensity-to-be-vaccinated weights.ResultsThe analysis included 85,389 ED/UC ARI encounters (17.0% influenza-A-positive; 37.8% vaccinated overall) and 19,751 hospitalizations (9.5% influenza-A-positive; 52.8% vaccinated overall). VE against influenza-A-associated ED/UC encounters was 44% (95% confidence interval [95%CI]: 40-47%) overall and 45% and 41% among adults aged 18-64 and ≥65 years, respectively. VE against influenza-A-associated hospitalizations was 35% (95%CI: 27-43%) overall and 23% and 41% among adults aged 18-64 and ≥65 years, respectively.ConclusionsVE was moderate during the 2022-2023 influenza season, a season characterized with increased burden of influenza and co-circulation with other respiratory viruses. Vaccination is likely to substantially reduce morbidity, mortality, and strain on healthcare resources.
Læs mere Tjek på PubMedJournal of Infectious Diseases, 4.12.2023
Tilføjet 4.12.2023
Journal of Infectious Diseases, 4.12.2023
Tilføjet 4.12.2023
AbstractBackgroundOnly 35.6%–50.8% of patients with Mycobacterium avium complex (MAC) pulmonary disease achieve sustained sputum culture conversion (SSCC) on treatment with the azithromycin-ethambutol-rifabutin standard of care (SOC). We tested the efficacy of ceftriaxone, a β-lactam with a lung penetration ratio of 12.18-fold.MethodsWe mimicked lung concentration-time profiles of seven ceftriaxone once-daily doses for 28 days in the hollow fiber system model of intracellular MAC (HFS- MAC). Monte Carlo experiments were used for dose selection.We also compared the once-daily ceftriaxone monotherapy to three-drug SOC against five MAC clinical isolates in HFS-MAC using γ (kill)-slopes. Results were translated to SSCC rates.ResultsCeftriaxone killed 1.02-3.82 log10 cfu/mL in dose-response studies. Ceftriaxone 2G once-daily was identified as the optimal dose. Ceftriaxone killed all five strains below day 0 versus 2/5 for SOC. The median γ (95% confidence interval) was 0.49(0.47-0.52) log10 cfu/mL/day for ceftriaxone and 0.38(0.34-0.43) log10 cfu/mL/day for SOC. In patients, the SOC was predicted to achieve SSCC rates of 39.3%(36%-42%) at 6 months (similar to meta-analyses results). The SOC SSCC was 50% at 8.18(3.64-27.66) months versus 3.58(2.20-7.23) months for ceftriaxone. Thus, ceftriaxone shortened time-to-SSCC 2.35-fold compared to SOC.ConclusionCeftriaxone is a promising agent for creation of short-course chemotherapy.
Læs mere Tjek på PubMedJournal of Infectious Diseases, 4.12.2023
Tilføjet 4.12.2023
AbstractBackgroundParasitic infections challenge vertebrate health worldwide, and off-target effects of antiparasitic treatments may be an additional obstacle to recovery. However, there have been few investigations of the effects of antiparasitics on the gut microbiome in the absence of parasites.MethodsWe investigated whether two common antiparasitics—albendazole and metronidazole—significantly alter the gut microbiome of parasite-free mice. We treated mice with albendazole or metronidazole daily for seven days and sampled the fecal microbiota immediately before and after treatment, and again after a two-week recovery period.ResultsAlbendazole did not immediately change the gut microbiota, while metronidazole decreased microbial richness by 8.5% and significantly changed community structure during treatment. The structural changes caused by metronidazole included depletion of the beneficial family Lachnospiraceae, and predictive metagenomic analysis revealed that these losses likely depressed microbiome metabolic function. Separately, we compared the fecal microbiotas of treatment groups after recovery, and there were minor differences in community structure between the albendazole, metronidazole, and sham-treated control groups.ConclusionsThese results suggest that a healthy microbiome is resilient after metronidazole-induced depletions of beneficial gut microbes and albendazole may cause slight, latent shifts in the microbiota but does not deplete healthy gut microbiota diversity.
Læs mere Tjek på PubMedJournal of Infectious Diseases, 4.12.2023
Tilføjet 4.12.2023
Journal of Infectious Diseases, 4.12.2023
Tilføjet 4.12.2023
AbstractBackgroundAlong with many global jurisdictions, Toronto, Canada experienced an outbreak of mpox in the spring/summer of 2022. Case counts declined following the implementation of a large vaccination campaign. A surge of case reports in early 2023 led to speculation that asymptomatic and/or undetected local transmission was occurring in the city.MethodsMpox cases and positive laboratory results are reported to Toronto Public Health. Epidemic curves and descriptive risk factor summaries for the 2022 and 2023 outbreaks were generated. First and second dose vaccination was monitored. Monkeypox virus wastewater surveillance and whole genome sequencing (WGS) were conducted to generate hypotheses about the source of the 2023 resurgence.Results515 cases were reported in the spring/summer outbreak of 2022 and 17 in the 2022-2023 resurgence. Wastewater data correlated with the timing of reported cases. WGS showed that the 2022-2023 resurgent cases were distinct from the other 2022 cases and closer to sequences from another country, suggesting a new importation as a source for recent cases. At the start of the 2022-2023 resurgence, it was estimated that only 16% of first dose vaccine recipients had completed their second dose vaccination.DiscussionThis investigation demonstrates the importance of ongoing surveillance and preparedness for mpox outbreaks. Undetected local transmission was not a likely source of the 2022-2023 resurgence. Ongoing pre-exposure vaccine promotion remains important to mitigate disease burden.
Læs mere Tjek på PubMedJournal of Infectious Diseases, 4.12.2023
Tilføjet 4.12.2023
AbstractBackgroundImmune dysregulation in people with HIV-1 (PWH) persists despite potent antiretroviral therapy (ART) and, consequently, PWH tend to have lower immune responses to licensed vaccines. However, limited information is available about the impact of mRNA vaccines in PWH. This study details the immunologic responses to SARS-CoV-2 mRNA vaccines in PWH and their impact on HIV-1.MethodsWe quantified anti-S IgG binding and neutralization of three SARS-CoV-2 variants of concern and complement activation in blood from virally suppressed men with HIV-1 (MWH) and men without HIV-1 (MWOH), and the characteristics that may impact the vaccine immune responses. We also studied antibody levels against HIV-1 proteins and HIV-1 plasma RNA.ResultsMWH had lower anti-S IgG binding and neutralizing antibodies against the three variants compared to MWOH. MWH also produced anti-S1 antibodies with a ten-fold greater ability to activate complement and exhibited higher C3a blood levels than MWOH. MWH had decreased residual HIV-1 plasma viremia and anti-Nef IgG approximately 100 days after immunization.ConclusionsMWH respond to SARS-CoV-2 mRNA vaccines with lower antibody titers and with greater activation of complement, while exhibiting a decrease in HIV-1 viremia and anti-Nef antibodies. These results suggest an important role of complement activation mediating protection in MWH.
Læs mere Tjek på PubMedJournal of Infectious Diseases, 4.12.2023
Tilføjet 4.12.2023
AbstractBackgroundThe key correlate of protection of respiratory syncytial virus (RSV) vaccines and monoclonal antibodies (mAb) is virus neutralization, measured using sera obtained through venipuncture. Dried blood obtained with a finger prick can simplify acquisition, processing, storage, and transport in trials, and thereby reduce costs. In this study we validate an assay to measure RSV neutralization in dried capillary blood.MethodsFunctional antibodies were compared between matched serum and dried blood samples from a phase I trial with RSM01, an investigational anti-RSV Prefusion F mAb. Hep-2 cells were infected with a serial dilution of sample-virus mixture using RSV-A2-mKate to determine half-maximal inhibitory concentration. Stability of dried blood was evaluated over time and during temperature stress.ResultsFunctional antibodies in dried blood were highly correlated with serum (R2 = 0.98, p
Læs mere Tjek på PubMedJournal of Infectious Diseases, 4.12.2023
Tilføjet 4.12.2023
AbstractBackgroundChronic inflammation persists in some people living with HIV (PLWH) during antiretroviral therapy and is associated with premature aging. The gp120 subunit of HIV-1 envelope sheds and can be detected in plasma, showing immunomodulatory properties even in the absence of detectable viremia. We evaluated whether plasmatic soluble gp120 (sgp120) and a family of gp120-specific anti-cluster A antibodies, linked to CD4 depletion in vitro, contribute to chronic inflammation, immune dysfunction, and sub-clinical cardiovascular disease in participants of the Canadian HIV and Aging cohort (CHACS) with undetectable viremia.MethodsCross-sectional assessment of sgp120 and anti-cluster A antibodies was performed in 386 individuals from CHACS. Their association with pro-inflammatory cytokines and subclinical coronary artery disease was assessed using linear regression models.ResultsHigh levels of sgp120 and anti-cluster A antibodies inversely correlated with CD4 count and CD4:CD8 ratio. The presence of sgp120 was associated with increased levels of IL-6. In participants with detectable atherosclerotic plaque and detectable sgp120, anti-cluster A antibodies and their combination with sgp120 levels correlated positively with the total volume of atherosclerotic plaques.Conclusionssgp120 may act as a pan toxin causing immune dysfunction and sustained inflammation in a subset of PLWH, contributing to the development of premature comorbidities.
Læs mere Tjek på PubMedMS Kapembwa, PA Batman, SC Fleming, GE Griffin
International Journal of Infectious Diseases, 4.12.2023
Tilføjet 4.12.2023
The emergence of the human immunodeficiency virus (HIV) epidemic in Africa was first reported among patients originating from Central Africa presenting with severe wasting symptoms resembling marasmus in 1983. The illness was associated commonly with chronic, and often life-threatening diarrhoea [1]. There was no evidence of an underlying immunosuppressive disease, no history of blood-product transfusion, homosexuality, or intravenous-drug abuse and the disease appeared to affect females as frequently as males.
Læs mere Tjek på PubMedBMC Infectious Diseases, 3.12.2023
Tilføjet 3.12.2023
Abstract We present a rare case of pathology-proven CMV pneumonitis in a patient with HIV infection after presenting with cough and fever. This presentation was complicated by recurrence of symptoms after treatment in the setting of continued uncontrolled HIV infection. This case raised the importance of further discussion regarding best treatment guidelines for CMV pneumonitis for patients with HIV.
Læs mere Tjek på PubMedBMC Infectious Diseases, 3.12.2023
Tilføjet 3.12.2023
Abstract Background The elderly with severe infection increased dramatically in intensive care unit (ICU). Proper antimicrobial therapy help improve the prognosis. Linezolid, as an antimicrobial drug, is commonly utilized to treat patients infected with methicillin-resistant S. aureus and vancomycin-resistant enterococci. Clinical evidence suggests elderly patients prone to linezolid overexposure. Here, we describe the results of three years’ linezolid adjustment experiences according to therapeutic drug monitoring (TDM), especially in the oldest old. Methods Linezolid therapeutic drug monitoring data were collected between January 2020 and November 2022 from patients who were admitted to ICU and treated with linezolid. All the patients started with a dosage of 600 mg, twice daily. The first TMD was carried out ten minutes before the seventh administration. The dosage adjustment was determined by the doctor according to the first TMD and patients\' condition, and the repeated TDM was conducted as required. The dosage adjustment in different age group was recorded. Laboratory data were compared between the old and the oldest old. The high mortality risk of the oldest old was also explored. Results Data of 556 linezolid TDM from 330 patients were collected. Among which, 31.6%, 54.8%, and 75% of patients had supra-therapeutic linezolid trough concentrations at the first TDM assessment in different age group, leading to the dosage adjustment rate of 31.0%, 40.3%, 68.8% respectively. The linezolid dosage adjustments according to TDM help to reach therapeutic concentration. The oldest old was in high risk of linezolid overexposure with lowercreatinine clearance. The norepinephrine maximum dosage but not linezolid Cmin was associated with 28-day mortality in the oldest old. Conclusions Elderly patients with linezolid conventional 600 mg twice-daily dose might be at a high risk of overexposure, especially in the oldest old. The linezolid dosage adjustments according to TDM help reach the therapeutic concentration. The high mortality of the oldest old was not related with initial linezolid overexposure.
Læs mere Tjek på PubMedBMC Infectious Diseases, 3.12.2023
Tilføjet 3.12.2023
BMC Infectious Diseases, 3.12.2023
Tilføjet 3.12.2023
Abstract Background Considering the fact that COVID-19 has undergone various changes over time, its symptoms have also varied. The aim of this study is to describe and compare the changes in personal characteristics, symptoms, and underlying conditions of individuals infected with different strains of COVID-19. Methods This descriptive-analytical study was conducted on 46,747 patients who underwent PCR testing during a two-year period from February 22, 2020 to February 23, 2022, in South Khorasan province, Iran. Patient characteristics and symptoms were extracted based on self-report and the information system. The data were analyzed using logistic regression and artificial neural network approaches. The R software was used for analysis and a significance level of 0.05 was considered for the tests. Results Among the 46,747 cases analyzed, 23,239 (49.7%) were male, and the mean age was 51.48 ± 21.41 years. There was a significant difference in symptoms among different variants of the disease (p
Læs mere Tjek på PubMedBMC Infectious Diseases, 3.12.2023
Tilføjet 3.12.2023
Abstract Introduction The neutrophil to lymphocyte ratio (NLR), an inflammatory biomarker, measures innate-adaptive immune system balance. In this systematic review and meta-analysis, we aim to analyze the current literature to evaluate the diagnostic role of NLR in neonatal sepsis. Methods PubMed, Web of Science, and Scopus were used to conduct a systematic search for relevant publications published before May 14, 2022. Results Thirty studies, including 2328 neonates with sepsis and 1800 neonates in the control group, were included in our meta-analysis. The results indicated that NLR is higher in neonates with sepsis compared to healthy controls (SMD = 1.81, 95% CI = 1.14–2.48, P-value
Læs mere Tjek på PubMedBMC Infectious Diseases, 3.12.2023
Tilføjet 3.12.2023
Abstract Background The purpose of this study was to evaluate the diagnostic value of the GeneXpert® MTB/RIF (Xpert®), Auramine O staining method, and Lowenstein-Jensen medium for bacteriologically confirmed pulmonary tuberculosis and explore the effects of the sputum bacillary load (SBL) and qRT‒PCR threshold cycle (Ct) value on the detection methods. Methods We retrospectively analysed the results in the Department of Infectious Disease for 49 months. The χ2 test was used to compare the performances of each method, receiver operating characteristic curve analysis was used to determine the optimal cut-off values, and the factors associated with a false-negative result from Xpert® were analysed by logistic regression. Results Simultaneous analysis of 980 sputum specimens showed that the positive detection rate of Xpert® did not increase with increasing SBL, and there were differences between the three when SBL ≤ 1 + (all P
Læs mere Tjek på PubMedBMC Infectious Diseases, 3.12.2023
Tilføjet 3.12.2023
Abstract Background The Omicron variant of SARS-CoV-2, currently the most prevalent strain, has rapidly spread in Jingzhou, China, due to changes in the country’s epidemic prevention policy, resulting in an unprecedented increase in cases. Previous studies reported hematological parameters’ predictive value in COVID-19 severity and prognosis, but their relevance for early diagnosis in patients infected by the Omicron variant, particularly in high-risk pneumonia cases, remains unclear. Our study aimed to evaluate these parameters as early warning indicators for Omicron-infected patients in fever clinics and those with pulmonary infections (PI). Methods A total of 2,021 COVID-19 patients admitted to the fever clinic and infectious disease department of Jingzhou Hospital Affiliated to Yangtze University from November 1, 2022, to December 31, 2022, were retrospectively recruited. Demographic and hematological parameters were obtained from the electronic medical records of eligible patients. These hematological parameters were analyzed by receiver operating characteristic (ROC) curves to determine whether they can be used for early diagnosis of COVID-19 patients in fever clinics and the presence of PI in COVID-19 patients. Results Statistical differences in hematological parameters were observed between COVID-19 patients with fever and PI and control groups (P
Læs mere Tjek på PubMedBMC Infectious Diseases, 3.12.2023
Tilføjet 3.12.2023
Abstract Objective Droplet digital PCR (ddPCR) is a novel assay to detect pneumocystis jjrovecii (Pj) which has been defined to be more sensitive than qPCR in recent studies. We aimed to explore whether clinical features of pneumocystis pneumonia (PCP) were associated with ddPCR copy numbers of Pj. Methods A total of 48 PCP patients were retrospectively included. Pj detection was implemented by ddPCR assay within 4 h. Bronchoalveolar fluid (BALF) samples were collected from 48 patients with molecular diagnosis as PCP via metagenomic next generation sequencing (mNGS) or quantitative PCR detection. Univariate and multivariate logistic regression were performed to screen out possible indicators for the severity of PCP. The patients were divided into two groups according to ddPCR copy numbers, and their clinical features were further analyzed. Results Pj loading was a pro rata increase with serum (1,3)-beta-D glucan, D-dimmer, neutrophil percentage, procalcitonin and BALF polymorphonuclear leucocyte percentage, while negative correlation with albumin, PaO2/FiO2, BALF cell count, and BALF lymphocyte percentage. D-dimmer and ddPCR copy number of Pj were independent indicators for moderate/severe PCP patients with PaO2/FiO2 lower than 300. We made a ROC analysis of ddPCR copy number of Pj for PaO2/FiO2 index and grouped the patients according to the cut-off value (2.75). The high copy numbers group was characterized by higher level of inflammatory markers. Compared to low copy number group, there was lower level of the total cell count while higher level of polymorphonuclear leucocyte percentage in BALF in the high copy numbers group. Different from patients with high copy numbers, those with high copy numbers had a tendency to develop more severe complications and required advanced respiratory support. Conclusion The scenarios of patients infected with high ddPCR copy numbers of Pj showed more adverse clinical conditions. Pj loading could reflect the severity of PCP to some extent.
Læs mere Tjek på PubMedBMC Infectious Diseases, 3.12.2023
Tilføjet 3.12.2023
Abstract Introduction The urgent need for new treatments for multidrug-resistant tuberculosis (MDR-TB) and pre-extensively drug-resistant tuberculosis (pre-XDR-TB) is evident. However, the classic randomized controlled trial (RCT) approach faces ethical and practical constraints, making alternative research designs and treatment strategies necessary, such as single-arm trials and host-directed therapies (HDTs). Methods Our study adopts a randomized withdrawal trial design for MDR-TB to maximize resource allocation and better mimic real-world conditions. Patients’ treatment regimens are initially based on drug resistance profiles and patient’s preference, and later, treatment-responsive cases are randomized to different treatment durations. Alongside, a single-arm trial is being conducted to evaluate the potential of sulfasalazine (SASP) as an HDT for pre-XDR-TB, as well as another short-course regimen without HDT for pre-XDR-TB. Both approaches account for the limitations in second-line anti-TB drug resistance testing in various regions. Discussion Although our study designs may lack the internal validity commonly associated with RCTs, they offer advantages in external validity, feasibility, and ethical appropriateness. These designs align with real-world clinical settings and also open doors for exploring alternative treatments like SASP for tackling drug-resistant TB forms. Ultimately, our research aims to strike a balance between scientific rigor and practical utility, offering valuable insights into treating MDR-TB and pre-XDR-TB in a challenging global health landscape. In summary, our study employs innovative trial designs and treatment strategies to address the complexities of treating drug-resistant TB, fulfilling a critical gap between ideal clinical trials and the reality of constrained resources and ethical considerations. Trail registration Chictr.org.cn, ChiCTR2100045930. Registered on April 29, 2021.
Læs mere Tjek på PubMedBMC Infectious Diseases, 3.12.2023
Tilføjet 3.12.2023
Abstract Background The purpose of this study was to evaluate the vaginal microecology and the distribution of human papillomavirus (HPV) subtypes in patients with uterine adhesions and explore the correlation between HPV infection and vaginal microecology imbalance and the occurrence of intrauterine adhesion (IUA). Methods A total of 479 women were enrolled in the study, including 259 in the normal group and 220 in the IUA group. Vaginal microecological and HPV analyses were performed on all participants. Significant differences between the two groups were analyzed, and Spearman correlation analysis was performed. Results The incidence of IUA in patients between 31 and 40 years of age was high. The I-II degree of vaginal cleanliness in the IUA group was significantly lower than that in the normal group, and the number of III-IV degree was significantly higher than that in the normal group. Moreover, the incidences of VVC (vulvovaginal candidiasis) and vaginal disorders and infections with HPV 16 and HPV 52 subtypes were significantly higher in the IUA group than in the normal group. The incidence of high-risk HPV infection combined with vaginal disorders in the IUA group was higher than that in the normal group. Correlation analysis showed that the occurrence of IUAs was positively correlated with HPV infection and negatively correlated with PH and vaginal microecological imbalance. Conclusion The HPV infection rate and vaginal microecology disorders affect the occurrence of IUAs. For patients with IUAs, control of the HPV infection rate and the prevention of vaginal microecological disorders should be improved.
Læs mere Tjek på PubMedBMC Infectious Diseases, 3.12.2023
Tilføjet 3.12.2023
Abstract Background GeneXpert MTB/RIF (Xpert) assay was applied widely to detect Mycobacterium tuberculosis (MTB) and rifampicin resistance. Methods Retrospectively investigated the association among treatment histories, phenotypic drug susceptibility testing (pDST) results, and clinical outcomes of patients infected with probe A absent mutation isolate confirmed by Xpert. Results 63 patients with only probe A absent mutation and 40 with additional pDST results were analyzed. 24 (60.0%) patients had molecular-phenotypic discordant rifampicin (RIF) susceptibility testing results, including 12 (12/13, 92.3%) new tuberculosis (TB) patients and 12 (12/27, 44.4%) retreated ones. 28 (28/39, 71.8%) retreated patients received first-line treatment regime within two years with failed outcomes. New patients had better treatment outcomes than retreated ones (successful: 83.3% VS. 53.8%; P value = 0.02). The clinical results of RIF-susceptible TB confirmed by pDST were not better than RIF-resistant TB (successful: 62.5% VS. 50.0%; P value = 0.43). INH-resistant TB and INH-susceptible TB had similar treatment outcomes too (successful: 61.5% VS. 50.0%; P value = 0.48). 11 (11/12, 91.7%) new patients treated with the short treatment regimen (STR) had successful outcomes. Conclusions More than half of mono probe A absent isolates had RIF molecular-phenotypic discordance results, especially in new patients. Probe A mutations were significantly associated with unsuccessful clinical outcomes, whether the pDST results were RIF susceptible or not. STR was the best choice for new patients. Trial registration retrospectively registered in Wuhan Jinyintan Hospital (No. 2021-KY-16).
Læs mere Tjek på PubMedBMC Infectious Diseases, 3.12.2023
Tilføjet 3.12.2023
Abstract Background We investigated the associations between the different doses of tigecycline, its efficacy and safety, and the role of tigecycline therapeutic drug monitoring for patients in the intensive care unit. Methods This study was a single-center cohort including patients infected with multidrug-resistant Acinetobacter baumannii (MDR-AB) and multidrug-resistant Klebsiella pneumoniae (MDR-KP) causing pulmonary infections. The steady-state plasma concentration after tigecycline administration was determined by High-Performance Liquid Chromatography (HPLC) in patients admitted to the ICU between October 2020 and December 2021. Multivariate analyses of tigecycline’s clinical efficacy and safety were performed to control confounding factors. Results For this study, we included 45 patients and 45 blood samples to determine steady-state trough concentrations of tigecycline. All patients were divided into the High Dose (HD) and Standard Dose (SD) groups. The median trough concentration of tigecycline was 0.56 μg/mL in the HD group, which was higher than in the SD group (0,21 μg/mL), p = 0.000. There was no significant difference between the two groups of patients in terms of bacterial eradication rate, mortality rate, and clinical efficacy. Multiple regression analysis showed that the ICU days were correlated with mortality OR 1.030(1.005–1.056), p = 0.017. APACHE II was significantly associated with clinical efficacy OR 0.870(0.755–1.002), p = 0.045. The level of fibrinogen decline in the HD group was significantly higher than in the SD group (-3.05 ± 1.67 vs -1.75 ± 1.90), p = 0.038. We identified that age and tigecycline treatment duration influenced fibrinogen decline. Conclusions Tigecycline plasma concentrations are significantly increased when using a high dose. However, the plasma concentration of tigecycline is not correlated with clinical efficacy and adverse reactions. Fibrinogen decline appears to be related to the patient’s age and days of tigecycline. Large sample data are still needed to confirm the clinical guidance significance of tigecycline TDM.
Læs mere Tjek på PubMedBMC Infectious Diseases, 3.12.2023
Tilføjet 3.12.2023
Abstract Introduction COVID-19 induced cytokine storm is a well-documented phenomena that contributes significantly in the disease’s evolution and prognosis. Therefore, therapies such as therapeutic plasma exchange, constitute a mainstay of therapeutic management especially for critically-ill patients. Methods We conducted a monocentric retrospective cohort study in the Resuscitation Department of the Mohammed VI University Hospital of Oujda-Morocco, to evaluate the efficiency of therapeutic plasma exchange on critically-ill COVID-19 patients over a 6 months period. We divided our patients into two groups: patients who received TPE (Therapeutic Plasma Exchange) sessions (TPE group) and patients who only benefited from the standard protocol treatment (non TPE group). Results Our study included a total of 165 patients, 34.5% of which benefited from TPE sessions. We observed an improvement of oxygenation parameters (SpO2 and PaO2/FiO2 ratio) and a progressive respiratory weaning, as well as a significant decrease of biomarkers indicative of inflammation (lymphocyte count, CRP (C Reactive Protein), IL-6, Ferritin) and coagulopathy (d-dimers, fibrinogen) in the TPE group after 5 consecutive TPE sessions. In comparison with the non-TPE group, The TPE-group patients had a shorter ICU (Intensive Care Unit) length of stay, required less frequently mechanical ventilation, and we more likely to be extubated. Furthermore, the TPE group had a lower mortality rate. Discussion Multiple studies have reported the safety and efficiency of therapeutic plasma exchange in the COVID-19 induced cytokine storm. Given the urgent character of the pandemic at the time, each center followed its own protocol in implementing plasma exchange. Conclusion Similar to the results reported in the literature, our study reports positive results after using TPE specifically in terms of respiratory weaning and an improvement of the cytokine storm biomarkers, and more importantly a lower mortality rate.
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