"Valutazione della profilassi con Letermovir nei pazienti CMV positivi sottoposti a trapianto di midollo allogenico"

Cytomegalovirus (CMV) is the most common viral infection in allogeneic hematopoietic stem cell transplantation. Developments in molecular diagnostic supported the spread of the pre-emptive therapy (PET), and quantitative Real Time-PCR assays has shown the potential of viral load measurement as a predictor of the infection development in CMV post-transplant management. Most patients require the pre-emptive therapy within the first six months after HSCT, with a significant morbidity and mortality. The most widely used antivirals for PET are ganciclovir and valganciclovir (oral prodrug of ganciclovir). Patients who are refractory to ganciclovir and valganciclovir can be treated with foscarnet. Letermovir is a novel CMV-specific antiviral with no effect on other herpesviruses and acts by inhibiting a component of the viral DNA terminase complex: subunit pUL56, involved in the DNA cleavage and packaging that has no equivalent target enzyme in the human body. We monitored patients with CMV DNA PCR once a week from day 0 until day 180 post-HSCT. We evaluated the efficacy of Letermovir as primary prophylaxis and we retrospectively compared the outcome with patients received standard antiviral prophylaxis therapy (PET). Our experience demonstrates the efficacy of Letermovir in a real-world setting for the prevention of clinically significant CMV infection

Comparative Analysis of Five Multiplex RT-PCR Assays in the Screening of SARS-CoV-2 Variants

The rapid and presumptive detection of SARS-CoV-2 variants may be performed using multiplex RT-PCR assays. The aim of this study was to evaluate the diagnostic performance of five qualitative RT-PCR tests as compared with next-generation sequencing (NGS). We retrospectively examined a multi-variant panel (n = 72) of SARS-CoV-2-positive nasopharyngeal swabs categorized as variants of concern (Alpha, Beta, Gamma and Delta), variants under monitoring (Iota and Kappa) and wild-type strains circulating in Liguria (Italy) from January to August 2021. First, NGS libraries of study samples were prepared and mapped to the reference genome. Then, specimens were screened for the detection of L452R, W152C, K417T, K417N, E484Q, E484K and N501Y mutations using the SARS-CoV-2 Variants II Assay Allplex, UltraGene Assay SARS-CoV-2 452R & 484K & 484Q Mutations V1, COVID-19 Ultra Variant Catcher, SARS-CoV-2 Extended ELITe MGB and Simplexa SARS-CoV-2 Variants Direct. The overall accuracy of these assays ranged from 96.9% to 100%. Specificity and sensitivity were 100% and 96-100%, respectively. We highly recommend the use of these assays as second-level tests in the routine workflow of SARS-CoV-2 laboratory diagnostics, as they are accurate, user friendly, low cost, may identify specific mutations in about 2-3 h and, therefore, optimize the surveillance of SARS-CoV-2 variants

Detection of influenza A(H1N1)pdm09 virus in a patient travelling from Shanghai to Italy in July 2018: an uncommon clinical presentation in a non-seasonal period

Influenza is one of the most common infectious diseases in travellers, especially in those returning from subtropical and tropical regions.In late June 2018 an influenza A(H1N1)pdm09 virus infection was diagnosed in a 36-years-old man, returned from a travel in Shanghai and hospitalized at the Ospedale Policlinico San Martino, Genoa, Italy, with a diagnosis of fever and an uncommon clinical presentation characterised by a persistent leukopenia. Phylogenetic analysis revealed a closeness with influenza A(H1N1)pdm09 strains circulating in the US in May-June 2018.Prompt recognition of influenza infection led to a proper case management, demonstrating the crucial role of the continuous influenza surveillance programme

Response to COVID-19 Vaccination in Patients with Inflammatory Bowel Disease on Biological Treatment

Background: The antibody response to coronavirus disease 2019 (COVID-19) vaccination in patients with inflammatory bowel disease (IBD) on biological drugs is still unclear. Aim: To determine the anti-SARS-CoV-2 spike 1 (anti-S1-IgG) response rate and antibody levels following a complete COVID-19 vaccination cycle in patients with IBD on biological treatment. Methods: We assessed antibody response to COVID-19 in consecutive patients with IBD on biological drugs and without prior exposure to COVID-19. Sera were prospectively collected at baseline and at 21 days (T1), 42 days (T2), and 3 months (T3) after the first vaccine dose. Results: Among the 42 patients included in the study, the overall response rate at T3 was 97.6%, with no difference across the various biological drugs. After the first dose (T1), the response rate was higher in patients receiving anti-tumour necrosis factor (TNF) compared to patients treated with other biologics (p = 0.031). Among the responders, the anti-S1 levels were not significantly different among the various biological drugs at all study timepoints. Concomitant corticosteroids and disease activity had no impact on the response rate at all study timepoints. No unexpected side events were observed. Discussion: The antibody response to vaccination against COVID-19 in patients with IBD on biological drugs is optimal, independently of their mechanism of action. Patients treated with anti-TNF seem to have an earlier response to vaccination, while concomitant low-dose corticosteroids and disease activity does not seem to impact response. This information can be used to program vaccination and inform patients

Comparative Diagnostic Accuracy of the STANDARD M10 Assay for the Molecular Diagnosis of SARS-CoV-2 in the Point-of-Care and Critical Care Settings

Accurate and rapid molecular diagnosis of COVID-19 is a crucial step to tackle the ongoing pandemic. The primary objective of this study was to estimate the real-world performance of the novel RT-PCR STANDARD M10 SARS-CoV-2 assay in a large number of nasopharyngeal (NP) specimens eluted in universal transport medium. The secondary objective was to evaluate the compatibility of this kit in testing NP samples eluted in an inactivated transport medium (essential for point-of-care testing) and lower respiratory tract (LRT) specimens, which are commonly collected in critical care. A total of 591 samples were analyzed. Compared with the standard extraction-based RT-PCR Allplex 2019-nCoV (time-to-result of 270 min), the sensitivities of the STANDARD M10 were 100% (95% CI: 98.1–100%), 95.5% (95% CI: 91.7–97.6%), and 99.5% (95% CI: 97.2–99.9%) for ≥1 gene, the ORF1ab gene, and the E gene, respectively, while the specificity was 100% (95% CI: 98.7–100%). The diagnostic accuracy was 100% in testing both NP samples eluted in an inactivated transport medium and LRT specimens. STANDARD M10 reliably detects SARS-CoV-2 in 60 min, may be used as a POC tool, and is suitable for testing LRT specimens in the critical care setting

Reactivation of Herpes Simplex Virus Type 1 (HSV-1) Detected on Bronchoalveolar Lavage Fluid (BALF) Samples in Critically Ill COVID-19 Patients Undergoing Invasive Mechanical Ventilation: Preliminary Results from Two Italian Centers

27noReactivation of herpes simplex virus type 1 (HSV-1) has been described in critically ill patients with coronavirus disease 2019 (COVID-19) pneumonia. In the present two-center retrospective experience, we primarily aimed to assess the cumulative risk of HSV-1 reactivation detected on bronchoalveolar fluid (BALF) samples in invasively ventilated COVID-19 patients with worsening respiratory function. The secondary objectives were the identification of predictors for HSV-1 reactivation and the assessment of its possible prognostic impact. Overall, 41 patients met the study inclusion criteria, and 12/41 patients developed HSV-1 reactivation (29%). No independent predictors of HSV-1 reactivation were identified in the present study. No association was found between HSV-1 reactivation and mortality. Eleven out of 12 patients with HSV-1 reactivation received antiviral therapy with intravenous acyclovir. In conclusion, HSV-1 reactivation is frequently detected in intubated patients with COVID-19. An antiviral treatment in COVID-19 patients with HSV-1 reactivation and worsening respiratory function might be considered.openopenGiacobbe, Daniele Roberto; Di Bella, Stefano Di; Dettori, Silvia; Brucci, Giorgia; Zerbato, Verena; Pol, Riccardo; Segat, Ludovica; D’Agaro, Pierlanfranco; Roman-Pognuz, Erik; Friso, Federica; Principe, Luigi; Lucangelo, Umberto; Ball, Lorenzo; Robba, Chiara; Battaglini, Denise; De Maria, Andrea De; Brunetti, Iole; Patroniti, Nicolò; Briano, Federica; Bruzzone, Bianca; Guarona, Giulia; Magnasco, Laura; Dentone, Chiara; Icardi, Giancarlo; Pelosi, Paolo; Luzzati, Roberto; Bassetti, MatteoGiacobbe, Daniele Roberto; Di Bella, Stefano Di; Dettori, Silvia; Brucci, Giorgia; Zerbato, Verena; Pol, Riccardo; Segat, Ludovica; D’Agaro, Pierlanfranco; Roman-Pognuz, Erik; Friso, Federica; Principe, Luigi; Lucangelo, Umberto; Ball, Lorenzo; Robba, Chiara; Battaglini, Denise; De Maria, Andrea De; Brunetti, Iole; Patroniti, Nicolò; Briano, Federica; Bruzzone, Bianca; Guarona, Giulia; Magnasco, Laura; Dentone, Chiara; Icardi, Giancarlo; Pelosi, Paolo; Luzzati, Roberto; Bassetti, Matte