Risultati per: Sclerosi multipla e legame con il virus della mononucleosi

Circulation, Volume 148, Issue Suppl_1, Page A17360-A17360, November 6, 2023. Introduction:The most common causes of myopericarditis are Coxsackie B followed by Coxsackie A, Echovirus, and Poliovirus. However, Epstein Barr Virus (EBV) may uncommonly cause myopericarditis and can mimic acute coronary syndrome (ACS).Case:A 19-year-old healthy non-smoker male presented with acute onset of central, positional chest pain preceded by a 5 day-long course of viral prodromal symptoms including sore throat. EKG showed inferolateral ST segment elevations (Figure 1). HS-Troponin T was markedly elevated (initial; 988, 1 hour; 1171). He was started on ibuprofen and colchicine for suspected myopericarditis. TTE showed LVEF 50% with borderline mild posterior and lateral wall hypokinesis with no pericardial effusion (Figure 1). Although, the presentation and PR depression were consistent with pericarditis, focal wall motion abnormality led to consideration of right or circumflex CAD such as coronary dissection. This was ruled out by coronary angiogram (Figure 2). Cardiac MRI demonstrated the epicardial pattern of gadolinium enhancement consistent with myopericarditis (Figure 2). Subsequently, patient tested positive for IgG (6.4) and IgM (3.2) [normal range 0.8 to 1.1] against EBV Capsid Antigens with unremarkable remaining viral panel results. His symptoms improved significantly with ibuprofen and colchicine. He was also treated with metoprolol succinate and lisinopril due to reduced ejection fraction.Conclusions:Cardiac complications from EBV infection are uncommon. Sometimes, the EKG with pericarditis can mimic ACS warranting an invasive test. Therefore, clinicians must maintain a high level of suspicion for myopericarditis resulting from EBV.

Circulation, Volume 148, Issue Suppl_1, Page A11882-A11882, November 6, 2023. Introduction:Respiratory syncytial virus (RSV) can cause severe illness among older adults, but potential cardiac complications have not been comprehensively described. We evaluated the frequency and severity of acute cardiac events among older adults hospitalized with laboratory-confirmed RSV to inform recommendations for RSV vaccine candidates in development.Methods:The RSV-Associated Hospitalization Surveillance Network (RSV-NET) abstracted medical record data among all hospitalized patients identified with laboratory-confirmed RSV infection (clinician-ordered testing) in a population-based catchment area of 38 counties in 9 states. Among adults aged ≥50 years hospitalized with RSV during the 2015-16 to 2017-18 RSV seasons, we estimated the period prevalence and 95% confidence interval (CI) of acute cardiac events, identified from the patient’s discharge diagnoses and ICD-10 codes. Multivariable generalized estimating equation models estimated the adjusted risk ratio (aRR) of intensive care unit (ICU) admission and in-hospital death by acute cardiac event status.Results:Among 3959 adults aged ≥50 years hospitalized with RSV (mean age 73 years), 20.8% (CI, 19.5-22.1) experienced an acute cardiac event during hospitalization, most frequently acute heart failure (14.3%; CI, 13.2-15.4; Table). Acute cardiac events were common among adults aged ≥75 years (25.0%; CI, 23.1-27.0) and among those with underlying cardiac disease (30.4%; CI: 28.5-32.3). Compared to patients without an acute cardiac event, those with an acute cardiac event were more likely to experience ICU admission (16.8% vs 27.0%; aRR: 1.7, CI: 1.5-1.9) and in-hospital death (4.1% vs 8.8%; aRR: 2.0, CI: 1.6-2.5).Conclusions:One in 5 older adults hospitalized with RSV experienced an acute cardiac event, which was associated with approximately double the risk of severe outcomes. Adults at greater risk of cardiac complications from RSV may benefit from vaccines when available.

Efficacia del 67% nell’anno successivo a quello di vaccinazione

New England Journal of Medicine, Volume 389, Issue 15, Page 1444-1444, October 2023.

New England Journal of Medicine, Volume 389, Issue 15, Page 1441-1442, October 2023.

This Medical News article discusses recent US data on West Nile virus disease.

L’India sta adottando misure urgenti per fermare la trasmissione di un virus raro ma mortale che si diffonde dai pipistrelli agli esseri umani

Pregliasco: “Avrà media intensità, vaccinare anziani e fragili”

Pregliasco: “avrà media intensità, vaccinare anziani e fragili”

Introduction
Kidney transplant recipients (KTRs) suffer from immunosuppression-related adverse events (iRAEs), such as infections and malignancy from chronic immunosuppression, but are also at risk of graft loss from rejection with underimmunosuppression. Biomarkers that predict both iRAEs and rejection while allowing individualisation of immunosuppression exposure are lacking. Although plasma viral DNA levels of torque teno virus (TTV), a widely prevalent, non-pathogenic virus, have been shown to predict both iRAE and rejection in newly transplanted KTRs within the first year after transplant, its role for prevalent KTRs on stable immunosuppression is less clear.
This study aims to determine the prognostic value of TTV levels for severe infections (defined as infections requiring hospitalisation) in prevalent KTRs on stable immunosuppression for at least 3 months and compare it against that of other commonly available biomarkers. The study also aims to explore the relationship between TTV levels and factors affecting the ‘net state of immunosuppression’ as well as other clinical outcomes.

Methods and analysis
This is a single-centre, prospective, observational cohort study of 172 KTRs on stable immunosuppression for more than 3 months. TTV levels will be measured using the TTV R-GENE kit upon recruitment when study subjects are admitted and when kidney allograft biopsies are performed. Subjects will be monitored for iRAEs and rejection for at least 12 months. The relationship between TTV load and clinical outcomes such as severe infections will be analysed and compared against that from other common biomarkers and previously published predictive scores.

Ethics and dissemination
The study was approved by the SingHealth Centralised Institutional Review Board (2023/2170). The results will be presented at conferences and submitted for publication in peer-reviewed journals.

Trial registration number
NCT05836636.

E’ un giovane di 25 anni. Condizioni cliniche in miglioramento

Objective
Exhausted T cells with limited effector function are enriched in chronic hepatitis B and C virus (HBV and HCV) infection. Metabolic regulation contributes to exhaustion, but it remains unclear how metabolism relates to different exhaustion states, is impacted by antiviral therapy, and if metabolic checkpoints regulate dysfunction.

Design
Metabolic state, exhaustion and transcriptome of virus-specific CD8+ T cells from chronic HBV-infected (n=31) and HCV-infected patients (n=52) were determined ex vivo and during direct-acting antiviral (DAA) therapy. Metabolic flux and metabolic checkpoints were tested in vitro. Intrahepatic virus-specific CD8+ T cells were analysed by scRNA-Seq in a HBV-replicating murine in vivo model of acute and chronic infection.

Results
HBV-specific (core18-27, polymerase455-463) and HCV-specific (NS31073-1081, NS31406-1415, NS5B2594-2602) CD8+ T cell responses exhibit heterogeneous metabolic profiles connected to their exhaustion states. The metabolic state was connected to the exhaustion profile rather than the aetiology of infection. Mitochondrial impairment despite intact glucose uptake was prominent in severely exhausted T cells linked to elevated liver inflammation in chronic HCV infection and in HBV polymerase455-463 -specific CD8+ T cell responses. In contrast, relative metabolic fitness was observed in HBeAg-negative HBV infection in HBV core18-27-specific responses. DAA therapy partially improved mitochondrial programmes in severely exhausted HCV-specific T cells and enriched metabolically fit precursors. We identified enolase as a metabolic checkpoint in exhausted T cells. Metabolic bypassing improved glycolysis and T cell effector function. Similarly, enolase deficiency was observed in intrahepatic HBV-specific CD8+ T cells in a murine model of chronic infection.

Conclusion
Metabolism of HBV-specific and HCV-specific T cells is strongly connected to their exhaustion severity. Our results highlight enolase as metabolic regulator of severely exhausted T cells. They connect differential bioenergetic fitness with distinct exhaustion subtypes and varying liver disease, with implications for therapeutic strategies.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Con i corvi, rappresentano indicatore di malattia in un’area

Esperimento alla Cleveland Clinic, allevia preoccupazioni