Positive IgG Research Articles

An adult with hemorrhagic varicella co-infects with cytomegalovirus: a case report

BackgroundHemorrhagic varicella (HV) is a particular form of chicken pox.,with high mortality in adults. This form of the disease is rare, to date, approximately 4 cases have been reported. Occasional cases of HV have been documented in adults with hematologic disorders or other diseases. While there is one reported case of simultaneous reactivation of cytomegalovirus in an adult with chickenpox, there is a lack of information regarding changes in liver function indicators for such patients. This is unfortunate, as CMV reactivation can further exacerbate liver failure and increase mortality. In this report, we present a case of hemorrhagic varicella reactivation with cytomegalovirus and provide some relevant discussions.Case presentationWe present the case of a 25-year-old male with HV, who had a history of nephrotic syndrome generally controlled with orally administered prednisone at a dosage of 50 mg per day for two months. The patient arrived at the emergency room with complaints of abdominal pain and the presence of hemorrhagic vesicles on his body for the past 3 days. Despite medical evaluation, a clear diagnosis was not immediately determined. Upon admission, the leukocyte count was recorded as 20.96 × 109/L on the first day, leading to the initiation of broad-spectrum antibiotic treatment. Despite the general interpretation that a positive IgG and a negative IgM indicate a previous infection, the patient’s extraordinarily elevated IgG levels, coupled with a markedly increased CMV DNA quantification, prompted us to suspect a reactivation of the CMV virus. In light of these findings, we opted for the intravenous administration of ganciclovir as part of the treatment strategy. Unfortunately,,the patient succumbed to rapidly worsening symptoms and passed away. Within one week of the patient’s demise, chickenpox gradually developed in the medical staff who had been in contact with him. In such instances, we speculate that the patient’s diagnosis should be classified as a rare case of hemorrhagic varicella.ConclusionSwift identification and timely administration of suitable treatment for adult HV are imperative to enhance prognosis.

Autoimmune Manifestations in a Cohort of Egyptian COVID-19 Patients

Abstract Introduction COVID-19 infection can result in a range of symptoms, from asymptomatic to severe, requiring intensive care and ventilatory support. Research has explored the association between COVID-19 and autoimmune conditions, including the detection of autoantibodies in COVID-19 patients. However, results are not conclusive, prompting us to conduct a cross-sectional study to evaluate the prevalence of autoimmune rheumatic manifestations in a cohort of Egyptian individuals diagnosed with COVID-19. Methods Ninety individuals with COVID-19 were included in the study. Patients were classified based on WHO criteria and laboratory data was collected. Autoimmune markers (ANA, RF, ACL IgM, ACL IgG) were measured and patients were grouped based on positive and negative results. Correlational analysis was conducted to assess the association between each marker and clinical severity of COVID-19 and autoimmune rheumatological manifestations. Results Of the studied patients, 13.3% had a positive ANA, 15.6% had a positive RF, 8.9% had a positive ACL IgM, and 5.6% had a positive ACL IgG. However, there was no statistically significant difference between severity groups regarding the results of ANA, RF, ACL IgM, and IgG. All patients with a positive ANA were present among severe and critical COVID-19 cases, and all patients with positive RF, ACL IgM, or ACL IgG were among moderate, severe, and critical cases. Conclusion Our study provides insight into the prevalence of autoimmune rheumatic manifestations in COVID-19 patients. While our results were inconclusive regarding the association between autoimmune markers and severity of disease, we found a statistically significant higher prevalence of several symptoms in critical COVID-19 patients. Our study highlights the importance of further investigation into the relationship between COVID-19 and autoimmune conditions.

Clinical Characteristics and Outcomes of Disseminated Strongyloidiasis in the United States-A Multicenter Network Analysis.

Human strongyloidiasis is a potentially life-threatening parasitic disease among immunocompromised hosts. We aim to determine the factors and mortality associated with disseminated strongyloidiasis. We conducted a U.S.-based multicenter retrospective cohort study to determine 90-day clinical outcomes for people diagnosed with Strongyloides infection in the TriNetX patient database. We identified adult patients with the International Classification of Diseases (10th revision, clinical modification) code for Strongyloides infection (B78) or a positive Strongyloides IgG antibody test and captured outcomes at 90 days. We identified 5,434 patients with strongyloidiasis, of whom 48 had disseminated strongyloidiasis for 0.9% prevalence of disseminated disease. Systemic connective tissue disorders, pulmonary eosinophilia, liver cirrhosis, blood disorders (monoclonal gammopathy, aplastic anemia, and lymphoid malignancy), malnutrition, alcohol use disorder, and transplantation status were frequent in patients with disseminated disease. Mortality was significantly higher in people with disseminated disease at 30 days (21%). The 90-day risk of hospitalization, bacteremia, and acute respiratory distress syndrome (ARDS) was higher in those with disseminated infection. People with disseminated strongyloidiasis had a heightened risk of hospitalization, bacteremia, acute respiratory distress syndrome, and mortality. The population at risk for severe strongyloidiasis infection is evolving, reflecting conditions in which glucocorticoids or additional immunosuppressive medications are commonly used for treatment.

Serological Screening for Severe Acute Respiratory Syndrome Coronavirus-2 in Type 1 Diabetic Children and Adolescents

Abstract Background Diabetes was identified as a risk factor for many infections. In the SARS-CoV-2 pandemic, diabetes is one of the leading comorbidities associated with infection severity. Aim of the Work To determine the severity of COVID-19 symptoms in type 1 diabetic children and adolescents. To Determine the effect of SARS-CoV-2 lockdown on glycemic control. Patients and Methods A cross sectional observational study was carried out in Pediatric and Adolescent Diabetology Unit (PADU), Children's Hospital, Ain Shams University between September 2020 and January 2022. The study included 500 randomly selected diabetic children and adolescents. They were tested for Hemoglobin A1C and SARS-CoV-2 IgM and IgG antibody. Results There is a significant relation between myalgia (p = 0.012 ), diarrhea( p = 0.007) and IgM positivity, and a significant relation between diarrhea and both IgG and IgM positivity (p = 0.005). Other symptoms had a non-significant relation with COVID-19 IgM or IgG. All symptoms suggestive of COVID-19 infection that were detected in our patients were not severe. During COVID-19 pandemic, glycemic control deteriorated in our patients as mean HbA1c reached 9.6% as compared to a mean level of 8.8% before COVID-19 pandemic. Conclusion Diabetes comorbidity did not increase the severity of COVID-19 symptoms to our patients. Glycemic control as indicated by HbA1c level showed deterioration during lockdown due to impaired access to care.

Seroprevalence and Risk Factors of Hepatitis B, C and D in Adults in Trabzon, Türkiye

Viral hepatitis are infections that can cause liver damage, become chronic, lead to cirrhosis, hepatocellular carcinoma and ultimately result in death due to their ability to spread in the community through blood and infected body fluids. The aim of this study was to determine the seroprevalence of hepatitis B (HBV), hepatitis C (HCV), and hepatitis D (HDV) transmitted through blood among individuals living in Trabzon province and to examine the factors potentially associated with seroprevalence. This cross-sectional study was conducted in Trabzon province, located in the northeast of Türkiye, including a total of 10 districts, including the central district. Since seroprevalence was calculated for HBV, HCV, and HDV in the study, the sample size was separately calculated for each, and the calculated maximum sample size of 1116 was accepted as the minimum sample size for the study. The study was completed with 1502 participants. Serological tests for HBV included HBsAg, anti-HBs, and anti-HBc IgG; for HCV, anti-HCV; and for HDV, anti-HDV were analysed. Data were evaluated for HBV risk factors using univariate analyses with Chi-square test and for multiple analyses using enter model logistic regression analysis. The mean age of the participants was 45.7 ± 16.6 years, with 767 (51.1%) being female. The prevalence of HBV seropositivity, indicating vaccination, was 23.0%, while the seroprevalence of HBV among unvaccinated adults was 27.4%. HBsAg positivity was 5.1%, and isolated anti-HBc IgG positivity was 4.2%. The proportion of individuals with HBsAg in the gray zone was 0.5%, while the positivity rates for anti-HBs and anti-HBc IgG (indicating past infection) were 17.6%. The prevalence of anti-HCV was six per thousand, while anti-HDV was not detected in the analyses. HBsAg positivity and co-infection with HCV were found in one person, and among the nine individuals positive for anti-HCV, isolated anti-HBc IgG positivity was detected in three. Increasing age, presence of a person with jaundice in the family, presence of diabetes mellitus, alcohol use and cupping therapy were identified as risk factors for HBV in the logistic regression analysis. Risk factors for HCV in univariate analyses were being over 40 years old, presence of hepatic steatosis and receiving dialysis treatment. The results of the study indicate that despite being included in our vaccination schedule and the administration of vaccines to high-risk adults, HBV still requires intensive attention as a public health problem. HCV, lacking a vaccine has been evaluated as an infectious agent that needs to be taken into consideration due to its potential risks and requires the complete implementation of individual and social precautions.

The role of health mediation in investigation of Hantavirus cases among informal settlements inhabitants of Cayenne area, French Guiana, 2022-2023.

In 2022, four severe cases of Hantavirus pulmonary syndrome (HPS) were reported in patients from informal settlements around Cayenne, the main city in French Guiana. Regional Health Agency (RHA) was commissioned by the French Public Health Agency to estimate the seroprevalence of Hantavirus infections in the neighborhoods of confirmed cases of HPS. RHA then commissioned the French Red Cross (FRC) mobile public health team, providing support in environmental health issues to the population living in informal settlements by health mediators, to facilitate the investigation. The objective of this study was to describe the health mediators' activities set up to improve the efficiency of the investigation. The health mediators' team was specifically trained by virologist and infectiologist specialized in HPS. They helped the investigating team and health workers at various steps of the investigation. These interventions are then described in the results section. The investigation took place between Nov. 2022 and March 2023 in three neighborhoods. During the pre-investigation activities, the mediators raised awareness about HPS of 343 people, among whom 319 (93%) planned to participate in the investigation. Altogether, 274 people finally participated in the investigation, including, i.e., 30.8% of the estimated population living in the three concerned settlements. The global proportion of patients with positive IgG anti-Hantavirus was 5.1%. The health mediators team supported the following steps: preliminary meetings and training modules, identification of resource persons, field visits and awareness and information campaigns (pre-investigation); on field data collection in informal settlements (per-investigation) and communication of individual results, public feedback meeting (post-investigation). The involvement of mediators was probably a factor in the success of the public health response to socially vulnerable people living in the investigated neighborhoods. The preliminary prevention activities helped to raise awareness of the health risk and to enroll participants. Health mediation and outreach activities seem relevant tools of epidemiological field investigations in diseases affecting inhabitants of informal settlements.

Testing Hepatitis E Seroprevalence among HIV-Infected Patients in Greece: The SHIP Study.

Hepatitis E virus (HEV) poses significant health concerns worldwide, particularly among people living with HIV (PLWHIV), due to an increased risk of chronic infection and progression to cirrhosis in individuals with low CD4 cell counts. This study aimed to investigate the prevalence, chronicity potential, and risk factors of HEV infection among PLWHIV in Greece, where data are currently absent. A synchronic multicentric study encompassing five major Greek university hospitals was executed over 24 months, recruiting 696 PLWHIV participants. The prevalence of HEV IgG antibodies was 16.5%, with 8.6% showing evidence of acute HEV infection (HEV IgM). Active viral replication (HEV RNA) was present in 2.3% of the study population. Longitudinal analysis revealed that of the 25 initially anti-HEV IgM-positive individuals, only 3 seroconverted to IgG positivity, and among those with prior HEV RNA positivity (16), none showed evidence of active replication in subsequent tests. Comparative subgroup analysis highlighted the lack of significant differences in HIV-related parameters between HEV seropositive and seronegative individuals. Laboratory evaluations generally showed no significant disparities across most parameters; however, a higher seropositivity for Hepatitis A was observed in the HEV-positive subgroup. Our findings highlight a considerable prevalence of HEV among PLWHIV in Greece, with no observed cases of chronicity.

Metabolic changes assessed by 1H MR spectroscopy in the corpus callosum of post-COVID patients

ObjectiveMany patients with long COVID experience neurological and psychological symptoms. Signal abnormalities on MR images in the corpus callosum have been reported. Knowledge about the metabolic profile in the splenium of the corpus callosum (CCS) may contribute to a better understanding of the pathophysiology of long COVID.Materials and methodsEighty-one subjects underwent proton MR spectroscopy examination. The metabolic concentrations of total N-acetylaspartate (NAA), choline-containing compounds (Cho), total creatine (Cr), myo-inositol (mI), and NAA/Cho in the CCS were statistically compared in the group of patients containing 58 subjects with positive IgG COVID-19 antibodies or positive SARS-CoV-2 qPCR test at least two months before the MR and the group of healthy controls containing 23 subjects with negative IgG antibodies.ResultsAn age-dependent effect of SARS-CoV-2 on Cho concentrations in the CCS has been observed. Considering the subjective threshold of age = 40 years, older patients showed significantly increased Cho concentrations in the CCS than older healthy controls (p = 0.02). NAA, Cr, and mI were unchanged. All metabolite concentrations in the CCS of younger post-COVID-19 patients remained unaffected by SARS-CoV-2. Cho did not show any difference between symptomatic and asymptomatic patients (p = 0.91).DiscussionOur results suggest that SARS-CoV-2 disproportionately increases Cho concentration in the CCS among older post-COVID-19 patients compared to younger ones. The observed changes in Cho may be related to the microstructural reorganization in the CCS also reported in diffusion measurements rather than increased membrane turnover. These changes do not seem to be related to neuropsychological problems of the post-COVID-19 patients. Further metabolic studies are recommended to confirm these observations.

Evaluation of Humoral Immune Response in COVID-19 Patients- A Comparative Study

Background: The novel coronavirus SARS-CoV-2 is a newly emerging virus. Positive detection of SARS-CoV-2 RNA by RT-PCR has been used to confirm SARS-CoV-2 infection. Recently positive detection of IgG and IgM antibodies specific to SARS-CoV-2 has also been recognized as deterministic evidence for confirmed SARS-CoV-2 infection. The antibody response in COVID-19 patient remains largely unknown, and the clinical values of antibody testing have not been fully demonstrated. Objective: To better clarify the humoral immune response during SARS-CoV-2 infection. Methods: This cross sectional study was carried out on 200 RT-PCR confirmed COVID-19 cases. For better evaluation of antibody response, patients were divided into two groups, group I and group II, each consisting of 100 persons. Results: Out of a total 200 cases antibody was detected in 104(52%) cases and antibody not detected in 96(48%) cases. Out of 104 seropositive cases only IgG was detected in 69.2% cases, only IgM in 10.6% cases and both IgG, IgM in 20.2% cases.In group I seropositivity was 68%. IgG, IgM and both IgG, IgM positivity were 58.8%, 14.7% and 26.5% respectively. In group II seropositivity was 36 %. Positivity for IgG, IgM and both IgG, IgM were 88.9%, 2.8% and 8.3% respectively. Conclusion: As we learn more about the long-term implications of COVID-19 on recovered individuals, antibody tests can be used to increase this understanding of the immune system response to SARS-CoV-2, quantify the magnitude of the COVID-19 outbreak and effectively manage patients. JAFMC Bangladesh, Vol 19, No 2 (December) 2023: 3-6

Investigation of Francisella tularensis Seroprevalence and Determination of Risk Factors for Tularemia among Hunters in Northern Cyprus.

Tularemia is a zoonotic disease (reservoir is usually rodents) caused by Francisella tularensis, especially seen in the northern hemisphere. Hunters are in the risk group for this disease. In this study, it was aimed to determine the seroprevalence of tularemia among hunters and determine the risk factors of tularemia in our country. The Turkish Republic of Northern Cyprus (TRNC) is divided into four regions (Nicosia, Kyrenia, Famagusta/Trikomo, and Morphou/Lefka) and 100 volunteer hunters randomly selected from these regions were included in our study. Tube agglutination test (TAT) and F. tularensis IgG and IgM (ELISA method) were applied in all sera. All hunters were filled with a pre-prepared questionnaire to determine risk factors for tularemia. TAT positivity was found in 11%. While F. tularensis ELISA IgG positivity was 17%, IgM positivity was not found in any hunters. Hunters with positive F. tularensis ELISA IgG test (17%) were accepted as seropositive in terms of tularemia. There was no statistically significant difference between the mean age of IgG-positive and negative hunters (p= 0.915). Of the 86 hunters who kept at least one hunting dog in their garden, 15 (17.4%) were IgG-positive. There was no significant relationship between feeding hunting dogs and tularemia (p= 0.561). Our study showed that the seroprevalence of tularemia was high (17%) among hunters, who are considered a risk group, in our country. We think that more epidemiological research should be done on tularemia infection and it should not be overlooked in the clinic.

Celiac disease prevalence in patients with idiopathic inflammatory myopathies, a cross-sectional study.

Up to 30% of patients with celiac disease (CD) suffer from concurrent autoimmune disease, compared to 3% of the general population. The association between CD and the current clinical phenotypes of inflammatory myopathies (IIM) patients has not been thoroughly addressed. Assess the CD features among patients with IIM and their relationship with the clinical phenotype and the myositis specific (MSA) and associated antibodies (MAA). For this cross-sectional study, we recruited 99 adult patients classified as IIM from a tertiary center in Mexico. We assessed serum MSA, MAA, and CD-associated autoantibodies (IgA anti-tissue transglutaminase (tTG) and both IgA and IgG anti-deaminated gliadin peptide (DGP)). Patients with highly suggestive serology for CD were then tested for IgG anti-endomysium antibodies, and a duodenal biopsy was performed. 70.7% of patients were positive for at least one antibody. Nine duodenal biopsies were taken, revealing findings compatible with celiac disease in two cases. Subjects with anti-MDA5 antibodies were more likely to have positive anti-tTG IgA antibodies (OR 6.76, 95% CI 1.85-24.62, P = 0.013) and suggestive CD serology (OR 6.41, 95% CI 1.62-25.29, P = 0.009). Patients with anti-Mi2 antibodies were more likely to have positive anti-DGP IgG antibodies (OR 3.35, 95% CI 1.12-9.96, P = 0.039), while positivity for these autoantibodies was less frequent in patients with anti-NXP2 antibodies (OR 0.22, 95% CI 0.06-0.80, P = 0.035). There is a higher prevalence of serologic and definite CD in patients with IIM compared to the general population. Identifying this subgroup of patients may have prognostic and therapeutic implications. Key points • The study estimated a serological celiac disease (CD) prevalence of 70.7% in patients with idiopathic inflammatory myopathies (IIM) and a biopsy-confirmed prevalence of 2%, suggesting that IIM patients should be considered a high-risk population for CD. • We identified a significant association between serological CD and the presence of anti-MDA5 and anti-Mi2 antibodies, suggesting a potential justification for celiac disease screening in this specific subgroup of patients. • The impact of gluten-free diets on IIM patients with serological markers of CD remains untested and warrants further investigation through prospective, randomized studies.

A case of variant of GBS with positive serum ganglioside GD3 IgG antibody

BackgroundAcute bulbar palsy-plus (ABPp) syndrome is an unusual variant of Guillain-Barré syndrome (GBS). Anti-GT1a and anti-GQ1b antibodies have been reported in patients with ABPp, but without reports related to GD3 antibodies.MethodsClinical data of a patient diagnosed as ABPp syndrome were reviewed clinically. And we summarized the GBS patients with ABP and facial paralysis reported in the literature.ResultsWe reported a 13-year-old girl presented with asymmetric bifacial weakness, bulbar palsy and transient limb numbness, and had positive serum IgG anti-GD3 antibody. Through reviewing the GBS patients with ABP and facial paralysis reported previously, we found that facial palsy could be unilateral or bilateral. The bilateral facial palsy could present successively or simultaneously, and could be symmetrical or asymmetrical. Other common symptoms included ophthalmoplegia, sensory abnormality and ataxia. IgG anti-GT1a and IgG anti-GQ1b antibodies were the most frequent. Most of the patients had full recovery within two weeks to one year of follow-up.ConclusionsWe reported a patient with asymmetric bifacial palsy and bulbar palsy, which seemed to fit the diagnosis of ABPp syndrome. This was the first report of ABPp variant of GBS with positive serum ganglioside GD3 IgG antibody.

Assessment of cytotoxic T-lymphocyte antigen-4 (CD152) Levels Associated with HBV in Patients with Diabetes Mellitus

Background: Diabetes mellitus is a chronic disease characterized by an imbalance in glucose homeostasis. The hepatitis B virus is a liver-attacking virus that can cause viral hepatitis, cirrhosis, and liver cancer. A cytotoxic T-lymphocyte antigen-4 called CTLA-4 is an immune checkpoint protein that is necessary for T cells to control immune responses and stop the HBV infection from spreading. It does this by acting as an inhibitory receptor, limiting liver damage during an acute infection, and making it easier for the infection to stay in the body during a chronic case. Objective: The study aims to assess CTLA-4 levels in relation to HBV infection in diabetes mellitus patients. Subjects and methods: A cross-sectional study was conducted from July to October 2023. The serum was obtained from 200 diabetic patients who were Iraqis. All of the patients were tested using an ELISA technique for CTLA-4 and HBc IgG. They were tested using a five-panel kit for HBsAb, HBsAg, HBcAb, HBeAg, and HBeAb and measured blood sugar levels. The statistical analysis approach was conducted using SPSS version 26. Results: Serum CTLA-4 levels were correlated with serum HBc IgG positivity (P = 0.000), total HBc Ab positivity (P = 0.000), and HBs Ab positivity (P = 0.000), and CTLA-4 level was correlated with diabetes mellitus (P = 0.034). Conclusions: The study concluded that elevated serum CTLA-4 levels in diabetic patients with HBV infection and type I diabetes compared to type II diabetes. This suggests that diabetes affects the immune system's response to HBV.

#2458 Factors associated with cytomegalovirus infection in kidney transplant patients: analysis from a nationwide registry data

Abstract Background and Aims Cytomegalovirus (CMV) has had a significant impact on solid organ transplantation. It can affect allograft function and increase patient morbidity and mortality. We have made several efforts to prevent CMV infection after kidney transplantation (KT), but we have not yet been able to prevent it satisfactorily. Drugs were used as preventive therapy or preemptive therapy, but they did not completely prevent the diseases. Therefore, it will be possible to reduce CMV infection by taking actions against factors that can easily cause CMV infection. We investigated factors that make CMV infection more likely and explored the effects of CMV infection using The Korean Organ Transplantation Registry (KOTRY) datasets. Method We used the data from the KOTRY datasets. A total of 7545 KT recipients were analysed. Results The mean age of the subjects was 49.7 ± 11.5 years (range, 19-80). Among the 7545 subjects, 58.6% were male. Three hundred and twenty-four (4.2%) subjects had CMV infection (CMV group). There were 4827 (64%) living donors, 2717 (36%) cadaveric donors, and 1338 (17.3%) ABO incompatible donors. Of the total, 95% were transplanted from positive to positive CMV IgG, and 1.9% were from positive to negative. Although preventive treatment is performed in the second cases, in most cases preemptive therapy is performed. The age was 49.6 ± 11.5 in the no CMV group and 51.4 ± 12.6 in the CMV group (P = 0.013). There was no difference in sex, weight and BMI in both cases. The causes of end stage renal disease were glomerulonephritis, DM, and hypertension in that order, and there was no difference in the rates of diabetes and hypertension between the two groups. There was no difference in the desensitization rate at 24% in the no CMV group and 23% in the CMV group. At the time of discharge after surgery, the tacrolimus dose was 6.4 mg/d±3.6 in the no CMV group and 6.3 ± 3.8 mg/d in the CMV group (P = 0.89). Tacrolimus concentration (C0) was 8.0 ± 2.6 ng/ml in the no CMV group and 8.9 ± 2.4 ng/ml in the CMV group. It was higher in the CMV group (P = 0.002). When divided into 3 tertiles based on C0, the break points were 6.7 and 8.9 ng/ml. There was a higher incidence of CMV in the third tertile group compared to the first and second tertiles, but there was no difference between the first and second groups. When the metabolic rate (tacrolimus concentration divided by dose) was divided into three groups, CMV occurred more frequently in the group with the lower metabolic rate, at 3.9% in the group with the lowest tertile and 2.3% in the highest tertile (P = 0.046). At 6 months, tacrolimus dose was 4.3 ± 2.4 mg/d in the no CMV group and 3.9 ± 2.3 mg/d in the CMV group, which was lower in the CMV group (P = 0.005). Tacrolimus concentration was 6.8 ± 2.4 ng/ml in the no CMV group and 6.4 ± 2.3 ng/ml in the CMV group, which was lower in the CMV group (P = 0.004). There was no difference according to metabolic rate. At discharge (62.5 ± 25.7 vs. 54.5 ± 26.5), at 6 month (56.0 ± 22.3 vs. 47.9 ± 19.0), and at 1 year (57.2 ± 20.0 vs. 48.8 ± 19.6 mL/min/1.73 m2), eGFR in the No CMV group was higher than that in the CMV group (P < 0.005). One thousand two hundred and sixty-four (16.8%) patients showed acute rejection within 1 year. Acute rejection occurred within 1 year in 36.4% of the CMV group and 15.9% of the no CMV group (P < 0.001). Delayed graft function occurred in 4.6% of the CMV group and 5.5% of the no CMV group (P < 0.001). Conclusion CMV was more common in older people, those with higher tacrolimus concentrations, and those with lower tacrolimus metabolic rates. The risk increases when the concentration exceeds 8.9 ng/ml, and after reducing the dose, the dose and concentration were lower in the CMV group at 6 month and 1 year. Although the dose was later reduced in the CMV group, more acute rejections occurred within 1 year, which suggests that CMV infection can trigger rejections. Delayed graft function occurred less frequently in the CMV group, which may be related to the higher concentration of tacrolimus.

#2600 Idiopathic full-house non-lupus nephropathy

Abstract Background and Aims A full-house pattern at immunofluorescence (IF) in kidney biopsies is usually associated with Lupus Nephritis (LN). However, it can be also secondary to other causes, such as infections, or it can idiopathic, without a defined origin. Idiopathic Full House non-lupus Nephropathy (iFH-N) represents a rare entity previously identified in small cohorts of patients, with different clinical features and outcomes. A limited number of the described cases developed overt systemic lupus erythematosus (SLE) during follow up, while renal outcome varied across different studies. A retrospective observational study aimed at evaluating clinical presentation and outcomes of patients with iFH-N in a Tertiary Center has been performed. Long-term renal function and development of overt SLE have been considered as main outcomes of the study. Method All native kidney biopsies performed from January 2012 to December 2022 in our Institution were considered. Full-house pattern was defined as simultaneous positivity for IgG, IgM, IgA, C3 and C1q staining at IF. Inclusion criteria were: age ≥18, full-house pattern at kidney biopsy, patients not meeting criteria for SLE diagnosis according to American College of Rheumatology (ACR) 1997 classification or Systemic Lupus International Collaborating Clinics (SLICC) 2012 criteria. Exclusion criteria: diagnosis of SLE, secondary causes of full-house pattern at kidney biopsy. We considered histological, clinical and laboratory features, performed therapies, renal function and SLE development during follow up. Results In the considered period, 2110 patients underwent a native kidney biopsy at our Institution. Of these, 91 patients had a histological finding of full-house nephropathy and were initially included for further evaluation. Of the 91 patients, 84 had received a diagnosis of SLE and were excluded, while 7 did not meet the criteria for a diagnosis of SLE. Two of these 7 were further excluded, having a full house pattern secondary to other conditions. Five patients were finally labelled as iFH-N. At kidney biopsy, all 5 included subjects had a Membranous Nephropathy, with extracapillary proliferation in 2 cases. They were all females, 4 Caucasians (80%), 1 Black (20%). At presentation, mean age was 28.2 years (range 21–40). All had impairment of kidney function, 2 of 5 had a full-blown nephrotic syndrome, 3 of 5 a nephrotic range proteinuria. Mean serum creatinine was 2.1 mg/dl (SD± 0.47), mean eGFR 35.2 ml/min/1.73 m2 (SD ±11), mean proteinuria 7.1 gr/24 h (SD ±3.3). Antinuclear antibodies (ANA) were negative in 4 of 5 patients; anti-dsDNA, anti-extractable nuclear antigens (ENAs) and antiphospholipid antibodies were negative in all subjects; slightly low C3 was present in 3 of 5 subjects. All patients received immunosuppressive therapy, including high dose intravenous (iv) steroids in association with cyclophosphamide (CYC) or mycophenolate mofetil, or Intensified B Cell Depletion Protocol (i.e. iv steroids + CYC and Rituximab). Mean follow-up from the time of kidney biopsy was 7.4 year (SD ± 2.4) (range 3–10 years). During follow up, 4 patients (80%) developed end stage renal disease (ESRD) needing renal replacement therapy, 3 of them within 24 months after presentation. The two patients with crescents had a severe prognosis, starting dialysis within 10 months after presentation. The fifth patient developed chronic kidney disease stage 4. One patient formally developed an ACR negative, SLICC positive SLE two years after presentation, with new positivity for ANA and anti-dsDNA antibodies at high titer and low C3, in addition to renal involvement. Conclusion All patients with iFH-N had similar presentation, being all young females, with a Membranous Nephropathy, nephrotic proteinuria and impairment of kidney function. They all had an aggressive form of kidney disease, refractory to different regimens of immunosuppression and with poor long-term renal outcome. Only one case developed SLE on the long term, although without systemic signs. The relationship between idiopathic full-house nephropathy and SLE remains controversial.

#1305 Analysis of clinicopathological characteristics of membranous nephropathy with concomitant malignancy and literature review

Abstract Background and Aims In recent years, the incidence of membranous nephropathy (MN) with malignancy has gradually increased, but the clinical and pathological characteristics of these patients are still unclear. Method Patients diagnosed with renal biopsy-proven MN and comorbid malignancy detected within 5 years before and after MN diagnosis were included. The control group were diagnosed with renal biopsy-proven IMN with no malignancy and no other clear secondary cause for MN. We present a comprehensive analysis of MN with concomitant malignancy in our cohort and literature review. Results A total of 19 MN patients with concomitant malignancy were evaluated at our center; among them, 13 (68.4%) were male, and the median age was 57.0 (45.0, 69.0) years. Malignancy occurred after the onset of renal disease in 61.1% of patients, with digestive system malignancy (36.8%) ranking as the predominant type. 8 (8/11) patients achieved either PR or CR during the follow-up period. Most patients had pathology typical of IMN. IF showed strong positivity for IgG (100%), whereas only 13 (68.4%) patients were positive for C3. IEM showed electron-dense deposits predominantly located in subepithelial. Specific MN antigen staining of renal tissues from 19 patients showed that the highest percentage was 68.4% (13/19) for PLA2R-only positivity followed by 15.8% (3/19) for THSD7A-only positivity. Specific MN antigen staining of malignant tissue was performed in 5 patients whose tumor samples were available. Only 2 patients expressed the same antigen on kidney and tumor. Screening 17 articles encompassing a total of 21 patients in whom MN-specific antigen staining was performed on both renal and tumor tissues simultaneously. Among these patients, 71.4% (15/21) were male, with a median age of 61.0 years (56.3, 72.8). In this cohort, malignancy was diagnosed before or simultaneously with MN in 15 patients (75.0%), with digestive system malignancy constituting the most prevalent comorbid malignancy, at 33.3%. Notably, THSD7A accounted for the highest proportion of MN antigens, at 66.7% (14/21); among these patients, 78.6% (11/14) also exhibited positive tumor THSD7A staining. Of the 21 patients, 72.2% (13/18) achieved CR or PR. No significant difference between the baseline characteristics was observed between the 19 patients from our center and 21 patients documented in the literature. Therefore, the clinicopathological data of these 40 patients were pooled and compared with 101 IMN patients without malignancy at our center. Compared to patients without malignancy, MN patients with malignancy were older at the time of renal biopsy (P = 0.017), had a lower eGFR (P = 0.035) and demonstrated a lower rate of CR or PR after treatment (P < 0.001). The rate of PLA2R positivity in the glomeruli of MN patients with concomitant malignancy was significantly lower (40.0% vs. 92.1%, P < 0.001), while the rate of THSD7A positivity was significantly higher (42.5% vs. 2.0%, P < 0.001). Renal tissue IgG subclass staining showed that the rate of IgG4 positivity was significantly decreased compared with that in IMN patients (59.3% vs. 90.1%, P < 0.001), and the rate of IgG2 positivity was significantly increased (36.0% vs. 16.5%, P = 0.033). Conclusion To conclude, malignancy screening should be more actively performed for MN patients presenting with the above characteristics.

Evaluation of naturally acquired immune responses against novel pre-erythrocytic Plasmodium vivax proteins in a low endemic malaria population located in the Peruvian Amazon Basin

BackgroundPlasmodium vivax represents the most geographically widespread human malaria parasite affecting civilian and military populations in endemic areas. Targeting the pre-erythrocytic (PE) stage of the parasite life cycle is especially appealing for developing P. vivax vaccines as it would prevent disease and transmission. Here, naturally acquired immunity to a panel of P. vivax PE antigens was explored, which may facilitate vaccine development and lead to a better understanding of naturally acquired PE immunity.MethodsTwelve P. vivax PE antigens orthologous to a panel of P. falciparum antigens previously identified as highly immunogenic in protected subjects after immunization with radiation attenuated sporozoites (RAS) were used for evaluation of humoral and cellular immunity by ELISA and IFN-γ ELISpot. Samples from P. vivax infected individuals (n = 76) from a low endemic malaria region in the Peruvian Amazon Basin were used.ResultsIn those clinical samples, all PE antigens evaluated showed positive IgG antibody reactivity with a variable prevalence of 58–99% in recently P. vivax diagnosed patients. The magnitude of the IgG antibody response against PE antigens was lower compared with blood stage antigens MSP1 and DBP-II, although antibody levels persisted better for PE antigens (average decrease of 6% for PE antigens and 43% for MSP1, p < 0.05). Higher IgG antibodies was associated with one or more previous malaria episodes only for blood stage antigens (p < 0.001). High IgG responders across PE and blood stage antigens showed significantly lower parasitaemia compared to low IgG responders (median 1,921 vs 4,663 par/µl, p < 0.05). In a subgroup of volunteers (n = 17),positive IFN-γ T cell response by ELISPOT was observed in 35% vs 9–35% against blood stage MSP1 and PE antigens, respectively, but no correlation with IgG responses.ConclusionsThese results demonstrate clear humoral and T cell responses against P. vivax PE antigens in individuals naturally infected with P. vivax. These data identify novel attractive PE antigens suitable for use in the potential development and selection of new malaria vaccine candidates which can be used as a part of malaria prevention strategies in civilian and military populations living in P. vivax endemic areas.

#2468 2-Step-Scores with optional histopathology for the prediction of delayed graft function and 1-year transplant loss in Eurotransplant

Abstract Background and Aims The decision for acceptance or discard of the increasingly rare and marginal deceased donor kidneys in Eurotransplant (ET) countries has to be made without solid evidence. Thus, we developed and validated flexible clinicopathological scores we call 2-Step Scores for the prognosis of delayed graft function (DGF) as 2-Step-DGF and one-year death-censored transplant loss (1y-tl) as 2-Step-1y, reflecting current practice of six ET countries including Croatia and Belgium. Method The training set was n = 620 for DGF and n = 711 for 1y-tl, with validation sets n = 158 and n = 162. In step 1, stepwise logistic regression models including only clinical predictors were used to estimate the risks. In step 2, risk estimates were updated for statistically relevant intermediate risk percentiles with nephropathology. Results Step 1 revealed an increased risk of DGF with increased cold ischaemia time, donor and recipient BMI, dialysis vintage, number of HLA-DR mismatches or recipient CMV IgG positivity. On the training and validation set, c-statistics were 0.672 and 0.704, respectively. At a range between 18% and 36%, accuracy of DGF-prognostication improved with nephropathology including number of glomeruli and Banff cv (updated overall c statistics of 0.696 and 0.701, respectively). Risk of 1y-tl increased in recipients with cold ischaemia time, sum of HLA-A. -B, -DR mismatches and donor age. On training and validation sets, c-statistics were 0.700 and 0.769, respectively. Accuracy of 1y-tl prediction improved (c-statistics = 0.706 and 0.765) with Banff ct. Overall, calibration was good on the training, but moderate on the validation set; discrimination was at least as good as established scores when applied to the validation set. Receiver operating characteristics of both 2-Step-DGF and 2-Step-1y compared to established scores are shown in Figs 1 and 2. Conclusion Our flexible 2-Step Scores with optional inclusion of time-consuming and often unavailable nephropathology should yield good results for clinical practice in ET, and may be superior to established scores. Our scores are adaptable to donation after cardiac death and perfusion pumps use.

LYME AND DENGUE FEVER: FROM BANGLADESH TO ITALY

Abstract Background Dengue fever (Flavivirus) and Lyme disease (Borrelia burgdorferi) are rare tropical infectious diseases transmitted by hematophagous vectors (Aedes mosquitoes and ticks, respectively), and they are extremely uncommon in Italy. In European countries, both represent a public health concern as they manifest as imported diseases. Case Report A 54–year–old man from Bangladesh was admitted with symptoms of fever, dyspnea, and pericarditic chest pain. Laboratory and imaging examinations revealed severe acute respiratory failure secondary to left lower lobe pneumonia and pleuropericardial effusion. Broad–spectrum antibiotic therapy and anti–inflammatory treatment were initiated, suspecting para–pneumonic pleuropericarditis. During hospitalization, there was a gradual improvement with a reduction in inflammatory indices and resolution of lung consolidation. The patient was discharged after 14 days with anti–inflammatory therapy (ibuprofen and colchicine). Approximately 7 days later, the patient returned to the emergency department complaining of a recurrence of symptoms and fatigue. The EKG showed phases of 2:1 AV block, EAS and EPS, complete de novo left bundle branch block (LBBB), alternating with an escape atrial rhythm, not evident in previous EKG. During hospitalization, complete AV block emerged with prolonged asystolic phases, requiring urgent placement of a temporary pacemaker. Concurrently, blood tests revealed anemia and increased levels of inflammatory markers, troponin, creatinine, transaminases, cholestatic indices, LDH, and lipase, indicative of multiple organ failure (MOF). Acute pathologies or active bleeding were ruled out by total body CT with contrast. Blood cultures and serological tests were performed to exclude infections by Trichinella, Mycoplasma, Borrelia, Dengue, and other rare infectious diseases. Due to progressive deterioration, the patient was transferred to a tertiary care hospital. In the following days, laboratory results showed positive IgG and IgM for Dengue (without serological evidence of viral RNA) and positive IgG and IgM antibodies for Borrelia burgdorferi. Conclusion In Italy, the incidence of these diseases is low, and their coexistence in the same host is even rarer (if not anecdotal). However, coinfection cannot be excluded in patients from areas where these diseases are endemic, such as Bangladesh.

Evaluation of antibody responses in healthcare workers before & after meningococcal vaccine and determination of meningococcal carriage rates

The rates of nasopharyngeal meningococcal carriage in healthcare workers are unknown. Meningococcal vaccine is recommended for risk groups but healthcare workers are not included in risk groups for many countries. Herein, we aimed to investigate the nasopharyngeal meningococcal carriage rates, basal and after one dose of Men-ACWY-DT vaccine response on the 30th day by evaluating meningococcus IgG antibody levels and decolonization at month six after vaccination among the detected carriers. Nasopharyngeal swab samples were taken before vaccination to evaluate meningococcal carriage in healthcare workers. All participants received a single dose of Men-ACWY-DT vaccine. Serum samples were collected immediately before vaccination and again on day 30 post-vaccination. Antibodies in the stored sera were analyzed using the ELISA method. Participants who were determined to carry meningococci at the initial visit underwent another round of nasopharyngeal swab tests six months post-vaccination to check for decolonization. Between November 2020 and May 2021, we evaluated samples from 100 physicians [52 % females, 28.28 ± 4.45 (min: 24, max: 49)]. The majority of the physicians worked in the emergency department (45 %), followed by the infectious diseases clinic (14 %). Fifty-eight physicians had a history of at least one contact with a meningococcus-infected patient, and 53 (91.4 %) had used prophylactic antibiotics at least once due to this exposure. None of the study group nasopharyngeal swab cultures were positive for Neisseria meningitidis. Before the Men-ACWY-DT vaccine, anti-meningococcus IgG positivity was detected in the serum samples of only 3 (3 %) participants. By day 30 after vaccination, 48 % of participants showed positive for antibodies. As we didn’t detect nasopharyngeal carriage in any participants, we didn’t evaluate decolonization among carriers six months post-vaccination. Notably, detection of antibodies was evident in about half of the participants on day 30 after receiving a single dose of the Men-ACWY-DT vaccine.