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Circulating DNA catches lymphoma relapse early
A newer technique aimed at detect circulating tumor DNA in the blood – cancer personalized profiling by deep sequencing (CAPP-Seq) – detected recurrence of diffuse large B cell lymphoma more than 6 months earlier than radiographic findings in a study at Stanford (Calif.) University, where the technique was invented.
The findings signal another win for “liquid biopsy,” the measurement of tumor DNA circulating in the blood, which is rapidly emerging as a quick and powerful tool for the diagnosis of a range of cancers and tumor subtypes, and prediction of tumor behavior and treatment response. Investigators at Stanford and elsewhere are studying liquid biopsy not only for lymphoma, but also for colorectal, thyroid, breast, prostate, and most other cancers. The Stanford team recently reported that its circulating DNA-detecting CAPP-Seq technique also helps in lung cancer.
In the new study, Stanford used CAPP-Seq (Cancer Personalized Profiling by deep Sequencing), which it called “an ultrasensitive capture-based targeted sequencing method” to analyze 166 plasma and 118 tissue samples from 92 patients with diffuse large B cell lymphoma (DLBCL) at diagnosis and various point afterward. The team compared the results to radiologic, and other standard diagnostic and monitoring techniques (Sci Transl Med. 2016 Nov 9;8[364]:364ra155).
At diagnosis, the amount of circulating DNA (ctDNA) correlated strongly with clinical indices and was independently predictive of patient outcomes; “whereas 100% of pretreatment samples had detectable ctDNA, only 37% of samples had abnormally high serum” lactate dehydrogenase, currently the most commonly used biomarker for DLBCL, said investigators, led by research fellow Florian Scherer, MD.
The group detected ctDNA in 73% of patients (8/11) who eventually relapsed a mean of 188 days before relapse was detected by standard-of-care radiologic techniques.
CAPP-Seq identified nine patients with a particular type of activated B cell-like tumor, for whom ibrutinib (Imbruvica) is particularly effective; ctDNA also predicted the transformation of indolent follicular lymphoma to DLBCL “with high sensitivity and specificity,” the group reported.
Stanford anticipates “ctDNA will have broad utility for dissecting tumor heterogeneity within and between patients with lymphomas and other cancer types, with applications for the identification of adverse risk groups, the discovery of resistance mechanisms to diverse therapies, and the development of risk-adapted therapeutics.”
The team said its approach “outperformed immunoglobulin sequencing and radiographic imaging for the detection of minimal residual disease and facilitated noninvasive identification of emergent resistance mutations to targeted therapies.” Meanwhile, while biomarkers hold “great promise for risk stratification and therapeutic targeting,” they are “currently difficult to measure in clinical settings,” the investigators said.
Roche bought the rights to CAPP-Seq from Stanford in 2015. Several authors are coinventors on patent applications for CAPP-Seq and also Roche consultants. Two are employees. Dr. Scherer had no disclosures. The work was funded by Stanford, the American Society of Hematology, the National Cancer Institute, and others.
A newer technique aimed at detect circulating tumor DNA in the blood – cancer personalized profiling by deep sequencing (CAPP-Seq) – detected recurrence of diffuse large B cell lymphoma more than 6 months earlier than radiographic findings in a study at Stanford (Calif.) University, where the technique was invented.
The findings signal another win for “liquid biopsy,” the measurement of tumor DNA circulating in the blood, which is rapidly emerging as a quick and powerful tool for the diagnosis of a range of cancers and tumor subtypes, and prediction of tumor behavior and treatment response. Investigators at Stanford and elsewhere are studying liquid biopsy not only for lymphoma, but also for colorectal, thyroid, breast, prostate, and most other cancers. The Stanford team recently reported that its circulating DNA-detecting CAPP-Seq technique also helps in lung cancer.
In the new study, Stanford used CAPP-Seq (Cancer Personalized Profiling by deep Sequencing), which it called “an ultrasensitive capture-based targeted sequencing method” to analyze 166 plasma and 118 tissue samples from 92 patients with diffuse large B cell lymphoma (DLBCL) at diagnosis and various point afterward. The team compared the results to radiologic, and other standard diagnostic and monitoring techniques (Sci Transl Med. 2016 Nov 9;8[364]:364ra155).
At diagnosis, the amount of circulating DNA (ctDNA) correlated strongly with clinical indices and was independently predictive of patient outcomes; “whereas 100% of pretreatment samples had detectable ctDNA, only 37% of samples had abnormally high serum” lactate dehydrogenase, currently the most commonly used biomarker for DLBCL, said investigators, led by research fellow Florian Scherer, MD.
The group detected ctDNA in 73% of patients (8/11) who eventually relapsed a mean of 188 days before relapse was detected by standard-of-care radiologic techniques.
CAPP-Seq identified nine patients with a particular type of activated B cell-like tumor, for whom ibrutinib (Imbruvica) is particularly effective; ctDNA also predicted the transformation of indolent follicular lymphoma to DLBCL “with high sensitivity and specificity,” the group reported.
Stanford anticipates “ctDNA will have broad utility for dissecting tumor heterogeneity within and between patients with lymphomas and other cancer types, with applications for the identification of adverse risk groups, the discovery of resistance mechanisms to diverse therapies, and the development of risk-adapted therapeutics.”
The team said its approach “outperformed immunoglobulin sequencing and radiographic imaging for the detection of minimal residual disease and facilitated noninvasive identification of emergent resistance mutations to targeted therapies.” Meanwhile, while biomarkers hold “great promise for risk stratification and therapeutic targeting,” they are “currently difficult to measure in clinical settings,” the investigators said.
Roche bought the rights to CAPP-Seq from Stanford in 2015. Several authors are coinventors on patent applications for CAPP-Seq and also Roche consultants. Two are employees. Dr. Scherer had no disclosures. The work was funded by Stanford, the American Society of Hematology, the National Cancer Institute, and others.
A newer technique aimed at detect circulating tumor DNA in the blood – cancer personalized profiling by deep sequencing (CAPP-Seq) – detected recurrence of diffuse large B cell lymphoma more than 6 months earlier than radiographic findings in a study at Stanford (Calif.) University, where the technique was invented.
The findings signal another win for “liquid biopsy,” the measurement of tumor DNA circulating in the blood, which is rapidly emerging as a quick and powerful tool for the diagnosis of a range of cancers and tumor subtypes, and prediction of tumor behavior and treatment response. Investigators at Stanford and elsewhere are studying liquid biopsy not only for lymphoma, but also for colorectal, thyroid, breast, prostate, and most other cancers. The Stanford team recently reported that its circulating DNA-detecting CAPP-Seq technique also helps in lung cancer.
In the new study, Stanford used CAPP-Seq (Cancer Personalized Profiling by deep Sequencing), which it called “an ultrasensitive capture-based targeted sequencing method” to analyze 166 plasma and 118 tissue samples from 92 patients with diffuse large B cell lymphoma (DLBCL) at diagnosis and various point afterward. The team compared the results to radiologic, and other standard diagnostic and monitoring techniques (Sci Transl Med. 2016 Nov 9;8[364]:364ra155).
At diagnosis, the amount of circulating DNA (ctDNA) correlated strongly with clinical indices and was independently predictive of patient outcomes; “whereas 100% of pretreatment samples had detectable ctDNA, only 37% of samples had abnormally high serum” lactate dehydrogenase, currently the most commonly used biomarker for DLBCL, said investigators, led by research fellow Florian Scherer, MD.
The group detected ctDNA in 73% of patients (8/11) who eventually relapsed a mean of 188 days before relapse was detected by standard-of-care radiologic techniques.
CAPP-Seq identified nine patients with a particular type of activated B cell-like tumor, for whom ibrutinib (Imbruvica) is particularly effective; ctDNA also predicted the transformation of indolent follicular lymphoma to DLBCL “with high sensitivity and specificity,” the group reported.
Stanford anticipates “ctDNA will have broad utility for dissecting tumor heterogeneity within and between patients with lymphomas and other cancer types, with applications for the identification of adverse risk groups, the discovery of resistance mechanisms to diverse therapies, and the development of risk-adapted therapeutics.”
The team said its approach “outperformed immunoglobulin sequencing and radiographic imaging for the detection of minimal residual disease and facilitated noninvasive identification of emergent resistance mutations to targeted therapies.” Meanwhile, while biomarkers hold “great promise for risk stratification and therapeutic targeting,” they are “currently difficult to measure in clinical settings,” the investigators said.
Roche bought the rights to CAPP-Seq from Stanford in 2015. Several authors are coinventors on patent applications for CAPP-Seq and also Roche consultants. Two are employees. Dr. Scherer had no disclosures. The work was funded by Stanford, the American Society of Hematology, the National Cancer Institute, and others.
FROM SCIENCE TRANSLATIONAL MEDICINE
Key clinical point: Major finding: Circulating tumor DNA was found in 73% of relapse patients a mean of 188 days before relapse was detected by standard-of-care radiologic techniques. Circulating tumor DNA was found in the plasma of 100% of patients at diagnosis, but only 37% had abnormally high serum lactate dehydrogenase, currently the most commonly used biomarker.
Data source: Analysis of 166 plasma and 118 tissue samples from 92 patients with diffuse large B cell lymphoma.
Disclosures: Roche bought the rights to CAPP-Seq from Stanford (Calif.) University in 2015. Several authors are coinventors on patent applications for CAPP-Seq and also Roche consults. Two are employees. The work was funded by Stanford, the American Society of Hematology, the National Cancer Institute, and others.
Puerperal NSAIDs show no hypertension risk
LAS VEGAS – Puerperal NSAID treatment appeared safe for women with severe preeclampsia and hypertension postpartum in a single-center, retrospective analysis with 324 women.
Given that an opioid is generally the alternative to analgesia with a nonsteroidal anti-inflammatory drug, these new data help refute a recent call to limit puerperal NSAID use, Oscar A. Viteri, MD, said at the annual Pregnancy Meeting sponsored by the Society for Maternal-Fetal Medicine.
Given the apparent safety of NSAIDs in this new analysis, their safety for nursing women, and concerns about opiates, it makes sense to defer any recommendations about avoiding NSAIDs in women with hypertension postpartum until their harm is proven in a adequately powered randomized trial, said Dr. Viteri, a maternal fetal medicine specialist at the University of Texas, Houston. “Opiates are a public health problem,” he stressed.
His analysis used data collected from all women who delivered at Children’s Memorial Hermann Hospital in Houston during 2013-2015. In that group he identified 399 mothers with preeclampsia with severe features that had been diagnosed prior to delivery, and among them 324 mothers had hypertension (a systolic blood pressure of at least 140 mm Hg, a diastolic pressure of at least 90 mm Hg, or both) at or after 24 hours following delivery. Within this subgroup of 324 mothers, 243 (75%) received puerperal NSAID treatment and 81 women (25%) did not. Dr. Viteri highlighted that three-quarters of the women in the study subgroup had received NSAIDs “despite” the 2013 Task Force recommendation.
“Many units” continue to use puerperal NSAIDs in women with hypertension postpartum, commented Mary E. D’Alton, MD, professor and chair of ob.gyn. at Columbia University, New York.
Dr. Viteri defined persistent hypertension in these women as a systolic blood pressure of at least 150 mm Hg, a diastolic pressure of at least 100 mm Hg, or both measured after delivery at least twice at an interval of at least 4 hours. This primary endpoint occurred in 70% of the women treated with an NSAID and in 73% of those who received no NSAID, a difference that was not statistically significant after adjustment for laboratory abnormalities, gestational age, and mode of delivery, Dr. Viteri reported. The women who received NSAIDs also showed a numerically lower rate of receiving new or additional antihypertensive drugs of 20%, compared with 31% among those not on NSAIDs, a nonsignificant difference.
The analysis also showed no differences between the women on NSAIDs and those who did not take them for all the other parameters examined, including highest, average, and discharge systolic and diastolic blood pressures. In addition, among the women who received NSAIDs the results showed no differences in blood pressures regardless of whether the women also were receiving antihypertensive treatment with labetalol or nifedipine. This is the largest study yet reported to examine the effect of puerperal NSAID treatment on women with hypertension, and also the first data on the impact of NSAID treatment on blood pressure in women taking various types of antihypertensive drugs, Dr. Viteri noted.
Despite this reassuring data “it is important to be cautious” when using NSAIDs to treat the type of women enrolled in this study, Dr. D’Alton said in an interview. One concern to keep in mind is the risk for renal injury from NSAID use in women with a history of severe hypertension. Although Dr. D’Alton believed that it is not necessary to monitor renal function routinely in hypertensive women receiving puerperal NSAID treatment, the impact of this practice on the kidneys was worth further investigation, she said.
Dr. Viteri and Dr. D’Alton had no disclosures.
[email protected]
On Twitter @mitchelzoler
LAS VEGAS – Puerperal NSAID treatment appeared safe for women with severe preeclampsia and hypertension postpartum in a single-center, retrospective analysis with 324 women.
Given that an opioid is generally the alternative to analgesia with a nonsteroidal anti-inflammatory drug, these new data help refute a recent call to limit puerperal NSAID use, Oscar A. Viteri, MD, said at the annual Pregnancy Meeting sponsored by the Society for Maternal-Fetal Medicine.
Given the apparent safety of NSAIDs in this new analysis, their safety for nursing women, and concerns about opiates, it makes sense to defer any recommendations about avoiding NSAIDs in women with hypertension postpartum until their harm is proven in a adequately powered randomized trial, said Dr. Viteri, a maternal fetal medicine specialist at the University of Texas, Houston. “Opiates are a public health problem,” he stressed.
His analysis used data collected from all women who delivered at Children’s Memorial Hermann Hospital in Houston during 2013-2015. In that group he identified 399 mothers with preeclampsia with severe features that had been diagnosed prior to delivery, and among them 324 mothers had hypertension (a systolic blood pressure of at least 140 mm Hg, a diastolic pressure of at least 90 mm Hg, or both) at or after 24 hours following delivery. Within this subgroup of 324 mothers, 243 (75%) received puerperal NSAID treatment and 81 women (25%) did not. Dr. Viteri highlighted that three-quarters of the women in the study subgroup had received NSAIDs “despite” the 2013 Task Force recommendation.
“Many units” continue to use puerperal NSAIDs in women with hypertension postpartum, commented Mary E. D’Alton, MD, professor and chair of ob.gyn. at Columbia University, New York.
Dr. Viteri defined persistent hypertension in these women as a systolic blood pressure of at least 150 mm Hg, a diastolic pressure of at least 100 mm Hg, or both measured after delivery at least twice at an interval of at least 4 hours. This primary endpoint occurred in 70% of the women treated with an NSAID and in 73% of those who received no NSAID, a difference that was not statistically significant after adjustment for laboratory abnormalities, gestational age, and mode of delivery, Dr. Viteri reported. The women who received NSAIDs also showed a numerically lower rate of receiving new or additional antihypertensive drugs of 20%, compared with 31% among those not on NSAIDs, a nonsignificant difference.
The analysis also showed no differences between the women on NSAIDs and those who did not take them for all the other parameters examined, including highest, average, and discharge systolic and diastolic blood pressures. In addition, among the women who received NSAIDs the results showed no differences in blood pressures regardless of whether the women also were receiving antihypertensive treatment with labetalol or nifedipine. This is the largest study yet reported to examine the effect of puerperal NSAID treatment on women with hypertension, and also the first data on the impact of NSAID treatment on blood pressure in women taking various types of antihypertensive drugs, Dr. Viteri noted.
Despite this reassuring data “it is important to be cautious” when using NSAIDs to treat the type of women enrolled in this study, Dr. D’Alton said in an interview. One concern to keep in mind is the risk for renal injury from NSAID use in women with a history of severe hypertension. Although Dr. D’Alton believed that it is not necessary to monitor renal function routinely in hypertensive women receiving puerperal NSAID treatment, the impact of this practice on the kidneys was worth further investigation, she said.
Dr. Viteri and Dr. D’Alton had no disclosures.
[email protected]
On Twitter @mitchelzoler
LAS VEGAS – Puerperal NSAID treatment appeared safe for women with severe preeclampsia and hypertension postpartum in a single-center, retrospective analysis with 324 women.
Given that an opioid is generally the alternative to analgesia with a nonsteroidal anti-inflammatory drug, these new data help refute a recent call to limit puerperal NSAID use, Oscar A. Viteri, MD, said at the annual Pregnancy Meeting sponsored by the Society for Maternal-Fetal Medicine.
Given the apparent safety of NSAIDs in this new analysis, their safety for nursing women, and concerns about opiates, it makes sense to defer any recommendations about avoiding NSAIDs in women with hypertension postpartum until their harm is proven in a adequately powered randomized trial, said Dr. Viteri, a maternal fetal medicine specialist at the University of Texas, Houston. “Opiates are a public health problem,” he stressed.
His analysis used data collected from all women who delivered at Children’s Memorial Hermann Hospital in Houston during 2013-2015. In that group he identified 399 mothers with preeclampsia with severe features that had been diagnosed prior to delivery, and among them 324 mothers had hypertension (a systolic blood pressure of at least 140 mm Hg, a diastolic pressure of at least 90 mm Hg, or both) at or after 24 hours following delivery. Within this subgroup of 324 mothers, 243 (75%) received puerperal NSAID treatment and 81 women (25%) did not. Dr. Viteri highlighted that three-quarters of the women in the study subgroup had received NSAIDs “despite” the 2013 Task Force recommendation.
“Many units” continue to use puerperal NSAIDs in women with hypertension postpartum, commented Mary E. D’Alton, MD, professor and chair of ob.gyn. at Columbia University, New York.
Dr. Viteri defined persistent hypertension in these women as a systolic blood pressure of at least 150 mm Hg, a diastolic pressure of at least 100 mm Hg, or both measured after delivery at least twice at an interval of at least 4 hours. This primary endpoint occurred in 70% of the women treated with an NSAID and in 73% of those who received no NSAID, a difference that was not statistically significant after adjustment for laboratory abnormalities, gestational age, and mode of delivery, Dr. Viteri reported. The women who received NSAIDs also showed a numerically lower rate of receiving new or additional antihypertensive drugs of 20%, compared with 31% among those not on NSAIDs, a nonsignificant difference.
The analysis also showed no differences between the women on NSAIDs and those who did not take them for all the other parameters examined, including highest, average, and discharge systolic and diastolic blood pressures. In addition, among the women who received NSAIDs the results showed no differences in blood pressures regardless of whether the women also were receiving antihypertensive treatment with labetalol or nifedipine. This is the largest study yet reported to examine the effect of puerperal NSAID treatment on women with hypertension, and also the first data on the impact of NSAID treatment on blood pressure in women taking various types of antihypertensive drugs, Dr. Viteri noted.
Despite this reassuring data “it is important to be cautious” when using NSAIDs to treat the type of women enrolled in this study, Dr. D’Alton said in an interview. One concern to keep in mind is the risk for renal injury from NSAID use in women with a history of severe hypertension. Although Dr. D’Alton believed that it is not necessary to monitor renal function routinely in hypertensive women receiving puerperal NSAID treatment, the impact of this practice on the kidneys was worth further investigation, she said.
Dr. Viteri and Dr. D’Alton had no disclosures.
[email protected]
On Twitter @mitchelzoler
AT THE PREGNANCY MEETING
Key clinical point:
Major finding: The incidence of persistent hypertension was 70% in women who received NSAIDs and 73% in women not on NSAISDs.
Data source: Retrospective analysis of data from 324 women at a single U.S. center.
Disclosures: Dr. Viteri and Dr. D’Alton had no disclosures.
Adolescents’ moderate use of digital technology tied to positive mental well-being
The moderate use of digital technology is not intrinsically harmful for adolescents and may be good for their mental well-being.
Those are the results of a study of 120,115 adolescents from the United Kingdom’s Department for Education National Pupil Database who were asked to complete questionnaires about their mental well-being and digital screen time, reported Andrew K. Przybylski, PhD, of the University of Oxford (England), and Netta Weinstein, PhD, of Cardiff (Wales) University.
The researchers began the study using what they called the “digital Goldilocks hypothesis.”
At the beginning of the study, Dr. Przybylski, Dr. Weinstein, and their team asked 15-year-olds from across England to complete the Warick-Edinburgh Mental Well-Being Scale, a 14-item self-report that seeks to measure factors such as happiness, life satisfaction, and psychological and social functioning. Meanwhile, the adolescents’ screen time was assessed through four questions asking about “watching films and other media, playing games, and using computers, and smartphones.”
About 20% of the participants reported a sum of more than 12 hours of digital engagement on weekdays, and 35% of the sample reported a total of more than 12 hours on weekend days. Girls reported spending more time using smartphones, using computers, and watching videos, and the boys devoted more time to playing computer and console games. Smartphones, however, were used more often daily among both girls and boys, Dr. Przybylski and Dr. Weinstein said.
After comparing the well-being and screen time data, the reseachers found that “the relations between screen time and mental well-being were either positive (P less than or equal to .001) or flat (P greater than .183), except for a negative link in the case of weekend smartphone use,” they said.
The investigators said their findings inform current guidelines that seek to limit adolescents’ technology use. “Future research and recommendations building on the Goldilocks hypothesis would be sensitive to the various types and contexts of media use and would be based on peaks and drops in well-being as well as other meaningful outcomes identified systematically,” they wrote.
Dr. Przybylski and Dr. Weinstein reported that they had no conflicts of interest to disclose.
The moderate use of digital technology is not intrinsically harmful for adolescents and may be good for their mental well-being.
Those are the results of a study of 120,115 adolescents from the United Kingdom’s Department for Education National Pupil Database who were asked to complete questionnaires about their mental well-being and digital screen time, reported Andrew K. Przybylski, PhD, of the University of Oxford (England), and Netta Weinstein, PhD, of Cardiff (Wales) University.
The researchers began the study using what they called the “digital Goldilocks hypothesis.”
At the beginning of the study, Dr. Przybylski, Dr. Weinstein, and their team asked 15-year-olds from across England to complete the Warick-Edinburgh Mental Well-Being Scale, a 14-item self-report that seeks to measure factors such as happiness, life satisfaction, and psychological and social functioning. Meanwhile, the adolescents’ screen time was assessed through four questions asking about “watching films and other media, playing games, and using computers, and smartphones.”
About 20% of the participants reported a sum of more than 12 hours of digital engagement on weekdays, and 35% of the sample reported a total of more than 12 hours on weekend days. Girls reported spending more time using smartphones, using computers, and watching videos, and the boys devoted more time to playing computer and console games. Smartphones, however, were used more often daily among both girls and boys, Dr. Przybylski and Dr. Weinstein said.
After comparing the well-being and screen time data, the reseachers found that “the relations between screen time and mental well-being were either positive (P less than or equal to .001) or flat (P greater than .183), except for a negative link in the case of weekend smartphone use,” they said.
The investigators said their findings inform current guidelines that seek to limit adolescents’ technology use. “Future research and recommendations building on the Goldilocks hypothesis would be sensitive to the various types and contexts of media use and would be based on peaks and drops in well-being as well as other meaningful outcomes identified systematically,” they wrote.
Dr. Przybylski and Dr. Weinstein reported that they had no conflicts of interest to disclose.
The moderate use of digital technology is not intrinsically harmful for adolescents and may be good for their mental well-being.
Those are the results of a study of 120,115 adolescents from the United Kingdom’s Department for Education National Pupil Database who were asked to complete questionnaires about their mental well-being and digital screen time, reported Andrew K. Przybylski, PhD, of the University of Oxford (England), and Netta Weinstein, PhD, of Cardiff (Wales) University.
The researchers began the study using what they called the “digital Goldilocks hypothesis.”
At the beginning of the study, Dr. Przybylski, Dr. Weinstein, and their team asked 15-year-olds from across England to complete the Warick-Edinburgh Mental Well-Being Scale, a 14-item self-report that seeks to measure factors such as happiness, life satisfaction, and psychological and social functioning. Meanwhile, the adolescents’ screen time was assessed through four questions asking about “watching films and other media, playing games, and using computers, and smartphones.”
About 20% of the participants reported a sum of more than 12 hours of digital engagement on weekdays, and 35% of the sample reported a total of more than 12 hours on weekend days. Girls reported spending more time using smartphones, using computers, and watching videos, and the boys devoted more time to playing computer and console games. Smartphones, however, were used more often daily among both girls and boys, Dr. Przybylski and Dr. Weinstein said.
After comparing the well-being and screen time data, the reseachers found that “the relations between screen time and mental well-being were either positive (P less than or equal to .001) or flat (P greater than .183), except for a negative link in the case of weekend smartphone use,” they said.
The investigators said their findings inform current guidelines that seek to limit adolescents’ technology use. “Future research and recommendations building on the Goldilocks hypothesis would be sensitive to the various types and contexts of media use and would be based on peaks and drops in well-being as well as other meaningful outcomes identified systematically,” they wrote.
Dr. Przybylski and Dr. Weinstein reported that they had no conflicts of interest to disclose.
FROM PSYCHOLOGICAL SCIENCE
Study provides new insight into B-cell metabolism
the spleen of a mouse, showing
inactivated GSK3 (magenta)
in B cells (blue) near follicular
dendritic cells (green).
Image from the lab of
Robert Rickert, PhD
Research published in Nature Immunology helps explain how B-cell metabolism adapts to different environments.
The study suggests the protein GSK3 acts as a metabolic checkpoint regulator in B cells, promoting the survival of circulating B cells while limiting the growth and proliferation of B cells in germinal centers.
“Our research shows that the protein GSK3 plays a crucial role in helping B cells meet the energy needs of their distinct states,” said study author Robert Rickert, PhD, of Sanford Burnham Prebys Medical Discovery Institute in La Jolla, California.
“The findings are particularly relevant for certain B-cell pathologies, including lymphoma subtypes, where there is an increased demand for energy to support the hyperproliferation of cells in a microenvironment that may be limited in nutrients.”
Dr Rickert and his colleagues noted that B cells predominate in a quiescent state until they encounter an antigen, which prompts the cells to grow, proliferate, and differentiate.
The team’s new study showed that GSK3 adjusts B-cell metabolism to match the needs of these different cell states.
In circulating B cells, GSK3 limits overall metabolic activity. In proliferating B cells in germinal centers, GSK3 slows glycolysis and the production of mitochondria.
In fact, GSK3 function is essential for B-cell survival in germinal centers. To understand why, the researchers looked at how B cells in these regions generate energy.
The team found that because these B cells are so metabolically active, they consume nearly all available glucose. That switches on glycolysis.
High glycolytic activity leads to an accumulation of toxic reactive oxygen species, as does rapid manufacture of mitochondria, which tend to leak the same chemicals.
Thus, by restraining the metabolism in specific ways, GSK3 prevents cell death induced by reactive oxygen species.
“Our results were really surprising,” Dr Rickert said. “Until now, we would have thought that slowing metabolism would only be important for preventing B cells from becoming cancerous, which it indeed may be. These studies provide insight into the dynamic nature of B-cell metabolism that literally ‘fuels’ differentiation in the germinal center to produce an effective antibody response.”
“It’s not yet clear whether or how GSK3 might be a target for future therapies for B cell-related diseases, but this research opens a lot of doors for further studies. To start with, we plan to investigate how GSK3 is regulated in lymphoma and how that relates to changes in metabolism. That research could lead to new approaches to treating lymphoma.”
This research was performed in collaboration with scientists at Eli Lilly and the Lunenfeld-Tanenbaum Research Institute at the University of Toronto. Funding was provided by the National Institutes of Health, the Lilly Research Award Program, the Arthritis National Research Foundation, and the Canadian Institutes of Health Research. 
the spleen of a mouse, showing
inactivated GSK3 (magenta)
in B cells (blue) near follicular
dendritic cells (green).
Image from the lab of
Robert Rickert, PhD
Research published in Nature Immunology helps explain how B-cell metabolism adapts to different environments.
The study suggests the protein GSK3 acts as a metabolic checkpoint regulator in B cells, promoting the survival of circulating B cells while limiting the growth and proliferation of B cells in germinal centers.
“Our research shows that the protein GSK3 plays a crucial role in helping B cells meet the energy needs of their distinct states,” said study author Robert Rickert, PhD, of Sanford Burnham Prebys Medical Discovery Institute in La Jolla, California.
“The findings are particularly relevant for certain B-cell pathologies, including lymphoma subtypes, where there is an increased demand for energy to support the hyperproliferation of cells in a microenvironment that may be limited in nutrients.”
Dr Rickert and his colleagues noted that B cells predominate in a quiescent state until they encounter an antigen, which prompts the cells to grow, proliferate, and differentiate.
The team’s new study showed that GSK3 adjusts B-cell metabolism to match the needs of these different cell states.
In circulating B cells, GSK3 limits overall metabolic activity. In proliferating B cells in germinal centers, GSK3 slows glycolysis and the production of mitochondria.
In fact, GSK3 function is essential for B-cell survival in germinal centers. To understand why, the researchers looked at how B cells in these regions generate energy.
The team found that because these B cells are so metabolically active, they consume nearly all available glucose. That switches on glycolysis.
High glycolytic activity leads to an accumulation of toxic reactive oxygen species, as does rapid manufacture of mitochondria, which tend to leak the same chemicals.
Thus, by restraining the metabolism in specific ways, GSK3 prevents cell death induced by reactive oxygen species.
“Our results were really surprising,” Dr Rickert said. “Until now, we would have thought that slowing metabolism would only be important for preventing B cells from becoming cancerous, which it indeed may be. These studies provide insight into the dynamic nature of B-cell metabolism that literally ‘fuels’ differentiation in the germinal center to produce an effective antibody response.”
“It’s not yet clear whether or how GSK3 might be a target for future therapies for B cell-related diseases, but this research opens a lot of doors for further studies. To start with, we plan to investigate how GSK3 is regulated in lymphoma and how that relates to changes in metabolism. That research could lead to new approaches to treating lymphoma.”
This research was performed in collaboration with scientists at Eli Lilly and the Lunenfeld-Tanenbaum Research Institute at the University of Toronto. Funding was provided by the National Institutes of Health, the Lilly Research Award Program, the Arthritis National Research Foundation, and the Canadian Institutes of Health Research.
the spleen of a mouse, showing
inactivated GSK3 (magenta)
in B cells (blue) near follicular
dendritic cells (green).
Image from the lab of
Robert Rickert, PhD
Research published in Nature Immunology helps explain how B-cell metabolism adapts to different environments.
The study suggests the protein GSK3 acts as a metabolic checkpoint regulator in B cells, promoting the survival of circulating B cells while limiting the growth and proliferation of B cells in germinal centers.
“Our research shows that the protein GSK3 plays a crucial role in helping B cells meet the energy needs of their distinct states,” said study author Robert Rickert, PhD, of Sanford Burnham Prebys Medical Discovery Institute in La Jolla, California.
“The findings are particularly relevant for certain B-cell pathologies, including lymphoma subtypes, where there is an increased demand for energy to support the hyperproliferation of cells in a microenvironment that may be limited in nutrients.”
Dr Rickert and his colleagues noted that B cells predominate in a quiescent state until they encounter an antigen, which prompts the cells to grow, proliferate, and differentiate.
The team’s new study showed that GSK3 adjusts B-cell metabolism to match the needs of these different cell states.
In circulating B cells, GSK3 limits overall metabolic activity. In proliferating B cells in germinal centers, GSK3 slows glycolysis and the production of mitochondria.
In fact, GSK3 function is essential for B-cell survival in germinal centers. To understand why, the researchers looked at how B cells in these regions generate energy.
The team found that because these B cells are so metabolically active, they consume nearly all available glucose. That switches on glycolysis.
High glycolytic activity leads to an accumulation of toxic reactive oxygen species, as does rapid manufacture of mitochondria, which tend to leak the same chemicals.
Thus, by restraining the metabolism in specific ways, GSK3 prevents cell death induced by reactive oxygen species.
“Our results were really surprising,” Dr Rickert said. “Until now, we would have thought that slowing metabolism would only be important for preventing B cells from becoming cancerous, which it indeed may be. These studies provide insight into the dynamic nature of B-cell metabolism that literally ‘fuels’ differentiation in the germinal center to produce an effective antibody response.”
“It’s not yet clear whether or how GSK3 might be a target for future therapies for B cell-related diseases, but this research opens a lot of doors for further studies. To start with, we plan to investigate how GSK3 is regulated in lymphoma and how that relates to changes in metabolism. That research could lead to new approaches to treating lymphoma.”
This research was performed in collaboration with scientists at Eli Lilly and the Lunenfeld-Tanenbaum Research Institute at the University of Toronto. Funding was provided by the National Institutes of Health, the Lilly Research Award Program, the Arthritis National Research Foundation, and the Canadian Institutes of Health Research.
HAART may contribute to profound escalation in syphilis
Highly active antiretroviral therapy taken by HIV-positive men who have sex with men may be contributing to the profound escalation in syphilis infections recently observed worldwide, a recent report suggests.
After noting reports of a substantial and rapid rise in syphilis infections around the globe, which have been largely confined to HIV-positive men taking HAART, researchers constructed mathematical models to test the possibility that HAART may inadvertently alter immune responses in ways that enhance the patient’s vulnerability to Treponema pallidum.
If these findings are verified in further studies, it will be “imperative” to address this unforeseen sequela before implementing global pre-exposure prophylaxis (PrEP) programs, they noted.
The investigators devised their mathematical models to account for the possibility that either HAART itself, or the use of HAART as a surrogate marker for high-risk sex, or both factors together could influence the association with syphilis. The first model assumed that one or more components of HAART could impair the immune response to T. pallidum, and the second assumed that men taking HAART would perceive themselves as low risk and increase their number of partners, thus heightening their ability to transmit the organism.
Each model demonstrated that immunologic changes or behavioral changes could produce syphilis outbreaks similar to those reported in the literature.
“Strikingly, the peak prevalence of the syphilis outbreak produced by both behavioral and immunologic changes [acting together] is larger than the sum of the peaks of outbreaks produced independently by either type of change,” Dr. Rekart and his associates said (Sex Transm Infect. 2017 Jan 16. doi: 10.1136/sextrans.2016.052870).
In other words, HAART-associated immunologic and behavioral changes “can in principle act synergistically to increase syphilis prevalence by amounts comparable with that observed in ongoing outbreaks,” they said.
It is notable that the rates of two other STDs, gonorrhea and chlamydia, have either failed to increase as much or as rapidly as syphilis, or have actually decreased, in the same patient populations. So, the researchers also examined the biological plausibility that HAART could increase patients’ susceptibility to syphilis but not to gonorrhea and chlamydia.
The immune system’s primary clearance mechanism of T. pallidum, macrophage-mediated opsonophagocytosis, requires “unperturbed mitochondrial function to ensure peak metabolic activity within macrophages, opsonic antibody production, and ... macrophage activation.” But HIV infection reduces the quality of opsonic antibodies, and some components of HAART significantly suppress mitochondrial function, the proinflammatory response, and macrophage activation. Theoretically, the combination of these factors could impair treponemal clearance via opsonophagocytosis, Dr. Rekart and his associates said.
In contrast, gonorrhea and chlamydia are caused by pathogens that are not so reliant on opsonophagocytosis to be cleared by the immune system. So, HAART would not lead to similar surges in the rates of gonorrhea and chlamydia infection.
Further studies are needed to corroborate these findings. If they are confirmed, the use of both HAART and PrEP will require changes in patient management to mitigate this increased risk for acquiring syphilis and perhaps other disorders, the researchers noted.
“A retrospective case-control and/or a prospective cohort study comparing the prevalence and epidemiological features of infectious syphilis cases among patients who are HIV-1 positive and treated with HAART, patients who are HIV-1 positive and untreated, and patients who are HIV-1-negative ... would be enlightening,” the investigators added.
Thie study was supported by the National Institute of Allergy and Infectious Diseases. Dr. Rekart and his associates reported having no relevant financial disclosures.
The novel hypothesis proposed by Dr. Michael L. Rekart and his associates is intriguing, and warrants careful consideration.
But it is critical to emphasize that the authors are in no way suggesting that antiretroviral therapy be reconsidered for the treatment and prevention of HIV. Rather, their aim is to stimulate discussion, inform research, and address the staggering increases in syphilis rates.
The focus on HIV appears to have tempered the urgency to control other STDs. But history has shown many times over that that would be a costly mistake. This study demonstrates why screening for, diagnosing, and treating all sexually transmitted infections must be a priority.
Susan Tuddenham, MD, is in the division of infectious diseases at Johns Hopkins University, Baltimore. She and her associates reported having no relevant financial disclosures. Dr. Tuddenham and her associates made these remarks in an editorial accompanying Dr. Rekart’s study (Sex Transm Infect. 2017 Jan 16. doi: 10.1136/sextrans.2016.052940).
The novel hypothesis proposed by Dr. Michael L. Rekart and his associates is intriguing, and warrants careful consideration.
But it is critical to emphasize that the authors are in no way suggesting that antiretroviral therapy be reconsidered for the treatment and prevention of HIV. Rather, their aim is to stimulate discussion, inform research, and address the staggering increases in syphilis rates.
The focus on HIV appears to have tempered the urgency to control other STDs. But history has shown many times over that that would be a costly mistake. This study demonstrates why screening for, diagnosing, and treating all sexually transmitted infections must be a priority.
Susan Tuddenham, MD, is in the division of infectious diseases at Johns Hopkins University, Baltimore. She and her associates reported having no relevant financial disclosures. Dr. Tuddenham and her associates made these remarks in an editorial accompanying Dr. Rekart’s study (Sex Transm Infect. 2017 Jan 16. doi: 10.1136/sextrans.2016.052940).
The novel hypothesis proposed by Dr. Michael L. Rekart and his associates is intriguing, and warrants careful consideration.
But it is critical to emphasize that the authors are in no way suggesting that antiretroviral therapy be reconsidered for the treatment and prevention of HIV. Rather, their aim is to stimulate discussion, inform research, and address the staggering increases in syphilis rates.
The focus on HIV appears to have tempered the urgency to control other STDs. But history has shown many times over that that would be a costly mistake. This study demonstrates why screening for, diagnosing, and treating all sexually transmitted infections must be a priority.
Susan Tuddenham, MD, is in the division of infectious diseases at Johns Hopkins University, Baltimore. She and her associates reported having no relevant financial disclosures. Dr. Tuddenham and her associates made these remarks in an editorial accompanying Dr. Rekart’s study (Sex Transm Infect. 2017 Jan 16. doi: 10.1136/sextrans.2016.052940).
Highly active antiretroviral therapy taken by HIV-positive men who have sex with men may be contributing to the profound escalation in syphilis infections recently observed worldwide, a recent report suggests.
After noting reports of a substantial and rapid rise in syphilis infections around the globe, which have been largely confined to HIV-positive men taking HAART, researchers constructed mathematical models to test the possibility that HAART may inadvertently alter immune responses in ways that enhance the patient’s vulnerability to Treponema pallidum.
If these findings are verified in further studies, it will be “imperative” to address this unforeseen sequela before implementing global pre-exposure prophylaxis (PrEP) programs, they noted.
The investigators devised their mathematical models to account for the possibility that either HAART itself, or the use of HAART as a surrogate marker for high-risk sex, or both factors together could influence the association with syphilis. The first model assumed that one or more components of HAART could impair the immune response to T. pallidum, and the second assumed that men taking HAART would perceive themselves as low risk and increase their number of partners, thus heightening their ability to transmit the organism.
Each model demonstrated that immunologic changes or behavioral changes could produce syphilis outbreaks similar to those reported in the literature.
“Strikingly, the peak prevalence of the syphilis outbreak produced by both behavioral and immunologic changes [acting together] is larger than the sum of the peaks of outbreaks produced independently by either type of change,” Dr. Rekart and his associates said (Sex Transm Infect. 2017 Jan 16. doi: 10.1136/sextrans.2016.052870).
In other words, HAART-associated immunologic and behavioral changes “can in principle act synergistically to increase syphilis prevalence by amounts comparable with that observed in ongoing outbreaks,” they said.
It is notable that the rates of two other STDs, gonorrhea and chlamydia, have either failed to increase as much or as rapidly as syphilis, or have actually decreased, in the same patient populations. So, the researchers also examined the biological plausibility that HAART could increase patients’ susceptibility to syphilis but not to gonorrhea and chlamydia.
The immune system’s primary clearance mechanism of T. pallidum, macrophage-mediated opsonophagocytosis, requires “unperturbed mitochondrial function to ensure peak metabolic activity within macrophages, opsonic antibody production, and ... macrophage activation.” But HIV infection reduces the quality of opsonic antibodies, and some components of HAART significantly suppress mitochondrial function, the proinflammatory response, and macrophage activation. Theoretically, the combination of these factors could impair treponemal clearance via opsonophagocytosis, Dr. Rekart and his associates said.
In contrast, gonorrhea and chlamydia are caused by pathogens that are not so reliant on opsonophagocytosis to be cleared by the immune system. So, HAART would not lead to similar surges in the rates of gonorrhea and chlamydia infection.
Further studies are needed to corroborate these findings. If they are confirmed, the use of both HAART and PrEP will require changes in patient management to mitigate this increased risk for acquiring syphilis and perhaps other disorders, the researchers noted.
“A retrospective case-control and/or a prospective cohort study comparing the prevalence and epidemiological features of infectious syphilis cases among patients who are HIV-1 positive and treated with HAART, patients who are HIV-1 positive and untreated, and patients who are HIV-1-negative ... would be enlightening,” the investigators added.
Thie study was supported by the National Institute of Allergy and Infectious Diseases. Dr. Rekart and his associates reported having no relevant financial disclosures.
Highly active antiretroviral therapy taken by HIV-positive men who have sex with men may be contributing to the profound escalation in syphilis infections recently observed worldwide, a recent report suggests.
After noting reports of a substantial and rapid rise in syphilis infections around the globe, which have been largely confined to HIV-positive men taking HAART, researchers constructed mathematical models to test the possibility that HAART may inadvertently alter immune responses in ways that enhance the patient’s vulnerability to Treponema pallidum.
If these findings are verified in further studies, it will be “imperative” to address this unforeseen sequela before implementing global pre-exposure prophylaxis (PrEP) programs, they noted.
The investigators devised their mathematical models to account for the possibility that either HAART itself, or the use of HAART as a surrogate marker for high-risk sex, or both factors together could influence the association with syphilis. The first model assumed that one or more components of HAART could impair the immune response to T. pallidum, and the second assumed that men taking HAART would perceive themselves as low risk and increase their number of partners, thus heightening their ability to transmit the organism.
Each model demonstrated that immunologic changes or behavioral changes could produce syphilis outbreaks similar to those reported in the literature.
“Strikingly, the peak prevalence of the syphilis outbreak produced by both behavioral and immunologic changes [acting together] is larger than the sum of the peaks of outbreaks produced independently by either type of change,” Dr. Rekart and his associates said (Sex Transm Infect. 2017 Jan 16. doi: 10.1136/sextrans.2016.052870).
In other words, HAART-associated immunologic and behavioral changes “can in principle act synergistically to increase syphilis prevalence by amounts comparable with that observed in ongoing outbreaks,” they said.
It is notable that the rates of two other STDs, gonorrhea and chlamydia, have either failed to increase as much or as rapidly as syphilis, or have actually decreased, in the same patient populations. So, the researchers also examined the biological plausibility that HAART could increase patients’ susceptibility to syphilis but not to gonorrhea and chlamydia.
The immune system’s primary clearance mechanism of T. pallidum, macrophage-mediated opsonophagocytosis, requires “unperturbed mitochondrial function to ensure peak metabolic activity within macrophages, opsonic antibody production, and ... macrophage activation.” But HIV infection reduces the quality of opsonic antibodies, and some components of HAART significantly suppress mitochondrial function, the proinflammatory response, and macrophage activation. Theoretically, the combination of these factors could impair treponemal clearance via opsonophagocytosis, Dr. Rekart and his associates said.
In contrast, gonorrhea and chlamydia are caused by pathogens that are not so reliant on opsonophagocytosis to be cleared by the immune system. So, HAART would not lead to similar surges in the rates of gonorrhea and chlamydia infection.
Further studies are needed to corroborate these findings. If they are confirmed, the use of both HAART and PrEP will require changes in patient management to mitigate this increased risk for acquiring syphilis and perhaps other disorders, the researchers noted.
“A retrospective case-control and/or a prospective cohort study comparing the prevalence and epidemiological features of infectious syphilis cases among patients who are HIV-1 positive and treated with HAART, patients who are HIV-1 positive and untreated, and patients who are HIV-1-negative ... would be enlightening,” the investigators added.
Thie study was supported by the National Institute of Allergy and Infectious Diseases. Dr. Rekart and his associates reported having no relevant financial disclosures.
FROM SEXUALLY TRANSMITTED INFECTIONS
Key clinical point: HAART may be contributing to the profound escalation in syphilis infections worldwide, perhaps by impairing immunity to Treponema pallidum.
Major finding: HAART-associated immunologic and behavioral changes can in principle act synergistically to increase syphilis prevalence by amounts comparable with that observed in ongoing outbreaks.
Data source: Mathematical modeling studies of potential HAART-induced changes in immune function and behavior among HIV-positive men who have sex with men.
Disclosures: This study supported by the National Institute of Allergy and Infectious Diseases. Dr. Rekart and his associates reported having no relevant financial disclosures.
Carbapenem-resistant K. pneumoniae occurs in 25% of long-term acute care hospital cultures
Nearly one-quarter of Klebsiella pneumoniae cultures in a network of U.S. long-term acute care hospitals are resistant to carbapenem, according to Jennifer H. Han, MD, and her associates.
From a sample of 3,846 K. pneumoniae cultures taken from 64 long-term acute care hospitals in 16 states, 946, or 24.6%, of the cultures were carbapenem-resistant, and were taken from 821 patients. Just under 54% of CRKP isolates were taken from a respiratory source, with 37% coming from urine and the remaining 9.4% coming from blood. Nearly all CRKP isolates were resistant to fluoroquinolones, and 59.2% were resistant to amikacin.
Of the 16 states where cultures were taken from, California had the highest rate of carbapenem resistance, with 45.5% of K. pneumoniae cultures showing resistance. Other states with high rates of CRKP included South Carolina, Kentucky, and Indiana.
“Given the chronically, critically ill population, with convergence of at-risk patients from multiple facilities, future studies of optimal infection prevention strategies are urgently needed for this setting. In addition, expansion of national surveillance efforts and improved communication between [long-term acute care hospitals] and acute care hospitals will be critical for reducing the continued emergence and dissemination of CRKP across the health care continuum,” Dr. Han and her associates concluded.
Find the full study in Clinical Infectious Diseases (doi: 10.1 LTACHs 093/cid/ciw856)
Nearly one-quarter of Klebsiella pneumoniae cultures in a network of U.S. long-term acute care hospitals are resistant to carbapenem, according to Jennifer H. Han, MD, and her associates.
From a sample of 3,846 K. pneumoniae cultures taken from 64 long-term acute care hospitals in 16 states, 946, or 24.6%, of the cultures were carbapenem-resistant, and were taken from 821 patients. Just under 54% of CRKP isolates were taken from a respiratory source, with 37% coming from urine and the remaining 9.4% coming from blood. Nearly all CRKP isolates were resistant to fluoroquinolones, and 59.2% were resistant to amikacin.
Of the 16 states where cultures were taken from, California had the highest rate of carbapenem resistance, with 45.5% of K. pneumoniae cultures showing resistance. Other states with high rates of CRKP included South Carolina, Kentucky, and Indiana.
“Given the chronically, critically ill population, with convergence of at-risk patients from multiple facilities, future studies of optimal infection prevention strategies are urgently needed for this setting. In addition, expansion of national surveillance efforts and improved communication between [long-term acute care hospitals] and acute care hospitals will be critical for reducing the continued emergence and dissemination of CRKP across the health care continuum,” Dr. Han and her associates concluded.
Find the full study in Clinical Infectious Diseases (doi: 10.1 LTACHs 093/cid/ciw856)
Nearly one-quarter of Klebsiella pneumoniae cultures in a network of U.S. long-term acute care hospitals are resistant to carbapenem, according to Jennifer H. Han, MD, and her associates.
From a sample of 3,846 K. pneumoniae cultures taken from 64 long-term acute care hospitals in 16 states, 946, or 24.6%, of the cultures were carbapenem-resistant, and were taken from 821 patients. Just under 54% of CRKP isolates were taken from a respiratory source, with 37% coming from urine and the remaining 9.4% coming from blood. Nearly all CRKP isolates were resistant to fluoroquinolones, and 59.2% were resistant to amikacin.
Of the 16 states where cultures were taken from, California had the highest rate of carbapenem resistance, with 45.5% of K. pneumoniae cultures showing resistance. Other states with high rates of CRKP included South Carolina, Kentucky, and Indiana.
“Given the chronically, critically ill population, with convergence of at-risk patients from multiple facilities, future studies of optimal infection prevention strategies are urgently needed for this setting. In addition, expansion of national surveillance efforts and improved communication between [long-term acute care hospitals] and acute care hospitals will be critical for reducing the continued emergence and dissemination of CRKP across the health care continuum,” Dr. Han and her associates concluded.
Find the full study in Clinical Infectious Diseases (doi: 10.1 LTACHs 093/cid/ciw856)
FROM CLINICAL INFECTIOUS DISEASES
Asymptomatic carriage of carbapenem-resistant Enterobacteriaceae ‘considerable’
Asymptomatic carriage of carbapenem-resistant Enterobacteriaceae is “considerable,” according to genetic analyses of bacterial isolates obtained from patients at four large U.S. hospitals.
To better understand the “urgent threat” of carbapenem resistance – specifically, to obtain a “snapshot” of how the resistant enterobacteria evolve, diversify, and spread – the researchers performed genetic analyses on 122 carbapenem-resistant and 141 carbapenem-susceptible bacterial isolates from patients hospitalized during a 16-month period at three Boston and one California medical centers. The isolates were obtained from urine (44%), respiratory tract (16%), blood (11%), wound (11%), and other samples, said Gustavo C. Cerqueira, PhD, of the Broad Institute of MIT and Harvard University in Cambridge, Mass., and his associates.
They found 8 species of bacteria that exhibited carbapenem resistance, chiefly Klebsiella pneumoniae. There also was a significant degree of diversity among resistant Enterobacteria. Most importantly, the investigators found evidence of substantial asymptomatic carriage of resistant bacteria and discovered several previously unrecognized mechanisms that produced resistance. Taken together, the findings indicate “continued innovation by these organisms to thwart the action of this important class of antibiotics,” reported Dr. Cerqueira, also affiliated with Massachusetts General Hospital in Boston, and his associates (Proc Nat Acad Sci USA. 2017 Jan 16 [doi:10.1073/pnas.1616248114]).
The study findings underscore the need for “an aggressive approach to surveillance and isolation” to control this continuing threat, they added.
This work was supported by the National Institute of Allergy and Infectious Diseases. Dr. Cerqueira and his associates reported having no relevant financial disclosures.
Asymptomatic carriage of carbapenem-resistant Enterobacteriaceae is “considerable,” according to genetic analyses of bacterial isolates obtained from patients at four large U.S. hospitals.
To better understand the “urgent threat” of carbapenem resistance – specifically, to obtain a “snapshot” of how the resistant enterobacteria evolve, diversify, and spread – the researchers performed genetic analyses on 122 carbapenem-resistant and 141 carbapenem-susceptible bacterial isolates from patients hospitalized during a 16-month period at three Boston and one California medical centers. The isolates were obtained from urine (44%), respiratory tract (16%), blood (11%), wound (11%), and other samples, said Gustavo C. Cerqueira, PhD, of the Broad Institute of MIT and Harvard University in Cambridge, Mass., and his associates.
They found 8 species of bacteria that exhibited carbapenem resistance, chiefly Klebsiella pneumoniae. There also was a significant degree of diversity among resistant Enterobacteria. Most importantly, the investigators found evidence of substantial asymptomatic carriage of resistant bacteria and discovered several previously unrecognized mechanisms that produced resistance. Taken together, the findings indicate “continued innovation by these organisms to thwart the action of this important class of antibiotics,” reported Dr. Cerqueira, also affiliated with Massachusetts General Hospital in Boston, and his associates (Proc Nat Acad Sci USA. 2017 Jan 16 [doi:10.1073/pnas.1616248114]).
The study findings underscore the need for “an aggressive approach to surveillance and isolation” to control this continuing threat, they added.
This work was supported by the National Institute of Allergy and Infectious Diseases. Dr. Cerqueira and his associates reported having no relevant financial disclosures.
Asymptomatic carriage of carbapenem-resistant Enterobacteriaceae is “considerable,” according to genetic analyses of bacterial isolates obtained from patients at four large U.S. hospitals.
To better understand the “urgent threat” of carbapenem resistance – specifically, to obtain a “snapshot” of how the resistant enterobacteria evolve, diversify, and spread – the researchers performed genetic analyses on 122 carbapenem-resistant and 141 carbapenem-susceptible bacterial isolates from patients hospitalized during a 16-month period at three Boston and one California medical centers. The isolates were obtained from urine (44%), respiratory tract (16%), blood (11%), wound (11%), and other samples, said Gustavo C. Cerqueira, PhD, of the Broad Institute of MIT and Harvard University in Cambridge, Mass., and his associates.
They found 8 species of bacteria that exhibited carbapenem resistance, chiefly Klebsiella pneumoniae. There also was a significant degree of diversity among resistant Enterobacteria. Most importantly, the investigators found evidence of substantial asymptomatic carriage of resistant bacteria and discovered several previously unrecognized mechanisms that produced resistance. Taken together, the findings indicate “continued innovation by these organisms to thwart the action of this important class of antibiotics,” reported Dr. Cerqueira, also affiliated with Massachusetts General Hospital in Boston, and his associates (Proc Nat Acad Sci USA. 2017 Jan 16 [doi:10.1073/pnas.1616248114]).
The study findings underscore the need for “an aggressive approach to surveillance and isolation” to control this continuing threat, they added.
This work was supported by the National Institute of Allergy and Infectious Diseases. Dr. Cerqueira and his associates reported having no relevant financial disclosures.
FROM THE PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES
Key clinical point: Asymptomatic carriage of carbapenem-resistant Enterobacteriaceae is “considerable.”
Major finding: Researchers found eight species of bacteria that exhibited carbapenem resistance, a significant degree of diversity among resistant enterobacteria, evidence of substantial asymptomatic carriage of resistant bacteria, and several previously unrecognized mechanisms that produced resistance.
Data source: Genetic analyses of 122 carbapenem-resistant and 141 carbapenem-susceptible bacterial isolates obtained from patients at 4 large U.S. hospitals.
Disclosures: This work was supported by the National Institute of Allergy and Infectious Diseases. Dr. Cerqueira and his associates reported having no relevant financial disclosures.
Older women with remitted depression show attention bias for negative information
Older women with a history of major depressive disorder are more likely to direct their attention to negative images than women without history of MDD, researchers report. The findings follow previous research showing that individuals currently depressed or at-risk show a similar attention bias.
The current study examined 33 postmenopausal women aged 45-75 years with an emotion dot probe (EDP) task combined with fMRI scans, in addition to cognitive and depression history screening and several self-rated measures.
“We examined resting-state functional connectivity before the EDP task to assess differences in intrinsic amygdala functional connections to other brain areas between the groups,” wrote Kimberly Albert, PhD, of Vanderbilt University, Nashville, Tenn., and her coauthors (J Affect Disord. 2017 Mar 1;210:49-52).
The women in the study with a history of MDD showed greater attention facilitation to negative images, greater amygdala activity, and greater amygdala-hippocampal functional connectivity than women without a history of MDD.
“Attention bias for negative information can be seen in individuals with past MDD without inducing a negative mood state. Attention bias for negative information may be an ongoing vulnerability for MDD recurrence independent of mood state,” Dr. Albert and her coauthors wrote.
Older women with a history of major depressive disorder are more likely to direct their attention to negative images than women without history of MDD, researchers report. The findings follow previous research showing that individuals currently depressed or at-risk show a similar attention bias.
The current study examined 33 postmenopausal women aged 45-75 years with an emotion dot probe (EDP) task combined with fMRI scans, in addition to cognitive and depression history screening and several self-rated measures.
“We examined resting-state functional connectivity before the EDP task to assess differences in intrinsic amygdala functional connections to other brain areas between the groups,” wrote Kimberly Albert, PhD, of Vanderbilt University, Nashville, Tenn., and her coauthors (J Affect Disord. 2017 Mar 1;210:49-52).
The women in the study with a history of MDD showed greater attention facilitation to negative images, greater amygdala activity, and greater amygdala-hippocampal functional connectivity than women without a history of MDD.
“Attention bias for negative information can be seen in individuals with past MDD without inducing a negative mood state. Attention bias for negative information may be an ongoing vulnerability for MDD recurrence independent of mood state,” Dr. Albert and her coauthors wrote.
Older women with a history of major depressive disorder are more likely to direct their attention to negative images than women without history of MDD, researchers report. The findings follow previous research showing that individuals currently depressed or at-risk show a similar attention bias.
The current study examined 33 postmenopausal women aged 45-75 years with an emotion dot probe (EDP) task combined with fMRI scans, in addition to cognitive and depression history screening and several self-rated measures.
“We examined resting-state functional connectivity before the EDP task to assess differences in intrinsic amygdala functional connections to other brain areas between the groups,” wrote Kimberly Albert, PhD, of Vanderbilt University, Nashville, Tenn., and her coauthors (J Affect Disord. 2017 Mar 1;210:49-52).
The women in the study with a history of MDD showed greater attention facilitation to negative images, greater amygdala activity, and greater amygdala-hippocampal functional connectivity than women without a history of MDD.
“Attention bias for negative information can be seen in individuals with past MDD without inducing a negative mood state. Attention bias for negative information may be an ongoing vulnerability for MDD recurrence independent of mood state,” Dr. Albert and her coauthors wrote.
FROM THE JOURNAL OF AFFECTIVE DISORDERS
Triclosan sutures halve surgical site infections in children
The use of triclosan-impregnated sutures reduced by half the incidence of surgical site infections in children, a large randomized study has determined.
Overall, the antibiotic-treated sutures cut the number of these infections by 52%, but they were particularly effective in reducing the risk of deep surgical site infections (SSIs), Marjo Renko, MD, wrote (Lancet Infect Dis. 2017;17[1]:50-7).
The study was conducted in clean wounds in healthy children and in a center that already had a very low rate of surgical site infections (just 5%) – showing that improvement is possible even in optimal care settings, wrote Dr. Renko, of the University of Oulu, Finland, and her colleagues.
“This randomized, controlled study shows that even in low-risk settings, where other prophylactic measures are available to use, triclosan-containing sutures effectively prevented the occurrence of SSIs in children,” the team wrote.
The study cohort comprised 1,633 children aged 7-17 who underwent surgery at a single Finnish hospital from 2010-2014. Most were there for planned surgery (87%); the remainder had emergency surgery. The most common surgical site was musculoskeletal (40%), followed by abdominal wall surgery (about 25%), and urogenital surgery (about 13%). The rest were intraabdominal or procedures on the nervous system, chest, and skin or subcutaneous tissue.
The children were randomized to either plain or triclosan-impregnated sutures. The primary outcome was the occurrence of a superficial or deep surgical site infection, based on Centers for Disease Control and Prevention criteria. The procedures were performed by 69 surgeons.
In a modified intent-to-treat analysis, a surgical site infection occurred in 3% of the triclosan-suture group (20 children) and in 5% of the control suture group (42 children). In the control group, these infections were most often of chest incisions (15%), followed by skin incisions (10%) and nervous system, intraabdominal, and musculoskeletal incisions (8% each). In the triclosan group, the most common site of infection was skin (10%), followed by musculoskeletal (4%), nervous system (2%), and urogenital and abdominal wall incisions (1% each).
Compared with control sutures, triclosan sutures reduced the overall risk of a surgical site infection by 52% (relative risk, 0.48; 95% confidence interval, 0.28-0.80). The number needed to treat to avoid one infection was 36.
The sutures were significantly more effective in reducing deep infections than superficial infections. Superficial infections occurred in 2% of the triclosan group (17) and 4% of the control group (28) – a risk reduction of 39% (RR, 0.61; 95% CI, 0.34-1.09) Deep infections occurred in less than 1% of the triclosan group (3) and 2% of the control group (14) – a risk reduction of 79% (RR, 0.21’ CI, 0.07-0.66).
Infections were associated with an increased incidence of wound dehiscence in the control group (6% vs. 4%), the need for additional antimicrobial agents (7% vs. 2%), and wound revisions (2% vs. less than 1%). Children in the control group also had more outpatient visits (8% vs. 4%) and were more often readmitted because of their infection (2% vs. 1%).
The authors noted that triclosan, in the setting of increased household use, “has raised concerns about the toxic effects of the drug on the human body. Observational studies have reported associations between triclosan exposures and altered thyroid hormone levels, body mass index, and waist circumference.”
Two Norwegian studies found that the drug was associated with inhalation allergies and seasonal allergies.
“Because of the agent’s suspected toxicity and to prevent further development of resistant bacteria, use of triclosan should be restricted and reserved only for medical procedures with adequate evidence,” they noted. However, “SSIs cause much morbidity and mortality after surgical procedures, and economic evaluations recommend the use of triclosan-containing material.”
Dr. Renko received grants from the Alma and K.A. Snellman Foundation, the Finnish Medical Foundation, and the Foundation for Pediatric Research.
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The study by Dr. Marjo Renko and her colleagues is impressive in its sheer numbers, if not so much in its findings, Felix J. Hüttner, MD, and Markus K. Diener, MD, wrote in an accompanying editorial (Lancet Infect Dis. 2017;17[1]:3-4).
“We congratulate the authors on successfully doing a pragmatic, large-scale trial in a difficult setting; randomized controlled trials in children are known to pose specific challenges to researchers. However, the monocenter design raises some concerns about the generalizability of the results.”
Single-center trials can overestimate treatment effects, the colleagues noted. Dr. Renko’s conclusions don’t line up with their own metaanalysis of triclosan-containing sutures for abdominal wall closure. In it, three single-center trials found in favor of the triclosan sutures, but two multicenter trials did not.
The variation in infection rates in each type of surgery is a clue to the difficulty of a one-size-fits-all intervention like the treated sutures. “The differences between the intervention group and the control group vary widely by surgery type – for example, 0% versus 15% for thoracic surgery, compared with 1% versus 1% for surgery of the urinary system and genitals. Thus, triclosan-containing sutures might only be beneficial for specific types of operations and in our opinion, it cannot be concluded that triclosan-containing sutures reduce surgical site infections in all of these indications. Future trials should focus at individual types of pediatric surgery to evaluate a potential beneficial effect.”
Dr. Hüttner and Dr. Diener are surgeons at the University of Heidelberg, Germany. Dr. Hüttner had no financial disclosures. Dr. Diener has received grants from Johnson & Johnson Medical Limited.
The study by Dr. Marjo Renko and her colleagues is impressive in its sheer numbers, if not so much in its findings, Felix J. Hüttner, MD, and Markus K. Diener, MD, wrote in an accompanying editorial (Lancet Infect Dis. 2017;17[1]:3-4).
“We congratulate the authors on successfully doing a pragmatic, large-scale trial in a difficult setting; randomized controlled trials in children are known to pose specific challenges to researchers. However, the monocenter design raises some concerns about the generalizability of the results.”
Single-center trials can overestimate treatment effects, the colleagues noted. Dr. Renko’s conclusions don’t line up with their own metaanalysis of triclosan-containing sutures for abdominal wall closure. In it, three single-center trials found in favor of the triclosan sutures, but two multicenter trials did not.
The variation in infection rates in each type of surgery is a clue to the difficulty of a one-size-fits-all intervention like the treated sutures. “The differences between the intervention group and the control group vary widely by surgery type – for example, 0% versus 15% for thoracic surgery, compared with 1% versus 1% for surgery of the urinary system and genitals. Thus, triclosan-containing sutures might only be beneficial for specific types of operations and in our opinion, it cannot be concluded that triclosan-containing sutures reduce surgical site infections in all of these indications. Future trials should focus at individual types of pediatric surgery to evaluate a potential beneficial effect.”
Dr. Hüttner and Dr. Diener are surgeons at the University of Heidelberg, Germany. Dr. Hüttner had no financial disclosures. Dr. Diener has received grants from Johnson & Johnson Medical Limited.
The study by Dr. Marjo Renko and her colleagues is impressive in its sheer numbers, if not so much in its findings, Felix J. Hüttner, MD, and Markus K. Diener, MD, wrote in an accompanying editorial (Lancet Infect Dis. 2017;17[1]:3-4).
“We congratulate the authors on successfully doing a pragmatic, large-scale trial in a difficult setting; randomized controlled trials in children are known to pose specific challenges to researchers. However, the monocenter design raises some concerns about the generalizability of the results.”
Single-center trials can overestimate treatment effects, the colleagues noted. Dr. Renko’s conclusions don’t line up with their own metaanalysis of triclosan-containing sutures for abdominal wall closure. In it, three single-center trials found in favor of the triclosan sutures, but two multicenter trials did not.
The variation in infection rates in each type of surgery is a clue to the difficulty of a one-size-fits-all intervention like the treated sutures. “The differences between the intervention group and the control group vary widely by surgery type – for example, 0% versus 15% for thoracic surgery, compared with 1% versus 1% for surgery of the urinary system and genitals. Thus, triclosan-containing sutures might only be beneficial for specific types of operations and in our opinion, it cannot be concluded that triclosan-containing sutures reduce surgical site infections in all of these indications. Future trials should focus at individual types of pediatric surgery to evaluate a potential beneficial effect.”
Dr. Hüttner and Dr. Diener are surgeons at the University of Heidelberg, Germany. Dr. Hüttner had no financial disclosures. Dr. Diener has received grants from Johnson & Johnson Medical Limited.
The use of triclosan-impregnated sutures reduced by half the incidence of surgical site infections in children, a large randomized study has determined.
Overall, the antibiotic-treated sutures cut the number of these infections by 52%, but they were particularly effective in reducing the risk of deep surgical site infections (SSIs), Marjo Renko, MD, wrote (Lancet Infect Dis. 2017;17[1]:50-7).
The study was conducted in clean wounds in healthy children and in a center that already had a very low rate of surgical site infections (just 5%) – showing that improvement is possible even in optimal care settings, wrote Dr. Renko, of the University of Oulu, Finland, and her colleagues.
“This randomized, controlled study shows that even in low-risk settings, where other prophylactic measures are available to use, triclosan-containing sutures effectively prevented the occurrence of SSIs in children,” the team wrote.
The study cohort comprised 1,633 children aged 7-17 who underwent surgery at a single Finnish hospital from 2010-2014. Most were there for planned surgery (87%); the remainder had emergency surgery. The most common surgical site was musculoskeletal (40%), followed by abdominal wall surgery (about 25%), and urogenital surgery (about 13%). The rest were intraabdominal or procedures on the nervous system, chest, and skin or subcutaneous tissue.
The children were randomized to either plain or triclosan-impregnated sutures. The primary outcome was the occurrence of a superficial or deep surgical site infection, based on Centers for Disease Control and Prevention criteria. The procedures were performed by 69 surgeons.
In a modified intent-to-treat analysis, a surgical site infection occurred in 3% of the triclosan-suture group (20 children) and in 5% of the control suture group (42 children). In the control group, these infections were most often of chest incisions (15%), followed by skin incisions (10%) and nervous system, intraabdominal, and musculoskeletal incisions (8% each). In the triclosan group, the most common site of infection was skin (10%), followed by musculoskeletal (4%), nervous system (2%), and urogenital and abdominal wall incisions (1% each).
Compared with control sutures, triclosan sutures reduced the overall risk of a surgical site infection by 52% (relative risk, 0.48; 95% confidence interval, 0.28-0.80). The number needed to treat to avoid one infection was 36.
The sutures were significantly more effective in reducing deep infections than superficial infections. Superficial infections occurred in 2% of the triclosan group (17) and 4% of the control group (28) – a risk reduction of 39% (RR, 0.61; 95% CI, 0.34-1.09) Deep infections occurred in less than 1% of the triclosan group (3) and 2% of the control group (14) – a risk reduction of 79% (RR, 0.21’ CI, 0.07-0.66).
Infections were associated with an increased incidence of wound dehiscence in the control group (6% vs. 4%), the need for additional antimicrobial agents (7% vs. 2%), and wound revisions (2% vs. less than 1%). Children in the control group also had more outpatient visits (8% vs. 4%) and were more often readmitted because of their infection (2% vs. 1%).
The authors noted that triclosan, in the setting of increased household use, “has raised concerns about the toxic effects of the drug on the human body. Observational studies have reported associations between triclosan exposures and altered thyroid hormone levels, body mass index, and waist circumference.”
Two Norwegian studies found that the drug was associated with inhalation allergies and seasonal allergies.
“Because of the agent’s suspected toxicity and to prevent further development of resistant bacteria, use of triclosan should be restricted and reserved only for medical procedures with adequate evidence,” they noted. However, “SSIs cause much morbidity and mortality after surgical procedures, and economic evaluations recommend the use of triclosan-containing material.”
Dr. Renko received grants from the Alma and K.A. Snellman Foundation, the Finnish Medical Foundation, and the Foundation for Pediatric Research.
[email protected]
On Twitter @Alz_Gal
The use of triclosan-impregnated sutures reduced by half the incidence of surgical site infections in children, a large randomized study has determined.
Overall, the antibiotic-treated sutures cut the number of these infections by 52%, but they were particularly effective in reducing the risk of deep surgical site infections (SSIs), Marjo Renko, MD, wrote (Lancet Infect Dis. 2017;17[1]:50-7).
The study was conducted in clean wounds in healthy children and in a center that already had a very low rate of surgical site infections (just 5%) – showing that improvement is possible even in optimal care settings, wrote Dr. Renko, of the University of Oulu, Finland, and her colleagues.
“This randomized, controlled study shows that even in low-risk settings, where other prophylactic measures are available to use, triclosan-containing sutures effectively prevented the occurrence of SSIs in children,” the team wrote.
The study cohort comprised 1,633 children aged 7-17 who underwent surgery at a single Finnish hospital from 2010-2014. Most were there for planned surgery (87%); the remainder had emergency surgery. The most common surgical site was musculoskeletal (40%), followed by abdominal wall surgery (about 25%), and urogenital surgery (about 13%). The rest were intraabdominal or procedures on the nervous system, chest, and skin or subcutaneous tissue.
The children were randomized to either plain or triclosan-impregnated sutures. The primary outcome was the occurrence of a superficial or deep surgical site infection, based on Centers for Disease Control and Prevention criteria. The procedures were performed by 69 surgeons.
In a modified intent-to-treat analysis, a surgical site infection occurred in 3% of the triclosan-suture group (20 children) and in 5% of the control suture group (42 children). In the control group, these infections were most often of chest incisions (15%), followed by skin incisions (10%) and nervous system, intraabdominal, and musculoskeletal incisions (8% each). In the triclosan group, the most common site of infection was skin (10%), followed by musculoskeletal (4%), nervous system (2%), and urogenital and abdominal wall incisions (1% each).
Compared with control sutures, triclosan sutures reduced the overall risk of a surgical site infection by 52% (relative risk, 0.48; 95% confidence interval, 0.28-0.80). The number needed to treat to avoid one infection was 36.
The sutures were significantly more effective in reducing deep infections than superficial infections. Superficial infections occurred in 2% of the triclosan group (17) and 4% of the control group (28) – a risk reduction of 39% (RR, 0.61; 95% CI, 0.34-1.09) Deep infections occurred in less than 1% of the triclosan group (3) and 2% of the control group (14) – a risk reduction of 79% (RR, 0.21’ CI, 0.07-0.66).
Infections were associated with an increased incidence of wound dehiscence in the control group (6% vs. 4%), the need for additional antimicrobial agents (7% vs. 2%), and wound revisions (2% vs. less than 1%). Children in the control group also had more outpatient visits (8% vs. 4%) and were more often readmitted because of their infection (2% vs. 1%).
The authors noted that triclosan, in the setting of increased household use, “has raised concerns about the toxic effects of the drug on the human body. Observational studies have reported associations between triclosan exposures and altered thyroid hormone levels, body mass index, and waist circumference.”
Two Norwegian studies found that the drug was associated with inhalation allergies and seasonal allergies.
“Because of the agent’s suspected toxicity and to prevent further development of resistant bacteria, use of triclosan should be restricted and reserved only for medical procedures with adequate evidence,” they noted. However, “SSIs cause much morbidity and mortality after surgical procedures, and economic evaluations recommend the use of triclosan-containing material.”
Dr. Renko received grants from the Alma and K.A. Snellman Foundation, the Finnish Medical Foundation, and the Foundation for Pediatric Research.
[email protected]
On Twitter @Alz_Gal
FROM LANCET INFECTIOUS DISEASES
Key clinical point:
Major finding: Overall, the sutures were associated with a 52% decrease in SSIs.
Data source: The study randomized 1,633 children undergoing surgery to the triclosan sutures or to a control suture.
Disclosures: Dr. Renko received grants from the Alma and K.A. Snellman Foundation, the Finnish Medical Foundation, and the Foundation for Pediatric Research.
West Nile virus accounted for 95% of domestic arboviral disease in 2015
West Nile virus was the most common cause of domestically acquired arboviral disease in the United States in 2015, according to a report from the Centers for Disease Control and Prevention.
A total of 2,282 cases of arboviral disease were reported to the CDC in 2015. Of those, 2,175 cases were caused by the West Nile virus. Of the patients with WNV, 1,616 were hospitalized because of the disease, and 146 died. Neuroinvasive WNV, which occurred in 1,455 cases, accounted for 1,382 of 1,616 WNV hospitalizations and 142 of 146 deaths.
Of the 107 non-WNV arbovirus cases reported to the CDC, 55 were La Crosse virus, 23 were St. Louis encephalitis, 11 were Jamestown Canyon virus, 7 were Powassan virus, and 6 were eastern equine encephalitis. In addition to La Crosse and Jamestown Canyon, 4 cases of additional California serogroup viruses were reported, as was 1 case of Cache Valley virus.
“Health care providers should consider arboviral infections in the differential diagnosis of cases of aseptic meningitis and encephalitis, obtain appropriate specimens for laboratory testing, and promptly report cases to public health authorities. Because human vaccines against domestic arboviruses are not available, prevention depends on community and household efforts to reduce vector populations, personal protective measures to decrease exposure to mosquitoes and ticks, and screening of blood donors,” the CDC investigators concluded.
Find the full report in the MMWR (doi: 10.15585/mmwr.mm6602a3).
West Nile virus was the most common cause of domestically acquired arboviral disease in the United States in 2015, according to a report from the Centers for Disease Control and Prevention.
A total of 2,282 cases of arboviral disease were reported to the CDC in 2015. Of those, 2,175 cases were caused by the West Nile virus. Of the patients with WNV, 1,616 were hospitalized because of the disease, and 146 died. Neuroinvasive WNV, which occurred in 1,455 cases, accounted for 1,382 of 1,616 WNV hospitalizations and 142 of 146 deaths.
Of the 107 non-WNV arbovirus cases reported to the CDC, 55 were La Crosse virus, 23 were St. Louis encephalitis, 11 were Jamestown Canyon virus, 7 were Powassan virus, and 6 were eastern equine encephalitis. In addition to La Crosse and Jamestown Canyon, 4 cases of additional California serogroup viruses were reported, as was 1 case of Cache Valley virus.
“Health care providers should consider arboviral infections in the differential diagnosis of cases of aseptic meningitis and encephalitis, obtain appropriate specimens for laboratory testing, and promptly report cases to public health authorities. Because human vaccines against domestic arboviruses are not available, prevention depends on community and household efforts to reduce vector populations, personal protective measures to decrease exposure to mosquitoes and ticks, and screening of blood donors,” the CDC investigators concluded.
Find the full report in the MMWR (doi: 10.15585/mmwr.mm6602a3).
West Nile virus was the most common cause of domestically acquired arboviral disease in the United States in 2015, according to a report from the Centers for Disease Control and Prevention.
A total of 2,282 cases of arboviral disease were reported to the CDC in 2015. Of those, 2,175 cases were caused by the West Nile virus. Of the patients with WNV, 1,616 were hospitalized because of the disease, and 146 died. Neuroinvasive WNV, which occurred in 1,455 cases, accounted for 1,382 of 1,616 WNV hospitalizations and 142 of 146 deaths.
Of the 107 non-WNV arbovirus cases reported to the CDC, 55 were La Crosse virus, 23 were St. Louis encephalitis, 11 were Jamestown Canyon virus, 7 were Powassan virus, and 6 were eastern equine encephalitis. In addition to La Crosse and Jamestown Canyon, 4 cases of additional California serogroup viruses were reported, as was 1 case of Cache Valley virus.
“Health care providers should consider arboviral infections in the differential diagnosis of cases of aseptic meningitis and encephalitis, obtain appropriate specimens for laboratory testing, and promptly report cases to public health authorities. Because human vaccines against domestic arboviruses are not available, prevention depends on community and household efforts to reduce vector populations, personal protective measures to decrease exposure to mosquitoes and ticks, and screening of blood donors,” the CDC investigators concluded.
Find the full report in the MMWR (doi: 10.15585/mmwr.mm6602a3).
FROM MORBIDITY AND MORTALITY REPORT