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In immunocompromised patients, high mortality and morbidity of invasive mucormycosis (IM) remain significant healthcare issues due in part to confusion of IM with invasive aspergillosis (IA) and failure to initiate appropriate therapy. A validated Mucorales (MUC) PCR detects the causative agents of IM with good sensitivity and specificity, as reported previously (M-227, ICAAC 2013). Published studies have not definitively determined the frequency of patients for whom pulmonary IA is suspected but IM is present. We aimed to (1) estimate the frequency of MUC PCR positivity in bronchoalveolar lavage (BAL) samples submitted for Aspergillus (ASP) PCR panel testing.
Pulmonary nocardiosis is an infection targeting immunocompromised patients characterized by high mortality and requires non-frontline antibiotics for treatment. Nocardiosis is currently confirmed or excluded by BAL fluid culture followed by further phenotypic identification steps. A culture-independent method with more timely results would accelerate the administration of appropriate treatment. A rapid Nocardia (NOC) PCR assay for BAL has neither been previously validated nor offered for clinical testing to our knowledge.
Antiviral resistance to human cytomegalovirus (CMV) is a growing concern for immunocompromised patients on prolonged antiviral regimens, and CMV remains the most clinically significant infection following allogeneic hematopoietic-cell transplantation. Letermovir targets subunit 2 of the viral terminase complex (UL56) and is approved for CMV prophylaxis in adult stem cell transplant recipients. Resistance to letermovir is conferred by point mutations in the UL56 gene, and with the potential clinical need for antiviral resistance testing, we have developed a UL56 sequencing assay covering 23 identified resistance mutations. Here we summarize the performance characteristics of the UL56 antiviral resistance assay.
CMV T Cell Immunity
Cytomegalovirus (CMV) infection is a common opportunistic infection associated with significant morbidity, mortality, and risk of allograft loss. Early detection of viremia and initiation of treatment prior to disease progression is paramount. Alternatively, in the absence of treatment, many patients also control CMV infection, including low-level viremia, without progressing to disease. Thus, many treatment decisions (e.g. viremia thresholds to initiate treatment) are not currently well-defined. Given the excessive toxicities and costs of antiviral therapy, there is growing interest in assays that measure CMV-specific T-cell immunity (TCI), which may predict protection against infection. The Viracor ® CMV T-cell Immunity Panel (CMV-TCIP) uses flow cytometry and intracellular cytokine staining (ICS) to measure % of CMV-specific CD4+ and CD8+ T-cells. Other currently available TCI commercial assays measure only aggregate (CD4+ and CD8+) or CD8+ immune responses only.
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Utility of Serum Beta-D Glucan Assay for Diagnosis of Invasive Fungal Infections in Solid Organ Transplant Recipients Beta-D glucan (BDG) assay is a noninvasive test for presumptive diagnosis of invasive fungal infections (IFI). The utility of BDG assay and cut off values for positive, intermediate or negative test has been primarily studied in patients with hematological malignancies. However, the role of BDG in solid organ transplant (SOT) recipients is not well described. The aim of this study is to evaluate the utility of serum BDG assay for IFI diagnosis in SOT recipients.
Isavuconazole is a broad-spectrum antifungal available in both intravenous (IV) and oral capsule formulations for the treatment of invasive aspergillosis and mucormycosis. Oral administration can be challenging as FDA prescribing information states capsules should not be chewed, crushed, dissolved, or opened. We describe the first two cases, to our knowledge, of patients who received isavuconazonium capsules sprinkled via NGT with concomitant therapeutic drug monitoring (TDM).
Higher peak adenovirus (ADV) viral loads (VL) have correlated with higher mortality in allogeneic hematopoietic cell transplant (HCT) recipients. ADV viral dynamics may inform trial design of new treatment strategies. We examined the relationship between cumulative viral burden expressed as average area under the curve (AAUC) and mortality.
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Read how Viracor is taking CMV clinical diagnostic testing to the next level:
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