SARS-CoV-2 mutation results in resistance to remdesivir in 2 sufferers
A report printed yesterday in Medical Infectious Illnesses describes a brand new SARS-CoV-2 mutation that confers resistance to the COVID-19 antiviral drug remdesivir in two persistently contaminated kidney transplant recipients handled with immunosuppressive medication.
NYU researchers recognized the V792I RNA-dependent 25 RNA polymerase mutation within the transplant sufferers, who have been hospitalized and skilled life-threatening COVID-19 issues from reinfection after receiving remdesivir.
“Ineffective immune clearance contributes to persistent viral replication in immunocompromised hosts and elevated alternatives for mutation,” the researchers wrote. “The failure to appropriately determine, deal with, and management the unfold of mutated SARS-CoV-2 isolates may have far-reaching penalties.”
One affected person was in his or her 60s and had obtained two doses of the Pfizer/BioNTech COVID-19 vaccine earlier than being contaminated with the Omicron subvariant BA.1.1 6 months after transplant and receiving a 5-day course of remdesivir. Twenty-four days later, the affected person was readmitted to the hospital and given remdesivir. After 3.5 months, the affected person was reinfected however had gentle signs, so no remedy was given.
The opposite affected person was in his or her 50s and had obtained two doses of the Moderna COVID-19 vaccine earlier than changing into contaminated 14 months after transplant. The affected person improved after receiving a 3-day course of remdesivir however was readmitted 18 days later due to worsening signs. After receiving a 5-day course of remdesivir, the affected person improved.
Remdesivir is assumed to work by disrupting SARS-CoV-2’s capability to copy. The authors famous that the drug is essential for treating COVID-19 in transplant recipients as a result of Paxlovid, one other antiviral, can intrude with immunosuppressant medication used to stop organ rejection in these high-risk sufferers.
“Our outcomes spotlight the significance of constant to watch how the coronavirus modifications over time and preserving looking out for genetic mutations that permit the virus to beat the medical neighborhood’s efforts to thwart it,” senior writer Adriana Heguy, PhD, stated in an NYU information launch. “Sooner or later, physicians may also display screen for such mutations earlier than making remedy selections for his or her most susceptible sufferers.”
Sep 26 Clin Infect Dis study
Sep 26 NYU news release
Trial: Fecal microbiota transplantation superior to antibiotics for C difficile
A randomized scientific trial performed in Denmark discovered that, in sufferers with a primary or second Clostridioides difficile an infection, fecal microbiota transplantation (FMT) was superior to standard-of-care antibiotic remedy in reaching sustained decision of signs, researchers reported final week in The Lancet Gastroenterology & Hepatology.
Performed at a college hospital in Aarhus, Denmark, the double-blind, placebo-controlled trial enrolled grownup sufferers with a primary or second C difficile an infection and randomly assigned them to obtain both FMT or placebo after receiving 10 days of vancomycin, the usual antibiotic remedy. Remedies have been administered on day 1 and between days 3 and seven, and sufferers have been adopted for 8 weeks or till recurrence. The first end result was decision of C difficile–related diarrhea (CDAD) after 8 weeks.
A complete of 42 sufferers have been assigned to FMT (21) or placebo (21) from Jun 21, 2021, to Apr 1, 2022. Interim evaluation on Apr 7 confirmed that 19 of 21 sufferers within the FMT group had decision of CDAD at 8 weeks, in contrast with 7 of 21 within the placebo group, for an absolute threat discount of 57%. Due to the considerably decrease decision charge within the placebo group, the trial was stopped for moral causes.
“In uncommon instances, it will probably occur that you just uncover that the remedy you might be investigating is so efficient that it’s ethically indefensible to proceed,” first writer Simon Mark Dahl Baunwall, MD, stated in a press launch from Aarhus College. “Our examine is one instance, in that the brand new FMT remedy is so a lot better than the usual remedy with antibiotics that it might be unethical to proceed, as a result of the sufferers within the management group would threat not receiving the FMT remedy.”
Total, 204 antagonistic occasions have been reported, with a number of reported in 20 of 21 sufferers within the FMT group and all 21 within the placebo group. The most typical antagonistic occasions have been diarrhea and belly ache.
Sep 21 Lancet Gastroenterol Hepatol abstract
Sep 26 Aarhus College press release
DRC declares finish of its fifteenth Ebola outbreak after single case
The Democratic Republic of the Congo (DRC) at this time declared that its newest Ebola flare-up is over, with the outbreak whole remaining at one case, which entails a lady whose sickness was genetically linked to a big outbreak in and round North Kivu province from 2018 by means of 2020.
The 46-year-old girl died in the course of August at a hospital in Beni. She was initially handled for different circumstances, however later confirmed signs in line with Ebola.
In a press release, the World Well being Group (WHO) stated the DRC’s enhancements in Ebola readiness and response have paid off. Well being officers launched an Ebola vaccine marketing campaign just a few days after the outbreak was declared, and greater than 500 individuals have been vaccinated, together with healthcare staff. Practically the entire 182 recognized contacts have been monitored for 21 days.
This was the DRC’s fifteenth Ebola outbreak. It has had a number of small resurgences that have been linked to persistent virus in survivors. Earlier this 12 months, nonetheless, the nation skilled an outbreak in Equateur province that was linked to a brand new leap from an animal supply.
Right this moment’s announcement that the most recent outbreak has ended comes as well being officers collect for a gathering in Kinshasa to look at Ebola relapses and methods to assist Ebola survivors. The virus is understood to persist in immune-protected areas of the physique.
Additionally, the tip of the outbreak comes as well being responders in Uganda battle an Ebola outbreak involving a special pressure—Sudan—centered in communities close to a busy highway that results in the DRC, an space close to the North Kivu outbreak space. Thus far, 36 sicknesses and 23 deaths have been reported in Uganda’s outbreak.
Uganda’s Well being Minister Jane Ruth Aceng Ocero, MBChB, MPH, stated at this time on Twitter than up to now there are not any confirmed instances in Kampala, the nation’s capital that’s dwelling to 1.5 million individuals. All samples from sick individuals in Kampala have been destructive. She added that officers are awaiting take a look at outcomes on a pattern from an individual from Kasangati, which is simply north of town.
Sep 27 WHO statement on end of outbreak
Sep 27 WHO statement on Ebola meeting
Sep 27 Aceng Ocero tweet
Aug 22 CIDRAP Information story