COVID Spike antibodies in neuromuscular condition: KU experience

Objective: To report on COVID spike antibody levels in patients with various neuromuscular conditions who received vaccination and assess the effect of immunosuppressive therapies on antibody levels. Background: Little is known about the immune response to COVID vaccination in immune suppressed patient. A multiple studies showed variable data regarding the effect of immunosuppression on the immune response to the vaccination. Design/Methods: We performed a retrospective chart review on patients in neuromuscular clinic who had COVID antibody testing. We collected demographic, clinical and treatment information. Descriptive statistics was performed on the data obtained. Results: We identified 82 patients to date. There were 41 male and 41 were female. The mean age of the patients enrolled was 66.27 ±13.66 and the mean duration of antibody acquisition since last date of vaccination was 152.45 days±57.09. High antibody titer>250 was seen in 44 patients (53.56%), low titer was seen in 27 patients (32.92%) and the antibody titer was not detectable in 8 patients (9.75%). 3 patients showed detected unmeasured antibody titer. Of the 44 patients with high antibody titers, 26 patients (59.1%) were on immunosuppressive medications compared to 23 of 27patients (85.19%) with low antibody titer and 7 of 8 patients without detectable antibodies (87.5%). Conclusions: Approximately half of the patients on immunosuppressive drugs did not develop adequate antibodies level against COVID-19 virus. A larger data set will be presented at the meeting as data collection is still ongoing.

SARS CoV-2 variant B.1.617.1 is highly pathogenic in hamsters than B.1 variant (preprint)

Background: The recent emergence of new SARS-CoV-2 lineage B.1.617 in India has been associated with a surge in the number of daily infections. This variant has combination of specific mutations L452R, E484Q and P681R reported to possibly enhance the transmissibility with likelihood of escaping the immunity. We investigated the viral load and pathogenic potential of B.1.617.1 in Syrian golden hamsters. Methods: Two groups of Syrian golden hamsters (9 each) were inoculated intranasally with SARS CoV-2 isolates, B.1 (D614G) and B.1.617.1 respectively. The animals were monitored daily for the clinical signs and body weight. The necropsy of three hamsters each was performed on 3, 5- and 7-days post-infection (DPI). Throat swab (TS), nasal wash (NW) and organ samples (lungs, nasal turbinate, trachea) were collected and screened using SARS-CoV-2 specific Real-time RT-PCR. Results: The hamsters infected with B.1.617.1 demonstrated increased body weight loss compared to B.1 variant. The highest viral load was observed in nasal turbinate and lung specimens of animals infected with B.1.167.1 on 3 DPI. Neutralizing antibody (NAb) and IgG response in hamsters of both the groups were observed from 5 and 7 DPI respectively. However, higher neutralizing antibody titers were observed against B.1.167.1. Gross pathology showed pronounced lung lesions and hemorrhage with B.1.671 compared to B.1. Conclusions: B.1617.1 and B.1 variant varied greatly in their infectiousness, pathogenesis in hamster model. This study demonstrates higher pathogenicity in hamsters evident with reduced body weight, higher viral load in lungs and pronounced lung lesions as compared to B.1 variant.

A rare cause of mononeuropathy multiplex

Objective: Present a case of mononeuropathy multiplex (MNM) due to a rare entity. Case Presentation: Fifty-eight-year-old male presented with a 4-month history of progressive, multifocal sensory disturbances in all extremities and acute onset right foot drop without systemic symptoms. Examination showed multifocal loss of pinprick sensation, distal weakness in the left upper extremity and right ankle dorsiflexion and plantarflexion weakness. Electrodiagnostic testing confirmed an asymmetric sensorimotor axonal polyneuropathy consistent with MNM. Neuroimaging of the brain and lumbar spine were unremarkable. Vasculitic, infectious, nutritional and immunologic laboratory studies were unrevealing to include negative myeloperoxidase (MPO) and serine protease 3 (PR3) antibody testing. Cerebrospinal fluid analysis was unremarkable. A fat pad biopsy was negative. Full body PET scan revealed hypermetabolic lesions in the left upper and lower lobes and a right lower lobe pleural based mass. Tissue biopsies were performed of the lung and right peroneus brevis muscle and sural nerve. Empiric treatment with corticosteroids and mycophenolate mofetil was discontinued within 1 month due to side effects and concerns related to the COVID-19 pandemic. Lung pathology results were ultimately diagnostic of lymphomatoid granulomatosis (LyG) with complementary findings of an inflammatory neuropathy with poorly formed, noncaseating granulomas on the sural nerve biopsy. Fite stain on the sural nerve biopsy was negative for Mycobacterium leprae. Conclusions: LyG is an extremely rare angiodestructive lymphoproliferative disease. In patients with pulmonary lesions and multifocal sensorimotor symptoms, LyG should be suspected as a cause of granulomatous MNM.