Detection of SARS-CoV-2 antibodies among the pre-vaccine population in Bali

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the cause of coronavirus disease 2019 (COVID-19), has affected millions of people globally. It is a very contagious disease with various clinical manifestations. However, even in asymptomatic patients, it is believed that this virus exposure induces cryptic antibodies as in symptomatic patients. This current study aims to assess the prevalence of SARS-CoV-2 seropositivity by detecting the antibodies specific to the receptor-binding domain (SRBD) of SARS-CoV-2 in the pre-vaccine population in Bali. We assessed specific antibody titers against trimeric spike glycoprotein (S) of SARS-CoV-2 using Roche Elecsys Anti-SARS-CoV-2 S immunoassay in the serum of 510 pre-vaccine subjects without a previous documented history of SARS-CoV-2 infection. The average age was 35.53 years with 56.7% of the subjects being male. Among 510 subjects, 190 (37.3%) subjects were detected to have SARS-CoV-2 SRBD antibody or be seropositive. The range of the antibody titer was zero to 250 U/mL with the average being 44.3 U/mL. The number of subjects who had anti-SARS-Cov-2 SRBD titer above 132 U/mL was 76 (14.9%);it was the minimal antibody titer needed to donate plasma for plasma convalescent therapy. This study revealed a pre-vaccination population, without a history of COVID-19 infection, with seropositivity to SARS-CoV-2, which indicates the underdiagnosis of COVID-19, especially in asymptomatic individuals.

The Role of Active Immunity and its Types

When a pathogen activates B cells and T cells, memory B cells and memory T cells form, and the major immune response happens as a result. These memory cells "remember" every unique pathogen an animal encounters over the course of its lifetime and can develop a potent secondary response if the pathogen is discovered again. Due to the immune system's proactive self-preparation, this sort of immunity is both active and adaptable. The innate immune system and both the cell-mediated and humoral components of immunity are frequently involved in active immunity. Here, Maiorino discusses the naturally and artificially acquired active immunity.

A case of COVID-19 with pernio-like skin lesions and increased red blood cell distribution width

Heparin resistance has been observed in patients with active severe COVID-19 infection. The red blood cell distribution (RDW), a component of the complete blood count that reflects cellular volume variation, has been shown to be associated with elevated risk for morbidity and mortality in a wide range of diseases. Cutaneous manifestations, RDW, and levels of LD and D-dimer might be useful biomarkers in triage of patients with COVID-19.

COVID-19: Comparison of Vaccination Coverage between Oral Health Care Practitioners and Other Health Care Personnel in Yaounde

Introduction: COVID-19 is a global pandemic for which vaccination coverage is still low in our environment. Health care workers and particularly those in the oral sphere are at high risk of contracting it. General objective: To evaluate the COVID-19 vaccination coverage among oral health care workers in comparison with other health care workers in Yaounde. Materials and methods: We conducted a cross-sectional study on 360 individuals in three hospitals in Yaounde, from February to April 2022, i.e., 3 months. All health personnel who gave their free consent consecutively were included. Statistical analysis was performed using SPSS 26.0 software with a statistical significance level of p<0.05. Results: The coverage rate of the COVID-19 vaccine was 34.2%. The rates of vaccination against COVID-19 were 43.3% and 32.2% in oral sphere practitioners and others respectively (p=0.135). There was no statistically significant difference in the distribution of vaccine received, adverse events and post-vaccination infection rate against SARS-CoV-2 between our two groups (p≥0.05). Conclusion: A similar distribution was found between oral health professionals and other health personnel in terms of vaccination rate, type of vaccine received, and post-vaccination adverse events against SARS-CoV-2. Education seems to be a priority action to target the most at-risk populations.

Place of the Rapid Diagnostic Test in the COVID-19 Management Strategy in Tunisia

Background: The objective of this study was to study the benefit of the rapid antigenic detection of SARS-CoV-2 and to demonstrate the contribution of this technique compared to real-time RT-PCR. Methods: The SARS-CoV-2 nucleocapsid N antigen rapid diagnostic test (Standard Covid-19 Ag Test, SD Biosensor) was performed on 49 patients. Real-time RT-PCR testing was performed only in 12 patients. Results: Nasopharyngeal swabs were taken from subjects whose mean age was 35 years (range 23-68 years) and who presented one of the following symptoms: dry cough (30.61%), chest tightness (28 %), fever (28%), headache (24.48%), asthenia (22.44%) and diarrhea in only 14.28%. The time between the onset of symptoms and the completion of the test ranged from 0 to 2 days. Of all rapid tests performed, 35 (71.42%) were negative and 14 (28.57%) were positive. Of the samples tested, 44 came from different IMKO departments. RT-PCR was performed in 8 patients whose rapid tests were negative and gave a positive result in 2 cases. Conclusion: The detection of SARS-CoV-2 should be evaluated and compared to the standard RT-PCR technique, which often offers significantly better sensitivity. It is necessary to carry out large studies to better understand the issue of potential SARS-CoV-2 recurrence in COVID-19 patients.

Akutes Auftreten einer eosinophilen Dermatitis nach COVID-19 Impfung mit BNT162b2 (Comirnaty)

Derzeit hat die Frage nach möglichen Nebenwirkungen der COVID-19 Immunisierung einen hohen Stellenwert, insbesondere auch, weil Auffrischimpfungen diskutiert werden und dadurch das Auftreten von Nebenwirkungen wahrscheinlicher wird. Um letztere besser zu verstehen, ist das Zusammentragen der aufgetretenen Nebenwirkungen unabdingbar. Daher berichten wir über einen neuen Fall aus unserer dermatologischen Hochschulambulanz der Medizinischen Hochschule Hannover, der einen möglichen Zusammenhang zwischen aktiver Immunisierung zur Prävention einer COVID-19-Erkrankung durch SARS-CoV-2 und der Rolle eosinophiler Granulozyten beleuchtet.

Erythema annulare centrifugum in the setting of COVID-19 infection: A case report and literature review

The lesional skin pathology showing dense lymphocytic infiltration with scant eosinophils (C, ×20, H & E;D, ×200, H&E) Most cases with EAC are clinically idiopathic, although the current concept regarding the disease pathogenesis suggests a delayed-type hypersensitivity to various antigens, including viral, bacterial, or fungal infections, drugs, foods, malignancy or other systemic diseases. 6 This is supported by evidence that the skin manifestation of EAC is alleviated by treatment of the underlying disease. EAC associated with viral infection has been reported to be triggered by various viruses, such as EB virus, poxvirus, HIV, varicella-zoster virus, and influenza virus, and is mostly transient like our case or displays a fluctuating skin lesion in parallel with the viral disease activity. To our knowledge, there have been only four case reports, including ours, for EAC encountered in association with COVID-19 infection;one of whom resolved with oral doxycycline, 7 and three others improved with topical steroids and/or antihistamine. 8,9 Except one child case, 8 their skin lesions appeared about 1 week after the onset of COVID-19 infection and disappeared within 1 month, suggesting the consequence of viral infection itself and/or preceded antiviral therapy.

Anti-COVID-19 Vaccination: Perception and Attitudes among Oral Health Practitioners and Other Health Personnel in Yaoundé

Introduction: Vaccination against COVID-19 promoted among high-risk populations such as an oral health care worker is one of the most rapidly and massively deployed interventions in history. Objective: The overall objective of our study was to assess the perception and attitudes regarding COVID-19 vaccination among oral health care workers in comparison to other health care workers in Yaoundé. Materials and methods: A cross-sectional study was conducted from February to April 2022 (3 months) on 360 health personnel in three hospitals in Yaoundé. All health personnel who gave informed consent were included in the study. Statistical analysis was performed using SPSS 26.0 software with a significance level of p<0.05. Results: In more than half of the cases, doubt about the efficacy of the COVID-19 vaccines was found without any difference between the oral practitioners (53.3%) and the others (58.7%) (p=0.476). Fear of harm was mainly found among oral practitioners (75.0% vs 46.4%;p=0.006). There was no statistically significant difference in terms of vaccination coverage and motivations for vaccination between our two socio-professional groups (p ≥0.05). Conclusion: the fear of the harmfulness of the COVID-19 vaccine was preponderant among healthcare personnel working in the oral sphere. De-structuring the representation of this vaccine among this population could improve the response to this disease.

Japan MG registry: Chronological surveys over 10years

The primary purpose of the Japanese myasthenia gravis registry (JAMG‐R) has been to research and promote high‐quality medical care for MG patients in Japan. We reviewed the findings of surveys performed by JAMG‐R over an ~10‐y period. The first goal for favorable quality of life (QOL) is a status of minimal manifestations (MM) or better with an oral prednisolone (PSL) dose of 5 mg/d or less (MM‐5 mg). Early and aggressive use of nonoral fast‐acting treatment together with low‐dose oral PSL (the "EFT strategy”) is recommended to reduce disease severity with minimal oral steroid use so that the MM‐5 mg target can be met as soon as possible. We conducted the fourth largest multicenter survey ever in 2021, obtaining detailed clinical information from 1710 consecutive MG patients all over Japan, and compared the 2021 surveys with those from 2012 and 2015. The frequency of patients treated with EFT strategies showed a gradual increase, reaching 39% of the total MG patients in the 2021 survey. The current and maximum dose of PSL and the number of days at high‐dose (>20 mg/d) PSL showed decreases. Survey results indicate that as EFT strategies have spread, the percentage of patients on MM‐5 mg has increased. We again confirmed that MM‐5 mg was associated with favorable QOL in the 2021 survey. Recent data regarding COVID‐19 suggests that it did not seriously impact the MG population in Japan;unfortunately, refractory MG, observed in 21% of patients, is still an unresolved problem.

Practice Notes from the AAAI

99441 – [Telephone evaluation and management service by a physician or other qualified healthcare professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment;Five-10 minutes of medical discussion.] Cellular Partners of Mast Cells and Basophils in Homeostasis and Allergic Disease You can find a full list of 2020 Virtual Annual Meeting sessions, including pricing for special sessions, by visiting the AAAAI Continuing Education Center at education.aaaai.org.Earn CME Credit with Select AAAAI Podcast Episodes The AAAAI is excited to offer free CME credit for members who listen to select episodes of our podcast, Conversations from the World of Allergy. Episodes offering CME credit will be identified with a CME icon and CME language in the podcast description.Lay Organizations The AAAAI places a high value on its relationships with patient advocacy organizations in support of our mutual concern for the needs of people with allergy, asthma and immunologic disease and their families. Allergy & Asthma Network allergyasthmanetwork.org American Partnership for Eosinophilic Disorders (APFED) apfed.org Asthma & Allergy Foundation of America (AAFA) aafa.org Alaska Chapter: aafaalaska.com California Chapter: aafa-ca.com Greater Kansas City Chapter: aafakc.org Maryland/Washington DC Chapter: aafa-md.org Michigan Chapter: aafamich.org New England Chapter: asthmaandallergies.org Texas Chapter: aafatexas.org St. Louis Chapter: aafastl.org Campaign Urging Research for Eosinophilic Disease (CURED) curedfoundation.org Food Allergy and Anaphylaxis Connection Team (FAACT) foodallergyawareness.org Food Allergy Research & Education (FARE) foodallergy.org Immune Deficiency Foundation (IDF) primaryimmune.org International FPIES Association fpies.org The Mastocytosis Society (TMS) tmsforacure.org US Hereditary Angioedema Association (HAEA) haea.org You Can Now Use Our Internet Point-of-Care Activity to Earn MOC The COVID-19 pandemic has altered the way we see patients and conduct research.

Adult-onset Still's disease following mRNA-1273 Moderna COVID-19 vaccination: A case report

Laboratory tests revealed slight elevations in C-reactive protein level (1.60 mg/dL;normal, ≤0.30 mg/dL), erythrocyte sedimentation rate (22 mm/h;normal, ≤11 mg/dL), and serum ferritin (1083 ng/mL;normal, ≤114 ng/mL) with a normal white blood cell count. Serological examinations for autoimmune diseases (e.g., antinuclear antibody, rheumatoid factor, anticyclic citrullinated peptide-antibody, anti-double-stranded DNA-antibody, anti-Smith antibody, anti-aminoacyl tRNA synthetase-antibody, anti-Mi-2-antibody, anti-transcriptional intermediary factor 1-γ-antibody, and anti-melanoma differentiation-associated gene 5-antibody) and infections (e.g., human immunodeficiency virus, hepatitis B virus, hepatitis C virus, parvovirus B19, syphilis, and Streptococcus) were negative. The etiology of AOSD is unclear;however, pathogen-associated- (PAMPs) or damage-associated molecular patterns may activate the immune system in genetically predisposed patients, 5 leading to interleukin (IL)-1β and IL-18 overproduction, known as a cytokine storm. 5 The SARS-CoV-2 spike proteins, envelope proteins, and viral RNA are potent PAMPs, whereas the nucleocapsid proteins can block IL-1β release. 1 The mRNA COVID-19 vaccines encode spike proteins but not nucleocapsid proteins, and thus may disturb the host immune system.

Neutrophilic dermatosis with necrobiotic changes as an unusual manifestation after the first shot of a COVID-19 mRNA vaccine together with a high fever and liver injury

Coronavirus disease 19 (COVID-19) mRNA vaccines sometimes cause various skin rashes. We report an unusual case of erythema nodosum-like nodules with vesicular and pustular papules, which arose after the first shot of a COVID-19 mRNA vaccine. A skin biopsy showed marked neutrophilic infiltration with necrobiotic changes throughout the dermis and subcutis. Immunohistochemically, CD8+ cells were much more common than CD4+ cells in the dense neutrophilic infiltrates. Many CD68+ macrophages were present around the CD8+ cells. No cases of neutrophilic dermatosis with necrobiotic changes have been reported. Thus, our findings should be added to the cutaneous adverse effects of the vaccines.

Persistent varicella zoster virus infection following mRNA COVID-19 vaccination was associated with the presence of encoded spike protein in the lesion

BackgroundSince the campaign of vaccination against COVID-19 was started, a wide variety of cutaneous adverse effects after vaccination has been documented worldwide. Varicella zoster virus (VZV) reactivation was reportedly the most frequent cutaneous reaction in men after administration of mRNA COVID-19 vaccines, especially BNT162b2.AimsA patient, who had persistent skin lesions after BNT162b2 vaccination for such a long duration over 3 months, was investigated for VZV virus and any involvement of vaccine-derived spike protein.Materials & MethodsImmunohistochemistry for detection of VZV virus and the spike protein encoded by mRNA COVID-19 vaccine. PCR analysis for VZV virus.ResultsThe diagnosis of VZV infection was made for these lesions using PCR analyses and immunohistochemistry. Strikingly, the vaccine-encoded spike protein of the COVID-19 virus was expressed in the vesicular keratinocytes and endothelial cells in the dermis.DiscussionmRNA COVID-19 vaccination might induce persistent VZV reactivation through perturbing the immune system, although it remained elusive whether the expressed spike protein played a pathogenic role.ConclusionWe presented a case of persistent VZV infection following mRNA COVID-19 vaccination and the presence of spike protein in the affected skin. Further vigilance of the vaccine side effect and investigation for the role of SP is warranted.

Potential role of AIM2 inflammasome in SARS‐CoV‐2 infection

SARS‐CoV‐2 is the causative agent of coronavirus disease 2019 (COVID‐19). The disease presents different degrees of severity related to the antiviral response of the host. According to clinical manifestations, patients could show mild, moderate and severe COVID‐19. Regarding immunological aspects, an increased interferon (IFN) response in COVID‐19 patients with mild and moderate symptoms were observed;however, in severe COVID‐19, IFN response is decreased. Patients with severe COVID‐19 display a hyperinflammatory disorder that leads to acute respiratory distress syndrome. Interestingly, the expression and activation of AIM2, a receptor induced by IFN, play an important role in the onset of antiviral response. In this review, we discuss the possible role of AIM2 during SARS‐CoV‐2 infection. We summarize the studies reporting the expression and activity of proteins involved upstream and downstream of AIM2‐inflammasome activation, such as IFN, ASC, Caspase‐1, IL‐1β, IL‐18, free‐dsDNA, IFI16, as well as SARS‐CoV‐2 viral load, cell death in groups of COVID‐19 patients with different clinical outcomes to infer the possible contribution of AIM2 in antiviral response of SARS‐CoV‐2 infection.

The quantity of unheated milk tolerated as a predictor of tolerance to baked milk

Background: Tolerance of baked milk indicates a good prognosis in IgE-mediated cow's milk allergy. Objective: The present study aims to investigate the predictors of baked milk tolerance, particularly the amount of milk tolerated in the first oral food challenge (OFC) test, in children with IgE-mediated cow's milk allergy. Methods: The study included 35 cases who were diagnosed with IgE-mediated cow's milk allergy upon open OFC testing in the Pediatric Allergy Clinic. Four weeks after the diagnosis, skin prick test (SPT) and OFC were performed with baked milk. Cases who did and did not develop reactions during OFC with baked milk were compared regarding clinical and laboratory parameters. Results: Twelve cases (33.3%) did not develop a reaction during OFC with baked milk. Those who had low levels of casein sIgE, ß-lactoglobulin sIgE, and a-lactoalbumin sIgE;small SPT wheal diameter for baked milk and a-lactoalbumin;and a large amount of unheated milk tolerated in the first OFC were found to be tolerant to baked milk (p < 0.05). For predicting baked milk tolerance, a cut-off level of the amount of unheated milk tolerated in OFC was calculated as 620 mg [with the area under the curve (AUC) 0.88 (95% confidence interval 0.77-0.99) in ROC curve analysis]. Conclusion: If a child with cow's milk allergy is able to tolerate more than 620 mg of milk protein during challenge with unheated milk, this may show that this child will tolerate baked milk, meaning that the child will be able to tolerate cow's milk in the future.

Urtikaria nach SARS-CoV-2-Impfung

Hintergrund: Infektionen sind die häufigsten nachgewiesenen Auslöser von akuter Urtikaria. Impfungen können Infektionen imitieren und ebenfalls Urtikaria auslösen. Methodik: In dieser Arbeit werden beispielhaft vier Patienten mit Urtikaria nach SARS-CoV-2-Impfung beschrieben und das Auftreten dieser Nebenwirkung mit Erkenntnissen aus der Literatur diskutiert. Ergebnisse: Nach SARS-CoV-2-Impfung kann sowohl eine akute (Fall 1) als auch chronische spontane Urtikaria (CSU) erstmalig auftreten (Fall 2), aber es kann sich auch eine gut eingestellte CSU verschlechtern (Fall 3) oder eine vorbekannte CSU wieder auftreten (Fall 4). Der zugrundeliegende Pathomechanismus ist noch nicht vollständig verstanden, jedoch erscheint eine Aktivierung des Immunsystems durch die Impfung, ähnlich wie bei einer infektgetriggerten Urtikaria, plausibel. Die Folgeimpfung wird auch bei einer positiven Anamnese hinsichtlich einer Urtikaria nach SARS-CoV-2-Impfung in der Vorgeschichte empfohlen und oftmals gut toleriert, dafür sollte eine prophylaktische Gabe von Antihistaminika erwogen werden. Eine Allergie auf einen Impfstoffbestandteil wie Polyethylenglykol (PEG), welche bis zu einer Anaphylaxie führen kann, ist vergleichsweise selten. Bei Urtikaria nach SARS-CoV-2-Impfung erlaubt eine genaue Anamnese die Risikoabschätzung und stellt die Indikation für weitere allergologische Diagnostik. Schlussfolgerung: Urtikaria ist eine relativ häufige kutane Nebenwirkung der SARS-CoV-2-Impfung bei vorbestehender Prädisposition und kann unterschiedliche Verläufe zeigen. Sie stellt keine Kontraindikation für weitere Impfungen dar. Die Notwendigkeit weiterer Allergiediagnostik besteht in der Mehrzahl der Fälle nicht.