Comparison of Humoral Response in Kidney Transplant Recipients and Donors and Healthy Volunteers Following Second Dose of SARS-CoV-2 mRNA Vaccine.

PURPOSE: To investigate the kinetics and durability of anti-spike glycoprotein (S) immunoglobulin G (IgG) after the second dose of mRNA-based SARS-CoV-2 vaccine in kidney transplant recipients (recipients) compared with those in kidney donors (donors) and healthy volunteers (HVs) and identify factors negatively associated with SARS-CoV-2 vaccine effectiveness in recipients. METHODS: We enrolled 378 recipients with no history of COVID-19 and no anti-S-IgG before the first vaccine and who received a second mRNA-based vaccine dose. Antibodies were detected using an immunoassay more than 4 weeks after the second vaccine dose. Anti-S-IgG <0.8, ≥0.8 to 15, and ≥15 U/mL were considered negative, weak positive, and strongly positive, respectively, whereas anti-nucleocapsid protein IgG was negative. Anti-S-IgG titer was determined in 990 HVs and 102 donors. RESULTS: Anti-S-IgG titers were 154, 2475, and 1181 U/mL in the recipient, HV, and donor groups, respectively, with values significantly lower in recipients. The anti-S-IgG-positivity rate of recipients gradually increased following the second vaccination, suggesting that recipients had a delayed response compared with the HV and donor groups, who had a 100% positivity rate at an earlier time point. Anti-S-IgG titers decreased in donors and HVs, whereas they remained stable in recipients, although at a significantly lower level. Independent negative factors associated with anti-S-IgG titers in recipients were age >60 years and lymphocytopenia (odds ratio: 2.35 and 2.44, respectively). CONCLUSIONS: Kidney transplant recipients demonstrate delayed and attenuated responses, with lower SARS-CoV-2 antibody titers after the second dose of the mRNA-based COVID-19 vaccine.

Long Term Follow-Up of Prototheca keratitis: A Case Report.

BACKGROUND: Prototheca spp. are rare human pathogens, and only three cases of Prototheca keratitis have been reported. They were treated with anti-fungal drugs and surgical excision. Two of the three cases were successful, and the case of an immunocompromised patient was not successful. Thus, the best treatment of Prototheca keratitis is still undetermined, and further investigations are needed. The purpose of this report is to present our findings in a case of Prototheca keratitis that was successfully treated with topical medications without surgical excision. METHODS: This study was performed in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Hidaka Medical Center, Toyooka Hospital. A written informed consent was obtained from the patient before beginning the medical treatments. CASE REPORT: A 75-year-old man with a history of stage 4 prostate carcinoma and bilateral limbal stem cell deficiency had undergone keratoepithelioplasty on his left eye for the deficiency. Postoperatively, a greyish-white epithelial opacity was noted on the central cornea of his left eye, and he had been treated with topical fluorometholone and oral dexamethasone together with a therapeutic contact lens. Corneal smears and contact lens swabs were positive for Prototheca spp. He required a continuous treatment with amphotericin B (AMPH-B) ointment, topical fluconazole (FLCZ), and voriconazole (VRCZ). This treatment protocol was effective, but recurrences developed when his general condition worsened. CONCLUSION: Our findings indicate that Prototheca keratitis can be successfully treated but not cured with topical AMPH-B, FLCZ, and VRCZ without surgical treatment. However, recurrences can develop when the general condition of the patient worsens. Thus, continuous monitoring and treatment are necessary in cases of Prototheca keratitis.

An Autopsy Case of Rupture of Infectious Thoracic Aortitis Induced by Methicillin-Resistant Staphylococcus Aureus.

BACKGROUND Infectious aortitis has a poor prognosis and high mortality rate if untreated. Here, we report a case of rupture of infectious aortitis induced by methicillin-resistant staphylococcus aureus (MRSA). CASE REPORT An 83-year-old female patient was hospitalized due to continuous fever and diarrhea, which was diagnosed as colitis. The colitis was determined to have been induced by small vessel vasculitis upon histological examination. Fasting and central venous hyperalimentation using a peripherally inserted central catheter (PICC) were carried out for rest of the intestine. Swelling and pus were observed at the insertion site of the PICC. Since methicillin resistant staphylococcus aureus (MRSA) was detected in the culture of the pus and the blood, the patient was treated with vancomycin. After confirming that the blood culture became negative, prednisolone (PDL) was started as therapy for the colitis. Her diarrhea and fever improved. After vancomycin was stopped, MRSA-arthritis appeared. She suddenly died due to acute massive hemorrhage into the mediastinum and left thoracic cavity from the atherosclerotic ulcer of the thoracic aorta. It took 98 days from the first detection of MRSA in her blood to her death. We found gram-positive coccus in the ruptured aortic ulcer and we also detected MRSA gene by polymerase chain reaction in the ulcer. These results suggest that MRSA could colonize in the aortic ulcer during the MRSA-bacteremia and the MRSA could contribute to the vulnerability of the aortic wall. CONCLUSIONS After septicemia occurrs in an elderly person, the patient should be followed up by considering infectious aortitis, especially when the patient has several risk factors.

Efficacy of mouth rinse in preventing oral mucositis in patients receiving high-dose cytarabine for allogeneic hematopoietic stem cell transplantation.

High-dose cytarabine is one of the major components of the conditioning regimen for hematopoietic stem cell transplantation (HSCT), and frequently causes severe oral mucositis. We have recently demonstrated that cytarabine is excreted into the saliva in patients receiving high-dose cytarabine, and proposed that it might locally and directly contribute to the development of oral mucositis. Therefore, this study was performed to assess whether removing the excreted cytarabine in the saliva by intensive mouth rinse during high-dose cytarabine infusion could reduce the incidence of oral mucositis. Fifteen patients with hematologic malignancies undergoing allogeneic HSCT who received total body irradiation (12 Gy) and high-dose cytarabine at a dose of 3 g/m(2) every 12 h for 4 days as a conditioning were evaluated. Patients were instructed to rinse their mouths using ice-cold water every 10 min, starting simultaneously with the 2-h cytarabine infusion and continuing up to 1 h after completion of each infusion. Oral mucositis was graded on a daily basis according to the National Cancer Institute, Common Toxicity Criteria. Thirty-five patients who previously underwent the same conditioning without mouth rinse served as controls. The incidence of Grades 2-3 and Grade 3 oral mucositis was significantly reduced in patients who performed mouth rinse as compared with the controls (40 vs. 80%, P = 0.009; 0 vs. 25. 7%, P = 0.02). In conclusion, mouth rinse during and shortly after high-dose cytarabine infusion could be an effective and inexpensive measure in reducing the incidence of moderate to severe oral mucositis caused by high-dose cytarabine. This finding strongly suggests the role of cytarabine excretion in the saliva in the development of cytarabine-associated oral mucositis.

An improved method for the measurement of the isotope ratio of ethanol in various samples, including alcoholic and non-alcoholic beverages.

The isotope ratios of ethanol, an important constituent or ingredient of some foods and various beverages and fuels, provide information about biological and geographical origin and quality. We have developed an improved method for measuring the isotope ratio of ethanol in various samples by gas chromatography-high temperature conversion or combustion-isotope ratio mass spectrometry (GC-TC/C-IRMS) with headspace solid-phase microextraction (HS-SPME). A HS-SPME method was developed by optimizing several different parameters, including salt addition, incubation temperature and time, and extraction time. The HS-SPME method enabled us to determine the isotope ratio at low ethanol concentrations (0.08 mM) in 50 min with good precision (+/-0.3 per thousand for delta(13)C and +/-5 per thousand for deltaD). An advantage of this technique is that it can be adapted for use with samples which have high viscosity and contain many matrix compounds, such as alcoholic and non-alcoholic beverages.