Immunogenicity and safety of the BNT162b2 mRNA COVID-19 vaccine in haematopoietic stem cell transplantation recipients.

The immunogenicity and safety of Pfizer-BioNTech BNT162b2 mRNA vaccine in allogeneic haematopoietic stem cell transplantation (HSCT) recipients are unknown. We prospectively followed 152 HSCT recipients who were at least six months following transplantation and with no active acute graft-versus-host disease (GVHD). Blood samples were taken 2-4 weeks after the second vaccination and analyzed for receptor-binding domain (RBD) antibodies and neutralizing antibodies (NA). 272 immunocompetent healthcare workers served as controls. At a median of 28 days after the second vaccination, 118 patients (77·6%) developed RBD immunoglobulin G (IgG) with a geometric mean titre (GMT) of 2·61 [95% CI (confidence interval), 2·16-3·16]. In the control group 269/272 (98·9%) developed RBD IgG, with a GMT of 5·98 (95% CI 5·70-6·28), P < 0·0001. The GMT of NA in HSCT recipients and controls was 116·0 (95% CI 76·5-175·9), and 427·9 (95% CI 354·3-516·7) respectively (P < 0001). Multivariate logistic regression analysis revealed that HSCT recipients with no chronic GVHD and no immunosuppressive therapy at the time of vaccination had significantly higher levels of NA following the second vaccination. Adverse events were minimal and were less common than in healthy controls. In conclusion; the BNT162b2 mRNA vaccination is safe and effective in HSCT recipients, especially those who are immunosuppression-free. A significant fraction developed protecting NA.

Cat Scratch Disease Presenting as Fever of Unknown Origin Is a Unique Clinical Syndrome.

BACKGROUND: Fever of unknown origin (FUO) is a rare manifestation of cat scratch disease (CSD). Data regarding CSD-associated FUO (CSD-FUO), particularly in adults, are limited. We aimed to study disease manifestations and long-term clinical outcome. METHODS: A national CSD surveillance study has been conducted in Israel since 1991. Data are obtained using questionnaires, review of medical records, and telephone interviews. FUO was defined as fever of ≥14 days without an identifiable cause. CSD-FUO patients were identified in the 2004-2017 CSD national registry. Follow-up included outpatient clinic visits and telephone/e-mail surveys. RESULTS: The study included 66 CSD-FUO patients. Median age was 35.5 years (range, 3-88). Median fever duration was 4 weeks (range, 2-9). Relapsing fever pattern was reported in 52% of patients, weight loss in 57%, and night sweats in 48%. Involvement of ≥1 organs occurred in 59% of patients; hepatosplenic space-occupying lesions (35%), abdominal/mediastinal lymphadenopathy (20%), ocular disease (18%), and multifocal osteomyelitis (6%) were the most common. Malignancy, particularly lymphoma, was the initial radiological interpretation in 21% of patients; 32% underwent invasive diagnostic procedures. Of the 59 patients available for follow-up (median duration, 31 weeks; range, 4-445), 95% had complete recovery; 3 patients remained with ocular sequelae. CONCLUSION: This is the first attempt to characterize CSD-FUO as a unique syndrome that may be severe and debilitating and often mimics malignancy. Relapsing fever is a common clinical phenotype. Multiorgan involvement is common. Recovery was complete in all patients except in those with ocular disease.

[Clinical-pathologic conference (cpc) - pulmonary insufficiency in Myasthenia Gravis patient].

A 64 year old Myasthenia Gravis patient was admitted with pulmonary insufficiency. The autopsy revealed diffuse Strongyloides stercoralis infection.

[Neurocognitive disturbances and psychiatric disorders among patients living with HIV-1 positive in Israel].

INTRODUCTION: Neurocognitive dysfunction and psychiatric disorders are common among people living with HIV. A large number of the patients are asymptomatic, but in neurocognitive assessment and specific questionnaires subclinical disturbances can be diagnosed. The aim of this research was to study the rate of neurocognitive disturbances, as well as psychiatric disorders (depression and anxiety) among Israeli people living with HIV, and to find predictors for these disturbances. METHODS: VaLidated neurocognitive tests and psychiatric assessment questionnaires (PHQ-9 and STAI) were conducted among 57 asymptomatic HIV-1 positive patients. Sociodemographic and clinical characteristics were collected from the patients' files. RESULTS: The rate of disturbances in the neurocognitive test was dependent on the test used. Whereas in Trail making A and B (TMA, TMB) high rates of disturbances were found, almost no patients with disturbances were found when the digit symbol substitution test (DSST) was used. In immediate and delayed memory testing (IMT and DMT) 47.7% and 49% memorized less than 75% of the numbers, respectively, while 18% of the patients had anxiety and 24% suffered from depression. The median quality of life measured by the analog scale was 7. In multivariate analysis we could not find predictive variables for neurocognitive or psychiatric disorders. DISCUSSION: Neurocognitive disturbances and psychiatric disorders are common among asymptomatic people living with HIV, irrelevant of the time of being positive, immunoLogical status, viral load or treatment received.