Impact of Toxoplasma gondii infection on human health

Toxoplasmosis is one of the most prevalent infectious disease around the globe and it is caused by the parasite named Toxoplasma gondii. Infections normally lead to asymptomatic parasite persistence in immunocompetent warm-blooded hosts, including up to 30-50% of humans. However, T. gondii infection has also a major medical concern and can lead to life-threatening diseases, after reactivation in immunocompromized individuals, particularly in patients with human immunodeficiency virus/cancer or organ transplant recipients, after vertical transmission to fetuses of pregnant women and by inducing recurrent uveitis in immunocompetent adults. More importantly, T. gondii undergoes stage conversion from its fast-replicating tachyzoite to slow replicating dormant bradyzoite preferentially in the brain and skeletal muscles, and lesser extent in the eye, liver, kidney and lung which enable the parasite to persist for the whole life of an individual. Due to the persistence behavior of the parasite in different parts of human body, T. gondii can develop multiple human diseases with severe clinical symptoms. In this study, we have summarized the association of T. gondii in multiple human diseases for instance Encephalitis, Parkinson’s disease, Schizophrenia, Heart disease, Ocular Toxoplasmosis, Congenital abnormalities, Cancer and Diabetes. This highlights the potential role of T. gondii in developing fatal diseases, particularly in immunocompromised individuals despite having asymptomatic nature of the parasite. Bioresearch Commu. 8(1): 1093-1099, 2022 (January)

Acute Liver Failure after Ingestion of Fried Rice Balls: A Case Series of Bacillus cereus Food Poisonings

Bacillus cereus foodborne intoxications and toxicoinfections are on a rise. Usually, symptoms are self-limiting but occasionally hospitalization is necessary. Severe intoxications with the emetic Bacillus cereus toxin cereulide, which is notably resistant heat and acid during cooking, can cause acute liver failure and encephalopathy. We here present a case series of food poisonings in five immunocompetent adults after ingestion of fried rice balls, which were massively contaminated with Bacillus cereus. The patients developed a broad clinical spectrum, ranging from emesis and diarrhoea to life-threatening acute liver failure and acute tubular necrosis of the kidney in the index patient. In the left-over rice ball, we detected 8 × 106Bacillus cereus colony-forming units/g foodstuff, and cereulide in a concentration of 37 μg/g foodstuff, which is one of the highest cereulide toxin contaminations reported so far from foodborne outbreaks. This report emphasizes the potential biological hazard of contaminated rice meals that are not freshly prepared. It exemplifies the necessity of a multidisciplinary approach in cases of Bacillus cereus associated food poisonings to rapidly establish the diagnosis, to closely monitor critically ill patients, and to provide supportive measures for acute liver failure and—whenever necessary—urgent liver transplantation.

Immunogenicity, Safety, and Tolerability of V114, a 15-Valent Pneumococcal Conjugate Vaccine, in Immunocompetent Adults Aged 18–49 Years With or Without Risk Factors for Pneumococcal Disease: A Randomized Phase 3 Trial (PNEU-DAY)

Background Adults with certain medical and behavioral factors are at increased risk for pneumococcal disease (PD). Sequential vaccination with 13-valent pneumococcal conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) is recommended for at-risk adults in some countries. Methods This phase 3 trial evaluated the safety, tolerability, and immunogenicity of sequential administration of either V114 (a 15-valent PCV containing serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 22F, 23F, and 33F) or PCV13, followed 6 months later by PPSV23, in immunocompetent adults aged 18–49 years with or without pre-defined risk factors for PD (NCT03547167). Overall, 1515 participants were randomized 3:1 to receive either V114 or PCV13, followed by PPSV23. Results Most common solicited adverse events (AEs) following administration of V114 or PCV13 as well as PPSV23 were injection-site pain and fatigue. The proportion of participants with AEs was comparable in both groups. V114 and PCV13 were immunogenic based on opsonophagocytic activity (OPA) geometric mean titers (GMTs) 30 days post-vaccination for all serotypes contained in each respective vaccine. OPA GMTs to the 2 unique serotypes in V114 were robust in the V114 group. PPSV23 was immunogenic for all 15 serotypes contained in V114 in both vaccination groups, including 22F and 33F. Conclusions V114 administered alone or sequentially with PPSV23 is well tolerated and immunogenic for all 15 serotypes, including those not contained in PCV13, in immunocompetent adults aged 18–49 years with or without certain medical or behavioral risk factors for PD.

Acute retinal necrosis with exudative retinal detachment in a child

Acute retinal necrosis (ARN) is a rare ocular emergency caused mainly by viral entities. ARN may be caused by Herpes zoster virus (HZV) and Herpes simplex virus (HSV), both HSV-1 and HSV-2. ARN mostly present in 20–60 years old immunocompetent adults. A 7-year-old girl presented to the eye clinic with complaints of left eye redness noted by her mother for 2–3 days. On examination with indirect ophthalmoscopy, no hypopyon was seen in either eye. In the left eye fundus view was hazy. Ultrasound B-scan performed showed exudative retinal detachment. PCR of ocular fluid was positive for HSV-1 DNA. The patient was started on topical steroids and antibiotics and systemic antivirals. In addition, she also received intravitreal ganciclovir 4 mg/0.1 mL three times under general anaesthesia. At her last follow-up, 3 years from her presentation, her right eye examination was within normal limits, and left eye showed thick vitreous bands with a posterior vitreous detachment, and left inferotemporal retinal scarring.

06. United States Healthcare Provider Preferences for Adult Pneumococcal Vaccine Recommendations

Background Pneumococcal vaccine recommendations for US adults are complex, varying by age and underlying conditions, and include both 23-valent polysaccharide vaccine (PPSV23) and 13-valent pneumococcal conjugate vaccine. The Advisory Committee on Immunization Practices (ACIP) will vote on new recommendations in October after the 15- (PCV15) and 20-valent (PCV20) conjugate vaccines are approved. Stakeholder acceptability is part of ACIP’s evidence to recommendation framework, but few data are available on health care providers’ (HCPs) preferences for potential recommendations. Methods 752 HCPs (300 physicians, 150 nurse practitioners, 150 physician assistants, & 152 pharmacists) were surveyed. Object case best-worst scaling (BWS) was used to elicit preferences for hypothetical recommendations for 1) adults 19-64 years with chronic conditions and 2) immunocompetent adults ≥65 years. Presented recommendations included combinations of PCV15/PCV20 either as routine or after shared clinical decision making (SCDM), and PPSV23 as routine, SCDM, or no recommendation. Following BWS, HCPs were asked to assume ACIP was considering implementing both of their preferred recommendations for the age/risk groups. HCPs were then given the opportunity to change their selections and propose recommendations not included in the BWS exercise. Additional information was collected using conventional survey items. Results Routine use of higher-valent PCVs in sequence with PPSV23 was most often preferred for both adults 19-64 with chronic conditions (40%) and immunocompetent adults ≥65 (49%) when elicited separately for each age/risk group. Most respondents (63%) revised their recommendations after considering implementation, which resulted in most (59%) favoring recommendations harmonized across the age/risk groups, and 75% favoring routine use of PCV15 or PCV20 among immunocompetent adults ≥65. When asked directly, HCPs generally approved of the idea of simplifying adult pneumococcal vaccine recommendations, harmonizing the interval between vaccines, and lowering the cutoff for age-based recommendations below 65 years. Conclusion US HCPs generally prefer simplification of the adult pneumococcal recommendation, favoring broad routine use of both higher-valent PCVs and PPSV23. Disclosures Jeffrey Vietri, PhD, Pfizer Inc (Employee, Shareholder) Kelley Meyers, PhD, RTI Health Solutions (Independent Contractor) Christine Poulos, PhD, Pfizer Inc (Other Financial or Material Support, Employee of RTI-HS, which received funds from Pfizer to conduct the study) Erica Chilson, PharmD, Pfizer, Inc (Employee, Shareholder) Vincenza Snow, MD, Pfizer Vaccines (Employee)

266. A Rare Case of Human Herpesvirus-6 (HHV-6) Encephalitis in an Immunocompetent Host

Background Human Herpesvirus-6 (HHV-6) seroprevalence rates in the United States range from 72-95%, but clinical illness in the adult population is extremely rare, which often presents as meningoencephalitis in immunocompromised hosts. The literature on HHV-6 encephalitis in immunocompetent adults is limited to a select number of case reports, ultimately providing scant treatment guidance for clinicians. Methods This is a unique case describing the clinical course of confirmed HHV-6 encephalitis in an immunocompetent host. Results The patient is a 77-year-old immunocompetent female presenting with two days of global aphasia and increased muscle tone. She presented hypertensive with a leukocytosis. Work-up for acute stroke was unremarkable, but lumbar puncture revealed an elevated white blood cell (WBC) count of 39 leukocytes/mm3 with a lymphocytic predominance. BioFire FilmArray® Meningitis/Encephalitis panel (FAME) demonstrated positivity for HHV-6 with a viral load of 8,500 copies/mL in the cerebrospinal fluid (CSF) and 4.1 million copies/mL in serum. The patient experienced temporary improvement in her aphasia after being initiated on intravenous (IV) ganciclovir for 12 days. Shortly after the initiation of therapy, her aphasia worsened with repeat CSF studies demonstrating an increased viral load to 35,700 copies/mL. She was subsequently transitioned to IV foscarnet for HHV-6B coverage and discharged after completing 21 days of therapy with marked improvement in her symptoms. Two weeks later, the patient was readmitted for recurrence of aphasia. MRI brain at that time was unremarkable with repeat lumbar puncture demonstrating a WBC count of 8 with 113 copies/mL of HHV-6. Serum levels were also elevated to 4.7 million c/mL. The patient was restarted on foscarnet but continued to deteriorate clinically. She ultimately experienced multiple seizure-like episodes resulting in a noncommunicative, somnolent state. She was transitioned to hospice care and passed away 2 days after discharge. Conclusion Despite the use of recommended medical therapies, the mortality and clinical progression of HHV-6 in immunocompetent adults is still unpredictable. Further studies are needed in this population to provide guidance for clinicians. Disclosures All Authors: No reported disclosures

Chronic Multifocal Osteomyelitis – Is Mycobacterium avium Complex Really the Culprit? A Case Report in an Adult Female

Introduction:There are reports which describe multiple lytic lesions seen on X-ray resulting from a non-tuberculous Mycobacterium skeletal infection in immunocompetent adults and children. AdditionallyIn addition, similar multifocal lesions have also been described in chronic recurrent multifocal osteomyelitis (CRMO) which is more common in children but has have rarely been reported in adults. We present a case of a 47-year-old female who presented with multiple osteolytic lesions and discuss how her diagnosis overlaps with CRMO and multifocal non-tuberculous osteomyelitis associated with Mycobacterium avium complex (MAC). Case Report:A 47-year-old female presented with a mass at her left sternoclavicular joint. Biopsy of the lesion showed acute and chronic inflammation suggesting osteomyelitis. The patient was on intravenousIV antibiotics with some improvement. After three 3 ½ and a half months, she was having knee pain and imaging showed another lesion and a bone scan found a third. Delayed cultures grew Mycobacterium avium complexMAC but ultimately the patient improved when she was taking naproxen for multifocal osteomyelitis. Conclusion:Multifocal lytic lesions on imaging in an adult can be multifocal osteomyelitis that, like in pediatric patients, may be treated best with nonsteroidal anti-inflammatory medications as with the patient in this case. Keywords:Multifocal Osteomyelitis, Mycobacterium Avium Complex, Osteitis Multifocal Osteomyelitis, Mycobacterium avium complex, osteitis.

Rhino-Orbital mucormycosis in an immunocompetent pediatric patient with hyperglycemia of the hospitalized patient

Introduction: Acute invasive rhino-orbital mucormycosis usually affects diabetic or neutropenic patients, and only exceptionally develops in immunocompetent adults and children. Methodology: A 12-years-old immunocompetent female, presented with complicated rhinosinusitis with a subperiosteal orbital abscess, without improvement after initial medical and surgical management, the patient also developed hyperglycemia of the hospitalized patient that represented a challenging and potentially lethal clinical scenario. Results: Diagnosed with an unsuspected rhino-orbital mucormycosis by direct microscopy and PCR, she survived after amphotericin B and surgical treatment. Conclusions: In cases with torpid clinical evolution, even in apparently immunocompetent patients, appropriate multidisciplinary workup must be performed to rule out opportunistic etiologies including mucormycosis to improve survival.