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JAMA Sep 2023Recent reports have suggested that cerebral amyloid angiopathy, a common cause of multiple spontaneous intracerebral hemorrhages (ICHs), may be transmissible through... (Comparative Study)
Comparative Study
IMPORTANCE
Recent reports have suggested that cerebral amyloid angiopathy, a common cause of multiple spontaneous intracerebral hemorrhages (ICHs), may be transmissible through parenteral injection of contaminated cadaveric pituitary hormone in humans.
OBJECTIVE
To determine whether spontaneous ICH in blood donors after blood donation is associated with development of spontaneous ICH in transfusion recipients.
DESIGN, SETTING, AND PARTICIPANTS
Exploratory retrospective cohort study using nationwide blood bank and health register data from Sweden (main cohort) and Denmark (validation cohort) and including all 1 089 370 patients aged 5 to 80 years recorded to have received a red blood cell transfusion from January 1, 1970 (Sweden), or January 1, 1980 (Denmark), until December 31, 2017.
EXPOSURES
Receipt of red blood cell transfusions from blood donors who subsequently developed (1) a single spontaneous ICH, (2) multiple spontaneous ICHs, or (3) no spontaneous ICH.
MAIN OUTCOMES AND MEASURES
Spontaneous ICH in transfusion recipients; ischemic stroke was a negative control outcome.
RESULTS
A total of 759 858 patients from Sweden (median age, 65 [IQR, 48-73] years; 59% female) and 329 512 from Denmark (median age, 64 [IQR, 50-73] years; 58% female) were included, with a median follow-up of 5.8 (IQR, 1.4-12.5) years and 6.1 (IQR, 1.5-11.6) years, respectively. Patients who underwent transfusion with red blood cell units from donors who developed multiple spontaneous ICHs had a significantly higher risk of a single spontaneous ICH themselves, compared with patients receiving transfusions from donors who did not develop spontaneous ICH, in both the Swedish cohort (unadjusted incidence rate [IR], 3.16 vs 1.12 per 1000 person-years; adjusted hazard ratio [HR], 2.73; 95% CI, 1.72-4.35; P < .001) and the Danish cohort (unadjusted IR, 2.82 vs 1.09 per 1000 person-years; adjusted HR, 2.32; 95% CI, 1.04-5.19; P = .04). No significant difference was found for patients receiving transfusions from donors who developed a single spontaneous ICH in the Swedish cohort (unadjusted IR, 1.35 vs 1.12 per 1000 person-years; adjusted HR, 1.06; 95% CI, 0.84-1.36; P = .62) nor the Danish cohort (unadjusted IR, 1.36 vs 1.09 per 1000 person-years; adjusted HR, 1.06; 95% CI, 0.70-1.60; P = .73), nor for ischemic stroke as a negative control outcome.
CONCLUSIONS AND RELEVANCE
In an exploratory analysis of patients who received red blood cell transfusions, patients who underwent transfusion with red blood cells from donors who later developed multiple spontaneous ICHs were at significantly increased risk of spontaneous ICH themselves. This may suggest a transfusion-transmissible agent associated with some types of spontaneous ICH, although the findings may be susceptible to selection bias and residual confounding, and further research is needed to investigate if transfusion transmission of cerebral amyloid angiopathy might explain this association.
Topics: Aged; Female; Humans; Male; Middle Aged; Blood Donors; Cerebral Amyloid Angiopathy; Cerebral Hemorrhage; Ischemic Stroke; Retrospective Studies; Erythrocyte Transfusion; Registries; Sweden; Denmark; Child, Preschool; Child; Adolescent; Young Adult; Adult; Aged, 80 and over; Transplant Recipients; Communicable Diseases
PubMed: 37698562
DOI: 10.1001/jama.2023.14445 -
Viruses Jul 2023Not in the history of transmissible illnesses has there been an infection as strongly associated with acute cerebrovascular disease as the novel human coronavirus... (Review)
Review
Not in the history of transmissible illnesses has there been an infection as strongly associated with acute cerebrovascular disease as the novel human coronavirus SARS-CoV-2. While the risk of stroke has known associations with other viral infections, such as influenza and human immunodeficiency virus, the risk of ischemic and hemorrhagic stroke related to SARS-CoV-2 is unprecedented. Furthermore, the coronavirus disease 2019 (COVID-19) pandemic has so profoundly impacted psychosocial behaviors and modern medical care that we have witnessed shifts in epidemiology and have adapted our treatment practices to reduce transmission, address delayed diagnoses, and mitigate gaps in healthcare. In this narrative review, we summarize the history and impact of the COVID-19 pandemic on cerebrovascular disease, and lessons learned regarding the management of patients as we endure this period of human history.
Topics: Humans; COVID-19; SARS-CoV-2; Pandemics; Stroke; Virus Diseases
PubMed: 37515284
DOI: 10.3390/v15071598 -
CMAJ : Canadian Medical Association... Nov 2023
PubMed: 37984939
DOI: 10.1503/cmaj.230960-f -
CMAJ : Canadian Medical Association... Jun 2023
Topics: Humans; Drug Hypersensitivity; Penicillins; Sexually Transmitted Diseases; Primary Health Care; Hypersensitivity
PubMed: 37364912
DOI: 10.1503/cmaj.221266-f -
CMAJ : Canadian Medical Association... Sep 2023
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Cell Jan 2024Although social interactions are known to drive pathogen transmission, the contributions of socially transmissible host-associated mutualists and commensals to host... (Review)
Review
Although social interactions are known to drive pathogen transmission, the contributions of socially transmissible host-associated mutualists and commensals to host health and disease remain poorly explored. We use the concept of the social microbiome-the microbial metacommunity of a social network of hosts-to analyze the implications of social microbial transmission for host health and disease. We investigate the contributions of socially transmissible microbes to both eco-evolutionary microbiome community processes (colonization resistance, the evolution of virulence, and reactions to ecological disturbance) and microbial transmission-based processes (transmission of microbes with metabolic and immune effects, inter-specific transmission, transmission of antibiotic-resistant microbes, and transmission of viruses). We consider the implications of social microbial transmission for communicable and non-communicable diseases and evaluate the importance of a socially transmissible component underlying canonically non-communicable diseases. The social transmission of mutualists and commensals may play a significant, under-appreciated role in the social determinants of health and may act as a hidden force in social evolution.
Topics: Animals; Humans; Microbiota; Noncommunicable Diseases; Social Factors; Symbiosis; Virulence
PubMed: 38181740
DOI: 10.1016/j.cell.2023.12.014 -
CMAJ : Canadian Medical Association... Apr 2024
Topics: Humans
PubMed: 38649171
DOI: 10.1503/cmaj.231460-f