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Objectives To evaluate the performance of nasal mid-turbinate self-testing using rapid antigen detection tests (RDT) for persons with suspected coronavirus disease 2019 (COVID-19) in the community. Self-testing for COVID-19 infection with lateral flow assay severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RDT, provides rapid results and could enable frequent and extensive testing in the community, thereby improving the control of SARS-CoV-2. Methods Participants visiting a municipal SARS-CoV-2 testing centre, received self-testing kits containing either the BD Veritor System (BD-RDT) or Roche SARS-CoV-2 antigen detection test (Roche-RDT). Oro-nasopharyngeal swabs were collected from the participants for quantitative RT-PCR (qRT-PCR) testing. As a proxy for contagiousness, viral culture was performed on a selection of qRT-PCR positive samples to determine the Ct-value at which the chance of a positive culture dropped below 0.5 (Ct-value cut-off). Sensitivity and specificity of self-testing were compared to qRT-PCR with a Ct-value below the Ct value cut-off. Determinants independently associated with a false-negative self-test result were determined. Results A total of 3201 participants were included (BD-RDT n = 1595; Roche-RDT n = 1606). Sensitivity and specificity of self-testing compared with the qRT-PCR results with a Ct-value below the Ct-value cut-off were 78.4% (95% CI 73.2%–83.5%) and 99.4% (95% CI 99.1%–99.7%), respectively. A higher age was independently associated with a false-negative self-testing result with an odds ratio of 1.024 (95% CI 1.003–1.044). Conclusions Self-testing using currently available RDT has a high specificity and relatively high sensitivity to identify individuals with a high probability of contagiousness.

Background Cytomegalovirus (CMV) is the most frequently contracted virus in preterm infants. Postnatal infection is mostly asymptomatic but is sometimes associated with severe disease. To diagnose an infection, urine or saliva samples can be tested for CMV-DNA by real-time polymerase chain reaction (rtPCR). Although the diagnostic accuracy of testing saliva samples has not been determined in preterm infants, saliva is widely used because it is easier to obtain than urine. Objectives To determine whether screening of saliva is equivalent to urine to detect a postnatal CMV infection in preterm infants. Study design Between 2010 and 2013 saliva and urine samples were collected from infants admitted to the Neonatal Intensive Care Unit of the University Medical Center Utrecht and born with a gestational age (GA) below 32 weeks. Urine samples were obtained within three weeks after birth and urine and saliva samples at term equivalent age (40 weeks GA) and tested for CMV-DNA by rtPCR. Infants with a congenital CMV infection were excluded. Results Of 261 preterm infants included in the study, CMV-DNA was detected in urine of 47 and in saliva of 43 children. Of 47 infants with postnatal CMV infection, CMV was detected in 42 saliva samples (sensitivity 89.4%; CI 76.9–96.5). Of 214 children without postnatal CMV infection, one saliva sample tested positive for CMV (specificity 99.5%; CI 97.4–99.9). Conclusions Screening saliva for CMV-DNA by rtPCR is inferior to urine to diagnose postnatal CMV infections in preterm infants.

We here report a 7 year old acute myeloid leukemia patient with persistent spiking fever likely caused by chronic echovirus 20 infection. After immunoglobulin substitution fevers subsided and the virus was cleared. Enterovirus infection should be considered in immunocompromised patients with unexplained persistent fever.

Background Alloimmune-mediated lung syndromes (allo-LSs) are life-threatening complications after hematopoietic cell transplantation (HCT). Respiratory virus (RV) has been suggested to play a role in the pathogenesis. Objective We studied the relation between RV DNA/RNA detection in the upper/lower airways before HCT and the occurrence of allo-LSs. Methods We retrospectively analyzed all HCT recipients between 2004 and 2014, in whom real-time PCR for RV was performed in nasopharyngeal aspirates (NPAs) and bronchoalveolar lavage (BAL) fluid before HCT. The main outcome of interest was the presence of an allo-LS, which was defined as idiopathic pneumonia syndrome or bronchiolitis obliterans syndrome. Other outcomes were overall survival and treatment-related mortality. We used Cox proportional hazard models, logistic regression models, and Fine-Gray competing risk regression for analyses. Results One hundred seventy-nine children (median age, 6.8 years) were included. RVs were found in 61% (41% in BAL fluid/NPAs and 20% in NPAs only). Rhinovirus was the most frequently detected RV (42%). Allo-LSs occurred in 13%. RV positivity in BAL fluid was a predictor for allo-LSs (hazard ratio, 3.8; 95% CI, 1.4-10.7; P = .01), whereas RV positivity in NPAs only was not. No other predictors were found. Grade II to IV acute graft-versus-host disease related to steroid treatment shows a trend toward a protective effect (odds ratio, 0.16; 95% CI, 0.0-1.3; P = .08). Allo-LSs significantly increased treatment-related mortality (52% ± 10% in allo-LSs and 20% ± 4% in non–allo-LSs, P = .007). Conclusions These results show that pre-HCT BAL fluid RV positivity was a predictor for allo-LSs. Screening for RVs before HCT might identify patients at risk for allo-LSs. This could have implications for prevention and treatment and might subsequently influence the outcomes of HCT., Graphical abstract

Multivesicular bodies (MVBs) are ubiquitous endocytic organelles containing numerous 50-80 nm vesicles. MVBs are very dynamic in shape and function. In antigen presenting cells (APCs), MVBs play a central role in the loading of major histocompatibility complex class II (MHC II) with antigenic peptides. How MHC II is transported from MVBs to the cell surface is only partly understood. One way involves direct fusion of MVBs with the plasma membrane. As a consequence, their internal vesicles are secreted as so-called exosomes. An alternative has been illustrated in maturing dendritic cells (DCs). Here, MVBs are reshaped into long tubules by back fusion of the internal vesicles with the MVB limiting membrane. Vesicles derived from the tips of these tubules then carry MHC II to the cell surface.

Refractory CNS infections often require intrathecal antibiotics but the safety of this practice has not been determined.We hereby describe our experience with intrathecal antibiotics in a series of patients admitted to a neurologic intensive care unit at a university center. Methods: Retrospective case series of all patients with refractory CNS infections admitted to a neurosciences ICU at a university hospital over 7 years. The following data were abstracted from the medical records: demographics, diagnosis, type of infection, organism, antibiotic used, time to negative cultures, and complications associatedwith intrathecal antibiotics. Results: A total of 26 patients were treated 12 (44%) male. Median age was 54 years old. The most common diagnosis was subarachnoid hemorrhage in 10/26 (38%), followed by brain tumors 6/26 (23%), intracranial hemorrhage 3/26 (12%), shunt infection 3/26 (12%), traumatic brain injury 2/26 (7%), primary meningitis and cerebral cyst 1/26 (4%) each. The most common organisms were gram negatives in 14 /26 (54%, gram positives in 6 /26 (23%), and coagulase negative staphylococcus in 6/26 (23%). The median time to CSF culture sterility was 8 days (range1-14). The antibiotics used were vancomycin in 10/26 (38%), gentamicin in 15/26 (58%), and amikacin in 1/26 (4%). No immediate complications occurred. Conclusions: Intra-thecal administration of antibiotics in patients with refractory CNS infections appears to be safe and appears to be effective at achieving CSF sterility.