Evaluación de estuches comerciales para el diagnóstico inmunológico y molecular de la enfermedad de Chagas en zonas endémicas de Venezuela / Evaluation of commercial kits for the immunological and molecular diagnosis of Chagas disease in endemic areas of Venezuela

IntroducciónLa sensibilidad y especificidad de las técnicas de diagnóstico para la enfermedad de Chagas dependen en gran parte de los antígenos y las dianas utilizadas y de la respuesta inmunológica y las características de la infección de la población donde se aplica, de allí la necesidad de la evaluación de las técnicas de diagnóstico disponibles en un área determinada, por lo que el objetivo de este trabajo fue evaluar dos estuches comerciales para el diagnóstico inmunológico y molecular de la enfermedad de Chagas en zonas endémicas de Venezuela.MétodosSe evaluaron los estuches: Chagas ELISA IgG+IgM® y Speed Oligo Chagas® (Vircell®, Granada, España). Se valoraron con 129 muestras (35 de pacientes en fase aguda, 33 en fase crónica, 31 de pacientes con otras enfermedades y 30 de individuos sanos). Se compararon los resultados con los obtenidos en las pruebas convencionales ELISA y PCR-ADN satélite de Trypanosoma cruzi.ResultadosCon Chagas ELISA IgG+IgM® se obtuvo una sensibilidad de 94,1% y especificidad de 93,4%, con Speed Oligo Chagas® se obtuvo una sensibilidad de 92,6% y especificidad de 100%, valores similares a los obtenidos con ELISA y PCR-ADNsat convencionales.ConclusiónLa sensibilidad y especificidad de los estuches comerciales evaluados los hacen adecuados para el diagnóstico de la enfermedad de Chagas en zonas endémicas de Venezuela.

IntroductionThe sensitivity and specificity of diagnostic techniques for Chagas disease depend largely on the antigens and targets used and on the immune response and characteristics of the infection of the population where it is applied, hence the need for evaluation of the diagnostic techniques available in a given area. So, the objective of this work was to evaluate two commercial kits for the immunological and molecular diagnosis of Chagas disease in endemic areas of Venezuela.MethodsThe evaluated kits were: Chagas ELISA IgG+IgM® and Speed Oligo Chagas® (Vircell®, Granada, Spain). They were evaluated with 129 samples (35 from patients in the acute phase, 33 in the chronic phase, 31 from patients with other diseases, and 30 from healthy individuals). The results were compared with those obtained in the conventional ELISA and PCR-satellite DNA tests for Trypanosoma cruzi.ResultsWith Chagas ELISA IgG+IgM® a sensitivity of 94.1% and specificity of 93.4% were obtained, with Speed Oligo Chagas® a sensitivity of 92.6% and specificity of 100% were achieved, values similar to those showed by conventional ELISA and satDNA-PCR.ConclusionThe sensitivity and specificity of the commercial kits evaluated make them suitable for the diagnosis of Chagas disease in endemic areas of Venezuela.

Frequency of positive oral food challenges and their outcomes in the allergy unit of a tertiary-care pediatric hospital

Introduction and objective: The oral food challenge (OFC) is the gold standard to diagnose food allergy (FA); however, it is not a procedure free from the risk of having significant allergic reactions, even life-threatening. The aims of our study were to evaluate the frequency of positive OFCs performed in children with a suspected diagnosis of IgE- and non-IgE–mediated (food protein–induced enterocolitis syndrome (FPIES)) FA and how the failed challenges were managed. Materials and methods: A retrospective chart review was done on all children who have had OFCs in a tertiary-care pediatric allergy unit from 2017 to 2019. Results: 682 patients were enrolled and 2206 challenges were performed: 2058 (93%) for IgE-mediated FA and 148 (7%) for FPIES. There were 262 (11.8%) challenge failures. The transfer to the emergency department was required 3 times (1.1%). None of the failed challenges resulted in death or hospitalization and 13.3% challenges did not require any treatment. Conclusions: Our findings confirm that food challenges can be performed safely in a specialized setting by well-trained personnel; all food challenge reactions, even the most serious, were reversible, thanks to a prompt recognition and treatment that generally did not worsen over time (AU)

22q11.2 deletion syndrome: 20 years of experience from two pediatric immunology units and review of clues for diagnosis and disease management

INTRODUCTION AND OBJECTIVES: The purpose of this study was to evaluate patients diagnosed with 22q11.2 deletion syndrome and determine the clues directing to diagnosis and evaluation of immunological findings for excellent management of the disease. MATERIAL AND METHODS: Thirty-three pediatric patients with 22q11.2 deletion syndrome diag­nosed between 1998 and 2019 at Pediatric Immunology Division of Ege University Faculty of Medicine and SBU Izmir Dr Behcet Uz Children's Education and Research Hospital were evaluated. RESULTS: This study includes the largest case series reported from Turkey. Congenital car­diac anomalies were the most common pathology associated with the syndrome (90.9%). Hypocalcemic symptoms were observed in 13 patients (40%). Twenty-two of the 33 (66.6%) patients were diagnosed before two years of age. Autoimmune diseases, dysmorphic facial findings, recurrent infections, growth retardation, and speech impairment were other clues for diagnosis in older patients. Clinical spectrum and immunological abnormalities of this syn­drome are quite variable. All T-cell subset counts were less than 5th percentile below median by age in one patient (3%) and 10 patients had normal all T-cell subset counts (30.3%). Overall, 69.6% of the patients had normal IgG, IgA, and IgM levels and two patients had panhypogam­maglobulinemia. Recurrent infections were revealed in 75.7% of the patients during follow-up. CONCLUSIONS: Presence of cardiac anomaly is more helpful in the diagnosis, especially under two years of age. Patients with immunologically high or standard risk did not show any differ­ence in terms of numbers and severity of infections and autoimmunity

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The use of in vivo and in vitro tests in children with beta lactam allergy

BACKGROUND: Drug allergies are reactions within the context of drug hypersensitivity reactions, which are caused by immunological mechanisms due to a previously sensitising drug. Beta-lactam antibiotics (BLA) are the leading agents causing drug hypersensitivity reactions in children. The aim of this study is to evaluate the diagnostic importance of in vivo and in vitro diagnostic tests in children with suspected immediate-type BLA hypersensitivity and to investigate the frequency of their use for the final diagnosis. METHODS: Patients admitted to the Outpatient Clinic of Division of Paediatric Allergy and Immunology with suspicion of immediate-type BLA hypersensitivity between December 2014 and December 2018 were investigated. Patients with a history of immediate reactions to BLA were examined by performing drug specific IgE, skin prick tests, intradermal tests and drug provocation tests (DPT). RESULTS: During the study period, 148 patients were admitted to our clinic with suspected immediate-type BLA hypersensitivity. Forty-eight patients completed all assessment steps and were enrolled in the study. It has been shown that 27 patients did not have drug allergy. BLA hypersensitivity was proven in 21 patients by using in vivo test algorithm. More than half of the patients were diagnosed via skin tests with culprit drug. CONCLUSION: Allergy work-up should be performed in patients with immediate reactions to BLA. A skin test can demonstrate BLA hypersensitivity in most patients. Thus, skin tests should be performed prior to the drug provocation test

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Long-term impact of an intervention on rapid antigen detection tests in acute pharyngitis / Impacto de una intervención a largo plazo del uso de una prueba antigénica rápida en la faringitis aguda

OBJECTIVE: This study was aimed at evaluating the appropriateness of use and interpretation of rapid antigen detection testing (RADT) and antibiotic prescribing for acute pharyngitis six years after a multifaceted intervention. DESIGN: Before-and-after audit-based study. LOCATION: Primary care centres in eight autonomous Communities. PARTICIPANTS: General practitioners (GP) who had participated in the HAPPY AUDIT intervention study in 2008 and 2009 were invited to participate in a third audit-based study six years later (2015). METHOD: RADTs were provided to the participating practices and the GPs were requested to consecutively register all adults with acute pharyngitis. A registration form specifically designed for this study was used. RESULTS: A total of 121 GPs out of the 210 who participated in the first two audits agreed to participate in the third audit (57.6%). They registered 3394 episodes of pharyngitis in the three registrations. RADTs were used in 51.7% of all the cases immediately after the intervention, and in 49.4% six years later. Antibiotics were prescribed in 21.3% and 36.1%, respectively (P < .001), mainly when tonsillar exudates were present, and in 5.3% and 19.2% of those with negative RADT results (P < .001). On adjustment for covariables, compared to the antibiotic prescription observed just after the intervention, significantly more antibiotics were prescribed six years later (odds ratio: 2.24, 95% confidence interval: 1.73-2.89). CONCLUSIONS: This study shows that that the long-term impact of a multifaceted intervention, focusing on the use and interpretation of RADT in patients with acute pharyngitis, is reducing

OBJETIVO: Evaluar la adecuación del uso e interpretación de las técnicas antigénicas rápidas (TAR) y la prescripción antibiótica en la faringitis aguda 6 años después de haber realizado una intervención multifacética. DISEÑO: Estudio antes-después basado en una auditoria. EMPLAZAMIENTO: Centros de salud en 8 comunidades autónomas. PARTICIPANTES: Se invitaron a médicos de familia (MF) que ya habían participado en el estudio de intervención HAPPY AUDIT en 2008 y 2009 a un nuevo AUDIT 6 años después (2015). MÉTODO: Se proporcionaron TAR a los centros participantes, y se pidió a los MF que registraran consecutivamente a todos los adultos con faringitis aguda. Usamos un registro diseñado específicamente para este estudio. RESULTADOS: Ciento veintiuno MF de los 210 que participaron en los primeros registros (57,6%) aceptaron a participar en el tercer registro. Se registraron 3.394 episodios de faringitis agudas en las 3 auditorías. Se usaron TAR en el 51,7% de los casos inmediatamente después de la intervención y en el 49,4%, 6 años después. Se prescribieron antibióticos en el 21,3%y 36,1%, respectivamente (p < 0,001), principalmente cuando había exudado amigdalar y en el 5,3 y 19,2% de los resultados de TAR negativos (p < 0,001). Después de ajustar por las distintas covariables, comparado con la prescripción antibiótica observada justo después de la intervención, prescribieron significativamente más antibióticos 6 años más tarde (odds ratio: 2,24 [IC 95%: 1,73-2,89]). CONCLUSIONES: Este estudio muestra que se reduce el impacto de una intervención multifacética a largo plazo enfocada al uso e interpretación de TAR en pacientes con faringitis aguda

Riesgo infeccioso en los tratamientos biológicos utilizados en enfermedades de base inmunológica / No disponible

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Recomendaciones para el estudio genético e inmunológico en la disfunción reproductiva / Recommendations regarding the genetic and immunological study of reproductive dysfunction

Varios miembros de diferentes asociaciones científicas y expertos de la reproducción han actualizado las recomendaciones de estudio genético e inmunológico en las parejas con disfunción en la reproducción con el fin de mejorar la asistencia sanitaria. El estudio se ha considerado altamente recomendable cuando la prueba diagnóstica es relevante para la toma de decisiones, moderada cuando estas han mostrado un resultado poco consistente y baja, cuando el beneficio de la prueba es incierto. Con la indicación de estas recomendaciones obtendremos una información relevante para el diagnóstico, pronóstico y tratamiento de la pareja con disfunción en la reproducción

In this article several members of diverse scientific associations and reproduction experts from Spain have updated different genetic and immunological procedure recommendations in couples affected by reproductive dysfunction with the goal of providing a set of useful guidelines for the clinic. The laboratory test has been considered as highly recommendable for making clinical decisions when the result of the diagnostic test is relevant, moderately recommendable when the results are of limited evidence because they are inconsistent, and low when the benefit of the test is uncertain. It is expected that these recommendations will provide some useful guidelines for the diagnosis, prognosis and treatment of couples presenting reproductive dysfunction

Estado actual del diagnóstico del síndrome antifosfolipídico / No disponible

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Intestinal IgA positive lymphocytes in acute liver necrosis decrease due to lymphocyte homing disturbance and apoptosis

Aim: the number of intestinal IgA+ lymphocytes are decreased in acute liver necrosis and the mechanism remains poorly understood. The purpose of this study was to observe the role of lymphocyte homing and apoptosis associated with decreased intestinal IgA positive lymphocytes in acute liver necrosis. Methods: the acute liver necrosis mouse model and LTßR pre-treatment were used to assess intestinal mucosal addressin cell adhesion molecule-1 (MAdCAM - 1) expression, cell apoptosis, IgA+ cells and secretory immunoglobulin A (SIgA). Results: MAdCAM - 1 mRNA and protein expression decreased significantly in the acute necrosis group; 0.57 ± 0.032 fold vs. baseline (p < 0.05) and 0.45 ± 0.072 fold vs. baseline (p < 0.05), respectively. LTßR pre-treatment could significantly improve the decline of MAdCAM - 1 mRNA and protein expression in the intestinal mucosa (1.83 ± 0.064 fold vs. baseline, p < 0.05 and 1.75 ± 0.046 fold vs. baseline, p < 0.05, respectively) and partially restore the decline in IgA+ lymphocytes and SIgA levels. There were increased rates of enterocyte apoptosis in both the acute liver necrosis and LTßR pre-treatment group; 0.79% vs. control (p < 0.05) and 0.77% vs. control (p < 0.05), respectively). Conclusion: our results suggest that the dysfunction of lymphocyte homing and apoptosis are both involved with decreased intestinal IgA+ lymphocytes in acute liver necrosis. LTßR pre-treatment can partially restore IgA+ cells and SIgA by increasing MAdCAM - 1 expression, rather than inhibiting lymphocyte apoptosis

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Detection of egg and milk residues on work surfaces in school canteens in the Hortaleza District, Madrid and their relevance to children with allergy to these food groups

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Un nuevo paradigma en la práctica de la Patología: la moderna Inmuno-Oncopatología / Modern Immuno-oncology: a new paradigm in Pathology

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Taller de GECLID: Determinación de CD25 soluble en suero / No disponible

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Is eosinophilic esophagitis an equivalent of pollen allergic asthma? Analysis of biopsies and therapy guided by component resolved diagnosis

Background: Eosinophilic esophagitis (EoE) is characterized by esophageal dysfunction and, histologically, by eosinophilic inflammation. There is not a clear etiologic treatment. Biopsies analysis using plant histology methods may show callose and pollen tubes in the esophageal mucosa. Component-resolved diagnosis (CRD) with microarrays could detect possible allergens involved and indicate an elimination diet and allergen immunotherapy (AIT). Methods: One hundred and twenty-nine patients with EoE were tested for environmental and food allergens. CRD, histological and botanical analysis were performed. Clinical scores and endoscopic biopsy were performed every six months for three years. Fifty healthy patients, 50 asthmatics due to pollen, and 53 celiac disease patients were included as comparison groups. CRD-directed AIT was administered in 91 EoE patients and elimination diet in 140 patients (87 EoE and all 53 CD patients). Results: CRD detected allergen hypersensitivity in 87.6% of patients with EoE. The predominant allergens were grass group 1 (55%), lipid transfer proteins (LTP) of peach and mugwort, hazelnuts and walnuts. Callose from pollen tubes was found in 65.6% of biopsies. After CRD-guided elimination diet and/or AIT, 101 (78.3%) EoE patients showed significant clinical improvement (p < 0.017) and 97 (75.2%) were discharged (negative biopsy, no symptoms, no medication) without relapse (AU)

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Fast protocol for the production of Histoplasma capsulatum antigens for antibody detection in the immunodiagnosis of histoplasmosis / Protocolo rápido de producción de antígenos de Histoplasma capsulatum para la detección de anticuerpos en el inmunodiagnóstico de la histoplasmosis

Background. Current methods for the production of Histoplasma capsulatum antigens are problematic in terms of standardization, specificity, stability, repeatability and reproducibility. Aims. In this study, we sought to optimize the methodology for producing H. capsulatum antigens, and to evaluate its applicability. Methods. Antigenic preparations obtained from 12 H. capsulatum isolates were evaluated by double immunodiffusion and immunoblotting assays against homologous and heterologous sera. Results. The evaluated and optimized protocol allowed a more stable production, as well as repeatable, reproducible, with shorter culture time and less costly. By double immunodiffusion and immunoblotting assays, the best pattern of reactivity was observed for antigens obtained with 33 days of culture from the isolates 200 and 406 against the M antigen and for the isolate 200 with 15 days against H antigen. The SDS-PAGE presented antigenic components of molecular masses between 17 and 119kDa. The immunoblotting sensitivity was 95.5% and 100% with histoplasmosis sera from ill patients and sera from H. capsulatum infected but otherwise healthy patients, respectively, to the antigen derived from isolates 200 and 406. Conclusions. We suggest the employment of the antigen from isolate 200, with 15 or 30 days of culture, in the double immunodiffusion and immunoblotting assays due to its good ability to discriminate both sera from patients with histoplasmosis illness and histoplasmosis infection, in addition to its high specificity against heterologous sera (AU)

Antecedentes. Los métodos actuales para la producción de antígenos de Histoplasma capsulatum son problemáticos en términos de estandarización, especificidad, estabilidad, repetitividad y reproducibilidad. Objetivos. En este estudio se buscó optimizar la metodología para la producción de antígenos y evaluar su aplicabilidad. Métodos. Las preparaciones antigénicas obtenidas de 12 cepas de H. capsulatum se evaluaron por doble inmunodifusión en gel de agar e inmunotransferencia frente a sueros homólogos y heterólogos. Resultados. El protocolo evaluado y optimizado permitió mayor sensibilidad en la producción, más estabilidad, repetitividad y reproducibilidad con menos tiempo de cultivo y menor coste. Los mejores patrones de reactividad por inmunodifusión en gel de agar e inmunotransferencia se observaron en el antígeno M obtenido tras 33 días de cultivo de las cepas 200 y 406, y en el antígeno H de la cepa 200 tras 15 días de cultivo. Con la técnica SDS-PAGE se separaron componentes antigénicos de masas moleculares entre 17 y 119kDa. La sensibilidad de la inmunotransferencia fue del 95,5% y del 100% con sueros obtenidos de pacientes con enfermedad y con sueros de pacientes infectados, pero sanos, respectivamente, con antígenos derivados de las cepas 200 y 406. Conclusiones. Sugerimos el empleo del antígeno de la muestra 200, con 15 o 30 días de cultivo, en los ensayos de doble inmunodifusión en gel e inmunotransferencia debido a su buena capacidad para discriminar los sueros de pacientes enfermos de histoplasmosis y los de pacientes portadores sanos, además de su elevada especificidad frente a sueros heterólogos (AU)

Los tests rápidos reducen la carga asociada a la tuberculosis en las prisiones de Azerbaiyán: importancia de la resistencia a rifampicina / Rapid tests reduce the burden of tuberculosis in Azerbaijan prisons: special emphasis on rifampicin-resistance

Objetivos: Evaluar el impacto de los tests rápidos para tuberculosis (TB) añadidos a los sistemas de cribado y de búsqueda pasiva de casos en la carga de enfermedad de TB en centros penitenciarios con alta incidencia de la misma en Azerbaiyán. Material y métodos: Inclusión retrospectiva de todos los casos nuevos y recurrentes de TB notificados desde el 1 de enero de 2009 hasta el 31 de diciembre de 2015. Resultados: Se identificaron un total de 2315 pacientes en 19 centros penitenciarios diferentes. Se implementaron los tests rápidos a los algoritmos de identificación de casos con la consiguiente reducción en las tasas anuales de los casos de TB notificados, los casos de baciloscopia positiva y los de TB resistente a la rifampicina (a una tercera, décima y quinta parte respectivamente). Tras la introducción de los tests rápidos en los algoritmos de cribado se observó una tendencia lineal significativa a la reducción de los casos notificados (p=0,009), los casos de baciloscopia positiva (p=0,011) y los de TB resistente a la rifampicina (p=0,02) con tasas anuales de reducción (con intervalo de confianza al 95%) de -432 (-614;-255), -356 (-517; -195) y -99 (-160;-38) respectivamente. La utilización de los tests rápidos también se tradujo en un incremento significativo del éxito terapéutico con fármacos de primera línea en todos los casos: los detectados por cribado y los identificados por búsqueda pasiva [odds ratio ajustado (Ora)= 2.38, IC95% 1,86-3,05; ORa=4,56, IC 95%:2,64-7,89 y ORa=2,60, IC 95% :1,81-3,75, respectivamente]. Conclusiones: La introducción de los tests rápidos en los sistemas de cribado de TB conllevan reducciones en la carga de enfermedad y en la resistencia a rifampicina con mejores resultados terapéuticos con fármacos de primera línea en centros penitenciarios

Aims: To evaluate the impact of addition of rapid tests for tuberculosis (TB) to mass screening and passive case finding on the burden of TB in high-incidence prisons of Azerbaijan. Materials and methods: All new and relapse TB cases notified in 01.01.2009-31.12.2015 were retrospectively included. Results: 2,315 TB patients were identified in 19 prisons. Implementation of the rapid tests to the case finding algorithms lead to 3-, 10- and 5-fold decrease in the annual rates of the notified, smear-positive and RIF-resistant TB cases, respectively. After introduction of rapid tests into the screening algorithms, there were significant linear trends towards decrease in the notified (p=0.009), smear-positive (p=0.011) and RIF-resistant TB cases (p=0.02) with the annual rates of decrease (95% confidence interval (CI)) being -435 (-614; -255), -356 (-517; -195), and -99 (-160; -38), respectively. Utilization of rapid tests also significantly increased treatment success with first-line drugs among all cases, cases detected by mass screening and those, detected by passive case finding [adjusted odds ratio (aOR)=2.38, 95% CI:1.86-3.05, aOR=4.56, 95% CI:2.64-7.89 and aOR=2.60, 95% CI:1.81-3.75, respectively]. Conclusions: Introduction of rapid tests into the screening lead to decline in the burden of TB and RIF-resistance, and improved outcomes of treatment with first-line drugs in prisons

Alergólogica 2015: a national survey on allergic diseases in the Spanish pediatric population

Background: Allergic diseases are highly prevalent in industrialized populations. In Spain, children suspected of having an allergic disease are usually referred by their primary care pediatrician to an allergy unit at a general hospital or a children’s hospital. We report data from a subanalysis of the pediatric population in Alergológica 2015. Methods: Data were collected from pediatric patients (age, ≤14 years) consulting an allergist for the first time in 2014 and the first quarter of 2015 in order to determine variations compared with data reported in Alergólogica 2005. Results: Alergológica 2015 included fewer pediatric patients than Alergológica 2005. The study population comprised 481 patients aged ≤14 years from more than 200 centers throughout Spain. Males accounted for 56.5%. Rhinoconjunctivitis was the main reason for consulting an allergist (53.8% vs 46.3% in 2005), followed by asthma (30.2% vs 34.6%), and food allergy (20.0% vs 14.5%). Conclusions: The findings of Alergológica 2015 show a notable increased frequency of allergic rhinitis, drug allergy, and food allergy. The frequency of other allergic conditions remained unchanged, except for asthma, whose frequency decreased, as in adult patients

Antecedentes: Las enfermedades alérgicas son muy prevalentes en las poblaciones industrializadas. En España, los niños con sospecha de enfermedad alérgica son habitualmente derivados por su médico de atención primaria a una unidad de alergia de un hospital general o de un hospital infantil. Se notifican los datos del subanálisis de la población pediátrica de Alergológica 2015. Métodos: Se recogieron los datos de los pacientes pediátricos (edad ≤ 14 años) que acudieron al alergólogo por primera vez en 2014 y el primer trimestre de 2015 con el objetivo de determinar las variaciones con respecto a los datos de Alergológica 2005. Resultados: Alergológica 2015 incluyó menos pacientes pediátricos que Alergológica 2005. La población estudiada comprendía 481 pacientes de edad ≤14 años, de más de 200 centros españoles. Los varones representaron el 56,5%. La rinoconjuntivitis fue el principal motivo de consulta al alergólogo (53,8% frente a 46,3% en 2005), seguida del asma (30,2% frente a 34,6%) y la alergia alimentaria (20,0% frente a 14,5%). Conclusiones: Los hallazgos de Alergológica 2015 muestran un aumento notable de la frecuencia de la rinitis alérgica, la alergia a fármacos y la alergia alimentaria. La frecuencia de otras afecciones alérgicas permaneció inalterada, excepto para el asma, cuya frecuencia disminuyó, al igual que en los pacientes adultos

Safety and Quality Recommendations in Allergy Medicine (Spanish acronym, RESCAL)

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