Detection of Plasmodium spp. in asymptomatic blood donors by the new Brazilian NAT PLUS HIV/HBV/HCV/Malaria Bio-Manguinhos kit.

BACKGROUND: Transfusion-transmitted malaria (TTM) is a public health problem in endemic and nonendemic areas. The Brazilian Ministry of Health (MH) requested the development of a nucleic acid amplification test (NAT) for the detection of Plasmodium spp. in public blood centers to increase blood safety. STUDY DESIGN AND METHODS: The new Brazilian NAT kit named NAT PLUS HIV/HBV/HCV/Malaria Bio-Manguinhos was first implemented in HEMORIO, a public blood center in the city of Rio de Janeiro. Since October 1, 2022, this blood center has been testing all its blood donations for malaria in a pool of six plasma samples to detect Plasmodium spp. by real-time polymerase chain reaction (PCR). RESULTS: Since the implementation of the NAT PLUS platform until February 2023, HEMORIO has successfully received and tested 200,277 donations. The platform detected two asymptomatic donors in the city of Rio de Janeiro, which is a nonendemic region for malaria. Our analyses suggested a malaria from the Amazon region caused by Plasmodium vivax, in the first case, while an autochthonous transmission case by Plasmodium malariae was identified in the rural area of Rio de Janeiro state. DISCUSSION: The NAT PLUS platform detects Plasmodium spp. in plasma samples with sensitivity capable of detecting subpatent infections. This is the first time worldwide that a group developed and implemented molecular diagnosis for Plasmodium spp. to be used by public blood centers to avoid TTM.

Use of a NAT-based assay to improve the surveillance system and prevent transfusion-transmitted malaria in blood banks.

BACKGROUND: Malaria can be transmitted by blood transfusion through donations collected from asymptomatic donors. Transfusion-transmitted malaria (TTM) poses a great risk to blood services worldwide. A good screening tool for Plasmodium spp. detection in blood banks must have a high sensitivity for prevention of TTM. However, in Brazilian blood banks, screening for malaria still relies on microscopy. METHODS: In Brazil, screening for human immunodeficiency virus type 1 (HIV), RNA/DNA for hepatitis C (HCV) and hepatitis B (HBV) viruses is mandatory for every blood donation and uses nucleic acid amplification testing (NAT). The aim of this study was to evaluate the inclusion of an assay for malaria to identify Plasmodium sp. from total nucleic acid (TNA; DNA/RNA) by targeting the 18S rRNA gene of the parasite. RESULTS: Considering the limitations of microscopy and the wide availability of the Brazilian NAT platform in the screening of blood units for HIV, HCV, and HBV, a molecular diagnostic tool was validated for detection of Plasmodium sp. in blood banks; a pilot study showed that using this novel NAT assay could reduce the risk of TTM. CONCLUSION: The prototype HIV/HCV/HBV/malaria NAT assay was effective in detecting infected candidate donors and has good prospects to be applied in routine screening for preventing TTM.

Correction to: Use of a NAT-based assay to improve the surveillance system and prevent transfusion-transmitted malaria in blood banks.

An amendment to this paper has been published and can be accessed via the original article.

Increase in the expression of CD4 + CD25+ lymphocytic T cells in the indeterminate clinical form of human Chagas disease after stimulation with recombinant antigens of Trypanosoma cruzi.

PURPOSE: Regulatory T cells are involved in the clinical course of chronic Chagas disease, possibly because they exercise a control in the patient's inflammatory response to Trypanosoma cruzi. This study analyzed the levels of CD4 + CD25+ T cells in chronic Chagas disease patients after in vitro stimulation of the peripheral blood mononuclear cells with CRA (Cytoplasmic Repetitive Antigen) or FRA (Flagellar Repetitive Antigen) T. cruzi antigens. METHODS: Groups of patients with the cardiac form and indeterminate form; and non-infected individuals, were selected. The CD4 + CD25+ T lymphocyte population, as well as the FoxP3 expression and the IL10 production, were evaluated by flow cytometry after stimulation with CRA or FRA. RESULT: The IND group presented higher levels of CD4 + CD25+ T cells than the CARD group. However, there was no evidence of a relationship between FoxP3 and IL10 with any of the chronic forms. CONCLUSIONS: Our results suggest the possible involvement of CD4 + CD25+ T cells specific to CRA and FRA in controlling the progression of clinical outcomes. Though, further studies are needed to define which mechanisms activate regulatory T cells and lead to pathology control in chronic human Chagas disease.

Correction: High accuracy of an ELISA test based in a flagella antigen of Leishmania in serodiagnosis of canine visceral leishmaniasis with potential to improve the control measures in Brazil-A Phase II study.

[This corrects the article DOI: 10.1371/journal.pntd.0006871.].

High accuracy of an ELISA test based in a flagella antigen of Leishmania in serodiagnosis of canine visceral leishmaniasis with potential to improve the control measures in Brazil - A Phase II study.

BACKGROUND: Canine Visceral leishmaniasis (CVL) is a serious public health problem, thus for its control, the Ministry of Health in Brazil recommends the rapid diagnosis and euthanasia of seropositive dogs in endemic areas. Therefore, our group had previously selected six recombinant proteins (rLci1, rLci2, rLci4, rLci5, rLci8, and rLci12) due to their high potential for CVL diagnostic testing. The present study aims to produce an immunodiagnostic test using the aforementioned antigens, to improve the performance of the diagnosis of CVL recommended by Brazilian Ministry of Health. METHODOLOGY/PRINCIPAL FINDINGS: To evaluate the recombinant proteins in the serological assays, positive and negative samples were selected based on parasitological test (culture) and molecular test (qPCR) of splenic aspirate. Initially, we selected 135 dog serum samples, 73 positives (symptomatic and asymptomatic) and 62 negatives to screen recombinant proteins on ELISA platform. Then, for rLci5 ELISA validation, 361 serum samples collected in a cross-sectional study were selected, being 183 positives (symptomatic and asymptomatic) and 178 negatives. In the screening of the recombinant proteins, rLci5 was the only protein to present a performance statistically higher than the performance presented by EIE-LVC test, presenting 96% (IC 95%; 85-99%) vs. 83% (IC 95%; 69-92%) of sensitivity for symptomatic dogs, 71% (IC 95%; 49-97%) vs. 54% (IC 95%; 33-74%) for asymptomatic dogs and 94% (IC 95%; 83-99%) vs, 88% (IC 95%; 76-95% of specificity. Thus, the rLci5 protein was selected to compose a final ELISA test. Validation of rLci5 ELISA showed 87% (IC 81-91%) of sensitivity, 94% (IC 95%; 90-97%) of specificity and 90% accuracy. Testing the EIE-LVC with the same validation panel, we observed a lower performance when compared to ELISA rLci5 (sensitivity of 67% (IC 95%; 59-74%), specificity of 87% (IC 95%; 81-92%), and accuracy of 77%). Finally, the performance of current CVL diagnostic protocol recommended by Brazilian Ministry of Health, using DPP-LVC as screening test and EIE-LVC as confirmatory test, was compared with a modified protocol, replacing EIE-LVC by rLci5 ELISA. The current protocol presented a sensitivity of 59% (IC 95%; 52-66%), specificity of 98% (IC 95%; 95-99%) and accuracy of 80% (IC 95%; 76-84%), while the modified protocol presented a sensitivity of 71% (IC 95%; 63-77%), specificity of 99% (IC 95%; 97-100%) and accuracy of 86% (IC 95%; 83-89%). CONCLUSION: Thus, we concluded that rLci5 ELISA is a promising test to replace EIE-LVC test and increase the diagnostic performance of CVL in Brazil.

[Hematological and histopathological evaluation of BALB/c and C57BL/6 mice exposed to Cytoplasmic Repetitive Antigen and Flagellar Repetitive Antigen recombinant antigens of Trypanosoma cruzi]. / Avaliação hematológica e histopatológica de camundongos BALB/c e C57BL/6 expostos aos antígenos recombinantes Cytoplasmic Repetitive Antigen e Flagellar Repetitive Antigen de Trypanosoma cruzi.

The Cytoplasmic Repetitive Antigen and Flagellar Repetitive Antigen recombinant antigens of Trypanosoma cruzi were inoculated into BALB/c and C57BL/6 mice and its effects evaluated at hematological and histopathological levels. The results showed that the histological pattern of the organs and the hematological profile of mice were not modified suggesting that these antigens are not harmful for the animal.

Avaliação hematológica e histopatológica de camundongos BALB/c e C57BL/6 expostos aos antígenos recombinantes Cytoplasmic Repetitive Antigen e Flagellar Repetitive Antigen de Trypanosoma cruzi / Hematological and histopathological evaluation of BALB/c and C57BL/6 mice exposed to Cytoplasmic Repetitive Antigen and Flagellar Repetitive Antigen recombinant antigens of Trypanosoma cruzi

Os antígenos recombinantes Cytoplasmic Repetitive Antigen e Flagellar Repetitive Antigen de Trypanosoma cruzi foram inoculados em camundongos BALB/c e C57BL/6 e o seu efeito avaliado a nível hematológico e histopatológico. Os resultados mostraram que o padrão histológico normal dos órgãos e o perfil hematológico dos camundongos não foram modificados sugerindo que esses antígenos não parecem causar dano ao animal.

Processo de transferência da tecnologia de produção do teste rápido de HIV-1 e HIV-2 em Bio-Manguinhos: um modelo para a incorporação de novas tecnologias / Process of transferring production technology of rapid test for HIV-1 and HIV-2 from Bio-Manguinhos: a model for the incorporation of new technologies

Nesta dissertação apresentamos o modelo utilizado pelo Instituto de Tecnologia em Imunobiológicos, Bio-Manguinhos, Fiocruz, para absorver uma nova tecnologia de produção de reativos para diagnóstico, de alta complexidade (imunocromatografia e fluxo lateral) e estratégico para a área de saúde de nosso país. Inicialmente, porque permitirá a produção de um Kit de diagnóstico (Teste Rápido HIV-1/2 – Bio-Manguinhos), de alto impacto social, indispensável para ampliar as ações de saúde pública em DST/Aids e, em seguida porque será capaz de democratizar o diagnóstico da infecção pelo HIV no Brasil. A absorção desta nova tecnologia redundará em uma economia de divisas para o Brasil com a consequente interrupção de grandes compras de Kits importados, além de gerar um potencial a ser futuramente usado no desenvolvimento e produção de Kits para o diagnóstico de outras importantes enfermidades que acometem a população brasileira, com baixo custo. Finalmente, devido às repercussões positivas em outros setores relacionados à produção, melhorando e fortalecendo a área de Reativos para Diagnóstico de Bio-Manguinhos. Estes são argumentos significativos para a implementação deste projeto baseado em transferência de tecnologia. Bio-Manguinhos estabeleceu as articulações necessárias junto ao Ministério da Saúde, especialmente junto ao PNDST/Aids, utilizando a demanda do setor público brasileiro, por um período de três anos, como contrapartida nas negociações com a empresa cedente da tecnologia, evitando, desta forma, qualquer gasto adicional de recursos públicos para absorver as referidas tecnologias. A Aids, ou SIDA, ainda é um dos maiores problemas de saúde pública no mundo, apresentando números absolutamente alarmantes – cerca de 40 milhões de pessoas infectadas pelo HIV, 5 milhões de novos casos por ano e 3,5 milhões de óbitos em 2004. No Brasil, apesar de ser adotada uma boa política de assistência e tratamento, que vem sendo citada como exemplo no mundo inteiro, ainda convivemos com uma epidemia que continua a se alastrar em ritmo preocupante, com estimativa de 600.000 brasileiros infectados. Atualmente, estamos presenciando uma revolução científica e tecnológica impar e, neste contexto, Bio-Manguinhos vem tendo como missão contribuir para a melhoria dos padrões de saúde pública brasileira, através da pesquisa tecnológica e da produção de imunobiológicos necessários para atender à demanda gerada pelo quadro epidemiológico do país. Assim, esta Instituição vem investindo, intensamente, em projetos de pesquisa e desenvolvimento (P e D), bem como na aquisição e incorporação de novas tecnologias para a produção, em escala industrial, de produtos capazes de suprir as demandas dos programas nacionais de saúde pública do Ministério da Saúde. Neste contexto, vem seguindo as tendências na área de Reativos para Diagnóstico Laboratorial que estão voltadas, principalmente, para uma melhor orientação da conduta terapêutica com diagnósticos mais precisos, diferenciais e mais precoces na detecção das doenças, maior rapidez nos resultados e realização dos testes afins nos próprios locais de atendimento de pacientes.