Relationship between serum lipopolysaccharide binding protein levels, disease activity, and clinical characteristics in Paraguayan patients with systemic lupus erythematosus.

INTRODUCTION: Systemic exposure to bacterial components like lipopolysaccharide (LPS) is among the non-genetic factors that could be involved in the onset or progression of systemic lupus erythematosus (SLE). Lipopolysaccharide-binding protein (LBP) participates in the recognition of LPS and in the inflammatory response. Here, we investigated LBP in SLE patients and its relationship with disease activity and SLE phenotypes. METHODS: Eighty-one adult patients with SLE from IMID-PY biobank (Paraguay) were included in the study. The clinical and laboratory variables were used to determine SLE activity. LBP levels were determined by ELISA in SLE patients and age- and sex-matched population-based controls. RESULTS: Patients with SLE have lower levels of circulating LBP compared to healthy controls (p = 0.0007). No significant correlation was found between serum LBP levels and disease activity. A significant difference was observed in LBP levels with regard to the presence of arthritis (p = 0.026). No other relation was found with clinical parameters. CONCLUSIONS: We found low levels of LBP in SLE patients compared to the control group. No correlation was detected between LBP levels and disease activity. It would be interesting for future studies to evaluate the impact of low levels of LBP on lupus immunopathogenesis.

Characterization of dengue cases among patients with an acute illness, Central Department, Paraguay.

BACKGROUND: In 2018, Paraguay experienced a large dengue virus (DENV) outbreak. The primary objective of this study was to characterize dengue cases in the Central Department, where the majority of cases occur, and identify factors associated with DENV infection. METHODS: Patients were enrolled from January-May 2018 if they presented with a suspected arboviral illness. Acute-phase specimens (≤8 days after symptom onset) were tested using rRT-PCR, a rapid diagnostic test for DENV nonstructural protein 1 (NS1) and anti-DENV IgM and IgG, and ELISA for IgG against NS1 from Zika virus (ZIKV). RESULTS: A total of 231 patients were enrolled (95.2% adults) at two sites: emergency care and an outpatient clinical site. Patients included 119 (51.5%) dengue cases confirmed by rRT-PCR (n = 115, 96.6%) and/or the detection of NS1 and anti-DENV IgM (n = 4, 3.4%). DENV-1 was the predominant serotype (109/115, 94.8%). Epidemiologically, dengue cases and non-dengue cases were similar, though dengue cases were less likely to reside in a house/apartment or report a previous dengue case. Clinical and laboratory findings associated with dengue included red eyes, absence of sore throat, leucopenia and thrombocytopenia. At an emergency care site, 26% of dengue cases (26/100) required hospitalization. In univariate analysis, hospitalization was associated with increased viral load, anti-DENV IgG, and thrombocytopenia. Among dengue cases that tested positive for IgG against ZIKV NS1, the odds of DENV NS1 detection in the acute phase were decreased 10-fold (OR 0.1, 0.0-0.3). CONCLUSIONS: Findings from a predominantly adult population demonstrate clinical and laboratory factors associated with DENV infections and the potential severity of dengue in this group. The combination of viral load and specific IgG antibodies warrant further study as a prognostic to identify patients at risk for severe disease.

[Implementation and evaluation of a locally sustainable system of prenatal diagnosis to detect cases of congenital Chagas disease in endemic areas of Paraguay]. / Implementación y evaluación de un sistema localmente sustentable de diagnostico prenatal que permite detectar casos de transmisión congénita de la enfermedad de Chagas en zonas endémicas del Paraguay.

A locally sustainable system of prenatal screening of Trypanosoma cruzi infection has been implemented in rural health care centers of endemic areas in Paraguay A total of 61.091 women from Paraguari and Cordillera Departments were serologically evaluated, where 7.802 (12,7%) resulted to be anti-T. cruzi IgG positive. A total of 1,865 infants born to seropositive mothers were examined by parasitological techniques, such as direct microscopic observation and polymerase chain reaction, and serologically by ELISA, ELISA-SAPA and IFI. 104 infected babies were detected and treated with benznidazole. The recovery of babies born to seropositive mothers performing a single examination at the age of 6 months was significantly higher, as compared with the recommended method involving two examinations, both at birth and after 6 months of age. Although at 6 months of age in 7% of the infants maternal IgG was still detected. PCR was the most sensitive technique for early detection of T. cruzi infection in babies, but we do not recommend it use for diagnosis in high endemic areas, considering that for the screening of 815 babies, 2000 reactions were needed. We propose a strategy to detect congenital transmission of Chagas disease, based on a large-scale study, where the shortcomings of the different serological and parasitological techniques are discussed.

Perfil antigénico en fase aguda y crónica de toxoplasmosis en embarazadas por la técnica de Western Blot / Antigenic profile in the acute and chronic phase of toxoplasmosis in pregnant women using the Western Blot technique

La toxoplasmosis es una enfermedad endémica con prevalencia mundial variable, cuyo agente causal es el parásito Toxoplasma gondii. Para un diagnóstico certero de la infección por T. gondii son necesarias combinaciones de métodos serológicos. Estudios recientes han reportado que la técnica de Western Blot permite evidenciar proteínas antigénicas como marcadores de la infección, así como ciertos perfiles proteicos como posibles indicadores de las fases de la infección, aguda y crónica. El objetivo del estudio fue identificar el perfil antigénico específico asociado a las diferentes fases de la toxoplasmosis. Fueron incluidos en el estudio 55 sueros de embarazadas con toxoplasmosis, diferenciados en fase aguda y crónica de la enfermedad por medio del método de ELISA de Avidez de IgG. Mediante el método de Western Blot se observó que las proteínas antigénicas p35, p43, p45, p56 y p107 fueron reconocidas por el 20- 60% de los sueros de pacientes en fase aguda, mientras que p65, p95, p98 y p113 fueron reconocidas por el 17-35% de sueros de pacientes en fase crónica. Se observó que seis proteínas antigénicas, p32, p38, p41, p48, p59 y p72, fueron reconocidas por más del 60% de los sueros de pacientes tanto en fase aguda como crónica. Los resultados obtenidos sugieren que estas seis proteínas podrían ser consideradas como marcadores diagnósticos de la enfermedad(AU)

Toxoplasmosis is an endemic disease with variable global prevalence, being the causative agent the parasite Toxoplasma gondii. For an accurate diagnosis of a T. gondii infection, combinations of serological methods are required. Recent studies have reported that the Western Blot technique allows the detection of antigenic proteins as markers of infection, as well as certain protein profiles as possible indicators of acute and chronic phases of infection. The objective of the study was to identify the specific antigenic profile associated with different phases of toxoplasmosis. Fifty five sera from pregnant women with toxoplasmosis were included in the study, differentiated in acute and chronic phase of the disease by an IgG Avidity ELISA. By using the Western Blot method it was observed that antigenic proteins p35, p43, p45, p56 and p107 were recognized by 20-60% of sera from patients in acute phase, while p65, p95, p98 and p113 were recognized by 17-35% of sera from patients in chronic phase. It was observed that six antigenic proteins, p32, p38, p41, p48, p59 and p72, were recognized by more than 60% of sera from patients in both acute and chronic phases. The results obtained in this study suggest that these six proteins could be considered as diagnostic markers of the disease(AU)