Serologic Screening for Genital Herpes Infection: US Preventive Services Task Force Reaffirmation Recommendation Statement.

Importance: Genital herpes is a common sexually transmitted infection caused by 2 related viruses, herpes simplex type 1 (HSV-1) and herpes simplex type 2 (HSV-2). Infection is lifelong; currently, there is no cure for HSV infection. Antiviral medications may provide clinical benefits to symptomatic persons. Transmission of HSV from a pregnant person to their infant can occur, most commonly during delivery; when genital lesions or prodromal symptoms are present, cesarean delivery can reduce the risk of transmission. Neonatal herpes infection is uncommon yet can result in substantial morbidity and mortality. Objective: To reaffirm its 2016 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a reaffirmation evidence update on targeted key questions to systematically evaluate the evidence on accuracy, benefits, and harms of routine serologic screening for HSV-2 infection in asymptomatic adolescents, adults, and pregnant persons. Population: Adolescents and adults, including pregnant persons, without known history, signs, or symptoms of genital HSV infection. Evidence Assessment: The USPSTF concludes with moderate certainty that the harms outweigh the benefits for population-based screening for genital HSV infection in asymptomatic adolescents and adults, including pregnant persons. Recommendation: The USPSTF recommends against routine serologic screening for genital HSV infection in asymptomatic adolescents and adults, including pregnant persons. (D recommendation).

Pilot Study Using Recombinant Antigens r-PROE and r-IGLL1 for the Serodiagnosis of Feather Duvet Lung.

BACKGROUND: Feather duvet lung (FDL) is an underestimated form of acute and chronic hypersensitivity pneumonitis. Serological tests for FDL need to be validated. We investigated the ability of recombinant pigeon Proproteinase E (r-PROE) and Immunoglobulin-lambda-like-polypeptide-1 (r-IGLL1) proteins to support the serological diagnosis of FDL, and propose them as a serological tool for clinicians to differentiate cases from FDL and Bird fancier's lung (BFL). METHODS: Specific IgG antibodies against r-PROE and r-IGLL1, analyzed with ELISA, were measured in patients diagnosed with FDL (n=31), BFL (n=15) controls exposed (n=15) and unexposed to feathers (n=15). RESULTS: The sensitivity and specificity of the r-PROE ELISA for the serological diagnosis of FDL cases versus exposed and unexposed controls were 74.2% and 86.7% respectively, with an index threshold of 0.5 (AUC: 0.89). In addition, this serological test was effective to support the serological diagnosis of FDL and BFL cases with significantly different thresholds. The r-IGLL1 ELISA was only effective for the serological diagnosis of BFL. Also, these two serological tests were useful for the diagnosis of both chronic and acute forms. CONCLUSIONS: The new diagnostic test for FDL using r-PROE protein should help to detect overt and hidden cases of FDL. The combination of both test will help the clinician in distinguish between the etiology of birds or feathers duvet.

Helicobacter pylori infection in subjects negative for high titer serum antibody.

AIM: To investigate the clinicopathological features of the patients testing negative for high titer serum anti-Helicobacter pylori (H. pylori) antibody. METHODS: The antibody titers were measured using antigens derived from Japanese individuals. 13C-urea breath test-positive individuals were defined as having H. pylori infection. We investigated the demographic characteristics, laboratory data, endoscopic findings including Kyoto classification of gastritis, and histology in negative-high titer patients without H. pylori eradication therapy. Kyoto classification consisted of scores for gastric atrophy, intestinal metaplasia, enlarged folds, nodularity, and redness. RESULTS: Of the 136 subjects enrolled, 23 (17%) had H. pylori infection. Kyoto classification had an excellent area under the receiver operating characteristics curve (0.886, 95% confidence interval: 0.803-0.968, P = 3.7 × 10-20) for predicting H. pylori infection with a cut-off value of 2. Further, Kyoto classification, H. pylori density, and neutrophil activity had high accuracies (89.7%, 96.3%, and 94.1%, respectively). Kyoto classification was independent of the demographic and laboratory parameters in multivariate analysis. CONCLUSION: Endoscopic Kyoto classification of gastritis is a useful predictor of H. pylori infection in negative-high titer antibody patients.

Screening for transfusion transmissible infections using rapid diagnostic tests in Africa: a potential hazard to blood safety?

Rapid diagnostic tests (RDTs) are routinely used in African blood centres. We analysed data from two cross-sectional studies representing 95 blood centres in 29 African countries. Standardized panels of sera containing varying concentrations of anti-human immunodeficiency virus (HIV) antibodies (Ab), hepatitis B virus antigen (HBsAg) and antihepatitis C virus (HCV) Ab were screened using routine operational testing procedures at the centres. Sensitivity of detection using RDTs was high for HIV Ab-positive samples, but low for intermediately HBsAg (51·5%) and HCV Ab (40·6%)-positive samples. These findings suggest that current RDT use in Africa could pose a hazard to blood safety.

Avaliação de antígenos recombinantes pré-selecionados de leishmania infantum quanto à reatividade a soros de cães vacinados / Evaluation of pre-selected recombinant antigens of Leishmania infantum as the reactivity to sera from vaccinated dogs

A leishmaniose visceral (LV) é atualmente um grande problema de saúde pública, tendo o cão como seu principal reservatório em áreas urbanas. O controle da enfermidade é baseado no diagnóstico e eutanásia de cães infectados por Leishmania infantum que apresentam soropositividade para infecção. Como tentativa de conter o aumento do número de casos de LV canina (LVC), duas vacinas comerciais vêm sendo empregadas como medida de controle. Os testes diagnósticos preconizados pelo Ministério da Saúde no Brasil para identificação da infecção em cães é o teste sorológico rápido (DPPLVC ©) como triagem e ELISA (EIA-Biomanguinhos) como confirmatório. Estes métodos não foram desenvolvidos para diferenciar cães vacinados e infectados. Assim, animais que se tornam sorologicamente positivos em razão da vacinação podem vir a ser eutanasiados. Sete antígenos recombinantes foram previamente selecionados a partir de bibliotecas de cDNA e DNA utilizando soros de homens e cães infectados por L. infantum e foram empregados no presente estudo para terem sua reatividade testada contra soros de animais vacinados, utilizando o teste de triagem multi antigen print imunoassay (MAPIA)...

Visceral leishmaniasis is currently a major public health problem, and the dog the main reservoir in urban areas. The control of the disease is based on the diagnosis and euthanasia of all Leishmania infantum-infected dogs showing seropositivity to infection. In attempt to contain the increase in the number of cases of canine visceral leishmaniasis (CVL), two commercial vaccines have been employed as a measure of prophylaxis. The diagnostic tests recommended by the Brazilian Ministry of Health to identify the infection in dogs are the rapid test DPP-LVC© for screening and EIABiomanguinhos to confirm. Serological methods currently used are not able to differentiate infected from vaccinated dogs, resulting in the euthanasia of animals that become serologically positive due to vaccination. Seven recombinant antigens were previously screened from a cDNA and DNA library using sera from Leishmania infantum-infected human and dogs and employed in this study to have their reactivity tested against sera from vaccinated dogs using the screening test multi antigen print imunoassay MAPIA...

Faulty washers and soiled micropipettors may generate false positive serological results.

BACKGROUND: Serological markers such as HBsAg and anti-HIV may be present in serum at very high concentrations and this may give rise to erroneous diagnoses due to cross-contamination. OBJECTIVES: To investigate poor equipment maintenance and use, including contamination with human serum, as a potential source of erroneous assay results. STUDY DESIGN: The potential of microtitre plate washers and micropipettors to transfer material between microplate wells and between specimens was examined. For the study of micropipettors we recruited 19 UK diagnostic laboratories. RESULTS: Four out of seven plate washers in use, until adjusted, had the potential to cause false positive HBsAg reactions. The centering of the probes that delivered the wash fluid, delivery pressure, wash volume and the use of a pre-programmed card to direct the washing procedure were important variables. We investigated soiling of tip cones of micropipettors. In every laboratory human IgG could be detected in at least a third of eluates from micropipettor tip cones; only 31 (14%) of 222 showed no evidence of contamination with human serum. Only one laboratory submitted eluates devoid of specific antibodies. Anti-HAV was the marker most commonly found (n = 68), followed by HBsAg (n = 27) and anti-HIV (n = 20). Seven micropipettor eluates from two laboratories were radioactively contaminated. CONCLUSIONS: Recommended precautions are regular checking, cleaning and servicing of equipment, care in interpreting weak reactions, reference back to serum left on the clot of the original specimen and testing of a follow up specimen. Poorly maintained immunoassay equipment can readily generate false positive results due to low-level cross-contamination, particularly with the current highly sensitive HBsAg and anti-HIV assays.