Quantitative assessment of multiple pathogen exposure and immune dynamics at scale.

IMPORTANCE: Serology reveals exposure to pathogens, as well as the state of autoimmune and other clinical conditions. It is used to evaluate individuals and their histories and as a public health tool to track epidemics. Employing a variety of formats, studies nearly always perform serology by testing response to only one or a few antigens. However, clinical outcomes of new infections also depend on which previous infections may have occurred. We developed a high-throughput serology method that evaluates responses to hundreds of antigens simultaneously. It can be used to evaluate thousands of samples at a time and provide a quantitative readout. This tool will enable doctors to monitor which pathogens an individual has been exposed to and how that changes in the future. Moreover, public health officials could track populations and look for infectious trends among large populations. Testing many potential antigens at a time may also aid in vaccine development.

Perfil sociodemográfico e laboratorial dos pacientes submetidos à hemodiálise em um centro de referência do Estado do Ceará / Sociodemographic and laboratory profile of patients undergoing hemodialysis in a reference center in the State of Ceará / Perfil sociodemográfico y de laboratorio de dos pacientes sometidos a hemodiálisis en un centro de referencia del Estado de Ceará

A Doença Renal Crônica (DRC) é uma importante redução da função renal que causa alterações no metabolismo dos indivíduos. Para acompanhar a progressão da DRC e prevenir possíveis complicações, foi realizada uma pesquisa para avaliar o perfil sociodemográfico, bioquímico e hematológico de pacientes com Insuficiência Renal Crônica (IRC) submetidos a hemodiálise. Esta pesquisa foi quantitativa, descritiva e transversal de caráter retrospectivo, realizada por meio da análise de dados secundários contidos nos prontuários dos pacientes. A coleta de dados ocorreu no Centro de Hemodiálise da cidade de Russas, no Ceará. A amostra foi constituída por 161 pacientes com DRC, sendo 63,35% do sexo masculino e 85,71% pardos, com uma idade média de 54,39 anos. Desses, 63,97% tinham entre 2 e 10 anos de tratamento e 57,76% possuíam ensino fundamental incompleto. 19,25% residiam em Russas. Resultados: Após a hemodiálise, os resultados mostraram 44 mg/dL de Ureia, 48,44% dos pacientes com valores normais. A hemoglobina e hematócrito médios foram 11,8 g/dL e 33,7%, respectivamente, sendo que 63,35% tiveram valores reduzidos. 85,10% dos pacientes tiveram contagem de plaquetas normal, 72,04% níveis adequados de ferro e albumina, 52,79% tiveram níveis elevados de ferritina, 23,61% redução de transferrina e níveis lipídicos satisfatórios. 79,50% apresentaram níveis séricos de potássio dentro da normalidade, 12,42% de fósforo acima do normal, 85,09% de cálcio dentro dos valores normais, 39,13% de PTHi normais e 86,33% de glicose dentro dos valores considerados normais. Com base nos resultados, concluiu-se que todos os pacientes em tratamento hemodialítico apresentam diversas alterações em decorrência da DRC e do próprio processo de tratamento. Portanto, a realização de exames para avaliar ou monitorar possíveis complicações da IRC é essencial para criar estratégias e intervenções mais eficazes, que melhorem a assistência prestada a esses pacientes e, consequentemente, da qualidade e expectativa de vida dos mesmos.

Chronic Kidney Disease (CKD) is an important reduction in kidney function that causes changes in the metabolism of individuals. To monitor the progression of CKD and prevent possible complications, a survey was carried out to assess the sociodemographic, biochemical and hematological profile of patients with Chronic Renal Failure (CRF) undergoing hemodialysis. This research was quantitative, descriptive and cross-sectional with a retrospective character, carried out through the analysis of secondary data contained in the patients' medical records. Data collection took place at the Hemodialysis Center in the city of Russas, Ceará. The sample consisted of 161 patients with CKD, 63.35% male and 85.71% brown, with an average age of 54.39 years. Of these, 63.97% had between 2 and 10 years of treatment and 57.76% had incomplete primary education. 19.25% resided in Russas. Results: After hemodialysis, the results showed 44 mg/dL of Urea, 48.44% of patients with normal values. Average hemoglobin and hematocrit were 11.8 g/dL and 33.7%, respectively, with 63.35% having reduced values. 85.10% of the patients had normal platelet counts, 72.04% had adequate levels of iron and albumin, 52.79% had high levels of ferritin, 23.61% had reduced transferrin and satisfactory lipid levels. 79.50% had serum levels of potassium within the normal range, 12.42% of phosphorus above normal, 85.09% of calcium within normal values, 39.13% of PTHi normal and 86.33% of glucose within the values considered normal. Based on the results, it was concluded that all patients on hemodialysis have several changes due to CKD and the treatment process itself. Therefore, carrying out tests to assess or monitor possible complications of CRF is essential to create more effective strategies and interventions that improve the care provided to these patients and, consequently, their quality and life expectancy.

La Enfermedad Renal Crónica (ERC) es una reducción importante de la función renal que provoca cambios en el metabolismo de los individuos. Para monitorizar la evolución de la ERC y prevenir posibles complicaciones, se realizó una encuesta para evaluar el perfil sociodemográfico, bioquímico y hematológico de los pacientes con Insuficiencia Renal Crónica (IRC) en hemodiálisis. Esta investigación fue cuantitativa, descriptiva y transversal con carácter retrospectivo, realizada a través del análisis de datos secundarios contenidos en las historias clínicas de los pacientes. La recolección de datos ocurrió en el Centro de Hemodiálisis de la ciudad de Russas, Ceará. La muestra estuvo constituida por 161 pacientes con ERC, 63,35% del sexo masculino y 85,71% pardos, con una edad media de 54,39 años. De estos, 63,97% tenían entre 2 y 10 años de tratamiento y 57,76% tenían primaria incompleta. El 19,25% residía en Russas. Resultados: Posterior a la hemodiálisis los resultados arrojaron 44 mg/dL de Urea, 48,44% de los pacientes con valores normales. La hemoglobina y el hematocrito medios fueron 11,8 g/dl y 33,7 %, respectivamente, con un 63,35 % con valores reducidos. El 85,10% de los pacientes presentaba plaquetas normales, el 72,04% presentaba niveles adecuados de hierro y albúmina, el 52,79% presentaba niveles elevados de ferritina, el 23,61% presentaba transferrina reducida y niveles satisfactorios de lípidos. El 79,50% presentaba niveles séricos de potasio dentro de la normalidad, el 12,42% de fósforo por encima de lo normal, el 85,09% de calcio dentro de los valores normales, el 39,13% de PTHi normal y el 86,33% de glucosa dentro de los valores considerados normales. Con base en los resultados, se concluyó que todos los pacientes en hemodiálisis tienen varios cambios debido a la ERC y al propio proceso de tratamiento. Por tanto, la realización de pruebas para evaluar o monitorizar las posibles complicaciones de la IRC es fundamental para crear estrategias e intervenciones más eficaces que mejoren la atención a estos pacientes y, en consecuencia, su calidad y esperanza de vida.

Enfermedad asociada a anticuerpos contra la glicoproteína de mielina de oligodendrocitos / Myelin oligodendrocyte glycoprotein antibody disease

Introducción: La enfermedad asociada a anticuerpos contra la glicoproteína de mielina del oligodendrocito (MOGAD, por sus siglas en inglés) es una entidad clínica recientemente identificada. La frecuencia de presentación del MOGAD es desconocida, pero se considera baja con respecto a otras enfermedades inflamatorias desmielinizantes. Materiales y métodos: Revisión narrativa de la literatura. Resultados: Las manifestaciones clínicas de esta condición son heterogéneas e incluyen neuritis óptica, mielitis, desmielinización multifocal del sistema nervioso central y encefalitis cortical. Se han descrito algunos hallazgos radiológicos que aumentan la sospecha diagnóstica, como el realce perineural del nervio óptico, el signo de la H en el cordón espinal y la resolución de lesiones T2 con el tiempo. El diagnóstico se basa en la detección de inmunoglobulinas G específicas contra MOG, en el contexto clínico adecuado. El tratamiento consiste en manejo de los ataques agudos con dosis altas de corticoides y en algunos casos se deberá considerar la inmunosupresión crónica, considerar la inmunosupresión crónica en pacientes con recurrencia o con discapacidad severa residual tras el primer evento. Conclusiones: En esta revisión narrativa se resumen los aspectos clave con respecto a la fisiopatología, las manifestaciones, el diagnóstico y el tratamiento de la MOGAD.

Introduction: The disease associated with antibodies against the myelin oligodendrocyte glycoprotein (MOGAD) is a recently identified clinical entity, with unknown frequency, but is considered low compared to other demyelinating inflammatory diseases. Materials And Methods: Narrative review. Results: The clinical manifestations are heterogeneous, ranging from optic neuritis or myelitis to multi-focal CNS demyelination or cortical encephalitis. There have been described characteristic MRI features that increase the diagnostic suspicion, such as perineural optic nerve enhancement, spinal cord H-sign or T2-lesion resolution over time. The diagnosis is based on the detection of specific G- immunoglobulins against MOG, in the suggestive clinical context. Acute treatment is based on high dose steroids and maintenance treatment is generally reserved for relapsing cases or patients with severe residual disability after the first attack. Conclusions: In this narrative review, fundamental aspects of pathophysiology, clinical and radiological manifestations, diagnosis and treatment of MOGAD are discussed.

Association between toxoplasmosis and autoimmune rheumatic diseases in Egyptian patients / Asociación entre toxoplasmosis y enfermedades reumáticas autoinmunes en pacientes egipcios

Purpose: To explore the association between T. gondii and autoimmune rheumatic diseases (ARDs). Methods: This study involved 82 patients with ARDs: 44 rheumatoid arthritis (RA), 28 systemic lupus erythematosus (SLE), and 10 systemic sclerosis (SSc) and 61 age- and sex-matched controls. Sociodemographic, clinical, and laboratory data were collected, and disease activity was assessed. Exposure to toxoplasmosis risk factors was investigated. Serological tests for anti-Toxoplasma IgM and IgG antibodies were assessed using ELISA. Results: In SLE patients, a significant difference of T. gondii IgM versus controls was detected (P=.03). In RA and SLE patients, T. gondii IgG showed a significant difference versus controls (34 (77.3%) P=.001 and 18 (64.3%) P=.03, respectively). There was no significant difference in SSc versus controls. Fetal congenital anomalies displayed a significant difference in IgM seropositive compared to seronegative patients (P=.04). Cat exposure showed a significant difference between IgM and IgG seropositive versus seronegative patients (12 (80.0%) P=.02 and 34 (59.6) P=.04, respectively). There was no significant difference in seropositive patients regarding history of abortion, neuro-psychiatric manifestations, disease activity parameters (ESR, CRP), or different regimens of medications. Conclusion: Toxoplasma IgM seropositivity is associated with SLE patients. T. gondii IgG seropositivity is associated with both RA and SLE patients. However, Toxoplasma seropositivity had no association with SSc patients. An association between fetal congenital anomalies and IgM seropositivity was demonstrated. A linkage between cat exposure as a risk factor and toxoplasmosis was suggested among ARD patiants. Exploration of impact of toxoplasmosis on ARDs is a necessity through randomized controlled trials.(AU)

Propósito: Explorar la asociación entre Toxoplasma gondii y enfermedades reumáticas autoinmunes (ERA).Métodos: Este estudio involucró a 82 pacientes con ERA: 44 con artritis reumatoide (AR), 28 con lupus eritematoso sistémico (LES) y 10 con esclerosis sistémica (SSc); y 61 controles emparejados por edad y sexo. Se recopilaron datos sociodemográficos, clínicos y de laboratorio, y se evaluó la actividad de la enfermedad. Se indagó exposición a factores de riesgo de toxoplasmosis. Las pruebas serológicas de anticuerpos IgM e IgG antitoxoplasma se evaluaron mediante ELISA.Resultados: En pacientes con LES se detectó una diferencia significativa de T. gondii IgM vs. controles (p = 0,03). En pacientes con AR y LES, T. gondii IgG mostró una diferencia significativa frente a los controles (34 [77,3%] p = 0,001 y 18 [64,3%] p = 0,03, respectivamente). No hay diferencia significativa en SSc vs. controles. Las anomalías congénitas fetales mostraron una diferencia significativa en los pacientes seropositivos para IgM en comparación con los pacientes seronegativos (p = 0,04). La exposición a los gatos mostró una diferencia significativa entre los pacientes seropositivos para IgM e IgG frente a los seronegativos (12 [80%] p = 0,02 y 34 [59,6] p = 0,04, respectivamente). No hubo diferencias significativas en pacientes seropositivos con respecto a antecedentes de aborto, manifestaciones neuropsiquiátricas, parámetros de actividad de la enfermedad (ESR, CRP) o diferentes regímenes de medicamentos.(AU)

Resultados en Navarra del estudio nacional de sero-epidemiología ENE-COVID / Results in Navarra of the national study of sero-epidemiology ENE-COVID

Fundamento: España ha sido uno de los países europeos más afectados por la pandemiade COVID-19. La encuesta serológica ENE-COVID, estudio de base poblacional tiene comoobjetivo estimar la seroprevalencia de la infección por SARS-CoV-2 en España a nivel nacionaly autonómico y su evolución temporal. Se presentan los resultados correspondientes a laComunidad Foral de Navarra. Metodología: Se seleccionaron 864 hogares de padrones municipales mediante muestreoaleatorio estratificado bietápico. La primera fase estudió la seroprevalencia en la primeraonda epidémica mediante tres rondas, entre el 27 de abril y el 22 de junio de 2020, en las queparticiparon 1.865 personas (77,5% de respuesta). Respondieron a un cuestionario sobre elhistorial de síntomas compatibles con COVID-19 y factores de riesgo y, si estuvieron de acuerdo,donaron sangre para detección de anticuerpos en laboratorio mediante inmunoensayoquimioluminiscente de micropartículas (IQM). Tras la desescalada se realizó una cuarta rondadel estudio, entre el 16 y el 19 de noviembre de 2020, para tener una imagen más completa dela extensión epidémica. Resultados: La seroprevalencia en Navarra fue 14,3 %, sin diferencias por sexo pero sí mayoren personas de 50-64 años (18%) y en residentes en secciones censales con mayor nivel derenta. La tasa de seroconversión entre la primera fase (rondas 1 a 3) y la cuarta ronda delestudio fue del 7,1% (IC95%: 5,3-9,4). Alrededor de un tercio de los participantes seropositivosfueron asintomáticos, con un rango de 21,9 % (19,1-24,9) a 35,8 % (33,1-38,5). Conclusión: Estos resultados enfatizaron la necesidad de mantener las medidas de saludpública para evitar una nueva ola epidémica.(AU)

Lessons learned from the implementation of integrated serosurveillance of communicable diseases in the Americas

[ABSTRACT]. Objective. Systematize the experience and identify challenges and lessons learned in the implementation of an initiative for integrated serosurveillance of communicable diseases using a multiplex bead assay in coun- tries of the Americas. Methods. Documents produced in the initiative were compiled and reviewed. These included concept notes, internal working papers, regional meetings reports, and survey protocols from the three participating countries (Mexico, Paraguay, and Brazil) and two additional countries (Guyana and Guatemala) where serology for sev- eral communicable diseases was included in neglected tropical diseases surveys. Information was extracted and summarized to describe the experience and the most relevant challenges and lessons learned. Results. Implementing integrated serosurveys requires interprogrammatic and interdisciplinary work teams for the design of survey protocols to respond to key programmatic questions aligned to the needs of the countries. Valid laboratory results are critical and rely on the standardized installment and roll-out of laboratory tech- niques. Field teams require adequate training and supervision to properly implement survey procedures. The analysis and interpretation of serosurveys results should be antigen-specific, contextualizing the responses for each disease, and triangulated with programmatic and epidemiological data for making decisions tailored to specific population socioeconomic and ecologic contexts. Conclusions. Integrated serosurveillance as a complementary tool for functional epidemiological surveil- lance systems is feasible to use and key components should be considered: political engagement, technical engagement, and integrated planning. Aspects such as designing the protocol, selecting target populations and diseases, laboratory capacities, anticipating the capacities to analyze and interpret complex data, and how to use it are key.

[RESUMEN]. Objetivo. Sistematizar la experiencia y determinar los desafíos y las enseñanzas obtenidas durante la apli- cación de una iniciativa de serovigilancia integrada de enfermedades transmisibles mediante un ensayo de perlas múltiples en países de la Región de las Américas. Métodos. Se recopilaron y revisaron los documentos generados en el marco de la iniciativa. Estos incluían notas conceptuales, documentos de trabajo internos, informes de reuniones regionales y protocolos de encuesta de los tres países participantes (Brasil, México y Paraguay) y otros dos países (Guatemala y Guyana) donde en las encuestas sobre enfermedades tropicales desatendidas también se incluía la serología para varias enfermedades transmisibles. Se recabó y resumió la información para describir tanto la experiencia como los desafíos y las enseñanzas de mayor relevancia. Resultados. La realización de encuestas serológicas integradas requiere equipos de trabajo interprogramáti- cos e interdisciplinarios para la elaboración de protocolos de encuesta que permitan responder a cuestiones programáticas fundamentales y ajustadas a las necesidades de los países. Es imprescindible contar con resultados de laboratorio válidos, para lo que es preciso que sus técnicas e instalaciones estén estandariza- das. Para que los equipos de campo puedan ejecutar correctamente los procedimientos de la encuesta, deben contar con una formación y supervisión adecuadas. El análisis y la interpretación de los resultados de las encuestas serológicas deben ser específicos para cada antígeno, situar las respuestas en el contexto de cada enfermedad y triangularse con los datos programáticos y epidemiológicos para tomar decisiones adaptadas a los contextos socioeconómicos y ecológicos específicos de la población. Conclusiones. Es uso de la vigilancia serológica integrada como una herramienta complementaria en los sistemas funcionales de vigilancia epidemiológica es algo posible; para esto deben tenerse en cuenta ciertos elementos fundamentales: el compromiso político, el compromiso técnico y la planificación integrada. A tal efecto, son fundamentales ciertos elementos como el diseño del protocolo, la selección de los grupos pobla- cionales y las enfermedades objetivo, la capacidad de los laboratorios, y la previsión de las capacidades de análisis e interpretación de datos complejos y la forma de utilizarlos.

[RESUMO]. Objetivo. Sistematizar a experiência e identificar desafios e lições aprendidas na implementação de uma iniciativa de vigilância sorológica integrada de doenças transmissíveis, usando ensaio de micro-esferas multiplex em países das Américas. Métodos. Os documentos produzidos na iniciativa foram compilados e examinados, e incluíram notas con- ceituais, documentos internos de trabalho, relatórios de reuniões regionais e protocolos de pesquisa dos três países participantes (México, Paraguai e Brasil) e de dois países adicionais (Guiana e Guatemala), onde a vigilância sorológica de várias doenças transmissíveis foi incluída em pesquisas sobre doenças tropicais negligenciadas. As informações foram extraídas e resumidas para descrever a experiência e os desafios e as lições aprendidas mais relevantes. Resultados. A implementação de inquéritos sorológicos integrados requer equipes de trabalho interpro- gramáticas e interdisciplinares para o delineamento de protocolos que respondam a questões programáticas chave, alinhadas com as necessidades dos países. Resultados laboratoriais válidos são essenciais, e depen- dem da instalação e implantação padronizadas de técnicas laboratoriais. As equipes de campo precisam de treinamento e supervisão apropriados para implementar adequadamente os procedimentos de pesquisa. A análise e a interpretação dos resultados dos inquéritos sorológicos devem ser antígeno-específicas, con- textualizando as respostas para cada doença, e trianguladas com dados programáticos e epidemiológicos para a tomada de decisões adaptadas aos contextos socioeconômicos e ecológicos específicos de cada população. Conclusões. A vigilância sorológica integrada como ferramenta complementar para sistemas de vigilância epidemiológica funcionais é viável. Os componentes-chave a seguir devem ser considerados: engajamento político, engajamento técnico e planejamento integrado. Aspectos como o delineamento do protocolo, a seleção de populações-alvo e doenças-alvo, a capacidade laboratorial, a previsão das capacidades para análise e interpretação de dados complexos e como usá-los são fundamentais.

Borreliosis de Lyme en población pediátrica: peculiaridades clínicas, diagnósticas y terapéuticas / Lyme borreliosis in pediatric population: Clinical, diagnostic and therapeutic features

Introducción: La borreliosis de Lyme (BL) es una entidad poco estudiada en pediatría, pero con ciertas peculiaridades. El objetivo de este estudio es conocer las características de los pacientes pediátricos con sospecha y/o confirmación de BL. Métodos: Estudio descriptivo y retrospectivo en menores de 14 años con diagnóstico clínico y/o serológico, sospechoso o confirmado, de BL entre 2015 y 2021. Resultados: Se estudiaron 21 pacientes: 18 con diagnóstico final de BL (50% mujeres; mediana de edad 6,4 años) y 3 falsos positivos. En los casos de BL, las manifestaciones clínicas presentadas fueron: neurológicas (3, meningitis; 6, parálisis facial), dermatológicas (6, eritema migratorio), articulares (uno) e inespecíficas (2). El diagnóstico serológico fue confirmatorio en el 83,3% de los casos. El 94,4% recibió antibioterapia (mediana de duración 21 días) y la evolución fue satisfactoria en todos los casos. Conclusiones: El diagnóstico de la BL es difícil en la población pediátrica y presenta peculiaridades clínicas y terapéuticas, pero el pronóstico es favorable.(AU)

Introduction: Lyme borreliosis (LB) in the paediatric population is an understudied entity with certain peculiarities. The objective of this study is to describe the characteristics of paediatric patients with LB, and their diagnostic and therapeutic processes. Methods: Descriptive and retrospective study in patients up to 14 years old with suspected or confirmed LB between 2015 and 2021. Results: A total of 21 patients were studied: 18 with confirmed LB (50% women; median age 6.4 years old) and 3 false positive of the serology. Clinical features in the 18 patients with LB were: neurological (3, meningitis; 6, facial nerve palsy), dermatological (6, erythema migrans), articular (one), and non-specific manifestations (2). Serological diagnosis was confirmatory in 83.3% of cases. A total of 94.4% patients received antimicrobial treatment (median duration 21 days). All recovered with resolution of symptoms. Conclusions: LB diagnosis is difficult in the paediatric population and presents clinical and therapeutic peculiarities, with favourable prognosis.(AU)

Serological characteristics of Lewis antibodies and their clinical significance - A case series

Abstract Introduction Lewis antibodies have been thought to play a small role in clinical transfusion practice, but recent reports suggest that they have gained more importance in the context of transfusion and transplantation. Data regarding the prevalence of Lewis antibodies and their clinical significance in the Indian context is very limited. Hence, this study was aimed at analyzing the serological characteristics and clinical significance of Lewis antibodies encountered in our patient and donor populations. Methods The retrospective data analyzed the records of red cell antibody screening results and the additional serological evaluation performed on the donor and patient samples included in the study. Results A total of 26 study subjects were noted to have Lewis antibodies (including 6 healthy donors and 20 patients). Of them, 13 individuals had anti-Leb, 10 had anti-Lea and the remaining three had an anti-Lea/Leb mixture. IgG Lewis antibodies were detected in 7 individuals. All cases of IgM Lewis antibodies detected were reacting at 37°C. Two patients were suspected of having hemolytic transfusion reactions due to Lewis antibodies. Antigen-negative cross-match compatible units were provided for transfusion in the recipients. Conclusion Lewis antibodies of the IgM class reacting at 37°C should be regarded as clinically important. The present study findings urge that the lab personnel look for the thermal amplitude of Lewis antibodies, irrespective of the fact that the antibody class and antigen-negative crossmatch compatible units should be provided to avoid hemolytic transfusion reactions.

Evaluation of five immunoassays and one lateral flow immunochromatography for anti-SARS-CoV-2 antibodies detection / Evaluación de cinco inmunoensayos y una inmunocromatografía de flujo lateral para la detección de anticuerpos anti-SARS-CoV-2

Introduction: In order to deal with the current pandemic caused by the novel SARS-CoV-2 coronavirus several serological immunoassays have been recently developed with the objective of being used as a complementary diagnostic tool and to support the RT-PCR technique currently considered the “gold-standard” method. However, these new assays need to be evaluated and validated. The purpose of this study was to assess the performance of five immunoassays (two ELISA and three CLIA assays) and one rapid immunochromatographic test for the detection of anti-SARS-CoV-2 antibodies. Methods: Five semiquantitative immunoassays (MENARINI®, PALEX®, VIRCLIA®, ROCHE® and SIEMENS®) and one lateral flow rapid test (WONDFO®) were performed. A total of 124 samples were studied. Case serum samples (n=78) were obtained from COVID-19 patients confirmed by real-time RT-PCR/epidemiological-clinical-radiological criteria, and control non-SARS-CoV-2 samples (n=46) belonged to healthy healthcare workers involved in a seroprevalence study. Results: Overall, the tests showed sensitivities around 70–90% and specificities greater than 95%, including the immunochromatographic test. In addition, we observed very good agreements among them, being better for the detection of IgG than for IgM antibodies (Cohen's kappa index of 0.95 for VIRCLIA® IgG with ROCHE®), as well as good diagnostic power of the tests as determined by the ROC curves. Conclusions: This study demonstrates the proper performance of the different immunoassays in order to be applied in the clinical practice as support in the diagnostic approach and in the development of vaccines and seroepidemiological studies of COVID-19.(AU)

Introducción: Para hacer frente a la pandemia actual causada por el nuevo coronavirus SARS-CoV-2 se han desarrollado recientemente varios inmunoensayos serológicos con el objetivo de ser utilizados como herramienta diagnóstica complementaria y apoyar la técnica de RT-PCR actualmente considerada como el “estándar de oro”. Sin embargo, estos nuevos ensayos deben evaluarse y validarse. El objetivo de este estudio fue evaluar cinco inmunoensayos (dos ELISA y tres ensayos CLIA) y una prueba inmunocromatográfica rápida para la detección de anticuerpos anti-SARS-CoV-2. Métodos: Se utilizaron cinco inmunoensayos semicuantitativos (MENARINI®, PALEX®, VIRCLIA®, ROCHE® y SIEMENS®) y un test de inmunocromatografía rápida (WONDFO®). Se estudiaron un total de 124 muestras. Las muestras de suero (n=78) se obtuvieron de pacientes COVID-19 confirmados por RT-PCR en tiempo real/criterios epidemiológicos-clínico-radiológicos. Las muestras control negativas (n=46) pertenecieron a personal sanitario involucrado en un estudio de seroprevalencia. Resultados: En general, las pruebas mostraron sensibilidades en torno al 70-90% y especificidades superiores al 95%, incluso la prueba inmunocromatográfica. Además, observamos muy buenas concordancias entre ellas, presentando mayores sensibilidades para la detección de anticuerpos IgG que para IgM (índice kappa de Cohen de 0,95 para VIRCLIA® IgG con ROCHE®), así como un buen poder diagnóstico de las técnicas determinado por las curvas ROC. Conclusiones: Este estudio demuestra el buen rendimiento de los diferentes inmunoensayos para ser empleados en la práctica clínica como apoyo en el proceso de diagnóstico, en el desarrollo de vacunas y estudios seroepidemiológicos de COVID-19.(AU)

High prevalence of serological weak D phenotype and preponderance of weak D type 4.0.1. genetic variant in a Nigerian population: implications for transfusion practice in a resource-limited setting

ABSTRACT Introduction: Prevalence of RhD negative phenotype in Nigeria is low; this leads to scarcity of RhD negative red cells for transfusion. Serological and molecular genotyping of RhD negative individuals for weak D types could reduce this scarcity. The aim of this study was to determine the serological prevalence and molecular types of weak D phenotypes among blood donors and pregnant women in Kano, Nigeria. Methods: A total of 4482 blood donors and pregnant women from three hospitals in Kano were recruited. An indirect antiglobulin test was used to determine weak D phenotypes. Molecular genotyping was performed on genomic DNA from whole blood amplified by polymerase chain reaction sequence-specific primers (PCR-SSP) with agarose gel electrophoresis. Results: The mean age of the participants was 26.50 ±5.79 years. The prevalence of the RhD negative phenotype was 4.2% (189/4482). Of the 189 RhD negative phenotypes, 20 (10.6%) were weak D positive. Molecular genotyping of the 20 Weak D positive phenotypes revealed 15 (75%) weak D type 4, of which 11 were due to the RHD*09.03 and RHD*DAR3 (T201R, F223V) polymorphisms and 4, due to RHD* 08.01 and RHD* DFV polymorphisms; 2 (10%) were due to the 602 C>G polymorphism, while the remaining 3 (15%) constituted partial D or other rare weak D types. Conclusion: The prevalence of weak D positive phenotypes is high in this study; weak D type 4 is the most common RhD genetic variant. Routine serologic weak D testing of RhD negative blood and molecular genotyping should be encouraged in resource-limited settings.

Serología y lucha antivenérea en el Instituto de Transfusión Sanguínea de Valencia (1937-1938): María Hervás Moncho / Serology and venereal control at the Blood Transfusion Institute of Valencia (1937-1938): María Hervás Moncho

ABSTRACT: During the Spanish Civil War, military transfusion services appeared for the first time. In Barcelona and Valencia –two of the main strongholds of the Republican rear– blood transfusion institutes were set up during the struggle. The one in Valencia had, as an annex, a serology laboratory run by María Hervás Moncho (1894-1963). Hitherto unknown to historiography, this Valencian doctor had spent a long training period at the Pasteur Institute in Paris during the 1920s under the tutelage of the prestigious immunologist Alex-andre Besredka (1870-1940). The aim of this paper is to rescue the figure of María Hervás Moncho from historiographical oblivion, and to analyze her work as the leader of the laboratory of the Institute of Blood Transfusion in Valencia. Hervás was particularly interested in increasing the sensitivity of serological tests used in the diagnosis of syphilis in order to reduce the incidence of false negatives and, therefore, of possible post-transfusion infections. In order to achieve our purpose several archival, hemerographical and bibliographical sources, both manuscript and printed, have been consulted. These are enumerated in the introduction

RESUMEN: Durante la Guerra Civil Española aparecieron por primera vez los servicios militares de transfusión. En Barcelona y Valencia –dos de los principales bastiones de la retaguardia republicana– se habilitaron durante la contienda sendos institutos de transfusión sanguínea. El de Valencia disponía, anexo, de un laboratorio de serología dirigido por María Hervás Moncho (1894-1963). Desconocida por la historiografía, esta médica valenciana había realizado durante la década de 1920 una prolongada estancia de formación en el Ins-tituto Pasteur de París bajo la tutela del prestigioso inmunólogo Alexandre Besredka (1870-1940). El objetivo de este trabajo es rescatar del olvido historiográfico la figura de María Hervás Moncho, analizando su trabajo al frente del laboratorio del Instituto de TransfusiónSanguínea de Valencia. Hervás estaba especialmente interesada en aumentar la sensibilidad de las pruebas serológicas empleadas en el diagnóstico de la sífilis al objeto de disminuir la incidencia de falsos negativos y, por tanto, de eventuales contagios post-transfusio-nales. Para alcanzar los objetivos planteados se han consultado diversas fuentes archivísticas, hemerográficas y bibliográficas, tanto manuscritas como impresas, que se especifican en la introducción.

Vacunación frente a hepatitis B en pacientes con enfermedad inflamatoria intestinal: respuesta inmunitaria y factores asociados / Vaccination against hepatitis B in patients with inflammatory bowel disease: immune response and associated factors

Fundamentos: Los pacientes con Enfermedad Inflamatoria Intestinal (EII) tienen más riesgo de infección por el virus de la hepatitis B (VHB) así como menor respuesta frente a la vacunación. El objetivo de este estudio fue analizar la respuesta inmunitaria tras la vacunación frente al VHB en los pacientes diagnosticados de EII y sus factores asociados. Métodos: Se realizó un estudio observacional retrospectivo sobre los pacientes con EII atendidos en la consulta de vacunas de pacientes de riesgo en el Complejo Hospitalario Universitario de Albacete durante el período 2011-2018. Se determinó la respuesta serológica tras la vacunación y los factoresasociados mediante modelos de regresión logística. Resultados: Se incluyeron 231 pacientes. La vacunación frente al VHB tuvo una respuesta inmunitaria óptima en un 82,7% de los pacientes. La probabilidad de respuesta a la vacunación aumentó en aquellos diagnosticados de colitis ulcerosa (OR 2,90; IC95% 1,11-7,61) y se redujo con la edad (80% menor en los de 40-55 años (OR 0,20; IC95% 0,05-0,83) y 88% menor en mayores de 55 años (OR 0,12; IC95% 0,03-0,53) frente a los menores de 40 años) y con la inmunosupresión farmacológica (OR 0,20; IC95% 0,58-0,71). Conclusiones: La disminución de la inmunogenicidad de la vacuna frente a la hepatitis B en los pacientes con EII tras el inicio del tratamiento inmunosupresor, así como con la edad, hacen prioritaria la vacunación temprana en este tipo de pacientes.(AU)

Background: Patients with Inflammatory Bowel Disease (IBD) are at increased risk of hepatitis B virus (HBV) infection as well as a lower response to vaccination. This study aimed to analyze the immune response after vaccination against HBV in patients diagnosed with IBD and its associated factors. Methods: A retrospective observational study was conducted on patients with IBD treated at the vaccination clinic for at-risk patients at the Complejo Hospitalario Universitario de Albacete during the period 2011-2018. Immune response after vaccination and associated factors were determined using logistic regression models. Results: 231 patients were included. HBV Vaccination had an optimal immune response in 82.7% of the patients. The likelihood of response to vaccination increased in those diagnosed with ulcerative colitis (OR 2.90; 95% CI 1.11-7.61) and decreased with age (80% lower in those aged 40- 55 years (OR 0.20; 95% CI 0.05-0.83) and 88% lower in those over 55 years of age (OR 0.12; 95% CI 0.03-0.53) compared to those under 40 years of age) and pharmacological immunosuppression (OR 0.20; 95% CI 0.58-0.71). Conclusions: The decrease in the immunogenicity of the vaccine against hepatitis B in patients with IBD after the beginning of immunosuppressive treatment, as well as with age, make early vaccination a priority in this kind of patients.(AU)

¿Sigue siendo útil la microscopia de campo oscuro en el diagnóstico de la sífilis primaria en el siglo XXI? / Is dark-field microscopy still useful for the primary syphilis diagnosis in the 21ST century?

IntroducciónLa serología luética en la sífilis primaria puede ser negativa los primeros 5-15 días. El objetivo de este trabajo fue evaluar los beneficios de incluir la microscopia de campo oscuro (MCO) en el algoritmo diagnóstico de la sífilis primaria.MetodologíaSe incluyó a todos los pacientes que acudieron a una clínica de infecciones de transmisión sexual de la Comunidad de Madrid entre 2015 y 2019 que presentaban una úlcera genital sospechosa de sífilis primaria. Se les realizó MCO y serología (EIA/TPPA/RPR).ResultadosDe las 806 muestras, el 53,2% (429) fueron positivas para MCO. De los 429, el 48% presentaba screening serológico negativo (EIA/RPR) y de ellos en el 77,6% el TPPA fue positivo.ConclusionesLa MCO permite un diagnóstico de sífilis primaria precoz, incluso sin confirmación serológica. Si no se dispone de técnicas directas, en primoinfección, la TPPA es de gran ayuda en el diagnóstico.

IntroductionSerological test for primary syphilis could be negative the first 5-15 days. The aim of this study was to evaluate the benefit of including dark field microscopy (DFM) in the diagnosis algorythm for primary syphilis.Materials/methodsPatients attended to a sexual transmission diseases clinic of Madrid, from 2015 to 2019, for a genital ulcer with clinical suspicion of primary syphilis. They were tested for DMF and serological test (EIA/TPPA/RPR).ResultsOver the total amount of samples (806), 53.2% (429) were positive for DFM. Thus, the 48% of the 429 patients had negative serological test (EIA/RPR) of which the 77.6% were positive at TPPA.ConclusionsDFM allows primary syphilis early diagnosis, even without serological test. If no direct detection methods are available, for patients without history of syphilis, TPPA could help to diagnose primary syphilis.

A systematic review of maternal TORCH serology as a screen for suspected fetal infection.

BACKGROUND: The acronym 'TORCH' refers to well-recognised causes of perinatal infections: toxoplasmosis, rubella, cytomegalovirus (CMV) and herpes simplex virus (HSV). A TORCH serology panel is often used to test for maternal primary infection following detection of ultrasound abnormalities in pregnancy. AIM: This review aims to estimate the diagnostic yield of maternal TORCH serology in pregnancy following fetal ultrasound abnormalities. MATERIALS AND METHODS: Primary studies published since 2000 that assessed maternal TORCH serology for suspected fetal infection and included information on indications for testing, definition of positive TORCH serology results, and perinatal outcomes were included. RESULTS: Eight studies with a total of 2538 pregnancies were included. The main indications for testing were polyhydramnios, fetal growth restriction and hyperechogenic bowel. There were 26 confirmed cases of congenital CMV, of which 15 had multiple ultrasound abnormalities. There were no cases of congenital toxoplasmosis, rubella or HSV confirmed in any of the eight studies. CONCLUSIONS: The clinical utility of TORCH serology for non-specific ultrasound abnormalities such as isolated fetal growth restriction or isolated polyhydramnios is low. It is time to retire the TORCH acronym and the reflex ordering of 'TORCH' panels, as their continued use obscures, rather than illuminates, appropriate investigation for fetal ultrasound abnormalities.

Avaliação soroepidemiológica de cães expostos a Rickettsia parkeri e correlação com a estrutura da paisagem no litoral do estado de São Paulo / Serosurvey on dogs for Rickettsia parkeri and correlation with landscape structure in São Paulo state coast (Brazil)

A febre maculosa causada por Rickettsia parkeri é a segunda riquetsiose de maior importância no Brasil. No estado de São Paulo, o agente é transmitido pelo carrapato Amblyomma ovale, que ocorre em número elevado em regiões costeiras de Mata Atlântica. Até o presente momento, não foi estabelecido como a estrutura da paisagem pode afetar a dispersão de carrapatos infectados por R. parkeri e, portanto, dinâmica de transmissão da doença. Propõe-se avaliar a relação entre a sorologia de cães domésticos expostos a R. parkeri e a estrutura da paisagem em áreas de comunidades adjacentes à Mata Atlântica no litoral paulista. Em um estudo transversal, foram selecionadas cinco áreas localizadas nos municípios de Cubatão, Peruíbe, São Sebastião, Cananéia e Ilhabela e, em cada área, amostras de soro de 30 cães foram colhidas e submetidas a reação de imunofluorescência indireta para detecção do título máximo de anticorpos anti-R. parkeri. Spearman foi usado como teste de correlação entre a sorologia e os componentes principais extraídos das métricas de paisagem em cada área de estudo. A análise da estrutura da paisagem evidenciou dois componentes principais não correlacionados que, somados, explicam 94,77% da variabilidade entre as áreas, em que o primeiro componente está relacionado à conectividade e o segundo componente está relacionado à quantidade de borda. A soroprevalência das áreas variou de 16,7% a 83,3%. A exposição de cães domésticos a R. parkeri está associada positivamente com a conectividade de habitat para A. ovale em áreas estudadas do litoral do estado de São Paulo. Não foi evidenciada associação entre a sorologia e a quantidade de borda na paisagem. É recomendado que as ações de vigilância epidemiológica para febre maculosa por R. parkeri sejam priorizadas em áreas com maior conectividade florestal, juntamente com a conscientização da posse responsável de cães.

Spotted fever caused by Rickettsia parkeri is the second most important rickettsiosis in Brazil. In São Paulo state, this agent is transmitted by the Amblyomma ovale tick, highly prevalent in coastal Atlantic Rainforest. Until the present moment, it is not known how landscape structure could affect A. ovale dispersion, and therefore, R. parkeri transmission dynamics. It is proposed to evaluate the seroepidemiology from R. parkeri exposed dogs and its correlation with landscape structure in São Paulo state coast. A transversal study was conducted to evaluate five different areas from communities nearby Atlantic Rainforest (municipalities of Cubatão, Peruíbe, São Sebastião, Cananéia and Ilhabela). Within each area, blood samples from 30 dogs were collected for serologic testing by indirect immunofluorescence assay. Correlation test Spearman was used between serology data and principal components extracted from landscape structure metrics in each area. Principal components analysis pointed two principal uncorrelated components which, together, explain 94,77% of the variability between landscape metrics. First component is related to landscape connectivity, and the second is related to edge abundance. It was found a seroprevalence from 16,7% to 83,3% in the different areas. A positive association between antibodies anti-R. parkeri found in dogs and landscape connectivity (p=0) was demonstrated. There was no association between serologic testing and edge abundance in the study areas. It is recommended that R. parkeri rickettsiosis surveillance to be priorized in connected forest areas, and responsible dog ownership must be encouraged.

Programa alternativo de evaluación externa de calidad para serología de SARS-CoV-2: calidad en tiempos de pandemia / Alternative external quality assessment programme for SARS-CoV-2 serology: quality in pandemic times

Resumen Para el control de la pandemia por COVID-19 es indispensable contar con ensayos confiables para la detección de anticuerpos anti-síndrome respiratorio agudo severo por coronavirus 2 (SARS-CoV-2). Por este motivo el Laboratorio de Serología y la Residencia de Bioquímica Clínica del Hospital Garrahan desarrollaron el primer Programa Piloto Alternativo de evaluación externa de la calidad para serología de SARS-CoV-2 en la Argentina, destinado a evaluar comparativamente el desempeño de los métodos disponibles de los participantes con el fin de asegurar resultados confiables y clínicamente útiles. El esquema constó de 4 envíos con 5 muestras cada uno, con reactividad variable contra SARS-CoV-2 en las que se evaluaron anticuerpos totales, IgG e IgM. Participaron 21 laboratorios, tanto públicos como privados, de la Provincia y de la Ciudad de Buenos Aires de forma gratuita. Informaron metodología utilizada y resultados. Al finalizar cada entrega se enviaron los reportes individuales y se realizó un informe final global con los resultados totales del ciclo. El mismo se llevó a cabo a lo largo del segundo semestre de 2020. Se informó un total de 643 resultados, 239 de anti- SARS-CoV-2 IgM, 365 de IgG y 39 de anticuerpos totales. Se observó mayor concordancia en las metodologías anti-SARS-CoV-2 IgG que en las IgM. ELISA/ COVIDAR fue la metodología más utilizada para IgG y ELFA/bioMérieux para IgM. El espectro de metodologías fue amplio. El programa fue útil para asegurar la calidad de los resultados y brindó a los participantes el marco necesario para emitir resultados confiables y armonizados.

Abstract For the control of COVID-19 pandemic it is essential to have reliable tests for the detection of antibodies against severe acute respiratory syndrome due to coronavirus 2 (SARS-CoV-2). For this reason, the Serology Laboratory and the Residence of Clinical Biochemistry of Hospital Garrahan developed the first Alternative Pilot Programme for external quality assessment for SARS-CoV-2 serology in Argentina, aimed at comparatively evaluating the actuaperformance of the available methods of the participants using different anti-SARS-CoV tests in order to ensure reliable and clinically useful results. The scheme consisted of 4 deliveries with 5 samples each throughout the second semester of 2020, with variable reactivity against SARS-CoV-2 in which total antibodies, IgG and IgM were evaluated. Twenty one public and private laboratories participated in the Province and the City of Buenos Aires for free. The methodology applied and the results were informed. At the end of each delivery, individual reports were sent and a final global report was made with the total results of the cycle. A total of 643 results were reported, 239 for anti-SARS-CoV-2 IgM, 365 for IgG and 39 for total antibodies. There was greater agreement in the anti-SARS-CoV-2 IgG methodologies than in IgM. ELISA/COVIDAR was the most frequently used methodology for IgG and ELFA/bioMérieux for IgM. The spectrum of methodologies was wide. The programme was useful to ensure the quality of the results, providing the participants with the necessary framework to issue reliable and harmonised results.

Resumo Para o controle da pandemia de COVID-19, é imprescindível a existência de testes confiáveis para a detecção de anticorpos anti síndrome respiratória aguda grave por coronavírus 2 (SARS-CoV-2). Por esse motivo o Laboratório de Sorologia e a Residência de Bioquímica Clínica do Hospital Garrahan desenvolveram o primeiro Programa Piloto Alternativo de avaliação externa da qualidade para sorologia de SARS-CoV-2 na Argentina, com o objetivo de avaliar comparativamente o desempenho dos métodos disponíveis dos participantes para garantir resultados confiáveis e clinicamente úteis. O esquema consistiu em 4 remessas com 5 amostras cada uma, com reatividade variável contra SARS-CoV-2 em que foram avaliados anticorpos totais, IgG e IgM. Participaram 21 laboratórios públicos e privados da Província e da Cidade de Buenos Aires que participaram em forma gratuita. Eles relataram a metodologia utilizada e os resultados. Ao final de cada entrega, foram enviados relatórios individuais e foi feito um relatório final global com os resultados totais do ciclo. Ele foi realizado ao longo do segundo semestre de 2020. Um total de 643 resultados foram relatados, 239 de anti-SARS-CoV-2 IgM, 365 de IgG e 39 de anticorpos totais. Foi observada maior concordância nas metodologias anti-SARS-CoV-2 IgG do que nas IgM. ELISA/COVIDAR foi a metodologia mais utilizada para IgG e ELFA/bioMérieux para IgM. O espectro de metodologias foi amplo. O programa foi útil para garantir a qualidade dos resultados, proporcionando aos participantes o enquadramento necessário para a emissão de resultados confiáveis e harmonizados.