Altered HLA class I and HLA-G expression is associated with IL-10 expression in patients with cervical cancer.

Although high-risk human papillomaviruses (HPVs) are an important risk factor in the etiopathogenesis of cervical cancer, increasing evidence suggests that the ability to avoid immune surveillance seems to be linked to the transforming potential of HPV and a rapid progression to cancer. In other cancer models, IL-10 contributes to impair anti-tumor immune response either by downregulating human leukocyte antigen Class I (HLA-I) expression or by increasing HLA-G expression. To comprehend how these alterations could contribute to evasion of immune surveillance in cervical cancer, we analyzed HLA-I, HLA-G and IL-10 expressions by immunohistochemistry in 63 biopsies from patients with cervical intraepithelial neoplasia III (CIN-III) and cervical cancer. Immunohistochemistry showed absent or weak HLA-I expression in 50/59 cases. In these cases, a high percentage had loss of heterozygosis. IL-10 and HLA-G expression were observed in 46.6 and 27.6% of cases, respectively. Concurrent upregulation of IL-10 was found in 87.5% of HLA-G positive cases (p = 0.000). Similarly, a significant association between IL-10 expression and HLA-I downregulation was found (p = 0.028). Finally, we observed higher HLA-G expression in patients with HLA-I downregulation than in those with normal HLA-I expression (p = 0.004). Our results suggest that, in cervical cancer, the IL-10 expression may induce an immunosuppressive environment by upregulating HLA-G expression and downregulating HLA class I expression.

Comparison of the QuantiFERON-TB and tuberculin skin test for detection of latent tuberculosis infection in cancer patients in a developing country.

Cancer patients have an increased risk of reactivation of latent tuberculosis infection. It is unknown which strategy on screening should be used in this population in developing countries. We aimed to determine the concordance between the tuberculin skin test (TST) and QuantiFERON®-TB (QFT) assay in order to diagnose latent tuberculosis infection in cancer patients. We conducted a cross-sectional study of the agreement of diagnostic tests. Prevalence and agreement between tests were calculated. A logistic regression to assess predictors of discordance was performed. The accuracy of the TST to predict QFT results by a receiver operating characteristic (ROC) curve was evaluated. We included 149 adults with cancer without active tuberculosis. Prevalence of latent tuberculosis infection was 21.5% (n=32), defined as positive results on either test. Test agreement was moderate for the diagnosis of latent tuberculosis infection (κ=0.43, 90% CI 0.26-0.6). No predictor was associated with the chance of discordant results. Agreement improved slightly using a cut-off point ≥8 mm (κ=0.5, 90% CI 0.35-0.66). In a moderate-incidence setting, a moderate agreement was found between tests in cancer patients. Modification of the cut-off points of test results achieved marginally better agreement between the TST and QFT.

Tuberculosis among health care workers treated at a university hospital in Bogotá D.C., Colombia. 2008-2018 / Tuberculosis en trabajadores de la salud atendidos en un hospital universitario de Bogotá D.C., Colombia. 2008-2018

Abstract Introduction: Worldwide, three people die of tuberculosis (TB) every minute. The risk of TB transmission among healthcare workers is up to 40 times higher than in the general population. Nevertheless, in Colombia, little importance has been given to this situation. Objective: To describe the demographic and clinical characteristics of healthcare workers with TB treated in a university hospital from Bogotá D.C. (Colombia), as well as their laboratory, histologic, and imaging findings, and the main criteria for their TB diagnosis. Materials and methods: Case series study. The medical records of 24 healthcare workers with TB who were treated in a quaternary care university hospital in Bogotá D.C. between January 2008 and December 2018 were reviewed. Sociodemographic and clinical data, as well as imaging and laboratory findings data, were collected. Results: There was no predominant sex (50% women and 50% men). The median age was 33.5 years (IQR: 24-52.7). Pulmonary TB was the most frequent form of TB (62.50%); in addition, acid-fast bacillus sputum stain was positive in 2 patients (8.33%). The histopathology report was useful for diagnosing TB in 66.66% of cases, and mycobacterial culture was positive in 75% of patients. Most of them were physicians (41.66%) and medical students (16.66%). Conclusions: A high proportion of women was found in the study population (1:1 ratio), and the histopathology report was useful for reaching a rapid TB diagnosis in most cases. In addition, physicians and medical students were the healthcare workers most affected by TB. In this sense, health institutions in the country should pay greater attention to biosafety measures among these workers; also, occupational epidemiological surveillance programs enhancing TB-transmission control are necessary.

Resumen Introducción. Cada minuto tres personas mueren de tuberculosis (TB) en el mundo. El riesgo de transmisión en trabajadores de la salud es hasta 40 veces mayor que en población general. Sin embargo, en Colombia se ha dado poca importancia a esta situación. Objetivo. Describir las características demográficas y clínicas de trabajadores de la salud con TB atendidos en un hospital universitario de Bogotá D.C., Colombia, así como los hallazgos paraclínicos (de laboratorio, histológicos y radiológicos) y los principales criterios de diagnóstico de TB en estos pacientes. Materiales y métodos. Estudio de serie de casos. Se revisaron las historias clínicas de 24 trabajadores de la salud con TB atendidos en un hospital universitario de cuarto nivel de Bogotá D.C. entre enero de 2008 y diciembre de 2018. Se recolectó información sociodemográfica y sobre las características clínicas de estos pacientes, así como sobre hallazgos radiológicos y de laboratorio. Resultados. No hubo un género predominante (50% mujeres y 50% hombres). La mediana de edad fue 33.5 años (RIQ: 24-52.7). La TB más frecuente fue la TB pulmonar (62.50%); además, en 2 pacientes (8.33%) la baciloscopia de esputo fue positiva. El estudio histopatológico fue útil en el diagnóstico del 66.66% de los casos, y el cultivo de micobacterias fue positivo en el 75% de los casos. La mayoría de los pacientes eran médicos (41.66%), seguidos de estudiantes de medicina (16.66%). Conclusión. Se encontró una alta proporción de mujeres (relación 1:1), y el estudio histopatológico permitió el diagnóstico rápido de TB en la mayoría de los casos. Además, los trabajadores de la salud más afectados fueron los médicos y los estudiantes de medicina. En este sentido, las instituciones de salud del país deben prestar mayor atención a las prácticas de bioseguridad de esta población, y se debe contar con programas de vigilancia epidemiológica ocupacional que favorezcan un mejor control de la transmisión.