A potent inflammatory response is triggered in asymptomatic blood donors with recent SARS-CoV-2 infection

ABSTRACT Background: The inflammatory response plays a significant role in the outcome of coronavirus disease (COVID-19). Methods: We investigated plasma cytokine and chemokine concentrations in non-infected (NI), asymptomatic severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)-infected blood donors (AS), and patients with severe COVID-19 (SC). Results: The SC group showed significantly higher levels of interleukin 6 (IL-6), IL-10, and CCL5 than the AS and NI groups. The SC and AS groups had considerably greater CXCL9 and CXCL10 concentrations than the NI group. Only NI and infected people showed separate clusters in the principal component analysis. Conclusions: SC, as well as AS was characterized by an inflammatory profile.

Prevalence of infection by human T Cell lymphotropic viruses (HTLV-1/2) in adult population in Vitoria-ES

ABSTRACT Introduction: Brazil has a high number of HTLV-1/2 infections which are unequally distributed in the country. Most prevalence studies have focused on specific populations, such as blood donors and pregnant women. Some areas, for example the state of Bahia, have robust information about HTLV-1/2 infection, however there is no information available about this infection in the general population of Vitoria, Espírito Santo, Brazil. Objective: To determine the prevalence of HTLV-1/2 infection in adults from the municipality of Vitoria, ES. Methods: A cross sectional study was performed from September 2010 to December 2011, in individuals of both sexes, aged 18 or older living in Vitoria-ES. Venous blood samples were collected and tested for anti-HTLV-1/2 antibodies by chemiluminescent immunoassay (CMIA). Individuals with CMIA reactive results were submitted to a new blood collection for retesting by CMIA, followed by PCR to confirm infection and discriminate the viral type. Results: From 1502 tested samples, eight were reactive in CMIA and all were confirmed by PCR. Therefore, the prevalence of HTLV-1/2 was 0.53% (8/1502, 95% CI: 0.2-1.0%). The infection rate was 0.7% in men (5/711, 95% CI: 0.17-1.51%), and 0.38% in women (3/791, 95% CI: 0 -0.81%). Conclusions: The prevalence of HTLV-1/2 infection was 0.53% (8/1502; 95% CI: 0.2 -0.9%). Confirmatory test using real-time PCR (qPCR) identified seven individuals positive for HTLV-1 and one for HTLV-2. Considering the risk of infected individuals to develop high morbidity and mortality diseases, it would be important to implement public health policies aimed at stopping transmission of these viruses in this municipality. 2021 Sociedade Brasileira de Infectologia. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license

Impact of a confirmatory RhD test on the correct serologic typing of blood donors

BACKGROUND: The RHD gene is highly polymorphic, which results in a large number of RhD variant phenotypes. Discrepancies in RhD typing are still a problem in blood banks and increase the risk of alloimmunization. In this study, the RhD typing strategy at a blood bank in Brazil was evaluated.METHODS: One-hundred and fifty-two samples typed as RhD negative and C or E positive by routine tests (automated system and indirect antiglobulin test using the tube technique) were reevaluated for RhD status by three methods. The method with the best performance was implemented and evaluated for a period of one year (n = 4897 samples). Samples that were D positive exclusively in the confirmatory test were submitted to molecular analysis.RESULTS: The gel test for indirect antiglobulin testing with anti-D immunoglobulin G (clone ESD1) presented the best results. Seventy samples (1.43%) previously typed as RhD negative showed reactivity in the gel test for indirect antiglobulin testing and were reclassified as D positive. D variants that may cause alloimmunization, such as weak D type 2 and partial DVI, were detected.CONCLUSION: The confirmatory RhD test using the gel test for indirect antiglobulin testing represents a breakthrough in transfusion safety in this blood center. Our results emphasize the importance of assessing the blood group typing strategy in blood banks.

Transmissão do HTLV-1/2 em grupos familiares: possíveis vias de contaminação / HTLV-1/2 transmission in family groups: possible routes of contamination

Introdução: portador assintomático do vírus linfotrópico de células T humanas (HTLV), sem conhecimento de sua positividade, pode transmiti-lo para seus contatos sexuais e familiares. Objetivo: determinar as rotas de transmissão do HTLV dentro dos grupos familiares da coorte Grupo Interdisciplinar de pesquisa em HTLV (GIPH), Belo Horizonte, Brasil. Métodos: a população do estudo foi formada por indivíduos do sexo feminino, que eram ex-doadoras de sangue com sorologia alterada para HTLV tipo 1 ou 2, detectada após doação de sangue em um hemocentro público (Hemominas) e por seus familiares. A partir dos resultados dos testes sorológicos, foram elaborados heredogramas dos grupos familiares. Em seguida, foram inferidas as possíveis rotas de transmissão do vírus dentro de cada grupo familiar. Resultados: foram selecionadas 275 mulheres; 206 tiveram pelo menos um familiar testado para HTLV, formando 95 grupos familiares nos quais foi possível deduzir a rota de contaminação. Em 23 (24,2%) grupos familiares observou-se contaminação por via vertical [IC 95% (20,7-27,7)], em 58 (61,1%) por via sexual [IC 95% (57,1-65,0)] e em 14 (14,7%) observou-se a existência de contaminação via sexual e via vertical [IC de 95% (11,8-17,6)]. Conclusão: os resultados obtidos são compatíveis com os encontrados em alguns países com alta prevalência de HTLV, já que em grandes áreas metropolitanas o vírus é transmitido principalmente por via sexual. É importante reconhecer a endemia do HTLV no Brasil para que sejam elaboradas medidas de prevenção adequadas.

Background: An asymptomatic carrier of HTLV-1/2 who is unaware of their serological status can spread the virus in their family group and to sexual contacts. Aim: To determine patterns of HTLV-1/2 infection and transmission in the GIPH cohort, Brazil. Methods: The population consisted of former female blood donors found positive for HTLV-1/2 after donating at a public blood center (Hemominas) in Brazil, their mothers and offspring, as well as the partners of male donors who came to be tested and their offspring. The possible pathways of HTLV transmission in these groups were analyzed. Pedigrees were prepared for the family groups after the serologic test results for the family members were ready. Results:Of 275 women, 206 had relatives tested for HTLV, comprising 95 family groups. In these family groups it was possible to infer that in 23 (24.2%) the contamination occurred by the vertical route [95% CI (20.7 to 27.7)], in 58 (61.1%) through sexual intercourse [CI 95% (57.1 to 65.0)] and in 14 (14.7%) both by sexual and vertical routes [CI 95% (11.8 -17.6)]. Conclusion: The results we obtained are consistent with those found in some countries with high prevalence of HTLV, since in large metropolitan areas the virus is transmitted primarily through sexual intercourse. The importance of knowing how HTLV is spreading in Brazil is to devise appropriate prevention measures.

The differential diagnosis of inflammatory joint disease in maternal-fetal microchimerism / Diagnóstico diferencial de doença inflamatória articular em microquimerismo materno-fetal

This study aimed at making the differential diagnosis of joint disease in a case of genetic chimerism in a female multiparous donor from the Regional Blood Bank of Guarapuava-PR (Hemocentro Regional de Guarapuava-PR), who had had three pregnancies of male fetuses. The patient showed joint pain prior to the last donation. It was possible to identify fetal cells remaining in circulation 20 years after her last pregnancy. Laboratory tests for acute phase proteins revealed possible termination of immune tolerance to circulating fetal cells. Thus, a hypothesis of graft-versus-host disease was formulated to explain the joint disease manifested by the donor.

Esse trabalho teve como objetivo fazer o diagnóstico diferencial de doença articular, em um caso de quimerismo genético de doadora multípara do Hemocentro Regional de Guarapuava-PR, com três gestações de fetos do sexo masculino, que apresentou dor articular previamente à última doação. Foi possível identificar células fetais ainda presentes na sua circulação após 20 anos da última gestação. Os exames laboratoriais para proteínas de fase aguda demonstram possível término da imunotolerância às células fetais circulantes na doadora e, com isso, uma hipótese de doença de enxerto contra o hospedeiro foi elaborada para explicar a doença articular manifestada pela doadora.

Thrombospondin-1 expression in human T-lymphotropic virus 1 asymptomatic carriers and patients with HTLV-associated myelopathy/tropical spastic paraparesis / Expressão de Trombospondina-1 em indivíduos infectados pelo HTLV-1 assintomáticos e pacientes portadores da mielopatia associada ao HTLV/Paraparesia Espástica Tropical

O Vírus Linfotrópico de células T humanas tipo 1 (HTLV-1) está associado a uma mielopatia (chamada mielopatia associada ao HTLV - HAM/TSP). A trombospondina-1 (TSP-1) é uma proteína da matriz que interfere com a adesão, a motilidade, e a proliferação celular. Níveis deexpressão de RNA mensageiro (mRNA) da trombospondina-1 foram avaliados em indivíduos infectados por HTLV-1: 11 pacientes assintomáticos, 18 com mielopatia ou oligossintomáticos, e 13participantes não-infectados. O RNA de células mononucleares do sangue periférico foi submetido à análise de RT-PCR para trombospondina-1. O número de indivíduos que expressaram esta proteína foi maior no grupo com mielopatia/sintomas (14/18, p igual 0,007). Em geral, a tendência para valores mais elevados de mRNA de trombospondina-1 foi observada no grupo de infectados pelo vírus (p igual 0,062). Os níveis mais elevados de expressão do mRNA foram detectados no início dos sintomas clínicos da HAM/TSP. Estudos adicionais com maior número de amostras são necessários para elucidar melhor o papel desta proteína da matriz na rede inflamatória relacionada à HAM/TSP.

High prevalence of HTLV-1 and 2 viruses in pregnant women in São Luis, state of Maranhão, Brazil / Alta prevalência dos vírus HTLV-1 e 2 em gestantes de São Luis, estado do Maranhão, Brasil

INTRODUCTION: Human T cell lymphotropic virus type 1 (HTLV-1) is endemic in the Caribbean, Japan, South America and regions of Africa. HTLV-2 is present in Native American populations and associated with IV drug use in Europe and North America. In Brazil, it is estimated that 1.5 million people are infected with HTLV-1/2. The study objective was to determine HTLV-1/2 prevalence in pregnant women in the prenatal care from three public services in São Luis, State of Maranhão, Brazil, and to counsel seropositive women to reduce viral transmission. METHODS: A cross-sectional study was conducted from February to December 2008; women with age of 18 to 45 years, with low risk for sexually transmitted disease (STD) were invited to participate. Blood samples were collected in filter paper, and HTLV-1/2 immunoenzymatic test (ELISA) was performed as a screening test. Women with reactive results were submitted to peripheral venous blood collection for ELISA repetition, followed by Western blot (WB) and real-time PCR to confirm and discriminate the infection between virus types 1 and 2. RESULTS: Of the 2,044 women tested, seven (0.3%) were ELISA reactive and confirmed positive (four were HTLV-1, and three were HTLV-2). All positive women were oriented not to breastfeed their newborns. CONCLUSIONS: This study showed that the virus is present in high prevalence in that population. Further studies covering other segments of the population are necessary to better characterize the presence of HTLV-1/2 in Maranhão and to elicit measures to prevent its spread.

INTRODUÇÃO: O vírus linfotrópico de células T humanas tipo 1 (HTLV-1) é endêmico no Caribe, Japão, América do sul e regiões da África. O HTLV-2 está presente em populações indígenas das Américas e usuários de drogas injetáveis na Europa e América do Norte. No Brasil, estimase que 1,5 milhões de pessoas estejam infectadas pelo HTLV-1/2. O objetivo deste estudo foi de determinar a prevalência do HTLV-1/2 em gestantes atendidas no pré-natal de três serviços públicos em São Luis, Maranhão, e orientar as mulheres soropositivas para reduzir a transmissão viral. MÉTODOS: Foi realizado um estudo transversal, de fevereiro a dezembro de 2008, com gestantes de 18 a 45 anos, com baixo risco de doença sexualmente transmissível (DST). Amostras de sangue foram coletadas em papel filtro e submetidas à técnica de ensaio imunoenzimático (ELISA) como teste de triagem para HTLV-1/2. As gestantes com resultado ELISA reativo foram submetidas à coleta de sangue venoso periférico para repetição do ELISA, seguido por WB e PCR em tempo real para confirmar e discriminar a infecção pelos tipos virais. RESULTADOS: Das 2.044 mulheres examinadas, sete (0.3%)tiveram resultados reativos e foram confirmadas soropositivas (quatro para HTLV-1 e três para HTLV-2). Todas as sete gestantes foram orientadas a não dar leite materno aos filhos. CONCLUSÕES: Este estudo mostrou que o HTLV-1/2 está presente em alta prevalência na população das mulheres grávidas estudadas. São necessários outros estudos contemplando diferentes segmentos populacionais para caracterizar a presença do HTLV-1/2 no Maranhão, e permitirmedidas preventivas contra a disseminação viral.

Molecular analysis of the GYPB gene to infer S, s, and U phenotypes in an admixed population of Minas Gerais, Brazil

OBJECTIVE: To implement genotyping for S, s and U antigens of the MNS blood group system at the Fundação Hemominas and to evaluate the occurrence of GYPB gene polymorphisms associated with the U- and U+var phenotypes and deletion of the GYPB gene for the first time in an admixed population of Minas Gerais, Brazil. The S, s and U antigens can cause transfusion reactions and perinatal hemolytic disease. Genotyping is a useful tool in immunohematology, especially when phenotyping cannot be performed. METHODS: Ninety-six samples from blood donors and patients with sickle cell disease previously phenotyped for the S, s and U antigens were selected. Allele-specific primer polymerase chain reaction (ASP-PCR) and polymerase chain reaction -restriction fragment length polymorphism (PCR-RFLP) assays were employed to identify the GYPB*S and GYPB*s alleles and the GYPB(P2) and GYPB(NY) variants, as well as deletion of the GYPB gene. RESULTS: The results of allele-specific genotyping (GYPB*S and GYPB*s) were totally in agreement with the phenotyping of S+ (n = 56), s+ (n = 60) and s- (n = 35) samples. However, the GYPB*S allele, in association with the GYPB(P2) variant, was detected in 17.5% of the S- samples (n = 40), which shows the importance of assessing this variant in the Brazilian population. Of the S-s- samples (n = 10), 60% had the deletion of the GYPB gene and 40% were homozygous or hemizygous for the GYPB(P2) variant. CONCLUSION: Genotyping was an effective strategy to infer the S, s, and U phenotypes in the admixed population from Minas Gerais (Brazil) and may contribute to transfusion safety.

Geographic distribution of human T-lymphotropic virus types 1 and 2 among mothers of newborns tested during neonatal screening, Minas Gerais, Brazil / Distribución geográfica del virus linfotrópico de células T humanas tipos 1 y 2 en madres de recién nacidos estudiados en el tamizaje neonatal en Minas Gerais, Brasil

OBJECTIVE: To evaluate the geographic distribution of human T-lymphotropic virus types 1 and 2 (HTLV-1/2) in the State of Minas Gerais, Brazil, in puerperal women whose newborns were tested for HTLV-1/2 during neonatal screening, and to overlap seropositivity with social and economic status determinants. METHODS: During September-November 2007, the dry-blood samples taken from newborns on filter paper for routine screening were also tested for maternal IgG anti-HTLV-1/2 antibodies. For reactive samples, the mothers of the newborns had blood drawn to test for these viruses. RESULTS: The study analyzed 55 293 specimens taken from newborns. Of these, 52 (9.4 per 10 000) were reactive and 42 mothers (7.6 per 10 000) were confirmed with HTLV-1/2 infection. HTLV-1/2 geographic distribution was heterogeneous, with a tendency to be higher in the North and North-East parts of Minas Gerais. The highest rates of seropositivity were observed in Vale do Mucuri (55.9 per 10 000) and in Jequitinhonha (16.0 per 10 000), overlapping with the State's worst social and economic indicators. CONCLUSIONS: To our knowledge this was the first time that neonatal screening for HTLV-1/2 was performed in Brazil. This model could be used in other areas with high HTLV-1/2 prevalence rates. The detection of carrier mothers can enable intervention measures, such as providing infant formula to newborns, to be implemented expeditiously to reduce vertical transmission.

OBJETIVOS: Evaluar la distribución geográfica del virus linfotrópico de células T humanas tipos 1 y 2 (HTLV-1/2) en el estado de Minas Gerais (Brasil), en mujeres puérperas en cuyos recién nacidos se analizó la presencia del HTLV-1/2 durante las pruebas neonatales de detección sistemática, y superponer la seropositividad con determinantes del estado socioeconómico. MÉTODOS: Entre septiembre y noviembre de 2007, en las muestras de sangre seca extraída a los recién nacidos en papel de filtro para un tamizaje sistemático, se analizaron también los anticuerpos maternos de tipo IgG anti-HTLV-1/2. En el caso de las muestras reactivas, se extrajo la sangre de las madres de los recién nacidos para realizar pruebas de detección de estos virus. RESULTADOS: En el estudio se analizaron 55 293 muestras extraídas de los recién nacidos. De estas, 52 (9,4 por 10 000) fueron reactivas y en 42 madres (7,6 por 10 000) se confirmó la infección por el HTLV-1/2. La distribución geográfica del HTLV-1/2 fue heterogénea, con una tendencia a ser mayor en el norte y el noreste de Minas Gerais. Las tasas más elevadas de seropositividad se observaron en Vale do Mucuri (55,9 por 10 000) y en Jequitinhonha (16,0 por 10 000), superponiéndose con los peores indicadores socioeconómicos del estado. CONCLUSIONES: Esta fue la primera vez que se realizó un tamizaje neonatal para el HTLV-1/2 en Brasil. Este modelo podría usarse en otras regiones con tasas de prevalencia altas del HTLV-1/2. La detección de las madres portadoras puede permitir la aplicación rápida de medidas de intervención, como por ejemplo, el suministro de leche maternizada a los recién nacidos, a fin de reducir la transmisión vertical.

Evaluation of the use of real-time PCR for human T cell lymphotropic virus 1 and 2 as a confirmatory test in screening for blood donors / Análise do uso da PCR em tempo real para HTLV-1 e 2 como teste confirmatório na triagem de doadores de sangue

INTRODUCTION: HTLV-1/2 screening among blood donors commonly utilizes an enzyme-linked immunosorbent assay (EIA), followed by a confirmatory method such as Western blot (WB) if the EIA is positive. However, this algorithm yields a high rate of inconclusive results, and is expensive. METHODS: Two qualitative real-time PCR assays were developed to detect HTLV-1 and 2, and a total of 318 samples were tested (152 blood donors, 108 asymptomatic carriers, 26 HAM/TSP patients and 30 seronegative individuals). RESULTS: The sensitivity and specificity of PCR in comparison with WB results were 99.4 percent and 98.5 percent, respectively. PCR tests were more efficient for identifying the virus type, detecting HTLV-2 infection and defining inconclusive cases. CONCLUSIONS: Because real-time PCR is sensitive and practical and costs much less than WB, this technique can be used as a confirmatory test for HTLV in blood banks, as a replacement for WB.

INTRODUÇÃO: A triagem para HTLV-1/2 em doadores de sangue geralmente utiliza imunoensaio enzimático, seguido de um método confirmatório como Western blot quando o EIA é positivo, mas este algoritmo mostra alta taxa de resultados inconclusivos, e elevado custo. MÉTODOS: Dois ensaios qualitativos de PCR em tempo real foram desenvolvidos para detectar HTLV-1 e 2 e um total de 318 amostras foram testadas por PCR (152 de doadores de sangue, 108 de portadores assintomáticos, 26 de pacientes HAM/TSP e 30 de indivíduos soronegativos). RESULTADOS: A sensibilidade e especificidade das PCR em relação aos resultados de WB foram de 99,4 por cento e 98,5 por cento, respectivamente. As PCR foram mais eficientes em identificar o tipo viral, a infecção pelo HTLV-2 e úteis para definir casos inconclusivos. CONCLUSÕES: Por serem sensíveis, práticas e de custo muito inferior ao do WB, as técnicas de PCR em tempo real podem ser usadas como teste confirmatório do HTLV em bancos de sangue, em substituição ao WB.

Lesões dermatológicas em pacientes infectados pelo vírus linfotrópico humano de células T do tipo 1 (HTLV-1) / Dermatologic lesions in patients infected with the human T-cell lymphotropic vírus type 1 (HTLV-1)

O vírus linfotrópico humano de células T do tipo 1 (HTLV-1) é o primeiro retrovírus isolado do ser humano. Descreveu-se, em pouco tempo, o seu papel etiológico em algumas doenças, com destaque para a leucemia/linfoma de células T do adulto (ATLL), a mielopatia associada ao HTLV-1/paraparesia espástica tropical (HAM/TSP) e a uveíte associada ao HTLV-1 (HAU). Na década de 90, o HTLV-1 foi associado a eczema grave da infância, conhecido como dermatite infecciosa (DI). Desde então, diversos outros tipos de lesões cutâneas têm sido observados em pacientes infectados pelo HTLV-1, em especial, nos doentes de HAM/TSP ou de ATLL. Porém, mesmo portadores assintomáticos do vírus apresentam doenças dermatológicas. Excetuando-se a dermatite infecciosa, não há lesão da pele específica da infecção pelo HTLV-1. Aqui, os autores apresentam as principais lesões dermatológicas descritas em pacientes infectados pelo HTLV-1, destacando o valor epidemiológico e clínico desses achados.

Erectile insufficiency as first symptom of HTLV I/II associated myelopathy: case report

A case of HTLV-I/II myelopathy in which the initial complaint was erectile insufficiency (EI) is reported. The only abnormalities found on the neurological exam were discrete weakness of the psoas and increased knee jerk reflexes. Diagnosis was male by demonstrating antibodies anti-HTLV I/II in the serum and cerebrospinal fluid (with the techniques of ELISA and Western blot), with confirmation by the polymerase chaim reaction (PCR). El can thus be the first symptom of HTLV-I/II infection and patients with EI of unknown etiology should be tested for HTLV-I/II in endemic areas.