Seroprevalencia del SARS-CoV-2 en los pacientes con enfermedades inmunomediadas en tratamiento con terapias biológicas y sintéticos dirigidos / Seroprevalence of SARS-CoV-2 antibodies in patients with immune-mediated inflammatory diseases treated with biological and synthetic targeted therapies

INTRODUCCIÓN: La seroprevalencia del SARS-CoV-2 en las enfermedades inflamatorias inmunomediadas (IMID) sigue siendo fuente de controversia. OBJETIVO: Comparar la seroprevalencia de anticuerpos (Ac) anti SARS-CoV-2 en pacientes con IMID en tratamientos con fármacos antirreumáticos modificadores de la enfermedad biológicos (FAMEb) o sintéticos dirigidos (FAMEsd) frente a un grupo de personas sin IMID. MÉTODOS: Estudio de pacientes con IMID y tratamientos con FAMEb y FAMEsd y de individuos sin IMID. Mediante la técnica de inmunoensayo por quimioluminiscencia indirecta, se determinaron las serologías IgG frente al SARS-CoV-2 entre octubre/2020 y mayo/2021. RESULTADOS: Se estudiaron 1.100 sujetos, 550 pacientes con IMID y 550 personas sin IMID. Se observó una seroprevalencia de 16% (88/550) en los pacientes frente a 19,3% (106/550) en el grupo de personas sin IMID, sin significación estadística (OR 0,790 [IC 95% 0,558-1,118]). Comparando los tratamientos con FAMEb o FAMEsd, se observó una tendencia a una menor seroprevalencia con rituximab, en relación con los individuos sin IMID (OR 0,296 [IC 95% 0,0871,007]). Asimismo, se encontró menor seroprevalencia en los pacientes que además de su FAMEb recibían tratamiento con metotrexato, en comparación con el grupo de personas sin IMID (OR 0,432 [IC 95% 0,223-0,835]). CONCLUSIONES: Las IMID en tratamiento con FAMEb o FAMEsd no influyen en la seroprevalencia frente al SARS-CoV-2 de los pacientes. El tratamiento concomitante con metotrexato disminuye de forma significativa la seroprevalencia en estos pacientes.

BACKGROUND: The seroprevalence of SARS-CoV-2 in immunemediated inflammatory diseases (IMID) remains controversial. AIM: To compare the seroprevalence of antibodies (Ab) to SARS-CoV-2 in patients with IMID receiving treatment with biological diseasemodifying antirheumatic drugs (bDMARD) or targeted synthetic (tsDMARD) versus a group of people without IMID. METHODS: Study of patients with IMID and treatments with bDMARD and tsDMARD and individuals without IMID. IgG serology against SARS-CoV-2 was measured using the two-step sandwich immunoassay technique by indirect chemiluminescence between October 2020 and May 2021. RESULTS: A total of 1100 subjects were studied, 550 patients with IMID and 550 persons without IMID. A seroprevalence of 16% (88/550) was observed in patients versus 19.3% (106/550) in the group of people without IMID, without statistical significance (OR 0.790 [95% CI 0.558-1.118]). Comparing the treatments with bD- MARD or tsDMARD, there was a tendency to lower seroprevalence with rituximab, in relation to individuals without IMID (OR 0.296 [95% CI 0.087-1.007]). In addition, lower seroprevalence was found in patients who received methotrexate treatment in addition to their bDMARD, compared to the group of individuals without IMID (OR 0.432 [95% CI 0.223-0.835]). CONCLUSIONS: IMIDs in treatment with bDMARDs or tsDMARDs do not influence the seroprevalence against SARS-CoV-2 in patients. Concomitant treatment with methotrexate significantly decreased seroprevalence in these patients.

Clinical risk factors for predicting anti-Sars-Cov-2 antibody immunoreactivity duration after mild COVID-19 infection / Fatores de risco clínicos para predizer a duração da imunoresatividade do anticorpo anti-Sars-Cov-2 após infecção leve por COVID-19

Introduction: coronavirus disease 2019 (COVID-19) is a complex multisystem disorder. It is not yet well known whether symptoms in the acute phase correlate with the duration of the immune response and the persistence of chronic symptoms.Objective: this study aimed to assess and monitor the clinical symptoms of COVID-19 and correlate them with the production of neutralizing antibodies.Methods: a cohort of 69 health workers at the University Hospital of the Federal University of Espírito Santo (HUCAM-UFES/EBSERH) diagnosed with SARS-CoV-2 infection confirmed via RT-PCR (Real-Time Reverse Transcription­Polymerase Chain Reaction) were evaluated from the onset of symptoms up to six months. SARS-CoV-2 IgG and IgM assays were used to detect the presence of IgG and IgM against the nucleocapsid protein of SARS-CoV-2 in serum samples. IgG and IgM antibody serology, pulmonary function via spirometry, and the clinical evolution of patients were performed at 15, 30, 45, 60, 90, and 180 days after the onset of COVID-19 symptoms.Results: sixty-nine health workers (age, 40 ± 10 years; 74% women) were evaluated for six months. All subjects showed mild to moderate COVID-19. The mean number of symptoms was 5.1 (± 2.3). The most common initial symptoms were muscle pain (77%), headache (75%), anosmia (70%), ageusia (64%), runny nose (59%), fever (52%), and coughing (52%). After 30 days, the patients had anosmia (18%), asthenia (18%), adynamia (14%), muscle pain (7%), and ageusia (7%). Regarding lung function, 9.25% presented with an obstructive pattern, and all recovered after six months. Of all analyzed participants, 18/69 (26%) did not have any reactive IgG or IgM values in any of the assessments. The IgG serology curve showed a peak, whereas IgM had the highest mean value on the 15th day. There was a progressive decrease and levels similar to those at baseline after 90 days, and 15/53 (28%) remained with reactive IgG after six months. Sore throat and shortness of breath were found to be independent risk factors, and patients with these symptoms were 5.9 times more likely to have reactive IgG on the 180th day. Patients with diarrhea were four times more likely to have reactive IgM.Conclusion: our findings showed that 26% of patients did not produce a humoral response post-mild COVID-19. Their antibody titers dropped significantly after 90 days, and only 28% maintained reactive IgG antibodies after six months. Sore throat and shortness of breath are predictors of a longer duration of the humoral immune response.

Introdução: a doença causada pelo coronavírus (COVID-19) é complexa e multissistêmica. Ainda não se sabe se os sintomas da fase aguda estão correlacionados com a duração da resposta imune e com a persistência dos sintomas crônicos.Objetivo: o presente estudo visa acessar e monitorar os sintomas clínicos do COVID-19, correlacionando-os com a produção de anticorpos neutralizantes.Método: uma coorte de 69 profissionais da saúde da Universidade Federal do Espírito Santo (HUCAM-UFES/EBSERH) diagnosticados com infecção por SARS-CoV-2 confirmada via RT-PCR (Real-Time Reverse Transcription-Polymerase Chain Reaction) foram avaliados do início dos sintomas até seis meses depois. Exames laboratoriais de IgG e IgM foram utilizados para detectar a presença de IgG e IgM contra a proteína do nucleocapsídeo do vírus SARS-CoV-2 nas amostras de plasma sanguíneo. Sorologia de anticorpos IgG e IgM, função pulmonar via espirometria e avaliação clínica dos pacientes foram realizadas nos dias 15, 30, 45, 60, 90 e 180 após o início dos sintomas da doença.Resultados: sessenta e nove profissionais da saúde (idade, 40 ± 10 anos; 74% mulheres) foram avaliados por seis meses. Todos apresentaram a forma leve a moderada do COVID-19. O número médio de sintomas foi 5.1 (± 2.3). O sintoma inicial mais comum foi dor muscular (77%), cefaleia (75%), anosmia (70%), ageusia (64%), coriza (59%), febre (52%), e tosse (52%). Após 30 dias, os pacientes mantiveram anosmia (18%), astenia (18%), adinamia (14%), dor muscular (7%), e ageusia (7%). Em relação à função pulmonar, 9.25% apresentaram padrão obstrutivo e todos recuperaram ao final dos seis meses. Dentre todos os participantes analisados, 18/69 (26%) não obtiveram nenhum valor de IgG e IgM considerados reagentes nos exames realizados. A curva sorológica de IgG mostrou um pico enquanto a de IgM apresentou seu maior valor médio no 15º dia. Houve um declínio progressivo e níveis similares aos basais aos 90. 15/53 (28%) permaneceram com IgG reagente após seis meses. Dor de garganta e dispneia foram considerados fatores de risco independentes, e os pacientes com esses sintomas tiveram 5,9 vezes mais chances de apresentar IgG reativa no 180º dia. Pacientes com diarreia tiveram quatro vezes mais chances de apresentar IgM reagente.Conclusão: nossos achados mostraram que 26% dos pacientes não produziram uma resposta humoral pós-COVID-19 leve. Seus títulos de anticorpos caíram significativamente após 90 dias e apenas 28% mantiveram anticorpos IgG reativos após seis meses. Dor de garganta e dispneia foram preditores de maior duração da resposta imune humoral

Cord Blood IgG Antibodies Against SARS CoV-2 in Pregnant Women at a Rural Teaching Hospital

Introduction: The significant risks posed to mothers and fetus by COVID-19 in pregnancy have sparked a worldwide debate surrounding the antenatal SARS-CoV-2 infection and vaccination. ACOG and CDC recognize pregnancy as a risk factor, Recent data demonstrated that pregnant women with COVID-19 infection are at increased risk for intensive care unit (ICU) admission, mechanical ventilation, and death, compared with properly matched nonpregnant women. Moreover, COVID-19 illness increases the risk for pregnancy complications such as preterm birth, pregnancy-induced hypertensive diseases, and thromboembolic diseases. Maternal IgG antibodies to SARS-CoV-2 where transferred across the placenta after asymptomatic as well as symptomatic infection during pregnancy. Proper transfer of neutralizing antibodies may be critical during pregnancy, as a greater proportion of neonates and infants have severe or critical illness upon COVID-19 infection than older pediatric counterparts. To detect cord bloodAims and Objectives: IgG antibodies against SARS CoV-2 in pregnant women. To assess the association between maternal and fetal SARS-CoV- 2 specific antibodies. A brief questionnaire was administered to 42 antenatal women attending for delivery atMethods: Mediciti Institute of Medical Sciences, Hyderabad, Telangana State. The questionnaire included information such as vaccination status, previous history of Covid infection, presence of any symptoms at the time of admission, comorbid conditions like DM, HTN, Thyroid disorders, etc. Following delivery, 2ml cord blood sample has been collected. Serum has been separated and used for detection of SARS CoV-2 IgG antibody titers by quantitative ELISA. Among 42Results: antenatal cases,4 were controls among them two were positive control and two were negative controls. Out of remaining 38, the SARS-CoV-2 IgG antibodies are detected in 14 cases. IgG was detected in the cord blood for 33.3% of the total cases. Among those detected positive for antibodies, 50% had preterm deliveries. IgG antibodies haveConclusion: been detected in the cord blood collected from the vaccinated women as well as the women affected with SARS-Co-2 and even increased the risk for pregnancy complications such as preterm birth, pregnancy-induced hypertensive diseases, Gestational Diabetes.

Multi System Inflammatory Syndrome In Neonates (MIS-N): A Case Report

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy may increase the risk of stillbirth, neonatal death, preterm birth, low birth weight, fetal distress, and neonatal asphyxia. Vertical transmission of SARS-CoV-2 is under investigation. Afew reports suggest the possibility of SARS-CoV-2 transmission from mothers to their neonates. The SARS-CoV-2 virus was reported as one of the rare causes of fetal inflammatory response syndrome (FIRS) and is associated with multisystem inflammatory syndrome in children (MIS-C).

Evaluación de ensayos ultramicroanalíticos para la detección de anticuerpos contra el SARS-CoV-2 / Evaluation of ultramicroanalytic assays to detect antibodies against SARS-CoV-2

Introducción: En el presente trabajo se muestran los resultados de la validación de los ensayos serológicos in vitro para la detección de anticuerpos IgM, IgG y anticuerpos totales contra el SARS-CoV-2 UMELISA SARS-CoV-2 IgM, UMELISA ANTI-SARS-CoV-2 y UMELISA SARS-CoV-2 IgG desarrollados por el Centro de Inmunoensayo (CIE). Métodos: Se utilizaron paneles de muestras de suero de individuos negativos y de casos confirmados de COVID-19 para determinar el desempeño analítico de cada ensayo. Resultados: La especificidad clínica de los ensayos UMELISA SARS-CoV-2 IgM, UMELISA ANTI-SARS-CoV-2 y UMELISA SARS-CoV-2 IgG fue del 100 por ciento en todos los ensayos y la especificidad analítica fue de 100 por ciento para los dos primeros ensayos y del 93,1 por cientopara el último. La sensibilidad clínica fue de 64,3, 80,8 y 97,5 por ciento, respectivamente. El valor predictivo positivo fue de 100 por ciento en todos los ensayos, en tanto que el negativo osciló entre 83,3 y 95,2 por ciento. La concordancia fluctuó entre 92,4 y 96,9 por ciento y el índice kappa de todos los ensayos fue muy bueno. La sensibilidad de los ensayos se incrementó a 82,76, 96,5 y 100 por ciento, respectivamente, en las muestras de suero colectadas con más de 14 días de iniciado el cuadro clínico. Conclusiones: Los ensayos demostraron una elevada sensibilidad y especificidad, lo que permite contar con herramientas basadas en una tecnología desarrollada en Cuba que posibilita la realización de estudios serológicos, vigilancia epidemiológica y de otro tipo, incluyendo los relacionados con vacunas en una plataforma con amplia distribución nacional(AU)

Introduction: This paper shows the results obtained in the validation of in vitro serological assays to detect IgM, IgG antibodies, and total antibodies against SARS-CoV-2 UMELISA SARS-CoV-2 IgM, UMELISA ANTI-SARS-CoV-2 and UMELISA SARS-CoV-2 IgG developed by the Immunoassay Center. Methods: Panels of serum samples from negative and COVID-19 confirmed patients were used to determine the analytical performance of each assay. Results: UMELISA SARS-CoV-2 IgM, UMELISA ANTI-SARS-CoV-2 and UMELISA SARS-CoV-2 IgG assays demonstrated 100 percent clinical specificity for all assays; and 100 percent analytical specificity for the first two assays, and 93.1 percent for the last one. Clinical sensitivity was 64.3 percent, 80.8 percent and 97.5 percent, respectively. The positive predictive value was 100 percent in all assays, while the negative predictive value ranged from 83.3 percent to 95.2 percent. Concordance varied from 92.4 percent to 96.9 percent, and kappa index in every assay was very good. Assays sensitivity increased to 82.7 percent, 96.5 percent and 100 percent, respectively for serum samples collected more than 14 days after onset of the symptoms. Conclusions: The assays demonstrated high sensitivity and specificity, which allows us to have Cuban technology-based tools for serological, epidemiological surveillance, and other types of studies, including those related to vaccines on a platform with wide national distribution(AU)