Serological and molecular analysis of parvovirus B19 infection in Mayan women with systemic lupus erythematosus in Mexico / Análisis serológico y molecular de la infección por parvovirus B19 en mujeres mayas con lupus eritematoso sistémico en México

Abstract Background: Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that mainly affects women, characterized by the production of autoantibodies. Its causal agent is unknown, but the combination of environmental, hormonal and genetic factors may favor the development of the disease. Parvovirus B19 has been associated with the development of SLE, since it induces the production of anti-single stranded DNA antibodies. It is unknown whether PV-B19 infection is an environmental factor that trigger or reactivate SLE in the Mexican Mayan population. Aim: A preliminary serological and molecular study of PV-B19 infection in Mayan women with established SLE was done. Methods: IgG and IgM anti PV-B19 were evaluated in 66 SLE patients and 66 control subjects, all women of Mayan origin. Viral DNA and viral load were analyzed by qPCR. Results: Insignificant levels of IgM were observed in 14.3% (4/28) of the patients and 11.4% (4/35) of control subjects. IgG was detected in 82.1% (23/28) of the patients and 82.9% (29/35) of control subjects, but were significantly higher in patients. Viral DNA was found in 86.0% (57/66) of the patients and 81.0% (54/66) of control subjects. Viral load, quantified in 28/66 patients and 31/66 controls which were positive for IgM and IgG, was significantly higher in controls. Conclusion: The high prevalence of PV-B19 in Yucatan, and the presence of IgM, IgG, and viral load in Mayan women with established SLE suggest that PV-B19 infection could be an environmental factor to trigger or reactivate SLE.

Resumen Antecedentes: Lupus eritematoso sistémico (LES) es una enfermedad sistemica autoinmune que afecta principalmente a las mujeres, caracterizada por la producción de autoanticuerpos. El agente causaal es desconocido. Pero la combinación de factores ambientales, hormonales y genéticos podría favorecer el desarrollo de la enfermedad. El parvovirus B19 se asoció con el desarrollo de LES, debido a que induce la producción de anticuerpos anti-cadena simple de DNA. Es desconocido si la infección PV-B19 es un factor ambiental que desencadena o reactiva LES en la población mexicana Maya. Objetivo: Se realizó un estudio serológico y molecular preliminar de la infección de PV-B19 en mujeres Mayas con LES. Métodos: Se evaluó IgG and IgM anti PV-B19 en 66 pacientes con LES y 66 controles sanos, todas las mujeres fueron de origen Maya. DNAViral y la carga viral fueron analizadas por qPCR. Resultados: Se determinaron niveles insignificantes de IgM en el 14.3% (4/28) de las pacientes y en el 11.4% (4/35) de los controles. IgG se detectó en el 82.1% (23/28) de los pacients y en el 82.9% (29/35) de los controles. Hubo un alta significancia en los pacientes con LES. DNA viral se encontró en el 86.0% (57/66) de los pacientes y en el 81.0% (54/66) de los controles. La carga viral se cuantifico en 28/66 pacientes y en 31/66 de los controles, la cual fueron positivos para IgM e IgG; fue significativamente mas alta en los controles. Conclusión: La alta prevalencia de PV-B19 en Yucatan y la presencia de IgM, IgG y una carga viral en mujeres Mayas con LES sugiere que la infección con PV-B19 poria ser un factor ambiental que desencadene o reactive el LES

Infecção pelo vírus Epstein-Barr em pacientes com lúpus eritematoso sistêmico / Epstein-Barr virus infection in patients with systemic lupus erythematosus

OBJETIVO: Verificar a associação entre a atividade do lúpus eritematoso sistêmico (LES) e a avidez das imunoglobulinas IgG anti-EBV. MÉTODOS: Analisou-se o sangue periférico de 66 pacientes distribuídos em dois grupos: 22 pacientes com LES em atividade e 44 pacientes com doença inativa. A presença e o índice de avidez de anticorpos IgG anti-EBV foram determinados pela técnica ELISA. (Enzygnost anti-EBV - Dade Behring). RESULTADOS: Identificou-se positividade no teste de detecção de IgG para EBV em 21 (95,5 por cento) pacientes do grupo LES ativo e em 40 (90,9 por cento) do grupo LES inativo. O índice de avidez alcançou valores 40 em 54 (88,5 por cento) pacientes, sendo 34 (85 por cento) do grupo LES inativo e 20 (95,2 por cento) do grupo LES ativo; em cinco (12,5 por cento) pacientes do grupo LES inativo, este índice ficou entre 20 e 40 e foi inferior a 20 em dois (3,3 por cento) pacientes. Adotando-se 20, 30 ou 40 como ponto de corte do índice de avidez, para diagnóstico de reativação da infecção por EBV, foram classificados como infecção reativada, nos grupos LES ativo e inativo, respectivamente: 1 (4,8 por cento) x 5 (12,5 por cento) pacientes, 1 (4,8 por cento) x 4 (10 por cento) pacientes e 1 (4,8 por cento) x 5 (12,5 por cento) pacientes. CONCLUSÃO: No presente estudo, não foi demonstrada associação entre a atividade do LES e a reativação do EBV. Esse fato parece indicar que a não eliminação dos linfócitos B infectados se deve à falha no mecanismo de apoptose ou à ação de linfócitos T citotóxicos, permitindo assim a progressão do LES.

OBJECTIVE: To verify the association of SLE activity to the avidity of IgG anti-EBV immune globulins. METHODS: Peripheral blood of 66 patients was analyzed, 22 had active SLE and 44 had inactive SLE. Presence and avidity index of IgG anti-EBV antibodies were determined by the ELISA method (Enzygnost® anti-EBV/IgG - Dade Behring). RESULTS: IgG anti-EBV test was positive for 21 (95.5 percent) patients in the active SLE group and 40 (90.9 percent) in the inactive group. The avidity index was 40 for 54 (88.5 percent) patients of which 34 (85 percent) belonged to the inactive SLE group and 20 (95.2 percent) to the active group. For 5 (12.5 percent) inactive SLE patients, the avidity index reached values ranging from 20 to 40; while for only 2 (3.3 percent) patients this index was lower than 20. Adopting 20, 30 or 40 as a cutoff point of the avidity index for diagnosis of reactivation of the EBV infection, the author classified as having reactivated infection, for active and inactive SLE groups, respectively: 1 (4.8 percent) x 1 (2.5 percent) patient; 1 (4.8 percent) x 4 (10 percent) patients and 1 (4.8 percent) x 5 (12.5 percent) patients. CONCLUSION: Association between EBV activity and SLE was not demonstrated. This appears to indicate that persistence of infected B lymphocytes may be due to failure in the apopotosis mechanism or to the action of T cytotoxic lymphocytes, permitting evolution of SLE.

Prevalence of cytomegalovirus and Epstein Barr virus in patients with juvenile rheumatoid arthritis and childhood systemic lupus erythematosus

The aim of this study was to investigate the possible role of cytomegalovirus [CMV] and Epstein-Barr virus [EBV] infections in the pathogenesis of juvenile rheumatoid arthritis [JRA] and childhood systemic lupus erythematosus [SLE]. The study included 31 JRA patients, 29 childhood onset SLE patients and 21 age and sex matched healthy controls. It was concluded that the prevalence of CMV and EBV is high in pediatric patients with JRA and SLE. These findings supported the hypothesis that these viral infections may be involved in the pathogenesis of autoimmune rheumatic diseases of childhood

Study of the role of parvo virus B19 in arthropathies of egyptian adult cases

This work was done to assess the relation between HPV B19 infection and arthropathies in Egyptian adults cases. For this purpose 40 rheumatoid arthritis [RA] cases, 10 osteoarthritis cases and 10 systemic lupus erythematosus [SLE] cases were selected to represent different types of arthropathies. The selection of cases was based on clinical diagnosis and laboratory tests [ESR, Hb level, Rose waller, detection of antinuclear antibodies and detection of hidden rheumatoid factor]. HPV B19 IgM and IgG were searched for by ELISA test in their sera as indicator of the state of HPV B19 infection. A control group was also included in this study, as 30 healthy persons with no previous complaint of rheumatic symptoms. HPV B19 IgM was detected in 60% of patients with RA, 40% of osteoarthritis cases and none of the SLE cases. Positive cases were more among females with long duration of illness affecting both big and small joints. These results indicated a possible causal association between acute HPV B19 and arthropathy. As regards HPV B19 IgG, it was detected in 57% of RA cases, 60% of osteoarthritis cases and 40% of SLE. The difference in IgG was statistically insignificant from the control group [46.7%]. The presence of HPV B19 IgG antibodies indicates previous exposure to the virus but does not indicate its time. Detection of HPV B19 IgM or rising titer of HPV B19 IgG may lead to early diagnosis of HPV B19 arthropathies

HIV infection in rheumatology clinic study of detection of HIV circulating antibodies in SlE patients

The detection of antibodies against HIV by ELISA using ABBOTT recombinant HIV[1]/HIV[2][3rd] generation EIA was performed in thirty SLE patients. Specimens repeatedly positive for HIV-1HIV2 antibodies were confirmed by Western Blot technique. The results were compared to those of ten normal controls and showed that three SLE female patients were positive. This supported the similarity of clinical manifestations, immunological features and some laboratory investigations between SLE and HIV infected patients and suggested that both may be attributed to the same or a similar virus but this needs to be documented by the isolation of the virus itself