Salivary immunoglobulin levels and periodontal indices in Brazilian children with and without type 1 diabetes.

This cross-sectional study evaluated the association between salivary immunoglobulins, plaque index, and gingival index in Brazilian children with and without type 1 diabetes mellitus (DM1). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for the reporting of observational studies was followed. The DM1 group had 38 children, and an equal number of volunteers matched by sex and age were recruited as controls. Clinical examination was performed for plaque index and gingival index determination. Non-stimulated whole saliva was collected. Concentrations of IgA, IgG, and IgM were determined by ELISA test. Data were tested by the Kolmogorov-Smirnov, Mann-Whitney, and Spearman tests and a multiple linear regression model (p<0.05) was performed. Gingival index was higher in the Control (DM1: 0.16±0.17; Control: 0.24±0.23, p=0.040). In DM1, there was a correlation between IgA and age (rho=0.371, p=0.024), IgM and IgG (rho=0.459, p=0.007), and IgM and gingival index (rho=0.394, p=0.014). In DM1, multiple linear regression showed that age (p=0.041; ß=0.363), gingival index (p=0.041; ß=0.398), and plaque index (p=0.008; ß=-0.506) were good predictors of IgA levels in saliva. Thus, IgA was the only researched immunoglobulin that was directly associated with plaque and gingival indices in Brazilian children with DM1, but not in control subjects.

Infrared spectroscopy as a predictive tool for the severity of COVID-19 using patient's saliva: A strategy to avoid hyperinflammation.

Discriminate the severity level of COVID-19 disease is still a challenge. Here we investigate the capability of micro-infrared absorption spectroscopy (micro-FTIR) to probe COVID-19 severity level and predict hyperinflammation, correlating the assigned vibrational data to relevant biomolecules related to the immune system. Saliva of 184 patients was analysed by ELISA assay (Hepcidin) and micro-FTIR. Vibrational bands related to IgM and IgA can discriminate healthy from Severe individuals (sensitivity ≥ 0.749, specificity ≥ 0.945) and are less effective in discriminating Mild or Moderate individuals from the Severe group (sensitivity ≥ 0.628, specificity ≥ 0.867). Analysis of the second derivative of spectra probed increased levels of IL-6 in the saliva a key additional information for the degree of severity prediction. Because the model discriminates all the groups regarding the Severe group, it predicts an intense state of inflammation based on FTIR analysis. It is a powerful tool for predicting hyperinflammation conditions related to SARS-CoV-2 infection and may be an ally in implementing drugs or therapeutic approaches to manage COVID-19 in the Severe stage in healthcare facilities.

Estandarización y evaluación del desempeño de un inmunoensayo para la detección de anticuerpos contra el dominio de unión a receptor de la proteína de espícula del virus SARS-CoV-2 / Establishment and performance evaluation of an immunoassay for the antibody detection against the receptor binding domain of the SARS-CoV-2 spike protein

Resumen Objetivo: Establecer un inmunoensayo semicuantitativo para la detección de anticuerpos contra el dominio de unión al receptor de la proteína de espícula del coronavirus del síndrome respiratorio agudo grave tipo 2 y la evaluación de su desempeño como herramienta de apoyo diagnóstico. Métodos: Se generó una proteína recombinante del dominio de unión a receptor de la proteína de espícula del coronavirus del síndrome respiratorio agudo grave tipo 2. Dicha proteína se empleó como sustrato antigénico en la estandarización de dos ensayos semicuantitativos por inmunoadsorción ligados a enzima para la detección de inmunoglobulinas M e inmunoglobulinas G humanas. Se utilizó un conjunto de muestras de suero positivas (n=129), provenientes de donantes voluntarios con infección previa por el virus SARS-CoV-2, confirmada mediante reacción en cadena de la polimerasa con transcriptasa reversa, y tomadas entre agosto de 2020 y noviembre de 2021. Además, se empleó un panel de muestras prepandémicas negativas (n=196) obtenidas antes de diciembre de 2019 para la evaluación del desempeño de los ensayos; se recibieron muestras múltiples seriadas de 99 donantes voluntarios para examinar la respuesta de la prueba ante la seroconversión y se estudió la posible asociación entre las seropositividades por coronavirus del síndrome respiratorio agudo grave tipo 2 y por el virus del dengue para la evaluación de reacciones cruzadas inespecíficas. Resultados: El ensayo de detección de inmunoglobulina G mostró 81.4 % de sensibilidad, 86.2 % de especificidad y valores predictivos positivos y negativos de 79.5 % y 87.6 % respectivamente. Por su parte, el ensayo de detección de inmunoglobulina M mostró solamente 72.1 % de sensibilidad, 54.1 % de especificidad y valores predictivos positivos y negativos de 25.6 % y 89.8 % respectivamente. No se encontraron diferencias significativas entre las mediciones semicuantitativas según sexo ni correlación lineal entre esta variable y la edad. Los valores obtenidos para el inmunoensayo presentaron diferencias significativas según el autorreporte de presencia o ausencia de síntomas compatibles con COVID-19. No se encontró correlación entre las seropositividades contra el coronavirus del síndrome respiratorio agudo grave tipo 2 y el virus del dengue. El ensayo de detección de inmunoglobulina G generó valores inferiores pero constantes en muestras de donantes voluntarios que autorreportaron no haber tenido contacto con el virus SARS-CoV-2. En contraste, las muestras de donantes expuestos al virus SARS-CoV-2 mostraron valores elevados pero variables en magnitud. Además, se observaron valores elevados y variables en muestras de voluntarios vacunados o con infección previa. Conclusiones: Nuestro ensayo de detección de inmunoglobulina M presenta escaso valor diagnóstico. Por el contrario, el ensayo de detección de inmunoglobulina G muestra un rendimiento satisfactorio y se apega al comportamiento reportado para este tipo de prueba según las características demográficas y clínicas de los usuarios; por lo tanto, este ensayo podría ser empleado como herramienta fiable y práctica en aplicaciones clínicas y como apoyo al diagnóstico. Es necesario desarrollar más estudios sobre reacciones cruzadas entre los anticuerpos contra el coronavirus del síndrome respiratorio agudo grave tipo 2 con aquellos de otras entidades de interés clínico, sobre todo las presentes en países tropicales como el nuestro.

Abstract Aim: To establish a semiquantitative immunoassay for antibody detection against the RBD of the severe acute respiratory syndrome coronavirus 2 spike protein and to evaluate its performance to be used as a diagnostic supporting tool. Methods: A recombinant severe acute respiratory syndrome coronavirus 2 spike protein was produced. This protein was used as antigenic substrate in two semiquantitative enzyme-linked immunoassays for the detection of human immunoglobulins M and immunoglobulins G. A set of serum samples (N=129) from patients with prior viral infection confirmed by reverse transcription polymerase chain reaction, processed between August 2020 and November 2021, were used as positive samples. A panel of pre-pandemic samples (N=196), obtained prior to December 2019, were used as negative samples to evaluate the assay performance. Multiple samples from 99 volunteers were used to examine test response to seroconversion. The interference between seropositivity against severe acute respiratory syndrome coronavirus 2 and dengue virus was also evaluated. Results: The immunoglobulin G detection assay showed 81.4% sensitivity, 86.2% specificity, and positive and negative predictive values of 79.5% and 87.6% respectively. The immunoglobulin M detection assay yielded 72.1% sensitivity, 54.1% specificity, and positive and negative predictive values of 25.6% and 89.8% respectively. No significant differences were found between the measurements according to sex or linear correlation between this variable and age. The values presented significant differences according to the condition of self-reported presence or absence of COVID-19 like symptoms. No correlation was found between seropositivity for severe acute respiratory syndrome coronavirus 2 and dengue virus. The immunoglobulin G detection assay generated lower but constant values on samples from voluntary donors who reported not having any contact with the virus compared to samples from donors exposed to it, and high but variable values in magnitude on samples from vaccinated volunteers or those with previous severe acute respiratory syndrome coronavirus 2 infection compared to samples from donors without exposure to the viral antigen. Conclusions: Our established immunoglobulin M detection assay presents poor diagnostic value. On the other hand, the immunoglobulin G detection assay shows satisfactory performance, and coheres to the behavior reported for this type of test according to the demographic and clinic characteristics of the volunteer, so it could be used as a reliable and practical tool in clinical applications and as diagnostic complement. It is necessary to develop more studies on cross-reactions of antibodies against severe acute respiratory syndrome coronavirus 2 with other entities of clinical interest and present in our tropical area.

Low detection rate of RT-PCR-confirmed COVID-19 using IgM/IgG rapid antibody tests in a large community sample in Lima, Peru.

BACKGROUND: Rapid IgM/IgG antibody tests were largely used in lieu of RT-PCR tests as part of COVID-19 public health response activities in Lima, Peru. To assess their utility, we explored the relationship between the time since onset of several COVID-19-related symptoms and the sensitivity of a rapid combined IgM/IgG antibody test. METHODS: We collected data from a community sample of individuals (n = 492) who received concurrent RT-PCR and rapid IgM/IgG antibody testing between May 2020 and March 2021. We estimated the sensitivity of the antibody test, against the RT-PCR test, by weeks since symptom onset via segmented regression analysis. RESULTS: The overall sensitivity of the rapid IgM/IgG antibody test was 46.7% (95% CI, 42.4-51.2%). Among 372 (75.6%) participants who reported COVID-19-related symptoms, sensitivity increased from 30.4% (95% CI, 24.7-36.6%) in week 1 after symptom onset to 83.3% (95% CI, 41.6-98.4%) in week 4. The test sensitivity increased by 31.9% (95% CI, 24.8-39.0%) per week until week 2 to 3, then decreased by - 6.0% (95% CI, - 25.7-13.7%) per week thereafter. CONCLUSION: Rapid antibody tests are a poor substitute for RT-PCR testing, regardless of presenting symptoms. This highlights the need for future pandemic planning to include timely and equitable access to gold-standard diagnostics, treatment, and vaccination.

Prevalencia de infección por COVID-19 por serología positiva (IgG/IgM) en personal médico de la cátedra y servicio de otorrinolaringología del Hospital de Clínicas / Prevalence of COVID-19 infection by positive serology (IgG/IgM) in medical personnel of the chair and service of otorhinolaryngology of the Hospital de Clínicas

Resumen Introducción: El personal de otorrinolaringología presenta una elevada exposición al virus SARS-CoV-2, debido a los procedimientos que lleva a cabo. Es fundamental tomar las medidas de protección adecuadas. Determinar la seroprevalencia nos dará un mejor panorama sobre la exposición, contagios y efectividad de medidas de protección adoptadas. Objetivo: Determinar la prevalencia de resultados serológicos positivos en personal médico que presta servicio en la Cátedra de Otorrinolaringología de marzo del 2020 a marzo de 2021. Material y Método: Estudio observacional, descriptivo, corte transversal, retrospectivo con asociación cruzada. Muestreo no probabilístico de casos consecutivos. La población total fue de 38 médicos del Servicio de Otorrinolaringología del Hospital de Clínicas. Resultados: La media de edades fue 37,4 años, 63,5% refirió haber atendido a paciente conocido portador de COVID-19. Un 42% refirió no haber cumplido con todas las medidas de protección personal, mientras que un 23,7% de los sujetos de estudio dio positivo para IgG, interpretándose como infección previa por COVID-19. Conclusión: Más de las dos terceras partes de los médicos refirió dar consulta a paciente COVID-19 positivo. Casi la cuarta parte de los médicos resultó ser positivo para COVID-19 según la prueba de serología anti-N. No se halló asociación entre consulta ni cirugía a pacientes portadores de COVID-19 y el contagio al personal médico.

Abstract Introduction: Otolaryngology personnel have a high exposure to SARS-CoV-2 virus due to the procedures they perform. It is essential to take appropriate protective measures. Determining seroprevalence will give us a better picture of exposure, contagion and effectiveness of protective measures adopted. Aim: To determine the prevalence of positive serological results in medical staff serving in the otolaryngology department from March 2020 to March 2021. Material and Method: Observational, descriptive, cross-sectional, retrospective, retrospective study with cross-association. Non-probability sampling of consecutive cases. The total population was 38 physicians of the Otolaryngology Service of the Hospital de Clinicas. Results: The mean age was 37.4. 63.5% reported having seen a patient known to be a COVID-19 carrier, while 42% reported not having complied with all personal protection measures. A 23.68% of the study subjects tested positive for IgG, interpreting previous COVID-19 infection. Conclusion: More than two-thirds of the physicians referred to giving consultation to COVID-19 positive patients. Almost a quarter of the physicians were positive for COVID-19 according to the Anti-N serology test. No association was found between consultation or surgery of patients with COVID-19 and infection of medical personnel.

Diagnostic performance of the rapid test for the detection of NS1 antigen and IgM and IgG anti-antibodies against dengue virus. / Rendimiento diagnóstico de la prueba rápida para la detección del antígeno NS1 y anticuerpos IgM e IgG contra el virus del dengue.

OBJECTIVES: Motivation for the study: search for accessible and efficient new diagnostic alternatives for the detection of the disease caused by the dengue virus. Main findings: good efficiency of the rapid test during the first days of the disease. As well as its high power to discriminate against other similar mosquito-borne diseases such as Zika and Oropuche. Implications: it could be applied as a screening test in endemic regions that do not have equipment or trained personnel to perform sophisticated and/or complex diagnostic tests. Strengthening public health policies in epidemiological surveillance, early diagnosis and timely treatment. To assess the diagnostic performance of the SD dengue DUO rapid test (Inyecta) for the detection of NS1, IgM and IgG in comparison to the ELISA test. MATERIALS AND METHODS: . This is a diagnostic test evaluation that included 286 serum samples from patients with symptomatology attributable to dengue from endemic areas of Peru. The samples were analyzed by ELISA and the SD dengue DUO rapid test (Inyecta) for IgM, NS1 and IgG at the Instituto de Investigación Nutricional in Lima. RESULTS: . The sensitivity of the rapid test was 68.0% for NS1 and IgM, and 86.0% for IgG, improving to 75.0% and 81.0% for NS1 and IgM, respectively, during the first three days. The specificity for all three analytes was greater than 87.0%. The concordance of the results, measured by the Kappa coefficient for the three analytes, was good and no cross-reaction with other arboviruses was found. CONCLUSIONS: . The SD dengue DUO rapid test allows detection of NS1, IgM and IgG with adequate sensitivity and specificity. Sensitivity for IgM and NS1 increases when detected during the first three days of symptoms. Therefore, we recommend its implementation in primary care centers for early and timely diagnosis.

OBJETIVOS.: Motivación para realizar el estudio: búsqueda de nuevas alternativas diagnósticas de fácil acceso y manejo eficientes para la detección de la enfermedad causada por el virus del dengue. Principales hallazgos: buena eficiencia de la prueba rápida evaluada en los primeros días de la enfermedad. Así como su alto poder para discriminar frente a otras enfermedades similares transmitidas por mosquitos como el Zika y Oropuche. Implicancias: podría aplicarse como una prueba de tamizaje en regiones endémicas que no cuentan con equipo o personal capacitado para realizar pruebas diagnósticas sofisticadas y/o complejas al momento de captar al paciente. Fortaleciendo las políticas de salud pública en vigilancia epidemiológica, diagnóstico temprano y tratamiento oportuno. Determinar el rendimiento diagnóstico de la prueba rápida SD dengue DUO (Inyecta) para la detección de NS1, IgM e IgG en comparación con la prueba de ELISA. MATERIALES Y MÉTODOS.: Es una evaluación de prueba diagnóstica que incluyó 286 muestras de suero de pacientes con sintomatología atribuible a dengue de zonas endémicas del Perú. Las muestras se analizaron por ELISA y la prueba rápida SD dengue DUO (Inyecta) para IgM, NS1 e IgG en el Instituto de Investigación Nutricional en Lima. RESULTADOS.: La sensibilidad de la prueba rápida fue de 68% para NS1 e IgM, y 86% para IgG, mejorando este parámetro a 75% y 81% para NS1 e IgM, respectivamente, en los tres primeros días. La especificidad para los tres analitos fue mayor a 87%. La concordancia de los resultados obtenidos medidos por el coeficiente Kappa para los tres analitos fue buena y no se encontró reacción cruzada con otros arbovirus. CONCLUSIONES.: La prueba rápida SD Dengue DUO permite detectar con una adecuada sensibilidad y especificidad NS1, IgM e IgG. La sensibilidad para IgM y NS1 aumenta cuando se detecta en los tres primeros días de síntomas, por lo que se recomienda su implementación en los centros de primer nivel de atención para un diagnóstico temprano y oportuno.

Validity and reliability of immunochromatographic IgM/IgG rapid tests for COVID-19 salivary diagnosis.

OBJECTIVES: To assess the accuracy of three immunochromatographic rapid tests for salivary detection of immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigens and the reliability of these tests comparing saliva with plasma samples. MATERIALS AND METHODS: Plasma and saliva samples from 62 patients diagnosed with coronavirus disease 2019 (COVID-19) and 20 healthy volunteers were assayed. IgM/IgG antibody against SARS-COV-2 was detected using three immunochromatographic rapid tests and compared with real-time reverse transcription-polymerase chain reaction (qRT-PCR). RESULTS: The tests' overall accuracy for detecting anti-SARS-CoV-2 antibodies ranged from 75.6 to 79.3 for saliva and 86.6-87.8 for plasma tests. The sensitivity of saliva and plasma tests increased with the severity of COVID-19 signs and symptoms. The chance of a positive plasma test in participants with a positive qRT-PCR test was 2.27 greater than a positive saliva test. CONCLUSIONS: Although rapid immunochromatographic tests are more accurate using plasma than saliva, which was expected considering its original use, our findings support the use of saliva as a straightforward supplementary method to assess seroconversion in patients with COVID-19, with important sensitivity and sensibility, especially in severe and critical cases.

Side effects of the BNT162b2 vaccine in the personnel of the Military Central Hospital.

OBJECTIVE: The pandemic disease by SARS-CoV-2 infection does not have an effective treatment. To prevent the disease, scientists developed vaccines that the clinicians use as an emergency licensed vaccine. The objective of this study was to determine the side effects in personnel vaccinated at the Military Central Hospital of Mexico with the BNT162b2 vaccine. PATIENTS AND METHODS: This study included the subjects who had received both doses of the BNT162b2 vaccine between December 2020 and February 2021. We asked about the side effects after the first and the second vaccine doses. One group had no history of COVID-19, and the second had a history of COVID-19. ANTI-SARS-CoV-2 antibodies were measured by the immunodetection technique in the second group only. RESULTS: We included 946 participants, 62% were women, and 80% were without comorbidities; 680 were included in the first group, and only 266 were in the second group. After the first dose, 77% of the first group and 86% of the second group presented some side effects. After the second dose, 84% of the first group and 89% of the second group showed some side effects. The main side effect was mild pain. All participants (126) were IgG positive, and only 26.9% were IgM positive at 17.5 days (12.8 days, 20.3 days) after the second dose. CONCLUSIONS: There is a positive correlation between side effects after the first dose in patients with a history of previous SARS-CoV-2 infection compared to those who did not. Nevertheless, this correlation is not present after the second dose. The low percentage of IgM could be related to the time interval between vaccination and sample measure.

COVID-19 in long-term care facilities in Brazil: serological survey in a post-outbreak setting.

This cross-sectional seroepidemiological survey presents the seroprevalence of SARS-CoV-2 in a population living in 15 Long-Term Care Facilities (LTCFs), after two intra-institutional outbreaks of COVID-19 in the city of Botucatu, Sao Paulo State, Brazil. Residents were invited to participate in the serological survey performed in June and July 2020. Sociodemographic and clinical characterization of the participants as well as the LTCF profile were recorded. Blood samples were collected, processed and serum samples were tested using the rapid One Step COVID-19 immunochromatography test to detect IgM and IgG anti-SARS-CoV-2. Among 209 residents, the median of age was 81 years old, 135 (64.6%) were female and 171 (81.8%) self-referred as being white. An overall seroprevalence of 11.5% (95% CI: 7.5% - 16.6%) was found. The highest seroprevalences of 100% and 76.9% were observed in LTCFs that had experienced COVID-19 outbreaks. Most residents with positive immunochromatography tests (70.8%) referred previous contact with a confirmed COVID-19 case. Although there was a relatively low seroprevalence of COVID-19 in the total number of elderly people, this population is highly vulnerable and LTCFs are environments at higher risk for COVID-19 dissemination. A well-established test for COVID-19 policies, the adequate characterization of the level of interaction between residents and the healthcare provider team and the level of complexity of care are crucial to monitor and control the transmission of SARS-CoV-2 in these institutions.

Experimental infection of tachyzoites of the NC1 strain of Neosporacaninum in female swine.

Neospora caninum is a protozoan that can cause reproductive problems in several animal species. Although N. caninum infection has been reported in swine, the pathogenesis and clinical signs are not fully known in this species. The objective of this work was to evaluate the effect of experimental infection with tachyzoites of the N. caninum strain Nc1 in swine matrices at different stages of gestation. For that purpose, 12 gilts, seronegative for N. caninum and T. gondii, were selected and allocated into four groups of three animals each. Animals in group A were not inoculated (control) and animals in groups B, C, and D were inoculated intravenously with of 2.9 × 107 tachyzoites, 30 days before conception, and at 45 and 90 days of gestation, respectively. Temperature, heart rate, blood, saliva, and vaginal mucus samples from the animals were collected periodically until the time of delivery for the investigation of IgG and IgM antibodies against N. caninum using IFAT and PCR to detect the parasite DNA. All gilts sero-converted from 5 and 7 DPI (days postinoculation) to IgM and IgG, respectively. Two gilts showed hypothermia on the 5th and 7th DPI, and five inoculated animals had leukocytosis on the 7th DPI. It was possible to detect DNA of N. caninum in samples of saliva (33/84), vaginal mucus (17/84), and blood (2/84). Based on serology (IgM) and PCR, three animals in group B showed evidence of reappearance of the infection during pregnancy. It is concluded that N. caninum can cause clinical signs in infected swine females, in addition to indicating saliva as a suitable diagnostic biological material for the detection of N. caninum DNA in this animal species.

Immune profiling of breast milk from mothers with treated celiac disease.

BACKGROUND: The protective effect of breastfeeding on celiac disease (CD) onset is controversial. We studied a wide range of milk components in milk produced by celiac mothers following long-term gluten-free diet (GFD) in comparison to milk produced by healthy mothers. METHODS: Breast-milk samples from celiac (n = 33) and healthy (n = 41) mothers were obtained during the first year of lactation. A panel of bioactive components was analyzed by enzyme-linked immunosorbent assay in the aqueous fraction. We studied molecules involved in defenses, immunoregulation, and strengthening of the gut-epithelial barrier. RESULTS: During late lactation (from 6 to 12 months after delivery), the content of total immunoglobulin A (IgA) and IgM was significantly lower in the milk produced by celiac patients. Nevertheless, gliadin (GFD)-specific IgA relative contribution was higher in this group, in contrast to tetanus toxoid-specific antibodies. The balance between pro-inflammatory and anti-inflammatory molecules was different. While interleukin-6, tumor necrosis factor-α, and monocyte chemoattractant protein-1 were most frequently found in samples from celiac mothers, soluble Toll-like receptor-2 prevalence was lower. CONCLUSIONS: We describe differences between the innate and adaptive immune profile of milk produced by celiac and healthy mothers. These results might explain previous controversial reports about breastfeeding and CD protection. IMPACT: In spite of a long-term adherence to GFD, the milk produced by mothers with CD exhibit a different immune profile, in relation with some immunoregulatory factors and antibody content. This work shows a more comprehensive characterization of milk from celiac mothers, including macronutrients, lysozymes, growth factors, and immunoregulatory components that had not been studied before. The present study widens the available data regarding the characteristics of human milk of celiac mothers following GFD. Further follow-up studies of the health of children who were breastfed by celiac mothers will be necessary in order to also estimate the impact of the present results therein.

Production of polyclonal antibodies anti - Igm of nile tilapia, Oreochromis niloticus for standardization of immunoenzymatic assay / Produção de anticorpos policlonais anti - Igm de tilápia-do-nilo, Oreochromis niloticus para padronização de ensaio imunoenzimático

In this letter, we describe the development of an immunodiagnostic assay capable of detecting specific IgM in the blood circulation of experimental Nile tilapia that received the vaccine against S. agalactiae.(AU)

Production of polyclonal antibodies anti - Igm of nile tilapia, Oreochromis niloticus for standardization of immunoenzymatic assay / Produção de anticorpos policlonais anti - Igm de tilápia-do-nilo, Oreochromis niloticus para padronização de ensaio imunoenzimático

In this letter, we describe the development of an immunodiagnostic assay capable of detecting specific IgM in the blood circulation of experimental Nile tilapia that received the vaccine against S. agalactiae.

[COVID-19-associated multisystem inflammatory syndrome in children: case series at a pediatric hospital in Peru]. / Síndrome inflamatorio multisistémico asociado a COVID-19 en niños: serie de casos en un hospital pediátrico de Perú.

During the COVID-19 pandemic, a new, severe and unusual condition called Multisystem Inflammatory Syndrome in children emerged, from which there is still much to learn. We report 8 children admitted to Instituto Nacional de Salud del Niño, in Lima, Perú. Their mean age was 5,1 years. Their clinical presentation included fever, acute gastrointestinal symptoms, ocular and mucocutaneous involvement. Four patients met criteria for classic Kawasaki Disease. All the patients had positive serology for SARS-CoV-2, abnormal complete blood counts and coagulation tests, and elevated inflammatory markers. Five had elevated liver enzymes and three had kidney involvement. Four patients met criteria for Macrophage Activation Syndrome. All of them received intravenous immune globulin, corticosteroids and aspirin. No coronary aneurysms were identified. Only one developed miocarditis, shock and was admitted to the Pediatric Intensive Care Unit. Most patients recovered successfully. Every child with fever, gastrointestinal and dermatological symptoms, associated with prior exposure to SARS-CoV-2, should be investigated for multi-systemic compromise.

La pandemia de COVID-19 ha traído una nueva afección grave e inusual denominada Síndrome Inflamatorio Multisistémico en niños, de la cual aún hay mucho por conocer. Presentamos una serie de 8 casos atendidos en el Instituto Nacional de Salud del Niño, Lima Perú. La edad media fue 5,1 años. La presentación clínica incluyó fiebre, problemas gastrointestinales agudos, afectación ocular y mucocutánea. Cuatro cumplieron criterios para Enfermedad de Kawasaki clásica. Todos tuvieron serología positiva para SARS-CoV-2, hemograma patológico, marcadores inflamatorios elevados y pruebas de coagulación alteradas. Cinco casos presentaron hipertransaminasemia y tres retención nitrogenada. Cuatro casos cumplieron criterios para Síndrome de Activación Macrófagica. Todos recibieron inmunoglobulina intravenosa, corticoides y ácido acetil salicílico. Ninguno desarrolló aneurismas coronarios. Solo uno presentó miocarditis, shock y requirió ingreso a Unidad de Cuidados Intensivos. La mayoría evolucionaron favorablemente. En todo niño con fiebre, síntomas gastrointestinales y dermatológicos; asociado a exposición al SARS-CoV-2, debe investigarse compromiso multisistémico.

Importance of clinical and laboratory characteristics in the diagnosis of dengue and chikungunya co-infection: Probable case report / Importancia de las características clínicas y de laboratorio en el diagnóstico de las infecciones concomitantes por dengue y chikungunya: reporte de un caso probable.

We report the case of a 38-year-old woman who initially consulted for an undifferentiated fever. Although her clinical condition evolved with signs and symptoms compatible with dengue with alarm signs and that the anti-dengue IgM detection in a single sample indicated it was a probable case that could have happened during the previous three months, the patient kept consulting due to little improvement. On the tenth day after the onset of symptoms, she presented with painful polyarticular symmetric edema, as well as hyperpigmented lesions in the nasolabial fold. Chikungunya diagnosis was confirmed by the presence of IgM antibodies. In endemic countries for dengue and chikungunya, the possibility of co-infection exists, but it may go unnoticed. On the other hand, the co-infection may worsen the clinical course of these diseases. Therefore, physicians should evaluate the clinical and laboratory characteristics of both infections to be able to diagnose the coinfection for adequate management and to minimize complications.

Se presenta el caso de una mujer de 38 años que consultó inicialmente por fiebre indiferenciada. A pesar de que el cuadro clínico evolucionó con manifestaciones clínicas de dengue con signos de alarma y de que la detección de IgM antidengue en una sola muestra indicaba que se trataba de un caso probable que había podido ocurrir durante los tres meses anteriores, la paciente consultó de forma reiterada, pues no presentaba una mejoría significativa. En el décimo día del inicio de los síntomas, se observó edema simétrico en múltiples articulaciones acompañado de dolor, así como lesiones hiperpigmentadas en el surco nasogeniano. Se confirmó el diagnóstico de chikungunya por la presencia de anticuerpos IgM. Aunque puede pasar desapercibida, en los países endémicos para dengue y chikungunya existe la posibilidad de la infección concomitante, la cual puede agravar la evolución clínica de cada una de estas enfermedades. Por ello, es necesario que el médico considere las características clínicas y de laboratorio de ambas enfermedades para diagnosticar su presencia simultánea, garantizar un manejo adecuado y minimizar las complicaciones.

Diagnóstico microbiológico de SARS-COV 2 / Microbiological diagnosis of SARS-VOC 2

Introducción: La enfermedad producida por el nuevo coronavirus constituye un reto para los sistemas de salud. En estos tiempos de pandemia disponer de pruebas que ayuden a un diagnóstico temprano e incluso a detectar pacientes asintomáticos, es una de las claves para disminuir los contagios y evitar la propagación. Objetivo: Revisar los aspectos más importantes en el diagnóstico del nuevo coronavirus. Desarrollo: La detección de ARN de SARS-CoV2 en muestras respiratorias, es la técnica de referencia y de elección para el diagnóstico microbiológico de COVID-19. Tomando la muestra de la parte posterior de la faringe y de las fosas nasales puede detectarse la presencia del virus. La detección de antígenos es un tipo de prueba de diagnóstico rápido la cual detecta la presencia de proteínas virales (antígenos) expresadas por el virus de la COVID-19. La detección de los anticuerpos generados en el organismo huésped infectado es una de las técnicas más utilizadas a nivel mundial en grandes poblaciones, incluso como pesquizaje, aunque su interpretación puede requerir intervención de médicos especializados. También está basada en la detección de anticuerpos del tipo IgM e IgG y algunas presentan la detección de anticuerpos IgA. Conclusiones: La interpretación de las pruebas serológicas debe realizarse con cautela, teniendo en cuenta sus limitaciones, y evaluarlas acorde a la situación clínica del paciente y de los resultados de la prueba de referencia(AU)

Introduction: The disease caused by the new coronavirus constitutes a challenge for health systems. In these times of pandemic, having tests that help early diagnosis and even detect asymptomatic patients is one of the keys to reducing infections and preventing the spread. Objective: To review the most important aspects in the diagnosis of the new coronavirus. Findings: Detection of SARS-CoV2 RNA in respiratory samples is the reference and technique of choice for the microbiological diagnosis of COVID-19. By taking samples from the back of the pharynx and the nostrils, the presence of the virus can be detected. Antigen detection is a type of rapid diagnostic test which detects the presence of viral proteins (antigens) expressed by COVID-19 virus. Detection of the antibodies generated in the infected host organism is one of the most widely used techniques worldwide in large populations, even as screening, although its interpretation may require the intervention of specialists. It is also based on the detection of IgM and IgG type antibodies and some have the detection of IgA antibodies. Conclusions: The interpretation of serological tests should be done with caution, taking into account the limitations, and assessing them according to the patient's clinical situation and the results of the reference test(AU)

Pneumonia por toxoplasmose em paciente imunocompetente / Toxoplasma pneumonia in an immunocompetent patient: case repor

Com grande distribuição mundial e incidência significativa, a toxoplamose é uma doença comum em mamíferos e pássaros, causada pelo protozoário Toxoplasma gondii. No homem, o parasitismo na fase proliferativa intracelular pode se apresentar sem sintomas, ou causar clínica transitória caracterizada por febre, fadiga e linfadenopatia. Por se tratar de patologia com sintomas inespecíficos e comuns a muitas outras, é fundamental a correta pesquisa de diagnósticos diferenciais, como citomegalovírus e Epstein-Barr. Relatamos o caso de um jovem e hígido, que desenvolveu pneumonia e, após confirmação sorológica para toxoplasmose e o tratamento adequado, apresentou melhora clínica.

With great worldwide distribution and significant incidence, toxoplamosis is a common disease in mammals and birds, caused by the protozoan Toxoplasma gondii. In humans, the parasitism in its intracellular proliferative phase may present no symptoms, or cause a transient condition characterized by fever, fatigue, and lymphadenopathy. Because it is a pathology with nonspecific symptoms that are common to many other conditions, it is fundamental to find the correct research of differential diagnoses, such as for Cytomegalovirus and Epstein Barr. We report a case of a young and healthy man who developed pneumonia and, after serological confirmation for toxoplasmosis and the appropriate treatment, presented clinical improvement

Serious adverse event: late neurotropic disease associated with yellow fever vaccine.

The yellow fever is a systemic disease that was under control due to the effective campaigns against the vector and promotion of vaccines programs. However, since 1999, outbreaks appeared because of inefficient control of the vector, and led to the need of amplifying the immunization in large scale against the yellow fever virus, and consequently, raising the risk of adverse reactions to the vaccine. We report a case of previously healthy infant, who was referred to our care service, after 3 days with fever, chills, nausea and vomits, he received support therapy and was discharged from the hospital. After 24 hours of supportive measures, he was discharge. The patient returned to our service with general condition decline, strabismus, inability to control of cervical musculature and reduced force of the legs. The patient vaccine had received all vaccines from the calendar, and he was vaccinated for yellow fever 20 days before symptoms. During the hospitalization, liquor was collected, and ceftriaxone and aciclovir were administered. After negative cultures from the liquor, the antibiotics were suspended. The computed tomography of patient's brain showed no alterations. Research for antibodies against yellow fever was requested, being positive for IgM in the liquor, and confirming the neurotropic disease associated with the yellow fever vaccine. On the fifth day of hospitalization, the patient showed improvement on the strabismus, cervical tonus, and musculature force. On the tenth day of hospitalization, patient showed complete improvement, and his laboratory exams no alterations. Subsequently, patient was discharged. The vaccine against yellow fever is safe, efficient and highly recommended, however it is not completely free from serious adverse reactions, including death.

Lupus eritematoso sistémico en actividad y cociente albúmina/globulina invertido, ¿hallazgo propio de la enfermedad? / Systemic Erythematosus Lupus and Albumin-Globulin Index, a specific finding in lupus flares?

Introducción: El lupus eritematoso sistémico es el modelo clásico de enfermedad autoinmune. En el desarrollo de la enfermedad intervienen varios tipos de inmunoglobulinas, con predominio de la IgG, IgM e IgA. Objetivo: Describir la utilidad del cociente albúmina/globulina como un indicador de actividad en el lupus eritematoso sistémico. Desarrollo: Se estima que el 50 por ciento de los pacientes con lupus eritematoso sistémico muestran una hipoalbuminemia con una hipergammaglobulinemia. La hipoalbuminemia en mayor medida está relacionada con la presencia de nefritis lúpica. La mitad de los pacientes con nefritis lúpica presentan proteinuria en el orden del síndrome nefrótico. Esta proteinuria iguala o invierte parcialmente el valor del cociente albúmina/globulina. El cociente albúmina/globulina invertido por sí solo es insuficiente para afirmar la presencia de actividad en el lupus eritematoso sistémico. Se deben excluir otras entidades clínicas causantes de hipergammaglobulinemia policlonal. Los criterios de actividad del lupus eritematoso sistémico incrementan la sensibilidad del cociente albúmina/globulina invertido. Conclusiones: La interpretación del cociente albúmina/globulina debe ir aparejada a la estimación de actividad por los criterios clínicos de mayor uso (SLICC, SLEDAI, BILAG). No en todos los pacientes con lupus eritematoso sistémico puede interpretarse como criterio de actividad, por lo que es necesario excluir otras entidades clínicas(AU)

Introduction: Systemic lupus erythematosus is the model of autoimmune disease. Several types of immunoglobulins are involved in the development of the disease, mainly IgG, IgM and IgA. Objective: To describe the potential use of the albumin/globulin ratio as an indicator of activity in systemic lupus erythematosus. Development: fifty percent of patients with systemic lupus erythematosus exhibit hypoalbuminemia with hypergammaglobulinemia. Hypoalbuminemia is mainly related to the presence of lupus nephritis. The half of patients with lupus nephritis develops proteinuria with values of nephrotic syndrome. The proteinuria equals or partially reverses the albumin/globulin ratio. The inverted albumin/globulin ratio is insufficient to establish the presence of lupus activity. Other clinical entities producing polyclonal hypergammaglobulinaemia should be excluded. The systemic lupus erythematosus activity criteria increase the sensitivity of the inverted albumin/globulin ratio. Conclusions: The interpretation of the albumin/globulin ratio requires the activity estimation by different clinical criteria (SLICC, SLEDAI, BILAG). The inverted albumin/globulin ratio cannot be interpreted as a stand-alone indicator of disease activity in every systemic lupus erythematosus patients(AU)

Serious adverse event: late neurotropic disease associated with yellow fever vaccine / Evento adverso grave: doença neurotrópica tardia associada à vacina da febre amarela

ABSTRACT The yellow fever is a systemic disease that was under control due to the effective campaigns against the vector and promotion of vaccines programs. However, since 1999, outbreaks appeared because of inefficient control of the vector, and led to the need of amplifying the immunization in large scale against the yellow fever virus, and consequently, raising the risk of adverse reactions to the vaccine. We report a case of previously healthy infant, who was referred to our care service, after 3 days with fever, chills, nausea and vomits, he received support therapy and was discharged from the hospital. After 24 hours of supportive measures, he was discharge. The patient returned to our service with general condition decline, strabismus, inability to control of cervical musculature and reduced force of the legs. The patient vaccine had received all vaccines from the calendar, and he was vaccinated for yellow fever 20 days before symptoms. During the hospitalization, liquor was collected, and ceftriaxone and aciclovir were administered. After negative cultures from the liquor, the antibiotics were suspended. The computed tomography of patient's brain showed no alterations. Research for antibodies against yellow fever was requested, being positive for IgM in the liquor, and confirming the neurotropic disease associated with the yellow fever vaccine. On the fifth day of hospitalization, the patient showed improvement on the strabismus, cervical tonus, and musculature force. On the tenth day of hospitalization, patient showed complete improvement, and his laboratory exams no alterations. Subsequently, patient was discharged. The vaccine against yellow fever is safe, efficient and highly recommended, however it is not completely free from serious adverse reactions, including death.

RESUMO A febre amarela é uma doença sistêmica que estava controlada graças às efetivas campanhas de combate ao vetor e aos programas de vacinação. Porém, desde 1999, os surtos reiniciaram-se, devido à ineficácia do controle do vetor, levando à necessidade da imunização em larga escala contra o vírus da febre amarela, gerando aumento do risco de ocorrência de reação adversa à vacina. O presente estudo se propôs a relatar o caso de um lactente previamente saudável, que procurou pronto atendimento, pois, há 3 dias, apresentava febre, calafrios, náusea e vômitos. Em 24 horas após medidas de suporte e alta, evoluiu com queda do estado geral, estrabismo, falta de controle da musculatura cervical e redução da força muscular de membros inferiores. O caderno vacinal encontrava-se completo, tendo recebido vacina contra febre amarela há 20 dias. Durante a internação, foi realizada coleta do liquor, e foram administrados ceftriaxona e aciclovir. Após cultura negativa do liquor, o antibiótico foi suspenso. A tomografia computadorizada de crânio não apresentou alterações. Solicitou-se pesquisa de anticorpos contra o vírus da febre amarela no liquor, sendo positiva para IgM e confirmando a doença neurotrópica associada à vacina da febre amarela. A partir do quinto dia de internação, o paciente evoluiu com melhora do estrabismo, do tônus cervical e da força muscular. No décimo dia de internação, apresentou melhora completa do quadro, sem alterações laboratoriais, recebendo alta. A vacina contra febre amarela é segura, eficaz e fortemente recomendada, porém não está completamente isenta de reações adversas graves, inclusive podendo levar a quadros fatais.