Evaluación de tres pruebas serológicas para la detección de anticuerpos contra el virus linfotrópico T humano tipo 1 (HTLV-1)

Introducción: El Perú es endémico al virus linfotrópico T humano tipo 1 (HTLV-1), por esas razones es importante conocer la fiabilidad de las pruebas diagnósticas que se usan en el país, con la finalidad de continuar o no su uso. El objetivo fue evaluar el rendimiento de tres pruebas serológicas ELISA Murex, ELISA Wantai e IFI INS-Perú para la detección de anticuerpos anti HTLV-1 frente a muestras peruanas. El estudio. Las tres pruebas fueron evaluadas frente a 382 sueros: 215 positivos y 167 negativos a HTLV-1 (Gold Standar: inmunoblot). Hallazgos. IFI no presentó falsos positivos, Wantai tuvo más falsos negativos (siete) y Murex más falsos positivos (ocho). Las tres pruebas mostraron resultados superiores a 95% para los parámetros estimados de exactitud diagnóstica. Conclusiones. IFI INS-Perú y ELISA Murex tuvieron buen rendimiento diagnóstico para la detección de anticuerpos contra HTLV-1 y son buenos candidatos para continuar siendo usados en Perú.

Background: Peru is endemic to the human T-lymphotropic virus type 1 (HTLV-1), for these reasons it is important to know the reliability of the diagnostic tests used in the country, in order to continue their use or not. The objective was to evaluate the performance of three serological tests ELISA Murex, ELISA Wantai and IFI INS-Peru for the detection of anti-HTLV-1 antibodies against Peruvian samples. The study. The three tests were evaluated against 382 sera: 215 positive and 167 negative for HTLV-1 (Gold Standard: immunoblot). Findings. IFI had no false positives, Wantai had more false negatives (seven) and Murex more false positives (eight). The three tests showed results above 95% for the estimated parameters of diagnostic accuracy. Conclusions. IIF INS-Perú and ELISA Murex had good diagnostic performance for the detection of antibodies against HTLV-1 and are good candidates to continue being used in Peru.

Patrones diferenciales entre Leishmaniasis y chagas, empleando epimastigotes de Trypanosoma cruzi / Differential patterns between leishmaniasis and chagas disease using Trypanosoma cruzi epimastigotes

En diferentes regiones de Latinoamérica la infección por T. cruzi y Leishmania se superponen, por lo cual se reportan infecciones mixtas circulantes, debido a esto; deben realizarse pruebas diagnósticas específicas para evitar reacciones cruzadas entre estas dos patologías. OBJETIVO: determinar patrones de fluorescencia que permitan la diferenciación entre Leishmaniasis, enfermedad de Chagas e infección mixta empleando epimastigotes de T. cruzi. MÉTODOS: se empleó la técnica de Inmunofluorescencia Indirecta utilizando epimastigotes de T. cruzi (TcV autóctono) como antígeno figurado frente a un panel de muestras de suero codificados como A, B, C y D correspondientes a pacientes con infección por: Leishmaniasis (A), Infección mixta por Leishmania y Chagas(B), Enfermedad de Chagas (C) y sin ninguna de las dos infecciones (D). RESULTADOS: en los cuatro paneles de muestras se observaron diferentes patrones de intensidad de fluorescencia a nivel de membrana y núcleo de los epimastigotes de T. cruzi (TcV autóctono). CONCLUSIONES: la técnica de Inmunofluorescencia (IFI) con antígenos de epimastigotes de T. cruzi a demostrado utilidad en la diferenciación entre enfermedad de Chagas, Leishmaniasis y/o infecciones mixtas por ambos parásitos en aquellas zonas donde la coexistencia de ambas es habitual

In different regions of Latin America, infection by T. cruzi and Leishmania overlap, for which mixed circulating infections are reported, due to this; Specific diagnostic tests must be performed to avoid cross reactions between these two pathologies. OBJECTIVE: to determine fluorescence patterns that allow the differentiation between Leishmaniasis, Chagas disease and mixed infection using T. cruzi epimastigotes. METHODS: the Indirect Immunofluorescence technique was used using epimastigotes of T. cruzi (autochthonous TcV) as figurative antigen against a panel of serum samples coded as A, B, C and D corresponding to patients with infection by: Leishmaniasis (A) , Mixed infection by Leishmania and Chagas (B), Chagas disease (C) and without either of the two infections (D). RESULTS: in the four sample panels, different patterns of fluorescence intensity were observed at the membrane and nucleus level of the epimastigotes of T. cruzi (autochthonous TcV). CCONCLUSIONS: the Immunofluorescence technique (IFI) with T. cruzi epimastigote antigens has proven useful in differentiating between Chagas disease, Leishmaniasis and / or mixed infections by both parasites in areas where the coexistence of both is common.

Aislamiento y caracterización de una cepa temprana de SARS-CoV-2 durante la epidemia de 2020 en Medellín, Colombia / Isolation and characterization of an early SARS-CoV-2 isolate from the 2020 epidemic in Medellín, Colombia

Introducción. El nuevo coronavirus causante de un brote de enfermedad respiratoria aguda en China en diciembre de 2019 se identificó como SARS-CoV-2. La enfermedad, denominada COVID-19, fue declarada pandemia por la Organización Mundial de la Salud (OMS). El primer caso de COVID-19 en Colombia se reportó el 6 de marzo de 2020; en este estudio se caracterizó un aislamiento temprano del virus SARS-CoV-2 de una muestra recolectada en abril de 2020. Objetivos. Describir y caracterizar una cepa temprana a partir de un aislamiento de SARS-CoV-2 durante la pandemia en Colombia. Materiales y métodos. Se obtuvo una muestra de un paciente con COVID-19 confirmada por qRT-PCR; la muestra fue inoculada en diferentes líneas celulares hasta la aparición del efecto citopático. Para confirmar la presencia de SARS-CoV-2 en el cultivo, se utilizó la qRT-PCR a partir de los sobrenadantes, la inmunofluorescencia indirecta (IFI) en células Vero-E6, así como microscopía electrónica y secuenciación de nueva generación (next-generation sequencing). Resultados. Se confirmó el aislamiento de SARS-CoV-2 en células Vero-E6 por la aparición del efecto citopático tres días después de la infección, así como mediante la qRT-PCR y la IFI positiva con suero de paciente convaleciente positivo para SARS-CoV-2. Además, en las imágenes de microscopía electrónica de trasmisión y de barrido de células infectadas se observaron estructuras compatibles con viriones de SARS-CoV-2. Por último, se obtuvo la secuencia completa del genoma, lo que permitió clasificar el aislamiento como linaje B.1.5. Conclusiones. La evidencia presentada en este artículo permite confirmar el primer aislamiento de SARS-CoV-2 en Colombia. Además, muestra que esta cepa se comporta en cultivo celular de manera similar a lo reportado en la literatura para otros aislamientos y que su composición genética está acorde con la variante predominante en el mundo. Finalmente, se resalta la importancia que tiene el aislamiento viral para la detección de anticuerpos, para la caracterización genotípica y fenotípica de la cepa y para probar compuestos con potencial antiviral.

Introduction: SARS-CoV-2 has been identified as the new coronavirus causing an outbreak of acute respiratory disease in China in December, 2019. This disease, currently named COVID-19, has been declared as a pandemic by the World Health Organization (WHO). The first case of COVID-19 in Colombia was reported on March 6, 2020. Here we characterize an early SARS-CoV-2 isolate from the pandemic recovered in April, 2020. Objective: To describe the isolation and characterization of an early SARS-CoV-2 isolate from the epidemic in Colombia. Materials and methods: A nasopharyngeal specimen from a COVID-19 positive patient was inoculated on different cell lines. To confirm the presence of SARS-CoV-2 on cultures we used qRT-PCR, indirect immunofluorescence assay, transmission and scanning electron microscopy, and next-generation sequencing. Results: We determined the isolation of SARS-CoV-2 in Vero-E6 cells by the appearance of the cytopathic effect three days post-infection and confirmed it by the positive results in the qRT-PCR and the immunofluorescence with convalescent serum. Transmission and scanning electron microscopy images obtained from infected cells showed the presence of structures compatible with SARS-CoV-2. Finally, a complete genome sequence obtained by next-generation sequencing allowed classifying the isolate as B.1.5 lineage. Conclusion: The evidence presented in this article confirms the first isolation of SARS-CoV-2 in Colombia. In addition, it shows that this strain behaves in cell culture in a similar way to that reported in the literature for other isolates and that its genetic composition is consistent with the predominant variant in the world. Finally, points out the importance of viral isolation for the detection of neutralizing antibodies, for the genotypic and phenotypic characterization of the strain and for testing compounds with antiviral potential.

Comparison between enzyme-linked immunosorbent assay and indirect immunofluorescence for detection of antineutrophil cytoplasmic antibodies / Comparação entre os métodos de ensaio imunoenzimático e imunoflurescência indireta para a pesquisa de anticorpos anticitoplasma de neutrófilos

ABSTRACT Objective To evaluate the performance of enzyme-linked immunosorbent assay and indirect immunofluorescence methods for the detection of antineutrophil cytoplasmic antibodies in a routine clinical laboratory setting. Methods A total of 227 samples were tested by indirect immunofluorescence and enzyme-linked immunosorbent assay with antigen specificity for antiproteinase 3 and antimyeloperoxidase. The proportions of positive samples were compared by McNemar hypotheses and agreement was described by Cohen's Kappa coefficient. Results The agreement of the tests was 96.5%, and the Kappa coefficient obtained was 0.70 (95%CI: 0.50-0.90; p<0.001). Considering indirect immunofluorescence as the gold standard, the sensitivity of the enzyme-linked immunosorbent assay was 0.62 and the specificity was 0.99, with diagnostic accuracy in 96% of cases. Some samples were negative in enzyme-linked immunosorbent assay and positive in indirect immunofluorescence. This situation occurred in all immunofluorescence patterns, but particularly in atypical patterns. Two samples with antiproteinase 3 positivity were considered negative in indirect immunofluorescence. Conclusion The enzyme-linked immunosorbent assay had high specificity but lower sensitivity. The performance of indirect immunofluorescence increases diagnostic sensitivity, while the search for antiproteinase 3 by enzyme-linked immunosorbent assay may also add diagnostic power.

RESUMO Objetivo Avaliar o desempenho das metodologias de ensaio imunoenzimático e imunofluorescência indireta para a detecção de anticorpos anticitoplasma de neutrófilos em um contexto de laboratório clínico de rotina. Métodos Foram testadas 227 amostras pelas metodologias de imunofluorescência indireta e ensaio imunoenzimático com especificidades para anticorpos antiproteinase-3 e antimieloperoxidase. As proporções de amostras positivas foram comparadas por hipóteses de McNemar, e a concordância foi descrita pelo coeficiente Kappa de Cohen. Resultados A concordância dos testes foi 96,5%, e o coeficiente Kappa obtido foi 0,70 (IC95%: 0,50-0,90; p<0,001). Utilizando a imunofluorescência indireta como padrão-ouro, a sensibilidade do ensaio imunoenzimático foi de 0,62 e a especificidade, 0,99, com acurácia diagnóstica em 96% dos casos. Algumas amostras apresentaram resultados negativos por ensaio imunoenzimático e positivos por imunofluorescência. Isso ocorreu em amostras com vários padrões de fluorescência, mas particularmente nos casos com padrões atípicos. Duas amostras com positividade antiproteinase 3 foram consideradas negativas por imunofluorescência. Conclusão Os métodos de ensaio imunoenzimático tiveram alta especificidade, mas sensibilidade inferior. A realização da imunofluorescência indireta aumenta a sensibilidade diagnóstica, ao mesmo tempo que a pesquisa de antiproteinase 3 por ensaio imunoenzimático também pode agregar poder diagnóstico.

Infectious endocarditis by Bartonella species: report of two cases / Endocarditis infecciosa por Bartonella: descripción de dos casos en Chile

ABSTRACT Infectious endocarditis (IE) by Bartonella species is an emerging problem worldwide. We report two cases of native valve Bartonella-associated IE events, both affecting adult male patients with a history of alcohol abuse and a low socioeconomic status. Admissions were due to pancytopenia and bleeding in one case and embolic stroke in the other. Blood cultures were negative and IgG indirect immunofluorescence assays (IFA) were positive for B. henselae/B. quintana in high titers (1/16,384-1/16,384, and 1/32,768 -1/16,384, respectively). Cases were classified as definitive IE events according to modified Duke criteria due to the presence of valve vegetations with at least three minor criteria. One patient required aortic mechanical valve replacement and survived, and the other died after a massive hemorrhagic transformation of his stroke. PCR amplification and sequencing of the 16S ribosomal bacterial DNA from a valve tissue sample obtained at surgery in the patient who survived, confirmed B. quintana as the etiological agent. Bartonella-associated IE is an emerging problem in Chile, present in disadvantaged populations. It should be suspected in patients with culture-negative IE. IFA does not discriminate between B. henselae and B. quintana infection, but high titers suggest IE. Complementary PCR techniques may help to elucidate the final causative agent.

La endocarditis infecciosa(EI) asociada a Bartonella es un problema emergente a nivel mundial. Publicamos los 2 primeros casos de EI en válvula nativa asociados a Bartonella en Chile, los que afectaron a pacientes masculinos con historia de consumo de alcohol y bajos ingresos. La hospitalización fue provocada por pancitopenia y hemorragias en un caso y por un evento cerebrovascular en el otro. Se solicitó serología para Bartonella por inmunofluorescencia indirecta (IFI) para ampliar el estudio ante hemocultivos negativos y en ambos casos se reportaron resultados intensamente positivos para B. henselae y B. quintana1/16.384-1/16.384 y 1/32.768 -1/16.384, respectivamente). Los casos se clasificaron como eventos definitivos de EI según los criterios modificados de Duke debido a la presencia de vegetaciones valvulares con al menos 3 criterios menores. Un paciente requirió reemplazo valvular aórtico y sobrevivió, y el otro falleció tras una transformación hemorrágica masiva del infarto cerebral. La amplificación del ADN ribosomal 16S por RCP y posterior secuenciación de una muestra de tejido valvular confirmó la presencia de B. quintana. La EI por Bartonella sp. es un problema emergente en Chile, probablemente asociada a poblaciones desfavorecidas, la que debe ser sospechada en pacientes con cultivos negativos. La IFI no permite discriminar infecciones por B. henselae o B. quintana pero los títulos altos sugieren EI. Técnicas complementarias por RCP pueden ayudar a dilucidar el diagnóstico.

Infección y enfermedad por Rickettsia spp. del grupo de las fiebres manchadas en pacientes febriles del Urabá antioqueño, Colombia / Rickettsia spp. infection of the group of spotted fevers in febrile patients of the Urabá Antioquia, Colombia

RESUMEN Objetivo: determinar la frecuencia de la infección y enfermedad por Rickettsia spp. del grupo de las fiebres manchadas en pacientes febriles del Urabá antioqueño, que asistieron a centros hospitalarios de la región. Métodos: se incluyeron en el estudio pacientes febriles provenientes de 9 instituciones de salud de la región del Urabá, los cuales fueron encuestados para determinar sus variables clínicas y demográficas. De estos pacientes se obtuvieron muestras de suero durante las fases aguda y convaleciente de la enfermedad. Para cada muestra se determinó la seropositividad (título ≥ 64) y su título de anticuerpos seriados dobles mediante inmunofluorescencia indirecta para IgG contra el antígeno de Rickettsia rickettsii. Resultados: se analizaron 89 pacientes febriles con 89 muestras de fase aguda y 60 en fase convaleciente. Los síntomas más comunes de los pacientes fueron cefalea, ictericia, mialgias, náuseas, dolor abdominal, trombocitopenia y vómito. El 55,1 % de los pacientes provenía de áreas rurales. Se obtuvo seropositividad del 40,4 % con títulos entre 64-512, infección previa en un 33,7 % y rickettsiosis en 6 pacientes (6,7 %). Los pacientes con seroconversión o serorefuerzo provenían de los municipios de Apartadó (n = 2), Chigorodó (n = 1), Necoclí (n = 2) y Turbo (n = 1); el hallazgo clínico más destacado fue la trombocitopenia. Conclusiones: se demostró que la infección y la enfermedad rickettsial continúan siendo activas en la zona del Urabá. Este hallazgo permite alertar a las autoridades de salud de la región para que se brinde tratamiento con antibióticos a los casos sospechosos de manera temprana y de esta forma evitar las muertes o secuelas derivadas de este tipo de infecciones.

SUMMARY Objective: Determine the frequency of infection and disease by Rickettsia spp. of the spotted fever group in febrile patients from Urabá Antioquia attended by hospital centers of the region. Methods: Patients from nine health institutions of the Urabá region were included in the study. These patients received a survey with questions about their clinical and socio-demographic variables. Eighty-nine acutephase serum samples, and 60 convalescent serum samples, were obtained from these patients, and each sample was tested (IgG) by Indirect Immunofluoerscence Assay (IIFA) using a dilution of 1:64 against R. rickettsii. Furtherly, positive sera were tittered by two-fold serial dilutions using the same antigen. Results: Patients showed symptoms such as fever, headache, jaundice, myalgias, nausea, abdominal pain, petechiae, thrombocytopenia and vomiting. Most of these patients came from rural areas (55,1 %). Seropositivity was obtained in 40,4 % patients with titers between 64-512, a 33,7 % with previous infection and the disease was found in 6 patients (6,7 %). Patients with seroconversion, or a fourlfold rise antibody titer between acute and convalescent samples, came from the municipalities of Apartadó (n = 2), Chigorodó (n = 1), Necoclí (n = 2) and Turbo (n = 1), and the most relevant clinical finding was thrombocytopenia in four of the patients. Conclusions: This study demonstrated that infection and rickettsial disease continues being active in the Urabá region. This situation represents a warning for the health authorities of the region and suggests them to provide appropriate treatment to avoid deaths or sequelae derived from this type of infections.

Rendimiento diagnóstico de la prueba de inmunofluorescencia indirecta para la detección de anticuerpos contra HTLV-1 / Diagnostic performance of the indirect immunofluorescence test for the detection of antibodies against HTLV-1

RESUMEN El objetivo del estudio fue determinar el rendimiento diagnóstico de la prueba de inmunofluorescencia indirecta (IFI) para la detección de anticuerpos contra HTLV-1. Se realizó un estudio de evaluación de prueba diagnóstica. Se usaron cultivos celulares MT2 infectados con HTLV-1 y K-562 sin infección, luego fueron sembrados, fijados en láminas para inmunofluorescencia y enfrentados a sueros. Se usaron 155 sueros (80 positivos para HTLV-1 y 75 positivos para otras enfermedades) procedentes de la seroteca del Instituto Nacional de Salud del Perú. Adicionalmente, se evaluó la repetibilidad (en el laboratorio) y reproducibilidad (en laboratorios de costa, sierra y selva) de la prueba. La prueba IFI para la detección de anticuerpos contra HTLV-1 tuvo una sensibilidad de 98,75% (IC 95%: 95,69-100%), una especificidad de 98,67% (IC 95%: 95,40-100%) y el índice de kappa de 0,975. No hubo falsos positivos ni falsos negativos; sin embargo, sí se obtuvo un resultado indeterminado y uno inespecífico. La prueba mostró 100% de concordancia en la repetibilidad y reproductibilidad. Concluimos que los resultados obtenidos son comparables a la prueba de referencia. La prueba de IFI presenta un buen rendimiento diagnóstico y sería de utilidad para la confirmación de HTLV-1.

ABSTRACT The objective of the study was to determine the diagnostic yield of the indirect immunofluorescence (IFI) test for the detection of antibodies against HTLV-1. A diagnostic test evaluation study was performed. HTLV-1-infected MT2 cells and HTLV-1-uninfected K-562 cells were cultured; then these cells were impregnated and fixed in sheets for immunofluorescence and faced to Peruvian sera. A total of 155 sera (80 HTLV-1-positive sera and 75 sera positive for other diseases) from the Peruvian Instituto Nacional de Salud were used. In addition, the parameters of repeatability (intra-laboratory) and reproducibility (in laboratories of the Peruvian coast, mountains and jungle) of the test were evaluated. The IFI test detected the presence of antibodies against HTLV-1 reaching a sensitivity of 98.75% (95% CI: 95.69 - 100.00%), a specificity of 98.67% (95% CI: 95.40 - 100.00%) and the Kappa index was 0.975. There were no false positives or false negatives; however, one undetermined result and one non-specific result were obtained. The test showed 100% qualitative agreement when performing the repeatability and reproducibility. The results obtained are comparable to the reference test. Therefore, the IFI test had a good diagnostic performance and would be useful for the confirmation of HTLV-1.

Podocitúria na doença de Fabry / Podocyturia in Fabry disease

Resumo Introdução: A doença de Fabry (DF) é uma desordem lisossômica ligada ao cromossomo X ocasionada por mutações no gene que codifica a enzima lisossômica α-galactosidase A (α-GAL). A redução ou ausência da atividade dessa enzima leva ao acúmulo progressivo de gb3. A doença renal é uma importante consequência clínica da acumulação de Gb3. Podócito é o tipo celular mais afetado na doença renal, que mostra apenas uma resposta parcial à Terapia de Reposição Enzimática. Além disso, a disfunção podocitária é a principal contribuinte para a perda progressiva da função renal e pode ser encontrada alterada mesmo antes do início da microalbuminúria. Assim, a podocitúria na DF pode ser uma ferramenta importante para prever a doença renal. Objetivo: O objetivo deste estudo foi quantificar a excreção urinária de podócitos em pacientes com DF (V269M, n = 14) e controles saudáveis (n = 40), e relacioná-las com as variáveis sexo, idade, tempo de terapia e a razão albumina: creatinina (AUC). Métodos: Podócitos urinários foram identificados utilizando imunofluorescência para podocalixina e DAPI. O número de células podocalixina positivo foi contado e o número médio foi utilizado (faixa normal 0-0.6 podócitos/mL). Resultados: O número médio de podócitos na urina de pacientes com DF foi significativamente maior do que os controles saudáveis (p < 0.0001). Observou-se uma correlação positiva entre podocitúria e AUC (p = 0.004; r2 = 0.6417). Conclusão: A podocitúria pode ser uma ferramenta adicional para avaliar a progressão da doença renal em pacientes que se espera que tenha um fenótipo mais agressivo.

Abstract Introduction: Fabry disease is a lysosomal storage disorder due to abnormalities in the GLA gene (Xq22). Such changes result in the reduction/absence of activity of the lysosome enzyme α-GAL, whose function is to metabolize globotriaosylceramide (Gb3). Renal disease is a major clinical outcome of the accumulation of Gb3. Podocyte injury is thought to be a major contributor to the progressive loss of the renal function and may be found altered even before the onset of microalbuminuria. Objective: The aim of this study was to quantify the urinary excretion of podocytes in Fabry disease patients (V269M, n = 14) and healthy controls (n = 40), and to correlate podocyturia with the variables gender, age, time of therapy and albumin: creatinine ratio (ACR). Methods: Urinary podocytes were stained using immunofluorescence to podocalyxin and DAPi. The number of podocalyxin-positive cells was quantified and the average number was taken (normal range 0-0.6 podocytes/mL). Results: The average number of podocytes in the urine of Fabry disease patients was significantly higher than in healthy controls (p < 0.0001). We observed a positive correlation between podocyturia and ACR (p = 0.004; (r2 = 0.6417). We found no correlation between podocyturia and gender, age or duration of therapy. Conclusion: Podocyturia is an important parameter in the assessment of renal disease in general, and it may serve as an additional early tool for monitoring Fabry disease nephropathy even before changes in ACR are seen. This may prove to be a useful tool to assess disease progression in patients expected to have a more aggressive phenotype.

Obstrução tubária em mulheres com imunofluorescência indireta positiva para clamídia / Tubal occlusion in women with indirect positive immunofluorescence for chlamydia

Objetivos: Avaliar o desempenho da imunofluorescência indireta para Chlamydia trachomatis em rastrear obstrução tubária. Métodos: Este é um estudo retrospectivo com 204 pacientes atendidas em um centro universitário e particular de infertilidade na cidade de Goiânia no período de 2006 a 2009. Para avaliar o risco de obstrução tubária as pacientes foram divididas em dois grupos: pacientes “expostas” à clamídia (imunofluorescênciaindireta ≥1:16) e “não expostas” (imunofluorescência indireta <1:16). Verificou-se, então, as pacientes que tiveram a “doença” (obstrução tubária) e “controles” (sem obstrução tubária) na histerossalpingografia. Para os cálculos foram utilizados os testes Qui-quadrado (χ2) e Exato de Fisher. O nível de p escolhido foi 0,05. Resultados: Das 72 pacientes com titulação significativa, 34 (47,2%) apresentaram a ocorrência de obstrução tubária. Em relação às 132 pacientes com titulação não significativa, somente 18 (13,7%) apresentaram obstrução tubária (p<0,001). Foi observado também um aumento progressivo entre os níveis de anticorpos e a probabilidade de obstrução tubária (p<0,001). Conclusões: Os resultados deste estudorevelaram que a sorologia para Chlamydia trachomatis é válida para rastreamento de lesão tubária, portanto, pode facilitar decisões naquelas mulheres que devem prosseguir com novas investigações.

Purpose: To evaluate the ability of indirect immunofluorescence for Chlamydia trachomatis to screening tubal occlusion. Methods: This is a retrospective study with 204 electronic records of patients attended at a university and private infertility center in the city of Goiania, in the period of 2006 to 2009. To evaluate the risk of tubal occlusion the patients were divided into two groups: patients “exposed” to chlamydia (IFI≥1:16) e “unexposed” (IFI<1:16). It was verified patients who had the “disease” (tubal occlusion) and “control” (without tubal occlusion) in the hysterosalpingography. For the calculations the Chi-square (χ2) and Fisher Exact Test were used. The p chosen level was 0,05. Results: Of the 72 patients with significant titers, 34 (47,2%) showed the occurrence of tubal occlusion. Concerning the 132 patients with no significant titers, only 18 (13,7%) had tubal occlusion(p<0,001). We also observed a progressive increase in the levels of antibodies and the likelihood of tubal occlusion (p<0,001). Conclusions: The results indicate that serology for Chlamydia trachomatis is valid for screening of tubal damage and may facilitate decisions on which women should proceed with further investigations.

Gravidez ectópica em pacientes com titulação significativa para Chlamydia trachomatis / Ectopic pregnancy in patients with significant titles for Chlamydia trachomatis

Objetivos: O estudo observou a relação entre gravidez ectópica e os níveis de anticorpos para Chlamydia trachomatis em mulheres inférteis. Materiais e métodos: Este é um estudo retrospectivo, com 204 prontuários eletrônicos de pacientes atendidas em um centro universitário e particular de infertilidade na cidade de Goiânia (GO), no período de 2006 a 2009. A gravidez ectópica foi avaliada por meio dos relatos das pacientes durante as consultas, e os níveis de anticorpos para Chlamydia trachomatis, pela imunofluorescência indireta. Foram considerados positivos os títulos iguais ou maiores que 1:16. Para os cálculos, foi utilizado o teste exato de Fisher, sendo o nível de p escolhido como 0,05. Resultados: Das 72 pacientes com titulação significativa, 9 (12,5%) apresentaram a ocorrência de gravidez ectópica. Em relação à 132 pacientes com titulação não significativa, somente 5 (3,8%) apresentaram gravidez ectópica (p<0,05). Conclusões: Os resultados sugerem que há uma relação positiva entre gravidez ectópica e infecção prévia por Chlamydia trachomatis.

Objectives: The study observed the relationship between ectopic pregnancy and the Chlamydia trachomatis antibody levels in infertile women. Material and methods: This is a retrospective study with 204 electronic records of patients attended at a university and private infertility center in the city of Goiania (GO), Brazil, in the period between 2006 to 2009. Ectopic pregnancy was evaluated by reports of patients during consultations and Chlamydia trachomatis antibody levels by indirect immunofluorescence test. Positive titres greater than or equal to 1:16 were considered. For the calculation, the Fisher’s exact test was used. The p level chosen was 0.05. Results: Of the 72 patients with significant titres, 9 (12.5%) showed the occurrence of ectopic pregnancy. Concerning the 132 patients with no significant titres, only 5 (3.8%) had ectopic pregnancy (p<0.05). Conclusions: The results suggest that there is a positive relation between ectopic pregnancy and prior Chlamydia trachomatis infection.

Inmunovaloración de anticuerpos IgM en muestras sospechosas de sarampión clínicamente

Se realiza el estudio de 60 sueros pareados sospechosos de Sarampión clínicamente llegados al Laboratorio Diagnóstico del Instituto de Medicina Tropical "Pedro Kourí" entre enero y mayo de 1996, procedentes de la vigilancia seroepidemiológica de la vacuna triple viral (sarampion, rubéola y parotiditis), a los cuales se les realizó la detección de anticuerpos hemaglutinantes a sarampión y rubéola, así como de IgM, con el estuche diagnóstico Clark Laboratories INC Measles IgM ELISA. Los casos positivos se confirmaron por las técnicas de inmunofluorescencia indirecta-IgM y neutralización. Se obtuvieron por inhibición de la hemaglutinación, 3 casos positivos a sarampión y rubéola, los cuales negativos a IgM de sarampión y a los que se les determinaron anticuerpos a Epstein Barr, Citomegalovirus y al virus herpes simple mediante inmunifluorescencia indirecta (IFI) la capacidad de estos virus de inducir respuesta policlonal. Por medio del ELISA IgM Clark se detectaron 6 casos positivos los cuales resultaron negativos por IFI.

60 matched sera clinically syspicious of measles that were received at the Diagnostic Laboratory of the "Pedro Kourí" Tropical Medicine Institute between January and May, 1996, coming from the seroepidemiological surveillance of the MPR vaccine were studied. The detection of measles and rubella hemagglutinant antibodies, as well as of IgM, was carried out with the Clark Laboratories INC. Measles IgM ELISA diagnostic kit. The positive cases were confirmed by the IgM-indirect immunofluorescence and neutralization. 3 positive cases to measles and rubella, which were negative to measles IgM, were obtained by hemagglutination inhibition. Antibodies against Epstein Barr, cytomegalovirus and herpes simplex virus were also determined by indirect immunofluorescence (IIF) due to the capacity of these viruses to induces polyclonal responses. 6 positive cases, which were negative by IIF, were detected by means of the above mentioned diagnostic kit.