Positive IgM Research Articles

A study of relationship between various platelet indices and outcome of dengue fever in pediatric patients

Background: The study analyzed clinical characteristics and platelet indices in 200 children (1 month to 15 years) diagnosed with dengue fever, admitted to affiliated hospitals. It aimed to explore the relationship between platelet indices and disease severity in pediatric patients of teaching hospitals affiliated with MRMC College with a confirmed diagnosis of dengue fever. Methods: In this study, the majority of patients were aged (10-15) years, with a small percentage (3.5%) being infants. Females accounted for 50% of the cases. Fever was the most common symptom, followed by headache, abdominal pain, and myalgia. Rash occurred in (14.5%) of cases. Among 200 cases, 80 exhibited warning signs, with varying positivity for NS1 and IgM. All patients required fluid therapy, and (77.5%) needed ICU care. Platelet count and Plateletcrit decreased initially but improved later, while PDW, MPV, and PLCR increased and then decreased. NS1-positive cases had lower platelet count and Plateletcrit but higher PLCR and MPV compared to IgM-positive cases. Results: The study found that lower platelet count and Plateletcrit, as well as higher mean platelet volume, were associated with more severe disease outcomes, including longer hospital stays, increased intensive care unit care, and higher fluid therapy requirements. However, there was no significant correlation between other platelet indices (PLCR and PDW) and disease severity indicators. Conclusions: In conclusion, this study provided valuable insights into the clinical features and platelet indices of patients with dengue fever. Understanding the relationship between these indices and disease severity can help in predicting the progression of the illness and improving patient management strategies.

Serological status for TORCH in women of childbearing age: a decade-long surveillance (2012-2022) in Italy.

Introduction. Serological screening and seroprevalence data for TORCH infections represent a key instrument to estimate immunity and vaccination levels and exposure rates to prevent and treat TORCH congenital infections.Hypothesis. Serology allows us to identify women susceptible to primary infection.Aim. Assess the prevalence of women at risk of primary infections by TORCH pathogens in Palermo, Sicily, Italy, in the decade 2012-2022.Methodology. A retrospective study was performed to evaluate the serological status (IgG and/or IgM) of 2359 women of childbearing age (WCBA), ranging from 16 to 46 years, attending the AOUP 'P. Giaccone' University Hospital of Palermo.Results. The results showed an overall prevalence of anti-TORCH IgG of 90.5 % for herpesvirus (HSV), 81.2 % for rubella virus (RV), 72.1 % for cytomegalovirus (CMV), 20.9 % for Toxoplasma gondii (TOX) and 4.8 % for Treponema pallidum (TP). IgM positivity was 16.9 % for HSV2, 10.3 % for TOX, 4 % for CMV and, 2 % for RV. A recent/active infection by TP was confirmed in 28.3 % of the seropositive women. Our results indicate that only a small percentage of WCBA were subjected to a comprehensive TORCH serological screening, while most WCBA were only tested for a single pathogen. In addition, no significant differences were found in terms of the overall TORCH IgG seroprevalence among different age groups (P>0.05).Conclusion. Identifying WCBA at risk of exposure during pregnancy allows us to prevent and reduce possible congenital infections, providing detailed guidelines and instructions. The results of this study showed that in Italy the risk of acquiring a primary infection by a TORCH agent is still high, therefore effective prevention strategies, including serological screening, should be implemented.

COVID-19 Serological Status in Beta-thalassemia Patients in Iran: A Retrospective Descriptive Study

Background: Patients with beta-thalassemia (BT) are more prone to infections than others, especially when they have some risk factors. Some reports showed the lower severity of Coronavirus disease 2019 (COVID-19) infection in this population. Objectives: In this study, we aimed to determine the serological status of COVID-19 in BT patients. Methods: This cross-sectional study was conducted in September 2020-February 2021 at Ali-Asghar Children's Hospital, Iran. All major and intermedia β-thalassemia patients dependent on blood transfusion were enrolled in this study. Demographic information, including age, gender, thalassemia type, history of splenectomy, and blood type, were recorded in a checklist. Moreover, the patients were asked about their exposure to COVID-19, and the related symptoms, such as cough, fever, headache, and anosmia, in the last six months. The enrolled cases were examined for anti-COVID-19 IgM and IgG to determine the serological status against this virus. Results: The positive IgG and IgM tests against COVID-19 were in 35.7% (25/70) and 20% (14/70) of cases, respectively, while 42.9% (30/70) were either IgM- or IgG-positive. Among the serologically positive cases, six had a history of at least one symptom suspicious of COVID-19. These six included one fever, two coughs, one anosmia, one dyspnea, and one cough and anosmia. Only one of the patients was hospitalized (1%) with fever and dyspnea. No Intensive Care Unit admission or mortality was reported. Conclusions: It seems that COVID-19 is more likely to be mild or asymptomatic in patients with BT.

Seroprevalence of Anti-SARS-CoV-2 IgG and IgM Antibodies among Government Employees in Iran.

The COVID-19 disease emerged in Wuhan, China, in December 2019 and quickly became a global health threat. Around 6,947,192 people have been killed around the world so far, including 146,292 in Iran. In addition to the definitive diagnosis of the disease by RT-PCR, immunological and serological tests can check the anti-SARS-CoV-2 N protein antibody titer in people at different stages of infection with acceptable sensitivity and specificity. The serological examination is an effective and efficient method for determining the prevalence of the disease, especially when asymptomatic cases are present or the diagnosis of symptomatic cases is incomplete. The study examined the seroprevalence of COVID-19 at the Razi Vaccine and Serum Research Institute (RVSRI) and the Agricultural Research, Education, and Extension Organization (AREEO). A total of 493 blood samples were collected from volunteers in June 2020 in AREEO, and 380 samples were collected in June and July 2020 in RVSRI. The total number of volunteers from both organizations was 873. Standard ELISA kits were used to measure IgG and IgM antibodies against SARS-CoV-2. A statistical analysis of the obtained data was conducted using SPSS (version 22.0). Among the total 873 volunteers examined in RVSRI and AREEO, 10.5% had elevated serum titers either for IgM or IgG, 3.55% of whom were women and 6.95% were men. Generally, 8.8% of people tested positive for IgM, which showed a recent infection with COVID-19 in people at that time and partially indicated the start of a new wave of COVID-19. In RVSRI, 3.42% of people with positive IgM titers (positive or negative IgG titers) were women and 5.53% were men. In AREEO, 3.02% were women and 5.72% were men. The seroprevalence rate of COVID-19 in RVSRI was 11.6%, 4.2% of which were women and 7.35% were men, with no significant difference between women and men. The COVID-19 seroprevalence in AREEO was 9.7%, 3.22% of which were women and 6.5% were men, with no significant difference between women and men.

Immunological changes in a cohort of COVID-19 survivors: Mansoura University experience

Background: COVID-19 is a global pandemic that has affected millions of people all over the world since 2019. Infection with COVID-19 initiates a humoral immune response that produces antibodies against specific viral antigens, which in turn is supposed to provide immunity against reinfection for a period of time. The aim of this research was to study the kinetics of IgM and IgG antibodies against SARS-CoV-2. Methods: One hundred and seventeen post-COVID-19 participants were enrolled in the study. Qualitative assessment of IgM and IgG antibodies over six months (three visits) post recovery was conducted. Results: The current study revealed a significant reduction in IgM and IgG titers between the first and second visits (p <0.001). After six months, the antibody titer had declined by 78.8% from the first visit for IgM and by 49.2% for IgG antibodies. Regarding younger age and male sex, statistically significant persistence of IgM antibodies was noticed at the six months follow up. Also, statistically significant persistent IgG immunity was found in male patients and diabetics by the end of the six months follow up. Conclusions: We observed a significant waning of IgM and IgG titers over a period of six months follow up.. The persistence of positive IgM and IgG antibodies by the end of six months was variable due to differences in age, gender and presence of diabetes mellitus.

Utility of Borrelia-specific IgM and IgG antibody titer determinations during a 12-year period - results from a clinical laboratory in Northern Sweden.

Interpretation of serological findings in suspected Lyme borreliosis (LB) is challenging and IgM reactivities may have low predictive value. Therefore, if used indiscriminately, there is a risk for incorrect diagnosis of LB. To evaluate the usefulness of IgM titer determination, we performed a study of the prevalence of Borrelia-specific antibodies in serological samples from patients with suspected LB analyzed during the period 2010 - 2021 at the University Hospital of Umeå in Sweden. In total, 19,335 samples had been analyzed for the presence of IgG and IgM antibodies. Overall, there were higher percentages of IgM positive or borderline titers, 1,847 (9.6%) and 905 (4.7%), respectively, than IgG positive or borderline titers, 959 (5.0%) and 406 (2.1%), respectively. Peak number of samples were recorded 2012 - 2013, exceeding 1,800, whereas there were around 1,200 during 2020 - 2021. The peak number of positive IgG and/or positive IgM samples were observed during the period 2015 - 2017 with close to, or above 400, and concomitantly, the proportion of IgG positive samples increased markedly. For IgG positive samples, the increase followed a positive linear time trend (P< 0.001). Peak monthly numbers were observed during August, September, and October. This seasonal increase was significant for the IgG positive group (P< 0.05), but not for the IgM positive/IgG negative group. Repeated samples were obtained from 3,188 individuals and of the initial samples 2,817 were (88%) IgG negative and 2,315 (72%) were IgM negative and of these, 130 (4%) showed IgG seroconversion and 300 (9%) IgM seroconversion. Collectively, the data demonstrate that IgG and/or IgM positive samples represented a minority of all samples, even when repeated sampling had occurred, and IgM positive samples were much more common than IgG positive samples. Thus, the accuracy of the clinical suspicion was low and this will lead to a low predictive value of the analysis, in particular of IgM. These findings question the use of IgM titer determination as a routine analysis.

Patterns of ECG Manifestations in Dengue Infection

Background: Dengue fever has emerged as one of the most common viral diseases in the world. The clinical manifestation ranges from mild febrile illness to severe disease such as dengue hemorrhagic fever and dengue shock syndrome. Dengue is known to affect various systems. So, different aspects of disease need to be explored. Cardiac involvement in dengue fever is not uncommon and has been reported in literature. ECG is widely used as a screening tool not only because it is easily available but also due to its ability to indicate cardiac involvement. Objective: The aim of the study was to determine the patterns of ECG changes and their frequency in a cohort of patients with dengue fever (DF) and dengue hemorrhagic fever (DHF) along with the association of ECG changes with severity of dengue infection and clinical manifestation of cardiac involvement. Method: We conducted a cross-sectional observational study involving 50 patients with dengue fever and dengue hemorrhagic fever, admitted in Medicine department of Dhaka Medical College Hospital, Dhaka from 1st October, 2017 to 31st March, 2018. Admitted patients with high grade fever and positive Dengue IgM, NS1 AG or RT-PCR were included. Patients with electrolyte abnormalities, preexisting heart disease, drugs interfering with heart rhythm were excluded from study. The Standard 12 lead ECG was carried out in study patients on 3rd day of disease onset and on the day of discharge after disease recovery. Frequency &amp; pattern of ECG changes like heart rate, rhythm, P wave, T wave, ST segments and QRS complex were analyzed and recorded. Statistical analysis was done using SPSS 25 on windows 10. Categorical and numerical data’s were expressed as frequencies and percentage. Cross tabulation was done between DF and DHF with different ECG findings. To establish the significance of various findings and association in between variables chi-square analysis, Pearson correlations were done in all cases. P value &lt; 0.05 considered significant Result: Total 50 patients with dengue fever were enrolled, 39 patients (78%) were diagnosed as dengue fever and 11 patients (22%) were diagnosed as dengue hemorrhagic fever (DHF). Mean age of the patient was 33.08 ± 9.79 years. Male – female ratio of 1.5:1 fever was noted in all 50 patients (100%), myalgia (94%), headache (84%), skin rash (82%), &amp; retro-orbital pain(54%), vomiting (26%), only 3 patients (6%) complained about abdominal pain. Only 4 patients had cardiac symptoms. 3 patients complained about palpitation and only 1 patient had symptom of chest pain and dyspnea. In most of the patients, (34 in number, 68%) ECG was normal. Only 16 patients (32%) had abnormal findings in ECG. 9 patients (18%) had bradycardia, 3 patients (6%) had tachycardia, 2 Patient (4%) had T Inversion and 1 patient (2%) had ST elevation and 1 patient (2%) had ST depression. Among total 16 abnormal ECG, predominant finding was bradycardia (&gt;50% of abnormal ECG). P value is &lt;0.01. Correlation of ECGs with clinical severity (Dengue fever and Dengue Hemorrhagic fever) found no statistically significant association (P value is 0.725). J MEDICINE 2023; 24(2): 119-124

Visualization of maternal IL-17a across the placental membrane.

IL-17a is a pro-inflammatory cytokine produced primarily by T helper-17 cells. Several studies have shown that maternal IL-17a, associated with maternal immune activation (MIA), affects the developing brain. However, the mechanisms underlying maternal IL-17a signaling remain partially unknown. This study detected trans-placental IL-17a passage using luminescent activity studies and an in vitro transfer assay. First, the luminescent activity was observed using LiCoR dye-conjugated IL-17a injected into pregnant mice. IL-17a luminescent activity was highly detected in the placenta and isolated fetus, but positive control IgG and negative control IgM showed low or no luminescence in the placenta and fetus, respectively. Next, IL-17a transmission across the placenta was investigated using a transwell experiment with trophoblast BeWo cells and primary trophoblast cells. Significant amounts of IL-17a were detected in the lower compartment. And in various placenta cell lines, IL-17a treatment significantly increased IL-17RA mRNA expression. However, it did not affect IL-17RC mRNA expression.This study showed that elevated IL-17a increased the IL-17RA expression in the trophoblast and may accumulate in the placenta. Furthermore, these results indicate the molecular basis of an important role in IL-17a/IL-17RA in the maternal placenta.

Feto-maternal outcomes of pregnancies in women with SLE: Experience from a tertiary care center of Asia.

We aim to quantify the risk of maternal and fetal complications in patients with SLE in order to identify the impact of SLE on pregnancy and of pregnancy on SLE. This retrospective record review study was conducted in Aga khan university hospital, Karachi, from Jan 1998 to Dec 2019. All pregnant patients with SLE diagnosed and delivered during this time were included in the study. Categorical variables were analyzed by using chi-square test and fisher exact test. Whereas quantitative point estimate was estimated as mean and SD. We matched the data and computed crude odds ratio of pre-eclamptic patients with respect to age of conception, gravida, and body mass index in both case and control group. The SLE disease activity was monitored during pregnancy under SLEDAI-2K Scoring system. The patients with mild (25.6%) and moderate (25.6%) disease activity were prevalent and most antenatal patients (51.7%) had flare up in third trimester. Adverse maternal outcomes include pre-eclampsia (28.8%), eclampsia (3.2%), cesarean section (57.6%), and thrombocytopenia (9.6%), whereas perinatal outcomes includes intrauterine growth retardation (24%), preterm birth <34weeks (19.2%) and <37weeks (63.2%), APGAR Score < 7 at 1min (5.6%), and neonatal death (5.6%) found to be statistically significant in between two groups There were more high-risk patients (42) with positive IgG (88%), IgM (83.3%), and lupus anticoagulant (33.3%) as compared to low-risk APS group. Planned pregnancy and less severe disease flares during pregnancy is associated with more favorable feto-maternal outcomes.

High seroprevalence of hepatitis E virus (HEV) in South Transdanubia, Hungary (2010-2022).

Hepatitis E virus (HEV) is an increasingly recognized etiological agent of acute, chronic and extrahepatic human infections with primarily zoonotic origin in Europe. Limited numbers of comprehensive population-based studies are available related to HEV seroepidemiology, especially from Central Europe.The aim of this study was to investigate the seroprevalence and trends of total and IgM antibodies against HEV in different age groups in the population of South Transdanubia, Hungary, within a thirteen years long period between the years 2010 and 2022.We retrospectively analysed the serological test results of HEV total and HEV IgM antibodies carried out by ELISA technique using Dia.Pro (Diagnostic Bioprobes, Italy) kit from serum samples collected from patients with or without hepatitis between January 1, 2010 and December 31, 2022.The number of tested samples (∑6,996 for total antibody and ∑6,582 for IgM) increased during the study period. The average HEV total and the IgM antibody seropositivities were 33% (2,307/6,996 samples) and 9.6% (642/6,582 samples), respectively, in the study population. The HEV total antibody seropositivity varied in different age groups between 3.9% (age group 1-5 years) and 58.6% (86-90 years) and showed an increasing positivity by age. At the age groups >50 years, nearly half (43%) of the population had antibodies against HEV. The HEV IgM positivity had an increasing trend of up to 13.9% in the age group 81-85 years.High HEV total and IgM antibody seroprevalence were detected in South Transdanubia, Hungary, confirming that this region is highly endemic for HEV infections in Europe.

Arterial stiffness tested by pulse wave velocity and augmentation index for cardiovascular risk stratification in antiphospholipid syndrome.

Cardiovascular disease is a major cause of morbidity and mortality in Antiphospholipid syndrome (APS). Arterial stiffness (ArS) has emerged as a predictor of future cardiovascular events in the general population. We aimed to assess ArS in patients with thrombotic APS versus diabetes mellitus (DM) and healthy controls (HC) and identify predictors of increased ArS in APS. ArS was evaluated by carotid-femoral pulse wave velocity (cfPWV) and augmentation index normalized to 75 beats/min (AIx@75) using the SphygmoCor device. Participants also underwent carotid/femoral ultrasound for atherosclerotic plaque detection. We used linear regression to compare ArS measures among groups and assess ArS determinants in the APS group. We included 110 patients with APS (70.9% female, mean age 45.4 years), 110 DM patients and 110 HC, all age/sex matched. After adjustment for age, sex, cardiovascular risk factors and plaque presence, APS patients exhibited similar cfPWV [β = -0.142 (95% CI -0.514, 0.230), p = 0.454] but increased AIx@75 [β = 4.525 (95% CI 1.372, 7.677), p = 0.005] compared with HC and lower cfPWV (p < 0.001) but similar AIx@75 (p = 0.193) versus DM patients. In the APS group, cfPWV was independently associated with age [β = 0.056 (95% CI 0.034, 0.078), p < 0.001], mean arterial pressure (MAP) [β = 0.070 (95% CI 0.043, 0.097), p < 0.001], atherosclerotic femoral plaques [β = 0.732 (95% CI 0.053, 1.411), p = 0.035] and anti-β2-glycoprotein I IgM positivity [β = 0.696 (95% CI 0.201, 1.191), p = 0.006]. AIx@75 was associated with age [β = 0.334 (95% CI 0.117, 0.551), p = 0.003], female sex [β = 7.447 (95% CI 2.312, 12.581), p = 0.005] and MAP [β = 0.425 (95% CI 0.187, 0.663), p = 0.001]. APS patients exhibit elevated AIx@75 vs HC and similar to DM patients, indicating enhanced arterial stiffening in APS. Given its prognostic value, ArS evaluation may help to improve cardiovascular risk stratification in APS.

Galactose-deficient IgA1 is Involved in IgA Deposition in Renal Grafts Biopsied One Hour after Kidney Transplantation.

Objective Asymptomatic renal immunoglobulin A (IgA) deposition occurs in healthy subjects, but its etiologic role in disease is unclear. Galactose-deficient IgA1 (Gd-IgA1) is involved in the pathogenesis of IgA nephropathy. We investigated Gd-IgA1 deposition in transplanted kidneys that were considered healthy showing subclinical latent IgA deposition one hour after transplantation. Methods A total of 723 transplanted kidney specimens biopsied 1 h after kidney transplantation from 2009 to 2016 at Nagoya Red Cross Hospital were examined. A total of 81 cases of IgA deposition were extracted, and 41 were ultimately studied. Double immunofluorescence staining for Gd-IgA1 and IgA was conducted to investigate the role of Gd-IgA1 in subclinical IgA deposition. Results Light microscopy findings for the 41 cases indicated only minor glomerular abnormalities. Immunofluorescence analyses revealed that all cases were positive for IgA. C3, IgG, and IgM positivity rates were 78.0%, 7.3%, and 60.9%, respectively. All 41 cases were positive for Gd-IgA1, which merged with IgA deposition in immunofluorescence double staining. IgA disappeared in 26 of 40 cases (65.0%) 1 year after kidney transplantation. In contrast, IgA redeposition was observed in three cases. Conclusion Gd-IgA1 was demonstrated in all transplanted kidneys, with latent IgA deposition noted in otherwise healthy kidneys. Deposition of Gd-IgA1 might indicate the initial stage of IgA nephropathy; however, additional factors, such as IgG deposition, are required for the ultimate development of IgA nephropathy.

Increasing positive rate of IgG against hepatitis E virus with steady IgM positivity and clinical incidence: A retrospective seroprevalence time series analysis of HEV from 2012 to 2021 in Chongqing, China.

China is an epidemic area of hepatitis E, and the serum prevalence data is very important for formulating prevention and control strategies. However, almost all related research in the past decade are cross-sectional studies. In this study, we analyzed the serological data from 2012 to 2021 in Chongqing for 10 consecutive years. We found that the positive rate of hepatitis E IgG antibody increased gradually, from 1.61% in January 2012 to 50.63% in December 2021. The autoregressive integrated moving average model was used to predict the trend, and it was found that it will continue to show an upward trend in the recent future. In contrast, the positive rate of IgM and clinical incidence of hepatitis E showed a relatively stable trend. Although the positive rate of antibodies gradually increased with age, there was no significant difference in the age distribution of the subjects each year. Therefore, these results suggest that the accumulated infection of hepatitis E in Chongqing may be gradually increasing, but the clinical incidence rate remains unchanged, which provides a new concern for formulating prevention and control strategies.

Una “vistosa” vasculite con edema, che riguarda gli arti e il viso e risparmia il tronco

Acute haemorrhagic oedema of infancy (AHEI) is a small vessel vasculitis that affects boys between 4 months and 2 years. It presents with a characteristic purpuric skin rash but with marked bruising and “typical” localizations in auricles and is often accompanied by oedema of face and extremities. It is typically post-infectious, especially after infections of the upper respiratory tract and rarely can be associated with gastrointestinal, renal, articular or testicular complications. The paper reports the case of a 2-year-and-5-month-old boy who, 5 days after the resolution of a febrile infection of the upper airways (with subsequent detection of positive IgM and IgG serology for SARS-Cov-2), presented with a rash with ecchymotic/purpuric lesions in his lower limbs, face and auricles associated with intense arthralgia, arthritis of a knee and deterioration of general conditions. The diagnosis of acute infantile haemorrhagic oedema was clear but the clinical presentation required an “important” therapeutic approach with intravenous steroids and an infusion of immunoglobulins.

Anti-Neutrophil Extracellular Trap Antibodies in Antiphospholipid Antibody-Positive Patients: Results From the Antiphospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking Clinical Database and Repository.

This study aimed to elucidate the presence, antigen specificities, and potential clinical associations of anti-neutrophil extracellular trap (anti-NET) antibodies in a multinational cohort of antiphospholipid (aPL) antibody-positive patients who did not have lupus. Anti-NET IgG/IgM levels were measured in serum samples from 389 aPL-positive patients; 308 patients met the classification criteria for antiphospholipid syndrome. Multivariate logistic regression with best variable model selection was used to determine clinical associations. For a subset of the patients (n=214), we profiled autoantibodies using an autoantigen microarray platform. We found elevated levels of anti-NET IgG and/or IgM in 45% of the aPL-positive patients. High anti-NET antibody levels are associated with more circulating myeloperoxidase (MPO)-DNA complexes, which are a biomarker of NETs. When considering clinical manifestations, positive anti-NET IgG was associated with lesions affecting the white matter of the brain, even after adjusting for demographic variables and aPL profiles. Anti-NET IgM tracked with complement consumption after controlling for aPL profiles; furthermore, patient serum samples containing high levels of anti-NET IgM efficiently deposited complement C3d on NETs. As determined by autoantigen microarray, positive testing for anti-NET IgG was significantly associated with several autoantibodies, including those recognizing citrullinated histones, heparan sulfate proteoglycan, laminin, MPO-DNA complexes, and nucleosomes. Anti-NET IgM positivity was associated with autoantibodies targeting single-stranded DNA, double-stranded DNA, and proliferating cell nuclear antigen. These data reveal high levels of anti-NET antibodies in 45% of aPL-positive patients, where they potentially activate the complement cascade. While anti-NET IgM may especially recognize DNA in NETs, anti-NET IgG species appear to be more likely to target NET-associated protein antigens.

Detection of Anti-ZIKV NS1 IgA, IgM, and Combined IgA/IgM and Identification of IL-4 and IL-10 as Potential Biomarkers for Early ZIKV and DENV Infections in Hyperendemic Regions, Thailand.

The frequency of Zika virus (ZIKV)-specific IgA and IgM and the cytokine expression profile of ZIKV-infected patients in hyperendemic areas remain unclear. This study investigated the rates of ZIKV non-structural protein 1 (NS1)-specific IgA and IgM and evaluated serum cytokine levels of ZIKV and Dengue virus (DENV) cases in Thailand to identify potential diagnostic biomarkers, elucidate the immunity against ZIKV and DENV, and investigate the association between cytokine levels and ZIKV symptoms. Low rates of positivity for ZIKV NS1-specific IgA and IgM were detected in our study. ZIKV NS1 IgA/M (11%, 11/101) in combination was more frequently detected than ZIKV NS1 IgM (2%, 2/101) or ZIKV NS1 IgA (4%, 4/96) alone, especially in acute ZIKV cases with previous DENV exposure (14%, 10/72). Cytokine analysis showed that both ZIKV and DENV infections induced polyfunctional immunity, and the latter triggered more prolonged responses. The existence of significant differences in IL-4 and IL-10 levels between acute ZIKV and acute DENV cases suggested that IL-4 (p = 0.0176) and IL-10 (p = 0.0003) may represent biomarkers for acute ZIKV and acute DENV infections, respectively. Analysis of the association between increased cytokine levels and ZIKV symptoms indicated that CXCL10 (p = 0.0029) was associated with exanthema, while IL-5 (p = 0.0496) was linked to headache. The detection of ZIKV NS1 IgA and IgM in combination may enhance the diagnosis of early ZIKV infection, particularly when levels of IgM or IgA alone are low or undetectable. IL-4 and IL-10 may serve as targets for the development of diagnostic tools to detect ZIKV and DENV infections early, respectively, in flavivirus-endemic regions.

Toxoplasma Lymphadenopathy: A Comparative Diagnostic Assessment of Clinical, Serological and Histopathological Findings.

Toxoplasma Gondii (TG) is a zoonotic protozoan with extensive symptomatology. Toxoplasmic lymphadenopathy is considered an affirmative sign and is proved by a biopsy of the enlarged nodule. This study was conducted to compare the clinical, serological, and histopathological findings for the diagnosis of toxoplasmic lymphadenopathy. This study involved biopsy examinations from twelve cases with TG lymphadenopathy. ELISA serological tests were performed for TG specific IgM and IgG immunoglobulins. PCR was done to ratify the results obtained by ELISA. The ages of the patients ranged from 15 to 48 years (mean=27.8). Most of the cases are male n=8(66.7%), while female n=4(33.3%). The asthenia was not only the most frequent clinical presentation (83.3%), but it also last longer. All cases had a positive biopsy. Eight (67.7%) cases revealed seropositivity. Two of them had positive PCR in those who were positive IgM, suggesting that the infection was acute. Six (50%) cases revealed positive IgG tests, while those with negative serology were 4(33.3%). The site of lymph nodes involvement had been assessed and mostly cervical (91.6%). The histopathological results yielded 100% positive findings, thus biopsy was very important in the diagnosis and differential diagnosis of lymph nodes enlargement. The chronic phase of toxoplasmosis does not show the protozoa in the blood causing an absent DNA band for amplification of the PCR cycles, which could explain the lack of bands particular for TG. A negative serological test does not exclude toxoplasmic lymphadenitis, especially in immune-compromised patients.

Clinico-microbiological profile of adults with enteric fever

Background: Enteric fever is a major public health problem; the burden of disease worldwide is approximately 11.9–26.9 million cases and 129,000–217,000 deaths each year. The burden of disease in India is approximately 6 million per year. Enteric fever is caused by Gram-negative bacteria Salmonella typhi or Salmonella paratyphi A, B or C, which is a bloodstream infection. The re-emergence of susceptibility of old antibiotics such as ampicillin, co-trimoxazole, and chloramphenicol in S. typhi has been observed. Aims: The objective of the study was to study the antibiotic sensitivity pattern of S. typhi, S. paratyphi A and S. paratyphi B and also the clinical and laboratory profile of enteric fever with respect to blood counts, liver function tests and typhoid serology in adult patients with enteric fever. Materials and Methods: The study was conducted in the Department of Internal Medicine and Microbiology at Sir Ganga Ram Hospital in 76 adult patients of blood culture-positive enteric fever. Clinical and laboratory profile of patients was recorded. Antibiotic sensitivity patterns were studied in all cases and the prevalence of multidrug-resistant strains, if the present was established. Results: The mean age in this study was 31.46 + 11.29 years. There were 46 male patients and 30 female patients. Fever was present amongst all patients (100%). Myalgia/headache was present amongst the majority of patients (98.7%). Pain in the abdomen (57.9%) was present. Leucopenia and leucocytosis were present in 25% and 2.6% of patients, respectively. Serum glutamic-oxaloacetic transaminase and serum glutamic-pyruvic transaminase were abnormal amongst 36.8% and 38.2% of patients, respectively. Complications, such as ileal perforation and gastrointestinal (GI) bleed, were not seen in the patients of enteric fever in this study. Typhidot IgM was positive in 50% of patients. S. typhi (blood culture) was amongst more than half of the patients (69.7%) and S. paratyphi A was 30.3%. Ampicillin was resistant to 5.3% and chloramphenicol and cotrimoxazole each were resistant to 2.6%. Levofloxacin was resistant to 38.2%. Ceftriaxone, azithromycin and cefixime were sensitive to 100%. Multidrug resistance (resistance to ampicillin, chloramphenicol and cotrimoxazole) was seen in 2.6% of cases, which was associated with S. typhi. There was no multidrug resistant (MDR) strain seen with S. paratyphi A. Conclusions: This study showed that fever, myalgia/headache, pain in the abdomen, nausea/vomiting and diarrhoea were the common clinical manifestations of enteric fever. Other important conclusions were low percentages of comorbidities, low occurrence of leucocytosis, high typhidot IgM positivity, low MDR and most of the drugs were 100% sensitive. Ileal perforation and GI bleeding were not found in any case of enteric fever in this study.

Clinico-Serological Profile of Infective Causes of Acute Hepatitis in Children Admitted to a Tertiary Care Centre.

Hepatitis is a major cause of healthcare burden in India. Hepatitis A is the most common cause of acute viral hepatitis in the pediatric population whereas hepatitis E virus (HEV) is the most important cause of epidemic hepatitis. Various other causes of acute infective hepatitis in children are dengue, malaria, and enteric fever. The aim of the present study is to understand the clinico-serological profilein cases of acute infective hepatitis in children. Methodology: The present study is a cross-sectional study that was carried out from 1 September 2017 to 31March 2019. A total of 89 children in the age group 1-18 years with clinically suspected acute infective hepatitis and subsequent confirmation on laboratory tests were included in the study. Hepatitis A (48.3%) was found to be the most common aetiology followed by dengue (22.5%) and hepatitis E (12.4%). No cases of hepatitis B or hepatitis C were found. The most common presenting complaint was fever (90%) and the most common clinical finding was icterus (69.7%). The sensitivity of icterus for the diagnosis of hepatitis was found to be 70%. Lab investigations showed a significant association between different etiologies of infective hepatitis with packed cell volume (PCV), white blood cell (WBC) count, and platelet count. Levels of aspartate aminotransferase (AST) and alanine transaminase (ALT) were raised in samples of patients with hepatitis A, hepatitis E, and combined hepatitis A and E infection as compared to other causes. All cases of hepatitis A and E were diagnosed with positive IgM antibody tests to the respective viral antigens. The most common complication was hepatic encephalopathy which was seen in patients with hepatitis A, dengue, and septicemia. Around 99% of patients recovered well and were discharged. One death occurred in a case of septicemia with septic shock withmultiple organ dysfunction syndrome (MODS). The most common cause of infective hepatitis in children is hepatitis A. Other causes like dengue, malaria, and typhoid should also be kept in mind. The absence of icterus does not rule out hepatitis. Lab investigations including serology are important to confirm the diagnosis of various causes of hepatitis. Timely immunization against hepatitis is strongly recommended.

ST-elevation myocardial infarction, severe cardiogenic shock, and myocarditis secondary to leptospirosis: A rare case report

Background: Leptospirosis is a bacterial infection that can lead to several organ dysfunctions. However, cardiac involvements in leptospirosis are uncommon findings. The unknown pathogenesis and association between leptospirosis and cardiac involvements can lead to a diagnostic challenge and case rarity. This study aims to report a diagnosis challenge through physical and laboratory examination of a patient with ST-elevation myocardial infarction (STEMI) and myocarditis without common leptospiral-associated organ dysfunction features. We also report the therapeutic strategies in this case, despite its clinical guideline limitation. Case: A 35-year-old male patient came to the emergency department with flu-like symptoms. Twenty-four hours later, the patient showed acute angina, STEMI, and elevated high-sensitivity cardiac troponin followed by cardiogenic shock without significant modifiable and non-modifiable risk factors for heart diseases. The patient received fibrinolytic, supportive therapy and correction of hemodynamic derangement. We found thrombocytopenia on the second day. Surprisingly, the immunoserology showed positive anti-leptospira IgM and negative anti-dengue IgM and IgG. Further, there was echocardiography suspected myocarditis due to high echogenicity in the left ventricle's basal-apical lateral endocardium. Thus, we diagnosed this case as leptospirosis with cardiac involvement. Direct cardiac tissue damage due to systemic vasculitis, disseminated intravascular coagulation, and pro-inflammatory cytokine storm is believed to be pathomechanism in leptospirosis with cardiac involvement. After diagnosis establishment, his final therapies in the hospital were Aspirin, Atorvastatin, Clopidogrel, Spironolactone, Ramipril, Carvedilol, Omeprazole, Doxycycline, and Ceftriaxone. Subsequently, he was discharged from hospital and continued to receive cardiovascular medications, antibiotics, antiplatelet, potassium-sparing diuretics, and omeprazole. Conclusion: This case highlights the importance of thorough clinical-laboratory evaluation in a patient with an atypical leptospiral presentation. Although leptospirosis is not a common cause of heart diseases such as STEMI, cardiogenic shock, and myocarditis, we recommend supportive therapy and correction of hemodynamic derangement for leptospirosis with cardiac involvement, in addition to leptospiral antibiotic drug itself.