J. M. Eiros

Defining immunological dysfunction in sepsis: A requisite tool for precision medicine

OBJECTIVESnImmunological dysregulation is now recognised as a major pathogenic event in sepsis. Stimulation of immune response and immuno-modulation are emerging approaches for the treatment of this disease. Defining the underlying immunological alterations in sepsis is important for the design of future therapies with immuno-modulatory drugs.nnnMETHODSnClinical studies evaluating the immunological response in adult patients with Sepsis and published in PubMed were reviewed to identify features of immunological dysfunction. For this study we used key words related with innate and adaptive immunity.nnnRESULTSnTen major features of immunological dysfunction (FID) were identified involving quantitative and qualitative alterations of [antigen presentation](FID1), [T and B lymphocytes] (FID2), [natural killer cells] (FID3), [relative increase in T regulatory cells] (FID4), [increased expression of PD-1 and PD-ligand1](FID5), [low levels of immunoglobulins](FID6), [low circulating counts of neutrophils and/or increased immature forms in non survivors](FID7), [hyper-cytokinemia] (FID8), [complement consumption] (FID9), [defective bacterial killing by neutrophil extracellular traps](FID10).nnnCONCLUSIONSnThis review article identified ten major features associated with immunosuppression and immunological dysregulation in sepsis. Assessment of these features could help in utilizing precision medicine for the treatment of sepsis with immuno-modulatory drugs.

Comparison of two assays for detection of HIV antibodies in saliva

The presence of HIV antibodies was screened in 241 paired samples of serum and saliva from seronegative subjects with risk factors for human immune deficiency virus (HIV) infection (n=99), asymptomatic and symptomatic HIV-seropositive patients (n=104) and healthy blood donors (n=38) as negative controls, in order to assess the reliability of two saliva tests for the detection of HIV antibodies. These results were confirmed by Western blot. The saliva samples were collected using an oral device (Salivette) maintained in the lateral gingival fold until the individual perceived that it was becoming less rigid due to hydration with saliva. The two tests were a rapid one (Test Pack) and a conventional one (GACELISA). The results for antibody detection in saliva show 99 % specificity and 99 % sensitivity for the rapid test versus 100 % sensitivity and 81 % specificity for the conventional test. All results for the saliva samples which were positive in the rapid test were confirmed by Western blot (WHO criteria), and there were no indeterminate Western blot results among the samples which were false-positive in the conventional enzyme immunoassay. No statistically significant differences were observed between the absorbance values of HIV-infected symptomatic and asymptomatic patients. The correlation for the results of the HIV-antibody analysis in the paired sera was 98 %. This method of saliva sampling in combination with a rapid and sensitive test for HIV-antibody detection may be applicable in studies conducted with limited technical resources or insufficiently trained health personnel or where blood sample collection is difficult.

Urine samples as a possible alternative to serum for human immunodeficiency virus antibody screening.

The detection of specific antibodies against human immunodeficiency virus (HIV) was tested by dot blot enzyme immunoassay in 95 urine samples from 72 individuals infected with HIV and 23 seronegative individuals. Western blot of paired serum samples from these same individuals was used as the gold standard. The dot blot tested had a sensitivity of 97.2% and a specificity of 100%; only two samples from HIV-infected individuals at Centers for Disease Control (CDC) stages II and IV were non-reactive. Reactive and discrepant samples (serum/urine) were confirmed by Western blot, which had a sensitivity of 98.6% and a specificity of 100%. The most commonly observed Western blot reactivity pattern in urine samples included bands against three groups of HIV structural proteins (ENV, POL, and GAG). The results indicate that urine can be used in screening for HIV antibodies in epidemiological studies of high-prevalence populations, though it is not recommended for individualized diagnostic purposes.

Influence of syphilis in hepatitis B transmission in a cohort of female prostitutes.

BACKGROUND AND OBJECTIVES. Prostitutes are a greater risk for hepatitis B virus (HBV) infection than the general population. We studied the influence of age and time as prostitute on HBV infection. We also examined the relationship between syphilis and HBV infection in a cohort of female prostitutes. STUDY DESIGN. The presence of hepatitis B surface antigen (HBsAg), antibodies to hepatitis B core antigen (anti-HBc), antibodies to hepatitis D virus (anti-HD) and treponemal antibodies (FTA-ABS) were determined in 368 prostitutes, of whom 147 were submitted to medical and serological follow-up every six months to evaluate the influence of syphilis in the transmission of hepatitis B. RESULTS AND CONCLUSION. The prevalence of HBsAg was 4.6%, of anti-HBc 31.2%, anti-HD 0.5% and FTA-ABS 35.0%. There was a statistical association between the presence of treponemal antibodies and anti-HBc (P = 0.022). The cohort study performed shows that the accumulated incidence of HBV infection in the FTA-ABS positive prostitutes (24.6%) was significantly higher than that of the FTA-ABS negative group (9.7%) (RR = 2.544; P = 0.034). Our results indicate that syphilis could facilitate the heterosexual transmission of HBV infection.

Prevalence of Genotypic Resistance in Untreated HIV Patients in Spain

Abstract.The aims of this retrospective study were to assess the prevalence of primary genotypic resistance to antiretroviral drugs in untreated HIV patients in Spain using the line probe assay and to determine its possible relationship to several epidemiological variables. The global prevalence of primary resistance was 12.5%. Primary mutations in the reverse transcriptase gene were found in two (2.2%) samples: M41L, K70R and M184 V were found in one sample and K70R in another. Primary mutations in the protease gene were detected in 12% of cases; V82A was the mutation most frequently detected (11/12, 91.6%). No statistical significance was found for any of the epidemiological variables studied. In conclusion, the prevalence of primary resistance detected is similar to that found by other authors.

Factors associated with the evolution of the viral load in individuals with HIV infection

The temporal evolution of the viral load (VL) in a group of patients under clinical care and the identification of individual variables that determined this evolution was studied using a retrospective descriptive study of the VL determinations on 1336 patients between September 1996 and June 2000. During follow-up, patients VLs increasingly fell below the detection threshold. Those patients who had received antiretroviral treatment prior to the monitoring of the viraemia presented lower VLs at the start of their follow-up. Those patients who had been cared for on the same unit throughout their follow-up maintained lower VLs. Female patients uniformly presented lower VL results than the males. The immunological status at the beginning of follow-up and the basal VL determined the initial evolution of the patients VL, although it did not do so in the final stages of follow-up. The immunological and virological state at the onset of the follow-up determines the evolution of the patients VL.

Gripe y viriasis respiratorias

Metaneumovirus humano. Virus de reciente descripcion. Puede afectar tanto al tracto respiratorio superior como inferior.nnDiagnostico de laboratorio. Se pueden emplear metodos directos (cultivo, deteccion antigenica o molecular), o indirectos (serologia). El diagnostico de eleccion lo constituyen los metodos directos.nnTerapia antivirica. Se emplean dos grupos de farmacos: los que actuan sobre la proteina M2 (amantadina y rimantadina) y los inhibidores de la neuraminidasa (zanamivir y oseltamivir). La ribavirina se ha usado en algunas infecciones por virus respiratorio sincitial.