Comparison on the performance of Leishmania major-like and Leishmania braziliensis braziliensis as antigen for new world leishmaniasis IgG-immunofluorescence test

The performance of an antigen of L. major-like promastigotes for the serological diagnosis of mucocutaneous leishmaniasis in the IgG-immunofluorescent test was compared to that of an antigen of L. braziliensis braziliensis. Each antigen was used to test two hundred and twenty-four sera of etiologies such as mucocutaneous leishmaniasis, deep mycoses, toxoplasmosis, malaria, Chagas' disease, visceral leishmaniasis, anti-nuclear factor, schistosomaiasis, rheumatoid factor and normal controls. Agreement between responses to each antigen was high: 77.2% of leishmaniases sera agreed on a positive or a negative result to both antigens and 91.1 % of control sera. Cross reactivity was restricted to Chagas' disease sera, visceral leishmaniasis, anti-nuclear factor and paracoccidiodomycosis. The quantitative response of leishmaniasis and Chagas' disease sera to both antigens was evaluated by a linear regression; although the y-intercept and the slope were different for each antigen, neither was better than the other in the disclosure of anti-Leishmania antibodies. In the case of Chagas' disease sera the L. major-like antigen was better than L. b. braziliensis' to disclose cross-reacting antibodies.O desempenho de um antígeno de promastigotas de L. major-like para o diagnóstico sorológico de leishmaniose mucocutânea pelo teste de imunofluorescência-IgG foi comparado com o desempenho de um antígeno de L. braziliensis braziliensis. Cada antígeno foi usado para testar 224 soros de etiologias como leishmaniose mucocutânea, micoses profundas, toxoplasmose, malária, doença de Chagas, leishmaniose visceral, fator anti-núcleo, esquistossomose mansônica, fator reumatóide e controles normais. A concordância entre as respostas a cada antígeno foi grande: 77,2% dos soros de leishmaniose mostraram resultado positivo para ambos os antígenos ou negativo, assim como 91,1% dos soros controle negativos. Reações cruzadas ficaram restritas à doença de Chagas, leishmaniose visceral, fator anti-núcleo e paracoccidioidomicose. A resposta quantitativa dos soros de leishmaniose e doença de Chagas foi avaliada pelo método de regressão linear; embora a intercessão com o eixo y e o "slope" fossem diferentes para cada antígeno nenhum deles se mostrou melhor na evidenciação de anticorpos anti-Leishmania. O antígeno de L. major-like mostrou-se melhor que o de L. b. braziliensis na evidenciação de anticorpos em soros de doença de Chagas

Effectiveness of antibacterial therapeutic clothing vs. nonantibacterial therapeutic clothing in patients with moderate-to-severe atopic dermatitis:a randomized controlled observer-blind pragmatic trial (ABC trial)

Background:Increased Staphylococcus aureus (SA) colonization is considered an important factor in the pathogenesis of atopic dermatitis (AD). Antibacterial therapeutic clothing aims to reduce SA colonization and AD inflammation; however, its role in the management of AD remains poorly understood. Objectives:To investigate the effectiveness of antibacterial therapeutic clothing+standard topical treatment in patients with moderate-to-severe AD vs. standard therapeutic clothing+standard topical treatment; and, if effectiveness was demonstrated, to demonstrate its cost-effectiveness. Methods:A pragmatic double-blinded multicentre randomized controlled trial (NCT04297215) was conducted in patients of all ages with moderate-to-severe AD. Patients were centrally randomized 1:1:1 to receive standard therapeutic clothing or antibacterial clothing based on chitosan or silver. The primary outcome was the between-group difference in Eczema Area and Severity Index (EASI) measured over 52 weeks. Secondary outcomes included patient-reported outcomes (PROs), topical corticosteroid (TCS) use, SA colonization, safety and cost-effectiveness. Outcomes were assessed by means of (generalized) linear mixed-model analyses. Results:Between 16 March 2020 and 20 December 2021, 171 patients were enrolled. In total, 159 patients were included (54 in the standard therapeutic clothing group, 50 in the chitosan group and 55 in the silver group). Adherence was high [median 7 nights a week wear (interquartile range 3–7)]. Median EASI scores at baseline and at 4, 12, 26 and 52 weeks were 11.8, 4.3, 4.6, 4.2 and 3.6, respectively, in the standard therapeutic clothing group vs. 11.3, 5.0, 3.0, 3.0 and 4.4, respectively, in the chitosan group, and 11.6, 5.0, 5.4, 4.6 and 5.8, respectively, in the silver group. No differences in EASI over 52 weeks between the standard therapeutic clothing group, the chitosan group [–0.1, 95% confidence interval (CI) –0.3 to 0.2; P=0.53] or the silver group (–0.1, 95% CI –0.3 to 0.2; P=0.58) were found. However, a small significant group×time interaction effect between the standard and silver groups was found (P=0.03), in which the silver group performed worse after 26 weeks. No differences between groups were found in PROs, TCS use, SA skin colonization and healthcare utilization. No severe adverse events or silver absorption were observed. Conclusions:The results of this study suggest no additional benefits of antibacterial agents in therapeutic clothing in patients with moderate-to-severe AD.</p