Diagnóstico molecular de toxoplasmosis en pacientes con VIH-SIDA

Introducción: La toxoplasmosis en pacientes con Síndrome de Inmunodeficiencia Adquirida (SIDA) constituye un problema de salud pública en el mundo. El diagnóstico tardío de infección por el Virus de la Inmunodeficiencia Humana (VIH), pobre adherencia al tratamiento antirretroviral y falta de profilaxis contribuyen a esta situación.Objetivos: Proponemos una nueva estrategia basada en la utilización de un marcador molecular que contribuya al diagnóstico de toxoplasmosis en pacientes con VIH-SIDA.Materiales y Métodos: Se incorporaron en este estudio pacientes adultos con VIH-SIDA que reunían los siguientes criterios de inclusión: manifestaciones clínicas de toxoplasmosis (compromiso neurológico, ocular, respiratorio, en piel y forma latente) y resultado positivo mediante la reacción de cadena de polimerasa (PCR) utilizando el gen B1 en muestras de sangre. A cada paciente se le realizó la historia clínica, recuento de células CD4, y cuando fuera indicado estudios por imágenes identificando lesiones ocupantes de cerebro (LOC) o no, punción de líquido cefalorraquídeo (LCR) tomografía de tórax y lavado broncoalveolar (BAL). A muestras de LCR y BAL se les efectuó microscopia óptica y PCR.Resultados: Con esta metodología se estudiaron 24 pacientes, sexo masculino, con edades comprendidas entre 22 y 63 años (promedio 43 años). Se identificaron 2/24 casos con formas latentes y 22/24 (91%) casos con síntomas. Presentaron cuadros neurológicos 15/24 casos (62%), siendo LOC 6/15 con uno de ellos en confección con Trypanosoma cruzi, y no LOC 9/15. Clínica respiratoria se presentó en 7/24 (29%) casos: no coinfectados 4/7 casos, 2 con patrón radiológico intersticial y 2 con focal; coinfectados 3/7 casos. Un caso mostró compromiso ocular y uno con lesiones dermatológicas. El recuento de CD4 promedio fue 60 células/mm3. Se obtuvieron muestras de LCR en 15 casos y de BAL en 7. La PCR en LCR fue positiva en 2/15 casos y en BAL en 7/7 casos. La serología se realizó en 12/24 casos con títulos positivos en 9 casos.Conclusiones: Estos hallazgos demuestran el valor clínico que tiene el uso de la técnica de PCR para el diagnóstico de toxoplasmosis cerebral y más importante aún para la identificación de las otras formas clínicas que habitualmente son subdiagnosticadas.Fil: Velásquez, J. N.. No especifíca;Fil: Ledesma, B. A.. No especifíca;Fil: Nigro, M. G.. No especifíca;Fil: Vittar, N.. No especifíca;Fil: Figueiras, O.. No especifíca;Fil: Ricart, J.. No especifíca;Fil: della Paolera, D.. No especifíca;Fil: Carnevale, Silvana. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Corti, M.. No especifíca;VI Congreso de Enfermedades Endemoepidémicas del Hospital de Infecciosas Francisco J. MuñizCiudad Autónoma de Buenos AiresArgentinaHospital de Infecciosas "Francisco J. Muñiz

Pediatric Systemic Multi-Inflammatory Diseases in Italy During Sars-Cov-2 Epidemic: From Kawasaki Disease To Kawacovid

Introduction: Italy was affected by the SARS-CoV-2 epidemic after its outbreak in China. With a 4-weeks delay after the peak in adults, we observed an abnormal number of patients with characteristics of a multi-inflammatory disease and similarities with Kawasaki Disease (KD). Others reported similar cases, defined PIMS-TS or MIS-C.1,2 Objectives: To better characterize clinical features and treatment response of PIMS-TS and to explore its relationship with KD. Methods: We conducted an observational, retrospective, multicenter study. On April 24th-2020 the Rheumatology Study Group of the Italian Pediatric Society launched a national online survey, to enroll patients diagnosed with KD or with a multisystem inflammatory disease between February 1st 2020 and May 31st. The population was then divided into two different groups: 1) Classical and incomplete KD, named Kawasaki Disease Group (KDG); 2) KD-like multi-inflammatory syndrome, named KawaCOVID (KCG). An expert panel of pediatric rheumatologists re-analyzed every single patient to ensure appropriate classification. Data were collected with an online database. Results: 149 cases were studied, 96 with KDG and 53 with KCG. The two population significantly differed for clinical characteristics (see table 1). Lymphopenia, higher CRP levels, elevated Ferritin and Troponin-T characterized KCG such as lower WBC and platelets (all p values<0,05). KDG received more frequently immunoglobulins (IVIG) and acetylsalicylic acid (ASA) (81,3% vs 66%; p=0.04 and 71,9% vs 43,4%; p=0.001 respectively) as KCG more often received glucocorticoids (56,6% vs 14,6%; p<0.0001). SARS-CoV-2 assay more often resulted positive in KCG than in KDG (75,5% vs 20%; p<0.0001). Short-term follow data on KCG showed minor complications while on KDG a majority of patients had persistence of CAA. Comparing KDG with a KD-Historical Italian cohort (598 patients), no statistical difference was found in terms of clinical manifestations and laboratory data between the two groups Conclusion: Our study would suggest that SARS-CoV-2 infection might determine two distinct inflammatory diseases in children: KD, possibly triggered by SARS-CoV-2, and PIMS-TS. Older age at onset and clinical peculiarities, like the occurrence of myocarditis, characterize this multiinflammatory syndrome. Our patients had an optimal response to treatments and a good outcome, with few complications and no deaths

Credibility and adjustment: gold standards versus currency boards

It is often maintained that currency boards (CBs) and gold standards (GSs) are alike in that they are stringent monetary rules, the two basic features of which are high credibility of monetary authorities and the existence of automatic adjustment (non discretionary) mechanism. This article includes a comparative analysis of these two types of regimes both from the perspective of the sources and mechanisms of generating confidence and credibility, and the elements of operation of the automatic adjustment mechanism. Confidence under the GS is endogenously driven, whereas it is exogenously determined under the CB. CB is a much more asymmetric regime than GS (the adjustment is much to the detriment of peripheral countries) although asymmetry is a typical feature of any monetary regime. The lack of credibility is typical for peripheral countries and cannot be overcome completely even by “hard” monetary regimes.http://deepblue.lib.umich.edu/bitstream/2027.42/40078/3/wp692.pd

Defining Kawasaki disease and pediatric inflammatory multisystem syndrome-temporally associated to SARS-CoV-2 infection during SARS-CoV-2 epidemic in Italy: results from a national, multicenter survey

Background: There is mounting evidence on the existence of a Pediatric Inflammatory Multisystem Syndrome-temporally associated to SARS-CoV-2 infection (PIMS-TS), sharing similarities with Kawasaki Disease (KD). The main outcome of the study were to better characterize the clinical features and the treatment response of PIMS-TS and to explore its relationship with KD determining whether KD and PIMS are two distinct entities. Methods: The Rheumatology Study Group of the Italian Pediatric Society launched a survey to enroll patients diagnosed with KD (Kawasaki Disease Group - KDG) or KD-like (Kawacovid Group - KCG) disease between February 1st 2020, and May 31st 2020. Demographic, clinical, laboratory data, treatment information, and patients' outcome were collected in an online anonymized database (RedCAP®). Relationship between clinical presentation and SARS-CoV-2 infection was also taken into account. Moreover, clinical characteristics of KDG during SARS-CoV-2 epidemic (KDG-CoV2) were compared to Kawasaki Disease patients (KDG-Historical) seen in three different Italian tertiary pediatric hospitals (Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste; AOU Meyer, Florence; IRCCS Istituto Giannina Gaslini, Genoa) from January 1st 2000 to December 31st 2019. Chi square test or exact Fisher test and non-parametric Wilcoxon Mann-Whitney test were used to study differences between two groups. Results: One-hundred-forty-nine cases were enrolled, (96 KDG and 53 KCG). KCG children were significantly older and presented more frequently from gastrointestinal and respiratory involvement. Cardiac involvement was more common in KCG, with 60,4% of patients with myocarditis. 37,8% of patients among KCG presented hypotension/non-cardiogenic shock. Coronary artery abnormalities (CAA) were more common in the KDG. The risk of ICU admission were higher in KCG. Lymphopenia, higher CRP levels, elevated ferritin and troponin-T characterized KCG. KDG received more frequently immunoglobulins (IVIG) and acetylsalicylic acid (ASA) (81,3% vs 66%; p = 0.04 and 71,9% vs 43,4%; p = 0.001 respectively) as KCG more often received glucocorticoids (56,6% vs 14,6%; p < 0.0001). SARS-CoV-2 assay more often resulted positive in KCG than in KDG (75,5% vs 20%; p < 0.0001). Short-term follow data showed minor complications. Comparing KDG with a KD-Historical Italian cohort (598 patients), no statistical difference was found in terms of clinical manifestations and laboratory data. Conclusion: Our study suggests that SARS-CoV-2 infection might determine two distinct inflammatory diseases in children: KD and PIMS-TS. Older age at onset and clinical peculiarities like the occurrence of myocarditis characterize this multi-inflammatory syndrome. Our patients had an optimal response to treatments and a good outcome, with few complications and no deaths