HIV-associated neurosyphilis: Report of a fatal case due to fear of work-place stigma

Syphilis and HIV infection are two STI diseases that have bidirectional influence on the clinical course of each other. There is a high risk of neurological extension if syphilis is not diagnosed early or if the patient has a co-infection with HIV. Both diseases have stigma associated with them and could affect the compliance to treatment, as was the case with this young employee of the medical department of a Nigerian tertiary hospital. He was diagnosed with HIV/ neurosyphilis co-infection and responded to penicillin therapy, but the fear of stigma at his workplace has made him to abandon hospital treatment for unorthodox therapy, which unfortunately cost him his life.Syphilis et infection par le VIH sont deux maladies qui ont des STI bidirectionnel infl uence sur l\u2019\ue9volution clinique de l\u2019autre. Il ya un risque \ue9lev\ue9 de troubles neurologiques extension si la syphilis n\u2019est pas diagnostiqu\ue9 \ue0 un stade pr\ue9coce ou si le patient a une co-infection avec le VIH. Les deux maladies sont les stigmatiser et pourrait infl uer sur la conformit\ue9 du traitement, comme ce fut le cas avec ce jeune personnel m\ue9dical d\u2019un h\uf4pital tertiaire nig\ue9riane. Il a re\ue7u un diagnostic de neurosyphilis et a r\ue9pondu \ue0 la th\ue9rapie de p\ue9nicilline, mais la peur de la stigmatisation \ue0 son lieu de travail a fait de lui \ue0 renoncer \ue0 l\u2019h\uf4pital pour un traitement de th\ue9rapie peu orthodoxe qui, malheureusement, lui a co\ufbt\ue9 la vie

Increased Hepatitis E Virus Seroprevalence Correlates with Lower CD4+Cell Counts in HIV-Infected Persons in Argentina

Hepatitis E virus (HEV) is a single-stranded RNA virus that can cause hepatitis in an epidemic fashion. HEV usually causes asymptomatic or limited acute infections in immunocompetent individuals, whereas in immunosuppressed individuals such as transplant recipients, HEV can cause chronic infections. The risks and outcomes of HEV co-infection in patients infected with human immunodeficiency virus (HIV) are poorly characterized. We used a third generation immunoassay to measure serum IgG antibodies specific for HEV in 204 HIV-infected individuals from Argentina and a control group of 433 HIV-negative individuals. We found 15 of 204 (7.3%, 95% CI 3.74-10.96%) individuals in the HIV-positive group to have positive HEV IgG levels suggestive of previous infection, compared to 19 of 433 (4.4%, 95% CI 2.5-6.3%) individuals in the HIV-negative control group (p = 0.12). Among HIV-positive individuals, those with HEV seropositivity had lower CD4 counts compared to those that were HEV seronegative (average CD4 count of 234 vs 422 mm(3), p = 0.01), indicating that patients with lower CD4 counts were more likely to be HEV IgG positive. Moreover, HEV seropositivity in patients with CD4 counts <200 mm(3) was 16%, compared to 4.5% in those with CD4 counts >200 mm(3) (p = 0.012). We found a positive PCR result for HEV in one individual. Our study found that increased seroprevalence of HEV IgG correlated with lower CD4 counts in HIV-infected patients in Argentina

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The immunoprevention measures (vaccination by schedule plus mass campaigns) to achieve the objectives subscribed by PAHO/WHO produced around the year 2000 a sharp drop in cases of rubella and measles in Argentina. For this reason, there is currently a young population that only has immunity through the vaccine. Objective: Given the latent risk of reintroduction of these viruses in the country, we set out to investigate the presence of anti-rubella and anti-measles IgG antibodies in people aged 7 to 19 years who, according to the National Immunization Calendar and data from the National Surveillance Program, they should have two doses of triple viral vaccine and should not have had contact with the virus naturally. A retrospective, descriptive cross-sectional study was conducted. 180 samples from people between 7 and 19 years of age who attended the Fundación para el Progreso de la Medicina de Córdoba (FPM) for routine biochemical analyzes between the months of September 2021 and February 2022 were processed. rubella was determined by CMIA (ABBOTT) (FPM) while indirect immunofluorescence was performed for measles IgG at the Reina Fabiola University Clinic. The seroprevalences found were 88.3% and 92.2% for measles and rubella, respectively. There were no significant differences between antibody concentrations by age subgroup (rubella p=0.1435, measles p=0.1049), but the antibody concentration among women was significantly higher than among men (rubella p=0.036, measles p=0.031). Among women, anti-rubella IgG was higher in the younger age subgroup (p=0.0196), but not for measles (p=0.1874) nor among age subgroups of men (rubella p=0.7445, measles p=0.1236). The seroprevalences detected reach the coverage objective recommended by the WHO to prevent the circulation of rubella, but not the measles virus. These results show the need to sustain efforts to keep the prevalence of antibodies generated by vaccination high, also knowing that during the pandemic their application decreased, increasing the risk of virus reintroduction into the country.Las medidas de inmunoprevención (vacunación por calendario más campañas masivas) para lograr los objetivos suscriptos de la OPS/OMS produjeron hacia el año 2000 una caída abrupta de casos de rubéola y sarampión en Argentina. Por este motivo, actualmente existe una población joven que sólo tiene inmunidad a través de la vacuna. Objetivo: ante el riesgo latente de reintroducción de estos virus en el país, nos propusimos investigar la presencia de anticuerpos IgG anti-rubéola y antisarampión en personas de 7 a 19 años de edad que, de acuerdo al Calendario Nacional de Inmunizaciones y los datos del Programa Nacional de Vigilancia, deberían tener dos dosis de vacuna triple viral y no deberían haber tenido contacto con el virus de manera natural. Se realizó un estudio retrospectivo, descriptivo transversal. Se procesaron 180 muestras de personas de entre 7 y 19 años de edad que concurrieron a realizarse análisis bioquímicos de rutina a la Fundación para el Progreso de la Medicina de Córdoba (FPM) entre los meses de septiembre de 2021 y febrero de 2022. La IgG rubéola se determinó por CMIA (ABBOTT) (FPM) mientras que para IgG sarampión se realizó inmunofluorescencia indirecta en la Clínica Universitaria Reina Fabiola. Las seroprevalencias encontradas fueron del 88.3% y 92.2% para sarampión y rubéola respectivamente. No hubo diferencias significativas entre concentraciones de anticuerpos por subgrupo etario (rubéola p=0.1435, sarampión p=0.1049), pero la concentración de anticuerpos entre mujeres fue significativamente mayor que entre hombres (rubéola p=0.036, sarampión p=0.031). Entre mujeres la IgG anti-rubéola fue mayor en el subgrupo etario de menor edad (p=0.0196), no así para sarampión (p=0.1874) ni entre subgrupos etarios de hombres (rubéola p=0.7445, sarampión p=0.1236). Las seroprevalencias detectadas alcanzan el objetivo de cobertura recomendado por la OMS para impedir la circulación de rubéola, no así de virus sarampión. Estos resultados evidencian la necesidad de sostener los esfuerzos para mantener elevadas las prevalencias de anticuerpos generados por la vacunación, sabiendo además que durante la pandemia bajó la aplicación de las mismas, aumentando el riesgo de reintroducción de los virus en el país.

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Parvovirus B19/B19V primary infection in pregnant women can be transmitted to the embryo/fetus and cause anomalies associated with TORCH syndrome. Local knowledge of the infection can help visualize the clinical picture to achieve early diagnosis. The objectives were to identify B19V in suspected cases of parvoviral infection during pregnancy and to describe the clinical manifestations present in positive cases. Descriptive, cross-sectional study. Inclusion criteria: pregnant patients with suspected B19V infection (compatible maternal or fetal-neonatal clinical manifestations or with epidemiological link), newborns (NB) of mothers with suspected or confirmed infection and NB with signs/symptoms associated with congenital infection (still present or not at birth), selected according to medical records of the clinical history. Viral DNA (PCR), specific IgM and IgG (ELISA) were determined in serum samples stored at the institution’s biobank. Ethical Committee of participating centers approved the protocol: Clinica Universitaria Reina Fabiola, Hospital Universitario de Maternidad y Neonatología, Clínica Privada Vélez Sársfield (2018-2022). A total of 242 patients were included (epidemiological weeks/EW 1-52, 171 pregnant women and 71 NB, 60 of them were mother-NB pair). Infection was confirmed in 27/242 (11.1%) cases, the majority (24/27, 88.9%) in pregnant women and 3/27 (11.1%) in NB. In the mother-NB pair group, 9 pregnant women and 2 NB were positive (vertical transmission rate: 22.2%). Epidemiological characteristics of B19V+ cases: mean age of pregnant women 30.1±6.3 years (p=0.45 versus study sample; median 30.5), 96% in EW 15-52 (autumn-spring). Clinical manifestations in pregnant women: maternal anemia 14/24 (58.3%), hydrops fetalis 5/24 (20.8%), abortion 5/24 (20.8%), fetal anemia 2/24 (8.3%), polyhydramnios 1/24 (4.2%), rash and arthralgia 1/24 (4.2%). One NB presented hydrops, another anemia, and one was asymptomatic, born to mother with rash, arthralgia, and anemia). Laboratory markers of infection: 16/27 (59.3%) cases were confirmed by detection of viral DNA (DNA+/IgM-/IgG+). During the study period, B19V was detected in 11% of the sample, being frequent in symptomatic pregnant women (24/171, 14%), with a rate of transmission to the fetus of 22%. Upon clinical suspicion, the complementary determination of virus and antibodies can improve diagnostic performance.La primoinfección por parvovirus B19/B19V en la embarazada puede transmitirse al embrión/feto y causar manifestaciones clínicas asociadas al síndrome de TORCH. Conocer la infección en nuestro medio puede contribuir a visibilizar su presentación clínica y promover el diagnóstico temprano. Los objetivos fueron identificar B19V en casos sospechosos de infección parvoviral durante la gestación y describir las manifestaciones clínicas presentes en los casos positivos. Estudio descriptivo, transversal. Se incluyeron pacientes embarazadas con sospecha de infección por B19V (manifestaciones clínicas maternas o feto-neonatales compatibles o nexo epidemiológico), RN de madres con infección sospechada o confirmada y RN con signos/síntomas asociables a infección congénita (aún presentes o no al nacer), seleccionados a partir de los datos de la historia clínica. Se determinó ADN viral (PCR), IgM e IgG específicas (ELISA) en muestras de suero recuperadas del biobanco. Protocolo aprobado por los Comités de Ética de los centros participantes: Clínica Universitaria Reina Fabiola, Hospital Universitario de Maternidad y Neonatología, Clínica Privada Vélez Sársfield (2018-2022). Se estudiaron 242 pacientes (semanas epidemiológicas/SE 1-52, 171 embarazadas y 71 RN, de ellos 60 constituían binomio madre-RN), confirmándose la infección en 27/242 (11,1%), la mayoría (24/27, 88,9%) en embarazadas y 3/27 (11,1%) en RN. En el grupo de binomios, fueron positivos 9 embarazadas y 2 RN (tasa de transmisión vertical: 22,2%). Características epidemiológicas de los casos B19V+: edad promedio de las embarazadas 30,1±6,3 años (p=0,45 versus muestra estudiada; mediana 30,5), 96% en las SE 15-52 (otoño-primavera). Manifestaciones marcadoras en embarazadas: anemia materna 14/24 (58,3%), hydrops fetal 5/24 (20,8%), aborto 5/24 (20,8%), anemia fetal 2/24 (8,3%), polihidramnios 1/24 (4,2%), exantema y artralgia 1/24 (4,2%). Un RN presentó hydrops, otro anemia y otro fue asintomático (con antecedente de madre positiva con exantema, artralgia y anemia en la madre). Marcadores laboratoriales de infección: 16/27 (59,3%) casos fueron confirmados por detección de ADN viral (ADN+/IgM-/IgG+). En el período estudiado se detectó B19V en 11% de la muestra, siendo frecuente en embarazadas sintomáticas (24/171, 14%), con una tasa de transmisión al feto de 22%. Ante la sospecha clínica, la determinación complementaria de virus y anticuerpos puede mejorar el rendimiento diagnóstico.

GM-CSF Signalling Boosts Dramatically IL-1Production

GM-CSF is mostly known for its capacity to promote bone marrow progenitor differentiation, to mobilize and mature myeloid cells as well as to enhance host immune responses. However the molecular actions of GM-CSF are still poorly characterized. Here we describe a new surprising facet of this “old” growth factor as a key regulator involved in IL-1βsecretion. We found that IL-1β release, a pivotal component of the triggered innate system, is heavily dependent on the signaling induced by GM-CSF in such an extent that in its absence IL-1β is only weakly secreted. GM-CSF synergizes with LPS for IL-1β secretion mainly at the level of pro-IL-1β production via strengthening the NF-κB signaling. In addition, we show that expression of Rab39a, a GTPase required for caspase-1 dependent IL-1β secretion is greatly augmented by LPS and GM-CSF co-stimulation suggesting a potential GM-CSF contribution in enhancing IL-1β exocytosis. The role of GM-CSF in regulating IL-1β secretion is extended also in vivo, since GM-CSF R−/− mice are more resistant to LPS-mediated septic shock. These results identify GM-CSF as a key regulator of IL-1β production and indicate GM-CSF as a previously underestimated target for therapeutic intervention

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta

Search for gravitational waves from Scorpius X-1 in the second Advanced LIGO observing run with an improved hidden Markov model

We present results from a semicoherent search for continuous gravitational waves from the low-mass x-ray binary Scorpius X-1, using a hidden Markov model (HMM) to track spin wandering. This search improves on previous HMM-based searches of LIGO data by using an improved frequency domain matched filter, the J-statistic, and by analyzing data from Advanced LIGO's second observing run. In the frequency range searched, from 60 to 650 Hz, we find no evidence of gravitational radiation. At 194.6 Hz, the most sensitive search frequency, we report an upper limit on gravitational wave strain (at 95% confidence) of h095%=3.47×10-25 when marginalizing over source inclination angle. This is the most sensitive search for Scorpius X-1, to date, that is specifically designed to be robust in the presence of spin wandering. © 2019 American Physical Society

Search for gravitational waves from Scorpius X-1 in the second Advanced LIGO observing run with an improved hidden Markov model

We present results from a semicoherent search for continuous gravitational waves from the low-mass x-ray binary Scorpius X-1, using a hidden Markov model (HMM) to track spin wandering. This search improves on previous HMM-based searches of LIGO data by using an improved frequency domain matched filter, the J-statistic, and by analyzing data from Advanced LIGO’s second observing run. In the frequency range searched, from 60 to 650 Hz, we find no evidence of gravitational radiation. At 194.6 Hz, the most sensitive search frequency, we report an upper limit on gravitational wave strain (at 95% confidence) of h95%0=3.47×10−25 when marginalizing over source inclination angle. This is the most sensitive search for Scorpius X-1, to date, that is specifically designed to be robust in the presence of spin wandering

Gravitational Waves and Gamma-Rays from a Binary Neutron Star Merger: GW170817 and GRB 170817A

On 2017 August 17, the gravitational-wave event GW170817 was observed by the Advanced LIGO and Virgo detectors, and the gamma-ray burst (GRB) GRB 170817A was observed independently by the Fermi Gamma-ray Burst Monitor, and the Anti-Coincidence Shield for the Spectrometer for the International Gamma-Ray Astrophysics Laboratory. The probability of the near-simultaneous temporal and spatial observation of GRB 170817A and GW170817 occurring by chance is $5.0\times {10}^{-8}$. We therefore confirm binary neutron star mergers as a progenitor of short GRBs. The association of GW170817 and GRB 170817A provides new insight into fundamental physics and the origin of short GRBs. We use the observed time delay of $(+1.74\pm 0.05)\,{\rm{s}}$ between GRB 170817A and GW170817 to: (i) constrain the difference between the speed of gravity and the speed of light to be between $-3\times {10}^{-15}$ and $+7\times {10}^{-16}$ times the speed of light, (ii) place new bounds on the violation of Lorentz invariance, (iii) present a new test of the equivalence principle by constraining the Shapiro delay between gravitational and electromagnetic radiation. We also use the time delay to constrain the size and bulk Lorentz factor of the region emitting the gamma-rays. GRB 170817A is the closest short GRB with a known distance, but is between 2 and 6 orders of magnitude less energetic than other bursts with measured redshift. A new generation of gamma-ray detectors, and subthreshold searches in existing detectors, will be essential to detect similar short bursts at greater distances. Finally, we predict a joint detection rate for the Fermi Gamma-ray Burst Monitor and the Advanced LIGO and Virgo detectors of 0.1-1.4 per year during the 2018-2019 observing run and 0.3-1.7 per year at design sensitivity