Risk of cytomegalovirus reactivation in patients with immune-mediated inflammatory diseases undergoing biologic treatment: a real matter?

The use of biological agents has grown exponentially in immune-mediated inflammatory diseases (IMID), often achieving a good control of disease progression and improving patients' quality of life. However, their use resulted in an increased risk of adverse events, including reactivation of chronic/latent infectious diseases. As for the risk of Cytomegalovirus (CMV) reactivation, very few data are available. We reviewed the literature reporting cases of CMV infection in IMID patients during biological therapy. Although the risk of CMV reactivation cannot be excluded, we concluded that there is no evidence to warrant CMV screening before starting a biological agent

Feasibility of a combined mobile-health electrocardiographic and rapid diagnostic test screening for chagas-related cardiac alterations

Background: Chronic Chagas cardiomyopathy (CChC) is the most common cause of death related to Chagas disease (CD). The aim of this study was to assess the feasibility of a combined rapid diagnostic test (RDT) and electrocardiographic (ECG) screening in a remote rural village of the Bolivian Chaco, with a high prevalence of CChC. Methods: Consecutive healthy volunteers > 15 years were enrolled in the community of Palmarito (municipality of Gutierrez, Santa Cruz Department, Bolivia) in February 2019. All patients performed an RDT with Chagas Stat-Pak(®) (CSP, Chembio Diagnostic System, Medford, NY, USA) and an ECG by D-Heart(®) technology, a low-cost, user-friendly smartphone-based 8-lead Bluetooth ECG. RDTs were read locally while ECGs were sent to a cardiology clinic which transmitted reports within 24 h from recording. Results: Among 140 people (54 men, median age 38(interquartile range 23–54) years), 98 (70%) were positive for Trypanosoma cruzi infection, with a linear, age-dependent, increasing trend (p < 0.001). Twenty-five (18%) individuals showed ECG abnormalities compatible with CD. Prevalence of ECG abnormalities was higher in infected individuals and was associated with higher systolic blood pressure and smoking. Following screening, 22 (16%) individuals underwent clinical evaluation and chest X-ray and two were referred for further evaluation. At multivariate analysis, positive CSP results (OR = 4.75, 95%CI 1.08–20.96, p = 0.039) and smoking (OR = 4.20, 95%CI 1.18–14.92, p = 0.027) were independent predictors of ECG abnormalities. Overall cost for screening implementation was <10 $. Conclusions: Combined mobile-Health and RDTs was a reliable and effective low-cost strategy to identify patients at high risk of disease needing cardiologic assessment suggesting potential future applications

Effect of a health education intervention on intestinal parasitic infections in Bolivian children

Abstract Backgrounds Intestinal parasitic infections (IPI) are a major health issue for children of low- and middle-income countries. Water, sanitation and hygiene (WASH) practices are crucial for preventing IPI. The aim of the study was to evaluate the effects of a school-based health education intervention on handwashing behavior and IPI prevalence in children Methods This is a randomized intervention trial in 8 primary schools in rural communities over the course of 3 school years; preliminary results from the first two years of the trial are here presented. Schools were randomly selected and assigned in a 1:1 ratio to intervention or control (no intervention) groups. For each school year, the intervention included 14 school-based educational sessions and 2 skit events, involving children aged 8-12 years. Knowledge, attitude and practice questionnaire and handwashing at key events was assessed at the beginning and end of each school year. IPI prevalence was assessed with repeated cross-sectional parasitology surveys 12 months apart, involving a minimum of 50 children for each school Results At baseline, no significant differences between intervention and control schools were present in the proportion of children who washed their hands at key events (7.2% vs 9.3%, p = 0.28), in IPI (79.4% vs 75.3%, p = 0.3) and multiple parasitic infections (MPI) prevalences (47.6 vs. 38.6; p = 0.051). At the end of the second year, the percentage of children who washed their hands at key events was significantly higher in the intervention schools (75.4% vs 12.1%, p &lt; 0.001), and the prevalence of IPI and MPI in the intervention schools were respectively about 25% and 15% lower than in the control schools (respectively, 42.9% vs 67.8%, p &lt; 0.001; 16.1% vs 31.6%, p &lt; 0.001) Conclusions A school-based health education intervention could achieve significant changes in hand-washing behaviors and reduction in the prevalence of IPI in children. The third year survey results are needed to confirm these findings Key messages An health education intervention on water, sanitation and hygiene (WASH) practices can reduce the risk of IPI infection in children. An health education intervention on water, sanitation and hygiene (WASH) practices could be configured as a sustainable long-term approach to intestinal parasitic infections control in children

Decline in total serum IgE and soluble CD30 in the context of soil-transmitted helminth decline in Bolivia

In the Bolivian Chaco, recent surveys documented a dramatic decrease in the prevalence of soil-transmitted helminth (STH) infections as compared with the 1980s after thirty years of preventive chemotherapy (PC). Concomitant immunological rearrangements are expected. Because nematode infections are associated with increased levels of circulating IgE and glycoprotein CD30 soluble form (sCD30), this study aims to evaluate changes in serological markers of T helper (Th)2-cells activity between 1987 (high STH prevalence) and 2013 (low STH prevalence) in rural communities in the Bolivian Chaco area. We collected 151 sera during two different surveys in 1987 (n = 65) and 2013 (n = 86) and measured the concentration of total IgE and sCD30 by immunoassays. We found a statistically significant age-independent decrease in the total IgE (P &lt; 0.0001) and sCD30 (P &lt; 0.0001) from 1987 to 2013. The significant decrease in serological Th2 markers (IgE and sCD30) between 1987 and 2013 is consistent with the drop in STH prevalence in this geographical area during the same period of time. Further studies might elucidate the clinical and epidemiological impact of these serological rearrangements