Rapid diagnostic tests for determining dengue serostatus: a systematic review and key informant interviews

ObjectivesVaccination for dengue with the live attenuated tetravalent CYD-TDV vaccine (Dengvaxia®) is only recommended in individuals who have had prior dengue virus (DENV) infection. Rapid diagnostic tests (RDT) for past DENV infection would offer a convenient method for pre-vaccination screening at point-of-care. A systematic review was conducted to evaluate the performance of current dengue RDTs for determining dengue serostatus, using IgG antibodies against DENV as a marker of past infection.MethodsPubMed and EMBASE databases were searched from 2000 to 2018 to identify studies evaluating dengue RDTs in individuals with known or possible previous DENV infection. Study quality was evaluated using GRADE and QUADAS-2 criteria. Semi-structured interviews were also performed with available dengue RDT manufacturers.ResultsThe performance of four dengue IgG RDTs was determined in 3137 individuals across ten studies conducted in 13 countries, with serum used in most of the studies. No studies reported data for determining dengue serostatus, and limited data were available regarding cross-reactivity with other viruses. The majority of studies demonstrated sensitivities and specificities between 80% and 100% for dengue IgG detection in samples from secondary infection or convalescent time-points after recent infection.ConclusionsAlthough current dengue IgG RDTs have shown reasonable performance compared with laboratory-based tests in secondary infection, additional research is needed to determine how RDTs would perform in relevant populations targeted for vaccination. New RDTs or modifications to current RDTs are feasible and may optimize the performance of these tests for use in a pre-vaccination screening approach.     

Serum immunoglobulin levels following allogeneic bone marrow transplantation

Summary In order to study the posttransplant evolution of serum immunoglobulin levels, we measured serum IgG, IgA and IgM levels in 50 recipients of allogeneic bone marrow before transplantation and at different intervals thereafter (days 39, 120, 365 and 730). IgG and IgM levels were depressed for 1 year and IgA levels for 2 years posttransplant. Immunoglobulin deficiency was more severe and prolonged in patients with graft versus-host-disease. Hypogammaglobulinemia may contribute to the frequent infections observed in these patients, especially those with chronic graft-versus-host disease.     

乙二胺四乙酸盐依赖性血小板假性减少症与自身免疫性疾病的关系

目的：探讨乙二胺四乙酸盐（EDTA）依赖性血小板假性减少症与自身免疫性疾病的相关性。方法：采用日本Olympus Au640生化分析仪测定EDTA依赖性血小板假性减少症患者的血清免疫球蛋白的水平，采用酶联免疫法进行患者抗心磷脂抗体和抗血小板抗体测定。结果：EDTA-PTCP患者的血清免疫球蛋白的水平普遍高于正常人，而且他们中的大部分人血清抗血小板抗体和／或抗心磷脂抗体阳性。结论：EDTA依赖性血小板假性减少症与某种自身免疫性疾病相关联。     

两种剂量静脉用丙种球蛋白后对感染早产儿血清免疫球蛋白G水平影响及效果观察

目的:探讨应用两种剂量静脉用丙种球蛋白(IVIG)后,感染早产儿血清免疫球蛋白G(IgG)水平变化及临床效果.方法:选取2013年6月～2014年11月在该院新生儿病房治疗的感染早产儿60例,随机分为A组(IVIG剂量为400 mg/kg)和B组(IVIG剂量为600 mg/kg)各30例,观察两组血清IgG水平变化以及临床疗效.结果:A组治疗总有效率为93.33％,B组治疗总有效率为96.67％,差异无统计学意义(P＞0.05);A组和B组治疗后血清lgG水平较治疗前有所升高,差异有统计学意义(P＜0.05),但B组治疗后血清lgG水平明显高于A组,差异有统计学意义(P＜0.05),两组血清免疫球蛋白M(lgM)和免疫球蛋白A(lgA)水平在治疗前后变化较小,差异无统计学意义(P＞0.05);B组感染征象缓解天数为(3.01±0.98)天,低于A组的(4.12±1.01)天,差异有统计学意义(P＜0.05),而两组住院天数比较差异无统计学意义(P＞0.05).结论:应用不同剂量IVIG均可提高血清感染早产儿血清lgG水平,但600mg/kg剂量的改善效果更为显著.     

Recent advances in the management of autoimmune pancreatitis in the era of artificial intelligence

Autoimmune pancreatitis (AIP) is a type of immune-mediated pancreatitis subdivided into two subtypes, type 1 and type 2 AIP. Furthermore, type 1 AIP is considered to be the pancreatic manifestation of the immunoglobulin G4 (IgG4)-related disease. Nowadays, AIP is increasingly researched and recognized, although its diagnosis represents a challenge for several reasons: False positive ultrasound-guided cytological samples for a neoplastic process, difficult to interpret levels of IgG4, the absence of biological markers to diagnose type 2 AIP, and the challenging clinical identification of atypical forms. Furthermore, 60% and 78% of type 1 and type 2 AIP, respectively, are retrospectively diagnosed on surgical specimens of resected pancreas for suspected cancer. As distinguishing AIP from pancreatic ductal adenocarcinoma can be challenging, obtaining a definitive diagnosis can therefore prove difficult, since endoscopic ultrasound fine-needle aspiration or biopsy of the pancreas are suboptimal. This paper focuses on recent innovations in the management of AIP with regard to the use of artificial intelligence, new serum markers, and new therapeutic approaches, while it also outlines the current management recommendations. A better knowledge of AIP can reduce the recourse to surgery and avoid its overuse, although such an approach requires close collaboration between gastroenterologists, surgeons and radiologists. Better knowledge on AIP and IgG4-related disease remains necessary to diagnose and manage patients.     

Biomarkers in autoimmune pancreatitis and immunoglobulin G4-related disease

Solitary organ autoimmune disorders, formerly known as autoimmune pancreatitis (AIP), autoimmune sialadenitis, and autoimmune sclerosing cholangitis, are now considered organ-specific manifestations of systemic immunoglobulin G4-related disease (IgG4-RD). AIP and IgG4-RD are characterized by elevated serum concentration of IgG4 antibody (Ab), accumulation of IgG4-expressing plasmacytes in the affected organs, and involvement of multiple organs. It is well established that enhanced IgG4 Ab responses are a hallmark of AIP and IgG4-RD for diagnosis and monitoring disease activity. However, a significant fraction of patients with AIP and IgG4-RD who develop chronic fibroinflammatory responses have normal serum concentrations of this IgG subtype. In addition, disease flare-up is sometimes seen even in the presence of normalized serum concentrations of IgG4 Ab after successful induction of remission by prednisolone. Therefore, it is necessary to identify new biomarkers based on the understanding of the pathophysiology of AIP and IgG4-RD. Recently, we found that activation of plasmacytoid dendritic cells producing both interferon-α (IFN-α) and interleukin-33 (IL-33) mediate murine AIP and human IgG4-RD. More importantly, we provided evidence that serum concentrations of IFN-α and IL-33 could be useful biomarkers for the diagnosis and monitoring of AIP and IgG4-RD activity after induction of remission in these autoimmune disorders. In this Frontier article, we have summarized and discussed biomarkers of AIP and IgG4-RD, including Igs, autoAbs, and cytokines to provide useful information not only for clinicians but also for researchers.