BackgroundCHIKV is suspected based on epidemiological and clinical criteria, however confirmation of the disease is only achieved by laboratory tests. Laboratory diagnosis is made by two approaches: the detection of viral RNA and identification of the specific immune response by serological methods. Serological tests are the most frequently used laboratory methods for the diagnosis of CHIKV. IgM is the first detected antibodies during 4 to 6 days after onset of symptoms followed by IgG. In Colombia, CHIKV's probable cases are not mandatory to be confirmed, so there is no standardization for laboratory confirmation testsObjectivesTo evaluate the performance of IgM and IgG antibodies against CHIKV in a cohort of patients with CHIKVMethodsIgM and IgG antibodies against CHIKV were measured by ELISA (AbcamÒ ab177835 and ab177835 anti-chikungunya virus IgM and IgG human ELISA kit, Cambridge, UK) technique in 604 patients with CHIKV suspicion. A typical case of CHIKV with high sensitivity and specificity obtained from a previous study was used as gold standard for diagnosis of CHIKV. Since CHIKV epidemic of 2014–2015 was the first to be reported in our country (Colombia), no second measurements of IgG were needed to confirmed infection.ResultsCut off point for IgG was 14,3 SU and for IgM was 11,2 SU. Mean values for IgG was 36,7 SU (±22,7) in patients with CHIKV and 8,6 SU (SD± 6,3) for IgM. Statistical significance was obtained for both IgG and IgM (p<0,0001) when comparing patients with and without CHIKV. Receiver operating characteristic (ROC) curves showed and area under the curve (AUC) of 0,81 for IgG and 0,65 for IgM (figure 1).ConclusionsOur study revealed a good performance of IgG and regular performance of IgM for the diagnosis of CHIKV in a cohort of CHIKV patients from Colombia's epidemic. Cut off points for both IgG and IgM were measured for future reference.Disclosure of InterestNone declared
BackgroundPatients with systemic autoimmune conditions often develop concomitant disease contributing to a higher mortality than in the general population. An early diagnosis and treatment is fundamental to improve the life expectancy of this population.ObjectivesThe objective of this study was to describe the frequency of comorbidities in patients with rheumatic diseases.MethodsBased on data from the population studied under the COPCORD strategy, in the prevalence of rheumatic disease in Colombia, the frequency of non-rheumatic diseases in patients with rheumatic diseases was described in 6 cities of Colombia (Bogotá, Medellín, Cali, Barranquilla, Bucaramanga and Cúcuta).ResultsFrom a total of 4020 individuals, 2274 rheumatic patients were identified.Sixty nine percent of the Colombian patients with rheumatic disease (n=1571) had some comorbidity. The most frequent was hypertension (HBP) in 20,95% (n=330), followed by migraine 19,11% (n=300) and venous insufficiency 17,69% (n=278). Seventeen percent had any mental disorders, of which, anxiety and depression were the most common (n=273).Other comorbidities like obesity (8,1%), diabetes (5,85%), heart disease (5,79%) and cerebrovascular disease (1,99%) were less common among rheumatic patients. The frequency of cancer was low 1.48% (n=23). Abstract AB1300 – Figure 1Abstract AB1300 – Figure 1Most frequent comorbidities in rheumatic patientsConclusionsHypertension is the most common comorbidity in patients with rheumatic diseases in Colombia. Screening and diagnosis in early stages of HBP is important, since it is the main modifiable cardiovascular risk factor. The goals of pharmacological and non-pharmacological treatment are essential to reduce the risk of coronary heart disease, stroke and end-stage renal disease. Additionally, migraine is the second most frequent disease that affects the patient’s quality of life. And venous insufficiency should be taken into account by primary care physicians in order to assure a complete health care assessment.Disclosure of InterestNone declared
Objectives:To describe 2 patients with the coexistence of SLE and Myasthenia Gravis (MG). Case 1: This is a 14-year-old girl with a diagnosis of MG since she was twelve. At that time a thymectomy was performed and the patient was treated with pyridostigmine and prednisone, with good clinical response. The dose of prednisone could be tapered off and the patient remained clinically stable for 2 years. Then she developed thrombocytopenic purpura, cutaneous lesions, polyarthralgias and a positive ANA 1: 640. With a diagnosis of SLE she is now on prednisone, hydroxychloroquine and ASS. Her MG remains stable. Case 2: This is a 25-year-old woman with a history of IPT 10 years ago. In 2003 she developed nephritis, polyarthritis, cutaneous lesions, muscular weakness and a secondary antiphospholipid syndrome. A simultaneous diagnosis of SLE and MG was made based on positive ANA and DNA, low complement and a positive test for anti-AChRs. The patient was treated with prednisone and azathioprine with good clinical response. Conclusions: The coexistence of SLE and MG is considered occasional. MG can precede the development of LES in 75% of cases and thymectomy may be a precipitating factor en some patients, as in case 1. The assessment for MG is suggested in every SLE patients with unexplained muscular weakness. Objectives:To study clinical and laboratory manifestations in 120 patients with SLE. Materials and Methods: 120 patients with Systemic Lupus Erythematosus (ACR criteria) were included. They were attended at Hospital Luis Vernaza (Guayaquil, Ecuador) in the past 3 years. We revised the clinical histories, laboratory results. Results: 120 SLE patients were seen in the past 36 months. 110 (92%) were women. Mean age 34.3 years (13-68), mean age at diagnosis 30.4 years (12-67), mean evolution time was 57.8 m (5-390) and mean delay at diagnosis was 14.3 m (0 -276). 11 patients (9%) were lost during the follow up. Clinical manifestations: systemic symptoms 95%, dermato-logical involvement 85%, arthritis 76%, hematologic 70%, nephritis 51%, pleural effusion 23%. Laboratory results: ANA positive 96%, DNA 73% m low C3 68%, low C4 75%, Anti Ro 26%, Anti La 9%, Anti SM 31%, Anti RNP 31%. Actual treatment: steroids 90%, inmunosuppresors 40%, antimalarials 68%. 9 patients (7.5%) died. Significative association was found between nephritis and low complement (P ϭ 0.001), nephritis and dead pts (P ϭ 0.01), thrombosis and antiphospholipids (P ϭ 0.02), hemolytic anemia and anticardiolipins IgM (P ϭ 0.03). Conclusions: Clinical and laboratory manifestations are similar to other series. High mortality rate was found. Objectives:To describe morbility and mortality on a lupus cohort of 120 patient followed at 3 years. Materials and Methods: 120 patients with Systemic Lupus Erythematosus (ACR criteria) were included. They were attended at Hospital Luis Vernaza (Guayaquil, Ecuador) in the past 3 years. We revised the clinical histories, laboratory results, searching for complications and mortality. Patients with and without complications were ...
BackgroundDuring 2014 and 2015 a chikungunya epidemic took place in Colombia concurrently with a COPCORD study across the country.ObjectivesTo describe the clinical characteristics of CHIKV infection in 6 different cities in Colombia and determine the most frequently associated clinical picture with CHIKV.MethodsWorld Health Organization criteria was used to identify CHIKV patients. A complete characterization and confirmation was established with CHIKV immunoglobulin G and IgM serology. Four possible scenarios were stablished: patients who met or not the criteria for probable case, and patients who met or not the criteria for confirmed case. P values were calculated between patients who met or not met the criteria. Sensibility and specificity was calculated for the WHO criteria.ResultsA total of 604 patients with MSK symptoms were evaluated in 6 different cities. The sociodemographic, clinical characteristics and joint involvement of the studied population is depicted in tables 1 and 2. Sensibility and specificity of the WHO criteria were 56.2% and 91.1% respectively (PPV: 83.3%, NPV: 74.4%).Table 1.Sociodemographic and Clinical Characteristics of Patients with Positive COPCORDWHO Probable Case CriteriaWHO Confirmed Case Criteria Met CriteriaDid Not Met CriteriaMet CriteriaDid Not Met Criteria (n: 180)(n: 424)(n: 150)(n: 454) Age (mean; SD) in years46,1±16,249,5±17,844,9±16,349,7±17,6*Gender Female (%)133 (73,9)285 (67,2)113 (75,3)305 (67,2)CHIKV IgG in SU (mean; SD)36,5±22,9*16,2±18,342,9±19,4*15,4±18,0CHIKV IgM in SU (mean; SD)9,0±6,9*6,6±5,19,8±7,2*6,5±4,9Fever (%)180 (100)*0 (0,0)150 (100)*30 (6,6)Rash (%)126 (70,0)*28 (6,6)109 (72,7)*45 (9,9)*p<0,005.Table 2.Clinical Characteristics of Joint InvolvementWHO Probable Case CriteriaWHO Confirmed Case Criteria Met CriteriaDid Not Met CriteriaMet CriteriaDid Not Met Criteria (n: 180)(n: 424)(n: 150)(n: 454) Symmetry (%) Arthralgia177 (98,3)*215 (50,7)147 (98,0)*245 (54,0) Arthritis85 (47,2)*14 (3,3)80 (53,3)*19 (4,2)Arthralgia (%) Elbows58 (32,2)*60 (14,2)48 (32,0)*70 (15,4) Wrists78 (43,3)*67 (15,8)65 (43,3)*80 (17,6) Hands120 (66,7)*126 (29,7)103 (68,7)*143 (31,5) Knees128 (71,1)*200 (47,2)107 (71,3)*221 (48,7) Ankles103 (57,2)*95 (22,5)92 (61,3)*106 (23,4) Feet71 (39,4)*94 (22,2)65 (43,3)*100 (22,0)Arthritis (%) Wrists17 (9,4)*4 (0,9)16 (10,7)*5 (1,1) Hands44 (24,4)*6 (1,4)42 (28,0)*8 (1,8) Knees21 (11,7)*4 (0,9)20 (13,3)*5 (1,1) Ankles43 (23,9)*8 (1,9)42 (28,0)*9 (2,0) Feet40 (22,2)*7 (1,7)39 (26,0)*8 (1,8)Myalgia (%)130 (72,2)*35 (8,3)106 (70,7)*59 (13,0)Fatigue (%)165 (91,7)*41 (9,7)137 (91,3)*69 (15,2)*p<0,005.ConclusionsOur study shows a clear clinical picture of systemic symptoms, high titters of CHIKV immunoglobulins, and a defined joint involvement, which will help clinicians to identify and differentiate CHIKV infection from other viral infections and MSK diseases. Also, the sensibility of the WHO criteria applied to our cohort of patients demonstrates the need to improve clinical criteria without the use of laboratory tests.Disclosure of Interes...
Host immune response as well as virulence factors are key in disease susceptibility. There are no known association studies of HLA class I and II alleles with chikungunya (CHIKV) infection in Latin American population. We aim to identify Human Leukocyte Antigen (HLA) alleles present in patients with CHIKV infection when compared to healthy controls, as well as allele association with the clinical spectrum of the disease. A cross-sectional analysis nested in a community cohort was carried out. We included patients 18 years and older with serological confirmation of CHIKV infection. HLA typing of HLA-A, HLA-B and HLA-DRB1 alleles was performed. Two-by-two tables were used to establish associations between allele presence and clinical characteristics. Data from 65 patients with confirmed CHIKV infection were analyzed for HLA typing. CHIKV infection was associated with the presence of HLA-A*68, HLA-B*35, HLA-DRB*01, HLA-DRB1*04 and HLA-DRB1*13 alleles with statistical significance when compared to healthy subjects. A statistically significant relationship was found between the presence of rash in the face or the abdomen and the presence of HLA-DRB1*04. Our study demonstrated that in our cohort, HLA type I as well as type II alleles are associated with CHIKV infection, and specifically an HLA type II allele with dermatological symptoms. Further research is needed to set a path for future investigation on genes outside the HLA system to improve knowledge in the pathophysiology of CHIKV infection and its host-pathogen interaction.
BackgroundHost factors like innate and adaptive immune response play an important part in disease susceptibility. Also, the role of host genetics factors in the pathogenesis of viral diseases have been reported. Human leukocyte antigen (HLA) is responsible for initiating innate and adaptive immune responses. Studies have demonstrated HLA class II alleles association to susceptibility or resistance to chikungunya virus infection (CHIKV), however there is no evidence of association studies of HLA class I and II in the Latin-American CHIKV epidemic.ObjectivesTo evaluate the association of human leukocyte A, B and DR antigens in a group of Colombian patients with CHIKV.MethodsCharacterization of HLA allele A, B, and DR of 62 patients with confirmed CHIKV was compared with 100 unrelated healthy subjects as a control group. The comparison between the different allele frequencies in the patient group and the control population was performed using chi2, with Bonferroni correction. A p value <0.05 was considered to be significant. The magnitude of associations was assessed using odds ratio (OR) and confidence intervals (CI) of 95%. To establish the homogeneity of the studied groups, the Hardy-Weinberg disequilibrium was used.ResultsOf the 62 patients studied 46 were female (74,2%). The mean age was 45,0 (SD±16,8) years. Most of the patients were from Barranquilla (64,5%; n: 40). Mean CHIKV immunoglobulin G (IgG) was 38,6 SU (SD±21,7), while IgM was 13,3 SU (SD±7,6). Also C reactive protein levels were high (mean: 14,7 mg/L; SD±8,4). Association alleles of HLA-A, and DR are depicted in table 1. No association was found with HLA-B alleles.Table 1.Associated Alleles with CHIKVPatientsControlOdds RatioCI p Cp Resistance A*28 0110,00,0-INF0,0020,040 A*29 6240,20,0–0,60,0020,048Susceptibility A*68 1429,92,1–45,10,0000,008 DRB1*01 2156,42,3–17,90,0000,001 DRB1*04 26113,61,6–8,00,0000,010 DRB1*13 2484,61,9–11,10,0000,004CHIKV: chikungunya virus infection; CI: confidence interval 95%; Cp: Bonferroni corrected p value.ConclusionsOur study demonstrated the alleles A*28 and A*29 to be associated with resistance to CHIKV, and alleles A*68, DRB1*01, DRB1*04 and DRB1*13 to be associated with susceptibility to CHIKV. No association was found in any HLA-B alleles.Disclosure of InterestNone declared
BackgroundThe World Health Organization (WHO) criteria for chikungunya virus infection (CHIKV) have a specificity of 91,1% with a low sensibility of 56,2%, which decreases the ability to detect patients with the infection. Because of this issue a group of rheumatology, epidemiology and bacteriology experts in diagnosing and treating CHIKV patients performed an agreement consensus on the clinical characteristics of CHIKV infection and proposed a set of clinical criteria. In order to test the performance of the new criteria and improve sensibility and specificity a clinical scenario was developed with the agreements from the expert panel and the clinical characteristics with higher odds ratios.ObjectivesTo improve sensibility and specificity of a set of clinical criteria for the diagnosis CHIKV.MethodsOdds ratios of the clinical features of patients with CHIKV infection were analysed. A clinical scenario was developed and sensitivity and specificity was calculated.Results37 clinical characteristics were evaluated in a cohort of 604 patients with suspicion of CHIKV. From those, 29 exhibited statistical significance and only 10 had high odds ratios (table 1). A clinical scenario with the following joint involvement (symmetrical arthritis of shoulders or wrists or hands or knees or ankles or feet) or systemic symptoms (fever or rash or myalgia or fatigue) poised a sensitivity of 74,2% (PPV: 83,5%) and a specificity of 88,4% (NPV: 81,2%). The following clinical characteristics extracted from the agreements of the consensus group were added to the clinical picture: origin from an epidemic area and abrupt onset of symptoms.Table 1.Clinical Characteristics with High Odds RatiosWHO Confirmed Case CriteriaOdds RatioCI (95%) p Met CriteriaDid Not Met Criteria (n: 150)(n: 454) Symmetry (%) Arthritis80 (53,3)19 (4,2)24,811,2–54,6<0,0001Arthritis (%) Wrists16 (10,7)5 (1,1)22,23,6–204,1<0,0001 Hands42 (28,0)8 (1,8)36,78,8–152,6<0,0001 Knees20 (13,3)5 (1,1)10,02,8–33,8<0,0001 Ankles42 (28,0)9 (2,0)24,47,5–79,3<0,0001 Feet39 (26,0)8 (1,8)69,39,6–510,8<0,0001Myalgia (%)106 (70,7)59 (13,0)13,08,1–20,7<0,0001Fatigue (%)137 (91,3)69 (15,2)16,910,9–26,8<0,0001Fever (%)150 (100)30 (6,6)13,18,4–20,5<0,0001Rash (%)109 (72,7)45 (9,9)14,08,5–22,9<0,0001WHO: World Health Organization; CI: Confidence Interval.ConclusionsOur study demonstrated that the proposed clinical scenario for suspicion of CHIKV improves diagnostic sensibility with a slight decrease in specificity, increasing the chance of diagnosis without the need for laboratory tests. We propose that a patient from an epidemic area (fulfilling epidemiological criteria according to the WHO) with an abrupt onset of a clinical picture of symmetrical arthritis of any of the following joints: hands, wrists, shoulders, knees or feet, or the presence of any of the following systemic symptoms: fever, rash, fatigue or myalgia, is more likely to have CHIKV infection.Disclosure of InterestNone declared
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