Hashimoto's Encephalopathy Masquerading as Rapidly Progressive Dementia and Extrapyramidal Failure

Hashimoto's encephalopathy is a rare immune-mediated disorder characterized by subacute encephalopathy with elevated thyroid antibodies. Hashimoto's encephalopathy is also known as steroid-responsive encephalopathy associated with autoimmune thyroiditis. We report a rare presentation of Hashimoto's encephalopathy presenting with acute neuropsychiatric disturbances, rapidly progressive dementia, seizures, and extrapyramidal failure. Neuroimaging revealed multifocal vasculitides of major cerebral vessels that support the autoimmune vasculitic theory as the underlying pathogenesis for Hashimoto's encephalopathy. Unfortunately, permanent irreversible cerebral damage has already ensued before her presentation to our center, which rendered steroid therapy ineffective. Serological testing for Hashimoto's thyroiditis must be in the investigation of all rapidly progressive dementias as early diagnosis and timely management of autoimmune thyroiditis may salvage sizable and eloquent cerebral tissues. The rarity of the condition should not preclude the investigation of Hashimoto's disease even in the presence of normal levels of thyroid hormones. Delayed diagnosis may result in irreversibly catastrophic encephalopathy in patients who once presented with potentially curable dementia.

A serological survey of canine leptospirosis in the city of Belgrade, Serbia

Canine leptospirosis is a zoonosis caused by bacteria belonging to the genus Leptospira. Dogs are one of the animal species involved in the cycle of preservation and transmission of leptospirosis in urban areas. Serological testing for the presence of specific antibodies against Leptospira spp. in dogs was continuously performed between 2010 and 2020 in the city of Belgrade. At the request of the owners themselves, other veterinary laboratories or laboratory clinics, 179 blood sera from 179 dogs were examined in the Laboratory for Immunology, Scientific Institute of Veterinary Medicine of Serbia. Blood sera samples from dogs were examined using the standard microscopic agglutination test (MAT) for the presence of specific antibodies against seven different serovars of Leptospira: Pomona, Icterohaemorrhagiae, Grippotyphosa, Sejroe, Canicola, Bataviae, and Australis. The number of seropositive dogs was 17/179 (9.5%). Among all examined sera, the highest titre of seropositive samples was to serovar Icterohaemorrhagiae (10/17, 58.8%), followed by Pomona (4/17, 23.5%), and serovar Canicola (3/17, 17.6%). Specific antibodies for serovars Grippotyphosa, Sejroe, Bataviae and Australis were not detected in any of the dog sera. Cross-reaction (the presence of two or three titres with different values where one of them was higher than others) between different serovars was diagnosed in a low number of sera (n=4), with the following serovars: Icterohaemorrhagiae and Pomona (n=3) and Pomona and Canicola (n=1). The confirmed specific antibody titres for Leptospira spp. were between 1:100 to 1:3000 (5 sera had titres of 1:100, 7 had titres of 1:300, 4 had titres of 1:1000, and 1 serum had a titre 1:3000). Monitoring canine leptospirosis is a useful tool in preventing leptospirosis in Belgrade.

Clinical Sensitivity, Specificity and Epidemiology of SARS-CoV-2 Serological Testing Using the Biozek COVID-19 Test

Background: Clinical validation using the Biozek COVID-19 test including sensitivity and specificity and associated patient-reported symptoms with SARS-CoV-2 seropositivity. Methods: 316 sera were analyzed including 47 hospitalized cases, 50 mild cases and 219 negative controls. Results were read visually by two technicians and in case of discrepancy by a third. Models were created between independent variables and IgG seropositivity using multivariable logistic regression analysis. Results: Sensitivity of both IgM and IgG together for hospitalized patients at all time periods was 68.1% (32/47) and 90.0% (27/30) after 10 days or more. From mild/asymptomatic cases the combined IgM and IgG sensitivity was 92.0% (46/50) and 91.8% (45/49) after 10 days or more. In the group of non-COVID-19 cases, the overall specificity was 99.1% (217/219). For IgG alone, the specificity was 99.5% (218/219). In the multivariable analysis loss of smell remained the strongest associated variable with an odds ratio (95%CI): 6.82 (5.61–8.31), p-value < 0.001. Our final prediction model yielded a ROC-AUC of 0.77 (0.74–0.81) showing acceptable discrimination. Conclusions: The Biozek COVID-19 test showed high specificity and good sensitivity 10 days after the first sickness day. Solely IgM positive tests must be interpreted with caution and preferably excluded. In order to capture most symptomatic COVID-19 cases, loss of smell should be included within symptomatic screening policies.

Rapid Serological Testing for Managing the COVID-19 Pandemic: A Review

With the onset of the novel coronavirus disease pandemic (COVID-19) that emerged from Wuhan in China, the need of the hour can be summarized into two groups. The first one is a potent vaccine as a prophylactic measure to prevent the virus from infecting people, and the second is a rapid diagnosis of the disease to help healthcare professionals and government authorities to plan and control the spread and provide effective care and treatment. This review delves into the latter, describing the COVID-19 and its treatment, including the race for an effective vaccine, and highlighting the role of serological testing in managing the pandemic since a well-designed study to understand mechanisms and serological correlations of protective immunity is crucial for rational clinical and public health policies. In conclusion, swift vaccination and response tactics, such as social distancing, hand hygiene, wearing of masks, and, if required, lockdown practices continue to be important in managing the pandemic while carefully monitoring any possible outbreak due to the variants.

Safety of Uncrossmatched ABO-Compatible RBCs in Alloimmunized Patients with Bleeding: Data from Two Decades: Results of a Systematic Analysis in 6,109 Patients

<b><i>Introduction:</i></b> Uncrossmatched ABO-compatible red blood cells (RBCs) are generally recommended in patients with life-threatening massive bleeding. There is little data regarding RBC transfusion when patients are transfused against clinically significant alloantibodies because compatible RBCs are not immediately available. <b><i>Methods/Patients:</i></b> All patients reviewed in this study (<i>n</i> = 6,109) required emergency blood transfusion and were treated at the Charité – Universitätsmedizin Berlin between 2001 and 2015. Primary uncrossmatched O Rh(D)-positive or -negative RBC units were immediately transfused prior to complete regulatory serological testing including determination of ABO group, Rhesus antigens, antibody screening, and crossmatching. <b><i>Results:</i></b> Without any significant change in the protocol of emergency transfusion of RBCs, a total of 63,373 RBC units were transfused in 6,109 patients. Antibody screening was positive in 413 patients (6.8%), and 19 of these patients received RBC units against clinically significant alloantibodies. None of these patients appeared to have developed significant hemolysis, and only one patient with anti-D seems to have developed signs of insignificant hemolysis following the transfusion of three Rh(D)-positive units. One patient who had anti-Jk^a received unselected units and did not develop a hemolytic transfusion reaction. <b><i>Conclusion:</i></b> Transfusion of uncrossmatched ABO-compatible RBCs against alloantibodies is highly safe in patients with life-threatening hemorrhage.

Modeling serological testing to inform relaxation of social distancing for COVID-19 control

Serological testing remains a passive component of the public health response to the COVID-19 pandemic. Using a transmission model, we examine how serological testing could have enabled seropositive individuals to increase their relative levels of social interaction while offsetting transmission risks. We simulate widespread serological testing in New York City, South Florida, and Washington Puget Sound and assume seropositive individuals partially restore their social contacts. Compared to no intervention, our model suggests that widespread serological testing starting in late 2020 would have averted approximately 3300 deaths in New York City, 1400 deaths in South Florida and 11,000 deaths in Washington State by June 2021. In all sites, serological testing blunted subsequent waves of transmission. Findings demonstrate the potential benefit of widespread serological testing, had it been implemented in the pre-vaccine era, and remain relevant now amid the potential for emergence of new variants.

The Importance of Expertly Evaluated Tests Underlined by COVID-19 Pandemic: A Mini Review

Background: The joint interest of clinicians and the laboratory test industry during the recent pandemic of the Coronavirus Disease 2019 (COVID-19) resulted in an explosion of accessible assays for COVID-19 serological testing. Content: The need of properly evaluated laboratory tests is more apparent today than ever before. Clinical application of the assay, analytical specifications, and performance convenience are the key criteria that must be followed while selecting an analytical method. An analytical evaluation is always performed before deciding to apply a procedure in the laboratory routine practice. Summary: Only after the evaluation, data collection, and analysis of the results in accordance with the established eligibility criteria can be concluded that the new assay is suitable for laboratory use.

Vulvar herpes zoster infection: a rare and challenging diagnosis

A 26-year-old woman under immunosuppression with infliximab due to Crohn’s disease was referred to the gynaecology emergency room with dispersed and coalescing vesicular lesions on the vulvar region extending to the right lower limb involving S2–S3 dermatome, associated with severe pain. Clinical history, physical examination and serological testing was consistent with herpes zoster infection. The patient was treated with valaciclovir for 14 days and cefradine for 7 days (due to the possibility of secondary bacterial infection). Significant symptomatic improvement was noted after 1 week. The 1-year follow-up was unremarkable. According to our knowledge and review of the literature, this is one of the few cases reported of vulvar herpes zoster, especially related to infliximab.

Persistence of SARS-CoV-2-Specific Antibodies for 13 Months after Infection

Background: Dynamics of antibody responses were investigated after a SARS-CoV-2 outbreak in a private company during the first wave of the pandemic. Methods: Workers of a sewing company (Lithuania) with known SARS-CoV-2 RT-PCR result during the outbreak (April 2020) were invited to participate in the study. Virus-specific IgG and IgM were monitored 2, 6 and 13 months after the outbreak via rapid IgG/IgM serological test and SARS-CoV-2 S protein-specific IgG ELISA. Results: Six months after the outbreak, 95% (CI 86–99%) of 59 previously infected individuals had virus-specific antibodies irrespective of the severity of infection. One-third of seropositive individuals had virus-specific IgM along with IgG indicating that IgM may persist for 6 months. Serological testing 13 months after the outbreak included 47 recovered individuals that remained non-vaccinated despite a wide accessibility of COVID-19 vaccines. The seropositivity rate was 83% (CI 69–91%) excluding one case of confirmed asymptomatic reinfection in this group. Between months 6 and 13, IgG levels either declined or remained stable in 31 individual and increased in 7 individuals possibly indicating an exposure to SARS-CoV-2 during the second wave of the pandemic. Conclusions: Detectable levels of SARS-CoV-2-specific antibodies persist up to 13 months after infection for the majority of the cases.