RESUMEN
INTRODUCTION: Most studies dealing with automated hematology analyzers (HAs) and malaria diagnosis are conducted in endemic countries. METHODS: We retrospectively studied cell blood counts (CBCs) performed with Sysmex XE-2100 and XE-5000 HAs in our center (Angers, France) regarding 67 patients returning from endemic areas and infected with various Plasmodium species. RESULTS: In 83% of infected samples with Plasmodium vivax (Pv), ovale (Po), or malariae (Pm), extra clouds of dots were present in neutrophil and/or eosinophil area(s) on routine differential (DIFF) scattergrams. In contrast, samples infected with Plasmodium falciparum (Pf) failed to show such DIFF scattergrams, or any other suggesting malaria infection (0/ 49 pts). Abnormal areas from DIFF scattergrams were related to the presence of mature schizonts and gametocytes, undestroyed by lysis agent, the latter not observed in Pf-infected patients from our series. The internal parameter WBC[DIFF] - WBC[BASO] raised in parallel to parasitemia in Pv, Po, and Pm samples but could not be used as a surrogate for parasitemia. In Pf infection, reticulocyte/ immature reticulocyte fraction (IRF) ratio showed a significant correlation with parasitemia (P < 0.05). A diagnostic model developed for Pf in endemic countries showed sensitivity of 77%. CONCLUSION: Using SYSMEX analyzers, Pv, Po, and Pm infections are easy to ascertain as DIFF scattergrams are almost specific (specificity = 99.9%). Pf infection diagnosis by CBC may be a more promising tool.
Asunto(s)
Pruebas Hematológicas/instrumentación , Pruebas Hematológicas/métodos , Malaria/sangre , Malaria/diagnóstico , Adolescente , Adulto , Anciano , Niño , Preescolar , Recuento de Eritrocitos , Índices de Eritrocitos , Femenino , Francia , Guinea , Humanos , Lactante , Recuento de Leucocitos , Malaria/parasitología , Masculino , Persona de Mediana Edad , Plasmodium/clasificación , Plasmodium/crecimiento & desarrollo , Plasmodium falciparum , Recuento de Plaquetas , Reproducibilidad de los Resultados , Recuento de Reticulocitos , Viaje , Adulto JovenRESUMEN
In murine systemic lupus erythematosus (SLE) models, nephritogenic anti-dsDNA IgG has been shown to cross-react with a kidney antigen, alpha-actinin, and to be critical in renal pathogenesis. In humans, studies of anti-alpha-actinin antibodies (Abs) are scarce, and these antibodies remain to be evaluated. We have thus far tested sera from patients with SLE (n = 103), rheumatoid arthritis (RA, n = 93), and primary Sjögren syndrome (pSS, n = 34), and from healthy subjects (n = 160), for the presence of anti-alpha-actinin and anti-DNA Abs. The latter were tested using several methods [IIF on Crithidia luciliae (Crit) and ELISA using dsDNA]. Anti-alpha-actinin Abs were confirmed by Western blot. Sera from 23 of 103 SLE patients, 3 of 93 RA patients, 1 of 33 pSS patients, and 1 of 160 controls scored positive for anti-alpha-actinin Abs. In SLE, the positivity was significantly associated with anti-dsDNA reactivity (22 of 23): 19 of 23 sera were alpha-actinin-positive/dsDNA-positive and 13 were alpha-actinin-positive/Crit-positive. Few cases were alpha-actinin-positive/dsDNA-negative: 1 SLE, 3 RA, and 1 control. Furthermore, anti-alpha-actinin Abs have been detected at high level before or at the early stage of lupus nephritis when compared with active and inactive SLE without kidney manifestations.