Beyond sepsis pathophysiology with cytokines: what is their value as biomarkers for disease severity?

Sepsis is a major challenge in medicine. It is a common and frequently fatal infectious condition. The incidence continues to increase, with unacceptably high mortality rates, despite the use of specific antibiotics, aggressive operative intervention, nutritional support, and anti-inflammatory therapies. Typically, septic patients exhibit a high degree of heterogeneity due to variables such as age, weight, gender, the presence of secondary disease, the state of the immune system, and the severity of the infection. We are at urgent need for biomarkers and reliable measurements that can be applied to risk stratification of septic patients and that would easily identify those patients at the highest risk of a poor outcome. Such markers would be of fundamental importance to decision making for early intervention therapy or for the design of septic clinical trials. In the present work, we will review current biomarkers for sepsis severity and especially the use of cytokines as biomarkers with important pathophysiological role.

Biomarkers for susceptibility to infection and disease severity in human malaria

Malaria remains a major infectious disease that affects millions of people. Once infected with Plasmodium parasites, a host can develop a broad range of clinical presentations, which result from complex interactions between factors derived from the host, the parasite and the environment. Intense research has focused on the identification of reliable predictors for exposure, susceptibility to infection and the development of severe complications during malaria. Although most promising markers are based on the current understanding of malaria immunopathogenesis, some are also focused more broadly on mechanisms of tissue damage and inflammation. Taken together, these markers can help optimise therapeutic strategies and reduce disease burden. Here, we review the recent advances in the identification of malarial biomarkers, focusing on those related to parasite exposure and disease susceptibility. We also discuss priorities for research in biomarkers for severe malaria.

Severity of tegumentary leishmaniasis is not exclusively associated with Leishmania RNA virus 1 infection in Brazil

Leishmania RNA virus (LRV) has been shown to be a symbiotic component of Leishmania parasites in South America. Nested retro-transcription polymerase chain reaction was employed to investigate LRV1 presence in leishmaniasis lesions from Brazil. In endemic areas of Rio de Janeiro (RJ), no LRV1 infection was observed even with mucosal involvement. LRV1 was only detected in Leishmania (V.) guyanensis cutaneous lesions from the northern region, which were obtained from patients presenting with disease reactivation after clinical cure of their primary lesions. Our results indicated that the severity of leishmaniasis in some areas of RJ, where Leishmania (V.) brazi-liensis is the primary etiological agent, was not associated with Leishmania LRV1 infection.

Evaluation of the WHO classification of dengue disease severity during an epidemic in 2011 in the state of Ceará, Brazil

In 2009, the World Health Organization (WHO) issued a new guideline that stratifies dengue-affected patients into severe (SD) and non-severe dengue (NSD) (with or without warning signs). To evaluate the new recommendations, we completed a retrospective cross-sectional study of the dengue haemorrhagic fever (DHF) cases reported during an outbreak in 2011 in northeastern Brazil. We investigated 84 suspected DHF patients, including 45 (53.6%) males and 39 (46.4%) females. The ages of the patients ranged from five-83 years and the median age was 29. According to the DHF/dengue shock syndrome classification, 53 (63.1%) patients were classified as having dengue fever and 31 (36.9%) as having DHF. According to the 2009 WHO classification, 32 (38.1%) patients were grouped as having NSD [4 (4.8%) without warning signs and 28 (33.3%) with warning signs] and 52 (61.9%) as having SD. A better performance of the revised classification in the detection of severe clinical manifestations allows for an improved detection of patients with SD and may reduce deaths. The revised classification will not only facilitate effective screening and patient management, but will also enable the collection of standardised surveillance data for future epidemiological and clinical studies.

Severity of chronic experimental Chagas' heart disease parallels tumour necrosis factor and nitric oxide levels in the serum: models of mild and severe disease

Heart tissue inflammation, progressive fibrosis and electrocardiographic alterations occur in approximately 30% of patients infected by Trypanosoma cruzi, 10-30 years after infection. Further, plasma levels of tumour necrosis factor (TNF) and nitric oxide (NO) are associated with the degree of heart dysfunction in chronic chagasic cardiomyopathy (CCC). Thus, our aim was to establish experimental models that mimic a range of parasitological, pathological and cardiac alterations described in patients with chronic Chagas’ heart disease and evaluate whether heart disease severity was associated with increased TNF and NO levels in the serum. Our results show that C3H/He mice chronically infected with the Colombian T. cruzi strain have more severe cardiac parasitism and inflammation than C57BL/6 mice. In addition, connexin 43 disorganisation and fibronectin deposition in the heart tissue, increased levels of creatine kinase cardiac MB isoenzyme activity in the serum and more severe electrical abnormalities were observed in T. cruzi-infected C3H/He mice compared to C57BL/6 mice. Therefore, T. cruzi-infected C3H/He and C57BL/6 mice represent severe and mild models of CCC, respectively. Moreover, the CCC severity paralleled the TNF and NO levels in the serum. Therefore, these models are appropriate for studying the pathophysiology and biomarkers of CCC progression, as well as for testing therapeutic agents for patients with Chagas’ heart disease.

Molecular characterisation and disease severity of leptospirosis in Sri Lanka

Leptospirosis is a re-emerging zoonotic disease all over the world, important in tropical and subtropical areas. A majority of leptospirosis infected patients present as subclinical or mild disease while 5-10% may develop severe infection requiring hospitalisation and critical care. It is possible that several factors, such as the infecting serovar, level of leptospiraemia, host genetic factors and host immune response, may be important in predisposition towards severe disease. Different Leptospirastrains circulate in different geographical regions contributing to variable disease severity. Therefore, it is important to investigate the circulating strains at geographical locations during each outbreak for epidemiological studies and to support the clinical management of the patients. In this study immunochromatography, microscopic agglutination test and polymerase chain reaction were used to diagnose leptospirosis. Further restriction fragment length polymorphism and DNA sequencing methods were used to identify the circulating strains in two selected geographical regions of Sri Lanka.Leptospira interrogans, Leptospira borgpeterseniiandLeptospira kirschneristrains were identified to be circulating in western and southern provinces. L. interroganswas the predominant species circulating in western and southern provinces in 2013 and its presence was mainly associated with renal failure.

The role of the New Trauma and Injury Severity Score (NTRISS) for survival prediction

The objective of this study was to verify if replacing the Injury Severity Score (ISS) by the New Injury Severity Score (NISS) in the original Trauma and Injury Severity Score (TRISS) form would improve the survival rate estimation. This retrospective study was performed in a level I trauma center during one year. ROC curve was used to identify the best indicator (TRISS or NTRISS) for survival probability prediction. Participants were 533 victims, with a mean age of 38±16 years. There was predominance of motor vehicle accidents (61.9%). External injuries were more frequent (63.0%), followed by head/neck injuries (55.5%). Survival rate was 76.9%. There is predominance of ISS scores ranging from 9-15 (40.0%), and NISS scores ranging from 16-24 (25.5%). Survival probability equal to or greater than 75.0% was obtained for 83.4% of the victims according to TRISS, and for 78.4% according to NTRISS. The new version (NTRISS) is better than TRISS for survival prediction in trauma patients.

Measuring trauma severity using the 1998 and 2005 revisions of the Abbreviated Injury Scale

Objetivo: Comparar a gravidade das lesões e do trauma mensurada pelas versões da Abbreviated Injury Scale 1998 e 2005 e verificar a mortalidade nos escores Injury Severity Score e New Injury Severity Score nas duas versões.Método: Estudo transversal e retrospectivo analisou lesões de pacientes de trauma, de três hospitais universitários do município de São Paulo, Brasil. Cada lesão foi codificada com Abbreviated Injury Scale 1998 e 2005. Os testes estatísticos aplicados foram Wilcoxon, McNemar-Bowker, Kappa e teste Z.Resultados: A comparação das duas versões resultou em discordância significante de escores em algumas regiões corpóreas. Com a versão 2005 os níveis de gravidade da lesão e do trauma foram significantemente reduzidos e a mortalidade foi mais elevada em escores mais baixos. Conclusão: Houve redução da gravidade da lesão e do trauma e alteração no percentual de mortalidade com o uso da Abbreviated Injury Scale 2005.





Desempenho dos ajustes do Trauma and Injury Severity Score (TRISS): revisão integrativa

RESUMO Objetivo identificar estudos que realizaram ajustes na equação do Trauma and InjurySeverity Score (TRISS) e compararam a capacidade discriminatória da equação modificada com a original. Método Revisão integrativa de pesquisas publicadas entre 1990 e 2014 nas bases de dados LILACS, MEDLINE, PubMed e SciELO utilizando-se a palavra TRISS. Resultados foram incluídos 32 estudos na revisão. Dos 67 ajustes de equações do TRISS identificados, 35 (52,2%) resultaram em melhora na acurácia do índice para predizer a probabilidade de sobrevida de vítimas de trauma. Ajustes dos coeficientes do TRISS à população de estudo foram frequentes, mas nem sempre melhoraram a capacidade preditiva dos modelos analisados. A substituição de variáveis fisiológicas do Revised Trauma Score (RTS) e modificações do Injury Severity Score (ISS) na equação original tiveram desempenho variado. A mudança na forma de inclusão da idade na equação, assim como a inserção do gênero, comorbidades e mecanismo do trauma apresentaram tendência de melhora do desempenho do TRISS. Conclusão Diferentes propostas de ajustes no TRISS foram identificadas nesta revisão e indicaram, principalmente, fragilidades do RTS no modelo original e necessidade de alteração da forma de inclusão da idade na equação para melhora da capacidade preditiva do índice.

Soil-applied silicon decreases severity of wheat spot blotch on silicon-deficient soils

Spot bloth caused by Bipolaris sorokiniana is an important wheat desease mainly in hot and humid regions. The aim of this study was to evaluate the response of wheat to different sources and modes of Si application, as related to the severity of wheat spot blotch and plant growth, in two Si-deficient Latosols (Oxisols). An greenhouse experiment was arranged in a 2 x 5 factorial completely randomized design, with eight replications. The treatments consisted of two soils (Yellow Latosol and Red Latosol) and five Si supply modes (no Si application; Si applied as calcium silicate and monosilicic acid to the soil; and Si applied as potassium silicate or monosilicic acid to wheat leaves). No significant differences were observed between the two soils. When Si was applied to the soil, regardless the Si source, the disease incubation period, the shoot dry matter yield and the Si content in leaves were greater. Additionally, the final spot blotch severity was lower and the area under the spot blotch disease progress curve and the leaf insertion angle in the plant were smaller. Results of Si foliar application were similar to those observed in the control plants.

Relationship between potassium fertilization and panicle blast severity in upland rice

The influence of K2O (0, 40, 80, 120 kg ha-1) at varying rates of N application (0, 30, 60 kg ha-1) at planting, on panicle blast (Pyricularia grisea (Cooke) Sacc.) was studied in a field experiment conducted during three consecutive years with the upland rice cultivar Douradão. Panicle blast severity decreased with increasing rates of potassium in the absence of nitrogen (N0). The relationship between panicle blast and K rates was quadratic at 30 kg ha-1 of nitrogen. Significant response to K fertilization was not obtained at 60 kg ha-1 of nitrogen in relation to panicle blast severity.

Plant growth and leaf-spot severity on eucalypt at different CO2concentrations in the air

The objective of this work was to evaluate the effects of increased air-CO2 concentration on plant growth and on leaf-spot caused by Cylindrocladium candelabrumin Eucalyptus urophylla. Seedlings were cultivated for 30 days at 451, 645, 904, and 1,147 µmol mol-1 CO2 ; then, they were inoculated with the pathogen and kept under the same conditions for seven days. Increased CO2concentration increased plant height and shoot dry matter mass, and decreased disease incidence and severity. Stem diameter was not affected by the treatments. Increased concentrations of atmospheric CO2 favorably affect eucalypt growth and reduce leaf-spot severity.

Gray mold severity and vase life of rose buds after pulsing with citric acid, salicylic acid, calcium sulfate, sucrose and silver thiosulfate

Gray mold of roses (Rosa hibrida) caused by Botrytis cinerea requires many management strategies for its control. The effect of pulsing rose cv. Kiss with solutions of citric acid, salicylic acid, sucrose, calcium sulfate, and silver thiosulfate (STS) on disease severity and vase life of the flowers was evaluated. The solutions were applied to cut stems at different stages of harvest, the variation in the opening stage of harvest did not affect the results. Pulsing with STS reduced the values of area under the disease progress curve (AUDPC) and of severity of disease by 15% and 55%, respectively, and increased the vase life of the flowers by 20%. Calcium sulfate consistently reduced AUDPC by 66% and maximum severity by 88%, and increased vase life of the flowers by 37%. Therefore, pulsing rose buds with solutions of STS and calcium sulfate is potentially useful in reducing losses due to gray mold after harvest and in extending the vase life.

Effect of temperature, leaf wetness, and rainfall on the production of Guignardia citricarpa ascospores and on back spot severity on sweet orange

The black spot of citrus (Citrus sp.) is caused by Guignardia citricarpa with ascospore production depending on temperature, leaf wetness, and rainfall. The number of ascospores produced was monitored using a spore trap and climatic factors were recorded using an automated meteorological station of 'Natal' and 'Valencia' sweet orange (Citrus sinensis) orchards in Mogi Guaçu in the state of São Paulo, Brazil, from November 2000 to March 2001. The fruits were bagged to prevent infection and the bags removed from different sets of fruit for one week during each of the 18 weeks of the season in both orchards. Ascospores were produced during the entire experimental period, from spring through summer, primarily after rain events. In both orchards, ascospore production reached a peak in January and February. Ascospore production was related to leaf wetness only in the Natal orange orchard but was not related to total rainfall or temperature in either orchard. Disease was most severe on fruit exposed the 7th, 8th, and 13th weeks after beginning the experiment in both cultivars as well as after the 16th week for 'Natal'. There was a strong relationship between disease severity and total rainfall for both orchards and a weak correlation between temperature and severity in the 'Natal' block only. There was no relationship between severity and leaf wetness or ascospore numbers.

Diagrammatic scale for assessment of soybean rust severity

A diagrammatic scale to assess soybean (Glycine max) rust severity, caused by the fungus Phakopsora pachyrhizi, was developed in this study. Leaflets showing different severity levels were collected for determination of the minimum and maximum severity limits; intermediate levels were determined according to "Weber-Fechner's stimulus-response law". The proposed scale showed the levels of 0.6; 2; 7; 18; 42, and 78.5%. Scale validation was performed by eight raters (four inexperienced and four experienced), who estimated the severity of 44 soybean leaflets showing rust symptoms, with and without the use of the scale. Except for rater number eight, all showed a tendency to overestimate severity without the aid of the diagrammatic scale. With the scale, the raters obtained better accuracy and precision levels, although the tendency to overestimate was maintained. Experienced raters were more accurate and precise than inexperienced raters, and assessment improvements with the use of the scale were more significant for inexperienced raters.