HPV16 genotype, p16/Ki-67 dual staining and koilocytic morphology as potential predictors of the clinical outcome for cervical low-grade squamous intraepithelial lesions.

OBJECTIVE: To evaluate the association of human papillomavirus (HPV) 16 and non-16 genotype, p16/Ki-67 dual staining and koilocytosis and their role in the prediction of the clinical outcome of low-grade squamous intraepithelial lesion (LSIL) cytology. METHODS: One hundred and fifty-five patients with LSIL were followed up and recorded as progression, persistence or regression. HPV genotyping was performed for high-risk HPV (hrHPV) DNA-positive cases. Koilocytosis was reviewed and p16/Ki-67 dual staining was performed on reprocessed conventional cytology slides. RESULTS: HPV16 was the most frequent genotype found in 16.3% of cases. p16/Ki-67 dual staining was positive in 36.1% of all cases. Progression, including concurrent cervical intraepithelial lesion grade 2 or above (CIN2+), was recorded in 13.8% of cases. A statistically significant difference between progressive and non-progressive cases was shown by the following: hrHPV-positive versus hrHPV-negative (P = 0.022), HPV16-positive versus non-16 HPV-positive (P < 0.001) and p16/Ki-67-positive versus p16/Ki-67-negative (P < 0.001) cases. Cases with combined HPV16 and p16/Ki-67 positivity showed the highest progression rate (58.3%). Non-koilocytic HPV16-positive cases showed a 50% progression rate compared with 10.1% for koilocytic non-16 HPV-positive cases (P = 0.010). The sensitivity of p16/Ki-67 dual staining for the detection of CIN2+ lesions was 80%, comparable with hrHPV (85%). The specificity of p16/Ki-67 dual staining was 71% and of hrHPV 42%. The highest specificity was found for HPV16 genotype presence (91%), but with low sensitivity (50%). CONCLUSION: HPV genotyping, p16/Ki-67 dual staining and koilocytic morphology can be useful in the prediction of clinical outcome in women initially diagnosed with LSIL cytology.

Salmonella enterica arthritis in a patient with rheumatoid arthritis receiving antitumour necrosis factor therapy / Artritis por Salmonella enterica en un paciente con artritis reumatoide que recibe terapia con factor de necrosis antitumoral

Antitumour necrosis factor (TNF) monoclonal antibodies have become an invaluable treatment against chronic inflammatory diseases such as rheumatoid arthritis (RA). However, due to increased risk of opportunistic infections, patients receiving antiTNF therapy should be closely monitored for serious infections. Here, we describe a case of acute Salmonella enteritidis infection of a joint arthroplasty that previously was functioning well, in a patient receiving infliximab treatment for RA. After prolonged antimicrobial chemotherapy and interrupted infliximab treatment, reimplantation of a new prosthesis was successfully performed two years after Salmonella septic arthritis. Therefore, because of the possibility of extraintestinal salmonellosis, screening for fecal colonization could be advisable in patients undergoing antiTNF treatment. Moreover, we emphasize the importance of appropriate counselling of these patients concerning food hygiene.

Los anticuerpos monoclonales del factor de necrosis antitumoral (FNT) se han convertido en un valioso tratamiento contra las enfermedades inflamatorias crónicas como la artritis reumatoide (AR). Sin embargo, debido al mayor riesgo de infecciones oportunistas, los pacientes que reciben terapia antiFNT se deben se monitoreados muy de cerca con respecto a la posibilidad de infecciones serias. Aquí describimos un caso de infección aguda por Salmonella enteritidis de una artroplastia de articulación que anteriormente funcionaba bien, en un paciente que recibía tratamiento con infliximab por RA. Después de prolongadas quimioterapias antimicrobianas y tratamiento interrumpido con infliximab, se realizó exitosamente la reimplantación de una nueva prótesis, dos años después de la artritis séptica por Salmonella. Por lo tanto, debido a la posibilidad de una salmonelosis extraintestinal, podría ser aconsejable el tamizaje de la colonización fecal en pacientes sometidos a tratamiento antiFNT. Por otra parte, hacemos hincapié en la importancia de aconsejar apropiadamente a estos pacientes con respecto a la higiene de los alimentos.

Salmonella enterica arthritis in a patient with rheumatoid arthritis receiving anti-tumour necrosis factor therapy.

Anti-tumour necrosis factor (TNF) monoclonal antibodies have become an invaluable treatment against chronic inflammatory diseases such as rheumatoid arthritis (RA). However, due to increased risk of opportunistic infections, patients receiving anti-TNF therapy should be closely monitored for serious infections. Here, we describe a case of acute Salmonella_enteritidis infection of a joint arthroplasty that previously was functioning well, in a patient receiving infliximab treatment for RA. After prolonged antimicrobial chemotherapy and interrupted infliximab treatment, reimplantation of a new prosthesis was successfully performed two years after Salmonella septic arthritis. Therefore, because of the possibility of extraintestinal salmonellosis, screening for fecal colonization could be advisable in patients undergoing anti-TNF treatment. Moreover we emphasize the importance of appropriate counselling of these patients concerning food hygiene.