Detección del tipo de papilomavirus humano por el método de PCR-RFLP en uncaso con neoplasia intraepitelial de alto grado y captura híbrida II negativa / Detection of human papillomavirus by PCR RFLP assay in a case with negative hybrid capture II result and high grade intraepithelial neoplasia Pap smear result

La infección persistente del virus del papiloma humano (HPV) es un factor necesario para eldesarrollo del cáncer de cuello uterino. Este caso reporta una mujer de 43 años, con imágenescitológicas persistentes de neoplasia intraepitelial de grado III (CIN III) y resultados negativos paraestudios colposcópicos y anatomopatológicos, como también, para HR-HPV analizado por el métodode Captura Híbrida II. Una evaluación histopatológica posteriormente confirmó la existencia de CINIII en mucosa cervical. A fin de detectar otros tipos de HPV no incluidos en la Captura Híbrida II, lamuestra fue analizada por el método de PCR-RFLP obteniendo un resultado positivo para HPV 73.En este caso, el uso del método de PCR-RFLP permitió detectar una infección por un tipo específicode HPV, brindando una información útil que puede ayudar en el manejo clínico de mujeres condiagnóstico citológico de CIN III y resultado de Captura Híbrida II negativo

Differential impact of recent Medicaid expansions by race and ethnicity.

OBJECTIVE: Between 1989 and 1995, expansions in Medicaid eligibility provided publicly financed health insurance to an additional 7 million poor and near-poor children. It is not known whether these expansions affected children's insurance coverage, use of health care services, or health status differently, depending on their race/ethnicity. The objective of this study was to examine, by race/ethnicity, the impact of the recent Medicaid expansions on levels of uninsured individuals, health care service utilization, and health status of the targeted groups of children. METHODS: Using a stratified set of longitudinal data from the National Health Interview Surveys of 1989 and 1995, we compared changes in measures of health insurance coverage, health services utilization, and health status for poor white, black, and Hispanic 1- to 12-year-old children. To control for underlying trends over time, we subtracted 1989 to 1995 changes in these outcomes among nonpoor children from changes among the poor children for each race/ethnicity group. Measures of coverage included uninsured rates and Medicaid rates. Utilization measures included annual probability of visiting a doctor, annual number of doctor visits, and annual probability of hospitalization. Health status measures included self-reported health status and number of restricted-activity days in the 2 weeks before the interview. Differences in means were analyzed with the use of Student's t tests accounting for the clustering sample design of the National Health Interview Surveys. RESULTS: Among poor children between 1989 and 1995, uninsured rates declined by 4 percentage points for whites, 11 percentage points for blacks, and 19 percentage points for Hispanics. Medicaid rates for these groups increased by 16 percentage points, 22 percentage points, and 23 percentage points, respectively. With respect to utilization, the annual probability of seeing a physician increased 7 percentage points among poor blacks and Hispanics but only 1 percentage point among poor whites (not significant) for children in good, fair, or poor health. Among those in excellent or very good health, the respective increases were 1 percentage point for poor whites (not significant), 7 percentage points for poor blacks, and 3 percentage points for poor Hispanics (not significant). Significant increases in numbers of doctor visits per year were recorded only for poor Hispanics who were in excellent or very good health, whereas significant decreases in hospitalizations were recorded for Hispanics who were in good fair or poor health. Measures of health status remained unchanged for poor children over time. The recorded decreases in uninsured rates and increases in Medicaid coverage remained robust to adjustments for underlying trends for all 3 race/ethnicity groups. With respect to adjusted measures of utilization and health status, the only significant differences found were among poor blacks who were in good, fair, or poor health and who registered increases in the likelihood of hospitalization and in poor Hispanics who were in excellent or very good health and who registered decreases in the numbers of restricted-activity days. CONCLUSIONS: Recent expansions in the Medicaid program from 1989 to 1995 produced greater reductions in uninsured rates among poor minority children than among poor white children. Regardless of race/ethnicity, poor children did not seem to experience significant changes during the period of the expansions in either their level of health service utilization or their health status.Medicaid, health insurance, health status, health services.

Pneumococci causing invasive disease in Britain 1982-1990.

A total of 5348 isolates of Streptococcus pneumoniae was serotyped and screened for insusceptibility to tetracycline, penicillin, erythromycin and chloramphenicol. Of these, 4238 (79%) were isolated from patients who had pneumonia or meningitis or were bacteraemic. Altogether, 3948 (74%) of the isolates belonged to one or other of the serotypes 1, 3, 4, 6, 8, 9, 14, 19 or 23 with serotypes 6, 14, 18, 19 and 23 being frequent causes of invasive disease in young children. Many isolates of type 1 were isolated from pneumonia and few from meningitis. Some 768 (14%) isolates were insusceptible to one or more antibiotic and 591 of these belonged to serotypes 6, 9, 14, 19 or 23. Representatives of type 14 resistant to erythromycin were prominent from 1986 onwards. There was an increase in the number of multi-resistant pneumococci from 1985. Among these were isolates of type 23 insusceptible to penicillin, chloramphenicol and tetracycline and cultures of type 6 resistant additionally to erythromycin.

Biochemical differences among human and animal streptococci of Lancefield group C or group G.

Pyogenic streptococci of Lancefield group C or group G from human or animal sources were examined with a view to increasing the number of diagnostic tests useful for their differentiation. Human strains of group G produced L-prolyl-L-arginine aminopeptidase but isolates of Streptococcus equisimilis (group C) did not. Tests for alpha-L-glutamate aminopeptidase together with fermentation of glycogen or sorbitol distinguished S. dysgalactiae from strains of S. equisimilis isolated from animals. It was confirmed that fermentation tests were helpful in the study of S. equi and S. zooepidemicus and that enzyme reactions helped distinguish between S. canis and the human strains of group G.

The serotypes of Streptococcus pyogenes present in Britain during 1980-1990 and their association with disease.

A total of 16,909 cultures of Streptococcus pyogenes (Lancefield group A) isolated in Britain during 1980-90 were examined for T- and M-protein antigens. One or other M antigen was detected in 92.6% of the strains. The numbers of isolates of some serotypes, such as M3 and M12, did not show great variation from year-to-year, whereas there were nationwide epidemics, extending over several years, caused by strains of serotypes M1 and M49. Isolates of serotypes M1 and M3 were associated particularly with invasive disease and fatal infections. Representatives of serotypes M80, M81 and the provisional types PT180, PT1658 and PT5757 were isolated most often from cases of pyoderma. Erythromycin resistance was detected in 30 serotypes but one half of all of the resistant isolates belonged to serotype M4.

Screening tests for pathogenic corynebacteria.

AIM: To provide simple tests that would help in the identification of corynebacteria that produce diphtheria toxin. METHODS: A collection of 99 freshly isolated corynebacteria was assembled and the cultures identified by conventional tests confirmed by an identification kit. Modifications were made to procedures for preparation of the culture medium for the Elek test and to the test for detection of pyrazinamidase (pyrazine carboxylamidase) activity. These two together with an indicator medium for cystinase activity were applied to the collection of organisms. RESULTS: Cystinase was detected in all 61 members of the toxigenic species and none produced pyrazinamidase. In contrast, all but two of the 38 representatives of non-toxigenic species yielded pyrazinamidase and none formed cystinase. Of the 61 cystinase producing cultures (which were also pyrazinamidase negative), 21 gave a positive Elek test with the modified culture medium. A total of 30 of these 61 were tested for toxigenicity in guinea pigs and the results of the animal and plate tests concorded. At least seven cultures could have been reported as non-toxigenic if Elek tests based on media prepared in the conventional way had been the only test available. CONCLUSION: The three procedures described go some way towards meeting the needs of diagnostic laboratories for efficient procedures for distinguishing pathogenic corynebacteria.

The role of streptococcal infection in the initiation of guttate psoriasis.

BACKGROUND AND DESIGN: Although the association between streptococcal infection and guttate psoriasis is well known, to date there has been little information on whether only limited groups and/or serotypes of beta-hemolytic streptococci are involved. One hundred eleven patients with a sudden onset or deterioration of psoriasis were investigated for evidence of streptococcal infection. Of these patients, 34 had acute guttate psoriasis, 30 had a guttate flare of chronic psoriasis, 37 had chronic plaque psoriasis, and 10 had other types of psoriasis. RESULTS: Serologic evidence of recent streptococcal infection was present in 19 (58%) of 33 patients with acute guttate psoriasis compared with seven (26%) of 27 patients with guttate exacerbations of chronic psoriasis. Streptococcus pyogenes was isolated from 19 (17%) of all 111 patients (9 [26%] of 34 with acute guttate psoriasis, four [13%] of 30 with guttate exacerbations of chronic psoriasis, and five [14%] of 37 patients with chronic psoriasis) compared with seven (7%) of 101 of a control population of patients being seen for treatment of viral warts. Other beta-hemolytic streptococci were found with equal frequency in the study and control populations. Thirteen isolates of 10 different streptococcal serotypes were obtained from the 64 patients with guttate psoriasis. These serotypes were similar in distribution and prevalence to those present in the local community. CONCLUSIONS: This study confirms the strong association between prior infection with S pyogenes and guttate psoriasis but suggests that the ability to trigger guttate psoriasis is not serotype specific.

Streptococcus pyogenes vulvovaginitis in children in Nottingham.

Isolates of Streptococcus pyogenes from vaginal swabs of children with vulvovaginitis received at Nottingham Public Health Laboratory during 1986-9 were studied. A total of 159 isolates was made during the 4 years, increasing from 17 in 1986 to 64 in 1989 and accounting for 11% of all vaginal swabs received from children. The numbers of throat swabs yielding S. pyogenes also showed an increase from 974 in 1986 to 1519 in 1989. A winter peak of isolates was noted for both vaginal swabs and throat swabs. A total of 98 strains from vaginal swabs were serotyped: 22 different types were identified, 61% of which were the common types M4, M6, R28 and M12. Erythromycin sensitivity was done on 89 strains; 84% were highly sensitive (MIC less than 0.03 mg/l). There are no other reports of such large numbers in the literature; the reason for seeing this increase in Nottingham is unclear.

Detection of diphtheria toxin in culture supernates of Corynebacterium diphtheriae and C. ulcerans by immunoassay with monoclonal antibody.

Monoclonal antibody (MAb) to diphtheria toxin was produced in mouse hybridomas, and shown by ELISA to be of sub-class IgG1. Hybridomas were inoculated into mice to produce ascitic fluid from which MAb was purified by caprylic acid. The MAb was shown by immunoblotting to be directed against the A fragment of the toxin and also against the intact toxin molecule. After conjugation with fluorescein isothiocyanate, it was used in an immunoassay to detect toxin in culture supernates of Corynebacterium diphtheriae and C. ulcerans. The assay correlated well with the Elek test and with virulence in guinea-pigs; but it gave occasional false positive results, probably by binding of MAb to defective toxin.

Streptococcal serotypes newly associated with epidemic post-streptococcal acute glomerulonephritis.

The increasing incidence of reported scabies in Trinidad, from 24.2/100,000 population in 1984 to 59.5/100,000 in 1985, led to a careful monitoring in 1986 of all patients with post-streptococcal acute glomerulonephritis (PSAGN). There were 181 cases of PSAGN; 84 beta-haemolytic streptococcal isolates from 72 patients were sent to the Central Public Health Laboratory, Colindale, for grouping and serotyping. The PSAGN epidemic of 1986 was bimodal. Streptococci of M-type 73 appeared to be associated with the first phase (March-May) and comprised 20% of the isolates serotyped. New to Trinidad, streptococci of M-type 48 (4% of the isolates serotyped) preceded the first phase of the epidemic and were isolated from two patients with PSAGN. Provisional type (PT) 5757, also new to Trinidad, had been previously identified only among serotypes from the United Kingdom and the Federal Republic of Germany. This type was isolated from seven patients, in six from skin lesions and in one from the throat. PT 5757 occurred during the first wave of the epidemic and comprised 14% of the strains serotyped. Thus, the first wave of the bimodal epidemic involved serotypes M73, M48 and PT 5757. The more intense second phase (July-October) was associated with the previously documented nephritogenic M-type 55.

The presence of M proteins in outbreak strains of Streptococcus equisimilis T-type 204.

Cultures of Streptococcus equisimilis (Lancefield group C) from three outbreaks of illness were found to carry the T-protein antigen 204. Strains of this type were not otherwise represented in a collection of 743 cultures of these 'pyogenes-like' streptococci isolated from other outbreaks of infection or as random isolates. Two of the three outbreaks were of pharyngitis. The third arose in a maternity unit where the organism was isolated from mothers with puerperal fever, from staff and also from the environment. Representative strains were found to carry M-protein antigens as judged by their ability to survive and multiply in fresh normal human blood. Comparison of absorbed rabbit antiserum to the M antigens in opsonic and precipitin tests showed that a distinct M antigen was present on isolates from one outbreak of sore throat and that all cultures from the other two incidents shared a common M antigen. Samples of serum were also available from patients in the outbreak of puerperal sepsis. Most patients developed antibodies to one or more streptococcal antigens including the M protein, streptolysin O, streptokinase and the hyaluronidase specific for strains of group C and group G streptococci.

Patterns of carriage of group B streptococci in genitourinary medicine clinic patients.

Anogenital carriage of group B streptococci was found in 46% (57/125) of men and 38% (68/179) of women attending a genitourinary medicine clinic. Colonisation with group B streptococci was more common in patients who had a history of more than one sexual partner in the preceding three months, but was not related to any previous sexually transmitted infection. Group B streptococci were isolated from either one or both partners of 28 couples, in 12 of which both partners yielded isolates that were indistinguishable by serotyping and phage typing. Colonisation with matching isolates of group B streptococci was more common in couples who had relatively stable relationships.