Is cystic echinoccocosis re-emerging in western Spain?

Cystic echinococcosis (CE) remains an important health problem in many areas of the world, including the Mediterranean region. We performed a retrospective study of cases reported from 1998 to 2012 in order to review and update the epidemiology of this disease in a highly endemic area situated in western Spain. A total of 471 patients were diagnosed with hydatid disease. Of these cases, 55·8% were male, with an average age of 62·3 ± 19·5 years. More importantly, 1·5% of patients were children, and 20·5% were aged <45 years. An active therapeutic approach was implemented for 92·6% of the CE patients with primary diagnoses; however, a 'watch and wait' strategy was used in 59·3% of all secondary CE diagnoses. The incidence rate of hydatid disease was significantly higher compared to the incidence described in the Notifiable Disease System in this area. Furthermore, a significant decrease in hydatid incidence during the years included in the study was observed (ß = -0·4357, P < 0·001). CE incidence has diminished in recent years, although active transmission remains in paediatric cases. Additionally, CE incidence remains high in our region despite public health plans for its control. The documented incidence of CE disease clearly underestimates the real numbers.

Imported transmissible diseases in minors coming to Spain from low-income areas.

We prospectively studied the prevalence of imported transmissible diseases in 373 immigrant children and adolescents coming from Sub-Saharan Africa, North Africa and Latin America to Salamanca, Spain. The most frequent transmissible diseases in this group were latent tuberculosis (12.7%), chronic hepatitis B virus infection (4.2%), hepatitis C virus infection (2.3%), syphilis (1.5%) and human T-lymphotropic virus type 1 or 2 infections (1.4%). A total of 24.2% of patients had serologic profiles suggesting past hepatitis B virus infection. Anti-human immunodeficiency virus antibodies were not detected in any subject. Largely asymptomatic immigrant children show a high prevalence of communicable diseases. Thus, infectious disease screenings are highly advisable in immigrant children coming from low-income countries.

[Tuberculous otitis media. Report of 3 cases]. / Otitis media tuberculosa. Estudio de 3 casos.

Tuberculous otitis media (TOM) is a rare cause of chronic suppurative infection of the middle ear. Due to that the symptoms and signs are often indistinguishable from those of nontuberculosis chronic otitis media and the fact that the index of suspicion is low, there is frequently a considerable delay prior to diagnosis. This can lead to irreversible complications such as facial nerve paralysis and labyrinthitis. Medical therapy with antituberculous drugs is usually effective. We report three cases with TOM diagnosticated and followed up in our Service from january 1993 to july 2001. Their charts were retrospectively reviewed for relevant historical data, physical findings, complementary studies, treatment and clinical response. We performed a review of the literature, emphasizing that TOM should be considered in the differential diagnosis of chronic otitis media.

Comparative evaluation of selective and nonselective media for primary isolation of Helicobacter pylori from gastric biopsies.

BACKGROUND: In this study, we compared and evaluated the efficacy of five culture media for the primary isolation of Helicobacter pylori from gastric biopsies. MATERIALS AND METHODS: A total of 1,174 biopsies (antrum and corpus) taken from 587 patients were plated in parallel on two selective media--Skirrow's medium and brain-heart infusion (BHI) agar supplemented with 10% sheep blood, polymyxin B, vancomycin, trimethoprim, and amphotericin B (HPA medium), and on three nonselective media--chocolate agar with Isovitalex, Columbia blood agar, and BHI-10% sheep blood agar. RESULTS: An isolation rate of 57.9% (680 of 1,174) was obtained with a combination of all media. HPA medium gave the highest isolation rate, 99.4% (676 of 680). Chocolate agar, Columbia blood agar, brain-heart blood agar, and Skirrow's medium showed very poor performance (23.5%, 28.5%, 65.9%, and 71% of all isolates, respectively). The number of cultures in HPA medium discarded due to contamination was only 2 (0.32%). There was no difference in the positive rate of culture in HPA medium between the antrum and the corpus of the stomach. CONCLUSIONS: The HPA medium is superior to Skirrow's medium and nonselective media in promoting growth of H. pylori and, on the basis of these results, we recommended the use of HPA medium for primary isolation of H. pylori from gastric biopsies.

[Antral biopsy in the prevention of gastric disease]. / Biopsia antral como prevención de la patología gástrica.

Approximately 1% of the gastric neoplasies are nowadays associated with the infection of the gastric mucus by Helicobacter pylori. In view of the fact that its prevalency is very high and that it does not exist any objective and universal estimator in its diagnosis but the digestive endoscopy and biopsy, it is proposed, in candidate patients for a digestive endoscopy, although the explorer observes an endoscopic normality, to carry out, systematically, and antral biopsy for its subsequent diagnosis, treatment and prevention both of the gastric pathology and the infection by Helicobacter pylori.

[Clinical-endoscopic-histologic correlations in gastric pathology. II]. / Correlaciones clínico-endoscópicas-histológicas en patología gástrica II.

Some authors do not accept as valid the clinical diagnosis of gastritis, due to the latter being mainly an anatomical-pathological term. Others, however, argue that such diagnosis may be establish through a correct anamnesis. A cross-sectional study of a hundred and fifty patients undergoing fibrosgastroscopy with antral biopsy and anamnesis, as well as clinical exploration in accordance with specific protocols, has been conducted. We have concluded that there does not exist as symptomatology associated to a concrete pathology, despite the presence of certain symptoms as, for example, the pain, that may be related with certain pathologies (14/20 of those developing H.H.E.D., 22/34 of those developing UB and 7/10 of those developing neoplasia). We also inferred that many of the patients (46/50) with endoscopic and histological normal findings (20/23), present as many as or more symptoms than those with pathological findings. This symptomatology may be due to a somatic disorder that could be hiding the process.

[Clinical-endoscopic-histological correlations in gastric pathology. I]. / Correlaciones clínico-endoscópicas-histológicas en patología gástrica. I.

We have conducted a blind cross-selectional study with 150 consecutive patients undergoing fibrogastroscopy and biopsy of the antral mucosa. The endoscopic sensitivity for the diagnosis of the several types of gastritis, is low (63%), although this technique is highly sensitive for other types of pathology. Consequently, we conclude that, in all endoscopic explorations, at least one biopsy of the antral mucosa must be done, given the anatomopathological definition of gastritis. In addition, the clinical use of this term should be restricted to the histologically demonstrated cases.

[Characteristics of Helicobacter (Campylobacter) pylori infection in our field]. / Características de la infección por Helicobacter (Campylobacter) pylori en nuestro medio.

The presence of helicobacter pylori in the stomach in patients with clinical signs of gastroduodenal disease and its possible relationship with several clinical, endoscopic and anatomopathologic characteristics of the illness were prospectively evaluated in 359 patients. H. pylori was isolated from 388 samples in 216 patients (60% of colonization). In patients with endoscopic and, or, anatomopathologic evidence of gastroduodenal alterations the microorganism was isolated in 67% of the instances whereas it was observed in only 7% of the patients free of such alterations (p less than 0.001). The prevalence was 100% in cases of bulboduodenitis, 77% in patients with peptic ulcer, 66% in cases of gastritis, and 20% in neoplastic patients. The colonization index for duodenal ulcer was 80% and that of gastric ulcer 70%. Among the cases with gastritis the highest index corresponde to the superficial chronic gastritis (82%). We failed to observe clinical signs that allowed to envisage the presence or absence of H. pylori in the gastric mucosa.

Scintigraphic evaluation of lumbosacral pain in brucellosis.

Low back pain is the most frequent rheumatologic manifestation of brucellosis. The diagnosis of brucellar sacroiliitis is hampered by the poor specificity of the clinical data and the poor sensitivity of the radiologic data. In this report, we show that scintigraphy not only increases the sensitivity but also allows an earlier diagnosis of disease and permits the detection of osteoarticular brucellar involvement in areas adjacent to the sacroiliac joint.

[Advances in the diagnosis of pulmonary complications in patients infected with the human immunodeficiency virus]. / Avances en el diagnóstico de las complicaciones pulmonares en pacientes infectados por el virus de la inmunodeficiencia humana.

Lung complications are the main cause of morbi-mortality in patients infected with HIV. In this review, we develop an algorithm with respect to the attitude to be taken when faced with an HIV-positive patient with respiratory affliction. The diagnosis value of non-invasive techniques are evaluated, as well as the right moment to be employed, and other future possibilities. Subsequently, the invasive studies are analysed (fiberoptic bronchoscopy, transbronchial biopsy, bronchial lavage samples). We dedicate a special section to bronchoalveolar lavage and to the test that must be carried out on the samples. Finally, the biological parameters which lead to the prognosis and/or control the treatment evolution of these patients are reviewed.

Seroepidemiological studies on human pulmonary dirofilariasis in Spain.

Preliminary data are presented on a serological survey of the human population of an area with a high prevalence of Dirofilaria immitis infection in dogs. Five per cent of the sera were positive for IgG. Simultaneous radiological study revealed a pulmonary nodule in one of the positive patients, and in this case the evolution of IgG and IgM levels was followed over a period of three months. None of the positive sera reacted with Toxocara canis antigens.

Cardiac tamponade in rheumatoid arthritis.

A 56-year-old woman with definite rheumatoid arthritis developed cardiac tamponade while her disease was both clinically and serologically inactive. To our knowledge such a complication has been reported only once previously.