RESUMO
Hip hemiarthroplasty (HHA) and total hip arthroplasty (THA) infections are usually considered as one entity; however, they may show important differences. We analyze these differences, as well as predictors of treatment failure (TF) and poor functional status among patients with prosthetic hip infections (PHIs). A multicenter cohort study of consecutive patients with PHIs was performed. The main outcome variable was TF after the first surgical treatment performed to treat the infection. Multivariate analysis was used to identify predictors of TF. A total of 127 patients with PHI were included (43 HHA, 84 THA). Patients with HHA infections were more frequently women (88% vs. 54%; p < 0.001), had comorbidities (86% vs. 67%, p = 0.02), and were older (median age 79 vs. 65 years, p < 0.001), and the reason for arthroplasty was more frequently a fracture (100% vs. 18%, p < 0.001). Failure of initial treatment and crude mortality were more frequent among HHA patients (44% vs. 23%, p = 0.01 and 28% vs. 7%, p = 0.001, respectively). However, HHA was not associated with TF in the multivariate analysis when hip fracture was considered; thus, variables independently associated with TF were hip fracture, inadequate surgical management, prosthesis retention, and higher C-reactive protein level. Failure of the first surgical treatment was associated with poorer functional status. HHA and THA infections showed significant differences in epidemiology, clinical features, and outcome. Although patients with HHA infections had a higher risk of TF, this was related to the reason for hip implant: a hip fracture. Success of the initial management of infection is a predictor of better clinical and functional outcome.
Assuntos
Infecções por Bactérias Gram-Negativas/microbiologia , Prótese de Quadril/efeitos adversos , Infecções Relacionadas à Prótese/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril , Feminino , Infecções por Bactérias Gram-Negativas/mortalidade , Infecções por Bactérias Gram-Negativas/cirurgia , Hemiartroplastia , Fraturas do Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Infecções Relacionadas à Prótese/mortalidade , Infecções Relacionadas à Prótese/cirurgia , Curva ROC , Falha de TratamentoAssuntos
Clostridioides difficile/isolamento & purificação , Infecções por Clostridium/prevenção & controle , Infecção Hospitalar/prevenção & controle , Enterocolite Pseudomembranosa/prevenção & controle , Gastroenterite/prevenção & controle , Controle de Infecções/métodos , Hospitais Universitários , Humanos , Incidência , Vigilância de Evento Sentinela , EspanhaRESUMO
A total of 559 fleas representing four species (Pulex irritans, Ctenocephalides felis, Ctenocephalides canis and Spilopsyllus cuniculi) collected on carnivores (five Iberian lynx Lynx pardinus, six European wildcat Felis silvestris, 10 common genet Genetta genetta, three Eurasian badger Meles meles, 22 red fox Vulpes vulpes, 87 dogs and 23 cats) in Andalusia, southern Spain, were distributed in 156 pools of monospecific flea from each carnivore, and tested for Bartonella infection in an assay based on polymerase chain reaction (PCR) amplification of the 16 S-23 S rRNA intergenic spacer region. Twenty-one samples (13.5%) were positive and the sequence data showed the presence of four different Bartonella species. Bartonella henselae was detected in nine pools of Ctenocephalides felis from cats and dogs and in three pools of Ctenocephalides canis from cats; Bartonella clarridgeiae in Ctenocephalides felis from a cat, and Bartonella alsatica in Spilopsyllus cuniculi from a wildcat. DNA of Bartonella sp., closely related to Bartonella rochalimae, was found in seven pools of Pulex irritans from foxes. This is the first detection of B. alsatica and Bartonella sp. in the Iberian Peninsula. All of these Bartonella species have been implicated as agents of human diseases. The present survey confirms that carnivores are major reservoirs for Bartonella spp.
Assuntos
Infecções por Bartonella/veterinária , Bartonella/isolamento & purificação , Carnívoros/parasitologia , Reservatórios de Doenças/veterinária , Sifonápteros/microbiologia , Animais , Bartonella/genética , Infecções por Bartonella/epidemiologia , Infecções por Bartonella/microbiologia , Sequência de Bases , DNA Bacteriano/química , DNA Bacteriano/genética , DNA Espaçador Ribossômico/química , DNA Espaçador Ribossômico/genética , Reservatórios de Doenças/microbiologia , Dados de Sequência Molecular , Filogenia , Reação em Cadeia da Polimerase , Alinhamento de Sequência , Espanha/epidemiologiaRESUMO
A total of 2,229 adults ticks (1,428 males and 801 females) belonging to the brown dog tick, Rhipicephalus sanguineus Latreille, 1806, collected from dogs in Seville province (Andalusia), distributed in 500 lots ranging from one to eight specimens per lot, were examined for the presence of rickettsiae by molecular techniques. Specific rickettsiae DNA were detected in 90 lots (18%) of ticks tested. Sequence analysis of amplicons revealed that R. sanguineus ticks were infected exclusively with Rickettsia massiliae (including the strain Bar-29). The results of this study extend the knowledge of the geographic distribution and prevalence of these spotted fever group (SFG) rickettsiae and indicate that at least two of them, with yet uncertain pathogenicity to humans, are present in brown dog ticks in south western Spain. Although Mediterranean spotted fever (MSF) is an endemic disease in Andalusia, Rickettsia conorii was not found, whereas R. massiliae, recently described as a pathogenic species, was highly prevalent in this area. Our data suggest that in Andalusia a number of MSF or MSF-like cases attributed to R. conorii could have been actually caused by other SFG rickettsia present in R. sanguineus, particularly, R. massiliae.
Assuntos
Rhipicephalus sanguineus/microbiologia , Rickettsia/isolamento & purificação , Animais , DNA Bacteriano/classificação , DNA Bacteriano/isolamento & purificação , Feminino , Masculino , Rickettsia/classificação , EspanhaRESUMO
Risk-factors for bloodstream infections caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli were investigated using an exploratory case-double control study in which 43 cases (70% producing CTX-M enzymes) were compared with: (i) 86 patients with bacteraemia caused by non-ESBL-producing E. coli; and (ii) 86 hospitalised patients. Previous follow-up as an outpatient, urinary catheterisation and use of oxyimino-beta-lactams or fluoroquinolones were independent risk-factors for ESBL-producing E. coli among patients with E. coli bacteraemia, and previous use of oxyimino-beta-lactams or fluoroquinolones were also independent risk-factors among hospitalised patients. These findings may help in identifying patients at greater risk for bloodstream infection caused by ESBL-producing E. coli in endemic areas.
Assuntos
Bacteriemia/microbiologia , Bacteriemia/prevenção & controle , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Escherichia coli/enzimologia , beta-Lactamases/biossíntese , Idoso , Antibacterianos/administração & dosagem , Estudos de Casos e Controles , Infecções por Escherichia coli/tratamento farmacológico , Feminino , Fluoroquinolonas/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Projetos Piloto , Fatores de Risco , Espanha/epidemiologia , beta-Lactamas/administração & dosagemRESUMO
In southern Spain, Dermacentor marginatus ticks can be infected with several genospecies of spotted fever Group (SFG) Rickettsia. We developed a nested polymerase chain reaction assay by using a species-specific probe targeting the ompA gene to detect and differentiate between the two groups of rickettsiae previously described in D. marginatus. SFG rickettsia has been detected in 85.15% of ticks studied (26.7% of positives have been to R. slovaca, the causative agent of TIBOLA-DEBONEL, and 73.3% to SFG rickettsia closely related to strains RpA4-JL-02-DnS14-DnS28).
Assuntos
Dermacentor/microbiologia , Rickettsia/isolamento & purificação , Animais , Clima , Genótipo , Geografia , Rickettsia/classificação , Rickettsia/genética , EspanhaRESUMO
The presence of Rickettsia felis was investigated in three species of pulicid fleas (Ctenocephalides felis, Ctenocephalides canis and Pulex irritans) collected in 38 locales in Andalusia (Spain) over the period 1999-2004. Amplification of a fragment of OmpB gene was positive in 54.17 % of lots of Ct. felis. The identity of the PCR bands was confirmed as R. felis by sequence data obtained directly from the PCR amplicon. No rickettsia was found in Ct. canis nor P. irritans.
Assuntos
Infecções por Rickettsia/epidemiologia , Rickettsia felis , Sifonápteros/microbiologia , Animais , Geografia , Humanos , Incidência , Infecções por Rickettsia/classificação , Sifonápteros/classificação , Espanha/epidemiologiaRESUMO
Rickettsia typhi and Rickettsia conorii, the etiologic agents of, respectively, murine typhus and Mediterranean spotted fever, are recognized as frequent causes of fever of intermediate duration in southern Spain; in addition, in recent years Rickettsia felis has been detected in potential vectors in this area. Nevertheless, limited data exist regarding the actual prevalence of past infection due to these three pathogens. In the present study, the prevalence of past infection due to R. felis, R. typhi, and R. conorii was determined in a representative population of southern Spain during 2002. In addition, the possible risk factors associated with exposure to these pathogens were investigated. An epidemiological survey was completed by all subjects included in the study. Serum samples were tested by indirect immunofluorescence assay. The prevalence of past infection due to R. felis, R. typhi, and R. conorii among the 504 total subjects was 6.5, 3.8 and 8.7%, respectively. In multivariate analysis, infection due to R. felis was independently associated with a high-risk occupation (one that required working outdoors in nature, close contact with domestic animals, or potential contact with rodents) (OR=5.8; 95%CI 2.1-15.6), while infection due to R. typhi was associated with older age (factor of 1.04 [95%CI 1.008-1.068]) and frequent insect bites (OR=10.3; 95%CI 2.3-45.5). Two factors were associated with infection due to R. conorii: a high-risk occupation (OR=9.3; 95%CI 3.7-23.2), and participation in outdoor activities (OR=7.2; 95%CI 1.4-38.5). The results confirm the widespread prevalence of past infection due to R. felis, R. typhi, and R. conorii in the population of southern Spain.
Assuntos
Febre Botonosa/epidemiologia , Infecções por Rickettsia/epidemiologia , Tifo Endêmico Transmitido por Pulgas/epidemiologia , Adolescente , Adulto , Idoso , Análise de Variância , Criança , Pré-Escolar , Estudos Transversais , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Rickettsia conorii , Rickettsia felis , Rickettsia typhi , Fatores de Risco , Estudos Soroepidemiológicos , Espanha/epidemiologiaRESUMO
The prevalence of past infections due to Bar29 rickettsial strain in a population from Southern Europe, as well as the possible risk factors associated to exposure to this rickettsia, were analysed. Among the 504 subjects included, global prevalence of past infections was 3.4%. Past infections were significantly more frequent in rural areas compared to urban (10.8 vs. 3.2%, OR 3.6 [1.1-12.3], P = .05), and suburban areas (10.8 vs. 1.9%, OR 6.2 [1.3-28.9], P = .02). In multivariate analysis the factors that were independently associated to past infection due to Bar29 strain were higher age (P = .037; factor of 1.033 [1.002-1.066]), and a risk profession (P = .005; OR = 5.7 [1.6-19.6]). These data point towards the presence of past Bar29 strain infections in a population from Southern Spain.
Assuntos
Infecções por Rickettsia/epidemiologia , Rickettsia/isolamento & purificação , Rickettsia/patogenicidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Animais , Anticorpos Antibacterianos/sangue , Criança , Pré-Escolar , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Imunoglobulina G/sangue , Lactente , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Rickettsia/imunologia , Infecções por Rickettsia/imunologia , Infecções por Rickettsia/microbiologia , Fatores de Risco , Espanha/epidemiologiaRESUMO
Human immunodeficiency virus (HIV) codes for a protein, Rev, that mediates the viral RNA export from the nucleus to the cytoplasm. Recently, it has been found that Sam68, the substrate of Src associated in mitosis, is a functional homologue of Rev, and a synergistic activator of Rev activity. Thus, it has been suggested that Sam68 may play an important role in the post-transcriptional regulation of HIV. Sam68 contains an RNA binding motif named KH [homology to the nuclear ribonucleoprotein (hnRNP) K]. Tyrosine phosphorylation of Sam68 and binding to SH3 domains have been found to negatively regulate its RNA binding capacity. Besides, tyrosine phosphorylation of Sam68 allows the formation of signalling complexes with other proteins containing SH2 and SH3 domains, suggesting a role in signal transduction of different systems in human lymphocytes, such as the T cell receptor, and leptin receptor, or the insulin receptor in other cell types. In the present work, we have found that Sam68 is tyrosine phosphorylated in peripheral blood mononuclear cells (PBMC) from HIV infected subjects, leading to the formation of signalling complexes with p85 the regulatory subunit of PI3K, GAP and STAT-3, and decreasing its RNA binding capacity. In contrast, PBMC from HIV infected subjects have lower expression levels of Sam68 compared with controls. These results suggest that Sam68 may play some role in the immune function of lymphocytes in HIV infection.
Assuntos
Infecções por HIV/imunologia , Leucócitos Mononucleares/imunologia , Fosfotirosina/metabolismo , Proteínas de Ligação a RNA/metabolismo , Transdução de Sinais/fisiologia , Proteínas Adaptadoras de Transdução de Sinal , Adulto , Western Blotting , Proteínas de Ligação a DNA , Infecções por HIV/metabolismo , Humanos , Immunoblotting/métodos , Imunoprecipitação , Ligação Proteica , RNA/metabolismo , RNA Mensageiro/análise , Proteínas de Ligação a RNA/genética , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
A cohort study was performed to investigate the risk factors for colonization with high-level aminoglycoside-resistant enterococci (HLARE) in intensive care unit (ICU) patients. Colonization was investigated by performing surveillance samples during ICU stay. Clonal relatedness of the isolates was assessed by pulsed-field gel electrophoresis. Eighty-six patients with an ICU stay of >48 h were included; two were colonized with HLARE at admission, and 24 (28.5%) acquired HLARE during their stay in the ICU. HLARE were initially isolated from rectal swabs alone. Thirty-five percent of Enterococcus faecalis and 57% of E. faecium showed high-level resistance to gentamicin or streptomycin. Most isolates were clonally unrelated. Using multi-variate analysis, the only variable associated with HLARE colonization was previous antimicrobial use. Five patients had HLARE isolated from clinical samples, three of them with infection; in all of these, colonization with the same clone had been detected previously by surveillance samples. We conclude that most infections due to HLARE in the ICU are preceded by previous colonization, and that antimicrobial use is the main risk factor for colonization.
Assuntos
Aminoglicosídeos/farmacologia , Infecção Hospitalar/epidemiologia , Farmacorresistência Bacteriana , Enterococcus/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Antibacterianos/farmacologia , Estudos de Coortes , Infecção Hospitalar/microbiologia , Impressões Digitais de DNA , DNA Bacteriano/genética , Eletroforese em Gel de Campo Pulsado , Enterococcus/isolamento & purificação , Enterococcus faecalis/efeitos dos fármacos , Enterococcus faecium/efeitos dos fármacos , Feminino , Genótipo , Gentamicinas/farmacologia , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Masculino , Epidemiologia Molecular , Fatores de Risco , Espanha/epidemiologia , Estreptomicina/farmacologiaRESUMO
Four immunocompetent adults presented with protracted fever lasting > 6 weeks and severe weight loss, associated with primary cytomegalovirus (CMV) infection. Each patient had spleen enlargement, lymphocytosis and hypertriglyceridaemia, but recovered spontaneously. A further 20 immunocompetent patients with primary CMV infection were also reviewed, and all presented the usual clinical picture of CMV mononucleosis. It was concluded that CMV mononucleosis should be considered in the differential diagnosis in patients with prolonged fever and weight loss if lymphocytosis is present.
Assuntos
Infecções por Citomegalovirus/fisiopatologia , Febre/etiologia , Imunocompetência , Mononucleose Infecciosa/fisiopatologia , Redução de Peso , Adulto , Idoso , Humanos , MasculinoRESUMO
Leptin, the 16 kDa product of the ob gene, is a an adipocyte-secreted hormone that centrally regulates weight. However, the physiological role of leptin is not limited to the regulation of food intake and energy expenditure, and leptin has a variety of effects in peripheral tissues, such as a regulatory role modulating the immune system. Thus, leptin receptor is expressed in human peripheral blood mononuclear cells, mediating the leptin stimulation of proliferation and activation, the production of proinflammatory cytokines from cultured monocytes, and the prevention of apoptotic death in serum-deprived monocytes. Because leptin can stimulate monocytes and the production of reactive oxygen species (ROS) are the result of monocyte activation, we investigated the effect of leptin on ROS production by human monocytes in vitro. Oxidative burst was measured by oxidation of the redox-sensitive dye 2',7'-dichlorofluorescein diacetate, and analysed by flow cytometry. We have found that stimulation with leptin produces oxygen radical formation by monocytes. This effect is dependent on the dose and maximal response is achieved at 10 nM leptin. Because HIV infection induces the production of ROS, we next investigated the effect of leptin on ROS production in monocytes from HIV-positive (HIV+) subjects. We have also found that monocytes from HIV+ subjects spontaneously produced increased amounts of free radicals. In contrast, leptin stimulation of monocytes from these patients partially inhibited the production of ROS. This effect of leptin was also dependent on the dose and maximal effect was achieved at 10 nM. The effect of leptin stimulating the production of ROS is consistent with the proinflammatory role in the immune system. On the other hand, the inhibitory effect on monocytes from HIV+ subjects may be explained by the attenuation of the oxidative burst by a delayed activation of monocytes in a hyperinflammatory state.
Assuntos
Infecções por HIV/metabolismo , HIV-1 , Leptina/farmacologia , Monócitos/metabolismo , Adulto , Estudos de Casos e Controles , Células Cultivadas , Feminino , Citometria de Fluxo , Infecções por HIV/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Monócitos/efeitos dos fármacos , Espécies Reativas de Oxigênio/metabolismo , Explosão Respiratória/efeitos dos fármacos , Estimulação QuímicaRESUMO
OBJECTIVE: To ascertain the factors affecting the time between the initiation of treatment and obtaining three negative sputum smears. DESIGN: In a study of 109 patients with pulmonary tuberculosis, the main variable was the period during which the patients had sputum smears once treatment was initiated. Multivariate analysis (multiple linear regression) was performed to document those variables independently associated with time to conversion. RESULTS: The patients had positive smears for a mean of 28.63 days. The most frequent radiographic pattern was cavitary disease (36.7%). HIV co-infection was present in 38.5% of the patients. HIV-infected patients showed a cavitation pattern in only 9.6% vs 52.2% of patients without HIV infection (P < 0.001). The variables that showed a statistically significant and independent relationship with the time to sputum smear conversion were pulmonary radiographic pattern, age and erythrocyte sedimentation rate (ESR). CONCLUSIONS: ESR, age and the presence of cavitary disease seem to be factors associated with a longer time to sputum smear conversion in patients with active pulmonary tuberculosis. However, HIV co-infection is associated with a shorter time to sputum conversion. A key factor is therefore the presence or not of cavitation, independently of HIV infection.
Assuntos
Escarro/microbiologia , Tuberculose Pulmonar/tratamento farmacológico , Adulto , Sedimentação Sanguínea , Comorbidade , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Análise Multivariada , Tuberculose Pulmonar/epidemiologiaRESUMO
Leptin, the Ob gene product, is an adipocyte hormone that centrally regulates weight control. In addition, other effects of leptin in peripheral tissues have been described. Thus, leptin has been found to regulate reproduction, haematopoiesis and immune function. We have found recently that leptin has a stimulatory effect on human peripheral blood mononuclear cells (PBMC). Monocytes are activated by leptin alone whereas T lymphocytes need a suboptimal stimulus of PHA or ConA before further activation by leptin. These effects are mediated by the long isoform of the leptin receptor, which has been shown to trigger signalling in PBMC. In fact, we have found that human leptin stimulates Janus kinase (JAK)-signal transducer and activator of transcription (STAT), phosphatidylinositol 3-kinase (PI3K) and mitogen-activated protein kinase (MAPK) pathways in PBMC. In order to assess possible regulation of the long isoform of the leptin receptor (Ob-R) in mononuclear cells upon activation, we have studied the expression of Ob-R by RT-PCR and Western blotting in PBMC activated in vitro by PHA or ConA and in vivo in HIV-infected patients. We have found that in vitro activation and in vivo HIV infection correlates with an increase in leptin receptor expression in PBMC. Moreover, the leptin receptor is tyrosine phosphorylated in PBMC from HIV-infected patients, suggesting that the leptin receptor is activated. These results are consistent with the suggested role of leptin in modulating the immune response.
Assuntos
Proteínas de Transporte/biossíntese , Regulação da Expressão Gênica , Infecções por HIV/imunologia , Leptina/fisiologia , Ativação Linfocitária/genética , Isoformas de Proteínas/biossíntese , Receptores de Superfície Celular , Linfócitos T/metabolismo , Adolescente , Adulto , Proteínas de Transporte/efeitos dos fármacos , Proteínas de Transporte/genética , Proteínas de Transporte/fisiologia , Células Cultivadas/metabolismo , Criança , Concanavalina A/farmacologia , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Infecções por HIV/complicações , Hepatite C/complicações , Hepatite C/imunologia , Humanos , Leptina/farmacologia , Ativação Linfocitária/efeitos dos fármacos , Masculino , Fosforilação , Fito-Hemaglutininas/farmacologia , Isoformas de Proteínas/efeitos dos fármacos , Isoformas de Proteínas/genética , Isoformas de Proteínas/fisiologia , Processamento de Proteína Pós-Traducional , RNA Mensageiro/biossíntese , Receptores para Leptina , Proteínas Recombinantes/farmacologia , Transdução de Sinais/efeitos dos fármacos , Linfócitos T/efeitos dos fármacosRESUMO
OBJECTIVE: To know the characteristics of nocardiosis in HIV infected patients. PATIENTS AND METHODS: Retrospective analysis of HIV infected patients with a concomitant Nocardia spp. infection in nine Andalusian hospitals. RESULTS: Eighteen cases of nocardiosis were studied. Seventeen patients were males and the mean age was 33.1 years. The risk behaviour for acquiring HIV infection was parenteral drug use in 15 patients (83.3%) and seven of them were active users when acquiring nocardiosis. The mean CD4 lymphocyte count was 66.3 106/l. The nocardiosis was manifested as disseminated disease in eight patients, only pulmonary disease in four cases, lymphocutaneous or soft-tissue nocardiosis in five, and pericarditis in the remaining patient. In the ten cases with pulmonary involvement, the chest X-ray revealed an alveolar, interstitial, and mixed pattern in five, three, and two patients, respectively. Most patients were treated with cotrimoxazole, with good clinical and microbiological responses in 88.8% of them. Some surgical procedures were required in six patients. Eight patients died, three on account of nocardiosis and five on account of other causes. There were three relapses. CONCLUSIONS: Nocardia spp. infection is rare among patients with AIDS and occurs in immunosuppressed patients and drug users. The pulmonary, cutaneous, and soft-tissue were the most commonly observed forms in our series. Despite the high frequency of disseminated infection, the response to th
Assuntos
Soropositividade para HIV/epidemiologia , Nocardiose/epidemiologia , Adulto , Anti-Infecciosos/uso terapêutico , Antígenos CD4/imunologia , Feminino , Humanos , Masculino , Nocardiose/tratamento farmacológico , Nocardiose/imunologia , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoRESUMO
BACKGROUND: The aim of the present study was to analyze the diagnostic profitability of echography as an indicator of extrapulmonary tuberculosis in patients with HIV infection. PATIENTS AND METHODS: HIV positive patients presenting fever of long duration were prospectively studied with an active search for specific echographic lesions. Descriptive statistics were performed by variance analysis. The diagnostic profitability of echography was evaluated by the calculation of sensitivity, specificity, positive predictive values (PPV) and negative predictive value (NPV). RESULTS: Criteria of prolonged fever was fulfilled by 116 patients. Thirty-five (30.2%) presented specific echographic alterations: 12 had multiple hyoechoic splenic lesions (34.3%), 11 abdominal adenopathies (31.4%), 9 splenic lesions and adenopathies (25.7%) and 3 showed hepato-splenic involvement and adenopathies (8.6%). The final diagnoses of these patients were: one case of toxoplasmosis, 2 MAI infection, 7 with no definitive diagnosis, and 25 (71.4%) tuberculosis. The mean CD4 lymphocyte count was 46.6 x 10(6)/L in patients with tuberculosis with no echographic findings, with a statistically significant difference of p < 0.05. The appearance of some echographic alterations had a global sensitivity of 37.3%, a specificity of 79.6% a PPV of 0.65 and a NPV of 0.51. The isolated findings of hypoechoic splenic lesions showed a sensitivity of 19.23%, a specificity of 95.12%, a PPV of 0.83 and a NPV of 0.47. CONCLUSIONS: The presence of multiple hypoechoic splenic lesions showed an elevated specificity, being greater than 95%, making this finding, although infrequent, that of greatest diagnostic profitability in the echographic study of tuberculosis. We therefore consider abdominal echography to be of great usefulness in the evaluation of patients with HIV infection and prolonged fever since the presence of these lesions, in the most severely immunosuppressed patients, may strongly suggest the diagnosis of extrapulmonary tuberculosis.
Assuntos
Abdome/diagnóstico por imagem , Infecções por HIV/complicações , Tuberculose Gastrointestinal/diagnóstico por imagem , Adulto , Humanos , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Tuberculose Gastrointestinal/complicações , UltrassonografiaRESUMO
An undescribed rickettsia was directly analyzed with specific rickettsial molecular biology tools on Ixodes ricinus L. collected in different localities of the province of Cadiz (southwestern Spain). On the basis of the results of the citrate synthase (glta) gene, 190 kD-outer membrane protein (rOmpA) gene, and 16S ribosomal RNA (16S rRNA) gene partial sequence data, it was found that this rickettsia is sufficiently genetically distinct from other Rickettsia to be considered a distinct taxonomic entity. The isolation and culture of this organism, as well as comparative antigenic analysis, are required to ensure its conclusive taxonomic placement among spotted fever rickettsiae. The epidemiologic role of this new rickettsial agent and its possible pathogenicity to wild and domestic animals or humans is still unknown and needs to be investigated.