[Helicobacter pylori infection in the child population in Spain: prevalence, related factors and influence on growth]. / Infección por Helicobacter pylori en población infantil: prevalencia, factores asociados e influencia sobre el crecimiento.

INTRODUCTION: A causal relationship between Helicobacter pylori infection and the occurrence of digestive diseases in adults and children has been proven. Worldwide, the prevalence of H. pylori varies and it is possibly influenced by differences in the level of development. The goals of this study were a) to ascertain the prevalence of H. pylori infection in the child population in Spain, b) to study several factors related to this infection, and c) to establish its possible influence on growth. PATIENTS AND METHODS: We performed a descriptive, cross-sectional survey of a representative sample of children aged 1 to 14 years old. The sample consisted of 284 children (prevalence 5 15 %; accuracy 5 4 %; CI > 95 %), selected at random and stratified by age and sex. A pre-coded questionnaire was used for data collection. Diagnosis of H. pylori was established by detection of H. pylori antigen in stools with enzyme immunoassay. RESULTS: The sample consisted of 144 boys and 140 girls, with a mean age of 6.89 6 4.25 years. The prevalence of H. pylori infection was 15.8 % and progressively increased with age: 1- to 3-year-olds (8.4 %), 4- to 9-year-olds (13.9 %), 10- to 14-year-olds (24 %) (p < 0.05). The prevalence was significantly higher in boys (p < 0.01). Analysis of socio-environmental variables showed a higher H. pylori infection rate in children from families with a low socioeconomic level (p < 0.01), a high rate of overcrowding (p < 0.05), and in immigrants (p < 0.001). The H. pylori infection rate was higher in children with recurrent abdominal pain (p < 0.001) and in those whose parents had suffered from gastroduodenal disease (p < 0.001). H. pylori infection was more frequent in children aged 10 to 14 years old with weight and height percentiles below the 25th percentile (p < 0.05). Comparison of means revealed no significant differences. CONCLUSIONS: The prevalence of H. pylori infection found in our study was slightly lower than that found in other studies carried out in Spain; our data were more similar to those of industrialized countries. H. pylori infection was linked to age, sex and deprived socioeconomic environments, and was more frequent in children with recurrent abdominal pain and in those whose parents suffered from gastroduodenal disease. H. pylori infection did not seem to negatively affect growth in our child population.

[Epidemic outbreak of tuberculosis]. / Brote epidémico de tuberculosis.

OBJECTIVE: To describe how collaboration between epidemiological surveillance and primary and specialist health care centres enabled rapid intervention during an outbreak of tuberculosis in a nursery school. MATERIAL AND METHODS: A child minder was diagnosed with tuberculosis. The persons exposed were identified. These were four child minders and 58 children under 4 years of age. The respective primary care pediatricians carried out a tuberculin test in all of the children. Children with a positive tuberculin test underwent radiological and microbiological study to rule out the disease. The adults underwent the same procedure. RESULTS: Detection among the children was rapid; 32.8 % were infected and six showed alterations in thoracic x-rays and were considered to be ill. In three children Mycobacterium tuberculosis was isolated and was genetically similar to the index case. Primary chemoprophylaxis was carried out in all children with a negative tuberculin test; secondary chemoprophylaxis was administered to infected children and specific treatment to the ill. In all children, evolution was satisfactory. CONCLUSIONS: Periodic surveillance for tuberculosis should be carried out among adults working with children. Genetic study of the strains isolated facilitates epidemiological analysis of these microepidemics.

[Invasive aspergillosis: a study of 20 cases]. / Aspergilosis invasiva: estudio de 20 casos.

OBJECTIVE: To assess the epidemiology of invasive aspergillosis (IA) and the frequency of recognition of this clinical entity. PATIENTS AND METHODS: Retrospective analysis of patients with the diagnosis of IA in the last three years. The diagnostic criteria of the American Institute of Infectious Diseases Mycoses Group were followed. RESULTS: During this period, 20 patients were diagnosed of IA: 9 (45%) had a hematologic malignancy, 14 (70%) had received corticosteroids, five (25%) had neutropenia, and three (15%) had no factors for immunosuppression. The disease was suspected in 15 cases (75%). Aspergillus spp. was recovered from sputum samples of the 16 patients who had the sample obtained. Seventeen patients (85%) died, 12 of them in spite of receiving antifungal therapy. Time relapsed since the beginning of symptoms and therapy was 14 days. CONCLUSIONS: The proportion of patients without neutropenia or severe immunosuppression is higher than usually thought. IA is a clinical entity of difficult diagnosis and occasionally it is diagnosed only at post-mortem examination. The high sensitivity of sputum culture may be due to the selection of cases with more severe infections as stringent diagnostic criteria were used. To improve the prognosis of IA it is necessary to initiate antifungal therapy early in the course of the disease and therefore, a high suspicion index is required, not only of the immunocompromised but also of the immunocompetent patient.

[Hodgkin's disease in patients with infection caused by the human immunodeficiency virus. Study of 9 cases]. / Enfermedad de Hodgkin en pacientes con infección por el virus de la inmunodeficiencia humana. Estudio de 9 casos.

Nine young males with Hodgkin's disease (HD) and antibodies against the human immunodeficiency virus were evaluated. They had been diagnosed since 1984 in three Madrid hospitals: Hospital 12 de Octubre, Hospital Ramón y Cajal, and Clínica Puerta de Hierro. Eight patients were intravenous heroin abusers and one was homosexual. In 8 patients (88.8%) HD presented in advanced stages (III and IV), and in 5 cases (55.5%) the histology corresponded to mixed cell type. Four patients (44.4%) developed opportunistic infections. In the immunological study a reduction of CD4+ lymphocytes below 0.4 X 10(3)/l was found in 5 of 7 patients (71.4%), and an inversion of CD4+/CD8+ ratio in 6 of 7 patients (85.7%). The response to therapy was poor. Five patients died (55.5%). In 4, the direct cause of death was an opportunistic infection. The reasons why we think that HD in patients with HIV infections should be considered as indicating acquired immunodeficiency syndrome are discussed.