First epidemic of aseptic meningitis due to echovirus type 13 among Spanish children.

Echoviruses are the commonest cause of aseptic meningitis (AM). Echovirus type 13 (EV-13) was the second enterovirus serotype associated with different local outbreaks of AM in Spain between February and October 2000. It was the first time that an epidemic AM caused by this virus was recognized in Spain. The index case appeared in the Canary Islands (Canarias). The EV-13 virus was isolated from 135 patients, predominantly from cerebrospinal fluid (CSF). All isolates were from children under 13 years. The age specific peak incidence was in infants under 1 year. Most patients had fever, headache and other meningeal signs. This enterovirus serotype, not previously detected in Spain, caused severe illness with a high attack rate.

Cidofovir treatment of human polyomavirus-associated acute haemorrhagic cystitis.

We report the case of an 18-year-old patient who received an allogeneic bone marrow transplant from an HLA-identical unrelated donor for a Ph+ acute lymphoblastic leukemia, in his third complete remission. Cyclophosphamide and busulfan were used as conditioning treatment. Acute graft-versus-host disease developed on day +9, and the response to adequate treatment (steroids) was favourable. On day +45 the patient developed an acute severe haemorhragic cystitis, and BK polyomavirus was demonstrated in urine samples using electron microscopy and polymerase chain reaction. Urinary symptoms did not improve in spite of palliative treatment, but a response was evident after 2 weeks of cidofovir treatment.

Intra-muscular vidarabine therapy for polyomavirus-associated hemorrhagic cystitis following allogeneic hemopoietic stem cell transplantation.

Hemorrhagic cystitis (HC) is a common complication following hemopoietic stem cell transplantation (HSCT), its incidence ranging from 7 to 52% of all patients. Late occurring HC frequently results from viral infections. We describe a patient who developed severe polyomavirus-associated HC, which responded dramatically to a single dose of intra-muscular vidarabine. Previous studies show an improvement in HC with vidarabine therapy, but to date only the intravenous route of administration has been described and responses described take from several days to weeks. This report confirms the safety and efficacy of vidarabine administered intramuscularly when used in patients with an adequate platelet count, thereby making its use feasible when intravenous vidarabine is not available.

Cerebral toxoplasmosis and Guillain-Barré syndrome after allogeneic peripheral stem cell transplantation.

We report an unusual case of cerebral toxoplasmosis associated with Guillain-Barré syndrome (GBS) in a 25-year-old patient diagnosed with chronic myelogenous leukaemia (CML), who underwent a mismatched allogeneic peripheral stem cell transplantation (PSCT). On day +83 he started with fever, and 7 days later tremor, muscular weakness, diplopia, dysarthria, respiratory difficulty, and universal arreflexia appeared, compatible with GBS. As the patient had a positive cytomegalovirus (CMV) antigenemia, this was the aetiology suspected for his neurologic findings, but specific treatment failed to improve his clinical situation, and he died on day +123. Necropsy demonstrated cerebral toxoplasmosis and axonal degeneration of nerve roots compatible with the axonal form of GBS. Interestingly, the polymerase chain reaction (PCR) signal for Toxoplasma gondii in two different cerebrospinal fluid (CSF) samples had been negative. In addition, this case showed unique magnetic resonance imaging (MRI) abnormalities. We conclude that a negative PCR on CSF cannot exclude toxoplasmosis in a transplant patient, and we emphasise the importance of considering Toxoplasma as an aetiology of fever and neurological symptoms in the transplant setting.

A serological survey and review of clinical Lyme borreliosis in Spain.

A serosurvey for Lyme disease was conducted by the National Reference Center for Microbiology in Spain. All serum specimens received from patients with erythema migrans (EM), arthritis, and cardiac and neurological disorders were tested for antibodies to Borrelia burgdorferi. Sera from 499 patients were tested. Of these patients, 310 had neurological disease, 101 had carditis, 79 had arthropathies, and 9 had EM; for 35 patients, a diagnosis of Lyme disease was confirmed. Of these 35, 68% had neurological disease, 6% had carditis, and 26% had EM. Twelve probable cases of Lyme disease were noted. The male-to-female ratio of patients with confirmed or probable disease was 1.6; all age groups were represented, but 25% of patients were within the age group of 0-9 years. The number of cases of Lyme disease decreases from the north of Spain (41%) to the south (26%), a distribution that is in agreement with the known range of Ixodes ricinus. Borrelia burgdorferi is a frequent cause of infection in some areas of Spain. It is possible that relapsing fever accounts for some of the serological reactivity to B. burgdorferi in residents of the south of Spain.

[Longitudinal study of mycobacteriosis, 1983-1987]. / Estudio longitudinal de micobacteriosis, 1983-1987.

The results obtained in the CNMVIS from 1983 to 1987 are reported for the different mycobacterial species identified, the susceptibility of M. tuberculosis to drugs, and the age and sex distribution of the infected patients, to provide additional data regarding the status of mycobacteriosis in this country. 3682 of the 4,015 isolated mycobacteria were identified as tuberculous; among these, the vast majority (99.4%) corresponded to M. tuberculosis. The other mycobacterial species amounted to 25 varieties. On the other hand, no significant changes developed during the five year period regarding predominance of the different species. Primary resistance of M. tuberculosis to chemotherapeutic agents was observed in 7.5% of instances, and acquired resistance in 25.4%; isoniazid, streptomycin and rifampin were the drugs to which resistance more commonly developed. The sex distribution of the affected individuals disclosed a mean males/females ratio of 3.7:1, as shown in similar studies. However, the age distribution did not fit with the reported pattern for other european countries, as in our study there was a greater frequency of tuberculosis in young adults aged 20-39 years.

[Heterosexual transmission of HIV infection, Madrid 1987]. / Transmisión heterosexual de la infección por VIH, Madrid 1987.

Seven males of 132 (5%) and 9 females of 85 (10%) out of 217 heterosexual individuals without addiction to drugs or previous blood transfusion who attended a STD clinic in Madrid because they had high risk sexual partners were found to have antiHIV antibodies by ELISA and immunofluorescence (CNMVIS). However, when variables such as sex, promiscuity and sexual habits were correlated with HIV infection, significant differences were not found between seropositive and seronegative individuals (kappa 2, p greater than 0.05). Among the factors statistically linked with the infection (kappa 2, p less than 0.05) there were the previous STD and the sustained sexual intercourse with proven HIV seropositive individuals: there 8 infected individuals out of 40 with such type of partners (relative risk 4.4). On the other hand, the partners of individuals with unknown serological findings had the following results: 4 seropositive individuals out of 71 partners of parenteral drug abusers, 3 of 82 users of prostitutes, and 1 infected individual out of the 24 remaining ones (partners of bisexual individuals or combinations) (relative risk of each of them less than 1). These results show the importance of heterosexual, not mediated by blood, HIV transmission in couples of high risk persons, and they suggest that the infection is highly likely if sexual intercourse is maintained with infected individuals irrespective of their sex.

Generalised tuberculosis in a patient with acquired immunodeficiency syndrome.

We describe a heroin addict who presented with cellular immunodeficiency, generalised tuberculosis, and pneumonia caused by Pneumocystis carinii, and discuss the risk of these associations.

[Acute gastroenteritis caused by rotavirus (author's transl)]. / Gastroenteritis aguda por rotavirus.

A prospective study of 87 children hospital admitted for acute gastroenteritis [AGE] with ages between 24 days and three years and a control group of 32 children with ages between six months and three years, is presented. In all cases a virological study of stools is made by electron microscopy [E/M]. In 63 percent of the 87 patients with AGE, viruses were isolated, being rotavirus the most common, 45.9 percent, a similar incidence as that found in developed countries. The clinical course and analytical findings within the groups with viral and non-viral AGE do not show significant differences. Special stress is set upon the reliability of the E/M technique on the stools for rotavirus induced AGE diagnosis, due to the good correlation with clinical data, presence of seroconversion and the finding of virus in duodenal juice. Results of intestinal biopsy in a certain group of children are shown.