Caracterización de Candida spp. aisladas a partir de urocultivos en la ciudad de Medellín / Characterization of Candida spp isolated from urine cultures of Medellín

Resumen Candida spp. es un agente etiológico importante en infecciones del tracto urinario, principalmente en población con terapia antimicótica de amplio espectro y con catéteres urinarios. Candida albicans es la especie más frecuente, pero otras especies han surgido como patógenos emergentes. En este trabajo se recolectaron aislamientos de Candida spp. de urocultivos de pacientes que consultaron en Dinamica IPS entre enero 2016 y noviembre 2017. Para estimar la frecuencia de las especies y observar los patrones de sensibilidad, se realizó la identificación fenotípica y su perfil de sensibilidad con el sistema comercial Vitek 2® (BioMérieux, Inc.), adicionalmente se evaluaron mediante análisis de las secuencia y filogenética ITS1-5.8S-ITS2. En el estudio se incluyeron 78 aislamientos de Candida spp. Las frecuencias de especies de Candida identificadas empleando las herramientas moleculares fueron: C. albicans (38,5%), C. tropicalis (23,1%), C. glabrata (21,8%), C. parapsilosis (10,3%), C. metapsilosis y C. krusei (2,5%) y C. guillermondi (1,3%). La identificación por métodos moleculares y por el sistema Vitek 2 fue: C. albicans (93,3%), C. glabrata (94,1%), C. tropicalis (83,3%), C. parapsilosis (75%) C. guilliermondii y C. krusei (100%). La sensibilidad de todos los aislamientos al fluconazol fue 93,6%.

Abstract Candida spp is an important etiologic agent in urinary tract infections, mainly in patients in broad-spectrum antifungal therapy, with urinary catheters. Candida albicans is the most frequent specie; but other species have arised as emerging pathogens. In this study, isolates of Candida spp. of urine cultures from patients who consulted in Dinamica IPS between January 2016 and November 2017 were evaluated. To estimate the frequency of the species and to observe the sensitivity patterns, the phenotypic identification and its sensitivity profile was performed employed the Vitek 2® commercial system. (BioMérieux, Inc) In addition the isolates were evaluated by sequence analysis and phylogenetics ITS1-5.8S-ITS2. This study included 78 isolates of Candida spp. The frequencies of Candida species identified using the molecular tools were: C. albicans (38.5%), C. tropicalis (23.1%), C. glabrata (21.8%), C. parapsilosis (10.3%), C. guillermondi (1.3%) and C. metapsilosis and C. krusei (2.5%). The identification by molecular methods and by Vitek 2 system were: C. albicans (93.3%), for C. glabrata (94.1%), C. tropicalis (83.3%), C. parapsilosis (75%) and 100% for C. guilliermondii and C. krusei.. fluconazole sensitivity of all isolates was 93.6%

Evaluación de una técnica de PCR en tiempo real para determinar colonización por Streptococcusagalactiae en mujeres gestantes de Medellín que consultan en Dinamica IPS / Evaluation of a real-time PCR technique to determine colonization by Streptococcus agalactiae in pregnant women of Medellín who consult in Dinamica IPS

Objetivo: Evaluar una técnica de PCR en tiempo real para determinar colonización por Streptococcus agalactiae en mujeres gestantes de Medellín. Materiales Y Métodos: Se realizó un estudio descriptivo prospectivo, en 150 mujeres gestantes, seleccionadas de forma aleatoria, en una IPS en el periodo comprendido entre Enero-Julio 2016. Criterio de inclusión: Ser gestante entre la semana 35-37, declaración voluntaria de participación en el estudio y de exclusión el uso de antibióticos. A las pacientes, se les tomó muestra con hisopo de lintroito vaginal y de la región anal. Las muestras se procesaron para qPCR, cultivo en caldo selectivo con posterior siembra en agar sangre de carnero y medio cromogénico para S. agalactiae STRB (ChromIDTMStrepto,BioMérieuxSA.). Resultados: La prevalencia de colonización por S. agalactiae en las gestantes fue de 20,9% y 22,3% en agar sangre y agar cromogénico STRB respectivamente, mientras que mediante PCR en tiempo real la prevalencia fue de 36%. Al comparar la qPCR con la prueba de oro se encontró: sensibilidad 79,31% (ICdel95%:0,61-0,90), especificidad 75,45% (IC del 95%: 0,66-0,82), valor predictivo positivo 46% (IC del 95%:0,32-0,59) y negativo 93,2% (IC del 95%: 0,86-0,96). Discusión: Elempleo de la qPCR permitió aumentar la sensibilidad y la oportunidad diagnostica (Eltiempo requerido empleando elcultivo fue de 24-48 Horas y por qPCR 6 horas) ,impactando la reducción de riesgos de transmisión neonata lde S.agalactiae, lo cualpodría representar una Disminución en días de estancia y costos hospitalarios por una infección prevenible.

Materials and Methods: A prospective and descriptive study was conducted in 150 pregnant women, randomly selected, at an IPS between January and July 2016. Inclusion criteria: gestation period week 35-37, voluntary declaration of participation in the study. Exclusion criteria: the use of antibiotics. Samples were taken from the vaginal introitus and the anal region using a hyssop and processed for qPCR as well as the gold standard test [selective broth culture with subsequent culture in blood agar and chromogenic medium for S. agalactiae STRB (ChromIDTMStrepto, BioMérieux SA)]. Results: The prevalence of colonization by S. agalactiae in pregnant women was 20.9% and 22.3% in blood agar and chromogenic agar STRB respectively, where as using qPCR the prevalence was 36.0%. The time required using the culture was 24-48h compared to 6h for qPCR. Our data comparing qPCR with the gold standard test showed: sensitivity 79.31% (95% CI: 0.61-0.90), specificity 75.45% (95% CI: 0.66-0.82), positive predictive value 46.0% (95% CI: 0.32-0.59) and negative 93.2%(95% CI: 0.86-0.96). Discussion: The use of the qPCR increased the sensitivity and the diagnostic opportunity (4x to 8x faster using qPCR), which can lead to a decrease in the risk of neonatal transmission of S. agalactiae and result in a reduction in the length of hospital stay and costs induced by a preventable infection.

Detección de Helicobacter pylori en muestras de agua y biopelícula de los grifos de las instituciones educativas oficiales en la ciudad de Medellín / Detection of Helicobacter pylori in water and biofilm samples from faucets of official educational institutions in the city of Medellin

Resumen Introducción: Helicobacter pylori (Hp) es uno de los agentes infecciosos etiológico de la gastritis crónica, el linfoma de MALT, el adenocarcinoma gástrico y del cáncer gástrico y puede ser transmitido a través del agua. Objetivo: determinar la presencia de Hp por medio de cultivos y PCR en muestras de agua y biopelícula de los grifos de las instituciones educativas oficiales de la ciudad de Medellín, y la presencia de algunos factores de riesgo para la contaminación del agua. Material y métodos: en 194 instituciones educativas del municipio de Medellín, 2010-2011, se tomó una muestra de agua y biopelícula del grifo, las cuales se sembraron en agar HPSPA y se les realizó una prueba de PCR directa convencional con el gen ureA. Además, se realizó una encuesta para evaluar factores de riesgo como antigüedad de la edificación, estado físico y material de los grifos, presencia de tanques o pozos de agua para consumo, disponibilidad de agua potable y disponibilidad de fuentes de agua diferentes a las del acueducto municipal. Resultados: la frecuencia de ADN de Hp por la prueba de PCR en agua y biopelículas fue del 2.1% en cada tipo de muestra y por cultivo fue de 11.3% tanto en agua como en biopelícula. Las muestras de agua positivas por PCR correspondieron a las instituciones educativas ubicadas en Manrique, Villa Hermosa, San Javier y Guayabal, Las muestras de biopelículas positivas estuvieron en los barrios Popular, Villa Hermosa, Palmitas y en Santa Elena. Conclusiones: Hp fue detectado en las muestras de agua y biopelícula obtenidas de las instituciones educativas oficiales de Medellín y se pudo determinar por cultivo en HPSPA y por PCR con el gen ureA. Sin embargo, ninguno de los factores de riesgo estudiados fueron predictores para la contaminación. (Acta Med Colomb 2017; 42: 121-128).

Abstract Introduction: Helicobacter pylori (Hp) is one of the etiological infectious agents of chronic gastritis, MALT lymphoma, gastric adenocarcinoma and gastric cancer and can be transmitted through water. Objective: to determine the presence of Hp by means of cultures and PCR in samples of water and biofilm of the faucets of the official educational institutions of the city of Medellin, and the presence of some risk factors for water contamination. Material and methods: In 194 educational institutions of the municipality of Medellin, 20102011, a sample of water and biofilm of faucet was taken and planted on HPSPA agar and a conventional direct PCR test was performed with the ureA gene. In addition, a survey to evaluate risk factors such as age of the building, physical and material condition of faucets, presence of water tanks or wells for consumption, availability of drinking water and availability of water sources other than those of the municipal aqueduct was carried out. Results: the frequency of Hp DNA by PCR test in water and biofilms was 2.1% in each type of sample and by culture was 11.3% in both water and biofilm. The positive water samples by PCR corresponded to the educational institutions located in Manrique, Villa Hermosa, San Javier and Guayabal. Positive biofilm samples were found in Popular, Villa Hermosa, Palmitas and Santa Elena districts. Conclusions: Hp was detected in the water and biofilm samples obtained from the official educational institutions of Medellin and could be determined by culture in HPSPA and by PCR with the ureA gene. However, none of the risk factors studied were predictors of contamination. (Acta Med Colomb 2017; 42: 121-128).

Reproducibilidad en la lectura de un set de placas de citología cérvico-uterinas en cuatro centros especializados de Medellín, Antioquia / Reproducibility of reading a set of cervical cytology smears in four specialized centers in Medellin, Antioquia

OBJETIVO: evaluar el grado de reproducibilidad en la lectura de placas de citología cérvico-uterina entre cuatro centros de lectura especializados de la ciudad de Medellín, Colombia. METODOLOGIA: 181 placas de citología cérvico-uterina provenientes de un estudio de prevalencia de anormalidades citológicas en Pueblorrico, Antioquia, se sometieron a lectura en cuatro centros especializados de Medellín. Se le pidió a cada centro que realizara una lectura rutinaria manteniendo el estudio en ciego por medio de recodificación de las placas, evitando que se filtrara información entre centros. Se calculó la concordancia general y el índice kappa de Fleiss. RESULTADOS : de las 181 placas, sólo en 55 placas los 4 centros concordaron en el resultado, obteniéndose un porcentaje de concordancia global del 30% y un índice kappa global de 0,31. Según la escala de Fleiss, se observó una baja reproducibilidad en la lectura de las placas citológicas entre los cuatro centros involucrados en el estudio. La concordancia por pares de centros presentó índices de kappa entre 0,3 a 0,7. CONCLUSION:existe una alta variabilidad en la interpretación de los resultados citológicos entre los centros estudiados. Es necesario implementar procesos de entrenamiento y unificación de criterios de lecturas de la citología cervical en nuestro medio.

OBJECTIVE: to assess the degree of reproducibility in the reading of cervical cytology smears among four specialized reading centers at Medellin, Colombia.. METHODOLOGY: 181 cervical cytology smears from a study on the prevalence of cytological abnormalities in Pueblorrico, a town located in the southwestern region of the state of Antioquia in Colombia, were re-read by four specialized centers in Medellin. Each center was asked to conduct a blind routine reading of the smears to avoid disclosure of information between centers. The reproducibility was measured by percentage agreement and kappa. RESULTS :of 181 smears only 55 matched across all 4 centers, with an overall concordance rate of 30% and an overall kappa of 0.31. According to Fleiss scale, poor reproducibility was observed. The concordance between pairs of centers ranged between 0.3 y 0.7. DISCUSSION:there is a high variability in the interpretation of cytological results among centers in Medellin. It is necessary to implement training processes and to unify readings for cervical cytology criteria.

Age-specific seroprevalence of human papillomavirus 16, 18, 31, and 58 in women of a rural town of Colombia.

OBJECTIVE: The study's objective was to estimate human papillomavirus (HPV) genotype-specific seroprevalence to determine population HPV exposure and inform vaccine policy. METHODS: This study is a cross-sectional prevalence survey of 878 women of Pueblorrico, a rural town of Colombia. A standardized questionnaire was used to obtain information on demographic characteristics, sexual and reproductive history, and smoking habits. Seropositivity to HPV-16, -18, -31, and -58 was determined by virus-like particles in an enzyme-linked immunosorbent assay. RESULTS: Overall seropositivity to any HPV genotype was 27.9%. The combined seroprevalence of women 15 to 19 and 20 to 24 years old was 35.4% (95% confidence interval [CI], 25.9-46.2) and 36.0% (95% CI, 27.7-45.3), respectively. Seroprevalence for HPV-16 was 17% (95% CI, 14.6-19.6); for HPV-18, 9.8% (95% CI, 8.0-11.9); for HPV-31, 11.4% (95% CI, 9.5-13.7); and for HPV 58, 12.5% (95% CI, 10.5-14.9). Higher HPV seropositivity was associated with the lifetime number of occasional sexual partners (odds ratio, 3.05; 95% CI, 1.26-7.37) and having more than 2 regular sexual partners (odds ratio, 3.00; 95% CI, 1.21-7.45) in women younger than 44 and older than 45 years old, respectively. Use of oral contraceptives and tobacco/cigarettes was significantly associated with reduced HPV seropositivity in women older than 45 but not in women younger than 44 years old. CONCLUSIONS: Human papillomavirus seropositivity is associated with measures of sexual behavior, particularly a greater lifetime number of sexual partners. Hormonal and tobacco/cigarette use may be factors influencing the HPV seropositivity in women older than 45 years old.

Prevalence of specific herpes simplex virus-2 antibodies and associated factors in women of a rural town of Colombia.

There is lack of age-specific seroprevalence surveys and identification of factors associated with herpes simplex virus type-2 seropositivity (HSV-2) in rural populations in Colombia. A random sample of 869 women was interviewed about socio-demographic aspects, sexual and reproductive history. Antibodies to HSV-2 were determined by a specific type immunoenzymatic technique (ELISA). Participants had a mean age of 38±16.1 years, 67% were married, 60% monogamous and 47% reported use of condoms. HSV-2 seroprevalence was 19.1% (95% CI: 16.6-21.9) and it was strongly associated with increasing age (Ptrend<0.001). In the logistic regression analysis, women who reported between two or three lifetime sexual partners (OR=2.4; 95% CI: 1.5-3.7), >31 years of sexual activity with regular or occasional sexual partners (OR=4.3; 95% CI: 1.2-15.7) and not using condoms with regular sexual partners (OR=2.1; 95% CI: 1.4-3.3) were more likely to be HSV-2 seropositive. The overall seroprevalence rate of women of Pueblorrico, Colombia, is lower than that reported in other Latin American countries especially in women>45 years. The difference may be explained by higher prevalence of condom use in this population or lower exposure to herpes infection in male as well as females in the past.

Lack of correlation between minimal erythema dose and skin phototype in a Colombian scholar population.

BACKGROUND: Sun exposure and skin phototype are the most relevant risk factors for skin cancer. Colombia has high levels of ultraviolet radiation during the whole year, therefore, both, high UVI's and outdoor worker's daily activities, in our country are very important risk factors for the development of cutaneous cancer. To date no study has evaluated the usefulness of Fitzpatrick's skin phototype classification in Colombians and its correlation with the minimal erythema dose (MED) and constitutional skin color. Such information is gaining importance in other nations due to the fact that several country's population is becoming more ethnically diverse. OBJECTIVES: To determine the skin phototype, accumulated sun exposure, sun protection behavior, MED and phenotype in a Colombian school population. METHODS: Last year high school students from the western Antioquia were invited to participate by phone and letter through their respective school directors. A self-questionnaire was handled to each student. A representative sample of the universe was selected for a medical examination by a dermatologist in order to validate the results of the self-questionnaire. The constitutional skin color was determined with the chromameter CR 300 Minolta. The MED was defined as the minimal dose of UVB being able to induce erythema 24 h later. RESULTS: Eight schools of the area agreed to participate in the study, and a total of 911 students (58% girls and 42% boys) filled-out the self-questionnaire. Sun exposure in the majority of individuals was in a level between moderate and very high. Ninety percent of students do not use any sun protection device or cream. Only a 50% of concordance between self-assessed skin phototype vs. medical skin phototype was found, and the highest concordance corresponded to skin phototype II (82%). There was a marked difference in skin photosensitivity of Colombians compared with reports in Caucasians. We observed a marked overlapping in MED's and L* values in phototypes II and III. CONCLUSIONS: The Fitzpatrick's classification was not useful in Hispanic populations such as ours. Therefore, a new skin-phototype classification system is required. In our population the constitutional color was a good predictor of the MED but it did not correlate with skin phototype. The self-assessed questionnaire method was not useful to determine skin cancer risk in our population. The majority of this population has light skin phototypes and is highly exposed to solar UV radiation without proper protection.

[Prevalence of epithelial squamous cell abnormalities and associated factors in women of a rural town of Colombia]. / Prevalencia de anormalidades de células epiteliales y factoresasociados en mujeres de un municipio rural colombiano.

INTRODUCTION: In spite of implementation of cytology-based cervical cancer screening in Colombia, mortality rates remain stable. The description of factors associated to cervical pre-neoplasic lesions is needed to establish strategies for mortality prevention. OBJECTIVE: The prevalence of epithelial squamous cell abnormalities was determined to explore the association of cytology abnormalities with described risk factors. MATERIALS AND METHODS: This population-based, cross-sectional study included 739 women randomly selected by age. A validated face-to-face questionnaire and conventional cervical cytology were used to collect the information. To establish the association between cervical abnormalities and some qualitative variables, the independent chi squared test was used. We also calculated prevalence ratio with their 95% confidence intervals. A logistic regression model was used to explore variables that potentially explain cytology abnormalities. RESULTS: The prevalence of squamous cell abnormality was 15.8%. Among women with abnormal cytology, 10% presented atypical squamous cells of undetermined significance, 3.9% low grade squamous intra-epithelial lesion and 1.9% high grade squamous intra-epithelial lesion. The adjusted logistical regression analysis showed that history of sexual transmitted disease, two or more sexual partners during entire life and previous abnormal cytology were associated with cytology abnormalities. CONCLUSION: The relation of epithelial squamous cell abnormalities with sexual behavior history reflexes the link between human papiloma virus infection and cervical cancer pre-neoplasic lesions. The frequency of use and knowledge about the purpose of cytology were factors that suggested other diagnostic limitations such as quality of cervical cytology or barriers to access health care. These latter factors may be the underlying basis for the high cervical cancer mortality rates.

Prevalencia de anormalidades de células epiteliales y factores asociados en mujeres de un municipio rural colombiano / Prevalence of epithelial squamous cell abnormalities and associated factors in women of a rural town of Colombia

Introducción. A pesar de la existencia de los programas de tamización basados en la citología, las tasas de cáncer de cuello uterino permanecen estables en Colombia. La descripción de los factores asociados a las lesiones precursoras de cáncer de cuello uterino es necesaria para establecer estrategias para su prevención.Objetivo. Determinar la prevalencia de las anormalidades de células epiteliales escamosas y su asociación con los factores de riesgo descritos. Materiales y métodos. Estudio transversal de población en 739 mujeres, seleccionadas en forma aleatoria. La información se recolectó mediante la citología y un cuestionario previamente validado. La medida de asociación fue la razón de prevalencia con su respectivo intervalo de confianza del 95 por ciento. Las variables de confusión fueron controladas en un modelo de regresión logística multivariado. Resultados.La prevalencia del evento fue de 15,8 por ciento. Entre las mujeres con citología anormal, 10 por ciento presentó células escamosas atípicas de significado indeterminado; 3,9 por ciento, lesión escamosa intraepitelial de bajo grado, y 1,9 por ciento, lesión escamosa intraepitelial de alto grado. La regresión logística ajustada sugiere que los antecedentes de enfermedades de transmisión sexual, una citología anormal y tener dos o más parejas regulares/ocasionales durante la vida se asocian con la presencia del evento. Conclusiones. La relación de anormalidades de células escamosas con conducta sexual refleja la asociación entre el virus del papiloma humano y lesiones preneoplásicas de cáncer de cuello uterino. El uso frecuente y el adecuado conocimiento sobre la citología, sugiere que aspectos tales como las dificultades con la calidad de la citología o el acceso al diagnóstico y tratamiento, pudieran explicar las altas tasas de cáncer de cuello uterino.

Effect of imiquimod in anogenital warts from HIV-positive men.

BACKGROUND: HIV-positive patients have unpredictable local immune responses even with severe systemic immunosuppression and data reported to date is insufficient to predict the effect of imiquimod in HIV-positive patients. OBJECTIVE: To evaluate the efficacy of 5% topical imiquimod in HIV-positive male patients with anogenital warts (AGW) and to elucidate its effect on recurrence. STUDY DESIGN: Open-label clinical trial. RESULTS: Of the 43 patients enrolled, 86% completed treatment. Patients' mean age was 34 years (range: 19-50). Thirty-one patients were receiving highly active antiretroviral therapy (HAART) therapy. At week 16, 10 patients completely cleared lesions and 21 patients had a wart size reduction > or =50%. At 20 weeks of therapy, 17 patients achieved total clearance whereas 14 patients had a >50% wart reduction. Clearance was not influenced by CD4-counts, HIV-viral load, previous therapy, or wart localization. Of the patients who experienced a complete clearance, five (29%) had a recurrence. Mean time of recurrence was 14.4 weeks. Erythema, pruritus, and burning sensation were the most frequent local skin reactions. CONCLUSIONS: Topical 5% imiquimod is safe and may benefit HIV-positive patients with anogenital warts particularly when it is used for up to 20 weeks. It is also useful to decrease wart recurrence.

Prevalencia de Staphylococcus aureus resistente a meticilina en personal de la unidad de terapia intensiva de la Clínica Universitaria Bolivariana, Medellín 2004 / Prevalence of personnel of the intensive of Medellín 2004

Objetivos. Se determinó la prevalencia de Staphylococcus aureus resistente a meticilina en el personal de la unidad de terapia intensiva de la Clínica Universitaria Bolivariana y la prevalencia de S. aureus en fosas nasales y faringe en la misma población. Metodología. En este estudio descriptivo, se tomaron muestras de fosas nasales y faringe de 45 trabajadores de la unidad de terapia intensiva. Las muestras se sembraron en agar sangre de cordero, a partir del cual se repicaron las colonias de Staphylococcus spp. identificadas por medio de la coloración de Gram y la prueba de catalasa. Mediante la prueba de la coagulasa en tubo y la fermentación del manitol, se confirmaron como S. aureus. A estos aislamientos se les determinó la sensibilidad a antibióticos por el método de Kirby-Bauer. Una vez establecida la resistencia a oxacilina a través del antibiograma, ésta se confirmó con la prueba de tamizaje en Mueller-Hinton con suplemento de oxacilina (6 µg/ml) y NaCl (4%). A los aislamientos SARM confirmados se les realizó el tamizaje de difusión por disco - con cefoxitina- para la predicción de la resistencia a meticilina mediada por el gen mecA. Los datos tabulados en Excel se analizaron en SPSS. Resultados. Laprevalencia de Staphylococcus aureus resistente a meticilina fue de 6,7%. La región anatómica en la que se obtuvo el mayor número de aislamientos correspondióa las fosas nasales.

Objective. Our objective was to determine the prevalence of methicilin resistant Staphylococcus aureus (MRSA) and methicilin sensitive Staphylococcus aureus (MSSA) in the nasal cavity of the personal that labours at the intensive care unit at the Clínica Universitaria Bolivariana. Methodology. In this descriptive study, samples from nasal cavity and pharynx were taken from 45 members of the Intensive Care Unit staff. The samples were seed on plates nurtured with lamb’s blood agar from which we isolated S. aureus colonies that were identified by means of the Gram coloration and the catalase. Coagulase test and manitol fermentation were perfomed in order to confirm S. aureus. The antibiotic sensitivity was determined by the Kirby Bauer method. The oxacillin resistance was confirmed with the Mueller Hinton screening test in oxacillin (6 mg/ml) and NaCl (4%) supplemented media. A diffusion screen test on disk with cefoxitin was performed to MRSA strains to predict whether the methicilin resistance was mediated by the mecA gen. The data was tabulated in Excel and analyzed in SPSS. Results. The prevalence of MRSA was 6.7%. Nasal cavity was the most common anatomical site from which the isolated came.

Molecular and serological evidence of the epidemiological association of HPV 13 with focal epithelial hyperplasia: a case-control study.

BACKGROUND: Focal epithelial hyperplasia is a benign proliferative condition that is more frequently found in children of certain ethnic groups. Human papillomavirus 13 and 32 DNA has been consistently detected in these lesions. OBJECTIVE: To demonstrate the epidemiological association of HPV 13 with FEH in the Emberá-Chamí community of Antioquia, Colombia. METHODS: A population-based, case-control study was conducted. One hundred and thirty-eight children were screened and 17 clinical and histologically-confirmed cases were sex and age-matched with 27 controls. Biopsies from FEH lesions and mouth washes from controls were obtained for DNA analysis. HPV 13 DNA was identified using a previously described type-specific PCR test. HPV 13 VLPs were produced by cloning of L1 from the HPV 13 cloned genome and seroreactivity against HPV 13 VLPs of sera from cases and controls were evaluated by ELISA. RESULTS: Among the whole population the prevalence of FEH was 13%. One-hundred-percent of the cases and 29.6% of the controls were HPV 13 positive. There was a significant difference in HPV DNA status between cases and controls (one-tailed Fisher exact test: P<0.0001). Antibodies against HPV 13 VLPs were found in 58.8% of cases and in 33.3% of controls, this difference was not statistically significant (P=0.089 Fisher exact test). However, the median of the ODs of the ELISA positive sera of the cases was 0.596 (interquartile range: 0.5075-0.8245) versus 0.452 (interquartile range: 0.337-0.479) in the controls and this was significantly different (P=0.0041 Man-Whitney test). CONCLUSIONS: We demonstrated a risk for association of FEH with infection with HPV 13. The higher level of antibodies against HPV 13 VLPs in cases may suggest the requirement of higher viral load or viral persistence for disease development.

Clinical, histopathological and virological findings in patients with focal epithelial hyperplasia from Colombia.

BACKGROUND: Focal epithelial hyperplasia (FEH) is a rare oral HPV-related disease, highly prevalent in certain ethnic communities. A previous study found 7.5% prevalence among school children from the Indian community Embera-Chami in Colombia. OBJECTIVE: To determine the prevalence and Human Papillomavirus (HPVs)-type in children with FEH. MATERIALS AND METHODS: One hundred and thirty-eight students were screened. All FEH samples were HPV-tested by two PCR-based systems. RESULTS: We identified 18 FEH cases. beta-globin amplification was obtained in 15 cases and nine were HPV-55-positive by the HPV-PCR-hybridization method. Nine cases (50%) were HPV-13-positive by the GP5+/GP6+-based method. Twelve cases (80%) were HPV-positive by one or the other method. Forty-four percent and 88% of interviewed parents reported family histories of FEH and toothbrush sharing, respectively. CONCLUSIONS: Human Papillomavirus-DNA was identified in the majority of FEH cases and HPV-13 was the only genotype involved. Frequent familiar infection suggests interfamiliar transmission, genetic predisposition or infection susceptibility among family members.