Vß T cell receptor (TCR) genes in circulating cells of patients with systemic lupus erythematosus and their healthy relatives / Genes del receptor variable beta de células T en células circulantes de pacientes con lupus eritematoso generalizado y sus familiares sanos.

Objective: We investigated the proportion of Vß T cell receptor (TCR) gene expression in peripheral CD3+ lymphocytes in familial and non-familial systemic lupus erythematosus (SLE) patients. Method: The Vß TCR repertoire was studied in 14 families in which several members had SLE. The Vß TCR usage in SLE patients (n = 27) was compared with that in healthy members of these multiplex families (n = 47), in 37 sporadic SLE patients who had no relatives with SLE, and in 15 healthy unrelated controls. Vß TCR repertoire expression was studied by multiparameter flow cytometry with the use of an array of 24 different Vß TCR gene family-specific monoclonal antibodies. Results: We found the same Vß TCR expression profile in the comparisons between sporadic SLE and familial SLE cases and healthy relatives, which included increased expression of Vß 5.2, Vß 11 and Vß 16, and lower expression of Vß 3, Vß 4, Vß 7.1 and Vß 17. Interestingly, solely Vß 17 was differentially expressed among sporadic and familial SLE. Also, increased expression of Vß 9 was the hallmark among familial SLE (casesand h ealthy relatives) in comparison to controls. Conclusion: These results highlight the notion that the final profile of the Vß TCR repertoire seen in familial and non-familial SLE seems to arise from the interaction of genetic, environmental, and immunoregulatory factors. Furthermore, it may contribute to the immunologic abnormalities affecting relatives of SLE patients.

Objetivo: Se investigó la proporción de la expresión génica del receptor variable beta de células T (Vß TCR) en linfocitos periféricos CD3+ en pacientes con lupus eritematoso generalizado (LEG) familiar y no familiar. Método: El repertorio de Vß TCR se estudió en 14 familias que presentaban más de un miembro con LEG. El uso de Vß TCR en pacientes con LEG (n = 27) se comparó con el de los miembros sanos de estas familias (n = 47), con 37 pacientes con LEG esporádico y con 15 controles sanos. La expresión del repertorio de Vß TCR se estudió por citometría de flujo multiparamétrica utilizando un arreglo de 24 diferentes anticuerpos monoclonales específicos de genes familiares para Vß TCR. Resultados: Se encontró el mismo perfil de expresión en las comparaciones entre los casos de LEG esporádico y familiar, así como en los consanguíneos sanos de las familias multicasos, que incluía una expresión incrementada de Vß 5.2, Vß 11 y Vß 16, y una menor expresión de Vß 3, Vß4, Vß 7.1 y Vß 7. De manera interesante, solo Vß 17 se expresó de modo diferente entre casos familiares y esporádicos de LEG. Igualmente, la expresión incrementada de Vß 9 fue el distintivo entre los casos de LEG familiar (casos y consanguíneos sanos) y los controles sanos. Conclusiones: Estos resultados refuerzan la noción de que el perfil final del repertorio Vß TCR observado en LEG familiar y no familiar parece surgir de la interacción de factores genéticos, ambientales e inmunorreguladores, además de que pueden explicar las alteraciones inmunitarias que se observan en los consanguíneos sanos de pacientes con LEG.

Evaluation of a new rapid diagnostic test for the detection of influenza and RSV.

INTRODUCTION: Influenza viruses and respiratory syncytial virus (RSV) can cause an acute respiratory disease that occurs seasonally in epidemic waves. This retrospective study was conducted to evaluate the Sofia(®) Influenza A+B and the Sofia(®) RSV fluorescence immunoassays (FIAs), two novel rapid detection tests (RDTs) for influenza A and B and RSV. METHODS: Two hundred and nine breath samples were selected from patients with respiratory symptoms determined to be positive/negative for influenza A, influenza B or RSV using one of the reference diagnostic techniques, cell culture and/or RT-PCR (Simplexa™Flu A/B & RSV). The Sofia Influenza A+B FIA was tested on 123 samples (63 from children and 60 from adults) and the Sofia RSV FIA was tested on 86 pediatric samples. Sensitivity and specificity values of both assays were calculated assuming the reference techniques as the gold standard. RESULTS: Sensitivity and specificity values for the Sofia Influenza A+B FIA were 73.1% and 97.8%, respectively. Sensitivity and specificity values for the Sofia RSV FIA were 87.5% and 86.7%, respectively. CONCLUSION: The sensitivity results obtained for the two assays were considerably higher than those reported for other RDTs. In conclusion, the Sofia Influenza A+B and the Sofia RSV FIAs are appropriate tools for the rapid diagnosis of these viruses.

Acute aortoiliac thrombosis due to cocaine intake.

Cocaine has become one of the most commonly abused recreational drugs, resulting in a significantly increased number of visits to the emergency department due to the acute symptoms caused by its intake. The acute onset of cardiovascular complications, such as myocardial infarction, arrhythmias, stroke, and kidney and spleen infarction, has been described in association with cocaine use, but aortic thrombosis has rarely been studied in this context. We report a case of acute aortoiliac thrombosis in a young male patient with no underlying medical records.

[Evaluation of the launch of an unambiguous patient identification strategy in the hospitals of the Valencian Healthcare Agency (Spain)]. / Identificación inequívoca de pacientes. Evaluación del lanzamiento y su implantación en los hospitales de la Agencia Valenciana de Salud.

INTRODUCTION AND OBJECTIVE: Identification problems are associated with errors arising in the course of providing patient care. To improve patient safety, a universal and unambiguous identification system is required. The aim of this study was to assess the experience of designing, implementing and evaluating the launch of a strategy for unambiguous patient identification, using an identification bracelet in all the hospitals of the Valencian Healthcare Agency. METHOD: The assessment included the design of the identification material (bracelet) and its contents; the production, placement and identification of the bracelets, and the degree of implementation achieved at the launch of this strategy. RESULTS: The identification strategy was successfully implemented in a satisfactory proportion of sites (100% of the hospitals and 76% of hospital emergency departments within the first 24 hours of its functioning). Evaluation of the points defined as critical also showed high levels of compliance. Overall, the experience described could help the deployment of similar efforts in other centers and health services.

Caracterización microbiológica y fenotipificación de la resistencia bacteriana en las infecciones intraabdominales en el Instituto Autónomo Hospital Universitario de los Andes, 2014-2017 / Microbiological characterization and phenotyping of bacterial resistance in intra-abdominal infections at the Instituto Autonomo Hospital Universitario de los Andes, 2014-2017

Objetivo: caracterizar los microorganismos involucrados en las infecciones intraabdominales, y fenotipificar sus perfiles de resistencia al uso de los antibióticos en el Servicio de Cirugía General del Instituto Autónomo Hospital Universitario de Los Andes, entre los años 2014 al 2017. Metodología: enfoque cuantitativo; tipo descriptivo, diseño no experimental de estudio de casos y transversal, a través de toma de muestras de secreciones abdominales en quirófano a las cuales se les realizó cultivo en medios de agar sangre y McConkey, tinción Gram, contaje de leucocitos, y prueba Kirby-Bauer de sensibilidad antimicrobiana. Muestra de 211 pacientes mayores de 16 años que acudieron a la institución con el diagnóstico de abdomen agudo quirúrgico infeccioso. Resultados: el abdomen agudo quirúrgico infeccioso por apendicitis aguda fue la infección intraabdominal más común, grupo etario que acudió con más frecuencia: <26 años. Agentes etiológicos más frecuentemente aislados: bacilos Gram negativos, especies más frecuentes: E. col i (57,3%), K. pneumon iae (10,9%) y P. a e rug i nosa (6,16%). De todos los microorganismos aislados 57,6% expresaron al menos un fenotipo de resistencia. Fenotipo más común: betalactamasa de espectro extendido y bomba de eflujo de quinolonas (18,8%). Microorganismos con mayores porcentajes de resistencia: Staphylococcus sp. y Enterococcus sp (~100%). Los mejores porcentajes de sensibilidad de la E. col i , K . p neumon ia e y P . a e rug i nosa fueron hacia al colistin, carbapenémicos y amikacina (100%). Conclusión: Los carbapenémicos y los aminoglucósidos seguirán siendo los fármacos de elección en las infecciones intraabdominales del Instituto Autónomo Hospital Universitario de Los Andes(AU)

Objective: to characterize the microorganisms involved in intraabdominal infections, and to phenotype their resistance profiles to the use of antibiotics in the General Surgery Service of the Instituto Autónomo Hospital Universitario de Los Andes, from 2014 to 2017. Methodology: quantitative approach; descriptive type, nonexperimental design of case study and transversal, through sampling of abdominal secretions in the operating room which were cultured in blood agar and McConkey media, Gram stain, leukocyte count, and Kirby-Bauer test for antimicrobial sensitivity. Sample of 211 patients older than 16 years who attended the institution with the diagnosis of acute surgical infectious abdomen. Results: acute surgical infectious abdomen due to acute appendicitis was the most common intra-abdominal infection, most frequent age group: <26 years. Most frequently isolated etiologic agents: Gram-negative bacilli, most frequent species: E. co l i (57.3%), K. p neumon ia e (10.9%) and P . a e rug i nosa (6.16%). Of all the isolated microorganisms, 57.6% expressed at least one resistance phenotype. Most common phenotype: extended-spectrum beta-lactamase and quinolone efflux pump (18.8%). Microorganisms with the highest percentages of resistance: Staphylococcus sp. and Enterococcus sp (~100%). The best percentages of sensitivity of E. col i , K . pneumoniae and P . a e rug i nosa were to colistin, carbapenemics and amikacin (100%). Conclusion: Carbapenemics and aminoglycosides will remain the drugs of choice in intra-abdominal infections at Instituto Autónomo Hospital Universitario de Los Andes(AU)

Comportamiento de la IgE y las subclases de IgG en las infecciones por Staphylococcus aureus / Manifestation of IgE and IgG subclasses in Staphylococcus aureus infections

RESUMEN Introducción: Las infecciones cutáneas por Staphylococcus aureus, se presentan con alta frecuencia en la comunidad. La forma superficial de esta es la foliculitis. Una extensión hacia el tejido subcutáneo da como resultado la formación de una lesión supurativa local llamada forúnculo. Aproximadamente el 20 % de los pacientes con forúnculo presentan una o más recidivas durante el año siguiente, y cierto número presenta forunculosis recidivante crónica durante meses o años. Objetivo: Conocer el comportamiento de los niveles de IgE y las subclases de IgG expresadas en pacientes y controles, para inferir el patrón de la respuesta inmune a la infección. Métodos: Se realizó un estudio prospectivo donde se determinaron las subclases de inmunoglobulina G (IgG) y los niveles de inmunoglobulina E (IgE) en suero de 25 enfermos con lesiones cutáneas por Staphylococcus aureus, y 25 controles sanos, provenientes del banco de sangre. Se elaboró un antígeno (Bacterina de Staphylococcus aureus) y en su enfrentamiento se procedió con la metodología de normalización y validación de ensayos inmunoenzimáticos para cuantificar IgG humana. Los resultados se expresaron en densidades ópticas y gráficamente como la relación matemática (IgG1/3) para Th1 e (IgE/IgG4) para Th2, en el suero de los pacientes. Resultados: Se obtuvo respuesta IgG1 e IgG4 en pacientes y controles y respuesta IgE anti Staphylococcus aureus en pacientes. Conclusiones: Como Staphylococcus aureus es flora normal de la piel, los controles ya han tenido contacto con él, lo que provoca el desarrollo de respuesta Th1 (IgG1) y anticuerpos bloqueadores (IgG4). Contrariamente, los enfermos desarrollan respuesta Th2 (IgE) y la infección.

ABSTRACT Introduction: Staphylococcus aureus skin infections occur with high frequency in the community. Folliculitis is its superficial form. An extension into the subcutaneous tissue results in the formation of a local suppurative lesion known as a furunculosis. Approximately 20% of patients with a furuncle have one or more recurrences over the next year, and a certain number have chronic relapsing furunculosis for months or years. Objective: to know the manifestation of IgE levels and IgG subclasses expressed in patients and controls, to infer the pattern of the immune response to infection. Methods: we conducted a prospective study where immunoglobulin G (IgG) subclasses and immunoglobulin E (IgE) levels were determined in serum of 25 ill patients with Staphylococcus aureus skin lesions, and 25 healthy controls, from the blood bank. An antigen (Staphylococcus aureus bacterin) was elaborated and in its confrontation, the normalization and validation methodology of immunoenzymatic assays to quantify human IgG was carried out. The results were expressed in optical densities and graphically as the mathematical ratio (IgG1/3) for Th1 and (IgE/IgG4) for Th2, in the serum of the patients. Results: IgG1 and IgG4 responses were obtained in patients and controls, and anti-Staphylococcus aureus IgE responses in patients. Conclusions: the controls have already had contact with Staphylococcus aureus, as it is normal flora of the skin, which causes the development of Th1 response (IgG1) and antibodies blockers (IgG4). On the contrary, ill patients develop a Th2 response (IgE) and the infection.

Proteinograma e inmunoglobulinas séricas en las infecciones cutáneas por Staphylococcus aureus / Proteinogram and serum immunoglobulins in skin infections caused by Staphylococcus aureus

RESUMEN Introducción: lesión típica ocasionada por el Staphylococcus aureus es el furúnculo o cualquier otro absceso localizado. Objetivo: describir el comportamiento del proteinograma y los niveles de inmunoglobulinas séricas. Métodos: se realizó un estudio longitudinal prospectivo con 70 pacientes portadores de forúnculos infectados por Staphylococcus aureus, que acudieron a las consultas de Inmunología en varias localidades de Villa Clara. Resultados: se determinaron las fracciones proteicas por método de elusión; se cuantificaron las inmunoglobulinas séricas por inmunodifusión radial simple, según edad, sexo y color de la piel de los pacientes. Se contrastaron las variables bajo la prueba de Ji cuadrado, con una significación de confianza del 95 %. Predominaron los pacientes con el color de la piel blanca sobre los no blancos. En la electroforesis de proteínas se obtuvieron resultados normales para las proteínas totales y la fracción gamma. Para la albúmina, fracción alfa 1, alfa 2 y beta globulina se obtuvieron valores bajos, por encima del 95 % válido. Conclusiones: todas las inmunoglobulinas resultaron normales o altas, según los intervalos de referencia para cada grupo de edad. Al correlacionar los valores de las inmunoglobulinas con las fracciones de la electroforesis, fue llamativo el resultado obtenido en la correlación entre la IgA y la fracción beta. De manera general, los anticuerpos no mostraron variaciones significativas en sus correlaciones, lo cual evidenció un pobre papel en la infección. Se concluyó que los valores de alfa 1, alfa 2 y beta globulina pueden tener importancia en la enfermedad.

ABSTRACT Introduction: the typical lesion caused by Staphylococcus aureus is the furuncle or any other localized abscess. Objective: to describe the manifestation of the proteinogram and serum immunoglobulin levels. Methods: a prospective longitudinal study was carried out in 70 patients with furuncles infected by Staphylococcus aureus, who came to the Immunology consultations from various locations of Villa Clara. Results: protein fractions were determined by elution method; serum immunoglobulins were quantified according to age, gender and skin color of the patients by simple radial immunodiffusion. Variables were contrasted under the Chi-square test, with 95% confidence significance. White patients predominated over non-white ones. Normal results were obtained for total proteins and gamma fraction in protein electrophoresis. Low values were obtained for albumin, alpha 1, alpha 2 and beta globulin fraction, above 95% valid. Conclusions: all immunoglobulins were normal or high, according to the reference intervals for each age group. The result obtained in the correlation between IgA and the beta fraction was striking when correlating the immunoglobulin values with the electrophoresis fractions. In general, the antibodies did not show significant variations in their correlations, which evidenced a poor role in infection. We concluded that alpha 1, alpha 2 and beta globulin values may be important in the disease.

The CD4:CD8 ratio is associated with IMT progression in HIV-infected patients on antiretroviral treatment.

INTRODUCTION: Inversion of the CD4:CD8 ratio (<1) has been identified as a hallmark of immunosenescence and an independent predictor of mortality in the general population. We aimed to assess the association between the CD4:CD8 ratio and intima-media thickness (IMT) progression in treated HIV-infected patients as a marker of early atherosclerosis. MATERIALS AND METHODS: A longitudinal study during three years was conducted in 120 HIV-infected patients receiving antiretroviral treatment (ART). We analyzed the associations between the CD4:CD8 ratio, cardiovascular risk factor and antiretroviral (ARV) treatment and progression of subclinical atherosclerosis assessed using carotid IMT at baseline and after three years. RESULTS: Finally, 96 patients completed the study. Seventy-six (79.1%) patients were male, aged 44±10 years, 39 (40.6%) were on treatment with Protease inhibitors, 49 (51.04%) with non-nucleoside reverse transcriptase inhibitors (NNRTI), 6 (6.25%) with integrase inhibitors, 3 (3.12%) with maraviroc and 2 (2.08%) only with nucleoside reverse transcriptase inhibitors (NRTI). The mean of ARV exposition was 6.9±5.9 years. Twenty six (27 %) patients had family history of ischemic heart disease, 51 (53.12%) were smokers, 12 (12.5%) hypertensive, 4 (4.16%) type 2 diabetes, 23 (23.9%) with dyslipidemia and 31 (32.3%) were infected with C hepatitis virus. Baseline IMT was significantly associated with age (rho=0.497; p<0.001), basal glucemia (rho=0.323; p=0.001), triglycerides (rho=0.232; p=0.023), Framingham score (rho=0.324; p=0.001), CD4:CD8 ratio (rho=-0.176; p=0.05) and dyslipidemia (0.72±0.16 mm vs 0.63±0.11 mm; p=0.029). In multivariable analysis where cardiovascular risk factor and ARV were included, IMT progression was inversely associated with CD4:CD8 ratio (OR=0.283; CI 95% 0.099-0.809; p=0.019) and treatment with NNRTI (OR=0.283; CI 95% 0.099-0.809; p=0.019). CONCLUSIONS: The inversion of CD4:CD8 ratio in treated HIV-infected patients is independently associated with IMT progression, a marker of age-associated disease. Therefore, it might be clinically useful as predictor of cardiovascular events. Surprisingly, there was a positive correlation between receiving NNRTI and progression of IMT.

Improvement of endothelial function after switching previously treated HIV-infected patients to an NRTI-sparing bitherapy with maraviroc.

INTRODUCTION: Nucleoside reverse transcriptase inhibitor (NRTI) is associated with endothelial dysfunction and proinflammatory effects. Maraviroc (MVC) is an antagonist of CCR5 receptor. CCR5 is the receptor of RANTES (Regulated on Activation, Normal T Cell Expressed and Secreted), a mediator of chronic inflammation and endothelial function. Our aim was to evaluate the maintenance of viral suppression and improvement of endothelial function in virologically suppressed HIV-infected patients switched to an NRTI-sparing combined antiretroviral therapy (cART) with MVC. MATERIALS AND METHODS: This observational, non-interventional, multicenter study was performed at the Infectious Diseases Service of Santa Lucia, Morales Meseguer, Virgen de la Arrixaca and Reina Sofía University Hospital (Murcia, Spain). The selection criteria were to be asymptomatic on a regimen with undetectable viral load (<50 HIV-RNA copies/mL) for at least six months, no previous treatment with R5 antagonists, no evidence of previous protease inhibitor (PI) failure and available R5 tropism test. Twenty-one HIV-infected patients were selected after the treatment regimen was changed to Maraviroc 150 mg/once daily plus ritonavir-boosted PI therapy. Endothelial function was prospectively evaluated through flow-mediated dilatation (FMD) of the brachial artery at baseline and at weeks 24. RESULTS: We included 21 patients on treatment with PI in combination with 2 NRTI. The mean cART exposition was 133±68.9 months. Fourteen (66.6%) were males, aged 49±9 years, 15 (71.4%) smokers, 4 (19.04%) family history of coronary heart disease, 1 (5.76%) type 2 diabetes and 3 (14.28%) hypertensive, mean total cholesterol was 185.5±35 mg/dL, c-LDL 100.2±37 mg/dL, tryglicerides 170.42±92.03 mg/dL, cHDL 52.6±15.5 mg/dL, CD4 779,5±383.28 cells/mL, nadir CD4 187,96±96 cells/mL. After 24 weeks of follow-up of a switch to an NRTI-sparing regimen, 95.2% of HIV-patients on viral suppressive cART maintained viral suppression and CD4+ T cell count. This cART switch improve endothelial function in patients with lower baseline FMD levels after 24 weeks (baseline FMD -1.19±4.84 % to 24 weeks FMD 11.32±7.27%; p=0.002). CONCLUSIONS: The results of our study show that a switch to an NRTI-sparing bi-therapy with MVC improves endothelial function and maintained the immune-virologic efficacy. This regimen emphasizes the needs for further clinical studies to associate these achievements with the incidence of non-AIDS-defining illnesses.

Riesgos a la salud humana en el barrio «Hoji Ya Henda¼, ciudad de Menongue / Risks to human health in "Hoji Ya Henda" neighborhood, Menongue city

Se desarrolló un estudio descriptivo de corte transversal para describir la existencia de riesgos a la salud humana presentes en el barrio «Hoji Ya Henda¼ de la ciudad de Menongue, provincia de Cuando Cubango, República de Angola, durante el primer semestre de 2017, a partir de la percepción de los estudiantes de quinto año de Licenciatura en Enfermería. Los principales riesgos ambientales identificados en la comunidad fueron la presencia de vectores en las casas (100 %), su estado constructivo (91 %), la calidad del agua (88 %) y la falta de agua dentro de las viviendas (80 %); en el caso de los riesgos psicosociales no asociados a la salud de los trabajadores, fueron percibidos el consumo excesivo de bebidas alcohólicas y de otras sustancias tóxicas

A descriptive cross-sectional study was conducted to describe the existence of risks to human health in "Hoji Ya Henda" neighborhood from Menongue city, Cuando Cubango province, Republic of Angola during the first semester of 2017 and based on the perception of fifth -year nursing students. The main environmental risks identified in the community were the presence of vectors in the houses (100 %), their constructive state (91 %), water quality (88 %) and lack of water inside them (80 %); while excessive consumption of alcoholic drinks and other toxic substances were among the psychosocial risks not associated with workers' health

Juvenile idiopathic arthritis and Wegener's granulomatosis--causal or casual acquaintances?

We report two cases of long-term juvenile idiopathic arthritis which developed recurrent subglottic stenosis secondary to localized Wegener's granulomatosis. In both cases, the biopsies taken from the affected region shown granulomatous vasculitis with multinucleated giant cells. Both patients presented positive serology for antineutrophil cytoplasmic antibodies by immunofluorescence (c-ANCA) and ELISA (PR3). The involvement or other organs was ruled out at the time of Wegener's granulomatosis diagnosis and during follow-up. To our knowledge, this is the first report of the association between juvenile idiopathic arthritis and a localized form of Wegener's granulomatosis.

[Synchronous chromophobe renal carcinoma and centrocytic lymphoma]. / Carcinoma renal cromófobo y linfoma centrocítico sincrónicos.

OBJECTIVES: To report a case of synchronic neoplasia--chromophobe renal cell carcinoma and low grade non Hodgkin lymphoma--in a 38-year-old male patient, because, although association of these two neoplasias is known, the fact of renal neoplasia being a chromophobe carcinoma is rarely referred to in medical bibliography (3 cases described after Med-Line search). METHODS/RESULTS: The diagnostic study included ultrasound and CT scan in a patient presenting with in non specific abdominal symptoms and neck adenopathy; patient underwent left radical nephrectomy and excision of neck adenopathy. Histologic and immuno-histochemical studies revealed the coexistence of chromophobe type renal cell carcinoma and diffuse centrocytic lymphoma. CONCLUSIONS: Column in the association between chromophobe histological type renal cell carcinoma and non Hodgkin lymphoma is very rare. Presence of these two tumors in the same patient may pose problems for clinical staging, prognostic predictions, and treatment. Then, due to the fact that it is not usual and that a local stage renal carcinoma presents with neck adenopathies, when they appear possible coexistence of these tumors should be suspected.

Furunculosis recidivante múltiple: estudio de 41 pacientes / Multiple relapsing furunculosis: a 41 patient study

Para describir las características clínicas y los hallazgos de laboratorio de pacientes con diagnóstico de furunculosis múltiple recidivante, se llevó a cabo el presente estudio prospectivo. Entre febrero y marzo de 2001 fueron atendidos en la consulta de Inmunología 41 pacientes con ese diagnóstico, entre tres meses y 15 años de edad. Fueron masculinos 25 pacientes y 16 femeninos. El 51,2 por ciento tenía antecedentes personales de atopia y 34,1 por ciento de infecciones recurrentes. Los signos y síntomas más frecuentes fueron: furúnculos, adenopatías regionales, dolor y fiebre. En el hemograma se halló anemia en el 56 por ciento de los casos; 20 pacientes (48,7 por ciento) presentaron eosinofilia, 27 (65,8 por ciento) monocitopenia y 23 (56 por ciento) linfocitopenia. En la electroforesis de proteínas se observó valor bajo de la ß globulina en 18 pacientes. La cuantificación de inmunoglobulinas fue normal o alta en la mayoría de los enfermos, mientras que más del 70 por ciento de los mismos presentaron niveles disminuidos de CD3 y CD4. Se encontraron bajos niveles séricos de oligoelementos (hierro, cinc, cobre y magnesio) que pueden haber influido en la inmunodepresión de los pacientes. En el 100 por ciento de los mismos se halló, mediante cultivo, infección por Staphylococcus aureus. El antibiótico de elección previo cultivo fue la penicilina G, y la mayoría de los pacientes requirió cambio de antibiótico. Reiteramos la importancia de realizar cultivo y antibiograma, así como recordar la casi universal resistencia de este germen a la penicilina G

Mecanismos inmunológicos y de escape en la infección por bacterias grampositivas: el estafilococo dorado: papel de las vitaminas y los minerales / Immunogical and escape mechanisms in Gram positive bacteria infection: the Staphylococus aureus: role of vitamins and minerals

Se realizó una revisión de los aspectos microbiológicos inherentes a la infección cutánea por estafilococo dorado y los relacionados con las características biológicas de las bacterias grampositivas, así como algunos aspectos nutricionales relacionados con el grado de suficiencia de la respuesta inmune contra este grupo de bacterias, que pueden estar implicados como factores de riesgo para la infección. Se hizo énfasis en los elementos de la respuesta inmune relacionados con la protección del huésped ante las infecciones por dichos gérmenes, así como los mecanismos de adaptación de las bacterias a la respuesta inmunológica. Se revisó el papel de las vitaminas y minerales antioxidantes en la inmunidad celular, que evidenció la estrecha relación entre la respuesta al estafilococo y los niveles de minerales y vitaminas que propician un funcionamiento adecuado del estallido respiratorio del leucocito polimorfonuclear neutrófilo (PMN), como primera línea de defensa contra el estafilococo patógeno