Epidemiological study of primary systemic vasculitides among adults in southern Spain and review of the main epidemiological studies.

OBJECTIVES: To study the incidence and prevalence of primary systemic vasculitides (PSV) in the Costa del Sol region (southern Spain) and to compare the major epidemiological studies in PSV with the results obtained in our area. METHODS: Retrospective study including permanent residents ≥14 years (or older) diagnosed with PSV at the Hospital Costa del Sol (Marbella, Spain) between 1994 and 2010. Epidemiological data were collected and the annual incidence rate during the study period and the prevalence in 2010 were calculated per million population, except for GCA, which was estimated per 100,000 population >50 years. RESULTS: Seventy-four adult patients were diagnosed with PSV, representing an annual incidence of 15.8 (95%CI 12.2-19.4) patients/million population. These diagnoses included 29 (39.1%) giant cell arteritis (GCA), 5 (6.7%) Takayasu's arteritis (TKA), 3 (4%) poly-arteritis nodosa (PAN), 29 (39.1%) antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) [10 (13.5%) granulomatosis with polyangiitis (GPA) (Wegener), 16 (21.6%) microscopic polyangiitis (MPA) and 3 (4%) eosinophilic granulomatosis with polyangiitis (EGPA) (Churg-Strauss)], 7 (9.4%) IgA vasculitis (Henoch-Schönlein) (IgAV) and one (1.3%) cryobulinaemic vasculitis (CV). The annual incidence and 2010 prevalence for each of the PSV, respectively, were: GCA: 2.2/12.2; TKA: 1.1/10.5; PAN: 0.6/2.6; AAV: 6.2/44.8 (GPA: 2.1/15.8; MPA: 3.4/23.8; EGPA: 0.6/5.3); IgAV: 1.5/7.9; and CV: 0.2/0. CONCLUSIONS: The first epidemiological study of PSV in southern Spain corroborates their infrequency, with GCA and AAV as the PSV most often diagnosed. In southern Spain, the incidence and prevalence of PSV are lower than in northern Spain and in countries in the Northern Hemisphere.

[Analysis of the epidemiological characteristics and prognostic factors in probable or confirmed invasive meningococcal disease in a cohort of adolescents and adults during an epidemic outbreak]. / Análisis de las características epidemiológicas y de los factores pronósticos en la enfermedad meningocócica invasiva probable o confirmada en una cohorte de adolescentes y adultos durante un brote epidémico.

OBJECTIVE: To describe the profile of people suffering Invasive Meningococcal Disease in Andalusia and the Canary Islands, and identify the risk factors for death. MATERIAL AND METHODS: A retrospective study was designed, recruiting cases from week 41 of 1995 to week 40 2000. Cases were probable or definite, and were extracted from the databases of the hospital by examining diagnosis at discharge or death. RESULTS: 167 cases were identified, with a mortality rate of 7.2%. Mean age was 28.88 years, this being greater in those who died (p = 0.041). There was no previous contact with the Health System before the diagnosis in 56.3% of the cases, this being associated with death (p = 0.017). The more frequent reason for contact was a low level of consciousness, and it was the only one associated to death (p = 0.036). Pharyngotonsilitis was associated with a lower incidence of death. About 24% of patients received antibiotics as out-patients and their use was associated to a lower incidence of death (p = 0.07). Temperature over 40 degrees C (p = 0.003) and heart rate lower than 60 beats per minute (p < 0.0005) were associated with death. Leucocytes in peripheral blood less than 4.500 cells/ microliter, or platelets less than 100.000 cells/microliter were associated with a greater proportion of deaths. In Cerebrospinal fluid, less than 5 leucocytes per microliter, or proteins less than 50 mg/dl were associated with more deaths. Neisseria meningitidis B was isolated in 47 patients (28.1%), and C in 77 cases (46.1%). Sepsis was significantly associated with death (p < 0.0005). CONCLUSIONS: The absence of previous contacts with the Health System reveals an abrupt onset of Meningococcal disease, with less inflammatory response and very severe. Out of hospital antibiotic treatment and pharyngoamygdalitis are associated with a better prognosis.

The influence of hepatitis C virus-human immunodeficiency virus co-infection on the appearance of liver enzyme elevation in people on high activity antiretroviral treatment.

BACKGROUND: Liver enzyme elevation (LEE) as a consequence of HAART is a problem among patients with HIV-HCV co-infection. METHODS: In this retrospective study, 145 patients with HIV who were on HAART and who developed LEE grades 3 and 4 of the World Health Organization (WHO) were followed up. Basal ALT, alcohol consumption, and HCV and HBV co-infection were recorded. Comparisons were made between patients with and without HCV co-infection. RESULTS: Three patients without co-infection presented LEE grade 3 versus 38 with co-infection (104 episodes). An increase in basal ALT (RR: 1.01) and HCV co-infection (RR: 6.6) were the variables associated with LEE grade 3. The number of days that HAART had to be withdrawn due to LEE was 58.15 and 4.85 in subjects with and without co-infection, respectively (p=0.024). CONCLUSION: Patients with HCV-HIV co-infection have more episodes of LEE and must go longer without HAART than people without co-infection.

[Endophthalmitis and multiple brain abscess in a patient with endocarditis due to Streptococcus agalactiae]. / Endoftalmitis y abscesos cerebrales múltiples en un paciente con endocarditis por Streptococcus agalactiae.

Endogenous endophthalmitis is a rare disease caused by hematogenic germ spread from an internal focus. Infections due to Streptococcus agalactiae are infrequent in adults although new cases had been described recently associated to inmunodepression. We present a patient with endocarditis due to Streptococcus agalactiae, endophthalmitis and multiple brain abscess. We also review the literature.

[Homozygous familial hypercholesterolemia. Response to combined cholestyramine and lovastatin therapy]. / Hipercolesterolemia familiar homocigota. Respuesta al tratamiento combinado con colestiramina y lovastatina.

Homozygous familiar hypercholesterolemia (FH) is a serious inherited disease caused by a genetic defect in the cell surface receptor that controls the degradation of low density lipoprotein (LDL). These patients often have myocardial infarction in their teens or early adulthood and are usually unresponsive to drugs. Recently it has been reported promising results using combined drugs regimens in patients with residual receptor activity. We report a new additional patient with receptor-defective homozygous FH treated with a combination of lovastatin and cholestyramine. The cholesterol levels were reduced in a 67% and there were adverse events related to treatment during a 7 month period of follow-up.

An outbreak of Plasmodium vivax malaria among heroin users in Spain.

We report the first outbreak of induced malaria among heroin users in Spain, and the first one caused by Plasmodium vivax in Europe. Five drug addicts from Madrid, who had never travelled to endemic areas, were admitted to hospital with fever and splenomegaly. Four had P. vivax malaria with low parasitaemia, ranging from 1 to 3% red blood cells. The fifth case was considered a "seropositive contact" because he had fever and positive malaria indirect fluorescent antibody test but negative blood smear. The source of infection was a young drug addict, who had often travelled to Equatorial Guinea. Another heroin user with a diagnosis of malaria refused to be admitted to our hospital for further study. All had shared contaminated injection equipment. Treatment with chloroquine was effective and none had recrudescence of malaria during a mean follow-up of six months. Drug addicts with unexplained fever may have been infected by malaria transmitted by sharing injections.