The value of serum aspartate aminotransferase and gamma-glutamyl transpetidase as biomarkers in hepatotoxicity.

BACKGROUND & AIMS: The current definition of the pattern of liver injury in hepatotoxicity (DILI) is given by the R (ratio) value, dividing alanine aminotransferase (ALT) and alkaline phosphatase (ALP) in upper limits of normal at DILI onset. We aimed to explore the validity of using aspartate aminotransferase (AST) and gamma-glutamyl transpeptidase (GGT) as biomarkers of hepatocelullar and cholestatic damage, respectively, when calculating the R value. METHODS: Clinical, laboratory and histological data from 588 DILI episodes included in the Spanish DILI Registry were analyzed. Linear regression analysis was performed to establish the most appropriate cut-off points for hepatocellular and cholestatic patterns when calculating R with AST and GGT. RESULTS: The overall agreement between ALT/ALP and AST/ALP was 76%, with 96%, 61% and 41% agreement in the hepatocellular (R ≥ 5), cholestatic (R ≤ 2) and mixed groups respectively (P < 0.001). Classified by the causative drug, the agreement was higher (87-95%) among drug classes that mainly present with hepatocellular damage and lower (48-58%) for those in which cholestatic-mixed injury predominate (P < 0.001)). The overall agreement between ALT/ALP and ALT/GGT was weak (59%), except for in hepatocellular cases that showed a good agreement (94%) (P = 0.001). Pattern of injury according to liver histology demonstrated 65%, 68% and 47% agreement for ALT/ALP, AST/ALP and ALT/GGT ratios respectively. CONCLUSIONS: AST can reliably replace ALT when calculating pattern of liver injury in DILI, while GGT can only substitute ALP when the R value scores as hepatocellular. The biochemical signature of causative drugs does influence the validity of the ratios with AST or GGT.

Antituberculosis drug resistance in isolates of Mycobacterium tuberculosis complex in southeast Spain.

OBJECTIVES: The aim of this study was to determine resistance to antituberculosis (anti-TB) drugs in Mycobacterium tuberculosis complex isolates from patients diagnosed with Tuberculosis (TB) in southeast Spain and to study related epidemiological factors. METHODS: This retrospective study analysed 5-year data (2012-2016) obtained in southeast Spain for a total equivalent population of 1 735 608 inhabitants. Clinical samples were examined from 557 patients with suspected pulmonary TB (n=470; 84.4%) or extrapulmonary TB (n=87; 15.6%), taking into account patient age, sex, human immunodeficiency virus (HIV) infection, country of birth and prior anti-TB treatment. RESULTS: TB was found more frequently in men than in women (66.6% vs. 33.4%), and the age group with the most cases (43.7%) was 36-55 years. Among the first-line anti-TB drugs, 7.0% of patients harboured isolates resistant to isoniazid (INH) and 1.6% to rifampicin (RIF); moreover, 1.4% of isolates were multidrug-resistant TB (MDR-TB) and 0.7% were extensively drug-resistant TB. There was a statistically significant relationship (P=0.028) between MDR-TB isolates and non-Spanish-born patients, but not between the latter and INH resistance. CONCLUSION: Resistance to INH and RIF was observed at levels similar to those published nationwide, with rates of MDR-TB being somewhat lower. Rates of HIV/TB co-infection have decreased considerably between 2012 and 2016.

Linfadenitis cervical por Mycobacterium avium en adulto inmunocompetente / Cervical lymphadenitis due to Mycobacterium aviumin an immunocompetent adult

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Lesiones cutáneas en paciente somalí con infección por VIH / Skin lesions in a Somali patient with HIV infection

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Exposición a Mycobacterium tuberculosis durante un viaje en autobús / Exposure to Mycobacterium tuberculosis during a bus travel

FUNDAMENTO: En un brote de tuberculosis ocurrido en un instituto se valora la posible influencia de una excursión en autobús como causa de contagio entre un caso índice y los viajeros. POBLACIÓN, PACIENTES Y MÉTODO: Estudio de contactos realizado al conductor, tres maestros y 49 alumnos que pertenecían a clases diferentes, y que viajaron de Málaga a Sierra Nevada en marzo de 1998. Se incluyó a todos los alumnos de las clases donde apareció algún caso de tuberculosis desde abril a diciembre de 1998 y a todos los profesores del instituto. RESULTADOS: En el instituto se estudió a un total de 232 alumnos, la prevalencia de infección fue del 35 por ciento, encontrando un total de 12 nuevos casos entre los alumnos. Ningún profesor de los 123 estudiados enfermó. De los que viajaron en autobús, dos profesores y 19 alumnos estaban infectados, y la prevalencia entre los alumnos fue del 46 por ciento; cinco de ellos estaban enfermos. La odds ratio de infección para los que tenían un compañero de clase con baciloscopia positiva fue de 5,5. Independientemente, el viajar en autobús (con respecto a los que no viajaron) supuso una odds ratio de 3.4. La mayoría de los viajeros infectados tenían relación de proximidad con el caso índice. CONCLUSIONES: En el brote de tuberculosis estudiado algunos de los alumnos enfermos e infectados no tenían ninguna relación de proximidad ni amistad con el caso índice en el instituto, por lo que parece confirmarse que para algunos alumnos la transmisión de la tuberculosis se produjo dentro del autobús (AU)