Características de pacientes con diagnóstico de patologías de ATM: una serie de casos / Characteristics of patients with diagnosis of TMJ pathologies: case series

Los tejidos que conforman la articulación temporomandibular (ATM) pueden verse afectados como cualquier otra articulación del cuerpo. Entre los factores etiológicos, podemos nombrar los traumáticos, infecciosos, autoinmunes y oclusales. El diagnóstico de las patologías de la ATM debe incluir una completa historia clínica, estudios de laboratorios y de imágenes. El objetivo del siguiente trabajo es describir características de una serie de pacientes que concurrieron a la consulta con signos y síntomas de patologías de la ATM a un consultorio particular en el sur de la provincia de Buenos Aires. Se estudió a 30 pacientes que concurrieron a la consulta con signos y síntomas de patología de la ATM; se completaron historias clínicas, se solicitaron estudios de laboratorio para la detección de anticuerpos específicos contra bacterias y resonancia nuclear magnética. La edad promedio de la población fue de 35 años, 26 eran mujeres y 25 tuvieron resultados de estudios bacteriológicos positivos. Sobre un total de 60 articulaciones, 54 presentaron alteración en la forma y de la posición del disco articular. Se verificó la importancia en la solicitud y asociación de estudios para el diagnóstico diferencial(AU)

Atypical presentation of acute rheumatic fever (ARF) in a 25-year-old woman in the Caribbean: a challenging diagnosis.

A 25-year-old woman presented a challenging diagnosis of acute rheumatic fever (ARF). Initial symptoms included dry cough and three minor Jones criteria (unabating fever (38.4°C, 0d), elevated acute phase reactants (C-reactive protein, 13d) and joint pain (monoarthralgia) in her neck (0d)). ARF was diagnosed only after presentation of two major Jones criteria (polyarthritis/polyarthralgia (16d) and erythema marginatum (41d)) and positive antistreptolysin O titre (44d). Parotid swelling, peripheral oedema, elevated liver enzymes and diffuse lymphadenopathy complicated the diagnosis. Throat swab, chorea and carditis were negative or absent. Atypical ARF is challenging to recognise. There is no diagnostic test and its presentation is similar to that of other diseases. While the 2015 Jones criteria modification increased specificity of ARF diagnosis, atypical cases may still be missed, especially by physicians in developed countries. Suspicion of atypical ARF, especially after travel to high incidence regions, would allow for earlier treatment and prevention of rheumatic heart disease.

Parameters indicative of persistence of valvular pathology at initial diagnosis in acute rheumatic carditis: the role of albumin and CD19 expression / Parâmetros indicativos de persistência de patologia valvular no diagnóstico inicial de cardite reumática aguda: o papel da albumina e da expressão de CD19

Abstract Objective: The aim of this study is to define the predictors of chronic carditis in patients with acute rheumatic carditis (ARC). Methods: Patients diagnosed with ARC between May 2010 and May 2011 were included in the study. Echocardiography, electrocardiography, lymphocyte subset analysis, acute phase reactants, plasma albumin levels, and antistreptolysin-O (ASO) tests were performed at initial presentation. The echocardiographic assessments were repeated at the sixth month of follow-up. The patients were divided into two groups according to persistence of valvular pathology at 6th month as Group 1 and Group 2, and all clinical and laboratory parameters at admission were compared between two groups of valvular involvement. Results: During the one-year study period, 22 patients had valvular disease. Seventeen (77.2%) patients showed regression in valvular pathology. An initial mild regurgitation disappeared in eight patients (36.3%). Among seven (31.8%) patients with moderate regurgitation initially, the regurgitation disappeared in three, and four patients improved to mild regurgitation. Two patients with a severe regurgitation initially improved to moderate regurgitation (9.1%). In five (22.8%) patients, the grade of regurgitation [moderate regurgitation in one (4.6%), and severe regurgitation in 4 (18.2%)] remained unchanged. The albumin level was significantly lower at diagnosis in Group 2 (2.6 ± 0.48 g/dL). Lymphocyte subset analysis showed a significant decrease in the CD8 percentage and a significant increase in CD19 percentage at diagnosis in Group 2 compared to Group 1. Conclusion: The blood albumin level and the percentage of CD8 and CD19 (+) lymphocytes at diagnosis may help to predict chronic valvular disease risk in patients with acute rheumatic carditis.

Resumo Objetivo: Definir os preditores da cardite crônica em pacientes com cardite reumática aguda (CRA). Métodos: Os pacientes diagnosticados com CRA entre maio de 2010 e maio de 2011 foram incluídos no estudo. Foram feitos os testes de ecocardiografia, eletrocardiograma, uma análise do subgrupo de linfócitos, provas de fase aguda, níveis de albumina plasmática, antiestreptolisina-O (ASO) na manifestação inicial. As avaliações ecocardiográficas foram repetidas no 6º mês de acompanhamento. Os pacientes foram divididos em dois grupos de acordo com a persistência da patologia valvular no 6º mês como Grupo 1 e Grupo 2 e todos os parâmetros clínicos e laboratoriais na internação foram comparados entre dois grupos de comprometimento valvular. Resultados: Durante o período do estudo de um ano, 22 pacientes apresentaram doença valvular; 17 (77,2%) apresentaram regressão da patologia valvular. Houve desaparecimento de regurgitação moderada inicial em oito pacientes (36,3%). Entre sete (31,8%) pacientes com regurgitação moderada inicialmente, a regurgitação desapareceu em três e quatro apresentaram melhoria para regurgitação leve. Dois pacientes com regurgitação grave inicialmente apresentaram melhoria para regurgitação moderada (9,1%). Em cinco (22,8%) pacientes o grau de regurgitação (regurgitação moderada em um [4,6%] e regurgitação grave em quatro [18,2]) continuou inalterado. O nível de albumina foi significativamente menor no diagnóstico no Grupo 2 (2,6 ± 0,48 gr/dL). A análise do subgrupo de linfócitos mostrou uma redução significativa no percentual de CD8 e um aumento significativo no percentual de CD19 no Grupo 2 em comparação com o Grupo 1. Conclusão: O nível de albumina no sangue e o percentual de linfócitos CD8 e CD19 (+) no diagnóstico podem ajudar a prever risco de doença valvular crônica em pacientes com cardite reumática aguda.

Parameters indicative of persistence of valvular pathology at initial diagnosis in acute rheumatic carditis: the role of albumin and CD19 expression.

OBJECTIVE: The aim of this study is to define the predictors of chronic carditis in patients with acute rheumatic carditis (ARC). METHODS: Patients diagnosed with ARC between May 2010 and May 2011 were included in the study. Echocardiography, electrocardiography, lymphocyte subset analysis, acute phase reactants, plasma albumin levels, and antistreptolysin-O (ASO) tests were performed at initial presentation. The echocardiographic assessments were repeated at the sixth month of follow-up. The patients were divided into two groups according to persistence of valvular pathology at 6th month as Group 1 and Group 2, and all clinical and laboratory parameters at admission were compared between two groups of valvular involvement. RESULTS: During the one-year study period, 22 patients had valvular disease. Seventeen (77.2%) patients showed regression in valvular pathology. An initial mild regurgitation disappeared in eight patients (36.3%). Among seven (31.8%) patients with moderate regurgitation initially, the regurgitation disappeared in three, and four patients improved to mild regurgitation. Two patients with a severe regurgitation initially improved to moderate regurgitation (9.1%). In five (22.8%) patients, the grade of regurgitation [moderate regurgitation in one (4.6%), and severe regurgitation in 4 (18.2%)] remained unchanged. The albumin level was significantly lower at diagnosis in Group 2 (2.6±0.48g/dL). Lymphocyte subset analysis showed a significant decrease in the CD8 percentage and a significant increase in CD19 percentage at diagnosis in Group 2 compared to Group 1. CONCLUSION: The blood albumin level and the percentage of CD8 and CD19 (+) lymphocytes at diagnosis may help to predict chronic valvular disease risk in patients with acute rheumatic carditis.

Valores referenciales de antiestreptolisina O y portadores asintomáticos de estreptococos β-hemolíticos en adolescentes y adultos del Municipio Francisco Linares Alcántara, Venezuela / Reference valúes antistreptolysin O and asymptomatic carriers of β-hemolytic streptococci in adolescents and adults at Municipality Francisco Linares Alcántara, Venezuela

Introduction: β-hemolytic streptococci (Streptococcus pyogenes) groups A, C or G, secretes streptolysin O, toxin which causes in the infected individual an adaptive humoral immune response with production of serum antibodies called anti-streptolysin O (ASO). Objectives: To determine the reference value of ASO in a sample of 159 individuals aged 16-72 years from municipality Francisco Linares Alcántara, Aragua state, applying indirect (passive) agglutination test. By using a throat swab sample which was sown in blood agar 5% the frequency of asymptomatic carriers of β-hemolytic streptococci was also determined. Results and Discussion: As reference value for determining ASO by agglutination method a title of up to 200 IU/mL was obtained, this reference value differs from that recommended by the commercial equipment. Asymptomatic carriers frequency was 21.2% (n = 34). The distribution of β-hemolytic streptococci isolated were: group A (17.6%), group B (32.3%), group C (20.5%), group D (2.9%), group F (8.8%), group G (14.7%) and unclusterable (2.9%). Conclusions: The new ASO reference value for teens and adults of the mentioned municipality is up to 200 IU/mL. β-hemolytic Streptococcus group B was the most frequently isolated.

Introducción: Los estreptococos β-hemolíticos del grupo A (Streptococcus pyogenes), C o G, secretan estreptolisina O, toxina que causa en el individuo infectado una respuesta inmune adaptativa humoral con producción de anticuerpos séricos denominados antiestreptolisina O (ASO). Objetivos: Determinar el valor referencial de ASO en una muestra poblacional de 159 individuos con edades comprendidas entre 16 y 72 años del municipio Francisco Linares Alcántara, estado Aragua mediante aglutinación (pasiva) indirecta. También se determinó la frecuencia de portadores asintomáticos de estreptococos β-hemolíticos utilizando una muestra de exudado faríngeo que se sembró en agar sangre de cordero al 5%. Resultados y Discusión: Como valor referencial para la determinación de ASO por el método de aglutinación se obtuvo un título de hasta 200 UI/mL, valor que difiere del recomendado por el kit comercial. La frecuencia de portadores fue 21,2% (n = 34). La distribución de los estreptococos β-hemolíticos aislados fue: grupo A (17,6%), grupo B (32,3%), grupo C (20,5%), grupo D (2,9%), grupo F (8,8%), grupo G (14,7%) y no agrupable (2,9%). Conclusiones: El nuevo valor referencial de ASO para adolescentes y adultos del municipio mencionado es hasta 200 UI/mL. Streptococcus β-hemolítico del grupo B fue el grupo más frecuentemente aislado.

[Reference values of antistreptolysin O and asymptomatic carriers of ß-hemolytic streptococci in adolescents and adults at Municipality Francisco Linares Alcántara, Venezuela]. / Valores referenciales de antiestreptolisina O y portadores asintomáticos de estreptococos ß-hemolíticos en adolescentes y adultos del Municipio Francisco Linares Alcántara, Venezuela.

INTRODUCTION: ß-hemolytic streptococci (Streptococcus pyogenes) groups A, C or G, secretes streptolysin O, toxin which causes in the infected individual an adaptive humoral immune response with production of serum antibodies called anti-streptolysin O (ASO). OBJECTIVES: To determine the reference value of ASO in a sample of 159 individuals aged 16-72 years from municipality Francisco Linares Alcántara, Aragua state, applying indirect (passive) agglutination test. By using a throat swab sample which was sown in blood agar 5% the frequency of asymptomatic carriers of ß-hemolytic streptococci was also determined. RESULTS AND DISCUSSION: As reference value for determining ASO by agglutination method a title of up to 200 IU/mL was obtained, this reference value differs from that recommended by the commercial equipment. Asymptomatic carriers frequency was 21.2% (n = 34). The distribution of ß-hemolytic streptococci isolated were: group A (17.6%), group B (32.3%), group C (20.5%), group D (2.9%), group F (8.8%), group G (14.7%) and unclusterable (2.9%). CONCLUSIONS: The new ASO reference value for teens and adults of the mentioned municipality is up to 200 IU/mL. ß-hemolytic Streptococcus group B was the most frequently isolated.

Incidencia de amígdalas hipertróficas: programa de salud escolar 2006 – 2007. Hospital León Becerra de Milagro / Incidence of hypertrophic tonsils: school health program from 2006 to 2007. León Becerra Hospital in Milagro

Se realizó un estudio prospectivo, descriptivo en el hospital “León Becerra”, del cantón Milagro durante el programa de Salud Escolar. Objetivo: determinar la frecuencia de amígdalas hipertróficas en pacientes entre 5 y 11 años, asintomáticos. Materiales y métodos: se escogió 4 escuelas donde se estudió a 1.219 niños, de los cuales 187 presentaban un crecimiento exagerado de las amígdalas, sin sintomatología. Se les realizó a cada uno de los pacientes: historia clínica y examen; biometría hemática completa (BHC), antiestreptolisina o (ASTO) y proteína C reactiva (PCR). Resultados: la frecuencia de esta patología corresponde al 15%.No depende del género. El 71% de los niños estudiados presentan algún grado de deficiencia nutricional. El 78% tiene antecedente de amigdalitis a repetición.

A prospective, descriptive study was performed at the "León Becerra" hospital in Milagro Canton during the School Health program. Objective: to determine the frequency of hypertrophic tonsils in asymptomatic patients between 5 and 11 years old. Materials and methods: we chose 4 schools where 1,219 children were studied, out of which 187 had an overgrowth of the tonsils, without symptoms. Medical history and examination, complete blood count (BHC), antistreptolysin O (ASTO) and C reactive protein (CRP) were made to each patient. Results: the prevalence of this disease is 15%. It does not depend on gender. 71% of the children studied presented some degree of nutritional deficiency. 78% have a history of recurrent tonsillitis.

[Serum levels of antistreptolysin O in teenagers from Mexican urban and rural areas]. / Titulos séricos de antiestreptolisina O en adolescentes del area urbana y rural en México.

BACKGROUND: Antistreptolysin O (ASLO) may be an isolated evidence of recent infection by group A Streptococcus, especially in patients suspected of having a nonsuppurative sequel to this infection. We evaluated ASLO titers in students from urban and rural areas, age and geographic characteristics of study population among several other variables, could be factors that may influence in the ASLO levels in children. OBJECTIVE: To determine sera titers ofASLO in healthy adolescents from rural and urban areas in Mexico. MATERIAL AND METHODS: ASLO were detected by nephelometry, including 218 sera from asymptomatic high school students, two schools belong to government, one was at urban area (group 1; n = 68) and other was located at country side (rural) area (group 2; n = 75). The remaining school belong to private system and was located at urban area (group 3; n = 75). RESULTS: We included 218 sera, 58% were from females. Age (years) was expressed as median (maximum-minimum values) for groups 1, 2, and 3; 13 (12-18), 14 (12-18) and 14 (12-16) respectively. Weight (kg), height (cm) and body mass index (BMI) was expressed by mean +/- SD values for groups 1, 2, and 3; weight 48.8 +/- 8.8, 50.8 +/- 7.8, 57.2 +/- 11 respectively; height 154 +/- 6.9, 156 +/- 6.8, 161 +/- 8.2 and BMI 20.2 +/- 3.0, 20.9 +/- 2.9, and 21.9 +/- 3.6 respectively; when comparison among groups was performed, we found statistical differences in all variables. Titers for ASLO (UI/mL) expressed as median (maximum-minimum values) for groups 1, 2, and 3 were: 147 (20-828), 129 (25-1390) and 84 (25-848). Statistical differences between groups 1 vs 3, and 2 vs 3 were found. DISCUSSION: We confirm the variability of serum ASLO values among high school students. Thus, group 1 exhibited the highest levels of ASLO, and lowest values of weight, height, and BMI. When comparing against group 2 differences were non-significant. When comparing ASLO titers, Group 3 displayed lowest levels, which significantly differed from those of both groups 1 and 2. These findings discard influence of geographic location in ASLO titers, and indicate that better socioeconomic conditions may play a role.

Prevalencia de Streptococcus beta hemolítico en pacientes con faringoamigdalitis aguda, en un hospitalde la ciudad de Chachapoyas, Amazonas / Prevalence of beta hemolytic Streptococcus in patients with acute pharyngoamigdalitis in a Chachapoyas, Amazonas hospital

Introducción: En Chachapoyas hay numerosos pacientes con faringoamigdalitis aguda y cuadros clínicos con las complicaciones no supurativas que causa el Streptococcus pyogenes. Diseño: Estudio transversal. Lugar: Hospital I Higos Urco, EsSalud, Chachapoyas, Amazonas, e Instituto de Medicina Tropical Daniel A. Carrión, Universidad Nacional Mayor de San Marcos. Participantes: Pacientes con faringoamigdalitis aguda. Intervenciones: A 148 pacientes, seleccionados aleatoriamente, que acudieron al consultorio externo de otorrinolaringología por presentar cuadros clínicos compatibles con faringoamigdalitis aguda, se les tomó muestras de secreción faringoamigdaliana con hisopos y, usando el medio de transporte Amies con carbón (Difco), fueron enviados al Instituto de Medicina Tropical Daniel A. Carrión, en donde fueron procesados. Principales medidas de resultados: Presencia de Streptococcus beta hemolítico y otras bacterias cultivables. Resultados: Las enterobacterias fueron las más aisladas (49,1 por ciento) de los cultivos positivos. Solo 5 Streptococcus beta hemolíticos fueron aislados: un Streptococcus pyogenes, tres Streptococcus agalactiae y un Streptococcus del grupo G, los cuales fueron sensibles a los betalactámicos, macrólidos y lincosamidas. Conclusiones: Se sugiere realizar estudios complementarios con el dosaje de antiestreptolisina O.

Introduction: There are numerous Chachapoyas patients with acute pharyngoamigdalitis and clinical non suppurative complications caused by Streptococcus pyogenes. Design: Transversal study. Setting: Hospital I Higos Urco, EsSalud, Chachapoyas, Amazonas, and Instituto de Medicina Tropical Daniel A. Carrion, Universidad Nacional Mayor de San Marcos. Participants: Patients with acute pharyngoamigdalitis. Interventions: One hundred and forty-eight randomized outpatient subjects attending an ear, nose and throat office for clinical symptoms compatible with acute pharyngoamigdalitis had a sample of pharynx and tonsils taken with a cotton swab and sent in Amies with carbon medium (Difco) to the Instituto de Medicina Tropical Daniel A. Carrion to be processed. Main outcome measures: Presence of beta hemolytic Streptococcus and other bacteriae. Results: Positive cultures revealed mainly Enterobacteriae (49,1 per cent). Only 5 beta hemolytic Streptococcus were isolated: one Streptococcus pyogenes, three Streptococcus agalactiae and one group G Streptococcus, all sensitive to betalactamics, macrolides and lincosamides. Conclusions: We suggest to do complementary studies with antiestreptolysin O determination.

[Correlation between serum levels of antistreptolysin O and C reactive protein]. / Correlación entre concentraciones séricas de anti-estreptolisina O y proteína C reactiva.

INTRODUCTION: Measurement of antibodies to extracellular products of group A streptococcus, specifically streptolysin O (ASO), is useful to detect previous streptococcal infection, besides its ability to identify those asymptomatic carriers or to support diagnosis of poststreptococcal disease. An inflammatory process has been considered as a one variable that could be modifying the interpretation of ASO test. OBJECTIVE: identify in serum from clinically healthy subjects the covariability of antibodies to streptolysin O (ASO) serum concentration, high sensitivity C reactive protein (hsCRP). METHODS: 87 serum samples from 87 clinically healthy subjects were tested. ASO, hsCRP, and total IgG were measured by nephelometry. Statistical analysis was performed using mean, median, and standard deviation with descriptive purpose; in addition, normality of the distribution of variables was determined. Spearman correlation test was performed in all cases. Significance was considered for p < or = 0.05. RESULTS: A non-parametric distribution was exhibited by both ASO and hsCRP values. Gaussian distribution was finding only for IgG values. Spearman correlation values for ASO against both hsCRP and IgG were 0.19 (p = NS). CONCLUSIONS: ASO values distribution did not correlate with dispersion of levels of hsCRP, neither IgG. This suggests that values obtained from clinically healthy subjects in this study where not modified influenced by a potential subjacent inflammatory process, neither IgG serum levels.

[Determination of antistreptolysin "O" and C-reactive protein among school children of Laranjal, PR]. / Determinação de anti-estreptolisina "O" e proteína C reativa entre escolares do município de Laranjal, PR.

For antistreptolysin "O" and C-reactive protein determination, carried out in Laranjal-PR, we analyzed the serum of 411 school children aged from 5 to 16. For antistreptolysin O, 13.6% had elevated titers and 5.1% were reactive for C-reactive protein. No differences related to age or sex were observed.

Determinação de anti-estreptolisina "O" e proteína C reativa entre escolares do município de Laranjal, PR / Determination of antistreptolysin \"O\" and C-reactive protein among school children of Laranjal, PR

Para a determinação de anti-estreptolisina "O" e proteína C reativa, no município de Laranjal-PR, foram analisados soros de 411 escolares, entre 5 a 16 anos. Para anti-estreptolisina "O", 13,6 por cento tiveram títulos elevados e 5,1 por cento foram reativos para proteína C reativa. Não foram observadas diferenças em relação ao sexo e faixa etária.

Relación entre Pitiriasis Rosada y títulos séricos de Antiestreptolisina O (ASO) / Relationship between Pityriasis Rosea and Antistreptolysin O (ASO) seric titles

Se realizó un estudio prospectivo de casos y controles en el Servicio de Dermatología del Hospital Regional Docente de Trujillo, entre el 01 de enero del 2001 hasta el 31 de diciembre del 2002, seleccionándose 76 pacientes divididos en dos grupos, uno de ellos con pitiriasis rosada y los títulos séricos de antiestreptolisina O y la frecuencia de la misma en el Servicio de Dermatología. Los resultados demostraron que los pacientes con pitiriasis rosada tienen títulos séricos de antiestreptolisina O elevados con mayor frecuencia que los del grupo control (OR=12,4). Veintiocho pacientes con pitiriasis rosada tuvieron elevación de antitresptolisina O (73.7 por ciento). La mayor frecuencia estuvo entre los 16 y 30 años de edad con 21 casos (55.2 por ciento) afectando más a las mujeres, 23 casos (60.5 por ciento). Los estudiantes predominaron en nuestra serie con 17 casos (45 por ciento). La mayoría, 14 provinieron del distrito urbano marginal de la Esperanza (37 por ciento). Las lesiones se localizaron en el abdomen en 36 casos. La primavera y el otoño fueron las estaciones en que consultaron el mayor número de pacientes, 12 casos cada una (31 por ciento). Cifra estadísticamente significativa (p < 0.05). Conclusiones: Los pacientes con pitiriasis rosada tienen títulos séricos de antiestreptolisina O elevados con mayor frecuencia y es de mayor presentación en jóvenes y en mujeres, mientras que la localización predominante fue el abdomen.

Parkinsonian features after streptococcal pharyngitis.

Bradykinesia and rigidity developed in a 10-year-old girl during an episode of Sydenham chorea. These parkinsonian features improved over 6 months. Serum analysis demonstrated elevated anti-streptolysin-O and anti-basal ganglia antibodies. We suggest that autoimmune antibodies may cause remitting parkinsonian signs subsequent to streptococcal tonsillitis as part of the spectrum of poststreptococcal CNS disease.

Etiopatogenia da febre reumática / Etiopathogenesis of the rheumatic fever

O autor afirma que, embora haja plena aceitação da responsabilidade do estreptococo beta hemolítico na etiologia da febre reumática (FR), persistem dúvidas se há concomitante uma afeccção viral. Revisa as estruturas do estrptococo e chama atenção para o fato de que cada surto da doença é produzido por um sorotipo diferente do estreptococo. Resume os mecanismos patogênicos em três modos diferentes: a) ação lenta das bactérias; b) ação tóxica dos produtos, como a exotoxina; c) fenômenos de hipersensibilidade. Enfatiza a descoberta do antígeno de células B denominado D8/17

Doenças reumáticas pediátricas / Pediatric rheumatic diseases

Mediante à alta prevalência da febre reumática em nosso meio e diante das dificuldades no diagnóstico de formas incompletas ou atípicas, assim como de outras manifestações reumáticas pós-estreptocócicas pediátricas, apresentamos as recomendações de consenso pelo Departamento de Reumatologia da Sociedade de Pediatria de São Paulo para a interpretação do teste da antiestreptolisina O na prática pediátrica.

Novidades e aspectos clínicos controversos da febre reumática / New developments and controversal clinical aspects of rheumatic fever

O autor focaliza neste trabalho alguns aspectos modernos da febre reumática (FR). São revisões bibliográficas detectadas nos últimos cinco anos e que não estão presentes nas revisões publicadas recentemente.

Detección de títulos de Antiestreptolisina o (AELO) en una población pediátrica y rural de Antioquia / Antistreptolysin O titre detection in a rural pediatric population

Introducción: la fiebre reumática, complicación no supurativa de la amigdalofaringitis causada por Streptococcus del Grupo A (SGA), es un problema de salud pública principalmente en niños de 6 a 15 años. 15 por ciento a 20 por ciento de la población es portadora del agente causal, lo cual es un factor importante de diseminación de la infección en comunidades. En Antioquia se reportan 800 – 1000 casos de pacientes con fiebre reumática al año, quienes consultan por presentar signos y síntomas sugestivos del diagnóstico, pero los casos cuya clínica es bizarra pasan desapercibidos agravando las secuelas. La detección de Antiestreptolisinas O revela la frecuencia de la infección por SGA en grupos de riesgo. Objetivos: determinar AELO en muestras de sangre tomadas en papel de filtro. Determinar la frecuencia de títulos de AELO en niños de 6 a 14 años. Metodología: se estudiaron 506 muestras de sangre en papel de filtro de niños de 6 a 14 años procedentes de diferentes regiones de Antioquia del banco de muestras del Instituto Colombiano de Medicina Tropical. Los títulos de AELO fueron medidos en el eluido de la muestra utilizando reactivos Difco. Resultados: de las 506 muestras estudiadas, 154 (30.4 por ciento) presentaron títulos de AELO ≥320, 71 (14 por ciento) tuvieron títulos ≥ 640. Discusión: la determinación de AELO en muestras de sangre en papel de filtro facilitan y disminuyen costos en estudios poblacionales conservando las características de la técnica. La frecuencia de títulos elevados de AELO en el grupo estudiantil revela que la infección SGA en Antioquia es importante, las complicaciones y secuelas permanecen desconocidas

O perfil da antiestreptolisina O no diagnóstico da febre reumática aguda / Antistretolysin O titer profile in acute rheumatic fever diagnosis

Objetivo: estabelecer o perfil dos títulos de ASO, mediante o diagnóstico diferêncial da FRA com outras afecções que também cursam com níveis elevados de ASO. Métodos: foram estudados 78 casos de FRA na apresentação e seguimento, 22 de coréia isolada, 45 de infecções orofaringeanas recorrentes (IOR) e 23 artrites idiopáticas juvenis (AIJ), com início ou reativação recente. A determinação sequêncial de ASO (UI/ml) foi realizada por ensaio nefelométrico automatizado (Behring -Germany) nos períodos de 0-7 dias, 1-2 semanas, 2-4 semanas, 4-6 meses, 6-12, 1-2 anos, 2-3 anos, 3-4 anos e 4-5 anos após o diagnóstico. Resultados: os títulos de ASO na fase aguda da FRA apresentaram elevação significativamente até o inervalo de 2-4 meses (p<0,0001), quando atingiram os níveis basais e permaneceram estáveis por 5 anos na vigência de profilaxia secundária com penicilina. Os valores de ASO na apresentação da FRA também foram mais elevadas e com diferença significante quando comparadas aos de coréia isolada, IOR e AIJ (p=0,0025). As variações etárias e o limite superior da normalidade (320 UI/ml) foram considerados para a comparação entre estes grupos, assim como para o cálculo da sensibilidade (73,3 por cento) e da especificidade (57,6 por cento) mediante o diagnóstico clínico de FRA. A especificidade e valor preditivo positivo do teste aumentaram com títulos crescentes, sendo mais alta com títulos maior ou igual a 960 UI/ml. Conclusão: esta reavaliação do perfil da ASO indicou uma resposta exuberante na fase da febre aguda da febre reumática indicou ainda que os seus níveis séricos podem diferenciá-la de outras afecções que também cursam com níveis elevados de ASO, como as infecções orofaringeanas recorrentes ou as artrites idiopáticas juvenis em atividade