[Use of MALDI-TOF in the rapid diagnosis of sepsis]. / Utilización de MALDI-TOF en el diagnóstico rápido de la sepsis.

The introduction of mass spectrometry through MALDI-TOF (matrix-assisted laser desorption ionization time-of-flight) in the diagnosis of bacteraemia and fungaemia has represented a revolution due to the rapidity and reliability of the results that it can offer to microbiology services and laboratories through analysis of the mass spectrum of the bacterial protein directly from positive blood culture bottles. These data are more useful if they are used in conjunction with other techniques able to identify the antibiotic resistance pattern of the microorganism. There is a need for a process of standardising sample processing protocols and for perfecting the identification of the agents causing bacteraemia, especially in some species of Gram-positive cocci and in polymicrobial processes. The introduction of this methodology provides rapid information that is highly important for the clinical management of bacteraemia. The availability of a multidisciplinary working group that applies all this information quickly and correctly in hospitals will improve the quality of care, reduce antibiotic expenditure and hospital stay and help to control the serious problem of antibiotic resistance.

[Microbiological diagnosis of imported malaria]. / Diagnóstico microbiológico de la malaria importada.

Current diagnosis of malaria is based on the combined and sequential use of rapid antigen detection tests (RDT) of Plasmodium and subsequent visualization of the parasite stained with Giemsa solution in a thin and thick blood smears. If an expert microscopist is not available, should always be a sensitive RDT to rule out infection by Plasmodium falciparum, output the result immediately and prepare thick smears (air dried) and thin extensions (fixed with methanol) for subsequent staining and review by an expert microscopist. The RDT should be used as an initial screening test, but should not replace microscopy techniques, which should be done in parallel. The diagnosis of malaria should be performed immediately after clinical suspicion. The delay in laboratory diagnosis (greater than 3 hours) should not prevent the initiation of empirical antimalarial treatment if the probability of malaria is high. If the first microscopic examination and RDT are negative, they must be repeated daily in patients with high suspicion. If suspicion remains after three negative results must be sought the opinion of an tropical diseases expert. Genomic amplification methods (PCR) are useful as confirmation of microscopic diagnosis, to characterize mixed infections undetectable by other methods, and to diagnose asymptomatic infections with submicroscopic parasitaemia.

Tropismo del VIH. Técnicas disponibles y utilidad / Methods for determination of HIV tropism and their clinical use

La necesidad de conocer previamente el tropismo constituye un requisito imprescindible para el uso de los fármacos antagonistas de los correceptores CCR5. Un fármaco de esta clase, maraviroc, está ya aprobado para el tratamiento de la infección por el virus de la inmunodeficiencia humana (VIH). Aunque en los ensayos de desarrollo de maraviroc, el tropismo se determinó mediante pruebas fenotípicas (Trofile®), la realización de éstas es compleja, tiene un coste elevado y su accesibilidad es limitada, lo que dificulta su utilización en la práctica clínica. Los métodos genotípicos basados en el análisis de la tercera región variable (V3) de la envuelta del VIH utilizando algoritmos de interpretación como geno2pheno y PSSM representan una alternativa rápida, barata y accesible en laboratorios diagnósticos para predecir el tropismo viral. En los análisis retrospectivos de los ensayos clínicos de maraviroc, las pruebas genotípicas realizadas mediante técnicas de genotipo convencional (o poblacional) o mediante las nuevas plataformas de secuenciación masiva (pirosecuenciación por 454) fueron capaces de predecir la respuesta virológica al fármaco con una exactitud similar a las pruebas fenotípicas y, actualmente, las recomendaciones españolas y europeas las incluyen como una alternativa aceptable para la determinación del tropismo viral en la práctica clínica (AU)

Determination of HIV-1 tropism is mandatory before using CCR5 antagonists in clinical practice. One drug of this class, maraviroc, has been approved for the treatment of HIV infection. The phenotypic assay, TrofileTM, was clinically validated in the clinical development program of maraviroc and has been widely used to select candidates for maraviroc therapy. Phenotypic tests, however, have the disadvantage of being complex, are costly and time-consuming, and their accessibility is limited, which hampers their routine use in clinical diagnosis. Genotypic assays, based on sequencing the third hypervariable (V3 loop) of the viral gene env, interpreted according to various genotypic bioinformatic tools, such as geno2pheno and PSSM, are faster and cheaper than phenotypic assays, and are also more accessible. In retrospective analyses of the maraviroc pivotal trials, genotypic methods using either conventional (“bulk”) or deep-sequencing technology predicted virologic response to maraviroc similarly to phenotypic assays and are now included within several European recommendations to guide the clinical use of CCR5 antagonists (AU)

Mesotelioma multiquístico peritoneal benigno / Benign multicystic peritoneal mesothelioma

El mesotelioma quístico peritoneal es una lesión caracterizada por la formación de múltiples quistes de tamaño variable que adoptan la forma de masas abdominales preferentemente pelvianas. Presentamos el caso de una mujer de 30 años con dolor abdominal y masa palpable cuya clínica sugería un cuadro de endometriosis. En la intervención quirúrgica se encontró una masa multiquística dependiente del epiplón mayor, por lo que se procedió a su extirpación. El diagnóstico anatomopatológico de la pieza fue de mesotelioma multiquístico peritoneal benigno, una enfermedad poco frecuente, en la que el problema más importante que se plantea es la alta tasa de recidiva locorregional (AU)