Estudio comparativo de concordancia y costes entre la prueba de la tuberculina y QuantiFERON ®-TB Gold In-Tube en el diagnóstico de la infección latente tuberculosa en contactos de pacientes con tuberculosis pulmonar / Comparative study of concordance and costs between tuberculin skin test and QuantiFERON ®-TB Gold In-Tube in the diagnosis of latent tuberculosis infection among contacts of patients with pulmonary tuberculosis

Introducción: El diagnóstico de la infección latente tuberculosa (ILT) es posible realizarlo mediante la prueba de la tuberculina (PT) o bien a través de las denominadas técnicas de interferon-γ release assays (IGRAS, «análisis de liberación del interferón-γ»), siendo QuantiFERON®-TB Gold In-Tube (QF-G-IT) la más usada. Los IGRAS permiten evitar algunos inconvenientes de la PT, especialmente la reacción cruzada con la vacuna con bacilo de Calmette-Guérin (BCG). No obstante, también presentan algunos problemas, como son los derivados del coste de la técnica, así como el ser un método de laboratorio que precisa una infraestructura y experiencia adecuadas. No existe un claro consenso sobre cuál de las técnicas debería utilizarse de forma prioritaria para el diagnóstico de la ILT. Método: Se trata de un estudio comparativo entre la PT y la QF-G-IT en nuestra cohorte de contactos de pacientes con tuberculosis pulmonar durante el período de estudio (n = 101). Se realizó un análisis de la concordancia global y por grupos según los contactos estuvieran vacunados con BCG o no. Se realizó, además, un estudio de costes de ambas técnicas y de las estrategias diagnósticas basadas en ellas. Resultados: La concordancia entre la PT y la QF-G-IT fue aceptable en el global de la muestra, pero muy buena en el grupo de no vacunados. Se registraron muy pocos casos de valores indeterminados. El estudio de costes mostró que la PT era más económica que la QF-G-IT; sin embargo, al analizar el coste de las estrategias según cada técnica, la PT mostró un mayor coste-beneficio. Conclusión: Aconsejamos considerar QF-G-IT como la única y preferente técnica para el diagnóstico de la ILT en contactos convivientes, basados en una buena concordancia general entre ambas técnicas (más aún si eliminamos el efecto de la vacuna) y un estudio de costes favorable a QF-G-IT (AU)

Introduction: Recently diagnosis of latent tuberculosis infection (LTBI) can be made using the tuberculin skin test (TST) or by techniques known as interferon-γ release assays (IGRAS), being QuantiFERON®-TB Gold In-Tube (QF-G-IT) the most used. The IGRAS avoid some drawbacks of the TST, especially cross-reaction with bacillus Calmette-Guérin (BCG) vaccine, but also present some problems such as those arising from cost and the need of having an adequate infrastructure and experience. There is no clear consensus on which technique should be preferentially used for the diagnosis of LTBI. Methods: This is a comparative study between the TST and QT-G-IT in a cohort of contacts of patients with pulmonary tuberculosis during the study period. An analysis of global agreement and groups was performed according to whether the contacts were vaccinated with BCG or not. A study of costs of both techniques and diagnostic strategies based on these techniques was performed. Results: The agreement between TST and QF-G-IT was acceptable in the whole sample yet it was very good in the unvaccinated group. Few cases of indeterminate values were recorded. The cost study showed that TST was cheaper than QF-G-IT; however when we analyzed the cost of the strategies according to each technique, the QF-G-IT showed a better cost-benefit. Conclusion: We suggest considering QF-G-IT as the only preferred technique for the diagnosis of LTBI in household contacts, based on good overall agreement between the 2 techniques (even if we eliminate the effect of the vaccine) and a cost analysis favorable to QF-G-IT (AU)

[Comparative study of concordance and costs between tuberculin skin test and QuantiFERON(®)-TB Gold In-Tube in the diagnosis of latent tuberculosis infection among contacts of patients with pulmonary tuberculosis]. / Estudio comparativo de concordancia y costes entre la prueba de la tuberculina y QuantiFERON(®)-TB Gold In-Tube en el diagnóstico de la infección latente tuberculosa en contactos de pacientes con tuberculosis pulmonar.

INTRODUCTION: Recently diagnosis of latent tuberculosis infection (LTBI) can be made using the tuberculin skin test (TST) or by techniques known as interferon-γ release assays (IGRAS), being QuantiFERON(®)-TB Gold In-Tube (QF-G-IT) the most used. The IGRAS avoid some drawbacks of the TST, especially cross-reaction with bacillus Calmette-Guérin (BCG) vaccine, but also present some problems such as those arising from cost and the need of having an adequate infrastructure and experience. There is no clear consensus on which technique should be preferentially used for the diagnosis of LTBI. METHODS: This is a comparative study between the TST and QT-G-IT in a cohort of contacts of patients with pulmonary tuberculosis during the study period. An analysis of global agreement and groups was performed according to whether the contacts were vaccinated with BCG or not. A study of costs of both techniques and diagnostic strategies based on these techniques was performed. RESULTS: The agreement between TST and QF-G-IT was acceptable in the whole sample yet it was very good in the unvaccinated group. Few cases of indeterminate values were recorded. The cost study showed that TST was cheaper than QF-G-IT; however when we analyzed the cost of the strategies according to each technique, the QF-G-IT showed a better cost-benefit. CONCLUSION: We suggest considering QF-G-IT as the only preferred technique for the diagnosis of LTBI in household contacts, based on good overall agreement between the 2 techniques (even if we eliminate the effect of the vaccine) and a cost analysis favorable to QF-G-IT.

La infección neonatal tardía por Streptococcus agalactiae en el área de Barcelona (1996-2010) / Streptococcus agalactiae late-onset neonatal infections in Barcelona (1996-2010)

OBJETIVO: Analizar las características de la sepsis neonatal tardía (SNT) por estreptococo del grupo B (EGB) y la evolución de su incidencia en 8 hospitales del área de Barcelona a lo largo de los 15 años de consolidación de las medidas de prevención de la infección neonatal precoz. MÉTODOS: Revisión retrospectiva de los pacientes diagnosticados de SNT por EGB desde 1996 a 2010. RESULTADOS: Se diagnosticaron 143 pacientes, de los que 51 habían nacido en otros centros. La incidencia global fue del 0,4 2‰ de recién nacidos vivos (RNV), oscilando entre el 0,14‰ en 2000 y el 0,80‰ en 2009. Se observó una tendencia al incremento del riesgo discreta pero sostenida a lo largo de los años, del 6,9% en las SNT totales, aunque sin la suficiente significación estadística. El 63,6% de los pacientes presentaron sepsis/bacteriemia, el 32,8% meningitis y el 3,5% artritis/osteomielitis. De los casos en los que se pudo obtener información sobre los antecedentes obstétricos, el 53% de las madres presentaron cultivo positivo a EGB al final del embarazo, el 53,8% recibieron profilaxis antibiótica intraparto y el 41,2% presentaron algún factor de riesgo, principalmente parto prematuro en el 35,9% de los casos. La mortalidad fue del 2,8%, y los serotipos mayoritarios, el III y el Ia. CONCLUSIONES: La incidencia de SNT por EGB no ha disminuido a pesar de las medidas de prevención de la SNP, y la posibilidad de su aparición debe ser tenida en cuenta

OBJECTIVE: To study the characteristics and evolution of group B Streptococcus (GBS) late-onset diseases, over a period of 15 years in 8 hospitals the Barcelona area and analyze the possible impact of prophylactic measures for the prevention of early-onset neonatal infections. METHODS: Retrospective review of all patients diagnosed with late-onset neonatal disease due to GBS from 1996 to 2010. RESULTS: A total of 143 patients were diagnosed. Of these, 51 were born in others hospitals. The overalll incidence was 0.42 per 1000 live births, varying between 0.14‰ in the year 2000 and 0.80‰ in 2009. A slight but sustained tendency of increased risk was observed over the years, 6.9% in the overall disease (with no statistical significance). Sepsis/bacteremia was detected in 63.6% of the newborns, meningitis in 32.8%, and arthritis/osteomyelitis in 3.5%. In cases with known obstetrics dates, 53% of mothers had been colonized by GBS during pregnancy, 53.8% received intrapartum antibiotic prophylaxis, and 41.2% had some obstetric risk factors, particularly premature birth in 35.9%. There was a 2.8% mortality rate in the neonates, and predominant serotypes were III and Ia. CONCLUSIONS: The incidence of GBS late-onset disease has not decreased despite the control practices of early-onset disease, and possibility of this appearing must be taken into account

[Streptococcus agalactiae late-onset neonatal infections in Barcelona (1996-2010)]. / La infección neonatal tardía por Streptococcus agalactiae en el área de Barcelona (1996-2010).

OBJETIVE: To study the characteristics and evolution of group B Streptococcus (GBS) late-onset diseases, over a period of 15years in 8hospitals the Barcelona area and analyze the possible impact of prophylactic measures for the prevention of early-onset neonatal infections. METHODS: Retrospective review of all patients diagnosed with late-onset neonatal disease due to GBS from 1996 to 2010. RESULTS: A total of 143 patients were diagnosed. Of these, 51 were born in others hospitals. The overalll incidence was 0.42 per 1000 live births, varying between 0.14‰ in the year 2000 and 0.80‰ in 2009. A slight but sustained tendency of increased risk was observed over the years, 6.9% in the overall disease (with no statistical significance). Sepsis/bacteremia was detected in 63.6% of the newborns, meningitis in 32.8%, and arthritis/osteomyelitis in 3.5%. In cases with known obstetrics dates, 53% of mothers had been colonized by GBS during pregnancy, 53.8% received intrapartum antibiotic prophylaxis, and 41.2% had some obstetric risk factors, particularly premature birth in 35.9%. There was a 2.8% mortality rate in the neonates, and predominant serotypes were III and Ia. CONCLUSIONS: The incidence of GBS late-onset disease has not decreased despite the control practices of early-onset disease, and possibility of this appearing must be taken into account.

[Toxoplasmosis and pregnancy. Multicenter study of 16,362 pregnant women in Barcelona]. / Toxoplasmosis y embarazo. Estudio multicéntrico realizado en 16.362 gestantes de Barcelona.

BACKGROUND AND OBJECTIVE: The aim of this study was to know: 1) the prevalence of antibodies against toxoplasma in pregnant women, 2) the incidence of primary infection during pregnancy and 3) the prevalence of congenital toxoplasmosis. SUBJECTS AND METHOD: Seroprevalence was prospectively analyzed in 16,362 pregnant women visited in 8 hospitals and 2 day care centers in Barcelona during 1999. Each participant laboratory included their own assays to detect toxoplasma-specific immunoglobulins IgM, IgA, IgG and IgG avidity antibodies. In case of positive specific IgM, a second serum sample was requested, which was processed in parallel with the first one. Three infection stages were defined: acute, possible and past (latent). Congenital infection was determined prenatally by polymerase chain reaction (PCR) in amniotic fluid or postnatally by serology in the newborn. RESULTS: Seroprevalence was 28.6%. The incidence of primary infection during pregnancy was 1.02/1,000 susceptible pregnant women. Nine women out of 12 with an acute toxoplasma infection became seroconverted during their pregnancies and five of them had infants with congenital toxoplasmosis (vertical transmission: 41.6%). All four children born alive had no symptoms during their follow-up. CONCLUSIONS: In this study, the prevalence of toxoplasmosis was low. Acute toxoplasmosis was detected mainly by seroconversion during pregnancy. The frequency of maternal-fetal transmission was near half of cases.