High prevalence of Mycobacterium tuberculosis DNA in biopsies from sarcoidosis patients from Catalonia, Spain.

BACKGROUND: Sarcoidosis is a systemic granulomatous disease of unknown etiology. The presence of mycobacterial nucleic acid components in patients with sarcoidosis has been demonstrated with varying degrees of success. OBJECTIVES: The aim of this study was to estimate the presence of Mycobacterium tuberculosis DNA in tissues from sarcoidosis patients, in Catalonia, Spain, as well as to assess the long-term clinical course in these patients. METHODS: Fifty-eight paraffin-embedded tissue biopsies corresponding to cases of sarcoidosis (n = 23), lung neoplasm (n = 23), and lung tuberculosis (n = 12) available in 1996 were analyzed in a retrospective study by means of a nested polymerase chain reaction using primers corresponding to the insertion element IS6110 of M. tuberculosis complex. For greater sensitivity, Southern blot hybridization was performed. Clinical data were recorded prior to and after PCR analysis (follow-up reported until 2002). RESULTS: M. tuberculosis DNA was present in 9 out of 23 sarcoidosis biopsies (39%), in 1 out of 23 control patients (4%) (p < 0.01), and in all tissue samples from the 12 control patients with tuberculosis. To date, none of these sarcoidosis patients has developed tuberculosis over a mean (+/-SD) follow-up period of 11 (+/-3.4) years. CONCLUSION: In our setting, M. tuberculosis DNA is present in tissue biopsies of significantly more sarcoidosis patients than controls. However, these results do not demonstrate causality, although they may suggest a link between M. tuberculosis infection and sarcoidosis in some cases. Follow-up of these patients suggests that M. tuberculosis-DNA-positive sarcoidosis patients are not at greater risk of developing tuberculosis than M. tuberculosis-DNA-negative patients.

Achilles tendinitis as the presentation form of Löfgren's syndrome.

Löfgren's syndrome is characterised by bilateral hilar adenopathy arthritis and erythema nodosum. Achilles tendinitis as the presentation form of Löfgren's syndrome is very unusual. Herein we present a case of bilateral achilles tendinitis as the presentation form of Löfgren's syndrome.

Sarcoidosis: family contact study.

AIM: To assess the familial aggregation in sarcoidosis in our environment. METHODS: The medical centers of Catalonia (Spain) were approached to identify, retrospectively, patients diagnosed as sarcoidosis from 1986 to 1988. 245 sarcoidosis cases were recorded (annual incidence: 1.36/100,000 inhabitants). Finally, in 1990 a telephone questionnaire was administered to 188 sarcoidosis cases. RESULTS: These cases reported 3,757 familial contacts, 5 of whom had confirmed sarcoidosis. The clinical presentation of familial sarcoidosis was similar to nonfamilial sarcoidosis, only Löfgren syndrome stood out. The prevalence of sarcoidosis among familial contacts was 1.33/1,000. CONCLUSIONS: The familial association is low and corresponds with the low annual incidence in our community.

Epidemiology of sarcoidosis in Catalonia: 1979-1989.

For the purpose of estimating the incidence rate and clinico-epidemiological characteristics of sarcoidosis in Catalonia (a country comprising the provinces of Barcelona, Tarragona, Lleida and Girona, with a total population of 6 million people), we did a retrospective study of new cases diagnosed in the country's qualified hospitals during 1979 and the three-year period from 1986 to 1988. The annual incidence rate in the province of Barcelona was 1.2/100,000 in 1979 and 1.5/100,000 in 1988. 245 cases were diagnosed in Catalonia in the three-year period covering 1986-88, the annual incidence rate being 1.36/100,000 inhabitants. We describe here the characteristics of this series of 245 cases (which is the first one representative of the whole of Catalonia), and compare them with those of other series published previously. We conclude that the incidence of sarcoidosis in our country is one of the lowest in Europe, with no significant variations observed over ten years. The most relevant clinico-epidemiological characteristics are its clear predominance in women (3:1), and the high frequency of Löfgren's syndrome (48% of cases), whose incidence is significantly higher in springtime.

Sarcoidosis: chest radiograph screening of familial contacts.

On the basis of the hypothesis that sarcoidosis might be a transmissible disease, we thought a study of the familial contacts of known cases, as is done in tuberculosis, might reveal asymptomatic cases. In order to assess the efficiency of chest radiographs in detecting asymptomatic sarcoidosis in such contacts, we carried out a cross-sectional study. The population studied consisted of 66 index cases of sarcoidosis who were self-selected by their agreeing to take part in the study. Criteria were established with regard to the size of the family to be studied, along with three grades of intensity in the relationship between the index cases and their respective contacts. 976 familial contacts over 14 years of age, from grandparents to grandchildren of the index cases were identified, including nonconsanguineous contacts. 496 close contacts were asked to take part in the survey. Among these contacts there were 2 with a previous sarcoidosis, a prevalence of 4/1,000. 239 of these 496 contacts agreed to radiograph screening. Among those screened, no new cases of sarcoidosis were detected. We concluded that at present in our environment, with a low incidence and good prognosis, routine screening of relatives is not indicated. Nevertheless, longitudinal epidemiological studies designed to ascertain the pattern of transmission of the disease and including chest radiograph screening in a population with a high incidence of the disease could be of interest.

[The Kveim-Siltzbach test in sarcoidosis]. / La prueba de Kveim-Siltzbach en la sarcoidosis.

BACKGROUND: The Kveim-Siltzbach test has been widely used in the diagnosis of sarcoidosis. This reactive is currently available in the authors' hospitals. Previous experience with this test in the same centers was reviewed to know its diagnostic usefulness. The present is the first series described in Spain. METHODS: From 1977 to 1988 the Kveim-Siltzbach test was performed in 79 patients diagnosed or suspected of having sarcoidosis. The study was carried out as cooperation of the validation process of sarcoid spleen suspensions (lots K12, K12 1/2, K32, K41, K42, K42 1/2 and K50 of the Colindale antigen) prepared in the Standards Laboratory for Serological Reagents in the Royal Brompton Hospital in London. RESULTS: The results of test positivity were determined following the criteria established by Siltzbach. The global sensitivity of the Kveim-Siltzbach test was 78% (CI 95% = 67.8-86.9). Positivity ranged from 84% in subacute sarcoidosis to 61% in chronic sarcoidosis (p = 0.08). Likewise, it was higher in patients with radiologic stage I (84%) and II (81%) with respect to stage III (62%) or the cases with exclusive extrathoracic sarcoidosis (stage 0) (57%) (p = 0.11). No association was found between the Kveim-Siltzbach test positivity and the elevation in serum values of the angiotensin-converting enzyme (p = 0.575). CONCLUSIONS: In the present study the Kveim-Siltzbach test showed high sensitivity in the diagnosis of sarcoidosis. This fact, together with the high specificity observed in other studies, makes the test a very useful tool for the non-invasive diagnosis of sarcoidosis.

Sarcoidosis in Spain.

We review the Spanish literature on sarcoidosis, and describe the most important epidemiological and clinical findings. Recent epidemiological data show a cumulative annual incidence rate of 1.36 per 100,000 inhabitants. The most relevant clinical aspects are the high incidence of Löfgren syndrome (48% of the cases), and the low percentage of cases diagnosed by routine chest X-ray (9%). Findings of intrathoracic and extrathoracic sarcoidosis, biopsy procedures, Kveim test, lung function tests, as well as the activity markers are, in general, similar to those previously described in the literature. The overall prognosis of sarcoidosis in Spain is good.

The effect of time and temperature on blood glucose measurements.

Diabetic patients admitted for home healthcare services may require daily blood glucose measurements by the nurse until glucose control is achieved. Improper storage of blood specimens and unstable environmental temperature may alter the reliability of blood glucose measurements. Because accurate measurements are essential in decision making for diabetic control, specimen collection and handling are important concerns for home healthcare nurses.

[Sarcoidosis in Catalonia: analysis of 425 cases]. / Sarcoidosis en Cataluña: análisis de 425 casos.

In a retrospective cooperative study carried out in three Barcelona hospitals, 425 patients in whom a diagnosis of sarcoidosis had been made during a 15-year period were evaluated. Several parameters were evaluated and compared with those from the longest series in the literature. Remarkable epidemiological and clinical features included the female predominance, explained by the high frequency of clinical presentations with erythema nodosum; the high incidence of other skin lesions, and, by contrast, the low frequency of eye involvement. It was also remarkable that in a few cases the diagnosis was made in a routine chest radiogram. In diagnostic procedures there was a good diagnostic yield from mediastinoscopy and muscle and pre-scalene fat biopsies The results of Kveim's test, functional respiratory testing and such current activity markers as 67-gallium pulmonary scintigraphy, serum levels of angiotensin converting enzyme and bronchoalveolar lavage were analyzed, and no differences with other series from the literature were found. The presence of the B8 allele and the A1 B8 haplotype was highly significant in subacute sarcoidosis. It is concluded that sarcoidosis is not an uncommonly found condition in this country if the suspicion index is high and an appropriate diagnostic workup is carried out. Its features are not different, as a rule, from those in other European series.

Breakage and detachment of an Abrams needle in the pleural cavity during performance of a pleural biopsy.

This is the report of a case of breakage and detachment in the pleural cavity of the tip of a nearly new Abrams needle during performance of a pleural biopsy. We have not found any reference in the literature to similar accidents and do not know what later complications may be produced by the metal body in the pleural cavity. In this case, there have been no complications 12 months after the incident.

[Delayed skin reaction in a group of 400 hospital patients: control study (author's transl)]. / Reactividad cutánea retardada en una población de 400 pacientes hospitalizados. Estudio control.

Delayed hypersensitivity skin tests were carried out with 5 antigens - PPD, staphylococcus, streptokinase/streptodornase, candida and trichophytin-in 400 hospital patients without any known causes for diminished delayed hypersensitivity. The degree of reactivity to each antigen was: PPD. 69.50%; candida 49.75%; streptokinase/streptodornase 44.50%; trichophytin 42.00%; staphylococcus 14.25%. Reactivity to either PPD or candida occurred in 86.50% of all cases. Positive response to streptokinase/streptodornase was present in 7%; which brings the total cases with reactions to one or more of the 3 antigens to 93.50%. Those who responded to trichophytin or staphylococcus were 3% only, bringing the total response of all cases to at least one antigen, to 96.5%.