Drug-resistant tuberculosis in Castilla-León, Spain, 1996-2000.

SETTING: During 1996-2000, a regional anti-tuberculosis drug resistance survey was conducted in Castilla-León, Spain. OBJECTIVE: To determine the incidence of drug-resistant tuberculosis (TB) in newly treated human immunodeficiency virus (HIV) negative and HIV-positive TB patients. DESIGN: Nine hundred and eighty-five Mycobacterium tuberculosis strains isolated from HIV-negative (926) and HIV-positive (59) patients were studied (one strain per patient). Univariate and multivariate analyses were used to determine the prevalence of drug resistance in high-risk groups. RESULTS: Thirty-eight isolates (3.8%) showed resistance to one of the following drugs: streptomycin (S), isoniazid (H), rifampicin (R) or ethambutol (E). Of these, 36 (3.9%) were from HIV-negative and 2 (3.4%) from HIV-positive patients. The rate of drug resistance among HIV-negative patients was 1.2%, 2.0%, 0.3% and 0.8%, respectively, for S, H, R and E, and for HIV-positive patients it was 3.4%, 0%, 0% and 1.7%. Among the HIV-negative patients, monoresistance was observed in 32 (3.4%) strains and resistance to both H and R (multi-drug resistance) was detected in one. CONCLUSION: The incidence of primary drug resistance in the surveyed area was low and increased resistance was not observed in the HIV-positive group (P = 0.99). Routine surveillance of drug resistance is recommended by the TB control programme in representative patient populations to optimise treatment regimens.

[Neurobrucellosis: four case reports]. / Neurobrucelosis: presentación de cuatro casos.

INTRODUCTION: Brucellosis is a form of anthropozoonosis that is found the world over. It has a particularly high incidence rate in Spain, above all in rural areas such as Extremadura, Castile and Leon, Castile-La Mancha and Aragon, largely due to the consumption of non-pasteurised milk and cheese. Neurobrucellosis can be defined as a set of either early or late neurological complications caused by Brucella. It is difficult to determine its frequency, although it oscillates between 2-18% of all cases of brucellosis. CASE REPORTS: We report the cases of four patients diagnosed as having neurobrucellosis. The different presenting clinical symptoms, the complementary explorations, treatment and duration are all described. CONCLUSIONS: The clinical features of neurobrucellosis vary greatly and, in general, tend to be chronic. Many of the laboratory procedures usually employed in the diagnosis of brucellosis frequently give negative results. For these reasons, and because it is a disease that is both treatable and curable, the degree of suspicion must be high, especially in endemic areas, so that an early diagnosis can be made to allow suitable treatment to be established.

Neurobrucelosis: presentación de cuatro casos / Neurobrucellosis: four case reports

Introduction. Brucellosis is a form of anthropozoonosis that is found the world over. It has a particularly high incidence rate in Spain, above all in rural areas such as Extremadura, Castile and Leon, Castile-La Mancha and Aragon, largely due to the consumption of non-pasteurised milk and cheese. Neurobrucellosis can be defined as a set of either early or late neurological complications caused by Brucella. It is difficult to determine its frequency, although it oscillates between2-18% of all cases of brucellosis. Case reports. We report the cases of four patients diagnosed as having neurobrucellosis. The different presenting clinical symptoms, the complementary explorations, treatment and duration are all described. Conclusions. The clinical features of neurobrucellosis vary greatly and, in general, tend to be chronic. Many of the laboratory procedures usually employed in the diagnosis of brucellosis frequently give negative results. For these reasons, and because itis a disease that is both treatable and curable, the degree of suspicion must be high, especially in endemic areas, so that an early diagnosis can be made to allow suitable treatment to be established (AU)

Introducción. La brucelosis es una antropozoonosis dedistribución mundial. Su incidencia en España es muy alta, sobretodo en áreas rurales de Extremadura, Castilla y León, Castilla-La Mancha y Aragón, en buena parte debido al consumo de leche y quesos no pasteurizados. La neurobrucelosis puede definirse como el conjunto de complicaciones neurológicas precoces o tardías debidas a Brucella. Su frecuencia es difícil de establecer, aunque oscila en un 2-18% de todos los casos de brucelosis. Casos clínicos. Presentamos cuatro pacientes diagnosticados de neurobrucelosis. Se exponen las diferentes formas de presentación clínica, las exploraciones complementarias, el tratamiento y su duración. Conclusiones. Las manifestaciones clínicas de la neurobrucelosis varían mucho y, en general, son de carácter crónico. En muchas ocasiones las determinaciones de laboratorio habitualmente empleadas para el diagnóstico de la brucelosis son negativas. Por estas razones, y por ser una enfermedad tratable y curable, se debe tener un elevado índice de sospecha, sobre todo en áreas endémicas, para hacer un diagnóstico precoz que permita instaurar el tratamiento adecuado (AU)

[Prevalence of antibodies against hepatitis A, B, C and E viruses in the rural child population in Northern Extremadura]. / Prevalencia de marcadores de hepatitis víricas en niños del norte de Extremadura.

OBJECTIVE: The purpose of this study was to determine the prevalence of antibodies against the A, B, C and E hepatitis viruses was studied in the rural child population of Plasencia (Northern area of Extremadura). MATERIAL AND METHODS: A set of 411 serum samples, corresponding to 209 boys and 202 girls, distributed in three age groups (4-5, 9-10 and 13-15 years) were studied. The population was randomly chosen from the entire child population of the Plasencia sanitary area. Enzyme immunoassay was used in all cases to determine the IgG antibodies against the A virus (anti-HAV), the antibodies against the antigen of the B virus core (anti-HBc), and the antibodies against the C virus (anti-HCV). In 95 cases of the 13-15 year old group we also determined the antibodies against the E virus (anti-HEV). RESULTS: The anti-HAV was positive in 104 samples (25.3%), 1 belonging to the 4-5 year old group, 46 to the 9-10 year olds (32.8%) and 57 to the 13-15 year old group (38.2%). The anti-HBc was found to be positive only in three children (0.7%). No serum samples presented anti-HCV. The anti-HEV was positive in 5 cases out of the 95 studied (5.3%). CONCLUSION: Our results indicate high HAV infection rates in the rural child population and a low prevalence of infection by HBV. No infection by HCV was detected. The recently described HEV is present in our area with a higher prevalence than in other European countries.

Genitourinary tuberculosis in Spain: review of 81 cases.

Cases of genitourinary tuberculosis diagnosed at the Hospital Clínico Universitario between January 1978 and December 1989 were studied. Genitourinary tuberculosis was the most frequent type of extrapulmonary tuberculosis diagnosed, accounting for 81 (40.9%) of 198 cases. Fifty-one patients (63%) were men. The mean ages of male and female patients were 48.4 years and 51.1 years, respectively (range, 21-75 years). Cases were widely distributed among most age groups; patients were most often 30-69 years of age. Constitutional symptoms were less frequent than local, urinary tract-related symptoms. Only 23.5% of patients had a known history of tuberculosis. Pyuria plus hematuria with sterile cultures was the commonest urinary finding. The results of intravenous pyelography were abnormal in 95% of cases. Ziehl-Neelsen staining gave positive results in 48% of cases. Cultures became positive after a mean (ISD) of 2.3 +/- 1.5 weeks. Sequelae were documented in 42% of cases, but only one death due to genitourinary tuberculosis was recorded.

Epidemiology and clinical significance of Blastocystis hominis in different population groups in Salamanca (Spain).

A prospective study was carried out to investigate the epidemiology and clinical significance of Blastocystis hominis in the following groups of the population of the city of Salamanca (Spain): in children attending 11 day care centres and 7 primary schools, two fecal samples were obtained from each child, and in 1231 patients attending the Clinical Hospital. A B. hominis incidence of 5.3-10.3% was found in the day care centres and an incidence rate of 13.4-19.4% was found in the primary schools. All the cases were observed in asymptomatic children. The incidence of B. hominis was greater in children older than 3 years in the day care centres and in the 10-14 year-old group in the primary schools. A heavier parasitization was observed in the boys than in the girls and in the students of schools in areas of low socio-economic level. B. hominis was identified in 40 patients attending the Clinical Hospital (3.25% of all those studied). The maximum peak of incidence was found in subjects with ages between 10 and 14 years. A follow up study was performed on 18 patients parasitized exclusively by B. hominis; 7 of these were considered to have acute gastroenteritis and one chronic gastroenteritis associated with the protozoan. No statistically significant association was observed between the number of B. hominis cells and the presence of diarrhoea. Our results show that despite the high number of asymptomatic carriers of B. hominis in the juvenile population, this protozoan may be, on other occasions, responsible for gastrointestinal symptoms.