La nueva gripe A (H1N1) 2009 en Atención Primaria: ¿qué nos hemos encontrado? / New influenza A (H1N1) 2009 in Primary Care: what have we found?

Objetivo: describir las características clínicas de los casos de gripe pandémica A (H1N1) 2009 diagnosticados por pediatras centinela del programa PIDIRAC (Programa de información diaria de las infecciones respiratorias agudas de Catalunya) en atención primaria (AP). Material y métodos: la muestra de estudio estaba formada por los casos visitados por cuatro de los pediatras centinela que participan en el programa PIDIRAC. Se recogieron de forma sistemática, para evitar sesgo de muestreo, muestras faríngeas y nasales de los casos sospechosos de gripe para su estudio virológico. Cada semana del periodo de estudio se seleccionaron los dos primeros pacientes que acudieron a la consulta y cumplían con los criterios de caso sospechoso, se recogieron sus datos demográficos y clínicos y se cursó el estudio viral. A los 55 niños con gripe pandémica A (H1N1) 2009 se les realizó un seguimiento telefónico para conocer la evolución del cuadro. Resultados: la mayor parte de los casos tenían una edad entre cinco y 14 años (89,1%; intervalo de confianza del 95% [IC 95%]: 77,8-95,9). Los síntomas más frecuentes fueron la fiebre (criterio de inclusión), que duró una media de 3,6 días (desviación estándar [DE]: 1,6) y la tos. Más de la mitad refirieron también odinofagia, rinitis o cefalea. En general, el cuadro clínico fue leve, aunque un niño fue ingresado durante 48 horas por presentar una neumonía. De los 13 niños que tenían antecedentes de asma, dos presentaron exacerbaciones leves. Ningún niño recibió tratamiento antiviral. Conclusión: a pesar de los temores iniciales, los casos de gripe pandémica A (H1N1) 2009 en los niños atendidos en nuestras consultas de AP han sido generalmente leves (AU)

Objective: to describe the clinical features of pandemic influenza cases diagnosed in primary health care by sentinel pediatricians who participate in the PIDIRAC surveillance scheme (Programa de información diaria de las infecciones respiratorias agudas de Catalunya). Methods: study sample included the cases of confirmed influenza A (H1N1) 2009 attended by sentinel pediatricians that collaborate with PIDIRAC. Pharyngeal and nasopharyngeal swabs for virologic analysis of suspected influenza cases were collected on a systematic basis in order to avoid bias. Every week during the study period the first two patients that consult and comply with the definition of suspicious case of influenza were recruited, if consent was obtained. Demographic characteristics and clinical features were recorded, and virologic studies were performed. The fifty-five children with confirmed pandemic influenza A (H1N1) 2009 were contacted by telephone in order to obtain information regarding their clinical status. Results: most of the cases were 5-14 years old children and adolescents (89.1%, 95% CI 77.8-95.9). The most frequent symptoms were fever (inclusion criteria), that lasted a mean of 3.6 days (SD = 1.6) and cough. More than 50% of patients also presented with sore throw, rhinitis or headache. In general, the disease was mild even though one child was hospitalised during 48 hours because he (or she) had a pneumonia. Of the thirteen patients who suffered from asthma only two had mild exacerbations. None of the patients needed antiviral treatment. Conclusions: despite initial fears, the cases of pandemic influenza A (H1N1) 2009 treated in our community health centres have been generally mild (AU)

[Clinical and epidemiological characteristics of influenza A virus infection in children aged less than 7 years old in primary care]. / Aspectos clínico-epidemiológicos de la infección por virus de la gripe A en menores de 7 años en atención primaria.

INTRODUCTION: The aim of this study was to describe the clinical and epidemiological features of confirmed influenza A virus infection in patients aged less than 7 years old. PATIENTS AND METHODS: We performed a retrospective, descriptive study of the clinical and epidemiological features of influenza A virus infection in patients aged less than 7 years old attending three primary care centers during the 2003-2004 influenza season. Patients with influenza A infection confirmed by immunofluorescence, cell culture, or polymerase chain reaction were interviewed to obtain clinical and epidemiological data on their disease. RESULTS: Influenza A virus was detected in 47 patients aged between 5 months and 7 years (mean: 37.3 +/- 5.7 months). Of these, 35 children (74.4 %) were aged between 0 and 4 years. The most frequent symptoms were fever (100 %), cough (95.7 %), and rhinorrhea (76.6 %). Gastrointestinal symptoms were present in 40.4 % of the patients. The mean duration of fever was 5.2 +/- 1.8 days (range 2-8). Complications occurred in nine patients (19.2 %). The frequency of influenza-like disease in parents was 9.1 % (8/88) at diagnosis of the index case and was 23.9 % (21/88) immediately after the episode in the child (p 5 0.01). The mean number of days of absence from school was 7.5 +/- 3.6 days. CONCLUSIONS: The mean age of our patients confirms that influenza is a frequent disease in infancy and childhood. The results demonstrate that the infection is transmitted from children to parents in the household setting, since the frequency of influenza-like symptoms in adults increases after influenza episodes in children.

Aspectos clínico-epidemiológicos de la infección por virus de la gripe A en menores de 7 años en atención primaria / Clinical and epidemiological characteristics of influenza A virus infectionin children aged less than 7 years old in primary care

Introducción El objetivo del estudio ha sido analizar aspectos clínicos y epidemiológicos en pacientes menores de 7 años con enfermedad confirmada por virus de la gripe A. Pacientes y métodos Estudio descriptivo retrospectivo sobre clínica y epidemiología de la infección por el virus de la gripe A en pacientes menores de 7 años, atendidos en 3 centros de atención primaria, durante la temporada gripal 2003-2004. Los pacientes con infección confirmada por inmunofluorescencia, cultivo celular o reacción en cadena de la polimerasa, fueron entrevistados para obtener la información clínico-epidemiológica. Resultados El virus de la gripe A se detectó en 47 pacientes de 5 meses a 6 años y 11 meses (media 37,3 6 5,7 meses). El 74,4 % (35/47) menor de 4 años. La fiebre (100 %), tos (95,7 %) y rinorrea (76,6 %) fueron los síntomas más frecuentes; la sintomatología gastrointestinal estuvo presente en el 40,4 % de los niños. La duración media de la fiebre fue de 5,2 6 1,8 días (rango 2-8). Se presentaron complicaciones en el 19,2 % (9/47). La frecuencia de síndromes gripales en los padres fue del 9,1 % (8/88) en el momento del diagnóstico de la gripe al caso índice y de 23,9 % (21/88) inmediatamente después de la enfermedad del niño (p 5 0,01). Los días de ausencia escolar fueron 7,5 6 3,6 días. Conclusiones La media de edad de nuestros pacientes confirma que la gripe es una enfermedad frecuente en lactantes y niños pequeños. Los resultados demuestran que en el entorno doméstico la infección se transmite de niños a padres, ya que la frecuencia de síndromes gripales en adultos aumenta tras la enfermedad del niño

Introduction The aim of this study was to describe the clinical and epidemiological features of confirmed influenza A virus infection in patients aged less than 7 years old. Patients and methods We performed a retrospective, descriptive study of the clinical and epidemiological features of influenza A virus infection in patients aged less than 7 years old attending three primary care centers during the 2003-2004 influenza season. Patients with influenza A infection confirmed by immunofluorescence, cell culture, or polymerase chain reaction were interviewed to obtain clinical and epidemiological data on their disease. Results Influenza A virus was detected in 47 patients aged between 5 months and 7 years (mean: 37.3 6 5.7 months). Of these, 35 children (74.4 %) were aged between 0 and 4 years. The most frequent symptoms were fever (100 %), cough (95.7 %), and rhinorrhea (76.6 %). Gastrointestinal symptoms were present in 40.4 % of the patients. The mean duration of fever was 5.2 6 1.8 days (range 2-8). Complications occurred in nine patients (19.2 %). The frequency of influenza-like disease in parents was 9.1 % (8/88) at diagnosis of the index case and was 23.9 % (21/88) immediately after the episode in the child (p 5 0.01). The mean number of days of absence from school was 7.5 6 3.6 days. Conclusions The mean age of our patients confirms that influenza is a frequent disease in infancy and childhood. The results demonstrate that the infection is transmitted from children to parents in the household setting, since the frequency of influenza-like symptoms in adults increases after influenza episodes in children

Sida. Repercusión en el Laboratorio de Microbiología Clínica / AIDS. Repercussions in the Clinical Microbiological Laboratory

No disponible

[The virus of human immunodeficiency: virological characteristics, natural history and physiopathology of the nervous system infection]. / Virus de la inmunodeficiencia humana: características virológicas, historia natural y fisiopatogenia de la infección del sistema nervioso.

Three phases are recognized in the natural history of infection by the human immunodeficiency virus (HIV): (a)an early or acute phase lasting several weeks, (b) an intermittent or chronic phase, with active low-grade viral replication, lasting several years and (c) the final stage or crisis, which corresponds to the clinical phase of AIDS. The virus may enter the nervous system at the time of seroconversion. However the clinical picture of dementia appears later, when there is marked immunodeficiency. HIV enters the nervous system carried in the macrophages, and usually infects the microglia but not the neurons. The physiopathology of dementia is not well known. It is thought that neuronal dysfunction may be mediated by viral proteins and cytokines synthetized by the infected cells and toxic to the neurones.

Prospective serological study of leptospirosis in southern Spain.

This article reports data concerning a serosurvey carried out in Southern Spain to assess the current epidemiological status of a population exposed to risk of leptospirosis. Microagglutination and IgM-EIA tests were carried out on sera from a sample of workers in agriculture-related occupations, exposed to marsh waters. A cohort of 197 workers were followed for a year in an active surveillance program to evaluate seroconversion (laboratory confirmed leptospirosis). The results have shown for the cohort a density of incidence: 6.4 x 100 persons per year, and for the reference population an accumulated incidence of 41.25/100,000. Prevalence rates (P) were 21.3 x 100 and 144 x 10(5) for the cohort and population respectively. Rates were higher in cray-fishers (P: 62.7%), rice-workers, and butchers. This is the first report identifying cray-fishers as a high risk group for leptospirosis, and the reporting of human contamination by Australis serogroup in Spain.

HIV antigen in the brains of patients with the AIDS dementia complex.

Human immunodeficiency virus infection was identified immunohistochemically in the brains of 8 patients with acquired immune deficiency syndrome dementia complex. Using a monoclonal antibody against a structural viral protein (p25), infection was detected in white matter and basal ganglia in a distribution paralleling that of the major neuropathological abnormalities. Viral antigen was identified principally in perivascular and parenchymal macrophages and in multinucleated cells of macrophage origin that were identified morphologically and by immunocytochemical staining for acid phosphatase isozyme. In 4 of the 8 patients, viral antigen was also detected in acid-phosphatase-negative, process-bearing neuroglial cells; in 2 patients, antigen was detected in basal ganglion cells that were morphologically consistent with neurons and in alkaline-phosphatase-positive cells with elongated nuclei that were most likely of endothelial origin.

A monoclonal antibody that induces T cell aggregation reacts with vascular endothelial cells and placental trophoblasts.

We have found that a mouse monoclonal antibody (alpha Leu-13) to a 16 kilodalton human lymphocyte surface antigen reacts with vascular endothelial cells as determined by immunoperoxidase staining of frozen tissue sections. In earlier studies, alpha Leu-13 was found to induce purified T cells to aggregate when added to cultures in nanogram concentrations. In the studies reported here, alpha Leu-13 stained vascular endothelial cells of arteries, capillaries, and veins in all organs examined from adults. It also reacted weakly with epithelial cells of proximal tubules of the kidney and with nonkeratinized basal epithelial cells of the cervix and esophagus. When a panel of tissues from a 14-wk-old fetus was examined, alpha Leu-13 was not found to react with endothelial cells of any specimen. However, it did stain medullary thymocytes and placental trophoblasts of this fetus. The implications of these findings to the possible function of the Leu-13 antigen in immune ontogeny are discussed.

Thrombotic cerebral vasculopathy associated with herpes zoster.

We describe the clinical, radiographic, and pathological findings in 3 patients with large-vessel cerebral vasculopathy following herpes zoster. Two of the patients were studied at postmortem examination, and a brain biopsy was performed in the third. Each of the 3 patients suffered thrombotic occlusions of large vessels without notable inflammatory or granulomatous changes following trigeminal or segmental herpes zoster infection. In the 2 autopsied patients, varicella-zoster virus (VZV) antigens were detected by immunoperoxidase staining within the media of the affected cerebral arteries. Little or no inflammation was associated with the foci of the VZV antigens. These studies provide evidence that the vasculopathy following herpes zoster may result from direct VZV infection of the artery and the in situ thrombosis can develop within the infected vessels in the absence of clear inflammatory vasculitis.