International, evidence-based consensus diagnostic criteria for HHV-8-negative/idiopathic multicentric Castleman disease.

Human herpesvirus-8 (HHV-8)-negative, idiopathic multicentric Castleman disease (iMCD) is a rare and life-threatening disorder involving systemic inflammatory symptoms, polyclonal lymphoproliferation, cytopenias, and multiple organ system dysfunction caused by a cytokine storm often including interleukin-6. iMCD accounts for one third to one half of all cases of MCD and can occur in individuals of any age. Accurate diagnosis is challenging, because no standard diagnostic criteria or diagnostic biomarkers currently exist, and there is significant overlap with malignant, autoimmune, and infectious disorders. An international working group comprising 34 pediatric and adult pathology and clinical experts in iMCD and related disorders from 8 countries, including 2 physicians that are also iMCD patients, was convened to establish iMCD diagnostic criteria. The working group reviewed data from 244 cases, met twice, and refined criteria over 15 months (June 2015 to September 2016). The proposed consensus criteria require both Major Criteria (characteristic lymph node histopathology and multicentric lymphadenopathy), at least 2 of 11 Minor Criteria with at least 1 laboratory abnormality, and exclusion of infectious, malignant, and autoimmune disorders that can mimic iMCD. Characteristic histopathologic features may include a constellation of regressed or hyperplastic germinal centers, follicular dendritic cell prominence, hypervascularization, and polytypic plasmacytosis. Laboratory and clinical Minor Criteria include elevated C-reactive protein or erythrocyte sedimentation rate, anemia, thrombocytopenia or thrombocytosis, hypoalbuminemia, renal dysfunction or proteinuria, polyclonal hypergammaglobulinemia, constitutional symptoms, hepatosplenomegaly, effusions or edema, eruptive cherry hemangiomatosis or violaceous papules, and lymphocytic interstitial pneumonitis. iMCD consensus diagnostic criteria will facilitate consistent diagnosis, appropriate treatment, and collaborative research.

Abundancia y diversidad de especies de Culicinae (Diptera: Culicidae) del Alto Orinoco, estado Amazonas, Venezuela / Abundance and species diversity of Culicinae (Diptera: Culicidae) from Alto Orinoco, Amazonas, Venezuela

Se realizó un estudio longitudinal en 18 comunidades o shabonos de las localidades Yanomami Ocamo y Mavaca del municipio Alto Orinoco entre Junio 1998 y Diciembre 2000 para caracterizar la fauna de culicinos. Se colocaron trampas CDC dentro de viviendas entre 1900 y 0600 horas a fin de capturar los mosquitos atraídos por personas protegidas por mosquiteros. Se capturaron un total de 4.635 culicinos pertenecientes a nueve géneros y 25 especies. Del total de especies identificadas, 18 especies (72%) constituyen nuevos registros para el estado Amazonas. Las especies más abundantes fueron Mansonia (Mansonia) titillans (48%), Aedes (Ochlerotatus) fulvus (16,9%) y Culex (Melanoconion) spissipes (12%). Se observaron correlaciones negativamente significativas entre precipitación, nivel del río y abundancia de Ma. titillans y Ae. fulvus. La abundancia y diversidad de especies resultó diferente entre comunidades. La mayor diversidad y abundancia se encontró en las comunidades Santa María de los Guaicas y Carlitos. El esfuerzo de captura, disponibilidad de criaderos y diversidad de hábitats en estas comunidades influye en esta diferencia con respecto a las otras comunidades. El presente constituye el primer y único estudio longitudinal realizado en el estado Amazonas para caracterizar la fauna de culicinos, la cual incluye especies de importancia en salud pública.

A longitudinal study was conducted in 18 communities or "shabonos" in the Yanomami inhabited Ocamo and Mavaca regions in the Alto Orinoco municipality between June 1998 and December 2000. CDC light traps were placed inside dwellings to catch mosquitoes attracted to humans protected by mosquito nets between 1900 and 0600 hours. A total of 4.635 culicines belonging to 9 genera and 25 species were captured. Of the total number of species identified, 18 (72%) are new reports for Amazonas state. The most abundant species were Mansonia (Mansonia) titillans (48%), Aedes (Ochlerotatus) fulvus (16.9%) and Culex (Melanoconion) spissipes (12%). There were significantly negative correlations between rainfall and river levels, and the abundance of Ma. titillans and Ae. fulvus. The abundance and species diversity of culicines differed among communities, with the highest values of both these parameters found in Santa María de los Guiacas and Carlitos. These differences were partly due to sampling effort but could also have been produced by the availability of larval habitats and niche diversity in these communities compared to the others surveyed. Up until, now this is the only longitudinal study to characterize the culicine fauna in Amazonas state, which includes several species of public health importance.

Vaginosis bacteriana: aspectos colposcópicos / Bacterial vaginosis: colposcopic aspects

Determinar mediante los criterios de Amsel, la vaginosis bacteriana en las pacientes estudiadas y definir los aspectos colposcópicos más frecuentes asociados a esta patología. Estudio descriptivo y transversal de pacientes que acudieron a la consulta de ginecología por leucorrea. A las pacientes que presentaron vaginosis bacteriana, se les realizó la evaluación colposcópica. Para el análisis estadístico de variables no paramétricas se aplicó la prueba de hipótesis de proporción. Departamento de Obstetricia y Ginecología, Hospital Universitario “Antonio Patricio de Alcalá ”, Cumaná. Se encontraron 65 pacientes con vaginosis bacteriana y en la evaluación colposcópica de la misma, lo más frecuente fue la colpitis a puntos finos rojos, difusa, con un patrón vascular de capilar simple y a la prueba de lugol, la imagen colposcópica fue el caoba irregular con 82 por ciento (P<0,05), estadísticamente significativo. El aspecto colposcópico característico de la vaginosis bacteriana con un patrón vascular capilar simple es la colpitis a puntos finos rojo difusa y a la prueba de lugol caoba irregular.

Postepizootic persistence of Venezuelan equine encephalitis virus, Venezuela.

Five years after the apparent end of the major 1995 Venezuelan equine encephalitis (VEE) epizootic/epidemic, focal outbreaks of equine encephalitis occurred in Carabobo and Barinas States of western Venezuela. Virus isolates from horses in each location were nearly identical in sequence to 1995 isolates, which suggests natural persistence of subtype IC VEE virus (VEEV) strains in a genetically stable mode. Serologic evidence indicated that additional outbreaks occurred in Barinas State in 2003. Field studies identified known Culex (Melanoconion) spp. vectors and reservoir hosts of enzootic VEEV but a dearth of typical epidemic vectors. Cattle serosurveys indicated the recent circulation of enzootic VEEV strains, and possibly of epizootic strains. Persistence of VEEV subtype IC strains and infection of horses at the end of the rainy season suggest the possibility of an alternative, cryptic transmission cycle involving survival through the dry season of infected vectors or persistently infected vertebrates.