Toll-Like Receptor 2 Promoter -196 to -174 Deletion Affects CD4 Levels Along Human Immunodeficiency Virus Infection Progression.

Toll-like receptor 2 (TLR2) plays a key role in innate immune response recognizing molecular patterns expressed by pathogens. rs111200466 is a TLR2 promoter insertion/deletion polymorphism with contradictory data about its role in human immunodeficiency virus type 1 (HIV-1) infection. We analyzed rs111200466 in HIV-1 disease progression and showed a correlation with a faster progression to the CD4+ < 200 cells/µL outcome for deletion allele carriers (Cox regression analysis: hazard ratio, 2.4 [95% confidence interval, 1.4-4]; P = .001). When naive patients with CD4+ < 200 cells/µL started antiretroviral treatment, rs111200466-deletion carriers showed a trend toward a slower, recovery rate (time required to reach CD4+ > 350 cells/µL; Cox P = .36). Our data suggest rs111200466 as a prognosis factor for HIV-1 disease progression.

Perspective of Spanish medical students regarding undergraduate education in infectious diseases, bacterial resistance and antibiotic use. / La formación de grado en enfermedades infecciosas, resistencia y uso de antibióticos desde la perspectiva de los estudiantes de Medicina.

INTRODUCTION: One of the main tools to optimize antibiotics use is education of prescribers. The aim of this article is to study undergraduate education in the field of infectious diseases, antimicrobial resistance and antibiotic stewardship from the perspective of Spanish medical students. MATERIAL AND METHODS: An anonymous online questionnaire was distributed among sixth grade students using different channels in Europe, within the ESGAP Student-Prepare survey. The questionnaire included 45 questions about knowledge, attitudes and perceptions about diagnosis, bacterial resistance, use of antibiotics and undergraduate training in infectious diseases. We present here the Spanish results. RESULTS: A total of 441 surveys were received from 21 medical schools. A total of 374 responses (84.8%) were obtained from the 8 most represented faculties, with a response rate of 28.9%. Most students felt adequately prepared to identify clinical signs of infection (418; 94.8%) and to accurately interpret laboratory tests (382; 86.6%). A total of 178 (40.4%) acknowledged being able to choose an antibiotic with confidence without consulting books or guidelines. Only 107 (24.3%) students considered that they had received sufficient training in judicious use of antibiotics. Regarding learning methods, the discussion of clinical cases, infectious diseases units rotatories and small group workshops were considered the most useful, being evaluated favorably in 76.9%, 76% and 68.8% of the cases. CONCLUSION: Medical students feel more confident in the diagnosis of infectious diseases than in antibiotic treatment. They also feel the need to receive more training in antibiotics and judicious antibiotic use.

Síndrome de vasoconstricción cerebral reversible tras abandono de hábito tabáquico y tratamiento con bupropión / Reversible cerebral vasoconstriction syndrome following smoking cessation and treatment with bupropion

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Spondylodiscitis in patients under haemodyalisis.

PURPOSE: The purpose of this study was to reach conclusions about the diagnosis and treatment of a series of patients with spondylodiscitis under haemodialysis treatment. METHODS: We collected and studied 23 patients included in a prospective database from two neighbouring hospitals. Descriptive statistical analysis was performed. RESULTS: The diagnosis was frequently made very late and early negative cultures were not uncommon; magnetic resonance images allowed for an early diagnosis with accurate anatomical information. Empirical antibiotic treatment with prompt surgery produced good results in patients under risk of, or having neurological problems. Surgical approaches did not differ from pyogenic or tuberculous spondylodiscitis. Age in our series was not a predictive issue. CONCLUSIONS: Whenever a patient under haemodialysis has symptoms of spinal disease, particularly back pain with fever, they should undergo an MRI. If diagnosis of spondylodiscitis is made prompt empirical antibiotherapy should be instituted. Blood cultures should be performed and tissue samples taken for cultures; however, culture outcome must not delay therapy. Early surgical decompression leads to good results.

Prevalencia de factores de riesgo cardiovascular y de síndrome metabólico en una cohorte de pacientes con infección por el virus de la inmunodeficiencia humana del sur de España. Estudio PREGO / Prevalence of cardiovascular risk factors and metabolic syndrome in a cohort of HIV-infected patients in Southern Spain. PREGO Study

Objetivo. Conocer la prevalencia de factores de riesgo cardiovascular (FRCV) y síndrome metabólico (SM) en pacientes con infección por el virus de la inmunodeficiencia humana (VIH). Métodos. Estudio observacional, multicéntrico y transversal de todos los pacientes con infección por el VIH atendidos de forma ambulatoria en 5 hospitales de la provincia de Málaga entre marzo y agosto de 2007. A todos los pacientes se realizó un cuestionario sobre FRCV, examen físico y analítica en ayunas. El riesgo cardiovascular (RCV) a 10 años se realizó mediante la ecuación de Framingham y el diagnóstico de SM se hizo en función de los criterios del National Cholesterol Education Program. Resultados. Se incluyó a 1.155 pacientes. El 76,9% eran varones y la edad media fue de 44,3 años. El 86,1% de los pacientes estaba en tratamiento antirretroviral. La prevalencia de FRCV fue la siguiente: tabaco 59%, hipertrigliceridemia 38,2%, cHDL bajo 40,6%, hipertensión arterial 10,6% y diabetes mellitus 9,4%. El 14,3% de los pacientes cumplía criterios de SM y los componentes más frecuentes fueron hipertrigliceridemia (88,3%) y colesterol unido a lipoproteínas de alta densidad bajo (78,7%). Los pacientes con SM tenían mayor RCV a 10 años (el 10,9 frente al 5,6%; p < 0,0001). El único factor asociado al SM fue la edad (odds ratio = 4,7; intervalo de confianza del 95%, 4,6-4,8). Conclusiones. Los FRCV en pacientes con infección por el VIH de nuestro medio son muy frecuentes, entre los cuales destaca el consumo de tabaco. La prevalencia de SM es similar a la de la población general española y se asocia a un mayor RCV. El único factor asociado al desarrollo de SM fue la edad (AU)

Objective. To analyse the prevalence of cardiovascular risk factors (CVRF) and metabolic syndrome (MS) in a cohort of HIV-infected patients. Methods. Observational, multicenter, and cross-sectional study of all HIV-infected outpatients from five hospitals in Málaga (Southern Spain). A questionnaire about CVRF, a physical exploration, and 12 hours fasting blood tests were performed in all cases. Cardiovascular risk at 10 years was assessed by Framingham equation, and MS diagnosis was based on the NCEP criteria. Results. 1155 patients were included. 76.9% were men, and the mean age was 44.3 years. 86.1% of the patients were on antiretroviral therapy. The prevalence of CVRF was the following: tobacco 59%, hypertriglicerydemia 38.2%, low cHDL 40.6%, hypertension 10.6%, diabetes 9.4%. 14.3% patients had MS, being hypertriglycerydemia (88.3%) and low cHDL (78.7%) the most frequent criteria. Patients with MS had a higher CVR at 10 years (10.9 vs 5.6%, p < 0.0001). Age was the only factor associated with MS (odds ratio = 4.7; 95% confidence interval 4.6-4.8). Conclusions. CVRF, mainly tobacco use, are very frequent among HIV-patients in our area. The prevalence of MS is similar as that of the Spanish general population and it is associated with a higher CVR. Age was the only factor associated with the development of MS (AU)

La asistencia infectológica actual en España / Infectious Disease Care in Spain

A pesar de la ausencia de un reconocimiento oficial de laactividad especializada en enfermedades infecciosas, ennuestro país la mayoría de los hospitales de las diferentescomunidades autónomas están dotados de estructuras,con una importante heterogeneidad entre ellas, capaces deofrecer unos niveles adecuados de calidad asistencial eneste tipo de patologías. Sus características fundamentalesson su relevante actividad asistencial, superior a otrasespecialidades médicas reconocidas oficialmente, y suimportante interrelación con otros servicios hospitalarios,constituyendo claramente una actividad asistencial de tipohorizontal. Además de ello, las denominadas unidadesasistenciales de enfermedades infecciosas desarrollanimportantes actividades a nivel de la salud pública de lacomunidad, de colaboración con la administraciónsanitaria, de contribución al uso racional de losantimicrobianos y de relación con la asistencia primaria.El futuro de los especialistas en enfermedades infecciosas,tras su reconocimiento oficial, sería la formación deunidades de gestión clínica en cada institución sanitaria,con el objetivo de coordinar toda la asistencia sanitariaespecializada, tanto en el ámbito del propio hospital comoen su área sanitaria de influencia(AU)

Despite the specialist activity of Infectious Diseases notbeing officially recognised, the majority of the hospitals inthe autonomous communities of Spain are equipped withstructures, with significant heterogeneity among them, tobe able to offer high quality care in these diseases. Themain characteristics of and Infectious DiseasesDepartment is its important healthcare activity, more thanin other officially recognised medical specialities, and also its important interrelationship with other services in thehospital which is clearly horizontal healthcare.Furthermore, the aforementioned infectious disease careunits have developed important activities in the arena ofcommunity and public health and, in collaboration withhealth authorities, contribute to the rational use ofantimicrobials and the relationship with Primary Care. Thefuture of specialists in infectious diseases, when they areofficially recognised, will be the creation of clinicalmanagement units in every health institution with theobjective of coordinating all the specialised health care,both in the hospital environment and in its health area ofinfluence(AU)

La asistencia infectológica actual en España / Infectious Disease Care in Spain

A pesar de la ausencia de un reconocimiento oficial de laactividad especializada en enfermedades infecciosas, ennuestro país la mayoría de los hospitales de las diferentes comunidades autónomas están dotados de estructuras, con una importante heterogeneidad entre ellas, capaces de ofrecer unos niveles adecuados de calidad asistencial en este tipo de patologías. Sus características fundamentales son su relevante actividad asistencial, superior a otras especialidades médicas reconocidas oficialmente, y su importante interrelación con otros servicios hospitalarios, constituyendo claramente una actividad asistencial de tipohorizontal. Además de ello, las denominadas unidadesasistenciales de enfermedades infecciosas desarrollanimportantes actividades a nivel de la salud pública de lacomunidad, de colaboración con la administraciónsanitaria, de contribución al uso racional de losantimicrobianos y de relación con la asistencia primaria.El futuro de los especialistas en enfermedades infecciosas, tras su reconocimiento oficial, sería la formación de unidades de gestión clínica en cada institución sanitaria, con el objetivo de coordinar toda la asistencia sanitaria especializada, tanto en el ámbito del propio hospital como en su área sanitaria de influencia

Despite the specialist activity of Infectious Diseases not being officially recognised, the majority of the hospitals in the autonomous communities of Spain are equipped with structures, with significant heterogeneity among them, to be able to offer high quality care in these diseases. The main characteristics of and Infectious Diseases Department is its important healthcare activity, more than in other officially recognised medical specialities, and also its important interrelationship with other services in thehospital which is clearly horizontal healthcare.Furthermore, the aforementioned infectious disease careunits have developed important activities in the arena ofcommunity and public health and, in collaboration withhealth authorities, contribute to the rational use ofantimicrobials and the relationship with Primary Care. The future of specialists in infectious diseases, when they are officially recognised, will be the creation of clinical management units in every health institution with the objective of coordinating all the specialised health care, both in the hospital environment and in its health area of influence

Influence of brucellosis history on serological diagnosis and evolution of patients with acute brucellosis.

Serological diagnosis of human brucellosis is problematic in endemic brucellosis regions and with patients having a history of brucellosis. The aim of this study is to ascertain the serologic and evolutionary behavior of the tests of serum agglutination, Coombs anti-Brucella, immunocapture-agglutination, enzyme-linked immunosorbent assay (ELISA) IgG, IgA, IgM and ELISA-IgG avidity against Brucella lipopolysaccharide (S-LPS), in patients with acute brucellosis based on whether or not a history of brucellosis exists. Titers and seropositivity in all the tests assayed were higher in the patients having brucellosis history (from 90.9% in ELISA-IgM to 100% in ELISA-IgG) than in the patients lacking such history (from 79.3% in ELISA-IgM to 86.2% in Coombs, immunocapture-agglutination, and ELISA-IgG). IgG S-LPS avidity results in patients with brucellosis history were significantly higher (always over 84%) than in patients without brucellosis history (from 48.0% in the initial sera to 81% ten months later) (p<0.001). The titers of antibodies against Brucella in the initial sera and ELISA-IgG avidity against S-LPS may allow distinguishing patients with brucellosis caused by primary infection in the initial stages of the disease from patients seropositive due to prior infections from Brucella.

Actualización sobre infecciones intraabdominales y posquirúrgicas / Update on intra-abdominal and post-surgical infections

The present article is an update of the literature onintra-abdominal infection, which represents a spectrumof diseases with a common pathogenesis. Establishinga prompt diagnosis and avoiding treatment delays arekey to achieving the best outcomes. Mortality dependson initiating early appropriate treatment to restore fluidand electrolyte imbalances, supporting the functionof vital organs, providing appropriate broad-spectrumantimicrobial therapy, and achieving adequate sourcecontrol.A multidisciplinary group of Spanish physicians with aninterest in these infections selected the most importantpapers produced in the field during 2005 and 2006.One of the members of the group discussed the contentof each of the selected papers, with a critical reviewby other members of the panel.After a review of the state of the art, papers from the fieldsof epidemiology, pathophysiology, basic science, causativemicroorganisms and microbiological diagnosis, mainclinical syndromes, principles of therapy, new antibioticsand surgical procedures, preventive measures,recommended antimicrobial regimens and guidelineswere discussed by the group. Faculty from this panel havemade an interesting contribution to our understandingand management of intra-abdominal infections at present.Their contribution is particularly relevant for clinicalpractice(AU)

El presente artículo es una puesta al día de la literaturasobre infecciones intraabdominales, que constituyen unagama de procesos con una patogenia común. Para lograrlos mejores resultados tiene una importancia decisivaestablecer un diagnóstico precoz y evitar los retrasos en eltratamiento. La reducción de la mortalidad se basaen iniciar precozmente un tratamiento apropiado pararestaurar los desequilibrios hidroelectrolíticos, en apoyarla función de los órganos vitales, en proporcionar untratamiento adecuado con antibióticos de amplio espectroy en controlar correctamente las fuentes de la infección.Un grupo multidisciplinario de médicos españolesinteresados en este campo seleccionó los trabajos másdestacados que se han publicado sobre el tema en 2005y 2006. Cada artículo seleccionado fue analizado por unmiembro del panel, y el resto de miembros efectuóuna revisión crítica.Después de revisar el estado del arte, el grupo discutiólos trabajos sobre epidemiología, fisiopatología,ciencias básicas, microorganismos causalesy diagnóstico bacteriológico, principales síndromesclínicos, fundamentos del tratamiento, nuevos antibióticosy procedimientos quirúrgicos, medidas preventivas,y pautas y normas antimicrobianas recomendadas.Los miembros de este panel han aportado unainteresante contribución a nuestros conocimientosy a la conducta a seguir actualmente antelas infecciones intraabdominales. Su contribuciónes especialmente relevante para la práctica clínica(AU

Update on intra-abdominal and post-surgical infections

El presente artículo es una puesta al día de la literatura sobre infecciones intraabdominales, que constituyen una gama de procesos con una patogenia común. Para lograr los mejores resultados tiene una importancia decisiva establecer un diagnóstico precoz y evitar los retrasos en el tratamiento. La reducción de la mortalidad se basa en iniciar precozmente un tratamiento apropiado para restaurar los desequilibrios hidroelectrolíticos, en apoyar la función de los órganos vitales, en proporcionar un tratamiento adecuado con antibióticos de amplio espectro y en controlar correctamente las fuentes de la infección.Un grupo multidisciplinario de médicos españolesinteresados en este campo seleccionó los trabajos másdestacados que se han publicado sobre el tema en 2005y 2006. Cada artículo seleccionado fue analizado por unmiembro del panel, y el resto de miembros efectuóuna revisión crítica.Después de revisar el estado del arte, el grupo discutiólos trabajos sobre epidemiología, fisiopatología,ciencias básicas, microorganismos causalesy diagnóstico bacteriológico, principales síndromesclínicos, fundamentos del tratamiento, nuevos antibióticos y procedimientos quirúrgicos, medidas preventivas, y pautas y normas antimicrobianas recomendadas. Los miembros de este panel han aportado unainteresante contribución a nuestros conocimientosy a la conducta a seguir actualmente antelas infecciones intraabdominales. Su contribuciónes especialmente relevante para la práctica clínica

The present article is an update of the literature onintra-abdominal infection, which represents a spectrumof diseases with a common pathogenesis. Establishinga prompt diagnosis and avoiding treatment delays arekey to achieving the best outcomes. Mortality dependson initiating early appropriate treatment to restore fluid and electrolyte imbalances, supporting the functionof vital organs, providing appropriate broad-spectrumantimicrobial therapy, and achieving adequate sourcecontrol.A multidisciplinary group of Spanish physicians with aninterest in these infections selected the most importantpapers produced in the field during 2005 and 2006.One of the members of the group discussed the contentof each of the selected papers, with a critical reviewby other members of the panel.After a review of the state of the art, papers from the fields of epidemiology, pathophysiology, basic science, causative microorganisms and microbiological diagnosis, main clinical syndromes, principles of therapy, new antibiotics and surgical procedures, preventive measures,recommended antimicrobial regimens and guidelineswere discussed by the group. Faculty from this panel havemade an interesting contribution to our understandingand management of intra-abdominal infections at present. Their contribution is particularly relevant for clinical practice (AU)

Prevalencia de mutaciones de resistencia primaria en los nuevos diagnósticos de infección por el VIH en la provincia de Málaga / Prevalence of primary resistance mutations in patients with newly diagnosed HIV infection in the province of Málaga (Spain)

Introducción. La prevalencia de mutaciones primarias de resistencia varía según los estudios. Analizamos dicha prevalencia, así como los subtipos del virus de la inmunodeficiencia humana (VIH) en nuestra área. Métodos. Estudio prospectivo en el que se realiza un test genotípico (Trugene HIV-1 genotyping kit; Bayer Healthcare Diagnostics) de resistencias e identificación del subtipo de VIH a todos los pacientes diagnosticados de infección por VIH en la provincia de Málaga durante el año 2005. Resultados. Se diagnosticaron 172 casos, 6 de ellos seroconversores recientes. Presentaron mutaciones de resistencia el 7,8% (intervalo de confianza [IC] del 95%: 3,5; 12,0%) de los 153 pacientes en los que se pudo tener un test genotípico (6 a los inhibidores de la transcriptasa inversa no análogos de los nucleósidos [ITINAN], 4 a los inhibidores de la transcriptasa inversa análogos de los nucleósidos [ITIAN], y 3 a los inhibidores de la proteasa [IP]). El 81,8% de los pacientes tenían subtipo B del VIH y el 18,1% no B (51,8% de ellos eran subsaharianos en los que la prevalencia de este subtipo fue del 73,6%). Entre los pacientes europeos sólo los españoles presentaron subtipo no B (prevalencia del 7,7%). El único factor que se asoció con mutaciones de resistencia fue la seroconversión (odds ratio [OR]: 9,2; IC 95%: 1,3-61,9; p < 0,02). Conclusiones. La prevalencia de mutaciones de resistencia en pacientes con nuevo diagnóstico de infección por el VIH en la provincia de Málaga no es despreciable, y la seroconversión es el único factor que se asoció a su presencia. Destaca la alta prevalencia de VIH subtipo no B en la población española. Con estos datos se debe recomendar la realización de tests genotípicos de resistencia en todos los nuevos diagnósticos de nuestra área (AU)

Introduction. The reported prevalence of primary resistance mutations differs between studies. An analysis was performed to determine the prevalence of primary resistance mutations and HIV subtypes in our area. Methods. Prospective study performed in all patients diagnosed with HIV in the year 2005 in the province of Malaga (Spain). Plasma samples from these patients were tested for genotypic resistance (TruGene HIV-1 genotyping kit; Bayer Healthcare Diagnostics) and HIV subtype. Results. A total of 172 cases were diagnosed, 6 of them recent seroconvertors. Genotype resistance testing disclosed resistance mutations in 7.8% (95% CI 3.5-12.0%) of 153 patients in which it was performed (6 to NNRTIs, 4 to NRTIs, and 3 to PIs). HIV subtype was B in 81.8% of patients, and non-B in 18.1% (51.8% of them of sub-Saharan origin, in whom the prevalence of this subtype was 73.6%). Among European patients, only those from Spain presented the non-B subtype (prevalence 7.4%). The only factor related with the presence of resistance mutations was seroconversion (OR 9.2; 95% CI 1.3-61.9; P < .02). Conclusions. There was a considerable prevalence of primary resistance mutations in patients with newly diagnosed HIV infection in Malaga province, with seroconversion being the only related factor. The high prevalence of the non-B HIV subtype in the Spanish population is noteworthy. Genotype resistance testing is recommendable in all newly diagnosed HIV patients in our area (AU)

Variation in the NRAMP1 gene does not affect susceptibility or protection in human brucellosis.

Genetic susceptibility to human brucellosis has so far been localized to variants of genes, which participate in the specific response and the innate immune response. The Nramp1 gene, which participates in the innate response, is related to susceptibility and protection in bovine brucellosis. We examined the polymorphism of the human NRAMP1 gene in 65 patients with brucellosis and 89 healthy controls and found no significant differences in the alleles studied. Thus, variants of the NRAMP1 gene do not appear to affect susceptibility or protection in human brucellosis.

HLA-B*39 allele confers susceptibility to osteoarticular complications in human brucellosis.

OBJECTIVE: To determine the contribution of HLA gene polymorphism toward susceptibility to osteoarticular focal forms of human brucellosis. METHODS: A total of 57 patients with brucellosis, of whom 23 had osteoarticular complications, and 73 healthy volunteers were genotyped for HLA class I and class II antigens by a polymerase chain reaction-sequence specific primer technique. RESULTS: The HLA-B*39 allele was present in significantly more patients with osteoarticular complications than in the other patients (35% vs 3%; p = 0.0006, OR 15.684, 95% CI 3.453-71.231), or in the controls. CONCLUSION: The increased presence of the HLA-B39 genotype in patients with brucellosis with clinical osteoarticular manifestations suggests that this genotype confers susceptibility to developing severe osteoarticular focal forms of the disease.

Chronic hepatosplenic abscesses in Brucellosis. Clinico-therapeutic features and molecular diagnostic approach.

In order to analyze the clinical and therapeutic features of chronic hepatosplenic abscesses, and to define the diagnostic yield of new molecular techniques, we describe seven cases, four hepatic and three splenic, of this uncommon complication of Brucellosis. Onset of symptoms in all cases was insidious and the diagnostic delay considerable. Abdominal CT scan showed large, poorly defined lesions, with heterogeneous attenuation and thick central calcifications surrounded by hypointense areas. Histologically, all cases presented granulomas with central necrosis, a polymorphic infiltrate, few giant cells and peripheral fibrosis. The diagnostic yield with conventional microbiologic techniques was poor, whereas a Brucella PCR-assay of a tissue or pus sample was positive in all six cases in which it was performed. Conservative therapy with antibiotics, either alone or combined with percutaneous drainage, failed in all cases, so that in this type of lesion, the treatment of choice should be medical-surgical, in order to guarantee excision of the central calcium nucleus responsible for the persistence of the infection.

Infección diseminada por Mycobacterium celatum / Disseminated infection due to mycobaterium celatum

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