Towards a Standard Psychometric Diagnostic Interview for Subjects at Ultra High Risk of Psychosis: CAARMS versus SIPS.

Background. Several psychometric instruments are available for the diagnostic interview of subjects at ultra high risk (UHR) of psychosis. Their diagnostic comparability is unknown. Methods. All referrals to the OASIS (London) or CAMEO (Cambridgeshire) UHR services from May 13 to Dec 14 were interviewed for a UHR state using both the CAARMS 12/2006 and the SIPS 5.0. Percent overall agreement, kappa, the McNemar-Bowker χ (2) test, equipercentile methods, and residual analyses were used to investigate diagnostic outcomes and symptoms severity or frequency. A conversion algorithm (CONVERT) was validated in an independent UHR sample from the Seoul Youth Clinic (Seoul). Results. There was overall substantial CAARMS-versus-SIPS agreement in the identification of UHR subjects (n = 212, percent overall agreement = 86%; kappa = 0.781, 95% CI from 0.684 to 0.878; McNemar-Bowker test = 0.069), with the exception of the brief limited intermittent psychotic symptoms (BLIPS) subgroup. Equipercentile-linking table linked symptoms severity and frequency across the CAARMS and SIPS. The conversion algorithm was validated in 93 UHR subjects, showing excellent diagnostic accuracy (CAARMS to SIPS: ROC area 0.929; SIPS to CAARMS: ROC area 0.903). Conclusions. This study provides initial comparability data between CAARMS and SIPS and will inform ongoing multicentre studies and clinical guidelines for the UHR psychometric diagnostic interview.

How promising is Lasioseius floridensis as a control agent of Polyphagotarsonemus latus?

The blattisociid mite Lasioseius floridensis Berlese was found associated with the broad mite, Polyphagotarsonemus latus (Banks), on gerbera leaves in Mogi das Cruzes, State of Sao Paulo, Brazil. Blattisociid mites are not common on aerial plant parts, except under high air humidity levels. Some Lasioseius species have been mentioned as effective control agents of rice pest mites, but nothing is known about the biology of L. floridensis. The objective of this study was to evaluate whether the observed co-occurrence of L. floridensis and P. latus was just occasional or whether the latter could be important as food source for the former, assumed by laboratory evaluation of the ability of the predator to maintain itself, reproduce and develop on that prey. Biological parameters of L. floridensis were compared when exposed to P. latus and to other items as food. The study showed that mating is a pre-requisite for L. floridensis to oviposit and that oviposition rate was much higher on the soil nematode Rhabditella axei (Cobbold) (Rhabditidae) than on P. latus. Ovipositon on the acarid mite Tyrophagus putrescentiae (Schrank) was about the same as on P. latus, but it was nearly zero when the predator was fed the fungi Aspergillus flavus Link or Penicillium sp., or cattail (Typha sp.) pollen. Survivorship was higher in the presence of pollen and lower in the presence of A. flavus or Penicillium sp. than in the absence of those types of food. Life table parameters indicated that the predator performed much better on R. axei than on P. latus. To evaluate the potential effect of L. floridensis as predator of P. latus, complementary studies are warranted to determine the frequency of migration of L. floridensis to aerial plant parts, when predation on P. latus could occur.

[Peritoneal dialyisis role in heart failure treatment, experience in our center]. / Papel de la diálisis peritoneal en el tratamiento de la insuficiencia cardíaca. Experiencia en nuestro centro.

Peritoneal dialysis is a renal replacement therapy indicated in patients with an unstable hemodynamic status. It has been used, by ultrafiltration, preferably in those patients with congestive heart failure refractory to conventional medical therapy. We present the experience of our center with five patients who were affected by severe congestive heart failure [Class IV on the New York Heart Association (NYHA) scale] and diverse stages of chronic renal failure, who received this therapy. Icodextrin has been used as an osmotic agent to induce ultrafiltration. The follow-up period ranged between 5 and 14 months (9.8 +/- 3.7 months). The results that we have found are similar to those of other studies: we observed a significant improvement in quality of life and a reduction in morbidity and hospitalization rates in all our patients. But it seems to be necessary to make a prospective randomized controlled trial with more number of individuals to confirm these promising facts, to clarify the impact on the survival, and to analyze the cost-benefit for treating patients suffering from refractory, end stage congestive heart failure.

Papel de la diálisis peritoneal en el tratamiento de la insuficiencia cardíaca. Experiencia en nuestro centro / Peritoneal dialysis role in heart failure treatment. Experience in our center

La diálisis peritoneal es una técnica sustitutiva de la función renal indicada en pacientes con inestabilidad hemodinámica. Por ello, se ha utilizado preferentemente en aquellos pacientes con insuficiencia cardíaca refractaria al tratamiento médico convencional. Presentamos la experiencia de nuestro centro con cinco pacientes que presentaban diversos grados de enfermedad renal crónica e insuficiencia cardíaca congestiva, que recibieron este tratamiento. Los resultados que hemos encontrado son superponibles a otros estudios realizados: en todos nuestros pacientes mejoró la clase funcional según la Clasificación de la New York Heart Association y disminuyeron los tiempos de hospitalización. Parece necesario realizar estudios prospectivos con mayor número de individuos para confirmar estas afirmaciones, aclarar el impacto sobre la supervivencia, y analizar el coste-beneficio

Peritoneal dialysis is a renal replacement therapy indicated in patients with an unstable hemodynamic status. It has been used, by ultrafiltration, preferably in those patients with congestive heart failure refractory to conventional medical therapy.We present the experience of our center with five patients who were affected by severe congestive heart failure [Class IV on the New York Heart Association (NYHA) scale] and diverse stages of chronic renal failure,who received this therapy. Icodextrin has been used as an osmotic agent to induce ultrafiltration. The follow-up period ranged between 5 and 14 months (9.8 ± 3.7 months). The results that we have found are similar to those of other studies:we observed a significant improvement in quality of life and a reduction in morbidity and hospitalization rates in all our patients. But it seems to be necessary to make a prospective randomized controlled trial with more number of individuals to confirm these promising facts, to clarify the impact on the survival, and to analyze the cost-benefit for treating patients suffering from refractory, end stage congestive heart failure

[Acute renal failure in the transretinoic syndrome]. / Insuficiencia renal aguda en el síndrome de ácido-transretinoico.

UNLABELLED: The all-trans retinoic acid (ATRA) is the treatment of first line of acute promyelocytic leukemia (APL). ATRA is usually well tolerated, but a few major side effects can be observed, ATRA syndrome (RAS) being the most important of them, potentially fatal. The manifestations of this Syndrome are fever, weight gain, pulmonary infiltrates, pleural or pericardial effusions, hypotension, liver dysfunction and renal failure. MATERIAL AND METHODS: We studied to the 29 patients diagnosed in (January of 2002 - December of 2004) of acute promyelocytic leukemia (APL), which were treated with ATRA, all received the 45 dose of mg/m(2)/d . The diagnosis of the leukemia was made by citomorphologist analysis. The criterion of renal insufficiency, it was an increase of the creatinina superior to 20% of the basal level. The definition of the transretinoico acid Syndrome was based on the clinical criteria of Frankel. RESULTS: Fourteen patients presented the Transretinoico Syndrome (48.3%), 11 of which (37.9%) died. The fundamental differences between the patients with or without ATRA were: fever (14 vs. 9, p=0,017), gain of weight (14 vs 0, p=0,000), pleural effusion (14 vs 2, p=0.000), pulmonary infiltrates (13 vs 1, p=0,000), cardiac failure (12 versus 2, p=0,000), respiratory distress (12 versus 4, p=0,003), presence of renal failure (10 vs 4, p=0,02), necessity of substitute renal treatment (6 vs 0, p=0,006) and arterial hypotension (12 vs. 3, p=0,001). The acute renal failure appeared in 10 of the 14 patients with SAR (71.4%), to 12+/-5 (1-25) days of the beginning of the treatment and their duration it was of 14+/-5 (1-46) days. Six (60%) needed substitute renal treatment and 5 (50%) died. Of the patients who survived, only a patient continues in dialysis. In both patient in that renal biopsy was made, the study showed signs of cortical necrosis. CONCLUSIONS: The appearance of acute renal failure in the course of the SAR is frequent, being observed deterioration of the renal function that needs substitute renal treatment in more than half the cases. The association of RAS with renal failure entails the high mortality (50%). The diagnosis and the precocious restoration of suitable the preventive measures and therapeutic are very important to avoid in possible the this serious complication of the treatment with ATRA.

Insuficiencia renal aguda en el síndrome de ácido-transretinoico / Acute renal failure in the transretinoic syndrome

El ácido transretinoico es el tratamiento de primera línea de la Leucemia Promielocítica Aguda. Habitualmente es bien tolerado, pero puede tener efectos secundarios, de los cuales el más grave es el Síndrome de Ácido Transretinoico, potencialmente fatal. Las manifestaciones de este Síndrome son fiebre, ganancia de peso, infiltrados pulmonares, derrame pleural o pericárdico, hipotensión, insuficiencia hepática e insuficiencia renal. Material y métodos: Se estudiaron 29 pacientes diagnosticados en los últimos 3 años (enero de 2002-diciembre de 2004) de Leucemia Promielocítica Aguda que fueron tratados con ácido transretinoico a dosis de 45 mg/m2/día. El diagnóstico de la leucemia se realizó por análisis citomorfológico. La insuficiencia renal aguda (IRA) se definió como un incremento de la creatinina superior al 20% del nivel basal y el Síndrome de Ácido Transretinoico (SAR) por los criterios de Frankel. Resultados: Catorce pacientes presentaron el Síndrome Transretinoico (48,3%), 11 de los cuales fallecieron (37,9%). Las diferencias fundamentales entre los pacientes con o sin ATRA fueron: fiebre (14 vs 9, p = 0,017), ganancia de peso (14 vs 0, p = 0,000), derrame pleural (14 vs 2, p = 0,000), presencia de infiltrados pulmonares (13 vs 1, p = 0,000), insuficiencia cardiaca (12 vs 2, p = 0,000), distress respiratorio (12 vs 4, p = 0,003), presencia de IRA (10 vs. 4, p=0,02), necesidad de tratamiento renal sustitutivo (6 vs 0, p = 0,006) e hipotensión arterial (12 vs 3, p = 0,001). La insuficiencia renal se produjo en 10 de los 14 pacientes con SAR (71,4%), a los 12 ± 5 (1-25) días del comienzo del tratamiento y su duración media fue de 14 ± 5 (1-46) días. Seis (60%) necesitaron tratamiento renal sustitutivo y 5 (50%) fallecieron. De los pacientes que sobrevivieron, sólo un paciente continúa en diálisis. En los dos pacientes en los que se realizó biopsia renal, el estudio histológico mostró signos de necrosis cortical. Conclusiones: La aparición de insuficiencia renal en el transcurso del SAR es frecuente, precisando tratamiento renal sustitutivo en más de la mitad de los casos. La asociación de SAR con IRA conlleva una alta mortalidad. El diagnóstico y la instauración precoz de las medidas preventivas y terapéuticas adecuadas son muy importantes para evitar en lo posible esta grave complicación del tratamiento con ATRA

The all-trans retinoic acid (ATRA) is the treatment of first line of acute promyelocytic leukemia (APL). ATRA is usually well tolerated, but a few major side effects can be observed, ATRA syndrome (RAS) being the most important of them, potentially fatal. The manifestations of this Syndrome are fever, weight gain, pulmonary infiltrates, pleural or pericardial effusions, hypotension, liver dysfunction and renal failure. Material and methods: We studied to the 29 patients diagnosed in (january of 2002-december of 2004) of acute promyelocytic leukemia (APL), which were treated with ATRA, all received the 45 dose of mg/m2/d. The diagnosis of the leukemia was made by citomorphologist analysis. The criterion of renal insufficiency, it was an increase of the creatinina superior to 20% of the basal level. The definition of the transretinoico acid Syndrome was based on the clinical criteria of Frankel. Results: Fourteen patients presented the Transretinoico Syndrome (48.3%), 11 of which (37.9%) died. The fundamental differences between the patients with or without ATRA were: fever (14 vs 9, p=0,017), gain of weight (14 vs 0, p = 0,000), pleural effusion (14 vs 2, p = 0.000), pulmonary infiltrates (13 vs 1, p = 0,000), cardiac failure (12 vs 2, p = 0,000), respiratory distress (12 vs 4, p = 0,003), presence of renal failure (10 vs 4, p = 0,02), necessity of substitute renal treatment (6 vs 0, p = 0,006) and arterial hypotension (12 vs 3, p = 0,001). The acute renal failure appeared in 10 of the 14 patients with SAR (71.4%), to 12 ± 5 (1-25) days of the beginning of the treatment and their duration it was of 14 ± 5 (1-46) days. Six (60%) needed substitute renal treatment and 5 (50%) died. Of the patients who survived, only a patient continues in dialysis. In both patient in that renal biopsy was made, the study showed signs of cortical necrosis. Conclusions: The appearance of acute renal failure in the course of the SAR is frequent, being observed deterioration of the renal function that needs substitute renal treatment in more than half the cases. The association of RAS with renal failure entails the high mortality (50%). The diagnosis and the precocious restoration of suitable the preventive measures and therapeutic are very important to avoid in possible the this serious complication of the treatment with ATRA

Association between vitamin D receptor FokI. Polymorphism and serum parathyroid hormone level in patients with chronic renal failure.

We investigated the relationship between vitamin D receptor (VDR) start codon polymorphism and serum levels of PTH, calcidiol, and calcium in 64 Spanish patients with chronic renal failure (CRF). An exon 2 fragment of the VDR gene was amplified by PCR, and cleaved with the restriction enzyme FokI. The alleles were identified according to the digestion pattern obtained as F (absence of restriction site) and f (presence of restriction site). Genotype frequencies in the patient population were 54.7% FF, 28.1% Ff and 17.2% ff, vs 46.7% FF, 43.3% Ff and 10% ff in a healthy control population. The difference between the two populations was statistically significant (p<0.01). Within the patient population, mean serum PTH level in the FF group was significantly higher (159.77+/-25.69 pg/ml) than in both the Ff and ff groups (106.67+/-19.07 and 77.55+/-15.85 pg/ml, respectively; p<0.05). However there were no significant differences in serum levels of calcidiol or calcium among genotypes. These results suggest that FokI polymorphisms of the VDR gene may determine parathyroid response in CRF patients.

[Estimation of bone mass of hemodialysis patients by digital radiologic radiogrammetry (DXR)]. / Estimación de la masa ósea de pacientes en hemodiálisis por radiogrametría radiológica digital (DXR).

Bone mass (BMD) may be evaluated by digital X-ray radiogrammetry (DXR) which it is estimated from multiple cortical measures carried out on five regions of interest over a simple hand-forearm X-ray film. We included 168 HD patients (108 men and 60 women; 63 +/- 14 and 66 +/- 12 years old respectively--p < 0.05-) coming from seven HD units in Asturias. We performed a hand-forearm X-ray, an epidemiologic questionnaire and we revised their medical and analytical records. As the normative data we used the measurements of a random sample of 247 subjects from our own population. The prevalence of osteoporosis was 7% and 40% in men and women respectively. BMD was correlated with weight (r = 0.346), time on HD (r = -0.188), time on treatment (r = -0.235). The porosity was correlated with PTH levels.

[Prevalence of vertebral fractures and aortic calcifications in hemodialysis patients: comparison with a population of the same age and sex]. / Prevalencia de fracturas vertebrales y calcificaciones aórticas en pacientes en hemodiálisis: comparación con una población de la misma edad y sexo.

Dialysis patients have bone metabolic disorders and a higher prevalence of fractures, principally peripheral fractures. However, there are few studies focusing on the prevalence of vertebral fractures. Moreover, aortic calcifications are very common and are an independent predictive factor of vascular morbidity and mortality. The objective of this study was to assess the prevalence of vertebral fractures and vascular calcifications in haemodialysis (HD) patients (n = 99), in comparison with a random sample of general population of similar age and from the same geographical area (n = 624) and study their relationship with clinical, biochemical and therapeutical data. The prevalence of vertebral fractures in HD patients and general population was 19.1% and 24.1% respectively (non-significant statistical differences). In both, sexes, the presence of vertebral fractures was positively associated with age, mean maximum Ca, mean maximum CaxP. In women, time in HD was positively associated as well. On the other hand, the prevalence of aortic calcifications was much higher in HD patients (77.9% vs 37.5%, p < 0.001). HD was a risk factor for aortic calcification in women [OR = 7.7 (IC 95% = 2.6-22.9)] as in men [OR = 5 (IC 95% = 1.9-12.9)]. Severe vascular calcifications were more frequent in HD patients, it reached 57.4% compared with 17% of general population (p < 0.001). Both, in women (64.5% vs 13.3% p < 0.001) and in men (51.4% vs 20.9%), respectively (p < 0.001). In conclusion, the prevalence of vertebral fractures was similar in HD patients and in general population. Nevertheless, frequency and severity of aortic calcifications was higher in HD patients.

Estimación de la masa ósea de pacientes en hemodiálisis por radiogrametría radiológica digital (DXR) / Bone mass estimated by digital x-ray radiomatry (DXR) in haemodialysis patients

La radiogrametría radiológica digital (DXR) mide la masa ósea (DMO) a partir de múltiples mediciones del espesor de la cortical en cinco regiones de interés de una radiografía que incluya mano y antebrazo. Se incluyeron 168 pacientes en hemodiálisis (108 hombres y 60 mujeres; 63 ± 14 y 66 ± 12 años respectivamente —p < 0,05—) procedentes de 7 Unidades de Diálisis de Asturias. Se les realizó una radiografía de mano y antebrazo, un cuestionario epidemiológico y se revisó la historia clínica. Los valores de referencia se obtuvieron de una muestra aleatoria de nuestra población (n = 247). La prevalencia de osteoporosis fue del 7% y 40% en hombres y mujeres respectivamente. La DMO se correlacionó con el peso (r = 0,346), tiempo en diálisis (r = -0,188) y tiempo en tratamiento (r = -0,235). La porosidad fue dependiente del grado de hiperparatiroidismo (AU)

Bone mass (BMD) may be evaluated by digital X-ray radiogrammetry (DXR) which it is estimated from multiple cortical measures carried out on five regions of interest over a simple hand –forearm X-ray film. We included 168 HD patients (108 men and 60 women; 63 ± 14 and 66 ± 12 years old respectively —p <0.05—) coming from seven HD units in Asturias. We performed a hand-forearm X-ray, an epidemiologic questionnaire and we revised their medical and analytical records. As the normative data we used the measurements of a random sample of 247 subjects from our own population. The prevalence of osteoporosis was 7% and 40% in men and women respectively. BMD was correlated with weight (r = 0.346), time on HD (r = -0.188), time on treatment (r = -0.235). The porosity was correlated with PTH levels (AU)

Prevalencia de fracturas vertebrales y calcificaciones aórticas en pacientes en hemodiálisis: comparación con una población de la misma edad y sexo / Prevalence of vertebral fractures and vascular calcifications in patients on haemodialysis: comparisson with a population of the same age and gender

Los pacientes en diálisis presentan alteraciones del metabolismo óseo y una mayor prevalencia de fracturas, fundamentalmente periféricas; sin embargo, hay pocos estudios realizados que cuantifiquen la prevalencia de fracturas vertebrales. Además, las calcificaciones aórticas son muy frecuentes y representan un factor predictivo independiente de morbilidad y mortalidad vascular. El objetivo del estudio fue conocer la prevalencia de fracturas vertebrales y calcificaciones vasculares en pacientes en hemodiálisis (HD) (n = 99), compararla con una muestra aleatoria de población general de edad similar y de la misma área geográfica (n = 624) y estudiar su relación con datos clínicos, bioquímicos y terapéuticos. La prevalencia de fracturas vertebrales en pacientes en HD y en la población general fue del 19,1% y 24,1% respectivamente (diferencias no significativas). En ambos sexos, las fracturas vertebrales se correlacionaron positivamente con la edad, Ca máximo medio, CaxP máximo medio. En mujeres, también se relacionaron con el tiempo en diálisis. Por el contrario, la prevalencia de calcificaciones aórticas fue muy superior en pacientes en HD (77,9% vs 37,5%, p < 0,001). La HD fue un factor de riesgo de calcificaciones aórticas tanto en mujeres [OR = 7,7 (IC 95% = 2,6-22,9)] como en hombres [OR = 5 (IC 95% = 1,9-12,9)]. Las calcificaciones vasculares severas fueron más frecuentes en pacientes en diálisis alcanzando un 57,4%, frente a un 17% de la población normal (p < 0,001), tanto en mujeres (64,5% vs 13,3% p < 0,001) como en hombres (51,4% vs 20,9%), respectivamente (p < 0,001). En conclusión, la prevalencia de fracturas vertebrales fue similar en pacientes en HD y en la población general, por el contrario la frecuencia y severidad de calcificaciones aórticas fue mayor en pacientes en HD (AU)

Dialysis patients have bone metabolic disorders and a higher prevalence of fractures, principally peripheral fractures. However, there are few studies focusing on the prevalence of vertebral fractures. Moreover, aortic calcifications are very common and are an independent predictive factor of vascular morbidity and mortality. The objective of this study was to assess the prevalence of vertebral fractures and vascular calcifications in haemodialysis (HD) patients (n = 99), in comparison with a random sample of general population of similar age and from the same geographical area (n = 624) and study their relationship with clinical, biochemical and therapeutical data. The prevalence of vertebral fractures in HD patients and general population was 19.1% and 24.1% respectively (non-significant statistical differences). In both, sexes, the presence of vertebral fractures was positively associated with age, mean maximum Ca, mean maximum CaxP. In women, time in HD was positively associated as well. On the other hand, the prevalence of aortic calcifications was much higher in HD patients (77.9% vs 37.5%, p < 0.001). HD was a risk factor for aortic calcification in women [OR = 7,7 (IC 95% = 2.6-22.9)] as in men [OR = 5 (IC 95% = 1.9-12.9)]. Severe vascular calcifications were more frequent in HD patients, it reached 57,4% compared with 17% of general population (p < 0.001). Both, in women (64,5% vs 13,3% p < 0,001) and in men (51,4% vs 20,9%), respectively (p < 0,001). In conclusion, the prevalence of vertebral fractures was similar in HD patients and in general population. Nevertheless, frequency and severity of aortic calcifications was higher in HD patients (AU)

Hypercalcemia, inappropriate calcitriol levels, and tuberculosis on hemodialysis.

We describe a female patient undergoing hemodialysis who developed tuberculosis, hypercalcemia, and inappropriately elevated calcitriol levels. These findings suggest ectopic production of calcitriol by tuberculous granulomas. Successful treatment of tuberculosis led to a substantial decrease in the levels of calcium and calcitriol.

Ultrafiltrable aluminium after very low doses of desferrioxamine.

BACKGROUND: The recommended dose of desferrioxamine for the treatment of aluminium intoxication is 5 mg/kg/week. However, there are no data about the efficiency of lower doses. The objective of this study was to investigate the capacity of very low doses of desferrioxamine in the generation of ultrafiltrable aluminium. METHODS: Five patients undergoing haemodialysis with a similar biochemical profile and serum aluminium levels >40 microg/l were studied. The three different doses of desferrioxamine used (0.5, 2.5 and 5.0 mg/kg) were administered randomly to each patient at 1 week intervals. Total and ultrafiltrable serum aluminium was measured before and 44 h after the administration of desferrioxamine. RESULTS: All doses of desferrioxamine significantly increased the total serum aluminium; no differences were found between 2.5 and 5.0 mg/kg. The total serum aluminium levels doubled with the 2.5 and 5.0 mg/kg doses, while the increase with 0.5 mg/kg was lower (32.6%, P<0.05). Ultrafiltrable aluminium increased with the three doses; from 7.1+/-2.8, 3.9+/-0.6 and 7.5+/-4.1 to 25.7+/-7.3, 44.3+/-10.1 and 59.1+/-19.8 microg/l, respectively (P<0.05). The efficiency of each dose was calculated using the ratio between the increase in ultrafiltrable aluminium and the dose of desferrioxamine administered. The efficiency ranged from 10.3+/-3.9 for the higher dose (5 mg/kg) to 37.2+/-10.3 for the lower dose (0.5 mg/kg). CONCLUSIONS: Our results suggest that very low-dose desferrioxamine (>5 mg/kg) increases the ultrafiltrable (potentially dialysable) aluminium.

Cytomegaloviraemia and T cell subpopulations in renal transplant patients.

We studied 54 consecutive recipients of renal transplants to evaluate their immunological responses to cytomegalovirus (CMV) infection. Forty-three (79.6%) patients developed CMV infection, and all of them subsequently recovered. Fourteen of these infected patients (32.6%) developed viraemia during the infectious process, four of whom then manifested the disease. The number of lymphocytes and their main subpopulations was normal before the appearance of CMV infection. During the infection there was a significant growth (P < 0.001) in the CD8+DR+ subset, corresponding to activated T suppressor/cytotoxic lymphocytes, whereas the natural killer measured subsets remained within normal limits during the whole infectious process. As all viraemic patients recovering from the infection developed CD8+DR+ activation, we conclude that this recovery is associated with the immunological activation.