Fisiopatología del envejecimiento prematuro en los pacientes con infección por el VIH / No disponible

Tras 30 años de epidemia de la infección por el VIH muchos pacientes infectados han sobrevivido hasta edades más avanzadas tras la introducción del tratamiento antirretroviral de gran eficacia (TAR) en 1996. De 2000 a 2004, los CDC informaron que el número de adultos ≥ 50 años de edad que viven con infección por VIH y / o SIDA se duplicó. Además se espera que el número de personas mayores con VIH / SIDA aumente aún más durante la próxima década. Se estima que para el año 2020, más de la mitad de todos los individuos infectados por el VIH en los Estados Unidos sean mayores de 50 años. in embargo este aumento de la población VIH mayor de 50 años conlleva a una mayor prevalencia de determinadas comorbilidades relacionadas con la edad que en la población general aparecen en personas más mayores. Por tanto, el éxito que supone haber conseguido una mayor supervivencia no es tal si esto refleja un envejecimiento prematuro asociado a la infección por el VIH que está asociado principalmente a un proceso de inmunoactivación e inflamación crónica (AU)

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Hipertensión intracraneal idiopática asociada a trombosis de cava inferior y déficit de proteína S / Idiopathic intracranial hypertension associated with inferior vena cava thrombosis and protein S deficiency

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[Infection by Strongyloides stercoralis in the county of Safor, Spain]. / Infección por Strongyloides stercoralis en la comarca de La Safor (Comunidad Valenciana).

BACKGROUND: Strongyloides stercoralis is an endemic nematode in tropical and subtropical regions, but almost unknown in Spain. PATIENTS AND METHODS: In order to know some epidemiological, clinical and analytic features of this infection in our area (La Safor, Valencia), we performed a prospective study for 19 months. Through the search for the parasite in feces of patients with eosinophilia, we identified 37 subjects who were studied at diagnosis and 4 months later. RESULTS: Thirty-three patients (89%) were currently, or had been agricultural workers, and thirty had worked barefooted and/or had drunk contaminated irrigation water. Twenty-three patients (62%) had a chronic or immunosuppressive diseases, and two of them on steroid treatment, developed a disseminated strongyloidiasis. Thirteen patients (35%) were asymptomatic; the rest had clinical manifestations attributed S. stercoralis, mainly digestive. Two of the patients with disseminated strongyloidiasis also had concomitant bacterial infections by Streptococcus bovis, Streptococcus faecalis and Enterobacter sp. At diagnosis, besides eosinophilia, 86.5% had raised levels of IgE. Four months later treatment, the number of eosinophils was normal and IgE levels significantly decreased. The diagnostic yield of parasitic study of feces was increased with the number of samples examined. Thiabendazole achieved erradication of the parasite in 35 patients, and the other two died because of disseminated strongyloidiasis. CONCLUSIONS: The presence of eosinophilia in patients from rural areas with subtropical climate should raise suspicion about infection by S. stercoralis, which, although sometimes is asymptomatic, may cause systemic bacterial infections in cases of hyperinfestation, specially when glucocorticoid treatment is given.

[Strongyloides stercoralis infection in patients with bronchial obstructive pathology]. / Infección por Strongyloides stercoralis en pacientes con patología bronquial obstructiva.

Strongyloides stercoralis infection was hardly seen in Spain until a few years ago but has recently been shown to be fairly common in some geographic areas. In the respiratory tract this germ can cause acute bronchospasms that make diagnosis difficult, particularly in patients with underlying bronchial disease. To determine if curing S. stercoralis infection is accompanied by clinical and functional improvement in patients with bronchial obstruction, we studied the evolution of 22 infected patients: 11 with no bronchopulmonary disease and 11 with chronic airway obstruction or asthma. The following variables were assessed in both groups at the moment of diagnosis of infection and four months after cure: levels of eosinophils and total serum IgE, respiratory symptoms, steroid doses and spirometric parameters. After four months we observed a significant decrease in eosinophil (16 versus 5%) and IgE (1,600 versus 770 IU/ml) levels in both groups. The number of bronchospasms and daily steroid doses required decreased in the group with bronchial disease. No significant differences were seen in spirometric parameters, however. The improvement in respiratory symptoms, blood parameters and need for medication leads us to believe that airway inflammation decreases after the infection has been eradicated, in spite of the lack of improvement in bronchial obstruction.