[Human fascioliasis with atypical severe presentation. Treatment with triclabendazole]
Merino Alonso J. Amerigo Garcia MJ. Alvarez Rubio L. Erdozain Ruiz I.
Servicio de Farmacia, Hospital Nuestra Senora de la Candelaria.
BACKGROUND: Fascioliasis is a zoonosis mainly involving sheep but which occasionally may be found in man as an accidental host. It is acquired by the consumption of herbs (watercress, wild endive, and dandelion) contaminated with metacercarias. The adult phase is established in the biliary tree. Most of the human infections are asymptomatic or with unspecific self limited abdominal symptoms making diagnosis difficult. METHODS: A case of human fascioliasis is of note because of two aspects: a) the infrequent, severe life threatening form of presentation: recurrent subcapsular hepatic hematomas, and b) favorable evolution of the patient on treatment with triclabendazol (to date its use is not approved in humans). RESULTS: Resistance to treatment with praziquantel was observed at a dosis of 75 mg/day for 2 days, being repeated 15 days later with no response. The patient was posteriorly treated with 10 mg/kg of a single dosis of triclabendazol following approval as "compassive use" with a favorable clinical response. CONCLUSIONS: This unusual disease requires a high index of suspicion to achieve diagnosis. Treatment with triclabendazol should be studied as a possible treatment of choice given is efficacy, absence of adverse effects and comfortable dosage.
[Variants of hepatitis C virus in different risk groups. Comparative study of a method for genotyping and another for serotyping]
Alonso P. Orduna A. San Miguel A. Gutierrez MP. Lorenzo B. Eiros JM. Bratos MA. Cuervo M. Rodriguez Torres A.
Hospital Comarcal de Monforte de Lemos, Lugo.
AIMS: The aim of this study was to know the prevalence of the different variants of HCV in the Health Care area of Monforte de Lemos (Lugo, Spain) and its distribution according to risk factors and to compare the results obtained with one genotyping and one serotyping technique. PATIENTS AND METHODS: Eighty-four patients with hepatitis C were studied, 25 of whom were IVDA, 14 had received blood transfusions, 4 hemodialysis and the risk factor was unknown in 41. The antibodies against HCV were studied by second generation EIA and confirmed by an immunoblot technique. Serotyping was carried out by an ELISA test. Genotyping was undertaken with a reverse hybridation test of the amplification obtained by polymerase chain reaction prior to reverse transcription (RT-PCR). RESULTS AND CONCLUSIONS: The genotypes most frequently observed were 1b (47.6%), 1a (20.2%) and 3 (14.3%). In the IVDA patients the genotypes 1a (40%) and 3 (24%) predominated. The 1b genotype was the most prevalent in the patients of unknown risk (68.3%) and patients with a history of blood transfusion (50%). The prevalence of the different serotypes was similar to that of the corresponding genotypes, with nearly 100% agreement. The number of untypable cases was greater in the serotyping technique (20.2%) than in the genotyping (2.4%). A greater number of mixed infections was detected with serotyping (7 cases, 8.3%) than with genotyping (1 case, 1.2%). Lesser sensitivity of the serotyping test was observed in the patients lacking anti-NS4 antibodies.
[Thrombosis of the hepatic artery and portal vein secondary to invasive aspergillosis following liver transplantation]
Gavilan F. Torre-Cisneros J. Delgado M. Briceno J. Herrero C. Martinez L. de la Mata M. Mino G.
Seccion de Enfermedades Infecciosas, Hospital Universitario Reina Sofia, Cordoba.
Thrombosis of the main hepatic vessels is a severe, frequent complication in patients requiring liver transplantation. It is usually a cause of emergency retransplantation. Two cases of hepatic vascular thrombosis secondary to disseminated aspergillosis are presented. Both patients demonstrated a septic state and required a second transplantation despite which they died within a few days. Necropsy showed disseminated aspergillosis with invasion of the portal venous system and the hepatic artery. The risk factors associated with this infection and the possible pathogenic mechanisms are discussed.
[Virus-specific serum and fecal antibodies response in children with acute rotavirus gastroenteritis]
Colomina J. Raga J. Gil MT. Buesa J.
Servicio de Microbiologia, Facultad de Medicina, Hospital Clinico Universitario, Universidad de Valencia. firstname.lastname@example.org
BACKGROUND: The analysis of the immune response to rotavirus infection and the characterization of the viral antigens recognized by specific antibodies are of great concern in evaluating the protection against rotavirus. MATERIAL AND METHODS: The levels of rotavirus-specific fecal (sIgA) and serum antibodies (IgM, IgG and IgA) were evaluated by ELISA in 25 children with acute gastroenteritis for rotavirus, in 11 of them during the acute and convalescent phases. The specificity of serum antibodies to viral polypeptides was characterized by immunoblotting. RESULTS: Serum IgM antibodies with a geometric mean titer (GMT) of 1/3,973 were the predominant antibodies detected during the acute phase. In comparison, IgG and IgA serum antibodies and sIgA coproantibodies levels were higher in the convalescent phase (GMT = 1/5,799, 1/257 and 1/137 respectively). Significant differences were observed for all the isotypes of immunoglobulins evaluated during the infection and in the convalescence (p < 0.01). Rotavirus-specific serum antibodies recognized mainly the structural VP6, VP7 and VP3/VP4 proteins. Other polypeptides also detected were VP1, VP5 and the non-structural NS34 protein. CONCLUSIONS: Rotavirus infection produce an intense humoral immune response both in serum and in the gut. Specific antibodies react against structural proteins of the internal (VP6) and external (VP7) capsids of rotavirus.
[The usefulness of abdominal echography in the diagnosis of extrapulmonary tuberculosis in patients with HIV infection]
Dominguez-Castellano A. Yanez P. Muniain MA. Balonga B. Rios MJ. Rodriguez-Bano J. Bueno C. Perez-Cano R.
Servicio de Medicina Interna, Hospital Universitario Virgen Macarena-San Lazaro, Sevilla. email@example.com
BACKGROUND: The aim of the present study was to analyze the diagnostic profitability of echography as an indicator of extrapulmonary tuberculosis in patients with HIV infection. PATIENTS AND METHODS: HIV positive patients presenting fever of long duration were prospectively studied with an active search for specific echographic lesions. Descriptive statistics were performed by variance analysis. The diagnostic profitability of echography was evaluated by the calculation of sensitivity, specificity, positive predictive values (PPV) and negative predictive value (NPV). RESULTS: Criteria of prolonged fever was fulfilled by 116 patients. Thirty-five (30.2%) presented specific echographic alterations: 12 had multiple hyoechoic splenic lesions (34.3%), 11 abdominal adenopathies (31.4%), 9 splenic lesions and adenopathies (25.7%) and 3 showed hepato-splenic involvement and adenopathies (8.6%). The final diagnoses of these patients were: one case of toxoplasmosis, 2 MAI infection, 7 with no definitive diagnosis, and 25 (71.4%) tuberculosis. The mean CD4 lymphocyte count was 46.6 x 10(6)/L in patients with tuberculosis with no echographic findings, with a statistically significant difference of p < 0.05. The appearance of some echographic alterations had a global sensitivity of 37.3%, a specificity of 79.6% a PPV of 0.65 and a NPV of 0.51. The isolated findings of hypoechoic splenic lesions showed a sensitivity of 19.23%, a specificity of 95.12%, a PPV of 0.83 and a NPV of 0.47. CONCLUSIONS: The presence of multiple hypoechoic splenic lesions showed an elevated specificity, being greater than 95%, making this finding, although infrequent, that of greatest diagnostic profitability in the echographic study of tuberculosis. We therefore consider abdominal echography to be of great usefulness in the evaluation of patients with HIV infection and prolonged fever since the presence of these lesions, in the most severely immunosuppressed patients, may strongly suggest the diagnosis of extrapulmonary tuberculosis.
[Outbreak of nosocomial diarrhea by Clostridium difficile in a department of internal medicine]
Ramos A. Gazapo T. Murillas J. Portero JL. Valle A. Martin F.
Servicio de Medicina Interna III, Clinica Puerta de Hierro, Madrid.
BACKGROUND: Clostridium difficile (DCD) is the main etiologic agent of nosocomial diarrhea of infectious origin. Most of the cases of DCD have been detected in a hospital environment. PATIENTS, MATERIAL AND METHODS: From October to November 1996 five cases of nosocomial diarrhea were detected with the presence of the toxin A of Clostridium difficile being observed in the stools. These patients were compared with a group of 19 patients without diarrhea (controls) who were admitted to the same ward during the same period as the patients with DCD. RESULTS: The hospital stay of the cases was greater (25 +/- 8 days) than that of the controls (14 +/- 10 days; p < 0.05). One hundred percent of the cases received antibiotics during admission (2 +/- 1.2 antibiotics per patient), versus 68% of the controls (1.1 +/- 0.9 antibiotics per patient, p > 0.05). The length of antibiotic treatment prior to the onset of the symptoms was 8 +/- 3 days (range 7-11 days). The type of antibiotic administered was similar in both groups. More of the cases with DCD (60%) had vesicle catheterization than the controls (11%, p < 0.05). All the patients with DCD presented abdominal pain and several liquid stools per day without blood or pus (3.2 +/- 0.45 stools per patient) and 2 (40%) fever. The mean length of diarrhea was 5.6 +/- 3.6 days. The serum albumin concentration on the first day of admission was significantly lower in the cases of DCD (2.9 +/- 0.4 mg/dl) than in the controls (3.3 +/- 3.4 mg/dl, p < 0.05). All the cases received antibiotic treatment for Clostridium difficile (oral metronidazol or vancomycin) with good clinical evolution. CONCLUSIONS: The patients with DCD had more often had vesicle catherization and presented a lower serum albumin concentration than the controls.