Javier Pardo

Microbiology and Outcome of Iliopsoas Abscess in 124 Patients

To describe the microbiology and outcome of iliopsoas abscess (IPA) in a large case series, we analyzed 124 cases of IPA collected from 1990 through 2004 in 11 hospitals in Spain. Twenty-seven (21.8%) patients had primary and 97 (78.2%) had secondary IPA. The main sources of infection were bone (50.5%), gastrointestinal tract (24.7%), and urinary tract (17.5%). A definitive microbial diagnosis was achieved in 93 (75%) cases. Abscess culture was the most frequent procedure leading to microbial diagnosis, followed by blood cultures. Staphylococcus aureus, Escherichia coli, and Bacteroides species were the most frequent microbial causes: S. aureus was the most common organism in patients with primary abscesses (42.9%) and with abscesses of skeletal origin (35.2%), whereas E. coli was the leading organism in those with abscesses of urinary (61.5%) and gastrointestinal (42.1%) tracts. Mycobacterium tuberculosis was found in 15 patients, 4 of them associated with human immunodeficiency virus (HIV) infection. Twenty (21.5%) cases had polymicrobial infections; these were more common among patients with abscesses of gastrointestinal origin. Information on clinical outcome was available for 120 patients; 19 (15.8%) had a relapse and 6 (5%) died due to complications related to the IPA. Patients who died were older and more likely to have bacteremia and E. coli isolated from cultures. In conclusion, secondary IPA is more prevalent than primary IPA. Among those with secondary IPA, most abscesses are secondary to a skeletal source. A bacterial etiology can be identified in most cases. The overall prognosis of patients with this condition is good. Abbreviations: AIDS = acquired immunodeficiency syndrome, CI = confidence interval, CT = computed tomography, HIV = human immunodeficiency virus, IPA = iliopsoas abscess, IQR = interquartile range, MRI = magnetic resonance imaging, MRSA = methicillin-resistant S. aureus, OR = odds ratio.

Helminth-related Eosinophilia in African immigrants, Gran Canaria.

Of 788 recent African adult immigrants to Las Palmas de Gran Canaria, 213 (27.0%) had eosinophilia. The most frequent causes were filariasis (29.4%), schistosomiasis (17.2%), and hookworm infection (16.8%). Stool microscopy and filarial and schistosomal serologic tests gave the highest diagnostic yield. Country of origin and eosinophil count were associated with specific diagnoses.

Utility of Schistosoma bovis Adult Worm Antigens for Diagnosis of Human Schistosomiasis by Enzyme-Linked Immunosorbent Assay and Electroimmunotransfer Blot Techniques

ABSTRACT Immunodiagnostic methods based on the detection of antibodies continue to be the most effective and practical methods for the diagnosis of imported schistosomiasis. Schistosoma bovis is a species whose final natural hosts are bovines, ovines, caprines, and small wild ruminants. Different studies have demonstrated the analogies existing between S. bovis and other Schistosoma species which affect humans. The objective of this work was to evaluate the utility of S. bovis adult worm antigens (AWA) for the diagnosis of imported human schistosomiasis by enzyme-linked immunosorbent assay (ELISA) and electroimmunotransfer blotting (EITB) techniques. By detecting eggs, the ELISA for S. bovis AWA was able to definitively detect imported cases with a sensitivity of 94%. The specificity of the ELISA for S. bovis AWA was 97%. There were no differences between the results of the S. bovis AWA ELISA for patients infected with Schistosoma mansoni and those infected with Schistosoma haematobium. The EITB technique showed bands of 85, 37, and 20 kDa, which are characteristic of infections with Schistosoma spp. Specific bands to indicate infection by different species of Schistosoma have not been detected. The combined use of the ELISA for S. bovis AWA and EITB increased the global sensitivity of the study to 97%. Our findings suggest that the ELISA for S. bovis AWA is a useful test for the immunodiagnosis of imported schistosomiasis and that EITB for detecting S. bovis AWA permits the confirmation of diagnosis when the ELISA for S. bovis AWA is positive.

Hidatidosis en la provincia de Salamanca: ¿debemos bajar la guardia?

INTRODUCTION Hydatid disease is a major health problem in endemic countries. In Spain, this disease was notifiable from 1981 to 1996, although its incidence kept increasing until the end of this period. From 1997 on, hydatid disease is only surveyed by endemic autonomous regions. Thus, true incidences for human hydatid disease in Spain are currently unknown. In this study the cases recorded from 1996 to 2003 at the Hospital Universitario (Salamanca) which receives patients from all Salamanca province, were analyzed. Method. We obtained epidemiological and clinical data from patients at the University Hospital (reference hospital in Salamanca province) with registered CIE-10 codification 122.0 to 122.9 (hydatid disease), from January 1996 to December 2003, excluding those patients not arriving from Salamanca. We estimated the incidence of hydatid disesase in Salamanca province regarding the total population of the province. RESULTS Our data show that the mean incidence (1996-2003) was 10,8/100.000 inhabitants, twice as many as previously reported by the notifiable diseases scheme. 30% of infected patients were younger than 45. In addition, during the last three years of study, several cases of paediatric hydatid disease were observed. The analysis of the origin of the cases showed a broad distribution throughout the whole province of Salamanca. CONCLUSIONS The real incidence of this disease seems to be higher than previously estimated. Importantly, the several cases of paediatric hydatid disease detected within the last two years of our study, suggest a possible re-emergence of hydatid disease.Introduccion La hidatidosis humana es un problema importante de salud en paises endemicos. En Espana, esta enfermedad fue de declaracion obligatoria (EDO) desde 1981 hasta 1996; el numero de casos en Castilla y Leon aumento desde 1985 a 1996. En 1997 la hidatidosis paso a ser vigilada por las Comunidades Autonomas con hidatidosis endemica. Actualmente el numero de casos y la incidencia anual son desconocidos. En este trabajo, investigamos la situacion actual de la hidatidosis humana en la provincia de Salamanca. Metodo Se seleccionaron pacientes del Hospital Universitario (hospital de referencia de la provincia de Salamanca) cuya codificacion en la novena Clasificacion Internacional de Enfermedades (CIE-9) fue 122.0 a 122.9 (hidatidosis) desde enero de 1996 hasta diciembre de 2003, excluyendose los pacientes residentes en otras provincias. Se obtuvieron datos epidemiologicos y clinicos de los registros informaticos y de las historias clinicas de los pacientes. Se estimo la incidencia provincial segun datos del censo poblacional. Resultados Nuestros resultados demuestran una incidencia media (1996-2003) de 10,8 casos por 100.000 habitantes/ano, 2 veces mayor que la registrada previamente mediante el sistema EDO. El 30% de los casos fueron en menores de 45 anos. En los anos 2000-2003 reaparecieron casos en pacientes en edad pediatrica. Tambien se demostro una amplia distribucion de casos en toda la provincia. Conclusiones La incidencia real de esta parasitosis es superior a la previamente estimada. La reaparicion de casos pediatricos y el mantenimiento del 30% de los casos en menores de 45 anos apuntan a una posible reemergencia de esta enfermedad.

Manejo práctico de una eosinofilia

In this first part of this paper we review the definition of eosinophilia and their classification according to the degree of elevation of eosinophils/microL. Aetiological factors related with eosinophilia were described in three groups of patients: a). autochthonous non-infected by HIV; b). HIV-infected; and c). arrived from tropical countries (imported eosinophilia). We included an algorithmic approach to the diagnosis, including the diagnostic studies that should be performed in patients with or without organ involvement. Pathological consequences of eosinophilia are indicated in the next part of the paper. Finally, therapeutical options used in patients with eosinophilia are reviewed, with an special emphasis on antihelminthic therapies and the management of the hypereosinophilic syndromes.

Diagnóstico de helmintiasis importadas

In recent years, there has been an increase in cases of imported helminthiasis in Spain because of two complementary causes: immigration and international travel. Although the prevalence of helminthiasis is high in the immigrant population, the risk of transmission to the Spanish population is low. In this review, we provide clues to aid in the diagnosis of the helminthiasis, highlighting the geographic characteristics, clinical findings and analytical results of the most frequent types. The low sensitivity of the classic parasitological diagnostic test, mainly in tissue helminthiasis, is described. In addition, the advantages and limitations of the common serological methods for detecting related circulating antigens and antibodies are presented. Certain molecular methods used in the diagnosis of imported helminthiasis and the best strategies for screening of this condition are discussed.

Application of an ELISA test using schistosoma bovis adult worm antigens in travellers and immigrants from a schistosomiasis endemic area and its correlation with clinical findings

We have recently evaluated an ELISA for the diagnosis of human schistosomiasis using S. bovis adult worm antigens (AWA Sb), showing a sensitivity of 94% and a specificity of 97% for patients diagnosed by egg detection. Nevertheless, the comparison of this AWA Sb ELISA with direct parasitological findings as the gold standard could introduce a selection bias, due to the well-known lack of sensitivity of direct methods in the detection of acute schistosomiasis and of low burden infections. The objective of the present work is to compare it with parasitological methods and commercial indirect haemagglutination test using S. mansoni antigens (WA Sm IHA) in 254 immigrants and travellers with different clinical settings; in addition, to find specific bands in the EITB of different phases of schistosomiasis. The AWA Sb ELISA showed 72% of seropositivity in patients with Katayama fever, while patients with eosinophilia and genito-urinary complaints showed 27% and 93%, respectively. The diagnosis yield was globally higher than direct egg detection or WA Sm IHA test with regard to the clinical setting. Finally, the utilization of EITB with S. bovis AWA permits the confirmation of diagnosis in chronic and acute phases of the disease.

Perforación del tabique nasal en un paciente boliviano

El amplio espectro clinico de las enfermedades debidas a Leishmania depende no solo de la especie, sino tambien de la respuesta inmunitaria del paciente1. En el nuevo mundo, la forma cutanea puede deberse a L. braziliensis, L. peruviana, L. guyanensis, L. panamensis, L. mexicana o L. amazonensis2; las formas mucocutaneas solo se han descrito con las especies del subgenero Viannia como Caso clinico