Juan Carlos Weitz

Association of Primary Pneumocystis carinii Infection and Sudden Infant Death Syndrome

To delineate clinical and histological features of the first Pneumocystis carinii infection affecting the immunocompetent host, P. carinii-specific histological stains were performed on autopsy lung specimens from 534 consecutive pediatric patients (those with AIDS and malignancies were excluded) in Santiago, Chile. P. carinii clusters were found in 4 (25%) of 16 infants who died of no apparent cause at arrival to the emergency department, and in 10 (2.9%) of 342 infants who died of multiple conditions at the hospital (P=.002, Fishers exact test). This prompted us to analyze additional series of infants with sudden infant death syndrome (SIDS). In 161 additional SIDS cases, 47 (35.1%) of 134 infants from Chile and 4 (14.8%) of 27 infants from Oxford, United Kingdom, were found to have P. carinii clusters in the lungs. The quantity of P. carinii cysts was small compared with the numbers seen in immunocompromised hosts with P. carinii pneumonitis. This study provides histological evidence that primary P. carinii infection is associated with SIDS.

Determinación de anticuerpos anti-transglutaminasa en el diagnóstico de enfermedad celíaca

Background: The diagnosis of celiac disease is based in clinical features, serology and intestinal biopsy. There are recent reports that antiglutaminase antibodies have a good correlation with anti endomisial antibodies. Aim: To assess the sensitivity and specificity of antitransglutaminase antibodies in the diagnosis of celiac disease and their correlation with antiendomisial antibodies. Material and methods: Forty nine patients with celiac disease (mean age 30 years, 12 male) were studied. Thirty were symptomatic and 19, asymptomatic. As controls, 34 subjects (mean age 27 years, seven male), with normal duodenal biopsies, were studied. Sera was processed for the determination of antigliadin IgA by ELISA, antiendomisium IgA by indirect immunofluorescence, and antitransglutaminase IgA by ELISA. Results: Antigliadin antibodies had a sensitivity of 73%, a specificity of 96%, a positive predictive value of 93% and a negative predictive value of 82% for the diagnosis of celiac disease. Antiendomisium and antitransglutaminase antibodies had a specificity and positive predictive value of 100%, sensitivities of 89 and 92% respectively and negative predictive values of 92 and 94% respectively. No significant differences in the diagnostic yield of antiendomisium and antitransglutaminase antibodies, were observed. Conclusions: In this group of patients, antitransglutaminase antibodies had a high concordance with antiendomisium antibodies, for the diagnosis of celiac disease. Considering that the determination of antitransglutaminase antibodies is of lower cost and less complicated than antiendomisium antibodies, it is a useful tool for the diagnosis and follow up of patients with celiac disease (Rev Med Chile 2003; 131: 31-6)

Brote de cryptosporidiosis en un centre de recuperación nutricional

An outbreak of cryptosporidiosis is described in a nutritional center of Santiago: the finding of the infection intwo undernourished in patient children lead to the study and detection of Cryptosporidum sp. in stool specimens of24.3%of the children in the same center. Examination of controls from a different center showed a 5.5%rate ofinfection (p <0.01). Eight patients suffered acute diarrhea, 6 had respiratory symptoms and 6 were asymptomatic.(Keywords: Cryptosporidium outbreak, nutritional care center).

Evolución de la eliminación de ooquistes de Cryptosporidium sp. en las heces de niños con síndrome diarreico

A prospective follow up was done to 62 children (2 to 40 months of age) who were admitted lo hospital because ofCryptosporidium sp. infection and acute diarrhea to measure the duration of fecal oocysts excretion. Fecal samples weretaken each two days and stained with Zlehl Neelsen technique. In 46 children a complete survey was done until oocystsdisappeared from their faeces. Sixteen children were discharged from hospital before completion of the study and theydidnt come back to follow up so they were not considered for mis report. The average duration of oocysts excretion, fromdiagnosis to the last positive fecal sample, was 16 days (range 3 to 48). In 22 cases (47.8%), excretion was longer than1 5 days, and in 32 [69,6%), oocysts persisted in faeces after clinical recovery. No patients evolved to chronic persistentinfection. The long protozoal excretion time in asymptomatic convalescent patients is of epidemiological significance forthe spread of this infection.(Key words: Cryplosporidium, fecal excretion, diarrhea, infantile.]