Determinación de anticuerpos anti-transglutaminasa en el diagnóstico de enfermedad celíaca / Antitransglutaminase antibodies for the diagnosis of celiac disease

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 percent, a specificity of 96 percent, a positive predictive value of 93 percent and a negative predictive value of 82 percent for the diagnosis of celiac disease. Antiendomisium and antitransglutaminase antibodies had a specificity and positive predictive value of 100 percent, sensitivities of 89 and 92 percent respectively and negative predictive values of 92 and 94 percent 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

Control de calidad externo en el diagnóstico parasitológico de cryptosporidium parvum / External quality control in the parasitological diagnoses of cryptosporidium parvum

Between 1991 and 1994, 8 external quality assessments of Cryptosporidium parvum infection diagnosis were performed. Stool specimens were sent to 74 laboratories, to be stained and examined. In 40 laboratories (54.1 percent), the diagnosis was correct in all evaluations, whereas in 34 (46 percent), the diagnosis disagreed with the parasitology reference laboratory in one ocassion or more. The mean correlation of diagnoses with the reference laboratory was 88 percent (range 79-96 percent). Ninty-three percent of negative samples and 87 percent of positive samples were correctly diagnosed. These figures are similar to those obtained abroad. These results lead to the development of a quality control network for the diagnosis of Cryptosporidium parvum infections along the country aiming to improve its reliability

Microsporidiosis en pacientes con diarrea crónica y sida, hiv asintomáticos y pacientes con diarrea aguda / Microsporidiosis in patients with chronic diarrhea and aids, asymptomatic hiv and patients with acute diarrhea

Microsporidia are intracellular protozoa that mainly affect AIDS patients and chronic diarrhea, caused by the strains Enterocytozoon bieneusi and septata intestinalis, is the most common clinical manifestation. The diagnosis is made in intestinal biopsies, however the recently developed trichomic stain with chromotrope 2R, is able to detect microsporidia in stools and has a good correlation with the biopsy. Using this technique, we studied 43 asymptomatic HIV infected subjects, 89 AIDS patients with chronic diarrhea and 186 patients with acute diarrhea as controls. Thirty three percent of patients with AIDS, 16.3 percent of HIV infected subjects and none of the individuals with acute diarrhea had microsporidia in their stools (p<0.05). In 15 patients with AIDS we detected intermitted stool microsporidia shedding; this finding should encourage repetitive examinations in negative cases. The trichomic stain for microsporidia is proposed as a routine test in AIDS patients with diarrhea

Dispepsia no ulcerosa: relaciones entre sintomatología, gstritis y helycobacter pylori / Non ulcerative dyspepsia: relationship between symptomatology, gastritis and helycobacter pylori

Background: histological alterations of gastric mucosa and its colonization by Helicobacter pylori are postulated to be implicated in the pathogenesis of non ulcer dyspepsia. Aim: to study the possible relationships between histological gastriitis and Helicobacter pylori in non ulcer dyspepsia symptomatology. Patients and Methods: 54 patients (39 female) with non ulcer dyspepsia whose ages ranged from 17 to 68 years were subjected to an upper Gl endoscopy with gastric mucosa biopsy samples for histological study and microbiological identification of Helicobacter pylori. Gastrointestinal complains were blindy quantified using a scored questionnaire. Results: 31 subjects (57.4 per cent) had Helicobacter pylori in their gastric mucosa. There was acute inflammatory activity in 26 of the 31 patients with Helicobacter pylori (81 per cent) and 15 of 23 without Helicobacter (65 per cent). The median score of symptoms was 7 (range 2-13) in patients with Helicobacter and 6 (range 2-10= in patients without Helicobacter. Conclusions: there were no significant differences in gastric mucosa acute inflammatory activity and non ulcer dyspepsia symptomatology between patients with or without Helicobacter pylori colonization of gastric mucosa