[Bartonella henselae endocarditis. Report of a case and review of the literature]. / Endocarditis por Bartonella henselae. Presentación de un caso y revisión de la literatura.

Bartonella spp are small Gram-negative rods, aerobic and highly fastidious. They are difficult to culture, in the routine bacterial cultures. They are considered as emergent human pathogens. Since 1993, three species of Bartonella (B. quintana, B. henselae, and B. elizabethae) have been described as causative agents of infectious endocarditis. In this paper we describe the case of a 43 year-old woman with a previous valvular heart disease, probably of rheumatic origin, owner of cats, that suffered an infectious endocarditis by Bartonella henselae in the aortic valve. This patient presented IgG titers against B. henselae of 1/4096 and against B. quintana of 1/256. She also had low IgM titers against B. henselae and B. quintana: 1/64 and 1/32, respectively. The patient received antibiotics for 12 weeks and suffered a valvular replacement due to the severe lesion on the aortic valve. On the endocardiac tissue of the removed valve DNA of B. henselae was detected (polymerase chain reaction-based assay). Clinical evolution of the patient was good. Diagnosis of Bartonella spp infection must be considered in every patient with infectious endocarditis and negative blood cultures, and particularly B. henselae in patients with previous valvular heart disease and regular contact with cats.

[Cordylobia anthropophaga cutaneous myiasis]. / Miasis cutánea por Cordylobia Anthropophaga.

The progressive increase in the number of people traveling to tropical countries has led to imported diseases becoming of increasingly greater importance. Cutaneous myasis (or fly larva infestations) are found among this type of diseases particularly frequent in tropical countries. Based on the observation of a case of massive cutaneous myasis by Cordylobia antropophaga of a 34 year old woman upon her return from a trip to Senegal, a review has been made of the major cases of furunculoid cutaneous myasis published in Spain, as well as of the biology, pathology, treatment and prevention of human myasis by Cordylobia anthropophaga. The aforesaid case was characterized by the infestation of an unusually large number of larvae, the etiology of which was not suspected until the final stage of the disease. Although the cases of cutaneous myasis are not as serious as other imported diseases, a knowledge of this disease is necessary from the preventive, diagnostic and curative standpoint. It is important to proceed to the identification of the larvae by distinguishing them from another type of myasis involving different therapeutic implications.

Endocarditis por Bartonella henselae. Presentación de un caso y revisión de la literatura / Bartonella henselae endocarditis. Report of a case and review of the literature

Bartonella spp son bacilos Gran negativos aerobios, difíciles de aislar con los medios empleados habitualmente en los laboratorios, considerados patógenos humanos emergentes. Desde 1993, tres especies del género Bartonella (B. quintana, B. henselae y B. elizabethae) se han descrito como agentes causales de endocarditis bacteriana. En el presente trabajo se describe el caso de una paciente de 43 años, con valvulopatía previa de posible origen reumático y dueña de gatos, que sufrió una endocarditis infecciosa por B. henselae sobre válvula aórtica. La paciente presentó un título de IgG frente a B. henselae de 1/4096 y de 1/256 frente a B. quintana detectándose IgM frente a ambas bacterias a título débil (1/64 y 1/32 respectivamente). La paciente fue tratada con antibióticos durante 12 semanas y sometida a recambio válvular ante la grave lesión existente en la válvula aórtica. En tejido endocárdico procedente de la válvula escindida se detectó DNA de B. henselae (reacción en cadena de la polimerasa). La evolución clínica fue buena. El diagnóstico de infección por Bartonella spp debe ser considerado en todos los pacientes con endocarditis infecciosa y hemocultivo negativo, y en particular B. henselae en pacientes con valvulopatía previa y contacto habitual con gatos. (AU)

[Responses to triple viral and tetanus vaccination in HIV-infected children]. / Respuesta a la vacunación triple vírica y tétanos en niños infectados por VIH.

Our objective was to study the antibody response to the parotiditis, rubella, measles and tetanus vaccines in HIV infected children. Forty-four children of HIV positive mothers, of which 14 were infected (SG) and 33 HIV negative (CG) were studied when they were between 2 and 3 years of age. Their response to vaccinations of four doses of tetanus toxoid and one dose of measles, rubella and parotiditis vaccines was assessed. Children in the SG were tested at the age of 5-6 years to study the evolution of the response. At the age of 2-3 years, all children had optimal protection against tetanus toxoid. The response to measles, parotiditis and rubella was poor (adequate levels of antibodies in 50%, 25% and 21%, respectively) in infected children and good (93%, 75% and 90%, respectively) in the CG. At 5-6 years of age, a decreased level of antitetanus antibodies were found in the SG, maintaining low protection levels. There was no evidence of any changes in the response to measles, while the number of cases with a good response to parotiditis and rubella increased. Further results are necessary to know the effectiveness of the booster. We conclude that: 1) The immunological response to vaccination is poor in HIV infected children. 2) There was no evidence of side effects or changes in the HIV symptoms after vaccination.

[Immunity against tetanus in childhood]. / Inmunidad frente al tétanos en población infantil.

In order to evaluate the programs of vaccination against tetanus, we have studied the presence of specific antibodies in a sample of children and adolescents from our region. We used a passive hemagglutination test, corroborating the results by a biological assay based on toxin-neutralization. Among the subjects investigated, 93.2% (551/591) had neutralizing toxin-antibodies at a protective level (> or = 0.01 ui/ml). The younger children were more protected (97.5% in children from 1 to 5 years old, and 79.2% in children from 16 to 19 years of age), (X2 = 25.39, p = 0.000-). We did not find any significant differences between the sexes in the degree of protection. Among protected subjects, the higher antibody titers were observed in children from 6 to 10 years old, coinciding with the age of a booster vaccine. The results show an excellent immunization coverage among the childhood population in our region. They also confirm the high effectiveness of this vaccine. However, this high protection was not found among people above the adolescent period.

Rubella in Guipuzcoa (Basque Country, Spain) a four-year serosurvey.

Since the early 1980s, Spain has practiced mass vaccination of preschool children and selective vaccination of prepubertal girls. Estimated vaccination coverage in the province of Guipúzcoa (Basque Country) in recent years is about 95% (confirmed minimums of 89% for preschool children and 87.5% for 11 to 12 year-old girls). From the seroepidemiological study we could deduce that there was extensive circulation of wild rubella virus until recently (72-75% of unvaccinated girls 10 to 11 years-old had rubella antibody). More than 98% of the population at risk, represented in this study by 13,564 women (67% of all who bore children over a four-year period), possessed rubella antibodies. In the course of the study period the number of subjects (puerperal women and children) susceptible to infection declined. In spite of this favorable situation, the seroepidemiological study disclosed certain gaps that should be corrected to meet the targets for the European Region of the Expanded Programme on Immunization, and to achieve the goal of elimination of wild rubella virus in the area.

[Prospective study of newborn infants born to mothers infected with human immunodeficiency virus]. / Estudio prospectivo en recién nacidos, hijos de madres infectadas por el virus de la immunodeficiencia humana.

Perinatal transmission of Human immunodeficiency virus (HIV) from mother to child is at the present time the most important cause of AIDS in children. Since August 1985 we have observed 24 babies with anti-HIV antibodies born to HIV-infected mothers. Their present status is: 6 have symptomatic infection, 6 undetermined infection, 10 had became seronegative and 2 were lost for follow-up. Our results suggest that the risk of infection for the baby is high and the onset of symptoms relatively early. Follow-up studies in babies born to HIV-infected mothers are needed in order to classify the true risk of infection in them and the natural history of the disease.

Prevalence of methicillin-resistant Staphylococcus aureus in a Spanish hospital.

Recent reports of the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in Europe are infrequent compared with reports in the 1960s. Annual incidence of the isolation of MRSA was studied in a general hospital in Guipúzcoa (Basque country) over a 9-year period. Overall prevalence was 4.5%-12.93% in the first 3 years (coinciding with an epidemic phase) and later 0.29%, underlining the cyclic and epidemic nature of this infection.