[Clinical relevance of nontuberculous mycobacteria]. / Relevancia clínica de los aislamientos de micobacterias no tuberculosas.

BACKGROUND: The isolation of nontuberculous mycobacteria (NTM) has increased in recent years largely due to the use of liquid cultivation media. In many cases such isolations lack clinical relevance, which is why the evaluation of their meaning must be carried out on the basis of international clinical criteria. This article studies the impact of using the criteria that the American Thoracic Society (ATS) has established for differentiating an infection of NTM colonisation in respiratory samples. METHODS: Microbiological and clinical study of the patients with repeated isolations of NTM in respiratory samples registered in our laboratory between 2000 and 2004. RESULTS: One hundred and sixteen positive cultivations of NTM were obtained, repeatedly isolated in 46 episodes corresponding to 42 patients. Eleven different species were identified: M. xenopi (16 cases), M. avium (12), M. kansasii (7), M. fortuitum (5), M. malmoense (2) and, finally, 1 of each of the following: M. genavense, M. simiae, M. gordonae and M. lentiflavum. It was possible to study 36 patients, of whom 17 met the criteria of the ATS, and, out of these, only 12 received specific treatment. In those cases that did not meet the ATS criteria the isolations did not have any clinical repercussion. In both the treated and untreated groups a clearly differentiated evolution was not observed. CONCLUSIONS: Facing the difficulty of attributing an etiological role to an NTM of respiratory samples, it is necessary to follow international criteria such as those of the ATS before beginning a specific treatment in order to avoid the incorrect treatment of patients.

Relevancia clínica de los aislamientos de micobacterias no tuberculosas / Clinical relevance of nontuberculous Mycobacteria

Fundamento: El aislamiento de micobacterias no tuberculosas (MNT) se ha incrementado en los últimos años debido en gran parte a la utilización de medios de cultivo líquidos. Estos aislamientos carecen en muchos casos de relevancia clínica, por lo que la valoración de su significado debe realizarse en base a unos criterios clínicos internacionales. En el presente trabajo hemos estudiado el impacto que supondría la aplicación de los criterios que la American Thoracic Society (ATS) ha establecido para diferenciar en muestras respiratorias una infección de una colonización por MNT. Métodos: Estudio microbiológico y clínico de los pacientes con aislamientos repetidos de MNT en muestras respiratorias registrados en nuestro laboratorio entre los años 2000-2004. Resultados: Se obtuvieron 116 cultivos positivos de MNT aisladas repetidamente en 46 episodios correspondientes a 42 pacientes. Se identificaron 11especies distintas: M. xenopi (16 casos), M. avium (12), M. kansasii (7), M. fortuitum (5), M. malmoense (2) y finalmente 1 de cada una de las siguientes: M. genavense, M. simiae, M. gordonae y M. lentiflavum. Se pudieron estudiar 36 pacientes, de los que 17 cumplían los criterios de la ATS y, de estos, sólo 12 recibieron tratamiento específico. En los casos que no se cumplían los criterios de la ATS los aislamientos no tuvieron ninguna repercusión clínica. En ambos grupos, tratados y no tratados, no se observó una evolución claramente diferenciada. Conclusiones: Ante la dificultad de atribuir a una MNT de muestras respiratorias un papel etiológico, es necesario atenerse a criterios internacionales como los de la ATS antes de iniciar un tratamiento específico para evitar tratamientos incorrectos a los pacientes (AU)

Background: The isolation of non tuberculous mycobacterias (NTM) has increased in recent years largely due to the use of liquid cultivation media. In many cases such isolations lack clinical relevance, which is why the evaluation of their meaning must be carried out on the basis of international clinical criteria. This article studies the impact of using the criteria that the American Thoracic Society (ATS) has established for differentiating an infection of NTM colonization in respiratory samples. Methods: Microbiological and clinical study of the patients with repeated isolations of NTM in respiratory samples registered in our laboratory between 2000and 2004.Results. One hundred and sixteen positive cultivations of NTM were obtained, repeatedly isolated in 46episodes corresponding to 42 patients. Eleven different species were identified: M. xenopi (16 cases), M.avium (12), M. kansasii (7), M. fortuitum (5), M. malmoense (2) and, finally, 1 of each of the following: M. genavense, M. simiae, M. gordonae and M. lentiflavum. It was possible to study 36 patients, of whom 17 met the criteria of the ATS, and, out of these, only 12 received specific treatment. In those cases that did not meet the ATS criteria the isolations did not have any clinical repercussion. In both the treated and untreated groups a clearly differentiated evolution was not observed. Conclusions: Facing the difficulty of attributing an etiological role to an NTM of respiratory samples, it is necessary to follow international criteria such as those of the ATS before beginning a specific treatment in order to avoid the incorrect treatment of patients (AU)

A large Legionnaires' disease outbreak in Pamplona, Spain: early detection, rapid control and no case fatality.

An outbreak of Legionnaire's disease was detected in Pamplona, Spain, on 1 June 2006. Patients with pneumonia were tested to detect Legionella pneumophila antigen in urine (Binax Now; Binax Inc., Scarborough, ME, USA), and all 146 confirmed cases were interviewed. The outbreak was related to district 2 (22 012 inhabitants), where 45% of the cases lived and 50% had visited; 5% lived in neighbouring districts. The highest incidence was found in the resident population of district 2 (3/1000 inhabitants), section 2 (14/1000). All 31 cooling towers of district 2 were analysed. L. pneumophila antigen (Binax Now) was detected in four towers, which were closed on 2 June. Only the strain isolated in a tower situated in section 2 of district 2 matched all five clinical isolates, as assessed by mAb and two genotyping methods, AFLP and PFGE. Eight days after closing the towers, new cases ceased appearing. Early detection and rapid coordinated medical and environmental actions permitted immediate control of the outbreak and probably contributed to the null case fatality.

[Microbiology of tuberculosis]. / Microbiología de la tuberculosis.

For a century, the diagnosis of tuberculosis, based on bacilloscopy and the isolation and identification of Mycobacterium tuberculosis in cultures, has been slow and not very sensitive. This has made it necessary on occasions to initiate treatment with tuberculostatics in an empirical way. The routine incorporation of liquid mediums and molecular genetic techniques in the final decade of the XX century brought an important advance by clearly increasing the sensitivity, precision and rapidity of diagnosis. The present blossoming of molecular techniques is making possible a better understanding of the disease's epidemiology, the factors of virulence and the mechanisms of resistance, which in the near future will give rise to new strategies of prevention and for treating the disease.

Microbiología de la tuberculosis / Microbiology of tuberculosis

Durante un siglo, el diagnóstico microbiológico de la tuberculosis, basado en la baciloscopia y en el aislamiento e identificación de Mycobacterium tuberculosis en los cultivos, ha sido poco sensible y lento lo que obligaba en ocasiones a iniciar de forma empírica tratamiento con tuberculostáticos. La incorporación rutinaria de medios de cultivo líquidos y técnicas de genética molecular, en la última década del siglo XX, ha supuesto un avance importante al aumentar claramente la sensibilidad, precisión y rapidez en el diagnóstico. La actual eclosión de las técnicas moleculares está permitiendo un mejor conocimiento de la epidemiología de la enfermedad, de los factores de virulencia y de los mecanismos de resistencia lo que dará lugar, en un futuro inmediato, a nuevas estrategias de prevención y tratamiento de la enfermedad

For a century, the diagnosis of tuberculosis, based on bacilloscopy and the isolation and identification of Mycobacterium tuberculosis in cultures, has been slow and not very sensitive. This has made it necessary on occasions to initiate treatment with tuberculostatics in an empirical way. The routine incorporation of liquid mediums and molecular genetic techniques in the final decade of the XX century brought an important advance by clearly increasing the sensitivity, precision and rapidity of diagnosis. The present blossoming of molecular techniques is making possible a better understanding of the disease’s epidemiology, the factors of virulence and the mechanisms of resistance, which in the near future will give rise to new strategies of prevention and for treating the disease

Valoración de la prueba de amplificación MTD-2 para la detección directa de Mycobacterium tuberculosis en la muestra / Evaluation of the MTD-2 test for the direct detection of Mycobacterium tuberculosis in specimens

Fundamento. Valorar la rentabilidad de la prueba Amplified Mycobacterium Tuberculosis DirecVt Test (MTD-2, Gen-Probe) en el diagnóstico microbiológico de la tuberculosis.Métodos. Se valoraron los resultados obtenidos con la prueba MTD-2 realizada en 146 muestras, junto con los del cultivo y baciloscopia. MTD-2 se realizó en todas las muestras con baciloscopia positiva (n=47) y en muestras con baciloscopia negativa, si había sido solicitada por el clínico (n=19); además, se testaron una serie de muestras seleccionadas en el laboratorio en base a los datos clínicos y a la calidad de la muestra (n=80). Se consideraron casos de tuberculosis aquellos en los que se aisló Mycobacterium tuberculosis y los que fueron tratados como tales.Resultados. Los resultados de sensibilidad, especificidad, valor predictivo positivo y negativo de la MTD-2 fueron: 95, 76, 71 y 96%. Para el cultivo: 84, 100, 100, y 90% y para la baciloscopia: 75, 94, 89 y 86% respectivamente. En las muestras con baciloscopia positiva, MTD-2 mostró una alta especificidad, diferenciando las que correspondían a M. tuberculosis de las debidas a otras micobacterias. En las muestras con baciloscopia negativa, la sensibilidad no alcanzó los niveles deseados y se obtuvo un bajo valor predictivo positivo. Conclusiones. MTD-2 ha demostrado ser de gran utilidad en muestras con baciloscopia positiva pues en pocas horas permite diagnosticar una tuberculosis o excluirla. Sin embargo, no nos parece recomendable su empleo en el diagnóstico rutinario de la tuberculosis, debido a su bajo valor predictivo positivo. Por esto, siempre que sea positiva en una muestra con baciloscopia negativa, éste resultado debe ser confirmado con otra muestra

Background. To evaluate the utility of the Amplified Mycobacterium Tuberculosis Direct Test (MTD-2, Gen-Probe) in the microbiological diagnosis of tuberculosis.Methods. We evaluated the results obtained in 146 specimens with the MTD-2 test, together with those of the culture and smears. The MTD-2 test was performed on all the smear positives specimens (n=47), on the smear-negative specimens, when the test was demanded (n=19), and in other smear-negative specimens previously selected, according to the clinical history of the patient (n=80). We considered real cases of tuberculosis, those that were culture positive for Mycobacterium tuberculosis and those that were specifically treated.Results. The overall sensitivity, specificity, positive and negative predictive values for the MTD test were: 95, 76, 71, and 96%, for the culture; and 84, 100, 100 and 90% and 75, 94, 89 and 86% for the smears, respectively. In smear positive specimens, the test showed a great specificity, and differentiated M. tuberculosis from other mycobacteria. In the smear negatives, the sensitivity of the test was low and so was the positive predictive value, especially in series performed with a high work load.Conclusions. Data from our study show that the MTD-2 test is a reliable method for rapid diagnosis of tuberculosis in smear positive specimens. However, due to its low sensitivity and positive predictive value, it is not recommended in the routine diagnosis of tuberculosis. Also, for this reason, whenever a positive result is obtained with a smear negative specimen, the result needs to be confirmed with another specimen

Donepezil-tacrine hybrid related derivatives as new dual binding site inhibitors of AChE.

A new series of donepezil-tacrine hybrid related derivatives have been synthesised as dual acetylcholinesterase inhibitors that could bind simultaneously to the peripheral and catalytic sites of the enzyme. These new hybrids combined a tacrine, 6-chlorotacrine or acridine unit as catalytic binding site and indanone (the heterocycle present in donepezil) or phthalimide moiety as peripheral binding site of the enzyme, connected through a different linker tether length. One of the synthesised compounds emerged as a potent and selective AChE inhibitor, which is able to displace propidium in a competition assay. These results seem to confirm the ability of this inhibitor to bind simultaneously to both sites of the enzyme and make it a promising lead for developing disease-modifying drugs for the future treatment of Alzheimer's disease. To gain insight into the molecular determinants that modulate the inhibitory activity of these compounds, a molecular modelling study was performed to explore their binding to the enzyme.

[Evolution of the epidemiological characteristics of tuberculosis in Navarra (1994-2003)]. / Evolución en las características epidemiológicas de la tuberculosis en Navarra (1994-2003).

AIM: To describe the changes in the incidence and the epidemiological profile of tuberculosis in Navarra. METHODS: The cases of tuberculosis in the 1994-2003 period were analysed. Cases reported to the system of obligatory notifiable diseases, completed with the microbiological diagnoses and the cases collected in other health registers. RESULTS: The incidence of tuberculosis fell from 21 per 100,000 inhabitants in the five-year period 1994-1998 to 16 per 100,000 in 1999-2003. In both periods the number of cases in men doubled that in women, and the maximum incidence occurred in the age groups from 25 to 44 and over 65 years of age. The diagnoses of tuberculosis in persons with HIV infection fell from 15.1% to 6.6% and those in immigrants rose from 2.2% to 21.3%. Somewhat over 3% of the cases had received prior anti-tuberculosis treatment and about 6% showed resistance to some medicine, without significant differences between periods. The proportion of potentially transmissible tuberculosis (73%) underwent no significant changes, nor did that of those with positive sputum bacilloscopy. The number of outbreaks (groupings of two or more cases) rose from 18 to 26 and the percentage of cases secondary to another recent case rose from 3.6% to 10.1% (p<0,001). In the 1999-2003 period, pulmonary localisation occurred in isolated form in 67.7% of the patients, and in combination with other localisations in another 5.1%. The isolated pleural form appeared in 9.9% and the meningeal form in 1.5%. CONCLUSION: There has been an advance in the control of tuberculosis although its incidence is still high with respect to other European countries. Control of imported cases is one of the challenges to be faced in coming years, without neglecting control measures in the autochthonous population.

Evolución en las características epidemiológicas de la tuberculosis en Navarra (1994-2003) / Evolution of the epidemiological characteristics of tuberculosis in Navarra (1994-2003)

Objetivo. Describir los cambios en la incidencia y en el perfil epidemiológico de la tuberculosis en Navarra. Métodos. Se analizaron los casos de tuberculosis del período 1994-2003 según el sistema de enfermedades de declaración obligatoria, completado con los diagnósticos microbiológicos y con los casos captados por otros registros sanitarios.Resultados. La incidencia de tuberculosis disminuyó desde 21 por 100.000 habitantes en el quinquenio 1994-1998 hasta 16 por 100.000 en 1999-2003. En ambos períodos los casos en hombres duplicaron a los de mujeres, y la máxima incidencia se produjo en los grupos de 25 a 44 y mayores de 65 años. Los diagnósticos de tuberculosis en personas con infección por el VIH disminuyeron del 15,1 al 6,6% y los realizados en personas inmigrantes aumentaron del 2,2 al 21,3%. Algo más del 3% de los casos había recibido tratamiento antituberculoso previo y en torno al 6% presentaban resistencia a algún fármaco, sin diferencias significativas entre periodos. La proporción de tuberculosis potencialmente transmisibles (73%) no experimentó cambios significativos, ni la de aquellas con baciloscopia de esputo positiva (53%). El número de brotes (agrupaciones de dos o más casos) pasó de 18 a 26 y el porcentaje de casos secundarios a otro reciente aumentó desde 3,6 a 10,1% (p<0,001). En el período 1999-2003, la localización pulmonar se presentó de forma aislada en el 67,7% y combinada con otras localizaciones en otro 5,1%. La forma pleural aislada apareció en el 9,9% y la meníngea en el 1,5% de los pacientes.Conclusión. Se ha avanzado en el control de la tuberculosis aunque todavía la incidencia es alta respecto a otros países europeos. El control de los casos importados es uno de los retos para los próximos años, sin descuidar las medidas de control en la población autóctona

Aim. To describe the changes in the incidence and the epidemiological profile of tuberculosis in Navarra. Methods. The cases of tuberculosis in the 1994-2003 period were analysed. Cases reported to the system of obligatory notifiable diseases, completed with the microbiological diagnoses and the cases collected in other health registers. Results. The incidence of tuberculosis fell from 21 per 100,000 inhabitants in the five-year period 1994-1998 to 16 per 100,000 in 1999-2003. In both periods the number of cases in men doubled that in women, and the maximum incidence occurred in the age groups from 25 to 44 and over 65 years of age. The diagnoses of tuberculosis in persons with HIV infection fell from 15.1% to 6.6% and those in immigrants rose from 2.2% to 21.3%. Somewhat over 3% of the cases had received prior anti-tuberculosis treatment and about 6% showed resistance to some medicine, without significant differences between periods. The proportion of potentially transmissible tuberculosis (73%) underwent no significant changes, nor did that of those with positive sputum bacilloscopy. The number of outbreaks (groupings of two or more cases) rose from 18 to 26 and the percentage of cases secondary to another recent case rose from 3.6% to 10.1% (p<0,001). In the 1999-2003 period, pulmonary localisation occurred in isolated form in 67.7% of the patients, and in combination with other localisations in another 5.1%. The isolated pleural form appeared in 9.9% and the meningeal form in 1.5%. Conclusion. There has been an advance in the control of tuberculosis although its incidence is still high with respect to other European countries. Control of imported cases is one of the challenges to be faced in coming years, without neglecting control measures in the autochthonous population

[Study of the resistance of Mycobacterium tuberculosis to the principal tuberculostatics (Hospital of Navarra 1996-2003)]. / Estudio de la resistencia de Mycobacterium tuberculosis a los principales tuberculostáticos (Hospital de Navarra 1996-2003).

INTRODUCTION: The aim of this study was to evaluate the sensitivity to the principal tuberculostatics of the M. tuberculosis stocks isolated in our laboratory and to study the factors related to resistance. METHODS: Study of 475 stocks of M. tuberculosis corresponding to all cases diagnosed in the eight year period between 1996 and 2003. We employed the BACTEC 460TB system, together with Lowenstein solid medium, in the cultivation of the samples. The sensitivity studies were carried out using the BACTEC 460TB system. RESULTS AND CONCLUSIONS: Both the incidence and the number of cases of resistant tuberculosis showed oscillations over the eight years of the study. The fact that there is no homogeneous tendency makes it necessary to maintain active surveillance of this process. Global resistance to isoniacide was 8%, making it is convenient to carry out sensitivity studies in all the diagnosed cases. The cases of multiresistant tuberculosis (resistant to at least isoniacide and rifampicin), did not exceed 3%. The prognosis of the patients with resistant tuberculosis was bleak in cases of coinfection with HIV; however, when the immunological defences were conserved, and guidelines for treatment with active drugs were provided, the recovery of the majority of the patients was achieved. At present, sensitive and rapid procedures are available to us, making it recommendable to study the sensitivity of all the stocks of M. tuberculosis that are isolated; this is essential in the case of HIV positive or immigrant patients.

Estudio de la resistencia de Mycobacterium tuberculosis a los principales tuberculostáticos (Hospital de Navarra 1996-2003) / Study of the resistance of Mycobacterium tuberculosis to the principal tuberculostatics (Hospital of Navarra 1996-2003)

Introducción. El objeto de este trabajo ha sidovalorar la sensibilidad a los principales tuberculostáticosde las cepas de M. tuberculosis aisladas en nuestrolaboratorio y estudiar los factores relacionados con laresistencia.Material y métodos. Se han estudiado 475 cepasde M. tuberculosis correspondientes a la totalidad delos casos diagnosticados entre los años 1996-2003ambos inclusive.En el cultivo de las muestras, se utilizó el sistemaBACTEC 460TB, junto con el medio sólido de Lowenstein.Los estudios de sensibilidad se realizaron medianteel sistema BACTEC 460TB.Resultados y conclusiones. Tanto la incidencia,como el número de casos de tuberculosis resistentes,se presentaron con oscilaciones a lo largo de los 8 añosdel estudio. El hecho de que no exista una tendenciahomogénea, obliga a mantener una vigilancia activafrente a este proceso.La resistencia global a isoniacida fue del 8%, por loque es conveniente realizar estudios de sensibilidad entodos los casos diagnosticados.Los casos de tuberculosis multirresistentes (resistentesal menos a isoniacida y rifampicina), no superaronel 3%.El pronóstico de los pacientes con tuberculosisresistente fue sombrío en los casos de coinfección conel VIH, sin embargo, cuando las defensas inmunológicasestaban conservadas, y se pautó un tratamientocon drogas activas, se consiguió la recuperación de lamayoría de los pacientes.En la actualidad, disponemos de procedimientossensibles y rápidos que hacen recomendable el estudiode sensibilidad en todas las cepas de M. tuberculosisaisladas, y en el caso de pacientes VIH+ o inmigrantes,resulta imprescindible

Introduction. The aim of this study was toevaluate the sensitivity to the principaltuberculostatics of the M. tuberculosis stocks isolatedin our laboratory and to study the factors related toresistance.Methods. Study of 475 stocks of M. tuberculosiscorresponding to all cases diagnosed in the eight yearperiod between 1996 and 2003.We employed the BACTEC 460TB system, togetherwith Lowenstein solid medium, in the cultivation of thesamples. The sensitivity studies were carried out usingthe BACTEC 460TB system.Results and conclusions. Both the incidence andthe number of cases of resistant tuberculosis showedoscillations over the eight years of the study. The factthat there is no homogeneous tendency makes itnecessary to maintain active surveillance of thisprocess.Global resistance to isoniacide was 8%, making itis convenient to carry out sensitivity studies in all thediagnosed cases.The cases of multiresistant tuberculosis (resistantto at least isoniacide and rifampicin), did not exceed3%.The prognosis of the patients with resistanttuberculosis was bleak in cases of coinfection with HIV;however, when the immunological defences wereconserved, and guidelines for treatment with activedrugs were provided, the recovery of the majority ofthe patients was achieved.At present, sensitive and rapid procedures areavailable to us, making it recommendable to study thesensitivity of all the stocks of M. tuberculosis that areisolated; this is essential in the case of HIV positive orimmigrant patients

[Evaluation of the MTD-2 test for the direct detection of Mycobacterium tuberculosis in specimens]. / Valoración de la prueba de amplificación MTD-2 para la detección directa de Mycobacterium tuberculosis en la muestra.

BACKGROUND: To evaluate the utility of the Amplified Mycobacterium Tuberculosis Direct Test (MTD-2, Gen-Probe) in the microbiological diagnosis of tuberculosis. METHODS: We evaluated the results obtained in 146 specimens with the MTD-2 test, together with those of the culture and smears. The MTD-2 test was performed on all the smear positives specimens (n=47), on the smear-negative specimens, when the test was demanded (n=19), and in other smear-negative specimens previously selected, according to the clinical history of the patient (n=80). We considered real cases of tuberculosis, those that were culture positive for Mycobacterium tuberculosis and those that were specifically treated. RESULTS: The overall sensitivity, specificity, positive and negative predictive values for the MTD test were: 95, 76, 71, and 96%, for the culture; and 84, 100, 100 and 90% and 75, 94, 89 and 86% for the smears, respectively. In smear positive specimens, the test showed a great specificity, and differentiated M. tuberculosis from other mycobacteria. In the smear negatives, the sensitivity of the test was low and so was the positive predictive value, especially in series performed with a high work load. CONCLUSIONS: Data from our study show that the MTD-2 test is a reliable method for rapid diagnosis of tuberculosis in smear positive specimens. However, due to its low sensitivity and positive predictive value, it is not recommended in the routine diagnosis of tuberculosis. Also, for this reason, whenever a positive result is obtained with a smear negative specimen, the result needs to be confirmed with another specimen.

[Progress in the control of HIV infection and AIDS in Navarre, 1985-2003]. / Progresos en el control de la infección por el VIH y el sida en Navarra, 1985-2003.

The epidemiological situation of HIV infection and AIDS in Navarre in 2003 is reviewed. Up until December 2003, 1,610 HIV infections had been diagnosed in residents of Navarre, of whom 41% had died. The new diagnoses of HIV fell by some 81% between 1993 and 2003, a year in which 28 cases were diagnosed (4.8 per 100,000 inhabitants). The fall basically occurred in infections in injection drug users, since the cases due to sexual transmission had remained stable. Over half of the infections diagnosed in the period 2000-2003 (58%) were attributable to heterosexual transmission, 18% occurred in parenteral drug users and 12% in homosexual men. Thirty-three percent were persons originally from other countries. The incidence of AIDS fell from 75 cases in 1996 to 20 in 2003, and mortality from 65 to 8 cases, respectively. In the 2000-2003 period, the average annual incidence of AIDS was 4.2 per 100,000 inhabitants and the average annual rate of mortality was 1.6 per 100,000 inhabitants. At the end of 2003, there were 902 living persons with a diagnosis of HIV monitored by the health system (1.6 known infections per 1,000 inhabitants). In 2003, 65% of the youths aged between 15 and 29 referred to coital sexual relations, a higher percentage than in previous years, but their level of information on the prevention of AIDS was acceptable. It is necessary to insist on prevention and to adapt this to the new situation.

Progresos en el control de la infección por el VIH y el sida en Navarra, 1985-2003 / Progress in the control of HIV infection and AIDS in Navarre, 1985-2003

Se revisa la situación epidemiológica de la infección por el VIH y el sida en Navarra en 2003.Hasta diciembre de 2003 se habían diagnosticado 1.610 infecciones por el VIH en residentes en Navarra, de los cuales el 41 por ciento habían fallecido. Los nuevos diagnósticos de VIH han disminuido un 81 por ciento entre 1993 y 2003, año en que se diagnosticaron 28 casos (4,8 por 100.000 habitantes). El descenso se produjo fundamentalmente en las infecciones en usuarios de drogas inyectadas, ya que los casos por transmisión sexual se han mantenido estables. Más de la mitad de las infecciones diagnosticadas en el período 2000-2003 (58 por ciento) eran atribuibles a transmisión heterosexual, el 18 por ciento ocurrieron en usuarios de drogas por vía parenteral y el 12 por ciento en hombres homosexuales. El 33 por ciento eran personas originarias de otros países. La incidencia de sida ha disminuido de 75 casos en 1996 a 20 en 2003, y la mortalidad de 65 a 8 casos, respectivamente. En el período 2000-2003 la incidencia media anual de sida fue de 4,2 por 100.000 habitantes y la tasa media anual de mortalidad de 1,6 por 100.000 habitantes. A finales de 2003 había 902 personas vivas con diagnóstico de VIH seguidas en el sistema sanitario (1,6 infecciones conocidas por 1.000 habitantes). En 2003 el 65 por ciento de los jóvenes de 15 a 29 años refería relaciones sexuales coitales, porcentaje mayor que en años anteriores, pero su nivel de información sobre prevención del sida fue aceptable. Es preciso insistir en la prevención y adaptarla a las nuevas situaciones (AU)

[Epidemiological surveillance of HIV/Aids infections in Navarra between 1985 and 2002]. / Vigilancia epidemiológica de las infecciones por el VIH/sida en Navarra entre 1985 y 2002.

In the year 1985, the first cases of Aids were diagnosed in Navarra. Since then and until December 2002, according to the notifications received, 2,329 persons with HIV have been counted, of whom 1,538 were from Navarra and 791 temporary residents in this autonomous community. In recent years, the incidence of new diagnoses of HIV infection and cases of Aids has shown a clear tendency to fall in Navarra. The decrease in cases has been very important amongst the users of intravenous drugs, while the cases amongst homo/bisexuals and cases related to heterosexual transmission have remained fairly stable. In the 1999-2002 period, the cases of infection through a sexual relationship have been more numerous than the cases registered in users of intravenous drugs. The proportion of cases in persons originating from countries with a high endemicity is increasing, coming to represent about 25% of the new cases of infection in the 2000-2002 period. The follow up of the 1,538 HIV patients of Navarra has shown that, at the end of 2002, death had occurred in 39.5% of cases, and it was possible to confirm that 55% were still alive. With regard to their relation to the health services, it has been found that of the 847 patients who are still living, the great majority (80%) are being attended to by the Infectious Services of the Hospital of Navarre and another 9.4% in the Internal Medicine Services of the Garcia Orcoyen and Reina Sofia Hospitals.

Vigilancia epidemiológica de las infecciones por el VIH/sida en Navarra entre 1985 y 2002 / Epidemiological surveillance of HIV/Aids infections in Navarra between 1985 and 2002

En el año 1985 se diagnosticaron en Navarra los primeros casos de sida. Desde entonces y hasta diciembre de 2002 según las notificaciones recibidas se han contabilizado 2.329 personas con infección por VIH, de las que 1.538 eran de Navarra y 791 residentes temporales en esta comunidad autónoma. La incidencia de nuevos diagnósticos de infección por VIH y casos de sida muestran una clara tendencia descendente en Navarra en los últimos años. La disminución de casos ha sido muy importante entre los usuarios de drogas de inyección, mientras que los casos entre los homo/bisexuales y los casos relacionados con la transmisión heterosexual se mantienen bastante estables. En el período 1999-2002, los casos de infección a través de una relación sexual son más numerosos que los casos registrados en usuarios de drogas de inyección. La proporción de casos en personas originarias de países de alta endemia está aumentando, llegando a suponer en torno al 25 por ciento de los nuevos casos de infección en el período 2000-2002.El seguimiento de los 1.538 pacientes VIH de Navarra ha mostrado que a finales del 2002, en el 39,5 por ciento se había registrado el fallecimiento y en el 55 por ciento se pudo constatar que seguían vivos. En cuanto a su relación con los servicios asistenciales, se ha encontrado que de los 847 pacientes que continúan vivos, una gran mayoría (80 por ciento) están siendo atendidos por el Servicio de Infecciosas del Hospital de Navarra y otro 9,4 por ciento en los Servicios de Medicina Interna de los Hospitales García Orcoyen y Reina Sofía (AU)

Vigilancia epidemiológica del VIH/SIDA en Navarra / Epidemiological surveillance of HIV/AIDS in Navarra

Han pasado más de 15 años desde que en 1985 se diagnosticaron en Navarra los primeros casos de SIDA. Desde entonces y hasta diciembre de 2001 según las notificaciones recibidas se han contabilizado 2.400 personas con infección por VIH, de las que aproximadamente 700 han desarrollado SIDA y 565 han fallecido por SIDA u otras causas. La incidencia de nuevas infecciones por VIH, casos de SIDA y muertes relacionadas con éste muestran una clara tendencia descendente en Navarra en los últimos años. La disminución de casos es muy importante entre los usuarios de drogas de inyección, mientras que los casos entre los homo/bisexuales masculinos y entre las personas infectadas tras una relación heterosexual se mantienen bastante estables. Por primera vez, a partir de 1999, las personas infectadas a través de una relación sexual son más numerosas que los usuarios de drogas por vía parenteral. La proporción de casos de SIDA e infección en personas originarias de países de alta endemia está aumentando, llegando a suponer el 23 por ciento de los nuevos casos de infección en los años 2000 y 2001. Los datos de Navarra reflejan igualmente la importante reducción de casos de SIDA y muertes relacionadas con el SIDA desde que en 1996 se introdujeron los tratamientos antirretrovirales más eficaces. Las estrategias para la detección de la infección por VIH en las personas que hayan mantenido prácticas de riesgo es importante si consideramos que en los años 2000 y 2001, en uno de cada 5 pacientes el diagnóstico de infección y enfermedad fue simultáneo lo que implica que estas personas no se beneficiaron de los tratamientos de la misma manera que si el diagnóstico hubiese sido anterior (AU)

[Epidemiological surveillance of HIV/AIDS in Navarra]. / Vigilancia epidemiológica del VIH/SIDA en Navarra.

More than fifteen years have passed since the first cases of AIDS were diagnosed in Navarra in 1985. According to the notifications received from then until December 2001, 2,400 people have been counted with HIV infection, of whom approximately 700 have developed AIDS, and 565 have died of AIDS or other causes. The incidence of new infections by HIV, cases of AIDS and deaths related to the latter, have shown a clear tendency to decline in Navarra in recent years. The decrease in cases is very important amongst the users of intravenous drugs, while the cases amongst masculine homo/bisexuals and amongst persons infected following a heterosexual encounter have remained fairly stable. For the first time, starting in 1999, persons infected through a sexual encounter are higher than the users of parenteral drugs. There has been an increase in the proportion of cases of AIDS and infection in persons originating from countries where the disease is endemic, accounting for over 23% of new cases of infection in the years 2000 and 2001. The figures for Navarra also reflect the important reduction of cases of AIDS and AIDS-related deaths since the introduction of more efficient anti-retroviral treatments in 1996. The strategies for the detection of HIV infection in persons who have maintained risk practices is important if we consider that in the years 2000 and 2001, there was a simultaneous diagnosis of infection and disease in one in every five patients. This implies that these persons did not benefit from treatments in the same way as they would have if the diagnosis had been made earlier.

Late fatal right ventricular perforation as complication of permanent pacing leads.

Perforation of the right ventricle during placement of pacing electrodes is a well-documented complication. Most of these perforations occur intraoperatively and rarely cause symptoms. This case report describes a fatal cardiac perforation that occurred 10 days after implantation of a permanent cardiac pacemaker. This complication should be considered as one of the potential mechanisms responsible for the high rate of sudden death observed in paced patients during the first year after pacemaker implantation.

[Effect of the number of samples studied on the diagnosis of tuberculosis]. / Influencia del número de muestras estudiadas en el diagnóstico de la tuberculosis.

BACKGROUND: For the microbiological diagnosis of tuberculosis, most standard laboratory guidelines recommend the processing of multiple specimens. This fact added to the nonspecific clinical presentation of many cases, contribute to a low efficiency of the tuberculosis laboratory. The introduction of new procedures have increased the sensibility of the diagnosis and so the cost. The object of our work, was to asses the value of examining 3-6 specimens, in optimizing the diagnosis. METHODS: We retrospectively reviewed 327 specimens from 105 patients with culture-proven tuberculosis, between 1997-1998. All specimens were received in the laboratory within 1 month of the initial diagnosis. RESULTS: Of the 7694 specimens received for acid-fast smear and culture in that period of time, 519 (6.7%) were positive for mycobacteria, many of them without clinical relevance. The average number of specimens processed by patient was 3.1, however 22% of the patients with culture-proven tuberculosis had less than tree specimens submitted at the time of diagnosis and 19% had more than three. In 49.5% of the patients, all the smears were negative and the diagnosis was done by culture. With the first specimen submitted were diagnosed 76% of the patients, and with the second we reach 94.2%, finally, we needed 3 specimens for the diagnosis of 104 from the 105 cases (99%). CONCLUSIONS: With the better sensibility achieved in the detection procedures, the interest in the improvement of the efficiency in the tuberculosis laboratory should consider the contribution of the specimen number on the diagnosis. If studying only one specimen we could fail 25% of the early diagnosis, we have rarely found more than two specimens being of diagnostic value. As the time for detecting a positive culture has decrease with the use of liquid media and probes for identification, we would recommend to submit only two specimens for the routine diagnosis and see the patient again 1 moth later. If in this time, the laboratory has'nt obtain any positive result and the clinician still suspect a tuberculosis, a second set of specimens can be submitted. With this measures, laboratory that received a great number of specimens, could assume the work of small laboratory without increasing there work and budget, and the diagnosis of tuberculosis will be optimized.