Peripheral Th17 cells expressing ß7 intestinal homing receptor in recent and chronic HIV infections.

The objective of this study was to conduct an analysis of peripheral blood Th17 cells with the ability to home to gut mucosa (CD4+ Th17+ ß7+ ) during recent or chronic human immunodeficiency virus (HIV) infections. The relationship between HIV load and systemic inflammation markers was studied. Twenty-five patients with recent (n = 10) or chronic (n = 15) untreated HIV infections; 30 treated HIV-infected patients with undetectable HIV load at the time of inclusion and 30 healthy controls were included. Bacterial translocation markers (16S rDNA), soluble CD14 (sCD14) and interleukin (IL)-6 monocyte activation parameters, CD4/CD8 ratio and T helper type 17 (Th17) subpopulations [CD4+ Th17+ expressing the IL-23 receptor (IL-23R) or ß7] were analysed at baseline and after 6 and 12 months of anti-retroviral therapy (ART). 16S rDNA was detected in all patients. Significantly increased serum levels of sCD14 and IL-6 and a decreased CD4/CD8 ratio were observed in patients. Similar percentages of CD4+ IL-23R+ and CD4+ Th17+ ß7+ cells were observed in healthy controls and patients at baseline. After 12 months of therapy, patients with a recent HIV infection showed significant increases of CD4+ IL-23R+ and CD4+ Th17+ ß7+ cell percentages and a decrease in IL-6 levels, although 16S rDNA continued to be detectable in all patients. No significant differences were observed in Th17 subpopulations in patients with chronic HIV infection after therapy. Early initiation of ART helps to increase the number of Th17 cells with the ability to home to the intestinal mucosa and to partially restore gut mucosal homeostasis. These results provide a rationale for initiating ART during the acute phase of HIV infection.

Fiebre Q aguda: riesgo de desarrollo de endocarditis / Acute Q fever and the risk of developing endocarditis

Objetivo: Valorar los datos clínicos y serológicos como parámetros indicativos de posible evolución a endocarditis tras un episodio de fiebre Q aguda. Pacientes y métodos: Estudio de cohortes retrospectivo de la evolución a endocarditis tras un episodio de fiebre Q aguda, analizando evolución clínica, serológica y tratamiento antibiótico recibido. Resultados: Se reclutó a 80 pacientes, presentando el 20% niveles de anticuerpos IgG de fase I ≥ 1:1.024 en los primeros 3 meses. Solo el 44% recibió antibioterapia en la fase aguda; únicamente 2 enfermos recibieron antibioterapia prolongada. Se realizó ecocardiograma al 15%. Ningún paciente presentó síntomas indicativos de infección crónica ni evolucionó a endocarditis tras una mediana de seguimiento de 100 meses, independientemente de la elevación precoz de anticuerpos IgG de fase I. Conclusiones: La elevación precoz de anticuerpos IgG fase I no se asoció a evolución a endocarditis a pesar de no haberse realizado tratamiento antibiótico prolongado en pacientes asintomáticos (AU)

Objectives: Assess clinical and serological data as parameters indicative of a possible evolution to endocarditis after an episode of acute Q fever. Patients and methods: Retrospective cohort study of evolution to endocarditis after an acute Q fever episode, analyzing the clinical and serological evolution and the antibiotic treatment administered. Results: Eighty patients were recruited, 20% of whom had phase I IgG antibody levels ≥ 1:1024 in the first 3 months. Only 44% of the patients underwent antibiotherapy in the acute phase; only 2 patients underwent extended antibiotherapy. Fifteen percent of the patients underwent an echocardiogram. None of the patients had symptoms suggestive of chronic infection or progressed to endocarditis after a median follow-up of 100 months, regardless of the early increase in phase I IgG antibodies. Conclusions: The early increase in phase I IgG antibodies in asymptomatic patients is not associated with progression to endocarditis despite not undergoing prolonged antibiotic treatment (AU)

Acute Q fever and the risk of developing endocarditis. / Fiebre Q aguda: riesgo de desarrollo de endocarditis.

OBJECTIVES: Assess clinical and serological data as parameters indicative of a possible evolution to endocarditis after an episode of acute Q fever. PATIENTS AND METHODS: Retrospective cohort study of evolution to endocarditis after an acute Q fever episode, analyzing the clinical and serological evolution and the antibiotic treatment administered. RESULTS: Eighty patients were recruited, 20% of whom had phase i IgG antibody levels ≥ 1:1024 in the first 3 months. Only 44% of the patients underwent antibiotherapy in the acute phase; only 2 patients underwent extended antibiotherapy. Fifteen percent of the patients underwent an echocardiogram. None of the patients had symptoms suggestive of chronic infection or progressed to endocarditis after a median follow-up of 100 months, regardless of the early increase in phase i IgG antibodies. CONCLUSIONS: The early increase in phase i IgG antibodies in asymptomatic patients is not associated with progression to endocarditis despite not undergoing prolonged antibiotic treatment.

[Viral infections]. / Infecciones víricas.

Viruses cause disease after they break through the natural protective barriers of the body, evade immune control, and either kill cells of an important tissue or trigger a destructive immune and inflammatory response. The outcome of a viral infection is determined by the nature of the virushost interaction and the host's response to the infection. Viral infections can be lytic or persistent (latency, recurrence and / or transformation of the the cell). Immune response is the best treatment, but it often contributes to the pathogenesis of a viral infection. The laboratory methods accomplish the following results: description of virus-induced cytopathologic effects (CPEs) on cells, electron microscopic detection of viral particles, isolation and growth of the virus, detection of viral components (proteins and nucleic acids) and evaluation of the patient's immune response to the virus.

Hepatocyte growth factor and chronic hepatitis C.

OBJECTIVE: The hepatocyte growth factor (HGF) is a pleiotropic cytokine produced by hepatic stellate cells and implicated in liver regeneration and fibrosis. Serum levels of HGF vary in liver diseases, reflecting hepatic damage and hepatocellular dysfunction. In this study, serum levels of HGF and the relationship between HGF and biochemical, histological and virological data, have been analysed in patients suffering from chronic hepatitis C (CHC). PATIENTS AND METHODS: Serum HGF concentration was measured by ELISA in sandwich in 45 patients with CHC. Correlation between HGF levels and histological (necroinflammatory activity and fibrosis score) and biochemical (transaminases, prothrombin activity, albumin, bilirubin), or virological (hepatitis C virus load) parameters was analyzed. Serum HGF concentration was also studied in a subgroup of the original sample treated with interferon and ribavirin. RESULTS: Sserum HGF concentrations of patients with CHC were significantly higher than those detected in healthy controls. Patients with significant fibrosis (F > or = 2) had a significantly older age, lower count of platelets and higher values of AST, GGT and HGF, than those patients with a fibrosis score F < 2. HGF concentration was identified by multivariate analysis as the only independent factor associated with significant fibrosis. Moreover, area under receiver operating curve, using HCG levels, showed similar values to those of previously validated non-invasive indexes of fibrosis. However, levels of HGF did not show a significant decrease in patients with a sustained response to anti-virus C therapy. CONCLUSION: Serum HGF concentration correlates with fibrosis score in patients with CHC, but is insensitive to monitor changes induced by anti-virus C therapy.

Factor de crecimiento hepatocitario y hepatitis crónica C / No disponible

Objetivo: el factor de crecimiento hepatocitario (HGF) es una citocinapleiotrópica producida por las células estrelladas hepáticas,que está implicada en la regeneración y la fibrosis hepática. La concentraciónsérica del HGF en las enfermedades hepáticas es variable,reflejando daño hepático y disfunción hepatocelular. En este estudiose ha analizado la concentración sérica del HGF en pacientes conhepatitis crónica por virus de la hepatitis C (VHC) y su relación conlos datos bioquímicos, histológicos y virológicos.Pacientes y métodos: se determinó la concentración séricade HGF mediante ELISA en sándwich y se analizó la correlaciónentre los niveles del HGF y los datos histológicos (actividad necroinflamatoria,estadio de fibrosis), bioquímicos (transaminasas,actividad de protrombina, albúmina, bilirrubina) y virológicos (cargaviral VHC) en 45 pacientes con hepatitis crónica C (HCC).También fueron evaluadas las cifras del HGF en el suero de unsubgrupo de pacientes de la muestra original sometidos a tratamientoantiviral con interferón y ribavirina.Resultados: la concentración sérica del HGF en pacientescon HCC fue significativamente mayor que la medida en controlessanos. Los pacientes con fibrosis hepática significativa (F ≥ 2) teníanuna edad significativamente mayor, unas cifras plaquetariassignificativamente inferiores y concentraciones séricas significativamentesuperiores de AST, GGT y HGF, en comparación conaquellos pacientes con un índice de fibrosis F < 2. En el análisismultivariante la concentración de HGF fue la única variable independienteasociada a la fibrosis significativa. El área bajo la curvaROC (receiver operating curve), usando las concentraciones séricasde HGF, mostró valores similares a los obtenidos con otros índices,previamente validados, que estiman fibrosis significativa enpacientes con HCC...(AU)

Objective: the hepatocyte growth factor (HGF) is a pleiotropiccytokine produced by hepatic stellate cells and implicated in liverregeneration and fibrosis. Serum levels of HGF vary in liver diseases,reflecting hepatic damage and hepatocellular dysfunction.In this study, serum levels of HGF and the relationship betweenHGF and biochemical, histological and virological data, have beenanalysed in patients suffering from chronic hepatitis C (CHC).Patients and methods: serum HGF concentration was measuredby ELISA in sandwich in 45 patients with CHC. Correlationbetween HGF levels and histological (necroinflammatory activityand fibrosis score) and biochemical (transaminases, prothrombinactivity, albumin, bilirubin), or virological (hepatitis C virus load)parameters was analyzed. Serum HGF concentration was alsostudied in a subgroup of the original sample treated with interferonand ribavirin.Results: sserum HGF concentrations of patients with CHCwere significantly higher than those detected in healthy controls. Patientswith significant fibrosis (F ≥ 2) had a significantly older age,lower count of platelets and higher values of AST, GGT and HGF,than those patients with a fibrosis score F < 2. HGF concentrationwas identified by multivariate analysis as the only independent factorassociated with significant fibrosis. Moreover, area under receiveroperating curve, using HCG levels, showed similar values to thoseof previously validated non-invasive indexes of fibrosis. However,levels of HGF did not show a significant decrease in patients with asustained response to anti-virus C therapy.Conclusion: serum HGF concentration correlates with fibrosisscore in patients with CHC, but is insensitive to monitorchanges induced by anti-virus C therapy(AU)

Absence of favourable changes in circulating levels of interleukin-16 or beta-chemokine concentration following structured intermittent interruption treatment of chronic human immunodeficiency virus infection.

Changes in virological and immunological parameters were analysed following structured intermittent interruption of highly active anti-retroviral therapy (HAART) of patients with chronic human immunodeficiency virus (HIV) infection. Parameters analysed were serum levels of the CD8+ T-cell-derived inhibitory molecules interleukin-16 (IL-16), monocyte inhibitory protein-1beta (MIP-1beta) and RANTES ('regulated upon activation, normal T-cell expressed and presumably secreted'), and the enhancer of HIV replication, monocyte chemotactic protein-1 (MCP-1). Twenty-five patients with chronic HIV infection were evaluated during three cycles of intermittent interruptions of therapy (8 weeks on/4 weeks off) in comparison with 20 healthy sex- and age-matched controls. At enrolment, HIV-infected patients showed significantly higher serum concentrations of IL-16 and RANTES, and significantly lower concentrations of MCP-1, than did healthy controls. Levels of MIP-1beta were similar in both groups. Only the serum levels of IL-16 increased significantly in HIV-infected patients after every treatment interruption. However, differences between the CD4+ or CD8+ T-cell counts/microL, HIV loads and serum concentrations of each cytokine at baseline and at the end of the three cycles of intermittent interruptions of therapy were not significant. It was concluded that structured intermittent interruption of HAART for patients with chronic HIV infection did not modify the immunological parameters, including serum levels of CD8+ T-cell-derived inhibitory molecules, or the virus parameters studied. Thus, the findings do not support the use of this treatment modality for the management of HIV-infected patients.

[Serial assessment of the nutritional status of patients infected by the human immunodeficiency virus. Role of tumor necrosis factor/its receptors]. / Valoración seriada del estado nutricional de enfermos infectados por el virus de la inmunodeficiencia humana. Papel del sistema factor de necrosis tumoral/receptores del mismo.

In order to analyze the nutritional status of HIV infected patients and the involvement of the tumour necrosis factor-alpha (TNF-alpha) and its soluble receptors (sTNFRI and sTNFRII) in such an status, forty HIV infected patients, with no associated systemic opportunist infections, were prospectively followed for eight months. From each patient the following were obtained: clinical history, dietetic survey, anthropometric measurements, CD4+ T lymphocyte/mm3 count, HIV load, and serum concentration of TNF and sTNFRI and sTNFRII. Patients showed a nutritional disorder which involved mainly the fat compartment (mean tricipital skin fold 9.8 +/- 4.2 mm, that is, 65.7 +/- 27.4% of the ideal fold), associated with a hypocaloric intake (mean daily intake 1,659.5 +/- 543.0 kcal), with normal proportions of the different organic principles. Serum concentrations of TNF (87.9 +/- 79.2 vs 8.7 +/- 6.1 pg/ml, p = 0.048) and its receptors, sTNFRI (6.1 +/- 2.6 vs 1.0 +/- 0.8 pg/ml, p < 0.001) and sTNFRII (41.9 +/- 18.6 vs 6.3 +/- 3.6 pg/ml, p < 0.001) were significantly higher than those detected in a sample of ten healthy controls. No correlation was found between nutritional alterations and concentrations of TNF or its receptors, viral load, and counts of CD4+ T lymphocytes/mm3. Seventeen patients completed the follow-up period. During this period, no significant modifications in the analyzed parameters were observed: tricipital skin fold, arm circumference, serum concentrations of albumin or transferrin, concentrations of tumoral necrosis factor or its receptor and caloric intake. The conclusion is that, despite the detected nutritional alterations in the nutritional status and those in the TNF/receptor system, our data no support and interrelationship between them.

Spectrum of parvovirus B19 infection: analysis of an outbreak of 43 cases in Cadiz, Spain.

In the spring of 1993, an epidemic of infection with human parvovirus B19 occurred in Cadiz, Spain. Evaluation of the 43 patients in whom this diagnosis was confirmed revealed four groups of predominant manifestations: (1) hematologic manifestations in six cases (13.9%), including four of aplastic crisis and two of pancytopenia; (2) dermatologic manifestations in 23 cases (53.4%), including 10 of erythema infectiosum and one of erythema multiforme ampullosum; (3) arthralgias/arthritis in nine cases (20.9%), including two with a chronic course; and (4) infection during pregnancy in three cases (7.0%), including two that ended in abortion. Of the 43 patients, 37.2% presented with fever and adenopathies, and these were the only manifestations in two cases. The appearance of clinical disease correlated with modifications in isotype and serum level of specific antibodies to parvovirus B19; the disappearance of IgM antibodies coincided with the resolution of clinical manifestations. Although their presence did not correlate with the course of the disease, the detection of circulating immune complexes in 81.6% of cases supports the possibility that some manifestations were immune mediated.

[Nocardiosis in a patient with AIDS]. / Nocardiosis en paciente con SIDA.

A young drug addict with positive anti-HIV antibodies, OKT4/OKT8 ratio below 1, oropharingeal candidiasis and pulmonary Pneumocystis carinii infection, dies due to a cerebral abscess with a septic status. The postmortem microbiologic study shows pulmonary abscesses and Nocardia asteroides is isolated from lung tissue and spinal fluid. We note out the rareness of this pathology and its relation to AIDS.

[Fungal peritonitis during continuous ambulatory peritoneal dialysis (CAPD)]. / Peritonitis fúngica en diálisis peritoneal continua ambulatoria (DPCA).

We report three cases of fungal peritonitis in patients undergoing CAPD, representing 1.3% of 228 episodes recorded during an 8 year period. The three patients, who had been catheterized for a long time, had previous episodes of bacterial peritonitis and had received antibiotic therapy. The culture was decisive to make the diagnosis. The change of the catheter and the treatment with antifungal agents contributed to cure the infection, although the three patients died from other causes. One case of peritonitis was caused by Candida lusitaniae.

[Antibiotic resistance of Shigella strains isolated in Cádiz (author's transl)]. / Resistencia a los antibióticos en cepas de Shigella aisladas en Cádiz.

The incidence of shigellosis at the Residencia Sanitaria Fernando Zamacola (Cáciz, Spain) and the antibiotic sensitivity of 94 strains of Shigella sonnei and 40 strains of Shigella flexneri, isolated during the year 1979, has been studied taking into account the present status of strain resistance to the major antibiotics. Three epidemic bouts of shigellosis were detected: one in february by Shigella sonnei (16 cases), and two others in august-september and november due to Shigella flexneri (43 and 29 cases). Children 2 to 5 years old had the highest incidence of Shigella infection. Almost all strains isolated were resistant to the sulphonamides (99.77%). Ampicillin and chloramphenicol had little efficacy against Shigella flexneri (95.00 and 92.50% resistance). The percent resistance of Shigella sonnei strains to phosphomycin was elevated (44.69%). All strains studied were sensitive to colimycin and showed little resistance to the combination trimethoprim-sulfamethoxazol (16.42%).