Evaluation of IgG antibody response against Rickettsia conorii and Rickettsia slovaca in patients with DEBONEL/TIBOLA.

The aim of the study was to determine the IgG antibody response to spotted fever group Rickettsia (SFGR) R. conorii and R. slovaca, and its specificity and sensitivity in patients with DEBONEL/TIBOLA. A prospective study of 31 patients with DEBONEL was carried out from January 2001 to May 2004. The SFGR serology testing (IgG IFA) for the diagnosis of DEBONEL/TIBOLA showed 61% sensitivity and 100% specificity. The R. slovaca antigen allowed the diagnoses in 18 of the 31 patients (58%), and 17 patients (55%) were diagnosed with this disease using R. conorii antigen. Therefore, using R. slovaca as antigen did not improve the sensitivity of the assay.

[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)

Dermacentor-borne necrosis erythema and lymphadenopathy: clinical and epidemiological features of a new tick-borne disease.

This paper describes the epidemiological and clinical features of a tick-borne disease differing somewhat from other tick-borne diseases found previously in Spain. All patients were bitten by Dermacentor marginatus or a large tick. The clinical features include a crustaceous or necrotic lesion at the site of the tick's attachment, surrounded by an erythema (erythema migrans-like) and painful regional lymphadenopathies. The probable aetiological agent is Rickettsia slovaca. Similar cases have been reported in other European countries.

Presence of granulocytic ehrlichia in ticks and serological evidence of human infection in La Rioja, Spain.

In order to estimate the risks of human granulocytic ehrlichiosis (HGE) in an endemic area for Lyme disease in the North of Spain (La Rioja), we collected and investigated by PCR specific to the E. phagocytophila group DNA, a total of 6870 Ixodes ricinus ticks. We also used an indirect immunofluorescence (IFI) test to study the presence of antibodies to the HGE agent in 147 human serum samples including patients with Lyme disease (LD), forestry workers, and persons with history of previous tick bite. Fifty serum samples from healthy people resident in urban areas and with no history of tick-bite disorder and without tick exposure were used as controls. Four of 76 adults and 49 of 203 nymphs pools carried E. phagocytophila DNA. This result, and the finding of 1.4% of sera reacting in the IFI test confirms that this tick-borne agent is present in La Rioja, and that humans show evidence of contact with it. HGE should be considered in the differential diagnosis of flu-like syndromes in the study area in the north of Spain.

[Determination of antibodies against A-60 antigen for diagnosis of M. tuberculosis infection. A useful tool for rationalization of chemoprophylaxis in HIV patients]. / Determinación de anticuerpos frente al antígeno A-60 para el diagnóstico de la infección por M. tuberculosis. Una herramienta útil para la racionalización de la quimioprofilaxis en pacientes VIH.

OBJECTIVE: To identify M. tuberculosis infection in HIV patients by use of PPD and an ELISA test detecting the presence of antibodies against antigen A-60 of M. bovis. METHODS: 116 incoming HIV patients were classified according to the CDC. The status of M. tuberculosis infection was probed with PPD (RT-23) and the state of anergy was estimated by a Multitest CM1 (Multitext). The presence of circulating antibodies of the IgG class against antigen A-60 was analysed by an ELISA. The clinical course of the patients was followed for 24 month. RESULTS: A positive serology (A-60) was found in 52.58% of the patients, coinciding with 70.45% of the positive PPD (p < 0.003). This statical observation was found when we studied all of the individuals, and those with more than 500 CD4 lymphocytes. The Multitext was positive in 11.11% of the patients with PPD (-), all of them without antibodies against A-60. However, 42.2% of the patients who were PPD and Multitext (-), had circulating antibodies against A-60. The following up of the patients during 24 months allowed the detection of 7 news cases of pulmonary tuberculosis, 4 of them had a positive A-60 serology, and 4 were anergy. CONCLUSIONS: HIV patients with M. tuberculosis infection have circulating antibodies against A-60 antigen of M. bovis with independence of their immunity status. In anergic patients the presence of this antibodies can be an useful tool for rationalizing the prophylaxis against M. tuberculosis. A seropositivity (A-60) indicates as well as does PPD a previous contact with M. tuberculosis.

Determinación de anticuerpos frente al antígeno A-60 para el diagnóstico de la infección por M. tuberculosis. Una herramienta útil para la racionalización de la quimioprofilaxis en pacientes VIH / Determination of antibodies against A-60 antigen for diagnosis of M. tuberculosis infection. An useful tool for rationalizing of chemoprophylaxis in HIV patients

Objetivo: Identificar la infección por M. tuberculosis en pacientes VIH mediante la determinación del PPD y de un test de ELISA para la detección de anticuerpos frente al antigeno A-60 de M. bovis.Métodos: Se han estudiado 116 pacientes VIH, clasificados de acuerdo a los CDC. El estado de infección por M. tuberculosis se diagnosticó mediante el PPD (RT-23) y el estado de anergia fue estimado mediante Multitest CMI (Multitext®). La presencia de anticuerpos circulantes del tipo IgG contra el antigeno A-60 fueron analizados por un método de ELISA. El curso clínico de los pacientes fue analizados durante 24 meses.Resultados: Se observó una serología positiva (A-60) en el 52,58 por ciento de los pacientes, coincidiendo con el 70,45 por ciento de los pacientes PPD (+) (p500 linfocitos CD4. El Multitext® fue positivo en el 11,11 por ciento de los pacientes PPD (-), todos ellos sin anticuerpos frente al antígeno A-60. Sin embargo, el 42,2 por ciento de los pacientes PPD y Multitext® (-) presentaban anticuerpos frente al antígeno A-60. El seguimiento de los pacientes durante 24 meses permitió la detección de 7 nuevos casos de tuberculosis pulmonar, 4 de ellos presentaban una serología positiva para el antígeno A-60, y 4 fueron anérgicos.Conclusiones: Los pacientes VIH con infección por M. tuberculosis presentan anticuerpos circulantes frente al antígeno A-60 de M. bovis con independencia de su estado de inmunidad. En los pacientes anérgicos, la presencia de estos anticuerpos puede ser una herramienta útil para racionalizar la profilaxis frente a M. tuberculosis . La seropositividad (A-60) indica, al igual que el PPD un contacto previo con M. tuberculosis. (AU)

[Migratory erythema (Lyme borreliosis). Clinicoepidemiologic features of 50 patients]. / Eritema migratorio (borreliosis de Lyme). Características clinicoepidemiológicas de 50 pacientes.

BACKGROUND AND OBJECTIVE: Erythema migrans (EM) is the earliest and most common manifestation of the infection caused by B. burgdorferi (Lyme borreliosis). The objective of the present work was to report the clinicoepidemiological features in a series of patients. PATIENTS AND METHODS: Retrospective collection of clinicoepidemiological features of the first fifty patients diagnosed of EM at La Rioja Hospital (March 1989-September 1998). RESULTS: In our series, no differences were observed regarding sex or living in a rural or urban area. Mean age was 41 years (range 9 to 78). In 70% of patients the antecedent of a tick bite was obtained and the incubation period was 6.48 days (1 to 15 days). The mean size of the lesions was 14.3 cm (5 to 40) and in 16% of patients satellite cutaneous lesions were observed. The areas where EM appeared were lower limbs and the perineal region (60%), chest (24%), head and neck (10%) and upper limbs (6%). Forty-eight percent of patients reported extra-cutaneous manifestations. All cases occurred during the spring, summer and autumn months, with a peak in June. The most common referred antecedent was walking in forest areas. All patients responded to antibiotic therapy. CONCLUSIONS: EM is common in the studied environment and presents with a marked polymorphism.

Eritema migratorio (borreliosis de Lyme). Características clinicoepidemiológicas de 50 pacientes / Erythema migrans (Lyme borreliosis). Clinicoepidemiological characteristics in 50 patients

Fundamento. El eritema migratorio (EM) es la manifestación precoz y más típica de la infección por B. burgdorferi (borreliosis de Lyme). El objetivo del presente estudio ha sido la descripción de la características clínicoepidemiológicas de una serie de pacientes.Pacientes y método. Recogida retrospectiva de las características clinicoepidemiológicas de los primeros 50 pacientes diagnosticados de EM en el hospital de La Rioja (marzo 1989septiembre 1998).Resultados. En nuestra serie no observamos diferencias por el sexo ni por habitar en un medio rural o urbano. La edad media fue de 41 años (9 a 78). En el 70 por ciento se recogió el antecedente de picadura de garrapata y el período de incubación fue de 6,48 días (1 a 15 días). El tamaño medio de la lesión fue de 14,3 cm (5 a 40) y en el 16 por ciento se observaron lesiones cutáneas satélites. Las zonas de aparición del EM fueron extremidades inferiores y periné 60 por ciento; tórax 24 por ciento; cabeza y cuello 10 por ciento, y extremidades superiores 6 por ciento. Un 48 por ciento refirieron manifestaciones extracutáneas. Todos los casos se produjeron en los meses de primavera, verano y otoño con un pico en el mes de junio, siendo la práctica de riesgo mayormente referida el paseo por zonas boscosas. Todos los pacientes respondieron al tratamiento antibiótico.Conclusiones. El EM es frecuente en el medio estudiado y se presenta con un gran polimorfismo (AU)

[Seroepidemiology of Bartonella henselae infection in a risk group]. / Seroepidemiología de la infección por Bartonella henselae en un colectivo de riesgo.

BACKGROUND: Bartonella henselae infections are closely related to a number of clinical conditions of growing interest in our environment. As cats are the reservoir, and their bites and scratches are the main transmission mechanism, we attempted to study the seroepidemiology of the infection caused by this microorganism in a risk group of patients (cat owners) and a control group (blood donors). PATIENTS AND METHODS: October 1977. Measurement of antibody titres to B. henselae at different dilutions (breakpoint > or = 1:64) by indirect immunofluorescence (IFI) in 83 cat owners and 85 blood donors. Also, an epidemiologic investigation was carried out (age, sex, alcohol, intake, common cat exposure, cat bite or cat scratch, number and age of cats, bite or presence of fleas, use of repellents, clinical picture consistent with cat scratch disease [CSD]). RESULTS: Twenty-four cat owners (28.9%) and five blood donors (5.9%) had titres > or = 1:64 (OR: 6.51; 95% CI: 2.32 to 22.9). Also, the logistic regression analysis showed an association with daily alcohol intake and the previous antecedent of lymph node enlargement of unknown origin among cat owners. CONCLUSIONS: A high prevalence of antibodies to B. henselae was demonstrate among cat owners.

Mediterranean spotted fever: a preliminary tick field study.

We studied the prevalence of rickettsialike organisms infection in different tick species (3154 adults) collected in several areas of the Ebro valley (Spain). The Gimenez stain showed a prevalence of rickettsia-like organisms in 38.6% of the studied ticks. Using the immunofluorescence assay, only two species, Rhipicephalus sanguineus (16.4%) and R. pusillus (19.9%) have shown organisms compatible with spotted fever group rickettsiae.

[Evaluation of methods of tick removal in human ixodidiasis]. / Evaluación de los métodos de retirada de garrapatas en la ixodidiasis humana.

BACKGROUND: There are two questions regarding tick transmitted diseases (Ixodidae) not sufficiently elucidated: How to remove the arthropod? and: should antibiotic prophylaxis be administered after the bite? SUBJECTS AND METHODS: From June 1st, 1991, to December, 31, 1992, all patients who were attended at La Rioja Hospital relating immediate bite or tick bite within the 48 hours before were prospectively studied. In all those patients an epidemiological inquiry was obtained, which included, apart from personal data and risk factors for tick bites, how arthropods had been removed, health exam and blood drawn for serological study for Borrelia burgdorferi and Rickettsia conorii. The protocol was repeated at one, two, four and six months after the bite. The removal method used at the Hospital was by pulling with fine tweezers and later disinfection with iodine povidone. RESULTS: Out of a total of 52 individuals who complied with the established criteria, only 41 ended the follow-up. A 63.4 percent of patients experienced some type of complication, including 3 cases of LB (erythema migrans). With regard to the type of removal method and the development of complications, only three patients who had ticks pulled with tweezers experienced complications compared with 23 patients who used other methods (p = 0.0058). With regard to specific complications (LB and/or spotted fever) and/or development of B. burgdorferi or R. conorii infection significant differences were also observed when tweezers were used for removal of ticks compared with other tick removal methods (p < 0.05). CONCLUSION: The removal of ticks with tweezers significantly protects from the development of complications and infection by tick-borne microorganisms. Antibiotic prophylaxis is recommended when the removal of the arthropod is carried out by using a method other than the recommended one.

[Seroprevalence of hepatitis B virus markers in pregnant women attending a public hospital in Navarra]. / Seroprevalencia de marcadores del virus de la hepatitis B en embarazadas asistidas en un hospital público de Navarra.

OBJECTIVE: To design efficient massive immunization programs for newborns it is essential to know the prevalence of HBV infection in pregnant women. As a contribution to this knowledge the prevalence of HBV markers was studied in pregnant women attended at a public hospital in Navarra. An assessment was also made of the relationship between prevalence of HBV markers and other epidemiological factors. METHODS: The gestational history was reviewed of 2,499 pregnant women aged 14-45 years attended at the hospital during 1991. The following factors were investigated: age, profession, job, and educational level of the woman and her partner, residence, Health Area, risk factors and serological markers (HbsAG, anti-HBs, anti-HBc, and, when appropriate, HBeAg/anti-Hbe. RESULTS: The screening rate of HBsAg in the group of pregnant women was 70%; the prevalence of positive HbsAg was 0.70%. The respective prevalence rates of anti-HBs, anti-HBc, and AMP were 6%, 7.5% and 8.6%. The type of residence, social class and risk exposure had influence on the prevalence of positive markers. CONCLUSIONS: The 70% of screening rate in the group of pregnant women is still far from reaching the goal of 95% intended in the Plan de Salud Infantil in Navarra for 1993. A prevalence of 0.70 for positive HBsAg was observed. No geographical differences were observed in the distribution of HBV markers, but its prevalence was influenced by the type of residence, social class and risk exposure. A discussion follows whether a massive immunization program form newborns in Navarra is warranted.

[Infection by Borrelia burgdorferi in patients with the human immunodeficiency virus. A diagnostic problem]. / Infección por Borrelia burgdorferi en pacientes infectados por el virus de la inmunodeficiencia humana. Un problema diagnóstico.

BACKGROUND: Given that Lyme's disease and HIV infection may present with similar clinical symptoms and that the serologic tests for the determination of antibodies against Borrelia burgdorferi present frequent false positives, the presence of antibodies against B. burgdorferi in patients with HIV in different evolutive stages was studied. METHODS: Antibodies against B. burgdorferi were determined by IFI and ELISA in a serum sample of 72 individuals with HIV. Western blot (WB) against B. burgdorferi was performed in the sera which were positive by one method or the other. The presence of antiphospholipid antibodies was also studied. RESULTS: A total of 24 sera (33%) were positive by IFI and/or ELISA. Twenty-one (29%) by IFI and 7 (10%) by ELISA (chi 2; p = 0.006). Four (5.5%) were positive by both methods. Only one of the sera was positive by IFI, ELISA and WB. No statistical relation was found upon comparison of the positive results against B. burgdorferi with the different evolutive stages of HIV infection or with the presence of antiphospholipid antibodies. CONCLUSIONS: The high prevalence of false positive serology to B. burgdorferi in the collective of patients with the human immunodeficiency virus infection together with the possibility of presenting similar clinical manifestations has led to extreme prudence in the diagnosis of infection by B. burgdorferi in patients with HIV infection.

[Erythema chronicum migrans (Lyme's disease). Clinico-epidemiologic study of 10 cases]. / Eritema crónico migratorio (enfermedad de Lyme). Estudio clínico epidemiológico de diez casos.

Migratory Chronic Erythema (MCE), which is the distinctive and diagnostic lesion of Lyme's disease, could manifest itself under different clinical manifestations. Following a clinical and a epidemiological point of view 10 cases of MCE, diagnosed during the last three years, have been studied and described. Its wide variability of the clinical manifestations is underlined, with a mean incubation period of 5.6 days between the onset of cutaneous symptoms and the tick bite. The zones mainly affected were lower limbs followed by trunk and neck. Size of lesion varied from 5 to 30 cm, with a mean of 13 cm. In two patients satellite cutaneous lesions were observed and six showed extra-cutaneous signs. Only in four patients antibodies against Borrelia burgdorferi were detected. Regarding epidemiology we did not found differences between the sexes, or by living on an urban or rural area. The tick bite was referred in half of the cases, 30% of the patients have a job related with wood, forest, farming or cattle. The season in which MCE was most frequent was spring-beginning of summer and end of summer-beginning of autumn. All patients responded to the therapy with tetracyclines and/or macrolides.

Epidemiology and prevalence of seropositivity against Borrelia burgdorferi antigen in La Rioja, Spain.

The aim of this study was to acquire a better knowledge of the epidemiology of Lyme disease. A seroepidemiologic study was made by evaluating the different levels of antibodies to Borrelia burgdorferi in a five hundred serum representative sample of a population from the province of La Rioja, Spain. Samples were randomly selected and stratified to take into account sex, age, rural or urban residence, and geographical area. All subjects included in the study were asked to fill out a questionnaire containing this information along with data concerning leisure activities, occupation, contact with animals, tick-bite and antecedent features related to Lyme disease. No statistical differences were found in relation to sex or age. The seroprevalence was very high (31.3%) in mountain areas, where Ixodes ricinus and deer are present. The risk factors associated with seropositivity were forestry and cattle-raising activities, as well as contact with animals. The best titer of antibodies associated with clinical antecedents of Lyme disease and related disorders was 1/256.

[Usefulness of warning flags in the handling of biological samples in an emergency room]. / Utilidad de los distintivos de precaución en el manejo de muestras biológicas en un servicio de urgencias.

The present study evaluates the utility of biohazard precautions labels for identifying biological samples of patients with probable severe transmissible infectious diseases. The study was performed in a total of 633 patients in the emergency department of a General Hospital. In an anonymous way we determine the presence or absence of serological markers of HIV and hepatitis B infection (HBsAg) and we evaluated the labeling of the sample. Our results demonstrate the very low usefulness of this common procedure: a total of 54.5% of HIV positive patients and 87.5% of those positive to HBsAg were not marked correctly. We discuss the necessity of using universal precautions instead of labeling samples in the current way.