Diagnóstico microbiológico de la infección por virus del papiloma humano / Microbiological diagnosis of human papilloma virus infection

La infección por el virus del papiloma humano (VPH) es la infección de transmisión sexual más frecuente en el mundo. Este virus ocasiona generalmente lesiones benignas, como verrugas genitales, pero también su persistencia ocasiona procesos malignos, como cáncer de cuello de útero (CCU) y, menos frecuentemente, anal, vaginal y de la cavidad orofaríngea. El CCU es una enfermedad muy severa, con alta mortalidad en muchos países. El cribado de CCU con citología ha tenido mucho éxito en estos últimos años, pero hay innumerable evidencia científica para que sea sustituida por la detección del VPH como prueba inicial. Para esto, hay en el mercado gran cantidad de técnicas, siendo aconsejable utilizar sistemas automáticos y pruebas aprobadas por la FDA. Un nuevo algoritmo basado en la detección individualizada de los genotipos 16 y 18 presentes en el 70% de los CCU ha sido propuesto por expertos y su implantación será inmediata en algunos países (AU)

Infection with human papillomavirus (HPV) is the leading cause of sexually transmitted infection worldwide. This virus generally causes benign lesions, such as genital warts, but persistent infection may lead to cervical cancer, anal cancer, vaginal cancer, and oropharyngeal cancer, although less frequently. Cervical cancer is a severe disease with a high mortality in some countries. Screening with cytology has been very successful in the last few years, but nowadays there are numerous studies that confirm that cytology should be replaced with the detection of HPV as a first line test in population based screening. There are several commercially available FDA approved tests for screening of cervical cancer. A new strategy, based on individual detection of the high risk genotypes HPV16 and HPV18, present in 70% of cervical cancer biopsies, has been proposed by some experts, and is going to be implemented in most countries in the future (AU)

Hepatitis E: situación actual en España / Hepatitis E: current state in Spain

La infección por el virus de la hepatitis E (VHE) es una enfermedad muy prevalente en países en vías de desarrollo, llegando a causar aproximadamente 3,5 millones de casos sintomáticos y 70.000 muertes anuales, según datos recientes de la Organización Mundial de la Salud. En países desarrollados, no se conoce aún con exactitud la prevalencia de anticuerpos frente al VHE (anti-IgG-VHE) e incluso en España puede variar desde el 0,6 hasta el 12% en población general según la zona geográfica o la metodología utilizada. La hepatitis E se considera una zoonosis en países desarrollados, pero otras vías de transmisión permanecen desconocidas. Un aspecto interesante de las manifestaciones clínicas es que puede producir desde infecciones asintomáticas hasta fallo hepático fulminante y variadas manifestaciones extrahepáticas. En pacientes trasplantados e inmunodeprimidos en general, el VHE causa hepatitis crónicas en un elevado número de casos. El diagnóstico de laboratorio es fácil de realizar y se basa en estudios serológicos y la detección del ARN-VHE en sangre. El tratamiento con ribavirina da buenos resultados en la mayoría de los casos. En cuanto a la prevención, la vacuna es una buena opción en países endémicos, pero no se ha evaluado en países de baja prevalencia o en pacientes de riesgo como trasplantados hepáticos. En España se han comunicado un número importante y creciente de hepatitis E autóctonas, por lo que es imprescindible conocer las situaciones clínicas en las que se debe sospechar y confirmar su diagnóstico en el laboratorio (AU)

Hepatitis E virus (HEV) infection is highly prevalent in developing countries, accounting for approximately 3.5 million asymptomatic infections and 70,000 deaths annually, according to World Health Organization estimations. In developed countries, the prevalence of HEV-IgG antibodies is not fully known, and in Spain it can range from 0.6% to 12% among the general population in different geographical areas. In developed countries, hepatitis E is considered a zoonotic infection, but other routes of transmission remain unknown. An interesting aspect regarding clinical manifestations is that they can vary from asymptomatic infection to fulminant hepatitis and various extrahepatic manifestations. Moreover, HEV can cause chronic hepatitis in a large number of transplanted and immunosuppressed patients. Diagnosis is based on serological studies and detection of viral RNA in blood. Treatment with ribavirin is successful in most cases. The vaccine is a good option to prevent the infection in developing countries, but has not been evaluated in low prevalence countries or in risk groups such as liver transplant patients. In Spain, a large and growing number of autochthonous cases of hepatitis E have been reported. It is therefore essential to determine the clinical scenarios where a diagnosis of hepatitis E must be confirmed in the laboratory (AU)

Paraparesia espástica tropical autóctona en la Comunidad de Madrid. Experiencia en el cribado del virus linfotrópico de células T humanas tipo I / Indigenous tropical spastic paraparesis in Madrid (Spain). Experience on screening of human T-lymphotropic virus

Recientemente hemos documentado un caso de paraparesia espástica tropical por HTLV-I en un paciente de nacionalidad española. Este retrovirus infrecuente en Europa rara vez produce sintomatología, pero cuando lo hace supone un grave problema sanitario. Aquí presentamos dicho caso y discutimos situaciones clínicas que justifiquen su detección. Se analizaron las peticiones de cribado de HTLV que recibimos durante 2014-2015 (n=123). El algoritmo diagnóstico fue: 1) Enzimoinmunoanálisis, 2) Hibridación reversa y 3) PCR de ADN proviral. Los resultados mostraron diversas situaciones de cribado de HTLV, destacando el estudio de paraparesia (22%). Se detectaron 7 casos de infección por HTLV-I: 5 pacientes de zona endémica, un paciente VIH+ y por último el caso de paraparesia mencionado. La vigilancia de HTLV-I en regiones no endémicas supone un reto sanitario al no estar bien establecido su balance coste-beneficio. Este caso apoya la inclusión de HTLV-I dentro del diagnóstico diferencial de paraparesia espástica de evolución insidiosa (AU)

We have recently documented a case of tropical spastic paraparesis by HTLV-I in a Spanish patient. HTLV-I infection is rare in Europe, and hardly ever is accompanied by symptoms, but if it does it could trigger a major health issue. This case is presented here, as well as a discussion on the situations in which HTLV-I detection is justified. An analysis was made of the HTLV diagnostic requests at our centre during 2014-2015 (n=123). The diagnostic algorithm was: 1) Enzyme immunoassay, 2) Reverse hybridization, and 3) Proviral DNA detection by PCR. The results showed several situations of HTLV screening, emphasising those related to paraparesis (22%). Seven cases of HTLV-I infection were found: five in patients from endemic regions, one in an HIV-infected patient, and the case of TSP mentioned above. HTLV-I surveillance in non-endemic regions is a challenging issue, as the cost-benefit ratio is not well-established. This case report emphasises the importance of including HTLV within the differential diagnosis of insidious spastic paraparesis (AU)

Hepatitis E and pregnancy: current state.

Hepatitis E virus (HEV) is responsible for more than 50% of acute viral hepatitis cases in endemic countries. Approximately 2 billion individuals live in hepatitis E-endemic areas and, therefore, are at risk of infection. According to World Health Organization, HEV causes about 20.1 million infections and 70 000 deaths every year. In developing countries with poor sanitation, this disease is transmitted through contaminated water and is associated with large outbreaks, affecting hundreds or thousands of people. In developed countries, autochthonous cases of HEV have been increasingly recognized in the past several years. Hepatitis E virus typically causes an acute, self-limiting illness similar to other acute viral hepatitis, such as hepatitis A or B, with about 0.2% to 1% mortality rate in the general population. However, the course of hepatitis E in pregnancy is different than the mild self-constraining infection described in other populations. During pregnancy, HEV infection can take a fulminant course, resulting in fulminant hepatic failure, membrane rupture, spontaneous abortions, and stillbirths. Studies from various developing countries have shown a high incidence of HEV infection in pregnancy with a significant proportion of pregnant women progressing to fulminant hepatitis with a fatality rate of up to 30%. The present review will highlight new aspects of the HEV infection and pregnancy.

Indigenous tropical spastic paraparesis in Madrid (Spain). Experience on screening of human T-lymphotropic virus. / Paraparesia espástica tropical autóctona en la Comunidad de Madrid. Experiencia en el cribado del virus linfotrópico de células T humanas tipo I.

We have recently documented a case of tropical spastic paraparesis by HTLV-I in a Spanish patient. HTLV-I infection is rare in Europe, and hardly ever is accompanied by symptoms, but if it does it could trigger a major health issue. This case is presented here, as well as a discussion on the situations in which HTLV-I detection is justified. An analysis was made of the HTLV diagnostic requests at our centre during 2014-2015 (n=123). The diagnostic algorithm was: 1) Enzyme immunoassay, 2) Reverse hybridization, and 3) Proviral DNA detection by PCR. The results showed several situations of HTLV screening, emphasising those related to paraparesis (22%). Seven cases of HTLV-I infection were found: five in patients from endemic regions, one in an HIV-infected patient, and the case of TSP mentioned above. HTLV-I surveillance in non-endemic regions is a challenging issue, as the cost-benefit ratio is not well-established. This case report emphasises the importance of including HTLV within the differential diagnosis of insidious spastic paraparesis.

Microbiological diagnosis of human papilloma virus infection. / Diagnóstico microbiológico de la infección por virus del papiloma humano.

Infection with human papillomavirus (HPV) is the leading cause of sexually transmitted infection worldwide. This virus generally causes benign lesions, such as genital warts, but persistent infection may lead to cervical cancer, anal cancer, vaginal cancer, and oropharyngeal cancer, although less frequently. Cervical cancer is a severe disease with a high mortality in some countries. Screening with cytology has been very successful in the last few years, but nowadays there are numerous studies that confirm that cytology should be replaced with the detection of HPV as a first line test in population based screening. There are several commercially available FDA approved tests for screening of cervical cancer. A new strategy, based on individual detection of the high risk genotypes HPV16 and HPV18, present in 70% of cervical cancer biopsies, has been proposed by some experts, and is going to be implemented in most countries in the future.

Performance of cobas 4800® and HPV genotype-specific distribution in opportunistic cervical cancer screening in Madrid / Evaluación del sistema cobas 4800® y distribución de genotipos del virus del papiloma humano en el cribado oportunista en Madrid

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Current Knowledge on Hepatitis E.

Although only a single serotype of hepatitis E virus (HEV), the causative agent of hepatitis E, has been identified, there is great genetic variation among the different HEV isolates reported. There are at least four major recognized genotypes of HEV: genotypes 1 and 2 are mainly restricted to humans and linked to epidemic outbreaks in nonindustrialized countries, whereas genotypes 3 and 4 are zoonotic in both developing and industrialized countries. Besides human strains, genotype 3 and 4 strains of HEV have been genetically characterized from swine, sika deer, mongooses, sheep, and rabbits. Currently, there are approximately 11,000 human and animal sequences of HEV available at the International Nucleotide Sequence Database Collaboration. HEV is the major cause of waterborne outbreaks of hepatitis in areas of poor sanitation. Additionally, it is responsible for sporadic cases of viral hepatitis in not only endemic but industrialized countries as well. Transmission of HEV occurs predominantly by the fecal-oral route, although parenteral and perinatal routes have been reported. HEV infection develops in most individuals as a self-limiting, acute, icteric hepatitis; with mortality rates around 1%. However, some affected individuals will develop fulminant hepatic failure, a serious condition that is frequently fatal without a liver transplant. This complication is particularly common when the infection occurs in pregnant women, where mortality rates rise dramatically to up to 25%. Among the preventive measures available to avoid HEV infection, two separate subunit vaccines containing recombinant truncated capsid proteins of HEV have been shown to be highly effective in the prevention of disease. One of them, HEV 239, was approved in China, and its commercialization by Innovax began in November 2012 under the name Hecolin(®).

Tratamiento de la hepatitis crónica B antígeno e positiva con antivirales orales: experiencia y resultados en la práctica clínica / HBeAg-positive chronic hepatitis B treatment with oral antiviral agents: Experience and results in clinical practice

INTRODUCCIÓN: La globalización y los movimientos migratorios hacen que la hepatitis crónica B Age+ (HCBe+) cobre cada día mayor relevancia en nuestro entorno. Objetivo Analizar las características epidemiológicas, evolución y respuesta al tratamiento con antivirales orales (AO) de los pacientes con HCBe+.Material y métodosSe analizaron 436 casos de infección crónica por el virus de la hepatitis B atendidos en el Hospital Universitario Ramón y Cajal desde 1990 hasta junio del 2012.ResultadosSesenta y cinco (14,9%) presentaban HCBe+. Siete pacientes en fase de tolerancia inmune no fueron tratados; los 58 restantes, sí. Fueron excluidos 4: 2 hepatitis agudas graves, una coinfección por VHC y otro por virus Delta. De los 54 restantes, 19 recibieron interferón con o sin AO y 35 solo Dos tratados durante menos de un mes no fueron incluidos en el análisis. Este se realizó finalmente en 33 pacientes. Duración media del tratamiento: 46,81 meses (6-138). Lamivudina fue el fármaco más prescrito (39,39%), seguida de tenofovir (24,24%) y entecavir (21,21%). Edad media: 42,08 ± 14 años; varones 75,75% (25/33). El 57,57% (19/33) seroconvirtió el antígeno e y el 27,27% (9/33) eliminó el antígeno de superficie. No se objetivó la reaparición de este último tras un seguimiento medio de 35,6 meses. Resistencias: 8 casos en 7 pacientes, 7 a lamivudina y uno a adefovir. CONCLUSIONES: El 15% de las HCB en nuestro medio son e+. El tratamiento con AO logra una elevada tasa de seroconversión (57,57%) y un considerable porcentaje de pérdida del antígeno de superficie (27,27%)

INTRODUCTION: Due to globalization and migratory movements, HBeAg+ chronic hepatitis B isbecoming increasingly important in Spain. OBJECTIVE: To analyze the epidemiological features, progression, and treatment response to oral antiviral agents (OA) in HBeAg+ chronic hepatitis B patients in our area. MATERIAL AND METHODS: We analyzed 436 patients with chronic hepatitis B infection followed up at the Ramón y Cajal Hospital from 1990 to June 2012. RESULTS: Sixty-five patients (14.9%) had HBeAg+ chronic hepatitis B. Seven patients in the immunotolerant phase were not treated, while the remaining 58 received treatment. Four patients were excluded: two due to severe acute hepatitis, one due to hepatitis C virus coinfection and another because of a Delta virus coinfection. Of the remaining 54 patients, 19 received interferon with or without OA, and 35 received only OA. Two patients treated for less than 1 month were not included in the analysis. The analysis was finally performed in 33 patients. The mean duration of treatment was 46.81 months (6-138). Lamivudine was the most frequently prescribed drug (39.39%) followed by tenofovir (24.24%) and entecavir (21.21%). The mean age was 42.08 ± 14 years and 75.75% (25/33) of the patients were male. Nineteen of 33 patients (57.57%) achieved seroconversion to anti-HBe, and 27.27% (9/33) showed clearance of HBsAg. There was no evidence of HBsAg reversion after a mean follow-up of 35.6 months. There were 8 cases of resistance in 7 patients: 7 to lamivudine and 1 to adefovir. CONCLUSIONS: Approximately 15% of chronic hepatitis B patients in our area are HBeAg+. Treatment with OA achieves a high seroconversion rate (57.57%) and a considerable percentage of HBsAg clearance (27.27%)

Hepatitis E: an emerging disease.

Currently, the infection with the hepatitis E virus represents the most frequent cause for acute hepatitis and jaundice in the world. According to WHO estimations, around two billion people, representing one third of the world's population, live in endemic areas for HEV and, therefore, are at risk of infection. In developed countries, the circulation of the virus in both human and animal (swine, boar, deer) sewage has been confirmed; however, the incidence rate is low compared to that of developing countries where outbreaks of acute hepatitis transmitted via the fecal-oral route are originated, more frequently in the flooding season or after natural disasters, combined with deficient sanitary conditions. There are currently 4 known genotypes of HEV. Genotypes 1 and 2 are isolated in all human epidemic outbreaks in developing countries, while genotypes 3 and 4 are isolated not only in humans but also in animals, in both developing and industrialized countries. These data support genotypes 3 and 4 having zoonotic nature. The diagnosis of this disease is based in the detection of anti-HEV IgG and IgM in blood serum using enzyme-linked immunosorbent methods. However, the method that best confirms the diagnosis is the RT-PCR, which detects HEV RNA in blood serum and also provides the genotype. The clinical course is generally that of an acute hepatitis which in some cases may require hospitalization and that, in transplant patients or HIV infected individuals can become a chronic hepatitis. Furthermore, the virus constitutes an important risk for pregnant women. The hepatitis E can present a wide range of symptoms, from a subclinical case to chronic liver disease with extrahepatic manifestations. For this reason, the diagnostic is challenging if no differential diagnosis is included. There is no specific antiviral drug for hepatitis E, but satisfactory results have been observed in some patients treated with pegylated interferon alfa2a and/or ribavirin. This revision is an update of all the molecular, epidemiological, clinic and preventive knowledge on this emergent disease up to date.

[HBeAg-positive chronic hepatitis B treatment with oral antiviral agents: experience and results in clinical practice]. / Tratamiento de la hepatitis crónica B antígeno e positiva con antivirales orales: experiencia y resultados en la práctica clínica.

INTRODUCTION: Due to globalization and migratory movements, HBeAg+ chronic hepatitis B is becoming increasingly important in Spain. OBJECTIVE: To analyze the epidemiological features, progression, and treatment response to oral antiviral agents (OA) in HBeAg+ chronic hepatitis B patients in our area. MATERIAL AND METHODS: We analyzed 436 patients with chronic hepatitis B infection followed up at the Ramón y Cajal Hospital from 1990 to June 2012. RESULTS: Sixty-five patients (14.9%) had HBeAg+ chronic hepatitis B. Seven patients in the immunotolerant phase were not treated, while the remaining 58 received treatment. Four patients were excluded: two due to severe acute hepatitis, one due to hepatitis C virus coinfection and another because of a Delta virus coinfection. Of the remaining 54 patients, 19 received interferon with or without OA, and 35 received only OA. Two patients treated for less than 1 month were not included in the analysis. The analysis was finally performed in 33 patients. The mean duration of treatment was 46.81 months (6-138). Lamivudine was the most frequently prescribed drug (39.39%) followed by tenofovir (24.24%) and entecavir (21.21%). The mean age was 42.08±14 years and 75.75% (25/33) of the patients were male. Nineteen of 33 patients (57.57%) achieved seroconversion to anti-HBe, and 27.27% (9/33) showed clearance of HBsAg. There was no evidence of HBsAg reversion after a mean follow-up of 35.6 months. There were 8 cases of resistance in 7 patients: 7 to lamivudine and 1 to adefovir. CONCLUSIONS: Approximately 15% of chronic hepatitis B patients in our area are HBeAg+. Treatment with OA achieves a high seroconversion rate (57.57%) and a considerable percentage of HBsAg clearance (27.27%).

Patients infected with HIV are at high-risk for hepatitis E virus infection in Spain.

Hepatitis E virus is responsible for sporadic cases of acute, self-limited viral hepatitis not only in endemic but also in industrialized countries. In addition, some reports confirm that it can cause chronic infection and even cirrhosis in immunosuppressed and also in patients infected with HIV. There are few data about prevalence and incidence of HEV chronic infection in HIV-HEV coinfected individuals in Spain. The aim of this study is to investigate the prevalence of anti-HEV IgG in a representative sample of 448 patients infected with HIV and determine the role of age, gender, and CD4 counts in the detection of anti-HEV IgG antibodies in blood. In addition, the clinical features and ALT levels in relation to the presence of anti-HEV IgM and/or HEV-RNA in the blood of these patients were investigated. Anti-HEV IgG antibodies were detected in serum using a commercial enzyme immunoassay. All positive samples were studied further for the presence of anti-HEV IgM antibodies. In addition, HEV RNA was amplified by reverse transcriptase (RT)-nested PCR in all serum samples with IgM anti-HEV. The overall prevalence of anti-HEV IgG was 10.4% (45/448, 95% C.I. 7.2-12.8%). HEV-RNA was found in only one patient out of the 45 anti-HEV IgG positive samples studied. Regarding to gender and CD4 count, no difference in seroprevalence could be observed. This prevalence data suggest that patients infected with HIV can be considered a risk group for HEV infection and that chronic coinfection HEV-HIV seems to be a very rare event.

Hepatitis agudas, crónicas y fulminantes por virus de la hepatitis E: 7 años de experiencia (2004-2011) / Acute, chronic and fulminant hepatitis E: Seven years of experience (2004-2011)

OBJETIVO: Estudiar las características clínicas y epidemiológicas de 43 casos de hepatitis aguda, 5 casos de hepatitis fulminante y uno de hepatitis crónica causados por el virus de la hepatitis E (VHE), detectados en un periodo de 7 ańos. Pacientes Cuarenta y nueve (35 varones y 14 mujeres) pacientes atendidos entre 2004 y 2011 en el Hospital Ramón y Cajal, en la Comunidad de Madrid. El diagnóstico se realizó por detección de anticuerpos IgG e IgM anti-VHE y ARN VHE en suero. Se consideró el diagnóstico de hepatitis E aguda cuando el paciente presentaba un cuadro clínico compatible con hepatitis aguda y se detectó IgM anti-VHE y/o ARN VHE en suero; la hepatitis E crónica se definió por la presencia de ARN del VHE en suero por un periodo de tiempo mayor de 6 meses, y el fallo hepático fulminante E cuando se observó un deterioro severo de la función hepática asociado encefalopatía en presencia de IgM anti-VHE y/o ARN VHE en suero. RESULTADOS: La edad media fue de 46,67 y 49,6 ańos en los enfermos con hepatitis aguda y fulminante, respectivamente. Entre los antecedentes epidemiológicos, 13 referían viaje a zonas endémicas, 4 tenían contacto con animales, 4 tenían esteatosis hepática relacionada con consumo de alcohol, 3 consumían regularmente productos de herbolario y 2 bebían agua de arroyos. DISCUSIÓN: El VHE origina hepatitis aguda autolimitada, aunque el 36,73% requirieron hospitalización. Sin embargo, el 10,2% comenzaron con hepatitis fulminante, necesitando trasplante hepático. La hepatitis E crónica es excepcional en inmunocompetentes. El aumento de incidencia es debido a la mayor facilidad de diagnóstico en estos últimos ańos

OBJECTIVE: To study the clinical and epidemiological profiles of in 43cases of acute hepatitis, 5 cases of fulminant hepatitis, and one of chronic hepatitis due to hepatitis E virus (HEV), detected over a 7-year period. PATIENTS: Forty-nine individuals (33male and 10female) treated between 2004 and 2011 in the Hospital Ramón y Cajal (Comunidad de Madrid, Spain). The diagnosis was made by the detection of IgG and IgM anti-HEV and RNA HEV in serum samples. Acute hepatitis E was defined by the presence of IgM anti-HEV and/or RNA HEV in serum, and chronic hepatitis E if the ARN was detectable more than 6months. Fulminant hepatitis E was diagnosed if encephalopathy was observed in addition to IgM anti-HEV and/or RNA HEV in serum. RESULTS: The median age was 46.67 and 49.6years in acute hepatitis E and fulminant hepatitis E, respectively. The risk factors recorded were travel to endemic areas in 13 patients, 4 were in contact with animals, 4suffered from hepatic steatosis due to alcohol consumption, 3consumed uncontrolled foods, and 2drank water from streams. DISCUSSION: HEV is the cause of acute self-limited hepatitis, although 36.73% of the studied cases had to be hospitalised. However a small number of patients, 10.2%, had fulminant hepatitis requiring liver transplant. Chronic hepatitis E is very infrequent in immunocompetent individuals. The increase in incidence of hepatitis E is due to the introduction of better diagnostic tests in recent year

Comparison of the performance of carcinogenic HPV typing of the Roche Linear Array and Qiagen LiquiChip® HPV assays.

BACKGROUND: Cervical cancer is caused by high-risk types of human papillomavirus (HPV). DNA testing of such high-risk types of HPV could improve cervical screening.The aim of the study was to compare the sensitivities and positive predictive values of two commercially available typing assays (Qiagen LQ and Roche LA) and to comparatively assess the distribution of HPV types with these two assays. METHODS: The study population comprised 311 ASCUS + women with abnormal pap tests who were HCII positive and who were admitted to three European referral gynecology clinics between 2007 and 2010 (Madrid, Marseille and Milan). All patients underwent LQ and LA tests. RESULTS: The sensitivity of the two assays for HPV typing was 94% for LQ and 99% for LA (compared with HCII). The overall concordance between LQ and LA was 93%. The three prevalent genotypes, HPV16, HPV18, and HPV31, were identified with a high concordance using the two assays: kappa 0.93, 0.83, and 0.91, respectively. Mixed genotypes were more frequently detected by LA than by LQ: 52% vs. 18%, respectively (p < .0001). CONCLUSIONS: These assays have a good clinical sensitivity for detecting HPV types in CIN2+ patients and allow the virus type to be detected in the same experiment. Our study revealed no significant difference between LQ and LA for CIN2+ or CIN3+ diagnosis, indicating similar distributions of HPV types and a mixed genotype detection that is higher for LA than for LQ.

Hepatitis E: current status.

Acute hepatitis E is a very common disease in developing countries, to the point that, according to World Health Organization estimates, one third of the world's population has been exposed to HEV. It also causes outbreaks in refugee camps or after natural disasters such as floods or earthquakes. Sporadic cases of acute hepatitis have been observed in practically all European countries and other developed geographical areas, not only in travelers from endemic countries but also in people with no risk factors. But, lately, new aspects of this infection are appearing in industrialized countries such as the possibility of the disease becoming chronic in transplant patients, the immunocompromised in general, and even in patients with previous liver disease who are immunocompetent. In this comprehensive review, we summarize the current knowledge on HEV infection.

[Acute, chronic and fulminant hepatitisE: seven years of experience (2004-2011)]. / Hepatitis agudas, crónicas y fulminantes por virus de la hepatitisE: 7años de experiencia (2004-2011).

OBJECTIVE: To study the clinical and epidemiological profiles of in 43cases of acute hepatitis, 5cases of fulminant hepatitis, and one of chronic hepatitis due to hepatitis E virus (HEV), detected over a 7-year period. PATIENTS: Forty-nine individuals (33male and 10female) treated between 2004 and 2011 in the Hospital Ramón y Cajal (Comunidad de Madrid, Spain). The diagnosis was made by the detection of IgG and IgM anti-HEV and RNA HEV in serum samples. Acute hepatitisE was defined by the presence of IgM anti-HEV and/or RNA HEV in serum, and chronic hepatitisE if the ARN was detectable more than 6months. Fulminant hepatitisE was diagnosed if encephalopathy was observed in addition to IgM anti-HEV and/or RNA HEV in serum. RESULTS: The median age was 46.67 and 49.6years in acute hepatitisE and fulminant hepatitisE, respectively. The risk factors recorded were travel to endemic areas in 13patients, 4were in contact with animals, 4suffered from hepatic steatosis due to alcohol consumption, 3consumed uncontrolled foods, and 2drank water from streams. DISCUSSION: HEV is the cause of acute self-limited hepatitis, although 36.73% of the studied cases had to be hospitalised. However a small number of patients, 10.2%, had fulminant hepatitis requiring liver transplant. Chronic hepatitisE is very infrequent in immunocompetent individuals. The increase in incidence of hepatitisE is due to the introduction of better diagnostic tests in recent years.

¿Cribado de infección por citomegalovirus en embarazadas? Perfil serológico en la Comunidad de Madrid / Routine screening for cytomegalovirus in pregnancy? Serologic profile in Madrid

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Estado actual de la hepatitis E / Hepatitis E. Current perspectives

La infección por el virus de la hepatitis E (VHE) es una enfermedad muy prevalente en países en vías de desarrollo y según estimaciones de la Organización Mundial de la Salud un tercio de la población mundial tiene contacto con el virus. Sus manifestaciones clínicas y la epidemiología son bien conocidas en países endémicos, pero recientemente se han publicado casos esporádicos en países desarrollados, en pacientes sin ningún antecedente de viajes. Se ha confirmado que la hepatitis E en estos países es una zoonosis, pero aún permanecen desconocidas otras vías de transmisión. Otro aspecto interesante es que el VHE puede producir hepatitis crónicas en trasplantados, inmunodeprimidos por otras causas e incluso en inmunocompetentes. También se han comunicado casos de hepatitis fulminantes y otras manifestaciones extrahepáticas. El diagnóstico se basa en estudios serológicos y detección de ARN del virus en sangre y heces. La vacuna es una buena opción para prevenir esta infección que afecta a un número muy elevado de personas en zonas geográficas deprimidas, pero desafortunadamente no está disponible todavía (AU)

Infection with hepatitis E virus (HEV) is highly prevalent in developing countries and the WHO estimates one third of the world population has had contact with the virus. Its diagnosis and epidemiology are well known in endemic countries but, recently, there have been sporadic cases in developed countries in patients with no history of travel. Currently in these countries, hepatitis E is considered a zoonosis yet there remain to be known other routes of transmission. Another interesting aspect is that HEV can cause chronic hepatitis in transplanted patients, other immunocompromised patients and even in immunocompetent people. There have also been reported cases of fulminant hepatitis and other extrahepatic manifestations. The diagnosis is based on serological studies and detection of viral RNA in blood and feces. The vaccine is a good option to prevent this infection that affects a large number of people in deprived geographical areas but unfortunately it is not available yet (AU)