Towards the elimination of hepatitis C: implementation of reflex testing in Andalusia

BACKGROUND AND AIM: undiagnosed hepatitis C virus (HCV) infection and/or inadequate access to care are barriers to the elimination of HCV. Reflex testing has proven to facilitate referral to care, treatment and viral elimination. In this study, a reflex testing program was implemented in Andalusia and its impact on access to care was evaluated. PATIENTS AND METHODS: an observational, retrospective and prospective study was performed across diagnostic laboratories responsible for HCV diagnosis in southern Spain. After surveying the barriers to performing reflex testing, the number of patients that were not referred for care in 2016 was retrospectively studied (pre-reflex cohort). Subsequently, several measures were proposed to overcome the identified barriers. Finally, reflex testing was implemented and its impact evaluated. RESULTS: the pre-reflex cohort included information from 1,053 patients. Slightly more than half of the patients (n = 580; 55%) visited a specialist for treatment evaluation during a median period of 71 days (interquartile range = 35-134) since the date of diagnosis. The post-reflex cohort (September 2017 to March 2018) included 623 patients. Only 17% (n = 106) of the patients had not been referred for care or evaluated for treatment in a median period of 52 days (interquartile range = 28-86). CONCLUSIONS: in 2016, nearly half of new HCV diagnoses in southern Spain were not referred for care. Barriers to the implementation of reflex testing were overcome in our study. Moreover, this strategy was effectively implemented in 2017. Reflex testing contributed to improving referral for care. This program will contribute to the micro-elimination of hepatitis C in Spain

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Towards the elimination of hepatitis C: implementation of reflex testing in Andalusia.

BACKGROUND AND AIM: undiagnosed hepatitis C virus (HCV) infection and/or inadequate access to care are barriers to the elimination of HCV. Reflex testing has proven to facilitate referral to care, treatment and viral elimination. In this study, a reflex testing program was implemented in Andalusia and its impact on access to care was evaluated. PATIENTS AND METHODS: an observational, retrospective and prospective study was performed across diagnostic laboratories responsible for HCV diagnosis in southern Spain. After surveying the barriers to performing reflex testing, the number of patients that were not referred for care in 2016 was retrospectively studied (pre-reflex cohort). Subsequently, several measures were proposed to overcome the identified barriers. Finally, reflex testing was implemented and its impact evaluated. RESULTS: the pre-reflex cohort included information from 1,053 patients. Slightly more than half of the patients (n = 580; 55%) visited a specialist for treatment evaluation during a median period of 71 days (interquartile range = 35-134) since the date of diagnosis. The post-reflex cohort (September 2017 to March 2018) included 623 patients. Only 17% (n = 106) of the patients had not been referred for care or evaluated for treatment in a median period of 52 days (interquartile range = 28-86). CONCLUSIONS: in 2016, nearly half of new HCV diagnoses in southern Spain were not referred for care. Barriers to the implementation of reflex testing were overcome in our study. Moreover, this strategy was effectively implemented in 2017. Reflex testing contributed to improving referral for care. This program will contribute to the micro-elimination of hepatitis C in Spain.

[Description of immunogens of Chlamydia pneumoniae recognized by serum of individuals with peripheral artery disease]. / Descripción de inmunógenos de Chlamydia pneumoniae reconocidos por el suero de sujetos con enfermedad arterial periférica.

BACKGROUND AND OBJECTIVE: The relationship between antibodies to C. pneumoniae and presence of the bacteria was studied in individuals with peripheral arterial disease. PATIENTS AND METHOD: An observational analytical, case-control study was performed in 118 patients (68 cases, 50 controls) to investigate immunoglobulin (Ig) G and A against C. pneumoniae in serum, using Western-blot (commercial and no commercial methods), ELISA and MIF; DNA of the bacteria in vascular tissue biopsy specimens was studied by polymerase chain reaction. RESULTS: Using commercial Western-blot, significant presence of IgG anti-39 kDa and anti-54 kDa was found in cases and was related to MIF results and C. pneumoniae DNA findings; IgA anti-LPS, anti-92 kDa and anti-Hsp60 kDa were also found and related to DNA presence. Using no commercial Western-blot, significant presence of 128.8 and 9.2 kDa bands for IgG was detected in cases and associated with DNA presence; 70.8, 58.9, 47.9, 47.5, 18.4, 12.1, 10.6, 8.1, and 7.6 kDa bands for IgG were found in cases; and DNA was present when 54.6 and 1.1 kDa bands for IgG and 79.4, 50.1, and 18.4 kDa bands for IgA were also detected. CONCLUSIONS: Using Western-blot, a greater serologic response was found against certain proteins of the bacteria in individuals with peripheral arterial disease. This may reflect an initial stage with presence of DNA and specific IgG. Subsequently, even in absence of the bacteria, an immunomediated disease may develop with presence of IgA and IgG.

Descripción de inmunógenos de Chlamydia pneumoniae reconocidos por el suero de sujetos con enfermedad arterial periférica / Description of immunogens of Chlamydia pneumoniae recognized by serum of individuals with peripheral artery disease

Fundamento y objetivo: Se estudian, en sujetos con enfermedad arterial periférica, los tipos de anticuerpos frente a Chlamydia pneumoniae y su relación con la presencia de la bacteria. Pacientes y método: Se ha realizado un estudio en 68 casos y 50 controles en los que se investigaron en suero las inmunoglobulinas (Ig) G y A frente a C. pneumoniae mediante Western-blot (comercial y no comercial), enzimoinmunoanálisis y microinmunofluorescencia (MIF), así como el ADN de la bacteria en biopsia de tejido vascular mediante reacción en cadena de la polimerasa. Resultados: Mediante Western-blot comercial se encontró, en los casos, una presencia significativa de IgG anti-39 kDa y anti-54 kDa, que se relacionaron con los resultados obtenidos mediante MIF y con la presencia de ADN de C. pneumoniae; así como de IgA antilipopolisacárido, anti-92 kDa y anti-Hsp60 kDa, que se relacionaron con la presencia de ADN. Mediante Western-blot no comercial destacó la presencia significativa, en los casos, de las bandas de 128,8 y 9,2 kDa para la IgG, que se asoció con la existencia de ADN; también se detectaron en los casos bandas de IgG de 70,8, 58,9, 47,9, 47,5, 18,4, 12,1, 10,6, 8,1 y 7,6 kDa; asimismo se detectó ADN cuando se observaron las bandas de 54,6 y 1,1 kDa de IgG, y las bandas de 79,4, 50,1 y 18,4 kDa de IgA. Conclusiones: En los sujetos con enfermedad arterial periférica se encontró una respuesta serológica, mediante Western-blot, más importante frente a determinadas proteínas de la bacteria. Esto podría reflejar una fase inicial con presencia de ADN e IgG específica. Posteriormente, aun en ausencia de la bacteria, podría existir una enfermedad inmunomediada con presencia de IgA e IgG

Background and objective: The relationship between antibodies to C. pneumoniae and presence of the bacteria was studied in individuals with peripheral arterial disease. Patients and method: An observational analytical, case-control study was performed in 118 patients (68 cases, 50 controls) to investigate immunoglobulin (Ig) G and A against C. pneumoniae in serum, using Western-blot (commercial and no commercial methods), ELISA and MIF; DNA of the bacteria in vascular tissue biopsy specimens was studied by polymerase chain reaction. Results: Using commercial Western-blot, significant presence of IgG anti-39 kDa and anti-54 kDa was found in cases and was related to MIF results and C. pneumoniae DNA findings; IgA anti-LPS, anti-92 kDa and anti-Hsp60 kDa were also found and related to DNA presence. Using no commercial Western-blot, significant presence of 128.8 and 9.2 kDa bands for IgG was detected in cases and associated with DNA presence; 70.8, 58.9, 47.9, 47.5, 18.4, 12.1, 10.6, 8.1, and 7.6 kDa bands for IgG were found in cases; and DNA was present when 54.6 and 1.1 kDa bands for IgG and 79.4, 50.1, and 18.4 kDa bands for IgA were also detected. Conclusions: Using Western-blot, a greater serologic response was found against certain proteins of the bacteria in individuals with peripheral arterial disease. This may reflect an initial stage with presence of DNA and specific IgG. Subsequently, even in absence of the bacteria, an immunomediated disease may develop with presence of IgA and IgG

High incidence of extended-spectrum beta-lactamases among outpatient clinical isolates of Escherichia coli: a phenotypic assessment of NCCLS guidelines and a commercial method.

The production of extended-spectrum beta-lactamases (ESBLs) among 357 clinical isolates of Escherichia coli and 175 of Klebsiella spp. was studied using both the National Committee for Clinical Laboratory Standards disk diffusion method and the semiautomated Wider system. We highlight the predominance of E. coli (50, 92.6%) among positive samples and the largely outpatient origin of these (40, 80%), including 39 samples of urine (97.5%) and one of urethral exudate. There were only four ESBL-producing isolates of Klebsiella spp. (7.4%), and three were in outpatient urine samples (75%, 2 K. oxytoca and 1 K. pneumoniae). The positive and negative predictive values for the Wider system were 81% and 98.5%, respectively. We stress the high incidence of ESBL in our setting, the predominance of cases in the outpatient setting, and the acceptable detection of ESBL by means of the Wider system in E. coli and Klebsiella spp.