Microepidemia familiar de botulismo alimentario en la Comunidad de Madrid / Familial microepidemic of food-borne botulism in the Region of Madrid

Introducción. El botulismo es un síndrome causado por la toxina del bacilo Clostridium botulinum. La toxina actúa bloqueando las terminaciones colinérgicas presinápticas de la placa motora y del sistema nervioso parasimpático, y ocasiona una parálisis flácida y un fallo parasimpático. El modo más habitual de adquisición de la enfermedad es por ingesta de toxina preformada presente en las conservas caseras mal esterilizadas, aunque otros mecanismos son posibles. Su incidencia actual en España es muy baja. Casos clínicos. Se describen tres miembros convivientes de una familia que presentaron un cuadro de botulismo alimentario. Las manifestaciones clínicas iniciales mostraron predilección por la paresia ocular y por sintomatología disautonó- mica de escasa especificidad, y la agregación familiar fue el indicio fundamental que sugirió el diagnóstico. Posteriormente, los pacientes empeoraron y dos de ellos presentaron afectación de la función respiratoria y precisaron ingreso prolongado en la unidad de cuidados intensivos. Los tres pacientes convalecieron y se recuperaron sin secuelas. Se consiguió detectar la toxina botulínica por bioensayo en los restos de alimentos, lo que confiere al caso la categoría diagnóstica de confirmado. Conclusiones. La microepidemia familiar presentada constituye un caso de afectación inicial predominantemente ocular y disautonómica. Asimismo, ilustra varios aspectos típicos de la enfermedad: la sospecha diagnóstica ante pacientes convivientes que acuden simultáneamente por clínica similar, las complicaciones características del proceso y su tratamiento, el diagnóstico de laboratorio y su historia natural hacia la resolución (AU)

Introduction. Botulism is a syndrome caused by the toxin of the bacillus Clostridium botulinum. The toxin acts by blocking the presynaptic cholinergic endings of the neuromuscular junction and of the parasympathetic nervous system, and gives rise to a flaccid paralysis and parasympathetic failure. The most common way to catch the disease is by ingestion of the preformed toxin present in badly sterilised home-made preserves, although other mechanisms are also possible. Its incidence in Spain today is very low. Case reports. We report the case of three members of a family living together who presented a clinical picture of foodborne botulism. The initial clinical symptoms showed a predilection for ocular paresis and for dysautonomic symptoms of little specificity, and the familial aggregation was the fundamental evidence that suggested the diagnosis. Later, the patients’ state got worse and two of them presented involvement of the respiratory function and required a lengthy stay in the intensive care unit. After a period of convalescence the three patients recovered without any sequelae. Botulinum toxin was detected by bioassay in some food samples, which allowed the diagnosis to be categorised as confirmed. Conclusions. The familial microepidemic reported here is a case of predominantly ocular and dysautonomic involvement. Likewise, it illustrates several aspects that are typical of the disease: the suspected diagnosis in cohabiting patients who visit at the same time for a similar clinical picture, the characteristic complications of the process and its treatment, the laboratory diagnosis and its natural history towards resolution (AU)

Varicella and herpes zoster in Madrid, based on the Sentinel General Practitioner Network: 1997-2004.

BACKGROUND: Varicella (chickenpox) is the primary disease caused by varicella-zoster virus. It is extremely contagious and is frequent in children. Indeed, in the absence of vaccination, a high proportion of the population is liable to contract it. Herpes zoster -more frequent among adults- is caused by reactivation of the latent virus. The objective of this study is to describe the status of and time trend for varicella and herpes zoster in the Madrid Autonomous Region prior to the introduction of the vaccine to the general population. DATA SOURCE: individualised varicella and herpes zoster case records kept by the Madrid Autonomous Region Sentinel General Practitioner Network for the period 1997-2004. Cumulative incidences, crude and standardised incidence rates, and age-specific rates of varicella and herpes zoster were calculated for each year. Kendall's Tau-b correlation coefficient was calculated to evaluate whether incidence displayed a time trend. Spectral density in the time series of weekly incidences was estimated using a periodogram. RESULTS: Standardised annual varicella incidence rates ranged from 742.5 (95% CI: 687.2-797.7) to 1239.6 (95% CI: 1164.5-1313.4) cases per 100 000 person-years. Most cases affected children, though complications were more frequent in adults. Varicella incidence displayed an annual periodicity but no trend over time. Most herpes zoster cases occurred at advanced ages, with incidence registering a rising annual trend but no seasonality factor. CONCLUSION: In the absence of vaccination, no significant changes in varicella incidence were in evidence recent years, though these were observed in the incidence of herpes zoster. Sentinel general practitioner networks are a valid instrument for surveillance of diseases such as varicella. Further varicella vaccination-coverage and vaccine-efficacy studies are called for.

Influence of breast-feeding and parental intelligence on cognitive development in the 24-month-old child.

This study was designed to analyze the relationship between breast-feeding and mental development at 24 months of age, independently of the influence of other factors. A total of 238 babies born between October 1995 and February 1998 were enrolled in an observational prospective cohort study. Cognitive development was assessed using the Bayley Infant Development Scale. The results of multiple linear regression analysis showed that infants breast-fed for longer than 4 months scored 4.3 points higher on the mental development scale than those breast-fed for less time. No differences were found in psychomotor development as a function of feeding regimen or duration. The positive linear correlation observed between parental IQ and mental development scores at 24 months was also statistically significant (mother: r = 0.39; p < 0.001; father: r = 0.43; p < 0.001). It may be concluded that breast-feeding for longer than 4 months has a positive effect on the child's mental development at 24 months of age. Parental intelligence also appears to influence cognitive development.

Influence of breast-feeding on mental and psychomotor development.

The purpose of this study was to analyze the effects of breast-feeding on cognitive and motor development. A prospective cohort study was carried out enrolling 249 babies from 2 rural and urban areas. Cognitive development was assessed at the age of 18 months. Results show that adjusted scores on the mental development index were 4.6 points higher in babies breast-fed for longer than 4 months than in those breast-fed for less time. No differences in psychomotor development were found as a function of type of feeding. A statistically-significant linear correlation was observed between the duration of breast-feeding and scores for Bayley's mental development index. These data suggest that breast-feeding for longer than 4 months has a positive effect on the baby's mental development measured at 18 months of age. Parental intelligence quotient also seems to have an influence on cognitive development.