Retronychia: an underdiagnosed disease.

Retronychia is a recently described cause of ingrowth of the nail plate on the ventral surface of the proximal nail fold. Clinical features are repeated episodes of proximal paronychia, nail plate thickening, and occasionally granulation tissue emergence. The usual treatments for paronychia such as antibiotics and antifungals are ineffective in these cases. Avulsion of the nail plate is the treatment of choice for these patients, but effective treatment is usually delayed owing to inadequate diagnosis. Herein, we describe a 28-year-old woman with a case of retronychia. She was treated for two months with oral and topical antifungal and antibiotics by her general practitioner. After proper diagnosis and avulsion of the nail she presented a normal and non-painful growth of the affected nail.

[Patterns of susceptibility to antibiotics of Enterobacteriaceae causing intra-abdominal infection in Spain: SMART 2003 study outcomes]. / Patrones de sensibilidad a antimicrobianos de Enterobacteriaceae causantes de infecciones intraabdominales en España: resultados del estudio SMART 2003.

SMART (Study for Monitoring Antimicrobial Resistance Trends) is an ongoing global antimicrobial surveillance program focused on clinical isolates from intra-abdominal infections. The objective of this subanalysis was to assess antimicrobial susceptibility patterns among Entero-bacteriaceae recovered at 13 participating Spanish sites during 2003. Antimicrobial susceptibility testing was performed using broth microdilution techniques according to the CLSI (formerly NCCLS) guidelines for MIC testing. The presence of extended-spectrum beta-lactamases (ESBL) was confirmed in isolates with a MIC of ceftriaxone, ceftazidime, or cefepime>or=2 mg/l by comparing cefepime MICs with and with-out clavulanate. A total of 981 Enterobacteriaceae recovered from 840 patients were tested, of which 398 (41%) were community-acquired. Escherichia coli was the most common isolate (571 isolates; 58%), followed by Klebsiella spp. (153; 16% Enterobacter spp. (97; 10%), and Proteus spp. (63; 6%). A total of 191 isolates (19%) from 176 patients produced inducible beta-lactamases. The carbapenems and amikacin were the most consistently active agents against the Enterobacteriaceae (susceptibility>or=99%). Resistance rates for ceftazidime, cipro-floxacin, and levofloxacin exceeded 10%. ESBLs were detected phenotypically in 61 (6%) isolates, being the most common E. coli (61%), Klebsiella spp. (20%), and Enterobacter spp. (8%). Antimicrobial resistance among Enterobacteriaceae isolated from intra-abdominal infections is a problem in Spain. A significant proportion of inducible beta-lactamase and ESBL-producing Enterobacteriaceae causing intra-abdominal infection were acquired in the community. The carbapenems ertapenem, imipenem and meropenem and the aminoglycoside amikacin were highly active in vitro against Enterobacteriaceae isolated from intra-abdominal sites, including ESBL-producing organisms.

Patrones de sensibilidad a antimicrobianos de Enterobacteriaceae causantes de infecciones intraabdominales en España: resultados del estudio SMART 2003 / Patterns of susceptibility to antibiotics of Enterobacteriaceae causing intra-abdominal infections in Spain: SMART 2003 study outcomes

El estudio SMART ( Study for Monitoring Antimicrobial Resistance Trends ) es un programa mundial de vigilancia de la resistencia a los antimicrobianos de microorganismos aislados de infecciones intraabdominales. En este subanálisis se evaluó el patrón de sensibilidad de las enterobacterias recogidas en los 13 centros españoles participantes en el año 2003. Se determinaron las CMI de diferentes antimicrobianos por el método de microdilución en caldo siguiendo las recomendaciones del CLSI (antes NCCLS). Se confirmó la presencia de betalactamasas de espectro extendido (BLEE) en aquellas cepas frente a las cuales las CMI de ceftriaxona, ceftazidima y cefepima eran ≥2 mg/l mediante la comparación de las CMI de cefepima con o sin ácido clavulánico (10 mg/l). Se evaluaron 981 enterobacterias de 840 pacientes. De ellas, 398 (41%) eran de adquisición comunitaria. Escherichia coli fue el aislamiento más frecuente (571 cepas; 58%), seguida por Klebsiella spp. (153 cepas; 16%), Enterobacter spp. (97 cepas; 10%) y Proteus spp. (63 cepas; 6%). Un total de 191 cepas procedentes de 176 pacientes eran productoras de betalactamasas inducibles (19%). Los carbapenémicos y la amikacina fueron los antibióticos más activos frente a las enterobacterias (sensibilidad ≥99%). La resistencia a ceftazidima, ciprofloxacino y levofloxacino fue superior al 10%. Se detectaron BLEE fenotípicamente en 61 (6%) de los aislamientos, siendo más frecuentes en E. coli (61%), Klebsiella spp. (20%) y Enterobacter spp. (8%). La resistencia entre las enterobacterias aisladas de infecciones intraabdominales constituye un problema en España. Una proporción significativa de las productoras de BLEE o de betalactamasas inducibles proceden de la comunidad. Los carbapenémicos ertapenem, imipenem y meropenem, y el aminoglucósido amikacina, son muy activos in vitro frente a las enterobacterias aisladas de focos intraabdominales, incluyendo aquéllas productoras de BLEE

SMART (Study for Monitoring Antimicrobial Resistance Trends) is an ongoing global antimicrobial surveillance program focused on clinical isolates from intra-abdominal infections. The objective of this subanalysis was to assess antimicrobial susceptibility patterns among Enterobacteriaceae recovered at 13 participating Spanish sites during 2003. Antimicrobial susceptibility testing was performed using broth microdilution techniques according to the CLSI (formerly NCCLS) guidelines for MIC testing. The presence of extended-spectrum beta-lactamases (ESBL) was confirmed in isolates with a MIC of ceftriaxone, ceftazidime, or cefepime >2 mg/l by comparing cefepime MICs with and without clavulanate. A total of 981 Enterobacteriaceae recovered from 840 patients were tested, of which 398 (41%) were community-acquired. Escherichia coli was the most common isolate (571 isolates; 58%), followed by Klebsiella spp. (153; 16%), Enterobacter spp. (97; 10%), and Proteus spp. (63; 6%). A total of 191 isolates (19%) from 176 patients produced inducible beta-lactamases. The carbapenems and amikacin were the most consistently active agents against the Enterobacteriaceae (susceptibility >99%). Resistance rates for ceftazidime, ciprofloxacin, and levofloxacin exceeded 10%. ESBLs were detected phenotypically in 61 (6%) isolates, being the most common E. coli (61%), Klebsiella spp. (20%), and Enterobacter spp. (8%). Antimicrobial resistance among Enterobacteriaceae isolated from intra-abdominal infections is a problem in Spain. A significant proportion of inducible beta-lactamase and ESBL-producing Enterobacteriaceae causing intra-abdominal infection were acquired in the community. The carbapenems ertapenem, imipenem and meropenem and the aminoglycoside amikacin were highly active in vitro against Enterobacteriaceae isolated from intra-abdominal sites, including ESBL-producing organisms

Staphylococcus haemolyticus y bacteriemias / Staphylococcus haemolyticus y bacteriemias

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Phenolic composition of litchi fruit pericarp.

Litchi (Litchi chinensis, Sapindaceae) is a nonclimacteric subtropical fruit that, once harvested, loses its red pericarp color because of browning reactions probably involving polyphenols. Low-pressure chromatography, high-pressure liquid chromatography, UV-visible spectral analysis, mass spectrometry, and nuclear magnetic resonance studies have allowed the determination and quantification of the polyphenolic composition of litchi pericarp. Litchi skins contain significant amounts of polyphenolic compounds. The principal characteristic of the litchi skin polyphenolic compounds is their ortho-diphenolic structure, which gives them high oxidability. Four major pigments were formally identified as cyanidin 3-rutinoside, cyanidin glucoside, quercetin 3-rutinoside (rutin), and quercetin glucoside. The tannin content was characterized after the depolymerization thiolysis reaction. Tannins (polymeric proanthocyanidins) are mainly constituted with epicatechin units linked by A- and B-type bonds. The different phenolic compounds of litchi cv. Kwai Mi were quantified by HPLC. Condensed tannins were the most abundant (4 mg x g(-1) of fresh skin), followed by epicatechin and procyanidin A2 (1.7 and 0.7 mg x g(-1) of fresh pericarp, respectively). The amount of anthocyanins was found to be comparable to that of flavonols, with a value of approximately 0.4 mg x g(-1) of fresh pericarp.

Interactions of grape seed tannins with salivary proteins.

To evaluate the amount and type of condensed tannins binding salivary proteins, which are supposed to be involved in astringent sensation, model systems allowing further analyses of proteins and condensed tannins were developed. The precipitates formed after addition of grape seed tannins to salivary proteins indicate that a binding interaction occurs. Dissociation of insoluble complexes was achieved by sodium dodecyl sulfate treatment. Thiolysis reaction allowed the quantification and characterization of proanthocyanidins on both the resulting pellet and the supernatant. Binding proteins were investigated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The higher polymerized tannins predominantly precipitated together with the salivary proteins. The condensed tannins remaining in solution were low molecular weight polymers.

Rapid diagnosis of human brucellosis by peripheral-blood PCR assay.

A single-step PCR assay with genus-specific primers for the amplification of a 223-bp region of the sequence encoding a 31-kDa immunogenetic Brucella abortus protein (BCSP31) was used for the rapid diagnosis of human brucellosis. We examined peripheral blood from 47 patients, with a total of 50 cases of brucellosis, and a group of 60 control subjects, composed of patients with febrile syndromes of several etiologies other than brucellosis, asymptomatic subjects seropositive for Brucella antibodies, and healthy subjects. Diagnosis of brucellosis was established in 35 cases (70%) by isolation of Brucella in blood culture and in the other 15 cases (30%) by clinical and serological means. The sensitivity of our PCR assay was 100%, since it correctly identified all 50 cases of brucellosis, regardless of the duration of the disease, the positivity of the blood culture, or the presence of focal forms. The specificity of the test was 98.3%, and the only false-positive result was for a patient who had had brucellosis 2 months before and possibly had a self-limited relapse. In those patients who relapsed, the results of our PCR assay were positive for both the initial infection and the relapse, becoming negative once the relapse treatment was completed and remaining negative in the follow-up tests at 2, 4, and 6 months. In conclusion, these results suggest that the PCR assay is rapid and easy to perform and highly sensitive and specific, and it may therefore be considered a useful tool for diagnosis of human brucellosis.

Simian immunodeficiency virus infection in a patas monkey (Erythrocebus patas): evidence for cross-species transmission from African green monkeys (Cercopithecus aethiops sabaeus) in the wild.

Socio-ethological studies on troops of African green monkeys (AGMs) (Cercopithecus aethiops sabaeus) and patas monkeys (Erythrocebus patas) in Senegal have documented physical contacts between these two species. Elevated simian immunodeficiency virus (SIV) seroprevalence rates have been reported for the different AGM subspecies. We report here the extent to which patas monkeys are infected and compare the relatedness of the viruses isolated from theses two different species. Among the 85 AGMs and 54 patas monkeys studied, 47% of 7.5%, respectively, had antibodies that cross-reacted with HIV-2 envelope proteins. From two AGMs a virus was isolated. From the patas monkeys, virus isolation was generally not possible, but from one animal that was ill a virus designated pamG31 was amplified by PCR. In addition, for the two SIVagm isolates, an 830 bp region spanning the env and nef genes was amplified and sequenced. Comparisons of sequences from the env/nef region revealed 80% identity between pam G31 and SIVagm isolates from AGMs of the sabaeus subspecies, and 94% identity between the two SIVagm isolates. Phylogenetic analysis showed that pamG31 belongs to the SIVagm sabaeus subgroup. This is the first report of a lentiviral infection in a patas monkey. The close genetic relatedness between pamG31 and SIVagm sabaeus viruses is a strong argument in favour of cross-species transmission of SIV between AGMs and patas monkeys in the wild. For these reasons, we propose to refer to this patas virus as SIVagm-pamG31.

Regulatory genes of simian immunodeficiency viruses from west African green monkeys (Cercopithecus aethiops sabaeus).

The high seroprevalence of simian immunodeficiency viruses (SIVs) in African green monkeys (AGMs) without immunological defects in their natural hosts has prompted consideration of SIV-infected AGMs as a model of apathogenic SIV infection. Study of the molecular mechanisms of SIVagm asymptomatic infection could thus provide clues for understanding the pathogenesis of human immunodeficiency viruses. Regulatory genes could be candidates for genetic control of SIVagm apathogenicity. We have characterized Vpr, Tat, Rev, and Nef genes of two SIVagm strains isolated from naturally infected sabaeus monkeys captured in Senegal. The results provide further evidence that SIVagm from West African green monkeys is the most divergent class of AGM viruses, with structural features in long terminal repeat sequences and Vpr and Tat genes that distinguish them from viruses isolated from other AGM species (vervet, grivet, and tantalus monkeys).

[Acute arterial thrombosis of the extremity in pseudoxanthoma elasticum]. / Trombosis arterial aguda extremitaria en el pseudoxantoma elástico.

We report a case of a patient with an elastic pseudoxanthoma (PXE) who presented an acute ischaemia at the left lower limb. The cause of such ischaemia was a thrombosis into the iliac and femoropopliteal arteries. Patient underwent a surgical procedure. The arteriopathy associated with a PXE rarely cause an arterial major occlusion. We did not found a case of acute arterial thrombotic ischaemia and PXE, treated with direct arterial revascularization in the reviewed literature.

[Combined use of rose Bengal and indirect immunofluorescence in the diagnosis of brucellosis]. / Empleo combinado del rosa de Bengala e inmunofluorescencia indirecta en el diagnóstico de la brucelosis.

In the present prospective study we have evaluated the sensitivity, specificity and predictive value of the Bengal rose and indirect immunofluorescence (IIF) in 122 patients with a bacteriological diagnosis of brucellosis. The sensitivity of the Bengal rose was 95.79% and its specificity 98.43%. IIF had a sensitivity of 68.80% and a specificity of 100% when the polyvalent anti-IgS conjugate was used. The combined parallel use of Bengal rose and IIF-IgS resulted in a sensitivity of 89.17% and a specificity of 100%. There was a good correlation between Bengal rose and serum agglutination test (r = 0.72); on the contrary, there were not good correlations between the fluorescent conjugates and Bengal rose, agglutination and Coombs test. In conclusion, the combined use of Bengal rose as a screening test and IIF as a confirmation study is a good diagnostic strategy for human brucellosis.

Fosfomycin in chronic urinary infections.

Fosfomycin has been used on 40 patients with serious urinary infections of different clinical nature, and produced by repetitive infection (prostatisms, carcinomas, lithiasis, hydronephrosis, etc.) The following were isolated in the urocultures: E. coli (60%), Klebsiella (15%), P. aeruginosa (15.0%), Proteus sp. (15.0%), Staphylococcus (5%), S. faecalis (2.5%) and Paracolobactrum coliforme (2.5%). All the germs isolated before treatment were sensitive to fosfomycin. The results, as regards response to the bacteriuria, were 71.4% eradication of the infection, 17.2% reinfections and 11.4% failures. The results are considered very satisfactory in view of the etiopathogenic nature of the processes under treatment.