Detection of Rickettsia massiliae/Bar29 and Rickettsia conorii in red foxes (Vulpes vulpes) and their Rhipicephalus sanguineus complex ticks.

To determine the prevalence of exposure to Rickettsia massiliae/Bar29 and Rickettsia conorii in wild red foxes, we collected blood samples and ticks from 135 foxes shot in different game reserve areas in Catalonia. To detect SFG rickettsia in Rhipicephalus sanguineus complex ticks collected from the foxes, we used real-time polymerase chain reaction (PCR) to screen for ompA gene and a tick-borne bacteria flow chip technique based on multiplex PCR. Serum samples were positive for antibodies against spotted fever group (SFG) rickettsiae in 68 (50.3%). Molecular techniques identified R. massiliae in 107 ticks, R. aeschlimannii in 3 ticks, and R. slovaca in one tick; no R. conorii was identified in any of the ticks analyzed. We conclude that red foxes can carry ticks with SFG rickettsia.

Randomized Trial of Clarithromycin for Mediterranean Spotted Fever.

The classic antibiotic treatment for Mediterranean spotted fever (MSF) is based on tetracyclines or chloramphenicol, but chloramphenicol's bone marrow toxicity makes tetracyclines the treatment of choice. However, it is convenient to have alternatives available for patients who are allergic to tetracyclines, pregnant women, and children <8 years old. We conducted a randomized clinical trial to compare clarithromycin with doxycycline or josamycin in the treatment of MSF. Forty patients were evaluated (23 male; mean age, 39.87 years); 13 patients were aged <14 years. Seventeen patients received clarithromycin, and 23 received doxycycline or josamycin. The interval between the onset of symptoms and the start of treatment was 4.04 ± 1.70 days in the clarithromycin group versus 4.11 ± 1.60 days in the doxycycline/josamycin group (P = not significant [NS]). Time to the disappearance of fever after treatment was 2.67 ± 1.55 days in the clarithromycin group versus 2.22 ± 1.35 days in the doxycycline/josamycin (P = NS). The symptoms had disappeared at 4.70 ± 2.25 days in the clarithromycin group versus at 4.75 ± 3.08 days in the doxycycline/josamycin (P = NS). There were no adverse reactions to treatment or relapses in either group. In conclusion, clarithromycin is a good alternative to doxycycline or josamycin in the treatment of MSF.

Coinfection with "Rickettsia sibirica subsp. mongolotimonae" and Rickettsia conorii in a Human Patient: a Challenge for Molecular Diagnosis Tools.

Rickettsioses are zoonoses transmitted by vectors. More than one agent can coexist in vectors. Although vectors may transmit more than one microorganism to humans, information on dual infections is scarce. We present a case of a patient with an atypical rickettsiosis diagnosis in whom two species of Rickettsia were detected.

Evaluation of the presence of Rickettsia slovaca infection in domestic ruminants in Catalonia, Northeastern Spain.

Rickettsia slovaca is the etiological agent of the human disease tick-borne lymphadenopathy (TIBOLA) transmitted by Dermacentor spp. ticks. In our area, Dermacentor marginatus is the most important tick vector; adult ticks feed on mammals, especially ungulates such as wild boars and domestic ruminants. The epidemiology of tick-transmitted diseases describes a wild cycle and a domestic cycle and both are connected by ticks. To identify the role of domestic ruminants in the transmission and maintenance of R. slovaca infection, blood samples from sheep (n=95), goats (n=91), and bullfighting cattle (n=100) were collected during a herd health program, and livestock grazing was selected to ensure tick contact. Samples were analyzed by serology using an indirect immunofluorescent assay (IFA) and molecular techniques (real-time PCR). Seroprevalence was 15.7% in sheep, 20.8% in goats, and 65.0% in bullfighting cattle. On the basis of molecular methods, R. slovaca infection was demonstrated in a goat blood sample with an antibody titer of 1:160. This is the first time that R. slovaca has been identified in a goat blood sample. These results suggest that domestic ruminants are exposed to R. slovaca infection and, because the domestic cycle is close to the human environment, this could increase the risk of transmitting the pathogen to human beings.

Rickettsia slovaca infection in humans in the northeast of Spain: seroprevalence study.

Catalonia is an endemic area of Mediterranean spotted fever. In 1997, A. Lakos described a new tick-borne infectious disease called tick-borne lymphadenopathy. The causative agent is Rickettsia slovaca, which is transmitted by Dermacentor marginatus ticks. We have diagnosed human cases in Catalonia. The objective of this study was to determinate seroprevalence of R. slovaca infection in humans in the northeast of Spain. The population included 217 subjects from Catalonia, northeast of Spain and was stratified by age and living place (rural, suburban, and urban). Age, gender, residence area, contact with animals, occupation, and history of rickettsioses was surveyed. Immunoglobulin G was measured by indirect immunofluorescence assay. Titers >or= 1/40 were considered. Seroprevalence of R. slovaca was 5.5% at titers of 1/40-1/320. Eight (3.7%) sera had antibodies against R. slovaca exclusively. Four sera reacted also against Rickettsia conorii and/or Bar29. Seroprevalence of R. slovaca would range from 3.7% to 5.5%. The only statistically significant association was that between R. slovaca seropositivity and age. We present serologic evidence of R. slovaca infection among population of Catalonia, northeast of Spain.

[Hypovitaminosis D associated to low sun exposure in the population over 64 years old]. / Hipovitaminosis D asociada a exposición solar insuficiente en la población mayor de 64 años.

BACKGROUND AND OBJECTIVE: To identify the factors related to hypovitaminosis D in the population over 64 years of age without known risk factors of hypovitaminosis D. SUBJECTS AND METHOD: It was a cross-sectional population study in individuals over 64 year-old attending basic healthcare areas in our hospital's area of reference. A survey was conducted to assess various items (functional capacity, exposure to sun, walks, eating habits). Blood samples taken from each participant were analyzed. RESULTS: A total of 239 individuals -mean age (standard deviation): 72 (5.4) years- were evaluated. 95% of the participants scored > 90 on the Barthel index. Mean serum 25-hydroxyvitamin D3 -25(OH)D3- concentration was 17 (7.5) ng/ml and intact parathormone was 60 (26 pg/ml). The prevalence of hypovitaminosis D was 87%, including 70.3% with insufficiency (25(OH)D3 between 11 and 25 ng/ml) and 16.7% with deficiency (25(OH)D3 < or = 10 ng/ml). The intake of vitamin D and calcium were below recommended levels. The principal source of vitamin D was oily fish. Participants with deficiency scored lower on the Barthel index, had a higher mean age, lived in flats, had less exposure to sun, and used to walk less in sun-hours. Higher levels of alkaline phosphatase and intact parathormone were found in participants with deficiency. The variables independently and significantly associated with vitamin D deficiency were a Barthel score < or = 90, scant exposure to sun and living in a flat. CONCLUSIONS: There is a high prevalence of hypovitaminosis D in the population aged over 64 years in our area, which is associated with lower functional capacity, scant exposure to sun and living in flats.

[Evaluation assessment of the cut-off point of vitamin D in the population older than 64 years old]. / Valoración del umbral óptimo de vitamina D en la población mayor de 64 años.

BACKGROUND AND OBJECTIVE: Serum 25(OH)D(3) is the best indicator of vitamin D status, although some controversy remains regarding "normal" and "abnormal" values. The objective was to identify the 25(OH)D(3) serum concentration threshold which allows to know the 25(OH)D(3) serum levels correlated to PTH(i) increase and to describe the prevalence of hypovitaminosis D. PATIENTS AND METHOD: Cross-sectional population study in subjects over 64 years of age residing in the basic healthcare areas in our hospital's area of reference. RESULTS: A total of 239 persons -mean age (standard deviation) 72 (5.4) years- were evaluated. Mean serum concentrations of 25(OH)D(3) and PTH(i) were 17 (7.5) ng/ml and 60.5 (26.1) pg/ml, respectively. 32% of the subjects showed an increase in the serum concentration of PTH(i) > 65 pg/ml. 96% of the cases with an increase in PTH(i) had serum concentrations of 25(OH)D(3) < or = 25.5 ng/ml. In 70% of the subjects, the serum concentration levels of 25(OH)D(3) ranged between 11 and 25 ng/ml and in 17% the levels of 25(OH)D(3) were lower than 10 ng/ml. CONCLUSIONS: The normal ranges for our population could correspond to levels of 25(OH)D3 > or = 25 ng/ml, with a 95% of sensibility to detect secondary hyperparathyroidism.

Epidemiological and clinical features, response to HAART, and survival in HIV-infected patients diagnosed at the age of 50 or more.

BACKGROUND: Over the last years, the mean age of subjects with HIV infection and AIDS is increasing. Moreover, some epidemiological and clinical differences between younger and older HIV-infected individuals have been observed. However, since introduction of HAART therapy, there are controversial results regarding their response to HAART. The aim of the present study is to evaluate epidemiological and clinical features, response to HAART, and survival in elderly HIV-infected patients with regard to younger HIV-infected patients. METHODS: A prospective cohort study (1998-2003) was performed on patients from Sabadell Hospital, in Northeast of Spain. The cohort includes newly attended HIV-infected patients since January 1, 1998. For the purpose of this analysis, data was censured at December 31, 2003. Taking into account age at time of diagnosis, it was considered 36 HIV-positive people aged 50 years or more (Group 1, G1) and 419 HIV-positive people aged 13-40 years (Group 2, G2). Epidemiological, clinical, biological and therapy data are recorded. Statistical analysis was performed using Chi-squared test and Fisher exact test, Mann-Whitney U test, Kaplan-Meier, Log Rank test, and Two-Way ANOVA from random factors. RESULTS: G1 showed higher proportion of men than G2. The most common risk factors in G1 were heterosexual transmission (P = 0.01) and having sex with men or women (P < 0.001). G1 and G2 show parallel profiles through the time regarding immunological response (P = 0.989) and virological response (P = 0.074). However, older people showed lower CD4 cell counts at first clinic visit (P < 0.001) and, eventually, they did not achieve the same counts as G2. G1 presented faster progression to AIDS (P < 0.001) and shorter survival (P < 0.001). CONCLUSION: Older patients have different epidemiological features. Their immunological and virological responses are good. However, older patients do not achieve the same CD4 cell counts likely due to they have lower counts at first clinic visit. Thus, it is essential physicians know older HIV-infected patients features to consider the possibility of HIV infection in these patients with the aim of treatment would not be delayed.

Valoración del umbral óptimo de vitamina D en la población mayor de 64 años / Evaluation assessment of the cut-off point of vitamin D in the population older than 64 years old

Fundamento y objetivo: El mejor indicador del estado de la vitamina D es la determinación en suero del 25-hidroxicolecalciferol [25(OH)D3], aunque cuáles son los valores normales es objeto de controversia. El objetivo del estudio ha sido conocer el umbral de 25(OH)D3 a partir del cual se produce la mayoría de los incrementos de los valores de parathormona intacta (PTHi) y describir la prevalencia de hipovitaminosis D en la población estudiada. Pacientes y método: Se ha realizado un estudio transversal de ámbito poblacional en personas mayores de 64 años procedentes de las áreas básicas de salud del área de referencia de un hospital. Resultados: Se evaluó a 239 personas, con una edad media (desviación estándar) de 72 (5,4) años. Los valores medios de 25(OH)D3 y de PTHi fueron 17 (7,5) ng/ml y 60,5 (26,1) pg/ml, respectivamente. El 32% presentó valores de PTHi superiores a 65 pg/ml. El 96% de los casos con PTHi elevada tenía valores de 25(OH)D3 iguales o inferiores a 25,5 ng/ml. El 70% de los participantes presentó valores de 25(OH)D3 entre 11 y 25 ng/ml y el 17%, valores inferiores a 10 ng/ml. Conclusiones: El umbral de normalidad para nuestra población podría corresponder a valores de 25(OH)D3 iguales o superiores a 25 ng/ml, con una sensibilidad del 95% para detectar hiperparatiroidismo secundario

Background and objective: Serum 25(OH)D3 is the best indicator of vitamin D status, although some controversy remains regarding «normal» and «abnormal» values. The objective was to identify the 25(OH)D3 serum concentration treshold which allows to know the 25(OH)D3 serum levels correlated to PTHi increase and to describe the prevalence of hypovitaminosis D. Patients and method: Cross-sectional population study in subjects over 64 years of age residing in the basic healthcare areas in our hospital's area of reference. Results: A total of 239 persons ­mean age (standard deviation) 72 (5.4) years­ were evaluated. Mean serum concentrations of 25(OH)D3 and PTHi were 17 (7.5) ng/ml and 60.5 (26.1) pg/ml, respectively. 32% of the subjects showed an increase in the serum concentration of PTHi > 65 pg/ml. 96% of the cases with an increase in PTHi had serum concentrations of 25(OH)D3 ¾ 25.5 ng/ml. In 70% of the subjects, the serum concentration levels of 25(OH)D3 ranged between 11 and 25 ng/ml and in 17% the levels of 25(OH)D3 were lower than 10 ng/ml. Conclusions: The normal ranges for our population could correspond to levels of 25(OH)D3 >= 25 ng/ml, with a 95% of sensibility to detect secondary hyperparathyroidism

[Clinical and epidemiological study of a series of HIV-infected patients over 50 years old]. / Estudio de una serie clínica de pacientes infectados por el VIH mayores de 50 años.

INTRODUCTION: The epidemiology of human immunodeficiency virus (HIV) infection has changed in recent years. Cases in persons over the age of 50 have increased, and the most frequent mode of transmission is sexual contact. The objective of this study is to analyse the epidemiological, clinical and evolution characteristics of a clinical series of HIV-infected patients over 50 years old at the time of diagnosis. METHODS: 165 HIV-infected patients over the age of 50, attended at Hospital Clinic (Barcelona) and Corporació Parc Taulí (Sabadell) during the period of 1985 to 2001, were studied. RESULTS: Among the total, 81% of the patients were men, mean age at the time of diagnosis was 58.5 years, and 81.8% had acquired the disease by sexual contact. The median initial CD4 T cell count was 216 cells/microl. Initial viral load was 1,000-100,000 copies/ml in 45.2% of the patients, whereas 52.3% had > 100,000 copies/ml. At the time of diagnosis, 30.9% had an AIDS-defining disease. The main opportunistic diseases were pulmonary tuberculosis, Kaposi's sarcoma, P. jiroveci (before carinii) pneumonia and non-Hodgkin lymphoma. Mortality due to AIDS was 32.7%. CONCLUSIONS: Subjects over 50 years old diagnosed with HIV-infection were predominantly men, who acquired the infection by sexual contact. A high percentage of patients were diagnosed with the development of an opportunistic disease.

Estudio de una serie clínica de pacientes infectados por el VIH mayores de 50 años / Clinical and epidemiological study of a series of HIV-infected patients over 50 years old

INTRODUCCIÓN. La epidemiología de la infección por el virus de la inmunodeficiencia humana (VIH) ha cambiado en los últimos años. Se observa un aumento de casos de infección en personas mayores de 50 años, y el mecanismo de transmisión más frecuente es la vía sexual. El objetivo de este estudio es analizar las características epidemiológicas, clínicas y evolutivas de una serie clínica de pacientes infectados por el VIH mayores de 50 años en el momento del diagnóstico. MÉTODOS. Se estudiaron 165 pacientes infectados por el VIH mayores de 50 años procedentes del Hospital Clínic de Barcelona y de la Corporació Parc Taulí de Sabadell en el período comprendido entre 1985 y 2001. RESULTADOS. El 81% de los pacientes eran varones. La edad media en el momento del diagnóstico fue de 58,4 años. El 81,8% adquirieron la infección por vía sexual. La media de CD4 iniciales fue de 216 cél./ml. El 45,2% de los pacientes presentaban una carga viral inicial entre 1.000 y 100.000 copias/ml y el 52,3% > 100.000 copias/ml. El 30,9% de los pacientes presentaban una enfermedad definitoria de sida en el momento del diagnóstico. Las principales enfermedades oportunistas fueron la tuberculosis pulmonar, el sarcoma de Kaposi, la neumonía por Pneumocystis jiroveci (antes carinii) y el linfomano hodgkiniano. El 32,7% murieron por sida. CONCLUSIONES. Las personas mayores de 50 años que se infectaron por el VIH eran predominantemente varones y adquirieron la infección por vía sexual. Existe una alta proporción de pacientes que fueron diagnosticados por una enfermedad oportunista (AU)

INTRODUCTION. The epidemiology of human immunodeficiency virus (HIV) infection has changed in recent years. Cases in persons over the age of 50 have increased, and the most frequent mode of transmission is sexual contact. The objective of this study is to analyse the epidemiological, clinical and evolution characteristics of a clinical series of HIV-infected patients over 50 years old at the time of diagnosis. METHODS. 165 HIV-infected patients over the age of 50,attended at Hospital Clinic (Barcelona) and Corporació Parc Taulí (Sabadell) during the period of 1985 to 2001,were studied. RESULTS. Among the total, 81% of the patients were men, mean age at the time of diagnosis was 58.5 years, and 81.8% had acquired the disease by sexual contact. The median initial CD4 T cell count was 216 cells/ml. Initial viralload was 1,000-100,000 copies/ml in 45.2% of the patients, whereas 52.3% had > 100,000 copies/ml. At the time of diagnosis, 30.9% had an AIDS-defining disease. The main opportunistic diseases were pulmonary tuberculosis, Kaposi’s sarcoma, P. jiroveci (before carinii) pneumonia and non-Hodgkin lymphoma. Mortality due to AIDS was 32.7%. CONCLUSIONS. Subjects over 50 years old diagnosed with HIV-infection were predominantly men, who acquired the infection by sexual contact. A high percentage of patients were diagnosed with the development of an opportunistic disease (AU)