Selected culture and drug-susceptibility testing methods for drug-resistant Mycobacterium tuberculosis screening in resource-constrained settings.

Evaluation of: Adikaram CP, Perera J, Wijesundera SS. The manual Mycobacteria Growth Indicator Tube and the Nitrate Reductase Assay for the rapid detection of rifampicin resistance of M. tuberculosis in low resource settings. BMC Infect. Dis. 12, 326 (2012). The control of drug-resistant tuberculosis (TB) requires an accurate and a rapid diagnostic for the detection of critical patterns of drug resistance. Rifampicin resistance is a good predictor of the presence of multidrug-resistant TB. Traditionally, in vitro susceptibility methods for Mycobacterium tuberculosis are time consuming and laborious. More rapid methods are available but are very expensive for routine use in low-resource settings. According to the article under evaluation, the Manual Mycobacteria Growth Indicator Tube and Nitrate Reductase Assay, in liquid medium, agreed well with the agar proportion method for the rapid detection of rifampicin resistance in low-resource settings. The results of both susceptibility tests will be available in less than 2 weeks and the cost per test is low. Major efforts are needed to improve the diagnostic and treatment success rate among patients with drug-resistant TB. Since 2007, the WHO has promoted new diagnostic tests such as Xpert Mycobacterium tuberculosis/rifampicin; point-of-care tests are nowadays under development.

La espectrometría de masas en el laboratorio de microbiología clínica / Mass spectrometry in the clinical microbiology laboratory

Actualmente, las enfermedades infecciosas siguen causando una elevada mortalidad y morbilidad. Los métodos de diagnóstico microbiológico se basan en el cultivo seguido de la identificación fenotípica del microorganismo una vez aislado, y el tiempo necesario para su obtención puede variar de 24 a 48h. Dado que la identificación microbiológica repercute directamente en el manejo del paciente y su pronóstico, son necesarias nuevas herramientas diagnósticas capaces de detectar e identificar cualquier microorganismo de manera rápida y fiable. A lo largo de los últimos años se han desarrollado diferentes técnicas moleculares basadas en la amplificación genética con el objetivo de reducir el tiempo necesario para la identificación de los microorganismos implicados en diferentes tipos de procesos infecciosos. Por otro lado, la espectrometría de masas ha surgido como una alternativa rápida y eficaz a los métodos convencionales para la identificación de microorganismos. En esta revisión se describe la tecnología en sus dos formas más utilizadas -desorción/ionización por láser asistida por matriz (MALDI-TOF) e ionización por electrospray (ESI-TOF)- para el análisis tanto de las proteínas como de los ácidos nucleicos microbianos, así como las diferentes plataformas comerciales disponibles. Así mismo, se hace una revisión de los trabajos de mayor interés en microbiología clínica (AU)

Infectious diseases are still a cause of high mortality and morbidity rates. Current microbiological diagnostic methods are based on culture and phenotypic identification of isolated microorganisms, which can be obtained in about 24-48 h. Given that the microbiological identification is of major importance for patient management, new diagnostic methods are needed in order to detect and identify microorganisms in a timely and accurate manner. Over the last few years, several molecular techniques based on the amplification of microbial nucleic acids have been developed with the aim of reducing the time needed for the identification of the microorganisms involved in different infectious processes. On the other hand, mass spectrometry has emerged as a rapid and consistent alternative to conventional (..) (AU)

[Mass spectrometry in the clinical microbiology laboratory]. / La espectrometría de masas en el laboratorio de microbiología clínica.

Infectious diseases are still a cause of high mortality and morbidity rates. Current microbiological diagnostic methods are based on culture and phenotypic identification of isolated microorganisms, which can be obtained in about 24-48 h. Given that the microbiological identification is of major importance for patient management, new diagnostic methods are needed in order to detect and identify microorganisms in a timely and accurate manner. Over the last few years, several molecular techniques based on the amplification of microbial nucleic acids have been developed with the aim of reducing the time needed for the identification of the microorganisms involved in different infectious processes. On the other hand, mass spectrometry has emerged as a rapid and consistent alternative to conventional methods for microorganism identification. This review describes the most widely used mass spectrometry technologies -matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) and electrospray ionization time-of-flight (ESI-TOF)-, both for protein and nucleic acid analysis, as well as the commercial platforms available. Related publications of most interest in clinical microbiology are also reviewed.

Posibilidades actuales para predecir la respuesta a la terapia en pacientes con hepatitis C crónica por el genotipo 1 del virus de la hepatitis C / Current options for predicting therapeutic response in chronically infected patients with hepatitis C virus genotype 1

Únicamente el 50% de los pacientes con infección crónica por el genotipo 1 del virus de la hepatitis C responde con éxito a la terapia estándar con interferón alfa pegilado y ribavirina, y los recientemente aprobados inhibidores de la proteasa deberán administrarse conjuntamente con estos dos fármacos. En consecuencia, predecir la respuesta a la terapia estándar, idealmente antes de iniciarla, sigue siendo un reto importante. Aunque se han descrito varios factores basales predictivos del fallo terapéutico, tanto del hospedador como del virus, ninguno de ellos es capaz de proporcionar predicciones fiables a nivel individual. Por otro lado, el desarrollo de modelos multivariantes que agrupan varios factores predictivos, hasta el momento no ha permitido obtener predicciones con el grado de fiabilidad necesario para poder ser implementados en la práctica clínica. Por lo tanto es necesario seguir investigando para mejorar estos modelos predictivos y describir nuevos factores que nos ayuden a predecir la respuesta de manera más fiable y reproducible. El desarrollo de algoritmos de selección de candidatos a recibir las nuevas terapias en función de sus probabilidades de responder o no a la terapia estándar permitirá reducir los costes asociados al tratamiento y mejorar la calidad de vida de los pacientes. Con esta revisión hemos querido dar una visión de las posibilidades actuales para predecir la respuesta a la terapia estándar en los pacientes con hepatitis C crónica por el genotipo 1 del virus de la hepatitis C (AU)

Only about 50% of patients chronically infected with hepatitis C virus genotype 1 achieve a successful response to standard treatment with pegylated interferon-alfa and ribavirin. Moreover, the recently approved protease inhibitors will have to be administered together with these drugs. Consequently, predicting response to standard treatment, ideally before starting it, remains an important challenge. Although several baseline predictors of treatment failure have been described, including clinical and virological factors, none of them is able to provide reliable predictions at the individual level. In addition, the development of multivariate models combining several predictive factors has not yet yielded predictions with the requisite reliability for use in clinical practice. Therefore, further research is needed to improve predictive models and to describe new factors that would enable us to predict treatment outcome with greater reliability and reproducibility. The development of candidate selection algorithms that help clinicians to identify which patients could benefit from the new therapies on the basis of their chances of responding to standard therapy is of major interest for both patient well-being and healthcare expense. This review attempts to provide a view of the current options for predicting the response to pegylated interferon-alfa plus ribavirin therapy in patients chronically infected with hepatitis C virus genotype 1 (AU)

[Current options for predicting therapeutic response in chronically infected patients with hepatitis C virus genotype 1]. / Posibilidades actuales para predecir la respuesta a la terapia en pacientes con hepatitis C crónica por el genotipo 1 del virus de la hepatitis C.

Only about 50% of patients chronically infected with hepatitis C virus genotype 1 achieve a successful response to standard treatment with pegylated interferon-alfa and ribavirin. Moreover, the recently approved protease inhibitors will have to be administered together with these drugs. Consequently, predicting response to standard treatment, ideally before starting it, remains an important challenge. Although several baseline predictors of treatment failure have been described, including clinical and virological factors, none of them is able to provide reliable predictions at the individual level. In addition, the development of multivariate models combining several predictive factors has not yet yielded predictions with the requisite reliability for use in clinical practice. Therefore, further research is needed to improve predictive models and to describe new factors that would enable us to predict treatment outcome with greater reliability and reproducibility. The development of candidate selection algorithms that help clinicians to identify which patients could benefit from the new therapies on the basis of their chances of responding to standard therapy is of major interest for both patient well-being and healthcare expense. This review attempts to provide a view of the current options for predicting the response to pegylated interferon-alfa plus ribavirin therapy in patients chronically infected with hepatitis C virus genotype 1.

La docencia de la microbiología y parasitología en los estudios de grado de medicina y su adaptación al Espacio Europeo de Educación Superior / The teaching of microbiology and parasitology in undergraduate medical education and its adaptation to the European Higher Education Area

La creación del Espacio Europeo de Educación Superior nos ofrece una serie de oportunidades para emprender una reforma profunda de los estudios de medicina y un cambio en las formas de trabajo del alumnado y el profesorado. El Plan de Bolonia se ha de implementar antes de 2010 en los países firmantes, entre ellos España, y ha de permitir la homologación de formaciones y de títulos. El grado de medicina tiene que constar de 360 créditos europeos (ECTS) repartidos en 6 cursos académicos (60 créditos por curso). La Facultad de Medicina de la Universidad Autónoma de Barcelona ha ultimado ya una propuesta de distribución de materias para el nuevo plan de estudios. En dicha propuesta se refuerza y revaloriza la enseñanza de los contenidos de la microbiología y parasitología (MyP) en relación con los planes de estudio vigentes, planteando de modo adecuado su ubicación, dimensión y competencias en el grado de medicina. La enseñanza de los contenidos de MyP médicas se incluye como una asignatura troncal de 8 ECTS en el tercer curso, y 2 asignaturas optativas de 2,5 y 3 ECTS a desarrollar en el primer semestre de quinto y sexto cursos, en el contexto de la mención "laboratorio clínico y experimental" (30 ECTS). Es de destacar también el papel relevante que ha de desempeñar la enseñanza de la microbiología en los aprendizajes integrados en medicina (AIM) en tercero, cuarto y quinto cursos. Los AIM son una innovación curricular que se basa en la planificación, organización y evaluación conjunta de una serie de asignaturas (24,5 ECTS) que se desarrollarán en grupos reducidos de alumnos y en formato de aprendizaje basado en problemas tutelados

The creation of the European Higher Education Area provides a series of opportunities for far-reaching reform of medical education and changes in the way both students and teachers work. The Bologna process must be implemented before 2010 in signatory countries, which include Spain, and must allow education and academic titles to be homologated. Medical degrees must consist of 360 European Credit Transfer System (ECTS) credits, divided into six academic years (60 credits per academic year). The Faculty of Medicine of the Autonomous University of Barcelona has already put the finishing touches to a proposal for the distribution of subjects in the new curriculum. This proposal strengthens and reassesses the teaching of microbiology and parasitology compared with current curricula, giving these subjects appropriate weight in undergraduate medical education. The teaching of medical microbiology and parasitology is included as a core subject worth 8 ECTS in the third year and two free-choice modules of 2.5 and 3 ECTS to be taken in the first semesters of the fifth and sixth years as part of the minor in "Clinical and Experimental Laboratory" (30 ECTS). The teaching of microbiology will also play an important role in the Integrated Learning in Medicine (INTEL-M) course in the third, fourth and fifth years. INTEL-M is an innovation in the syllabus based on the joint planning, organization and evaluation of a series of subjects (24.5 ECTS) that are developed in small groups of students and in the form of problem-based learning

[Serologic diagnosis of Mycoplasma pneumoniae infections]. / Diagnóstico serológico de las infecciones por Mycoplasma pneumoniae.

Mycoplasma pneumoniae is a human pathogen with worldwide distribution. This microorganism is a common cause (10-30%) of community-acquired pneumonia, also called primary atypical pneumonia because of the spectrum of clinical and radiological findings. The immune response is mainly based on rapid antibody production against peptide and glycolipid antigens derived from this microorganism. During the primary infection, IgM levels generally rise within the first week, and are then followed by an IgG response. Titers of IgG and IgA increase in reinfections. Microbiological diagnosis is based on specific antibody detection. Polymerase chain reaction (PCR) techniques performed on sputum or pharyngeal/nasopharyngeal exudates, as well as the development of multiplex PCR reactions allowing identification of M. pneumoniae and other respiratory pathogens, would by highly useful in routine diagnosis. The most common serological techniques are complement fixation, immunofluorescence, particle agglutination, and enzyme immunoassay. Diagnosis should be performed by selecting the most appropriate test according to functional criteria and population groups. Specific detection of IgM antibodies should not be included in the differential diagnosis in adults and young people. Diagnostic criteria including seroconversion or rising IgG titers may not be clinically useful, because of the time delay and the difficulty of obtaining a second serum specimen for testing, given the mildness of the clinical symptoms.

Diagnóstico serológico de las infecciones por Mycoplasma pneumoniae / Serologic diagnosis of Mycoplasma pneumoniae infections

Mycoplasma pneumoniae es un patógeno exclusivamente humano y de distribución universal. Es causa del 10-30% de las neumonías adquiridas en la comunidad que, por su forma de presentación clinicorradiológica, se denomina neumonían atípica primaria. La respuesta inmunitaria se manifiesta por la rápida producción de anticuerpos frente a antígenos proteicos y glucolipídicos del microorganismo. En la primoinfección se produce un incremento en forma de IgM durante la primera semana, seguido de IgG, y en las reinfecciones se genera una respuesta de IgG e IgA. El diagnóstico microbiológico se ha basado en la demostración de anticuerpos específicos. La aplicación de técnicas de reacción en cadena de la polimerasa en muestras de esputo o exudado faríngeo/nasofaríngeo y el desarrollo de técnicas de reacción en cadena de la polimerasa múltiple, que permiten detectar M. pneumoniae y otros patógenos respiratorios, pueden ser de elevada utilidad en laboratorios de diagnóstico clínico. Las técnicas serológicas aplicables más usuales son la fijación del complemento, la inmunofluorescencia, la aglutinación de partículas y el enzimoinmunoanálisis. Para realizar el diagnóstico se deben seleccionar las técnicas por criterios funcionales y, sobre todo, adecuado al grupo poblacional. La detección específica de IgM no se debe aplicar en infecciones en niños mayores ni en adultos. Tampoco el diagnóstico basado en la seroconversión o el incremento del título de IgG resulta práctico, pues es tardío y, además, es difícil obtener una segunda muestra de suero, dada la levedad del cuadro clínico

Mycoplasma pneumoniae is a human pathogen with worldwide distribution. This microorganism is a common cause (10-30%) of community-acquired pneumonia, also called primary atypical pneumonia because of the spectrum of clinical and radiological findings. The immune response is mainly based on rapid antibody production against peptide and glycolipid antigens derived from this microorganism. During the primary infection, IgM levels generally rise within the first week, and are then followed by an IgG response. Titers of IgG and IgA increase in reinfections. Microbiological diagnosis is based on specific antibody detection. Polymerase chain reaction (PCR) techniques performed on sputum or pharyngeal/nasopharyngeal exudates, as well as the development of multiplex PCR reactions allowing identification of M. pneumoniae and other respiratory pathogens, would by highly useful in routine diagnosis. The most common serological techniques are complement fixation, immunofluorescence, particle agglutination, and enzyme immunoassay. Diagnosis should be performed by selecting the most appropriate test according to functional criteria and population groups. Specific detection of IgM antibodies should not be included in the differential diagnosis in adults and young people. Diagnostic criteria including seroconversion or rising IgG titers may not be clinically useful, because of the time delay and the difficulty of obtaining a second serum specimen for testing, given the mildness of the clinical symptoms

Profesionalización de la investigación biomédica en España: ¿vamos a desaprovechar otra oportunidad? / Professionalization of biomedical research in Spain: shall we miss the opportunity

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