Evaluation of two reverse transcription polymerase reaction assays (GEN ETI-K HGV RNA and LCx GBV-C assay) for the detection of GB virus C/hepatitis G virus RNA in clinical samples.

Our study evaluates the analytical performance of two amplification methods in the detection of GB Virus C/Hepatitis G Virus, GEN ETI-K HGV RNA (GEN) and the LCx GBV-C Assay (LCx). GB Virus C RNA was detected by at least one test in 58/315 samples (18.41%). Fifty-five samples (17.46%) were positive by the GEN method and 51 samples (16.19%) by the LCx method. The same rate of detection was found for 71 haemodialysis patients and 18 non-A non-E hepatitis. Method based differences in prevalence were observed for patient samples from the general population, 8/106 (7.55%) positive by GEN vs 7/106 (6.60%) by LCx; and HIV infected patients, 26/98 (26.53%) vs 23/98 (23.46%). For chronic type C hepatitis 10/22 (45.5%) were positive by both methods, with two samples discordant. Overall, discordance was observed for ten samples, with seven positive only by the GEN ETI-K HGV RNA, and three positive only by the LCx GBV-C Assay. An additional evaluation of serial samples, from chronic type C hepatitis patients under interferon treatment, revealed three samples which were positive only by the GEN method. Results were 100% concordant for patients under haemodialysis and for non-A non-E hepatitis, 95.9% in the HIV positive group, 90.9% in the chronic type C hepatitis group, and 97.1% in the general population group. Overall, a 97.2% of concordance was found between methods. Both tests have a similar diagnostic performance, though in our opinion, LCx GBV-C Assay better suits the requirements of a clinical microbiology diagnostic laboratory.

Manejo terapéutico del síndrome de corazón izquierdo hipoplásico / Therapeutic alternatives for the management of idiopathic dilated cardiomyopathy during childhood

La abstención terapéutica en el síndrome de corazón izquierdo hipoplásico (SCIH) es una opción cada vez menos utilizada. Se analizan las alternativas terapéuticas en el SCIH y las dificultades preoperatorias, quirúrgicas y postoperatorias que obligan a un manejo integral de los pacientes exigiendo una colaboración multidisciplinar absoluta. Se comparan los resultados entre cirugía convencional (intervención de Norwood) y trasplante cardiaco. Existe controversia sobre cuál es la mejor alternativa y se resalta, en la literatura, la importancia de la curva de aprendizaje en ambas técnicas. Se aportan datos sobre la experiencia en este síndrome de la Sección de Cardiología Pediátrica del HGU 'Gregorio Marañón' de Madrid. Se concluye que el SCIH es una patología susceptible de tratamiento y con resultados a corto-medio plazo aceptables si se efectúa una adecuada selección de pacientes y de centros de tratamiento (AU)

Valoración del soplo cardiaco inocente / Assessment of the inocent heart murmur

El soplo cardiaco inocente es la causa más frecuente de consulta al especialista en cardiología Pediátrica. Existen en la literatura múltiples referencias en las que se afirma que para la valoración de si un soplo cardiaco tiene o no una base anatomicopatológica es suficiente con una adecuada valoración clínica, sin necesidad de pruebas complementarias, especialmente la ecocardiografía, salvo que el paciente tenga menos de 2 años o no colabore. Se revisa la literatura actual sobre el tema y se propone un protocolo de estudio diferente en el que siempre debe utilizarse la ecocardiografía para establecer un diagnóstico definitivo de ausencia de patología cardiaca cuando el paciente es enviado para valoración al especialista en cardiología Pediátrica. Se comentan los datos a favor de ese protocolo y se critica la valoración únicamente clínica, basándose en la realidad actual sobre la escasa eficaz preparación tanto de los médicos de atención primaria como de los especialistas en cardiología Pediátrica respecto al entrenamiento en la técnica auscultatoria. Se propone la utilización siempre de la ecocardiografía, porque en estos momentos es una técnica al alcance de la mayoría de los centros y constituye un método relativamente sencillo, rápido y casi definitivo para eliminar la existencia de cardiopatías no sintomáticas (AU)

GB virus C in patients with liver disease of unknown etiology.

To assess the prevalence of GBV-C in patients suffering unknown liver disease we have investigated the GBV-C-RNA in serum of 54 patients: 10 with acute and 32 with chronic non-A-E hepatitis (16 active and 16 persistent), 10 with hepatocellular carcinoma, 2 diagnosed with hepatic fulminant failure, and 91 healthy blood donors (control). PCR with primers from NS3 helicase region was performed and the product was identified by a double strand DNA enzyme immunoassay. GBV appears to infect 40 and 31% of acute or chronic non-A-E hepatitis respectively. Also the GBV genome was found in 1 in 10 samples of hepatocarcinoma, in 2 cases of fulminant hepatitis, and in 1 in 91 of the control group. In spite of these results the role of GBV in the etiology of liver diseases has to be analyzed in more comprehensive studies.

[Hemodynamic changes during laparoscopic surgery. Preliminary study]. / Alteraciones hemodinámicas durante la cirugía laparoscópica. Estudio preliminar.

The haemodynamic changes produced by laparoscopic surgery in children have been evaluated. A transesophageal echocardiographic study on 13 patients (7 males and 6 females, 10.8 +/- 2.7 years old) has been performed before, during and after peritoneal CO2 gas insufflation. A change on the Doppler waves pattern of the infradiaphragmatic veins along with an increase in blood flow velocity were observed. Pulmonary veins suffered minimal changes showing an increase on either the systolic pressure and on atrial contraction. Diastolic retrograde flow in aorta reflected an increase in peripheral vascular resistance. Cardiac output increased minimally. All haemodynamic changes returned to basal after gas peritoneal desufflation. These data show that laparoscopic surgery could produce important cardiac derangements in children with ventricular dysfunction or in patients presenting left ventricular outlet obstruction. In these patients laparoscopic surgery might be precluded.

[Efficacy of two gene species in the serological diagnosis of Borrelia burgdorferi infections]. / Eficacia de dos genoespecies en el diagnóstico serológico de la infección por Borrelia burgdorferi.

BACKGROUND: There is phenotypic and genetic variability among the species Borrelia burgdorferi that produces Lyme disease. Three gene species and seven serotypes have been defined. AIM: To study the efficacy of two gene species in the serological diagnosis of Borrelia burgdorferi infections in Granada, Spain. MATERIAL AND METHODS: One thousand sixty nine sera coming from 1,251 subjects without Lyme borreliosis were analyzed. These subjects were studied for health or pregnancy controls, differential diagnosis of viral disease, diagnosis of syphilis, neurological or rheumatic diseases. In all samples, antibodies against Borrelia burgdorferi (B31 and Pko strains) and against Treponema pallidum were investigated. Screening tests (ELISA and hemagglutination) were followed by confirmations tests for positive samples (Western Blot IgG strain B31 and FTA-abs respectively). A clinical and laboratory follow up was done for subjects with positive serological tests. RESULTS: The global rate of positive antibodies against Borrelia burgdorferi B31 was 8.31% and against the strain Pko was 0.64%. Western blot was negative in 36% of subjects with positive ELISA B31. The distribution of antibodies against the strain B31 was acute herpes virus infection in 16%, gestation in 3%, HIV infection in 6.4%, T pallidum infection in 36%, rheumatic diseases in 25%, neurological diseases in 17.5% and health controls in 7.4%. The percentage of positive Western Blot analyzes were 0.8, 2.1 and 0.4% respectively. A reversion of positive ELISA tests was observed in 6 subjects. CONCLUSIONS: The disparity in rates of antibodies against Borrelia burgdorferi in different geographic regions may be due to differences in the serological tests used. The high rate of false positive ELISA tests underscores the need to use other serological tests.

[Correlation between the presence of cytomegalovirus antibodies and antigen in blood leukocytes for the diagnosis of primary active infection]. / Correlación entre la presencia de anticuerpos y antígeno de citomegalovirus en los leucocitos de sangre para el diagnóstico de la infección activa primaria.

BACKGROUND: The diagnosis of cytomegalovirus infections measuring IgG or IgM antibodies has a high rate of false positive or negative results, specially in immunocompromised patients. AIM: To compare the diagnostic yield of antibodies against cytomegalovirus with the measurement of the antigen in peripheral leukocytes. MATERIAL AND METHODS: Forty three blood samples coming from pediatric patients with suspected cytomegalovirus infections were analyzed. Low affinity IgG and IgM antibodies against Epstein Barr virus and cytomegalovirus, using indirect ELISA assays, and the virus antigen in peripheral leukocytes, using a commercial immunoperoxidase assay, were measured. RESULTS: Seven patients had positive IgM antibodies against cytomegalovirus. In five of these the viral antigen was detected in peripheral leukocytes. Twenty patients had positive antibodies against Epstein Barr virus, and in 16 patients all serologic tests were negative. CONCLUSIONS: There is not a good correlation between antibodies against cytomegalovirus and the detection of its antigen in patients with acute infections.

GBV-RNA detection by polymerase chain reaction with several primer pairs.

The identification of specific genomic sequences of GB viruses (GBV) has made it possible to utilize the polymerase chain reaction (PCR) for evaluation of the viraemia. Several studies have demonstrated the RNA-GBV presence in sera from different patients amplifying several portions of the virus. In this investigation the PCR results when different regions of GBV (NS3, UTR and putative CORE and E1) were amplified in the same sample. In 245 samples studied there were two (0.8%) discordant results and the NS3 primer showed the greatest sensitivity. The lowest percentage of positivity was obtained with CORE-E1 primers. These results could be because the nucleocapside/E1 region was extremely variable in length and sequences, although degenerated primers and probes were used. Discordances were attributable to laboratory errors, variability in the viral genome, the presence of primer inhibitors in samples or a low viral load.

Reliability of four methods for the diagnosis of acute infection by Epstein-Barr virus.

We studied the reliability of new indirect tests in the diagnosis of acute infection by Epstein-Barr virus (EBV). Studied for all samples were method 1, the heterophil antibodies (Abs) (Monolatex, Biokit, Germany); method 2, the IgM Abs to EBV with ELISA tests (antigen pools, Enzygnost, Behring-werke, Germany); method 3, EA (Biotest Diagnostics, Germany); and method 4, the IgG avidity test. The reliability of the four tests for the detection of primary infection by EBV was: sensitivity (method 1: 89.1%; method 2: 100%; method 3: 79.7%; method 4: 99%); specificity (method 1: 98%; method 2: 100%; method 3: 84%; method 4: 100%); positive predictive value (method 1: 97.6%; method 2: 100%; method 3: 73.6%; method 4: 100%), and negative predictive value (method 1: 90.7%; method 2: 100%; method 3: 84%; method 4: 99%). The IgG avidity test (method 4) is simple and automated in the laboratory and is very useful for ascertaining, from a single sample, the time since infection. It is criteria of recent primoinfection higher levels than 55% of IgG with low avidity for the antigen. The investigation of the Abs to antigen pools (method 2) by ELISA of virus had a high reliability, but the investigation of heterophil Abs by latex (method 1) and the Abs IgM to EA (method 2) were lacking in sensibility regarding their use in the diagnosis of the primoinfection.

Low prevalence of circulating anti-type 6 human herpes virus IgG-antibodies in Spanish children.

The prevalence of circulating anti-HHV-6 IgG-antibodies in an infant population, was investigated to assess the evolution of antibody titres from birth to adulthood. Endpoint titration was done by indirect immunofluorescence, in 525 samples of serum from children, healthy adults and pregnant women. In the children, seropositivity increased from the age of 6 months, and was highest (56.52%) between 7 months and 1 year, suggesting that the initial infection occurred between 6 and 12 months of age.

Seroepidemiology of measles, mumps and rubella virus infections in normal children and adults in southern Granada, Spain: response to a vaccination programme.

A seroepidemiological study of measles, mumps and rubella virus infection in normal children and adults in southern Granada, Spain, and the response to a vaccination programme was carried out. Protection from the mumps and rubella virus was reduced in the group of 3 to 7 year-old children vaccinated at age 15 months indicating the need for revaccination against rubella as well as the mumps virus.

Are IgG antibody avidity assays useful in the diagnosis of infectious diseases? A review.

The reliability of tests for the identification of low avidity specific IgG in infectious diseases was investigated. The IgG antibody avidity assays were proposed in order to examine the probable aetiology, the accurate moment of primary infection and to distinguish between reactivation, reinfection or primary infection, in cases with false positive IgM or without specific IgM response. Such assays improve the usual serological techniques.

[Wallenberg syndrome in childhood secondary to the striking by lightening]. / Síndrome de Wallenberg en la infancia secundario a electrofulguración.

Wallenberg's Syndrome (WS) is exceptional in childhood. We present a case of a 10 year-old girl with a WS caused by an embolism in the right lateral portion of the medulla secondary to an electrofulguration, but with an unusual progressive outcome, developing clinical signs of medial medullar injury, leading even into a respiratory failure 30 days after admittance. She only became stable after surgical lesion decompression. There was no evidence of vascular malformation, finding only a great oedema. The pathology only showed changes compatible with brain infarction. This case makes again clear the superiority of MRI upon CT-scan to diagnose a WS. We think that the unusual progression of the lesion was due to great medullar oedema found on surgery, involving the brain regional flow.

Circulating Candida antigens and antibodies: useful markers of candidemia.

To investigate the utility of the 48-kDa antigen from Candida albicans in its commercial form (Directigen; Becton Dickinson) and three other serodiagnostic methods (detection of one antigen by Pastorex Candida [Sanofi Diagnostics Pasteur] and detection of immunoglobulin G [IgG] and IgM antibodies to C. albicans blastoconidia [bioMerieux]) for diagnosis of invasive Candida infection, we conducted a prospective clinical trial among 10 patients with candidemia (group 1), 30 patients colonized by C. albicans (group 2), 20 patients with bacteremia (group 3), and 20 subjects without clinical or microbiological evidence of infection. The Directigen system was positive for at least one serum sample each from eight patients in group 1. In groups 2, 3, and 4, it was positive for only three patients. There was no reaction to the Pastorex system in any of the patients infected with or colonized by C. albicans or in the non-Candida-carrying controls. The IgG antibody concentration oscillated between 100 and 800 (mean, 510 +/- 268) IU/ml for the patients in group 1. In this group, eight patients had IgG antibody levels of > 400 IU/ml. The percentages of persons with IgG antibody levels of > 400 IU/ml in groups 2, 3, and 4 were 43.3, 0, and 0, respectively. Specific IgM antibody was present in all group 1 patients but not in those in groups 2, 3, and 4. The sensitivity and specificity of the Directigen test were 65 and 97.1%, respectively. For the Pastorex test, the sensitivity was 0%. The sensitivity of IgG antibodies was 80%, with a specificity of 81.4%, while the IgM antibodies were 100% specific and sensitive. Both the positive and negative predictive values of specific IgM antibodies appeared to be superior to those of the other three tests.

Acute meningoencephalitis as the sole manifestation of Q fever.

The case of a 25-year old man who presented with meningoencephalitis as the sole clinical manifestation of Q fever is described. Serological studies revealed the presence of IgM and IgG antibodies to Coxiella burnetii. The patient responded favourably to a ten-day course of i.v. ceftriaxone and was discharged without any neurological sequelae.