[Human immunodeficiency virus infection in Guatemala]. / Infeccion por virus de inmunodeficiencia humana en Guatemala.

PIP: A prospective study of HIV seroprevalence was conducted in Guatemala City and Quetzaltenango between January 30, 1990, and June 30, 1991, to furnish a realistic idea of the magnitude of seroprevalence in Guatemala. Subjects included 305 patients with proven tuberculosis (TB), 500 consecutive patients in an emergency room, 600 military recruits from different parts of Guatemala, 500 consecutive patients at a prenatal clinic, and 300 women receiving emergency room treatment for complications of abortion. Participation was anonymous and confidential. Subjects ranged in age from 18 to 40 years. Seropositivity rates were 1% for the 305 TB patients, 1% for the 500 emergency room patients, 0.2% for the 600 military recruits, 0% for the 500 pregnant women, and 0.7% for the 300 postabortion patients. Seroprevalence was low, but the presence of risk factors suggests that it will increase in the future. Sexual activity begins at young ages. 71% of military recruits reported becoming sexually active by age 15. 45-80% of TB and emergency room patients and military recruits reported having more than one sexual partner at the time of the interview. Only 2-3% of women reported having more than one partner. Between 4% and 30.7% of the five groups reported a history of sexually transmitted diseases, of which one-third were ulcerative. 17% of TB patients and 2-3% in the other groups had received blood transfusions. Fewer than 20% in any group reported ever using condoms.^ieng

Protection of breast-fed infants against Campylobacter diarrhea by antibodies in human milk.

To investigate the role of breast-feeding in preventing diarrhea caused by Campylobacter jejuni, we followed 98 Mexican children prospectively for 2 years beginning at their birth. Attack rates of diarrhea in children less than 6 months of age who were not fed human milk were 2.3 times greater than those in children of the same age who were fed human milk. Breast-fed children remained free of diarrhea for a longer time than non-breast-fed children (p less than 0.0005). The diarrhea attack rate caused by C. jejuni for non-breast-fed infants was significantly greater (p less than 0.005) than that in the breast-fed group. Secretory IgA milk antibody titers against glycine acid-extractable antigen of C. jejuni were high in colostrum, decreased during the first month of breast-feeding, and generally persisted throughout lactation. Human milk consumed by children in whom Campylobacter diarrhea developed did not contain secretory IgA antibodies to the glycine acid-extractable common antigen of Campylobacter. This study shows an association between Campylobacter antibodies in human milk and prevention of diarrhea caused by Campylobacter.

High incidence of subclavian dialysis catheter-related bacteremias.

This retrospective cohort study reviews the incidence of bacteremia in 48 patients undergoing hemodialysis using subclavian vein dialysis catheters (SDC) as temporary vascular access. Twelve (25%) of these patients had catheter-related bacteremia, and the most frequently isolated organisms were coagulase-negative staphylococci. Three patients developed right-sided endocarditis and one of them died due to pulmonary embolism. The presence of possible risk factors for SDC-related bacteremia, including duration of catheterization and number of hemodialysis procedures, were not statistically different when patients with and without bacteremia were compared, with the exception of a significantly lower incidence of bacteremia among those patients receiving antibiotic therapy at the time of catheter insertion. The use of resterilized catheters was not a risk factor. Specific guidelines for SDC insertion and care were established and followed, after which the infection frequency was reduced to 7.5% (1 episode per 45.5 patient-weeks of catheter use) in this high-risk population.