Neumonía bacteriémica por Pasteurella multocida sin contacto animal previo en paciente inmunocompetente / No disponible

Describimos el caso clínico de un paciente que acude a nuestro centro hospitalario por síntomas infecciosos y se diagnostica de neumonía con aislamiento en hemocultivos de Pasteurella multocida. La curiosidad de este diagnóstico radica en el hecho de que Pasteurella multocida es un microorganismo que coloniza el tracto gastrointestinal y respiratorio de una gran variedad de mamíferos y aves, que constituyen su principal reservorio. Sin embargo no es habitual su aislamiento en humanos y tampoco que sea el causante de una neumonía bacteriémica sin haber contacto con animales ni estado de inmunosupresión

We describe the clinical case of a patient who came to our hospital presenting infectious symptoms, who was diagnosed with pneumonia with isolated Pasteurella multocida growth in blood cultures. The curiosity of this diagnosis lies in the fact that Pasteurella multocida is a microorganism that colonizes the gastrointestinal and respiratory tract in a large variety of mammals and birds, which are its main reservoir. Whilst this isolation is unusual in humans, it is seldom the cause of a bacteremic pneumonia without contact with animals or a state of immunosuppression

Neumomediastino espontáneo: ¿más frecuente de lo que pensamos? / Spontaneous pneumomediastinum in Primary Care: more common than we think?

El neumomediastino es infrecuente en Pediatría, posiblemente se deba a que es un cuadro infradiagnosticado. Los síntomas clásicos son disnea y dolor torácico de aparición brusca, así como enfisema subcutáneo en algunas ocasiones. Para su diagnóstico suele bastar con una radiografía simple de tórax. El tratamiento es conservador en la mayoría de los casos, con analgesia oral y reposo. Ya que la evolución suele ser benigna, existiendo bajo riesgo de complicaciones o recurrencias, son innecesarias pruebas complementarias, así como hospitalizaciones. Presentamos dos casos clínicos que acuden a consulta por cuadros diferentes, con un diagnóstico final similar (AU)

Pneumomediastinum is uncommon in Pediatrics, possibly due to an underdiagnosed pathology. The classic symptoms are shortness of breath and chest pain of sudden onset and sometimes subcutaneous emphysema. Usually it is sufficient with a simple chest radiograph for the diagnosis. Treatment is conservative in most cases, with oral analgesia and rest. Since evolution is usually benign, and there is low risk of complications or recurrences, additional tests and hospitalizations are unnecessary. We present two clinical cases who consult for different pathologies, but finally had the same diagnosis (AU)

Osteopetrosis autosómica dominante: a propósito de 3 casos y una mutación / Autosomal dominant osteopetrosis: A presentation of 3 cases and a new gene mutation

La osteopetrosis (OP) es una rara enfermedad ósea congénita producida por una alteración funcional en los osteoclastos con incapacidad para la reabsorción ósea normal, produciéndose un aumento de la densidad mineral ósea y esclerosis ósea. Puede clasificarse en autosómica recesiva (OPTB) o autosómica dominante (OPTA1-2). Existe una gran variabilidad clínica de la enfermedad, desde asintomática a letal en los primeros meses de vida, con expresividad variable en los miembros de una familia. Su diagnóstico es principalmente clínico con confirmación genética, y el tratamiento es sintomático. Se presentan una serie de casos de OP, con el hallazgo de una nueva mutación en el gen LRP5 causante de OPTA1 en uno de ellos

Osteopetrosis (OP) is a congenital bone disease which is caused by a functional disorder in osteoclasts with inability for normal bone resorption, leading to increased bone mineral density and bone sclerosis. It can be classified into different groups according to their clinical and their genetic characteristics: autosomal recessive with several subtypes (OPTB) or autosomal dominant type 1 or 2 (OPTA1-2). There is a wide clinical variability of the disease, from asymptomatic to lethal in the first months of life, with variable expressivity in the family members. Diagnosis is mainly clinical with genetic confirmation of the OP, and treatment is symptomatic. Three cases of OP are presented, with the discovery of a new gene mutation in LRP5 which caused OPTA1 in one of them

[Autosomal dominant osteopetrosis: a presentation of 3 cases and a new gene mutation]. / Osteopetrosis autosómica dominante: a propósito de 3 casos y una mutación.

Osteopetrosis (OP) is a congenital bone disease which is caused by a functional disorder in osteoclasts with inability for normal bone resorption, leading to increased bone mineral density and bone sclerosis. It can be classified into different groups according to their clinical and their genetic characteristics: autosomal recessive with several subtypes (OPTB) or autosomal dominant type 1 or 2 (OPTA1-2). There is a wide clinical variability of the disease, from asymptomatic to lethal in the first months of life, with variable expressivity in the family members. Diagnosis is mainly clinical with genetic confirmation of the OP, and treatment is symptomatic. Three cases of OP are presented, with the discovery of a new gene mutation in LRP5 which caused OPTA1 in one of them.

Tromboembolismo pulmonar en paciente afectado de nefropatía lúpica / Pulmonary thromboembolism in a child with lupus nephropathy

No disponible

Sepsis y meningitis neonatal por «Streptococcus bovis» biotipo I («S. gallolyticus» subsp. «gallolyticus»). Comunicación de un caso y revisión de la bibliografía / Neonatal sepsis and meningitis caused by "Streptococcus bovis" biotype I ("S. gallolyticus" subsp. "gallolyticus"). Report of a case and review of the literature

Streptococcus bovis es un microorganismo del grupo D no enterococo, que produce habitualmente infecciones en adultos inmunodeprimidos y, de forma excepcional, casos de infecciones invasivas en neonatos, generalmente causadas por la variante 2 del biotipo II. Es importante la correcta identificación microbiológica, ya que su tratamiento y pronóstico son muy diferentes respecto al resto de estreptococos. Presentamos el caso de un neonato de 9 días de vida, con un cuadro clínico de sepsis y meningitis con convulsiones y hemorragia intracraneal, aislamiento en sangre y en el líquido cefalorraquídeo de S. bovis biotipo I, y buena respuesta clínica al tratamiento con ampicilina y cefotaxima. Este caso es el primero registrado en nuestra unidad, y posiblemente también el primero documentado en la literatura según la revisión de la bibliografía realizada. Se comentan aspectos de interés de la afección (AU)

Streptococcus bovis is a nonenterococcal, group D streptococcus, which frequently causes infections in immunocompromised adults and exceptionally cases of invasive infections in neonates, often caused by the variant 2 of the biotype II. It is important the correct microbiological identification because the treatment and prognostic are very different from other streptococcus. We report a case of a 9-day-old neonate with sepsis and meningitis with seizures and intracranial bleeding, with CSF and blood isolation of S. bovis biotype I, with good response to ampicillin and cefotaxime treatment. This is the first case in our service and probably the first documented in the literature according to the bibliography review. We comment the most interesting aspects of the affection (AU)

Effect of progesterone on human zona pellucida sperm binding and oocyte penetrating capacity.

OBJECTIVE: To determine if sperm exposure to P produces an enhancement in its fertilizing capacity. DESIGN: Sperm from fertile donors were exposed to P at 0.1 and 1.0 microgram/mL for 1 or 24 hours. The effects on hyperactivated (HA) motility at 1 and 4 hours, acrosome reaction (as determined by Pisum sativum agglutinin or T6/antibody techniques), on human zona pellucida binding (by using the hemizona assay), and on the penetrating ability (by using the zona-free hamster ova assay) were evaluated. RESULTS: Exposure to P at 1.0 microgram/mL enhanced HA motility after 1 and 4 hours of P exposure, the acrosome reaction after 24 hours' incubation, the number of sperm bound/hemizona after 1-hour incubation, and the penetration rates in the hamster ova assay at both incubation intervals. CONCLUSION: Sperm exposure to P enhances its fertilizing capacity in fertile men, and further investigation is warranted as a possible treatment for male factor patients.

Evaluation of interceed(TC7) for reduction of postoperative adhesions in rabbits.

OBJECTIVE: To evaluate the effectiveness of Interceed(TC7) (Johnson and Johnson, New Brunswick, NJ) in the prevention of postoperative adhesions in a rabbit uterine horn model. Interceed(TC7) was tested in the presence and absence of absorbable suture. DESIGN, SETTING, PARTICIPANTS: Forty-one New Zealand white rabbits had lesions created on bilateral uterine horns at laparotomy. Lesions were randomly allocated to treatment with Interceed(TC7) or control. The effect of Interceed(TC7) was evaluated on sutured lesions (4-0 polyglactin 910; Ethicon, Inc., Somerville, NJ) as well as on open cut lesions (no sutures applied). MAIN OUTCOME MEASURES: Adhesion formation, using a grading system ranging from 0 to 3. RESULTS: Interceed(TC7)-treated animals in the sutured group (average adhesion score +/- SD = 2.15 +/- 1.3) did not differ from controls (average score +/- SD = 2.35 +/- 0.93) in adhesion formation, P = 0.47. Rabbits with open cut lesions treated with Interceed(TC7) (average adhesion score +/- SD = 1.89 +/- 1.1) did not differ from control animals (average score +/- SD = 1.83 +/- 1.2), P = 0.88. CONCLUSIONS: Interceed(TC7) was not an effective adhesioprophylactic agent in the presence or absence of nonreactive absorbable suture.

Effect of interleukin-1 on gamete interaction and mouse embryo development.

Early stages of endometriosis have been shown to be associated with infertility. The pathophysiology of this relationship is unclear. To determine if interleukin-1 (IL-1), a peritoneal macrophage product, has any effect on gamete interaction and early embryo development, human recombinant IL-1 was added to the coincubation of gametes in the sperm penetration assay (SPA), human zona pellucida assay (ZPPA) and culture medium (Ham's F-10) used for processing semen samples with the layering method, with analysis of velocity and motility after 24 hours. IL-1 was also added to mouse embryos (two cells) cultured for 72 hours. The results showed that IL-1 caused impairment of SPA and ZPPA when compared to control medium, without significant alterations in sperm velocity and motility. Also, IL-1 demonstrated significant inhibition of mouse embryo development. These results help explain subfertility associated with early stages of endometriosis.

Detection of endotoxin in human in vitro fertilization by the zona-free mouse embryo assay.

Endotoxin has been found to be a contaminant in human in vitro fertilization (IVF), leading to low pregnancy rates, mostly through embryo fragmentation. We wished to determine if standard quality control assays (one-cell and two-cell mouse embryo culture) were able to detect the presence of endotoxin and how they compared with the zona-free mouse embryo assays. Endotoxin was detected by the zona-free mouse embryo assays but not by the one- or two-cell mouse embryo assays. When excessive embryo fragmentation is noticed in the human IVF system, the use of zona-free mouse embryo assays is recommended.

Long-term preservation of blood samples for diagnosis of Trypanosoma cruzi infection.

Feasability and suitability for field research of a whole-blood preservation method was evaluated through the screening of anti-Trypanosoma cruzi antibodies in 1209 samples under different conditions. Antibody reactivity of paired samples from preserved capillary blood (CBP) and sera from venous blood (VBS) were studied by specific techniques. Over 96% concordance was found on indoor studies carried out with samples without storage or after 15 or 30 days preservation of CBP at 37 degrees C and VBS at -20 degrees C. Outdoor studies performed at field conditions, achieved a 92.1% concordance.

Monoclonal antibodies against the flagellar fraction of epimastigotes of Trypanosoma cruzi: immunoprotection against metacyclic trypomastigotes obtained by immunization of mice with an affinity-purified antigen.

Subcellular fractions of Trypanosoma cruzi (epimastigotes) were assayed in their capacity to induce protective or aggressive effects in experimental animals. The flagellar fraction showed the best immunoprotective properties without tissular aggression. Monoclonal antibodies were prepared from mice immunized with this fraction. One of them, FCH-F8-4, was able to neutralize the infectivity of bloodstream trypomastigotes, to produce complement-mediated lysis on cell culture-derived trypomastigotes and to recognize the surface of trypomastigotes and epimastigotes by immunofluorescence. FCH-F8-4 reacted in Western blotting with several epimastigote proteins ranging from 50 to 150 kDa, showing a more intense reactivity with 4 bands while it reacted with two molecules on trypomastigote preparations (15 and 48 kDa). Purified antibody was coupled to CNBr-activated Sepharose and used to purify antigens from epimastigote extracts. These antigens were used to immunize BALB/c mice in the presence of Bordetella pertussis as adjuvant. Animals were protected against a challenge with 10(3) metacyclic forms of T. cruzi (Tulahuén strain). Only 40% of immunized mice presented detectable parasites in blood after challenge. Parasitemia decreased 90% in relation to controls in those animals. Survival of immunized mice was 100% in all immunoprotection experiments. These results suggest that the epitope recognized by FCH-F8-4 present in the purified antigens keeps the protective characteristics of flagellar fraction and could be a candidate for the development of a vaccine against T. cruzi infection.

Usefulness of serology for the evaluation of Trypanosoma cruzi transmission in endemic areas of Chagas' disease.

Thirteen communities from 7 Argentinian provinces were selected for the evaluation of serology as an indicator of transmission of Chagas disease. Of the communities appraised, 6 did not have a history of previous treatment with insecticides and 7 had received sporadic or continuous insecticide treatment. The inhabitants of 20% of the houses of each locality were studied by serology. The samples were obtained by finger pricking and 50 microliters of blood were mixed with 15 microliter of 50% glycerine solution in tissue culture media to be assayed by Indirect Hemagglutination and Indirect Immunofluorescence tests. In untreated areas, the prevalence of infection in infants 0-4 years old was 17.5%, reaching to over 22% for the 5-9 year old group, and to 33.3% in 10-14 year old individuals. The prevalence in treated and surveyed areas was 2.6% in 0-4 year old children, 5.4% in 5-9 year old and 6.2% in 10-14 year old youngsters. The differences between both areas were statistically significant (p less than 0.005). This study favors serology as a valid indicator for the evaluation of transmission of Chagas disease in rural areas.

Characterization by electrophoretic zymograms of 19 Trypanosoma cruzi clones derived from two chronic chagasic patients.

1. Electrophoretic patterns of aspartate aminotransferase, glucose-6-phosphate dehydrogenase, phosphoglucomutase, glucose-phosphate isomerase, malic enzyme and alcohol dehydrogenase have been analyzed in extracts from Trypanosoma cruzi, Tulahuén strain, 19 clones derived from isolates obtained from two chronic chagasic patients from Argentina and from Brazilian stocks Silvio X10/1 (zymodeme 1), Esmeraldo/1 (zymodeme 2), and CAN-III/1 (zymodeme 3). 2. The clones isolated from one of the patients were genetically heterogeneous. 3. Phosphoglucomutase and glucose phosphate isomerase patterns for the clones analyzed clearly differ from those of the Brazilian stocks. 4. Grouping of clones on the basis of isozyme patterns showed some correlation with that based on total DNA per organism. 5. Under the experimental conditions used, the polyacrylamide gel electrophoresis micromethod employed was advantageous over starch gel electrophoresis.

Monoclonal antibodies against the flagellar fraction of epimastigotes of Trypanosoma cruzi: complement-mediated lytic activity against trypomastigotes and passive immunoprotection in mice.

Trypanosoma cruzi, the causative agent of Chagas' disease, is widely spread in Central and South America. The present report describes three monoclonal antibodies (mAbs) directed against the flagellar fraction of epimastigotes (Ffe) of the parasite, Tulahuén strain. The three mAbs were of IgG1 isotype. Indirect immunofluorescence assays revealed that the three mAbs bind to epimastigotes, the FCH-F8-1 and -3 bind to blood trypomastigotes (BT) and FCH-F8-1 is the only one that binds to amastigotes. Three different proteins of the parasite were recognized by the mAbs in immunoprecipitation assays: an 85 kDa of BT with the FCH-F8-1 mAb, a 40 kDa of Ffe with the FCH-F8-2 mAb, and a 90 kDa of Ffe and of BT with the FCH-F8-3 mAb. Positive complement mediated lysis (CML) of BT and metacyclic forms, obtained from the insect vector feces, were shown by the FCH-F8-1, while FCH-F8-3 only showed CML against the metacyclic trypomastigotes. FCH-F8-2 did not mediate any CML activity. Passive transference of the mAbs to BALB/c mice conferred protection, in terms of survival, ranging from 50 (FCH-F8-2 and -3) to 80% (FCH-F8-1) against a challenge with 1 X 10(3) BT. These results suggest that FCH-F8-1 may be a useful tool to purify proteins in order to investigate their role in immunoprotection experiments.

Immunoprotection of mice against Trypanosoma cruzi with a lyophilized flagellar fraction of the parasite plus adjuvant.

The immunization with the flagellar (F) fraction from epimastigotes of Trypanosoma cruzi has been shown to protect mice against a challenge of bloodstream trypomastigotes of the parasite, both in terms of mortality and decrease in parasitemia. We have compared the immunoprotective properties of the fresh F fraction with those of a lyophilized F (LF) fraction, alone or together with Bordetella pertussis (Bp) as adjuvant. The best results were obtained with LF + Bp: after challenge with 1 X 10(3) metacyclic trypomastigotes, 100% of the mice immunized with LF + Bp survived, and 60% of them showed no signs of parasitemia. Only the animals in which patent parasitemia was demonstrated presented heart and muscle infiltrates.