20 research outputs found
Profilaxis antibiótica en cirugía
Existe una abundantísima documentación en la literatura acerca de la eficacia de los
antibióticos utilizados profilácticamente en cirugía (1-10). Probablemente lo más útil
para el trabajo diario de un hospital sea la adopción de pautas concretas que permitan
ser evaluadas periódicamente a través de la colaboración, entre otros, de anestesistas,
cirujanos y microbiólogos (11,12). En esta línea hemos revisado, de una manera
intencionadamente esquemática, diversas facetas relativas a la profilaxis antibiótica en
cirugía. Para ello comentaremos algunos aspectos generales de profilaxis de la
infección postquirúrgica, unas breves normas para la utilización profiláctica de
antibióticos y resumiremos determinadas indicaciones en función del tipo de
intervención
Rickettsia slovaca Infection: DEBONEL/TIBOLA
Producción CientíficaThis study describes the epidemiological, clinical, and microbiological characteristics of a new tick-borne disease in Spain—Dermacentor-borne necrosis erythema lymphadenopathy (DEBONEL). The clinical presentations include an eschar at the site of the tick bite, surrounded by an erythema and painful regional lymphadenopathy. The disease appears during the colder months and its vector is Dermacentor marginatus (D. marginatus). From January 1990 to December 2004, 54 patients presented at Hospital of La Rioja with these clinical and epidemiological data. The ratio of females to males was 32/22. The average age was 37 years. In all cases tick bites were located on the upper body (90% on the scalp). The median incubation period was 4.7 days. Signs and symptoms were mild in all cases. Only a small number of patients presented mild and nonspecific abnormalities in a complete blood cell count and mild elevation of erythrocyte sedimentation rates and C-protein reactive and liver enzyme levels. Serological evidence of acute rickettsiosis was observed in 19 patients (61%). In 29% sera tested by polymerase chain reactions (PCRs) were positive. The sequence obtained from a PCR product revealed 98% identity with Rickettsia sp. strains RpA4, DnS14, and DnS28. All ticks removed from patients were PCR-positive. Sequencing showed 8 of them identified as R. slovaca and 2 as Rickettsia sp. strains RpA4, DnS14, and DnS28
HTLV-1 infection in solid organ transplant donors and recipients in Spain
Background: HTLV-1 infection is a neglected disease, despite infecting 10–15 million people worldwide and
severe illnesses develop in 10% of carriers lifelong. Acknowledging a greater risk for developing HTLV-1
associated illnesses due to immunosuppression, screening is being widely considered in the transplantation
setting. Herein, we report the experience with universal HTLV testing of donors and recipients of solid organ
transplants in a survey conducted in Spain.
Methods: All hospitals belonging to the Spanish HTLV network were invited to participate in the study. Briefly, HTLV
antibody screening was performed retrospectively in all specimens collected from solid organ donors and recipients
attended since the year 2008.
Results: A total of 5751 individuals were tested for HTLV antibodies at 8 sites. Donors represented 2312
(42.2%), of whom 17 (0.3%) were living kidney donors. The remaining 3439 (59.8%) were recipients. Spaniards
represented nearly 80%.
Overall, 9 individuals (0.16%) were initially reactive for HTLV antibodies. Six were donors and 3 were recipients.
Using confirmatory tests, HTLV-1 could be confirmed in only two donors, one Spaniard and another from
Colombia. Both kidneys of the Spaniard were inadvertently transplanted. Subacute myelopathy developed
within 1 year in one recipient. The second recipient seroconverted for HTLV-1 but the kidney had to be
removed soon due to rejection. Immunosuppression was stopped and 3 years later the patient remains in
dialysis but otherwise asymptomatic.
Conclusion: The rate of HTLV-1 is low but not negligible in donors/recipients of solid organ transplants in
Spain. Universal HTLV screening should be recommended in all donor and recipients of solid organ
transplantation in Spain. Evidence is overwhelming for very high virus transmission and increased risk along
with the rapid development of subacute myelopath
Rapid subacute myelopathy following kidney transplantation from HTLV-1 donors: role of immunosuppresors and failure of antiretrovirals
Two kidney transplant recipients from a single donor became infected with HTLV-1 (human T-lymphotropic virus type 1) in Spain. One developed myelopathy 8 months following surgery despite early prescription of antiretroviral therapy. The allograft was removed from the second recipient at month 8 due to rejection and immunosuppressors discontinued. To date, 3 years later, this patient remains infected but asymptomatic. HTLV-1 infection was recognized retrospectively in the donor, a native Spaniard who had sex partners from endemic regions. Our findings call for a reappraisal of screening policies on donor-recipient organ transplantation. Based on the high risk of disease development and the large flux of persons from HTLV-1 endemic regions, pre-transplant HTLV-1 testing should be mandatory in Spain
Relation of hepatitis C virus genotypes to risk factors and hepatic disease in Spanish patients
Producción CientíficaObjective:To ascertain the prevalence of hepatitis C virus (HCV) genotypes in Spain and their distribution by risk factors.
Methods:The study covered 216 patients with hepatitis C. Of these, 63 were intravenous drug users (IVDU), 44 had received transfusions, and 30 were hemodialyzed, and in 79 the risk factors were unknown. Antibodies against HCV were detected by second-generation enzyme immunoassay (EIA) and confirmed by immunoblot. HCV RNA presence was investigated by reverse transcription-polymerase chain reaction (RT-PCR), and a reverse hybridization test of the amplifications was used for the genotyping.
Results:The most frequently encountered genotypes were 1b (48.1%), 1a (21.3%) and 3a (11.1%). HCV genotypes 1a (42.8%) and 3a (20.6%) were the most prevalent genotypes in IVDU patients, while 1b was the most frequent in patients with unknown risk factors (62.0%), transfused patients (68.1%) and hemodialyzed patients (50.0%). Mixed infections were detected in nine cases (4.1%); three appeared in IVDU patients (4.7% of the total IVDUs), two in transfused patients (4.5%) and four (50%) in patients with unknown risk factors. No statistically significant differences were found in average ages of the IVDU patients with different genotypes. Non-IVDU patients having genotype 3a presented the lowest average age of all. No significant statistical differences were observed in alanine aminotransferase levels among patient groups with different genotypes (p >0.05 in all cases). Subtype 1b was present in six of the seven cases of cirrhosis (85.7%) and in nine of the 18 cases of active chronic hepatitis (50.0%)