Características clínico-epidemiológicas de los pacientes inmigrantes con infección por el VIH: estudio de 371 casos

Introducción: El número de pacientes inmigrantes infectados por el VIH ha aumentado en España en los últimos años y actualmente representan una parte importante de la epidemia. El objetivo de nuestro estudio es conocer las características clínico-epidemiológicas de los inmigrantes con infección VIH atendidos en una unidad monográfica en Madrid. Material y métodos: Estudio retrospectivo en el que se incluyen todos los pacientes nacidos en un país distinto de España atendidos en una unidad monográfica de VIH en Madrid entre 1992 y 2009. Resultados: Un total de 371 pacientes incluidos (53,1% latinoamericanos, 24,5% africanos subsaharianos, 22,4% otros), de los que el 60% eran varones. Incremento desde el 0,3% de los nuevos pacientes en 1992 al 49,2% en 2009. El principal motivo para realizarse la prueba del VIH fue el embarazo/parto en las mujeres (32,7%) y presentar una enfermedad de categoríaB en los hombres (17,4%). En el 92% el mecanismo de transmisión era sexual. La enfermedad asociada a sida más frecuente fue la tuberculosis. El porcentaje de pacientes con IgG positiva para VHA, VHC, Toxoplasma, Treponema, CMV y VVZ fue, respectivamente, del 90, del 7,7, del 60, del 26,7, del 96 y del 95%. El 5,4% tenían un Ags-VHB positivo y el 17%, un PPD positivo. En el colectivo de hombres que mantienen sexo con hombres el 62% tuvieron al menos un episodio de lúes. La prevalencia de HLA-B5701 fue del 6, del 0,9 y del 3,8% en la raza caucásica, amerindia y negra, respectivamente. Conclusiones: Los pacientes inmigrantes con infección por el VIH suponen un porcentaje importante de los nuevos pacientes. Se trata de un grupo heterogéneo en cuanto a sus características clínicas y epidemiológicas.1.478 JCR (2012) Q4, 89/116 Microbiology, 57/69 Infectious disease

Universal promoter scanning by Pol II during transcription initiation in Saccharomyces cerevisiae

Abstract Background The majority of eukaryotic promoters utilize multiple transcription start sites (TSSs). How multiple TSSs are specified at individual promoters across eukaryotes is not understood for most species. In Saccharomyces cerevisiae, a pre-initiation complex (PIC) comprised of Pol II and conserved general transcription factors (GTFs) assembles and opens DNA upstream of TSSs. Evidence from model promoters indicates that the PIC scans from upstream to downstream to identify TSSs. Prior results suggest that TSS distributions at promoters where scanning occurs shift in a polar fashion upon alteration in Pol II catalytic activity or GTF function. Results To determine the extent of promoter scanning across promoter classes in S. cerevisiae, we perturb Pol II catalytic activity and GTF function and analyze their effects on TSS usage genome-wide. We find that alterations to Pol II, TFIIB, or TFIIF function widely alter the initiation landscape consistent with promoter scanning operating at all yeast promoters, regardless of promoter class. Promoter architecture, however, can determine the extent of promoter sensitivity to altered Pol II activity in ways that are predicted by a scanning model. Conclusions Our observations coupled with previous data validate key predictions of the scanning model for Pol II initiation in yeast, which we term the shooting gallery. In this model, Pol II catalytic activity and the rate and processivity of Pol II scanning together with promoter sequence determine the distribution of TSSs and their usage.http://deepblue.lib.umich.edu/bitstream/2027.42/173852/1/13059_2020_Article_2040.pd

Causes of fever in returning travelers: a European multicenter prospective cohort study

BACKGROUND: Etiological diagnosis of febrile illnesses in returning travelers is a great challenge, particularly when presenting with no focal symptoms [acute undifferentiated febrile illnesses (AUFI)], but is crucial to guide clinical decisions and public health policies. In this study, we describe the frequencies and predictors of the main causes of fever in travelers. METHODS: Prospective European multicenter cohort study of febrile international travelers (November 2017-November 2019). A predefined diagnostic algorithm was used ensuring a systematic evaluation of all participants. After ruling out malaria, PCRs and serologies for dengue, chikungunya and Zika viruses were performed in all patients presenting with AUFI </= 14 days after return. Clinical suspicion guided further microbiological investigations. RESULTS: Among 765 enrolled participants, 310/765 (40.5%) had a clear source of infection (mainly traveler's diarrhea or respiratory infections), and 455/765 (59.5%) were categorized as AUFI. AUFI presented longer duration of fever (p < 0.001), higher hospitalization (p < 0.001) and ICU admission rates (p < 0.001). Among travelers with AUFI, 132/455 (29.0%) had viral infections, including 108 arboviruses, 96/455 (21.1%) malaria and 82/455 (18.0%) bacterial infections. The majority of arboviral cases (80/108, 74.1%) was diagnosed between May and November. Dengue was the most frequent arbovirosis (92/108, 85.2%). After 1 month of follow-up, 136/455 (29.9%) patients with AUFI remained undiagnosed using standard diagnostic methods. No relevant differences in laboratory presentation were observed between undiagnosed and bacterial AUFI. CONCLUSIONS: Over 40% of returning travelers with AUFI were diagnosed with malaria or dengue, infections that can be easily diagnosed by rapid diagnostic tests. Arboviruses were the most common cause of AUFI (above malaria) and most cases were diagnosed during Aedes spp. high season. This is particularly relevant for those areas at risk of introduction of these pathogens. Empirical antibiotic regimens including doxycycline or azithromycin should be considered in patients with AUFI, after ruling out malaria and arboviruses

HIV and tuberculosis co-infection among migrants in Europe: A systematic review on the prevalence, incidence and mortality.

International human migration has been rapidly growing. Migrants coming from low and middle income countries continue to be considerably vulnerable and at higher risk for infectious diseases, namely HIV (Human Immunodeficiency Virus) and tuberculosis (TB). In Europe, the number of patients with HIV-TB co-infection has been increasing and migration could be one of the potential driving forces.This systematic review aims to improve the understanding on the burden of HIV-TB co-infection among migrants in Europe and to assess whether these populations are particularly vulnerable to this co-infection compared to nationals.MEDLINE®, Web of Science® and Scopus® databases were searched from March to April 2016 using combinations of keywords. Titles and abstracts were screened and studies meeting the inclusion criteria proceeded for full-text revision. These articles were then selected for data extraction on the prevalence, incidence and mortality.The majority of HIV-TB prevalence data reported in the analysed studies, including extrapulmonary/disseminated TB forms, was higher among migrant vs. nationals, some of the studies even showing increasing trends over time. Additionally, while HIV-TB incidence rates have decreased among migrants and nationals, migrants are still at a higher risk for this co-infection. Migrants with HIV-TB co-infection were also more prone to unsuccessful treatment outcomes, death and drug resistant TB. However, contradicting results also showed lower mortality compared to nationals.Overall, a disproportionate vulnerability of migrants to acquire the HIV-TB co-infection was observed across studies. Such vulnerability has been associated to low socioeconomic status, poor living conditions and limited access to healthcare. Adequate social support, early detection, appropriate treatment, and adequate access to healthcare are key improvements to tackle HIV-TB co-infection among these populations