Diagnóstico microbiológico de las micosis invasoras

The prognosis of invasive fungal infections (IFI) depends on the speed of diagnosis and treatment. Conventional diagnostic methods are of low sensitivity, laborious and too slow, leading to the need for new, faster, and more efficient diagnostic strategies.There are several techniques for diagnosing a candidemia that are faster than the conventional blood culture (BC). Once yeast growth in BC is detected, species identification can be speeded up by mass spectrometry (30 minutes), commercialised molecular techniques (60-80 minutes) or fluorescent in situ hybridization (90 minutes). The combined detection of biomarkers (antimicellium, mannan and anti-mannan or β-glucan) has shown to be of greater use than their individual use. Commercialised nucleic acid amplification techniques (Septifast®, T2Candida®) are very reliable alternatives to BC. The detection of the capsular antigen of Cryptococcus, by means of latex agglutination or immuno-chromatography, is a valuable technique for cryptococcosis diagnosis.Direct microscopic examination and culture of representative specimens is used for the conventional diagnosis of IFI by filamentous fungi. Detection of galactomannan and β-glucan are considered diagnostic criteria for probable invasive aspergillosis and probable IFI, respectively, despite the lack of specificity of the latter. The detection of fungal volatile organic compounds in breath is an interesting diagnostic strategy in pulmonary infections. Although widely used, nucleic acid detection techniques are not considered diagnostic criteria for IFIs caused by moulds in consensus documents, due to their lack of standardisation. However, they are the only alternative to culture methods in invasive infections by Scedosporium/Lomentospora, Fusarium, zygomycetes, or dematiaceous fungi.     

Valoración de la utilidad del test de estimulación intraarterial con calcio en el diagnóstico de localización del hiperinsulinismo endógeno

Background and objectiveThe aim of this study was to assess the utility of arterial calcium stimulation with hepatic venous sampling (ASVS) in the localization of tumors in patients with endogenous hyperinsulinism not detected with other methods.Patients and methodsWe performed a retrospective study of 26 patients admitted to our hospital for hypoglycemia who underwent ASVS because the source of hyperinsulinism was not clearly identified by other imaging techniques. The histopathological result in patients who underwent a surgical procedure was considered the reference for statistical study of the accuracy of this technique. Statistical analysis was performed by comparing proportions with the chi-squared test with Yates’ correction for contingency tables, and Cohen′s kappa coefficient as a measure of interrater agreement between two observations.ResultsSurgery was performed in 17 patients, 13 with positive ASVS and the remaining four with negative results. An insulinoma was removed in 12 patients, and 10 of these were detected in the ASVS. A total of 76.9 % of positive ASVS tests corresponded to a histological diagnosis of insulinoma, and 83% of these insulinomas were positive in ASVS. This association was statistically significant (chi cuadrado = 7.340; p = 0.012). Two of three patients with nesidioblastosis had a positive response in the ASVS. A good and statistically significant agreement was obtained between histopathologic diagnosis and ASVS results (κ=0.556, p = 0.007).ConclusionsASVS is a useful procedure in the localization diagnosis of endogenous hyperinsulinism not detected by other imaging tests. This technique allows tumors in the pancreatic gland to be identified and may be useful in the choice of the surgical technique to be used.     

Evaluación de la realización del cribado del pie diabético en Atención Primaria

AimTo ascertain whether patients with type 2 diabetes are screened for diabetic foot, and to analyze the factors related to patients and centers associated to performance of such screening.Material and methodsA multicenter, epidemiological, cross-sectional study was conducted. The clinical records of 443 patients with type 2 diabetes monitored at Primary Care for at least 12 months were reviewed. Demographic and healthcare variables and characteristics of the primary care center were recorded.ResultsIn the previous year, 51.2% of patients had been trained on foot self-care, 56.4% had undergone foot inspection, 39.5% had been examined with a monofilament, and palpation of peripheral pulses and measurement of the ankle-brachial index were performed in 45.8 and 10.1% of patients, respectively. Diabetic foot screening (inspection, monofilament testing, and palpation of peripheral pulses) was performed in 37% of study patients. Ulcer risk stratification was done in 12.4% of patients. A significant association was found between diabetic foot screening and presence of foot deformities (P < .001), history of neuropathy (P = .005), and history of peripheral artery disease (P < .05). Screening was also associated to some characteristics of the center, such as reception of information about goal achievement (P < .001) and economic incentives for goal attainment (P < .001).ConclusionsCompliance with diabetic foot screening and ulcer risk stratification in patients with type 2 diabetes in Primary Care was poor.     

Absence of asymptomatic malaria in schoolchildren of Quibdó, Chocó

Asymptomatic malaria is characteristic of high intensity transmission areas in Africa but unusual in low transmission areas in Latin America. Nevertheless, asymptomatic malaria has been reported to be frequent in areas in Latin America with high and moderate intensity of transmission. Asymptomatic malaria can affect both individuals who carry parasites and are cryptic carrier reservoirs for the community. Individuals chronically infected with malaria parasites are usually unidentifiable by most malaria control programmes. In order to identify whether asymptomatic individuals harboring malaria parasites are an important reservoir of infection in Quibdó, Chocó, the prevalence of asymptomatic malaria was assessed in schoolchildren. This study was part of a major study of the epidemiology of malaria in Quibdó. A total of 255 children from 5 schools were examined, of which 223 were included in the analysis. Children reported headache (34%), cough (32%), and diarrhoea (9%). None of the children presented a positive thick smear. In addition, IFA tests in a subsample of 25 children were negative. By these criteria, the prevalence of asymptomatic malaria in Quibdó schoolchildren is 0% (95%C.I.: 0.0-1.4). Although asymptomatic malaria in adults possibly occurs, a very low prevalence is predicted.     

Lesiones histoplasmóticas autópsicas como índice epidemiológico de la enfermedad en Los Andes Venezolanos

Resumen En 244 autopsias de los años 1961, 1962 y 1963 de sujetos de más de 2 años de edad fué encontrado un 25% de casos con lesiones histoplasmóticas, en su gran mayoría de carácter residual, en pulmones y ganglios linfáticos. Esta cifra corresponde exactamente al porcentaje de reactores positivos a la prueba de histoplasmina en la población de nuestra región. Fueron corroborados los resultados deStraub &Schwarz, quienes en Cincinnati/Ohio encontraron la misma concomitancia entre los resultados de estos métodos de estudio, ambos igualmente valiosos para determinar el indice epidemiológico de histoplasmosis en una zona determinada.Puesto que en nuestros estudios no fueron aplicadas las mismas técnicas completas como en Cincinnati las cifras positivas en nuestro ambiente pueden eventualmente ser más altas, pero no alcanzan las cifras aún más elevadas, reportadas de otras zonas de Venezuela. En nuestro material el número de casos con lesiones histoplasmóticas antiguas múltiples en el pulmón, que sugieren ser primarios, era mayor que en la primera serie deStraub &Schwarz. Parece que entre nosotros la infección tiene lugar en períodos más tempranos de la vida que en EEUU de Norteamérica.El más alto índice de infección, de casi 50%, fué encontrado en personas provenientes de la región de la Cuenca del Lago de Maracaibo, disminuyendo algo en los valles de baja altura de las montañas y llegando a cifras bajas en los lugares de mayor altura.

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Summary In 244 autopsies in patients from 2 years of age on, in 1961, 1962 and 1963 histoplasmic lesions were found in 25% of all cases, mostly residual foci in lungs and lymph nodes. This percentage is exactly the same as the percentage of histoplasmin sensitivity in our environment. Thus, the results ofStraub &Schwarz who found the same percentage of anatomic lesions and histoplasmin reactors in Cincinnati, Ohio, were confirmed in our material. Morphologic methods in autopsies are a valuable tool for epidemiologic investigations regarding histoplasmosis.Since a more exact technique of examination was applied in Cincinnati, it is probable that the positive percentage in our environment is even higher. A higher number of multiple residual histoplasmotic foci in the lungs was found in our series in comparison with the first material ofStraub &Schwarz. Multiple histoplasmic foci in some of these cases may be due to primary infection. Infection withH. capsulatum occurs apparently in our environment more frequently in younger persons.The highest infection rate of almost 50% was found in patients who lived in the tropical lowlands near the Lake of Maracaibo and the Panamerican Highway. A lower rate occurred in the mountain valleys up to approximately 3000 feet of altitude, and decreased even more in higher altitudes.

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Zusammenfassung In 244 Sektionen vom 2. Lebensjahr an aus den Jahren 1961, 1962 und 1963 wurde in 25% aller Fälle Histoplasmose in Form von Residualläsionen in Lungen und Lymphknoten gefunden. Diese Zahl entspricht genau dem Prozentsatz der Bevölkerung in unserer Gegend, die positiv auf Histoplasmin reagiert. Damit werden die Befunde vonStraub &Schwarz, die an Autopsien in Cincinnati, Ohio erhoben wurden, bestätigt. Neben der Histoplasminreaktion ist es auch mittels anatomischer Untersuchungen möglich, Aussagen über das Ausmass der Infektion mitHistoplasma capsulatum in einer bestimmten Gegend zu machen.Da bei den Untersuchungen in Cincinnati genauere Untersuchungsmethoden zur Anwendung kamen, ist es möglich, dass der Prozentsatz unserer positiven Fälle eher noch höher liegt. Die Zahl unserer Fälle mit multiplen residualen Histoplasmoseherden in den Lungen ist noch höher als in der ersten Untersuchungsserie vonStraub &Schwarz. Es könnte sich in einem Teil der Fälle durchaus um multiple Primärkomplexherde handeln. Anscheinend findet die Infektion mitH. capsulatum bei uns in früheren Lebensaltern statt.Die höchste Infektionsrate von fast 50% wurde in Personen aus den gegen den Maracaibosee zu gelegenen tropischen Gebieten gefunden. Sie war etwas geringer in den Gebirgstälern bis zu etwa 1000 m Höhe und gering in Gebieten grösserer Höhe.