Biomedical subjects
Publications and source records attributed to J A Oteo.
DEBONEL/TIBOLA is a tick-borne acute/sub-acute infection transmitted in our environment by Dermacentor marginatus and mainly caused by Rickettsia slovaca. The aim of our study was to know the effect of starting early treatment in the course of the DEBONEL/TIBOLA.
Our aim was to identify variants of Anaplasma phagocytophilum 16S rRNA gene sequences among products amplified from Ixodes ricinus collected in La Rioja, Spain. A. phagocytophilum AP-variant 1, reported as non-pathogenic, was detected in 12 samples (two adults and ten nymphs). This finding could justify the low incidence of human anaplasmosis in our area, despite the high prevalence of A. phagocytophilum in ticks.
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This paper describes the epidemiological and clinical features of a tick-borne disease differing somewhat from other tick-borne diseases found previously in Spain. All patients were bitten by Dermacentor marginatus or a large tick. The clinical features include a crustaceous or necrotic lesion at the site of the tick's attachment, surrounded by an erythema (erythema migrans-like) and painful regional lymphadenopathies. The probable aetiological agent is Rickettsia slovaca. Similar cases have been reported in other European countries.
Ticks are obligate haematophagous acarines that parasitise every class of vertebrate (including man) and have a worldwide distribution. An increasing awareness of tick-borne diseases among clinicians and scientific researchers has led to the recent description of a number of emerging tick-borne bacterial diseases. Since the identification of Borrelia burgdorferi as the agent of Lyme disease in 1982, 11 tick-borne human bacterial pathogens have been described in Europe. Aetiological diagnosis of tick-transmitted diseases is often difficult and relies on specialised laboratories using very specific tools. Interpretation of laboratory data is very important in order to establish the diagnosis. These guidelines aim to help clinicians and microbiologists in diagnosing infection transmitted by tick bites and to provide the scientific and medical community with a better understanding of these infectious diseases.
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Ehrlichiosis comprises a group of emerging tick-borne infectious diseases caused by obligate intracellular Gram-negative bacteria that infect leukocytes. Infections caused by members of the genus Ehrlichia have been described in animals and humans, but to date there are no convincing reports of the presence of other types of human ehrlichiosis different from human granulocytic ehrlichiosis (HGE) in Europe. The European vector is the same as that of Lyme borreliosis, the hard tick Ixodes ricinus, and HGE has a similar epidemiology to that of Borrelia burgdorferi infection. Across Europe, I. ricinus is infected to a variable extent (0.4-66.7%) with the causative agent Ehrlichia (Anaplasma) phagocytophila genogroup, and since its first description in Slovenia in 1997, details of 15 patients have been published. Diagnosis requires careful consideration of all circumstances and symptoms (history of tick bite and the presence of a flu-like syndrome with variable degrees of anemia, thrombocytopenia, and leukopenia, and elevated liver enzymes). Some differences can be seen between US and European HGE patients. European HGE cases have a less severe course, and the presence of morulae is uncommon. In Europe, verification of HGE has been based on PCR and immunofluorescence antibody tests, because no isolation from humans has been reported.
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In order to estimate the risks of human granulocytic ehrlichiosis (HGE) in an endemic area for Lyme disease in the North of Spain (La Rioja), we collected and investigated by PCR specific to the E. phagocytophila group DNA, a total of 6870 Ixodes ricinus ticks. We also used an indirect immunofluorescence (IFI) test to study the presence of antibodies to the HGE agent in 147 human serum samples including patients with Lyme disease (LD), forestry workers, and persons with history of previous tick bite. Fifty serum samples from healthy people resident in urban areas and with no history of tick-bite disorder and without tick exposure were used as controls. Four of 76 adults and 49 of 203 nymphs pools carried E. phagocytophila DNA. This result, and the finding of 1.4% of sera reacting in the IFI test confirms that this tick-borne agent is present in La Rioja, and that humans show evidence of contact with it. HGE should be considered in the differential diagnosis of flu-like syndromes in the study area in the north of Spain.
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OBJECTIVE: To identify M. tuberculosis infection in HIV patients by use of PPD and an ELISA test detecting the presence of antibodies against antigen A-60 of M. bovis. METHODS: 116 incoming HIV patients were classified according to the CDC. The status of M. tuberculosis infection was probed with PPD (RT-23) and the state of anergy was estimated by a Multitest CM1 (Multitext). The presence of circulating antibodies of the IgG class against antigen A-60 was analysed by an ELISA. The clinical course of the patients was followed for 24 month. RESULTS: A positive serology (A-60) was found in 52.58% of the patients, coinciding with 70.45% of the positive PPD (p < 0.003). This statical observation was found when we studied all of the individuals, and those with more than 500 CD4 lymphocytes. The Multitext was positive in 11.11% of the patients with PPD (-), all of them without antibodies against A-60. However, 42.2% of the patients who were PPD and Multitext (-), had circulating antibodies against A-60. The following up of the patients during 24 months allowed the detection of 7 news cases of pulmonary tuberculosis, 4 of them had a positive A-60 serology, and 4 were anergy. CONCLUSIONS: HIV patients with M. tuberculosis infection have circulating antibodies against A-60 antigen of M. bovis with independence of their immunity status. In anergic patients the presence of this antibodies can be an useful tool for rationalizing the prophylaxis against M. tuberculosis. A seropositivity (A-60) indicates as well as does PPD a previous contact with M. tuberculosis.
Tuberculosis (TB) is one cause of pericardial disease. In order to know the incidence of tuberculous pericardial effusion (TPE) in patients with pulmonary tuberculosis (PT), the factors associated with their presence and whether human immunodeficiency virus (HIV) patients have a higher risk, we analyzed different parameters and performed an echocardiography to evaluate the presence of TPE. The incidence of TPE was 14.1%, and the presence of pleural effusion was associated with TPE (OR 24.39). HIV patients do not have a higher risk of TPE, independently of immunosuppression. It is necessary to eliminate the presence of TPE in patients with PT, mainly in those with pleural effusion.
BACKGROUND: Bartonella henselae infections are closely related to numerous clinical infections of growing interest in Spain. Since immunosuppressed patients are a potential risk group for infection by this bacteria, the aim of the present was to study the seroepidemiology of B. henselae infection in a risk group (patients with HIV infection) and in a control group (donors). PATIENTS AND METHODS: In October, 1997, antibodies versus B. henselae were determined at different dilutions (cut off > or = 1:64) by immunofluorescence in 52 patients with HIV infection and 85 donors. An epidemiologic study included age, sex, smoking, alcohol intake, INVDA, HIV infection, AIDS stage, cutaneous anergy, CD4 lymphocyte count, antiretroviral treatment and chemoprophylaxis versus P. carinii. RESULTS: Nine of the patients with HIV infection (17.3%) and five donors (5.88%) presented titers > or = 1:64 with no significant differences (p = 0.06) (adjusted OR: 1.7; CI 95%: 0.34-8.54). Moreover, multiple logistic regression analysis did not show any risk or protection factor associated with B. henselae infection in patients with HIV infection. CONCLUSIONS: A high level of seroprevalence of antibodies versus B. henselae was observed in patients with HIV infection. No risk or protection factors associated with B. henselae infection in patients with HIV infection were found.
A skin biopsy from a patient with erythema migrans was inoculated into C3H/He mice and into culture medium. A Borrelia garinii strain named Rio1 was isolated from both a direct BSK medium culture and a mouse ear-punch biopsy culture. Inoculating human tissue into mice produced a disease resulting in severe inflammation of the left tibio-tarsal joint, development of perivascular infiltrates as seen in ear-punch biopsies and the spread of spirochaetes along the skin, far from the inoculation site. The isolation of this strain confirms the circulation of this Borrelia species in Spain as a human pathogen, as well as its arthrogenicity in an animal model. The method used to recover strain Rio1 from human tissue is described as rapid and sensitive compared to direct inoculation of tissue into BSK medium.
AIM: Evaluate the need to give prophylactic antibiotic therapy in patients that undergo elective surgery for cholelithiasis. METHODS: Prospective study in 35 patients the underwent surgery for cholelithiasis, without infectious risk factors. All of them, the hemocultives, endotoxin and Tumor Necrosis Factor has been evaluated along the surgical process. RESULTS: The hemocultives were in all the patients negatives. The levels of Tumor Necrosis Factor decreased along the surgical process, without modifications of endotoxin levels. There were no significant differences in either of the points of the analysis. CONCLUSIONS: Biliary surgery in patients that undergo elective surgery for cholelithiasis, without infectious risk factors, is a clean surgery, and so, in this patients is not indicated systematically an antibiotic prophylaxis.
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