RESUMEN
The aim of this prospective observational study was to determine the accuracy of American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) criteria in predicting infection or colonization related to multidrug-resistant (MDR) bacteria at intensive-care unit (ICU) admission. MDR bacteria were defined as methicillin-resistant Staphylococcus aureus, ceftazidime-resistant or imipenem-resistant Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia, and extended-spectrum ß-lactamase-producing Gram-negative bacilli. Screening for MDR bacteria (using nasal and rectal swabs and tracheal aspirates from intubated patients) was performed at ICU admission. Risk factors for infection or colonization with MDR bacteria at ICU admission were determined using univariate and multivariate analyses. The accuracy of ATS/IDSA criteria in predicting infection or colonization with these bacteria at ICU admission was calculated. Eighty-three (13%) of 625 patients were infected or colonized with MDR bacteria at ICU admission. Multivariate analysis allowed identification of prior antimicrobial treatment (OR 2.3, 95% CI 1.2-4.3; p 0.008), residence in a nursing home (OR 2, 95% CI 1.1-3.7; p <0.001), and prior hospitalization (OR 3.9, 95% CI 1.7-8.8; p <0.001) as independent predictors of infection or colonization with MDR bacteria at ICU admission. Although sensitivity (89%) and negative predictive values (96%) were high, low specificity (39%) and a positive predictive value (18%) were found when ATS/IDSA criteria were used in predicting infection or colonization with MDR bacteria at ICU admission. In patients with pneumonia, adherence to guidelines was associated with increased rates of appropriate initial antibiotic treatment and de-escalation. ATS/IDSA criteria had an excellent negative predictive value and a low positive predictive value concerning infection or colonization with MDR bacteria at ICU admission.
Asunto(s)
Farmacorresistencia Bacteriana Múltiple , Control de Infecciones , Unidades de Cuidados Intensivos , Admisión del Paciente , Acinetobacter baumannii/efectos de los fármacos , Antibacterianos/uso terapéutico , Infecciones Bacterianas/clasificación , Causalidad , Ceftazidima/farmacología , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/microbiología , Humanos , Imipenem/antagonistas & inhibidores , Imipenem/farmacología , Resistencia a la Meticilina , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Neumonía Bacteriana/tratamiento farmacológico , Neumonía Bacteriana/microbiología , Guías de Práctica Clínica como Asunto , Estudios Prospectivos , Pseudomonas aeruginosa/efectos de los fármacos , Factores de Riesgo , Sociedades Médicas , Stenotrophomonas maltophilia/efectos de los fármacos , beta-Lactamasas/biosíntesisRESUMEN
The arboviral disease with the highest human incidence in South America is dengue fever. In French Guiana, where all four dengue serotypes, i.e., DENV-1, DENV-2, DENV-3 and DENV-4, are present, the disease is endemic with epidemic outbreaks. Though previous serological studies have suggested a sylvatic cycle, involvement of wild mammals in the dengue cycle in the neotropics has never been confirmed. The purpose of this study was to search for the presence of DENV in wild animals captured at two different sites between 2001 and 2007. About 10,000 trap/nights were performed leading to the capture of 464 non-flying mammals (rodents and marsupials). In addition, mistnests placed in the same zone yielded 152 bats. Reverse transcription-polymerase chain reaction amplification to detect infection by any of the four dengue serotypes demonstrated viral RNA in the livers and/or sera of 92 captured animals. Sequence analysis of amplification products revealed that the DENV-1, DENV-3 and DENV-4 serotypes were distinct from those circulating in humans at the same periods. Analysis for DENV-2 showed that some strains were divergent from concurrent human strains but that others were identical. The latter finding suggests that wild neotropical mammals living in periurban area can be infected by dengue virus strains circulating in humans. However, further investigation will be needed to determine if neotropical mammals are incidental hosts or potential reservoirs of dengue virus.
Asunto(s)
Dengue/transmisión , Vectores de Enfermedades , Mamíferos/virología , Clima Tropical , Animales , Dengue/clasificación , Dengue/genética , Humanos , ARN Viral/aislamiento & purificación , Reacción en Cadena de la Polimerasa de Transcriptasa InversaRESUMEN
The Gammaherpesvirinae sub-family is divided into two genera, the Lymphocryptovirus and the Rhadinovirus. Until recently, Epstein-Barr virus (EBV), the human prototype of the Lymphocryptovirus genus, and simian homologues have only been detected in humans and Old World non-human primates. In other respects, the Rhadinovirus genus was only represented by Herpesvirus saimiri and Herpesvirus ateles of New World monkey species. Therefore, the general thinking at that time was that the separation of the continents resulted in drastic changes in the Gammaherpesvirinae evolution. The discovery of the human herpesvirus 8 (HHV8), belonging to the Rhadinovirus genus, followed by the identification of CalHV3 (Callitrichine herpesvirus 3) a lymphocryptovirus of marmoset, challenged this old paradigm. The recent description of numerous viruses belonging to the Gammaherpesvirinae subfamily from different Old and NewWorld primate species let to develop and to support co-speciational evolution hypotheses of these viruses and their hosts. This review focuses on our current knowledge of the genetic diversity and evolution of primate Gammaherpesvirinae.
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Proteínas Adaptadoras Transductoras de Señales/genética , Infecciones por Helicobacter/genética , Helicobacter pylori , Linfoma de Células B de la Zona Marginal/genética , Neoplasias Gástricas/genética , Adulto , Anciano , Proteína 10 de la LLC-Linfoma de Células B , Cromosomas Humanos Par 1 , Cromosomas Humanos Par 14 , Femenino , Infecciones por Helicobacter/terapia , Humanos , Linfoma de Células B de la Zona Marginal/terapia , Masculino , Persona de Mediana Edad , Proteínas de Neoplasias/genética , Translocación GenéticaRESUMEN
BACKGROUND: The usefulness of chemotherapy to treat gastric diffuse large B-cell lymphomas (DLBCL) is well known. Whether or not chemotherapy should be performed as the only treatment or after surgical resection is debated. The aim of this study was to compare two strategies: surgical resection plus chemotherapy versus chemotherapy alone. PATIENTS AND METHODS: Between January 1988 and December 1996, 58 patients included in the trials promoted by the Groupe d'Etude des Lymphomes de l'Adulte (GELA) (LNH-87 and LNH-93) received chemotherapy and 48 included in the protocol of the Groupe d'Etude des Lymphomes Digestifs (GELD) underwent surgical resection followed by chemotherapy. They all presented with localized DLBCL (stage IE and IIE according to the Ann Arbor classification). From the GELA group, seven patients received additional radiotherapy. Gastrectomy was total in 27 of the 48 patients in the GELD group. In both groups chemotherapy included anthracyclin and alkylating agents. Chemotherapy was more intensive in the GELA group than in the GELD group. RESULTS: In the GELA and the GELD groups, distribution according to sex ratio, age (>60 or < or = 60 years), ECOG performance status (> or = 2 or <2) and staging (IE or IIE) was similar. Univariate analysis comparing prognostic factors in both groups showed significant differences: serum lactate dehydrogenase level above normal (28.6% versus 2.4%, P = 0.001), tumor size >10 cm (28.6% versus 12.5%, P = 0.04), patients with International Prognostic Index (IPI) >1 (21.4% versus 11.1%, P = 0.168) and 5-year survival (79% versus 90%, P = 0.03). Multivariate analysis of prognostic factors with a Cox model showed that IPI was the only independent prognostic factor (odds ratio 3, P = 0.03). Consequently, patients with IPI 0-1 were selected for comparison between the GELA group (44 patients) and the GELD group (40 patients). There was no significant difference between the two groups. Median follow-up was 59 months (range 3-128). Estimates of 5-year survival rates and event-free survival rates were 90.5% versus 91.1% (P = 0.303) and 85.9% versus 91.6% (P = 0.187), respectively. In the GELA group, seven of 44 patients died: five from a lymphoma-unrelated cause and two from tumor progression. In the GELD group, four of 40 patients died: two of unrelated causes and two from tumor progression. CONCLUSIONS: This study shows that in localized gastric DLBCL with IPI 0-1, a similar 5-year survival rate (>90%) is to be expected with either surgery plus chemotherapy or chemotherapy alone.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Gastrectomía , Linfoma de Células B/tratamiento farmacológico , Linfoma de Células B/cirugía , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/cirugía , Adulto , Anciano , Terapia Combinada , Progresión de la Enfermedad , Supervivencia sin Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Resultado del TratamientoRESUMEN
We report a case of a human gastric composite tumor occurring seven years after a partial gastrectomy for a low grade B cell MALT lymphoma. Histological examination of the tumor revealed two intimately intermingled components: 1. A moderately to poorly differentiated tubulo-acinar adenocarcinoma with signet-ring cells; and 2. Isolated or clustered small neuroendocrine cells without atypia expressing chromogranin A, somatostatin and/or glucagon, serotonin (5-HT) and, the 5-HT2B receptors. In addition to immunohistochemical detection, the presence of 5-HT2B receptors was shown pharmacologically through [125I]-DOI binding. Since 5-HT2B receptors have been demonstrated to have autocrine functions and, mitogenic and transforming properties, these results suggest a role of 5-HT in neuroendocrine malignant transformation. On the other hand, the expression of somatostatin and the detection by reverse transcriptase polymerase chain reaction (RT-PCR) of somatostatin receptor subtypes 2, 3, and 5, which have been shown to be involved in tumor regression, might account for the long evolution of this case (> 5 yr). This case illustrates the importance of local humoral modulation in tumor growth. Moreover, ultrastructural results favor a unique origin of the tumor cells from one amphicrine cell type.
Asunto(s)
Adenocarcinoma/metabolismo , Tumores Neuroendocrinos/metabolismo , Receptores de Serotonina/metabolismo , Neoplasias Gástricas/metabolismo , Adenocarcinoma/química , Adenocarcinoma/patología , Cromogranina A , Cromograninas/análisis , Cromograninas/metabolismo , Gránulos Citoplasmáticos/ultraestructura , Femenino , Glucagón/análisis , Glucagón/metabolismo , Humanos , Técnicas para Inmunoenzimas , Persona de Mediana Edad , Neoplasias Primarias Secundarias/química , Neoplasias Primarias Secundarias/metabolismo , Neoplasias Primarias Secundarias/patología , Tumores Neuroendocrinos/química , Tumores Neuroendocrinos/patología , ARN Mensajero/análisis , ARN Mensajero/metabolismo , ARN Neoplásico/análisis , Receptor de Serotonina 5-HT2B , Receptores de Serotonina/análisis , Receptores de Serotonina/genética , Receptores de Somatostatina/análisis , Receptores de Somatostatina/clasificación , Receptores de Somatostatina/genética , Receptores de Somatostatina/metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Serotonina/análisis , Serotonina/metabolismo , Somatostatina/análisis , Somatostatina/clasificación , Somatostatina/genética , Somatostatina/metabolismo , Neoplasias Gástricas/química , Neoplasias Gástricas/patologíaRESUMEN
We investigated the characterization of different HIV-1 subtypes present in French Guiana by use of three different methods. Serological methods were used for the initial screening, which were then confirmed by the heteroduplex mobility assay (HMA). The V3 env region was subsequently sequenced for phylogenetic analysis, to confirm the subtype of the samples, and to assign a subtype to samples that gave results that were difficult to interpret or discordant by serology or HMA. A total of 221 HIV-1 seropositive samples were typed; 110 of them were confirmed by HMA and 16 were sequenced. Of the 221 samples tested 210 patients (95%) were found to be infected with subtype B, 10 (4.5%) were infected with subtype A, and one patient was infected with subtype F. Phylogenetic analysis demonstrated that the strains from French Guiana were closely related to the subtype A and B subtypes, and that one strain was closely related to an F subtype (100% bootstrap value). Four strains from French Guiana clustered in the subtype A (99% bootstrap value) and the other strains were associated with subtype B (100% bootstrap value). The geographic position of French Guiana suggested that HIV-1 was probably introduced into the country via several routes, and thus the pattern of the HIV-1 epidemic might evolve in the near future.
Asunto(s)
Variación Genética , Proteína gp120 de Envoltorio del VIH/genética , Infecciones por VIH/virología , VIH-1/genética , Fragmentos de Péptidos/genética , Serodiagnóstico del SIDA , Secuencia de Aminoácidos , Secuencia de Bases , ADN Viral , Guyana Francesa , Proteína gp120 de Envoltorio del VIH/clasificación , Infecciones por VIH/sangre , Infecciones por VIH/diagnóstico , Infecciones por VIH/inmunología , VIH-1/clasificación , VIH-1/inmunología , Análisis Heterodúplex , Humanos , Datos de Secuencia Molecular , Fragmentos de Péptidos/clasificación , FilogeniaRESUMEN
BACKGROUND AND AIMS: Discrepant remission rates (41-100%) have been reported for patients with localised low grade gastric mucosa associated lymphoid tissue (MALT) lymphoma after eradication of Helicobacter pylori. The aim of this study was to explain these discrepancies and to determine the predictive factors of gastric lymphoma regression after anti- H pylori treatment. PATIENTS AND METHODS: Forty six consecutive patients with localised gastric MALT lymphoma (Ann Arbor stages I(E) and II(E)) were prospectively enrolled. All had gastric endoscopic ultrasonography and H pylori status assessment (histology, culture, polymerase chain reaction, and serology). After anti-H pylori treatment, patients were re-examined every four months. RESULTS: Histological regression of the lymphoma was complete in 19/44 patients (43%) (two lost to follow up). Median follow up time for these 19 responders was 35 months (range 10-47). No regression was noted in the 10 H pylori negative patients. Among the 34 H pylori positive patients, the H pylori eradication rate was 100%; complete regression rate of the lymphoma increased from 56% (19/34) to 79% (19/24) when there was no nodal involvement at endoscopic ultrasonography. There was a significant difference between the response of the lymphoma restricted to the mucosa and other more deep seated lesions (p<0.006). However, using multivariate analysis, the only predictive factor of regression was the absence of nodal involvement (p<0.0001). CONCLUSION: In H pylori positive patients with localised gastric MALT lymphoma, carefully evaluated and treated without any lymph node involvement assessed by endoscopic ultrasonography, complete remission of lymphoma was reached in 79% of cases.
Asunto(s)
Quimioterapia Combinada/uso terapéutico , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori , Linfoma de Células B de la Zona Marginal/tratamiento farmacológico , Omeprazol/análogos & derivados , Neoplasias Gástricas/tratamiento farmacológico , 2-Piridinilmetilsulfinilbencimidazoles , Adulto , Anciano , Amoxicilina/uso terapéutico , Antibacterianos/uso terapéutico , Antiulcerosos/uso terapéutico , Claritromicina/uso terapéutico , Femenino , Infecciones por Helicobacter/complicaciones , Humanos , Lansoprazol , Linfoma de Células B de la Zona Marginal/microbiología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias , Omeprazol/uso terapéutico , Penicilinas/uso terapéutico , Estudios Prospectivos , Inducción de Remisión , Neoplasias Gástricas/microbiologíaRESUMEN
AIMS: We recently showed that refractory sprue is distinct from coeliac disease, the former being characterized by abnormal intraepithelial T-lymphocytes expressing a cytoplasmic CD3 chain (CD3c), lacking CD3 and CD8 surface expression, and showing TCRgamma gene rearrangements. To take advantage of the abnormal phenotype of CD3c + CD8 - intraepithelial lymphocytes (IEL) in refractory sprue we developed a simple method to distinguish coeliac disease from refractory sprue. METHODS AND RESULTS: Comparative immunohistochemical studies using anti-CD3 and anti-CD8 antibodies were applied on paraffin-embedded and frozen biopsy specimens in refractory sprue (n = 6), coeliac disease (n = 10), healthy controls (n = 5) and suspected refractory sprue (n = 6). Comparable results were obtained on fixed and frozen biopsy specimens. In four of the six patients with suspected refractory sprue, abnormal CD3c + CD8 - IEL and TCRgamma gene rearrangements were found, as in refractory sprue; the remaining two patients had normal (CD3 + CD8 +) IEL and no TCRgamma gene rearrangements. Both patients had coeliac disease, as one failed to comply with a gluten-free diet, while the other was a slow responder. CONCLUSION: This simplified immunostaining method using anti-CD3 and anti-CD8 antibodies on paraffin sections can distinguish active coeliac disease from refractory sprue and should prove useful in clinical practice.
Asunto(s)
Enfermedad Celíaca/patología , Adulto , Anciano , Complejo CD3/metabolismo , Antígenos CD8/metabolismo , Enfermedad Celíaca/metabolismo , Femenino , Reordenamiento Génico de la Cadena gamma de los Receptores de Antígenos de los Linfocitos T , Humanos , Técnicas para Inmunoenzimas , Masculino , Persona de Mediana Edad , Fenotipo , Reacción en Cadena de la Polimerasa , Estudios Prospectivos , Estudios RetrospectivosRESUMEN
METHODS: Four patients with clinicopathological features suggesting a new distinct entity defining extensive small intestinal CD4 T cell infiltration were observed. RESULTS: All four patients presented with chronic diarrhoea, malabsorption, and weight loss. Biopsy specimens of the small intestine disclosed extensive and diffuse infiltration of the lamina propria by pleomorphic small T lymphocytes, which were positive for CD3, CD4, CD5, and the beta chain of T cell receptor in all three cases studied and negative for CD103 in all three cases studied. It is notable that, in all invaded areas, the infiltrating cells showed no histological change throughout the whole evolution. In three patients, lymphocyte proliferation was monoclonal and there was extraintestinal involvement. In one patient, lymphoproliferation was oligoclonal and confined to the small intestine. In all four patients, there was no evidence of coeliac disease. Although none of the four patients responded to single or multiple drug chemotherapy, median survival was five years. CONCLUSION: Extensive small intestinal CD4 T cell infiltration is a rare entity, distinct from coeliac disease and associated with prolonged survival.
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Linfocitos T CD4-Positivos/patología , Enfermedad Celíaca/complicaciones , Mucosa Intestinal/patología , Intestino Delgado/patología , Linfoma de Células T/patología , Adulto , Enfermedad Celíaca/inmunología , Cromosomas Humanos Par 5 , Femenino , Reordenamiento Génico de Linfocito T , Humanos , Inmunohistoquímica , Hibridación in Situ , Linfoma de Células T/genética , Masculino , Persona de Mediana Edad , Translocación Genética , TrisomíaRESUMEN
We report the case of a 40-yr-old man presenting with symptoms of small bowel obstruction. Small bowel x-rays revealed a stricture of the mid-jejunum. Push enteroscopy found a polypoid mass at 1 meter of the ligament of Treitz. Histopathological examination of the biopsy and surgical specimens showed a diffuse infiltrate of the mucosa made of medium to large cells, which were stained on immunohistochemistry by the leucocyte marker CD45 and the histiocyte/monocyte marker CD68 but were negative for the B and T cell markers. Cytological examination of the ascitic fluid revealed many myelobasts with cytoplasmic Auer rods and positive myeloperoxidase staining. There was no evidence of blood or bone marrow involvement suggestive of acute leukemia or myeloproliferative disorders. These findings were consistent with the diagnosis of preleukemic granulocytic sarcoma (or chloroma). Chemotherapy led to complete remission, but 21 months later the patient developed an acute myeloid leukemia. He died from aspergillus pneumonitis, 10 months after bone marrow allograft. Preleukemic granulocytic sarcoma of the small bowel is a rare condition and its diagnosis is usually not easy, requiring histochemical or immunohistochemical studies. Most cases have progressed to acute myeloid leukemia.
Asunto(s)
Neoplasias Intestinales/complicaciones , Obstrucción Intestinal/etiología , Intestino Delgado , Yeyuno , Leucemia Mieloide/complicaciones , Adulto , Endoscopía , Humanos , Neoplasias Intestinales/patología , Obstrucción Intestinal/diagnóstico por imagen , Intestino Delgado/diagnóstico por imagen , Yeyuno/patología , Leucemia Mieloide/patología , Masculino , RadiografíaRESUMEN
AIMS: Primary intestinal T-cell lymphomas account for about 5% of all primary gastrointestinal lymphomas and are mostly associated with coeliac disease. They usually express the CD3-associated T-cell receptor alpha/beta heterodimer and HML1, and some are related with Epstein-Barr virus (EBV). As far as we know, the present report describes the first case of primary gamma-delta (gamma delta) EBV-associated intestinal T-cell lymphoma without enteropathy. Only hepatosplenic, nasal and cutaneous gamma delta T-cell lymphomas have previously been described. METHODS AND RESULTS: Our case concerned a 43-year-old man with no history of coeliac disease, who presented with multifocal small bowel involvement showing high grade T-cell lymphoma with medium sized and large pleomorphic cells and a small pleomorphic T-cell component. Angioinvasion and angiocentricity were occasionally present. Immunohistochemical studies of lymphoma cells showed a T-cell gamma delta phenotype (CD3+, CD2+, TCR delta 1+, V delta 2+ and beta F1-) without expression of CD4, CD8, CD5, or HML1. Most tumour cells were positive for the cytotoxic granular proteins TiA1 and granzyme B. Rearrangement of the TCR gamma chain gene was demonstrated by polymerase chain reaction and in-situ hybridization with EBER probes revealed strong nuclear positivity in virtually all neoplastic cells. CONCLUSION: We described the first case of primary intestinal gamma delta T-cell lymphoma without enteropathy in which EBV might fulfil a pathogenic role.
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Herpesvirus Humano 4/aislamiento & purificación , Neoplasias Intestinales/patología , Neoplasias Intestinales/virología , Linfoma de Células T/patología , Linfoma de Células T/virología , Adulto , Reordenamiento Génico de la Cadena gamma de los Receptores de Antígenos de los Linfocitos T , Herpesvirus Humano 4/genética , Herpesvirus Humano 4/patogenicidad , Humanos , Inmunofenotipificación , Hibridación in Situ , Neoplasias Intestinales/inmunología , Linfoma de Células T/inmunología , Masculino , Receptores de Antígenos de Linfocitos T gamma-delta/genética , Receptores de Antígenos de Linfocitos T gamma-delta/metabolismoAsunto(s)
Zarigüeyas/genética , Alelos , Secuencia de Aminoácidos , Animales , Secuencia de Bases , Secuencia de Consenso , Grupo Citocromo b/genética , ADN/genética , Cartilla de ADN/genética , Ecosistema , Guyana Francesa , Genética de Población , Biología Molecular , Datos de Secuencia Molecular , Oligodesoxirribonucleótidos/genética , Homología de Secuencia de Ácido Nucleico , Especificidad de la EspecieAsunto(s)
Enfermedad Inmunoproliferativa del Intestino Delgado/patología , Linfoma de Células T/patología , Linfocitos T/patología , Adulto , Animales , Antígenos de Diferenciación de Linfocitos B/metabolismo , Antígenos de Diferenciación de Linfocitos T/metabolismo , Complejo CD3/metabolismo , Cryptosporidium/aislamiento & purificación , Diagnóstico Diferencial , Humanos , Inmunohistoquímica , Enfermedad Inmunoproliferativa del Intestino Delgado/metabolismo , Enfermedad Inmunoproliferativa del Intestino Delgado/parasitología , Linfoma de Células T/metabolismo , Masculino , Linfocitos T/metabolismoRESUMEN
The development of synchronous gastric adenocarcinoma and primary gastric lymphoma is rare. We report a case of low grade B-cell lymphoma of mucosa associated lymphoid tissue intermingled with a gastric adenocarcinoma and without Helicobacter pylori infection. This observation leads to discuss the pathogenesis of these tumors and the role of Helicobacter pylori infection in the development of gastric lymphoma and carcinoma.