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SETTING: During 1996-2000, a regional anti-tuberculosis drug resistance survey was conducted in Castilla-León, Spain. OBJECTIVE: To determine the incidence of drug-resistant tuberculosis (TB) in newly treated human immunodeficiency virus (HIV) negative and HIV-positive TB patients. DESIGN: Nine hundred and eighty-five Mycobacterium tuberculosis strains isolated from HIV-negative (926) and HIV-positive (59) patients were studied (one strain per patient). Univariate and multivariate analyses were used to determine the prevalence of drug resistance in high-risk groups. RESULTS: Thirty-eight isolates (3.8%) showed resistance to one of the following drugs: streptomycin (S), isoniazid (H), rifampicin (R) or ethambutol (E). Of these, 36 (3.9%) were from HIV-negative and 2 (3.4%) from HIV-positive patients. The rate of drug resistance among HIV-negative patients was 1.2%, 2.0%, 0.3% and 0.8%, respectively, for S, H, R and E, and for HIV-positive patients it was 3.4%, 0%, 0% and 1.7%. Among the HIV-negative patients, monoresistance was observed in 32 (3.4%) strains and resistance to both H and R (multi-drug resistance) was detected in one. CONCLUSION: The incidence of primary drug resistance in the surveyed area was low and increased resistance was not observed in the HIV-positive group (P = 0.99). Routine surveillance of drug resistance is recommended by the TB control programme in representative patient populations to optimise treatment regimens.

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Nocardia farcinica is an infrequent infection that usually appears in patients with predisposing conditions, especially in immunosuppressed patients, although it has also been found in healthy individuals. Its importance as a new pathogen has been recognized only in recent years. Mainly, it affects the lung, indistinguishable from other types of pneumonia in the clinical and radiological characteristics. The main reason for detection is therapeutic failure.

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La Nocardia farcinica es una infección infrecuente, que tiene tendencia a aparecer en pacientes con factores de riesgo predisponentes, fundamentalmente inmunodeprimidos, aunque también ha sido descrita en pacientes inmunocompetentes. Su importancia como patógeno emergente ha sido reconocida tan sólo en los últimos años. Afecta predominantemente al pulmón, siendo indistinguible en cuanto a su presentación clínica y radiológica del resto de las neumonías. El fracaso terapéutico es la razón principal de su sospecha (AU)

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Objetivo. Se revisa la incidencia de MNT aisladas en muestras biológicas de pacientes de nuestra área asistencial con objeto de conocer su frecuencia y hacer una valoración clínica de los hallazgos. Material y métodos. El período de estudio abarcó 12 años (1992-2003). Los métodos de procesamiento de las muestras fueron los convencionales (1992-1995) y a partir de 1995 se incorporó el sistema MB/BacTTM (BioMerieux). Para el frotis se empleó tinción fluorescente (auramina fenicada). La identificación de las micobacterias se realizó en el propio laboratorio o en el CNMV Carlos III de Madrid. Se utilizaron técnicas convencionales y sondas genéticas (Accuprobe®, BioMerieux). Para valorar la significación clínica de los hallazgos se siguieron los criterios internacionales. Resultados. En este período se procesaron 39.560 muestras, aislándose 2.484 micobacterias (6,3 por ciento), de las cuales 362 (14,6 por ciento) fueron MNT; las MNT correspondían a 245 pacientes. La procedencia de las muestras fue respiratoria (300), genitourinaria (40), adenopatía (7) y otros (15). La distribución de las especies fue: M. gordonae (95; 26,2 por ciento), M. fortuitum (70; 19,3 por ciento), M. avium complex (47; 13,0 por ciento), M. kansasii (20; 5,5 por ciento), M. aurum (13; 3,6 por ciento) y M. chelonae (10; 2,8 por ciento). La proporción de aislamientos de MNT con frotis positivo fue de 8,8 por ciento. Las especies con mayor indicencia de frotis positivos fueron M. avium complex (32 por ciento) y M. kansasii (35 por ciento). En relación con la evidencia de patología asociada en los pacientes, los resultados fueron: M. avium complex (20/20), M. kansasii (14/14), M. xenopi (8/8), M. serofulaceum (2/5), M. fortuitum (2/45), M. marinum (1/1). Conclusiones. 1) La incidencia de aislamientos de MNT ha sido similar a otras series de proyección nacional. 2) Existe una gran concordancia entre patología asociada y las especies M. avium complex, M. kansasii y M. xenopi. 3) La correlación frotis / cultivo fue superior en los aislamientos de M. avium complex y M. kansasii que en los restantes (AU)

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Revisamos el problema del arsénico en el agua de consumo, como problema de salud pública. La concentración de arsénico en el agua de consumo no debe ser superior al límite establecido de 50 microgramos/litro según la legislación vigente máxima en algunos países. El arsénico es un metaloide que se encuentra de manera natural ampliamente distribuido en la corteza terrestre. Es my ubicuo y está presente en cantidades ínfimas en todo tipo de rocas, suelos, agua y aire. El arsénico puede existir en cuatro estados de valencia: (3, 0, +3 y +S). Se distribuye extensamente en el agua superficial y subterránea. Las concentraciones de arsénico en aguas son muy variables, generalmente bajas, pudiendo existir concentraciones altas de forma natural o como consecuencia de la actividad humana. La mayoría de las zonas con altos niveles de arsénico son resultado de procesos naturales. Los distintos problemas de arsénico en aguas subterráneas ocurren tanto bajo condiciones reducidas como oxidantes, y también en ambientes húmedos y secos. La gente puede estar expuesta al arsénico por muchas vías diferentes. En intentos de suicidio y homicidio ocurren altos niveles de exposición por ingestión. También pueden ocurrir altas exposiciones por largos períodos de tiempo en algunos puestos de trabajo a través de la inhalación -o ingestión de polvo. El arsénico ha estado desde hace mucho tiempo asociado con efectos tóxicos, produciendo marcados impactos sobre la salud, tras exposición oral o inhalación, que van desde la muerte aguda a efectos crónicos como cáncer y enfennedades del sistema vascular. Los niveles de arsénico o de sus metabolitos en la sangre, el pelo, las uñas y la orina se utilizan como biomarcadores de la exposición al arsénico. Por tanto, el arsénico en el agua de bebida supone un importante problema de Salud Pública, que debe ser tenido en cuenta en nuestro entorno, debe ser conocido en sus diferentes aspectos por el personal sanitario relacionado con la Salud Pública y sobre el que debe hacerse una vigilancia periódica. (AU)

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Twenty patients with urinary tuberculosis were treated with ofloxacin (200 mg/day, 6 months), rifampin (600 mg/day, 3 months) and isoniazid (300 mg/day, 3 months) between 1989 and 1990. All patients were new cases, diagnosed by observation and/or isolation of Mycobacterium tuberculosis in one of the three morning urine samples. Bacteriological culture conversion (negativization) was assessed as a clinical guide of efficacy, comparing it, as the only parameter, against a control group (150 patients) with urinary tuberculosis who received conventional therapy. Bacteriological follow-up studies were performed in both groups monthly for 6 months, then again 6 months later and then every year for 10 years after completion of treatment. In the 20 patients, the initial culture was positive with over 100 colonies per culture (>50%); the smear was positive in 45% of the patients (most were 2+). All strains were susceptible to rifampin, isoniazid and ofloxacin. Two patients discontinued treatment. Beginning with the first month of treatment, the bacteriological conversion was 100%, 89.5% and 100% in the remaining controls. In the control group, which received conventional treatment, the conversion was: 90%, 87%, 93% and 100% in the remaining controls. Treatment with ofloxacin resulted in a bacteriological conversion similar to that following conventional treatment ( p>0.05, Fisher's exact test). After 10 years of patient follow-up, we conclude that ofloxacin, in combination with rifampin and isoniazid (both for 3 months only is effective against M. tuberculosis, providing satisfactory bacteriological and clinical efficacy.

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Twenty patients with urinary tuberculosis were treated with ofloxacin (200 mg/day, 6 months), rifampin (600 mg/day, 3 months) and isoniazid (300 mg/day, 3 months) between 1989 and 1990. All patients were new cases, diagnosed by observation and/or isolation of Mycobacterium tuberculosis in one of the three morning urine samples. Bacteriological culture conversion (negativization) was assessed as a clinical guide of efficacy, comparing it, as the only parameter, against a control group (150 patients) with urinary tuberculosis who received conventional therapy. Bacteriological follow-up studies were performed in both groups monthly for 6 months, then again 6 months later and then every year for 10 years after completion of treatment. In the 20 patients, the initial culture was positive with over 100 colonies per culture (>50%); the smear was positive in 45% of the patients (most were 2+). All strains were susceptible to rifampin, isoniazid and ofloxacin. Two patients discontinued treatment. Beginning with the first month of treatment, the bacteriological conversion was 100%, 89.5% and 100% in the remaining controls. In the control group, which received conventional treatment, the conversion was: 90%, 87%, 93% and 100% in the remaining controls. Treatment with ofloxacin resulted in a bacteriological conversion similar to that following conventional treatment ( p>0.05, Fisher's exact test). After 10 years of patient follow-up, we conclude that ofloxacin, in combination with rifampin and isoniazid (both for 3 months only is effective against M. tuberculosis, providing satisfactory bacteriological and clinical efficacy (AU)

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OBJECTIVE: To determine the primary drug resistance (PDR) of Mycobacterium tuberculosis in ten hospitals in the Castile-León Community for a five-year period (1991-1995), in a sanitary area with almost two millions of inhabitants. MATERIAL AND METHODS: The sensitivity of 825 strains of Mycobacterium tuberculosis to antituberculous drugs was studied using the proportion method; 773 strains were from HIV-negative patients and 52 from HIV-positive patients. RESULTS: Thirty-four out of the 824 strains were resistant to one or more drugs: 31 (4%) from HIV-negative patients and 3 (5.7%) from HIV-positive patients. The resistance to the different drugs for strains from HIV-negative patients was: streptomycin, 2.4%; isoniazid, 1.8%; ethambutol, 0.6%, and rifampin, 0.2%. For HIV-positive patients, resistance to streptomycin was 5.7% and to isoniazid 1.9%. Resistance to a single agent was the resistance mode observed most commonly: 23 (2.9%) in HIV-negative patients and 2 (3.3%) in HIV-positive patients. There was not a single strain resistant to isoniazid and rifampin. CONCLUSIONS: The incidence of PR in the surveyed area was low, including isoniazid. The group of HIV-positive patients did not show a significant increase in resistance (p = 0.4; OR, 1.44; 95% CI, 0.43-4.86). Regular surveillance of drug resistance is recommended to adjust therapeutic regimes.

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We make here a preliminary report of the first 65 cases of tularemia diagnosed at our hospital pertaining to an epidemic outbreak occurred in the area served by the hospital. Diagnosis was made by the presence of a consistent clinical picture and the following laboratory criteria: antibody titre to. Francisella tularensis (tube agglutination) higher than or equal to 1/160, seroconversion or recovery of the microorganism from biological material. The mean age of our patients was 53.8 +/- 13.5 years and female sex predominated (45 women). Fever, lymph node enlargement, cutaneous ulcers, asthenia, and weight loss were the most common symptoms. The presentation clinical forms included: ulceroganglionar (69%), typhoidal (14%), ganglionar (12.5%), pneumonic (1.5%), oculoganglionar (1.5%) and atypical (1.5%). The analytical data did not show significant changes with the exception of erythrocyte sedimentation rate. Streptomycin was the antibiotic of choice, followed by ciprofloxacin and gentamicin. The failure rate was 22%, and ciprofloxacin was used for retreatment in twelve occasions and ofloxacin in 1 occasion with a good response. Tularemia is an infective disease which can become endemic in Spain and that should be considered by clinicians, particularly when unilateral enlarged lymph nodes, prolonged febrile syndromes, pharyngitis with negative culture, poor response to beta-lactams and atypical pneumonia are present.

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BACKGROUND: To study the electrophoretic RNA patterns of human rotavirus (RV) during three years in Valladolid (Spain). MATERIAL AND METHODS: From october 1986 to october 1989 we have studied the electrophoretic RNA patterns of RV in 104 fecal samples. Stools were first screened by a latex agglutination test (LA) and reactive samples were confirmed by a commercial enzymeimmunoassay (EIA) and electron microscopy (EM) (negative stain). Electropherotyping was made according to conventional methods. RESULTS: 96.2% of the samples studied yield a defined electropherotype. We have found 8 different types of patterns of genomic RV-RNA circulating in these three years. Two of them belonged to short pattern (C and E) and six to long pattern (A, B, D, F, G and H). CONCLUSIONS: 98.0% of the genomic RNA founded were of long pattern, from which pattern A was the most prevalent (72%) during the study, without a seasonal distribution. Pattern B was found in 20% of cases, while the rest were found only occasionally.

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