https://uvadoc.uva.es/handle/10324/41462 2026-04-06T17:57:51Z https://uvadoc.uva.es/handle/10324/46015 Background: Although most HTLV infections in Spain have been found in native intravenous drug users carrying HTLV-2, the large immigration flows from Latin America and Sub-Saharan Africa in recent years may have changed the prevalence and distribution of HTLV-1 and HTLV-2 infections, and hypothetically open the opportunity for introducing HTLV-3 or HTLV-4 in Spain. To assess the current seroprevalence of HTLV infection in Spain a national multicenter, cross-sectional, study was conducted in June 2009. Results: A total of 6,460 consecutive outpatients attending 16 hospitals were examined. Overall, 12% were immigrants, and their main origin was Latin America (4.9%), Africa (3.6%) and other European countries (2.8%). Nine individuals were seroreactive for HTLV antibodies (overall prevalence, 0.14%). Evidence of HTLV-1 infection was confirmed by Western blot in 4 subjects (prevalence 0.06%) while HTLV-2 infection was found in 5 (prevalence 0.08%). Infection with HTLV types 1, 2, 3 and 4 was discarded by Western blot and specific PCR assays in another two specimens initially reactive in the enzyme immunoassay. All but one HTLV-1 cases were Latin-Americans while all persons with HTLV-2 infection were native Spaniards. Conclusions:The overall prevalence of HTLV infections in Spain remains low, with no evidence of HTLV-3 or HTLV-4 infections so far. 2012-01-01T00:00:00Z https://uvadoc.uva.es/handle/10324/45935 Background:HIV-2 infection is characterized by low plasma viraemia and slower progression to AIDS in compari-son with HIV-1 infection. However, antiretroviral therapy in patients with HIV-2 is less effective and often fails toprovide optimal CD4 recovery.Methods:We examined viral tropism in persons with HIV-2 infection enrolled in the HIV-2 Spanish cohort. Viraltropism was estimated based on V3 sequences obtained from plasma RNA and/or proviral DNA.Results:From a total of 279 individuals with HIV-2 infection recorded in the Spanish national register, 58 V3sequences belonging to 42 individuals were evaluated. X4 viruses were recognized in 14 patients (33%).Patients with X4 viruses had lower median CD4+cell counts than patients with R5 viruses [130 (17 – 210) versus359 (180 – 470) cells/mm3;P¼0.007]. This was true even considering only the subset of 19 patients on antiretro-viral therapy [94 (16 – 147) versus 184 (43 – 368) cells/mm3;P¼0.041]. In multivariate analysis, significant differ-ences in CD4+cell counts between patients with X4 and R5 viruses remained after adjusting for age, gender,antiretroviral therapy and viral load.Conclusions:The presence of X4-tropic viruses in HIV-2 infection is associated with low CD4+cell counts, regard-less of antiretroviral treatment. Along with CD4+cell counts, viral tropism testing may assist decisions aboutwhen to initiate antiretroviral therapy in HIV-2-infected individuals. 2014-01-01T00:00:00Z https://uvadoc.uva.es/handle/10324/45919 Fundamento:El Campylobacteres uno de los principalespatógenos entéricos, sin embargo algunos aspectos de su epi-demiología no se conocen con precisión. El objetivo de estetrabajo es analizar en la provincia de Valladolid la tendencia yvariación estacional de las gastroenteritis que provoca.Métodos:Se realizó un análisis de series temporalesmediante un modelo aditivo a partir de las declaraciones reali-zadas al Sistema de Información Microbiológico por los dosprincipales hospitales de la provincia de Valladolid. Se conside-ró como caso a los pacientes que presentaron un coprocultivocon un aislamiento de Campylobacterspp. en el período 2000-2004. Se determinaron la tendencia, los coeficientes estaciona-les de la serie de casos, las tasas de incidencia en función de laedad,el sexo y el año de declaración y las razones de tasas.Resultados:Se observó una tendencia descendente en ladeclaración de casos durante el periodo de estudio y se detec-tó un coeficiente estacional significativo en la cuatrisemanaseis (c=12,854,p=0,023). La tasa de incidencia fue mayor enlos menores de cinco años y en los hombres,ascendiendo a1841,9 casos (IC 95: 1797,2-1889,6) y 99,7 casos (IC 95%96,9-102,4) por 100.000 habitantes-año respectivamente.Conclusiones:La infección por Campylobactertienelugar en mayor medida en la época del final de la primavera,afectando principalmente a los niños. Es necesario profundizaren el conocimiento de la epidemiología de este microorganis-mo a nivel local con un abordaje multidisciplinar que conside-re tanto aspectos microbiológicos como epidemiológicos.; Background: Campylobacter is one of the main enteric pathogens, nevertheless many aspects of its epidemiology still are not well known. This study aims to analyze the trend and seasonal pattern in Valladolid. Methods: A time series analysis was developed using an additive model. The information sources were the reports to the Microbiological Information System from the main hospitals in Valladolid. Patients who showed a positive coproculture to Campylobacter spp. in the period 2000-2004 were considered cases. Trend, seasonal coefficients, incidence rates by age, sex and year of notification and incidence rate ratios were calculated. Results: A decreasing trend in reported cases was observed. A significant seasonal coefficient was obtained in the 6th four-week period (c=12,854, p = 0.023). The incidence rate was higher among those under five years of age and among males, rising up to 1841.9 cases (95% CI: 1797.2-1889.6) and 99.7 cases (95% CI: 96.9-102.4) per 100,000 inhabitants-year respectively. Conclusions: Campylobacter infections occurs to a greater extent in late springtime, affecting mainly children. It is necessary to delve deeper into the knowledge of the epidemiology of this microorganism at the local level with a multidisciplinary approach, taking both microbiological and epidemiological aspects into account. 2007-01-01T00:00:00Z https://uvadoc.uva.es/handle/10324/45909 Fundamento: La varicela es una enfermedad infecciosa fundamentalmente infantil producida por el virus Herpes Vari- cela Zoster que produce importantes costes sanitarios y socia- les. En 2005 Castilla y León introdujo en su calendario de vacunación infantil la vacuna de la varicela a los niños de once años susceptibles de padecerla. Dicha estrategia no modifica la importante morbilidad que genera en edades inferiores. El objetivode este trabajo es valorar la rentabilidad de la vacuna- ción sistemática frente a la varicela a los niños de 15 meses de edad en Castilla y León. Métodos: Se ha planteado una evaluación económica de coste-beneficio a través de un árbol de decisión. Se estudia una cohorte ficticia de 100.000 niños castellano-leoneses que en el año 2004 cumplieran 15 meses, alos que se les administraría junto a la vacuna triple vírica la de la varicela. El estudio se plantea desde la perspectiva social. El horizonte temporal ele- gido ha sido hasta que la cohorte de estudio cumpliera 15 años, aplicando una tasa de descuento del 3%. Para valorar la incer- tidumbrede algunas variables se ha desarrollado un análisis de sensibilidad. Resultados: El coste-beneficio de la introducción de la vacuna en el calendario de vacunación infantil se cifra en 1,23. Conclusiones: Desde la perspectiva social la estrategia de vacunación frente a la varicela, junto a la triple vírica se mues- tra rentable. La rentabilidad se ve modificada tanto si se intro- duce una segunda dosis de vacuna como si se analizan sólo los costes directos sanitarios; Background: Chicken pox is a mainly childhood contagious disease caused by the Varicella Zoster Virus which gives rise to major healthcare and social costs. In 2005, Castile and Leon added chicken pox vaccine injections to its childhood vaccination schedule for eleven year-olds subject to coming down with this disease. This strategy does not modify the major mobility generated thereby at younger ages. This study is aimed at evaluating the profitability of systematic vaccination for chicken pox in infants 15 months of age in Castile and Leon. Methods: An economic cost-benefit evaluation has been set out by jeans of a decision-making tree. A fictitious cohort of 100,000 children in Castile and Leon having reached 15 months of age in 2004 is studied, to whom the chicken pox vaccine would be administered in conjunction with the mumps, measles, rubella vaccines. This study is approached from the social standpoint. The time horizon selected was that of up until the study cohort was to reach 15 years of age, applying a 3% discount rate. A sensitivity analysis was made for evaluating the uncertainty of some variables... Results: The cost-benefit ratio of adding this vaccine to the childhood vaccination schedule amounts to 1.23. Conclusions: From the social standpoint, administering chicken pox vaccine in conjunction with the mumps, measles, rubella vaccines show itself to be profitable. The profitability is modified both if a second dose of vaccine is added as well as if only the direct healthcare costs are analyzed. 2008-01-01T00:00:00Z https://uvadoc.uva.es/handle/10324/45746 Hemos leído con agrado el editorial de Diògene Fadini etal1, y al hilo de sus afirmaciones quisiéramos establecer unaaportación sencilla para documentar el empleo clínico delos antivirales en el contexto pandémico al que aluden losautores.Estos se ̃nalan con acierto que la aparición de resistenciaa oseltamivir parece ser independiente de la prevalencia deluso del fármaco, y refieren la contribución de Dharan et al2relativa a su empleo en los Estados Unidos de América, sibien cabe matizar que esta serie hace referencia a aisladosanteriores a la aparición de la cepa pandémica 2011-01-01T00:00:00Z https://uvadoc.uva.es/handle/10324/45736 The demands on the health services by patients infected with type 1 human immunodeficiency virus (HIV–1) are increasing markedly. In Spain, past or present intravenous drug users account for a significant proportion of the total infected individuals [1]. Their visits to doctors are random and do not fit into defined patterns. 1997-01-01T00:00:00Z https://uvadoc.uva.es/handle/10324/45733 The use of saliva as an alternative biological fluid to serum in diagnosis or screening of infectious diseases by antibody detection has been the main subject of several articles in the last few years [1, 2, 3, 4, 5, 6]. Saliva samples can be obtained simply, without specialized personnel, and the process is non-traumatic for the patient and economic and poses no contamination risks for health workers. For these reasons, saliva samples may be of great utility in underdeveloped nations, where there is a severe shortage of personnel and specialized equipment. Saliva is a mixture of the secretions produced by the salivary glands and gingival crevicular transudate (GCT). The use of GCT, which has a greater concentration of immunoglobulins (Ig) of the IgG type than does complete saliva [7], seems to improve detection of such Ig in the samples [8]. 1997-01-01T00:00:00Z https://uvadoc.uva.es/handle/10324/45700 Objective: To estimate the prevalence of HTLV infection among pregnant women in Spain. Methods: A commercial ELISA incorporating HTLV-I and HTLV-II antigens was used for HTLV antibody screening. Repeatedly reactive samples were further examined by western blot. Moreover, confirmation with PCR was performed when cells were available. Results: 20 366 pregnant women in 12 different Spanish cities were tested in a 3 year period (July 1996 to August 1999). 32 samples were repeatedly reactive by ELISA, and 10 of them were confirmed as positive by western blot (eight for HTLV-II and two for HTLV-I). In addition, three of 13 women who had an indeterminate western blot pattern yielded positive results for HTLV-II by PCR. All 11 HTLV-II infected women had been born in Spain, and all but one were former drug users. Seven of them were coinfected with HIV-1. One HTLV-I infected woman was from Peru, where HTLV is endemic and where she most probably was infected during sexual intercourse. Conclusion: The overall prevalence of HTLV infection among pregnant women in Spain is 0.064% (13/20 366), and HTLV-II instead of HTLV-I is the most commonly found variant. A strong relation was found among HTLV-II infection and specific epidemiological features, such as Spanish nationality and injecting drug use. Although HTLV-II can be vertically transmitted, mainly through breast feeding, both the low prevalence of infection and its lack of pathogenicity would not support the introduction of HTLV antenatal screening in Spain 2000-01-01T00:00:00Z https://uvadoc.uva.es/handle/10324/45692 Dietary counseling and intervention based on application of conventional criteria have been ineffectivein preventing the progressive weight loss associated with HIV infection. The aim of the study was to compare theprogression of clinical and nutritional indicators during nutritional supplementation with or without anenterotropic peptide-based formula enriched with n-3 fatty acids. 2001-01-01T00:00:00Z https://uvadoc.uva.es/handle/10324/45670 Objective:To ascertain the prevalence of hepatitis C virus (HCV) genotypes in Spain and their distribution by risk factors. Methods:The study covered 216 patients with hepatitis C. Of these, 63 were intravenous drug users (IVDU), 44 had received transfusions, and 30 were hemodialyzed, and in 79 the risk factors were unknown. Antibodies against HCV were detected by second-generation enzyme immunoassay (EIA) and confirmed by immunoblot. HCV RNA presence was investigated by reverse transcription-polymerase chain reaction (RT-PCR), and a reverse hybridization test of the amplifications was used for the genotyping. Results:The most frequently encountered genotypes were 1b (48.1%), 1a (21.3%) and 3a (11.1%). HCV genotypes 1a (42.8%) and 3a (20.6%) were the most prevalent genotypes in IVDU patients, while 1b was the most frequent in patients with unknown risk factors (62.0%), transfused patients (68.1%) and hemodialyzed patients (50.0%). Mixed infections were detected in nine cases (4.1%); three appeared in IVDU patients (4.7% of the total IVDUs), two in transfused patients (4.5%) and four (50%) in patients with unknown risk factors. No statistically significant differences were found in average ages of the IVDU patients with different genotypes. Non-IVDU patients having genotype 3a presented the lowest average age of all. No significant statistical differences were observed in alanine aminotransferase levels among patient groups with different genotypes (p >0.05 in all cases). Subtype 1b was present in six of the seven cases of cirrhosis (85.7%) and in nine of the 18 cases of active chronic hepatitis (50.0%). 1997-01-01T00:00:00Z https://uvadoc.uva.es/handle/10324/45629 Abstract In total, 320 vaginal or rectal swabs were cultured on Granada medium (GM) or Group B Streptococcus Differential Agar (GBSDA), and were also inoculated into LIM broth (Todd–Hewitt broth supplemented with selective antibiotics), for detection of group B Streptococcus (GBS). Overall, GBS isolates were detected on 53 of the 320 swabs; 47 of these isolates grew on both GM and GBSDA, five only on GBSDA, and one only following subculture from LIM broth. GBSDA appears to be a valid alternative to GM for the growth of GBS isolates from pregnant women. 2005-01-01T00:00:00Z https://uvadoc.uva.es/handle/10324/45626 No cabe duda de que la situación mundial de resistencias a los antimicrobianos es un hecho preocupante, y ha sido abordado por su interés y actualidad por conocidos especialistas en publicaciones de máximo prestigio1. Este hecho es más relevante en lo que se refiere a nuestro país, lo cual tiene una relación directa con el elevado consumo de antibióticos que tiene lugar en nuestro entorno según han demostrado diversos estudios, los cuales han probado que desde la introducción de los antibióticos y su uso masivo, se ha constatado a escala mundial un aumento importante de la prevalencia de las resistencias. Una valoración superficial lo atribuiría únicamente al consumo, pero esto no es del todo cierto. Evidentemente, la resistencia bacteriana a antibióticos es un hecho predecible y tal vez inevitable del uso de antibióticos, pero tanto en la aparición como en su posterior extensión influyen otros factores. 2005-01-01T00:00:00Z https://uvadoc.uva.es/handle/10324/45592 Background: Saccharomyces cerevisiae is well known in the baking and brewing industry and is also used as a probiotic in humans. However, it is a very uncommon cause of infection in humans. Methods: During the period of 15–30 April 2003, we found 3 patients with S. cerevisiae fungemia in an intensive care unit (ICU). An epidemiological study was performed, and the medical records for all patients who were in the unit during the second half of April were assessed. Results: The only identified risk factor for S. cerevisiae infection was treatment with a probiotic containing Saccharomyces boulardii (Ultralevura; Bristol-Myers Squibb). This probiotic is used in Europe for the treatment and prevention of Clostridium difficile–associated diarrhea. The 3 patients received the product via nasograstric tube for a mean duration of 8.5 days before the culture result was positive, whereas only 2 of 41 control subjects had received it. Surveillance cultures for the control patients admitted at the same time did not reveal any carriers of the yeast. Strains from the probiotic capsules and the clinical isolates were identified as S. cerevisiae, with identical DNA fingerprinting. Discontinuation of use of the product in the unit stopped the outbreak of infection. A review of the literature identified another 57 cases of S. cerevisiae fungemia. Overall, 60% of these patients were in the ICU, and 71% were receiving enteral or parenteral nutrition. Use of probiotics was detected in 26 patients, and 17 patients died. Conclusions: Use of S. cerevisiae probiotics should be carefully reassessed, particularly in immunosuppressed or critically ill patients. 2005-01-01T00:00:00Z https://uvadoc.uva.es/handle/10324/45587 Background: Human immunodeficiency virus (HIV) treatment guidelines have evolved, shifting from more-aggressive to more-conservative approaches. The potential impact of these shifts on the transmission of drug-resistant virus is unknown. Methods: Drug-resistance genotypes were examined in all consecutive patients with recent HIV type 1 (HIV-1) seroconversion (hereafter, "HIV-1 seroconverters") seen at 10 Spanish hospitals since 1997. During the same period, the proportion of patients with chronic HIV-1 infection having undetectable viremia was examined, to estimate the extent and effectiveness of antiretroviral therapy. Results: A total of 141 recent HIV-1 seroconverters were identified, 67.4% of whom were men who have sex with men. The rate of primary drug-resistance mutations, by year of infection, was 33.3% for 1997, 29.4% for 1998, 20% for 1999, 14.3% for 2000, 3.4% for 2001, 15.4% for 2002, and 10.9% for 2003. On the other hand, the proportion of 8388 persons with chronic HIV-1 carriage who had an undetectable virus load was 33.4% for 1997, 34.6% for 1998, 39.7% for 1999, 47.5% for 2000, 52.9% for 2001, 39.7% for 2002, and 58.1% for 2003. A significant inverse correlation between transmission of drug-resistant HIV-1 and undetectable virus load was found (r=-0.955, by Spearman's test; P=.001). The lowest rate of transmission of drug-resistant HIV-1 was seen in 2001, when relatively "aggressive" treatment guidelines were used. Transmission of drug-resistant HIV-1 increased in 2002, in parallel with a reduction in the number of patients with chronic HIV-1 carriage and undetectable virus load, reflecting the popularity of drug holidays or treatment interruptions. Conclusion: The rate of drug resistance in recent HIV-1 seroconverters inversely correlates with the proportion of chronically HIV-1-infected individuals who have undetectable virus loads in the same region, which indirectly reflects antiretroviral treatment rules at any given time. 2005-01-01T00:00:00Z https://uvadoc.uva.es/handle/10324/45562 The prevalence of drug resistance mutations was 12.1% among 198 persons who experienced human immunodeficiency virus (HIV) seroconversion identified in Spain during 1997–2004. There was a significant increase of K103N and of non-B subtypes over time. Transmission of HIV infection around the time of seroconversion was shown in 8 couples and in 2 clusters of 3 individuals 2005-01-01T00:00:00Z https://uvadoc.uva.es/handle/10324/45493 The World Health Organization (WHO) has recently released updated guidelines for HIV diagnosis that recommend serum antibody testing by either EIAs or rapid tests and that encourage the identification of unrecognized HIV infections [1]. However, this approach may fail to identify subjects with acute infection. In consideration of the potential public health benefits of not missing individuals in the most contagious phase of infection, implementation of routine HIV RNA screening has been suggested [2]. We want to stress that there are other situations in which viral load is detectable in the absence of reactive antibody tests and in which the introduction of nucleic acid testing may be beneficial. This is the case for HIV-infected subjects in whom specific antibody responses are absent, as for the case reported here. 2008-01-01T00:00:00Z