Prevalence of agglutinating antibodies to Toxoplasma gondii in small ruminants of the Madrid region, Spain, and identification of factors influencing seropositivity by multivariate analysis

A seroepidemiological survey of Toxoplasma gondii infection in sheep and goats was conducted in the Madrid region of Spain. Sera were collected from 60 herds, for which farming management information and other relevant data for their characterization were also obtained through a questionnaire. The seroprevalence was 11.8% (64 out of 541), using the modified (2-mercaptoethanol) direct agglutination technique with a 1:64 cut-off titre. The relationship between seropositivity and the variables in the questionnaire was assessed by multivariate analysis. Four variables were found to be significantly associated with seroprevalence. Two of them, the presence of cats and a previous history of abortion outbreaks in the farm, were factors known to be linked with toxoplasmosis, indicating the validity of the serological data. Seropositivity was also related to a lack of replacements in the preceding year. Proximity to other farms appeared to be a protective factor negatively associated with seropositivity, probably because it was an indicator of proximity to an urban area and the availability of local sanitary facilities.

Colonization and infection with methicillin-resistant Staphylococcus aureus: associated factors and eradication

OBJECTIVES

To identify characteristics associated with methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection, and to evaluate the efficacy of systemic and topical antimicrobials in the eradication of MRSA carriage among hospitalized patients.

DESIGN

A case-control study was done to identify associations. Odds ratios were estimated by unconditional multiple logistic regression. Cohort study was done to evaluate MRSA decolonization efficacy by an oral regimen. Patients infected or colonized with MRSA received a 5-day course of oral (160 mg/800 mg) trimethoprim-sulfametroxazole twice daily and 600 mg of rifampin once daily as decolonization treatment. The proportion of MRSA-free patients after decolonization treatment was determined. Persistence of clearing was estimated by the Kaplan-Meier method.

SETTING

Ramón y Cajal Hospital, a 1,249-bed, tertiary-care teaching hospital in Madrid, Spain.

PATIENTS

One hundred ninety-two patients with hospital-acquired MRSA infection/colonization and 195 MRSA-free random controls.

RESULTS

Six factors were associated independently with MRSA infection/colonization: age (every 10 years of age, odds ratio [OR] = 1.3); ward (surgical, OR = 1; medical, OR = 3.1; intensive care unit, OR = 60); previous hospitalization (OR = 6.9); coma (OR = 25.3); invasive procedures (each, OR = 1.7); 3 or more weeks of hospitalization (OR = 3.8). We failed to show antibiotic therapy to be an independent risk factor for MRSA hospital infection/colonization. Overall, MRSA eradication was 64.2% by day 2 to 9 after completion of treatment. Kaplan-Meier product limit survival analysis showed that the probability of remaining MRSA-free was 65.3% (SE = 0.09) at 32 days after completion of treatment.

CONCLUSIONS

The results offer a rationale for reduction of MRSA infection/colonization in the hospital by interventions aimed at early identification of patients at higher risk, at prompt discharge of patients, and at preventing dissemination while performing invasive procedures. They also provide estimates of antibiotic treatment efficacy to reduce the reservoir of MRSA in the hospital.

[Predictive factors of surgical infection in heart surgery]

BACKGROUND

Deep infection of the surgical site in cardiac surgery may lead to very severe complications. There is controversy as to the importance which different factors may have in the incidence of this complication. The aim of this study was to determine the importance of determined factors on the risk of deep infection of the surgical site.

METHODS

A retrospective study of 1,127 patients submitted to cardiac surgery from 1989 to 1991 was performed. The factors associated to the development of deep surgical infection were determined by univariant analysis. A multiple logistic regression model was designed to identify the factors independently associated to the risk of infection. The morbidity of surgical infection attributable to prolonged preoperative stay was calculated.

RESULTS

Of the numerous factors associated to risk of surgical site infection on univariant analysis, only five were independently associated to risk of infection on multivariant analysis: prolonged preoperative stay (OR = 2.4 [1.1-5.5]), dirty surgery (OR = 3.2 [1.0-9.9]), length of the intervention (OR [every hour] = 1.5 [1.2-2.0]), diabetes mellitus or chronic obstructive pulmonary disease (OR = 2.6 [1.2-5.6]) and functional grade according to the New York Heart Association (OR = 3.4 [1.5-7.7]). The proportion of deep infection attributable to prolonged preoperative stay was 41.8% (4.0-58.2).

CONCLUSIONS

The incidence of deep surgical infection may be decreased with a reduction, whenever possible, of the length of surgical intervention and preoperative stay.

Expression of lymphocyte function-associated antigen (LFA)-1 in B-cell chronic lymphocytic leukemia

We investigated the expression of the lymphocyte function associated (LFA)-1 adhesion molecule, recognized by the CD11a and CD18 monoclonal antibodies, in 53 patients with B-cell chronic lymphocytic leukemia (B-CLL) and in 37 controls. The mean percentage of control lymphocytes expressing CD11a and CD18 positivity was 92 +/- 5.5 and 90 +/- 8.7, respectively and, in patients with B-CLL, 14.2 +/- 10.3 and 14.8 +/- 10.3 respectively (p < 0.001). No statistical difference was found between CD11a and CD18 expression and the Rai clinical stages. In our experience a decrease of LFA-1 is a constant finding in B-CLL, in the early stages of the disease. It may, therefore, be useful to differentiate between slight increases of neoplastic cells and reactive blood lymphocytosis.

[Alloimmune neonatal neutropenia: flow cytometry study of the 1st patient described in Spain with identification of an anti-NA1]

A strong antibody was found in a mother (first pregnancy) who had a severe neutropenic baby. The father's granulocytes were typed by flow cytometry as NA1+, NA2+, NB1+, ND1+ and the mother as NA1-, NA2+, NB1+ and ND1+. The antibody was identified as anti-NA1 by us, and confirmed later by a reference laboratory. The serum reacted with 54.8% of the 31 donors tested. The same antibody was found in the child's serum 35 days after birth, and the reactivity was stronger than in the mother's serum. The HLA-DR, DQ from the mother was DR3, DR7; DR52, DR53; DQ2. The baby's granulocytes were recovered slowly over a four-month period, but the course was benign without any specific treatment. Five months after birth, with recovery, the child's serum became negative and his granulocytes were confirmed as NA1+. Due to the difficulties in fully diagnosing and working with granulocytes we suspect that there are undetected cases; only one case has been recorded in Spain before.

A new chromosomal anomaly associated with mature B-cell chronic lymphoproliferative disorders: del(7)(q32)

Among 63 patients with chronic lymphoproliferative disorders (CLPD) studied cytogenetically in our laboratory, four showed a del(7)(q32); in two it was the sole cytogenetic anomaly and in two it was part of a complex karyotype. We suggest that despite the rarity of this anomaly, it could be related to CLPD.

[Duodenal ulcer and duodenocholedochal fistula]

A new case of choledocoduodenal fistula secondary to duodenal ulcer is reported, which manifested as an ulcer complicated by haemorrhage, duodenal stenosis and cholangitis. We recommend endoendoscopy as the main diagnostic tool. Surgical treatment should consist of avoidance of the fistulous tract, cholecystectomy, cholangiography, truncal vagotomy and gastroduodenal drainage by pyloroplasty or gastroduodenostomy.

Inhibitory effect of peak 2-4 of uremic middle molecules on platelet aggregation

It is well-known that uremic patients present prolonged bleeding times as a common complication. Factors responsible for this disorder have been extensively investigated. In order to elucidate the possible role of uremic middle molecules as responsible for the bleeding tendency observed in uremia, we have studied the effect on platelet aggregation of middle molecules obtained from uremic plasma by Sephadex and ion-exchange chromatography. Our results show that some purified middle molecular fractions have a specific inhibitory activity on platelet aggregation and suggest an important role for these compounds in the pathogenesis of uremic bleeding.

[Morphology of Sarcoptes Scabiei (variety hominis) under scanning electron microscopy]

Some morphologic aspects of S. S. by SEM in twelve parasites (female) extracted from the lesions with a pin are studied. We think that the extraction method and the posterior colocation of the parasite has contributed to its better understanding. We describe the dorsal cleft, a characteristic formation of the sarcoptidos, tapered on both sides with thorns in the form of shark's teeth. We analyze the details of the Ambulacro, constituted by the cut or the strait Pedicelo, with a distal extremity in the form of Condyl in which the suction cups are articulated. We can see, in the anogenital portion, two independent anal and genital orificius and, in the ventral area, the tocostoma, or cleft, where the eggs are deposited. Finally we analyze the bucal organs, the Pedipulpos, the morphology and disposition of the hipostoma and the queliceros.