Prevention of vaccine-matched and mismatched influenza in children aged 6-35 months: a multinational randomised trial across five influenza seasons

BACKGROUND

Despite the importance of vaccinating children younger than 5 years, few studies evaluating vaccine prevention of influenza have been reported in this age group. We evaluated efficacy of an inactivated quadrivalent influenza vaccine (IIV4) in children aged 6-35 months.

METHODS

In this phase 3, observer-blinded, multinational trial, healthy children from 13 countries in Europe, Central America, and Asia were recruited in five independent cohorts, each in a different influenza season. Participants were randomly assigned (1:1) to either IIV4 (15 μg haemagglutinin antigen per strain per 0·5 mL dose; a single dose on day 0 for vaccine-primed children, and two doses, on days 0 and 28, for vaccine-unprimed children) or to one or two doses of a non-influenza control vaccine. Primary endpoints were moderate-to-severe influenza or all influenza (irrespective of disease severity) confirmed by RT-PCR on nasal swabs. Cultured isolates were further characterised as antigenically matched or mismatched to vaccine strains. Efficacy was assessed in the per-protocol cohort and total vaccinated cohort (time-to-event analysis), and safety was assessed in the total vaccinated cohort.

FINDINGS

Between Oct 1, 2011, and Dec 31, 2014, 12 018 children were recruited into the total vaccinated cohort (6006 children in the IIV4 group and 6012 children in the control group). 356 (6%) children in the IIV4 group and 693 (12%) children in the control group had at least one case of RT-PCR-confirmed influenza. Of these 1049 influenza strains, 138 (13%) were A/H1N1, 529 (50%) were A/H3N2, 69 (7%) were B/Victoria, and 316 (30%) were B/Yamagata. Overall, 539 (64%) of 848 antigenically characterised isolates were vaccine-mismatched (16 [15%] of 105 for A/H1N1; 368 [97%] of 378 for A/H3N2; 54 [86%] of 63 for B/Victoria; 101 [33%] of 302 for B/Yamagata). Vaccine efficacy was 63% (97·5% CI 52-72) against moderate-to-severe influenza and 50% (42-57) against all influenza in the per-protocol cohort, and 64% (53-73) against moderate-to-severe influenza and 50% (42-57) against all influenza in the total vaccinated cohort. There were no clinically meaningful safety differences between IIV4 and control.

INTERPRETATION

IIV4 prevented influenza A and B in children aged 6-35 months despite high levels of vaccine mismatch. Vaccine efficacy was highest against moderate-to-severe disease, which is the most clinically important endpoint associated with greatest burden.

FUNDING

GlaxoSmithKline Biologicals SA.

Immunization of sea bream (Sparus aurata) juveniles against Photobacterium damselae subsp. piscicida by short bath: Effect on some pro-inflammatory molecules and the Mx gene expression

Cytokines are a family of proteins derived from macrophages, lymphocytes, granulocytes, mast cells and epithelial cells and can be divided into interferons (IFNs), Interleukins (ILs) and Tumor Necrosis factors (TNFs) among others. The presence of cytokines in a wide number of fish species has been proved and several molecules types have been already cloned and sequenced. In this work some proinflamatory molecules and Mx gene were detected in the liver of vaccinated sea bream juveniles with an average body weight of 5 g. The method of immunization was by short bath and three different bacterins against the marine pathogen Photobacterium damselae subsp. piscicida were designed and used to immunize fish. Five genes encoding for five different molecules were analyzed by real time PCR: IL-1β, IL Ir-2, Cox-2, Mx and TNFα. Gene expression was quantified along four days after fish immunization and results were compared among groups. Results show that the heat-inactivated vaccine stimulates the up-regulation of IL-1β, IL Ir-2, Cox-2 and TNFα genes whereas the UV-light inactivated vaccine was the unique vaccine which stimulates the expression of Mx gene. The present is a novel study that shows by the first time the effect of the inactivation process of vaccines on the expression levels of genes involved in the defense against Photobacterium damselae subsp piscicida.

The in vitro effect of probiotic Vagococcus fluvialis on the innate immune parameters of Sparus aurata and Dicentrarchus labrax

In this study we evaluated the effect of the probiotic Vagococcus fluvialis on the cellular immune unspecific system of two different fish species of great interest in aquaculture such as gilthead sea bream (Sparus aurata) and European sea bass (Dicentrarchus labrax). Leucocytes from head kidney of the two fish species were extracted and concentration adjusted to 10(7) cells ml(-1). Phagocytic and respiratory burst activity and the peroxidase content of leucocytes were observed 30 min after incubation with the probiotic Vagococcus fluvialis alive or inactivated with heat shock or UV-light at different concentrations of 10(7), 10(8), 10(9) cfu ml(-1) (final concentration 10(6), 10(7), 10(8) cfu ml(-1)). V. fluvialis produced dose-dependent increments in respiratory burst in sea bream leucocytes. The respiratory burst activity of sea bream head kidney leucocytes incubated with 10(6) cfu ml(-1) of live and inactivated bacteria was not stimulated. The highest values of peroxidase content were observed in sea bass cells with stimulation indexes higher than 1 in HK leucocytes incubated with 10(8) cfu ml(-1) of live and inactivated bacteria. Statistical analysis revealed that differences being only significant in sea bass leucocytes where 10(8) cfu ml(-1) bacteria denote statistically significant differences (P < 0.05) respect to other concentrations. Highest values of phagocytic activity were obtained in sea bass macrophages incubated with UV-light inactivated bacteria (27.33% ± 1.45), where significantly differences with sea bass HK leucocytes were detected. Our results suggest that the in vitro assays are a useful tool to optimize the effective dose of probiotic bacteria. Although in vivo studies are necessary to confirm the immunomodulatory effect of this strain.

In vitro study of adherence, invasion, and persistence of Streptococcus iniae in fibroblastic-like fish cell line SAF-1

Streptococcus iniae is a major fish pathogen producing invasive infections that result in economic losses in aquaculture. Gentamicin protection assays were used to investigate the ability of different S. iniae strains to invade and adhere to fibroblastic-like fish cell line SAF-1. All strains tested were detected intracellularly using both techniques, with variable internalization degrees between strains. The experiments carried out at 4°C demonstrated that active cell metabolism is necessary for bacterial internalization. Intracellular bacteria were detected for up to 3 d with a round morphology and were stained with 4',6-diamidino-2-phenylindole (DAPI), indicating that some bacterial cells may remain viable inside SAF-1 cells. Our in vitro findings indicate that S. iniae is capable of adhering, entering, and surviving within fibroblastic cells, which may be important for the persistence and establishment of a carrier state.

Interaction of Corynebacterium pseudotuberculosis with ovine cells in vitro

Caseous lymphadenitis is an infectious and contagious disease caused by Corynebacterium pseudotuberculosis, with a worldwide distribution and high prevalence in small ruminant populations. This disease causes significant economic loss in small ruminants through reduced meat, wool, and milk production. C. pseudotuberculosis can also affect horses, domestic and wild large ruminants, swine, and man. It is considered an occupational zoonosis for humans. As part of in vitro investigations of the pathogenesis of C. pseudotuberculosis, this study analyzed its capacity to adhere to and invade the FLK-BLV-044 cell line, derived from ovine embryonic kidney cells. C. pseudotuberculosis showed a measurable capacity to adhere to and invade this cell line with no significant differences between the four strains assessed. The incubation of the cell line at 4ºC, pre-incubation with sugars, complete and heat inactivated antiserum, and heat-killed and ultraviolet-killed bacteria produced a significant (P < 0.05) decrease in the invasion efficiency or inability to invade the cell line. Plate counting and fluorescence studies showed intracellular bacteria for up to 6 days. Non-phagocytic cells may therefore act as a suitable environment for C. pseudotuberculosis survival and play a role in the spread of infection and/or maintenance of a carrier state.

Presence of C. albidus, C. laurentii and C. uniguttulatus in crop and droppings of pigeon lofts (Columba livia)

Columba livia is an important reservoir and carrier of Cryptococcus neoformans, Cryptococcus uniguttulatus, Cryptococcus laurentii and Cryptococcus albidus. Upper digestive tract of this species is also known as a habitat for Cryptococcus neoformans. Given the increasing clinical interest of this microorganism, 331 swabs from crop and 174 dropping samples from pigeon lofts in Grand Canary Island have been studied. The obtained results show an extensive presence samples 81 positive (24.47%) of Cryptococcus spp. in analysed crops: 32 (9.66%) for C. neoformans, 24 (7.2%) for C. uniguttulatus, 23 (6.9%) for C. albidus and 2 (0.6%) for C. laurentii. In the same way, Cryptococcus spp was also isolated in 82 (47.13%), dropping samples: C. neoformans in 59 (33.9%), C. uniguttulatus, in 9 (5.17%), C. laurentii in 8 (4.59%) and C. albidus in 6 (3.44%) of the investigated samples, respectively. The cryptococcosis produced by species of cryptococci other than C. neoformans has become more important during the last decade, supporting the study on the role of pigeon in the epidemiology of this disease.

Prevalence and clinical characteristics of human metapneumovirus infections in hospitalized infants in Spain

Human metapneumovirus (hMPV), a condition recently described in the Netherlands, causes lower respiratory infections, particularly in young children and among the elderly. The objective of this study was to describe the characteristics of hMPV infections in hospitalized infants <2 years of age and to compare them to those of infections caused by respiratory syncytial virus (RSV). A prospective study was conducted on the clinical characteristics of infants admitted to hospital for respiratory infection through 5 years. Simultaneous detection of influenza A, B, and C viruses, RSV, and adenoviruses was performed in clinical samples by multiple reverse transcription nested-PCR assay. The presence of hMPV was tested in all samples using two separate RT-PCR tests. Some respiratory virus was detected in 70.5% of the 1,322 children included in the study. hMPV was found in 101 of the positive nasopharyngeal aspirates (10.8%), and was the most common virus after RSV and rhinovirus. Peak incidence was found in March. Over 80% of children were <12 months. The more common diagnoses were bronchiolitis (49.5%) and recurrent wheezing (45.5%). Fifty-four percent of cases required oxygen therapy and, one percent, assisted ventilation. Thirty percent were co-infections, with clinical characteristics indistinguishable from single infections. Seventy-one hMPV single infections were compared to 88 RSV single infections. hMPV infections were significantly more frequent than RSV in infants older than 6 months (P = 0.04). Recurrent wheezing was diagnosed more frequently in hMPV patients (P = 0.001). All other variables tested were similar, in both groups. hMPV was the third most frequent virus after RSV and rhinovirus in infants <2 years of age, hospitalized for respiratory infection, and was associated with bronchiolitis and recurrent wheezing. hMPV predominantly occurred in spring. Co-infections were frequent and clinically similar to single infections and RSV infections.

Complement consumption by Photobacterium damselae subsp. piscicida in seabream, red porgy and seabass normal and immune serum. Effect of the capsule on the bactericidal effect

A virulent strain of Photobacterium damselae subsp. piscicida (Pdp) was grown without (C form) or with (C+ form) glucose supplementation, the latter to enhance capsule formation. Both forms were resistant to killing by normal serum of seabream, red porgy and seabass. However, the C form was killed by immune serum of all three fish species while the C+ form was killed only by seabream and red porgy sera and to a lesser extent than the C form. Both C and C+ forms consumed complement in normal serum and this consumption was enhanced by precoating the bacteria in specific fish antibody. Complement consumption was greatest in seabass serum, especially with antibody-coated C+ form yet in this case the bacteria were not killed. The killing of the C form in immune serum of all three fish species was completely inhibited by EGTA/Mg(2+), indicating that the mechanism of complement activation leading to killing of the bacteria was by the classical pathway. The results suggest that immune serum killing by the classical complement pathway may provide some degree of protection against pasteurellosis, but enhanced expression of the capsule by Pdp in vivo may restrict complement-mediated killing, especially in immunised seabass.

Cellular immune response to pulmonary infections in HIV-infected individuals hospitalized with diverse grades of immunosuppression

The lymphocyte profile of 521 HIV-infected subjects hospitalized at Jackson Memorial (2001-2002) was compared across main respiratory diseases. Study data included medical history and all laboratory evaluations performed during hospitalization. Community-acquired pneumonias (CAP, 52%), Pneumocystis jiroveci pneumonia (PCP, 24%), tuberculosis (TB, 9%) and non-tuberculous mycobacterial diseases (NTM, 12%) were the most frequent causes of admission. Patients hospitalized with PCP and NTM exhibited the lowest CD4 counts (P=0.003). PCP patients had the highest B-cell percentages (P=0.04). CAP patients had the highest CD8 and CD4 percentages and the lowest percentage of Natural Killer (NK) cells and viral burdens. TB patients exhibited the lowest NK-cell (11.4+/-6.3) and B-cell percentages (13.6+/-12) and the highest CD8 (59+/-14) percentage. NTM patients, in contrast, had the highest NK-cell percentages of the groups (19.1+/-11.6, P=0.01). Additionally, immune responses associated with respiratory pathogens differed in HIV-infected patients with CD4(+) cells above and below 200 counts.

Human metapneumovirus infections in hospitalised infants in Spain

BACKGROUND

Human metapneumovirus (hMPV) causes lower respiratory tract infections, particularly in young children and the elderly.

METHODS

A prospective study was conducted on the clinical characteristics of infants <2 years of age admitted to hospital for respiratory infection and the characteristics of hMPV infections were compared with those of infections caused by respiratory syncytial virus (RSV). Influenza A, B and C viruses, RSV, parainfluenza viruses, and adenoviruses were simultaneously detected in clinical samples by multiple reverse transcription nested-PCR assay. The presence of hMPV was tested in all samples using two separate RT-PCR tests.

RESULTS

A respiratory virus was detected in 65.9% of the 749 children included in the study. hMPV, found in 69 of the positive nasopharyngeal aspirates (14%), was the most common virus after RSV. Peak incidence was in March and over 80% of children were <12 months of age. The most common diagnoses were recurrent wheezing (49.3%) and bronchiolitis (46.4%). Oxygen therapy was required by 58% of patients, and assisted ventilation by one. Clinical characteristics in the 18 co-infections were indistinguishable from those of single infections. Fifty one hMPV single infections were compared with 88 hRSV single infections. Recurrent wheezing was diagnosed more frequently in hMPV patients. All other variables tested were similar in both groups.

CONCLUSIONS

hMPV was the second most frequent virus after RSV in infants <2 years of age hospitalised for respiratory infection and was associated with lower respiratory tract infections. hMPV occurred predominantly in springtime. Co-infections were frequent and clinically similar to single infections and RSV infections.

Isolation of Cryptococcus species including C. neoformans from cloaca of pigeons

Upper digestive tract of the pigeon (Columba livia) is well known as a reservoir for different species of Cryptococcus, but lower portions are not so frequently studied. In the present study, we tested on selective media a total of 331 pigeon cloacal swabs; Cryptococcus spp. were recovered from 26 (7.85%). Cryptococcus uniguttulatus was isolated from 11 samples (3.32%), C. laurentii from six (1.81%), C. neoformans var. neoformans from six (1.81%) and C. albidus from three of them (0.91%). The results show the importance of pigeon in the cryptococcosis epidemiology as reservoir and carrier for C. neoformans var. neoformans, but also for other Cryptococcus species of increasing clinical interest.

Virulence factors and pathogenicity of Hafnia alvei for gilthead seabream, Sparus aurata L

Virulence factors (eae gene, haemolytic capacity, fimbriae, resistance to the bactericidal effect of serum, siderophore production) and pathogenicity for gilthead seabream, Sparus aurata L., were analysed for 23 Hafnia alvei strains. None of the strains used in LD50 studies were lethal for seabream at doses as high as >10(8) cfu mL(-1). In chronic challenge studies differences in severity of the inflammatory response were observed between strains. On the basis of correlation of the inflammatory response to different strains of H. alvei in seabream with those virulence factors studied, it was only possible to establish a positive correlation between pathogenicity and resistance to the bactericidal effect of fish serum. Gilthead seabream is thus a species with considerable resistance to experimental infection with H. alvei. The bacterium does, however, have the capacity to remain viable in seabream for up to 3 months, without any clinical signs. Hafnia alvei is a well-recognized human and animal pathogen. Thus, as the pathogen can coexist with aquaculture operations, cultured gilthead seabream could represent a risk to human health as a carrier in some circumstances.

Early infections in adult patients undergoing unrelated donor cord blood transplantation

Early transplant-related mortality after cord blood transplantation from unrelated donors (UD-CBT) is close to 50%, mainly due to infectious complications. We have studied the incidence and characteristics of early infections (before day 100) in a series of 27 adult patients (median age 30 years, range 16-46) undergoing UD-CBT at a single institution. All 27 patients experienced at least one infectious episode and 18 (66%) suffered a severe infection. Bacteremia occurred in 55% of patients (13 with Gram-positive and 11 with Gram-negative microorganisms). Eleven of 19 CMV-seropositive patients (58%) developed CMV antigenemia and one patient had CMV disease. Fungal infections were documented in three patients (11%), comprising invasive fungal infections in two cases and a localized esophagitis in one. Ten patients (37%) died before day 100 after transplantation. Infection was considered the primary cause of death in four patients (sepsis by Acinetobacter spp. bacteremia in three cases) and contributed to death in another four. The most striking findings in this series were the high incidence of, and mortality due to multiresistant Acinetobacter spp. and the low incidence of and lack of mortality due to CMV disease. This report confirms that infection is a major complication in adults undergoing UD-CBT.

Infectious complications in patients undergoing unrelated donor bone marrow transplantation: experience from a single institution

OBJECTIVE

To analyze the incidence and characteristics of documented infections in patients with hematologic malignancies undergoing unrelated donor bone marrow transplantation (UD-BMT).

METHODS

We studied the occurrence of infections in 22 patients with hematologic malignancies or severe aplastic anemia who underwent UD-BMT from April 1990 to December 2000. The median age was 26 years (range 13-46). Acyclovir-ganciclovir, co-trimoxazole, fluconazole-nystatin and ciprofloxacin were administered for anti-infectious prophylaxis.

RESULTS

We registered 61 infectious episodes. During the early post-transplant period, there were eight clinically documented infections (CDIs), four cases of fever of unknown origin (FUO), seven cases of bacteremia, two cases of cytomegalovirus (CMV) antigenemia, and one case of CMV disease. In the intermediate period (days 30-100 after BMT), there were nine cases of CMV antigenemia, three bacterial infections, two fungal infections, one case of disseminated toxoplasmosis, and one case of FUO. In the late period (day 100 and later), we documented 13 viral infections, eight bacterial infections, one CDI, and one case of invasive aspergillosis. Infections contributed to death in 10 of 17 patients. Citrobacter bacteremia and sepsis of unknown origin were the main causes of infectious mortality in the early period. Infection was the main cause of death in six of seven patients in the late period.

CONCLUSION

A high incidence of life-threatening infections and infection-related mortality was observed. A high rate of CMV infection in the early period, and death caused by multiresistant Gram-negative microorganisms in the late period, were the main findings in this series.

Trace metals in tissues of gray whale (Eschrichtius robustus) carcasses from the Northern Pacific Mexican Coast

Samples of liver, lung, heart, muscle, and blubber tissue from the carcasses of juvenile gray whales (Eschrichtius robustus) found stranded on the coast off the Sea of Cortez, México were analyzed for a range of trace metals (Cu, Fe, Zn, Mn, Ni, Pb, and Cd). The highest concentrations of copper, iron, zinc, and manganese were found in liver; nickel and lead in heart, and cadmium in kidney. In all tissues analyzed, iron, zinc and copper were present in the highest concentrations; however, some whales also showed high levels of cadmium in the kidney which could be related to their diet. Elevated concentrations of copper were found only in the liver of one whale. In general, where low levels of iron were found in the liver, they were associated with poor nutrition. Lead, nickel, manganese and zinc levels in liver were within the normal range, indicating that these whales had not been exposed to high levels of these metals.

Does the perception of downloading speed influence the evaluation of web-based lectures?

Medical schools put little emphasis upon education on public health, even though public health has played an important role in this century. One way to harness its benefit in order to improve global health in the 21st century is to globally share lectures on public health through the Internet. We have developed the Supercourse comprising of web-based learning modules on epidemiology in a standardized format with the size of each web page less than 10 kilobytes. A cross-sectional observational study was conducted to investigate the association of the perception of the access speed to Web-based lectures by teachers with their perception of lecture quality. There were 223 teachers who rated the lectures: 72% were from North America or Western Europe, 40% had taught epidemiology, and 14% reported that the speed of access was slow. Odds ratio of above-average rating among those who reported that the speed of access was fast relative to those who reported that the speed of access was slow was 4.25 (2.03-8.91; P = 0.001). The odds ratios were similar and significant after taking into account several other factors, including the variation of rating across lectures, region, and experiences in teaching epidemiology. The results indicate that the perception of the quality of Web-based lectures is related to the speed of access to a web page. The speed of access may be as important, if not more important, as the content itself. This suggests that, to share educational materials on the Web globally for teachers, one must consider not only the content, but also how people at local sites gain access to the Internet.

Hemodynamic effects of noninvasive bilevel positive airway pressure on patients with chronic congestive heart failure with systolic dysfunction

BACKGROUND AND STUDY OBJECTIVES

Noninvasive positive airway pressure may play a significant role in treating patients with congestive heart failure (CHF). We tested our hypothesis that noninvasive bilevel positive airway pressure improves left ventricular performance in patients with chronic CHF secondary to severe systolic dysfunction.

OBJECTIVES

To determine the cardiac performance of patients using bilevel positive airway pressure, and to describe the hemodynamic effects of bilevel positive airway pressure and its use as a therapeutic adjunct in these patients.

DESIGN

Prospective, cohort, nonrandomized study.

SETTING

Outpatient medicine clinic.

PATIENTS

Fourteen patients (9 men and 5 women) with stable chronic CHF with left ventricular ejection fraction < or =35%; mean age was 60.6 years (range, 43 to 87 years).

INTERVENTIONS

Bilevel positive airway pressure via nasal mask at an inspiratory pressure of 5 cm H(2)O and an expiratory pressure of 3 cm H(2)O on spontaneous mode at room air for 1 h.

MEASUREMENTS AND RESULTS

Myocardial performance and changes were measured using clinical and echocardiographic parameters. Baseline clinical and echocardiographic parameters were compared with the same parameters after 1 h of bilevel positive airway pressure. Statistically significant (p<0.05, Wilcoxon matched pair signed-rank test) decreases were noted in these mean values: systolic BP from 136.21 to 124.14 mm Hg (p = 0.008), heart rate from 85.07 to 74.71 beats/min (p = 0.002), respiratory rate from 23.07 to 15.43 breaths/min (p = 0.001), and systemic vascular resistance from 1671. 46 to 1236.27 dyne. s. cm(3) (p = 0.001). Statistically significant increases were noted in these mean values: cardiac output from 5.09 to 6.37 L/min (p = 0.004), ejection fraction from 28.71% to 34.36% (p = 0.001), and end-diastolic volume from 224.36 to 246.21 mL (p = 0.045).

CONCLUSION

Bilevel positive airway pressure has excellent potential for improving left ventricular performance of patients with chronic CHF secondary to severe systolic dysfunction.

[Neonatal colonization by Ureaplasma urealyticum and the development of bronchopulmonary dysplasia]

OBJECTIVE

The study purpose was to investigate the association between neonatal Ureaplasma urealyticum isolation, and bronchopulmonary dysplasia (BDP), in infants who had birth weights < 1,500 g, admitted in the Pediatric Intensive Care Unit, La Fe Hospital, Valencia, Spain.

METHODS

A cohort study was designed, since March 1996 until April 1998, with a cohort of exposed and no exposed, determined by isolation of U. urealyticum in tracheal aspirate or pharyngeal cultures. 137 infants were admitted to the intensive care unit in this period, and 101 of them were enrolled in this study.

RESULTS

U. urealyticum was isolated in 27 (26.7%) patients. The infants with U. urealyticum positive culture had a significantly lower gestational age (mean 28.1, SD 2.4 vs 29.2, SD 2.4; p = 0.048) than negative culture infants. BDP occurred in 30 infants (29.7%), and was significantly associated with decreasing gestational age (mean 26.9, SD 1.7 vs 29.7, SD 2.2; p < 0.001) and lower birth weight (mean 965.8, SD 166.7 vs 1121.4, SD 232.1; p < 0.001). However, after correction for gestational age by logistic regression analysis, DBP was significantly related to decreasing gestational age, but not to the presence of a positive U. urealyticum culture. In the cohort of U. urealyticum positive infants, BPD occurred in 9 (33%) vs 21 (28%) in the not colonized cohort. The odds ratio associated with colonization was 1.3 (CI 95% 0.5-3.2; p = 0.63).

CONCLUSIONS

BPD was significantly associated with decreasing gestational age, independently of birth weight and U. urealyticum colonization.

[Cryptococcal lymphadenitis in a dog.]

We describe a case of canine crytococcosis, the clinical symptoms were: feverish syndrome, vomiting and diarrhoeas and bilateral lymphadenitis in superficial lymph nodes. Microbiology and histopathology study of popliteal lymph node biopsy demonstrated the presence of round yeasts of some 3 microm of diameter, which we identified as Cryptococcus neoformans. Thirty months after suspending the medication the dog returned to the surgery; the dog was very thin and it had nervous symptoms; the owners decided it upon euthanasia. After carrying out the necropsy we take samples for their microbiology and histopathology study, both techniques detect to C. neoformans in marrow, CNS tissue and lymph nodes.

[Prevalence of antibodies against herpes simplex virus, Epstein-Barr virus and cytomegalovirus in a group of patients after hemodialysis]

Infections from herpes virus play a key role in post-transplantation pathology, so it is indispensable to characterize the group of would-be renal transplant recipients. IgG antibody titers were detected by indirect immunofluorescence to Herpes simplex virus, Epstein Barr virus (EBV) and cytomegalovirus (CMV) in 100 patients treated with hemodialysis in the Nephrology Institute. The prevalence of antibodies to cytomegalovirus and to Herpes simplex and Epstein Barr viruses was 100% and 95% respectively. Average geometric titers (AGT) of antibodies to CMV were significantly higher. There was no correlation between AGT and sex, age, time of disease remission, number of blood transfusions and number of transplants.

[Enterovirus meningoencephalitis in the last 5 years]

The results of the study of Enterovirus as viral meningoencephalitis producing agents, carried out from 1990 to 1994, are described, 546 feces samples, 95 cerebrospinal fluids and 1,058 matched sera were studied and obtained from 1,388 patients clinically diagnosed with this disease. Samples for viral isolation were inoculated into two different cellular systems. The highest number of isolation was found in diploid cells from human fibroblast. Antibody determinations were carried out by a neutralization test (micromethod) with 11 Enterovirus antigens (Echo 4, 6, 9, 11 and 30; and Coxsackie B1, 2, 3, 4, 5 and 6) and in epidemic periods with the isolated virus. During the years under study, 2 epidemic outbreaks took place: on caused by Coxsackie A9 (1990-1991) and the other one by Echo 30 (1994). A greater positivity to Echo 6 and 11 was found among the matched sera.

Septicemia associated with Hafnia alvei in laying hens

In the present work Hafnia alvei was isolated from laying hens displaying a reduction in egg production, loss of appetite, opisthotonus, and death. Multifocal necrotizing hepatitis and splenitis were the most prominent lesions. The organism was identified microbiologically. Laying hens were experimentally inoculated by the oral and intraperitoneal route to show the pathogenicity of the organism. A very similar clinicopathologic effect resulted from this trial. Several experimentally infected laying hens died due to septicemia. We conclude that H. alvei may cause a septicemia similar to that reportedly caused by Salmonella spp. in avian species.

IgG concentration in mammary secretions of goats throughout lactation in healthy and coagulase-negative staphylococci infected udders

Radial immunodiffusion was used to determine immunoglobulin (Ig)-G concentrations in 16 mammary secretions from uninfected udder halves and in 10-14 secretions from halves subclinically infected with coagulase-negative staphylococci in goats throughout lactation. IgG concentrations in samples from uninfected halves decreased rapidly during the first week after parturition (P < 0.001 ), henceforth falling slowly up to 30 d post-partum (P < 0.001). From 30 d post-partum to 180 d of lactation, IgG concentration showed a continuous decline to the end of the experiment but these changes were not statistically significant until 150 d after kidding (P < 0.01). IgG concentrations in lacteal secretions of halves harbouring coagulase-negative staphylococci showed a similar pattern, from the first month of lactation, to that observed in healthy udder halves, but concentrations were always lower. These differences were significant from 2 months after parturition (P < 0.001). IgG concentrations were compared with somatic cell counts obtained using an automatic counter (Fossomatic).

Polyarthritis in kids associated with Mycoplasma putrefaciens

Fifteen two- to three-week-old kids, fed artificially with goats' milk from a dairy, were found to have polyarthritis. The most affected joints were the carpals, either unilaterally or bilaterally, and in some cases the tarsal joints. Mycoplasma putrefaciens was isolated from the joints which showed an acute fibrinopurulent arthritis. No clinical mastitis was detected in the dairy.

[Prolonged total parenteral nutrition in surgery. A case report of severe malnutrition]

We present a 15-years-old female patient severely malnourished due to complications of abdominal surgery, who received total parenteral nutrition during 118 days. The clinical and laboratory parameters are analyzed and a photographic sequence is presented. During the treatment period nitrogen balance was positive and her weight increased in 50%.

[Detection of cytomegalovirus in urine by the shell-vial technique: usefulness of diluting the sample]

To assess the toxicity of urine samples on human fibroblast cell monolayer using Shell-vial technique for cytomegalovirus antigen detection. A total of 227 urine samples were processed, inoculated on Shell-vial simultaneously, being either diluted (1:1) and non diluted in transport media. After 24-48 hours incubation, the fibroblast cells monolayer was stained using fluorescein-marked monoclonal anti-cytomegalovirus antibodies. Cytomegalovirus was detected in 9.6% of samples inoculated with diluted urine, and in 5.2% of samples inoculated with non-diluted urine. Destruction of monolayer cells was seen in 13.2 and 22.4, respectively. With Shell-vial technique for detecting cytomegalovirus in urine samples, a high number of positive results was obtained using diluted urine. Also a significant minor destruction of cells monolayer was observed with the same inoculum.

[Heterotopic pancreas]

Heterotopic pancreas is a rare entity, usually asymptomatic, and found incidentally during laparotomy, when symptomatic it is for some complication, gastric obstruction, gastrointestinal hemorrhage, Meckel's diverticulum, obstructive jaundice. We report four patients, with this diagnostic and make a bibliographic review of this entity.

[Aeromonas spp. isolated from human feces. Species and pathogenicity factors]

The role of Aeromonas genus as a primary intestinal pathogen is still a matter of controversy. We have studied the isolation of Aeromonas spp. from human stools samples, looking for the production of pathogenic factors and its relationship with different species. From a total of 471 strains isolated, 241 were A. caviae, 127 A. sobria, 89 A. hydrophila and 14 non-typable strains. The pathogenic factors production was studied in a bacteria-free filtrate from a 18 hours trypticase-soy broth culture. Enterotoxin production was assessed by suckling-mice test, cytotoxin production by using Hela cells monolayer and hemolysin production by double dilution from the filtrate, plated in microdilution plates, against rabbit red-blood cells. Enterotoxin production test was positive for A. sobria, A. hydrophila and A. caviae in 81.1%, 62.9% and 7.0% of strains respectively. Cytotoxin production was also positive for these species in 96.6%, 76.4% and 4.1%, and hemolysin production was positive in 95.3%, 70.7% and 2.4% of the strains respectively.

[Ligation and sclerosis technique combined with electrocoagulation resection of internal hemorrhoids]

We review 1331 patients who were treated by sclerosis and rubber band ligation, stepped binding, simultaneous binding and sclerosis with electrocoagulation resection as the main hemorrhoidal bundle treatment, from July 1977 through July 1990, was performed. The benefits on symptoms, complications, and final outcome were analyzed. Binding of only one hemorrhoidal bundle with sclerosis of the other two in the 74.9%, binding of two bundles with sclerosis of the other in the 13.7% and simultaneously binding of the three bundles in the 4.8% was performed. Binding, sclerosis and electrocoagulation resection of three bundles was also performed in the 6.45%.

[Vascular compression of the duodenum]

The acute vascular compression of the duodenum is a well-recognized clinical entity, characterized by recurrent vomiting, abdominal distention, weight loss, post prandial distress. The cause of compression is considered to be effect produced as a result of the angle formed by the superior mesenteric vessels and sometimes by one of its first two branches, and vertebrae and paravertebral muscles, when the angle between superior mesenteric vessels and the aorta it's lower than 18 degrees we can saw this syndrome. The duodenojejunostomy is the best treatment, as well as in our patient.