SUMMARYWe describe an outbreak of skin lesions due to Mycobacterium chelonae subsp. abscessus associated with injections of lidocaine (lignocaine) given by a 'bioenergetic' (a practitioner of alternative medicine) in Colombia. The lidocaine carpules and the lesions of the patients yielded mycobacteria with identical biochemical characteristics.Using the methodology of Sartwell and a case control design we examined the incubation period and assessed risk factors. Of 667 potentially exposed individuals, a total of 298 patients were interviewed, of whom 232 had skin lesions. The median incubation period was 305 days (range 15-59 days). Male sex (OR 2-85, 95 % CI 126-6-5 1), increasing age (OR 1-25, 95 % CI 103-1-53), subcutaneous injection route (OR 3-72, 95 % CI 1-09-12-7) and number of injections (OR 101, 95% CI 1001-03) were risk factors for disease.To our knowledge, this is the largest reported outbreak of M. chelonae infection, the first in which the organism has been isolated from the putative vehicle of infection, and the first in which the incubation period could be determined.

No abstract

During the period 2000-2003, wild grey foxes (Urocyon cinereoargenteus) in northern Colombia became infected with rabies. In order to derive phylogenetic relationships between rabies viruses isolated in foxes, dogs and humans in this region, 902 nt cDNA fragments containing the G-L intergenic region and encoding the cytoplasmic domain of protein G and a fragment of protein L were obtained by RT-PCR, sequenced and compared. Phylogenetic analysis showed that rabies viruses isolated in foxes, dogs and humans belonged to a single genetic variant. Speculative analysis together with epidemiological data indicated that rabies in foxes may have been due to contact with rabid dogs. Rabies transmission between dogs, wild foxes and humans may happen in natural conditions in northern Colombia. This finding is the first to suggest dog-to-fox rabies transmission in South America, and provides another example of dog rabies variants being able to successfully colonize wildlife hosts.

Background Sarcopenia is a syndrome characterized by progressive loss of skeletal muscle mass, which results in decreased muscle strength and impairment of physical and functional capacity. There are no data regarding this disorder in AS patients and the possible beneficial effect of anti-TNF therapy in this complication. Objectives To determine the longitudinal anti-TNF induced changes in the frequency of sarcopenia and in body composition of AS patients. Methods Thirty active AS patients (24 men and 6 women) were assessed at baseline (BL), 6 (6M), 12 (12M) and 24 months (24M) after anti-TNF therapy. Patients were evaluated for clinical parameters (BASDAI, BASFI, BASMI, ASQol) and inflammatory markers (ESR, CRP). Physical activity remained stable during the study. Body weight and Body Mass Index (BMI) were also measured. Fat mass (FM), total lean mass (LM) and appendicular lean mass (ASM = sum of arms and legs) were analyzed by dual-energy X-ray absorptiometry (DXA). Sarcopenia was defined when the relative skeletal muscle mass index (RSMI= ASM/height2) was less than 7.26 kg/m2for men and 5.45 kg/m2for women (Baumgartner’s criteria). Results Sarcopenia was found in 16.6% of AS patients. There was a significant decrease in the frequency of sarcopenia with a complete reversion in all patients at 24 months (BL: 16.6% vs. 6M: 13.3% vs. 12M: 6.6% vs. 24M: 0%, p<0.001). This finding was paralleled by an increase of body weight (BL: 72.65 kg vs. 6M: 73.87 kg vs. 12M: 74.65 kg vs. 24M: 75.01 kg, p=0.007), BMI (BL: 25.66 kg/m2 vs. 6M: 26.07 kg/m2 vs. 12M: 26.34 kg/m2 vs. 24M: 26.90 kg/m2, p=0.038) and total lean mass (BL: 52.56 kg vs. 6M: 53.19 kg vs. 12M: 54.08 kg vs. 24M: 54.01 kg, p≤0.001), particularly in the first 12 months of therapy (BL vs. 12 months, p<0.05). No difference was observed in fat mass (BL: 17.79 kg vs. 6M: 18.10 kg vs. 12M: 18.14 kg vs. 24M: 18.90 kg, p=0.07) and percentage of fat mass (BL: 24.14% vs. 6M: 24.27% vs. 12M: 54.08% vs. 24M: 24.86%, p=0.146). BASDAI (BL: 5.11 vs. 6M: 2.79 vs. 12M: 2.79 vs. 24M: 2.57, p<0.001), BASFI (BL: 5.40 vs. 6M: 2.97 vs. 12M: 2.86 vs. 24M: 2.41, p<0.001), BASMI (BL: 4.07 vs. 6M: 3.23 vs. 12M: 3.07 vs. 24M: 3.00, p=0.001) and ASQoL (BL: 10.03 vs. 6M: 6.43 vs. 12M: 6.40 vs. 24M: 5.80, p<0.001) improved during study period, with asignificant reduction in ESR (BL: 23.75 mm/h vs. 6M: 8.17 mm/h vs. 12M: 7.30 mm/h vs. 24M: 9.87 mm/h, p<0.001) and CRP levels (BL: 37.03 mg/L vs. 6M: 3.36 mg/L vs. 12M: 7.22 mg/L vs. 24M: 5.32 mg/L, p<0.001) after TNF therapy. Conclusions The novel demonstration of anti-TNF induced recovery in sarcopenia reinforces its beneficial effect in muscle mass and functional capacity in AS patients, most likely associated with inflammation resolution. References Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR et al (1998) Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 147:755-63 Disclosure of Interest None Declared