Resumen. Tema y alcance: este artículo pretende ofrecer al lector una mirada general sobre la toxoplasmosis, una zoonosis causada por Toxoplasma gondii que afecta tanto a los hospederos intermediarios, como a los definitivos. Buscamos que pueda entenderse la dinámica de la enfermedad, dejando de lado ciertos mitos al respecto. Características: los félidos (Felidae) son los hospederos definitivos, entre los cuales encontramos a los gatos como los más cercanos a la especie humana, que desarrollan la forma sexuada del parásito y arrojan al medio los ooquistes infectivos; de allí que su presencia es esencial en el ciclo biológico de T. gondii. Hallazgos: las investigaciones sobre gatos a nivel mundial son limitadas dado que existe una alta complejidad en la toma de muestras; sin embargo, se dispone de una amplia variedad de estudios sobre la taxonomía, la morfología, el ciclo de vida y la biología molecular, y sobre la distribución epidemiológica, sus hospederos, las vías de transmisión, las fuentes de contaminación y los factores de riesgo asociados con la infección dentro de esta especie y hacia otras vulnerables. Conclusiones: el conocimiento acerca de esta parasitosis es de gran importancia, sobre todo en los casos de mujeres embarazadas y personas inmunodeprimidas, en quienes se pueden manifestar complicaciones de la enfermedad.
Today, one of the healthcare challenges is to detect diseases before they occur so they can be prevented. It is well known the high frequency of iron deficiency (ID) with anemia (IDA) or without anemia, Latent Iron deficiency (LID) in fertile women, due to menstruation and sometimes due to poor diet. Also well known is the relatively high frequency of anemia in chronic diseases (ACD) or the previous clinical stage without anemia that we will call Latent Functional Iron Deficiency (LFID) and hemochromatosis (HEM) in the general population. In this study we were trying to see how frequently iron metabolism disturbances were present: LFID, LID and HEM in fertile, non-anemic women. Patients and Methods: We collected 211 consecutive random women with an age between 12 and 45 years old with a hemoglobin (Hb) between 12 g/dL and 13 g/dL. We have tested all of them for the complete blood count, reticulocyte count and reticulocyte derived parameters (MRV, IRF, etc.), iron profile: serum iron (Fe), Transferrin (Tf), Ferritin (Fer), Transferrin Saturation (TfS%). We analyzed the most common genetic abnormalities related to Hereditary Hemochromatosis in all the women with Ferritin higher than 100 with normal or high iron, and we froze serum for further analysis: Soluble Transferrin receptor (sTfR), Hepcidin, CRP, etc. We then studied what are the best possible parameters and cut-offs to help in the detection of suspect iron metabolism disturbances. RESULTS: we found 31 LID (14.7%), 7 Latent Functional Iron deficiency (LFID)(3.3%), 9 Hemochromatosis (HH) (4.3%) and 164 with normal Iron profiles (77.7%). From the 9 Hemochromatosis the genetic studies we studied, shown three heterozygotic and two homozygotic mutation for the H 63 D and one heterozygotic mutation for the gen C 282 T. We found differences statistically significant to differentiate the abnormalities analyzed as compared to normals (N) with these parameters or combination of them: LID vs N: MCV, MCH, MCHC, RDW. LFID vs N: MCV, MCH, MCHC, RDW and combined parameters, like Maf (Hb x MCV). HH vs N: MCV, MCH, MCHC and MRV. Some of the discriminant functions we found increase significantly the sensitivity and specificity of the parameters used alone Stats Latent Iron deficiency vs Normal Female Stat / Parameter Hb x MCV/100 (R) MCV MCH MCHC RDW Mean LID 10,8 86,8 29,0 33,3 14,5 Mean Normal 11,2 88,9 30,0 33,7 14,1 p Student test (*U Mann) p 0,0209 p 0,05 p 0,0095 p 0,0029 p 0,0054 * Cut off < 10,5 <82,77 <29,5 <33,66 >13,99 Stats Latent Functional Iron Deficiency and HH / Disease LFID LFID LFID HH HH HH Stat / Parameter HbxMCV/100 (R) HbxMCVx(1/RDW)(R) RDW MRVxMCV/100 (R) MCH MRV Mean 10,7 7,2 14,9 104,0 31,3 113,2 Mean Normal 11,2 8,0 14,1 93,0 30,0 104.7 p Student test (*U Mann) p 0,075 NS p 0,036 p 0,0291 * p 0,0069 p 0,0016 p 0,0097 Cut off <10,5 <7,49 >13,61 >92,4 >30,26 >106,4
RESUMENLa hepatitis autoinmune es una enfermedad inflamatoria hepática mediada por un mecanismo de autoinmunidad. Este trastorno tiene un amplio espectro clínico y debe ser sospechado en presencia de elevación de inmunoglobulinas y aminotransferasas en un paciente con histopatología positiva para hepatitis. El diagnóstico se realiza descartando otras causas de hepatitis (viral, secundaria a medicamentos) y complementado con los estudios de autoanticuerpos típicos de esta enfermedad. El tratamiento se fundamenta en la monoterapia con corticoesteroides o su asociación con otros inmunomoduladores, obteniéndose buenas tasas de respuesta terapéutica. La tasa de infección hospitalaria en pacientes con cirrosis hepática oscila entre 32-34% siendo la bacteremia la cuarta fuente más frecuente, la cual tiene como etiología al género Aeromonas en un 5%. Se presenta el caso de una paciente de 51 años con hepatitis autoinmune quien consulta por descompensación de enfermedad hepática secundaria a bacteremia por un microorganismo poco común. MÉD.UIS. 2017;30(3):121-7.Palabras claves: Hepatitis Autoinmune. Bacteremia. Aeromonas. Autoanticuerpos. Autoinmunidad. Bacteremia caused by Aeromonas caviae in-patient with autoinmune hepatitis: case report ABSTRACTAutoimmune hepatitis is an inflammatory hepatic disease mediated by an autoimmune mechanism. This disorder has a broad clinical spectrum and should be suspected in the presence of elevated aminotransferases and immunoglobulins in a patient with histopathology hepatitis. Diagnosis is made by ruling out other causes of hepatitis (viral, secondary to drugs) and confirmation with positive autoantibodies. Treatment is based on corticosteroid monotherapy or its association with other immunomodulators, obtaining good therapeutic response rates. Rate of hospital infection in patients with hepatic cirrhosis ranges from 32-34%, with bacteremia being the fourth most frequent source, where Aeromonas represents 5% of these cases. We report the case of a 51-year-old patient with autoimmune hepatitis who consults for decompensation of secondary liver disease with a rare microorganism. MÉD.UIS. 2017;30(3):121-7.
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