No abstract

The prevalence of tuberculin skin test reactions among intravenous drug abusers and differences in tuberculin skin test positivity between HIV-seropositive and HIV-seronegative subjects were evaluated in a cross-sectional study of 1131 subjects. They were recruited from a therapeutic community, from those who attended the centre for the treatment of drug addiction and from those who visited for any reason an acute tertiary-care hospital in Vitoria-Gasteiz, Basque Country (Spain). All subjects underwent skin testing with purified protein derivative (PPD) tuberculin and testing for HIV antibodies. CD4(+) T-lymphocyte count was determined in HIV-seropositive individuals. Positive PPD tests were recorded in 35% of drug users who were HIV-seropositive and in 65% in those who were HIV-seronegative. In the HIV-infected group, there was a significant association between results of the tuberculin test and CD4(+) T-lymphocyte count. When the CD4(+) T-lymphocyte count was > or = 500 cells/mm(3), percentages of positive PPD tests were similar in HIV-seropositives and HIV-seronegatives (47% versus 65%) but when the CD4(+) count was < 500 cells/mm(3), positive PPD tests occurred in only 21% of HIV-seropositives. The PPD test showed a decreased sensitivity for detecting tuberculosis infection in HIV-infected intravenous drug users with CD4(+) T-lymphocyte counts fewer than 500 cells/mm(3).

Background Prompt treatment with effective antimalarials is important in the treatment of malaria. Purpose To assess the suitability of the first-line antimalarials in our hospital according to a proposed treatment protocol following the World Health Organisation (WHO) guidelines and to analyse the admissions for suspected uncomplicated malaria. Materials and methods We collected data from the clinical history (2008–2012): patient’s country of origin, prior prophylaxis and the time of initiation of antimalarial treatment. Antimalarial treatment received during hospitalisation was collected from the prescription program, and identification of Plasmodium species from patients analytics. Results There were 32 patients, 5 of them children. 33 cases diagnosed suspected malaria (one was a relapse): 32 came from Africa and one from Asia. 22 cases were immigrants returned from their country of origin after visiting friends and relatives, 2 were passengers, 4 recently arrived immigrants and 4 were no data. Of the 33 cases, 22 had not taken prophylaxis, 3 had taken prophylaxis completely, 5 had taken prophylactics incompletely and 3 were no data. Plasmodium species were confirmed in all cases except one: 25 were P. falciparum, 4 P. vivax, 1 P. ovale and 2 were not identified. The treatment received during hospitalisation was: 25 cases (76%) quinine-doxycycline, 2 quinine-clindamycin, 2 (1 was a child) atovaquone-proguanil, 2 chloroquine-primaquine and in 2 data was not available. As current guidelines recommended, in 13 suspected malaria cases (40%) treatment started in the Emergency Department, 8 did not begin any treatment despite suspected malaria, 2 cases of malaria was not suspected and in 10 there were no data. Conclusions In the last five years the treatment for suspected uncomplicated malaria has been quinine-doxycycline. Due to lack of a malaria protocol and reviewing the WHO guidelines for malaria treatment (2010), a protocol was proposed. This led to updating the first-line antimalarial treatment, introducing atovaquone-proguanil for uncomplicated malaria. No conflict of interest.