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We performed a cross-border molecular epidemiology analysis of multidrug-resistant tuberculosis in Peru, Spain, and Italy. This analysis revealed frequent transmission in Peru and exportation of a strain that recreated similar levels of transmission in Europe during 2007-2017. Transnational efforts are needed to control transmission of multidrug- resistant tuberculosis globally. © 2019, Centers for Disease Control and Prevention (CDC). All rights reserved.

8 páginas, 4 figuras, 1 tabla. Información suplementaria accesible en: https://doi.org/10.1038/s41598-020-59373-w, It is relevant to evaluate MDR-tuberculosis in prisons and its impact on the global epidemiology of this disease. However, systematic molecular epidemiology programs in prisons are lacking. A health-screening program performed on arrival for inmates transferred from Peruvian prisons to Spain led to the diagnosis of five MDR-TB cases from one of the biggest prisons in Latin America. They grouped into two MIRU-VNTR-clusters (Callao-1 and Callao-2), suggesting a reservoir of two prevalent MDR strains. A high-rate of overexposure was deduced because one of the five cases was coinfected by a pansusceptible strain. Callao-1 strain was also identified in 2018 in a community case in Spain who had been in the same Peruvian prison in 2002-5. A strain-specific-PCR tailored from WGS data was implemented in Peru, allowing the confirmation that these strains were currently responsible for the majority of the MDR cases in that prison, including a new mixed infection., This work was supported by ERANet-LAC [ELAC2015/T08–0664, E035-ERANet-LAC/J110-2016/FONDECYT, PER-2012-ELAC2015/T08-0664] and Instituto de Salud Carlos III [AC16/00057, FIS15/01554, FIS13/01207] and cofunded by European Regional Development Funds from the European Commission: “A way of making Europe”. FA holds a grant from IFARHUSENACYT [270-2016-293].

In this work we propose an automated electronic equipment oriented to the detection of mycobacteria by means of the analysis of fluorescence in MGIT tube cultures using digital image processing. The equipment aims to improve detection efficiency, since this procedure is mostly performed by visual inspection and has low reliability due to subjectivity. Part of the proposed system acts as an incubator for the growth of mycobacteria, which will maintain a temperature of 37°C±1°C. It also has a mobile camera for the acquisition of images of each tube in the enclosure, as well as an algorithm implemented in a single-board computer. The algorithm detects if a tube emits fluorescence, which is an indicator of the presence of mycobacteria in the broth. The steps of the algorithm involve transforming the RGB images to the HSV color model, filtering and classification by K-Nearest Neighbor. Equipment validation was made from a set of samples processed by a medically certified and approved professional electronic equipment. The results were compared with those obtained by the BD Bactec 960 MGIT equipment achieving a Cohen Kappa coefficient of 0.9355 in the evaluation of 40 samples selected by the specialist.

Objetivos: Determinar las características fenotípicas y genotípicas de las β-lactamasas de espectro extendido (BLEE) en E. coli aislados de cultivos de orina de pacientes de la comunidad en un laboratorio privado de la ciudad de Lima, Perú. Material y métodos: Se evaluaron 53 aislamientos de E. coli por dos métodos fenotípicos: Jarlier y CLSI, el perfil de susceptibilidad se realizó mediante disco difusión y la caracterización genotípica mediante PCR para los genes blaCTX-M, blaTEM y blaSHV. Resultados: Los 53 aislamientos productores de BLEE representaron el 16,30% del total de aislados de E. coli, afectando principalmente a mujeres mayores de 65 años. El perfil de susceptibilidad evidenció alta resistencia a AMP,CEF,CRO(100%), LEV(87%), NOR(92%), CIP y NAL(94%), CXM y CTX(96%),SXT(70%), ATM(75%) y TOB (85%); asimismo elevada sensibilidad a NIT e IPM(100%), AMK(91%) y FOF(73,6%). El tipo de gen bla más frecuente fue blaCTX-M (55%), seguido por la coexistencia blaCTX-M+TEM (24%), blaTEM (13%) y blaSHV (6%). Conclusiones: La frecuencia de E. coli productores de BLEE fue de 16,3%; siendo el gen tipo blaCTX-M el más frecuente, información valiosa para orientar la terapia antimicrobiana empírica. Objective: To determine the phenotypic and genotypic features of extended spectrum beta-lactamase (ESBL) producing strains of Escherichia coli isolated from urine samples of patients attending outpatient services in a private laboratory in Lima, Peru. Methods: 53 E. coli isolates were evaluated using two phenotypic methods: Jarlier and CLSI, the susceptibility profile was performed using the disk diffusion method and the genotypic features were analyzed using PCR for detecting blaCTX-M, blaTEM y blaSHV genes. Results: The 53 ESBL producing strains of E. coli accounted for 16,30% of all E. coli isolates affecting mostly women older than 65 years. High resistant profile to AMP, CEF, CRO (100%), LEV (87%), NOR (92%), CIP, NAL (94%), CXM, CTX (96%), SXT (70%), ATM (75%) and TOB (85%) was observed. High susceptibility to NIT, IPM (100%), AMK (91%) and FOF (73.6%) was observed. The most frequent bla gen was blaCTX-M (55%), followed by blaCTX-M+TEM (24%), blaTEM (13%) and blaSHV (6%). Conclusions: The rate of ESBL producing strains of E. coli was 16.3% and the blaCTX-M gen was the most common gene type. These results provide valuable information for starting empiric antibiotic therapy in this setting.

SummaryObjectiveTo evaluate the diagnostic performance of two liquid-phase culture media for the diagnosis of pulmonary tuberculosis.Patients and methodsFrom May to July 2003, sputum samples for culture were obtained from patients with respiratory symptoms attending the Hospital Nacional Cayetano Heredia. These were cultured in Ogawa medium, mycobacteria growth indicator tube (MGIT), and modified Middlebrook 7H9. Results were compared against a composite reference standard.ResultsOne hundred sputum specimens from 100 patients were included. Of these, 33 had culture-proven tuberculosis. The sensitivity of MGIT was found to be 100%. The modified Middlebrook 7H9 medium was found to have a sensitivity of 72.73%, while the sensitivity of Ogawa medium was found to be 69.70%. The mean growing time for MGIT was 12.18 days (95% confidence interval 10.24 to 14.12; p

This study evaluated a new decontamination and concentration (DC) method for sputum microscopy and culture. Sputum samples from patients with suspected pulmonary tuberculosis (TB) (n=106) were tested using the proposed hypertonic saline–sodium hydroxide (HS–SH) DC method, the recommended N-acetyl-l-cysteine–sodium citrate–sodium hydroxide (NALC-NaOH) DC method and unconcentrated direct smear (Ziehl–Neelsen) techniques for the presence of mycobacteria using Löwenstein-Jensen culture and light microscopy. Of 94 valid specimens, 21 (22.3 %) were positive in culture and were further characterized as Mycobacterium tuberculosis. The sensitivity for acid-fast bacilli (AFB) smears was increased from 28.6 % using the direct method to 71.4 % (HS–SH) and 66.7 % (NALC-NaOH) using DC methods. Both concentration techniques were highly comparable for culture (kappa=0.794) and smear (kappa=0.631) for AFB. Thus the proposed HS–SH DC method improved the sensitivity of AFB microscopy compared with a routine unconcentrated direct smear; its performance was comparable to that of the NALC-NaOH DC method for AFB smears and culture, but it was methodologically simpler and less expensive, making it a promising candidate for evaluation by national TB control programmes in developing countries.

Objetivos: Describir las características clínicas, micológicas e histopatológicas de una serie de pacientes con micosis ganglionar y determinar si las afecciones ganglionares por hongos o micosis ganglionares pueden imitar otras patologías ganglionares infecciosas y no infecciosas. Material y Métodos: Se evaluaron 154 pacientes atendidos en el Departamento de enfermedades infecciosas y transmisibles del Hospital Nacional Cayetano Heredia de Lima entre enero del 2003 y enero del 2004. Estos pacientes participaron en un estudio de validación de una prueba diagnóstica para tuberculosis ganglionar pero tuvieron un diagnóstico definido de micosis ganglionar. Resultados: De 154 pacientes con linfadenopatía evaluados durante el tiempo de estudio, 7 tuvieron micosis ganglionar, dos de ellos eran pacientes inmunocompetentes y los cinco restantes inmunosuprimidos, uno por linfoma y los otros por VIH. Conclusiones: Las afecciones ganglionares por hongos o micosis ganglionares pueden ser grandes imitadoras de otras patologías ganglionares infecciosas y no infecciosas. (Rev Med Hered 2004;15:211-217). Objective: Describe clinical, mycological and histopathological characteristics of a series of patients with lymph node mycosis. Material and Methods: All patients here described were attended at the Hospital Nacional Cayetano Heredia in Lima between January 2003 and January 2004. These patients participated in a study on the accuracy of a diagnostic test for tuberculosis but got a definite diagnosis of lymph node mycosis. Results: Of 154 patients with lymphadenopathy evaluated during the study period, 7 were diagnosed with lymph node mycosis. Two were immunocompetent patients and 5 had immune suppression, one because of lymphoma and 4 because of HIV infection. Conclusions: There can be a strong resemblance between lymph node mycosis and lymphadenopathy caused by other infectious and non infectious diseases. (Rev Med Hered 2004;15:211-217).

ObjectivesTo compare the performance of liquid culture on simple Middlebrook 7H9 to the one of manual mycobacterial growth indicator tube (MGIT) and solid culture on Ogawa for the diagnosis of smear-negative tuberculosis (SN-TB) in a high-burden, resource-constrained setting. MethodsSputum samples from patients with clinical suspicion of SN-PTB admitted to two-third-level hospitals in Lima between September 2005 and May 2008 were cultured in parallel on simple Middlebrook 7H9, manual MGIT and Ogawa. A case of SN-TB was defined as one with a positive culture in any medium. ResultsAmong samples from 542 patients, 151 (28%) cases of SN-TB were identified. The sensitivity of Middlebrook 7H9 (0.76, 95% CI 0.69-0.83) was not substantially different from that of MGIT (0.85, 95% CI 0.79-0.91). Ogawa had the lowest sensitivity (0.63, 95% CI 0.55-0.71). The median turnaround time was similar for both liquid media (18days), and it was shorter than that of Ogawa (30days). ConclusionsCulture on simple Middlebrook 7H9 performs almost as well as MGIT, at a probably more affordable cost. Further studies on the cost-effectiveness of this overlooked technique should be performed. ObjectifsComparer les performances de la culture liquide sur milieu simple Middlebrook 7H9 a celles sur MGIT manuel et sur milieu solide Ogawa pour le diagnostic de la tuberculose pulmonaire a frottis negatif (TBP-FN) dans une region a prevalence elevee et a ressources limitees. MethodesDes echantillons de crachats de patients avec une suspicion clinique de TBP-FN, admis dans deux hopitaux tertiaires a Lima entre septembre 2005 et mai 2008, ont ete cultives en parallele sur milieu simple Middlebrook 7H9, MGIT manuel et Ogawa. La TBP-FN a ete defini comme un cas avec au moins une culture positive sur n'importe quel milieu. ResultatsParmi les echantillons de 542 patients, 151 (28%) cas de TBP-FN ont ete identifies. La sensibilite du Middlebrook 7H9 (0,76; IC 95%: 0,69 a 0,83) n'etait pas significativement differente de celle du MGIT (0,85; IC 95%: 0,79 a 0,91). Ogawa avait la sensibilite la plus faible (0,63; IC 95%: 0,55 a 0,71). Le delai median etait similaire pour les deux milieux liquides (18 jours) et etait plus court que pour Ogawa (30 jours). ConclusionsLa culture sur milieu simple Middlebrook 7H9 est presque qu'aussi performante que sur MGIT a un cout probablement plus abordable. Des etudes supplementaires sur le rapport cout-efficacite de cette technique neglige devraient etre effectuees. ObjetivosComparar el desempeno del cultivo en medio liquido Middlebrook 7H9 con el sistema manual MGIT y el cultivo solido en Ogawa, para el diagnostico de tuberculosis con baciloscopia negativa (TB-BN) en un lugar con una carga alta de enfermedad y pocos recursos. MetodosLas muestras de esputo de los pacientes con sospecha clinica de TB-BN admitidos en dos hospitales de tercer nivel en Lima, entre Septiembre 2005 y Mayo 2008, se cultivaron en paralelo en medio liquido de Middlebrook 7H9, en MGIT y en Ogawa. Un caso de TB-BN se definio como positivo para cultivo en cualquier medio. ResultadosEntre las muestras de 542 pacientes, se identificaron 151 (28%) casos de TB-BN. La sensibilidad del 7H9 (0.76, IC 95% 0.69-0.83) no era sustancialmente diferente de la del MGIT (0.85, IC95% 0.79-0.91). El Ogawa tenia la menor sensibilidad (0.63, IC 95% 0.55-0.71). El tiempo medio de respuesta era similar para los dos medios liquidos (18 dias) y era mas corto que el del Ogawa (30 dias). ConclusionesEl cultivo en medio liquido Middlebrook 7H9 tiene un desempeno casi tan bueno como el de MGIT, con un coste probablemente mas asumible. Se deberian realizar mas estudio sobre la costo-efectividad de esta tecnica olvidada.

Objectives Diagnosis of smear-negative pulmonary tuberculosis (SNPT) remains a challenge, particularly in resource-constrained settings. We evaluated a diagnostic algorithm that combines affordable laboratory tools and a clinical prediction rule (CPR). Methods We derived, based on published evidence, a diagnostic algorithm for SNPT. Sputum concentration constitutes its first step. In suspects with negative results, SNPT probability is classified with a CPR as low (excluded), high (confirmed) or intermediate. For intermediate patients, sputum Middlebrook 7H9 liquid culture is performed, and they are assessed after 2 weeks. If clinically deteriorated, with still negative liquid culture, bronchoscopy is offered. Otherwise, results of Middlebrook 7H9 culture are awaited. We prospectively evaluated this algorithm against a reference standard of solid and liquid cultures in two reference hospitals in Lima, Peru. Results 670 SNPT suspects were included from September 2005 to March 2008. The prevalence of SNPT was 27% according to the reference standard. The algorithm's overall accuracy was 0.94 (95% CI 0.91–0.95), its sensitivity was 0.88 (95% CI 0.82–0.92) and its specificity, 0.96 (95% CI 0.94–0.98). Sputum concentration, the CPR, Middlebrook 7H9 sputum culture and bronchoscopic samples defined a diagnosis of SNPT according to the algorithm in 57 (37%), 25 (16%), 63 (41%) and 8(5%) of patients, respectively. 65% of patients were diagnosed within 3 weeks. Conclusions The algorithm was accurate for SNPT diagnosis. Sputum concentration, CPR and selective Middlebrook 7H9 culture are essential components. Objectifs Le diagnostic de la tuberculose pulmonaire a frottis negatif (TPFN) reste un defi, en particulier dans les pays a ressources limitees. Nous avons evalue un algorithme de diagnostic qui combine des outils de laboratoire abordables et une regle de prediction clinique (RPC). Methodes Nous avons etabli, sur base des donnees publiees, un algorithme de diagnostic pour la TPFN. La concentration des expectorations constitue sa premiere etape. Chez les suspects avec des resultats negatifs, la probabilite de TPFN est classee avec une RPC comme: faible (exclue), elevee (confirmee) ou intermediaire. Pour les patients intermediaires, la culture des crachats dans du milieu liquide Middlebrook 7H9 a ete effectuee et evaluee au bout de deux semaines. Dans le cas d'une deterioration clinique avec une culture liquide toujours negative, la bronchoscopie est offerte. Dans le cas contraire, les resultats de culture dans le Middlebrook 7H9 sont attendus. Nous avons evalue prospectivement cet algorithme par rapport a une norme de reference basee sur la culture en milieux solides et liquides dans deux hopitaux de reference a Lima, au Perou. Resultats 670 suspects de TPFN ont ete inclus de septembre 2005 a mars 2008. La prevalence de la TPFN etait de 27% selon la norme de reference. La precision globale de l'algorithme etait de 0.94 (IC 95%: 0.91–0.95), sa sensibilite etait de 0.88 (IC 95%: 0.82–0.92) et sa specificite de 0.96 (IC 95%: 0.94–0.98). La concentration des expectorations, la RPC, la culture des expectorations dans le Middlebrook 7H9 et des echantillons bronchoscopiques ont defini un diagnostic de la TPFN selon l'algorithme chez 57 (37%), 25 (16%), 63 (41%) et 8 (5%) patients respectivement. 65% des patients ont ete diagnostiques endeans 3 semaines. Conclusions L'algorithme etait precis pour le diagnostic de la TPFN. La concentration des expectorations, la RPC et la culture selective dans le Middlebrook 7H9 sont des elements essentiels. Objetivos El diagnostico de la tuberculosis pulmonar con baciloscopia negativa (TPBN) continua siendo un gran reto, particularmente en lugares con pocos recursos. Hemos evaluado un algoritmo de diagnostico que combina herramientas de laboratorio asequibles y una regla de prediccion clinica (RPC). Metodos Basandonos en evidencia publicada, derivamos un algoritmo diagnostico para TPBN. El primer paso es concentrar el esputo. En pacientes con resultados negativos pero con sospecha de TB la probabilidad de TPBN se clasifica con una RPC como baja (excluida), alta (confirmada) o intermedia. Para pacientes con una clasificacion intermedia, se realiza un cultivo de esputo en medio liquido Middlebrook 7H9 y se evaluan dos semanas mas tarde. Si estan clinicamente deteriorados, con un cultivo liquido aun negativo, se realiza una broncoscopia. Evaluamos de forma prospectiva este algoritmo frente a un estandar de referencia de cultivos solido y liquido en dos hospitales de referencia en Lima, Peru. Resultados Se incluyeron 670 pacientes con sospecha de TPBN entre Septiembre 2005 y Marzo 2008. La prevalencia de TPBN era un 27% segun el estandar de referencia. La precision del algorithmo era de 0.94 (IC 95% 0.91–0.95), la sensitibilidad era de 0.88 (IC 95% 0.82–0.92) y la especificidad de 0.96 (IC 95% 0.94–0.98). La concentracion de esputo, el RPC, el cultivo de esputo Middlebrook 7H9 y las muestras de la broncoscopia definieron un diagnostico de TPBN segun el algoritmo en 57 (37%), 25 (16%), 63 (41%) y 8(5%) de los pacientes respectivamente. Un 65% de los pacientes fueron diagnosticados en un plazo de tres semanas. Conclusiones El algoritmo era preciso para el diagnostico de TPBN. La concentracion de esputo, la RPC y el cultivo en Middlebrook 7H9 eran componentes esenciales.

Un estudio llevado acabo entre julio y noviembre de 2014 sobre la flora presente en las areas verdes dentro de las 16 hectareas del Centro Nuclear “Oscar Miro Quesada de la Guerra (RACSO)”, Carabayllo, Lima, ha permitido la identificacion de un total de 70 especies de plantas vasculares distribuidas en 39 familias y 62 generos. Las familias mas representativas fueron: Fabaceae, Euphorbiaceae y Solanaceae con 8 (11%), 5 (7 %) y 4 (6 %) especies respectivamente. Ademas, se indican los generos y especies endemicas del Peru registradas en la zona estudiada. Este trabajo es un esfuerzo inicial para promover el conocimiento de las especies biologica

Conducting a same day smears is a strategy that has recently been adopted by the World Health Organization. Our study sought to determine the additional diagnostic yield of a second sputum smear taken on the same day among patients with respiratory symptoms, attended at the emergency room from two hospitals in Lima. We included 270 patients from January to November 2011, which were asked two samples of sputum within two hours; the samples were processed by the Ziehl Neelsen method. The frequency of positive sputum smears was 18.5%. The additional diagnostic yield for the second smear was 20.9%. Considering the high prevalence of tuberculosis diagnosed by sputum smear, it is suggested that this test be included routinely in the emergency rooms of hospitals in Lima Metro area.

The study aimed to evaluate the presence of E. coli O157 (rfb O157 gene) in young alpacas (Vicugna pacos) with and without diarrhea, and the genes that codify their main factors of virulence such as intimin (eae gene), Shiga toxin 1 (gene Stx1) and Shiga toxin 2 (Stx2 gene). Strains of E. coli from a previous study in Puno, Peru were used. A total of 55 and 52 strains of E. coli from young alpacas with and without diarrhea respectively were used. Strains were processed by the polymerase chain reaction (PCR) technique. Both groups resulted negative for the presence of E. coli O157. In the group of alpacas without diarrhea, 7 strains were positive for the gene eae and 4 for Stx2. In the group of alpacas with diarrhea 2 strains were positive for the genes eae and Stx1, 1 for eae and Stx2, 5 for eae, 1 for Stx1 and 5 for Stx2. The survey did not identify the presence of serogroup E. coli O157; however identified the presence of Stx and eae genes which shows that this species might be acting as domestic reservoir of enterohaemorrhagic E. coli. El estudio tuvo como objetivo evaluar la presencia de E. coli O157 (gen rfb O157) en crías de alpacas (Vicugna pacos) con y sin diarrea, así como los genes que codifican la intimina (gen eae), toxina Shiga 1 (gen Stx1) y toxina Shiga 2 (gen Stx2). Se utilizaron cepas de E. coli provenientes de un ensayo previo realizado en Puno, Perú. Se evaluaron 55 y 52 cepas de E. coli provenientes de crías de alpacas con y sin diarrea. Las cepas fueron procesadas mediante la prueba de reacción en cadena de la polimerasa (PCR). Ambos grupos resultaron negativos a la presencia de E. coli O157. En el grupo de crías de alpacas sin diarrea, 7 cepas fueron positivas para el gen eae y 4 para Stx2. En el grupo de crías de alpacas con diarrea 2 cepas resultaron positivas para los genes eae y Stx1, 1 para eae y Stx2, 5 para eae, 1 para Stx1 y 5 para Stx2. El estudio no identificó la presencia del serogrupo E. coli O157; sin embargo, se identificó la presencia de los genes eae y Stx, lo que demuestra que esta especie doméstica podría estar actuando como reservorio de E. coli enterohemorrágica.

This paper presents the first evaluation of the molecular epidemiology of Mycobacterium tuberculosis in Peru. We characterised 323 isolates using spoligotyping and mycobacterial interspersed repetitive units variable number tandem repeats (MIRU-VNTR) typing. We aimed to determine the levels of genetic diversity and genetic differentiation among and within Peruvian isolates and the epidemiological factors which may be driving patterns of population structure and evolution of M. tuberculosis in Peru. Our results compared to the fourth international spoligotyping database (SpolDB4) and MIRU-VNTRplus, show that the main M. tuberculosis families present are Latin American-Mediterranean, Haarlem, T, and Beijing. Bayesian clustering recovered 15 groups in the Peruvian M. tuberculosis isolates, among which two were composed mainly of orphans, implying the presence of native “Peruvian” strains not previously reported. Variable levels of association with drug resistance were observed, with Beijing genotypes not showing any association with multidrug resistance, while in other groups MIRU-VNTR loci 2, 23, 31, and 40 were found to be associated with the multidrug-resistant tuberculosis (MDR-TB) phenotype, suggesting that a linkage disequibrium between these MIRU and drug resistance loci may be present. Genetic differentiation was present among drug resistant and sensitive strains. Ethambutol appeared to be the main driver of differentiation, suggesting that strong selection pressure could have been exerted by drug treatment in Peru over recent years.

Staphylococcus aureus es un importante patógeno involucrado en una serie de infecciones e intoxicaciones, presenta múltiples factores de virulencia y su impacto se incrementa por su notable resistencia a los antimicrobianos. Objetivo: Determinar la frecuencia de Staphylococcus aureus meticilino resistente adquiridos en la comunidad, en hospitales de Lima- Perú. Material y métodos: Se realizó un estudio descriptivo multicéntrico. La resistencia a meticilina se determinó por el método Oxacillin Agar Screen. El origen de la cepa fue determinado mediante los criterios de los CDC; la Leucocidina de Panton Valentine fue identificada por métodos moleculares. Resultados: Se aislaron 276 cepas de Staphylococcus aureus, 160 fueron resistentes a meticilina (58%), 9 de ellas fueron identificadas como adquiridas en la comunidad (5,6%). La PVL fue identificada en 25 cepas (9,1%), 14 fueron MSSA y 11 MRSA, de éstas últimas solo 4 fueron MRSAcom, 7 fueron MRSAhosp (p

The aim of this study was to assess and apply a microsatellite multiplex system for parentage determination in alpacas. An approach for parentage testing based on 10 microsatellites was evaluated in a population of 329 unrelated alpacas from different geographical zones in Peru. All microsatellite markers, which amplified in two multiplex reactions, were highly polymorphic with a mean of 14.5 alleles per locus (six to 28 alleles per locus) and an average expected heterozygosity (H(E)) of 0.8185 (range of 0.698-0.946). The total parentage exclusion probability was 0.999456 for excluding a candidate parent from parentage of an arbitrary offspring, given only the genotype of the offspring, and 0.999991 for excluding a candidate parent from parentage of an arbitrary offspring, given the genotype of the offspring and the other parent. In a case test of parentage assignment, the microsatellite panel assigned 38 (from 45 cases) offspring parentage to 10 sires with LOD scores ranging from 2.19 x 10(+13) to 1.34 x 10(+15) and Delta values ranging from 2.80 x 10(+12) to 1.34 x 10(+15) with an estimated pedigree error rate of 15.5%. The performance of this multiplex panel of markers suggests that it will be useful in parentage testing of alpacas.

The aim of this study was to determine the usefulness of fluorescence microscopy (FM) at a referral centre in a middle-income country. Direct Ziehl-Neelsen (ZN) and direct, as well as concentrated, smear FM were performed on 2179 suspect sputa, with Löwenstein-Jensen (LJ) culture as the gold standard. ZN, direct FM and concentration FM detected 36.0, 38.6 and 37.0%, respectively, of 272 culture-positive specimens. Patient-wise, there were 8.1% (126/1553) positives on any smear compared with 12.0% (187/1553) on any culture. ZN, direct FM and concentrated FM smear were positive in 43.3, 46.5 and 45.5%, respectively, of culture-proven cases. All differences between microscopy and culture were significant (P

This study developed a clinical score based on clinical and radiographic data for the diagnosis of smear-negative pulmonary tuberculosis (SNPT). SNPT was defined as a positive culture in Ogawa in a patient with two negative sputum smears. Data from patients admitted to the emergency ward with respiratory symptoms and negative acid-fast bacilli (AFB) smears was analyzed by means of logistic regression to develop the predictive score.Two hundred and sixty two patients were included. Twenty patients had SNPT. The variables included in the final model were hemoptysis, weight loss, age > 45 years old, productive cough, upper-lobe infiltrate, and miliary infiltrate. With those, a score was constructed. The score values ranged from -2 to 6. The area under the curve for the ROC curve was 0.83 (95% CI 0.74-0.90). A score of value 0 or less was associated with a sensitivity of 93% and a score of more than 4 points was associated with a specificity of 92% for SNPT. Fifty-two point twenty-nine percent of patients had scores of less than one or more than four, what provided strong evidence against and in favor, respectively, for the diagnosis of SNPT. The score developed is a cheap and useful clinical tool for the diagnosis of SNPT and can be used to help therapeutic decisions in patients with suspicion of having SNPT.

Summary Objectives To assess the diagnostic validity of laboratory cerebrospinal fluid (CSF) parameters for discriminating between tuberculous meningitis (TBM) and other causes of meningeal syndrome in high tuberculosis incidence settings. Methods From November 2009 to November 2011, we included patients with a clinical suspicion of meningitis attending two hospitals in Lima, Peru. Using a composite reference standard, we classified them as definite TBM, probable TBM, and non-TBM cases. We assessed the validity of four CSF parameters, in isolation and in different combinations, for diagnosing TBM: adenosine deaminase activity (ADA), protein level, glucose level, and lymphocytic pleocytosis. Results One hundred and fifty-seven patients were included; 59 had a final diagnosis of TBM (18 confirmed and 41 probable). ADA was the best performing parameter. It attained a specificity of 95%, a positive likelihood ratio of 10.7, and an area under the receiver operating characteristics curve of 82.1%, but had a low sensitivity (55%). None of the combinations of CSF parameters achieved a fair performance for ‘ruling out' TBM. Conclusions Finding CSF ADA greater than 6 U/l in patients with a meningeal syndrome strongly supports a diagnosis of TBM and permits the commencement of anti-tuberculous treatment.

[Volumen 1] Tomás Alvira Alvira y Manuel Alía Medina / Estudio geológico-edáfico de las tierras rojas situadas al Norte de Toledo.-- Emilio Zapatero Ballesteros y Agapito San Juan / Trabajos de microbiología forestal y agrícola en la provincia de Valladolid (I parte).-- Cruz Rodríguez Muñoz / Motril: un extenso microclima.-- Emilio Guinea / Phitobiología tropicalis¿Un caso de batracofilia en Orchidaceae?.-- Luis Cavanillas Rodrlguez y Mª Dolores Angulo Carpio / Estudios de transpiración vegetal.-- José Mª R. de la Borbolla y Alcalá y A. de Castro Brzezicki / Análisls de plantas II: La determínación de Nicotina.-- José Antonio Jiménez Salas / La mecánica del suelo, una nueva rama de la Edafología.-- Florencio Bustinza Lachiondo / Contribución a la historia de la penicilina.-- Hermann Stremme.-La cartografía de los tipos de suelos biogenéticos y el mapa edafológico internacional de Europa.-- Gerhard C. Redtich / Agricultura y su organización en Holanda.-- Reseña.-- Libros publicados, [Volumen 2] E. Gutierrez Ríos y A. Mª Medina Ortega / Procesos de erosión en Sierra Nevada(I).-- José Antonio Jiménez Salas / Suelos de la zona del Protectorado de España en Marruecos.-- Ernesto Vieitez Cortizo / Estudios botánicos sobre la flora alergógena y contenido en polen de la atmósfera de la comarca de Santiago de Compostela.-- Luis Cavanillas Rodríguez / Estudios de transpiración vegetal.-- Arnaldo Socías Amorós / Un ciclo vital en el Pseudomonas aeruginosa.-- José Manuel Pertierra.-La conservación del suelo en los Estados Unidos de América del Norte y el problema español de la erosión.-- Reseña, 2019-08.- CopyBook.- Libnova.- Biblioteca ICA