Prevalence of anti-hantavirus antibodies in patients with hypertransaminemia in Madrid (Spain)

The hantaviruses are involved in a number of clinical syndromes of different severity and prognosis. Hantaviruses are widely distributed around the world, but the spectrum of illnesses they cause outside recognized endemic areas is unclear. A retrospective analysis was performed to detect anti-hantavirus antibodies in the serum of patients with hypertransaminemia of unknown etiology and in that of healthy members of the general population of Madrid (Spain). Antibodies were detected by indirect immunofluorescence and enzyme immunoassay; positive results were confirmed by Western blotting. Of the 182 patients with hypertransaminemia, 11 (6%) were positive for anti-hantavirus IgG antibodies; Western blotting using recombinant Puumala virus N antigen showed one of these patients to have hantavirus-specific IgM antibodies. Among the 146 healthy subjects from the general population, 3 (2%) were positive for anti-hantavirus IgG antibodies. These results show that anti-hantavirus antibodies are more commonly detected in patients with hypertransaminemia than in healthy people.     

The overlap phenotype: the (missing) link between asthma and COPD

A 27?year old female with Graves’ disease presented with fever, exertional dyspnea and polyarthralgia. Erythema nodosum had occured three months earlier. The patient declared irregular use of propylthiouracil (PTU) for the last 8?months. Neutropenia and microscopic hematuria developed in the second week of admission. Chest X-ray showed inhomogenous pulmonary opacities, left pleural effusion and cardiomegaly. Computed tomography (CT) revealed multiple subpleural nodules, left pleural effusion, pericardial effusion, enlarged mediastinal and axillary lymph nodes. Bronchoalveolar lavage (BAL) cytology demonstrated hemosiderin laden macrophages. Histopathologic examination of the transbronchial biopsy specimen revealed a nonspecific inflammation. Serum was positive for ANA, P-ANCA, MPO-ANCA, PR3-ANCA and negative for anti-ds-DNA, C-ANCA, C3, C4 and anti-histone antibody. All symptoms resolved in two months after PTU withdrawal and starting steroid treatment. The same clinical manifestations recurred when the patient used PTU erronously one month after discharge. This is a case of PTU induced-autoimmune disease in whom the accurate distinction between drug-induced-lupus (DIL) and vasculitis was not possible due to the significant overlap of clinical and laboratory findings causing a significant diagnostic challenge for the chest physician.     

Class II MHC antigens in early rheumatoid arthritis in Bath (UK) and Madrid (Spain)

OBJECTIVE: A number of studies have indicated that rheumatoid arthritis (RA) is a less severe disease in Mediterranean countries than in Northern Europe. We investigated whether differences in the frequency of class II MHC antigens might contribute to this variation in disease severity. METHODS: Typing at HLA-DR and -DQ loci was carried out at low and high resolutions by polymerase chain reaction amplification in patients with early RA of less than 6 months' duration (68 patients in Madrid and 68 in Bath) and in control subjects (929 in Madrid and 226 in Bath). Only ethnic Spanish and British individuals were included as patients and controls. RESULTS: Shared epitope (SE) alleles represented 19.8 and 28.9% of the total number of class II MHC alleles in controls from Madrid and Bath respectively (P: = 0.00001), this difference being largely due to increased numbers of DRB1*0401 individuals in the British subjects (P: = 0.0000001). Analysis of the patients showed the expected increase in SE alleles when compared with their respective control groups (Madrid, 31.6 vs 19.8%; Bath, 42.6 vs 28. 9%). In Bath the SE was mainly encoded by HLA-DR4 alleles (74.1%), while in Madrid it was encoded almost equally by DR4 (51.1%) and DR1 (44.7%) alleles. The risk of developing RA in carriers of SE alleles was similar in the two cities (Bath, odds ratio 1.83, 95% confidence interval 1.23-2.78; Madrid, odds ratio 1.87, 95% confidence interval 1.25-2.77), and was largely accounted for by HLA-DRB1*0401 alleles. CONCLUSION: We conclude that rheumatoid patients in Bath differ from their Spanish counterparts in class II antigen expression and allele frequency. This may be explained partly by genetic differences between the control populations in the two centres, and may help to explain the greater incidence of more severe rheumatoid disease expression seen in RA patients in the UK.     

Characteristics of asthma and COPD overlap syndrome (ACOS) in the Canadian population

Objective: Asthma is a chronic disease affecting both children and adults, whereas chronic obstructive pulmonary disease (COPD) is a respiratory disease most commonly related to smoking and is usually seen in adults. When the airway disease shares features of both asthma and COPD, the phenotype is referred to as asthma and COPD overlap syndrome (ACOS). The objective of this cross-sectional study is to characterize ACOS in the Canadian population. Methods: Data from the first three cycles of the Canadian Health Measures Survey (CHMS) were used in this study. The study included 9059 subjects aged 30?years and above. The CHMS included a detailed interviewer-administered questionnaire and spirometry measurements. Based on the self-report, subjects were categorized into control, ACOS, COPD only and asthma only groups. Results: The prevalence of ACOS, COPD and asthma groups was 1.59%, 2.21% and 6.65%, respectively. The proportion of females was significantly greater than males in the ACOS group. The proportion of wheeze was highest in the ACOS group (64.93%) whereas the prevalence of shortness of breath was the highest in the COPD group (46.25%). Heart disease, cancer, arthritis and liver disease were more prevalent in the ACOS group than in COPD, asthma and control groups. Severity of airway obstruction was the highest in the ACOS group and was followed by COPD, asthma and control groups, respectively. Conclusions: Characteristics of ACOS in the Canadian population were similar to those observed in the developed countries and longitudinal studies are required to determine the incidence and risk factors of ACOS.