OBJECTIVE: Human papillomavirus (HPV) genotypes and their relative prevalences were determined in a cohort of 310 sexually active women in Trinidad, West Indies. METHODS: Cervical samples were collected with Ayre's spatulas and endocervical brushes. Samples were used for the conventional Papanicolaou test and for determining HPV genotypes by amplification of a section of the viral L1 gene, followed by DNA sequencing and probe hybridization. RESULTS: HPV infections were identified in 126 of 310 (40.6%) women. Of them, 83 (65.8%) were infected with high-risk HPV, 16 (12.7%) with low-risk HPV, and 27 (21.4%) with HPV types of unknown risk. HPV 52 (12.7%) was the most frequently occurring high-risk type, followed by HPV 66 (10.3%), HPV 16 (9.5%), and HPV 18 (8.6%). High-risk types HPV 16 and HPV 66 were each found in 3 (20.0%) and HPV 18 was found in 1 (6.6%) of the 15 women with abnormal cytology. CONCLUSIONS: Cervical HPV prevalence and heterogeneity of HPV genotypes are high in this Trinidad cohort. The relative importance of HPV genotypes in the development of cervical lesions needs further investigation in Trinidad in order to better understand the epidemiology of HPV infections as well as to determine the role of HPV testing in the screening, prevention, and control of cervical cancer. This pilot study provided important information on the prevalence of HPV genotypes, which will be used in future nationwide studies.

OBJETIVO: Se determinaron los genotipos del papilomavirus humano (PVH) y su prevalencia relativa en una cohorte de 310 mujeres sexualmente activas de Trinidad, en la zona de las Indias Occidentales. MÉTODOS: Se tomaron muestras del cuello uterino con espátula de Ayre y cepillo endocervical. Las muestras se usaron para llevar a cabo la prueba convencional de Papanicolaou y para determinar los genotipos de PVH mediante la amplificación de una sección del gen vírico L1, seguida de secuenciación del ADN e hibridación con sonda. RESULTADOS: Se encontró una infección por PVH en 126 de las 310 mujeres (40,6%). De ellas, 83 (65,8%) estaban infectadas con PVH de alto riesgo, 16 (12,7%) con PVH de bajo riesgo, y 27 (21,4%) con tipos de PVH de riesgo desconocido. De los PVH de alto riesgo, el más frecuente fue el PVH 52 (12,7%), seguido por el PVH 66 (10,3%), el PVH 16 (9,5%) y el PVH 18 (8,6%). Entre las 15 mujeres con citología anormal se encontraron los PVH de alto riesgo 16 y 66 en 3 (20,0%) mujeres cada uno, y el PVH 18 en 1 (6,6%). CONCLUSIONES: Tanto la prevalencia de PVH en el cuello uterino como la heterogeneidad de los genotipos de PVH son elevadas en esta cohorte de Trinidad. La importancia relativa de los genotipos de PVH en la aparición de las lesiones cervicales requiere de mayor investigación en Trinidad para conocer más a fondo las características epidemiológicas de las infecciones por PVH, así como para determinar el papel del estudio de los PVH en la detección sistemática, la prevención y el control del cáncer del cuello uterino. Este estudio piloto suministró información importante sobre la prevalencia de los genotipos de PVH, que se usará en futuros estudios que se lleven a cabo en todo el país.

The incidence and distribution of ESBL producing microorganisms such as E. coli and K. pneumoniae have been demonstrated and varies in different health care facilities and as well as other countries This study was carried out to determine the frequency of occurrence and the antimicrobial susceptibility pattern of ESBL producing E. coli and K. pneumoniae species from clinical isolates at a tertiary hospital in Trinidad & Tobago. Standard microbiological procedures and automated MicroScan System was used to identify, screen for putative ESBL production and determine antimicrobial susceptibility of 1,118 clinical isolates of Enterobacteriaceae species at the microbiology laboratory of the Eric Williams Medical Science Complex, Trinidad & Tobago over a 36 months period. All ESBL producing isolates flagged by the automated system were further confirmed by E-test method. The E-test confirmed a 15.2% ESBL rate among the K. pneumoniae isolates and 9.3% among the E. coli isolates. There was also a 1.8% rate of ESBL production in K. pneumoniae and 0.2% in E. coli isolates from specimens received from community health facilities into the laboratory. Isolates recovered from the intensive care unit of the hospital had 2.1% E. coli and 8.2% K. pneumoniae ESBL producers. Although all ESBL positive isolates were completely susceptible to imipenem and meropenem; and all positive K. pneumoniae isolates were susceptible to amikacin, there was a low susceptibility of ESBL positive E. coli to the aminoglycosides. However, susceptibility of these ESBL producing isolates to the fluoroquinolones varied. There is a high rate of ESBL production among isolates of E. coli and K. pneumoniae at this hospital that is linked to the extensive inappropriate use of third generation cephalosporins in the country. Further molecular studies are needed to characterize the types of these ESBL prevailing in the country.

OBJECTIVE: This study was undertaken to determine the prevalence of human immunodeficiency virus-type 1 (HIV-1) infection in patients with pulmonary tuberculosis at the National Chest Hospital in Jamaica. METHODS: This retrospective study reviewed the hospital records of 537 patients admitted over a seven-year period from 1995 to 2001. We used a standardized data collection form to obtain data for sociodemographic characteristics, clinical features, signs and symptoms, laboratory diagnosis, treatment and outcome. RESULTS: We found that 11.6% (47/406) of the patients who met the inclusion criteria and were diagnosed as having pulmonary tuberculosis were HIV-1 seropositive. Most HIV-positive patients with tuberculosis were males, and prevalence of HIV coinfection among patients with tuberculosis was highest in patients aged 30-39 years. The mortality rate in patients with tuberculosis and HIV infection was 23.4% (11/47) compared to 3.9% (14/359; P = 0.001) in HIV-negative patients. Patients were treated with standard quadruple drug therapy. No multiple drug resistance was noted in the Mycobacterium tuberculosis isolates. CONCLUSIONS: The prevalence of HIV in patients with tuberculosis in Jamaica is similar to that in other developing countries, but the mortality rate is higher and this warrants prompt diagnosis of HIV infection and early institution of highly active antiretroviral therapy.

OBJECTIVE: El presente estudio se efectuó para determinar la prevalencia del virus de la inmunodeficiencia humana tipo 1 (VIH-1) en pacientes con tuberculosis pulmonar del National Chest Hospital en Jamaica. MÉTODOS: En este estudio retrospectivo se revisaron los expedientes hospitalarios de 537 pacientes ingresados a lo largo de un período de siete años, de 1995 a 2001. Utili- zamos un formulario uniformado para obtener los datos relacionados con las características sociodemográficas; los rasgos, signos y síntomas clínicos; el diagnóstico de laboratorio; el tratamiento administrado, y los resultados observados. RESULTADOS: Encontramos que 11,6% (47/406) de los pacientes que satisfacían los criterios de inclusión y a quienes se les había diagnosticado tuberculosis pulmonar tenían seropositividad al VIH-1. La mayoría de los pacientes tuberculosos con positividad a VIH eran de sexo masculino, y la mayor prevalencia de infección simultánea con VIH en pacientes tuberculosos se observó en personas entre los 30 y 39 años de edad. La tasa de mortalidad en pacientes con tuberculosis e infección por VIH fue de 23,4% (11/47), en comparación con 3,9% (14/359; P = 0,001) en pacientes sin infección por VIH. A los pacientes se les administró el tratamiento estándar con cuatro medicamentos. No se observó ninguna resistencia en las cepas aisladas de Mycobacterium tuberculosis. CONCLUSIONES: En Jamaica la prevalencia de VIH en pacientes con tuberculosis es parecida a la observada en otros países en desarrollo, pero la tasa de mortalidad en estos pacientes es mayor. Por lo tanto, es imprescindible diagnosticar la infección por VIH en etapa temprana e iniciar de inmediato el tratamiento antirretrovírico de gran actividad.