Meningitis por Criptococcus neoformans en pacientes con SIDA en el Hospital Santo Tomas / Cryptococcus neoformans meningitis in patients with AIDS at the Saint Thomas Hospital

The authors studied the clinical histories of 17 patients with AIDS who were hospitalized with the diagnosis of Meningoencephalitis. Laboratory studies showed the causative agent to be Cryptococcus neoformans. All patients had fever and most had localized headache. Some patients had nausea and vomiting, nuchal rigidity and convulsions. One each had blurred vision, photophobia, periods of disorientation, ataxia, lumbar or cervical pain. Cell count, chemical analysis, India ink preparation and culture of the cerebrospinal fluid confirmed the diagnosis and the etiologic agent. Blood cultures were negative in the few patients on whom it was performed. The best results of therapy were obtained in the patients who received Amphotericin B and Fluocytosine (80%) in dosages of 0.3 to 1 mg/k/day and 150 mg/day respectively, for 21 days

Neumonía por Pneumocistis carinii en pacientes con SIDA en El Hospital Santo Tomas / Pneumocistis carinii pneumonia in patients with AIDS at the Saint Thomas Hospital

The authors examined material from the respiratory tract obtained from 55 patients, with silver Methenamine and Giemsa stains to detect Pneumocystis carinii. Twenty five patients were positive. All had fever and fatigue, 80% had dyspnea, 72% had productive cough, and significant weight loss occurred in 48%. None of the patients had signs of pulmonary consolidation. Chest X-Ray showed diffuse infiltrates in 55.2%. Nodular lesions in both lung fields were present in 6.9%. A local infiltrate was seen in 13.6% and no infiltrates were seen in 10.3%. LDH was elevated in all (ranging from 885 4500 UI), 84% of the patients had a PO2 of 70 mmHg or less. Most of the patients, 80%, responded to therapy with Trimethoprim-Sulfa

10 años de infecciones nosocomiales en el Hospital Santo Tomás / 10 years of nosocomial infections at the Santo Tomás Hospital

The incidence of nosocomial urinary tract infections (UTI) in the medical services of Santo Tomás Hospital from 1980 to 1985 was 56% in Neurology Section, 73% in cardiology and 74% in nephrology. These percentages declined, with epidemiological surveillance, to 21%, 31% and 53% respectively, for the period between 1986 and 1990. In the surgical services the incidence of nosocomial UTI was 85% in urology and 15% in general surgery, from 1980 to 1985. The incidence remained unchanged in urology (81%) and general surgery (17%) despite epidemiological surveillance, but decreased in neurosurgery (from 55% to 37%) for the period between 1986 and 1990. Between 1985 and 1990, Staphyloccocus aureus was the most frequently isolated bacterium from surgical wounds (34%) and from patients with intravenous catheters (23%). Pseudomonas aeruginosa was the most frequently isolated bacterium in nosocomial UTI (26%) and respiratory tract infections (45%) and in patients with nosocomial septicemia, it was a species of Klebsiella

Septicemia por Staphylococcus aureus en el Hospital Santo Tomas. / Septicemia due to Staphylococcus aureus at the Hospital Santo Tomas

La septicemia por S. aureus es causa importante de mortalidad y de morbilidad en nuestro medio, en la poblacion de 15 a 25 anos de edad. La existencia de enfermedad subyacente no es requisito indispensable para el establecimiento de estafilococemia, en una poblacion que no tiene garantizado el tratamiento temprano y adecuado de las lesiones primarias. El diagnostico es dificil y la mortalidad aumenta en pacientes con mas de 50 anos de edad. La mortalidad en la endocarditis por S. aureus es mayor que en la septicemia, lo cual podemos atribuir al diagnostico tardio y a la ausencia de iniciativa terapeutica de tipo quirurgico. El tratamiento de la septicemia por S. aureus debe hacerse con penicilina semisintetica, independientemente de si la infeccion fue adquirida en la comunidad o en el hospital. La nefritis intersticial es siempre una complicacion potencial cuando se usa meticilina y cuando el tratamiento se prolonga mas alla de dos semanas