Sensitivity to sparfloxacin and other antibiotics, of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis strains isolated from adult patients with community-acquired lower respiratory tract infections: a European multicentre study. SPAR Study Group. Surveillance Programme of Antibiotic Resistance.

A survey of resistance to sparfloxacin was carried out in ten European countries, namely Slovakia, France, Germany, Great Britain, Hungary, the Republic of Ireland, Italy, The Netherlands, Portugal and Spain. Respiratory samples were collected from 4297 patients with lower respiratory tract infections and cultured for the presence of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. Altogether 2101 strains were isolated and tested for their susceptibility to sparfloxacin, ciprofloxacin, erythromycin, tetracycline and penicillin G (S. pneumoniae) or amoxycillin (H. influenzae and M. catarrhalis). Each country tested strains using methods commonly used in that country, and with breakpoints selected based on those used in that country. Penicillin resistance in pneumococci was seen in those countries in which it had been reported previously, namely Spain, France and Hungary. Only four strains of pneumococci were resistant to sparfloxacin (MIC > or = 2 mg/L), while ciprofloxacin-resistant strains were isolated more frequently, particularly in the Republic of Ireland and Hungary. Almost all of the strains of H. influenzae tested were resistant to erythromycin, (MIC50 > or = 4 mg/L), but all strains were highly sensitive to sparfloxacin (MIC90 < or = 0.06 mg/L). The number of strains of H. influenzae producing beta-lactamase varied between countries, whereas most strains of M. catarrhalis produced beta-lactamase. In M. catarrhalis, erythromycin and tetracycline resistance was rare, but sensitivity to amoxycillin varied. Sparfloxacin was particularly active against H. influenzae and M. catarrhalis, and was the most active compound tested. Overall, the activity of sparfloxacin was greater than that of ciprofloxacin against all three pathogens, and resistance to it was rare.

Transverse myelitis as a first manifestation of systemic lupus erythematosus: a case report.

Transverse myelitis as a first manifestation of systemic lupus erythematosus (SLE) is very uncommon. No pathognomonic clinical or biochemical characteristics exist, and therefore an early diagnosis is often difficult. Therapy with intravenous pulses of methylprednisolone and cyclophosphamide has been shown to improve the prognosis. However, morbidity and mortality rates in transverse myelitis are still high due to the fact that complications such as opportunistic infections and pulmonary embolism are still frequent causes of death. We report a woman with relapsing transverse myelitis which was the first manifestation of SLE. A good response to pulse methylprednisolone and cyclophosphamide therapy was obtained but she died later as a result of a pulmonary embolism. We conclude that intravenous pulse methylprednisolone and cyclophosphamide therapy improve the prognosis of transverse myelitis associated with SLE but that a careful follow-up is needed to avoid complications due to the illness itself or secondary to the therapy.

Clinical, endoscopic, immunologic, and therapeutic aspects of oropharyngeal and esophageal candidiasis in HIV-infected patients: a survey of 114 cases.

The medical records of 114 consecutive HIV-infected patients with oropharyngeal and esophageal candidiasis, in whom esophagoscopy was performed, were reviewed. Esophageal candidiasis and isolated oral candidiasis were found in 75% and 25% of patients, respectively. Esophageal candidiasis was the AIDS-defining illness in 65 patients and dysphagia was the commonest symptom, but asymptomatic Candida esophagitis was observed in 43% of them. Symptoms were present in six patients with oropharyngeal candidiasis; three of them had a normal esophagoscopy and the other three had acute nonfungal esophagitis. Invasive fungal esophagitis was confirmed by biopsy in 47/74 patients (64%). The patients with esophageal candidiasis had lower CD4+ cell counts (129/microliter) and CD4:CD8 ratios (0.23) than those with oropharyngeal candidiasis (CD4 179/microliter; CD4:CD8 0.35). Thirty-six patients with esophageal candidiasis were treated with fluconazole, 100 mg/daily, for 28 days, and another 34 patients received the same dose for 10 days. A similar efficacy was seen in both regimens, but a higher incidence of oropharyngeal fungal colonization and liver dysfunction was observed in the longer therapy (p < 0.001). We conclude that asymptomatic C. esophagitis is common in HIV-infected patients. Patients with oropharyngeal candidiasis may complain of esophageal symptoms; it could be due to superficial C. infection or another not-identified opportunistic infection. More severe immunologic impairment was required to develop esophageal candidiasis than oropharyngeal candidiasis. A short course of 10 days of fluconazole therapy could be the standard regimen for the treatment of C. esophagitis in AIDS.

Complete proximal tubular acidosis (Type 2, RTA) in chronic active hepatitis.

Fifteen patients with chronic active hepatitis (CAH) were tested in order to ascertain the site of tubular dysfunction in renal tubular acidosis (RTA) associated with CAH. Renal plasma flow and GFR were reduced in the patients compared to controls (P < 0.005). Underbasal and acidification conditions, twelve patients showed normal acid-base balance and net acid excretion, while three patients had basal hyperchloremic metabolic acidosis while passing alkaline urine and showing bicarbonaturia. A sustained acidification test showed adequate urinary acidification in these three patients. Bicarbonate loading carried out in two of the three patients showed a proximal tubular acidifying defect (Type 2 RTA), Distal RTA (Type 1 RTA) complicating CAH is widely known, but these data suggest that CAH can also involve the proximal convoluted tubule in isolation.