Actualización en el diagnóstico de las infecciones de transmisión sexual / Update on the Diagnosis of Sexually Transmitted Infections

Las infecciones de transmisión sexual (ITS) son uno de los problemas de salud pública más frecuentes y universales. Debido a que las ITS son responsables de una alta morbilidad, así como de secuelas graves, es muy importante que todos los profesionales de la salud las tengan en cuenta en el momento de valorar al paciente. La dificultad en el control de las ITS se debe principalmente al retraso diagnóstico. Las pruebas diagnósticas permiten realizar un manejo etiológico, así como facilitar un tratamiento más efectivo tanto de los pacientes sintomáticos como de los asintomáticos, y finalmente permitirán interrumpir de una forma más precoz la cadena epidemiológica de transmisión. En la presente revisión se ha llevado a cabo una actualización acerca de los principales métodos diagnósticos existentes en las ITS más relevantes

Sexually transmitted infections (STIs) are one of the most frequent and universal Public Health problems. Health professionals should be aware of the possibility of STIs due to their high morbidity and the presence of sequelae. The delay in the diagnosis is one of the factors that justifies the difficulty to infections control. Diagnostic tests allow the introduction of aetiological treatment and also lead to treating symptomatic and asymptomatic patients more effectively, as well as to interrupt the epidemiological transmission chain without delay. In this review we have made an update of the main existing diagnostic methods for the more important STIs

Update on the Diagnosis of Sexually Transmitted Infections. / Actualización en el diagnóstico de las infecciones de transmisión sexual.

Sexually transmitted infections (STIs) are one of the most frequent and universal Public Health problems. Health professionals should be aware of the possibility of STIs due to their high morbidity and the presence of sequelae. The delay in the diagnosis is one of the factors that justifies the difficulty to infections control. Diagnostic tests allow the introduction of aetiological treatment and also lead to treating symptomatic and asymptomatic patients more effectively, as well as to interrupt the epidemiological transmission chain without delay. In this review we have made an update of the main existing diagnostic methods for the more important STIs.

Clinical and microbiologic characteristics of pleuro-pulmonary infection due to Streptococcus intermedius.

The clinical and microbiological characteristics of pleuro-pulmonary infection (PPI) caused by Streptococcus intermedius is described, including 6 cases in the literature and 9 cases handled at the present centre. Out of the 15 patients, 12 were male; mean age at diagnosis was 62.06 ± 15 years. Twelve had risk factors for S. intermedius infection such as alcoholism in 5 (35.7%) patients, periodontal disease in 3 (24.6%) cases, chronic obstructive pulmonary disease in 3 (24.6%), and diabetes mellitus in 2 (14.2%). Cough was present in 12 (80%) patients and chest pain and dyspnea in 9 (60%). The mean diagnosis interval was 34 days. The diagnosis was obtained from pleural fluid aspirate in 13 (86.6%) cases and from biopsy/tissue samples in 2. The most frequently antimicrobials used for treatment were ceftriaxone + levofloxacin. Ten patients cured with a combination of medical and surgical treatment and 2 patients died as a consequence of infection. The incidence of PPI caused by S. intermedius is increasing in our health area; drainage along with antibiotic therapy is recommended for treatment.

Clinical and microbiological findings of septic arthritis caused by Haemophilus parainfluenzae.

OBJECTIVES: To report a case of septic arthritis due to H. parainfluenzae and to review the clinical and microbiological characteristics of published case patients. PATIENTS AND METHODS: Data was collected on age, sex, infection localization, underlying risk factors, symptom onset-diagnosis interval, analytical findings, microbiological diagnosis, treatment, outcome, and follow-up of the present patient (presenting with septic arthritis of the pubic symphysis due to H. parainfluenzae) and those identified in a literature analysis. RESULTS: Data of 18 patients, including 17 reported case patients, was collected. Mean age at presentation was 51±9 years. Underlying diseases for septic arthritis were recorded in 11 patients. The infection site was the knee in eight patients, hip and/or acromioclavicular joint in five. Pain was observed in 15 patients and fever in 10; the mean symptom onset-diagnosis interval was 9.4 days. Diagnosis was obtained from synovial fluid aspirate in 12 patients and from blood cultures in four. Susceptibility of H. parainfluenzae strains was reported in 12 cases. Eight patients were treated with cephalosporins and 10 with penicillins. A favorable outcome was observed in 13 patients. CONCLUSIONS: Septic arthritis caused by H. parainfluenzae is a rare entity that requires a high level of suspicion before application of laboratory methods for rapid diagnosis and treatment.

Pleural effusion due to Parvimonas micra. A case report and a literature review of 30 cases.

The clinical and microbiological characteristics of infections caused by Parvimonas micra is described, including 30 cases in the literature and a new case handled at the present centre. Out of the 31 patients, 18 were male; mean age at diagnosis was 65.1 ± 13.0 years. Infection site was the vertebral spine in 14 patients and joints and heart valves in 5 each one; pain was present in all patients with articular localization and in almost all patients with vertebral involvement. The diagnosis was obtained from fluid aspirate or drainage in 13 cases and blood cultures in 11. In 8 cases, molecular techniques were also applied. The most frequently used antimicrobials were clindamycin, penicillin, amoxicillin and ceftriaxone. The outcome was positive with the medical treatment in 28 patients. P. micra infections are uncommon and requires a high index of suspicion.

[Tuberculous prosthetic knee joint infection: a case report and literature review]. / Artritis tuberculosa sobre prótesis de rodilla: descripción de un caso y revisión de la literatura.

OBJECTIVE: Prosthetic late infection occurs in the second month after surgery in the context of haematogenous spread from another source. Prosthetic mycobacterial infection is a rare complication whose clinical management is not standardized. CASE: Patient of 77 years with no personal history except for diabetes and a prosthetic replacement of right knee with osteoarthritis three years ago. Patient goes to hospital emergency box for 6 months pain in the right knee with mechanical inflammatory signs but no fever associated. After their return within 5 days and clinical worsening is reporting growth of Mycobacterium tuberculosis in knee aspirate and antitubercular treatment is established for 9 months. Nuclear magnetic resonance imaging studies also confirmed the diagnosis of tuberculosis spondylitis in the clinical context of the patients. After surgery, M. tuberculosis was again isolated from intraoperative samples and therefore the patient received another batch of treatment for 9 months. After a year of monitoring, the development was acceptable but few months later, the patient died for cardiovascular causes. In the literature review, 15 publications with a total of 17 clinical cases of prosthetic infection by M. tuberculosis were found from 1980 to 2014. CONCLUSIONS: Prosthetic tuberculous arthritis, although it is a rare presentation, it should be noted, especially in patients with predisposing conditions with a history of tuberculosis infection.

Monitorización ambulatoria de presión arterial y enfermedad renal crónica en pacientes hipertensos diabéticos tipo 2 y en pacientes hipertensos / Ambulatory blood pressure monitoring and chronic kidney disease in type 2 diabetic hypertense patients and hypertense patients

Objetivos. La valoración del perfil circadiano de la presión arterial (PA) y la estimación adecuada de la presencia de enfermedad renal crónica constituyen nuevas aproximaciones en la evaluación del riesgo cardiovascular. En este estudio hemos pretendido conocer las características del patrón circadiano y la enfermedad renal de los pacientes diabéticos tipo 2 e hipertensos con respecto a los pacientes únicamente hipertensos. Pacientes y método. En una unidad especializada de riesgo cardiovascular se estudiaron 180 pacientes, 146 hipertensos y 34 hipertensos diabéticos tipo 2 con edades comprendidas entre 18 y 80 años. Se realizó historia clínica, bioquímica, electrocardiograma y se descartó la existencia de causa secundaria de hipertensión. A todos se les determinó el grado de enfermedad renal y se les realizó monitorización ambulatoria de presión arterial (MAPA) durante 24 horas. Resultados. La edad media del los pacientes hipertensos (H) fue de 47,9 ± 13,6 años, y la de los hipertensos diabéticos (H-D) fue de 57,2 ± 8,5 años. Las PA clínicas fueron más alta en los pacientes H-D que en los pacientes H (165 ± 15,1/99,7 ± 9,4 mmHg frente a 153,4 ± 23,6/96,7 ± 12,0 mmHg), respectivamente. En MAPA la presión arterial sistólica (PAS) de 24 h diurna y nocturna también eran más elevadas en los pacientes H-D que en los H. El 82,4 % de los pacientes H-D fueron non dipper frente al 71,2 % de los H (p = 0,28). El filtrado glomerular (FG) en los pacientes H-D fue de 66,7 ± 10,1 ml/min frente a 74,8 ± 3,2 ml/min (p < 0,0001) de los pacientes H. Conclusiones. Es preciso valorar con atención la enfermedad renal y el patrón circadiano de presión arterial de los pacientes hipertensos diabéticos tipo 2

Objectives. Evaluation of the circadian blood pressure (BP) profile and adequate calculation of the presence of chronic renal disease make up new approaches in evaluation of cardiovascular risk. In this study, we have aimed to know the characteristics of the circadian pattern and kidney disease of type 2 diabetic and hypertense patients in regards to patients who are only hypertense. Patients and methods. In a specialized cardiovascular risk unit, 180 patients were studied, with 146 hypertense and 34 type 2 diabetic hypertense subjects aged 18 and 80 years. A clinical, biochemical and electrocardiogram history was obtained and secondary cause of hypertension ruled out. The degree of kidney disease was determined in all of them and 24 hour ambulatory blood pressure monitoring (ABPM) was performed. Results. Mean age of the hypertense patients (H) was 47.9 ± 13.6 years and of diabetic hypertense (D H) subjects was 57.2 ± 8.5 years. The clinical BPs were higher in D-H patients than in H patients (165 ± 15.1/99.7 ± 9.4 mmHg versus 153.4 ± 23.6/96.7 ± 12.0 mmHg), respectively. In ABPM the daytime, nighttime, and 24 hour SBP were higher in D-H patients than in H ones. A total of 82.4 % of the D-H patients were non dipper versus 71.2 % of the H (p = 0.28). Glomerular filtration (GF) in D-H patients was 66.7 ± 10.1 ml/min versus 74.8 ± 13.2 ml/min (p < 0.0001) of the H patients. Conclusions. Renal disease and the circadian blood pressure pattern of type 2 diabetic hypertense patients must be evaluated carefully

[Clinical characteristics of 47 patients with primary hyperparathyroidism surgically treated]. / Características clínicas de 47 casos de hiperparatiroidismo primario intervenidos quirúrgicamente.

BACKGROUND: The primary hyperparathyroidism is usually an asymptomatic disease. Actually, specialists are attempting to consider to what extent it can be necessary to undergo surgery in this disease. In this article, we are going to describe the clinical and biochemical characteristics of our patients with primary hyperparathyroidism as well as the diagnostic procedures and the results after operation. METHODS: Firstly, we have analysed 47 records of patients with primary hyperparathyroidism and intervened in our hospital during the last 5 years. Secondly, we assessed the biochemical results before and after the surgical intervention, the outcome of parathyroid echography, thoracico-cervical tomography, technietium-99-mm-sestamibi gammagraphy and bone densitometry. Finally, we followed up the assessment of the operation of the patients with hyperparathyroidism. RESULTS: 47 patients were intervened of hyperparathyroidism. 89.4% were women and average the age was 61.4 +/- 12.8 years. Most of them were asymptomatic (45.7%). The gammagraphy was the procedure with best sensibility and specificity, 75 and 100%. Bone densitometry showed that there were no patients with diminished calcification of the bones. The principal diagnostic of pathologic anatomy was adenoma (85.1%). Excluding one single case, the rest of patients healed of their illness after intervention. CONCLUSIONS: Primary hyperparathyroidism is asymptomatic in most of the cases. It is mainly an adenoma process. The best diagnostic procedure is technietium-99-mm-sestamibi gammagraphy. The most appropriate and successful treatment is surgery.

Características clínicas de los pacientes hipertensos esenciales respecto al consumo de sal / Clinical characteristics of patients with essential hypertension regarding salt intake

Numerosos estudios epidemiológicos y experimentales han puesto de manifiesto la estrecha relación entre el consumo de sal y la presión arterial. El objetivo de este estudio fue conocer la ingesta de sodio en 293 pacientes hipertensos no tratados previamente e identificar las características clínicas de los mismos que nos permitiera definir el perfil de los pacientes que consumen mayor cantidad de sodio. Se seleccionaron los pacientes hipertensos que acudían por primera vez a una consulta especializada de hipertensión arterial (HTA) y no tratados farmacológicamente, al menos durante el mes anterior. Se determinó la excreción urinaria de sodio en orina de 24 horas en dos ocasiones como índice del consumo de sodio. El 13 por ciento de los pacientes presentó un consumo inferior a 100 mEq/24 h y un 35 por ciento superior a 200 mEq/24 h.El consumo de sodio fue mayor en los hombres, en los pacientes más jóvenes, los que tenían un índice de Quetelet mayor, fumadores, estrato social más alto y menos años de duración de la HTA. No encontramos diferencias en el consumo de sal en los pacientes hipertensos con diabetes o hiperlipidemia asociada. El análisis de regresión lineal múltiple identificó como variables independientes en el consumo de sal al índice de Quetelet, sexo, edad y tabaco. No se encontró correlación entre el consumo de sal y la presión arterial. En conclusión, destacamos el alto consumo de sodio en nuestro medio en pacientes hipertensos que previamente se les había indicado la necesidad de moderar el consumo de sal. El consumo más elevado se observa entre los hombres, jóvenes, obesos y fumadores (AU)

Características clínicas de 47 casos de hiperparatiroidismo primario intervenidos quirúrgicamente / The clinical manifestations of 47 patients with pri mary hyperparathyroidism intervened

Fundamento y objetivo: El hiperparatiroidismo primario (HPTP) en la mayoría de los casos es asintomático. Hoy día, se discute la necesidad de someter a estos enfermos a paratiroidectomía. En el presente estudio, pretendemos describir las características clínicas y bioquímicas de nuestra serie de HPTP, además, de describir las técnicas utilizadas en el diagnóstico y los resultados obtenidos tras la intervención quirúrgica. Material y métodos: Hemos revisado las historias clínicas de 47 pacientes diagnosticados y operados de HPTP en nuestro centro en los últimos cinco años. Primero, recogimos las manifestaciones clínicas; segundo, los resultados bioquímicos anteriores y posteriores a la intervención quirúrgica; tercero, los datos de la ecografía paratiroidea, tomografía computerizada (TC) cervico-torácica, gammagrafía paratiroidea con 99Tc-Sestamibi y densitometría dual de rayos X ( DEXA); y por último, los resultados derivados de la intervención quirúrgica. Resultados: Fueron intervenidos 47 pacientes de HPTP, 89,4 por ciento mujeres, con edad media 61,4 ± 12,8 años. La gran mayoría se encontraban asintomáticos (45,7 por ciento). En cuanto a las técnicas de localización, la gammagrafía con 99mTc-sestamibi fue la que tuvo mayor sensibilidad y especificidad 75 y 100 por ciento, respectivamente. Ninguno de los pacientes presentó osteoporosis mediante densitometría ósea. El principal diagnóstico fue el de adenoma 85,1 por ciento. Todos los pacientes curaron tras la intervención, con la excepción de un solo caso. Conclusión: El HPTP presenta escasos síntomas. Principalmente se trata de adenomas. La técnica de localización preoperatoria más útil es la gammagrafía. El tratamiento definitivo es la extirpación (AU)

[Clinical characteristics of patients with essential hypertension regarding salt intake]. / Características clínicas de los pacientes hipertensos esenciales respecto al consumo de sal.

A number of epidemiologic and experimental studies have revealed the close relationship between salt intake and blood pressure. The objective of this study was to know the salt intake among 293 not previously treated hypertensive patients and to identify their clinical characteristics that would allow us to define the profile of patients with high sodium intake. Hypertensive patients who first attended a specialized high blood pressure (HBP) clinic not previously treated with drugs, at least for the last month were selected. Sodium 24 h urinary excretion was determined on two occasions, as sodium intake index. Thirteen percent of patients had a salt intake lower than 100 mEq/24 h and 35% of patients higher than 200 mEq/24 h. Sodium intake was higher among men, younger patients, those with a higher Quetelet index, smokers, higher socioeconomic status, and less years with IBP. No differences were observed between salt intake among hypertensive patients with associated diabetes or hyperlipidemia. The Quetelet index, sex, age and smoking were identified as independent variables for salt intake by the multiple linear regression analysis. No correlation was found between salt intake and blood pressure. In conclusion, a high sodium intake was observed in our setting among hypertensive patients who had previously been advised to moderate salt intake. The highest salt intake was observed among men, youths, obese and smokers.

[Liver abscess caused by Klebsiella pneumoniae in diabetic patients]. / Absceso hepático por Klebsiella pneumoniae en pacientes diabéticos.

Pyogenic liver abscess are macroscopic collections of pus within the hepatic parenchyma after a bacterial infection. These infections are usually polymicrobial in nature, and in most occasions due to biliary tract diseases or cryptogenetic in origin. Monomicrobial hepatic abscess caused by Klebsiella pneumoniae are uncommon lesions in western countries. These lesions are associated with underlying diseases, particularly diabetes mellitus, and are frequently complicated with septic metastasis. We report here three cases of monomicrobial liver abscess caused by Klebsiella pneumoniae in diabetic patients, without septic metastasis and a favourable outcome.

[A comparative study of 9 cases of adrenal pheochromocytoma and 11 cases of extra-adrenal pheochromocytoma]. / Estudio comparativo de nueve casos con feocromocitoma adrenal y once casos con feocromocitoma extraadrenal.

Twenty patients with the diagnosis of pheochromocytoma were studied from January 1990 to January 1998. Nineteen patients had a pathologic investigation performed. The mean age of patients was 49 +/- 16 years (range: 24-71 years), 8 males and 12 females. Nine cases corresponded to adrenal and eleven to extra-adrenal (paragangliomas) pheochromocytomas. The anatomic location was similar in both adrenal glands and for paragangliomas the cervical location predominated. The most consistent clinical finding in our patients was maintained arterial hypertension, followed by headache, palpitations and flushing. Biochemically, an increase in urine catecholamine levels or their metabolites was found in 82.2%. The clonidine test was very useful, particularly for cases where biochemical results were discrepant. CT, NMR and gammagraphy with 123I-MIBG have a high sensitivity for locating pheochromocytomas. NMR and gammagraphy with 111In-pentetreotide located cases in which CT or 123I-MIBG were negative. Preoperative treatment with adrenergic alpha-blockers allowed to surgery with no arterial tension complications. Only one patient with multiple abdominal paragangliomas relapsed. No differences regarding clinical manifestations, biochemical parameters or imaging studies were found between pheochromocytomas and paragangliomas, except their location.

[Varicella complicated by pericarditis and pneumonia]. / Varicela complicada con pericarditis y neumonía.

Varicella is a highly infectious disease mainly affecting young children under 14 years of age, and being generally mild. In adults immunodeficient children and neonates exposed in utero, the illness tends to be more severe with higher incidence of complications. The type of complication is linked to the age: in children, bacterial infection of skin lesions and acute cerebellar ataxia are more frequent while lower respiratory tract infection, Reye syndrome and encephalitis are less common. Varicella pneumonia is found typically in adult patients and diffuse encephalitis which course is worse than children could be less frequently. Acute pericarditis is an exceptional complication with a benign course, but only if myocarditis or pericardial effusion are not concurrent. It usually appears in teenagers and young adults; only a few times, it has been linked to other complications as pneumonia or arthritis. We report a varicella case in an adult patient who suffered from pneumonia and pericarditis, both of them were benign.