[Peritoneal tuberculosis as a complication in a case of unclassifiable myelodysplastic/myeloproliferative disease]. / Tuberculosis peritoneal como complicación en un caso de síndrome mielodisplásico/mieloproliferativo inclasificable.

We report the case of a 68-year-old male with a diagnosis of unclassifiable myelodysplatic/myeloproliferative disease (WHO classification), under prolonged steroid treatment and unsuccesful chemotherapy response, who developed progressive asthenia, thoracic pain, minimal efforts dyspnea, and abdominal distension, that initially was suspicious of splenic rupture. Exploratory laparotomy showed multiple peritoneal implants, and a diagnosis of peritoneal tuberculosis was obtained from local biopsy. Definitive diagnosis included a positive result to culture and PCR urine test, together with a possible pleural and splenic tuberculous affectation. Response to tuberculostatic treatment was successful. To the best of our knowledge, this is the first reported case with such characteristics.

Sepsis de repetición en un paciente con gammapatía monoclonal de significado incierto / Several episodes of bacterial infections in a patient with monoclonal gammapathy of undetermined significance

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[Diarrhoea in the traveller]. / Diarrea del viajero.

Diarrhoeic diseases caused by water and food contaminated by enteropathogens continue to be an important cause of morbidity in countries with a low level of development. Some 50,000 cases of diarrhoea in travellers are estimated in the world every day, and this is the main cause of consultation by travellers who return from undeveloped zones. The principal determinant of risk is the place of destination; there are significant differences between different regions with respect to risk and to the aetiology of the diarrhoea. The most frequent cause of diarrhoeas is of bacterial origin, which represents between 60 and 85% of the cases, while parasites represent 10% and some 5% are produced by viruses. Although it normally follows a benign course, complications can arise, with mortality being only exceptionally associated to this disease. Prevention is essentially based on strictly following elemental hygienic measures and avoiding the ingestion of foodstuffs and drinks with a risk of contamination. Prophylaxis with antibiotics is only advisable in journeys of short duration, in which the risk and/or seriousness of diarrhoeas, above all in immunosuppressed patients, are higher than the possible collateral effects. The treatment of diarrhoea in the traveller is based on adequate hydration, and the use of microbians is reserved for moderate and serious situations, with quinolones being the drug of choice. Rifaximine is a new drug approved for the treatment of diarrhoeas in the traveller, above all in areas with enteropathogens that are resistant to quinolones.

Diarrea del viajero / Diarrhoea in the traveller

Las enfermedades diarreicas causadas por la contaminación de agua y alimentos por enteropatógenos continúan siendo causa de importante morbilidad en los países con escaso nivel de desarrollo. Se estima alrededor de unos 50.000 casos diarios de diarreas del viajero en el mundo, siendo el principal motivo de consulta de los viajeros que regresan de zonas no desarrolladas. El principal determinante de riesgo es el lugar de destino, existiendo diferencias importantes entre las distintas regiones en cuanto al riesgo y la etiología de la diarrea. La causa más frecuente de diarreas es la bacteriana, que representa del 60 al 85% de los casos, los parásitos representan el 10% y un 5% están producidas por virus. Aunque habitualmente cursa de forma benigna, pueden aparecer complicaciones, siendo excepcional la mortalidad asociada esta enfermedad. La prevención se basa fundamentalmente en seguir estrictamente las medidas higiénicas elementales y evitar la ingesta de alimentos y bebidas con riesgo de contaminación. La profilaxis con antibióticos sólo se aconseja en viajes de corta duración, en los que el riesgo y/o gravedad de las diarreas, sobre todo en pacientes inmunosuprimidos, sean superiores a los posibles efectos colaterales. El tratamiento de la diarrea del viajero se basa en una adecuada hidratación y se reserva el uso de antimicrobianos para situaciones clínicas moderadas y graves, siendo las quinolonas el fármaco de elección. La rifaximina es un nuevo fármaco aprobado para el tratamiento de las diarreas del viajero, sobre todo en áreas con enteropatógenos resistentes a las quinolonas

Diarrhoeic diseases caused by water and food contaminated by enteropathogens continue to be an important cause of morbidity in countries with a low level of development. Some 50,000 cases of diarrhoea in travellers are estimated in the world every day, and this is the main cause of consultation by travellers who return from undeveloped zones. The principal determinant of risk is the place of destination; there are significant differences between different regions with respect to risk and to the aetiology of the diarrhoea. The most frequent cause of diarrhoeas is of bacterial origin, which represents between 60 and 85% of the cases, while parasites represent 10% and some 5% are produced by viruses. Although it normally follows a benign course, complications can arise, with mortality being only exceptionally associated to this disease. Prevention is essentially based on strictly following elemental hygienic measures and avoiding the ingestion of foodstuffs and drinks with a risk of contamination. Prophylaxis with antibiotics is only advisable in journeys of short duration, in which the risk and/or seriousness of diarrhoeas, above all in immunosuppressed patients, are higher than the possible collateral effects. The treatment of diarrhoea in the traveller is based on adequate hydration, and the use of microbians is reserved for moderate and serious situations, with quinolones being the drug of choice. Rifaximine is a new drug approved for the treatment of diarrhoeas in the traveller, above all in areas with enteropathogens that are resistant to quinolones

HIV-associated primary body-cavity-based lymphoma: clinico-biologic features in three patients diagnosed at the same institution.

Primary effusion lymphoma (PEL) is a recently individualized form of non-Hodgkin lymphoma (WHO classification) that mainly develops in HIV infected males, more frequently in homosexuals and advanced stages of the disease (total CD4+ lymphocyte count below 100-200/mL). Occasionally, it appears in others immunodepressive states (such as solid organs postransplant period) and even, although very rarelly, in immunocompetents patients. From a pathogenetic point of view, PEL has been related to Kaposi's sarcoma-associated herpes virus (also named human herpesvirus 8) and to the clinical antecedent of Kaposís sarcoma. Relative unfrequency of this disease, the absence of wide casuistics allowing a better characterization, and its unfavorable outcome, support the need of a deeper knowledge. We present here the clinical-biological findings of three patients that were diagnosed of pleural PEL in our institution in the last two years.

Linfoma primario de cavidades asociado a infección por VIH: características clínico-biológicas en tres pacientes diagnosticados en un mismo centro / Hiv-associated primary body-cavity-based lymphoma: clinico-biologic features in three patients diagnosed at the same institution

El linfoma primario de cavidades (LPC) constituye un variedad de linfoma no Hodgkin individualizada por la clasificación OMS, que se desarrolla principalmente en pacientes varones con infección por HIV, más frecuentemente homosexuales y en estadios avanzados de la enfermedad (recuento total de linfocitos CD4+ inferior a 100-200/µL), aunque en ocasiones pueden aparecer en otras circunstancias asociadas a estados de inmunodepresión (como puede ser en el postrasplante de órganos sólidos) e incluso, de forma muy ocasional, en pacientes inmunocompetentes. Desde un punto de vista patogenético se ha relacionado con el virus herpes asociado a sarcoma de Kaposi (también denominado virus herpes tipo 8) y al propio antecedente clínico de sarcoma de Kaposi. La relativa rareza de esta enfermedad, la falta de casuísticas amplias que logren caracterizarla mejor y su pronóstico tan desfavorable, obligan a profundizar en un mejor conocimiento de la misma. Presentamos los hallazgos clínico-biológicos de tres pacientes diagnosticados de LPC pleural en nuestro centro en los últimos dos años (AU)