Micosis pulmonar por Paracoccidioides brasiliensis: confusión peligrosa con sarcoidosis / Pulmonary mycosis caused by Paracoccidioides brasiliensis: dangerous confusion with sarcoidosis

Se presenta el caso de un paciente de origen sudamericano con una enfermedad pulmonar diagnosticada inicialmente de sarcoidosis y tratado con corticoides. A pesar de una mejora inicial, el paciente fue empeorando hasta que por fin el cuadro se atribuyó a una paracoccidioidomicosis. Esta micosis sistémica tiene rasgos comunes con la sarcoidosis, pero el tratamiento difiere hasta el punto de que los corticoides pueden poner en peligro la vida del paciente (AU)

We present the case of a patient from South America with a lung disease that was initially diagnosed as sarcoidosis and treated with corticoids. Despite an initial improvement, the patient worsened gradually until his condition was finally attributed to paracoccidioidomycosis. This systemic mycosis has features in common with sarcoidosis, but the treatment differs drastically because corticoids can place the patient's life at risk (AU)

[Pulmonary mycosis caused by Paracoccidioides brasiliensis: dangerous confusion with sarcoidosis]. / Micosis pulmonar por Paracoccidioides brasiliensis: confusión peligrosa con sarcoidosis.

We present the case of a patient from South America with a lung disease that was initially diagnosed as sarcoidosis and treated with corticoids. Despite an initial improvement, the patient worsened gradually until his condition was finally attributed to paracoccidioidomycosis. This systemic mycosis has features in common with sarcoidosis, but the treatment differs drastically because corticoids can place the patient's life at risk.

Automatic detection of patients with nosocomial infection by a computer-based surveillance system: a validation study in a general hospital.

OBJECTIVE: To validate an automated system for the detection of patients with nosocomial infection (NI) in an intensive care unit (ICU). DESIGN: Retrospective analysis of data from the hospital information system. We applied 3 different NI suspicion criteria (positive microbiology reports, antibiotic administration, and diagnosis of clinical infection) and compared the results to those of a prospective NI incidence study done in the ICU during the same period (1999-2002). SETTING: A 250-bed general hospital in Barcelona, Spain. PATIENTS: From April 15, 1999, through June 30, 2002, 1380 patients were admitted to the ICU. Of these, 1043 had an ICU stay of more than 24 hours and were included in the study. RESULTS: At least one NI suspicion criterion was present for 242 patients (23.2%); 2 criteria were present for 184 patients (17.6%); and all 3 criteria were present for 112 (11.7%). Comparison of hospital information system data to the results of the prospective study indicated that the combination of 2 criteria demonstrated the most satisfactory sensitivity (94.3%; 95% confidence interval [CI], 79.5%-99.0%) and specificity (83.6%; 95% CI, 76.8%-88.9%). The positive predictive value was 55.9% (95% CI, 42.5%-68.6%); the negative predictive value was 98.5% (95% CI, 94.2%-99.7%). The system could assign a site of infection for 90.4% of the NIs detected. CONCLUSION: The hospital information system was a useful tool for retrospectively detecting patients with an NI during the ICU stay. Given its high sensitivity, it may be useful as an alert for the NI team.

Favorable outcome of pneumonia due to Panton-Valentine leukocidin-producing Staphylococcus aureus associated with hematogenous origin and absence of flu-like illness.

Reported here is what is believed to be the first case of community-acquired pneumonia caused by a Panton-Valentine leukocidin-producing strain of Staphylococcus aureus in Spain. Although lung infections caused by S. aureus strains carrying this powerful leukocidin gene are associated with necrotizing pneumonia and high mortality, the previously healthy 28-year-old male reported here experienced a good clinical course and recovery. It is thought that the hematogenous origin of the infection, the patient's lack of any previous respiratory viral infection and prompt initiation of therapy may explain the satisfactory evolution in this case.

[Streptococcus salivarius meningitis after spinal anesthesia]. / Meningitis por Streptococcus salivarius tras anestesia espinal.

Streptococcus salivarius is a usual commensal of skin, gastrointestinal tract, genitourinary tract, oral cavity and paranasal sinuses. Although it is usually considered to have low virulence, S. salivarius may cause life-threatening infections, particularly endocarditis. On the other hand, bacterial meningitis after spinal anesthesia is very rare, there being some reported cases caused by S. salivarius, S. mitis, Staphylococcus aureus and Enterococcus faecalis. We report a 57 year old man who developed meningitis symptoms within 10 h of an uncomplicated inguinal herniorrhaphy performed during spinal anesthesia. Cerebrospinal cultures grew S. salivarius sensitive to penicillin. The patient was successfully treated with penicillin G and left the hospital without sequelae. In the literature, bacterial meningitis due to S. salivarius is rarely reported. Of the 28 cases, 18 occurred after lumbar puncture for diagnostic or for spinal anesthesia, 5 occurred following a bacteriemia for upper gastrointestinal endoscopy or intestinal neoplasia, and the other 5 in patients who had dural defects. We discuss the possible etiological causes of the meningitis due to S. salivarius cases reports. The early recognition of this entity and the aseptic precautions likely to reduce the incidence of infectious complications after lumbar puncture are stressed.