[The adult respiratory stress syndrome and septic shock associated with tuberculosis]. / Síndrome de distrés respiratorio del adulto y shock séptico asociados a tuberculosis.

The increase in the incidence of tuberculosis infection in the last few years has caused a recurrence of atypical clinical forms, as well as the development of associations and uncommon complications during the clinical course, which include the adult respiratory distress syndrome (ARDS) and septic shock. Three patients with ARDS are here reported; two patients had findings of septic shock and negative serology to human immunodeficiency virus and the only etiological agent documented was M. tuberculosis. The three patients required hemodynamic support and two of them mechanical ventilation. None of the patients survived the episode. Tuberculosis, particularly the disseminated forms, should be considered as possible etiology in high risk patients with septic shock, ARDS or both.

[Salmonella ssp non-typhi focal infections]. / Infecciones focales por Salmonella spp no-typhi.

Provided here are the descriptions of 18 patients with focal infections caused by Salmonella spp no-typhi occurring in a period of seven years at the Puerta de Hierro Clinic. In all cases, there was at least one local factor, treatment, or underlying illness associated with decreased resistance to infection. Antecedents of severe gastroenteritis were found in seven cases (38 percent). Eighty-three percent had previous or concomitant bacteremia caused by the same serotype of Salmonella isolated in the focal infection. S. enteritidis was the most prevalent serotype (66 percent). The most common localizations were plueropulmonary (5), osteoarticular (5), and intravascular (3). Relapsing infection was demonstrated in five cases. There was 28 percent mortality. Statistically, age greater than 65 years and the absence of surgical intervention were associated with a worse prognosis.

Syndrome of inappropriate antidiuretic hormone secretion and herpes zoster infection: 1. Report of this association in a patient suffering from AIDS.

The syndrome of inappropriate secretion of antidiuretic hormone is a common consequence of neurologic and pulmonary infections as well as drug intake and many other clinical situations. Its association with herpes varicella-zoster virus infections is scarcely reported in the literature. It generally appears in immunosuppressed patients suffering from serious underlying diseases. There are also a few cases of syndrome of inappropriate secretion of antidiuretic hormone related to vidarabine use. We report the case of a man infected by human immunodeficiency virus who developed a disseminated herpes varicella-zoster virus infection and symptoms due to hyponatremia caused by antidiuretic hormone excess. The patient was cured with saline hypertonic infusion, water restriction, and intravenous administration of acyclovir. To the best of our knowledge, this is the first case of this association in a human immunodeficiency virus infected patient. We propose the use of acyclovir instead of vidarabine in the management of these situations.

[Tuberculous meningitis in patients without HIV infection. Presentation of 21 cases]. / Meningitis tuberculosa en pacientes no infectados por VIH. Presentación de 21 casos.

BACKGROUND: Tuberculous meningitis accounts for 5% to 12% of all extrapulmonary tuberculosis cases in western-hemisphere population non infected by HIV virus, and carries a high mortality rate. METHODS: We analyze retrospectively 21 patients with tuberculous meningitis in HIV negative patients seen from 1975 to 1989, with emphasis on clinical, laboratory and therapeutic features. RESULTS: In 48% of cases there were not typical meningeal signs, and 61% of patients showed neurological focal signs and/or seizures. CSF examination revealed a clear fluid with high cell counts (mostly lymphocytes), high protein and low sugar levels in 67% of cases. However, the microbiologic examination had a low yield of diagnosis (33%). The clinical course is prolonged, and treatment is usually delayed. Morbidity and mortality were high (34% and 10% of cases). In this study, the use of steroids did not show a significant reduction in mortality nor in neurological sequelae. CONCLUSION: Tuberculous meningitis in HIV negative patients is a chronic infection, without meningeal signs in most cases and linked to a high rate of neurological defects. The microbiologic tests have low yield of diagnosis. Steroid drugs seem to be indicated only if there are additional complications.

Surgical wound infection by Aspergillus fumigatus in liver transplant recipients.

Cutaneous aspergillosis is generally associated with immunosuppression, burns, and major trauma. Most cases are acquired by direct inoculation, although cutaneous involvement does occasionally occur with disseminated disease. Surgical wound infections caused by Aspergillus species are very unusual and to our knowledge have not been described in the setting of organ transplantation. We describe two liver transplant recipients who developed wound aspergillosis during a nosocomial outbreak of Aspergillus infection. Infection developed in the second and fourth postoperative week respectively, and in both cases wound appearance mimicked necrotizing fasciitis. Both patients died despite local debridement and antifungal therapy with amphotericin B. Aspergillus must be added to the list of potential pathogens of surgical wounds, especially in the setting of organ transplantation.