Neumonía familiar grave con aislamiento de Streptococcus pneumoniae / No disponible

Introducción: Presentamos una agregación intrafamiliar de neumonía grave, con aislamiento de Streptococcus pneumoniae en la esposa. Caso 1: Hombre de 54 años, ingresa el 27 de julio por dolor torácico y fiebre. Radiografía de tórax consolidación LID. Microbiología: antígenos urinarios negativos. Hemocultivos y cultivo de esputo negativos. A las pocas horas es trasladado a Cuidados Intensivos por shock séptico. Se instauró levofloxacino y ceftriaxona. Fiebre persistente, que mejoró tras la administración de vancomicina. Evolución favorable. Caso 2: Mujer de 50 años, esposa del caso 1, consulta el 31 de julio por fiebre y tos. Rx tórax condensación alveolar basal bilateral, pequeño derrame pleural derecho. Microbiología: antígeno neumococo en orina positivo, Streptococcus pneumoniae serotipo 1 en los hemocultivos. Toracocentesis exudado pleural con pH 7,46, cultivo negativo. Presentó hipotensión, oliguria, sepsis grave, e ingreso en UCI el mismo día del ingreso. Inicialmente se trata con ceftriaxona y azitromicina. Por persistencia de la fiebre, posteriormente con levofloxacino y vancomicina, con recuperación. Conclusiones: Presentamos un brote familiar de neumonía grave con aislamiento de neumococo serotipo 1

Introduction: We present a case of family aggregation of severe pneumonia with Streptococcus pneumoniae isolation in wife. Case 1: A 54 year old man was admited on July 27 for chest pain and fever. The chest radiograph LID consolidation. Microbiology: Streptococcus pneumoniae urinary antigens and Legionella pneumophila serogroup 1: negative. Negative blood cultures and sputum culture. A few hours later he was transferred to intensive care from septic shock. It was established antibiotic therapy with levofloxacin and ceftriaxone. He had persistent fever despite antibiotic, which improved after administration of vancomycin. Favorable clinical evolution. Case 2: 50 year old woman, wife of case 1, consulting on July 31 with fever and cough. The Rx chest bilateral basal alveolar condensation, small right pleural effusion. Microbiology: positive urine pneumococcus antigen, was isolated Streptococcus pneumoniae serotype 1 in blood cultures. Thoracentesis pleural exudate with pH 7.46, negative culture. He presented hypotension, oliguria, severe sepsis, and ICU admission the day of admission. Initially it treated with ceftriaxone and azithromycin. By persistent fever, later with levofloxacin and vancomycin, with recovery. Conclusions: We present a family outbreak of severe pneumonia with pneumococcal serotype 1 isolation

Analysis of cytokine and specific antibody profiles in hydatid patients with primary infection and relapse of disease.

We studied in vitro cytokine production by peripheral blood mononuclear cells (PBMC) from patients with primary and recurrent hydatid disease when cells were incubated with mitogen (PHA) and antigen from hydatid cyst fluid (HCFAg); levels of specific IgE, IgG4 and eosinophil counts were also measured in sera. When specifically stimulated, PBMC from patients produced higher levels of IL-2 (P < 0.02), IFN-gamma (P < 0.0028) and IL-5 (P < 0.01) than those from uninfected donors, whereas IL-10 levels were comparable. Notably, IL-5 was also produced in higher levels (P < 0.01) by PBMC from patients when incubated with PHA. The IL-5:IFN-gamma ratio was significantly greater (P < 0.02) when measured in response to specific stimulation than it was for PHA-stimulated cultures. These cytokine data suggest a bias towards a Th2-response which is in agreement with the high levels of IgG4 and IgE observed. The polarized response appears to be related to clinical status, as differences between patients with primary infection and those with relapse of disease were demonstrated, with significantly higher levels of IgE (P < 0.003), IgG4 (P < 0.04) titres and eosinophil counts (P < 0.04) in the latter; in addition a tendency to an increased production of IL-5 buy lower IFN-gamma was also observed in this group. These results merit further study as they are suggestive of a putative role of Th2-like responses in susceptibility to reinfection by E. granulosus.

[Legionellosis at intensive care units: study of 30 cases]. / Legionelosis en cuidados intensivos: estudio de 30 casos.

A prospective study during 44 months has been carried out in order to establish the incidence of pneumonia due to Legionella sp. in our hospital's intensive care unit (ICU). Thirty cases of legionellosis were diagnosed (22.2% of the studied pneumonias) two of them were acquired in the ICU and 76.6% were caused by L. pneumophila serotype. The most evident symptomatology was intense dyspnea, neurological disorders, acute respiratory and renal failure. The biochemical alterations, most commonly encountered were increased liver enzymes, hypoxemia, hypoalbuminemia, increased urea, creatinine and hematuria. As a consequence of this severe disease, the mortality rate was high (13 out of 30 cases).