[Pneumococcal pneumonia with bacteremia in adults: a descriptive study from the north-west of Spain]. / Neumonía neumocócica con bacteriemia en adultos: estudio descriptivo en el noroeste de España.

OBJECTIVE: Analysis of adults patients (> 15 years of age) with Bacteremic Pneumococcal Pneumonia (BPP), in the Hospital Complex of Pontevedra. MATERIAL AND METHODS: 83 cases of BPP were studied in the last 6 years (1995-2000). RESULTS: There were 57 men and 26 women. The overall mean age was 56 year-old; in those smaller than 40 years, there was 60% infected by the HIV. The patients' two thirds, had > 1 predisposing condition, highlighted: the cigarette smoking, the alcoholism and the HIV infection. The typical clinical presentation of pneumococcal pneumonia, we find it in 73%. The calculation of the pneumonia severity index (PSI, Fine et al.), it framed half of the patients in the group of low risk of mortality. The resistance to the penicillin in the isolations, was of 31%. The initial antibiotic treatment was modified, in 11% of the cases. The fatal cases (10%) had: superior age to 65 years, presence of mental confusion, a bigger hypoxemia and hypercapnia, admission in the ICU, atypical presentation, existence of pleural effusion and a PSI bigger than 140. CONCLUSIONS: The patient with BPP in our area, presents some similar clinical characteristics to those described in other series; the half is included in the group of low risk of mortality. Apart from other factors already well-known, a superior PSI at 140, is related directly with the mortality.

[Primary actinomycosis of the abdominal wall. Description of 2 cases and review of the literature]. / Actinomicosis primaria de la pared abdominal. Descripción de dos casos y revisión de la literatura.

We report two cases of isolated abdominal wall actinomycosis and review 18 previously reported cases to further characterize the clinical findings and the therapeutic management of this syndrome. This diagnosis would be advocated in patients with a palpable abdominal mass of subacute appearance with a previous history of digestive medical illness, diabetes, abdominal surgery, or prolonged IUD use. In contrast with other actinomycosis locations, remarkable data were a more elevated mean age of patients; a female predominance; a prevalent location of mass in abdominal lower left quadrant; and a shorter duration of symptomatology before to diagnosis. The CT is the first choice for imaging study and percutaneous needle aspiration would be recommended for definite diagnosis. The long-term antibiotic therapy, with or without percutaneous drainage, is the first treatment choice because is very effective and made unnecessary a more invasive surgical management. The prognosis is excellent with adequated treatment.

[Hematogenous meningitis caused by Staphylococcus aureus with sacro-iliitis and multiple abscesses. An infrequent association]. / Meningitis hematogéna por Staphylococcus aureus con sacroileítis y abscesos múltiples. Una asociación infrecuente.

INTRODUCTION: Meningitis due to Staphylococcus aureus (MSA) is an uncommon infectious condition. It forms from 1-9% of all cases of bacterial meningitis, and is characterized by a high morbidity and mortality. Ever since the first publications dealing with this type of meningitis, two basic mechanism have been described for the development of this infection: post-neurosurgical and hematogenous, also known as spontaneous. CLINICAL CASE: Our objective is to present the case of a 65 year old woman who developed hematogenous Staphylococcus aureus meningitis, without any predisposing factors. During clinical investigation, the meningeal infection was seen to be associated with septic arthritis of the right sacro-iliac joint (shown on isotope studies) and with retro-peritoneal and gluteal abscesses (shown on computerized tomography). In this patient the pathological findings were: MSA, retroperitoneal and gluteal abscesses, and unilateral sacro-ileitis. To date such a combination has not been described (Medline search from January 1982 up to june 1996). CONCLUSIONS: After analysis of the pathogenic findings of the MSA directly involved in this case we conclude by emphasizing the following points: 1. It is very important to make a thorough search for a primary infectious focus responsible for MSA, completing the physical examination of the patient with imaging techniques (conventional radiology, CT, isotope studies, etc.). 2. Depending on the primary focus found in an MSA, antibiotic treatment may sometimes have to be complemented by other methods of treatment to avoid subsequent complications.

[Pleural effusion as the only manifestation of cryptococcosis in an AIDS patient]. / Derrame pleural como única manifestación de criptococosis en un paciente con SIDA.

Cryptococcosis is often seen in immunodeficient patients, including those with AIDS. It usually affects mainly the respiratory tract and central nervous system. We present a rare case of pleural involvement with no sign of disease at other sites. A review of the literature yields only three other similar cases. We discuss the diverse clinical manifestations of cryptococcosis, particularly those found in the respiratory tract.