[Mediterranean boutonneuse fever. Study of 246 cases]. / Fiebre botonosa mediterránea. Estudio de 246 casos.

The clinical and epidemiological feature of 246 cases of Mediterranean boutonneuse fever diagnosed in 1983-1988 were evaluated. It was found that the clinical and epidemiological profile of the disease remained stable as compared with previous studies. The frequent muscle involvement, with increase in serum muscular enzymes in up to 32% of patients and with histologically documented myositis in 2 patients is emphasized. 7% of patients had severe forms of the disease. The risk factors of these forms were evaluated, and the different features in adults and children were compared. The outcome was favourable in all patients.

[Bacteremia in the patient with liver cirrhosis. Prospective study of 61 episodes]. / Bacteriemia en el paciente con cirrosis hepática. Estudio prospectivo de 61 episodios.

We prospectively evaluated 61 episodes of bacteremia in 54 patients with hepatic cirrhosis, representing 9% of the overall number of bacteremic episodes in adult patients seen in our center during the study period. Spontaneous bacteremia represented 46% of all episodes (virtually always in patients with ascites), followed by the urinary origin (30%). Gram negative organisms were isolated in 71% of episodes. 43% of these were hospital-acquired 25% of patients had spontaneous peritonitis. Among other complications of bacteremia there were shock (28%), renal failure (24%), and disseminated intravascular coagulation (6%). The mortality rate due to sepsis was 28%, that due to complications of cirrhosis by itself was 20%, and that of nonrelated diseases was 8%. Shock and renal failure secondary to bacteremia were independent predictors of a poor prognosis.

Seroepidemiological survey of Mediterranean spotted fever in an endemic area ('Vallés Occidental', Barcelona, Spain).

A seroepidemiological survey of Mediterranean spotted fever was carried out in the region of 'Vallés Occidental', Barcelona (Spain). The prevalence of antibodies to Rickettsia conorii in human beings and dogs was determined by indirect immunofluorescence. In 200 samples of sera from subjects without former history of boutonneuse fever, an overall prevalence of antibodies to R. conorii of 11.6% was found. Seropositivity was significantly higher in the age group greater than 50 years. A significant correlation between seropositivity and habitat, social status, contact with dogs or risky practices was not found. In 48 sera from subjects with a history of Mediterranean spotted fever in the previous 10 years, the overall prevalence of antibodies was 68.7%, being 56.2% among those individuals who had suffered from the disease between 5 and 10 years earlier. In 103 dog serum samples collected during the summer, seropositivity was 36.8%. Positive sera were only detected in 1 of the 97 samples collected in winter, which suggests a relatively short duration of the canine immune response after contact with R. conorii.

New trends in Mediterranean spotted fever.

Mediterranean Spotted Fever is a disease caused by Rickettsia conorii. It is endemic to the Mediterranean area, where, for the last few years, the number of cases has increased, possibly due, in part, to climatic factors. The main clinical aspects of a prospective series of 246 cases diagnosed from 1983 to 1988 are presented. The most characteristic manifestations were fever, exanthema and tache noire. Other frequent manifestations were headache, myalgia and arthralgia, and with lesser frequency, hepatomegaly, splenomegaly, gastrointestinal symptoms and conjunctivitis. Notable analytical changes are the rise of hepatic and muscular enzymes in a large number of patients. In some cases we have found signs of myositis in muscular biopsy. The evolution of our patients was usually favorable though serious and even deadly forms of the disease have been described. One of the factors that seems to greatly influence the appearance of these forms is delay in the initiation of effective treatment.

[Bacteremia secondary to decubitus ulcer]. / Bacteriemia secundaria a úlceras de decúbito.

We have prospectively evaluated 16 episodes of bacteremia induced by decubitus ulcers. The most commonly isolated microorganisms were Staphylococcus aureus, Proteus mirabilis, Pseudomonas aeruginosa and Bacteroides fragilis. Bacteremia was polymicrobial in 5 cases (31%). Most ulcers were already present at the time of admission, but bacteremia developed within the hospital in 13 patients. In 3 patients, ulcers did not show local features of infection. The initial antibiotic therapy was satisfactory in 13 cases. Mortality rate directly associated with bacteremia was 18%, but the overall mortality rate was 62%. We did not identify data permitting a reliable prediction of the findings of blood culture; therefore, the initial empirical therapy should be active against Staphylococcus aureus, Pseudomonas, enteric Gram-negative bacilli and anaerobes including Bacteroides fragilis.

Spontaneous bilateral chylothorax: uniform features of a rare condition.

A 67-yr-old woman was admitted with dyspnoea, chest and neck pain and swelling of both supraclavicular fossae and the neck. Chest X-ray showed bilateral pleural effusions. Thoracocentesis yielded a milky fluid with a high triglyceride level. Four previously published cases had similar clinical manifestations. The pathophysiology is discussed.

[Mediterranean spotted fever in childhood. Prospective study of 130 cases]. / Fiebre botonosa mediterránea en la infancia. Estudio prospectivo de 130 casos.

Authors present a prospective study of 130 cases of Mediterranean spotted fever treated between 1983 and 1985 in two Departments of Paediatrics of the Valles Occidental, area near Barcelona. Thirty-eight percent of the children came from suburban areas, an urban areas, an urban or rural origin being less frequent. Previous contacts with dogs existed in 86% of the cases. Most frequent clinical signs were fever (100%) maculo-papular rash (97%) and arthromyalgias (70%). The "tache noire" was found in 87% of the cases. Presence of arthritis in two patients is underlined. Indirect immunofluorescence to Rickettsia conorii was positive (much greater than 1/40) in 75% of the cases. All patients improved after treatment with tetracycline or erythromycin. There were no relapse.

Erythromycin versus tetracycline for treatment of Mediterranean spotted fever.

Eighty one children aged between 1 and 13 years participated in a randomised comparative trial of tetracycline hydrochloride and erythromycin stearate for treatment of Mediterranean spotted fever. Both therapeutic regimens proved effective, but in patients treated with tetracycline both clinical symptoms and fever disappeared significantly more quickly. Likewise, when those patients who began treatment within the first 72 hours of illness are considered the febrile period had a significantly shorter duration in the group treated with tetracycline. One patient was switched to tetracycline because there was no improvement of clinical manifestations, with persistence of fever, myalgias, and prostration, after receiving eight days of treatment with erythromycin. These results suggest that tetracyclines are superior to erythromycin in the treatment of Mediterranean spotted fever.

Mediterranean spotted fever: a cooperative study of 227 cases.

The clinical manifestations of 227 cases of Mediterranean spotted fever (Boutonneuse fever) were reviewed, and the epidemiologic aspects of 170 cases from the Vallés Occidental region in the county of Barcelona, Spain, were analyzed. In this area an increase in the incidence of the disease has been noticed during the last several years. The patients evaluated presented with high fever and a generalized maculopapular rash. The tache noire at the site of the tick bite was seen in 166 cases (73%). Other common clinical manifestations were myalgia (73%), headache (69%), conjunctivitis (32%), hepatomegaly (44%), and splenomegaly (19%). Hepatic function tests (serum glutamic-pyruvic transaminase, serum glutamic-oxaloacetic transaminase) gave abnormal results in 55% of all cases. The Weil-Felix reaction was positive in 79% of the cases; the OX19 strain of Proteus vulgaris was the strain most frequently agglutinated. Treatment with oral oxytetracycline or chloramphenicol was effective in all cases.