Infección por VIH-1 y enfermedad inflamatoria intestinal / HIV-1 infection and inflammatory bowel disease

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Infección faríngea por Mycoplasma pneumoniae en un adulto joven. Un caso / Pharyngeal infection by Mycoplasma pneumoniae in a young man. A case report

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Bacteriemia oportunista por Campylobacter fetus en un paciente aparentemente sano / Opportunistic Campylobacter fetus bacteremia in an apparently healthy patient

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Síncope y dolor abdominal en una mujer de 57 años / Syncompe and abdominal pain in a 57-year-old woman

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Tuberculosis costal en paciente VIH. Presentación clínica y revisión / Tuberculosis of the ribs in HIV patient. Clinical presentation and review

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[Prognostic factors of bacteremia: prospective study]. / Factores pronósticos de la bacteriemia: estudio prospectivo.

BACKGROUND: To identify the epidemiology and risk factors with influence in the outcome and mortality of a series of bacteriemic patients. MATERIAL AND METHODS: A prospective study of bloodstream infections with clinical significance detected in a secondary hospital of 650 beds over period from May 1998 to May 1999. The true bacteriemia was defined in basis to the criteria both the physician and microbiologist. A total of 16 variables were defined and categorized such as clinical-epidemiologic, intrinsic risk factor, extrinsic risk factor, outcome and survival. We used SPSS statistical package: For cuantitative variables we carried out with the mean with confidence interval of 95%, for cualitative variables: number and %. Univariate analysis of the results was carried out with the X2 test and t Student, the survival was expressed with Kaplan Meyer graphics and the logistic regression model. RESULTS: A total of 320 positive blood cultures were studied but only 272 blood cultures were considered true bacteriemia in 259 patients. The calculated incidence of significant episodes of bacteriemia per 1000 admissions/year was 13. The overall mortality was 22% whereas death attributable to bacteriemia was 16%. The mean age was 66.9 years (IC 95% 65-69), 59% episodes occurred in men. The 78% episodes occurred in patients hospitalized in medical services. 52% episodes were of nosocomial infection and 48% of community acquired infection. According to the severity of the underlying disease, 15% had fatal diseases and 35% episodes occurred in patients without underlying disease. According to the univariant analysis, the variables which where significantly associated with greater risk death were: etiology (fungus), septic shock, the inadequate antibiotic therapy, presence of extrinsic factors (central intravenous catheter, performance of invasive procedures, previous antimicrobial therapy) and the hospital stay of less than 10 days. According to the multivariable analysis showed that the factors remaining independent predictors of mortality were: septic shock (p < 0.0001, OR: 8), inadequate antimicrobial therapy (p < 0.005, OR: 6.7), existence of two or more extrinsic risk factors (p < 0.04). CONCLUSIONS: The presence of septic shock was the most important variable which influenced in the mortality in our serie, together with inappropriate antimicrobian therapy and the association of various extrinsic risk factors. These variables could be modified partly, for this reason the aggressive hemodynamic control and the early and appropriate antibiotic therapy would be the support of the successful bacteriemia management.

Factores pronóstico de la bacterimia: estudio prospectivo / Pronostic factors of the bloodstream infections: prospective study

Objetivo : Conocer la epidemiología e identificar los factores de riesgo que influyeron en la mortalidad de nuestros pacientes con bacteriemia.Material y métodos: Estudio prospectivo de las bacteriemias significativas detectadas en un hospital secundario de 650 camas en el período de mayo de 1998 a mayo de 1999. La catalogación como significativa se realizó de acuerdo con el criterio del clínico y microbiólogo implicados.Se analizaron 16 variables categorizadas como clínico-epidemiológicas, factores de riesgo intrínseco y extrínseco, evolución y supervivencia. El análisis estadístico se hizo en base al programa informático SPSS; para variables cuantitativas se utilizó la media con IC del 95 por ciento, y para las variables cualitativas: nº y por ciento. El análisis bivariante se realizó con t Student y X2; la supervivencia se expresó con gráficas de Kaplan-Meyer y el índice de regresión logística de Cox.Resultados: Se analizaron 320 hemocultivos que tras la valoración del clínico se redujeron a 272 episodios de bacteriemia clínicamente significativa en 259 pacientes, con una incidencia de 13 casos/1000 admisiones/año. La mortalidad global fue del 22 por ciento, mientras la directamente relacionada con la bacteriemia fue del 16 por ciento. La edad media fue 66,9 años (IC 95 por ciento: 65-69) con predominio de varones(59 por ciento), localizándose en el área médica hasta un 78 por ciento de los casos, siendo de origen nosocomial el 52 por ciento y comunitario el 48 por ciento. Un 15 por ciento de los casos eran portadores de enfermedad fatal y hasta un 35 por ciento carecían de enfermedad de base.Según el análisis univariante se asoció con mayor de riesgo de muerte (p<0,05): la etiología (fungemias), la presencia de shock, adecuación de tratamiento, existencia de factores extrínsecos (catéter central, antibioticoterapia previa y procedimientos invasivos) y estancia hospitalaria menor de 10 días. Con el análisis multivariante sólo se identificaron como factores pronósticos independientes: Shock séptico (p<0,0001 con RR. 8), adecuación de tratamiento (p<0,001 con RR 6,67), presencia de más de 2 factores extrínsecos (p<0,04).Conclusiones: La aparición de shock al diagnóstico fue la variable que más influyó en la mortalidad de nuestros pacientes, seguida de la inadecuación del tratamiento antibiótico y la existencia de factores de riesgo extrínsecos. Estas variables modificables en cierto grado obligan a incidir sobre la necesidad de un control hemodinámico agresivo y el establecimiento de un tratamiento antibiótico precoz adecuado (AU)

[Medullary carcinoma of the thyroid. Familial variety]. / Carcinoma medular de tiroides. Variedad familiar.

A patient who consulted because of diarrhea was diagnosed of thyroid medullar carcinoma (TMC) associated to pheochromocytoma. All members of his family were studied for a possible family variety of TMC with a genetic origin. In the 21 family members studied basal and calcium-pentagastrin stimulated calcitonin levels were determined and parathyroid and adrenal gland function were explored to rule out pheochromocytoma. Elevated levels of calcitonin agreed with pathological findings of TMC. Pheochromocytoma carriers had altered catecholamines and an abnormal abdominal CT scan. The clinical, analytical and radiologic findings in the four affected family members are described. The histopathological study revealed a pheochromocytoma in one case and bilateral TMC in two cases. The cytology of aspiration biopsy samples was positive for TMC in three cases. The importance of calcitonin determinations is emphasized as well as the obligatory determination of catecholamines and adrenal CT scan in order to rule out the coexistance of pheochromocytoma. The reasons for not utilizing gammagraphy with meta-iodine benzyl guanidine in these four cases are also explained.