[Pneumococcal bacteremia in patients aged over 65 years. A study of 161 cases]. / Bacteriemia neumocócica en pacientes mayores de 65 años. Estudio de 161 casos.

BACKGROUND: Here we present the results from a prospective analysis of pneumococcal bacteremia in patients older than 65 years, highlighting its differences with regard to patients aged from 15 to 64 years. PATIENTS AND METHOD: We performed a prospective follow-up study (1988-1999) of patients older than 14 years whohad blood cultures positive for Streptococcus pneumoniae(S. pneumoniae). S. pneumoniae was identified using standard techniques. The antimicrobial sensitivity was analysed using the broth midrodilution technique and the serotype was studied in a reference laboratory. Statistical analyses were performed by means of the SPSS program, version 9.0. RESULTS: 161 out of 321 bacteremias occurred in 154 patients older than 65 years (86 males). Most frequent underlying diseases were chronic obstructive pulmonary disease (COPD), diabetes and neoplasia. Most patients had pneumonia, 29.7% with ilfiltrates involving at least two lung lobes. 9.4% of bacteremias were nosocomial. Among patients older than 65 years, 32.5% of strains were resistant to penicillin, compared to 21.7% in patients younger than 65 years(p = 0.034). Mortality in patients over 65 years was higher than in younger patients (25.3% vs 11.5%; p = 0.002) and mortality predictive factors in a multivariate analysis were age, nosocomial bacteremia and multi-lobe involvement (in patients with pneumonia). CONCLUSIONS: There is a high incidence of pneumococcal bacteremia in patients over 65 years of age. These patients have a higher rate of resistance to penicillin and a higher mortality rate than younger patients. Mortality predictive factors are age, nosocomial bacteremia and multi-lobe involvement.

Prevalence of antibodies to spotted fever group rickettsiae in human beings and dogs from and endemic area of mediterranean spotted fever in Catalonia, Spain.

We assessed the prevalence of antibodies to spotted fever group rickettsiae in human beings and dogs by indirect immunofluorescence in the region of 'Vallés Occidental', Barcelona (Spain). In the group of 150 serum samples from patients without former history of Mediterranean spotted fever, 12 had antibodies to Rickettsia conori. The overall seroprevalence was 8% (95% confidence interval, 4.6% to 13.5%). There were no statistically significant differences between the mean ages of patients with positive and negative antibodies to R. conorii. However, seropositivity was significantly more common among patients living in semi-rural areas. In the group of 138 dog serum samples, 36 (26.1%) sera had antibodies to R. conorii. When the present results were compared with those obtained in a previous seroepidemiological survey carried out in the same geographical region in 1987, no significant differences were found. Therefore, although the epidemiological markers have dropped, this does not absolutely confirm the decrease of the presence of R. conorii in this area.

Plasma levels of tumor necrosis factor alpha in patients with Mediterranean spotted fever: clinical and analytical correlations.

Twenty consecutive patients with serologically confirmed Mediterranean spotted fever were analyzed for determination of plasma levels of tumor necrosis factor alpha (TNF-alpha) by means of an ELISA. Increased levels of TNF-alpha in plasma were found during the acute phase of the disease (52.3 +/- 49.8 pg/mL) compared to levels in the convalescent phase (9.0 +/- 9.3 pg/mL; P < .001) or in healthy controls (6.5 +/- 3.2 pg/mL; P < .001). Plasma TNF-alpha levels were significantly higher in patients with severe Mediterranean spotted fever. Levels of TNF-alpha correlated significantly with serum levels of C-reactive protein and triglycerides and inversely with serum levels of sodium.

[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.

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.

[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.