Update on the diagnosis of invasive fungal infection.

The number of patients at risk of suffering invasive fungal infection (IFI) is increasing. Because of its high mortality, new rapid and accurate diagnostic tools are needed. Last advances in invasive candidiasis diagnosis comprise Peptide Nucleic Acid Fluorescent In-Situ Hybridization (PNA-FISH), direct MALDI-TOF or multiplex acid nucleic testing. While all of them rely in positive blood cultures, T2Candida uses PCR coupled with T2Magnetic resonance detection directly in whole blood, allowing detection of 1-3 UFC/mL of Candida in about four hours. Beyond galactomannan (GM), novelties in IFI caused by molds include the international standardization of PCR techniques, with several commercial kits available. A combination of GM and PCR appears to be a good diagnostic strategy for invasive aspergillosis. PCR coupled to electrospray ionization/mass spectrometry and detection of volatile organic compounds in exhaled air by gas chromatography/mass spectrometry are other promising approaches to IFI diagnostic that still need to be validated.

[Epidemiological aspects of mycosis in the critical patient]. / Aspectos epidemiológicos de las micosis en el paciente crítico.

Fungemia, generally causes by Candida spp., is the most frequent deep mycoses in the critical patient and is many times clinically undistinguishable from bacterial septicemia. Less frequently, respiratory or disseminated mycosis produced by Aspergillus or other filamentous fungi, such as Scedosporium, Fusarium, Pneumocystis, Acremonium or zygomycetes have been described. Currently, invasive candidiasis is the fourth cause of nosocomial infection in Europe and the USA. Furthermore, in the SCOPE study, Candida is the third microorganism isolated from the blood culture in the ICU and the mortality that can be attributed to it reaches 25 %-38 %. Currently, the incidence of candidemia has been estimated to be 2 cases per every 1,000 admissions in the mixed critical units and 9.9 cases in the critical surgical units. On its part, invasive aspergillosis is observed in 1.25 % of the patients admitted to the ICU and mostly affects patients with chronic bronchopathy treated with glucocorticoids. It is considered as an indicator of bad prognosis and is associated to very high mortality rates (40 %-100 %).

[Malaria. Analysis of 31 cases (1993-2002)]. / Paludismo. Análisis de 31 casos (1993-2002).

The objective of this work is the study of malaria in the population of our hospital area. The characteristics of 31 cases of imported malaria diagnosed in the University Hospital La Fe of Valencia are described. The study included the period between 1993 and 2002. The predominance of males (81%), of the age group of 20-40 years (average: 37.68), and of the patients native from African countries (all except for a patient from Ecuador) of which 40% came from Equatorial Guinea, were outstanding results. The most prevalent species was Plasmodium falciparum (72%). Only 12.9% of the patients received antimalarial prophylaxis with mefloquine, without appropriate compliance. Malaria continues to be the most important protozoan infection in the world, and currently a possible reintroduction of this infection is observed in Spain. That is why is necessary to improve the information offered to the tourists who visit tropical countries. The clinical suspicion is also essential in patients who come from endemic areas.

Paludismo. Análisis de 31 casos (1993-2002) / Malaria. Analysis of 31 cases (1993-2002)

El objetivo de este trabajo es estudiar el paludismo en la población de nuestro ámbito hospitalario. Se describen una serie de características de 31 casos de paludismo importado diagnosticados en el Hospital Universitario La Fe de Valencia en el período de estudio comprendido entre 1993 y 2002. Destaca el predominio de los varones (81 por ciento), el grupo de edad de 20-40 años (media: 37,68) y el origen desde países africanos (todos excepto un caso que provenía de Ecuador), de los cuales el 40 por ciento procedían de Guinea Ecuatorial. La especie más prevalente fue Plasmodium falciparum (72 por ciento). Tan sólo el 12,9 por ciento de los enfermos llevaron profilaxis antipalúdica con mefloquina sin un cumplimiento correcto. El paludismo sigue siendo la infección por protozoos más importante del mundo, y se observa una posible reintroducción en España. Debido a ello hay que mejorar la información a los turistas que visitan países tropicales. También es fundamental la sospecha clínica en enfermos que provienen de áreas endémicas (AU)

Lesión cutánea papuloeritematosa tras punción con acícula de pino en paciente en tratamiento corticoideo / Erythematous papules on the skin after pine needle puncture in a patient receiving corticoid treatment

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Fiebre persistente, pancitopenia y esplenomegalia en un portador detrasplante cardíaco como manifestaciones de leishmaniasis visceral / Persistent fever, pancytopenia and spleen enlargement in a heart transplant carrier as presentation of visceral leishmaniasis

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[Strongyloides stercoralis infection in a cortico-dependent patient with chronic airflow obstruction]. / Infección por Strongyloides stercoralis en un paciente con obstruccion crónica al flujo aéreo corticodependiente.

We report a case of Strongyloides stercoralis infection in a male agricultural worker with corticoid dependent chronic obstructive air flow disease and bronchial hyperreactivity. The clinical picture initially involved digestive symptoms and bronchospasm resistant to steroid treatment. Diagnosis was established by demonstrating the larvae of S. stercoralis in stool. We emphasize that this infection should be suspected in patients living in endemic areas such as Spain, and describe S. stercoralis-caused respiratory manifestations that can be masked by bronchial disease.