Espondilitis infecciosa: treinta años después persisten los mismos problemas. ¿Debemos cambiar el enfoque? / Infectious spondylitis: 30 years later, problems persist. Should we change the approach?

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Tigecycline therapy for infections due to carbapenemase-producing Klebsiella pneumoniae in critically ill patients.

BACKGROUND: The aim of this study was to assess the efficacy of tigecycline in the treatment of infections due to carbapenemase-producing Klebsiella pneumoniae (CPKP) in critically ill patients. METHODS: A retrospective observational study was conducted in critically ill patients receiving different tigecycline doses for severe CPKP infections. We evaluated demographic data, localization and severity of infection, response to therapy, and mortality. RESULTS: Fifteen patients received tigecycline for 16 episodes of CPKP infection. The main infections were pneumonia (31%), urinary tract infection (31%), peritonitis (20%), catheter-related bacteraemia (12%), and meningitis (6%). Most infections were complicated with severe sepsis (44%), septic shock (12%), and/or bacteraemia (19%). The daily maintenance dose of tigecycline was 200 mg in 10 episodes and 100 mg in 6 episodes. The overall 30-day mortality rate was 25%. Univariate analysis showed that mortality was significantly associated (p < 0.01) with mean APACHE II and SOFA scores and the presence of immunosuppression, but not with the tigecycline dose. CONCLUSIONS: Tigecycline appears to be an effective therapy for severe infections due to CPKP in critically ill patients. Mortality is related to the severity of the underlying disease. We observed no benefit from a higher maintenance dose of tigecycline, although the number of patients included in the study was too small to draw any general conclusions in this regard.

Nocardiosis asociada a la infección por VIH: ¿estamos ante una enfermedad diferente? / Nocardiosis associated with HIV infection: are we before a different disease?

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Mujer de 74 años con bacteriemia estafilocócica y dolor lumbar / Seventy-four year old woman with staphylococcal bacteremia and back pain

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Malignancy in systemic lupus erythematosus: a report of five cases in a series of 96 patients.

The association of systemic lupus erythematosus (SLE) and malignancy has been reported previously and suggests an increased risk of cancer in this disease. Lymphomas are the most frequent neoplasias reported in these patients and carcinoma of the cervix and breast are also seen. Several factors probably play a role in the aetiology of malignancies associated with SLE including intrinsic disturbances of immunity and concomitant immunosuppressive therapy. We report five solid tumors (one breast carcinoma, one squamous cell carcinoma of the anus, one adenocarcinoma of the rectum, one carcinoma of the cervix and one carcinoma of the gallbladder) among 96 patients with SLE. The most striking finding in this study was the absence of haematological malignancies. The incidence of malignancy in the series, the age of diagnosis of SLE and neoplasia and the time delay between SLE and malignancy diagnosis was similar to other series. We did not find any clinical or immunological feature that predicted the development of neoplasia. In conclusion, patients with SLE may have the same malignancies as the general population after adjustment for age and sex. There are no predictive indicators for malignancy and immunosuppressive therapy may be a contributing factor.

[Intra-abdominal paraganglioma: clinical, functional, structural, and immunohistochemical study of an exceptional case]. / Paraganglioma intraabdominal: estudio clínico, funcional, estructural e inmunohistoquímico de un caso excepcional.

Paragangliomas are tumors, derived from paraganglionary system, able to synthesize and to liberate substances with neuroregulatory activity. They are rare, mainly in the neck located, difficult to anatomo-pathologic diagnose, and of poor prognosis. They may present as space-occupying lesions or as secondary syndromes due to the liberation of biologically active substances. Whenever it is possible, surgical excision is the treatment of choice. Nor chemotherapy, nor immunomodulators, like alpha-2b-interferon, have provided satisfactory results. A 57 year-old man, with a non-surgical paraganglioma characterized by abdominal mass associated with liver and bone metastasis, is presented. The rarity of the intra-abdominal presentation, the image study findings, the histopathological and immunohistochemical examinations, and the evolution after alpha-2b-interferon therapy are analyzed.

[A clinical study of Kaposi's sarcoma associated with the acquired immunodeficiency syndrome]. / Estudio clínico del sarcoma de Kaposi asociado al síndrome de inmunodeficiencia adquirida.

We have retrospectively studied 35 cases of Kaposi's sarcoma in 460 patients with AIDS (incidence of 7.6%) during a period of 10 years. All of them were males, with a mean age of 38 years. 88% of the cases belonged to the homosexual risk group. The tumor was the diagnostic criteria of AIDS in 25 patients. At the moment of the diagnosis, 4 patients were at stage I, 23 at stage II, 1 at stage III and 7 at stage IV, according to the Mitsuyasu's classification; 7 patients had systemic symptoms. The tumor was localized at the skin (34 cases), mucosa (16), digestive tract (7), lung (6) and ganglion (4). The immunological study revealed lymphopenia in 74% of patients, reduction of T4 lymphocytes ( < 0.5 x 10(9)/L) in 93% and inverted T4/T8 ratio in 96%. Sixteen patients received antitumoral treatment (8 with chemotherapy, 7 with interferon and 5 with radiotherapy). The response was stabilization of lesions in 8 cases, partial remission in 2 and progression in 3; in other 3 cases, such response was not assessed. The mortality was 48% and the average survival, 13 months. Opportunistic infections were the cause of death in most patients. Our results confirm the clinical and evolutive characteristics of the Kaposi's sarcoma associated to AIDS; disseminated cutaneous affectation with frequent visceral affectation, poor response to treatment and low survival associated to the presence of opportunistic infections. The lower incidence of tumor observed in our study is related to the different distribution of the risk groups for HIV in our country.

Clinical, endoscopic, immunologic, and therapeutic aspects of oropharyngeal and esophageal candidiasis in HIV-infected patients: a survey of 114 cases.

The medical records of 114 consecutive HIV-infected patients with oropharyngeal and esophageal candidiasis, in whom esophagoscopy was performed, were reviewed. Esophageal candidiasis and isolated oral candidiasis were found in 75% and 25% of patients, respectively. Esophageal candidiasis was the AIDS-defining illness in 65 patients and dysphagia was the commonest symptom, but asymptomatic Candida esophagitis was observed in 43% of them. Symptoms were present in six patients with oropharyngeal candidiasis; three of them had a normal esophagoscopy and the other three had acute nonfungal esophagitis. Invasive fungal esophagitis was confirmed by biopsy in 47/74 patients (64%). The patients with esophageal candidiasis had lower CD4+ cell counts (129/microliter) and CD4:CD8 ratios (0.23) than those with oropharyngeal candidiasis (CD4 179/microliter; CD4:CD8 0.35). Thirty-six patients with esophageal candidiasis were treated with fluconazole, 100 mg/daily, for 28 days, and another 34 patients received the same dose for 10 days. A similar efficacy was seen in both regimens, but a higher incidence of oropharyngeal fungal colonization and liver dysfunction was observed in the longer therapy (p < 0.001). We conclude that asymptomatic C. esophagitis is common in HIV-infected patients. Patients with oropharyngeal candidiasis may complain of esophageal symptoms; it could be due to superficial C. infection or another not-identified opportunistic infection. More severe immunologic impairment was required to develop esophageal candidiasis than oropharyngeal candidiasis. A short course of 10 days of fluconazole therapy could be the standard regimen for the treatment of C. esophagitis in AIDS.