Haemophagocytic syndrome associated with infections: Not so uncommon. / Síndrome hemofagocítico asociado a infecciones: no tan infrecuente.

BACKGROUND: Haemophagocytic syndrome (HPS) is a severe immunological disorder characterised by uncontrolled inflammation and multiple organ failure. HPS can be triggered by viral, bacterial, fungal and parasitical infections. We report our experience with infection-related HPS and estimate its local incidence. MATERIAL AND METHOD: We conducted an observational retrospective study of infection-associated HPS in patients treated in the Department of Infectious Diseases of a university hospital within a 5-year period, as well as a review of the published series in Europe. RESULTS: HPS was associated with infection by cytomegalovirus in 2 women with Crohn's disease and was associated with visceral leishmaniosis in 4 patients (3 men, 1 woman; 1 case of multiple myeloma; 2 cases of solid tumours; 1 case of no apparent disease). Two patients died, and the estimated incidence rate was 0.58/100,000 inhabitants/year. The published series are mixed. CONCLUSIONS: Infection-related HPS must be more common than reported. The geographical environment can influence the triggering infections (in our environment, Leishmania should be considered).

Role of Periostin in Uncontrolled Asthma in Children (DADO study).

BACKGROUND AND OBJECTIVE: Asthma is the most common chronic disease in children. Cases of severe asthma (SA) are underdiagnosed. Periostin is a biomarker for SA in adults, but its role in children is poorly understood. Objectives: The aims of the study were to estimate the percentage of cases of uncontrolled severe asthma (UcSA) in children with poorly controlled asthma and to evaluate the role of periostin as a biomarker. MATERIAL AND METHODS: We performed an observational study in children aged 5 to 14 years with poorly controlled asthma. Demographic and clinical data were collected in addition to the results of the lung function test, the fraction of exhaled nitric oxide, the skin prick test, total IgE, specific IgE, blood eosinophil count, serum periostin, treatment, asthma control, and quality of life. Variables were compared between the group with UcSA and the other children. RESULTS: Fifty children with poorly controlled asthma (72% male) were included. Nineteen children (38%) had UcSA. Most children had limitations in their activities of daily living and had visited the emergency department. In addition, 38% were hospitalized. Quality of life was poor. Only 42% of the children received appropriate treatment. The UcSA group was more likely to have a total IgE >500 kUA/mL (52.6% vs 19%, P=.02) and less likely to have serum periostin >1000 ng/mL (31.2% vs 63%, P=.04). CONCLUSIONS: In our setting, 38% of children with poorly controlled asthma have UcSA, which is associated with higher levels of total serum IgE and lower levels of serum periostin.

Leptospirosis en un área sanitaria del suroeste español / Leptospirosis in South-western Spain

Introducción: La leptospirosis tiene una distribución mundial y predomina en regiones tropicales. Su incidencia puede estar infraestimada. Describimos las características de la leptospirosis en el suroeste de España. Pacientes y métodos: Serie de casos retrospectiva de 86 casos de leptospirosis diagnosticados entre abril de 1997 y abril de 2013. Se analizan datos epidemiológicos, clínicos, analíticos y pronósticos. Resultados. La edad media de los pacientes fue de 43,1 años (desviación estándar 13,8). El 84,9% fueron varones. La incidencia anual media fue de 1,99/100.000 habitantes. El 94% de los pacientes tenían actividades de riesgo: contacto con animales en el 82,5% y con aguas estancadas en el 31,7%. Las principales manifestaciones clínicas fueron la fiebre (94,1%), artromialgias (60,7%) y cefalea (53,3%). El 48% de los casos tuvieron hipertransaminemia, el 26,3% insuficiencia renal y el 16,9% trombocitopenia. Trece pacientes (15,1%) tuvieron enfermedad de Weil (EW) y 11 meningitis. Los pacientes con meningitis eran de menor edad (31,2±9,2 frente a 44,8±15,2, p=0,004) y los pacientes con EW de mayor edad (53,5±15,8 frente a 41,2±14,5, p=0,007). Cincuenta y siete pacientes requirieron hospitalización (66,3%) y 6 de ellos fallecieron (7,0%). Se asociaron a mortalidad la edad superior a los 60 años (odds ratio [OR] 45,0, intervalo de confianza al 95% [IC 95%] 4,7-436,6) y el diagnóstico de EW (OR 15,8, IC 95% 2,5-98,7). Conclusiones: La leptospirosis tiene en nuestro entorno una incidencia no despreciable. Incide preferentemente en varones con actividades reconocidas como de riesgo, que presentan fiebre y artromialgias. Debe incluirse en el diagnóstico diferencial de la meningitis linfocitaria. La mortalidad se asocia a mayor edad (AU)

Introduction: Leptospirosis is a zoonosis of worldwide distribution and tropical predominance. Its incidence could be underestimated in template regions. We describe the manifestations of leptospirosis in an area of Southwestern Spain. Patients and methods: Eighty-six cases of leptospirosis (April 1997-April 2013) were retrospectively analyzed. The diagnosis was based in clinical and serological (Leptospira IgM ELISA) judgement. Epidemiological, clinical, laboratory, and prognostic dates were recorded. Results: The mean age was 43.1±13.8 years (84.9% males). The mean annual incidence was 1.99/100.000. There were activities of risk in 94%: 82.5% contact with animals (57.4% pigs, 38.1% dogs, 31.7% cows, 22.2% sheeps), and 31.7% contact with pooled water. The most frequent symptoms were fever (94.1%), arthromyalgias (60.7%), and cephalalgia (53.3%). The main laboratory alterations were hypertransaminemia (48%), renal insufficiency (26.3%), and thrombocytopenia (16.9%). A lymphocytic meningitis was associated in 11 cases (12.5%) and a picture of Weil's disease was observed in 13 patients (15.1%). The patients with meningitis were younger (31.2±9.2 versus 44.8 ±15.2, p=0.004). The patients with Weil's disease were older (53.5±15.8 versus 41.2±14.5, p=0.007). Fifty seven patients were hospitalized (66.3%) and 6 patients died (7.0%). Factors independently associated with mortality were age >60 years (odds ratio [OR] 45.0, confidence interval 95% [CI95%] 4.7-434.6) and diagnosis of Weil's disease (OR 15.8, CI95% 2.5-98.7). Conclusions: In our experience, leptospirosis have a not despicable incidence and tends to show fever and arthromyalgias in men with risk activities. Leptospirosis should be included in the differential diagnosis of lymphocytic meningitis. Mortality is associated with older age (AU)

Leptospirosis in South-western Spain.

INTRODUCTION: Leptospirosis is a zoonosis of worldwide distribution and tropical predominance. Its incidence could be underestimated in template regions. We describe the manifestations of leptospirosis in an area of Southwestern Spain. PATIENTS AND METHODS: Eighty-six cases of leptospirosis (April 1997-April 2013) were retrospectively analyzed. The diagnosis was based in clinical and serological (Leptospira IgM ELISA) judgement. Epidemiological, clinical, laboratory, and prognostic dates were recorded. RESULTS: The mean age was 43.1 ± 13.8 years (84.9% males). The mean annual incidence was 1.99/100.000. There were activities of risk in 94%: 82.5% contact with animals (57.4% pigs, 38.1% dogs, 31.7% cows, 22.2% sheeps), and 31.7% contact with pooled water. The most frequent symptoms were fever (94.1%), arthromyalgias (60.7%), and cephalalgia (53.3%). The main laboratory alterations were hypertransaminemia (48%), renal insufficiency (26.3%), and thrombocytopenia (16.9%). A lymphocytic meningitis was associated in 11 cases (12.5%) and a picture of Weil's disease was observed in 13 patients (15.1%). The patients with meningitis were younger (31.2 ± 9.2 versus 44.8 ± 15.2, p=0.004). The patients with Weil's disease were older (53.5 ± 15.8 versus 41.2 ± 14.5, p=0.007). Fifty seven patients were hospitalized (66.3%) and 6 patients died (7.0%). Factors independently associated with mortality were age >60 years (odds ratio [OR] 45.0, confidence interval 95% [CI95%] 4.7-434.6) and diagnosis of Weil's disease (OR 15.8, CI95% 2.5-98.7). CONCLUSIONS: In our experience, leptospirosis have a not despicable incidence and tends to show fever and arthromyalgias in men with risk activities. Leptospirosis should be included in the differential diagnosis of lymphocytic meningitis. Mortality is associated with older age.

Manejo clínico-microbiológico de los hemocultivos positivos por Staphylococcus coagulasa negativos / Clinical-microbiological management of blood cultures positive for coagulase-negative staphylococci

Un varón de 53 años de edad ingresado por rachas de taquicardia ventricular sostenida y sometido a cardioversión eléctrica, portador de una vía venosa central femoral derecha, comienza con picos febriles, y en los hemocultivos se aísla Staphylococcus epidermidis. ¿Qué valor tiene el aislamiento, en los hemocultivos, de S. epidermidis, un microorganismo que forma parte de la flora habitual de la piel y mucosas del paciente? ¿Cómo debe manejarse esta situación? ¿Deben administrarse antimicrobianos? ¿Cuáles? ¿Durante cuánto tiempo?(AU)

A 53-year old male admitted for episodes of sustained ventricular tachycardia subjected to electrical cardioversion, carrier of a right femoral central venous catheter, began with febrile peaks, and Staphylococcus epidermidis was isolated in the blood cultures. What is the value of isolation in the blood cultures of S. epidermidis, a microorganism that forms a part of the usual flora of the skin and mucous of the patient? How should this situation be managed? Should an antimicrobial agent be administered? Which one? For how long?(AU)

[Clinical-microbiological management of blood cultures positive for coagulase-negative staphylococci]. / Manejo clínico-microbiológico de los hemocultivos positivos por Staphylococcus coagulasa negativos.

A 53-year old male admitted for episodes of sustained ventricular tachycardia subjected to electrical cardioversion, carrier of a right femoral central venous catheter, began with febrile peaks, and Staphylococcus epidermidis was isolated in the blood cultures. What is the value of isolation in the blood cultures of S. epidermidis, a microorganism that forms a part of the usual flora of the skin and mucous of the patient? How should this situation be managed? Should an antimicrobial agent be administered? Which one? For how long?

[Hospital mortality in the Internal Medicine Services of a first level center]. / Mortalidad hospitalaria en el Servicio de Medicina Interna de un hospital de primer nivel.

BACKGROUND AND OBJECTIVE: Hospital mortality is a indicator of quality of care, and their study may improve assistance of hospitalized patients. Our objective was to know the most frequent death causes of hospitalized patients, to identify clinical and analytical variables associated with each cause, and to determine gender differences. MATERIAL AND METHODS: A systematic and retrospective revision of 113 medical reports of death patients was carried out; it corresponded 26% of all deaths occurred between March 2002 to November 2004. At each case, epidemiological variables, previous clinical reports, biochemical and haematological parameters, death cause and in-hospital complications were registered. RESULTS: Mean age was 79 +/- 10 years and 58.4% of cases were males. Thirty eight percent had previous admission, and 45% had functional class III-IV. Men died with less age that women (76.6 +/- 10.3 versus 82.3 +/- 8.0 p < 0.002) and they had more frequent antecedents of chronic bronchopulmonary disease (43% versus 19%, p <0.04); however, women had worse ventilatory situation at admission. The main death causes were cardiopulmonary (56% whole, 34% because of respiratory insufficience, 14% because of pneumonia, and 8% because of acute lung oedema), followed by neurological causes (25% whole, 23% because of stroke) and 19% because another reason (neoplasia, multiorganic failure, hepatic insufficience and renal failure). Patients died from cardiopulmonary cause had a more frequent previous hospitalization (p < 0.04). Patients died from neurological cause had higher systolic and diastolic blood pressure at admission (p < 0.0001), higher rate of hypertension (p < 0.0001) and more frequent nosocomial fever (p = 0.0001). CONCLUSIONS: In our Service, male patients died with less age that women, the main death causes were cardiorespiratory diseases and subsequently neurologic diseases. Hypertension at admission was most frequent in patients died from neurologic cause.

Mortalidad hospitalaria en el Servicio de Medicina Interna de un hospital de primer nivel / Hospital mortality in the Internal Medicine Services of a first level center

Introducción: La mortalidad hospitalaria es un indicador de calidad asistencial y su estudio puede mejorar la asistencia de los pacientes hospitalizados. Nuestro objetivo fue conocer las causas de muerte más frecuentes en los pacientes hospitalizados, identificar variables clínicas y analíticas asociadas a cada causa y determinar diferencias según el género. Material y métodos: Se realizó una revisión sistemática y retrospectiva de 113 informes médicos de pacientes fallecidos, que correspondían al 26% de todos los fallecimientos ocurridos en el Servicio de Medicina Interna entre marzo de 2002 y noviembre de 2004. En cada caso se registraron variables epidemiológicas, historia clínica previa, parámetros bioquímicos y hematológicos, la causa de la muerte y complicaciones intrahospitalarias. Resultados: La edad media fue de 79 ± 10 años y el 58,4% de los casos correspondieron a varones. Tuvieron ingreso previo un 38% y el 45% se encontraba en una clase funcional III-IV. Los hombres fallecieron a una edad más temprana que las mujeres (76,6 ± 10,3 frente a 82,3 ± 8,0 p < 0,002) y con más frecuencia tuvieron antecedentes de enfermedad broncopulmonar crónica (43% frente a 19%, p < 0,04); sin embargo, las mujeres tuvieron peor situación ventilatoria al ingreso. Las principales causas de muerte fueron cardiopulmonares (56% en total, un 34% por insuficiencia respiratoria, 14% por neumonía y 8% por edema agudo de pulmón), seguidas de las causas neurológicas (25%, un 23% por ictus) y por un 19% de otras causas (neoplasia, fracaso multiorgánico, insuficiencia hepática e insuficiencia renal). Los fallecidos de causa cardiopulmonar habían tenido un ingreso previo con mayor frecuencia (p < 0,04). Los fallecidos por causa neurológica tenían al ingreso cifras más elevadas de tensión arterial sistólica y diastólica (p < 0,0001), mayor frecuencia de antecedentes de hipertensión arterial (p < 0,0001) y en mayor proporción fiebre nosocomial (p = 0,0001). Conclusión: En nuestro servicio, los hombres fallecen a edad más temprana que las mujeres y las principales causas de muerte son las enfermedades cardiopulmonares seguidas de las neurológicas. La hipertensión arterial se presenta al ingreso con mayor frecuencia en los fallecidos por causa neurológica

Background and objective: Hospital mortality is a indicator of quality of care, and their study may improve assistance of hospitalized patients. Our objective was to know the most frequent death causes of hospitalized patients, to identify clinical and analytical variables associated with each cause, and to determine gender differences. Material and methods: A sistematic and retrospective revision of 113 medical reports of death patients was carried out; it corresponded 26% of all deaths occurred between mars 2002 to november 2004. At each case, epidemiological variables, previous clinical reports, biochemical and haematological parameters, death cause and in-hospital complications were registered. Results: Mean age was 79 ± 10 years and 58.4% of cases were males. Thirty eight percent had previous admission, and 45% had functional class III-IV. Men died with less age that women (76.6 ± 10.3 versus 82.3 ± 8.0 p < 0.002) and they had more frequent antecedents of chronic bronchopulmonary disease (43% versus 19%, p <0.04); however, women had worse ventilatory situation at admission. The main death causes were cardiopulmonary (56% whole, 34% because of respiratory insufficience, 14% because of pneumonia, and 8% because of acute lung oedema), followed by neurological causes (25% whole, 23% because of stroke) and 19% because another reason (neoplasia, multiorganic failure, hepatic insufficience and renal failure). Patients died from cardiopulmonary cause had a more frequent previous hospitalization (p < 0.04). Patients died from neurological cause had higger systolic and diastolic blood pressure at admission (p < 0.0001), higger rate of hypertension (p < 0.0001) and more frequent nosocomial fever (p = 0.0001). Conclusions: In our Service, male patients died with less age that women, the main death causes were cardiorespiratory diseases and subsequently neurologic diseases. Hypertension at admission was most frequent in patients died from neurologic cause

[Epidemiology of hepatocellular carcinoma in a rural area. Role of hepatotrophic viruses on survival]. / Epidemiología del carcinoma hepatocelular en un área rural. Papel de los virus hepatotropos en la supervivencia.

BACKGROUND: Chronic hepatitis C and B are the main causes of hepatocellular carcinoma (HCC) worldwide. It is not clear whether chronic hepatitis C or B virus (HCV or HBV) infection is a prognostic factor for HCC. This study aimed to asses epidemiology of HCC in a rural area and to determine if chronic HCV or HBV infection had any impact on survival after the diagnosis of HCC. MATERIAL AND METHODS: Fifty-one consecutive patients were retrospectively studied. All of them were diagnosed of HCC between january 1994 and december 2002 in a First Level Hospital. The following variables were analysed: age, sex, HCV and HBV infection, chronic alcohol abuse (daily intake upper 80 g), clinical presentation, Child stage, number ol liver nodules, therapeutic options and survival. RESULTS: The mean age at diagnosis of HCC was 68,5 years old (age range 45-90) and 45 patients (88,6%) were male. Heavy alcohol intake (66%) and chronic HCV infection (42,8%) were the most prevalent etiologic factors. Chronic HBV was found in 11,9%. Chronic HCV or HBV infection was present in 48,9%. Twenty-five percent were asymptomatic and 66% were in Child stage A. The rate single lesion / multilobular HCC was 52/48. Only 6% of all patients could be treated with a curative intention. The mean survival was 10,9 +/- 9,1 months, and there were no differences in age, sex, Child stage and number of nodules. There was a significantly higher survival in patients with chronic HCV or HBV infection (16,7 +/- 13,1 months versus 4,75 +/- 5,3 months in seronegative patients; p=0.02). On multivariate analysis, only chronic HCV or HBV infection was associated with survival longer than 10 months (OR 22,3; CI 95% 1,8-277,9). CONCLUSIONS: In our area, heavy alcohol abuse and HCV infection were the most prevalent etiologic factors of HCC. Chronic HCV or HBV infection was associated with longer survival in patients with HCC.

Trombosis venosa profunda asociada a neumonía varicelosa y anticuerpos anticardiolipina / Deep vanous thrombosis associated with varicella pneumonia and anticardiolipin antibody

No disponible

[Alveolar hemorrhage in mixed cryoglobulinemia associated with hepatitis C virus infection]. / Hemorragia alveolar en el seno de una crioglobulinemia mixta asociada a infección por el virus de la hepatitis C.

Alveolar hemorrhage in mixed cryoglobulinemia associated with hepatitis C virus infection. A 61 year-old woman with type II mixed cryoglobulinemia associated to hepatitis C virus infection has suffered alveolar hemorrhage with multiple pulmonary infiltrates, purpura, glomerulonephritis and polyneuropathy. The respiratory and kidney findings resolved with prednisone, but glomerulonephritis reappeared when interferon-alpha treatment was started and prednisone was reduced. This is the third case of alveolar hemorrhage and glomerulonephritis associated with mixed cryoglobulinemia reported in the literature. The lung involvement in mixed cryoglobulinemia is reviewed. The clinic manifestations (asthma, pleural effusion, hemoptysis or pulmonary fibrosis) are uncommon, but the lung involvement is very frequent if roentgenographic signs and necropsy findings are assessed.