[Splenic abscess and cat-scratch disease]. / Abscesos esplénicos y enfermedad por arañazo de gato.

Cat-scratch disease is caused by a Gram-negative bacillus known as Bartonella henselae. This disease is usually benign and causes regional adenitis that does not require treatment. However, some patients develop more serious atypical forms of the disease including prolonged systemic illness with hepatic and splenic abscesses.A 14-year-old girl was admitted to hospital with a 12-day history of persistent high fever and abdominal pain. Ultrasonography and computerized tomography of the abdomen revealed splenic abscesses. These findings, together with an antecedent of cat exposure, led to the suspicion of cat-scratch disease, which was confirmed by serology. The girl was treated with intramuscular ceftriaxone and clinical evolution was favorable. Splenic cat-scratch disease is infrequent. Cat-scratch disease sometimes presents as fever of unknown origin and consequently this disease should be considered in the differential diagnosis of prolonged fever. Although evolution is usually favorable, antibiotic therapy is recommended in systemic manifestations of cat-scratch disease.

Abscesos esplénicos y enfermedad por arañazo de gato / Splenic abscess and cat-scratch disease

La enfermedad por arañazo de gato es una infección causada por un bacilo gramnegativo conocido como Bartonella henselae. Esta enfermedad se comporta habitualmente de forma benigna causando un cuadro de adenitis regional que no precisa tratamiento; sin embargo, algunos pacientes desarrollan formas atípicas y más graves entre las que se encuentra un cuadro caracterizado por una afectación visceral en forma de granulomas hepáticos y esplénicos. Se presenta el caso de una niña de 14 años con síntomas de fiebre elevada de 12 días de evolución y abdominalgia. La ecografía y la tomografía computarizada (TC) abdominal mostraron abscesos esplénicos que junto al antecedente de exposición a gatos hizo sospechar el diagnóstico de enfermedad por arañazo de gato que se confirmó por serología. Fue tratada con ceftriaxona intramuscular con muy buena evolución clínica. La afectación hepatoesplénica suele ser una forma poco común de la enfermedad. En ocasiones se presenta como un síndrome febril de origen desconocido por lo que debemos tener en cuenta esta enfermedad en el diagnóstico diferencial de fiebre prolongada. Aunque la evolución suele ser favorable se recomienda tratamiento antibiótico en las formas atípicas de la enfermedad por arañazo de gato (AU)

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.

Antibiotic susceptibility of Streptococcus pneumoniae isolates from paediatric patients.

We studied 91 strains of Streptococcus pneumoniae isolated in the Children's and Maternity Hospital San Juan de Dios of Barcelona, Spain, from July 1984 to June 1986. All strains were recovered from miscellaneous sites in different patients. We tested their susceptibility to 14 antimicrobial agents: penicillin, gentamicin, chloramphenicol, tetracycline, co-trimoxazole, erythromycin, vancomycin, rifampicin, cephalothin, cefaclor and cefotaxime. In addition, for 56 of the strains, cefonicid, cefoxitin and imipenem were included. We found many strains with decreased penicillin susceptibility (52.8%). Among the beta-lactam antibiotics tested, cefotaxime and imipenem showed the lowest MIC (less than or equal to 1 mg/l). Only 5.5% of the strains showed resistance to erythromycin, and all were susceptible to vancomycin and rifampicin. Tetracycline and co-trimoxazole were the antimicrobials with the highest prevalence of resistance (72.5% and 67%, respectively). Our isolates were distributed in 21 serotypes, serotype 23 being the most frequent among strains with decreased penicillin susceptibility (50%).

[Neisseria meningitidis with low sensitivity to penicillin]. / Neisseria meningitidis con baja sensibilidad a la penicilina.

Authors study 464 strains of N. meningitidis isolated from cerebrospinal fluid and/or blood of children with meningococcal disease in a childrens' hospital in Barcelona from January 1979 to September 1986. These strains are distributed in four serogroups and eight serotypes, being serogroup B and serotype 2 the most frequent ones. Authors have isolated 4 strains with decreased penicillin susceptibility, three with a MIC of 0.2 microgram/ml and one with a MIC of 0.4 microgram/ml. All four belong to serogroup B, three to serotype 1 and one was non-typable. This alert on possible therapeutic failures that could emerge in next future and implies the necessity of in vitro testing susceptibility of all strains of N. meningitidis isolated from pathologic products in order to detect possible resistances.