ABSTRACT
BACKGROUND AND OBJECTIVE: To analyze the risk factors associated with mortality in invasive pneumococcal disease in the university hospital Fundación Jiménez Díaz (Madrid, Spain) during 11 years. PATIENTS AND METHOD: We performed a retrospective study of patients attending the emergency service of the hospital from January 1993 to August 2003. We registered data on mortality, clinical and microbiological evolution and relapses. RESULTS: We studied 263 patients with pneumococcal baceteremia and invasive disease caused by Streptococcus pneumoniae (pneumonia, meningitis, sepsis, bacteremia of unknown origin and oligoarthritis). Mortality was 12.5%. Variables associated with mortality in a logistic regression analysis included absence of leukocytosis (p = 0.04), acidosis (p < 0.01), respiratory signs and symptoms (tachypnea, pleuritic pain) (p = 0.02), and neurologic manifestations (decreased consciousness level; (p < 0.01). CONCLUSION: Patients at highest risk of death because of invasive pneumococcal disease are critically ill, with no leukocytosis, with severe respiratory or neurological symptoms and undergoing invasive procedures such as mechanical ventilation and tracheostomy.
Subject(s)
Pneumococcal Infections/microbiology , Pneumococcal Infections/mortality , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Severity of Illness Index , Streptococcus pneumoniae/isolation & purification , Surveys and Questionnaires , Survival RateABSTRACT
A heterogeneous herpes simplex virus type 2 (HSV-2) population was characterised from an AIDS patient with relapsing genital ulcer. The isolate had an unusual antiviral spectrum, showing resistance to penciclovir and susceptibility to acyclovir. Two viral populations were plaque purified, one resistant and the other susceptible to both antiviral drugs. The resistant clone was deficient in thymidine kinase (TK) activity and a nucleotide substitution, thymine for cytosine, at position 153 was identified in its TK gene. This mutation resulted in an amino acid change, arginine to tryptophan, in the ATP binding site. In the deficient mutant, a loss of virulence was observed in mice.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Acyclovir/analogs & derivatives , Acyclovir/pharmacology , Antiviral Agents/pharmacology , Herpes Genitalis/complications , Herpes Genitalis/virology , Herpesvirus 2, Human/drug effects , Amino Acid Substitution , Animals , Base Sequence , Chlorocebus aethiops , DNA, Viral/genetics , Drug Resistance, Viral/genetics , Female , Genes, Viral , Guanine , Herpesvirus 2, Human/enzymology , Herpesvirus 2, Human/genetics , Herpesvirus 2, Human/isolation & purification , Humans , Male , Mice , Thymidine Kinase/genetics , Thymidine Kinase/metabolism , Vero Cells , Virulence/geneticsABSTRACT
Gnathostomiasis is a rare nematode disease acquired by travelers to endemic areas. The most common clinical presentations are cutaneous forms; however, neurologic involvement can also occur. We present two cases of gnathostomiasis, one of them with severe neurologic complications, in Spanish travelers to Thailand and Mexico, who consumed local food and became infected.
