Diagnóstico post mortem de septicemia neumocócica en una mujer joven con hiposplenia / Post-mortem diagnosis of pneumococcal septicaemia in young woman with hyposplenia

La enfermedad neumocócica es una importante causa de morbimortalidad. La descripción de casos de identificación post mortem de Streptococcus pneumoniae (SP) es infrecuente. Presentamos un caso de fallecimiento por sepsis fulminante secundaria a SP en una mujer joven con factores de riesgo. Se trata de un fallecimiento comunicado por urgencias hospitalarias como una parada cardiaca extrahospitalaria de posible origen abdominal. La autopsia judicial reveló hallazgos compatibles con un cuadro de sepsis fulminante, por lo que se comunicó a vigilancia epidemiológica de salud pública. Se realizaron estudios microbiológicos post mortem, que permitieron aislar SP en el cultivo de líquido pleural, posteriormente la PCR en sangre identificó SP y se caracterizó el serotipo (22F). A pesar de que la hipoesplenia era conocida desde la adolescencia y ser una indicación de vacunación, la paciente no estaba vacunada frente al SP por ninguna de las 2 vacunas actualmente recomendadas en España

Pneumococcal infections are a significant cause of morbidity and mortality. Post-mortem identification of Streptococcus pneumoniae (SP) is uncommon. A case of death due to fulminant pneumococcal septicaemia in a young woman with hyposplenia is presented. The death was notified by the hospital emergency department as an out-of-hospital cardiac arrest of possible abdominal aetiology. Forensic autopsy found changes suggestive of fulminant septicaemia and the public health epidemiology service was informed. Post-mortem microbiology studies were carried out, in which SP was isolated in the pleural fluid culture, and later PCR in blood identified SP, as well as determining and the serotype (22F). Although hyposplenia was known since adolescence, and was an indication of vaccination, the patient was not vaccinated against SP by any of the two currently recommended vaccines in Spain

Antimicrobial susceptibility, virulence potential and sequence types associated with Arcobacter strains recovered from human faeces.

PURPOSE: The genus Arcobacter includes bacteria that are considered emergent pathogens because they can produce infections in humans and animals. The most common symptoms are bloody and non-bloody persistent diarrhea but cases with abdominal cramps without diarrhea or asymptomatic cases have also been described as well as cases with bacteremia. The objective was to characterize Arcobacter clinical strains isolated from the faeces of patients from three Spanish hospitals. METHODOLOGY: We have characterized 28 clinical strains (27 of A. butzleri and one of A. cryaerophilus) isolated from faeces, analysing their epidemiological relationship using the multilocus sequence typing (MLST) approach and screening them for their antibiotic susceptibility and for the presence of virulence genes.Results/Key findings. Typing results showed that only one of the 28 identified sequence types (i.e. ST 2) was already present in the MLST database. The other 27 STs constituted new records because they included new alleles for five of the seven genes or new combinations of known alleles of the seven genes. All strains were positive for the ciaB virulence gene and sensitive to tetracycline. However, 7.4 % of the A. butzleri and A. cryaerophilus strains showed resistance to ciprofloxacin. CONCLUSION: The fact that epidemiological unrelated strains show the same ST indicates that other techniques with higher resolution should be developed to effectively recognize the infection source. Resistance to ciprofloxacin, one of the antibiotics recommended for the treatment of Arcobacter intestinal infections, demonstrated in 10.7 % of the strains, indicates the importance of selecting the most appropriate effective treatment.

[Clinical characteristics and outcome of infective endocarditis in individuals of the general population managed at a teaching hospital without cardiac surgery facilities. Study of 120 cases]. / Características clínicas y evolución de la endocarditis infecciosa en una población general no seleccionada, atendida en un hospital docente que no dispone de cirugía cardiaca. Estudio de 120 casos.

INTRODUCTION AND OBJECTIVES: To assess the clinical characteristics and management of infective endocarditis at a teaching hospital without cardiac surgery facilities. METHODS: Descriptive case-control study looking at trends. Risk factors, the occurrence of complications, the rate of referral for cardiac surgery, and the mortality rate were assessed. RESULTS: The study included 120 patients referred between 1990 and 2004, with a mean age of 50.8 (17.8) years (67.6% men). Disease incidence did not change throughout the study. Some 55% of infective endocarditis cases were from the ordinary general population, 25% were intravenous drug users, and 20% were of nosocomial origin. The number in the last category had increased over time. The most commonly isolated microorganism was Staphylococcus aureus. Around 83% of patients presented with a severe complication, with cardiac failure and septic metastasis being the most common. The in-hospital mortality rate was 19.2%. Acute renal failure (odds ratio 6.7, 95% confidence interval, 1.9-24) and perivalvular abscess (odds ratio 9.2, 95% confidence interval, 1.6-54) were independent predictors of death. The introduction in 2002 of a multidisciplinary infective endocarditis team, which included a consultant cardiac surgeon, was associated with a significant increase in referrals for surgery, from 14.5% to 34.5% (P=.03), though in-hospital mortality was not significantly altered, decreasing from 20.9% to 13.8% (P=.4). CONCLUSIONS: The occurrence of acute renal failure and perivalvular abscess worsen the prognosis of infective endocarditis. The introduction of a multidisciplinary infective endocarditis team altered management of the disease and increased referrals for cardiac surgery.

Características clínicas y evolución de la endocarditis infecciosa en una población general no seleccionada, atendida en un hospital docente que no dispone de cirugía cardiaca. Estudio de 120 casos / Clinical characteristics and outcome of infective endocarditis in individuals of the general population managed at a teaching hospital without cardiac surgery facilities. Study of 120 cases

Introducción y objetivos. Analizar las características clínicas y el tratamiento de la endocarditis infecciosa (EI) en un hospital docente que no dispone de cirugía cardiaca. Métodos. Estudio descriptivo, de tendencias, y de casos y controles. Se analizaron los factores de riesgo, las complicaciones, la indicación de cirugía cardiaca y la mortalidad. Resultados. Se recogieron 120 casos entre 1990 y 2004 con una edad de 50,8 ± 17,8 años (67,6%, varones). La incidencia se mantuvo estable a lo largo del estudio. La distribución por categorías de EI fue: población general no seleccionada, 55%; asociada a drogadicción parenteral, 25%, y nosocomial, 20%, y se observó un incremento de esta última en el tiempo. Staphylococcus aureus fue el aislamiento más frecuente. Un 83% de pacientes presentó alguna complicación grave, y las más frecuentes fueron la insuficiencia cardiaca y las metástasis sépticas. La mortalidad intrahospitalaria fue del 19,2%. La insuficiencia renal aguda (odds ratio [OR] = 6,7; intervalo de confianza [IC] del 95%, 1,9-24) y el absceso perivalvular (OR = 9,2; IC del 95%, 1,6-54) fueron predictores independientes de muerte. La disponibilidad desde 2002 de un grupo de trabajo multidisciplinario sobre EI y de una consultoría de cirugía cardiaca se asoció con un aumento significativo de la indicación de tratamiento quirúrgico (el 14,5 frente al 34,5%; p = 0,03) y no se observaron cambios en la mortalidad intrahospitalaria (el 20,9 frente al 13,8%; p = 0,4). Conclusiones. La insuficiencia renal aguda y el absceso perivalvular en el curso de una EI son factores de mal pronóstico. Un enfoque multidisciplinario de la EI ha comportado cambios en su tratamiento y ha incrementado la indicación de cirugía cardiaca

Introduction and objectives. To assess the clinical characteristics and management of infective endocarditis at a teaching hospital without cardiac surgery facilities. Methods. Descriptive case-control study looking at trends. Risk factors, the occurrence of complications, the rate of referral for cardiac surgery, and the mortality rate were assessed. Results. The study included 120 patients referred between 1990 and 2004, with a mean age of 50.8 (17.8) years (67.6% men). Disease incidence did not change throughout the study. Some 55% of infective endocarditis cases were from the ordinary general population, 25% were intravenous drug users, and 20% were of nosocomial origin. The number in the last category had increased over time. The most commonly isolated microorganism was Staphylococcus aureus. Around 83% of patients presented with a severe complication, with cardiac failure and septic metastasis being the most common. The in-hospital mortality rate was 19.2%. Acute renal failure (odds ratio 6.7, 95% confidence interval, 1.9-24) and perivalvular abscess (odds ratio 9.2, 95% confidence interval, 1.6-54) were independent predictors of death. The introduction in 2002 of a multidisciplinary infective endocarditis team, which included a consultant cardiac surgeon, was associated with a significant increase in referrals for surgery, from 14.5% to 34.5% (P=.03), though in-hospital mortality was not significantly altered, decreasing from 20.9% to 13.8% (P=.4). Conclusions. The occurrence of acute renal failure and perivalvular abscess worsen the prognosis of infective endocarditis. The introduction of a multidisciplinary infective endocarditis team altered management of the disease and increased referrals for cardiac surgery