Group A streptococcal bacteremia: outcome and prognostic factors / Bacteriemia por estreptococos del grupo A: resultados y factores pronóstico

In the last two decades, an increase in the incidence of invasive group A streptococcus (GAS) infections has been reported. The aim of this study was to determine the clinical and epidemiological characteristics and the natural history of GAS bacteremias at our hospital by performing a retrospective study of all cases of GAS bacteremia diagnosed at our University hospital from 1994 to 2003. We reported 42 cases of GAS bacteremia (27 men, mean age 42.3 ± 31.6 years). None had more than one episode and four cases were nosocomial. The mean annual incidence rate was 1.01 cases per 100,000 population. An increase in the incidence but not in severity of GAS bacteremia was observed in the last 5-year period (p<0.001). The rates were highest in young children and the elderly and those with underlying medical conditions; 73.8% of patients had some underlying chronic illness, and the most relevant conditions included peripheral vascular disease and diabetes mellitus. Mortality was high and the worst outcome corresponded to elderly patients with streptococcal toxic shock syndrome (STSS). Thirty patients (71.4%) had a disruption in the integrity of the skin barrier, 14 (33.3%) were immunocompromised patients and 6 patients (14.3%) were intravenous drug users. A source of the bacteremia was noted in 38 patients (90.5%), with skin and soft tissue infection being the major portals of entry. Twelve patients (28.6%) fulfilled the STSS criteria. All strains were susceptible to penicillin and vancomycin. Resistance to erythromycin was 21.4% and to ciprofloxacin was 17.5%. The global mortality rate was 28.6%. Only STSS was significantly associated with increased mortality in the multivariate analysis

En las dos últimas décadas se ha descrito un aumento de la incidencia de infecciones por estreptococos del grupo A invasivos. El objetivo de este estudio fue determinar las características clínicas y epidemiológicas y la historia natural de las bacteriemias por estreptococos del grupo A en nuestro hospital. Se estudiaron retrospectivamente todos los casos diagnosticados en un solo hospital de nivel terciario entre 1994 y 2003, y describimos 42 (27 varones, edad media 42,3 ± 31,6 años). Ninguno presentó más de un episodio y cuatro fueron infecciones nosocomiales. La tasa media de incidencia anual fue de 1,01 casos por 100.000 habitantes. Se ha observado un aumento en la incidencia de bacteriemia por estreptococos del grupo A, pero no de su gravedad, durante los últimos 5 años (p <0.001). Las tasas de incidencia más altas se observaron en niños y ancianos. El 73,8% de los pacientes afectados presentaron una enfermedad crónica subyacente, siendo las más relevantes la enfermedad vascular periférica y la diabetes mellitus. Treinta pacientes (71,4%) presentaban una herida u otra alteración de la integridad de la barrera cutánea, 14 (33%) estaban inmunodeprimidos y 6 (14,3%) eran drogadictos por vía intravenosa. En 38 casos (90,5%) se registró un foco de entrada de la bacteriemia, siendo los más habituales las infecciones cutáneas y de tejidos blandos. Doce pacientes (28,6%) cumplieron los criterios de síndrome de “shock” tóxico estreptocócico. Todas las cepas fueron sensibles a la penicilina y la vancomicina. La resistencia a la eritromicina fue del 21,4% y al ciprofloxacino del 17,5%. La tasa global de mortalidad fue del 28,6%. En el análisis multivariado, sólo el “shock” tóxico estreptocócico se asoció significativamente a una mayor mortalidad. Durante los últimos cinco años se ha observado un aumento en la incidencia de bacteriemia por estreptococos del grupo A en nuestro hospital. Los niños pequeños, los ancianos y los pacientes con enfermedades subyacentes son más susceptibles a adquirir esta infección. La mortalidad fue alta y los peores resultados se observaron en los pacientes ancianos con síndrome de “shock” tóxico estreptocócico

Group A streptococcal bacteremia: outcome and prognostic factors.

In the last two decades, an increase in the incidence of invasive group A streptococcus (GAS) infections has been reported. The aim of this study was to determine the clinical and epidemiological characteristics and the natural history of GAS bacteremias at our hospital by performing a retrospective study of all cases of GAS bacteremia diagnosed at our University hospital from 1994 to 2003. We reported 42 cases of GAS bacteremia (27 men, mean age 42.3 +/- 31.6 years). None had more than one episode and four cases were nosocomial. The mean annual incidence rate was 1.01 cases per 100,000 population. An increase in the incidence but not in severity of GAS bacteremia was observed in the last 5-year period (p<0.001). The rates were highest in young children and the elderly and those with underlying medical conditions; 73.8% of patients had some underlying chronic illness, and the most relevant conditions included peripheral vascular disease and diabetes mellitus. Mortality was high and the worst outcome corresponded to elderly patients with streptococcal toxic shock syndrome (STSS). Thirty patients (71.4%) had a disruption in the integrity of the skin barrier, 14 (33.3%) were immunocompromised patients and 6 patients (14.3%) were intravenous drug users. A source of the bacteremia was noted in 38 patients (90.5%), with skin and soft tissue infection being the major portals of entry. Twelve patients (28.6%) fulfilled the STSS criteria. All strains were susceptible to penicillin and vancomycin. Resistance to erythromycin was 21.4% and to ciprofloxacin was 17.5%. The global mortality rate was 28.6%. Only STSS was significantly associated with increased mortality in the multivariate analysis.

[Meningitis and brain abscess caused by Streptococcus intermedius in a patient infected with HIV-1]. / Meningitis y absceso cerebral por Streptococcus intermedius en un paciente con infección por VIH-1.

Streptococcus milleri group have been recognized as an important pathogens for abscess formation in various organs. Streptococci other than Streptococcus pneumoniae are a rare cause of bacterial meningitis in adults and can be associated with the presence of an undiagnosed brain abscess. Brain abscess is a focal collection within the brain parenchyma which can arise as a complication of a variety of infections. The most common etiologic organisms in clinical series have been microaerophilic streptococci and anaerobic bacteria. Although intracranial mass lesions that occur as a result of infection have commonly been reported in patients infected with the human immunodeficiency virus, brain abscess due to the common bacterial pathogens are rarely described in HIV infected patients and Toxoplasma gondii is the organism most frequently isolated from stereotactic brain biopsy in these patients. We report a patient with both HIV-1 infection and streptococcal meningitis secondary to brain abscess caused by S. intermedius.

Meningitis y absceso cerebral por Streptococcus intermedius en un paciente con infección por VIH-1 / Meningitis and brain abscess caused by streptpcoccus intermedius in a patient infected with HIV-1

Los estreptococos de grupo milleri se caracterizan por su tendencia a provocar infecciones piógenas invasoras en diferentes localizaciones. Las meningitis estreptocócicas no neumocócicas son poco frecuentes en pacientes adultos y pueden asociarse a la presencia de un absceso cerebral. Los abscesos cerebrales son colecciones localizadas dentro del parénquima cerebral que se originan como complicación de una infección, siendo los estreptococos microaerófilos y las bacterias anaerobiaslos microorganismos más frecuentemente aislados. Aunque no es inusual la presencia de colecciones intracraneales de etiología infecciosa en pacientes con infección por VIH-1, los abscesos cerebrales producidos por las bacterias piógenas habituales son muy infrecuentes y es T. gondiiel agente etiológico más frecuente. Aportamos un caso de meningitis y absceso cerebral por S. intermedius en un paciente con infección por VIH-1

Streptococcus milleri group have been recognized as an important pathogens for abscess formation in various organs. Streptococci other than Streptococcus pneumoniae are a rare cause of bacterial meningitis in adults and can be associated with the presence of an undiagnosed brain abscess. Brain abscess is a focal collection within the brain parenchyma wich can arise as a complication of a variety of infections. The most common etiologic organisms in clinical series have been microaerophilic streptococci and anaerobic bacterias. Although intracraneal mass lesions that occur as a result of infection have commonly been reported in patients infected with the human immunodeficiency virus, brain abscess due to the common bacterial pathogens are rarely described in HIV infected patients and Toxoplasma gondii is the organism most frecuently isolated from stereotactic brain biopsy in these patients. We report a patient with both HIV-1 infection and streptococcal meningitis secondary to brain abscess caused by S. intermedius

Espondilitis brucelósica: a propósito de un caso atípico / Brucellar spondylitis: review of an unusual case

No disponible

No disponible

[Hemoperitoneum secondary to spontaneous rupture of the umbilical vein]. / Hemoperitoneo secundario a la rotura espontánea de la vena umbilical.

Patients with ascites can develop spontaneous hemoperitoneum after injury or as a complication of diagnostic or therapeutic techniques. Spontaneous rupture of intra-abdominal varices is a rare complication of portal hypertension and an infrequent cause of hemoperitoneum that causes high mortality (75%). We present a new case of spontaneous hemoperitoneum secondary to umbilical vein rupture in a male patient with liver cirrhosis and review the cases previously described in the literature.

Hemiparesia derecha como forma de presentación de carcinoma renal de células claras / Right hemiparesia as presentation of renal cell carcinoma

No disponible