ABSTRACT
Introducción: El síndrome hemofagocítico (SHF) es un trastorno inmunológico grave caracterizado por una inflamación descontrolada con fracaso multiorgánico. Puede estar desencadenado por infecciones víricas, bacterianas, fúngicas o parasitarias. Se describe nuestra experiencia de SHF asociado a infecciones y se estima su incidencia local. Material y método: Estudio retrospectivo observacional de SHF asociado a infecciones en adultos atendidos en el Servicio de Patología Infecciosa de un hospital universitario durante 5años y revisión de las series publicadas en Europa. Resultados: En 2 mujeres con enfermedad de Crohn, el SHF se asoció a infección por citomegalovirus y a leishmaniosis visceral (mieloma múltiple 1, tumor sólido 2, sin enfermedad evidente 1) en 4 pacientes (3 hombres). Fallecieron 2 enfermos. La incidencia estimada fue 0,58/100.000/año. Las series publicadas son heterogéneas. Conclusiones: El SHF asociado a infecciones debe de ser más frecuente de lo descrito. El entorno geográfico puede influir en las infecciones desencadenantes (en nuestro medio, debe buscarse Leishmania)
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)
Subject(s)
Humans , Male , Female , Young Adult , Aged , Lymphohistiocytosis, Hemophagocytic/diagnosis , Multiple Organ Failure/diagnosis , Etoposide/therapeutic use , Glucocorticoids/therapeutic use , Retrospective Studies , Cytomegalovirus Infections/diagnosis , Leishmaniasis/diagnosis , Multiple Myeloma/complications , Crohn Disease/complications , Treatment OutcomeABSTRACT
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).
ABSTRACT
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)
Subject(s)
Humans , Leptospira/pathogenicity , Leptospirosis/epidemiology , Arthralgia/etiology , Diagnosis, Differential , Risk Factors , Primary Health Care , Zoonoses/transmission , Retrospective StudiesABSTRACT
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.
Subject(s)
Leptospirosis/epidemiology , Weil Disease/epidemiology , Zoonoses/epidemiology , Adult , Age Factors , Aged , Animals , Cattle , Diagnosis, Differential , Dogs , Enzyme-Linked Immunosorbent Assay , Female , Humans , Incidence , Leptospirosis/mortality , Male , Middle Aged , Retrospective Studies , Risk Factors , Sheep , Spain/epidemiology , Swine , Young Adult , Zoonoses/microbiology , Zoonoses/mortalityABSTRACT
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)
Subject(s)
Humans , Male , Middle Aged , 24966/methods , Fever/complications , Fever/etiology , Staphylococcus epidermidis/isolation & purification , Staphylococcus epidermidis/metabolism , Staphylococcus epidermidis/pathogenicity , Bacteremia/complications , Bacteremia/diagnosis , Catheter Ablation/methods , Microbial Sensitivity Tests , Microbiology/trends , 24966/policies , Microbiological Techniques , Electric Countershock , Staphylococcus epidermidis , Bacteremia/microbiology , Leukocytosis/complicationsABSTRACT
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?
Subject(s)
Bacteremia/blood , Bacteremia/microbiology , Staphylococcus epidermidis/isolation & purification , Coagulase , Humans , Male , Middle Aged , Staphylococcus epidermidis/enzymologyABSTRACT
Brucellosis, a zoonosis with a worldwide distribution, is a systemic infection that can present with involvement of both nervous and musculoskeletal systems. We report a case of spondylitis and meningoencephalitis and describe the clinical features, and difficulties in treatment. Osteoarticular complications of brucellosis are common but involvement of the nervous system is rare and it should be included in the differential diagnosis of any obscure neurologic disorder.
Subject(s)
Brucellosis/diagnosis , Brucellosis/microbiology , Meningoencephalitis/diagnosis , Meningoencephalitis/microbiology , Spondylitis/diagnosis , Spondylitis/microbiology , Anorexia/microbiology , Anti-Bacterial Agents/therapeutic use , Back Pain/microbiology , Brucellosis/therapy , Combined Modality Therapy , Diagnosis, Differential , Female , Fever/microbiology , Humans , Laminectomy , Magnetic Resonance Imaging , Meningoencephalitis/therapy , Middle Aged , Spondylitis/therapy , Time FactorsSubject(s)
HIV Infections/complications , Syphilis, Cutaneous/complications , Adult , Female , Humans , Skin Ulcer/complicationsSubject(s)
Abscess/etiology , Postoperative Complications , Prostatectomy , Prostatic Hyperplasia/surgery , Splenic Diseases/etiology , Abscess/diagnostic imaging , Abscess/therapy , Drainage , Humans , Imipenem/therapeutic use , Male , Middle Aged , Splenectomy , Splenic Diseases/diagnostic imaging , Splenic Diseases/therapy , Thienamycins/therapeutic use , Tomography, X-Ray ComputedABSTRACT
We present the case of a 31-year-old man hospitalized for the study of a fever syndrome. The patient developed acute respiratory failure, with anemia and hepatic affection. In the histological examination of the liver and bone marrow, the presence of granulomas suggesting a tuberculous etiology was demonstrated. Antibodies IgG anti-Coxiella burnetti were detected, using indirect immunofluorescence, at the level of 1/200, with latter seroconversion to 1/800. Therapy with doxycycline was administered (200 mg/day during 14 days). Fever subsided in 24 hours and the other clinico-biochemical disorders disappeared in the following days. After the literature review, we conclude that Q fever must be taken into account for the differential diagnosis of any granulomatous disease observed in the liver and/or bone marrow. We can confirm that any granuloma is specific of just one pathological entity. The diagnosis must be always supported by other clinical, supplementary and serological data.
Subject(s)
Granuloma/diagnosis , Liver Diseases/diagnosis , Q Fever/diagnosis , Tuberculoma/diagnosis , Tuberculosis, Hepatic/diagnosis , Acute Disease , Adult , Anemia/etiology , Bronchiolitis/etiology , Diagnosis, Differential , Diagnostic Errors , Fever of Unknown Origin/etiology , Granuloma/etiology , Humans , Liver Diseases/etiology , Male , Q Fever/complications , Respiratory Insufficiency/etiologySubject(s)
Heroin Dependence , Heroin/administration & dosage , Adult , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
Syphilis is an ever changing disease with an increasing incidence in the last years. Diagnosis of neurological damage remains on cerebrospinal fluid studies and serologic test in patients with appropriate clinical manifestations. Modern neuroimaging techniques are now available in the diagnostic workup of patients with neurosyphilis. Our experience with such techniques in two patients with meningo-vascular syphilis and general paresis points out to the role of magnetic resonance imaging in disclosing ischemic lesions in these patients, although these lesions were not absolutely specific of the disease.
