Global study of viral diarrhea in hospitalized children in Spain: results of structural surveillance of viral gastroenteritis net work (VIGESS-net) 2006-2008.

BACKGROUND AND OBJECTIVES: Detection and characterization of gastroenteritis cases (viruses) was conducted during eleven years through the surveillance VIGESS-net, which was created in an effort to conduct a structured surveillance of rotavirus genotypes co-circulating in Spain. STUDY DESIGN AND RESULTS: This phase includes the study of 2048 fecal samples from children <5 years old, hospitalized in fifteen different hospitals throughout Spain from March 2006 to March 2008. Of them, 821 (40.1%) samples were rotavirus positive. Rotavirus was identified as the only etiological agent in 694 (33.9%) cases and in 127 (6.2%) was found as coinfection with other enteric viruses, mainly with noroviruses. Predominant G genotypes detected were G1 (49.8%) followed by G9 (32.9%), G3 (2.6%), G8 (1.0%), G4 (0.4%), G6 (0.2%) and G12 (0.2%). The G2 was encountered in 3.2% of cases. Rotavirus mixed G-types infections occurred in 3.9% of cases. The main G/P combinations were G1P[8] (51.9%) and G9P[8] (35.6%), which predominates alternatively in the first and second period of the study. More rare combinations occur in less than 7.4% of cases. CONCLUSION: The diversity of rotavirus circulating strains suggests to maintain a surveillance system through different regions of the country.

[Sclerosing cholangitis and AIDS]. / Colangitis esclerosante y SIDA.

Bile tract pathology in AIDS has been described as an incomplete biliary obstructive syndrome and acalculous cholecystitis. Most reported cases have been associated to bile ducts infection by Cytomegalovirus (CMV) and/or Cryptosporidium. We present a case of sclerosing cholangitis and acalculous cholecystitis in an AIDS patient in whom Cryptosporidium was identified in the cholecystectomy sample and this same agent together with Candida Albicans in bile. We highlight the need to suspect this pathology in HIV infected patients who present a bile obstruction picture and/or cholecystitis, the possible etiological role of Candida Albicans, which has not been previously described, as well as the increasing association of bile pathology and AIDS.

[Pneumococcal meningitis. 6-year review]. / Meningitis neumocócica. Revisión de seis años.

We have reviewed 29 episodes of pneumococcal meningitis seen in a 6-year period (1983-1988) in 11 pediatric patients and 16 adults. An underlying disease or condition was present in 81.5% of cases, in 55.5% there was an anatomical defect, either congenital, acquired or traumatic in origin. Gram stain of CSF was positive in 86% of cases, and latex test was positive in the 22 CSF samples analyzed with this technique. MIC for penicillin ranges from 1 to 2 mcg/ml in 51.7% of cases. These isolates were also resistant to tetracycline (100%), trimethoprim-sulfamethoxazole (100%) and chloramphenicol (87%). All strains isolated were sensitive to vancomycin, rifampin and cefotaxime. Of all 14 episodes due to penicillin-sensitive strains, 10 cases were treated with this drug and in 4 cases, third generation cephalosporins were prescribed. All cases showed good clinical response. Of all 15 episodes due to penicillin-resistant strains, vancomycin was used first in 10 cases, cefotaxime in three, moxalactam in one and ampicillin plus chloramphenicol in another. Treatment failures (one in cefotaxime and one in moxalactam group) were solved with vancomycin. Of all 12 patients treated with vancomycin, clinical and microbiological cure was achieved in 10 cases. Two additional patients died, one with sterile CSF after 45 days of admission and one few hours after admission. Our data give support to vancomycin as a useful therapeutic option in the treatment of pneumococcal meningitis due to penicillin-resistant strains.

The in vitro activity of beta-lactam antibiotics against gentamicin and/or carbenicillin-resistant Pseudomonas aeruginosa strains.

We studied the behaviour of 56 clinical isolates of Pseudomonas aeruginosa strains against the following beta-lactam antibiotics: cefotaxime, cefoperazone, cefsulodin, lamoxactam, Ro 13-9904, azlocillin, mezlocillin and ticarcillin. Twenty-six strains were resistant to gentamicin and 30 to gentamicin and/or carbenicillin. The MICs were measured by the serial dilution test on solid agar. Cefsulodin was the most active cephalosporin against carbenicillin-resistant strains (MIC greater than or equal to 128 mg/l); it inhibited 56.6% of these strains at a concentration of 8 mg/l. Azlocillin was the most active penicillin, inhibiting 79.96% of the same strains at a concentration of 64 mg/l. Cefsulodin was the most active cephalosporin against the gentamicin-resistant group of Pseudomonas aeruginosa strains (MIC greater than or equal to 8 mg/l) which were sensitive to carbenicillin (MIC less than or equal to 64 mg/l). It inhibited 100% of the strains at a concentration of 4 mg/l. All of the penicillins studied inhibited all of the strains in this group. The required concentrations were the following: 16 mg/l for azlocillin, 32 mg/l for mezlocillin and 64 mg/l for ticarcillin.