Detection and characterization of a ST6 clone of vanB2-Enterococcus faecalis from three different hospitals in Spain.

Thirteen vancomycin-resistant and teicoplanin-susceptible Enterococcus faecalis isolates were recovered from unrelated patients in three Spanish hospitals from November 2009 to December 2010. All isolates carried the vanB2 gene, showed indistinguishable or closely-related PFGE patterns and were ascribed to the sequence type ST6 (included into the high-risk clonal-complex CC2). They showed a multiresistance phenotype (erythromycin, tetracycline, ciprofloxacin and high-level-resistance to streptomycin, gentamicin and kanamycin) and harboured the aac(6')-aph(2"), ant(6)-Ia, and tet(M)+/-tet(L) genes. All isolates produced gelatinase and harboured the gelE gene, but not the esp or hyl genes. The inclusion of the vanB2 gene into the Tn5382 transposon was demonstrated in one isolate. Clonal dissemination of vanB2-containing the E. faecalis strain is demonstrated.

[Scintigraphy in breast cancer]. / Explorarea scintigrafica a tumorilor mamare.

Scintigraphy was evaluated in comparison to clinical and paraclinical methods used in diagnosis of breast tumors. 32 patients with palpable breast tumors were investigated by clinical examination, ultrasound, mammography and scintigraphy. Different radiopharmaceuticals marked with 99mTc were used, having different affinity for the tumoral tissue. A Siemens Diacam gamma camera was used. Patients were submitted to dynamic study of early blood-pool and tissular phase, followed by late static incidences. Regions of interest were compared with similar areas of the contralateral breast. Conclusions were compared to histopathological diagnosis. We have calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each of the investigation methods. The sensitivity was 80% for clinical examination, 100% for ultrasonography, 66% for mammography and 100% for scintigraphy. The specificity was 77% for clinical examination, 50% for ultrasonography, 90% for mammography and 80% for scintigraphy. PPV was 75% for clinical examination, 60% for ultrasonography, 80% for mammography and 82% for mammography. NPV was 82% for clinical examination, 100% for ultrasonography, 71% for mammography and 100% for scintigraphy. Good correlation was found between scintigraphy and histopathology. Ultrasound and mammography also confirmed, in most cases, the clinically suspected diagnosis. Including scintigraphy in the investigation protocol for breast tumors will allow a better assessment of the therapy.

[Cervical pregnancy]. / Sarcina cervicala.

The authors report a case of cervical pregnancy in a nulliparous woman (after treatment for secondary infertility) treated systemically and locally with methotrexate. Related to the case, they make some considerations concerning early diagnosis and conservative treatment of ectopic cervical pregnancies, in order to maintain the patients' fertility. The woman presented in this case report is now 5-weeks intrauterine pregnant.

[Outbreak of Legionnaires' disease in a private apartment building]. / Brote de enfermedad de los legionarios en un edificio de viviendas particulares.

BACKGROUND: An outbreak of legionnaires disease occurred in Zaragoza (Spain) in an uncommon environment such as a private apartment building was studied. METHODS: The investigation began upon notification of 3 patients admitted with pneumonia, living in the same apartment building. The suggestion of a common source of infection led to an active search for cases and a micro-environmental study of the zone where the patients lived, as well as a follow up study of other cases with hospital acquired pneumonia throughout the city. RESULTS: Six cases were detected over 9 days with a rate of 1.54%. The evolution of all the cases was favorable. The causal agent was serologically identified as Legionella pneumophilia serogroup 1 which was also found in the shower of one of the patient's bath with further confirmation that the strain isolated belonged to the Pontiac subgroup. CONCLUSIONS: The probable source of infection was the potable water. The stagnation, low temperature of the boiler and the under-chlorination of the water are factors which may have contributed to the appearance of this outbreak. The control of this type of outbreak must be based on a specific information system which treats this disease as requiring individualized declaration.