Evolution of Salmonella spp. isolated compared to those of Campylobacter spp. in faecal samples for 12 years.

OBJECTIVE: The Autonomous Community of Galicia has adopted DECREE 216/2011 on health standards for poultry production, in addition to the Spanish national programs. However, no program has yet been implemented to eradicate campylobacteriosis, which shares the same reservoir. The aim of this study was to compare the evolution of Salmonella spp. isolates with respect to those of Campylobacter spp. in faecal samples received by the Microbiology Department. METHODS: A retrospective descriptive comparative study was conducted through the Laboratory Information System (SIL) of Salmonella spp. isolated against Campylobacter spp. in faeces between 2011 and 2022 at the Lucus Augusti University Hospital (HULA), Lugo, Spain. RESULTS: A total of 35,704 stool samples were analysed, of which 3,045 were positive. 751 Salmonella spp. were isolated. Statistical differences were observed in the annual distribution (p<0.01), with a clear turning point in 2018. Five hundred and five patients required hospital care, especially in 2014 with 72 patients (69%). On the other hand, 1,587 Campylobacter spp. were isolated. Required hospital care 1,002 patients during the study, with a peak in 2019 with 111 cases (62%). CONCLUSIONS: The reduction of salmonellosis cases and the maintenance of campylobacteriosis cases are directly related to the implementation of DECREE 216/2011. This, in turn, has reduced the pressure on hospitals in the HULA health area. Therefore, we believe that the ONE Health concept is being strengthened in the area studied.

[Microscopy vs. molecular biology in the diagnosis of intestinal protozoal infections, is it time for a change?] / Microscopía vs. biología molecular en el diagnóstico de infecciones protozoarias intestinales, ¿es el momento del cambio?

OBJECTIVE: Microscopic examination of the intestinal parasites, from the patient's concentrated feces, has a lower sensitivity when compared to molecular diagnostic techniques. Therefore, the objective of this study has been to compare both techniques, as well as to evaluate whether there is a correlation between the microscopic examination and the threshold cycles (Ct) obtained for Blastocystis hominis. METHODS: Retrospective study of the samples received in the Microbiology laboratory during September 2021. The MiniParasep SF® concentration test was performed for microscopic visualization and then PCR was performed with the Seegene AllplexTM Parasite Assay panel. RESULTS: A 27% (n=74) of the samples were positive by molecular diagnosis, with a total of 87 parasites detected. 53% (n=39) were women with a mean age of 47 ± 24 years. In 76% (n=56) of the cases the service of origin was Primary Care. The most frequently found parasite was B. hominis, 85% (n=64), followed by Dientamoeba fragilis 20% (n=15) and Giardia lamblia 11% (n=8). Co-infection by two parasites was detected in 13 cases (B. hominis + D. fragilis in 6 cases, and B. hominis + G. lamblia in 7 cases). In the microscopic diagnosis, 9.5% (n=26) positivity was obtained. The most frequently found parasite was B. hominis, 84% (n=23), followed by G. lamblia, which was seen in three cases by microscopy. D. fragilis was not seen in any case. Coinfection of B. hominis + G. lamblia was observed in one sample. CONCLUSIONS: Techniques for molecular diagnosis of intestinal parasites are fast, reliable and more sensitive than microscopic techniques, improving microbiological diagnosis and quality of care.

[Left distal femoral diaphysis-metaphyseal injury in a 13-year-old patient]. / Lesión diafiso-metafisaria distal femoral izquierda en paciente de 13 años.

This paper aims to present the usefulness of the different diagnosis imaging methods (anatomical and functional) in the characterization of bone injury. Any data, however insignificant, is justified and should be specified. In this case, the discrepancy between the vascular and pool phases in the bone scintigraphy with 99mTc-MDP reveals revealed a lesion with an intense reaction secondary to the "foreign body effect", which is not necessarily malignant.

Lesión diafiso-metafisaria distal femoral izquierda en paciente de 13 años / Left distal femoral diaphysis-metaphyseal injury in a 13 years old patient

El objetivo es presentar la utilidad de los distintos métodos de diagnóstico por imagen (anatómicos y funcionales), en la caracterización de una lesión ósea.Cualquier dato, por insignificante que este sea, tiene su justificación y debe ser especificado. En este caso, la discrepancia en la gammagrafía ósea con 99mTc-MDP, entre las fases vascular y 'pool', revela a una lesión con intensa reacción secundaria al efecto de 'cuerpo extraño', que necesariamente no tiene que ser maligna (AU)

[Pyogenic liver abscess: changes in etiology, diagnosis and treatment over 18 years]. / Absceso hepático piógeno: cambios en la etiología, diagnóstico y tratamiento a lo largo de 18 años.

BACKGROUND: There are no detailed studies in our country on the impact of modern imaging techniques on diagnosis, treatment and prognosis of pyogenic liver abscesses. MATERIAL AND METHODS: All patients with the diagnosis of PLA from 1981 to 1998 were included in the study. The study was divided in two periods: 1981 to 1989 and 1990 to 1998. RESULTS: Compared with the first time period, the following was observed from 1990 to 1998: the mean age was higher (52 versus 65 years, p = 0.006), infections with identified source increased (33% versus 74%, p = 0.003), diagnosis was earlier (13 versus 3 days, p = 0.0002), modern imaging techniques were used more frequently (17% versus 96%, p = 0.002), the proportion of recovered microorganisms increased (53% versus 88%, p = 0.002), as well as use of percutaneous drainage (0% versus 37%, p = 0.002) and the prognosis was better (mortality rate 40% versus 10%, p = 0.01). CONCLUSIONS: Relevant changes were observed among patients in our hospital in the nineties regarding epidemiology, management and prognosis of PLAs. Part of these changes are due to a higher use of new imaging techniques.

[Clinical profile and prognosis of bacteremia in patients with cirrhosis based on the Child-Pugh classification]. / Perfil clínico y pronóstico de las bacteriemias en pacientes cirróticos de acuerdo con la clasificación de Child-Pugh.

The characteristics of 70 cases of bacteremia in cirrhotic patients were studied according to the Child-Pugh classification as severity marker of liver involvement. Factors influencing on prognosis were determined. For a comparative analysis, 1,006 cases of bacteremia in non-cirrhotic patients were included. Sixteen patients corresponded to group A, 23 to group B and 31 to group C in the Child-Pugh classification. Patients in group A had a predominance of extra-enteric microorganisms, mainly Staphylococcus aureus (37.5%; p = 0.02), well-defined source (urinary tract, respiratory tract, skin) and good prognosis (mortality rate 6.2%). In contrast, patients in group C had a high recovery rate of Escherichia coli (41.9%) and pneumococcus (19.3%), undetermined source (51.6%; p = 0.05), ascites (83.9%), with or without concomitant peritonitis (41.1%; p = 0.03) and poor prognosis (mortality rate 48.3%; p = 0.008). The characteristics of patients in group B were similar to those of patients in group C but prognosis was as in patients in group A. The immediate mortality rate in the studied patients was 26%. The parameter which best predicted survival in the multivariate analysis was the Child-Pugh classification.

[Brucellar meningitis as a peculiar form of clear fluid meningitis. Clinical study]. / La meningitis brucelar como forma peculiar de meningitis de líquido claro. Estudio clínico.

Out of 200 patients diagnosed of acute of chronic brucellosis, cases were first selected who had neurologic involvement (14%) and then those who had brucellar meningitis (CDC criteria) which corresponds to 4% of the total of the series. The clinical course, evolution time, neurologic manifestations and serologic and bacteriologic characteristics in blood and specifically in the cerebrospinal fluid (CSF). This study was contrasted with the literature review and the conclusion is reached that brucellar meningitis is a peculiar form of clear fluid meningitis, not exceptional in our environment considering the prevalence of brucellosis.

[Bacteremia in the elderly. Clinical features and prognostic factors]. / Bacteriemia en ancianos. Aspectos clínicos y factores pronósticos.

BACKGROUND: The analysis of the most relevant characteristics and prognostic factors in elderly patients with bacteremia. PATIENTS AND METHODS: For the period 1989-1993 a prospective study of all significant bacteremias in adult patients admitted to a General Hospital was performed. Patients were visited until their death or during at least 50 days. The most relevant findings in elderly patients (over 65 years old) are described. Overall survival probabilities were obtained by Kaplan-Merner analysis. Cox proportional models were used to examine hazards of dying. RESULTS: Of the 1,128 bacteremias studied, 603 (53.9%) were in elderly patients. In this group, the increasing age was related with higher frequency of urinary (p = 0.02) and biliary (p = 0.001) sources of infection and lower frequency of underlying neoplasia (p = 0.06), immunosuppression (p = 0.0000) and development of septic shock (p = 0.02). These differences are higher in patients over 85. Among older patients the survival probability in the day 21 after diagnosis was 0.71 (95% CI 0.66-0.74), significantly lower to the probability in younger patients (p = 0.0001). In the elderly patients, the worse prognestic was associated to shock (RR = 8; 95% CI 5.8-11), indeterminated source of infection (RR = 3.6; 95% CI 2.2-5.8), underlying neoplasia (RR = 1.7; 95% CI 1.3-2.4), neutropania (RR = 1.5; 95% CI 1.1-2.1) nosocomial acquisition (RR = 1.3; 95% CI 1.0-3.1) and inappropriate treatment (RR = 1.2; 95% CI 1.0-3.2), but age was not an independent contributor. CONCLUSIONS: We found differences between the clinical characteristics and the prognosis of bactermia in elderly and younger patients. Among elder patients, those over 85 years old constitute a particular group with well defined characteristics.

[The incidence of the antiphospholipid syndrome in the clinical and biological manifestations of systemic lupus erythematosus]. / Incidencia del síndrome antifosfolípido en las manifestaciones clínicas y biológicas del lupus eritematoso sistémico.

In the present investigation a study was made on the incidence of antiphospholipid syndrome (APS) on clinical and biological manifestations in a series or 32 patients (28 females and 4 males with a mean age of 25 years) diagnosed of SLE (ARA criteria) and APS (Harris criteria) compared with a group of 25 patients (19 females and 6 males with a mean age of 38 years) diagnosed of SLE without APS. This entails a selection from 124 patients diagnosed of SLE, and an incidence of 25.8% and 9.7% for ACA and LA, respectively. After a clinical protocol was filled, a complete immunological profile was obtained, with lymphocyte subsets, IL-2 receptor, coagulation study, isotype determination for anticardiolipin antibody (ACA), lupus anticoagulant (LA), serology for syphilis and imaging diagnostic techniques. Comparative results, with an statistic assessment, are shown in tables. It is concluded that SLE + APS population can be considered as definite for a peculiar SLE subtype.