Demographic, clinical and microbiological characteristics of the first 30 human monkeypox confirmed cases attended in a tertiary hospital in Madrid (Spain), during the May-June 2022 international outbreak.

The present outbreak of Human Monkeypox (HMPX) that has begun in May 2022 and has spread across all continents in less than two months has qualitative and quantitative characteristics that make it different from the pattern of human disease previously caused by this virus. It has spread with enormous ease, affects almost exclusively adults, behaves as a sexually transmitted disease and focuses on very specific groups and transmission conditions. The high incidence in the city of Madrid in males that have sex with males (MSM) has allowed us to observe and report the experience with the first 30 cases diagnosed in our institution. Patients presented with febrile symptoms, genital and paragenital skin lesions reminiscent of smallpox, but less extensive and severe. The disease may also cause proctitis, pharyngitis and perioral lesions. The PCR test for diagnostic confirmation has been shown to be very sensitive and effective, not only in skin lesions but also in blood and other fluids such as pharyngeal, rectal exudates and blood. A very high proportion of patients with HMPX also have other sexually transmitted diseases that must be actively detected in this context. The spontaneous evolution of our patients has been good and hospitalization has been practically unnecessary. Transmission to non-sexual cohabitants and health personnel has been nonexistent and the lesions have disappeared in less than 30 days without leaving sequelae and no need for specific antiviral treatment.

Gripe pandémica, gripe estacional o ¿de todo un poco? (sobre la gestión de la pandemia de la nueva gripe A (H1N1) 2009 en España) / No disponible

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Complicaciones infecciosas en la artritis reumatoide / Infectious complications in rheumatoid arthritis

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[Bacteremia caused by Pseudomonas aeruginosa in patients with AIDS]. / Bacteriemia causada por Pseudomonas aeruginosa en pacientes con SIDA.

Severe infections caused by Pseudomonas aeruginosa are uncommon in patients infected with HIV. These infections are usually recurrent, bear a poor prognosis and their potential for nosocomial transmission is questioned. From May 1991 to December 1994, a total of 2,739 admissions were recorded at the VIH Unit in our hospital. Seven of those patients suffered 9 episodes of P. aeruginosa bacteremia (3.28 episodes/1,000 admissions). All cases were acquired nosocomially. The mean CD4 count was 30.7 cells/ml. Mortality associated with Pseudomonas aeruginosa bacteremia was 43%. With molecular typing techniques homologies over 98% were demonstrated for the two episodes in patient 4 and the episode in patient 3 (very close in time, 1993) and almost 99% between the isolate from patient 7 and the two isolates (identical) from patient 6. The other three isolates had relationship (to themselves and to the other isolates) lower than 97%. Our findings suggest that patient-to-patient transmission of severe infections caused by P. aeruginosa in patients with AIDS.

[Gastroenteritis due to Aeromonas in pediatrics]. / Gastroenteritis por Aeromonas en pediatría.

OBJECTIVE: In recent years the incidence of gastroenteritis due to Aeromonas spp has increased significantly. The purpose of this study was to investigate the etiology and clinical manifestations of this disease. PATIENTS AND METHODS: In the period between 1986 and 1992, we found Aeromonas spp in seventy patients (88 samples) between 0 and 16 years of age. We were able to analyze 53 of these samples. RESULTS: Of all of the patients, 66% were males and 58.5% were younger than two years old. We found a pattern in the disease with 83% of the cases occurring in summer and autumn. The infection was polymicrobial in 43% of the patients. The clinical manifestations most often found were fever (71%), vomiting (62.5%) and abdominal pain (9.4%). Diarrhea was watery in 71.7% and 64% of the cases lasted less than a week. The number of stools was 5 to 10 per day in 58% of the patients. Forty patients (75.5%) required hospitalization, with the stay being longer than 10 days in 25%. There were 30% of the patients that required antibiotic therapy, mostly due to concomitant infections and not due to the diarrheic episodes, with all of them having a satisfactory evolution.

[Drug-resistant tuberculosis at a general hospital]. / Tuberculosis resistente a fármacos en un hospital general.

OBJECTIVES: To determine the prevalence of M. tuberculosis isolates resistant to drugs in a general hospital and to assess its association with HIV infection. MATERIALS AND METHODS: Susceptibility analysis of all isolates of M. tuberculosis in a 4-year period (1990-1993). The proportion method was used to study the susceptibility to eight drugs. To assess the association of resistance with HIV infection a crossing was made of patients records who had M. tuberculosis recovered and that of patients with positive serology to HIV. RESULTS: Forty-two out of a total of 760 isolates (5.5%) were resistant to at least one drug, including isoniazid in 27 (3.3%), rifampin in 13 (1.6%), and pyrazinamide in 2 (0.2%). None of the isolates was resistant to ofloxacin. Twenty isolates (2.6%) were resistant to more than one drug and 9 (1.2%) were resistant to at least isoniazid and rifampin. Overall, 39% of resistance to one drug occurred in patients who had not received previous therapy with that drug. A greater incidence of resistant isolates was observed in HIV+ patients (7.3%) than in HIV- patients (4.6%), although this difference did not reach a statistical significance. CONCLUSIONS: Drug resistance rate in M. tuberculosis isolates in our hospital is still low and apparently not associated with HIV infection.

[Endocarditis due to Pseudomonas aeruginosa (author's transl)]. / Endocarditis por Pseudomonas aeruginosa.

A case of pseudomonas endocarditis of biliary origin with impairment of the mitral and tricuspid heart valves is reported. Former history of the patient did not reveal narcotic addiction or previous open-heart surgery. Osteomyelitis is an uncommon complication of pseudomonas endocarditis. Echocardiography was a useful diagnostic method in the present case, showing the vegetation on the tricuspid valve. The poor prognosis of cases with left valvular heart disease which are resistant to medical treatment is emphasized. Differential count of the colonies did not localize the affected heart valve in this case.