[Listeriosis in the nonpregnant adult during an epidemic outbreak on Grand Canary]. / Listeriosis en el adulto no gestante durante un brote epidémico en Gran Canaria.

Twenty-two cases of community-acquired epidemic listeriosis were recorded from December 31st, 1991, to May 15th, 1993, at the Nuestra Señora del Pino Hospital, Las Palmas. The incidence during this outbreak was 31 times higher than the corresponding incidence in the last few years. Twelve cases occurred in pregnant women and/or neonates and ten in non-pregnant adult individuals. Our aim was to study the clinical, biological, radiological, and evolutive issues in non-pregnant adult patients. Six patients had some immunosuppressive condition: cancer, chemotherapy, AIDS, diabetes, and alcoholism. Eight patients had documented involvement of central nervous system: 6 cases of meningitis and 3 of cerebritis (one case had both meningitis and cerebritis); in the remaining two patients associated with seizures and acute confusional states, respectively. A neurological involvement was not documented because of the fulminant clinical course. CSF examination revealed mononuclear predominance in half of meningitis cases and was normal in two of the three cerebritis cases. The mean time from admission to diagnosis was 3.5 days. All patients but the two who died in the first hours of the disease received ampicillin and an aminoglycoside. The response to therapy was excellent with exception of one patient with meningitis who died in the fourth day of therapy. The clustering of listeriosis cases should alert physicians about the possibility of an epidemic outbreak. Listeria infection in non-pregnant adult individuals in this outbreak showed a high rate of neurological involvement, with focal cerebritis and pleocytosis with a mononuclear predominance in meningitis.

[Mycobacterial infections: yield of bacillary microscopy in different clinical samples (1975-1988)]. / Infecciones por micobacterias: rendimiento de la baciloscopia en diferentes muestras clínicas (1975-1988).

BACKGROUND: The yield of microscopy examination as a quick diagnostic test in several pulmonary and nonpulmonary samples referred to the mycobacterial laboratory of a general hospital is reviewed. METHODS: During a 14-year period (1975-1988), 113,836 biological products were investigated. In 9,972 a positive culture for mycobacteria was obtained. For the microscopy examination the auramin technique was used; if positive, acid-alcohol resistance was confirmed by overstaining with the Ziehl-Neelsen technique. The culture was used as the reference method. RESULTS: Microscopic examination was positive in 34% of samples with a positive culture, being 39% for Mycobacterium tuberculosis and 10% for environmental mycobacteria. The overall specificity was 99%, the positive predictive value was 91% and the negative predictive value was 94%. In pleuropulmonary samples the sensitivity ranged from 48% in sputum and 2% in pleural biopsy, with specificity higher than 99%. In nonpulmonary samples, sensitivity, specificity and positive and negative predictive values varied with the type of sample. The false positive rate (positive microscopy with negative culture) was 0.3, and it was shown that 80% of these patients had received previous therapy. In organic fluids (pleural, peritoneal, cerebrospinal), the sensitivity was not greater than 13%. CONCLUSIONS: Sputum, bronchoaspirate and bronchoalveolar lavage were better for the diagnosis of tuberculosis than gastric aspirate. Approximately 1 in each positive microscopy examinations corresponded to environmental mycobacteria. In some nonpulmonary samples with high sensitivity the positive predictive value was low. 80% of the false positive results corresponded to previously treated patients.

[Viral infections associated with intestinal invagination]. / Infecciones víricas asociadas a invaginación intestinal.

Intestinal invagination is rather frequently associated with local tumors, adenovirus infections, and occasionally with Yersinia enterocolitica. However, in many cases the etiology is not known. We have studied 88 children with intestinal invagination in whom cellular cultures of Hep 2 and pulmonary fibroblasts of human embryo have been inoculated with a fecal sample. The clinical reports have been reviewed retrospectively. In 19 patients (21.59%) we obtained an adenovirus and in 12 patients (13.63%) we isolated enteroviruses. These results have been compared with a control group of 1,059 children of a comparable age and during the same period of time who were admitted because diagnoses other than intestinal invagination. All controls where subjected to viral investigation in feces following the same procedure. In 71 of controls (6.7%) there were adenovirus in feces and in 74 cases (6.98%) the culture evidenced enteroviruses. Group differences for adenovirus were statistically significant (p = 0.00000172), whereas infections for enteroviruses reached a small significance (p = 0.03892). Among the 18 patients with intestinal invagination in whom the cultures were positive for adenoviruses, 10 presented a recent high airway infection. In contrast, this infection was only observed in 3 out of the 12 patients with culture positive to enteroviruses. The etiology of intestinal invagination in a large number of patients remains to be established. There are many pathogenic intestinal viruses that might cause intestinal invagination but they may be unable to grow into cellular cultures.