Tuberculosis diseminada con afectación grave del sistema nervioso central poco sintomática / Almost symptom free disseminated tuberculosis severely affecting the central nervous system

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[Acalculous cholecystitis: an uncommon form of presentation of Q fever]. / Colecistitis alitiásica: una forma infrecuente de presentación de fiebre Q.

Acute acalculous cholecystitis is a very rare clinical presentation of Q fever. We report the case of a 38-year-old man who presented with fever associated with elevation of liver enzyme levels and thickening of the gallbladder wall on abdominal ultrasonography and who was initially diagnosed with acute acalculous cholecystitis. Due to the persistence of fever and transaminase elevation despite antibiotic treatment, a liver biopsy was performed. Characteristic "doughnut" epithelioid granulomas were observed, suggesting a diagnosis of granulomatous hepatitis caused by Q fever, which was confirmed by serological methods. Treatment with doxycycline was commenced and the patient subsequently showed rapid clinical improvement, with disappearance of fever and normalization of liver enzyme levels. We review 8 cases of acute cholecystitis associated with Q fever published in the literature and stress the importance of liver biopsy in the etiological diagnosis of patients with prolonged fever and abnormal liver function tests.

Colecistitis alitiásica: una forma infrecuente de presentación de fiebre Q / Acalculous cholecystitis: an uncommon form of presentation of Q fever

La colecistitis aguda alitiásica es una forma infrecuente depresentación de la fiebre Q. Se expone el caso clínico de unpaciente varón de 38 años con un síndrome febril asociado aalteraciones en las pruebas de función hepática y un engrosamientode la pared vesicular en la ecografía abdominal,que permitió establecer un diagnóstico inicial de colecistitisalitiásica. La falta de respuesta al tratamiento habitual, juntocon la persistencia de la fiebre e hipertransaminasemia,motivó la realización de una biopsia hepática que mostró lapresencia de granulomas de células epitelioides «en rosquilla» típicos de la hepatitis granulomatosa por fiebre Q. Eldiagnóstico se confirmó posteriormente mediante serología.El tratamiento con doxiciclina fue altamente efectivo, conrápida desaparición de la fiebre y normalización de laspruebas de función hepática.Además, se realiza una revisión de los 8 casos de colecistitisaguda asociada a fiebre Q descritos en la bibliografía y sesubraya el papel de la biopsia hepática en el diagnósticoetiológico de los cuadros de fiebre prolongada asociada a alteracionesen el perfil hepático

Acute acalculous cholecystitis is a very rare clinical presentationof Q fever. We report the case of a 38-year-old manwho presented with fever associated with elevation of liverenzyme levels and thickening of the gallbladder wall on abdominalultrasonography and who was initially diagnosedwith acute acalculous cholecystitis. Due to the persistence offever and transaminase elevation despite antibiotic treatment,a liver biopsy was performed. Characteristic «doughnut epithelioid granulomas were observed, suggesting adiagnosis of granulomatous hepatitis caused by Q fever,which was confirmed by serological methods. Treatmentwith doxycycline was commenced and the patient subsequentlyshowed rapid clinical improvement, with disappearanceof fever and normalization of liver enzyme levels.We review 8 cases of acute cholecystitis associated with Q feverpublished in the literature and stress the importance ofliver biopsy in the etiological diagnosis of patients with prolongedfever and abnormal liver function tests

[Bacteremia in the elderly: associated and prognostic factors]. / Bacteriemia en el anciano: factores asociados y pronósticos.

BACKGROUND: Bacteremia is associated with high morbidity and mortality rates and its prevalence increases with age. The objective of the present investigation was to know the epidemiology, associated factors and prognosis in patients with bacteremia in our environment and in relation with age. METHODS: Two hundred and twenty-nine episodes of bacteremia were prospectively studied; 97 (42%) cases corresponded to patients aged > 70 years. The prognostic factors were evaluated by the univariate and multivariate analysis in the whole cohort and univariate study of associated factors for an age > 70 years. RESULTS: The etiology, infectious sources, nosocomial acquisition, and complications apart from shock (p = 0.02) were similar in the elderly patients. The associations of diabetes (p = 0.05), COPD and/or heart disease (p = 0.01), and exitus were higher for patients > 70 years. The main independent prognostic factor in the series was disseminated intravascular coagulation (p < 0.001, multivariate OR 14.2). CONCLUSIONS: Patients older than 70 years have a higher incidence of shock and mortality associated with infection. The higher overall mortality rate in the series was associated with disseminated intravascular coagulation and multisystemic failure irrespective of age.