Clinical and epidemiological characterization of a lymphogranuloma venereum outbreak in Madrid, Spain: co-circulation of two variants.

The lymphogranuloma venereum (LGV) outbreak described in the Netherlands in 2003, increased the interest in the genotyping of Chlamydia trachomatis. Although international surveillance programmes were implemented, these studies slowly decreased in the following years. Now data have revealed a new accumulation of LGV cases in those European countries with extended surveillance programmes. Between March 2009 and November 2011, a study was carried out to detect LGV cases in Madrid. The study was based on screening of C. trachomatis using commercial kits, followed by real-time pmpH-PCR discriminating LGV strains, and finally ompA gene was sequenced for phylogenetic reconstruction. Ninety-four LGV infections were identified. The number of cases increased from 10 to 30 and then to 54 during 2009-2011. Incidence of LGV was strongly associated with men who have sex with men; but in 2011, LGV cases were described in women and heterosexual men. Sixty-nine patients were also human immunodeficiency virus (HIV) positive, with detectable viral loads at the moment of LGV diagnosis, suggesting a high-risk of co-transmission. In fact, in four patients the diagnosis of HIV was simultaneous with LGV infection. The conventional treatment with doxycycline was prescribed in 75 patients, although in three patients the treatment failed. The sequencing of the ompA gene permitted identification of two independent transmission nodes. One constituted by 25 sequences identical to the L2b variant, and a second node including 37 sequences identical to L2. This epidemiological situation characterized by the co-circulation of two LGV variants has not been previously described, reinforcing the need for screening and genotyping of LGV strains.

Hepatic fibrin-ring granulomas in visceral leishmaniasis.

Hepatic fibrin-ring granulomas and leishmania parasites were found in the liver biopsy specimens of 3 patients with prolonged fever and hepatosplenomegaly. It was recognition of the leishmanias in the liver biopsy specimen that prompted the diagnosis in all cases. There was no evidence of Q fever, Hodgkin's disease, cytomegalovirus hepatitis, or allopurinol treatment, which are the recognized causes of hepatic fibrin-ring granulomas. This report extends the range of etiologies of hepatic fibrin-ring granulomas. As a result, leishmaniasis should always be a consideration to the pathologist and the clinician in the differential diagnosis of fibrin-ring granulomas.

Evaluation of aztreonam in the treatment of severe bacterial infections.

We investigated the clinical efficacy and safety of aztreonam in the treatment of 50 episodes of infection in 46 adult patients. The clinical condition of patients at the beginning of treatment was critical or poor in 28 of the episodes of infection. Episodes treated were 39 urinary tract infections (12 of them with concomitant bacteremia), 2 soft tissue infections, 8 patients with osteomyelitis (1 with concomitant bacteremia), and one episode of pneumonia. Significant isolated microorganisms were aerobic or facultative gram-negative rods and were responsible for the following episodes of infection (number of episodes): members of the family Enterobacteriaceae (49), Pseudomonas aeruginosa (5), and Haemophilus influenzae (1). The overall rate of clinical response to aztreonam was 94% of the treated episodes. Colonization or superinfection or both occurred in 29 episodes, but only 8 episodes required antimicrobial therapy. Aztreonam seems to be an effective single agent therapy for many bacterial infections. Colonization and superinfection by Candida sp., Streptococcus faecalis or Staphylococcus aureus must be monitored.

Evaluation of ceftazidime in the treatment of severe bacterial infection.

We investigated the clinical efficiency and safety of ceftazidime for treatment of 33 episodes of infection in 30 patients (17 males and 13 females), whose ages ranged from 9 to 92 years (mean 52.5). Fourteen patients had ultimately fatal disease and the remaining 16 had non-fatal diseases. The clinical condition of patients at the beginning of treatment was critical or poor in 16 cases. Episodes of infection treated were: 24 urinary tract infections (eight of them with concomitant bacteraemia), seven wound infections (one with concomitant bacteraemia and three with osteomyelitis), and two episodes of pneumonia. Twenty-nine episodes of infection were monomicrobial and the four remaining ones were polymicrobial. Significant organisms isolated were all aerobic or facultatively anaerobic Gram-negative rods and were responsible for the following episodes of infection: Escherichia coli (14), Pseudomonas aeruginosa (12), Pseudomonas cepacia (1), Proteus mirabilis (5), Serratia marcescens (2), Klebsiella (2), Enterobacter aerogenes (1) and Haemophilus influenzae (1). Total dosage of ceftazidime ranged from 28 to 240 g (mean 82.4 g), and mean duration of therapy was 17 days (range 8 to 44 days). The overall rate of clinical response to ceftazidime was 91%. Local and general tolerance to the drug was excellent. Enterococcal and/or candida colonization occurred in 12 episodes (36%) and superinfections by the same micro-organisms occurred in three episodes. Ceftazidime seems to be an effective and safe single agent for therapy of many bacterial infections, including those caused by Ps. aeruginosa.

Comparison of ceftazidime concentrations in bile and serum.

Biliary excretion of ceftazidime, a new broad-spectrum cephalosporin, was studied in two groups of patients after administration of a 2-g dose intravenously. Group A included 10 patients in whom ceftazidime levels in bile were measured during cholecystectomy. Group B included 10 patients with indwelling biliary tubes in whom ceftazidime levels in bile and serum were simultaneously measured at 0.5, 1, 2, 4, 6, and 8 h after administration of the drug. Although ceftazidime levels were variable, they exceeded the minimal inhibitory concentrations of most biliary tract pathogens in both groups.

[Acute Q fever: study of 23 patients (author's transl)]. / Fiebre Q aguda: experiencia en 23 casos.

Twenty-three patients with Q fever who were diagnosed over a 3 year period are described. The majority came from the Madrid urban area and less than half had epidemiological antecedents. Nine patients presented with pulmonary infiltrations, 12 with suppressed fever and in 2 criteria for fever of unknown origin were met. The majority had clinical or analytic data of hepatic disease and liver biopsy practiced in 4 patients showed granulomas. Diagnosis was established through the increment of seric antibodies against antigens of phase II C. burnetii, detected by complement fixation test. Acute Q fever is not a rare disease in our environment and must be taken into account when a differential diagnosis is looked for in processes such as fever of short evolution, fever of unknown origin, pneumoniae and granulomatous hepatitis.