[Extrapulmonary tuberculosis]. / Tuberculosis extrapulmonar, una revisión.

Up to 25% of tuberculosis cases present extrapulmonary involvement. This is produced by haematogenous and lymphatic spread of the M. tuberculosis bacillus to other organs. The most common locations are the lymph nodes, pleura and the osteoarticular system. The problem with these types of tuberculosis is the difficulty in establishing a definitive diagnosis, since the clinical symptoms and results of imaging tests may be vague. It is often necessary to resort to invasive diagnostic testing such as ultrasound or CAT-guided FNAB, used to collect biological samples for diagnosis. Despite the growing use of and advances in recent years of molecular methods for early detection of mycobacteria DNA, cultures continue to be the gold standard that enable a firm microbiological diagnosis to be made. Treatment for these types of tuberculosis do not differ from treatment regimens for pulmonary forms of the same disease. The same antibiotic regimens for 6 months are recommended, and any extension of this period is advisable solely in tuberculosis affecting the central nervous system and in Pott's disease.

Tuberculosis extrapulmonar, una revisión / Extrapulmonary tuberculosis

Hasta en un 25% de los casos de tuberculosis existe afectación extrapulmonar. Esta afectación es producida por la diseminación hematógena y linfática del bacilo de M. tuberculosis hacia otros órganos. Las localizaciones más frecuentes son la ganglionar, pleural y osteo-articular. El problema de estas formas de tuberculosis radica en la dificultad para llegar a su diagnóstico definitivo, ya que tanto los síntomas clínicos, como las pruebas de imagen pueden ser inespecíficos. La mayoría de las veces es necesario recurrir a pruebas diagnósticas invasivas como PAAF guiada con ecografía o TAC, para la recolección de muestras biológicas para su diagnóstico. A pesar del auge y el avance, en los últimos años, de los métodos moleculares para la detección precoz de ADN de la micobacteria, el cultivo sigue siendo el gold estándar que permite el diagnóstico microbiológico definitivo. El tratamiento de estas formas de tuberculosis, no va diferir de las pautas de tratamiento de las formas pulmonares. Se recomienda utilizar los mismos regímenes de antibióticos con una duración de 6 meses y únicamente prolongar la duración en las tuberculosis con afectación del sistema nervioso y en la espondilitis tuberculosa con afectación neurológica (AU)

Up to 25% of tuberculosis cases present extrapulmonary involvement. This is produced by haematogenous and lymphatic spread of the M. tuberculosis bacillus to other organs. The most common locations are the lymph nodes, pleura and the osteoarticular system. The problem with these types of tuberculosis is the difficulty in establishing a definitive diagnosis, since the clinical symptoms and results of imaging tests may be vague. It is often necessary to resort to invasive diagnostic testing such as ultrasound or CAT-guided FNAB, used to collect biological samples for diagnosis. Despite the growing use of and advances in recent years of molecular methods for early detection of mycobacteria DNA, cultures continue to be the gold standard that enable a firm microbiological diagnosis to be made. Treatment for these types of tuberculosis do not differ from treatment regimens for pulmonary forms of the same disease. The same antibiotic regimens for 6 months are recommended, and any extension of this period is advisable solely in tuberculosis affecting the central nervous system and in Pott’s disease (AU)

La infección del tracto urinario en los servicios de medicina interna / Urinary tract infections in internal medicine

Objetivos. Análisis de las características de los pacientes ingresados en servicios de medicina interna (MI) con el diagnóstico de infección tracto urinario (ITU). Pacientes y métodos. Estudio transversal, descriptivo, retrospectivo de pacientes ingresados y diagnosticados de ITU en los informes de alta de diversos servicios de MI de nuestro país (1 de octubre al 31 de diciembre de 2007). Se registraron variables de filiación, factores de riesgo para ITU complicada, criterios diagnósticos, resultados microbiológicos y antibióticos utilizados. Resultados. Se reclutaron 992 pacientes (61,8% mujeres), de 57 hospitales, con edad media de 75,3 años. Procedían de residencia el 18,1%. Presentaban dependencia física el 53,5%. El 78,3% tenía algún factor de riesgo (diabetes mellitus 33,6%, sondaje vesical 24,1%). El tipo sindrómico de ITU más frecuente fue «ITU no especificada» (38,1%). En el 46% se llegó al diagnóstico exclusivamente por alteraciones del sedimento y/o urocultivo positivo. E. coli fue el patógeno más frecuente (64,17%), mostrando sensibilidad intermedia o resistente el 22,8% a amoxicilina-clavulánico, el 34,8 % a levofloxacino y el 40,6% a ciprofloxacino. La amoxicilina-clavulánico fue el antibiótico más utilizado (30,9%). La ITU demoró el alta en un 13,3% de los pacientes. La infección intrahospitalaria (23%) fue estadísticamente más frecuente en los pacientes sondados (50,5 vs 16,2%) y la mortalidad (3,4%) en mayores (81,2 vs 75,1 años), pacientes con P. aeruginosa (11,8 vs 4,1%) y en aquellos con sepsis urinaria (41,4 vs 16,2%). Conclusiones. Los pacientes dados de alta con ITU en los servicios de MI son de edad avanzada y frecuentemente presentan factores de riesgo. En excesivas ocasiones el diagnóstico se basa en criterios no específicos. E. coli es el patógeno más frecuente. Las quinolonas no deberían ser utilizadas en el tratamiento de primera línea en los pacientes con ITU complicada o grave, dado el alto porcentaje de resistencias(AU)

Objectives. Analysis of characteristics of patients in internal medicine (IM) hospital wards in Spain with the diagnosis of urinary tract infection (UTI). Patients and methods. Observational, descriptive, retrospective study of a population of inpatients with UTI diagnosis (October-December, 2007). Recorded variables included personal data, risk factors for complicated UTI, diagnosis criteria, microbiological results and antibiotics used. Results. A total of 992 patients (61.8% women), from 57 hospitals, were recruited. Mean age was 75.3 years old (SD 16.5), with 18.1% from nursing homes and with some physical dependence in 53.5%. The majority (78.3 %) had some risk factors (diabetes mellitus 33.6%, vesical catheterization 24.1%). Non-specific UTI was the most frequent diagnosis (38.1%). UTI was diagnosed in 46%, based exclusively on urinary sediment alterations and/or positive cultures. E. coli was the most frequent pathogen (64.17%), with intermediate sensitivity or resistance of 22.8% to amoxicillin-clavunanic, 34.8% to levofloxacin and 40.6% to ciprofloxacin. Amoxicillin-clavulanic was the most used antibiotic (30.9%). UTI delayed hospital discharge in a 13.3%. Intrahospital-UTI was statistically more frequent (23%) with vesical catheterization (50.5 vs 16.2%) and mortality (3.4%) in older patients (81.2 vs. 75.1 years old.), in patients with P. aeruginosa cultures (11.8 vs 4.1%) and in those with urinary sepsis (41.4 vs 16.2%). Conclusions. Patients in internal medicine wards with a UTI diagnosis are older and with risk factors. Frequently, UTI is diagnosed based on non-specific criteria. E. coli is the most frequent pathogen. Quinolones should not be the first-line treatment in complicated or severe UTI, due to the high percentages of resistance(AU)

[Urinary tract infections in internal medicine]. / La infección del tracto urinario en los servicios de medicina interna.

OBJECTIVES: Analysis of characteristics of patients in internal medicine (IM) hospital wards in Spain with the diagnosis of urinary tract infection (UTI). PATIENTS AND METHODS: Observational, descriptive, retrospective study of a population of inpatients with UTI diagnosis (October-December, 2007). Recorded variables included personal data, risk factors for complicated UTI, diagnosis criteria, microbiological results and antibiotics used. RESULTS: A total of 992 patients (61.8% women), from 57 hospitals, were recruited. Mean age was 75.3 years old (SD 16.5), with 18.1% from nursing homes and with some physical dependence in 53.5%. The majority (78.3 %) had some risk factors (diabetes mellitus 33.6%, vesical catheterization 24.1%). Non-specific UTI was the most frequent diagnosis (38.1%). UTI was diagnosed in 46%, based exclusively on urinary sediment alterations and/or positive cultures. E. coli was the most frequent pathogen (64.17%), with intermediate sensitivity or resistance of 22.8% to amoxicillin-clavunanic, 34.8% to levofloxacin and 40.6% to ciprofloxacin. Amoxicillin-clavulanic was the most used antibiotic (30.9%). UTI delayed hospital discharge in a 13.3%. Intrahospital-UTI was statistically more frequent (23%) with vesical catheterization (50.5 vs 16.2%) and mortality (3.4%) in older patients (81.2 vs. 75.1 years old.), in patients with P. aeruginosa cultures (11.8 vs 4.1%) and in those with urinary sepsis (41.4 vs 16.2%). CONCLUSIONS: Patients in internal medicine wards with a UTI diagnosis are older and with risk factors. Frequently, UTI is diagnosed based on non-specific criteria. E. coli is the most frequent pathogen. Quinolones should not be the first-line treatment in complicated or severe UTI, due to the high percentages of resistance.

[Analysis of population attended in a tuberculosis unit in Madrid. Evolution and impact of immigration from 1997 to 2006]. / Análisis de la población atendida en una unidad de tuberculosis en Madrid. Evolución e impacto de la inmigración desde 1997 a 2006.

BACKGROUND: In Spain there is a high prevalence of tuberculosis (TB). The aim of this study is to describe population attended in an Isolation Unit, analysing the changes that have occurred in 10 years, the impact of immigration and factors that may condition the loss of following. PATIENTS AND METHODS: Descriptive study of all patients admitted to the Isolation Unit of Hospital Cantoblanco-La Paz from 1997 to 2006. Univariate analysis and multiple logistic regression analysis were performed. RESULTS: 832 patients were studied, 69.4% men, with a mean age of 40.8 years 37.5% immigrants. In new cases, resistance to isoniazid was documented in 6.7% and multidrug resistance in 3.1%, and in previously treated cases, in 11.2% and 8.4%, respectively. Treatment was completed by 74.1%, 17.5% were lost, which was associated with drugs consumption (OR 3.01; CL 95% 1.18-3.41), being immigrant (OR 2.14; CL 95% 1.42-3.21) and HIV infection (OR 1.96; CL 95% 1.18-3.41). In the 10 years, percentage of immigrants and patients who proceeded from the Emergency Departments increased and results improved, while HIV infection and loss of following reduced. CONCLUSIONS: Profile of patient with TB has changed in last years in association with immigration. In spite of better results, more actions are needed in order to improve the adherence and epidemiologic control of the disease. (c) 2009 Elsevier España, S.L. All rights reserved.

Análisis de la población atendida en una unidad de tuberculosis en Madrid. Evolución e impacto de la inmigración desde 1997 a 2006 / Analysis of population attended in a tuberculosis unit in Madrid. Evolution and impact of immigration from 1997 to 2006

Fundamento y objetivo. La tuberculosis (TB) sigue teniendo una alta prevalencia en España. El objetivo de este trabajo es describir la población atendida en una unidad de aislamiento, analizando los cambios que se han producido en 10 años, el impacto de la inmigración y los factores que pueden condicionar la pérdida en el seguimiento. Pacientes y métodos. Estudio descriptivo que incluye a todos los pacientes ingresados en la Unidad de Aislamiento del Hospital Cantoblanco-La Paz desde 1997 a 2006. Se realizó análisis univariante y mediante regresión logística múltiple. Resultados. Se estudiaron 832 pacientes, el 69,4% varones, con una edad media de 40,8años. El 37,5% eran inmigrantes. Se documentó la resistencia a isoniazida en el 6,7%y multirresistencia en el 3,1% de casos nuevos; y entre los pacientes pre tratamiento y entre los previamente tratados el 11,2 y el 8,4%, respectivamente. Completaron el tratamiento el 74,1%. Se perdieron un 17,5%, lo que se asoció a consumo de drogas (odds ratio [OR] 3,01; intervalo de confianza [IC] al 95% 1,18-3,41), ser inmigrante (OR 2,14; IC95% 1,42-3,21) e infección por el virus de la inmunodeficiencia humana (VIH) (OR 1,96;IC 95% 1,18-3,41). En los diez años aumentó el porcentaje de inmigrantes y de pacientes que procedían de Servicios de Urgencias y se constató una mejoría en los resultados; disminuyeron la infección por VIH y las pérdidas de seguimiento. Conclusiones. El perfil de paciente con TB ha cambiado en los últimos años en relación con la inmigración. A pesar de la mejoría en los resultados, aún son necesarias medidas que incrementen el cumplimiento y el control epidemiológico de la enfermedad (AU)

Background. In Spain there is a high prevalence of tuberculosis (TB). The aim of this study is to describe population attended in an Isolation Unit, analysing the changes that have occurred in 10 years, the impact of immigration and factors that may condition the loss of following. Patients and methods. Descriptive study of all patients admitted to the Isolation Unit of Hospital Cantoblanco-La Paz from 1997 to 2006. Univariate analysis and multiple logistic regression analysis were performed. Results. 832 patients were studied, 69.4% men, with a mean age of 40.8 years 37.5%immigrants. In new cases, resistance to isoniazid was documented in 6.7% and multidrug resistance in 3.1%, and in previously treated cases, in 11.2% and 8.4%, respectively. Treatment was completed by 74.1%, 17.5% were lost, which was associated with drugs consumption (OR 3.01; CL 95% 1.18-3.41), being immigrant (OR 2.14; CL 95% 1.42-3.21)and HIV infection (OR 1.96; CL 95% 1.18-3.41). In the 10 years, percentage of immigrants and patients who proceeded from the Emergency Departments increased and results improved, while HIV infection and loss of following reduced. Conclusions. Profile of patient with TB has changed in last years in association with immigration. In spite of better results, more actions are needed in order to improve the adherence and epidemiologic control of the disease (AU)

Risk factors for multidrug-resistant tuberculosis in a tuberculosis unit in Madrid, Spain.

The setting for this retrospective cohort study was a specialised tuberculosis unit in Madrid, Spain. The objective was to describe the risk factors for multidrug-resistant tuberculosis (MDR-TB). The medical records of all patients admitted to the unit were reviewed retrospectively to identify factors associated with multidrug resistance. Patients with positive culture for M. tuberculosis and with available drug-susceptibility tests were included. The variables assessed were age, gender, country of origin, homelessness, alcohol consumption, intravenous drug use, methadone substitution therapy, contact with a tuberculosis patient, sputum smear, site of disease, previous tuberculosis treatment, HIV infection, history of imprisonment, diabetes mellitus and chronic obstructive pulmonary disease. Thirty patients with MDR-TB and 666 patients with non-MDR-TB were included from the years 1997 to 2006. The only factors associated with MDR-TB in multivariate analysis were previous tuberculosis treatment (OR: 3.44; 95% CI: 1.58-7.50; p = 0.003), age group 45-64 years (OR: 3.24; 95% CI: 1.34-7.81; p = 0.009) and alcohol abuse (OR: 0.12; 95% CI: 0.03 to 0.55; p = 0.003). In our study, patients who had had previous treatment for tuberculosis, who were 45-64 years of age or who had no history of alcohol abuse were more likely to have MDR-TB.

Utilización de heparinas de bajo peso molecular en pacientes hospitalizados en Medicina Interna / Use of low molecular heparins in inpatients of Internal Medicine

No disponible

[Use of rifabutin in cases of toxicity to rifampicin]. / Uso de rifabutina en casos de toxicidad a rifampicina.

Rifampicin is an essential drug in the present treatment of tuberculosis. On some occasions, it cannot be used due to severe adverse effects. Rifabutin is a drug of the same family, with a similar activity and difference adverse effects. This study describes the beneficial results of the substitution of rifampicin with rifabutin in patients with severe toxicity.

Uso de rifabutina en casos de toxicidad a rifampicina / Use of rifabutin in cases of toxicity to rifampicin

La rifampicina es un fármaco esencial en el tratamiento actual de la tuberculosis. En algunas ocasiones no se puede utilizar por efectos adversos graves. La rifabutina es un fármaco de la misma familia, con una actividad similar y efectos adversos diferentes. En este estudio se describen los resultados beneficiosos de la sustitución de rifampicina por rifabutina en pacientes con toxicidad intensa (AU)

Rifampicin is an essential drug in the present treatment of tuberculosis. On some occasions, it cannot be used due to severe adverse effects. Rifabutin is a drug of the same family, with a similar activity and difference adverse effects. This study describes the beneficial results of the substitution of rifampicin with rifabutin in patients with severe toxicity (AU)

Piomiositis en paciente diabética / Pyomyositis in diabetic patient

No disponible

Bacteriemias / Bacteremia

No disponible

[Anaerobic bacteriemias: clinical and epidemiological characteristics of anaerobic bacteremias in ten years]. / Bacteriemia por anaerobios: características clinicoepidemiológicas de las bacteriemias por anaerobios en dos periodos con una diferencia de 10 años.

BACKGROUND: The anaerobic bacteremia incidence is decreasing during the last years, and although it carries a high mortality rate there are studies that ask about the possibility of avoid anaerobic blood cultures thinking about the clinical prediction capacity of them. The objective of this study is the analysis of incidence and clinical characteristics of anaerobic bacteremias in two periods with 10 years of difference and empiric antibiotic treatment received, and if it was changed when microbiological results were received . METHODS: Prospective study of anaerobic bacteremias during 1985-86 and 1996-97, at university hospital analyzing clinical characteristics, incidence, analysis, evolution and empiric antibiotic treatment received. The statistical analysis was performed with the chi square test or exact Fisher test with statistical significance with p<0.05, talking about variables with p<0.10. RESULTS: The incidence of anaerobic bacteremias was higher in 1996-97 with 24 cases (5.08%), that during 1985-86 with 22 cases (4.24%). The variables with statistical significative differences with p<0.10 were: intrahospitalary adquisition (p<0.10); genitourinary and vascular manipulation (p=0.02 and p=0.06), and hypotension (p=0.034) more frequent during the first period than during the second one. There isn t statistical difference in evolution to cure although the percentage was higher during the second period (62.5%), that during the first one (54.6%), being the empiric treatment very high in both periods. Bacteroides fragilis was the most frequent microorganism and abdominal origin the most frequent one in both periods. CONCLUSION: Although there is a low anaerobic bacteremia incidence this one hasn't diminished in ten years. Anaerobic bacteremias have a high mortality index although the most part of empirical antibiotic treatments are correct. It could ask about the possibility of avoid anaerobic blood cultures or ask about them only in clinic suspicion of them.

Enfermedad pulmonar por Mycobacterium scrofulaceum / Pulmonary disease caused by Mycobacterium scrofulaceum

No disponible

Bacteriemia por anaerobios: características clinicoepidemiológicas de las bacteriemias por anaerobios en dos periodos con una diferencia de 10 años / Anaerobic bacteremias: clinical and epidemiological characteristics of anaerobic bacteremias in ten years

Fundamento: La incidencia de bacteriemia por anaerobios parece que está disminuyendo en los últimos años, y pese a la elevada mortalidad de las mismas existen estudios que plantean la supresión de medios de crecimiento para anaerobios basándose en la predictibilidad de dichas bacteriemias. El objetivo del estudio es analizar la incidencia, y características clínicas de las bacteriemias por anaerobios en dos periodos con 10 años de diferencia, analizando si el conocimiento de dichos microorganismos modificó las decisiones terapéuticas tomadas empíricamente antes del conocimiento de los mismos. Métodos: Estudio prospectivo y anterógrado de las bacteriemias por anaerobios durante 1985-86 y 1996-97 en un hospital universitario, analizando su incidencia, características clínicas, analíticas y su evolución a curación o muerte. Para el análisis estadístico se realizó test de chi cuadrado o test exacto de Fisher, considerándose estadísticamente significativas p<0,05, comentándose las variables con p < 0,10. Resultados: La incidencia de bacteriemia por anaerobios (sobre el total de las bacteriemias diagnosticadas) fue superior en 1996-97 con 24 casos (5,08 por ciento), que durante 1985-86 con 22 casos (4,24 por ciento). Las variables con diferencias estadísticamente significativas con p < 0,10 fueron: adquisición intrahospitalaria (p < 0,10); manipulaciones genitourinarias (p = 0,02); manipulaciones vasculares (p de 0,06) y la presencia de hipotensión (p = 0,034) más frecuentes durante el primer periodo que en el segundo. No se observa diferencia estadísticamente significativa en cuanto a la evolución a curación aunque el porcentaje de estas fue superior durante el segundo periodo (62,5 por ciento) que durante el primero (54,6 por ciento), siendo el número de tratamientos empíricos adecuados muy elevado en ambos (77 y 87 por ciento respectivamente). En ambos periodos el germen más frecuentemente aislado fue Bacteroides fragilis, y el foco de origen más frecuente fue el abdominal. Conclusión: Aunque la incidencia de bacteriemias por anaerobios es baja, esta no ha disminuído en 10 años. Las bacteriemias por anaerobios tienen una elevada mortalidad pese a que la mayor parte de ellas reciben tratamiento empírico adecuado. Todo ello podría plantear la posibilidad de suprimir los medios de cultivo para anaerobios, o solicitarlos en casos clínicamente sospechoso (AU)