Transfusion-associated sepsis caused by Candida parapsilosis.

BACKGROUND AND OBJECTIVES: The contamination of blood components by bacteria is an adverse event, which, although very uncommon, has an exceptionally high mortality rate. CASE REPORT: A patient suffering from terminal adenocarcinoma of the ovary received a red blood cell unit. During the transfusion, the patient developed fever. Cultures of both the patient's blood and the blood unit were done, and she was treated with antibiotics. Forty-eight and seventy-two hours after the transfusion, Candida parapsilosis grew in the blood cultures of the red blood cell bag and of the patient. The infection was controlled with amphotericin. The patient died from cancer progression. CONCLUSIONS We describe the first case of transfusion-associated sepsis caused by C. parapsilosis.

[Mesenteric lymph node cavitation: a rare complication of celiac disease in the adult]. / Cavitación ganlionar mesentérica: una rara complicación de la enfermedad celíaca del adulto.

A case of coeliac disease (CD) and mesenteric lymph node cavitation (MLNC) in a 42-years-old female is presented. The other cases reported in the literature are also reviewed. The most important ganglionar histological features are described and a pathogenic explanation is suggested.

Immune complex-mediated haemolytic anaemia and Evans syndrome induced by diclofenac.

BACKGROUND AND OBJECTIVES: Sodium diclofenac is one of the most widely used nonsteroidal anti-inflammatory drugs. Cases of acute haemolytic anaemia have been ascribed to the drug. We describe such a case, mediated by immune complexes. MATERIALS AND METHODS: Standard serologic tests were carried out for blood grouping and the detection and identification of red cell allo- and autoantibodies. Drug-anti-drug complexes were detected with an ex-vivo method. RESULTS: Warm IgG drug-independent red cell and platelet autoantibodies were detected in the serum. At first, the patient was diagnosed as having the Evans syndrome, and corticosteroids were administered. Later, because of the severity of the anaemia, the possibility of an immune complex mechanism was considered. This was confirmed by the detection of diclofenac-dependent antibodies that reacted with RBC only in the presence of urine from a volunteer receiving diclofenac as a source of ex-vivo antigen. The antibodies neither reacted with an in-vitro solution of the drug nor with the volunteer's serum. Diclofenac and corticosteroids were stopped, and the clinical condition of the patient completely normalised within 15 days. CONCLUSIONS: We describe a patient with acute haemolytic anaemia caused by diclofenac through an immune complex mechanism.

Comparison of solid and liquid culture media with polymerase chain reaction for detection of Mycobacterium tuberculosis in clinical samples.

The aim of this study was to determine the sensitivity of different methods--two commercial polymerase chain reaction (PCR) kits (a protocol of nested PCR and a protocol of amplification of the IS6110 insertion element), the radiometric Bactec system, the Septi-Chek AFB culture system, and culture in Löwenstein-Jensen (LJ) solid medium--for the detection of Mycobacterium tuberculosis. One hundred clinical samples from 51 patients with culture-positive tuberculosis (81 specimens) and 19 controls (19 specimens) were used. Eighty-nine percent of the samples were smear negative. In the 81 specimens obtained from patients with tuberculosis, the frequency of positivity was 66.6% for nested PCR, 63% for culture in liquid media, 38.3% for IS6110 assay, and 28.4% for culture in LJ medium. In 18 samples obtained by invasive procedures in patients with tuberculosis, mycobacterial DNA was detected by nested PCR in 83.3% (including all samples positive by culture on liquid media), by culture in liquid media in 77.7% by culture on LJ medium in 27.7%, and by the IS6110 assay in 11.1%. No false-positive results were obtained from the negative control specimens with any of the techniques tested. The sensitivity of the reamplification protocol appears to be superior to that of the IS6110 assay and similar to that of the Bactec system.

[Microangiopathic hemolytic anemia associated with neoplasms: an analysis of 5 cases and a review of the literature]. / Anemia hemolítica microangiopática asociada a neoplasias: análisis de cinco casos y revisión de la literatura.

From January of 1990 to June of 1993 a diagnosis of microangiopathic hemolytic anemia (MHA) was made in 5 out off 121 new patients with malignant tumor. There were 3 females and 2 males, with a mean age of 57 yr (range: 43-75), and a primary tumor in stomach (n = 2), pancreas (n = 1) and of unknown origin (n = 2). In all cases histologic type was adenocarcinoma and diagnosis was obtained by marrow examination. Four patients developed a disseminated intravascular coagulation syndrome. Intravascular deposits of fibrin, intimal proliferation and tumoral microembolisms were noted in 2 cases. Patients did not received chemotherapy, and the median survival was 7 days (range: 3-61).

The diagnostic usefulness of a DNA probe for Mycobacterium tuberculosis complex (Gen-Probe) in Bactec cultures versus other diagnostic methods.

The combination of the radiometric Bactec system and the Gen-Probe for Mycobacterium tuberculosis complex (MTB) in detection and identification of mycobacteria was evaluated. Löwenstein-Jensen and Coletsos media for isolation, and Bactec-NAP test and cellular morphology and grouping for identification of MTB and mycobacteria other than tuberculosis (MOTT) were also evaluated. The study included all specimens submitted to our laboratory for mycobacteria detection over a 6-month-period. The mean recovery times of MTB were 13.7, 23.3, and 21.2 days for Bactec, Löwenstein-Jensen and Coletsos, respectively. Bactec system recovered 87.8% of MTB strains and 98% of MOTT, and the conventional media 82.9% of MTB and 19.2% of MOTT. Ziehl-Neelsen smears and Bactec-NAP were effective in differentiating MTB and MOTT strains (3.3% and 9.6% respectively of the cultures were uninterpretable). Gen-Probe (cutoff point for MTB = 5% of hybridisation) was applied to 100 positive vials of Bactec. All cultures of MTB with a growth index (GI) > 400 displayed hybridisation > 9% (average 28.9%) but for a GI < 400, 17% of cultures showed < 5% of hybridisation (average 18.6%). All cultures for MOTT had < 5% hybridisation. With the combination Bactec/Gen-Probe the average time of the final report could be reduced to 15.5 days.

[Reactive arthritis caused by Giardia lamblia in a patient with secretory IgA deficiency]. / Artrite reactiva por Giardia lamblia num doente com défice de IgA secretora.

The authors report a case of seronegative polyarthritis resistant to the anti-inflammatory therapy in a 16-year-old male with intermittent diarrhea. A stool examination showed the presence of cysts of Giardia lamblia and an immunological study detected a partial serum IgA deficiency, including its secretory fraction. Based on clinical, analytical and radiological findings and the clinical improvement after treatment with metronidazole, a diagnosis of reactive arthritis associated to chronic giardiasis was made. Authors make a brief review of the literature the regarding this case.

[Drug surveillance: concepts, objectives, and methods]. / Farmacovigilância: conceitos, objectivos e métodos.

Adverse reactions to drugs, by their frequency and morbidity, constitute a very important problem in clinical practice today. However, it is not always possible to establish the definitive causal relationship between the drug and the clinico-laboratory situation. This is not only due to the variability of these findings and the inherent difficulties of the methodology used, but also the fact that most doctors show little sensitivity to such an important subject. In this paper we present a short review of the drug surveillance programme: basic concepts, objectives and the most important methodology, as well as the current situation in the EEC countries.

[Rhodococcus equi pneumonia in a patient with acquired immunodeficiency syndrome]. / Neumonía por Rhodococcus equi en un paciente afecto de síndrome de inmunodeficiencia adquirida.

A male patient of 33 years of age with AIDS developed pneumonia with abscess formation and a slow clinical course. The sputum, bronchoalveolar lavage and blood cultures yielded a Gram-positive, partially acid-alcohol resistant bacillus which was identified as Rhodococcus equi. This organism has been uncommonly implicated in pneumonia in patients with immunodeficiency, particularly with neoplasia and severe cell immunity deficiency. It has been very rarely reported in patients with AIDS. To our knowledge, this is the first reported case in Spain.