[Resistance of Mycobacterium tuberculosis in Ferrol, Spain. Associated factors]. / Resistencias de Mycobacterium tuberculosis en Ferrol. Factores asociados.

OBJECTIVE: To know the frequency of resistances of Mycobacterium tuberculosis and the associated factors. PATIENTS AND METHODS: Prospective study of the sensitivity of Mycobacterium tuberculosis by means of the method of the proportions of Canetti in the Hospital Arquitecto Marcide-Profesor Novoa Santos (Ferrol, Spain) among 1991 and 1998. A descriptive and multiple regression analyses were performed. RESULTS: Were studied 355 strains. Primary resistance: Isoniazid 1.1%, Streptomycin 1.1%. Secondary resistance: Isoniazid 11.6%, in the 5.2% existed multidrug-resistance. The risk factors for drug-resistant tuberculosis were previous treatment (odds ratio [OR] = 10.9; 95% CI, 2.9-39.4) and age higher than 40 years (OR = 3.9; 95% CI, 1.1-14.5). CONCLUSIONS: A low frequency of resistance was observed. The factors associated with the resistances were previous treatment and age.

[Meningococcal infection caused by Neisseria meningitidis serogroup C]. / Infección meningocócica por Neisseria meningitidis serogrupo C.

BACKGROUND: In recent years an increase has been observed in the prevalence of meningococcal infection by Neisseria meningitidis serogroup C and in the appearance of strains with moderate resistance to penicillin. PATIENTS AND METHODS: A microbiologic study of the cases of meningococcal infection of serogroup C treated from 1995 to 1996 in the health care area of Ferrol (La Coruña, Spain) was carried out. RESULTS AND CONCLUSIONS: Twenty-nine cases were detected in 1995 and 28 in 1996. Meningococcal infection was observed in patients ranging from 8 months to 21 years of age (mean 5.7 years). Distribution by sex was homogeneous. Two patients died. According to the clinical presentation, 11 were sepsis (38%), 4 meningitis (14%) and 14 both processes (48%). In 4 LCR samples, the analytical study was normal with posterior positive culture results. The detection of bacterial antigen by latex agglutination in CSF only detected 32% of the cases. MIC study determined that 11 strains (38%) presented moderate resistance to penicillin, 9 with a MIC of 0.12 microgram/ml, one with a MIC of 0.25 microgram/ml and another with a MIC of 0.5 microgram/ml. In all the cases the strains were sensitive to cefotaxime (MIC < or = 0.06 microgram/ml) and rifampicin (MIC < or = 0.5 microgram/ml). All the strains belonged to serogroup C serotype 2b, serosubtype P1.2,5. During the study period 4 additional cases of meningococcal disease by serogroup B were observed.

[The epidemiology of tuberculosis in El Ferrol]. / Epidemiología de la tuberculosis en El Ferrol.

BACKGROUND: This study was undertaken to know the frequency of tuberculosis in El Ferrol and to contribute to the knowledge of the situation in Spain. METHODS: A retrospective study of all the cases of tuberculosis diagnosed in the Hospital A. Marcide-Novoa Santos (El Ferrol, Spain) from 1990 to 1993 was performed. RESULTS: Seven hundred twenty-four patients were diagnosed, with a mean annual prevalence of 83.3/100,000 inhabitants. Six hundred sixty-four cases (430 males [64.8%]) were evaluated. The mean age was 35.5 +/- 19 years with 58.9% under the age of 35. 98.7% of the patients lived in the health care area and 73.2% were admitted, with 13.7% having previous history of tuberculosis. Sixty-one cases (11.1%; Cl: 8.25-13.7) had HIV infection. Diagnosis was microbiological in 505 cases (76%), anatomopathological in 60 (9%) and in 99 (14.9%) diagnosis was achieved by clinical and radiological criteria. Pulmonary localization (67.2%) was the most frequent form and was predominant in males, while lymph node and osteoarticular localizations were more frequent in women. The incidence of bacilliferous patients was 30.7/100,000 inhabitants. A delay of more than one month took place in the diagnosis of 66.4% of the bacilliferous patients. CONCLUSIONS: The incidence of tuberculosis in El Ferrol is very high with an important delay in the diagnosis of bacilliferous patients. The high percentage of patients admitted to hospital carries considerable costs in the treatment of the disease.

[Clinicoepidemiologic study of tuberculosis in the Ferrol area (1990-1991)]. / Estudio clinicoepidemiológico de la tuberculosis en el área de Ferrol (1990-1991).

BACKGROUND: To know about the main characteristics of tuberculous disease in our county. METHOD: A two-year period (1990-91), retrospective survey of the patients diagnosed of tuberculosis at a hospital from the north of La Coruña (Spain) was performed. A total of 322 cases were found, 165 diagnosed at the hospital and the remaining cases at the clinic. In the latter group, microbiological findings were the only diagnostic criteria considered. On the hospital-diagnosed cases three diagnostic categories were established: 1) definite; 2) probable, and 3) clinical diagnosis. RESULTS: The 1991 annual rate was 73.8 cases/100.000 inhabitants and the estimate rate was 80 cases/100.000. On analysis of the hospital-based diagnosed subgroup (165 patients), there was a male predominance (112/165), mean age was 35 years and 75% of patients were 44-year-old or younger. The most common clinical presentation was pulmonary (94 cases), pleural (33 cases) and pleuro-pulmonary disease (18 cases). Nine patients had concurrent infection with the human immunodeficiency virus. There was a culture-proven diagnosis of infection by Mycobacterium tuberculosis on 117/165 cases. A total of 115 cases (69.7%) received a three-drugs, 9 months therapy. The clinical outcome was fully satisfactory in 79/101 patients (78.2%) with a follow-up longer than 6 months. Only in one case there was a tuberculosis-related death. CONCLUSIONS: The high incidence rate, as well as age distribution and the frequency of pleural disease suggest a high tuberculous endemy at our region, over the rates from other parts of Spain.

[Endocarditis and splenic abscess from Salmonella no typhi]. / Endocarditis y absceso esplénico por Salmonella no typhi.

Several focal forms of infection by Salmonella no typhi, as the endocarditis, are very rare and the coexistence of splenic abscess is even more rare. We present a case in which the simultaneous presence of both infections was observed and we review the literature with special emphasis in the therapeutical aspects.