Endocarditis infecciosa por enterococo: descripción de 12 casos / Enterococcal infective endocarditis: description of 12 cases

Con el objetivo de identificar a los pacientes diagnosticados en nuestro hospital de endocarditis infecciosa por enterococo se ha realizado un estudio retrospectivo durante un período de 12 años (1994-2005), analizando sus características clínicas y microbiológicas, así como el tratamiento y la evolución de la enfermedad. Se encontraron 12 casos de endocarditis por enterococo, lo que representó el 6% del total de endocarditis y el 7% de las bacteriemias por enterococo. Se trataba de 8 hombres y 4 mujeres, con edades comprendidas entre los 37 y los 94 años. El microorganismo causante fue E. faecalis en 10 casos y E. faecium en 2 casos. Dos de los E. faecalis eran resistentes a aminoglucósidos. La válvula afectada con mayor frecuencia fue la aórtica, con 9 casos, seguida de la mitral, con 2 y de la tricúspide, 1 caso. En 10 pacientes la endocarditis se instaló sobre una válvula nativa y sólo en 2 casos sobre válvula protésica. Únicamente 5 pacientes tenían antecedentes de enfermedad valvular cardiaca. El tratamiento antimicrobiano más utilizado fue la combinación de ampicilina y gentamicina, que se empleó en 8 pacientes. Cuatro casos fueron tratados con monoterapia; 2 de ellos con ampicilina y 2 con vancomicina. Siete pacientes se complicaron con insuficiencia cardíaca, cinco de los cuales precisaron tratamiento quirúrgico de sustitución valvular aórtica. Los 4 enfermos tratados con monoterapia presentaron complicaciones graves, que provocaron la muerte de 2 pacientes

We have performed a retrospective study of patients diagnosed with infective endocarditis due to Enterococcus in our hospital for a period of 12 years (1994-2005). We review clinical and microbiological aspects, therapy, and outcome. We found 12 cases that were 6 % of total endocarditis, and 7% of enterococcal bacteremia. Eight cases were male, and 4 were female, aged between 37 and 94 years. The causative organism of endocarditis was E. faecalis in 10 patients and E. faecium in 2. Two E. faecalis were resistant to aminoglycosides. Aortic valve was the most frequently affected with 9 cases, followed by mitral valve (2 cases), and tricuspid valve (1 case). In 10 cases endocarditis affected a native valve,and only in 2 cases a prosthetic valve. Only 5 patients had underlying valve disease. The most frequently used antimicrobial therapy was the combination of ampicillin plus gentamicin (8 patients). Four cases were treated with monotherapy, 2 with ampicillin, and 2 with vancomycin. Seven patients suffered heart failure, and five of them required surgical therapy with aortic valve replacement. All the patients treated with monotherapy had severe complications, that led to death in 2 of them

[Enterococcal infective endocarditis: description of 12 cases]. / Endocarditis infecciosa por enterococo: descripción de 12 casos.

We have performed a retrospective study of patients diagnosed with infective endocarditis due to Enterococcus in our hospital for a period of 12 years (1994-2005). We review clinical and microbiological aspects, therapy, and outcome. We found 12 cases that were 6 % of total endocarditis, and 7% of enterococcal bacteremia. Eight cases were male, and 4 were female, aged between 37 and 94 years. The causative organism of endocarditis was E. faecalis in 10 patients and E. faecium in 2. Two E. faecalis were resistant to aminoglycosides. Aortic valve was the most frequently affected with 9 cases, followed by mitral valve (2 cases), and tricuspid valve (1 case). In 10 cases endocarditis affected a native valve, and only in 2 cases a prosthetic valve. Only 5 patients had underlying valve disease. The most frequently used antimicrobial therapy was the combination of ampicillin plus gentamicin (8 patients). Four cases were treated with monotherapy, 2 with ampicillin, and 2 with vancomycin. Seven patients suffered heart failure, and five of them required surgical therapy with aortic valve replacement. All the patients treated with monotherapy had severe complications, that led to death in 2 of them.

Infección por parvovirus B1 9 con rash petequial en un adulto / No disponible

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["Tropical" imported diseases: experience of a specialized unit in a general hospital]. / Enfermedades importadas "tropicales": experiencia de una consulta especializada en un hospital general.

BACKGROUND: In the last few years a considerable increase in imported diseases has occurred as a result of an increase in the numbers of travellers, international collaborative organizations, and immigrants. Altogether, this has prompted the setting-up of specialized units. MATERIALS AND METHODS: A report is given of the characteristics of patients attended at the Tropical Diseases Unit in the Basurto Hospital, since its set-up in March 1996 to March 1999. RESULTS: A total of 171 patients were attended at this unit after staying in tropical areas. Patients were classified as tourists (72), ONG collaborators (50) and immigrants (49). The origin areas were Africa (84 cases), Central America (49 cases), South America (23 cases) and Asia (15 cases). The main complaints included fever (61 cases), digestive symptoms (40 cases), skin problems (31 cases). The most common diagnoses were malaria (34), self-limited fever (17), self-limited diarrhoea (16), amebiasis (8), giardiasis (6), scabies (7) and cutaneous larva migrans (5). CONCLUSIONS: Health care activities included preventive issues, but mainly diagnosis and treatment of imported diseases. Among the attended individuals, there were not only travellers but also a significant proportion of immigrants and ONG collaborators. The most common diseases were malaria and digestive and cutaneous conditions.

[Acute pancreatitis and infection with the human immunodeficiency virus]. / Pancreatitis aguda e infección por el virus de la immunodeficiencia humana.

BACKGROUND: Retrospective study of the etiology and evolution of 40 episodes of acute pancreatitis in 28 patients infected with the human immunodeficiency virus (HIV). RESULTS: AIDS criteria were met by 89.3% of patients. The likely etiology was an opportunist infection in 32.5% of episodes, drug use in 22.5%, and biliary lithiasis in 5%. AP secondary to AIDS-associated cholangitis occurred in 35.7% of episodes. Sixty percent of episodes were severe in nature. The mortality rate reached 30%. CONCLUSIONS: AP in HIV infected patients: a) is more frequent in the advanced stages of disease; b) opportunistic infections and drugs are the most frequent causes in our environment; c) in a third of patients it is probably secondary to AIDS associated cholangitis; d) biliary lithiasis seems to be less common than in the general population, and e) it is associated with a high severity and mortality.

[Primary adrenal failure and AIDS: report of 11 cases and review of the literature]. / Insuficiencia suprarrenal primaria y SIDA: descripción de once casos y revisión de la literatura.

OBJECTIVE: To know the prevalence of adrenal insufficiency (AI) in our patients with acquired immunodeficiency syndrome (AIDS) and to compare the clinical manifestations with those reported in previous series in the literature. PATIENTS AND METHODS: Retrospective study with review of clinical records of patients with AIDS diagnosed of AI (plasma cortisol after synthetic ACTH < 18 micrograms/dl) in our hospital for a period of 6 and a half years. RESULTS: Eleven out of 65 patients (17%) with the hormonal study performed were diagnosed of AI. The prevalence of AI in our patients with AIDS was 1.66%. The response of plasma cortisol to synthetic ACTH was abnormal in the 11 patients (mean increase: 1.89 micrograms/dl). Nine out of the 11 patients had a decreased basal plasma cortisol level (mean: 4.75 micrograms/dl). Basal plasma ACTH levels were increased (mean: 638.9 pg/ml) in seven out of nine patients. Patients were severely immunosuppressed (mean CD4: 21/microliter). While the clinical course was subacute (mean: 5.1 weeks), nine out of the eleven patients developed an adrenal crisis which required emergency therapy. Ten patients had an opportunist infection--M. tuberculosis (3), M. avium-intracellulare (3), Cytomegalovirus (3), histoplasmosis (1)--which could involve the adrenal glands in ten patients. All patients responded to treatment but their mean survival was 5.6 weeks. CONCLUSIONS: Although the prevalence of AI in our patients with AIDS was low (1.66%), it is important to be aware of the disease and to order a basal plasma cortisol value after synthetic ACTH, as treatment improves the life quality of patients if AI is confirmed, despite a short survival time.