Buzón L

Visceral leishmaniasis in immunocompromised hosts

Visceral leishmaniasis is infrequently reported in immunocompromised hosts; hence, the clinical manifestations and outcome of the disease in these patients are unknown. In a series of 10 patients with visceral leishmaniasis complicating renal transplantation (three), hematologic neoplasms (two), systemic lupus erythematosus (two), or infection with human immunodeficiency virus (three), typical hallmarks of kalaazar such as enlargement of spleen or hyperglobulinemia were absent in three and six patients, respectively. Extensive visceral involvement was noted by biopsies or autopsies in four patients. Diagnosis was made during evaluation for fever of unknown origin. Myriads of amastigotes were seen in bone marrow smears. Measurement of antibodies against Leishmania donovani was positive in each patient tested. Ultimately, three patients died, and chronic infections refractory to treatment developed in two other patients. Visceral leishmaniasis is a potentially fatal infection in immunocompromised hosts. Current antiparasitic therapy frequently fails to eradicate L. donovani from infected tissues.

Infectious endocarditis in children

SummaryWith the object of analyzing current characteristics of infectious endocarditis (IE) in children, we carried out a retrospective study of 23 cases of IE in children under 15 years of age seen at the Hospital Ramón y Cajal in Madrid (Spain) between 1977 and 1985.The incidence was high (1.3 cases per 1000 children admitted). The male/female ratio was 2∶1. Eight patients were under 2 years of age and 15 over 2 years, the majority being adolescents. The two groups presented marked etiological and prognostic differences. Congenital heart disease was the predisposing factor in 20 of the 23 cases.Streptococcus viridans (nine cases) andStaphylococcus aureus (eight cases) were the most frequent organisms. Fourteen cases were on a native valve and nine were secondary (seven of these on prosthetic patches).In spite of advances in therapy, IE continues to be a severe illness: the mortality rate in our series was 26%. Factors associated with a poor prognosis were: age less than 2 years,Staphylococcus aureus as the causative agent, and the presence of prosthetic material.

Brucellosis and parenteral drug abuse

The Centers for Disease Control has used a medium similar to those in this study for testing TMP-SMZ against Haemophilus influenzae and a variety of nonfastidious bacteria (4, 5). In our study, we attempted to find a single suitable medium for all drug-organism combinations, but hemin (X factor) inhibited Streptococcus pneumoniae and NAD (V factor) inhibited Streptococcus pyogenes. These supplements also alkalinized the media, which lowered erythromycin MIC% as has occurred with gram-negative enteric bacilli (6). The horse serum was not necessary for all organisms but was included because it minimized the number of medium modifications necessary without affecting the activities of the drugs.