C. Martínez Vázquez

An update on infective endocarditis of dental origin.

Abstract Objectives : The aim of this study was to analyse the prevalence of dental treatment and oral infections related to the development of infective endocarditis (IE). Methods : A retrospective study of 103 cases of IE diagnosed from 1997 to 1999 was conducted in Galicia, Spain. Results : According to the Dukes endocarditis criteria (1994), 87 cases (84.5%) were considered definite IE. A presumed oral portal of entry was recorded in 12 patients (13.7%). Oral infections were held responsible in six cases while the remaining six had received dental treatment in the previous three months (three tooth extractions, one scaling, one cleaning, one fillings). In eight cases of IE (66.6%) typical oral pathogenic microflora was identified, with Streptococcus viridans being the most frequent. In four patients no previous cardiac disease was recorded. Conclusions : These results suggest that prevalence and characteristics of IE cases of dental origin did not change significantly in the last decades. The need for increased oral hygiene and improved dental care should be emphasized on preventing IE of dental origin. Continued education of physicians and dentists on the importance of the knowledge of current prophylactic protocols should also be considered.

Bacteriemia por Enterococcus faecalis

Objetivo Evaluar las caracteristicas epidemiologicas, clinicas, microbiologicas y pronosticas de la bacteriemia por Enterococcus faecalis. Metodos Estudio retrospectivo de historias clinicas de pacientes con bacteriemia por E. faecalis en un periodo de 7 anos (enero 1995-diciembre 2001). Resultados Se documentaron 95 episodios de bacteriemia: el 83,2% de adquisicion intrahospitalaria, el 85,3% en relacion con procedimientos invasivos previos y el 9,5% en neonatos. El 57,9% de los sujetos tenia una enfermedad subyacente y el 41,1% habia recibido previamente antibioticos de amplio espectro sin actividad frente al enterococo. El 32,6% de las bacteriemias se considero primaria, y en el resto los focos de infeccion mas frecuentemente asociados fueron cardiovasculares, intraabdominales, urogenitales y pulmonares. El estudio de resistencias demostro un solo caso de resistencia a ampicilina y ninguno a glucopeptidos. La mortalidad global fue del 23,9%, aunque solo en el 9,9% se considero directamente atribuible a la bacteriemia. En el analisis multivariante el tratamiento inadecuado y la ventilacion mecanica fueron factores de mal pronostico. Conclusiones En nuestro medio la bacteriemia por E. faecalis es fundamentalmente una infeccion nosocomial que afecta a pacientes con graves enfermedades subyacentes sometidos a procedimientos invasivos y tratamientos antibioticos previos de amplio espectro. La ampicilina sigue siendo el tratamiento de eleccion. La inadecuacion del tratamiento antibiotico empirico inicial y la ventilacion mecanica son factores de mal pronostico.

Failure of Indinavir to Inhibit Candida albicans In Vitro

1. Alvar I, Canavate C, Gutierrez-Solar B, Jimenez M, Laguna F, Lopez-Velez R, Molina R, Moreno J: Leishmania and human immunodeficiency virus coinfection: the first ten years. Clinical Microbiology Reviews (1997) 10 :298–319 2. Gradoni L, Scalone A, Gramiccia M, Troiani M: Epidemiological surveillance of leishmaniasis in HIV-1 infected individuals in Italy. AIDS (1996) 10 :785–791 3. World Health Organization: Leishmania/HIV coinfection. Epidemiological analysis of 692 retrospective cases. Weekly Epidemiological Record (1997) 72 :49–54 4. van Eys GJJM, Schoone GJ, Kroon CM, Ebeling SB: Sequence analysis of small subunit RNA genes and its use for detection and identification of Leishmania parasites. Molecular and Biochemical Parasitology (1992) 51 :133–142 5. Minodier P, Piarroux R, Gambarelli F, Joblet C, Dumon H: Rapid identification of causative species in patients with Old World leishmaniasis. Journal of Clinical Microbiology (1997) 35 :2551–2555 6. Laguna F, Garcia-Samaniego J, Soriano V, Valencia E, Redondo C, Alonso MJ, Gonzalez-Lahoz JM: Gastrointestinal leishmaniasis in human immunodeficiency virus-infected patients: report of five cases and review. Clinical Infectious Diseases (1994) 19 :48–53 7. Villanueva JL, Torre-Cisneros J, Jurado R, Villar A, Montero M, López F, Sánchez-Guijo P, Kindelán JM: Leishmania oesophagitis in an AIDS patient: an unusual form of visceral leishmaniasis. American Journal of Gastroenterology (1994) 89 :273–275 8. Gutiérrez-Macias A, Alonso-Alonso JJ, Aguirre-Errasti C: Esophageal leishmaniasis in a patient infected with the human immunodeficiency virus. Clinical Infectious Diseases (1995) 21 :229–230 9. Piarroux R, Gambarelli F, Dumon H, Fontes M, Dunan S, Mary C, Toga B, Quilici M: Comparison of PCR with direct examination of bone marrow aspiration, myeloculture and serology for diagnosis of visceral leishmaniasis in immunocompromised patients. Journal of Clinical Microbiology (1994) 32 :746–749 10. Osman OF, Oskam L, Zijlstra EE, Kroon NCM, Schoone GJ, Khalil EAG, El-Hassan AM, Kager PA: Evaluation of PCR for diagnosis of visceral leishmaniasis. Journal of Clinical Microbiology (1997) 35 :2454–2457

Pielonefritis y embarazo: Experiencia durante un año en un hospital general

Objetive: The incidence of pyelonephritis during pregnancy reaches 2%. We recommend obtaining a urinalysis during the first trimester in order to detect asymptomatic bacteriuria and treat those cases with positive urine culture. Methods: We restrospectively reviewed all cases diagnosed as acute pyelonephritis in pregnant women admitted to our hospital during 2004 and analyzed demographic data, diagnostic methods, treatments, outcome, new episodes and the impact on the date of birth and the newborn. Results: We studied all the cases of pyelonephritis in pregnant women diagnosed in our hospital for one year (4,700 childbirths). We found that screening of bacteriuria was done incorrectly based on the presence ofpyuria in the sediment of urine specimen. The incidence was 0.21 %, and such a low rate might be related to the possibility that some patients were not admitted in our hospital. Prognosis was excellent being E. coli the only agent isolated in all cases. Pyelonephritis that occurred during the first trimester relapsed. Conclusions: A urine culture must be obtained during the first trimester of pregnancy and should be repeated after completion of adequate therapy of an infection, particularity if bacteriuria is detected in the first trimester.

Prevalencia del síndrome antifosfolípido en pacientes menores de 65 años con infarto agudo de miocardio

Introduccion El sindrome antifosfolipido (SAFL), caracterizado por fenomenos tromboticos y/o perdidas fetales y/o plaquetopenia asociados a anticuerpos antifosfolipidos, puede cursar con infarto agudo de miocardio (IAM). La presencia de SAFL en pacientes jovenes con IAM oscila entre el 14% y el 21%, patologia que conlleva actitudes terapeuticas especificas al presentar en su evolucion nuevos eventos tromboticos segun algunos autores. Material y Metodos Se realiza un estudio prospectivo en 25 pacientes con IAM y edad inferior o igual a 65 anos que ingresaron en nuestro centro a lo largo de un ano, comparandolos con controles con factores de riesgo similares. Se determinan anticuerpos anticardiolipina (ACA) IgG e IgM en las primeras 24 horas desde el inicio de la clinica de IAM y a los tres meses. Resultados El seguimiento oscilo entre tres meses y un ano. En el grupo de pacientes, la positividad de ACA en las dos determinaciones fue superior (12%) a la del grupo control (5%) (p = 0,36). La positividad de ACA en dos ocasiones no fue un factor de riesgo para nuevos eventos tromboticos. Conclusion La positividad de ACA es superior en el grupo de pacientes con IAM (determinados precozmente y a los tres meses) que en la poblacion general, si bien la presencia de dichos anticuerpos no incrementa el riesgo de nuevos eventos tromboticos postinfarto.

Linfadenitis necrotizante histiocitaria o enfermedad de Kikuchi: Apariencia radiológica mediante TC

: Histiocytic necrotizing lymphadenitis, Kikuchi Fujimotos disease (KFD) is characterised by fever and lymphadenopathy, usually large cervical, unilateral lymph nodes. Such clinical presentation demands a work-up to exclude serious medical conditions like malignancy and infections. Foci of necrosis with lymphocytic Histiocytic predominance in association with scarce polymorphonuclear cells on lymph node examination, confirm the diagnosis of KFD. Many different patterns of computed tomographic (CT) appearance of KFD have been reported. We describe the CT scan finding in two patients with this disease. All our cases showed, after two and three weeks of evolution respectively, enlarged lymph nodes with hypodense centres and peripheral ring enhancement. These radiological alterations correlated with the central lymph node necrosis found in the anatomopathological studies. In conclusion, KFD should be considered in patients with fever, cervical lymph node enlargement and CT scan showing hypointense centres and peripheral ring enhancement.

Absceso epidural espinal sin espondilodiscitis. Descripción de cuatro casos

Realizamos un estudio retrospectivo de los casos diagnosticados de absceso epidural espinal sin espondilodiscitis asociada recogidos a lo largo de cinco anos en nuestro hospital. Describimos cuatro casos que afectan a varones con una edad comprendida entre 59 y 67 anos. Todos presentaron fiebre, reactantes de fase elevados y dolor raquideo, apreciandose en tres de ellos datos de compresion medular. Dos pacientes tenian enfermedades de base: diabetes mellitus y linfoma no Hodgkin. En 3 pacientes se aislo S. aureus y S. agalactiae en el otro. La localizacion del absceso fue variable, siendo el espacio epidural posterior el mas frecuentemente afectado. Un paciente se trato solo con antibioticos, siendo sometidos los tres restantes tambien a intervencion quirurgica. Se evidencio en todos ellos una completa resolucion clinica, analitica y radiologica.