Lourdes Mateu

Community-acquired Legionella pneumonia in Elderly patients: Characteristics and outcome

OBJECTIVES: To compare the risk factors, clinical and laboratory features, and outcome of community‐acquired pneumonia (CAP) caused by Legionella pneumophila in elderly (aged ≥65) and younger patients.

Streptococcus pneumoniae and Legionella pneumophila pneumonia in HIV-infected patients

We compared the epidemiological data, clinical features and mortality of community-acquired pneumonia (CAP) by Streptococcus pneumoniae and Legionella in HIV-infected patients and determined discriminative features. An observational, comparative study was performed (January 1994 to December 2004) in 15 HIV patients with CAP by Legionella and 46 by S. pneumoniae. No significant differences were observed in delay until initiation of appropriate antibiotic therapy. Smoking, cancer and chemotherapy were more frequent in patients with Legionella pneumonia (p=0.03, p=0.00009 and p=0.01). Patients with Legionella pneumonia had a higher mean CD4 count (p=0.04), undetectable viral load (p=0.01) and received highly active antiretroviral therapy more frequently (p=0.004). AIDS was more frequent in patients with S. pneumoniae pneumonia (p=0.03). Legionella pneumonia was more severe (p=0.007). Extrarespiratory symptoms, hyponatraemia and increased creatine phosphokinase were more frequent in Legionella pneumonia (p=0.02, p=0.002 and p=0.006). Respiratory failure, need for ventilation and bilateral chest X-ray involvement were of note in the Legionella group (p=0.003, p=0.002 and p=0.002). Mortality tended to be higher in the Legionella group (6.7 vs 2.2%). In conclusion, CAP by Legionella has a higher morbimortality than CAP by S. pneumoniae in HIV-infected patients. Detailed analysis of CAP presentation features allows suspicion of Legionnaires’ disease in this subset.

Impact of Copper and Silver Ionization on Fungal Colonization of the Water Supply in Health Care Centers: Implications for Immunocompromised Patients

Copper and silver ionization is a well-recognized disinfection method to control Legionella species in water distribution systems in hospitals. These systems may also serve as a potential indoor reservoir for fungi. The prevalence of fungi was significantly lower in ionized than in nonionized water samples from health care facilities. The clinical consequences of this finding require further investigation.

Impact of the 2009 influenza A H1N1 pandemic on invasive pneumococcal disease in adults

Abstract Background: The incidence of invasive pneumococcal disease (IPD) appears to be associated with influenza. The objectives of this study were to evaluate the changes in IPD incidence and clinical data as well as the trends in Streptococcus pneumoniae serotype distribution in adults during the peak period of the 2009 influenza A H1N1 pandemic (IAP). Methods: We performed a prospective multicentre study on IPD from week 42 to 48, 2009 in an area of Barcelona (Catalonia, Spain) covering 1,483,781 adult inhabitants. Serotyping was done by Quellung reaction. The data from 2009 were compared to those from the same periods in 2008 and 2010. Results: Two hundred and three cases of IPD were detected during 2009, compared with 182 in 2008 and 139 in 2010. The incidence of IPD during the 7-week study period in 2009 (2.89) was statistically higher than that observed in 2008 (1.96) and 2010 (1.46). IAP was confirmed in 3/30 patients during the 2009 study period. Patients with IPD in 2009 were significantly healthier and younger than those in the other years, although the mortality was higher than in 2008 (p = 0.05) and 2010 (p > 0.05). Eleven (10 non-PCV-7) serotypes not present in 2008 appeared in 2009. Conclusions: During weeks 42 to 48, in which the 2009 IAP peaked in Catalonia, the incidence of IPD was statistically higher than that observed in the same time period in 2008 and 2010, with some differences in the epidemiological data, showing a close relationship between S. pneumoniae and influenza.

Artritis séptica por Staphylococcus aureus resistente a la meticilina en adultos

INTRODUCTION Septic arthritis due to methylcyllin resistant Staphylococcus aureus (MRSA) is a serious infection that has increased in incidence in the past 10years. METHODS We conducted a retrospective study (1984-2011) in which a description of the clinical and epidemiological characteristics of MRSA arthritis in adults was performed and then compared to native joint infections caused by MRSA vs. methylcyllin sensitive Staphylococcus aureus (MSSA). RESULTS Fourteen MRSA infections were included (7 native joint, 5 prosthetic and 2 bursae). No case was polyarticular. There was significant comorbidity, although none was associated to rheumatoid arthritis. Seven patients had bacteremia. Four required surgical treatment. Six died. When comparing the 7 patients with native joint MRSA infection with the 17 cases caused by MSSA, no significant differences in risk factors were seen, except more malignancies in the MRSA group. The infection was polyarticular in 7 cases (41%) of the MSSA group. Bacteremia was more frequent in the MRSA group (71.4 vs 58.8%). Empirical antibiotic was useful in 28.6% of MRSA cases versus 100% of MSSA cases. There was a greater tendency to associated mortality in MRSA arthritis (57.1% vs 17.6%, P=.07). CONCLUSIONS MRSA septic arthritis is a serious condition that occurs in the elderly and patients with high comorbidity. It is usually monoarticular, with positive blood cultures and higher mortality than MSSA arthritis. In patients at risk, vancomycin empiric antibiotic therapy is indicated.

Mansonella perstans aislada en una punción-aspiración de glándula salival

Los autores no manifiestan ningun conflicto de intereses. Las parasitosis cronicas por nematelmintos de localizacion histica (filarias) son comunes en los ecosistemas tropicales; sus larvas (microfilarias) se aislan en los vasos linfaticos, la piel o la sangre. Se presenta el caso de un paciente nigeriano afecto de insuficiencia renal grave que ingreso por un absceso en la glandula submandibular derecha. En la puncion- aspiracion con aguja fina se identifico una microfilaria de la especie Mansonella perstans . En el posterior estudio anatomopatologico posquirurgico de la glandula, se determino infiltrado inflamatorio agudo con abundantes eosinofilos y microfilarias. En la revision bibliografica efectuada se constatan algunos aislamientos de filarias hematicas o linfaticas especialmente en tejidos epiteliales o glandulares; todos ellos, al igual que el que se presenta, en condiciones de inflamacion o malignidad. La decision de tratar o no con ivermectina o mebendazol una filariasis de escasa patogenicidad como las del genero Mansonella debe individualizarse en cada caso.

Mansonella perstans Isolated on Aspiration Puncture of a Salivary Gland

Chronic parasitosis due to nematode worms (filariae) in tissue are very common in tropical ecosystems; their larvae (microfilariae) have been isolated in lymph vessels, skin, and blood. The case reported here is of a Nigerian patient suffering severe renal failure and admitted owing to the presence of a right submandibular gland abscess. In the FNAP, the presence of a Mansonella perstans microfilaria was identified. Post-surgery examination of pathology samples from the gland reported an acute inflammatory infiltrate including abundant eosinophils and microfilariae. There are some reports in the literature of haematic or lymphatic microfilariae, especially in epithelial or glandular tissues, and, as in this case, in inflammatory or malignant conditions. Both ivermectin and mebendazol are used for treatment; the scant pathogenicity of the genus Mansonella should, however, lead to an individualized decision.