Vicente Falcó

Bacterial pneumonia in HIV-infected patients: a prospective study of 68 episodes

We collected clinical and microbiological observations, as well as follow-up on human immunodeficiency virus (HIV)-infected patients with bacterial pneumonia, and compared pneumococcal pneumonia in patients with and without HIV infection. Fifty five HIV-infected patients, who had had 68 episodes of bacterial pneumonia, were studied prospectively. Twenty one HIV-infected patients with pneumococcal pneumonia were compared to 69 non-HIV-infected patients with pneumococcal pneumonia. Aetiological diagnosis was established in 48 cases (71%). The most common causative agents were S. pneumoniae and H. influenzae. Sixty percent of episodes took place in asymptomatic carriers of HIV infection and 37% in acquired immune deficiency syndrome (AIDS) patients. Overall mortality was 10%. Fifty five percent of patients with follow-up had recurrent episodes. Bacteraemic pneumococcal pneumonia was more frequent in HIV- than in non-HIV-infected patients, and the mortality of pneumococcal pneumonia was also higher in HIV- (19%) than in non-HIV-infected (4.3%) patients. We conclude that bacterial pneumonia is a frequent problem in HIV-infected patients and that recurrent episodes are common. The clinical presentation of pneumococcal pneumonia is generally indistinguishable from that occurring in normal hosts, but bacteraemia is more common and the mortality is higher in HIV-infected patients.

Rubella infection in adult onset Still's disease

The aetiology of adult onset Stills disease remains unknown although some authors have tried to relate it to a viral infection.1-10 We describe here a case of typical adult onset Stills disease with a seroconversion in the rubella antibody titre to emphasise that it is probably more than a coincidental event. A 26 year old woman was admitted because of fever with chills, a pruritic rash, myalgia, sore throat and headache. At the time of physical examination the temperature was 40°C and the pulse rate 104 beat/min. The rash consisted of small pruritic macules over back, periorbicular, legs and arms. The pharynx was erythematous. Some small cervical lymphadenopathies were detected. The leucocyte count was 42.3 × 109 cells/l (93.2% neutrophils) and the haemoglobin concentration was 79 g/l. Liver enzymes were slightly increased, aspartate aminotransferase (AST) 0.80 μkat/l and alanine aminotransferase (ALT) 0.73 μkat/l, but increased to AST 11.77 μkat/l and ALT 7.68 μkat/l …

Diagnostic accuracy of pleural fluid polymorphonuclear elastase in the differentiation between pyogenic bacterial infectious and non-infectious pleural effusions.

Background and Objectives: To establish the diagnostic accuracy of the markers of neutrophil activity (elastase and lysozyme) determined in pleural fluid, for differentiating between pyogenic bacterial infectious and non-infectious pleural effusions. Patients and Methods: At our tertiary referral teaching hospital, 160 patients over 14 years with pleural effusion (PE), classified as pyogenic bacterial infectious (41 parapneumonic complicated, 32 parapneumonic non-complicated) and non-infectious (32 neoplasm and 55 undiagnosed pleural exudates) were examined in a prospective study. Polymorphonuclear elastase (PMN-E) was determined by an immunoactivation method and lysozyme by a turbidimetric method. Receiver operating characteristic (ROC) curves were used to evaluate diagnostic accuracy. Results: Pleural fluid PMN-E was the biochemical marker that best differentiated between pyogenic bacterial infectious and non-infectious PE. The ROC area under the curve (AUC) for PMN-E was 0.8276. A PMN-E value over 230 µg/l diagnosed infectious PE with a specificity of 0.81 and a sensitivity of 0.74. The ROC AUC for proteins plus lactate dehydrogenase was 0.7430. Differences between the two ROC curves were significant (p = 0.032). After excluding purulent parapneumonic complicated PE, the sensitivity of a pleural fluid PMN-E value equal to or greater than 230 µg/l was 0.64 and the specificity 0.81. Conclusions: Pleural fluid PMN-E was the marker that best differentiated infectious from non-infectious PE, and PMN-E values lower than 230 µg/l suggest non-infectious PE.

Tumoraciones diagnosticadas en 65 pacientes afectados de neurofibromatosis tipo I

Fundamento La aparicion de neoplasias es mas frecuente en la neurofibromatosis tipo I que en la poblacion general. Pacientes y metodo Se ha analizado a 65 pacientes diagnosticados de neurofibromatosis tipo I con el objetivo de conocer el tipo de neoplasias que han presentado. Resultados Se ha estudiado a 65 pacientes, 48 varones (74%) y 17 mujeres (26%). En total 47 pacientes (72%) padecieron un total de 67 tumores, de los cuales 47 (70%) fueron benignos y 20 (30%) malignos. Los principales tumores benignos fueron 25 neurofibromas, 11 tumores benignos del sistema nervioso central (SNC) y 11 tumores extraneurologicos. Los principales tumores malignos fueron 6 sarcomas, 6 carcinomas, tres tumores malignos del SNC y 2 leucemias linfoblasticas agudas. Conclusion En la neurofibromatosis la incidencia de neoplasias es alta y condiciona la morbimortalidad de los pacientes que la presentan.

Postprandial serum cholylglycine in the detection of hepatotoxicity induced by antituberculous agents

Abstract Background : Measurement of bile acid levels has been proven helpful in the detection of hepatic abnormalities when routine liver function test results are normal or only slightly elevated. We compared the effectiveness of postprandial serum cholylglycine (CG), as determined by RIA, with commonly used liver function tests (SGOT, SGPT, alkaline phosphatase, gamma-glutamyl transpeptidase) in order to detect liver injury in patients receiving antituberculous agents. Method : We studied 100 patients receiving antituberculous agents. Laboratory tests were carried out before the initiation of therapy and after 1, 2, 3 and 8 weeks of treatment. The risk of hepatotoxicity in relation to age (>35 years) and/or the addition of pyrazinamide to the 6-month isoniazid–rifampin regimen was also assessed. Results : The percentage of patients with hepatic dysfunction detected by abnormal serum CG levels was significantly greater than that detected with conventional liver function tests. Neither age over 35 years nor the use of pyrazinamide was associated with a greater number of abnormalities in liver function tests. Conclusion : Postprandial serum CG by RIA proved to be a sensitive parameter for detecting hepatotoxicity by antituberculous agents.