[Isolation of Candida spp. from ascites in cirrhotic patients]. / Aislamiento de Candida spp. en ascitis de pacientes con cirrosis hepática.

The isolation of Candida spp. in ascites of cirrhotic patients is an uncommon situation in clinical practice. Factors that have been associated with increased susceptibility to primary fungal peritonitis are exposure to broad-spectrum antibiotics and immunosuppression, a typical situation of these patients. We report seven episodes of Candida spp. isolation in ascites of cirrhotic patients detected in our hospital during the past 15years.

Randomized Trial of Clarithromycin for Mediterranean Spotted Fever.

The classic antibiotic treatment for Mediterranean spotted fever (MSF) is based on tetracyclines or chloramphenicol, but chloramphenicol's bone marrow toxicity makes tetracyclines the treatment of choice. However, it is convenient to have alternatives available for patients who are allergic to tetracyclines, pregnant women, and children <8 years old. We conducted a randomized clinical trial to compare clarithromycin with doxycycline or josamycin in the treatment of MSF. Forty patients were evaluated (23 male; mean age, 39.87 years); 13 patients were aged <14 years. Seventeen patients received clarithromycin, and 23 received doxycycline or josamycin. The interval between the onset of symptoms and the start of treatment was 4.04 ± 1.70 days in the clarithromycin group versus 4.11 ± 1.60 days in the doxycycline/josamycin group (P = not significant [NS]). Time to the disappearance of fever after treatment was 2.67 ± 1.55 days in the clarithromycin group versus 2.22 ± 1.35 days in the doxycycline/josamycin (P = NS). The symptoms had disappeared at 4.70 ± 2.25 days in the clarithromycin group versus at 4.75 ± 3.08 days in the doxycycline/josamycin (P = NS). There were no adverse reactions to treatment or relapses in either group. In conclusion, clarithromycin is a good alternative to doxycycline or josamycin in the treatment of MSF.

Disseminated infection by Mycobacterium sherrisii and Histoplasma capsulatum in an African HIV-infected patient.

Mycobacterium sherrisii is a new species of opportunistic, slow-growing, non-tuberculous Mycobacterium closely related to Mycobacterium simiae that can currently be identified with the sequence of 16S rARN gene and the heat-shock protein 65. Few cases of patients infected by this Mycobacterium have been reported and all of them were associated with human immunodeficiency virus or other immunosuppressive conditions. Clinical management is complex, because there is not a clear correlation between the in vitro antibiotic susceptibility testing and the patient's clinical outcome.

Seroepidemiological survey of hantavirus infection in healthy people in Vallès Occidental, Barcelona.

INTRODUCTION: Hantaviruses are the etiological agents of hemorrhagic fever with renal syndrome in Europe and Asia, and hantavirus pulmonary syndrome in America. Approximately 150,000 cases are reported annually worldwide. In Spain, some hantavirus infection cases have been described. Besides, rodents that have been described as hantavirus reservoirs are present. The aim of the present study was to determinate the seroprevalence of hantavirus in humans in the northeast of Spain. MATERIALS AND METHODS: During a 5-month period, 217 serum samples were collected. The study population was stratified by age, gender, and residential area. Age, gender, residential area, contact with pets, contact with wild animals, contact with farm animals, and occupation were surveyed. Immunoglobulin G antibodies to Hantaan virus, Seoul virus, or Puumala virus were examined by immunofluorescence assay. Titles ≥1/32 against any of the hantavirus were considered positive. RESULTS: Four (1.8%) positive samples were detected. Age ranged from 14 to 67 years. Two subjects were male. Three samples reacted to both Puumala virus and Hantaan virus. The other one reacted against all three hantavirus surveyed. Titles ranged from 32 to 1024. The highest titles were found against Seoul virus. CONCLUSIONS: Our data show serological evidence about hantavirus infection among population of Catalonia, northeast of Spain. Seroprevalence rate was (around 2%) similar to other regions of Spain.

[Genitourinary mycobacteriosis: retrospective study of 45 cases in a general hospital]. / Micobacteriosis genitourinaria: estudio retrospectivo de 45 casos en un hospital general.

INTRODUCTION: Genitourinary tuberculosis (GUT) is the third most frequent extrapulmonary tuberculous infection, following pleural and nodal involvement. Associated clinical symptoms are mild, and the diagnosis and treatment of this condition are often delayed. METHODS: This study determines the clinical and epidemiological characteristics, and outcome of patients diagnosed with GUT in our center over the last 10 years. Patients with positive Löwenstein-Jensen urine or biopsy culture, or pathologic study suggestive of tuberculosis were included. Cases of multifocal tuberculosis and positive Löwenstein-Jensen, but with no urinary symptoms or radiological alterations, were considered to have mycobacteriuria. RESULTS: Forty-five patients were analyzed (62% men; mean age, 49.4 years). Among the total, 33% had a coexisting disease (14 were infected by human immunodeficiency virus). Twenty-six patients (57%) had renal tuberculosis, 5 (11%) orchiepididymitis, and 14 (31%) were classified as having mycobacteriuria. The most frequent clinical manifestations were urination syndrome (61%), low back pain (44%), and macroscopic hematuria (12%). Ziehl stain was positive in 38% cases. Urine culture was positive for other microorganisms in 9 patients (20%). Intravenous urography oriented the diagnosis in 87.5% of cases. The average interval between onset of symptoms and diagnosis was 15 months. Cure without sequelae was obtained in 60%. Surgery was indicated in 10 patients. CONCLUSIONS: The index of suspicion for GUT should be high when patients present with repeated urinary syndromes. The current use of imaging studies other than urography and the finding of other microorganisms in urine culture can delay the diagnosis.

Rickettsia slovaca infection in humans in the northeast of Spain: seroprevalence study.

Catalonia is an endemic area of Mediterranean spotted fever. In 1997, A. Lakos described a new tick-borne infectious disease called tick-borne lymphadenopathy. The causative agent is Rickettsia slovaca, which is transmitted by Dermacentor marginatus ticks. We have diagnosed human cases in Catalonia. The objective of this study was to determinate seroprevalence of R. slovaca infection in humans in the northeast of Spain. The population included 217 subjects from Catalonia, northeast of Spain and was stratified by age and living place (rural, suburban, and urban). Age, gender, residence area, contact with animals, occupation, and history of rickettsioses was surveyed. Immunoglobulin G was measured by indirect immunofluorescence assay. Titers >or= 1/40 were considered. Seroprevalence of R. slovaca was 5.5% at titers of 1/40-1/320. Eight (3.7%) sera had antibodies against R. slovaca exclusively. Four sera reacted also against Rickettsia conorii and/or Bar29. Seroprevalence of R. slovaca would range from 3.7% to 5.5%. The only statistically significant association was that between R. slovaca seropositivity and age. We present serologic evidence of R. slovaca infection among population of Catalonia, northeast of Spain.

[Infectious osteitis pubis]. / Osteítis infecciosa del pubis.

INTRODUCTION: Infectious osteitis pubis is an uncommon disease that must be distinguished from the noninfectious form of this condition. METHODS: Four cases of infectious osteitis pubis diagnosed over the last ten years in our hospital are described. RESULTS: The diagnosis was established on the basis of clinical symptoms, consistent imaging studies, and positive blood cultures (2/4) or bone biopsy (2/4). Prolonged antibiotic treatment with previous debridement of abscesses provided favorable outcomes (4/4). CONCLUSION: Infectious osteitis pubis should be suspected in patients with groin pain and predisposing factors.

Evidence of infection in humans with Rickettsia typhi and Rickettsia felis in Catalonia in the Northeast of Spain.

Murine typhus is a cause of fever of intermediate duration in the south of Spain, where antibodies against Rickettsia typhi and Rickettsia felis were observed in humans. This study presents the first report from the northeast of Spain. Human serum samples were tested by serological test. R. typhi and R. felis seroprevalences were 8.8% and 3.2%, respectively.

Short report: seroprevalence of human infection by Coxiella burnetii in Barcelona (northeast of Spain).

Coxiella burnetii is the causal agent of Q fever, a worldwide-distributed zoonosis, which is endemic in Spain. C. burnetii has an extensive reservoir, including farm animals and pets. The aim of this study was to determine the seroprevalence of C. burnetii in humans in Vallés Occidental (Barcelona, northeast of Spain) and its possible related risk factors. The prevalence of phase II antibodies from 216 subjects was determined by indirect immunofluorescence assay (IFA). Age, sex, living place, occupation, and contact with animals were surveyed. A 15.3% seroprevalence was found (> or = 1/40), and 8.8% of samples had titers > or = 1/80. Seropositive cases were significantly higher in patients > 44 years of age. No statistically significant correlation was found between seropositivity and the remaining variables studied. Therefore, infection by C. burnetii seems to be endemic in our region, with a prevalence ranging from 9% to 15%, depending on the titers that are to be considered significant.

Serological evidence of infection with Rickettsia typhi and Rickettsia felis among the human population of Catalonia, in the northeast of Spain.

Murine typhus (MT) is a cause of fever of intermediate duration in the south of Spain. Rickettsia typhi has been described as the MT etiological agent. Rickettsia felis produces an infection similar to MT. The aim of the study is to determine their seroprevalence in humans in Catalonia. Antibodies to Rickettsia typhi and Rickettsia felis from 217 serum samples were examined by indirect immunofluorescence assay (IFA). Age, gender, residence area, contact with animals, and occupation were surveyed. Rickettsia typhi and Rickettsia felis seroprevalences were 8.8% and 3.2%, respectively. Rickettsia typhi was present in 7.6% of the samples in urban, 8.5% in semirural, and in 21.4% in rural areas, whereas Rickettsia felis was present in 3.5% in urban, 1.7% in semirural, and 7.1% in rural area. The only statistically significant association observed was that between Rickettsia felis seropositivity and age. Our data seem to indicate the presence of Rickettsia typhi and Rickettsia felis in humans in Catalonia.

Prevalence of Bartonella henselae in cats in Catalonia, Spain.

Bartonella henselae, an emerging pathogen bacterium, is the main causative agent of the cat scratch disease. While the first clinical descriptions were associated with immunosupressed patients, it is now more frequently observed in patients with normal immune status (endocarditis and bacteremia). Cats were found to be the only known reservoir of B. henselae. In this paper, we report the results obtained in the first study made to investigate the prevalence of B. henselae bacteremia and antibodies in domestic cats in Catalonia, Spain. Serum samples from 115 cats were tested for antibodies to B. henselae by immunofluorescent antibody testing, and 29.6% had a titer >or= 1:64. Seven B. henselae strains were isolated using standard culture techniques and amplification by a polymerase chain reaction and subsequent sequencing was performed on the intergenic spacer region between the 16 and 23S ribosomal RNA genes. Of all factors concerning the studied bacteremia rate (age, sex, habitat, presence of antibodies, contact with animals, parasites), only the presence of antibodies to B. henselae was statistically significant.

Bacillary angiomatosis caused by Bartonella quintana.

Bacillary angiomatosis is a disorder of neovascular proliferation involving skin and lymph nodes of immunosuppressed patients. Bartonella henselae or Bartonella quintana have been inculpated as causative by direct culture or PCR amplification of DNA sequences. Here, we report the clinical evolution of a patient infected with human immunodeficiency virus (HIV) whose B. quintana infection was diagnosed by PCR.