Mycobacterium africanum, an emerging disease in high-income countries?

BACKGROUND: Mycobacterium africanum is a cause of tuberculosis (TB) that has mainly been described in Africa, but immigration and travel patterns have contributed to the spread of the disease to other countries. METHODS: We retrospectively reviewed TB cases due to M. africanum during 2000-2010 in seven Spanish hospitals. Selected clinical charts were reviewed using a predefined protocol that included demographical, clinical and microbiological data and outcome. RESULTS: Although 57 cases were diagnosed, only 36 clinical charts were available for review: 82.8% were men and the mean age was 31.6 years (range 12-81). Forty-four cases were from Africa, 1 from the Philippines, 1 from India, and 4 from Spain, while the country of origin was unknown in 7 cases. The most frequent site of infection was the lung (58.3%). Four cases (6.9%) were resistant to at least one first-line anti-tuberculosis drug. CONCLUSIONS: Disease due to M. africanum in industrialised countries is mainly associated with immigration from endemic areas, although some cases also occur among native-born populations.

[Sample collection methods for urine culture and analysis]. / Métodos para la recogida de muestras de orina para urocultivo y perfil urinario.

A review of the scientific evidence available on the validity of existing sample collection methods for urine culture and analysis in childhood is presented. Few studies evaluating diagnostic tests have analyzed the various available techniques with respect to valid patterns of reference. Except for clean catch midstream urine samples, there are no estimators of validity (sensitivity, specificity, probability quotients) that can be generalized to most of the techniques and that could guide decision making. Consequently, data from descriptive studies on the risk of contamination, feasibility, safety and acceptability of each technique will have to be considered in decision making. Urine collection by means of adhesive perineal bag is the most widely used method in Spain in children who do not control urine emission. Nevertheless, this technique has a high risk of contamination and a very low positive predictive value, limiting its diagnostic utility. Urethral catheterization and suprapubic bladder aspiration are considered the tests of choice; however, because these tests are invasive, their use is restricted. Therefore, when choosing the technique to be used, the patient's circumstances and our working environment will have to be considered.

Drug-resistant tuberculosis in Castilla-León, Spain, 1996-2000.

SETTING: During 1996-2000, a regional anti-tuberculosis drug resistance survey was conducted in Castilla-León, Spain. OBJECTIVE: To determine the incidence of drug-resistant tuberculosis (TB) in newly treated human immunodeficiency virus (HIV) negative and HIV-positive TB patients. DESIGN: Nine hundred and eighty-five Mycobacterium tuberculosis strains isolated from HIV-negative (926) and HIV-positive (59) patients were studied (one strain per patient). Univariate and multivariate analyses were used to determine the prevalence of drug resistance in high-risk groups. RESULTS: Thirty-eight isolates (3.8%) showed resistance to one of the following drugs: streptomycin (S), isoniazid (H), rifampicin (R) or ethambutol (E). Of these, 36 (3.9%) were from HIV-negative and 2 (3.4%) from HIV-positive patients. The rate of drug resistance among HIV-negative patients was 1.2%, 2.0%, 0.3% and 0.8%, respectively, for S, H, R and E, and for HIV-positive patients it was 3.4%, 0%, 0% and 1.7%. Among the HIV-negative patients, monoresistance was observed in 32 (3.4%) strains and resistance to both H and R (multi-drug resistance) was detected in one. CONCLUSION: The incidence of primary drug resistance in the surveyed area was low and increased resistance was not observed in the HIV-positive group (P = 0.99). Routine surveillance of drug resistance is recommended by the TB control programme in representative patient populations to optimise treatment regimens.

[Cost benefit analysis of body surface cultures at a neonatal unit]. / Análisis de coste y rentabilidad de los cultivos superficiales en una unidad neonatal.

INTRODUCTION: Infection continues to be a cause of concern in neonatal units. The high cost of the body surface cultures used to study infection and their limited utility is controversial. MATERIAL AND METHODS: The medical records of newborns admitted for suspected infection in 1999 were retrospectively reviewed. Request criteria, cost, and the clinical utility of body surface cultures were analyzed. RESULTS: In 1999, body surface cultures were requested in 204 newborns admitted to hospital (70 % of all admitted newborns). Of these, six were diagnosed with bacteremia (6.23/1000; 95 % CI: 5.9-6.5). The most frequently isolated microorganisms were Escherichia coli and Streptococcus agalactiae. The total cost of body surface cultures was 6,510.95 euros (1,083,331 pesetas). In 25 % of cases the results of cultures influenced clinical decision making. The cost necessary to obtain clinical repercussion in a patient was 191.50 euros (31,863 pesetas). Requesting two body surface cultures only (otic and umbilical) halved the cost without diminishing their clinical utility. CONCLUSIONS: A considerable percentage of newborns admitted to hospital present suspected infection requiring microbiological studies. Although the cost of body surface cultures is high, the results of these cultures influence diagnostic and therapeutic decisions in a quarter of patients. We do not believe that eliminating the use of these cultures would be beneficial. However, their cost can be reduced by carefully selecting request criteria and by limiting cultures to two samples (otic and umbilical).

[Treatment review in rhinocerebral mucormycosis]. / Revisión del tratamiento en la mucormicosis rinocerebral.

The rhinocerebral mucormycosis is the more common form produced by Rhizopus, a genus of fungi. It's a serious infective disease with high mortality, that needs a precocious medical treatment. Amphotericin B is the choice medical treatment, but liposomal amphotericine B in recent years is a better drug, due to minor renal toxicity and greater tisular diffusion. Even can not to treat all affected areas it's necessary an extensive surgical treatment according to individual characteristics and disease evolution. A 56-year-old man with rhinocerebral mucormycosis, caused by Rhizopus, who was treated with liposomal-amphotericin B and extensive rhino-orbital surgery is presented.

[Familial outbreaks of fascioliasis: usefulness of serologic investigation by enzyme immunoassay]. / Brotes familiares de fascioliasis: utilidad del estudio serológico por enzimoinmunoanálisis.

BACKGROUND: To assess the usefulness of an enzyme immuno-assay test for the diagnosis of two familial outbreaks of Fasciola hepatica parasitosis in the Zamora area, where watercress are a normal part of the diet. PATIENTS AND METHODS: The microbiological diagnosis of two familial outbreaks of fascioliasis was analyzed, which included the search for eggs in feces by the Kato technique and two serologic tests, one screening test by indirect hemagglutination, and a confirmatory test by enzyme-immunoassay in 12 patients. RESULTS: Five out of the six seropositive patients had eggs detected in their feces. To note that two of the patients with eosinophilia that excreted eggs--one asymptomatic and the other with abdominal pain--had a positive result in the EIA test only and with high titers. CONCLUSIONS: The EIA test is useful for the diagnosis and study of fascioliasis outbreaks to interpret the significance of low titers in the screening test in patients with eosinophilia.

[Comments on the treatment of rhinocerebral mucormycosis]. / Comentarios sobre el tratamiento en la mucormicosis rinocerebral.

Rhinocerebral mucormycosis is a serious infectious disease with a high mortality rate that requires early medical treatment. Liposomal amphotericin B is the medical treatment of choice because of its low renal toxicity and good tissue diffusion. Surgical treatment is necessary, even if all affected areas cannot be reached. The surgical indication should be based on individual characteristics and disease evolution. The case of a 56-year-old man with rhinocerebral mucormycosis caused by Rhizopus and treated with liposomal amphotericin B and extensive rhino-orbital surgical treatment is commented.

Pediatric parenteral nutrition mixtures design program: validity and stability study.

The formulation and elaboration of a correct parenteral nutrition (PN) in infancy requires the use of many parameters, the realization of complicated mathematical calculations, and repeated and individualized adjustments of the final constituents. The use of computer programs in the confection of PN has simplified the whole process, but, to our understanding, the programs being used at the moment lack the flexibility needed to generalize its use in the pediatric age. The aim of this work is to present a new computer program able to make up complete pediatric units of PN by itself, which follow the nutritional requirements and the marketed preparations established for each clinical situation. The program provides, automatically, standard amounts for each nutrient, according to age, water needs, and route of administration. The program turns these amounts, which can be modified before or after knowing the final composition, into milliliters of each commercial product and provides a complete analysis of the PN solution. It is also possible to adapt the basic configuration of the program to the needs of each patient, modifying the nutritional requirements and the products that the program will use. In order to assess the validity of the program, we made up a series of PN solutions, for a simulated sample of patients, which represented different clinical situations and age groups. We analyzed the composition of the mixtures and its physical-chemical stability. No problems in the PN solutions generated by the program when using our standard configuration were found. A study of reproducibility was carried out and no difficulties of execution, errors, or differences in the composition of the PN solutions designed by the different physicians were found. Average time needed for the design of a PN was less than 5 min. The use of computer programs in the design of mixtures of PN reduces errors and time, allowing a better use of this technique of nutritional support.

[Focal infections caused by non-typhi Salmonella: a review of our case series and comparison with other series]. / Infecciones focales por Salmonella no typhi: revisión de nuestra casuística y comparación con otras series.

Nine cases of local infection due to non typhi Salmonella enterica, some of them of unusual localization, in 8 patients (mean age 64.9 +/- 12.4 years) attended in Zamora's Virgen de la Concha Hospital over a period of five years, are described. Focal salmonellosis represented 1.5% of non-typhi salmonellosis cases in that period (9 out of 606 detected cases). 6 of the 8 patients (75%) showed a predisposing disease. In two patients the previous existence of gastroenteritis due to Salmonella was assessed and only in one of them concomitant bacteremia was detected. Soft-tissue infections were the more frequent clinical feature: plantar abscess, two abdominal wall abscesses--one of them after cholecystectomy--post-pericardiotomy thoracic wall abscess and perianal abscess. Three soft-tissue infections were due to group B serotypes. 4 out of five soft-tissue infections evolved favorably with surgical treatment. The rest of the series is formed by two cases with acute cholecystitis in patients with previous cholelithiasis (one of whom relapsed originating an abdominal wall abscess), a recurrent pleural empyema and a purulent pericarditis. The pericarditis was produced by S. enteritidis. Patient showed signs of cardiac tamponade, his condition improving after pericardial drainage and parenteral and intrapericardial administration of ciprofloxacin. Epidemiologic and clinic characteristic of our series are compared with other series of focal salmonellosis.