RESUMO
OBJECTIVE: Although the incidence of human immunodeficiency virus (HIV)-associated tuberculosis (TB) has decreased, changes in other characteristics of the disease are largely unknown. To describe the trends in TB in patients infected with HIV from 1995 to 2013. METHODS: We review all cases of TB in a tertiary hospital in Madrid, Spain. RESULTS: Among 1,284 patients diagnosed of TB, 298 (23%) were coinfected with HIV. The prevalence of HIV infection during the period of study has decreased from 40% to 14% (p for the trend < 0.001). Clinical presentation has also changed. Although pulmonary and extrapulmonary TB has remained unchanged, miliary presentation has significantly decreased (from 36% to 22%, p = 0.005). The 4-drug regimen was the preferable scheme, with higher implementation at the end of the study period (82% from 1995-1999 to 95% in 2010-2013, p = 0.43). Factors such as treatment failure (OR: 11.7; CI 95%: 3.12-44.1) and miliary form (OR: 2.8; CI 95%; 1.09-7.3) were independently associated with TB related mortality, while the longer duration of treatment was as a protective factor (OR 0.7; CI 95%: 0.6-0.8). CONCLUSIONS: HIV has decreased very significantly as a risk factor for the development of TB. Despite improvement in the treatment of both TB and HIV, and in overall mortality, deaths attributable to the disease in this population remain high mostly in miliary and relapsing forms.
Assuntos
Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Tuberculose/complicações , Tuberculose/epidemiologia , Adulto , Antituberculosos/farmacologia , Antituberculosos/uso terapêutico , Farmacorresistência Bacteriana , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis , Prevalência , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Centros de Atenção Terciária , Resultado do Tratamento , Tuberculose/mortalidade , Tuberculose Miliar/epidemiologia , Tuberculose Miliar/mortalidadeRESUMO
BACKGROUND: There are a lot of controversies related to the diagnostic and therapeutic management of Whipple s disease. PATIENTS: We present 4 cases of Whipple's disease, collected from the Gastroenterology Service of the Hospital Ramon y Cajal, from Madrid. RESULTS: The average age was 69. The first symptoms were in order of frequency, arthralgias, loss of weight, arthritis, diarrhoea, fever, epigastric pain and neurologic symptoms. Three were treated with trimethoprim-sulphamethoxazol and one with cefixime. There were no recurrences. CONCLUSIONS: The endoscopic appearance of the duodenum is fundamental for the suspicion of the disease. The initial parenteral treatment may consist of ceftriaxone and try to avoid using streptomycine because of its toxicity, followed by oral trimethoprim-sulphamethoxazol. As an alternative to the latter, cefixime is usually effective. The typical findings of the duodenum biopsy can persist several months or years after finishing the treatment, decreasing the value of endoscopic pursuit after treatment.
Assuntos
Doença de Whipple , Idoso , Biópsia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Whipple/diagnóstico , Doença de Whipple/tratamento farmacológicoRESUMO
Transrectal prostate biopsy is the most accurate method for prostate cancer diagnosis. Although an antimicrobial prophylaxis is employed in most cases, infectious complications are among the most severe. We present a case of E. coli multirresistant meningitis after transrectal prostate biopsy despite quinolone prophylaxis.
Assuntos
Biópsia/efeitos adversos , Farmacorresistência Bacteriana Múltipla , Infecções por Escherichia coli/etiologia , Escherichia coli/efeitos dos fármacos , Meningites Bacterianas/etiologia , Próstata/patologia , Reto/microbiologia , Idoso , Amoxicilina/farmacologia , Amoxicilina/uso terapêutico , Dano Encefálico Crônico/etiologia , Cefepima , Cefalosporinas/farmacologia , Cefalosporinas/uso terapêutico , Ciprofloxacina/administração & dosagem , Ciprofloxacina/farmacologia , Ciprofloxacina/uso terapêutico , Ácido Clavulânico/farmacologia , Ácido Clavulânico/uso terapêutico , Confusão/etiologia , Quimioterapia Combinada/farmacologia , Quimioterapia Combinada/uso terapêutico , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/microbiologia , Gentamicinas/farmacologia , Gentamicinas/uso terapêutico , Humanos , Masculino , Meningites Bacterianas/complicações , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/microbiologia , Pré-Medicação , Próstata/diagnóstico por imagem , Reto/diagnóstico por imagem , Ultrassonografia , Vancomicina/farmacologia , Vancomicina/uso terapêuticoRESUMO
OBJECTIVE: To identify risk factors for colonization and bacteremia among patients with non-tunnelled central venous catheters. MATERIALS AND METHODS: A prospective study was conducted of a cohort of patients carrying non-tunnelled central venous catheters. Different parameters were obtained and the degree of its association with colonization of the distal portion of the catheter or with bacteremia associated with colonization was estimated. The CDC (centers for Disease Control) diagnostic criteria of colonization and catheter-related bacteremia were used. RESULTS: A total of 118 catheters were eventually analyzed, corresponding to 114 patients, with a catheterization mean time of 14 +/- 8 days (mean +/- SD); out of these 114 patients, 51 were colonized and in 22 the presence of associated bacteremia was confirmed. The parameters associated with a higher risk for catheter colonization included length of colonization, femoral location, number of lumina and a vital prognosis lower than one month. All these factors, with the exception of the increase in the number of lumina, showed an independent association with colonization on the multivariate analysis [catheterization length (in weeks): OR 1.46; 95% CI: 1.0-2.11; femoral location: OR 3.73; 95% CI: 1.16-11.9; vital prognosis lower than one month: OR 12.7; 95% CI: 1.4-112.7]. As for risk for catheter-related bacteremia, the univariate analysis showed an association with catheterization length and a vital prognosis lower than one month; the latter was the only factor that maintained an independent association in the multivariate analysis (OR 5.75; 95% CI: 1.17-28.27). CONCLUSION: The present study documents the relevance of prolonged catheterization as a consistent risk for colonization of non-tunnelled central venous catheters. This risk increases independently in canalization at femoral site and particularly among severely ill patients. The presence of these factors allows the identification of a high risk population for the development of catheter related bacteremia.