[Comparative study of prognostic and risk factors for mortality in polymicrobial bacteremia-fungemia in a university hospital: development over 10 years]. / Estudio comparativo de los factores de riesgo y pronósticos de mortalidad en las bacteriemias-fungemias polimicrobianas de un hospital universitario: evolución en 10 años.

OBJECTIVE: Eighty-two episodes of polymicrobial bacteremia in two time periods, 1986-87 and 1996-97, were compared to assess differences in risk factors and outcome to mortality. METHODS: A prospective, concurrent, anterograde study with univariate analysis of all episodes of polymicrobial bacteremia was performed in Hospital de la Princesa. Logistic regression analysis was applied to all significant variables (p < 0.05) in the univariate analysis in either of the two time periods. RESULTS: Variables showing statistically significant differences in incidence between the two time periods included the following: hospital acquired bacteremia; previous use of antibiotics; genitourinary, respiratory and cardiovascular manipulations; septic metastases; and absence of leukocytosis. These factors were more frequently present during 1986-87 than during 1996-97. The overall RR of outcome to mortality was five-fold greater during the first period than the second: RR 5.6 (CI 1.76-17.56) p < 0.001. The clinical characteristics at the onset of bacteremia associated with mortality in the first period were: underlying disease - < RR 2.20 (CI 1.18-4.08), steroid treatment - < RR 4.24 (CI 0.68-26.59), hypotension - < RR 2.05 (CI 1.0-4.17), and disseminated intravascular coagulation - < RR 2.31 (CI 1.69-3.35). Clinical characteristics at the onset of bacteremia associated with mortality in the second period were: hypotension - < RR 1.44 (CI 1.01-2.08), underlying disease - < RR 1.16 (CI 1.02-1.34), and disseminated intravascular coagulation - < RR 6.40 (CI 1.15-35.69). The variables independently associated with mortality in polymicrobial bacteremia were: period - < RR 2.05 (CI 1.50-2.10), underlying disease - < RR 7.05 (CI 2.68-7.50), hypotension - < RR 7.06 (CI 3.80-7.29), and (probably) vascular manipulations - < RR 3.41 (CI 0.85-4.53). CONCLUSION: Polymicrobial bacteremia-associated mortality was five-fold greater in 1986-87 than in 1996-97. The variables independently associated with mortality risk were underlying disease, hypotension, the period studied (which would include a number of variables not analyzed in this work) and, probably, vascular manipulations.

Early single dose therapy with ofloxacin for empirical treatment of acute gastroenteritis: a randomised, placebo-controlled double-blind clinical trial.

This study is a double-blind, placebo-controlled, randomised clinical trial to evaluate the clinical and microbiological efficacy and safety of single dose ofloxacin for acute diarrhoea. Eligible patients were 16 years of age or older with a history of acute diarrhoea lasting no more than 48 h; 117 patients were randomised and 97.4% (114/117) were evaluable for efficacy. Of these, 58% were suspected to have ingested contaminated foods. Enteric pathogens were isolated in 61.5% of the patients, Salmonella enteritidis being reported in 87.5%. The patients received either a single 400 mg dose of ofloxacin, or placebo. The average duration of diarrhoea was 2.56 +/- 2.21 days in the ofloxacin group and 3.41 +/- 2.5 in the placebo group (P = 0.117). The average duration of fever was 0.63 +/- 0.95 days in the ofloxacin group and 1.05 +/- 0.96 in the placebo group (P = 0.02). Symptoms remained unchanged for more than 48 h in only 7% of the patients who received ofloxacin, compared with 12% in the placebo group (P = 0.485). Only 32% of patients in the ofloxacin group remained culture positive after 48 h compared with 59% in the placebo group (P = 0.0018). These represent a relative risk reduction (RRR) for stool clearance of 45.5% and absolute risk reduction (ARR) of 27% (95% Cl, 8-44.7), with a number of patients needed to treat (NNT) of 3.7 (95%, 2.7-11.3). After 15 days, 23.3% of patients in the ofloxacin group had a positive culture compared with 28.9% in the placebo (P = 0.63). This represents an RRR of 19%, an ARR of 5.6% and a NNT of 17.8. Adverse events in the ofloxacin group were observed in only one patient who reported headache and in one patient in the placebo group who developed a rash. In summary, empirical treatment with a single dose of ofloxacin in acute diarrhoea did not reduce the intensity or duration of symptoms (except possibly length of fever). It was notable however that stool cultures became negative for S. enteritidis by 48 h, with no relapse after 2 weeks of follow-up.

[Diabetes mellitus induced by pentamidine, without previous episodes of hypoglycemia, in patients with AIDS]. / Diabetes mellitus inducida por pentamidina, sin episodios previos de hipoglucemia, en pacientes con SIDA.

The onset of a pneumonia by P. carinii in AIDS patients have force scientist to look for others therapies against this parasite. It is more necessary when the first line treatment which is cotrimoxazol produced secondary effects or not therapeutic effects. Pentamidine which is an agent usually used to treat leishmaniasis and trypanosomiasis, but it is an alternative for P. carinii infection. The problems are the frequent and severe secondary effects when administered by continuous infusions and less when it is inhaled. Between those effects are the changes in carbohydrate metabolism which are 9% of them. It is frequent observe hypoglycemia during infusion following by hyperglycemia in 5% of the cases which convert the patients in diabetic insulinodependent. A case of a patient who developed diabetes mellitus insulinodependent, 10 days after the end of pentamidine treatment, without previous episodes of hypoglycemia, is presented. The medical literature is reviewed.

Hairy leucoplakia--a clinical, histopathological and ultrastructural study in 33 patients.

Thirty-three cases of hairy leucoplakia (HL) in HIV-positive patients were studied. The most frequent clinical presentation was the development of corrugated plaques on the lateral sides of the tongue without spiculations on the surface. In all biopsies, herpetic-type viral inclusions were found. In 12 out of 14 cases in whom an electromicroscopic study was carried out, only viral particles of the herpes group were found. Human papillomavirus (HPV) was not demonstrated, although by means of immunohistochemistry, positive labelling for HPV was found in 95% of the cases. The aetiopathological significance of these findings remains to be evaluated.

[Changes in the cerebrospinal fluid in patients with HIV infection]. / Alteraciones del líquido cefalorraquídeo en pacientes con infección por VIH.

Spinal fluid from 53 HIV infected patients has been reviewed. A diagnosis was made exclusively from the spinal fluid exam in 15 cases while in 15 others it contributed to diagnosis together with other exams. The exam did not contribute any positive data in 23 cases. AIDS diagnosis was obtained in 11 patients by the spinal fluid exam. The most frequently occurring disease was infectious meningitis (10 cases) being 3 of them HIV aseptic meningitis. In our experience, a spinal fluid exam in HIV infected patients and fever of unknown origin did contribute useful data for the diagnosis of AIDS in a large number of cases.

[Tuberculosis in patients with HIV infection]. / Tuberculosis en pacientes con infección por VIH.

28 cases of tuberculosis in patients infected with HIV, 22 of them having AIDS criteria (CDC 87), are presented. Tuberculosis was the first diagnosis criteria in 34% of the cases 68% were I.V.U., 25% homosexuals and 7% heterosexual. Half of the patients had disseminated tuberculosis and the other half had localised disease with a high frequency of pulmonary setting. The most frequent symptoms were fever and constitutional syndrome (92% and 91%). The patient's chest X-rays showed few cavitations and infiltrates and frequently had mediastinal and/or hilar (22%) lymphatic gland enlargement. The study of lymphocyte populations showed levels of CD4 lower than 400 in 79% of the cases. The response to treatment was favorable in 16 patients and only 3 died of tuberculosis.

Abscess caused by Salmonella enteritidis within a glioblastoma multiforme.

Focal intracranial infections due to Salmonella species are rare. We report a case of brain abscess caused by Salmonella enteritidis within a glioblastoma multiforme.