Systemic lupus erythematosus associated with acute parvovirus B19 infection.

Acute parvovirus B19 infection has been implicated in the pathogenesis of several autoimmune conditions, including systemic lupus erythematosus. Viruses, including human parvovirus B19, may trigger bouts of systemic lupus erythematosus in genetically susceptible individuals. Herein, we report on two patients who developed systemic lupus erythematosus associated with acute parvovirus B19 infection and discuss the possible pathogenetic mechanisms implicated.

[Pulmonary infection by Mycobacterium kansasii. Presentation of 27 cases (1988-1992)]. / Enfermedad pulmonar por Mycobacterium kansasii. Presentación de 27 casos (1988-1992).

BACKGROUND: The aim of this study was to know the incidence of pulmonary disease by Mycobacterium kansasii in our medium in the general population with a description of the characteristics as well as the subjects which this disease affects. The incidence was related with the isolation of Mycobacterium tuberculosis on consideration of the hospital studied (practically a monography of thoracic diseases). METHODS: A retrospective review of the clinical histories of patients with positive cultures of Mycobacterium kansasii in respiratory samples was performed with the criteria of the pulmonary diseases attended in the authors center over the period from January 1988 to December 1992 being defined. A descriptive analysis of the clinical and radiographic variables, treatment and evolution was also carried out. RESULTS: Mycobacteria was isolated in 1,755 respiratory samples processed by the Laboratory of Microbiology with 95% corresponding to Mycobacterium tuberculosis and 4.5% to non tuberculin mycobacteria. Mycobacterium kansasii made up 83% of the latter (3.7% of global significant isolations). Pulmonary disease by Mycobacterium kansasii was diagnosed in 27 patients (26 males and 1 female) with a mean age of 48 years (range: 24-84 years). No disseminated forms of disease were observed in this series. The sputum demonstrated high diagnostic profitability (positive in 26/27). Clinical and radiological variables were unspecific (only 1 normal) with a high percentage of cavitation being observed (74%). Most were carriers of chronic and/or general pulmonary diseases. The evolution was favorable in 70.3% of the cases with 3 patients dying (11.1%), all with severe subjacent disease and one of a cause not related with the infection. Three recurrences were observed (11.1%) and 2 persistence of positive culture (7.4%). One of the strains was niacin positive (expectional feature). CONCLUSIONS: Mycobacterium kansasii is not a rare producer of disease in our medium in the general population being found in 3.7% of the total significant isolations of mycobacteria in respiratory samples in the authors center over the period from 1988 to 1992. It was found to be associated to pulmonary or general subjacent diseases preferable affecting middle-aged males. The clinical are radiological features were not specific with a high percentage of cavitation being observed. No disseminated disease was found. Conventional combined chemotherapy was effective with persistence and recurrence being seen in 11% and 7%, respectively. The prognosis of the disease was primarily determined by the basal situation of the host.

[Cat-scratch disease. A report of 4 cases and a review of the literature]. / Enfermedad por arañazo de gato. Descripción de cuatro casos y revisión de la literatura.

Four cases of cat-scratch diseases are here reported and a review of the literature is made. The disease, apart from its typical presentation form as a usually self-limited regional lymph node enlargement, can occasionally spread and involve several organs systems. Indirect immunofluorescence serological tests have been of help for its diagnosis and should be included among the diagnostic criteria for the disease. In particular cases, nuclear magnetic resonance can be useful to suggests the diagnosis.

[Adverse reactions to trimethoprim-sulfamethoxazole in AIDS patients]. / Reacciones adversas a trimetoprima-sulfametoxazol en pacientes con SIDA.

BACKGROUND: The aim of the present was to evaluate the incidence of side effects to Trimethoprim-sulphamethoxazole (TMP-SMX) in 32 patients with AIDS and pneumonia by Pneumocystis carinii. METHODS: A retrospective study was carried out following a protocol which included all items related with the drug used. RESULTS: Side effects to TMP-SMX were seen in 75% of the patients treated with the most important and severe being at a cutaneous level. These severe reactions require withdrawal of the drug and its substitution by pentamidine in half of the cases, while in the remaining 25% the reactions were mild. To date none of the 9 patients prophylactically treated with TMP-SMX have relapsed over 3 years of follow up while 4 out of the 9 treated with pentamidine have had relapsed. CONCLUSIONS: Trimethoprim-sulphamethoxazole is the ideal prophylactic drug for those who are able to tolerate it. Following review of the literature 2 schedules of tolerance induction were proposed for use in patients who have had previous reactions with this drug, including a rapid schedule and another slow schedule.

[Disease caused by Mycobacterium kansasii in patients with HIV infection]. / Enfermedad por Mycobacterium kansasii en pacientes con infección por VIH.

BACKGROUND: To describe the clinical features and response to therapy in Mycobacterium kansasii disease among HIV infected patients, an increasing problem in our setting. METHODS: A retrospective survey of all charts from patients with HIV infection with Mycobacterium kansasii infection recorded between April 1985 and December 1991. RESULTS: A total of 13 patients were identified. All of them had clinically significant respiratory tract samples with a definite M. kansasii isolation. Only three had disseminated disease. In all but two cases, CD4 cell count at diagnosis time was lower than 200/mm3. Chest X-ray films showed interstitial pattern (8 cases) or alveolar condensation (3 cases) and lung cavities were seen in 4 patients. All patients with lung disease and one with disseminated disease responded well to anti-tuberculous therapy. CONCLUSION: Mycobacterium kansasii produces disease in advances stages of HIV-induced immunosuppression. The most common primary location is pulmonary, but disseminated forms can also be seen. The infection can be controlled with standard anti-tuberculous therapy.

[Pyomyositis in AIDS]. / Piomiositis en SIDA.

We describe two cases of pyomyositis in two patients with acquired immunodeficiency syndrome. Neither of the two cases had previous history of predisposing factors and both patients began with fever and pain at the site of the lesions. Aspiration by punction was required in addition to the antimicrobial therapy.

[Endocarditis caused by Lactobacillus]. / Endocarditis por Lactobacillus.

Endocarditis due to Lactobacillus is rare. Its main features were a subacute course and greater difficulties for achieving a complete recovery even using appropriate antimicrobial therapy with serum levels above MIC. We present one case of Lactobacillus endocarditis in a patient with allergy to penicillin, due to a vancomycin-resistant strain. She was successfully treated with clindamycin and gentamicin. We emphasize the need and importance of sensitivity tests and antibiotic tolerance when choosing an optimal treatment for this infection.

[Tuberculosis and AIDS. Study of 54 patients]. / Tuberculosis y SIDA. Estudio de 54 pacientes.

We present 54 cases of tuberculosis (TBC) and Acquired Immunodeficiency Syndrome (AIDS) that were observed during five years and represent 37% of our AIDS patients. TBC was diagnosed before AIDS in 7, after AIDS in 5 and simultaneously in 42. Eighty-seven per cent were intravenous drug users (IVDU) and no hemophilia cases were recorded. The tuberculin skin test (PPD) showed a reaction greater than 5 mm in 43%. Prophylaxis has not been used in any patient. TBC was localized in 39% and disseminated in 61%; the lung was the main organ involved. Diagnosis was established by culture in 42 cases and by pathology exam in 12 cases. Eighteen patients had multiple isolations, while 36 had a single one. Co-occurrence with other opportunistic infections was observed in 27 cases. Death related to TBC was seen in 3 patients, and there were no differences in survival between disseminated and localized presentations. Compliance of treatment was very low and follow-up was not achieved in large number of patients.