[Human prion diseases: An overview]. / Enfermedades por priones humanas. Una revisión general.

Prion diseases are a group of neurodegenerative diseases. The disease-causing agent is a protein (PrP), that is normally produced in the nervous system, aggregated in an abnormal form. The abnormal protein, known as prion (PrPSc), is capable of self-propagation promoting the misfolding of the normal protein (PrP). These conditions can be acquired sporadically, genetically, or infectiously either by eating meat contaminated with prions or from iatrogenic exposure. The diagnosis of these diseases is often challenging. The use of highly sensitive and specific diagnostic tools, such as MRI and RT-QuIC, may aid in the diagnosis. Neuropathological examination of brain tissue ensures a definite diagnosis. At present, no treatment significantly improves the course of prion diseases; however, an early diagnosis is of paramount importance for patient care decision planning, infection control purposes, and genetic counseling.

A rare case of pleural effusion due to Prevotella dentalis.

Prevotella dentalis is a Gram-negative anaerobic rod involved in various human diseases, especially oral infections. We report a rare case of a pleural effusion due to this microorganism in an elderly patient. An 88-year-old man with chronic respiratory disease presented with a left pleural effusion for more than 1 month. Culture of drained pleural fluid resulted in isolation of P. dentalis. Resistance to penicillin and moxifloxacin was documented. Treatment with drainage and clindamycin was established, but the patient developed cognitive impairment and died after a worsening of his general condition.

Infections caused by Scedosporium/Lomentospora species: Clinical and microbiological findings in 21 cases.

The clinical and microbiological characteristics of infections caused by Scedosporium/ Lomentospora species in 21 patients are described. We searched retrospectively the records for Scedosporium/ Lomentospora species seen at the University Hospital Virgen de las Nieves from 2006 to 2017. Out of them, 16 were male; mean age at diagnosis was 57.8 (±SD 15) years; all patients had risk factors for fungal infection such as corticosteroids and/or immunosuppressive treatment in 18 (85.7%) patients, pulmonary diseases in seven (33.3%) cases, hematological malignancies in six (28.5%), and organ transplantation in three (14.2%) patients. Most patients had infection in the lung/pleura (17/80.9%); cough was present in 12 patients and dyspnea in another 12, and the mean interval until diagnosis was 13.6 days. The most frequent species was S. apiospermum/S. boydii in 14 patients (66.6%), followed by L. prolificans in seven. The diagnosis was obtained from sputum in 12 (57.1%) cases, followed by pleural fluid and bronchoalveolar lavage in two of each. The most frequently used antifungals were voriconazole and amphotericin B, but combination of more than one antifungal drug was only used in three patients. Ten patients were cured, and six patients died as a consequence of the infection; three patients had chronic infection. In general, infections caused by Scedosporium/Lomentospora species are rare, serious, and difficult to diagnose and treat, having a high index or mortality especially in those caused by L. prolificans.

A Rare Case of Osteomyelitis Caused by Haemophilus Parainfluenzae.

Haemophilus parainfluenzae is a rare cause of bone and joint infections. We report a case of calcaneal osteomyelitis due to this microorganism with a review of all published. A 23-year-old woman presented with a 1-month history of pain and inflammation in the calcaneus area. Osteomyelitis was suspected at this location based on computed tomography images. Culture of six bone biopsies and surrounding tissue resulted in the isolation of H. parainfluenzae. Surgical drainage and debridement was performed, and antibiotic treatment was prescribed, resolving the infection.

Candida Prosthetic Joint Infection. A Review of Treatment Methods.

Fungal microorganisms are still a rare cause of bone and joint infections. We report a new case of knee prosthetic joint infection due to Candida albicans in a patient with a previous two-stage right knee arthroplasty for septic arthritis due to S. epidermidis occurred several months ago. Moreover, the treatment in 76 cases of Candida prosthetic joint infection has been discussed. Forty patients were female and mean age at diagnosis was 65.7 (± SD 18) yrs. No risk factors for candidal infection were found in 25 patients. Infection site was the knee in 38 patients and hip in 36; pain was present in 44 patients and swelling in 24. The most frequent species was C. albicans, followed by C. parapsilosis. Eleven patients were only treated with antifungal drugs being the outcome favourable in all of them. Two-stage exchange arthroplasty was performed in 30 patients, and resection arthroplasty in other 30; in three patients one-stage exchange arthroplasty was done. A favourable outcome was found in 58 patients after antifungal plus surgical treatment, in 11 after antifungal treatment alone and in one after surgery alone. The type of treatment is still not clearly defined and an algorithm for treatment in fungal PJI should be established, but various types of surgical procedures may be applied.

Candida-induced prosthetic joint infection. A literature review including 72 cases and a case report.

BACKGROUND: The clinical and microbiological characteristics of prosthetic joint infection (PJI) caused by Candida species is described, including 72 cases in the literature and a case of Candida glabrata infection handled at the present centre. METHODS: We describe one patient and using the key words 'fungal prosthetic joint infection' and 'candida prosthetic joint infection' we searched MEDLINE (National Library of Medicine, Bethesda, MD), Web of Science, CINAHL and Cochrane systematic review databases for case reports of this condition. RESULTS: Out of the 73 patients, 38 were female; mean age at diagnosis was 65.7 (± SD 18) yrs; 50 had risk factors for candidal infection such as systemic disease (e.g. rheumatoid arthritis, Sjogren's syndrome, systemic lupus erythematosus) and/or immunosuppressive therapy in 18 (24.6%) cases, diabetes mellitus in 14 (19.1%), immunosuppression due to malignant or chronic disease in 24 (32.8%) and long-term antibiotic use in four (5.4%) patients. Infection site was the knee in 36 patients and hip in 35; pain was present in 43 patients and swelling in 23 and the mean surgery-diagnosis interval was 32 months. The most frequent species was C. albicans, followed by C. parapsilosis. The diagnosis was obtained from joint fluid aspirate in 33 cases and intra-operative samples in 16. Susceptibility to antifungals was tested in only 21 isolates. The most frequently used antifungals were fluconazole and amphotericin B. Two-stage exchange arthroplasty was performed in 30 patients and resection arthroplasty in 31; 56 patients were cured with a combination of medical and surgical treatment; one patient died from the infection. CONCLUSION: PJI caused by Candida requires a high index of suspicion; surgery with long-term antifungal therapy is recommended.

Localized mucosal leishmaniasis caused by Leishmania infantum mimicking cancer in the rhinolaryngeal region.

The clinical, microbiological, and histopathological findings of six patients with mucosal leishmaniasis are reported. Five of these patients were Spanish with no history of travel abroad, while the other was from Bolivia but had lived in Spain for more than 5 years. Two patients had no underlying disease, while the other four had several other medical conditions. Lesions were located in the nose in three patients and in the larynx in the other three. Symptoms included difficulty in swallowing, nasal obstruction, dysphonia, and polypoid lesions mimicking cancer. The diagnosis was based on the identification of parasites, or on PCR assay or culture. Five patients were treated with liposomal amphotericin B and the other with antimonial compounds.

Autochthonous lepromatous leprosy in a Spanish woman with burns on both feet and skin lesions.

The incidence of leprosy is decreasing worldwide and it is considered a rare disease in developed countries. In Spain, leprosy is mainly an imported disease with only few autochthonous cases seen. The diagnosis is difficult because of a low index of suspicion and the absence of visualisation of fast-acid bacilli in the lesions. Here, we report an autochthonous case of leprosy diagnosed after 4 years of evolution of skin lesions. Mechanical rupture of the biopsy helped finally to make the correct diagnosis of the disease.

Disseminated infection due to Saksenaea vasiformis secondary to cutaneous mucormycosis.

Mucormycosis is an uncommon opportunistic fungal infection caused by Zygomycetes. It usually affects immunocompromised, diabetic and trauma patients with infected wounds. We report a case of disseminated infection secondary to facial cutaneous mucormycosis caused by Saksenaea vasiformis in a diabetic patient who had a farming accident causing him severe head injury. The patient was treated with a combination of surgical debridement and antifungal therapy with liposomal amphotericin B, but he had a slow and fatal outcome. In cases of tissue necrosis following trauma involving wound contact with soil (i.e., potential fungal contamination), testing for the presence of Zygomycetes fungi such as S. vasiformis in both immunocompetent and immunocompromised patients is crucial. The reason is that this infection usually has a rapid progression and may be fatal if appropriate treatment is not administered.

[Effect of modified liberation doxazosin on blood pressure, insulin resistance, and catecholamine secretion in patients with true resistant hypertension]. / Efecto de la doxazosina de liberación modificada en la presión arterial, la resistencia a la insulina y la secreción de catecolaminas en pacientes con hipertensión arterial resistente verdadera.

BACKGROUND AND OBJECTIVE: There are not studies about the utility of modified liberation doxazosin (MLD) in the combined treatment of the true resistant hypertension (TRH). The aim of this study was to determinate the effect of MLD on the blood pressure (BP), insulin resistance, and the catecholamine secretion in these patients. PATIENTS AND METHOD: Twenty seven patients with TRH from our unit were studied above and after 12 weeks of treatment with MLD (8 mg/day). The following parameters, among others, were analysed: office BP, ambulatory BP (ABPM), rennin, aldosterone and insulin plasmatic levels, urinary catecholamines and the insulin sensitivity index. RESULTS: Two patients were excluded because of adverse sides. After the treatment period, 53.8% of patients experimented a decrease of office diastolic BP higher than 10 mmHg, and 44% of them presented a decrease of 24-hour diastolic BP higher than 5 mmHg (answer patients). Likewise, 38.5% and 24% of patients achieved an adequate office BP and ABPM control, respectively. Also, a significant decrease of insulin resistance and urinary catecholamines, and an increase of aldosterone in plasma were observed. The rest of parameters remained invariables. CONCLUSIONS: MLD could be useful in the TRH treatment, because this drug decreased significantly BP, insulin resistance and catecholamine secretion in these patients, with a good tolerance.

[Predictive factors of hypertension in patients with diagnostic doubts of persistent hypertension]. / Factores predictivos de hipertensión arterial en pacientes con dudas diagnósticas de hipertensión mantenida.

BACKGROUND: White coat hypertension (WCH) is a prevalent clinical situation which requires a therapeutic management different from persistent hypertension (PH). To distinguish between patients with WCH and uncertain hypertension from patients with PH, an ambulatory blood pressure monitoring (ABPM) is usually indicated, yet it is not available in primary care. Thereby, predictors of WCH on the basis of pre-test (pre-ABPM) clinical characteristics have been suggested. However, little is known about the predictors of PH. The aim of this study was to ascertain predictors of PH in patients referred from the primary care due to suspicion of WCH or uncertain hypertension. PATIENTS AND METHOD: A 24-hours ABPM was performed in 230 consecutive patients referred from primary care because of suspicion of WCH or uncertain hypertension. WCH was defined as an increased office BP with a mean daytime BP, as measured by ABPM, < 135/85 mmHg. Uncertain hypertension was diagnosed when patients had had episodic (2 or more) office BP >140 and/or 90 mmHg together with normal BP determinations. Patients with increased office BP with a mean daytime BP [by ABPM]3 135/85 mmHg were considered as having PH. RESULTS: In 178 patients, ABPM was successful. Eighty-six patients (48.3%) had PH and the remainder (92 patients; 51.7%) were considered as having WCH. In the PH group, there were more males (67.4% vs 43.5%; p < 0.001), patients were older (42.8 [11.8] years vs 35.7 [11.2] years), there were more smokers (39.5 vs 26.1%; p = 0.056), they consumed more alcohol (p = 0.001) and coffee (p < 0.001) and they had higher levels of hemoglobin (p = 0.001) and creatinine (p = 0.003) and lower levels of uric acid (p<0.001) than the WCH group. Also they had an office BP and an ambulatory BP higher than WCH patients. A multivariate logistic regression analysis revealed that PH was significantly associated with a male gender (odds ratio [OR] = 3.26; confidence interval [CI]: 1.54-6.88; p = 0.001), office systolic BP > 145 mmHg (OR = 6.53; CI, 2.67-16.11; p < 0.001), age (> 35 years) (OR = 5.03; CI, 2.35-10.78; p < 0.001) and smoking (OR = 3.07; CI, 1.38-6.84; p = 0.005). CONCLUSIONS: Our findings indicate that in patients referred from primary care due to suspicion of WCH or uncertain hypertension, the prevalence of PH was 48.3%. PH was more frequent among men older than 35 years, smokers and those with an ambulatory systolic BP > 145 mmHg.