[Meningitis caused by Staphylococcus aureus. Analysis of 16 cases]. / Meningitis por Staphylococcus aureus. Análisis de dieciséis casos.

During the period between 1982 and 1987, 16 cases of meningitis due to Staphylococcus aureus were diagnosed. Nine patients (56%) had undergone a previous neurosurgical operation and 5 of them were carriers of a cerebrospinal fluid (CSF) shunt. Seven patients (44%) had spontaneous meningitis. Fever and meningeal signs were the most common clinical findings. 50% of patients were comatose. The Gram stain of CSF showed Gram positive cocci in 7 cases. Blood cultures were positive in all patients with spontaneous meningitis and negative in the neurosurgical group. Overall mortality rate was 37.5%, and it was lower in the neurosurgical group than in the spontaneous meningitis. Other factors associated with a poor outcome were advanced age, bacteremia and septic shock.

[Moraxella (Branhamella) catarrhalis: its isolation in the respiratory secretions of adult patients]. / Moraxella (Branhamella) catarrhalis: aislamiento en secreciones respiratorias de pacientes adultos.

OBJECTIVE: We have designed a retrospective study in order to know the clinical significance of the isolation of Moraxella (Branhamella) catarrhalis (MC) in respiratory specimens of adult hospitalized patients. METHODS: We performed a Gram stain and culture on blood-agar, MacConkey media and quantitative culture in chocolate-agar to all respiratory samples. In patients with a clinical diagnosis of pneumonia BCYE-alpha was added. During 2 years (1992-1993) MC was isolated in respiratory specimens from 52 patients. We revised the clinical history of all these patients. RESULTS: MC was isolated in 60 respiratory specimens (sputum and/or tracheobronchial aspirates) from 52 patients. The Gram stain showed gram-negative cocci in 77% and gram-positive cocci in 17% of the cases. MC grew in pure culture in 28 specimens (46.6%). In 23% of cases MC was isolated with Streptococcus pneumoniae and in 21% with Haemophilus influenzae. Fifty-two stocks (86.6%) produced beta-lactamase. Twelve patients had a clinical diagnosis of pneumonia, 8 of them had an underlying chronic respiratory disease. Other 24 patients with an underlying chronic respiratory disease had a bronchial infection as a cause of exacerbation of their respiratory disease. Seven patients without an underlying chronic respiratory disease had a clinical episode of acute bronchitis. Finally, in 9 patients the isolation of MC was considered a colonization. CONCLUSIONS: In 17% cases MC was identified as a gram-positive cocci in the Gram stain, which may cause false diagnosis. The etiological importance of MC in episodes of acute exacerbation of patients with an underlying chronic respiratory disease is high.

[Neisseria meningitidis: isolation from low respiratory tract secretions of adult patients]. / Neisseria meningitidis: aislamiento en secreciones respiratorias de vías bajas de pacientes adultos.

OBJECTIVE: A bibliographic research was made using the Medline system of the clinico-microbiological features of reported cases of Neisseria meningitidis (NM) bronchopulmonary infection, as well as a retrospective study of NM isolation from lower respiratory tract secretions from adult inpatients. MATERIALS AND METHODS: All specimens from respiratory secretions were Gram stained and cultured onto blood. MacConkey and chocolate (quantitative) agar plates; a BCYE-alpha agar plate was also used when pneumonia was diagnosed. Fifty-five clinical records were retrospectively reviewed of patients with positive cultures for NM, for a 12-year period (1983-1994). RESULTS: A total of 67 samples were positive among the 55 patients studied; sputum and tracheobronchial samples predominated. NM was recovered in pure culture from 48 specimens (71.6%) and with counts higher than 10(6) colony forming units/ml (CFU). Twenty-seven isolates (40.3%) corresponded to serogroup B and 21 isolates (31.3%) did not group with serogroups A, B and C. Twenty-two patients were diagnosed of pneumonia; eleven of these 22 patients had an underlying chronic lung disease. Ten patients had a respiratory overinfection, in eight cases an episode of acute bronchitis was recorded and, finally, in 15 patients there was NM colonization only. CONCLUSION: The pathogenic role of NM in lower respiratory tract infections is probably underestimated because its isolation is difficult, particularly when there is oropharyngeal flora present, since in our study, in which only conventional culture media were used, samples which had NM recovered had a high number of colonies, in pure culture in most cases.

[Varicella pneumonia in the adult. A review of 25 cases]. / Neumonía varicelosa en el adulto. Revisión de 25 casos.

OBJECTIVE: To study the clinical, therapeutic, and evolutive features in 25 patients with the diagnosis of varicella pneumonia (VP) in the last 15 years. PATIENTS AND METHODS: The diagnosis was established by clinical and radiologic criteria in the course of varicella infection. The antecedents of smoking habit, pregnancy, and underlying disease were evaluated. Hypoxemia was defined as a pO2 < or = 65 mmHg with a FiO2 of 0.21. RESULTS: Twenty-five patients (16 males and 9 women; mean age 31.5 years, range: 24-43 years) were included in the study. Ninety-two percent of patients were smokers of more than 20 cigarettes a day; five met criteria of simple chronic bronchitis, 3 were known carriers of human immunodeficiency virus (HIV) and one had a chronic liver disease caused by hepatitis C virus. In 16 patients (64%) there were no underlying diseases and none of the female patients was pregnant. Respiratory symptoms began from the first and seventh day after the skin rash, and the most common symptoms were cough (76%), dyspnea (48%), and chest pain (44%). In 22 patients an arterial gas determination was obtained and hypoxemia was documented in 8 patients (32%). Hypoxemia was greater and statistically significant in patients with underlying diseases (p < 0.01). Chest X-ray revealed an interstitial pattern predominantly at both bases. Intravenous acyclovir therapy was started in 19 patients (76%) with severe respiratory symptoms and/or underlying disease. Three patients (12%) were admitted to the Intensive Care Unit for mechanical ventilation. All patients had a favourable clinical course. CONCLUSIONS: Adult patients with symptoms of VP had a favourable clinical course with intravenous acyclovir, and the presence of hypoxemia was more commonly observed when underlying diseases were also present.

[Analysis of factors associated with anticoagulant treatment indication in chronic atrial fibrillation. Prospective study of 170 patients admitted at an internal medicine service]. / Análisis de los factores asociados a la indicación de tratamiento anticoagulante en la fibrilación auricular crónica. Estudio prospectivo de 170 pacientes ingresados en un servicio de Medicina Interna.

BACKGROUND: Anticoagulant therapy reduces the risk of stroke among patients with chronic atrial fibrillation. The objective of this study was to evaluate the use of anticoagulant therapy and to analyze the factors associated with the indication of anticoagulants in patients with chronic atrial fibrillation. PATIENTS AND METHODS: Prospective study of all patients with chronic atrial fibrillation admitted to our Department of Internal Medicine from February 1997 to September 1998. From each patient data related to the cause of atrial fibrillation, other associated vascular risk factors, use of anticoagulant and/or antiplatelet agents and contraindication to anticoagulants were recorded. RESULTS: A total of 170 patients with chronic atrial fibrillation were studied. The mean age of patients was 77 years (range: 49-94). One hundred and four patients (61%) were older than 75 years. Atrial fibrillation was the main cause for admission only in 11 patients (6.5%). One hundred and sixty-seven patients (98%) had indication for receiving anticoagulant therapy; however, it was indicated in only 67 patients (39%). In other 68 patients (40%), antiplatelet agents were used. Patients over 75 years received anticoagulants less frequently (p < 0.0001). Factors associated with the prescription of anticoagulants in the bivariate analysis included: diabetes mellitus (p = 0.046), high cholesterol level (p = 0.023), age < or = 75 years old (p < 0.0001), history of previous embolic events (p = 0.001) and valvular atrial fibrillation (p < 0.0001). The multivariate analysis showed that only two factors were indeed associated with the prescription of anticoagulants: age < or = 75 years (OR: 6.15) and valvular atrial fibrillation (OR: 4.24). CONCLUSIONS: Anticoagulant therapy is underused in patients with chronic atrial fibrillation, particularly in elderly patients.