Persistence of chlorine-sensitive Legionella pneumophila in hyperchlorinated installations.

AIMS: To study the persistence of Legionella over time in different disinfected facilities and analysing whether failures in bacterial eradication could be the result of a decrease in the susceptibility of the persistent strains to subsequent treatments. METHODS AND RESULTS: A long-term environmental surveillance was carried out in three different facilities associated with cases of Legionnaires' disease (a hospital, a fishing boat and a hotel). Despite several hyperchlorination episodes, amplified fragment length polymorphism, pulsed field gel electrophoresis-SfiI and arbitrarily primed polymerase chain reaction methods demonstrated that a specific clone of L. pneumophila serogroup 1 was able to survive for 17, 5 and 10 years in the hospital, fishing boat and the hotel, respectively. Isolates from different years from the same facility showed similar minimal inhibitory concentration and minimal bactericidal concentration values against eight different disinfectants. CONCLUSIONS: Hyperchlorination over long periods of time did not prevent the persistence of L. pneumophila. The lack of effectiveness did not appear to be the result of a decreased susceptibility of Legionella to chlorine. Hyperchlorination did not modify in vitro susceptibility of Legionella to other disinfectants to which the bacteria had not previously been exposed. SIGNIFICANCE AND IMPACT OF THE STUDY: Persistent Legionella in treated installations remain sensitive to disinfectants; hence, new strategies of treatment, different from hyperchlorination, should be developed to achieve bacterial eradication.

A large Legionnaires' disease outbreak in Pamplona, Spain: early detection, rapid control and no case fatality.

An outbreak of Legionnaire's disease was detected in Pamplona, Spain, on 1 June 2006. Patients with pneumonia were tested to detect Legionella pneumophila antigen in urine (Binax Now; Binax Inc., Scarborough, ME, USA), and all 146 confirmed cases were interviewed. The outbreak was related to district 2 (22 012 inhabitants), where 45% of the cases lived and 50% had visited; 5% lived in neighbouring districts. The highest incidence was found in the resident population of district 2 (3/1000 inhabitants), section 2 (14/1000). All 31 cooling towers of district 2 were analysed. L. pneumophila antigen (Binax Now) was detected in four towers, which were closed on 2 June. Only the strain isolated in a tower situated in section 2 of district 2 matched all five clinical isolates, as assessed by mAb and two genotyping methods, AFLP and PFGE. Eight days after closing the towers, new cases ceased appearing. Early detection and rapid coordinated medical and environmental actions permitted immediate control of the outbreak and probably contributed to the null case fatality.

A small outbreak of Legionnaires' disease in a cargo ship under repair.

It was reported that two mechanics working on a cargo ship under repair in the port of Barcelona had died after having fever. An investigation was made into the possibility of any additional cases and the presence of Legionella pneumophila in the ship they were repairing and in their hotel. The contaminated water system was treated with sodium hypochlorite. Both patients died after having been repeatedly diagnosed as having influenza. The two cases occurred among those who had been working with the pump of the ship's water system, while no cases were observed among the other workers (p = 0.02). Various serogroups of L. pneumophila were isolated from the ship's water pump and distribution system. However, organism of serogroup 1, subgroup Pontiac (Knoxville) were identified with identical deoxyribonucleic acid (DNA) patterns in the lung tissue of one patient and in the cooling water circuit valve of the ship's water pump. The first postintervention control water samples showed no further growth of legionella, but serogroups 4 and 8 were identified 8 months later. This legionellosis outbreak, although small, was highly lethal, probably due to the high levels of bacteria to which the patients were exposed and also because of the failure of correct diagnosis. International recommendations on prevention and control of legionellosis, which include ships under repair, are required.

Hallazgos a la ultrasonografía transvaginal en 27 casos comprobados de embarazo ectópico / Findings of the transvaginal ultrasonography in 27 confirmed cases of ectopic pregnancy

Se realiza un estudio prospectivo del aspecto ultrasonográfico transvaginal en 27 pacientes con diagnóstico comprobado de embarazo ectópico. Diez pacientes se intervienen quirúrgicamente de entrada, 13 son tratadas con inyección de metrotexato MTX y 4 con manejo expectante. Durante la evolución es necesario añadir cirugía en 3 casos. Se estableció una importante correlación entre imágenes ultrasonográficas, la clínica, hallazgos quirúrgicos y anatomía patológica. Creemos que la imagen definida como anillo tubario en la ultrasonografía transvaginal USTV es altamente compatible con un embarazo ectópico temprano. Puesto que la detección precoz del embarazo ectópico se asocia a métodos de tratamiento conservador, tales como aspiración tubaria, manejo expectante, inyección local o sistémica de MTX, y todo lo anterior, a mejor pronóstico reproductivo, consideramos a la USTV un procedimiento valioso en el manejo del embarazo ectópico EE, y que debe agregarse a otros métodos ya tradicionales

Correlación ecográfico-histológica de tumores ováricos / Echographic-hystological correlation in ovarian neoplasms

Se estudian prospectivamente 100 mujeres postadoras de masas pélvicas, con indicación quirúrgica; todas ellas estudiadas y tratadas en el Servicio de Obstetricia y Ginecología del Hospital del Salvador, entre enero 1988 y enero 1989. Las tumoraciones pélvicas, fueron clasificadas siguiendo el esquema del Departamento de Obstetricia y Ginecología de la Universidad de Tokio, destinado a correlacionar la imagen ecográfica, con la histología del tumor y especialmente a distinguir, en forma "preoperatoria" la naturaleza benigna o maligna de la masa; no se orienta al diagnóstico precoz del Ca. ovárico en la población general. La clasificiación divide a los tumores en 6 grupos con dos o tres subgrupos, para cada uno de ellos. La probabilidad de que el tumor sea benigno es alta para aquellos ubicados en los grupos I al IV (valor predictivo) de benignidad: 98,4%) y la posibilidad de malignidad es alta, especialmente en el grupo VI (valor predictivo de malignidad 63,6%). En algunos tipos de tumores, se aprecia una alta correlación entre, tipo histólogico y grupo de la clasificación. Los resultados obtenidos sugieren el uso de esta clasificación, en el estudio preoperatorio de tumores ováricos

Evaluación ultrasonográfica del volumen vesical / Ultrasonographic evaluation of the vesical volume

Se estudiaron 12 pacientes de sexo femenino del Policlínico de Ginecología del Hospital del Salvador, efectuándose mediciones de varios parámetros ultrasonográficos de la vejiga (diámetros y perímetros), con volúmenes conocidos instilados por sonda. Los resultados se someten a estudio matemático y estadístico computarizado, obteniéndose una fórmula de fácil aplicación para calcular volumen vesical. Se compara esta fórmula con otras de la literatura observándose que presenta un mayor grado de certeza y confiabilidad. Se destacan las ventajas del método ultrasonográfico para determinar volumen vesical en pacientes con patología uroginecológica

Importancia del somatotipo del feto en la estimación de su peso / Importance of the fetal somatotype in the weight prediction

Se estudia el error en la predicción del peso fetal en una población de 183 fetos, mediante 6 fórmulas desarrolladas por diversos autores. Al agrupar los fetos según el índice ponderal: longitud femoral/diámetro abdominal, se observan diferencias significativas en la cuantía del error producido por cada una de las ecuaciones analizadas