Meningitis bacteriana por bacilos gramnegativos en adultos inmunodeprimidos no neuroquirúrgicos. Réplica / Bacterial meningitis due to gram-negative bacilli in immunosuppressed adults who have not undergone neurosurgery. Reply

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[Bacterial meningitis due to gram-negative bacilli in adults]. / Meningitis bacteriana por bacilos gramnegativos en adultos.

INTRODUCTION: Gram-negative bacilli are causative agents of bacterial meningitis in the neonatal period but rarely cause meningitis in adults without risk factors. AIM: To report on meningitis due to gram-negative bacilli (MGNB) in adults diagnosed in a hospital over a 25-year period. PATIENTS AND METHODS: We reviewed the medical records of all patients with an age > or = 14 years who had been diagnosed with MGNB between 1982 and 2006. RESULTS: Fifteen cases of MGNB are included (10.5% of the cases of bacterial meningitis with an identified aetiology), with a mean age of 48 years (14-79). Twelve (80%) were post-operative: recent neurosurgery (9 cases, 75%) and having a neurosurgical device (8 cases, 67%) were risk factors. Three (20%) were spontaneous: two were of a urinary origin and one had an undetermined origin. The aetiology was: Pseudomonas aeruginosa (3 cases), Escherichia coli (3 cases), Enterobacter aerogenes (2 cases), Pseudomonas fluorescens (1 case), Klebsiella pneumoniae (1 case), Morganella morganii (1 case), Acinetobacter anitratus (1 case), Acinetobacter iwoffii (1 case) and Flavobacterium brevis (1 case); in one patient with Gram positive staining for gram-negative bacilli, the culture was negative, and three of them (20%) were mixed infections (Staphylococcus spp.). Three patients (20%) died. CONCLUSIONS: In adults, gram-negative bacilli rarely cause spontaneous meningitis, but are a common causation of post-neurosurgical meningitis and in those with neurosurgical devices. The mortality rate of MGNB is high.

Meningitis bacteriana por bacilos gramnegativos en adultos / Bacterial meningitis due to gram-negative bacilli in adults

Introducción. Los bacilos gramnegativos son agentes etiológicos de meningitis bacteriana en el período neonatal pero raramente causan meningitis en adultos sin factores de riesgo. Objetivo. Describir las meningitis por bacilos gramnegativos en adultos, diagnosticadas en un hospital durante un período de 25 años. Pacientes y métodos. Se revisaron las historias clínicas de los pacientes con edad >= 14 años que habían sido diagnosticados de meningitis por bacilos gramnegativos entre 1982 y 2006. Resultados. Se incluyen 15 casos de meningitis por bacilos gramnegativos (10,5% de las meningitis bacterianas de etiología identificada), con una mediana de edad de 48 años (intervalo: 14-79 años). Doce (80%) fueron postoperatorias:neurocirugía reciente (9 casos, 75%) y ser portador de un dispositivo neuroquirúrgico (8 casos, 67%) fueron los factores de riesgo. Tres (20%) fueron espontáneas: dos de origen urinario y una de origen no determinado. La etiología fue: Pseudomonas aeruginosa (3 casos), Escherichia coli (3 casos), Enterobacter aerogenes (2 casos), Pseudomonas fluorescens (1 caso), Klebsiella pneumoniae (1 caso), Morganella morganii (1 caso), Acinetobacter anitratus (1 caso), Acinetobacter iwoffii (1 caso) y Flavobacterium brevis (1 caso); en un enfermo con tinción de Gram positiva para bacilos gramnegativos el cultivo resultó negativo, y tres (20%) fueron infecciones mixtas (Staphylococcus spp.). Tres pacientes (20%) fallecieron. Conclusiones. En adultos, los bacilos gramnegativos raramente causan meningitis espontánea, pero son una etiología frecuente de meningitis posneuroquirúrgicas y en portadores de dispositivos neuroquirúrgicos. La mortalidad de la meningitis por bacilos gramnegativos es elevada (AU)

Introduction Gram-negative bacilli are causative agents of bacterial meningitis in the neonatal period but rarely cause meningitis in adults without risk factors. Aim. To report on meningitis due to gram-negative bacilli (MGNB) in adults diagnosed in a hospital over a 25-year period. Patients and methods. We reviewed the medical records of all patients with an age >= 14 years who had been diagnosed with MGNB between 1982 and 2006. Results. Fifteen cases of MGNB are included (10.5% of the cases of bacterial meningitis with an identified aetiology), with a mean age of 48 years (14-79). Twelve (80%) were post-operative: recent neurosurgery (9 cases, 75%) and having a neurosurgical device (8 cases, 67%) were risk factors. Three (20%) were spontaneous: two were of a urinary origin and one had an undetermined origin. The aetiology was: Pseudomonas aeruginosa (3 cases), Escherichia coli (3 cases), Enterobacter aerogenes (2 cases), Pseudomonas fluorescens (1 case), Klebsiella pneumoniae (1 case), Morganella morganii (1 case), Acinetobacter anitratus (1 case), Acinetobacter iwoffii (1 case) and Flavobacterium brevis (1 case); in one patient with Gram positive staining for gram-negative bacilli, the culture was negative, and three of them (20%) were mixed infections (Staphylococcus spp.). Three patients (20%) died. Conclusions. In adults, gram-negative bacilli rarely cause spontaneous meningitis, but are a common causation of postneurosurgical meningitis and in those with neurosurgical devices. The mortality rate of MGNB is high (AU)

Contribution of monocytes to overproduction of interleukin-6 in a case of cardiac myxoma.

Cardiac myxoma cells have been demonstrated to produce interleukin (IL)-6, but its role in the systemic and immunologic manifestations of patients with this tumor is controversial. There is no evidence of any other source of such cytokine, but here we report a case of myxoma with systemic manifestations at diagnosis in which we evaluated the IL-6 production by peripheral blood cells before and after surgical tumor resection. Peripheral blood mononuclear cells were isolated by density gradient centrifugation, and the IL-6 expression in monocytes and lymphocytes was evaluated by flow cytometry. Before surgery, 74.4% of monocytes produced IL-6, but 1 month after surgery, a decrease in both the number of monocytes and the percentage of these cells expressing IL-6 was found along with an improvement of systemic and immunologic manifestations. Here, we demonstrated for the first time that monocytes contribute to the elevated production of IL-6 in patients with myxoma.