Thirty years of human infections caused by Yersinia enterocolitica in northern Spain: 1985-2014.

Yersinia enterocolitica infection is a zoonosis with worldwide distribution, gastroenteritis being by far the most common clinical manifestation of human infection. In Gipuzkoa, northern Spain, human Y. enterocolitica infections increased from the mid-1980s to the beginning of the 21st century (from 7·9 to 23·2 annual episodes per 100 000 population) to decrease to 7·2 annual episodes per 100 000 population in the last years of the study. The hospital admission rate due to yersiniosis during the last 15 years of the study was 7·3%. More than 99% of isolates were serotype O:3. Infection affected mainly children under 5 years of age (average rate: 140 episodes per 100 000 population). The incidence in adults was low but hospitalisation increased with age, exceeding 50% in people over 64 years old.

Disseminated infection and colonization by Scedosporium prolificans: a review of 18 cases, 1990-1999.

Scedosporium prolificans infection was analyzed in 18 patients from whom the fungus was isolated during the period 1990-1999. Of these 18 patients, 12 had some predisposing factor and either unconfirmed infection or colonization, and 6 patients had confirmed disseminated infection: 4 patients with leukemia died, 1 patient with breast cancer who underwent autologous bone marrow transplantation survived, and 1 patient with advanced acquired immunodeficiency syndrome died, although the fungal infection did not seem to affect his clinical symptoms.

Comparison of the automated nonradiometric Bactec MGIT 960 system with Löwenstein-Jensen, Coletsos, and Middlebrook 7H11 solid media for recovery of mycobacteria.

The aim of this study was to evaluate the sensitivity of as well as the time to detection of mycobacteria by three procedures: solid media with traditional reading, microscopy on solid media, and liquid culture using the automated nonradiometric Bactec MGIT 960 system. A total of 2832 respiratory specimens were tested, 315 of which were positive for mycobacteria. The most frequently isolated species was Mycobacterium tuberculosis (201 isolates). One hundred twenty mycobacteria other than tuberculosis were isolated, 72 of which were Mycobacterium xenopi strains. Sensitivity of each of the different media compared to all media combined for growth of Mycobacterium tuberculosis was 93%, 76.1%, 79.6%, and 75.1% for Bactec MGIT 960, Middlebrook 7H11 plates, Löwenstein-Jensen, and Coletsos, respectively. Sensitivity of the Bactec MGIT 960 for detection of all mycobacterial isolates was 75.1%. When this automated system was supplemented with visual inspection, the sensitivity increased to 89.4%. The sensitivity of Middlebrook 7H11 plates, Löwenstein-Jensen, and Coletsos was 50.8%, 60.7%, and 52.3%, respectively. Time to detection of Mycobacterium tuberculosis using the Bactec MGIT 960 system and Middlebrook 7H11 plates with microscopic reading was 12.7 and 13 days, respectively; using the traditional Löwenstein-Jensen and Coletsos media, time to detection was 22.8 and 22.7 days, respectively.

[Pulmonary cavitation lesions in patients infected with the human immunodeficiency virus: an analysis of a series of 78 cases]. / Lesiones pulmonares cavitadas en los pacientes infectados por el virus de la inmunodeficiencia humana: análisis de una serie de 78 casos.

BACKGROUND: To assess the clinical, radiologic and microbiological features of lung cavitation and HIV infection. Evaluation of the differences related to this disease in the last years. PATIENTS AND METHODS: Retrospective review of all patients with lung cavitation and HIV infection admitted at our hospital from January 1989 until December 1994 and prospective study of all patients with the same characteristics during 1995 and 1996. Lung cavitation was defined as any parenchymal lesion, with air content, visible in a simple X-ray and greater than 1 cm of diameter. Criteria for confirmed, probable or possible diagnosis were defined. RESULTS: 78 cases of lung cavitation have been identified in 73 patients. The radiologic patterns included unilobar and multilobular involvement in 31 and 47 cases, respectively. Cavities were multiple and single in 40 and 38 cases respectively. Findings with fine needle aspiration biopsy (FNAB) were diagnostic in 11 out of 14 cases. A clinical diagnosis was performed in all 78 cases, with microbiological results in 69 cases (88.5%): Mycobacterium tuberculosis in 20, Pneumocystis carinii in nine, Pseudomonas aeruginosa in nine, Staphylococcus aureus in eight (5 endocarditis with cavitary septic emboli), Rhodococcus equi in six, P. aeruginosa and S. aureus in three, Salmonella enteritidis in three, Cryptococcus neoformans in two, Aspergillus fumigatus in two and others in 7 cases. Confirmed, probable and possible diagnosis was considered in 54, 15 and 9 cases, respectively. Thirteen episodes of spontaneous pneumothorax were found. CONCLUSIONS: The lung cavitation rate is low, compared with the number of admissions related to HIV infection; nevertheless, many of them are in close relationship with HIV infection, and most of them are caused by treatable infections. It is important to know the clinical and radiological characteristics, in order to establish an early diagnosis and an appropriate therapy. Pseudomonas aeruginosa is becoming an important cause of lung cavitation. In our series, spontaneous pneumo-thorax was not related to Pneumocystis carinii pneumonia in 61.5% of cases.

[Coinfection by mycobacteria in HIV-positive patients]. / Coinfección por micobacterias en pacientes HIV-positivos.

BACKGROUND: The aim of this study was to describe the clinical characteristics and therapeutic management of coinfection by mycobacteria in the authors hospital. METHODS: Two cases of coinfection detected in mixed cultures in agar 7H11 or simultaneous positive cultures in several evaluable clinical samples (blood cultures for MAI and M. kansasii and sputum or stools for M. tuberculosis). RESULTS: One coinfection by MAI and M. tuberculosis and another by MAI and M. kansasii in two severely immunosuppressed HIV positive patients with less than 0.010 CD4 lymphocytes/10(9)/l. The clinical manifestations were unspecific, with fever and deterioration of the general state predominating over the 30-45 days of evolution. One of the patients improved with treatment which, in both cases, included a macrolide. Survival was very short and death was by intercurrent causes. CONCLUSIONS: For the diagnostic of coinfection in severely immunosuppressed patients multiple organic samples should be taken and appropriately processed to detect the mixed cultures or the presence of different mycobacteria in different samples from the same patients. Although the diagnosis of the species is fundamental, the empiric treatment of a disease by mycobacteria in severely immunosuppressed patients should include at least: ethambutol and clarithromycin or azithromycin in addition to other first line tuberculostatic drugs until definitive identification.

Rapid detection of tuberculous and non-tuberculous mycobacteria by microscopic observation of growth on Middlebrook 7H11 agar.

The rate of recovery and time to the detection of mycobacteria in clinical specimens were measured in traditional egg-based media cultures and on Middlebrook 7H11 agar plate cultures using microcolony detection. In the 5438 specimens processed, a total of 293 (5.4%) clinically relevant mycobacterial isolates were detected (Mycobacterium tuberculosis, n = 231; Mycobacterium avium complex, n = 60; Mycobacterium kansasii, n = 2). Of these, 227 (77%) and 237 (81%) isolates were detected on Lowenstein-Jensen medium and Coletsos medium, respectively, and 265 (90%) isolates were detected on Middlebrook 7H11 plates examined microscopically. The detection time was shorter with the microcolony detection method. While the Lowenstein-Jensen and Coletsos media required an average of 23 and 25 days, respectively, for first detection of mycobacteria, microcolony detection on Middlebrook 7H11 required an average of only 12 days. For acid-fast, stain-positive specimens that were culture positive for Mycobacterium tuberculosis, the average interval to positivity was nine days for the microcolony method compared with 20 and 21 days for the Lowenstein-Jensen and Coletsos media, respectively. Microscopic detection on Middlebrook 7H11 agar plates is a rapid, accurate and inexpensive method of detecting Mycobacterium tuberculosis and other clinically important mycobacteria.

[The indications for the antipneumococcal vaccine in Spain]. / Indicación de la vacuna antineumocócica en España.

The anti-pneumococcal vaccine, with 23 capsular polysaccharides, is an effective vaccine used in most of the developed countries, although still not commercially available in Spain. Between January 1981 and June 1992, we isolated 784 Streptococcus pneumoniae from clinical samples (excluding asymptomatic carriers), 728 of which could be serotyped (300 isolated in hemoculture and/or LCR). 91.5% of the total and 93.3% of the most invasive strains, as well as 98.1% of the penicillin-resistant strains or 98.8% of the isolated multiresistant strains, presented a serotype covered by the current vaccine. The high resistance to antibiotics of the pneumococcus in Spain makes more urgent the indication of the vaccine in our community.

Low risk of mother to infant transmission of hepatitis B virus in Guipúzcoa (Basque country, northern Spain).

The prevalence of HBsAg carriers in 18,196 pregnant women (64% of women who gave birth in Guipúzcoa in 1986-1991) was 0.61% (0.43% for the last two years of the study). Three of the carriers were also HBeAg/HBV-DNA positive and two were anti-HDV positive. Anti-HBc prevalence was 6.5% in 602 20-40 year old women and 1.6% in 428 girls 10-11 years old (0.47% of gypsy ethnic subjects are not included).

[Comparison of Yersinia enterocolitica strains isolated from swine and humans in Guipuzcoa]. / Comparación de cepas de Yersinia enterocolitica porcinas y humanas aisladas en Guipúzcoa.

Yersinia enterocolitica biotype 4, serotype 3 is a pathogenic bacteria for men. Its most likely reservoir are pigs. We have compared 48 Y. enterocolitica serotype 0:3 strains isolated from pig's tonsils samples as well as porcine-derived food with 301 Y. enterocolitica serotype 0:3 isolate from human stool's samples. All strains are positive for virulence tests. Yersinia enterocolitica serotype 0:3, biotype 4, phage-type VIII was nearly the only single pathogenic strain isolated from both origins in our county. Human and porcine strains showed a similar percentage of chloramphenicol and cotrimoxazol resistance. This pattern of resistance is not common among Y. enterocolitica strains isolated outside of our geographic area. The nearly identical patterns of human and porcine strains, as well as the high frequency of isolation from pig's tonsils (49.5%) and uncooked meal (12.9%) confirm the hypothesis that pigs are the most likely reservoir for human infections in our county.

[Rhodococcus equi in HIV infected patients: 2 new cases]. / Rhodococcus equi en pacientes con infección por el VIH: dos nuevos casos.

We reported two HIV infected patients with bacteremia and pneumonia due to Rhodococcus equi. None of them had suffer any opportunistic infection before this episode. Clinical presentation includes respiratory tract symptoms of subacute onset and fever. The X-ray examination in both cases revealed pneumonia and lung abscess in upper lobes as well as lung infiltrates in other lobes. The microorganism was isolated in lung fine needle aspiration, bronchoalveolar lavage and blood cultures in both cases. One patient died and the other was under antibiotic treatment 5 months after discharge. The therapeutic options in this infection must include the use of at least two different antibiotics to which the microorganism is sensitive, and for a prolonged period of time. Surgical treatment should be considered if the evolution is poor.

[Human genital myiasis due to Sarcophaga]. / Miasis genital humana por Sarcophaga.

Human myiasis are infestations produced by fly larvae which invade human tissues or cavities. We report a case of semi-specific myiasis which consisted in infestation of the vulvar region of an eighty-six-year old, diabetic patient who was admitted in a clinical center for elderly. The development from larva to adult fly was carried out in the laboratory and it was identified as Sarcophaga. The infestation was resolved extracting the larvae and washing the affected area with an antiseptic solution.

[Peritoneal pneumococcal infections]. / Infecciones neumocócicas peritoneales.

The clinical-microbiological characteristics of 13 patients iun whom Streptococcus pneumoniae (Pneumococcus) was isolated from the peritoneum over eight and a half years in a third grade hospital are reviewed. It is noteworthy the fact that only in 7 cases primary or spontaneous peritonitis were treated; the remaining cases were secondary to perforation or genital infection in females. The presence of antibiotic resistance in pneumococcus was high and global mortality was low.

[Malaria. Experience at a general hospital]. / Paludismo. Experiencia en un hospital general.

General hospitals should not ignore tropical diseases, even if they are not directly concerned with them. In our area, 3 and 6 instances of malaria have been diagnosed per year, 13 cases having been observed during the last 3 years. Prognosis is related with the quickness in achieving the diagnosis after the onset of symptoms; in our series it ranged from 4 days and one month. The outcome was good in all cases. To keep a reasonable good suspicion level, it should be remembered that the latency period between the infection and the development of symptoms may be very long. In 4 patients, the symptoms began 6 or more months after the patient had returned from the endemic zone. Chemoprophylaxis does not prevent the development of the disease in all individuals, although it is an effective prophylactic measure. Eight of these 13 patients had not undergone chemoprophylaxis or it had been incorrect. There was a remarkably high rate of patients infected by Pl. falciparum strains with in vivo resistance to antimalarial agents (chloroquine and fansidar).