Epidemiology and outcome of candidaemia in patients with oncological and haematological malignancies: results from a population-based surveillance in Spain.

A prospective, population-based surveillance on candidaemia was implemented in five metropolitan areas of Spain from May 2010 to April 2011. We aimed to describe the distribution and susceptibility pattern of Candida species, and to evaluate risk factors for mortality in patients with oncological (solid tumours) and haematological malignancies. Adults (≥ 16 years) with cancer were included in the present report. Impact of therapeutic strategies on 7- and 30-day mortality were analysed by logistic regression, adjusting for propensity score by inverse weighting probability of receiving early antifungal treatment and catheter removal. We included 238 (32.6%) patients (195 oncological, 43 haematological). Compared with oncological patients, haematological patients were more likely to have received chemotherapy (53.5% versus 17.4%, p < 0.001) or corticosteroids (41.9% versus 21%, p < 0.001), and have neutropenia (44.2% versus 1.5%, p < 0.001). Overall, 14.8% of patients developed breakthrough candidaemia. Non-albicans Candida species (71.1% versus 55.6%, p 0.056) and Candida tropicalis (22.2% versus 7.6%, p 0.011) were more frequent in haematological patients. Based on EUCAST breakpoints, 27.6% of Candida isolates were non-susceptible to fluconazole. Resistance to echinocandins was negligible. Mortality at 7 and 30 days was 12.2% and 31.5%, respectively, and did not differ significantly between the patient groups. Prompt antifungal therapy together with catheter removal (≤ 48 hours) was associated with lower mortality at 7 days (adjusted OR 0.05; 95% CI 0.01-0.42) and 30 days (adjusted OR 0.27; 95% CI 0.16-0.46). In conclusion, non-albicans species are emerging as the predominant isolates, particularly in haematological patients. Prompt, adequate antifungal treatment plus catheter removal may lead to a reduction in mortality.

Predictive factors for mortality in patients with methicillin-resistant Staphylococcus aureus bloodstream infection: impact on outcome of host, microorganism and therapy.

Mortality related to methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) remains high, despite changes in the epidemiology. To analyze the current predictive factors for mortality we conducted a prospective study in a large cohort of patients with MRSA-BSI from 21 Spanish hospitals. Epidemiology, clinical data, therapy and outcome were recorded. All MRSA strains were analysed, including susceptibility to antibiotics and molecular characterization. Vancomycin MICs (V-MIC) were tested by the E-test and microdilution methods. Time until death was the dependent variable in a Cox regression analysis. Overall, 579 episodes were included. Acquisition was nosocomial in 59% and vascular catheter was the most frequent source (38%). A dominant PFGE genotype was found in 368 (67%) isolates, which belonged to Clonal Complex (CC)5 and carried SCCmecIV and agr2. Microdilution V-MIC50 and V-MIC90 were 0.7 and 1.0 mg/L, respectively. Initial therapy was appropriate in 66% of episodes. Overall mortality was observed in 179 (32%) episodes. The Cox-regression analysis identified age >70 years (HR 1.88), previous fatal disease (HR 2.16), Pitt score >1 (HR 3.45), high-risk source (HR 1.85) and inappropriate initial treatment (HR 1.39) as independent predictive factors for mortality. CC5 and CC22 (HR 0.52 and 0.45) were associated with significantly lower mortality rates than CC8. V-MIC ≥1.5 did not have a significant impact on mortality, regardless of the method used to assess it.

Prophylactic therapy with valganciclovir in high-risk (cytomegalovirus D+/R-) kidney transplant recipients: a single-center experience.

BACKGROUND: A prospective study was performed in kidney transplant patients at risk of developing cytomegalovirus (CMV) infection (CMV D+/R-). They were treated with valganciclovir (VGC) for 3 months as prophylactic therapy. The aim was to determine the safety and efficacy of prophylactic therapy with VGC. METHODS: Antigenemia and/or polymerase chain reaction CMV was routinely performed every 2 weeks up to month 3, monthly to month 6, and every other month until the end of the first year posttranplantation, as well as when clinically indicated. RESULTS: From July 2007 to April 2010, 366 renal transplantations were performed at our center, including 34 (9%) high-risk patients for CMV infection. The median age was 47 years; 19 were males and 15 females. Twelve (35%) patients developed CMV infections: 10 (34%) gastrointestinal disease and 3 viral syndromes. The timing of the clinical manifestations was 16% (3/12) between months 1 and 3, 75% (8/12) between months 4 and 6, and 8% (1/12) in month 9 posttransplantation. CONCLUSION: Treatment with intravenous ganciclovir followed by oral VGC was successful in all patients. No opportunistic infections or allograft rejection were observed; only 1 patient developed thrombocytopenia as an adverse event to VGC.

Implantación de prótesis autoexpandibles sobre estenosis aórticas por arteritis de Takayasu asociada a enfermedad de Crohn / The implantation of autoexpandible prostheses in aortic stenosis by Takayasu arteritis associated with Crohn's disease

Presentamos el caso de una mujer diagnosticada de enfermedad de Crohn que desarrolló una estenosis severa de la aorta abdominal por enfermedad de Takayasu manifestada por claudicación de ambos miembros inferiores. La colocación de prótesis intravasculares autoexpandibles (stents) sobre las lesiones aórticas estenóticas resolvió el cuadro, tanto desde el punto de vista hemodinámico como clínico de forma inmediata. (AU)

Primary actinomycosis of the urinary bladder.

Actinomycosis is caused by bacilli of the Actinomyces sp. They are Gram-positive, anaerobic or microaerophilic non-spore-forming bacilli. Actinomyces israelii is the most common aetiological agent. A case is reported of primary actinomycosis in the urinary bladder successfully treated with ceftriaxone.

[Cat-scratch disease: series of 14 cases. The diagnostic usefulness of serology]. / Enfermedad por arañazo de gato: serie de 14 casos. Utilidad diagnóstica de la serología.

BACKGROUND: Disease by cat scratch (CSD) is a syndrome characterized by regional adenopathies following cat scratch or bite. Despite knowing the etiologic agent of the same, there is still controversy in the diagnosis of the syndrome in daily clinical practice. MATERIALS AND METHODS: The cases of CSD diagnosed from 1990 to 1997 with positive serology for Bartonella henselae performed by indirect immunofluorescence were reviewed. RESULTS: In 13 out of the 14 patients studied direct contact with cats was reported. Lymph node involvement corresponded to the following regions: axillary (57%), inguinal (28%), epitroclear (21%), cervical (14%), and periauricular (7%). In 35% of the cases, several territories were involved. In 3 patients the adenopathies were fluctuating. Eleven anatomopathologic studies were performed with 6 diagnoses of granulomatous adenitis, 3 reactive adenitis and 2 purulent adenitis. The serology for Bartonella henselae was positive in all the patients with a range of 1/64-1/256. The evolution was favorable in all the patients. DISCUSSION: Interpretation of the results of serology should be cautions and always related to the clinical and epidemiological picture of the patient. This technique should be considered as another criteria in the diagnosis of cat scratch disease to the detriment of the cutaneous test.

[Osteomyelitis of the frontal bone (Pott's puffy tumor). A report of 5 patients]. / Osteomielitis del hueso frontal (tumor blando de Pott). Presentación de cinco pacientes.

BACKGROUND: Frontal bone osteomyelitis is considered to be rare but it may develop intracranial complications such as subperiosteal abscess that appears as a painful fluctuated forehead tumor (Pott's puffy tumor). METHODS: We reviewed retrospectively the clinical history of those patients showing frontal swelling tumour in our Neurosurgery and Infectious Diseases Departments between July 1994 and December 1997 and whose definitive diagnosis was cranial osteomyelitis. RESULTS: We reported five cases of patients who had been submitted to a neurosurgical operation between 9 months and 27 years ago. The main clinical features were intermittent painful frontal swelling episodes (with or without fever). These episodes were self-limited or limited after short trend of antibiotics. Imaging techniques were necessary for the diagnosis and especially in order to exclude intracranial complications (such as epidural abscess found in two patients). The ascertain diagnosis is made by debriding, histological studies and cultures from the material. Staphylococcus aureus was isolated in three of the patients, Haemophilus influenzae in one patient and Pseudomonas aeruginosa in the other one. All patients were treated with surgery and specific antibiotic therapy during twelve weeks minimum, being definitively cured. CONCLUSIONS: It is not well know the etiopathogenic mechanism concerning this rare disease. We remark the importance of a prompt diagnosis because of the high frequency of intracranial complications as well as combined treatment: surgery and long term antibiotic therapy (not less than 8 weeks), is necessary to cure the disease.

[Tularemia: report of 16 cases in the Castilla-Leon community]. / Tularemia: descripción de 16 casos procedentes de la Comunidad de Castilla-León.

OBJECTIVE: To report the clinico-epidemiological characteristics of 16 patients with the diagnosis of tularemia. METHOD: Retrospective review of clinical records of patients admitted to the hospital or examined at health centers in Vizcaya, with clinical course and epidemiology consistent with tularemia, from January to March 1998. CASE DEFINITION: Patient with suggestive clinical course and epidemiology (exposure to hares coming from the epizootic area) and positive serology (antibodies to Francisella tularensis > 1/160 in convalescent phase serum). RESULTS: Sixteen patients (8 males, 8 females) with a mean age of 53 years. The incubation period ranged from 1 and 8 days (mean: 5). Nine patients had the ulceroganglionar form, two the pharyngeal form, one the oculoganglionar form and one the typhoidal form. In three patients only cutaneous lesion or lesions were observed. The antibiotic treatment administered included streptomycin for five patients, tobramycin for 2 patients, and ciprofloxacin, azithromycin and amoxicillin (plus doxycycline) for other three patients. Three patients received initially antitermic drugs (with poor response) and later two of them, doxycycline. The administered antibiotic in the remaining three patients was unknown. The clinical course was satisfactory in all of them and so far no relapses have been detected. CONCLUSIONS: The ulceroglandular form, as it appears in literature, was the most common form in this series of patients with tularemia. Neither severe diseases nor complications were observed. Although streptomycin is considered the drug of choice, other antibiotics are likely equally effective, at least for the non complicated forms of the disease.

[Duodenal gangliocytic paraganglioma]. / Paraganglioma gangliocítico duodenal.

We report a case of duodenal Gangliocytic Paranglioma in a 73 year old man, who presented with a history of melena. An upper gastrointestinal barium study showed a polyp located in the second portion of the duodenum. This lesion was endoscopically resected. Pathological examination revealed a Gangliocytic Paraganglioma. We describe the general characteristics of this neoplasm, as well as the theories about its histogenesis.