[Acute bacterial meningitis in older people]. / Meningitis aguda bacteriana en ancianos.

INTRODUCTION: The age distribution of acute bacterial meningitis (ABM) has shifted from children to adults. At the same time, older population is increasing. The aim of this study is to characterize ABM in elderly patients. MATERIAL AND METHODS: We reviewed the meningitis cases diagnosed at our hospital (1982-2006), including ABM cases defined by established criteria. Two groups were analyzed: elderly patients (aged > or =60) and young adults (aged 14-59). RESULTS: Ninety-five of 239 ABM (40%) were diagnosed in elderly patients, while 144 (60%) were found in younger adults. In elderly people, 32% were nosocomial, 49% had postoperative risk factors, and 24% were spontaneous infections. The combination of fever, neck stiffness, and altered mental status was present in 45%. Elderly people presented altered mental status more often (p=0,002), had higher protein level (p=0,023) and higher percentage of positive cerebrospinal fluid culture (p=0,039). The most common pathogens were Streptococcus pneumoniae (20%), coagulase-negative Staphylococcus (14%) and Listeria monocytogenes (8%), whereas meningitis of unknown etiology was less common (p=0,014). Elderly patients had a higher mortality rate (19% vs. 6%, p=0,001), closely related to: age > or =years, altered mental status, absence of headache or vomiting, development of complications and systemic complications, and infection by Staph. aureus. In the multivariate model, age > or =75 years [OR=6,65; p=0,008], absence of headache [OR=0,15; p=0,003], and development of complications [OR=4,55; p=0,015] remained significantly associated with mortality. CONCLUSIONS: In elderly people, ABM affects patients with risk factors,and is predominantly due to Strep. pneumoniae. This age group has a higher mortality rate, which is associated with advanced age and development of complications.

Meningitis aguda bacteriana en ancianos / Acute bacterial meningitis in older people

Introducción La distribución de la meningitis aguda bacteriana (MAB) se ha desplazado de la infancia a la edad adulta, mientras crece la proporción de ancianos en la población. El objetivo es describir la MAB en ancianos. Material y métodos Estudio de las meningitis diagnosticadas en nuestro hospital entre 1982–2006, incluyendo las que cumplieron criterios diagnósticos de MAB, clasificándolas en dos grupos: ancianos (≥60 años) y adultos (14–59 años). Resultados Noventa y cinco de 239 MAB (40%) ocurrieron en ancianos y 144 (60%) en adultos. En ancianos, 32% fueron nosocomiales y 49% tuvieron factores de riesgo posoperatorios, siendo espontáneas 24%. El 45% presentaron fiebre, alteración de conciencia y signos meníngeos, cursando más frecuentemente con alteración de conciencia (p=0,002), cifras más elevadas de proteínas (p=0,023) y cultivo positivo de líquido cefalorraquídeo (p=0,039). Los patógenos más comunes fueron Streptococcus pneumoniae (20%), Staphylococcus coagulasa negativo (14%) y Listeria monocytogenes (8%), mientras que la etiología desconocida fue menos frecuente (p=0,014). La mortalidad fue superior (19% vs. 6%; p=0,001), relacionándose con: edad ≥75 años, alteración de conciencia, ausencia de cefalea y vómitos, desarrollo de complicaciones y de complicaciones sistémicas, y etiología por Staphylococcus aureus. En el análisis multivariante, la edad ≥75 años [OR=6,65; p=0,008] y el desarrollo de complicaciones [OR=4,55, p=0,015] permanecieron asociadas a mortalidad, y la cefalea a curación [OR=0,15; p=0,003]. Conclusiones La MAB en ancianos ocurre en presencia de factores de riesgo y la etiología más común es S. pneumoniae. Su mortalidad, superior a la de los adultos, se asocia a la edad y al desarrollo de complicaciones(AU)

Introduction The age distribution of acute bacterial meningitis (ABM) has shifted from children to adults. At the same time, older population is increasing. The aim of this study is to characterize ABM in elderly patients. Material and methods We reviewed the meningitis cases diagnosed at our hospital (1982–2006), including ABM cases defined by established criteria. Two groups were analyzed: elderly patients (aged ≥60) and young adults (aged 14–59). Results Ninety-five of 239 ABM (40%) were diagnosed in elderly patients, while 144 (60%) were found in younger adults. In elderly people, 32% were nosocomial, 49% had postoperative risk factors, and 24% were spontaneous infections. The combination of fever, neck stiffness, and altered mental status was present in 45%. Elderly people presented altered mental status more often (p=0,002), had higher protein level (p=0,023) and higher percentage of positive cerebrospinal fluid culture (p=0,039). The most common pathogens were Streptococcus pneumoniae (20%), coagulase-negative Staphylococcus (14%) and Listeria monocytogenes (8%), whereas meningitis of unknown etiology was less common (p=0,014). Elderly patients had a higher mortality rate (19% vs. 6%, p=0,001), closely related to: age ≥75 years, altered mental status, absence of headache or vomiting, development of complications and systemic complications, and infection by Staph. aureus. In the multivariate model, age ≥75 years [OR=6,65; p=0,008], absence of headache [OR=0,15; p=0,003], and development of complications [OR=4,55; p=0,015] remained significantly associated with mortality. Conclusions In elderly people, ABM affects patients with risk factors,and is predominantly due to Strep. pneumoniae. This age group has a higher mortality rate, which is associated with advanced age and development of complications(AU)

[Cardiac myxoma: an analysis of 30 patients]. / Mixoma cardíaco: serie de 30 pacientes.

INTRODUCTION: Myxomas are the most common type of benign heart tumors. The aim of this study was to correlate the clinical forms of presentation of cardiac myxoma and complementary laboratory results with the morphological features of the tumor. MATERIALS AND METHODS: We reviewed retrospectively a total of 30 cardiac myxomas seen in 2 institutions after a period of 22 years. In the same period 5 cardiac sarcomas were identified. The Chi-Square test and Fischer's exact test were used to compare the variables. In one patient the IL-6 production by peripherals blood cells before and after surgical tumor resection was evaluated. RESULTS: The patients were evenly distributed between genders. The mean age of this group was 60 years. The most prevalent clinical manifestations were cardiac symptoms (73,3%), constitutional symptoms (30%) and embolisms (26,7%). All cases were diagnosed by transthoracic echocardiography and the most frequent location of the tumor was the left atrium. Larger-diameter myxomas were observed in older patients and correlated with cardiac symptoms, radiological and electrocardiographical abnormalities. Smaller-diameter myxomas presented more frequently embolic phenomenons. There were no deaths during the postoperative period and the principal postoperative complication was transient arrhytmias. There was no evidence of recurrence of the disease. In one patient with systemic manifestations monocytes were observed to contribute to the increased serum levels of IL-6. CONCLUSIONS: Myxomas are the most frequent tumors of the heart. The most common initial manifestations were cardiac symptoms. Diagnosis was achieved in all patients by transthoracic echocardiography. The size and macroscopic appearance of the tumor correlated with the age of the patients and some clinical symptoms and laboratory RESULTS: Surgical excision was a safe and effective procedure. (c) 2009 Elsevier España, S.L. All rights reserved.

Mixoma cardíaco: serie de 30 pacientes / Cardiac myxoma: an analysis of 30 patients

Introducción y objetivos: El mixoma es la neoplasia benigna cardíaca más frecuente. El objetivo de este estudio es relacionar los síntomas y los hallazgos en las pruebas complementarias de los pacientes diagnosticados de mixoma con las características macroscópicas del tumor. Material y métodos: Se analizaron de forma retrospectiva en dos hospitales de tercer nivel un total de 30 mixomas cardíacos en los últimos 22 años. En el mismo período se identificaron 5 sarcomas cardíacos. Para las comparaciones se utilizó el test de la ji cuadrado y el test exacto de Fischer. En un paciente con síntomas sistémicos e inflamatorios se determinó la producción de interleucina 6 (IL-6) en células mononucleares de sangre periférica antes y después de la cirugía. Resultados: La distribución de los enfermos fue equitativa para ambos sexos. La edad media fue de 60 años. Las manifestaciones clínicas más prevalentes fueron los síntomas cardíacos (73,3%), seguidos de los síntomas generales (30%) y las manifestaciones embólicas (26,7%). El diagnóstico se realizó mediante ecocardiograma, siendo la localización predominante la aurícula izquierda. Los tumores de mayor tamaño se presentaron en edades avanzadas y se relacionaron más frecuentemente con manifestaciones cardíacas y con más alteraciones radiológicas y electrocardiográficas. Por el contrario, los tumores de menor tamaño y pediculados tuvieron manifestaciones embólicas con mayor asiduidad. No hubo mortalidad postoperatoria aunque sí arritmias transitorias. No se describieron recidivas locales. Se comprobó que los monocitos de sangre periférica contribuyen de forma mayoritaria a la producción de IL-6 en un paciente con síntomas sistémicos. Conclusiones: El mixoma es la neoplasia cardíaca más frecuente. Los síntomas cardíacos son la forma de presentación más común de los mixomas. El diagnóstico se realizó mediante ecocardiografía. El tamaño y la morfología del tumor se relacionan con la edad del paciente y con algunas manifestaciones clínicas y hallazgos de las pruebas complementarias. El tratamiento es quirúrgico y suele ser seguro y curativo (AU)

Introduction: Myxomas are the most common type of benign heart tumors. The aim of this study was to correlate the clinical forms of presentation of cardiac myxoma and complementary laboratory results with the morphological features of the tumor. Materials and methods: We reviewed retrospectively a total of 30 cardiac myxomas seen in 2 institutions after a period of 22 years. In the same period 5 cardiac sarcomas were identified. The Chi-Square test and Fischer's exact test were used to compare the variables. In one patient the IL-6 production by peripherals blood cells before and after surgical tumor resection was evaluated. Results: The patients were evenly distributed between genders. The mean age of this group was 60 years. The most prevalent clinical manifestations were cardiac symptoms (73,3%), constitutional symptoms (30%) and embolisms (26,7%). All cases were diagnosed by transthoracic echocardiography and the most frequent location of the tumor was the left atrium. Larger-diameter myxomas were observed in older patients and correlated with cardiac symptoms, radiological and electrocardiographical abnormalities. Smallerdiameter myxomas presented more frequently embolic phenomenons. There were no deaths during the postoperative period and the principal postoperative complication was transient arrhytmias. There was no evidence of recurrence of the disease. In one patient with systemic manifestations monocytes were observed to contribute to the increased serum levels of IL-6. Conclusions: Myxomas are the most frequent tumors of the heart. The most common initial manifestations were cardiac symptoms. Diagnosis was achieved in all patients by transthoracic echocardiography. The size and macroscopic appearance of the tumor correlated with the age of the patients and some clinical symptoms and laboratory results. Surgical excision was a safe and effective procedure (AU)

[Enterococcal meningitis in adults]. / Meningitis enterocócica en adultos.

INTRODUCTION: In recent years, Enterococcus species have emerged as significant human pathogens capable of causing a variety of nosocomial and community-acquired infections. However, enterococcal meningitis (EM) is an uncommon disease. This study describes the clinical features and outcome of EM in adults seen at a tertiary hospital during 25 years. METHODS: We reviewed the charts of all patients (aged > or = 14 years) evaluated between 1982 and 2006 with EM. RESULTS: Six cases of EM were diagnosed (4,2% of culturepositive bacterial meningitis), with a mean age of 67 years (range, 47-83). All cases had postoperative meningitis, and the most common predisposing condition was the presence of CSF devices (5 cases). The clinical course was acute (duration of symptoms of one day in 5 cases). Most patients presented with fever and headache (5 cases), and changes in mental status (4 cases). The most common CSF abnormalities were pleocytosis (6 cases), elevated protein level (6 cases), and hypoglycorrhachia (3 cases). Gram CSF stain was positive in one case, and culture in all cases (4 were E. faecalis and 2 were E. faecium). Treatment included vancomycin (5 cases) or ampicillin plus gentamicin (one case), CSF devices were removed in all patients, and there were no deaths or sequelae. CONCLUSIONS: EM is an uncommon disease, most of cases had a postoperative origin, and CSF devices are the most common predisposing condition. A favourable outcome was observed in the cases reported.

[Comparative study of meningitis due to Staphylococcus aureus and coagulase-negative Staphylococci in adults]. / Estudio comparativo de las meningitis por Staphylococcus aureus y Staphylococci coagulasa negativo en adultos.

INTRODUCTION: Staphylococcus spp. rarely cause community-acquired acute bacterial meningitis (ABM), but they are a frequent cause of nosocomial meningitis. AIMS. We describe and conduct a comparative analysis of ABM due to S. aureus and coagulase-negative (CoN) Staphylococci in adults. PATIENTS AND METHODS: We reviewed the medical records of patients aged 14 or over who had been diagnosed with ABM, including those with a positive cerebrospinal fluid (CSF) culture for Staphylococcus spp. RESULTS: Forty cases were included (28% of the ABM), 12 due to S. aureus and 28 due to CoN Staphylococci. Incidence increased over time: 1.9% in the first third of the study, 22.9% in the second and 19.4% in the third (p = 0.003). In 67% of cases it was nosocomial and post-operative in 95%. Neurosurgical devices (74%) and recent neurosurgery (26%) were the risk factors, and both associated 61%. Clinical signs and symptoms and alterations to CSF were similar in both groups, but bacteraemia (60% versus 20%) and the development of complications were more frequent in infections due to S. aureus. Overall mortality rate was above 15%, and was higher in infections due to S. aureus (67% versus 0%). Mortality was also associated with spontaneous acquisition of the infection (25% versus 0%), the development of septic complications (37% versus 6%), bacteraemia (62% versus 19%) and not withdrawing or changing the neurosurgical device (60% versus 0%). CONCLUSIONS: Staphylococcus spp. are a frequent cause of ABM in hospitals with neurosurgery, especially in the post-operative period following neurosurgical procedures and/or in carriers of CSF drainage devices. Prognosis in infections caused by CoN Staphylococci is favourable, in contrast to the high mortality rate caused by S. aureus.

Estudio comparativo de las meningitis por Staphylococcus aureus y Staphylococci coagulasa negativos en adultos / Comparative study of meningitis due to staphylococcus aureus and coagulase-negative staphylococci in adults

Introducción. Los Staphylococcus spp. raramente causan meningitis aguda bacteriana (MAB) comunitaria, pero sonuna etiología frecuente de meningitis nosocomial. Objetivo. Descripción y análisis comparativo de MAB por S. aureus y Staphylococci coagulasa negativos (CoN) en adultos. Pacientes y métodos. Revisión del historial de pacientes de edad igual o superior a 14 años diagnosticados de MAB, incluyendo aquéllos con cultivo de líquido cefalorraquídeo (LCR) positivo paraStaphylococcus spp. Resultados. Se incluyen 40 casos (el 28% de las MAB), 12 por S. aureus y 28 por Staphylococci CoN. La incidencia aumentó en el tiempo: el 1,9% en el primer tercio del estudio, el 22,9% en el segundo y el 19,4% en el tercero (p = 0,003). El 67% fue nosocomial y el 95%, postoperatorio. Los dispositivos neuroquirúrgicos (74%) y la neurocirugía reciente(26%) fueron los factores de riesgo, y ambos se asociaron en el 61%. La clínica y alteraciones del LCR fueron similares en ambos grupos, pero en infecciones por S. aureus fue más frecuente la bacteriemia (60% frente a 20%) y el desarrollo de complicaciones(50% frente a 11%). La mortalidad global fue del 15%, superior en infecciones por S. aureus (67% frente a 0%). La mortalidad se asoció también a adquisición espontánea de la infección (25% frente a 0%), desarrollo de complicaciones sépticas (37% frente a 6%), bacteriemia (62% frente a 19%) y no retirar o sustituir el dispositivo neuroquirúrgico (60% frente a 0%).Conclusiones. Los Staphylococcus spp. son una etiología frecuente de MAB en hospitales con neurocirugía, especialmente en el postoperatorio neuroquirúrgico y/o en portadores de dispositivos de drenaje del LCR. El pronóstico en infecciones por Staphylococci CoN es favorable, frente a la elevada mortalidad causada por S. aureus

Introduction. Staphylococcus spp. rarely cause community-acquired acute bacterial meningitis (ABM), but they area frequent cause of nosocomial meningitis. Aims. We describe and conduct a comparative analysis of ABM due to S. aureus and coagulase-negative (CoN) Staphylococci in adults. Patients and methods. We reviewed the medical records of patients aged 14 or over who had been diagnosed with ABM, including those with a positive cerebrospinal fluid (CSF) culture for Staphylococcus spp. Results. Forty cases were included (28% of the ABM), 12 due to S. aureus and 28 due to CoNStaphylococci. Incidence increased over time: 1.9% in the first third of the study, 22.9% in the second and 19.4% in the third (p = 0.003). In 67% of cases it was nosocomial and post-operative in 95%. Neurosurgical devices (74%) and recent neurosurgery (26%) were the risk factors, and both associated 61%. Clinical signs and symptoms and alterations to CSF were similar in both groups, but bacteraemia (60% versus 20%) and the development of complications were more frequent ininfections due to S. aureus. Overall mortality rate was above 15%, and was higher in infections due to S. aureus (67% versus 0%). Mortality was also associated with spontaneous acquisition of the infection (25% versus 0%), the development of septic complications (37% versus 6%), bacteraemia (62% versus 19%) and not withdrawing or changing the neurosurgical device (60% versus 0%). Conclusions. Staphylococcus spp. are a frequent cause of ABM in hospitals with neurosurgery, especially inthe post-operative period following neurosurgical procedures and/or in carriers of CSF drainage devices. Prognosis in infections caused by CoN Staphylococci is favourable, in contrast to the high mortality rate caused by S. aureus

Meningitis enterocócia en adultos / Enterococcal meningitis in adults

Introducción. Recientemente Enterococcus spp han emergido como agentes causales de una variedad de infecciones comunitarias y nosocomiales. Sin embargo, la meningitis enterocócica (ME) es una enfermedad infrecuente. El objetivo de este estudio es describir las ME en adultos diagnosticadas en un hospital de tercer nivel durante 25 años. Métodos. Se revisaron las historias clínicas de los pacientes con edad = 14 años que habían sido diagnosticados de ME entre 1982 y 2006. Resultados. Se incluyen 6 casos de ME (4,2 % de las meningitis bacterianas de etiología identificada), con una media de edad de 67 años (47-83). Todas fueron meningitis postoperatorias y el factor predisponente más frecuente fue el ser portador de dispositivos neuroquirúrgicos (5 casos). El curso clínico fue agudo (1 día de duración de los síntomas en 5 casos), presentando la mayoría fiebre y cefalea (5 casos) y alteración de conciencia (4 casos). En líquido cefalorraquídeo se observó pleocitosis (6 casos), proteínas elevadas (6 casos), hipoglucorraquia (3 casos), tinción de Gram positiva (1 caso) y cultivo positivo (6 casos, 4 con E. faecalis y 2 con E. faecium). El tratamiento incluyó vancomicina (5 casos) y ampicilina más gentamicina (1 caso), los dispositivos neuroquirúrgicos se retiraron a todos y no hubo fallecimientos ni secuelas atribuibles a la infección. Conclusiones. Enterococcus spp causan infrecuentemente meningitis, teniendo la mayoría de los casos un origen postoperatorio y siendo el principal factor predisponente el ser portador de algún tipo de dispositivo neuroquirúrgico. En los casos descritos la evolución fue favorable (AU)

Introduction: In recent years, Enterococcus species have emerged as significant human pathogens capable of causing a variety of nosocomial and community-acquired infections. However, enterococcal meningitis (EM) is an uncommon disease. This study describes the clinical features and outcome of EM in adults seen at a tertiary hospital during 25 years. Methods: We reviewed the charts of all patients (aged > or = 14 years) evaluated between 1982 and 2006 with EM. Results: Six cases of EM were diagnosed (4,2% of culturepositive bacterial meningitis), with a mean age of 67 years (range, 47-83). All cases had postoperative meningitis, and the most common predisposing condition was the presence of CSF devices (5 cases). The clinical course was acute (duration of symptoms of one day in 5 cases). Most patients presented with fever and headache (5 cases), and changes in mental status (4 cases). The most common CSF abnormalities were pleocytosis (6 cases), elevated protein level (6 cases), and hypoglycorrhachia (3 cases). Gram CSF stain was positive in one case, and culture in all cases (4 were E. faecalis and 2 were E. faecium). Treatment included vancomycin (5 cases) or ampicillin plus gentamicin (one case), CSF devices were removed in all patients, and there were no deaths or sequelae. Conclusions: EM is an uncommon disease, most of cases had a postoperative origin, and CSF devices are the most common predisposing condition. A favourable outcome was observed in the cases reported (AU)

Tumoración en la pared anterior del hemotórax izquierdo / No disponible

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Mujer de 36 años con tumoración quística pancreática y trombopenia / 36-year old woman with cystic pancreatic tumor and thrombopenia

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