Abscesos piógenos y tuberculosos del músculo psoas / Pyogenic and tuberculous abscesses of the psoas muscle

Objetivos. Precisar las características clínicas de los pacientes con absceso del músculo psoas (AP) y las posibles diferencias existentes entre los AP piógenos o tuberculosos. Pacientes y métodos. Revisión retrospectiva de los pacientes diagnosticados de AP en un hospital (1983-2009). Se establecieron dos grupos, piógenos y tuberculosos, y se compararon sus hallazgos clínicos, analíticos y evolución. Resultados. Se incluyeron 30 pacientes con AP, 25 piógenos y 5 tuberculosos, En 9 ocasiones fueron primarios y en 21 secundarios (a patología esquelética en 8 a patología urológica en 8 y a gastrointestinal en 8). No se observaron diferencias clínicas entre ambos grupos. Los pacientes con AP piógenos tendieron a tener mayores cifras de leucocitos (13.871 vs. 8.560/mm3, p=0,018) y de velocidad de sedimentación globular (VSG) (108 vs. 17mm/h, p<0,0001) y menores de hemoglobina (11 vs. 14g/dL, p=0,008) Se diagnosticaron por tomografía computarizada (TC) en 29 pacientes y por resonancia magnética en 1, ambas con una sensibilidad diagnóstica del 100%, frente al 50% de la ecografía. La lateralidad izquierda fue menos frecuente en los AP piógenos (44 vs. 100%, p=0,031). Los hemocultivos y el cultivo de pus del absceso fueron positivos en el 22% y 82% de las ocasiones en las que se realizó. Los gérmenes aislados con más frecuencia fueron bacilos gramnegativos, Streptococcus spp. y S. aureus. El 50% de los casos fueron drenados percutáneamente, el 13% quirúrgicamente y el 3% por ambas técnicas. Fallecieron 2 pacientes, ambos con absceso piógeno. Conclusiones. Los abscesos piógenos secundarios constituyen el grupo de AP más frecuente. La TC es el procedimiento diagnóstico de elección. La presencia de leucocitosis, anemia, VSG elevada y la lateralidad derecha sugieren etiología piógena. El drenaje percutáneo está sustituyendo al quirúrgico y permite obtener muestras diagnósticas(AU)

Objectives. To describe the clinical characteristics of patients with abscess on the psoas muscle (PA) and to identify the possible differences existing between pyogenic and tuberculous etiologies. Patients and methods. A retrospective review of patients diagnosed of PA in one hospital was conducted (1983-2009). Two groups were established, that is pyogenic and tuberculous, and the clinical findings, analyses and evolution were compared. Results. Thirty PA were included, 83% pyogenic and 17% tuberculous, average age 53 years. On 9 occasions, 30% were primary and on 21 occasions, 70% secondary (to skeletal pathology in 8, to urological in 8 and to gastrointestinal in 8). No clinical differences were observed between both groups. Pyogenic and tuberculous etiologies were differentiated analytically through leukocyte values (13,871 vs. 8,560/mm3, p=0.018), hemoglobin (11 vs. 14g/dL, p=0.008) and erythrocyte sedimentation rate (ESR) (108 vs. 17mm/h, p<0.0001). Abscesses were diagnosed by computed tomography (CT) in 29 patients (97%) and by magnetic resonance in 1 (3%), both with a diagnostic sensitivity of 100%, as opposed to 50% for ultrasound scanning. Left laterality was less frequent in pyogenic abscesses (44% vs. 100%, p=0.031). The blood cultures were positive in 22% and abscess pus culture in 82%. Gram negative bacilli, Streptococcus spp. and S. aureus were the most frequent isolations. A total of 67% were drained: transcutaneously 50%, surgically 13% and both techniques 3%. Two patients died (7%), both with pyogenic abscess. Conclusions. Secondary pyogenic abscesses constitute the most frequent PA group. CT is the diagnostic procedure of choice. Leukocytosis, anemia, raised ESR and right laterality suggest pyogenic etiology. Transcutaneous drainage is substituting surgical drainage and also makes it possible to obtain diagnostic samples(AU)

[Pyogenic and tuberculous abscesses of the psoas muscle]. / Abscesos piógenos y tuberculosos del músculo psoas.

OBJECTIVES: To describe the clinical characteristics of patients with abscess on the psoas muscle (PA) and to identify the possible differences existing between pyogenic and tuberculous etiologies. PATIENTS AND METHODS: A retrospective review of patients diagnosed of PA in one hospital was conducted (1983-2009). Two groups were established, that is pyogenic and tuberculous, and the clinical findings, analyses and evolution were compared. RESULTS: Thirty PA were included, 83% pyogenic and 17% tuberculous, average age 53 years. On 9 occasions, 30% were primary and on 21 occasions, 70% secondary (to skeletal pathology in 8, to urological in 8 and to gastrointestinal in 8). No clinical differences were observed between both groups. Pyogenic and tuberculous etiologies were differentiated analytically through leukocyte values (13,871 vs. 8,560/mm(3), p=0.018), hemoglobin (11 vs. 14 g/dL, p=0.008) and erythrocyte sedimentation rate (ESR) (108 vs. 17 mm/h, p<0.0001). Abscesses were diagnosed by computed tomography (CT) in 29 patients (97%) and by magnetic resonance in 1 (3%), both with a diagnostic sensitivity of 100%, as opposed to 50% for ultrasound scanning. Left laterality was less frequent in pyogenic abscesses (44% vs. 100%, p=0.031). The blood cultures were positive in 22% and abscess pus culture in 82%. Gram negative bacilli, Streptococcus spp. and S. aureus were the most frequent isolations. A total of 67% were drained: transcutaneously 50%, surgically 13% and both techniques 3%. Two patients died (7%), both with pyogenic abscess. CONCLUSIONS: Secondary pyogenic abscesses constitute the most frequent PA group. CT is the diagnostic procedure of choice. Leukocytosis, anemia, raised ESR and right laterality suggest pyogenic etiology. Transcutaneous drainage is substituting surgical drainage and also makes it possible to obtain diagnostic samples.

Meningitis bacteriana asociada a analgesia y anestesia espinal / Bacterial meningitis secondary to spinal analgesia and anaesthesia

Introducción: Aunque infrecuentes, las complicaciones infecciosas de la analgesia y la anestesia espinal (AE) pueden ser mortales. El objetivo del estudio es describir las meningitis bacterianas asociadas a AE diagnosticadas a adultos en un hospital durante un período de 25 años. Métodos: Se revisaron las historias clínicas de los pacientes con edad ≥14 años que habían sido diagnosticados de meningitis bacteriana asociada a AE entre 1982 y 2006. Resultados: Se incluyen 8 casos (3,3% de las diagnosticadas durante el periodo de estudio), con una mediana de edad de 62 años (35-80). El procedimiento de AE efectuado fue: bomba de infusión de morfina con catéter epidural (3 casos) o intratecal (3), electroestimulación epidural (1) y anestesia epidural (1). La localización en columna fue: cervical (2 casos), dorsal (3) y lumbar (3). El tiempo transcurrido del inicio de la AE al diagnóstico fue de 7-101 días (mediana de 26). Tuvieron fiebre 8 casos (100%) y cefalea 7 (87,5%), cursando con rigidez de nuca 4 (50%). En líquido cefalorraquídeo se observó pleocitosis en 8 casos (100%), proteínas elevadas en 8 (100%) e hipoglucorraquia en 5 (62,5%). La etiología fue: Staphylococcus epidermidis (2 casos), Staphylococcus aureus (2), Enterococcus faecalis (1), Streptococcus milleri (1), flora mixta (S. epidermidis y Pseudomonas fluorescens) (1), cultivos negativos (1). El tratamiento incluyó antibioterapia y retirada del dispositivo de analgesia, falleciendo un paciente (12,5%). Conclusiones: La AE es infrecuente como factor de riego de meningitis bacteriana, pero la gravedad de la infección obliga a considerarla en el diagnóstico diferencial de la cefalea y del síndrome febril en estos pacientes (AU)

Introduction: Although rare, infectious complications from spinal analgesia and anaesthesia (SA) can have serious morbidity and mortality. This study describes the clinical features and outcome of SA-associated bacterial meningitis in adults seen in a hospital over a 25 yearperiod. Methods: We reviewed the charts of all patients (aged ≥14 years) diagnosed with SA-associated bacterial meningitis between 1982 and 2006. Results: Eight cases of SA-associated bacterial meningitis were diagnosed (3.3% bacterial meningitis), with a median age of 62 years (range, 35-80). SA procedures were: morphine infusion pumps with epidural (3 cases) or intrathecal (3) catheters, spinal cord stimulation with epidural neuroelectrode (1), and epidural anesthesia (1). Site of spinal insertion was: cervical (2 cases), thoracic (3), and lumbar (3). The median time to onset of meningitis was 26 days (range, 7-101) after AE. The most common clinical findings were fever (8 cases, 100%), headache (7 cases, 87.5%), and neck stiffness (4 cases, 50%). CSF abnormalities were pleocytosis (8 cases, 100%), elevated protein level (8 cases, 100%), and hypoglycorrhachia (5 cases, 62.5%). The causative organisms were Staphylococcus epidermidis (2 cases), Staphylococcus aureus (2), Enterococcus faecalis (1), Streptococcus milleri (1), and S. epidermidis and Pseudomonas fluorescens (1); one patient had a negative CSF culture. Treatment included antibiotics and to remove the analgesia device in all patients. There was one death (12.5%) (AU)

[Bacterial meningitis secondary to spinal analgesia and anaesthesia]. / Meningitis bacteriana asociada a analgesia y anestesia espinal.

INTRODUCTION: Although rare, infectious complications from spinal analgesia and anaesthesia (SA) can have serious morbidity and mortality. This study describes the clinical features and outcome of SA-associated bacterial meningitis in adults seen in a hospital over a 25 yearperiod. METHODS: We reviewed the charts of all patients (aged ≥14 years) diagnosed with SA-associated bacterial meningitis between 1982 and 2006. RESULTS: Eight cases of SA-associated bacterial meningitis were diagnosed (3.3% bacterial meningitis), with a median age of 62 years (range, 35-80). SA procedures were: morphine infusion pumps with epidural (3 cases) or intrathecal (3) catheters, spinal cord stimulation with epidural neuroelectrode (1), and epidural anesthesia (1). Site of spinal insertion was: cervical (2 cases), thoracic (3), and lumbar (3). The median time to onset of meningitis was 26 days (range, 7-101) after AE. The most common clinical findings were fever (8 cases, 100%), headache (7 cases, 87.5%), and neck stiffness (4 cases, 50%). CSF abnormalities were pleocytosis (8 cases, 100%), elevated protein level (8 cases, 100%), and hypoglycorrhachia (5 cases, 62.5%). The causative organisms were Staphylococcus epidermidis (2 cases), Staphylococcus aureus (2), Enterococcus faecalis (1), Streptococcus milleri (1), and S. epidermidis and Pseudomonas fluorescens (1); one patient had a negative CSF culture. Treatment included antibiotics and to remove the analgesia device in all patients. There was one death (12.5%). CONCLUSIONS: SA is a rare predisposing condition to bacterial meningitis but, due to the seriousness of the infection, it should be considered in the differential diagnosis for any patient who develops fever or headache in this setting.

Endocarditis por Candida albicans sin factores de riesgo / No disponible

No disponible

[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

Tumoración en la pared anterior del hemotórax izquierdo / No disponible

No disponible