Bacteriemia por "Bordetella holmesii" en un paciente con drepanocitosis / Febrile syndrome caused by Bordetella holmesii and sickle cell disease

Introducción: Bordetella holmesii es un microorganismo que fue aislado por primera vez en un varón esplenectomizado en 1983. Existen pocos casos descritos en la literatura hasta ahora, pero todos comparten un factor de riesgo común: la inmunodepresión del paciente. Se presenta el caso de un niño diagnosticado de dicha infección en nuestro hospital. Caso clínico: Niño de 11 años de edad diagnosticado de drepanocitosis homocigota y asplenia funcional a los 8 años, que ingresa por un cuadro de mialgias de 24 horas de evolución, disuria y dolor lumbar, en tratamiento con amoxicilina-ácido clavulánico desde las 12 horas previas debido a la presencia de un síndrome febril sin foco. A su ingreso se inicia rehidratación y tratamiento antibiótico intravenoso. Se obtienen los resultados de las pruebas complementarias realizadas durante su ingreso, en los que destaca el aislamiento en el hemocultivo de un bacilo gramnegativo a las 72 horas, que no pudo ser identificado inicialmente pero fue catalogado como B. holmesii tras ser analizado por espectrómetro de masas en nuestro laboratorio de referencia. Tras su recuperación, destaca como dato analítico la presencia de una trombocitosis llamativa. Conclusión: Los gérmenes causantes de bacteriemias en los últimos años han cambiado y B. holmesii se presenta como un patógeno emergente que cabe tener en cuenta en los pacientes que presenten un síndrome febril e inmunosupresión como factor de riesgo

Introduction: Bordetella holmesii is a microorganism which was isolated in a splenectomized male in 1983 for the first time. Few cases have been described in the literature since then, but all of them share a common risk factor: the immunodepression of the patient. We introduce the case of a child diagnosed with the above mentioned infection in our hospital. Clinical case: 11-year-old child diagnosed of homozygous sickle cell disease and functional asplenia at 8 years of age, who was admitted to the hospital for muscle pain of 24 hours of evolution, dysuria and backache. He was being treated with amoxicilina-acid clavulanic for 12 hours because of a febrile syndrome without focus. When he was admitted to the hospital a rehydration and antibiotic intravenous treatment is initiated. Once the results of the complementary tests made during his admission become available, in which it stands out the isolation in the blood culture of a gram-negative bacilli after 72 hours, which could not be initially identified, but eventually was recognized as a B. holmesii after being analysed by mass spectrometry in our reference laboratory. After his recovery, the presence of a mild thrombocytosis is stressed as an analytical data. Conclusion: The microorganism which causes bacterieamia has changed in the last years and B. holmesii seems to be an emerging pathogenic which must be considered in patients who have a febrile syndrome and immunosuppression as a risk factor

Hemorragia digestiva baja grave activa por úlcera apendicular / Active lower gastrointestinal bleeding due to appendiceal ulcer

Presentamos un caso de hemorragia digestiva baja grave por úlcera apendicular asociada a la toma de ácido acetilsalicílico con cubierta entérica. La colonoscopia urgente pudo precisar la localización y las características de la lesión sangrante durante el episodio agudo y permitió un tratamiento eficaz mediante apendicectomía simple

We present a case of severe lower gastrointestinal bleeding due to appendiceal ulcer associated with intake of enteric coated aspirin. Urgent colonoscopy revealed the location and characteristics of the source of bleeding during the acute episode, allowing effective treatment through simple appendicectomy to be performed

[Active lower gastrointestinal bleeding due to appendiceal ulcer]. / Hemorragia digestiva baja grave activa por úlcera apendicular.

We present a case of severe lower gastrointestinal bleeding due to appendiceal ulcer associated with intake of enteric coated aspirin. Urgent colonoscopy revealed the location and characteristics of the source of bleeding during the acute episode, allowing effective treatment through simple appendicectomy to be performed.

[Severe acute gastroenteritis due to Aeromonas in a patient colectomized for Crohn's disease]. / Gastroenteritis aguda grave por Aeromonas en paciente colectomizado por enfermedad de Crohn.

We report a case of severe acute diarrhoea produced by Aeromonas sobria, a specimen with controversial human pathogenicity. A 26-year-old man with Crohn's disease previously colectomized was admitted with a cholera-like clinical presentation and renal failure. Aeromonas sp. can be isolated in both children and adults and in healthy people, A. hydrophila being most often detected. Severe infections due to other Aeromonas sp., usually A. sobria and A. caviae, have been rarely described. Most patients have underlying illnesses such as chronic liver disease or neoplasms. In our patient colectomy played a key role.