Comparison of two methods for obtaining and transporting corneal samples in suspected infectious keratitis.

BACKGROUND AND PURPOSE: The purpose of this study is to compare two alternative methods of collecting and transporting media for the diagnosis of corneal ulcers, as not all clinical settings have conventional culture materials and transport media available. METHODS: In this open-label, prospective, comparative, and randomized study, patients with clinical suspicion of infectious keratitis with high risk of loss of vision had corneal specimens collected using two methods and transport media: Eswab scraping with Amies transport medium and 23-gauge needle scraping in BACTEC Peds broth. The order of each collection method was randomized. The samples were processed by standard methods, comparing the positivity frequencies for both by parametric and nonparametric tests, according to normality criteria. RESULTS: Corneal infiltrates from 40 eyes of 40 patients were analyzed. Culture positivity rate was 50% for Eswab and 35% for 23-gauge needle (P=0.258). The overall growth rate of the two methods combined was not higher than with the swab alone. The results obtained with a swab were not influenced by the collection sequence (P=0.112); however, the positivity rate was significantly higher when the sample taken with the needle was performed first (P=0.046). CONCLUSIONS: The single sample Eswab method of collection and transportation for the diagnosis of high risk corneal ulcers is a valid alternative and can be used in cases in which, for various reasons, there is no access to the full set of traditional culture materials.

Infecciones de transmisión sexual: experiencia de una consulta multidisciplinar en un hospital terciario (2010-2013) / Sexually Transmitted Infections: Experience in a Multidisciplinary Clinic in a Tertiary Hospital (2010-2013)

INTRODUCCIÓN: Las infecciones de transmisión sexual son un motivo de consulta creciente en nuestro medio. El objetivo de este trabajo es describir y analizar las características epidemiológicas, conductuales, clínicas y microbiológicas de los pacientes registrados en una unidad de infecciones de transmisión sexual de un hospital terciario. MÉTODOS: Estudio descriptivo, retrospectivo y unicéntrico realizado en una unidad multidisciplinar especializada en infecciones de transmisión sexual de un hospital terciario entre 2010 y 2013. Se recogieron datos epidemiológicos, clínicos y conductuales mediante entrevista oral abierta y cuestionario estandarizado, y se llevó a cabo la obtención de muestras para estudio microbiológico. RESULTADOS: Se estudiaron 546 pacientes, de los cuales fueron 96% varones, 41% infectados por el VIH, 56% hombres que tienen sexo con hombres. Los motivos de consulta más prevalentes fueron: uretritis, úlceras genitales y/o anales/perianales, proctitis, úlceras orales, contacto sexual de persona con ITS conocida y contacto sexual de riesgo. Los diagnósticos microbiológicos más frecuentes fueron: Neisseria gonorrhoeae en uretritis, Treponema pallidum en úlceras genitales y/o anales/perianales y Chlamydia trachomatis serovares de linfogranuloma venéreo en proctitis. Las principales ITS estudiadas fueron más prevalentes en varones homosexuales e infectados por el VIH. CONCLUSIÓN: Se confirma el incremento en la incidencia de las infecciones de transmisión sexual en los últimos años y las características epidemiológicas de la epidemia VIH/ITS de nuestro entorno

INTRODUCTION: The number of consultations for sexually transmitted infections (STIs) is increasing in Spain. The aim of this study was to describe and analyze the epidemiological, behavioral, clinical, and microbiological characteristics of patients registered at the STI unit of a tertiary hospital. METHODS: This was a retrospective, single-center descriptive study carried out between 2010 and 2013 in a multidisciplinary unit specialized in STIs, situated in a tertiary hospital. Epidemiological, clinical, and behavioral data were gathered using a face-to-face interview and a standardized questionnaire. Samples were collected for microbiology analysis. RESULTS: The study included 546 patients: 96% were men, 41% had human immunodeficiency virus (HIV) infection, and 56% were men who have sex with men. The reasons for consultation were the following: urethritis; genital, anal, or perianal ulcers; proctitis; oral ulcers; sexual contact with a person with a known STI; and high-risk sexual contact. The most common microbiological diagnoses were Neisseria gonorrhoeae in urethritis, Treponema pallidum in genital and anal or perianal ulcers, and Chlamydia trachomatis lymphogranuloma venereum serovars in proctitis. The highest prevalences of the main STIs studied occurred in homosexual men with HIV infection. CONCLUSION: This study confirms the increase in the incidence of STIs in recent years and the epidemiological characteristics of the HIV/STI epidemic in Spain

Sexually Transmitted Infections: Experience in a Multidisciplinary Clinic in a Tertiary Hospital (2010-2013).

INTRODUCTION: The number of consultations for sexually transmitted infections (STIs) is increasing in Spain. The aim of this study was to describe and analyze the epidemiological, behavioral, clinical, and microbiological characteristics of patients registered at the STI unit of a tertiary hospital. METHODS: This was a retrospective, single-center descriptive study carried out between 2010 and 2013 in a multidisciplinary unit specialized in STIs, situated in a tertiary hospital. Epidemiological, clinical, and behavioral data were gathered using a face-to-face interview and a standardized questionnaire. Samples were collected for microbiology analysis. RESULTS: The study included 546 patients: 96% were men, 41% had human immunodeficiency virus (HIV) infection, and 56% were men who have sex with men. The reasons for consultation were the following: urethritis; genital, anal, or perianal ulcers; proctitis; oral ulcers; sexual contact with a person with a known STI; and high-risk sexual contact. The most common microbiological diagnoses were Neisseria gonorrhoeae in urethritis, Treponema pallidum in genital and anal or perianal ulcers, and Chlamydia trachomatis lymphogranuloma venereum serovars in proctitis. The highest prevalences of the main STIs studied occurred in homosexual men with HIV infection. CONCLUSION: This study confirms the increase in the incidence of STIs in recent years and the epidemiological characteristics of the HIV/STI epidemic in Spain.

[Cat-scratch disease. Presentation of 2 cases in a family with serologic follow-up and discussion of diagnostic methods]. / Enfermedad por arañazo de gato. Presentación de dos casos familiares con seguimiento serológico y discusión de métodos diagnósticos.

Two cases are reported of cat scratch disease which we consider worth describing both because of their familial presentation (the involved patients were brothers) and the serologic follow-up performed after diagnosis, which showed significant increases in IgG antibody titers to Bartonella henselae in both patients, one on day 35 and the other on day 45 after diagnosis. Cat scratch disease is a rarely diagnosed condition in our environment and it is easily misdiagnosed with other regional lymphadenitis; hence, a serologic test revealing a seroconversion or a significant increase in serologic titers will be very useful, as well as the epidemiologic antecedent of cat exposure.

[Early onset of neonatal sepsis due to Streptococcus agalactiae: study of ten years (1985-1994) and the utility of intrapartum prophylaxis]. / Sepsis neonatal precoz por Streptococcus agalactiae: estudio de diez años (1985-1994) y eficacia de la profilaxis intraparto.

OBJECTIVES: The objectives of this study were to determine the characteristics of early onset neonatal sepsis (EONS) due to group B streptococci (GBS) in our population and to evaluate the efficacy of a prevention program in our hospital during a 4 year period. MATERIAL AND METHODS: We revised all cases of EONS due to GBS between 1985 and 1994 and studied pregnant women colonized by GBS and their infants between 1991 and 1994. RESULTS: In ten years, we diagnosed 45 cases of EONS due to GBS, 30 born in our hospital and 15 born in other hospitals. Sixty-two percent of the patients presented some risk factor (gestation < 37 weeks, rupture of membranes > 18 hours or intrapartum fever > or = 37.8 degrees C. Between 1991 and 1994, 93% of pregnant women colonized by GBS received antibiotic prophylaxis, 14.7% of these women had some risk factor for infection. Two infants from mothers colonized had EONS due to GBS. One mother did not receive antibiotic prophylaxis and the other presented intrapartum fever. In another 5 cases observed during this period, the vaginal culture of the mother was negative for GBS. The incidence of EONS due to GBS during these 4 years was 0.82 cases per 1,000 live births. CONCLUSION: We consider it necessary to use antibiotic prophylaxis in all pregnant carriers of GBS, as well as the administration of antibiotics to pregnant women with a rupture of membranes < 34 weeks of gestation and the practice of an intrapartum culture for the detection of GBS in pregnant women without previous cultures and premature rupture of the membranes.

[Severe infection caused by Candida parapsilosis in an infant]. / Infecciones graves por Candida parapsilosis en el lactante.

Three cases of serious infections due to Candida parapsilosis in infants are reported. Two patients are children exposed to abdominal surgery, parenteral nutrition and antibiotic treatment, who developed catheter-associated sepsis with successful response to change of catheter and intravenous amphotericin B, despite one of the patients showed a relapse some weeks after. Third patient, a hydrocephalic child with external ventricular shunt, developed cerebrospinal fluid infection without response to antifungal treatment and died. Sepsis and meningitis due to Candida parapsilosis can be observed in infants with some risk factors, as use of intravascular or intraventricular catheters. Change of the catheter and treatment with amphotericin B are indicated in these infections.