Tularemia epidemic in northwestern Spain: clinical description and therapeutic response.

This study describes the clinical characteristics of tularemia in Spain's first epidemic outbreak and the therapeutic response and compares the efficacy of 3 antibiotics (streptomycin, ciprofloxacin, and doxycycline). For 142 cases of tularemia, the therapeutic failure rate was 22.5%; ciprofloxacin was the antibiotic with the lowest percentage of therapeutic failures and with the fewest side effects.

Report on five cases of tularaemic pneumonia in a tularaemia outbreak in Spain.

A report is given on five cases of atypical tularaemic pneumonia selected from among 140 cases of tularaemic infection in a previously reported outbreak occurring in 1997. Prior to this outbreak no human cases of tularaemia had been reported in Spain. All cases were diagnosed serologically. All five patients reported on here had a mild form of the disease, which was treated successfully with streptomycin in four cases and ciprofloxacin in one case. Tularaemic pneumonia should be considered in the differential diagnosis of atypical pneumonia in Spain, especially in hunters and other persons who handle animal carcasses.

[Tularemia in the differential diagnosis of cervical lymph node enlargement. An outbreak of tularemia in Castilla-León, Spain]. / La turalemia en el diagnóstico diferencial de las adenopatías cervicales. A propósito de un brote tularémico en Castilla-León.

The presence of enlarged cervical lymph nodes is a diagnostic challenge in disease of the head and neck. Lymph node enlargement may be secondary to local or general infectious disease, to non-infectious systemic disease, or to lymphatic metastasis of tumoral processes. Among the many infectious processes that originate cervical lymph nodes is tularemia. This disease is uncommon in Spain, but was unusually frequent in Castilla-León in the last months of 1997, with 136 cases diagnosed in our hospital, 13 accompanied by lymph node enlargement of the head and neck. This article shows that tularemia should be considered in the differential diagnosis of cervical lymph node enlargement in our region.

La turalemia en el diagnóstico diferencial de las adenopatías cervicales. A proposito de un brote tularémico en Castilla-León / Tularemia in the differential diagnosis of cervical lymph node enlargernent. An outbreak of tularemia in Castilla-León, Spain

La presencia de adenopatías cervicales plantea un reto diagnóstico en la patología de cabeza y cuello. Estas pueden ser secundarias a procesos infecciosos locales o generales, a enfermedades sistémicas no infecciosas o deberse a la diseminación metastásica linfática de procesos tumorales. Entre los múltiples cuadros infecciosos que pueden desarrollar adenopatías cervicales se encuentra el de la Tularemia. Esta enfermedad, rara en nuestro medio, se ha presentado con inusitada incidencia en Castilla-León en los últimos meses de 1997, alcanzando los 136 casos diagnosticados en nuestro Hospital, de los cuales 13 desarrollaron adenopatías en la región de cabeza y cuello. El propósito de este artículo es presentar a la Turalemia como una enfermedad a tener en cuenta en el diagnóstico diferencial de las adenopatías cervicales en nuestro medio (AU)

The presence of enlarged cervical lymph nodes is a diagnostic challenge in disease of the head and neck. Lymph node enlargement may be secondary to local or general infectious disease, to non-infectious systemic disease, or to lymphatic metastasis of tumoral processes. Among the many infectious processes that originate cervical lymph nodes is tularemia. This disease is uncommon in Spain, but was unusually frequent in Castilla-León in the last months of 1997, with 136 cases diagnosed in our hospital, 13 accompanied by lymph node enlargement of the head and neck. This article shows that tularemia should be considered in the differential diagnosis of cervical lymph node enlargement in our region (AU)

[Preliminary report of an epidemic tularemia outbreak in Valladolid]. / Descripción preliminar de un brote epidémico de tularemia en Valladolid.

We make here a preliminary report of the first 65 cases of tularemia diagnosed at our hospital pertaining to an epidemic outbreak occurred in the area served by the hospital. Diagnosis was made by the presence of a consistent clinical picture and the following laboratory criteria: antibody titre to. Francisella tularensis (tube agglutination) higher than or equal to 1/160, seroconversion or recovery of the microorganism from biological material. The mean age of our patients was 53.8 +/- 13.5 years and female sex predominated (45 women). Fever, lymph node enlargement, cutaneous ulcers, asthenia, and weight loss were the most common symptoms. The presentation clinical forms included: ulceroganglionar (69%), typhoidal (14%), ganglionar (12.5%), pneumonic (1.5%), oculoganglionar (1.5%) and atypical (1.5%). The analytical data did not show significant changes with the exception of erythrocyte sedimentation rate. Streptomycin was the antibiotic of choice, followed by ciprofloxacin and gentamicin. The failure rate was 22%, and ciprofloxacin was used for retreatment in twelve occasions and ofloxacin in 1 occasion with a good response. Tularemia is an infective disease which can become endemic in Spain and that should be considered by clinicians, particularly when unilateral enlarged lymph nodes, prolonged febrile syndromes, pharyngitis with negative culture, poor response to beta-lactams and atypical pneumonia are present.

Endocarditis caused by Enterococcus avium.

Enterococcus avium has rarely been reported as a pathogen in humans. We describe a case of endocarditis caused by E. avium. It responded to ampicillin and gentamicin, although a valve replacement was necessary for severe aortic insufficiency. This microorganism should be regarded as significant in endocarditis.

[Study of the influence of anticonvulsant treatment on thyroid function]. / Estudio de la influencia del tratamiento anticonvulsivante en la función tiroidea.

We studied in two groups of epileptic patients the thyroid alterations induced by anticonvulsant therapy (AC). Group I (28 cases): T4t and TSH were measured before and after 3 and 6 months on treatment with AC. Group II (75 cases on treatment): thyroid hormones were measured only once. In cases with low value of T4t or high TSH a TRH test and FT4 determination were performed. In group I two cases with low T4t were found after six months on treatment (7%), one of them with low FT4 and both with normal TSH. In group II we found 6 cases (7.8%) with low T4t and FT4, two of them with high TSH. It was not possible argue against factor and the low incidence reported argue against rutinary screening. Anycase, this screening will never be performed before the lag time observed (6 months).