Infección diseminada por Mycobacterium scrofulaceum en un paciente infectado por el VIH / Disseminated infection by Mycobacterium scrofulaceum in an infected HIV patient

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Fasciolasis en el sur de Galicia. Presentación de dos casos / Fasciolasis in the South of Galicia. Review of two cases

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[Primary actinomycosis of the abdominal wall. Description of 2 cases and review of the literature]. / Actinomicosis primaria de la pared abdominal. Descripción de dos casos y revisión de la literatura.

We report two cases of isolated abdominal wall actinomycosis and review 18 previously reported cases to further characterize the clinical findings and the therapeutic management of this syndrome. This diagnosis would be advocated in patients with a palpable abdominal mass of subacute appearance with a previous history of digestive medical illness, diabetes, abdominal surgery, or prolonged IUD use. In contrast with other actinomycosis locations, remarkable data were a more elevated mean age of patients; a female predominance; a prevalent location of mass in abdominal lower left quadrant; and a shorter duration of symptomatology before to diagnosis. The CT is the first choice for imaging study and percutaneous needle aspiration would be recommended for definite diagnosis. The long-term antibiotic therapy, with or without percutaneous drainage, is the first treatment choice because is very effective and made unnecessary a more invasive surgical management. The prognosis is excellent with adequated treatment.

Actinomicosis primaria de la pared abdominal. Descripción de dos casos y revisión de la literatura / Primary actinomycosis of abdominal wall. Report of 2 cases and literature review

Presentamos dos casos de actinomicosis aislada de la pared abdominal y revisamos 18 casos publicados previamente para describir las características clínicas y el manejo terapéutico de este síndrome. Su diagnóstico debe plantearse en pacientes con una masa abdominal palpable, de aparición subaguda, con una historia previa de enfermedad digestiva, diabetes, cirugía abdominal o uso prolongado de DIU. Contrastan con otras formas de actinomicosis, la edad media más alta de los pacientes, el predominio del sexo femenino, la localización prevalente de la lesión en el cuadrante inferior izquierdo del abdomen y la menor duración de la sintomatología previa al diagnóstico. La TAC es la técnica de imagen de primera elección y se debe recomendar la aspiración percutánea con aguja para un diagnóstico definitivo. La administración prolongada de antibióticos, con o sin drenaje percutáneo, es el tratamiento de elección ya que es muy efectivo y hace innecesario el manejo quirúrgico más agresivo.El pronóstico es excelente con un tratamiento adecuado. (AU)

[Epidemiology of tuberculosis in Galicia]. / Epidemiología de la tuberculosis en Galicia.

BACKGROUND: To know the real incidence of tuberculosis in Galicia and its epidemiological characteristics. METHODS: Study of data recorded in the "Galician Programme for Tuberculosis Control and Prevention", where an active epidemiological survey of every diagnosis of tuberculosis is carried out in every part of Galicia. RESULTS: 1995 cases were included in this study, with an incidence of 72.7/100,000 inhabitants. 58% of the cases were detected by the epidemiological survey. 92% of the cases were newly diagnosed cases, being the remain relapses. The highest incidence were localized in the areas of A Coruña and Vigo. The mean age was 40.5 years with 57% being between 15 and 44 years. Male incidence was 92.8/100,000 and female incidence was 54.0/100,000 (RR = 1.72; CI 95%: 1.57-1.88). 18.1% of the patients had at least one of the following risk factors associated: HIV infection (9.1%), alcoholism (8.4%) or injecting drug use (7.3%). Other risk factors for tuberculosis were very unusual. Pulmonary localization was the most frequent form with 1389 cases (incidence: 50.6/100,000). 742 patients were considered to be bacilliferous (incidence: 27/100,000). CONCLUSIONS: The incidence of tuberculosis in Galicia is high. Its epidemiological characteristics suggest a historical lack of measures of tuberculosis control.

Epidemiología de la tuberculosis en Galicia / Epidemiology of tuberculosis in Galicia

Objetivo: Conocer la incidencia real de la tuberculosis en Galicia y sus características epidemiológicas. Método: Estudio de los datos recogidos durante 1996 en el "Programa Gallego de Prevención y Control de la Tuberculosis" en el cual se realiza un sistema de vigilancia activa epidemiológica de los casos de tuberculosis diagnosticados en la totalidad de la comunidad autónoma de Galicia. Resultados: Se incluyeron en el estudio 1995 casos de tuberculosis que suponen una incidencia de 72,7 por cien mil habitantes. Un 58% de los casos fueron detectados mediante el sistema de vigilancia activa epidemiológica. El 92%de los casos fueron iniciales, siendo el resto recidivas. Las mayores tasas de incidencia se dieron en las áreas de influencia de A Coruña y de Vigo. La edad media fue de 40,5 años, con el 57% de los pacientes entre los 15 y 44 años. La incidencia específica en varones fue de 92,8 por cien mil y en mujeres de 54,0 por cien mil (RR=1,72; IC95%: 1,57-1,88). Un 18,1% de los pacientes presentaron al menos uno de los siguientes factores de riesgo: anticuerpos frente al virus de la inmunodeficiencia humana (9,1%), alcoholismo (8,4%) o adicción a drogas por vía parenteral (7,3%). La presencia de otros factores de riesgo fue muy escasa. La localización pulmonar fue la forma más frecuente con 1389 casos (incidencia: 50,6 por cien mil); con 742 pacientes bacilíferos (incidencia: 27,0 por cien mil). Conclusiones: Galicia presenta una elevada incidencia de tuberculosis con unas características epidemiológicas que sugieren un déficit histórico en las medidas de control de la enfermedad (AU)

[Pleural effusion as the only manifestation of cryptococcosis in an AIDS patient]. / Derrame pleural como única manifestación de criptococosis en un paciente con SIDA.

Cryptococcosis is often seen in immunodeficient patients, including those with AIDS. It usually affects mainly the respiratory tract and central nervous system. We present a rare case of pleural involvement with no sign of disease at other sites. A review of the literature yields only three other similar cases. We discuss the diverse clinical manifestations of cryptococcosis, particularly those found in the respiratory tract.

[Enteral nutrition and changes in taste in diabetic patients: a double-blind prospective study]. / Nutrición enteral y alteraciones del gusto en pacientes diabéticos: estudio prospectivo doble ciego.

The authors present a prospective double blind test aimed at objectively determining the acceptance of flavoured orally administered enteric diets specific to patients with glucose metabolism alterations (Glucerna and Precitene Diabet), in the light of the taste disorders described in such patients. Sixty-two patients were studied, 32 diabetics and 32 control patients, who were given a sample of each product; the level of acceptance was quantified on a modified wine-tasting scale. The average taste of the diabetics was 12.1 points (SD = 4.34) for Glucerna, and 10.1 (SD = 3.91) for the Precitene Diabet. In the control patients, the scores were 12.7 (SD = 3.78) and 13.2 (SD = 3.23) respectively. Multiple regression analysis did not reveal significant differences in taste according to age, sex or place of origin. Average taste among the diabetic patients as a whole with both products was 11.2 points and, for the nondiabetics, 12.92. The model detected significant differences (p = 0.01) between the two groups. The average taste of the diabetics was less than that of the non-diabetics, irrespective of all the remaining variables examined, including the type of preparation. These results confirm the lower oral acceptance in diabetic patients, possibly associated with disorders in the sense of taste, showing the utility of the modified wine-tasting scale as a test in evaluating the acceptance of enteric diets which must be administered orally.