Relación entre la infección por el virus del papiloma humano y Chlamydia trachomatis / Relationship between human papillomavirus infection and Chlamydia trachomatis

La infección persistente por el virus del papiloma humano (VPH) es un requisito necesario pero no suficiente para el desarrollo del cáncer de cuello uterino (CCU), puesto que solo una baja proporción de las pacientes infectadas desarrolla una lesión intraepitelial cervical o un CCU. Esto hace pensar que son necesarios algunos cofactores que favorezcan dicha progresión. Según varios estudios, la infección por Chlamydia trachomatis (CT) es más prevalente en las pacientes con infección por VPH y parece que puede influir en la progresión de las lesiones epiteliales producidas por el VPH, relacionándose así de forma indirecta con el CCU. El cribado de la infección por CT y el correcto tratamiento de los casos permitiría evitar las consecuencias derivadas de la propia infección (salpingitis, EIP, esterilidad…) y la influencia que ejerce en el desarrollo del cáncer de cérvix

Human papillomavirus (HPV) infection is required but not sufficient to develop cervical cancer, since only a small proportion of HPV-infected women develop cervical intraepithelial lesions or cancer. This leads to the conclusion that other factors are required to facilitate disease progression. According to several studies, Chlamydia trachomatis (CT) infection is more prevalent in HPV-infected women and seems to contribute to the progression of HPV-related epithelial lesions. It is therefore indirectly related to cervical cancer. CT infection screening and the proper treatment of this condition could avoid the consequences of this genital infection (salpingitis, pelvic inflammatory disease, infertility, etc.) and its impact on developing cervical cancer

Endoftalmitis postoperatoria por Candida parapsilosis / Post-operative endophthalmitis due to Candida parapsilosis

No disponible

[Lipid nutrition and the epidermal barrier: The connection between immune-mediated inflammatory diseases and peroxisome proliferator-activated receptors, a new therapeutic target in psoriasis and atopic dermatitis]. / Barrera epidérmica y nutrición lipídica. La conexión PPAR e inmunopatología inflamatoria como nuevas dianas de tratamiento en dermatitis atópica y psoriasis.

The authors describe peroxisome proliferator-activated receptor (PPAR) transcription factors as connectors between the enzymatic mechanisms of the epidermal barrier and the abnormal immune and inflammatory responses that characterize atopic dermatitis and psoriasis. Also described is a new connection between lipid metabolism and the epidermal barrier. A suggestion that emerges is that atopic dermatitis and psoriasis share at least 2 pathogenic mechanisms-namely, deficient expression of PPAR-#a and impaired production of interleukin-10 and interferon-γ-in spite of differences in causes and manifestations. A standardized olive oil formulation with powerful bactericidal and fungicidal effects also has the ability to increase serum levels of these 2 cytokines and regulate serum levels of high-density lipoprotein cholesterol in patients at high risk for inflammatory and cardiovascular disease, suggesting that these may be among the mechanisms responsible for the benefits observed following oral and/or topical administration in patients with atopic dermatitis or psoriasis.

Barrera epidérmica y nutrición lipídica. La conexión PPAR e inmunopatología inflamatoria como nuevas dianas de tratamiento en dermatitis atópica y psoriasis / Lipid Nutrition and the Epidermal Barrier: The Connection Between Immune-Mediated Inflammatory Diseases and Peroxisome Proliferator-Activated Receptors, a New Therapeutic Target in Psoriasis and Atopic Dermatitis

Los autores describen los factores peroxisome proliferator-activated receptors (PPAR) como conectores entre los mecanismos enzimáticos de la barrera epidérmica (BE) y las alteraciones inmuno/inflamatorias que caracterizan a dermatitis atópica (DA) y psoriasis. Igualmente, se describe una nueva conexión entre el metabolismo lipídico y la BE. El análisis de estos hechos permite sugerir que DA y psoriasis, aunque diferentes en su causalidad y clínica, exhiben al menos dos hechos patogénicos comunes, que se manifiestan por defectos en la expresión de PPAR-ά y en la producción de IL-10 e IFN-γ. La capacidad de una formulación magistral de aceites de oliva (FMAO) para aumentar los niveles séricos de ambas citocinas, y regular el colesterol HDL sérico, en pacientes con alto riesgo inflamatorio/cardiovascular, junto a sus potentes efectos bactericidas y fungicidas, sugiere que estos sean algunos de los mecanismos responsables de los positivos efectos observados con la FMAO (oral y/o tópica) en pacientes con DA y psoriasis (AU)

The authors describe peroxisome proliferator-activated receptor (PPAR) transcription factors as connectors between the enzymatic mechanisms of the epidermal barrier and the abnormal immune and inflammatory responses that characterize atopic dermatitis and psoriasis. Also described is a new connection between lipid metabolism and the epidermal barrier. A suggestion that emerges is that atopic dermatitis and psoriasis share at least 2 pathogenic mechanisms–namely, deficient expression of PPAR-ά and impaired production of interleukin-10 and interferon- IFNγ–in spite of differences in causes and manifestations. A standardized olive oil formulation with powerful bactericidal and fungicidal effects also has the ability to increase serum levels of these 2 cytokines and regulate serum levels of high-density lipoprotein cholesterol in patients at high risk for inflammatory and cardiovascular disease, suggesting that these may be among the mechanisms responsible for the benefits observed following oral and/or topical administration in patients with atopic dermatitis or psoriasis (AU)

Lipid Nutrition and the Epidermal Barrier: The Connection Between Immune-Mediated Inflammatory Diseases and Peroxisome Proliferator-Activated Receptors, a New Therapeutic Target in Psoriasis and Atopic Dermatitis. / Barrera epidérmica y nutrición lipídica. La conexión PPAR e inmunopatología inflamatoria como nuevas dianas de tratamiento en dermatitis atópica y psoriasis.

The authors describe peroxisome proliferator-activated receptor (PPAR) transcription factors as connectors between the enzymatic mechanisms of the epidermal barrier and the abnormal immune and inflammatory responses that characterize atopic dermatitis and psoriasis. Also described is a new connection between lipid metabolism and the epidermal barrier. A suggestion that emerges is that atopic dermatitis and psoriasis share at least 2 pathogenic mechanisms-namely, deficient expression of PPAR-#a and impaired production of interleukin-10 and interferon-γ-in spite of differences in causes and manifestations. A standardized olive oil formulation with powerful bactericidal and fungicidal effects also has the ability to increase serum levels of these 2 cytokines and regulate serum levels of high-density lipoprotein cholesterol in patients at high risk for inflammatory and cardiovascular disease, suggesting that these may be among the mechanisms responsible for the benefits observed following oral and/or topical administration in patients with atopic dermatitis or psoriasis.

Vacunas profilácticas frente al virus del papiloma humano: Documento de consenso 2008* / Prophylactic human papillomavirus vaccines: Consensus Document 2008

No disponible

No disponible

Endocarditis infecciosa por enterococo: descripción de 12 casos / Enterococcal infective endocarditis: description of 12 cases

Con el objetivo de identificar a los pacientes diagnosticados en nuestro hospital de endocarditis infecciosa por enterococo se ha realizado un estudio retrospectivo durante un período de 12 años (1994-2005), analizando sus características clínicas y microbiológicas, así como el tratamiento y la evolución de la enfermedad. Se encontraron 12 casos de endocarditis por enterococo, lo que representó el 6% del total de endocarditis y el 7% de las bacteriemias por enterococo. Se trataba de 8 hombres y 4 mujeres, con edades comprendidas entre los 37 y los 94 años. El microorganismo causante fue E. faecalis en 10 casos y E. faecium en 2 casos. Dos de los E. faecalis eran resistentes a aminoglucósidos. La válvula afectada con mayor frecuencia fue la aórtica, con 9 casos, seguida de la mitral, con 2 y de la tricúspide, 1 caso. En 10 pacientes la endocarditis se instaló sobre una válvula nativa y sólo en 2 casos sobre válvula protésica. Únicamente 5 pacientes tenían antecedentes de enfermedad valvular cardiaca. El tratamiento antimicrobiano más utilizado fue la combinación de ampicilina y gentamicina, que se empleó en 8 pacientes. Cuatro casos fueron tratados con monoterapia; 2 de ellos con ampicilina y 2 con vancomicina. Siete pacientes se complicaron con insuficiencia cardíaca, cinco de los cuales precisaron tratamiento quirúrgico de sustitución valvular aórtica. Los 4 enfermos tratados con monoterapia presentaron complicaciones graves, que provocaron la muerte de 2 pacientes

We have performed a retrospective study of patients diagnosed with infective endocarditis due to Enterococcus in our hospital for a period of 12 years (1994-2005). We review clinical and microbiological aspects, therapy, and outcome. We found 12 cases that were 6 % of total endocarditis, and 7% of enterococcal bacteremia. Eight cases were male, and 4 were female, aged between 37 and 94 years. The causative organism of endocarditis was E. faecalis in 10 patients and E. faecium in 2. Two E. faecalis were resistant to aminoglycosides. Aortic valve was the most frequently affected with 9 cases, followed by mitral valve (2 cases), and tricuspid valve (1 case). In 10 cases endocarditis affected a native valve,and only in 2 cases a prosthetic valve. Only 5 patients had underlying valve disease. The most frequently used antimicrobial therapy was the combination of ampicillin plus gentamicin (8 patients). Four cases were treated with monotherapy, 2 with ampicillin, and 2 with vancomycin. Seven patients suffered heart failure, and five of them required surgical therapy with aortic valve replacement. All the patients treated with monotherapy had severe complications, that led to death in 2 of them

[Enterococcal infective endocarditis: description of 12 cases]. / Endocarditis infecciosa por enterococo: descripción de 12 casos.

We have performed a retrospective study of patients diagnosed with infective endocarditis due to Enterococcus in our hospital for a period of 12 years (1994-2005). We review clinical and microbiological aspects, therapy, and outcome. We found 12 cases that were 6 % of total endocarditis, and 7% of enterococcal bacteremia. Eight cases were male, and 4 were female, aged between 37 and 94 years. The causative organism of endocarditis was E. faecalis in 10 patients and E. faecium in 2. Two E. faecalis were resistant to aminoglycosides. Aortic valve was the most frequently affected with 9 cases, followed by mitral valve (2 cases), and tricuspid valve (1 case). In 10 cases endocarditis affected a native valve, and only in 2 cases a prosthetic valve. Only 5 patients had underlying valve disease. The most frequently used antimicrobial therapy was the combination of ampicillin plus gentamicin (8 patients). Four cases were treated with monotherapy, 2 with ampicillin, and 2 with vancomycin. Seven patients suffered heart failure, and five of them required surgical therapy with aortic valve replacement. All the patients treated with monotherapy had severe complications, that led to death in 2 of them.

[Clinical and epidemiological study of disease caused by Mycobacterium kansasii in the metropolitan area of Bilbao, Spain]. / Estudio clinicoepidemiológico de la enfermedad por Mycobacterium kansasii en el área urbana de Bilbao.

OBJECTIVE: Epidemiological description of individuals from whom Mycobacterium kansasii isolates were obtained in respiratory samples, and analysis of the isolates using molecular biological techniques. MATERIAL AND METHODS: A descriptive retrospective/ prospective study was carried out from January 1994 to April 2002 in Basurto Hospital and Santa Marina Hospital and from January 2000 to April 2002 in Cruces Hospital, Galdakao Hospital, and San Eloy Hospital. Diagnosis of the disease was performed according to American Thoracic Society criteria; other definitions were also applied to allow inclusion of all cases. Disease caused by M. kansasii in patients who were not infected with the human immunodeficiency virus (HIV) was compared with disease caused by Mycobacterium tuberculosis in a control group. Polymerase chain reaction was applied with analysis of restriction fragment length polymorphisms to differentiate between species of mycobacteria and classify them into genotypes. Amplified fragment length polymorphisms were used to recognize clones within each genotype. RESULTS: The patient charts of 334 patients in which an isolate of M. kansasii had been recorded were reviewed. We considered 220 patients to be suffering from disease caused by M. kansasii (American Thoracic Society criteria along with probable disease according to established definitions). The disease was more frequent in male patients (n=185; 84.1%) and in individuals who were not HIV positive (n=184; 83.6%). The highest incidence of disease in the Bizkaia region was found in Margen Izquierda-Encartaciones, where the rate was 8.05 per 100 000 inhabitants. In the Bilbao area, the highest rate was found in the districts lying on the outskirts. The underlying diseases were tuberculosis (20.5%), chronic obstructive pulmonary disease (25.9%), pulmonary neoplasia (7.7%), silicosis (0.9%), chronic liver disease (11.4%), and duodenal ulcer (8.6%). The most frequent constitutional symptoms were fever (39.1%), loss of appetite (23.2%), and weight loss (33.3%). Among the respiratory symptoms, the most outstanding were cough (70.9%) and expectoration (62.3%). The most frequent radiographic patterns were cavitation and pulmonary infiltration. The most common treatment regimen was rifampicin, isoniazid, and ethambutol (43.4%), and the average duration was 12 months in patients who were HIV negative. Analysis of antibiotic sensitivity, performed on 56 strains, revealed that 100% were resistant to isoniazid, while none displayed rifampicin resistance. Thirty-four cases of disease caused by M. kansasii were compared with 68 cases of tuberculosis, all of them without HIV infection. The comparison revealed a predominance of smokers, respiratory symptoms, and cavitation in patients with disease caused by M. kansasii. The majority of the isolates (98.5%) corresponded to genotype I. A total of 8 clones were obtained; the clones designated 1 and 3 were more common in HIV-positive and HIV-negative individuals respectively. CONCLUSIONS: In recent years, there has been an increase in the number of patients with disease caused by M. kansasii in the province of Bizkaia. The disease is more frequent in male patients, individuals who are HIV negative, and in urban areas. In addition, more respiratory symptoms and a higher incidence of cavitation were found in patients with disease caused by M. kansasii than in those with tuberculosis. Genotype I is the most common isolate, and clones 1 and 3 affect 80% of patients suffering from the disease.

Estudio clinicoepidemiológico de la enfermedad por Mycobacterium kansasii en el área urbana de Bilbao / Clinical and epidemiological study of disease caused by mycobacterium kansasii in the metropolitan area of Bilbao, Spain

OBJETIVO: Descripción epidemiológica de los individuos con aislamiento de Mycobacterium kansasii en muestras respiratorias y análisis de estos aislamientos mediante técnicas de biología molecular. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo, prospectivo y descriptivo de enero de 1994 a abril de 2002 en los hospitales de Basurto y Santa Marina, y de enero de 2000 a abril de 2002 en los hospitales de Cruces, Galdakao y San Eloy. Se aplicaron los criterios de la American Thoracic Society para el diagnóstico de enfermedad y se utilizaron otras definiciones para abarcar todos los casos. Se comparó la enfermedad por M. kansasii en pacientes sin infección por el virus de la inmunodeficiencia humana (VIH) con un grupo control con enfermedad por Mycobacterium tuberculosis. Se aplicó la reacción en cadena de la polimerasa con análisis de RFLP (restriction fragment-length polymorphisms) para diferenciar las especies de micobacterias y subtipificación en genotipos, y la AFLP (amplified fragment-length polymorphisms) para reconocer clones dentro de cada genotipo. RESULTADOS: Se revisaron 334 historias clínicas de pacientes en los que existía un registro de aislamiento microbiológico de M. kansasii. Consideramos que 220 eran enfermos (criterio de la American Thoracic Society más enfermedad probable de definiciones creadas). La enfermedad era más frecuente en varones (n = 185; 84,1%) y en personas sin infección por el VIH (n = 184; 83,6%). La tasa de incidencia de enfermedad más alta en la comarca de Bizkaia fue en Margen Izquierda-Encartaciones, con un 8,05 por cada 100.000 habitantes, y en el Área de Bilbao, en los distritos de la periferia. Las enfermedades de base fueron: tuberculosis (20,5%), enfermedad pulmonar obstructiva crónica (25,9%), neoplasia de pulmón (7,7%), silicosis (0,9%), hepatopatía crónica (11,4%) y gastrectomía (8,6%). Los síntomas constitucionales más frecuentes fueron: fiebre (39,1%), anorexia (23,2%) y disminución de peso (33,3%). Entre los síntomas respiratorios destacaron la tos (70,9%) y la expectoración (62,3%). Los patrones radiológicos más frecuentes fueron cavitación e infiltrados pulmonares. La pauta de tratamiento más habitual fue rifampicina, isoniacida y etambutol (43,4%), y el tiempo medio de duración fue de 12 meses en las personas sin infección por el VIH. En el estudio de sensibilidad realizado en 56 cepas, el 100% fue resistente a isoniacida y ninguna mostró resistencia a rifampicina. Se compararon 34 casos de enfermedad por M. kansasii con 68 casos de tuberculosis, todos sin infección por el VIH, y se obtuvieron los siguientes resultados: predominio de fumadores, de síntomas respiratorios y de cavitación en los pacientes con enfermedad por M. kansasii. El 98,5% de los aislamientos pertenecieron al genotipo I. Se obtuvieron un total de 8 clones; el clon denominado 1 fue más frecuente en personas con infección por el VIH y el denominado 3 en los que no la presentaban. CONCLUSIONES: Se ha registrado un aumento del número de pacientes con enfermedad por M. kansasii en la provincia de Bizkaia en los últimos años. Dicha enfermedad es más frecuente en varones, personas sin infección por el VIH y zonas urbanas. Asimismo, se han encontrado más síntomas respiratorios como manifestaciones clínicas y mayor presencia de cavitación como hallazgo radiológico en la enfermedad por M. kansasii al compararla con la tuberculosis. El genotipo I es el aislado con más frecuencia, y los clones 1 y 3 afectan al 80% de los individuos enfermos

OBJECTIVE: Epidemiological description of individuals from whom Mycobacterium kansasii isolates were obtained in respiratory samples, and analysis of the isolates using molecular biological techniques. MATERIAL AND METHODS: A descriptive retrospective/ prospective study was carried out from January 1994 to April 2002 in Basurto Hospital and Santa Marina Hospital and from January 2000 to April 2002 in Cruces Hospital, Galdakao Hospital, and San Eloy Hospital. Diagnosis of the disease was performed according to American Thoracic Society criteria; other definitions were also applied to allow inclusion of all cases. Disease caused by M. kansasii in patients who were not infected with the human immunodeficiency virus (HIV) was compared with disease caused by Mycobacterium tuberculosis in a control group. Polymerase chain reaction was applied with analysis of restriction fragment length polymorphisms to differentiate between species of mycobacteria and classify them into genotypes. Amplified fragment length polymorphisms were used to recognize clones within each genotype. RESULTS: The patient charts of 334 patients in which an isolate of M. kansasii had been recorded were reviewed. We considered 220 patients to be suffering from disease caused by M. kansasii (American Thoracic Society criteria along with probable disease according to established definitions). The disease was more frequent in male patients (n=185; 84.1%) and in individuals who were not HIV positive (n=184; 83.6%). The highest incidence of disease in the Bizkaia region was found in Margen Izquierda-cartaciones, where the rate was 8.05 per 100 000 inhabitants. In the Bilbao area, the highest rate was found in the districts lying on the outskirts. The underlying diseases were tuberculosis (20.5%), chronic obstructive pulmonary disease (25.9%), pulmonary neoplasia (7.7%), silicosis (0.9%), chronic liver disease (11.4%), and duodenal ulcer (8.6%). The most frequent constitutional symptoms were fever (39.1%), loss of appetite (23.2%), and weight loss (33.3%). Among the respiratory symptoms, the most outstanding were cough (70.9%) and expectoration (62.3%). The most frequent radiographic patterns were cavitation and pulmonary infiltration. The most common treatment regimen was rifampicin, isoniazid, and ethambutol (43.4%), and the average duration was 12 months in patients who were HIV negative. Analysis of antibiotic sensitivity, performed on 56 strains, revealed that 100% were resistant to isoniazid, while none displayed rifampicin resistance. Thirtyfour cases of disease caused by M. kansasii were compared with 68 cases of tuberculosis, all of them without HIV infection. The comparison revealed a predominance of smokers, respiratory symptoms, and cavitation in patients with disease caused by M. kansasii. The majority of the isolates (98.5%) corresponded to genotype I. A total of 8 clones were obtained; the clones designated 1 and 3 were more common in HIV-positive and HIV-negative individuals respectively. CONCLUSIONS: In recent years, there has been an increase in the number of patients with disease caused by M. kansasii in the province of Bizkaia. The disease is more frequent in male patients, individuals who are HIV negative, and in urban areas. In addition, more respiratory symptoms and a higher incidence of cavitation were found in patients with disease caused by M. kansasii than in those with tuberculosis. Genotype I is the most common isolate, and clones 1 and 3 affect 80% of patients suffering from the disease

Infección por parvovirus B1 9 con rash petequial en un adulto / No disponible

No disponible

Enfermedades importadas 'tropicales': experiencia de una consulta especializada en un hospital general / Imported 'tropical' diseases: experience of a specialty clinic in a general hospital

Introducción. En los últimos años el incremento de viajeros, organizaciones de cooperación internacional y de inmigrantes ha originado un aumento considerable de las enfermedades importadas, y por ello la creación de unidades especializadas. Material y métodos. Se realiza un estudio de las características de los pacientes atendidos en la Unidad de Enfermedades Tropicales del Hospital de Basurto desde el inicio de su funcionamiento en marzo de 1996 hasta marzo de 1999.Resultados. En el período del estudio fueron atendidos, tras estancia en zonas tropicales, 171 pacientes. De éstos, 72 eran turistas, 50 cooperantes de Organizaciones No Gubernamentales (ONG) y 49 inmigrantes. Las áreas de procedencia fueron: África en 84 casos, Centroamérica-Caribe en 49, Sudamérica en 23 y Asia en 15. Los principales motivos de consulta fueron: fiebre (61 casos), síntomas digestivos (40 casos) y problemas cutáneos (31 casos), y los diagnósticos más frecuentes: paludismo (34), fiebre autolimitada (17), diarrea autolimitada (16), amebiasis (8), giardiasis (6), sarna (7) y larva migrañas cutánea (5).Conclusiones. La actividad asistencial ha incluido aspectos preventivos, pero fundamentalmente el diagnóstico y tratamiento de enfermedades importadas. Entre las personas atendidas se encuentran no solamente viajeros, sino una proporción importante de inmigrantes y cooperantes de ONG. Las enfermedades más frecuentes han sido el paludismo y enfermedades digestivas y cutáneas (AU)

["Tropical" imported diseases: experience of a specialized unit in a general hospital]. / Enfermedades importadas "tropicales": experiencia de una consulta especializada en un hospital general.

BACKGROUND: In the last few years a considerable increase in imported diseases has occurred as a result of an increase in the numbers of travellers, international collaborative organizations, and immigrants. Altogether, this has prompted the setting-up of specialized units. MATERIALS AND METHODS: A report is given of the characteristics of patients attended at the Tropical Diseases Unit in the Basurto Hospital, since its set-up in March 1996 to March 1999. RESULTS: A total of 171 patients were attended at this unit after staying in tropical areas. Patients were classified as tourists (72), ONG collaborators (50) and immigrants (49). The origin areas were Africa (84 cases), Central America (49 cases), South America (23 cases) and Asia (15 cases). The main complaints included fever (61 cases), digestive symptoms (40 cases), skin problems (31 cases). The most common diagnoses were malaria (34), self-limited fever (17), self-limited diarrhoea (16), amebiasis (8), giardiasis (6), scabies (7) and cutaneous larva migrans (5). CONCLUSIONS: Health care activities included preventive issues, but mainly diagnosis and treatment of imported diseases. Among the attended individuals, there were not only travellers but also a significant proportion of immigrants and ONG collaborators. The most common diseases were malaria and digestive and cutaneous conditions.

Infección respiratoria por Chlamydias / Chlamydial respiratory infections

Objetivo: Describir las clamidiasis respiratorias diagnosticadas en el Hospital de Basurto (Bilbao) los cuatro últimos años (Junio del 93 a Mayo del 97). Diseño: Estudio descriptivo retrospectivo basado en la revisión de historias clínicas partiendo de casos con serología y clínica compatibles. Resultados: Encontramos 12 casos de infección por Chlamydia verificados con la técnica de ELISA (inespecífica para las tres especies de Chlamydia) que se confirmaron tras Inmunofluorescencia como infección por Chlamydia pneumoniae de las que describimos clinica (fiebre el 100 porciento, tos el 75 %, crepitantes el 75 %, expectoración el 50 %...), diagnóstico (Neumonía con condensación radiológica en el 91,6 %) y tratamiento (doxiciclina, eritromicina...). Conclusiones: Destacar la escasa presencia de casos infectados por C. pneumoniae y la ausencia de C. psittaci en este medio hospitalario durante ese periodo (AU)

[Bacteremia by Corynebacterium striatum and neutrocytic ascites. Presentation of a case and review of the literature]. / Bacteriemia por Corynebacterium striatum y ascitis neutrocítica. Presentación de un caso y revisión de la literatura.

Corynebacterium striatum is a Gram-positive pleomorphic bacillus that has been regarded as a saprophyte of mucous membranes and skin. There are certain difficulties in identifying the Corynebacteria species in the laboratory and it is often necessary to resort to techniques which are not available in all laboratories. Over recent years, C. striatum has shown itself to be a potential pathogen generally in weakened or immunodepressed individuals, in relation with intravenous catheters and in intensive care units. We report a case of bacteremia by C. striatum and neutrocytic ascites probably related to that microorganism, and, in view of the rarity of this isolement, we have reviewed the cases published on this subject.

[Primary adrenal failure and AIDS: report of 11 cases and review of the literature]. / Insuficiencia suprarrenal primaria y SIDA: descripción de once casos y revisión de la literatura.

OBJECTIVE: To know the prevalence of adrenal insufficiency (AI) in our patients with acquired immunodeficiency syndrome (AIDS) and to compare the clinical manifestations with those reported in previous series in the literature. PATIENTS AND METHODS: Retrospective study with review of clinical records of patients with AIDS diagnosed of AI (plasma cortisol after synthetic ACTH < 18 micrograms/dl) in our hospital for a period of 6 and a half years. RESULTS: Eleven out of 65 patients (17%) with the hormonal study performed were diagnosed of AI. The prevalence of AI in our patients with AIDS was 1.66%. The response of plasma cortisol to synthetic ACTH was abnormal in the 11 patients (mean increase: 1.89 micrograms/dl). Nine out of the 11 patients had a decreased basal plasma cortisol level (mean: 4.75 micrograms/dl). Basal plasma ACTH levels were increased (mean: 638.9 pg/ml) in seven out of nine patients. Patients were severely immunosuppressed (mean CD4: 21/microliter). While the clinical course was subacute (mean: 5.1 weeks), nine out of the eleven patients developed an adrenal crisis which required emergency therapy. Ten patients had an opportunist infection--M. tuberculosis (3), M. avium-intracellulare (3), Cytomegalovirus (3), histoplasmosis (1)--which could involve the adrenal glands in ten patients. All patients responded to treatment but their mean survival was 5.6 weeks. CONCLUSIONS: Although the prevalence of AI in our patients with AIDS was low (1.66%), it is important to be aware of the disease and to order a basal plasma cortisol value after synthetic ACTH, as treatment improves the life quality of patients if AI is confirmed, despite a short survival time.