Resultados de una intervención de descolonización de Staphylococcus aureusen pacientes portadores a los que se indica una prótesis articular / Eradication of Staphylococcus aureus in carrier patients undergoing joint arthroplasty

INTRODUCCIÓN: La infección de prótesis articular (IPA) es una complicación con graves repercusiones cuyo principal agente responsable en la mayoría de los casos es Staphylococcus aureus. El propósito del presente estudio es evaluar si la descolonización de los pacientes portadores de S. aureus a los que se indica una prótesis articular consigue una disminución en la incidencia de IPA por S. aureus. MATERIAL Y MÉTODOS: Estudio de intervención antes-después en el que se comparó la incidencia de IPA en pacientes bajo cirugía de prótesis articular de rodilla o cadera entre enero y diciembre de 2011 a los que se realizó estudio de detección de colonización nasal por S. aureus y erradicación si procedía, con un protocolo de mupirocina intranasal y ducha con clorhexidina, con respecto a una serie histórica de pacientes intervenidos entre enero y diciembre de 2010. RESULTADOS: En el período de control se realizaron 393 artroplastias en 391 pacientes. En el período de intervención se implantaron 416 prótesis en 416 pacientes. Se realizó estudio de colonización a 382 pacientes (91,8%), de los que 102 fueron positivos (26,7%) y se trataron según el protocolo. Se produjeron 2 casos de de IPA por S.aureus frente a 9 en el año control (0,5% vs 2,3%, odds ratio [OR]: 0,2, intervalo de confianza [IC] del 95%: 0,4 a 2,3, p = 0,04). CONCLUSIÓN: En nuestro estudio la aplicación de un protocolo de detección de colonización/ erradicación de S.aureus consiguió un descenso significativo de la incidencia de IPA por S.aureus respecto a un control histórico

INTRODUCTION: Prosthetic joint infection (PJI) is a complication with serious repercussions and its main cause is Staphylococcus aureus. The purpose of this study is to determine whether decolonization of S. aureuscarriers helps to reduce the incidence of PJI by S. aureus. MATERIAL AND METHODS: An S. aureus screening test was performed on nasal carriers in patients undergoing knee or hip arthroplasty between January and December 2011. Patients with a positive test were treated with intranasal mupirocin and chlorhexidine soap 5 days. The incidence of PJI was compared with patients undergoing the same surgery between January and December 2010.RESULTS: A total of 393 joint replacements were performed in 391 patients from the control group, with 416 joint replacements being performed in the intervention group. Colonization study was performed in 382 patients (91.8%), of which 102 were positive (26.7%) and treated. There was 2 PJI due S. aureuscompared with 9 in the control group (0.5% vs 2.3%, odds ratio [OR]: 0.2, 95% confidence interval [CI]: 0.4 to 2.3, P = .04). CONCLUSIONS: In our study, the detection of colonization and eradication of S.aureus carriers achieved a significant decrease in PJI due to S.aureus compared to a historical group

[Eradication of Staphylococcus aureus in carrier patients undergoing joint arthroplasty]. / Resultados de una intervención de descolonización de Staphylococcus aureus en pacientes portadores a los que se indica una prótesis articular.

INTRODUCTION: Prosthetic joint infection (PJI) is a complication with serious repercussions and its main cause is Staphylococcus aureus. The purpose of this study is to determine whether decolonization of S.aureus carriers helps to reduce the incidence of PJI by S.aureus. MATERIAL AND METHODS: An S.aureus screening test was performed on nasal carriers in patients undergoing knee or hip arthroplasty between January and December 2011. Patients with a positive test were treated with intranasal mupirocin and chlorhexidine soap 5 days. The incidence of PJI was compared with patients undergoing the same surgery between January and December 2010. RESULTS: A total of 393 joint replacements were performed in 391 patients from the control group, with 416 joint replacements being performed in the intervention group. Colonization study was performed in 382 patients (91.8%), of which 102 were positive (26.7%) and treated. There was 2 PJI due S.aureus compared with 9 in the control group (0.5% vs 2.3%, odds ratio [OR]: 0.2, 95% confidence interval [CI]: 0.4 to 2.3, P=.04). CONCLUSIONS: In our study, the detection of colonization and eradication of S.aureus carriers achieved a significant decrease in PJI due to S.aureus compared to a historical group.

Síndrome papulopurpúrico en guante y calcetín y trombocitopenia en relación con infección por parvovirus B19 / Papular-purpuric gloves and socks syndrome and thrombocytopenia related to parvovirus B19 infection

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Infección por Plasmodium ovale: descripción de 16 casos y revisión del tema / Plasmodium ovale infection: description of 16 cases and a review

Introducción Existe poca información sobre la malaria por Plasmodium ovale importada. Método Se estudiaron retrospectivamente 16 casos. Resultados La mayoría presentó un periodo de incubación de 2 a 53 meses y eran africanos inmigrantes o residentes en España que viajaron a África occidental; 10 presentaban enfermedades de base y 5 sufrieron una infección previa por P. falciparum; 3 pacientes presentaron complicaciones graves y 3 estaban asintomáticos. El test rápido fue positivo en 2 de 10 pacientes. A 5 se diagnosticó únicamente con PCR. Conclusiones La infección por P. ovale puede ser asintomática o producir complicaciones graves hasta 5 años después del regreso (AU)

Introduction: Information on imported malaria caused by Plasmodium ovale parasite is scarce. Methods: Sixteen cases were studied retrospectively.Results: Most cases had an incubation period ranging from 2 to 53 months and were African immigrantsrecently arrived or residents in Spain who had visited West Africa. Ten patients had underlying diseasesand 5 suffered from a previous P. falciparum infection. Three patients had severe complications and 3 were asymptomatic. Rapid malaria test was positive in 2 out of 10 patients. Five were diagnosed onlywith PCR. Conclusions: P. ovale infection can be asymptomatic or cause severe complications up to 5 years afterarriving (AU)

[Plasmodium ovale infection: description of 16 cases and a review]. / Infección por Plasmodium ovale: descripción de 16 casos y revisión del tema.

INTRODUCTION: Information on imported malaria caused by Plasmodium ovale parasite is scarce. METHODS: Sixteen cases were studied retrospectively. RESULTS: Most cases had an incubation period ranging from 2 to 53 months and were African immigrants recently arrived or residents in Spain who had visited West Africa. Ten patients had underlying diseases and 5 suffered from a previous P. falciparum infection. Three patients had severe complications and 3 were asymptomatic. Rapid malaria test was positive in 2 out of 10 patients. Five were diagnosed only with PCR. CONCLUSIONS: P. ovale infection can be asymptomatic or cause severe complications up to 5 years after arriving.

[Imported malaria in a general hospital in Madrid]. / Paludismo importado en un hospital general de Madrid.

INTRODUCTION: To study the clinical and epidemiological characteristics of malaria and the diagnosis of this condition in a general hospital that does not have a specialized tropical medicine unit. METHODS: Retrospective study of all malaria cases diagnosed by thick film and/or PCR-positive status for any Plasmodium spp. from 1999 to 2003 in Hospital Príncipe de Asturias in Alcalá de Henares (Madrid, Spain). RESULTS: Over the period studied, 89 cases of malaria were diagnosed. Most patients were African immigrants who had recently left their countries of origin (52%), or immigrants residing in Spain who had traveled to Africa for a short visit (35%) and did not take prophylaxis. The distribution of cases by species was Plasmodium falciparum 89%, P. ovale 7% and P. malariae 4%. Clinical data were non-specific and the percentage of severe complications was low (6.7%). A second-generation test for rapid detection of P. falciparum antigen (PfHRP2) was studied in a group of 46 patients with suspected malaria; the results obtained were similar to thick film as compared to PCR for diagnosing P. falciparum infection. CONCLUSIONS: Access to information on prevention and chemoprophylaxis should be available to all travelers, particularly immigrants visiting their countries of origin. Most semi-immune patients with uncomplicated malaria can be treated on an outpatient basis. PfHRP2 antigen detection, a fast, reliable method for diagnosing malaria due to P. falciparum, can be used in addition to the thick film method in our setting.

Paludismo importado en un hospital general de Madrid / Imported malaria in a general hospital in Madrid

Introducción. Estudiar las características epidemiológicas de la malaria y su diagnóstico en un hospital general sin unidad especializada de Medicina Tropical. Métodos. Se estudiaron retrospectivamente todos los casos de malaria diagnosticados con gota gruesa y/o reacción en cadena de la polimerasa (PCR) positivas para cualquier especie de Plasmodium desde 1999 a 2003 en el Hospital Príncipe de Asturias de Alcalá de Henares (Madrid). Resultados. En este período se diagnosticaron 89 casos de malaria. La mayoría eran inmigrantes africanos recién llegados (52%) o inmigrantes residentes en España que viajaron a África de visita durante poco tiempo (35%) y no tomaron ninguna profilaxis. La distribución por especies fue: Plasmodium falciparum, 89%; P. ovale, 7%; y P. malariae, 4%. La clínica fue inespecífica y el porcentaje de complicaciones graves fue bajo (6,7%). Con los test de detección rápida de antígenos palúdicos PfPRH2 de segunda generación realizados en un grupo de 46 pacientes con sospecha de malaria se obtuvieron resultados equiparables a la gota gruesa en comparación con la PCR en el diagnóstico de la infección por P. falciparum. Conclusiones. Se debe mejorar el acceso a la información preventiva y a la quimioprofilaxis para todos los viajeros, especialmente para los inmigrantes que vuelven de visita a sus países de origen. La mayoría de pacientes semiinmunes con malaria no complicada puede recibir un tratamiento ambulatorio. En nuestro medio, la detección rápida de antígenos puede ser una técnica complementaria de la gota gruesa, sencilla y fiable en el diagnóstico rápido de malaria por P. falciparum (AU)

Introduction. To study the clinical and epidemiological characteristics of malaria and the diagnosis of this condition in a general hospital that does not have a specialized tropical medicine unit. Methods. Retrospective study of all malaria cases diagnosed by thick film and/or PCR-positive status for any Plasmodium spp. from 1999 to 2003 in Hospital Príncipe de Asturias in Alcalá de Henares (Madrid, Spain). Results. Over the period studied, 89 cases of malaria were diagnosed. Most patients were African immigrants who had recently left their countries of origin (52%), or immigrants residing in Spain who had traveled to Africa for a short visit (35%) and did not take prophylaxis. The distribution of cases by species was Plasmodium falciparum 89%, P. ovale 7% and P. malariae 4%. Clinical data were non-specific and the percentage of severe complications was low (6.7%). A second-generation test for rapid detection of P. falciparum antigen (PfHRP2) was studied in a group of 46 patients with suspected malaria; the results obtained were similar to thick film as compared to PCR for diagnosing P. falciparum infection. Conclusions. Access to information on prevention and chemoprophylaxis should be available to all travelers, particularly immigrants visiting their countries of origin. Most semi-immune patients with uncomplicated malaria can be treated on an outpatient basis. PfHRP2 antigen detection, a fast, reliable method for diagnosing malaria due to P. falciparum, can be used in addition to the thick film method in our setting (AU)