[Infection after orthotopic liver transplantation: analysis of the first 120 consecutive cases]. / Infección después del trasplante hepático ortotópico: análisis de los 120 primeros casos consecutivos.

OBJECTIVE: To report the infectious complications and presentation time of the first 120 consecutive liver transplants performed at our institution. METHODS: Prospective study of infectious complications among 120 consecutive adult patients who received orthotopic liver transplantation at Hospital de Cruces, from February 1996 to November 1998. Two patients received a renal transplant concomitantly. The same surveillance protocols were used for all patients and the criteria used to define infections were those reported by other authors. RESULTS: The group consisted of 120 patients, 95 males and 25 females. The age ranged from 20 and 66 years (mean: 54 +/- 9 years). The indications for transplantation included alcoholic cirrhosis (47%), HCV cirrhosis (20%), hepatocellular carcinoma (17.5%), fulminant hepatitis (6%), primary biliary cirrhosis (2.5%) and miscellaneous conditions (7%). Three patients required retransplantation. Acute rejection was histologically diagnosed in 38 patients (31%). None of the patients had corticosteroid-resistant rejection. Fifty-one patients (42.5%) developed 76 episodes of severe infection, which included: 48 episodes of bacterial infection among 33 patients (27.5%), tuberculosis in 7 patients (6%), 9 episodes of fungal infection among 8 patients (7%) and cytomegalovirus (CMV) infection among 8.5% of patients. No patient developed Pneumocystis carinii pneumonia. Fifteen (12.5%) patients died: six (12.5%) with active infection, and in four of them the infection was considered the cause of death. CONCLUSIONS: Infection rates due to bacteria and fungi were similar to those reported in the literature. A high rate of tuberculosis was found, which possible correlated with the high incidence of this disease in the general population. The low incidence of CMV infection was probably due to the preemptive therapy with gancyclovir. Trimethoprim-sulfamethoxazol prophylaxis against Pneumocystis carinii was highly effective.

Infección después del trasplante hepático ortotópico: análisis de los 120 primeros casos consecutivos / Infection after orthotopic liver transplantation: analysis of the first 120 consecutive cases

Objetivo. Describir las complicaciones infecciosas y tiempo de presentación en los 120 primeros trasplantes hepáticos consecutivos realizados en nuestro centro. Métodos. Estudio prospectivo de las complicaciones infecciosas que presentaron 120 pacientes adultos consecutivos que recibieron trasplante hepático ortotópico en el Hospital de Cruces entre febrero de 1996 y noviembre de 1998. Dos pacientes recibieron simultáneamente trasplante renal. En todos los pacientes se realizaron los mismos controles de vigilancia y los criterios para definir las infecciones fueron los descritos por otros autores. Resultados. Del grupo total, 95 eran varones y 25 mujeres. La edad osciló entre 20 y 66 años (media: 54 ñ 9 años). Las indicaciones de trasplante fueron: cirrosis alcohólica (47 por ciento), cirrosis por virus de la hepatitis C (VHC) (20 por ciento), carcinoma hepatocelular (17,5 por ciento), hepatitis fulminante (6 por ciento), cirrosis biliar primaria (2,5 por ciento) y otras indicaciones (7 por ciento).Tres pacientes precisaron retrasplante. Se diagnosticó histológicamente rechazo agudo en 38 pacientes (31 por ciento). Ninguno presentó rechazo corticorresistente. Cincuenta y un pacientes (42,5 por ciento) desarrollaron 76 episodios de infección grave, que correspondían: infección bacteriana, 48 episodios en 33 pacientes (27,5 por ciento); tuberculosis, 7 pacientes (6 por ciento); infección fúngica, 9 episodios en 8 pacientes (7 por ciento), y enfermedad por citomegalovirus (CMV) el 8,5 por ciento de los pacientes. Ningún paciente desarrolló infección por Pneumocystis carinii. Fallecieron 15 (12,5 por ciento): seis (40 por ciento) con infección activa y en cuatro de ellos la infección se consideró causa mayor de la muerte. Conclusiones. La tasa de infecciones por bacterias y hongos es similar a la recogida en la literatura. Encontramos una tasa alta de tuberculosis, que se corresponde posiblemente con la alta incidencia de esta enfermedad en la población general. La baja incidencia de enfermedad por CMV la asociamos con el tratamiento anticipado con ganciclovir. La profilaxis con trimetropin-sulfametoxazol es altamente eficaz frente a Pneumocystis carinii (AU)

[Osteomyelitis of the frontal bone (Pott's puffy tumor). A report of 5 patients]. / Osteomielitis del hueso frontal (tumor blando de Pott). Presentación de cinco pacientes.

BACKGROUND: Frontal bone osteomyelitis is considered to be rare but it may develop intracranial complications such as subperiosteal abscess that appears as a painful fluctuated forehead tumor (Pott's puffy tumor). METHODS: We reviewed retrospectively the clinical history of those patients showing frontal swelling tumour in our Neurosurgery and Infectious Diseases Departments between July 1994 and December 1997 and whose definitive diagnosis was cranial osteomyelitis. RESULTS: We reported five cases of patients who had been submitted to a neurosurgical operation between 9 months and 27 years ago. The main clinical features were intermittent painful frontal swelling episodes (with or without fever). These episodes were self-limited or limited after short trend of antibiotics. Imaging techniques were necessary for the diagnosis and especially in order to exclude intracranial complications (such as epidural abscess found in two patients). The ascertain diagnosis is made by debriding, histological studies and cultures from the material. Staphylococcus aureus was isolated in three of the patients, Haemophilus influenzae in one patient and Pseudomonas aeruginosa in the other one. All patients were treated with surgery and specific antibiotic therapy during twelve weeks minimum, being definitively cured. CONCLUSIONS: It is not well know the etiopathogenic mechanism concerning this rare disease. We remark the importance of a prompt diagnosis because of the high frequency of intracranial complications as well as combined treatment: surgery and long term antibiotic therapy (not less than 8 weeks), is necessary to cure the disease.

[Tularemia: report of 16 cases in the Castilla-Leon community]. / Tularemia: descripción de 16 casos procedentes de la Comunidad de Castilla-León.

OBJECTIVE: To report the clinico-epidemiological characteristics of 16 patients with the diagnosis of tularemia. METHOD: Retrospective review of clinical records of patients admitted to the hospital or examined at health centers in Vizcaya, with clinical course and epidemiology consistent with tularemia, from January to March 1998. CASE DEFINITION: Patient with suggestive clinical course and epidemiology (exposure to hares coming from the epizootic area) and positive serology (antibodies to Francisella tularensis > 1/160 in convalescent phase serum). RESULTS: Sixteen patients (8 males, 8 females) with a mean age of 53 years. The incubation period ranged from 1 and 8 days (mean: 5). Nine patients had the ulceroganglionar form, two the pharyngeal form, one the oculoganglionar form and one the typhoidal form. In three patients only cutaneous lesion or lesions were observed. The antibiotic treatment administered included streptomycin for five patients, tobramycin for 2 patients, and ciprofloxacin, azithromycin and amoxicillin (plus doxycycline) for other three patients. Three patients received initially antitermic drugs (with poor response) and later two of them, doxycycline. The administered antibiotic in the remaining three patients was unknown. The clinical course was satisfactory in all of them and so far no relapses have been detected. CONCLUSIONS: The ulceroglandular form, as it appears in literature, was the most common form in this series of patients with tularemia. Neither severe diseases nor complications were observed. Although streptomycin is considered the drug of choice, other antibiotics are likely equally effective, at least for the non complicated forms of the disease.

[Otomastoiditis caused by Aspergillus in AIDS]. / Otomastoiditis por Aspergillus en el SIDA.

BACKGROUND: Aspergillus otomastoiditis is an infrequent infection that occurs in most cases in immunocompromised hosts. Although fungal infections are common in AIDS patients, few cases of Aspergillus otomastoiditis have been reported. METHODS: Two clinical cases of AIDS patients with Aspergillus otomastoiditis are reported, and a review of the literature is performed. RESULTS: Clinical presentation in both cases was similar to those of other diseases involving middle and internal ear. Infection was linked to severe immunosuppression (C3 group). CONCLUSIONS: Aspergillus otomastoiditis is an infrequent infection in AIDS patients. Different routes by which Aspergillus obtains access to the middle ear have been proposed (tympanogenic, meningogenic, hematogenous and direct spread from paranasal sinuses or external auditory canal). Otorrhea, otalgia, hearing loss and facial nerve involvement are common findings. Bone destruction and invasion of brain or skull base may occur. CT or MRI are necessary to evaluate the extent of the disease. Etiologic diagnosis requires histopathologic confirmation on deep tissue biopsy or isolation from blood cultures or fistula exudates, because Aspergillus is a common saprophytic fungus in external auditory canal. Concurrent infections (i.e. Pseudomonas aeruginosa) frequently delay the correct diagnosis. Aggressive surgical resection and intravenous antifungal chemotherapy (amphotericin B or itraconazole) are the main therapeutic options. Outcome is poor as a consequence of severity, delay of etiologic diagnosis and difficulty of aggressive surgical approach in compromised patients. In patients with AIDS a low CD4 cell count would favour invasive Aspergillus infection, implying a worse outcome.

[Tuberculosis and AIDS. Study of 54 patients]. / Tuberculosis y SIDA. Estudio de 54 pacientes.

We present 54 cases of tuberculosis (TBC) and Acquired Immunodeficiency Syndrome (AIDS) that were observed during five years and represent 37% of our AIDS patients. TBC was diagnosed before AIDS in 7, after AIDS in 5 and simultaneously in 42. Eighty-seven per cent were intravenous drug users (IVDU) and no hemophilia cases were recorded. The tuberculin skin test (PPD) showed a reaction greater than 5 mm in 43%. Prophylaxis has not been used in any patient. TBC was localized in 39% and disseminated in 61%; the lung was the main organ involved. Diagnosis was established by culture in 42 cases and by pathology exam in 12 cases. Eighteen patients had multiple isolations, while 36 had a single one. Co-occurrence with other opportunistic infections was observed in 27 cases. Death related to TBC was seen in 3 patients, and there were no differences in survival between disseminated and localized presentations. Compliance of treatment was very low and follow-up was not achieved in large number of patients.

[The use of thymostimulin in lymphoma and myeloma patients]. / Utilización de la timoestimulina en pacientes con mieloma y linfoma.

The benefit of the immunomodulation properties of thymic hormones in patients receiving chemotherapy for malignant diseases is yet to be defined. The efficacy of thymostimulin (TP-1) on hematological tolerance is evaluated, the performance level, the number and severity of the infections and skin reactions in two groups of homogeneous and randomized patients, diagnosed as having lymphoma and myeloma. Both patient groups (receiving or not receiving treatment) consisted of 20 persons. This observation was carried out in 96 courses of chemotherapy in each group; no significant differences having been noted in respect of the performance status at the beginning nor at the end of the study period between the 2 treatment groups. The hematological tolerance to chemotherapy, skin reactions and number and severity of infections registered were not significantly different between the 2 groups. In conclusion, we were unable to confirm an improvement in the clinical parameters of the myeloma and lymphoma patients receiving chemotherapy and thymostimulin during the period of observation.