First report of bacteremia by Janibacter terrae in humans.

The genus Janibacter comprises nine different species mainly found in the environment. Only two human infections by these microorganisms have been previously reported, one by J. melonis and another one by an undescribed Janibacter sp. Herewith we report the first human cases of infection by J. terrae in four bacteremic patients. The microorganisms were isolated from two consecutive blood cultures taken from four febrile patients with several underlying conditions. All patients were treated with antibiotics, two of them with favorable outcome. Two severely immunocompromised patients died, and one was treated with an antibiotic in vitro active against the isolate. Janibacter terrae was identified by phenotypic and 16S rDNA amplification methods. This report includes also the first data on antimicrobial susceptibility of this opportunistic pathogen. Clinical microbiologists should be aware of this microorganism which can be identified by phenotypic and molecular methods.

Linfohistiocitosis hemofagocítica asociada a infecciones virales: reto diagnóstico y dilema terapéutico / Hemophagocytic lymphohistiocytosis associated with viral infections: diagnostic challenges and therapeutic dilemmas

La linfohistiocitosis hemofagocítica es un síndrome clinicopatológico de evolución potencialmente fatal, en el que una respuesta inmune no controlada e ineficaz conduce a hiperinflamación. Puede aparecer como una enfermedad familiar o esporádica, asociado a diferentes factores desencadenantes: infecciones, neoplasias, enfermedades autoinmunes o inmunodeficiencias adquiridas, pero la asociación más consistente es con infecciones virales, especialmente el virus de Epstein-Barr. Las principales características clínicas son fiebre, disfunción hepática, coagulopatía y pancitopenia. El diagnóstico es difícil debido a la rareza de este síndrome y a la falta de especificidad de los hallazgos clínicos, sin embargo, un diagnóstico y tratamiento precoces son importantes para disminuir la mortalidad. El tratamiento debe ser dirigido al control de la enfermedad subyacente y a suprimir la respuesta inflamatoria exagerada mediante el uso de inmunosupresores (AU)

Hemophagocytic lymphohistiocytosis is a frequently fatal clinicopathologic syndrome in which an uncontrolled and ineffective immune response leads to severe hyperinflammation. It may occur as either a familial disorder or a sporadic condition in association with a variety of triggers: infections, malignancies, autoimmune diseases, and acquired immune deficiencies. However, the most consistent association is with viral infections, especially Epstein-Barr virus. The main clinical features are fever, liver dysfunction, coagulation abnormalities and pancytopenia. Early diagnosis and treatment are important to reducing mortality, but the diagnosis is difficult because of the rarity of the syndrome and the lack of specificity of the clinical findings. Treatment should be directed towards treating the underlying disease and to suppressing the exaggerated inflammatory response through the use of immunosuppressive agents (AU)

Hemophagocytic lymphohistiocytosis associated with viral infections: Diagnostic challenges and therapeutic dilemmas. / Linfohistiocitosis hemofagocítica asociada a infecciones virales: reto diagnóstico y dilema terapéutico.

Hemophagocytic lymphohistiocytosis is a frequently fatal clinicopathologic syndrome in which an uncontrolled and ineffective immune response leads to severe hyperinflammation. It may occur as either a familial disorder or a sporadic condition in association with a variety of triggers: infections, malignancies, autoimmune diseases, and acquired immune deficiencies. However, the most consistent association is with viral infections, especially Epstein-Barr virus. The main clinical features are fever, liver dysfunction, coagulation abnormalities and pancytopenia. Early diagnosis and treatment are important to reducing mortality, but the diagnosis is difficult because of the rarity of the syndrome and the lack of specificity of the clinical findings. Treatment should be directed towards treating the underlying disease and to suppressing the exaggerated inflammatory response through the use of immunosuppressive agents.

Dermabacter hominis: a usually daptomycin-resistant gram-positive organism infrequently isolated from human clinical samples.

During a 12-year period, Dermabacter hominis was isolated from 21 clinical samples belonging to 14 patients attending a tertiary hospital in León, Spain. Samples included blood cultures (14), peritoneal dialysis catheter exit sites (three), cutaneous abscesses (two), an infected vascular catheter (one) and a wound swab (one). Identification was made by API Coryne™ V2.0, Biolog™ GP2 and 16S rRNA gene amplification. Six febrile patients had positive blood cultures (one, two or three sets) and all of them were treated with teicoplanin (two patients), vancomycin, ampicillin plus gentamicin, amoxicillin/clavulanic acid and ciprofloxacin (one each). An additional patient with a single positive blood culture was not treated, the finding being considered non-significant. In the remaining seven patients the organism was isolated from a single specimen and three of them received antimicrobial treatment (ciprofloxacin, ceftriaxone plus vancomycin and amoxicillin/clavulanic acid). At least ten patients had several underlying diseases and conditions, and no direct mortality was observed in relation to the isolated organism. All isolates were susceptible to vancomycin, rifampin and linezolid. Resistance to other antibiotics varied: erythromycin (100%), clindamycin (78.5%), ciprofloxacin (21.4%) and gentamicin, quinupristin-dalfopristin, benzylpenicillin and imipenem 7.1% each. Thirteen isolates were highly resistant to daptomycin with MICs ranging from 8 to 48 (MIC90 = 32 mg/L); only one was daptomycin-sensitive (MIC = 0.19 mg/L).

[Cavited pneumonia with Mycobacterium gastri positive culture smear]. / Neumonía cavitada con cultivo de esputo positivo para Mycobacterium gastri.

BACKGROUND: Mycobacterium gastri is an atypical non pigmented mycobacteria infrequent in clinical practice. Few reports have been published about infections caused by microorganism, and only three of them, all before 1986, were respiratory infections. METHODS: We report a case of cavitary pneumonia with sputum culture positive for Mycobacterium gastri, and we review the previous published cases. RESULTS: We describe a 79-years old man diagnosed of chronic obstructive pulmonary disease (COPD), with chronic respiratory failure, hypertension, Alzheimer's disease and multiple myeloma IgG lambda type IIA, with multiple previous admissions in our institution. He has again admitted because of an acute episode of cough and fever. The chest radiography demonstrated a right lower cavitary infiltrate, and the sputum culture showed growth of Mycobacterium gastri. DISCUSSION: We report a case of cavitary pneumonia in an immunocompromised patient caused by M. gastri resistant to isoniazid and pyrazinamide with fatal evolution. All of the cases previously described had a favourable outcome with the different treatment used.

Citalopram como causa de síndrome de secreción inadecuada de hormona antidiurética / Citalopram in the etiology of inappropiate antidiuretic hormone secretion syndrome

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Empiema crónico por Pseudomonas aeruginosa / Chronic empyema for Pseudomonas aeruginosa

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Infección urinaria por corynebacterium urealyticum / Urinary infection due to corynebacterium urealyticum

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[Sarcoidosis in a sanitary area at Leon (Spain). Epidemiology and clinical features]. / Sarcoidosis en el área sanitaria de León. Epidemiología y clínica.

BACKGROUND: The incidence of sarcoidosis is different among distincts geographic areas, probably due to climate variations. At present, there is in Spain few studies that correlate the observed cases with a concrete population. The aim of this study is to investigate the epidemiology of sarcoidosis in Leon"s sanitary area, in comparison with others spanish geographic areas. Moreover, we present a description of the clinic and radiologic characteristics of the studied cases. METHOD: We analyzed the cases of sarcoidosis attended in the area from 1993 until 2001. The incidence, age, sex, place of residence and clinic-radiologic characteristics are described. The population data of the sanitary area to calculate the incidence were obtain from the Insalud"s data base. The climatology values were collected from the National Institute of Meteorology. RESULTS: The incidence of sarcoidosis in Leon"s sanitary area was 1,37/100.000 habitants/year, and was similar to that founded in Catalonia, Galizia and others provinces of the Castilla and Leon community. We observed a higher incidence of sarcoidosis in female patients, because of predominance of cases among women aged forty years or more. No differences between rural and urban populations were founded. The clinical characteristics were similar those described in other geographics areas of our country. CONCLUSION: Although there are climate differences between the geographics areas of Spain, these aren"t enough to explain his influence in the incidence of sarcoidosis, which is similar in all of them, at least in the middle north of the country.

[Listeria monocytogenes meningitis in the adult in Spain. Report of 10 cases and review of the literature]. / Meningitis por Listeria monocytogenes en el adulto en España. Presentación de 10 casos y revisión de la literatura.

INTRODUCTION: Ten new cases of Listeria monocytogenes meningitis (LMM) in the adult are here reported. Also, a review is made of reported cases by Spanish authors in the last 30 years, with an analysis of the predisposing conditions and mortality rate from this type of bacterial meningitis (BM) throughout the study period. METHODS: The reported cases met two criteria: CSF biochemistry consistent with BM and positive CSF and/or blood culture for Listeria monocytogenes. The bibliographic search of previously reported cases was made through Medline. Cases were divided into two periods: from 1974 to 1988, and from 1989 onwards. Predisposing conditions, therapy, and mortality were analyzed and compared between the two study periods. RESULTS: The features of the cases reported here did not differ from those in the cases reported so far, with the single feature of two HIV-positive patients. Of the analyzed cases, 73% had some predisposing condition. Thirty-eight and 39% of the total of patients and of patients with some predisposing conditions, respectively, died, with a statistically significant difference (p < 0.001) between those with and without predisposing conditions. Among the treated patients, 87% received either ampicillin or penicillin and the mortality rate among these patients was 30%. No differences regarding mortality was rate observed between the two study periods, the total of cases of between those treated with the aforementioned antibiotics. CONCLUSIONS: Patients with LMM commonly have a predisposing condition. The mortality rate in this type of BM is still high among those treated with ampicillin or penicillin, and a decrease in the mortality rate was not observed when the reported cases in Spain in the last 30 years were analyzed. The optimal therapy for this condition is still to be defined.

Meningitis por Listeria monocytogenes en el adulto en España. Presentación de 10 casos y revisión de la literatura / Listeria monocytogenes meningitis in the adult in Spain. Report of 10 cases and review of the literature

Introducción. Se presentan 10 nuevos casos de meningitis por Listeria monocytogenes (MLM) en adultos y, junto con ellos, se revisan los publicados por autores españoles en los últimos 30 años, analizando las enfermedades predisponentes y mortalidad de este tipo de meningitis bacteriana (MB) a lo largo del período de estudio. Métodos. Los casos presentados aquí reunían estos dos criterios: analítica de líquido cefalorraquídeo (LCR) compatible con MB y cultivo positivo de Listeria monocytogenes en LCR y/o sangre. La búsqueda de casos publicados previamente se hizo a través de Medline. Se dividieron los casos en dos períodos: de 1974 a 1988 y de 1989 en adelante. Se analizaron las enfermedades predisponentes, tratamiento y mortalidad, comparando ambos períodos. Resultados. Las características de los nuevos casos presentados no difieren de lo publicado hasta ahora, con la única particularidad de que dos de los 10 estaban infectados por el virus de la inmunodeficiencia humana (VIH). De los casos analizados, el 73 por ciento sufría alguna enfermedad predisponente. Falleció el 39 por ciento del total, y entre los que había información sobre enfermedad de base, el 40 por ciento, con diferencia significativa (p < 0,001) entre los que tenían alguna y los que no. De los pacientes tratados, lo fueron con ampicilina o penicilina el 87 por ciento, y entre éstos la mortalidad fue del 30 por ciento. No se halló diferencia en la mortalidad entre los dos períodos ni en el total de casos ni entre los tratados con los citados antibióticos. Conclusiones. Los pacientes con MLM presentan con mucha frecuencia una enfermedad predisponente. La mortalidad en este tipo de MB es alta aun entre los tratados con ampicilina o penicilina, no observándose una disminución de la mortalidad al analizar los casos publicados en España en los últimos 30 años. Está por definir el mejor tratamiento de esta enfermedad (AU)