Streptococcus agalactiae infective endocarditis: analysis of 30 cases and review of the literature, 1962-1998.

We describe 30 cases (1.7%) of community-acquired penicillin-susceptible Streptococcus agalactiae endocarditis among 1771 episodes of endocarditis diagnosed in 4 Spanish hospitals from 1975 through 1998. Endocarditis affected a native valve (most often the mitral valve) in 25 cases (83%). Surgical valve replacement was performed for 12 patients (40%). Fourteen patients (47%) died. Mortality rates for patients with native and prosthetic valve endocarditis were 36% and 100%, respectively (P=.01). The mortality rate for native valve endocarditis decreased during the last 6 years of the study (from 61% in 1975-1992 to 8% in 1993-1998; P<.05). Additionally, 115 cases in the literature from 1962-1998 were reviewed. During 1980-1998, the percentage of patients who underwent cardiac surgery increased from 24% (in the previous period, 1962-1979) to 43% (P=.05) and the mortality rate decreased from 45% to 34% (P=NS). S. agalactiae is an uncommon cause of endocarditis with a high mortality rate, although the prognosis of native valve endocarditis has improved in recent years, probably because of an increased use of cardiac surgery.

[The prognostic value of cytomegalovirus antigenemia and viremia for the development of cytomegalovirus disease and the survival of AIDS patients]. / Valor predictivo de la antigenemia y la viremia por citomegalovirus para el desarrollo de enfermedad por citomegalovirus y la supervivencia en pacientes con SIDA.

OBJECTIVES: To analyse risk factors for morbidity and survival associated with blood cytomegalovirus (CMV) detection with the antigenemia method among AIDS patients. PATIENTS AND METHODS: CMV antigenemia and CMV blood cultures in 277 AIDS patients IgG-CMV sero-positive with a CD4 level lower than 200 x 10(6)/l under antiretroviral monotherapy were analysed. We consider cases the 116 patients with one or more positive blood samples tested for pp65 antigenemia or CMV culture. They were matched with 161 control patients with negative antigenemia or viremia. RESULTS: Multivariate analysis pointed out a significant positive association for blood CMV reactivation with the following variables: CMV disease development and CMV urine detection, sex-acquired HIV infection, CD4+ < 50 x 10(6)/l and matched time from AIDS diagnosis to CMV blood culture correlated with positive antigenemias. Quantitative antigenemia title showed predictive value for risk of CMV disease although 23% of retinitis patients had persistent undetectable antigenemia. CMV invasive disease developed in 48% of cases and 11% of controls (relative risk [RR]: 7.9; 95% confidence interval [CI]: 4.2-14.7). Mortality after 12 months of follow-up was 73% vs 52% respectively (p < 0.001). Time survival curves after CD4+ count adjusting remained significantly lower for case patients (median, 127 days vs 355 days; p < 0.01 by log-rank test). Increased death rate was found in patients with CMV disease (74%), followed by patients with CMV antigenemia but no disease (70%) and patients without antigenemia or CMV disease (mortality 49%). CONCLUSIONS: CMV blood detection in AIDS patients may be considered as a bad prognosis marker for CMV morbidity and survival. This risk increases with higher CMV antigenemias. Therefore, pre-emptive anti-CMV therapy should be considered in this restricted population.

[Rhodococcus equi pneumonia in a patient with acquired immunodeficiency syndrome]. / Neumonía por Rhodococcus equi en un paciente afecto de síndrome de inmunodeficiencia adquirida.

A male patient of 33 years of age with AIDS developed pneumonia with abscess formation and a slow clinical course. The sputum, bronchoalveolar lavage and blood cultures yielded a Gram-positive, partially acid-alcohol resistant bacillus which was identified as Rhodococcus equi. This organism has been uncommonly implicated in pneumonia in patients with immunodeficiency, particularly with neoplasia and severe cell immunity deficiency. It has been very rarely reported in patients with AIDS. To our knowledge, this is the first reported case in Spain.

[Tuberculous pericarditis: diagnostic value of adenosine deaminase]. / Péricardite tuberculeuse: valeur diagnostique de l'adénosine désaminase.

Adenosine desaminase activity was measured in the pericardiac fluid of 35 patients with pericarditis of undetermined origin who were operated upon for diagnostic or therapeutic purposes. The causes of pericarditis fell into 6 categories: I, tuberculosis (8 cases); II, idiopathy (17 cases); III, neoplasia (6 cases); IV, purulent bacterial infection (2 cases); V, constriction (2 cases) and VI, radiotherapy (1 case). The highest mean adenosine desaminase value (143 U/l) was found in group I. Other values were 34 in group II, 48 in group III and 45 in groups IV to VI. There was a statistically significant difference in this respect between group I and the other groups (P less than 0.0001). If 60 U/l is taken as discriminant value for the diagnosis of tuberculous pericarditis, then the adenosine desaminase value has a 100 percent sensitivity and an 80 percent specificity. Measuring this value therefore is a very promising procedure.

[Endocarditis caused by Coxiella burnetii in aortic prosthesis. Presentation of a case with a fatal course]. / Endocarditis por Coxiella burnetii sobre prótesis aórtica. Presentación de un caso de evolución fatal.

A case of endocarditis caused by Coxiella burnetii in a patient with an aortic Starr-Edwards prosthesis is described. The diagnosis was made by detecting high titres of antibody against Coxiella burnetii phase I antigens. After 15 weeks of chemotherapy with tetracycline and cotrimoxazole, aortic prosthetic valve replacement was carried out because of haemodynamic deterioration and he died 4 days later. The histologic picture of the excised valve was consistent with endocarditis. Coxiella burnetii should be considered in the differential diagnosis of culture-negative endocarditis in our country, especially when the patient has not receiving antibiotic treatment in the last 2 weeks.