[Mechanisms of disease in Mycoplasma pneumoniae infection. Clinical manifestations and complications]. / Mecanismos de enfermedad en la infección por Mycoplasma pneumoniae. Manifestaciones clínicas y complicaciones.

CONTEXT: Mycoplasma pneumonia has been related to several conditions. With this study we have tried to establish the condition more frequently associated and their physiopathological mechanism. METHOD: One-hundred and five patients admitted to Puerta de Hierro Hospital between March 1996 and July 2001, with IgM positive serology to Mycoplasma were evaluated. Thirty four cases were selected upon the basis of two criteria: patients which positivity was confirmed by seroconversion, elevation of the antibody titer, or confirmation by complement fixation were included, and patients with some intercurrent condition or with other diagnoses were ruled out. RESULTS: 26 patients (77%) showed a respiratory infection, and 20 of them showed a pneumonia. Two types of complications were observed. The first type were the complications due to an invasion of the tissue by Mycoplasma, with 5 cases of pleuropericarditis and three cases of pleuritis; in 5 of these there was simultaneously a respiratory process. The second type were the complications mediated by an autoimmune mechanism, with two cases of reactive arthritis, one case of vasculitis with cutaneous predominance, one case of urticaria a frigore, three cases of lymphocytic meningitis, one case of disseminated encephalitis, one patient with Guillain-Barré syndrome and one case of Adie's tonic pupil. Six of these patients showed a respiratory infection on the previous days with an average delay of 10 days between the beginning of the respiratory symptomatology and the appearance of one of these diseases. CONCLUSIONS: Mycoplasma pneumoniae can give rise to disease through a mechanism of direct invasion and through autoimmunity mechanisms. The second group of complications is seen by more frequency in young women.

Mecanismos de enfermedad en la infección por Mycoplasma pneumoniae. Manifestaciones clínicas y complicaciones / Mechanisms of disease in Mycoplasma pneumoniae infection. Clinical manifestations and complications

Fundamento. Se ha relacionado Mycoplasma pneumoniae con diversas procesos orgánicos. Con este estudio tratamos de establecer las patologías más frecuentemente asociadas y el mecanismo fisiopatológico implicado. Método. Se analizan 105 pacientes ingresados en el Hospital Puerta de Hierro entre marzo de 1996 y julio de 2001 con serología IgM positiva a Mycoplasma. Se seleccionaron 34 casos siguiendo dos criterios: de un lado se confirmó la positividad por seroconversión, elevación del título de anticuerpos o confirmación por fijación del complemento, de otro se rechazaron aquellos en los que había un proceso intercurrente o se llegó a otro diagnóstico. Resultados. Veintiséis enfermos (77 por ciento) presentaron una infección respiratoria; en 20 de ellos fue neumonía. Dos son el tipo de complicaciones observadas: aquellas en las que media una invasión del tejido por Mycoplasma, con 5 casos de pleuropericarditis y 3 de pleuritis. En 5 de éstos hubo un proceso respiratorio de forma simultánea. En un segundo grupo estuvieron mediadas por un proceso autoinmune, con dos artritis reactivas, una vasculitis de predominio cutáneo, una urticaria a frígore, tres meningitis linfocitarias, una encefalitis diseminada, un síndrome de Guillain-Barré y un caso de pupila tónica de Adie. En 6 de éstos hubo una infección respiratoria en los días previos con una demora media de 10 días entre el inicio de la clínica respiratoria y la aparición de uno de estos cuadros. Conclusiones. Mycoplasma pneumoniae puede producir enfermedades por un mecanismo de invasión directa y por mecanismos de autoinmunidad. Este último grupo de complicaciones se da con mayor frecuencia en mujeres jóvenes (AU)

[The adult respiratory stress syndrome and septic shock associated with tuberculosis]. / Síndrome de distrés respiratorio del adulto y shock séptico asociados a tuberculosis.

The increase in the incidence of tuberculosis infection in the last few years has caused a recurrence of atypical clinical forms, as well as the development of associations and uncommon complications during the clinical course, which include the adult respiratory distress syndrome (ARDS) and septic shock. Three patients with ARDS are here reported; two patients had findings of septic shock and negative serology to human immunodeficiency virus and the only etiological agent documented was M. tuberculosis. The three patients required hemodynamic support and two of them mechanical ventilation. None of the patients survived the episode. Tuberculosis, particularly the disseminated forms, should be considered as possible etiology in high risk patients with septic shock, ARDS or both.

[Salmonella ssp non-typhi focal infections]. / Infecciones focales por Salmonella spp no-typhi.

Provided here are the descriptions of 18 patients with focal infections caused by Salmonella spp no-typhi occurring in a period of seven years at the Puerta de Hierro Clinic. In all cases, there was at least one local factor, treatment, or underlying illness associated with decreased resistance to infection. Antecedents of severe gastroenteritis were found in seven cases (38 percent). Eighty-three percent had previous or concomitant bacteremia caused by the same serotype of Salmonella isolated in the focal infection. S. enteritidis was the most prevalent serotype (66 percent). The most common localizations were plueropulmonary (5), osteoarticular (5), and intravascular (3). Relapsing infection was demonstrated in five cases. There was 28 percent mortality. Statistically, age greater than 65 years and the absence of surgical intervention were associated with a worse prognosis.

Syndrome of inappropriate antidiuretic hormone secretion and herpes zoster infection: 1. Report of this association in a patient suffering from AIDS.

The syndrome of inappropriate secretion of antidiuretic hormone is a common consequence of neurologic and pulmonary infections as well as drug intake and many other clinical situations. Its association with herpes varicella-zoster virus infections is scarcely reported in the literature. It generally appears in immunosuppressed patients suffering from serious underlying diseases. There are also a few cases of syndrome of inappropriate secretion of antidiuretic hormone related to vidarabine use. We report the case of a man infected by human immunodeficiency virus who developed a disseminated herpes varicella-zoster virus infection and symptoms due to hyponatremia caused by antidiuretic hormone excess. The patient was cured with saline hypertonic infusion, water restriction, and intravenous administration of acyclovir. To the best of our knowledge, this is the first case of this association in a human immunodeficiency virus infected patient. We propose the use of acyclovir instead of vidarabine in the management of these situations.

[Abdominal tuberculosis today. A review of 46 cases]. / Tuberculosis abdominal en la época actual. Revisión de 46 casos.

The clinical features, radiological and therapeutic response of 46 cases of abdominal tuberculosis (AT) seen at a university hospital are presented. Diagnosis was anatomopathologic in 39 cases (85%) and clinical with response to tuberculostatic in 7 cases (15%). Most of the patients did not have history nor exposition to tuberculosis. Both sexes were similar affected, mean age 43 years old, between 11 and 79. Clinical manifestations were no specific, the most frequent fever (65%), abdominal pain (63%) and constitutional syndrome with asthenia, anorexia and weight loss (63%). Thorax radiograph was normal in 50% and PPD negative in 42%, so in 10% of patients both tests were negative. More than half of the patients had other disease. 82% of patients were cured with tuberculostatic. 18% of patients died. AT seen now is different from classic descriptions. Is not a complication of pulmonary tuberculosis (PT) as it was to be in the past. Thinking in AT only in patients with PT make most patients lead without diagnosis.

[Lupus induced by quinidine]. / Lupus inducido por quinidina.

The case is described of a 34 year old female who suffered quinidine induced lupus, which appeared 14 months after the administration of the drug, and it was necessary to substitute it. This secondary effect o quinidine, which is rarely described, can go unnoticed if it is no kept in mind. The diagnostic criteria for drug induced lupus ar discussed and the clinical and analytical manifestations of 27 cases o quinidine induced lupus described in the literature are reviewed.

Spontaneous tension pyopneumopericardium--a case with recovery after surgery.

Tension pyopneumopericardium is a rare condition with a very high mortality. The majority of cases are due to perforation of oesophagus or bronchi into the pericardial cavity. We report a patient with spontaneous pyopneumopericardium who survived with antibiotic treatment and surgical drainage.