Listeriosis no gestacional: cambios en frecuencia, formas clínicas y factores pronósticos / Non-perinatal listeriosis: changes in frequency, clinical spectrum and prognostic factors

Introducción: La infección por Listeria monocytogenes es una enfermedad grave que afecta mayoritariamente a personas de edad avanzada e inmunodeprimidos y cuya incidencia está aumentando. En este estudio se analizan los casos de listeriosis en dos hospitales con el fin de estudiar cambios en su incidencia, formas de presentación clínica y posibles factores asociados a mortalidad. Material y métodos: Estudio retrospectivo multicéntrico de pacientes con listeriosis diagnosticada por aislamiento microbiológico entre 1977 y 2021 en dos hospitales universitarios de Madrid. Se recogen variables epidemiológicas, clínicas, estado de inmunodepresión, pruebas complementarias y tratamiento. Se analizan factores asociados a mortalidad. Resultados: Se analizaron 194 casos de listeriosis. La incidencia de listeriosis por ingresos aumentó a lo largo del estudio, con una importante caída del número de casos en 2020. La bacteriemia aislada (37,1%) y la afectación del sistema nervioso central (SNC) (36,6%) fueron las presentaciones más frecuentes. El 21% de los casos tuvo síntomas de gastroenteritis. El 16,5% presentó otras infecciones focales, siendo las más frecuentes peritonitis bacteriana espontánea (8,2%), colecistitis (2,1%), infección respiratoria (1,5%) e infección de prótesis vascular (1,5%). La mortalidad intrahospitalaria fue del 24,7%. Fueron factores independientes asociados a mortalidad al ingreso la edad (odds ratio [OR] 1.027, intervalo de confianza [IC] 95% 1.003-1.056) y la presencia de tumor sólido (OR 3.525, IC 95% 1.652-7.524). Conclusiones: En este estudio se constata un aumento de la incidencia de listeriosis en nuestro medio. Las presentaciones más frecuentes fueron la bacteriemia aislada y la afectación del SNC. La mortalidad intrahospitalaria se asoció a la edad y al diagnóstico de tumor sólido.(AU)

Introduction: Listeria monocytogenes infection is a severe disease affecting mainly aged people and patients with immune depression. The incidence of listeriosis seems to be increasing. In the present study cases of listeriosis from two hospitals are analyzed with the aims of studying changes in its incidence, clinical forms of presentation and possible factors associated with mortality. Methods: Retrospective multicentric study of patients with culture-proven listeriosis in two university hospitals in Madrid between 1977 and 2021. Epidemiological and clinical variables, as well as factors for immune depression, complementary studies and treatments were registered. Factors associated with mortality were analyzed. Results: A total of 194 cases of listeriosis were analyzed. The incidence of listeriosis among in-patients increased through the study period, with a significant drop in the number of cases in 2020. The most common clinical presentations were isolated bacteriemia (37.1%) and central nervous system involvement (CNS) (36.6%). Symptoms of gastroenteritis occurred in 21% of cases. Other focal infections were present in 16.5% of patients, the most frequent were spontaneous bacterial peritonitis (8.2%), cholecystitis (2.1%), respiratory infection (1.5%) and vascular prothesis infection (1.5%). In-hospital mortality was 24.7%. Independent factors associated with mortality at admission were age (odds ratio [OR] 1.027, 95% confidence interval [95% CI]1.003–1.056) and a diagnosis of a solid tumor (OR 3.525, 95% CI1.652–7.524). Conclusions: This study confirms an increasing incidence of listeriosis in our millieu. The most common clinical presentations were isolated bacteriemia and central nervous system involvement. In-hospital mortality was associated with age and the diagnosis of a solid tumor.(AU)

Non-perinatal listeriosis: Changes in frequency, clinical spectrum and prognostic factors.

INTRODUCTION: Listeria monocytogenes infection is a severe disease affecting mainly aged people and patients with immune depression. The incidence of listeriosis seems to be increasing. In the present study cases of listeriosis from two hospitals are analyzed with the aims of studying changes in its incidence, clinical forms of presentation and possible factors associated with mortality. METHODS: Retrospective multicentric study of patients with culture-proven listeriosis in two university hospitals in Madrid between 1977 and 2021. Epidemiological and clinical variables, as well as factors for immune depression, complementary studies and treatments were registered. Factors associated with mortality were analyzed. RESULTS: A total of 194 cases of listeriosis were analyzed. The incidence of listeriosis among in-patients increased through the study period, with a significant drop in the number of cases in 2020. The most common clinical presentations were isolated bacteriemia (37.1%) and central nervous system involvement (CNS) (36.6%). Symptoms of gastroenteritis occurred in 21% of cases. Other focal infections were present in 16.5% of patients, the most frequent were spontaneous bacterial peritonitis (8.2%), cholecystitis (2.1%), respiratory infection (1.5%) and vascular prothesis infection (1.5%). In-hospital mortality was 24.7%. Independent factors associated with mortality at admission were age (Odds Ratio [OR] 1.027, 95% confidence interval [IC95%] 1.003-1.056) and a diagnosis of a solid tumor (OR 3.525, IC95% 1.652-7.524). CONCLUSIONS: This study confirms an increasing incidence of listeriosis in our millieu. The most common clinical presentations were isolated bacteriemia and central nervous system involvement. In-hospital mortality was associated with age and the diagnosis of a solid tumor.

HIV infection and multiple sclerosis: a case with unexpected "no evidence of disease activity" status.

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system whose etiology remains unclear. It has been suggested that MS can be triggered by certain viruses; however, human immunodeficiency virus (HIV) infection is associated with reduced incidence of MS. We present the case of a young patient diagnosed with active relapsing-remitting MS whose clinical course substantially improved following HIV infection and treatment. The patient achieved no evidence of disease activity status without any disease-modifying drugs. Both HIV-induced immunosuppression and antiretroviral therapy may have attenuated the clinical course in this patient.

Increased HIV infection in patients with stroke in Spain. A 16-year population-based study / Aumento de la infección por VIH en pacientes con ictus en España. Estudio poblacional a nivel nacional a lo largo de 16 años

INTRODUCTION: An increased incidence of stroke in HIV-infected patients has already been reported, suggesting that HIV infection may be a cerebrovascular risk factor. The objective of this study was to assess temporal trends in the proportion of HIV infection among patients with stroke in Spain. METHODS: Data were obtained from the minimum basic dataset (MBDS) of all patients hospitalized in Spain between 1997 and 2012 with a primary or secondary diagnosis of stroke. The annual proportion of HIV infection and time trends (stratifying by type of stroke and HIV stage) were calculated, and predictors of HIV infection and the social and economic impact of HIV-infected (HIV+) and non-infected (HIV−) patients were analyzed. RESULTS: Of 857,371 patients hospitalized with an incident stroke, 2134 (0.25%) had HIV infection. A 2.5% year-on-year increase (OR 1.025, 95% CI 1.015-1.036, p < 0.0001) of the proportion of HIV-infected patients was observed due to an increase in the asymptomatic stage of the infection (per year OR 1.077, 95% CI 1.057-1.097, p < 0.0001), as the proportion of patients with AIDS remained stable. Factors independently associated with HIV infection and stroke were active smoking, stimulating drugs and hepatitis C virus (HCV) infection. A higher mortality rate, longer hospital stay and a higher cost per hospitalized patient was observed among HIV+ patients. CONCLUSIONS: From 1997 to 2012, there was an increase in the proportion of HIV infection among patients hospitalized with stroke irrespective of the classical vascular risk factors, reinforcing the role of HIV infection as a cerebrovascular risk factor

INTRODUCCIÓN: Se ha observado previamente un aumento de la incidencia de ictus en pacientes con VIH (VIH+), lo que sugiere que esta infección es un factor de riesgo cerebrovascular (FRCV). El objetivo fue analizar las tendencias temporales del porcentaje de VIH+ en pacientes con ictus en España. MÉTODOS: Los datos se obtuvieron del Conjunto Mínimo Básico de Datos (CMBD), incluyendo a todos los pacientes hospitalizados en España entre 1997 y 2012 con un diagnóstico primario o secundario de ictus. Se calcularon el porcentaje anual de infección por VIH y las tendencias temporales (estratificados por el tipo de ictus y el estadio del VIH), así como los factores predictores independientes de infección por VIH en pacientes con ictus. La mortalidad, las estancias hospitalarias y el coste por paciente fueron similares entre los pacientes VIH+ y los pacientes no infectados por el VIH (VIH-). RESULTADOS: De los 857.371 pacientes hospitalizados con un ictus incidente, 2.134 (0,25%) presentaban infección por VIH. Se observó un aumento de un 2,5% anual (OR: 1,025; IC del 95%: 1,015-1,036; p < 0,0001) en el porcentaje de infección por VIH, secundario a un aumento en el estadio asintomático de la infección (OR anual: 1,077; IC del 95%: 1,057-1,097; p < 0,0001), puesto que el porcentaje permaneció estable en pacientes con SIDA. La infección por el virus de la hepatitis C (VHC), el consumo de drogas estimulantes y el tabaquismo activo fueron factores independientemente asociados a sufrir un ictus y presentar VIH. Se observó una mayor mortalidad (OR: 1,81; p < 0,0001) y una mayor estancia hospitalaria y coste por paciente hospitalizado en los pacientes VIH+. CONCLUSIONES: De 1997 a 2012, se ha observado un aumento del porcentaje de infección por VIH en pacientes hospitalizados con ictus independientemente de los factores de riesgo clásicos, lo que refuerza el papel de las infecciones por VIH como FRCV

Increased HIV infection in patients with stroke in Spain. A 16-year population-based study.

INTRODUCTION: An increased incidence of stroke in HIV-infected patients has already been reported, suggesting that HIV infection may be a cerebrovascular risk factor. The objective of this study was to assess temporal trends in the proportion of HIV infection among patients with stroke in Spain. METHODS: Data were obtained from the minimum basic dataset (MBDS) of all patients hospitalized in Spain between 1997 and 2012 with a primary or secondary diagnosis of stroke. The annual proportion of HIV infection and time trends (stratifying by type of stroke and HIV stage) were calculated, and predictors of HIV infection and the social and economic impact of HIV-infected (HIV+) and non-infected (HIV-) patients were analyzed. RESULTS: Of 857,371 patients hospitalized with an incident stroke, 2134 (0.25%) had HIV infection. A 2.5% year-on-year increase (OR 1.025, 95% CI 1.015-1.036, p<0.0001) of the proportion of HIV-infected patients was observed due to an increase in the asymptomatic stage of the infection (per year OR 1.077, 95% CI 1.057-1.097, p<0.0001), as the proportion of patients with AIDS remained stable. Factors independently associated with HIV infection and stroke were active smoking, stimulating drugs and hepatitis C virus (HCV) infection. A higher mortality rate, longer hospital stay and a higher cost per hospitalized patient was observed among HIV+ patients. CONCLUSIONS: From 1997 to 2012, there was an increase in the proportion of HIV infection among patients hospitalized with stroke irrespective of the classical vascular risk factors, reinforcing the role of HIV infection as a cerebrovascular risk factor.

Infarto medular y de cuerpos vertebrales cervicales tras consumo de sildenafilo / Infarction of the spinal cord and of cervical vertebral bodies following consumption of sildenafil

No disponible

Deterioro cognitivo como factor independiente de riesgo hospitalario: estudio DECOFIRH / Cognitive impairment as a predictor of functional decline after hospitalization: DECOFIRH Study

Objetivo. El deterioro cognitivo está infradiagnosticado. El estudio DECOFIRH pretende detectar la tasa de deterioro cognitivo no conocido y su impacto en la situación funcional de estos pacientes tras un ingreso hospitalario mediante cuestionarios realizados a un informador. Pacientes y métodos. Estudio observacional prospectivo realizado sobre una serie de casos, de pacientes comprendidos entre 70 y 85 años, que ingresan en el Servicio de Medicina Interna de un hospital terciario. Se excluyó a los pacientes con diagnóstico de demencia o enfermedades neurológicas graves, así como a los que habían sido hospitalizados recientemente. Los tests empleados en la detección de deterioro cognitivo fueron Alzheimer's Disease 8 (AD8) e Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Asimismo, se evaluó la situación funcional mediante el índice de Barthel en el momento del ingreso y tres meses después. Resultados. Durante los tres meses de seguimiento ingresaron 809 pacientes y cumplieron los criterios de inclusión 79 (9,7%) de ellos. Su edad media era de 80 años. Mediante el IQCODE se detectó una tasa de deterioro cognitivo del 30,3%, y con el AD8, del 34,1%. En el ingreso, el 37,9% de los pacientes era funcionalmente independiente. A los tres meses, este porcentaje cayó al 24%. Conclusiones. En nuestra muestra, casi un tercio de los ancianos sin comorbilidades sistémicas o neurológicas graves dio positivo para la detección de deterioro cognitivo según nuestros tests basados en el informador, sin ser éste conocido previamente. El deterioro funcional afecta casi a una cuarta parte de estos pacientes a los tres meses del ingreso (AU)

Aim. Cognitive impairment is underdiagnosed in the elderly. We aimed to study the rate of positive responses to an informant-based questionnaires and functional disability after hospital discharge. Patients and methods. Observational prospective case series of patients aged 70-85 years-old admitted for hospitalization in an Internal Medicine ward. All medical records were reviewed and those patients with no previous diagnosis of dementia or related neurological conditions, no previous recent hospitalization or not having a caregiver were evaluated after signing an informed consent. A medical interview including the Alzheimer's Disease 8 (AD8), the Informant Questionnaire. on Cognitive Decline in the Elderly (IQCODE) and Barthel Index was completed. Barthel Index was obtained three months after discharge. Results. During a 3-month period a total of 809 admissions were screened and 79 (9.7%) fulfilled the study criteria. Patient’s mean age was 80 years-old. Common comorbidities were arterial hypertension (83.5%), major surgery (54.4%) and heart disorders (50.6%). The most frequent cause of admission was infectious disease (37.9%). Test positivity for cognitive impairment was 30.3% for IQCODE and 34.1% for AD8. At admission 37.9% of the patients were functionally independent. At three months this percentage dropped to 24%. Conclusions. In this small sample size, almost a third of older patients, without major comorbidities or neurological disorders, admitted to a general hospital showed an informant-based suggestion of cognitive impairment previously undiagnosed. Functional impairment affects almost a quarter of these patients three months after admission (AU)