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[Coverage of the 23-valent pneumococcal vaccine in those older than 64 years of age in the region of Castellon and Valencia, Spain]. / Cobertura de la vacuna antineumocócica 23-valente en los mayores de 64 años en el area de Castellón y Valencia.

The different serotypes of Streptococcus pneumoniae isolated from adults aged over 64 years in the Valencia and Castellon health region of Spain from June 1999 to December 2003 were analyzed. A total of 163 strains were evaluated; 58.3% were invasive, 47.24% were from respiratory source, and 4.9% were from exudates. The greatest percentage of samples was obtained from the group of patients aged 65 to 75 years (60.7%), while the lowest percentage was obtained from the group of patients aged over 85 years (10.4%). In the latter group, 53% of the strains were invasive and 29.4% were isolated from sputum. A total of 21 serotypes were identified, with the most common (> 3%) being: serotype 3 (22.1%); serotype 19 (12.9%); serotype 6 (12.3%); serotype 9 (8.6%); serotype 14 (10.4%); serotype 23 (8%); serotype 29 (3.7%); and serotype 18 (3.1%). Serotype 3 was the most common serotype found in all samples, with the exception of exudate, while serotype 23 was not isolated in blood. In this population group, the coverage of the 23-valent vaccine was 88.4%. Serotypes not included in this vaccine but isolated from invasive samples were serotypes 16, 24, 29 and 35. No changes were observed in serotype distribution over the 4-year period of the study. However, it is necessary to continue epidemiological monitoring to determine whether serotype substitution occurs.

[Pasteurella multocida infection of cavitated lung squamous carcinoma]. / Infección por Pasteurella multocida de un carcinoma escamoso de pulmón cavitado.

Pasteurella multocida has rarely been reported to cause lung disease in humans. Infection usually arises from bites or scratches from animal carriers of the pathogen. Cases of pneumonia, lung abscess, airway infection or infection of pre-existing bronchiectasis have been described, usually in individuals who are in direct contact with carrier animals and who have a chronic debilitating disease. It is unusual for P. multocida to be ingested and appear among oropharyngeal flora in humans. We report the first case published (Medline search 1966-2002) of a cavitated lung with squamous carcinoma that became infected by P. multocida in an elderly patient who denied contact with potential carrier animals. We believe that the P. multocida infection in humans is underdiagnosed because clinical suspicion is low and the bacterium is highly susceptible to common antibiotics.

Infección por Pasteurella multocidade un carcinoma escamoso de pulmón cavitado / Pasteurella multocida infection of cavitated lung squamous carcinoma

Pasteurella multocida raramente se ha descrito como productor de enfermedad pulmonar en humanos. Su infección suele producirse tras la mordedura o arañazo de animales portadores. Se han comunicado algunos casos de neumonías, abscesos pulmonares, infecciones de las vías aéreas superiores e infección de bronquiectasias preexistentes, habitualmente en individuos en contacto directo con animales portadores y afectados de patología crónica debilitante. Es excepcional que P. multocida aparezca como comensal en la flora orofaríngea humana. Presentamos el primer caso publicado (Medline, 19662002) de un carcinoma escamoso de pulmón cavitado e infectado por P. multocida en un individuo de avanzada edad que negó el contacto con animales potencialmente portadores. Pensamos que la infección pulmonar por P. multocida en humanos está infradiagnosticada debido a la baja sospecha clínica y por la excelente susceptibilidad de este microorganismo a los antibióticos comúnmente utilizados (AU)

Gastrointestinal bezoars: sonographic and CT characteristics.

OBJECTIVE: The purpose of this study was to assess the value of imaging studies--conventional abdominal radiographs, sonography, and CT--in the diagnosis of gastrointestinal bezoars. METHODS AND METHODS: A review was made of the radiologic findings of 17 consecutive patients with surgically verified gastrointestinal bezoars over a period of 51 months. RESULTS: Twelve patients had a history of previous gastric surgery. In no patient was a bezoar clinically suspected. Phytobezoars were recorded in 16 patients and a trichobezoar in only one. A total of 33 bezoars were identified at surgery. Two patients had isolated gastric bezoars, whereas 15 patients had bezoars located in the small bowel. Among the latter group, associated gastric bezoars were found in eight patients, and five patients had multiple intestinal bezoars. Abdominal radiographs revealed bezoars in three patients, sonography revealed bezoars in 15, and CT revealed bezoars in all 17. Seven patients had associated gastric bezoars revealed at CT versus only two patients with gastric bezoars revealed at sonography. CT revealed multiple intestinal bezoars in five patients whereas sonography revealed them in only two patients. CONCLUSION: Both sonography and CT are reliable methods for diagnosing gastrointestinal bezoars. CT is more accurate, however, and exhibits a quite characteristic bezoar image; in addition, this imaging technique is able to reveal the presence of additional gastrointestinal bezoars.

[Scimitar sign in a partially anomalous pulmonary venous drainage]. / Signo de la cimitarra en un drenaje venoso pulmonar anómalo parcial.

The scimitar sign is an uncommon finding, that shows an anomalous pulmonary vein coursing to the right cardiac border, that drains to the inferior vena cava. Usually it is associated to other cardiovascular or pulmonary anomalies, within the hypogenetic lung syndrome. We present a rare case of a few symptomatic man 46 years-old, with partial anomalous pulmonary venous drainage, diagnosed upon finding the scimitar sign in a roentgenogram of the chest, in absence of the hypogenetic lung syndrome. We comment the role of CT in the diagnosis.

[Massive intravascular hemolysis in septicemia caused by Clostridium perfringens]. / Hemólisis intravascular masiva en septicemia por Clostridium perfringens.

A case of massive haemolytic anaemia in the course of a C. perfringens sepsis of hepatic origin is presented. The diagnosis was strongly suggested by the presence of intragranulocytic capsulated bacilli in a Giemsa stained peripheral blood smear. The patient developed disseminated intravascular coagulation. The outcome was fatal and the patient died eight hours after admission. We review the aetiopathogenesis, diagnosis and therapy of haemolysis in Clostridium perfringens infections.

[Detection of anti-cytomegalovirus antibodies: comparison of 3 commercial methods]. / Detección de anticuerpos anti-citomegalovirus: comparación de tres métodos comerciales.

A group of 188 sera from pregnant women was screened for cytomegalovirus (CMV) antibodies by immunofluorescence assay (IFA), enzyme immunoassay (EIA), and passive latex agglutination (LA) tests. There were 178 (94.6%) sera for which there was complete agreement between the three tests. One hundred-sixty three sera were positive by two or more methods and judged to be true positives. Accordingly, the highest sensitivity was shown by the EIA and LA tests (100% in both cases). The sensitivity of IFA test was similar (97%). A ranking for technical demand, hands-on time, turnaround time, requirement for special equipment and objectivity sharply favoured the LA test.