Artritis séptica por Scedosporium apiospermum de lenta instauración tras infiltración periarticular / Slow onset septic arthritis by Scedosporium apiospermum after periarticular infiltration

Antecedentes. Las artritis fúngicas de origen hematógeno suelen afectar preferentemente a pacientes con afectación de la inmunidad celular o a usuarios de drogas por vía intravenosa. En el paciente inmunocompetente suele producirse por la inoculación del microorganismo mediante un mecanismo invasor. La experiencia del tratamiento con azoles en estos pacientes es muy escasa. Caso clínico. Presentamos un caso clínico de artritis por Scedosporium apiospermum caracterizado por su lenta instauración, falta de respuesta a posaconazol y caspofungina, y resolución final mediante desbridamiento y tratamiento con voriconazol. Conclusiones. La administración de voriconazol junto al desbridamiento quirúrgico constituye un tratamiento eficaz en la artritis por S. apiospermum(AU)

Background. Fungal arthritis is usually of haematogenous origin, and mainly affects patients with impaired cellular immunity or users of intravenous drugs. The infection in immunocompetent patients is generally caused by direct inoculation of the microorganism through an invasive device. The experience of azole therapy in these patients is limited. Case report. We report a case of arthritis caused by Scedosporium apiospermum characterized by its slow onset, lack of response to posaconazole and caspofungin, and its successful resolution after surgical debridement and treatment with voriconazole. Conclusions. Treatment with voriconazole and surgical debridement is an effective therapy for arthritis due to S. apiospermum(AU)

Absceso hepático piógeno: presentación clínica y predictores de evolución desfavorable / Pyogenic liver abscess: clinical presentation and predictors of unfavorable outcome

Objetivos Describir clínicamente el absceso hepático piógeno (AHP) e identificar factores asociados a evolución desfavorable. Material y métodos Revisión retrospectiva de historias de pacientes con absceso hepático (1996-2009), incluyendo los que cumplían criterios diagnósticos de AHP. Se clasificaron en evolución favorable y desfavorable (sepsis grave, complicaciones infecciosas a distancia, complicación local, ingreso en cuidados intensivos, ingreso > 30 días, fallecimiento, reingreso).Resultados Se incluyen 54 AHP, 65% hombres, edad media 61 años. Factores predisponentes: enfermedad biliopancreática, 33%; ingreso reciente, 20%; enolismo, 15%; diabetes mellitus, 15%; antecedente de neoplasia digestiva, 11%, y de cirugía abdominal, 11%. Origen: criptogénico, 65%; biliar, 31%; portal, 4%. Sintomatología: fiebre, 100%; dolor abdominal, 65%; vómitos, 37%; hepatomegalia, 33%; síndrome de respuesta inflamatoria sistémica, 26%; ictericia, 9%. Hemocultivos positivos, 40%, y cultivo de pus, 65%. Escherichia coli y Streptococcus spp. fueron los aislamientos más frecuentes. Se efectuó drenaje percutáneo en el 72% (el 6% también quirúrgico), y recibieron solo antibioterapia el 28%. Evolución desfavorable 52%, asociada a mayor edad (p=0,016), antecedentes de enfermedad biliopancreática (p=0,007), síndrome de respuesta inflamatoria sistémica al diagnóstico (p=0,005), alteración de la coagulación (p=0,043), elevación de AST (p=0,033) y etiología biliar (p<0,001). Conclusiones El AHP se desarrolla en pacientes con comorbilidad, si bien más frecuentemente son criptogénicos. La mayoría curan con antibioterapia y drenaje percutáneo, sin cirugía. La mortalidad es del 9%, pero la mitad sigue una evolución desfavorable, que se asocia a la etiología biliar y a determinadas alteraciones analíticas (AU)

Objectives To describe the clinical features of pyogenic liver abscesses (PLA) and identify the factors associated with an unfavorable outcome. Material and methods We performed a retrospective review of the clinical histories of patients with liver abscess (1996-2009), including those that met the diagnostic criteria for PLA. Outcome was classified as favorable or unfavorable (severe sepsis, distant infectious complications, local complications, intensive care unit admission, admission for>30 days, death, readmission).Results There were 54 patients with PLA (65% men), with a mean age of 61 years. Predisposing factors consisted of biliopancreatic disease in 33%, recent admission in 20%, alcoholism in 15%, diabetes mellitus in 15%, a history of gastrointestinal neoplasm in 11% and abdominal surgery in 11%. The cause was cryptogenic in 65%, biliary in 31%, and portal in 4%. Symptoms consisted of fever in 100%, abdominal pain in 65%, vomiting in 37%, enlarged liver in 33%, systemic inflammatory response syndrome in 26%, and jaundice in 9%. Blood and pus cultures were positive in 40% and 65%, respectively. The most frequently isolated microorganisms were E. coli and Streptococcus spp. Percutaneous drainage was performed in 72% (surgical drainage was also performed in 6%), and antibiotic treatment alone was administered in 28%. Outcome was unfavorable in 52% and was associated with greater age (p=0.016), a history of biliopancreatic disease (p=0.007), systemic inflammatory response syndrome at diagnosis (p=0.005), coagulation alterations (p=0.043), aspartate aminotransferase elevation (p=0.033), and biliary etiology (p<0.001).Conclusions PLA developed in patients with comorbidity, although most were cryptogenic. The majority of PLA were resolved with antibiotic therapy and percutaneous drainage, without surgery. Mortality was 9%, but half the patients had unfavorable outcome, associated with biliary etiology and some laboratory alterations (AU)

[Pyogenic liver abscess: clinical presentation and predictors of unfavorable outcome]. / Absceso hepático piógeno: presentación clínica y predictores de evolución desfavorable.

OBJECTIVES: To describe the clinical features of pyogenic liver abscesses (PLA) and identify the factors associated with an unfavorable outcome. MATERIAL AND METHODS: We performed a retrospective review of the clinical histories of patients with liver abscess (1996-2009), including those that met the diagnostic criteria for PLA. Outcome was classified as favorable or unfavorable (severe sepsis, distant infectious complications, local complications, intensive care unit admission, admission for>30 days, death, readmission). RESULTS: There were 54 patients with PLA (65% men), with a mean age of 61 years. Predisposing factors consisted of biliopancreatic disease in 33%, recent admission in 20%, alcoholism in 15%, diabetes mellitus in 15%, a history of gastrointestinal neoplasm in 11% and abdominal surgery in 11%. The cause was cryptogenic in 65%, biliary in 31%, and portal in 4%. Symptoms consisted of fever in 100%, abdominal pain in 65%, vomiting in 37%, enlarged liver in 33%, systemic inflammatory response syndrome in 26%, and jaundice in 9%. Blood and pus cultures were positive in 40% and 65%, respectively. The most frequently isolated microorganisms were E. coli and Streptococcus spp. Percutaneous drainage was performed in 72% (surgical drainage was also performed in 6%), and antibiotic treatment alone was administered in 28%. Outcome was unfavorable in 52% and was associated with greater age (p=0.016), a history of biliopancreatic disease (p=0.007), systemic inflammatory response syndrome at diagnosis (p=0.005), coagulation alterations (p=0.043), aspartate aminotransferase elevation (p=0.033), and biliary etiology (p<0.001). CONCLUSIONS: PLA developed in patients with comorbidity, although most were cryptogenic. The majority of PLA were resolved with antibiotic therapy and percutaneous drainage, without surgery. Mortality was 9%, but half the patients had unfavorable outcome, associated with biliary etiology and some laboratory alterations.

[Slow onset septic arthritis by Scedosporium apiospermum after periarticular infiltration]. / Artritis séptica por Scedosporium apiospermum de lenta instauración tras infiltración periarticular.

BACKGROUND: Fungal arthritis is usually of haematogenous origin, and mainly affects patients with impaired cellular immunity or users of intravenous drugs. The infection in immunocompetent patients is generally caused by direct inoculation of the microorganism through an invasive device. The experience of azole therapy in these patients is limited. CASE REPORT: We report a case of arthritis caused by Scedosporium apiospermum characterized by its slow onset, lack of response to posaconazole and caspofungin, and its successful resolution after surgical debridement and treatment with voriconazole. CONCLUSIONS: Treatment with voriconazole and surgical debridement is an effective therapy for arthritis due to S. apiospermum.