Meningitis por Enterococcus faecium secundaria a anestesia epidural. A propósito de un caso y revisión de la literatura / Enterococcus faecium meningitis secondary to epidural anesthesia. About a case and review of the literature

La meningitis séptica secundaria a anestesia epidural es una complicación rara, pero grave, que suele estar relacionada con contaminación exógena a partir de técnicas de asepsia inadecuadas, por lo que los microorganismos más frecuentes observados son S. aureus y S. salivarius. Nosotros describimos el caso de una mujer que, tras la realización de anestesia epidural para un parto eutócico, presentó una meningitis séptica por Enterococcusfaecium (E. faecium), que recidivó posteriormente, probablemente debido a una ventriculitis piogénica que pasó inadvertida en el primer episodio. Destacamos la rareza del caso, hacemos hincapié en extremar las medidas de asepsia y revisamos la literatura sobre el tratamiento más adecuado en este tipo de complicaciones.(AU)

Septic meningitis secondary to epidural anesthesia is a rare but serious complication that is usually related to exogenous contamination from inadequate aseptic techniques, so the most frequent microorganisms observed are S. aureus and S. salivarius. We describe the case of a woman who, after receiving epidural anesthesia for normal delivery, presented septic meningitis due to E. faecium with recurrence after antibiotic treatment, probably secondary to pyogenic ventriculitis undetected in the first episode. We highlight the rarity of the case, emphasizing the need for strict aseptic technique, and review the literature on the most appropriate treatment for this type of complication.(AU)

Enterococcus faecium meningitis secondary to epidural anesthesia. About a case and review of the literature.

Septic meningitis secondary to epidural anesthesia is a rare but serious complication that is usually related to exogenous contamination from inadequate aseptic techniques, so the most frequent microorganisms observed are S. aureus and S. salivarius. We describe the case of a woman who, after receiving epidural anesthesia for normal delivery, presented septic meningitis due to E. faecium with recurrence after antibiotic treatment, probably secondary to pyogenic ventriculitis undetected in the first episode. We highlight the rarity of the case, emphasizing the need for strict aseptic technique, and review the literature on the most appropriate treatment for this type of complication.

Enterococcus faecium meningitis secondary to epidural anesthesia. About a case and review of the literature. / Meningitis por Enterococcus faecium secundaria a anestesia epidural. A propósito de un caso y revisión de la literatura.

Septic meningitis secondary to epidural anesthesia is a rare but serious complication that is usually related to exogenous contamination from inadequate aseptic techniques, so the most frequent microorganisms observed are S. aureus and S. salivarius. We describe the case of a woman who, after receiving epidural anesthesia for normal delivery, presented septic meningitis due to E. faecium with recurrence after antibiotic treatment, probably secondary to pyogenic ventriculitis undetected in the first episode. We highlight the rarity of the case, emphasizing the need for strict aseptic technique, and review the literature on the most appropriate treatment for this type of complication.

[Clinical and therapeutic differences in neuro-ophthalmological involvement secondary to syphilis]. / Diferencias clinicas y terapeuticas de la afectacion neurooftalmologica secundaria a sifilis.

INTRODUCTION. There are many forms of neuro-ophthalmological involvement secondary to syphilis, and not all of them are well known. Our aim is to determine the clinical and therapeutic differences in these patients. CASE REPORTS. Our sample included eight patients diagnosed with an ocular and neuro-ophthalmological disorder due to syphilis over the years 2012 and 2013. Five of them presented uveitis, pan-eveitis being the most frequent, with three cases. Two cases presented papilloedema and another displayed retrobulbar optic neuropathy. A total of 62.5% were diagnosed with neurosyphilis, the presence of which was related with compromise of the optic nerve (p = 0.035). None of them gave positive for VDRL in cerebrospinal fluid and they were diagnosed by the presence of FTA antibodies together with high protein levels in cerebrospinal fluid, lymphocytic pleocytosis or intrathecal synthesis of antibodies. In the absence of uveitis, diagnosis was delayed by a mean time of 2.6 months (p = 0.047). All the patients, except one who required a vitrectomy, progressed favourably with intravenous antibiotic therapy. CONCLUSIONS. In cases of neuro-ophthalmological compromise, whether inflammatory or non-inflammatory, the physician must bear syphilis in mind as a potential causation in order to avoid delays in the diagnosis, since early well-tailored treatment can prevent permanent loss of sight.

TITLE: Diferencias clinicas y terapeuticas de la afectacion neurooftalmologica secundaria a sifilis.Introduccion. Existen multiples formas de afectacion neurooftalmologica secundaria a sifilis, no siempre bien conocidas. Nuestro objetivo es conocer las diferencias clinicas y de tratamiento en estos pacientes. Casos clinicos. Se incluyeron ocho pacientes diagnosticados de afectacion ocular y neurooftalmologica por sifilis durante los años 2012 y 2013. Cinco presentaron uveitis, siendo la panuveitis la forma mas frecuente, con tres casos. Dos casos presentaron papiledema, y otro, neuropatia optica retrobulbar. Un 62,5% fue diagnosticado de neurosifilis, cuya presencia se relaciono con la afectacion del nervio optico (p = 0,035). Ninguno de ellos presento positividad para VDRL en el liquido cefalorraquideo, y se diagnosticaron por la presencia de anticuerpos FTA junto con hiperproteinorraquia, pleocitosis linfocitaria o sintesis intratecal de anticuerpos. En ausencia de uveitis, se produjo un retraso diagnostico medio de 2,6 meses (p = 0,047). Todos los pacientes, salvo uno que preciso vitrectomia, evolucionaron favorablemente con antibioterapia intravenosa. Conclusiones. En casos de afectacion neurooftalmologica, inflamatoria y no inflamatoria, el clinico debe tener en cuenta la sifilis como potencial etiologia para evitar un retraso diagnostico, puesto que un adecuado tratamiento precoz puede evitar una perdida de vision permanente.

[Pulmonary fibrosis as a presentation form of the Jo-1 syndrome]. / Fibrosis pulmonar como forma de presentación del síndrome Jo-1.

Jo-1 syndrome is a disease recently described, included on the list of connective tissue diseases. Its clinical features are myositis and/or pulmonary fibrosis associated to the presence of precipitant antibodies against intracellular enzyme call histidine T-RNA synthetase. This antibody is related to pulmonary fibrosis associated to myositis and some scientist gave predictive value on the onset of pulmonary fibrosis in patients with myositis. However, isolated association of pulmonary fibrosis have been exceptionally described. A patient with severe interstitial pulmonary affliction and positive Jo-1 antibody without myositis is presented. The actual knowledge of the disease and its association is reviewed.

Detección de infecciones subclínica en lepra

Se revisan los distintos procedimientos y técnicas inmunológicas utilizadas para la detección subclínica de la lepra resaltando qué ventajas e inconvenientes desde el punto de vista epidemiológico y de especificidad. El antígeno específico del M. leprae, glicolípido fenólico destaca como el más utilizando actualmente.