Update in Infectious Diseases 2019.

The IX Course of Antimicrobials and Infectious Diseases update included a review of the main issues in clinical microbiology, epidemiology and clinical aspects for a current approach of infectious pathology. The present introduction summarizes about the most important meetings related to infectious diseases during 2018 (ECCMID, IAS, ASM and ID Week). In addition, the course provides a practical information to focus on nosocomial infection models, with immunosuppressed patients or complex multidrug-resistant pathogens. The closing lecture of this year reviewed the infection during donation process.

Description of carbapenemase-producing Enterobacteriaceae isolates in a Spanish tertiary hospital. Epidemiological analysis and clinical impact.

OBJECTIVE: The aim of the study was to carry out an epidemiological analysis of patients with carbapenemase-producing Enterobacteriaceae (CPE) isolations in our hospital as well as to perform a description of the genotypic temporal evolution of CPE isolated. METHODS: An observational prospective cohort study was performed involving all patients with CPE isolates from clinical samples during November 2014 to November 2016 in a Spanish teaching hospital. Patients were clinically evaluated and classified either as infected or colonized. Information on the consumption of carbapenems in the hospital during the study period was also analyzed. PCR was used for identification of the carbapenemase genes blaKPC, blaVIM, and blaOXA-48. RESULTS: A total of 301 CPE isolates were obtained (107 in 2014, 89 in 2015 and 105 in 2016). Klebsiella pneumoniae (73.4%) was the most prevalent microorganism. Hundred and seventy (56.7%) of carbapenemases detected were blaOXA-48, 73 (24.3%) were blaKPC and 57 (19%) were blaVIM. In year 2014 KPC was predominant while in 2016 OXA-48 predominated. In 2014 we observed a significant association between the medical wards and the ICU with a higher prevalence of OXA-48 (OR 4.15; P<0.001) and VIM (OR 7.40; P<0.001) in the univariate analysis, in the following years there was no association. Regarding the clinical significance of microbiological results after assessing our patients, 60% of isolates represented infection and 40% behaved as colonizers. One third of hospitalized patients with CPE isolation died within 30 days, regardless of whether they were colonized or infected. CONCLUSIONS: We have observed an epidemiological change in the genotypes of our isolates along the study period. A thorough knowledge of the CPE's epidemiological distribution in each hospital is fundamental for optimizing antimicrobial chemotherapy.

Update in Infectious Diseases 2018.

VIII Updating Course of Antimicrobials and Infectious Diseases has reviewed useful microbiological, epidemiological and clinical aspects for a current approach of infectious pathology. Present manuscript summarizes a chronicle about the main infection related meetings during 2017 (ECCMID, IAS, ASM and ID Week). In addition, the course proposed a practical approach for understanding different type of pathogens and our selected topics this year were the epidemiology of bacterial nosocomial infection, a practical approach to Clostridium difficile infection patients, a two year selection of the top ten papers about fungal infection and an update in fungal biofilms. Finally, proffesors made a practical approach by main clinical syndromes like sepsis, infections in oncohematological patients, CNS infections in immunosuppressed patients and reviewed the top ten papers in transplant infectious diseases and infection control during the last two years.

BAHNG score: predictive model for detection of subjects with the oropharynx colonized by uncommon microorganisms.

OBJECTIVE: Pneumonia is most frequently produced by the microaspiration of flora that colonizes the oropharynx. Etiological diagnosis of pneumonia is infrequent in clinical practise and empirical treatment should be prescribed. The aims of the present study were to determine the factors associated with oropharynx colonization by uncommon microorganisms (UM) and to develop a predictive model. METHODS: A cross-sectional study that included all pa-tients living in one long-term care facilities was developed. Demographic, comorbidities, basal functional status and clinical data were collected. To determinate the oropharyngeal colonization, a single sample of pharynx was obtained for each subject using a cotton swab. RESULTS: A total of 221 subjects were included, mean age 86.27 (SD 8.05) years and 157 (71%) were female. In 32 (14.5%) subjects UM flora was isolated, Gram-negative bacilli in 16 (7.2%) residents, and Staphylococcus aureus in 16 (7.2%). The predictive model included the presence of hypertension, neuromuscular disease, Barthel <90 and use of PEG. The BAHNG score (BArthel, Hypertension, Neuromuscular, Gastrostomy), showed an area under the curve of 0.731 (CI 95% 0.643-0.820; p<0.001). We have classified patients according to this score in low (0-2 points), intermediate (3-5 points) and high risk (≥ 6). The probability of UM colonization in the oropharyngeal based on this classification is 4.1%, 15.8% and 57.1% for low, intermediate and high risk, respectively. CONCLUSIONS: The BAHNG score could help in the identifications of elderly patients with high risk of colonization by UM. In case of pneumonia the evaluation of the subject through this score could help in the initial decisions concerning antibiotic treatment.

Useful independent factors for distinguish infection and colonization in patients with urinary carbapenemase-producing Enterobacteriaceae isolation.

OBJECTIVE: The aim of this study is to know epidemiologic and clinical differences among those patients colonized or infected by carbapenemase-producing Enterobacteriaceae (CPE) and develop a predictive model to facilitate the clinical approach concerning to start antimicrobial therapy. METHODS: Observational retrospective cohort study was performed involving all patients with Urine carbapenemase-producing Enterobacteriaceae isolation (UCPEI) between November 2013 and July 2015. Patients were classifieds as colonized or infected considering Center for Disease Control and Prevention (CDC) definition for urinary tract infection (UTI). RESULTS: A total of 72 patients were included, mean age 76.4 (IQR 23-99) years and 40 (55.6%) were women. Thirty-four (47.2%) were colonized and 38 (52.8%) met the criteria of UTI and were considered infected. The independent variables associated to infection were female sex, peripheral vascular disease, admission in medical ward, permanent urinary catheter carrier, previous antimicrobial therapy, and length of stay. Isolation of OXA-48 carbapenemase-producing Enterobacteriaceae behaved as a non UTI (colonization) factor in comparison with KPC or VIM CPE. The developed predictive model showed an area under the curve (AUC) of 0.901 (95% CI: 0.832-0.970; p < 0.001). CONCLUSIONS: The predictive model that includes all this factors has demonstrated a good accuracy for infection diagnosis in these patients, an important issue considering that establishing the diagnosis of infection is not always easy in the profile of patients in which a CPE is isolated.

Incidencia de lesiones deportivas en jugadores y jugadoras de baloncesto / Amateur injury incidence rate among amateur basketball players

El objetivo del presente estudio es conocer las tasas de incidencia lesional en entrenamiento y competición, tipos de lesión y tiempo de baja deportiva en jugadores/as de baloncesto amateur de las categorías comprendidas entre Benjamín y Senior. Se realizó un seguimiento de las lesiones sufridas en 25 equipos (289 jugadores/as de entre 8-34 años) adscritos a los juegos municipales y federados de la Comunidad de Madrid. Se contabilizaron 48 lesiones durante 10.961 Exposiciones de los jugadores/as a la actividad (AEs). Un 16,61% se lesionó durante este periodo. Las tasas de incidencia fueron 1,77- 11,8/1.000 AEs para el sexo femenino y 3,63-9,3/1.000 AEs para el masculino en práctica y competición respectivamente. El esguince de ligamento fue el tipo de lesión más común (45,83%) y el esguince de tobillo el diagnóstico lesional más frecuente para la muestra total (20,83%). El mecanismo de lesión y tiempo de baja difirió entre sexos (AU)

The purpose of the present study was to determine the injury rate both in practice and competition, injury diagnoses and time loss in amateur basketball players within Benjamin and Senior categories. Injuries suffered in 25 teams (289 basketball players aged 8-34) were followed up as long as they were affiliated with municipal and federation competitions in Madrid (Spain). 48 injuries were sustained during 10961 athletes’ exposures (AEs). 16.61% of basketball players got injured during this time. Injury rate was 1.77-11.8 per 1000 AEs for girls and 3.63-9.3 per 1000 AEs for boys in practice and competition respectively. Ligament sprains became the most common injury diagnoses (45.83%) and ankle sprain the most common injury (20.83%). As for mechanisms that resulted in injury and time loss there were wide differences according to gender (AU)

[Update in Infectious Diseases 2016]. / Actualización en Patología Infecciosa 2016.

Antimicrobial resistance increases it health, social and economic impact. in all areas (state, regional and local), initiatives to try to contain the problem of resistance arise. In the update of this year 2016, we study microbiological, epidemiological and clinical aspects of multi-resistant bacteria, as well as resources for therapeutic approach, from ancient to modern drugs from therapeutic combinations to optimization Stewardship programs. In the case of fungal infection, we analyze clinical scenarios with different species in yeast or new clinical settings in filamentous fungi. Taking paediatric population, homologies and differences with adults in invasive fungal infection were compared. Finally in the field of parasitology, treatment of severe malaria imported or that resistant to antimalarial drugs were reviewed.

Activity of linezolid and tedizolid against clinical isolates of methicillin-resistant and methicillin and linezolid resistant Staphylococcus aureus: an in vitro comparison.

OBJECTIVE: The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in Spain is approximately 20-30%. However, resistance to linezolid is rare, and the main reports are from nosocomial outbreaks. The objective of the present study was to compare the in vitro susceptibility of linezolid with that of tedizolid against MRSA isolates and methicillin-and linezolid-resistant isolates (MLRSA) mediated by the cfr gene. METHODS: The in vitro susceptibility of linezolid and tedizolid was determined using the E-test with 18 MRSA strains and 18 cfr-mediated MLRSA strains obtained from clinical isolates in the microbiology service of a tertiary university hospital. RESULTS: All MRSA strains were susceptible to both antibiotics. Analysis of the MRSA isolates revealed that the MIC50 and MIC90 of linezolid were 1.5 and 2 mg/L, respectively; those of tedizolid were 0.25 and 0.4 mg/L. The MIC50 and MIC90 of tedizolid remained at 0.75 and 1 mg/L against the MLRSA strains (MIC90 ≥ 8 mg/L). CONCLUSIONS: Both for MRSA and for MLRSA, the MICs obtained for tedizolid were at least 2 dilutions lower than those of linezolid, thus demonstrating between 2 and 4 times greater activity in vitro than linezolid.

Eficacia y complicaciones en el empleo de prótesis autoexpandibles de colon: análisis de un periodo de 15 años / Efficacy and complications in the use of self-expanding colonic stents: an analysis of 15 years’ experience

Objetivo. Analizar la eficacia y seguridad del procedimiento para colocar las prótesis autoexpandibles de colon. Evaluar los factores asociados a complicaciones. Realizar un análisis dosimétrico del procedimiento. Material y métodos. Realizamos un estudio descriptivo retrospectivo unicéntrico de 478 procedimientos para colocar prótesis metálicas autoexpandibles de colon. Se insertaron 423 prótesis de nitinol y 79 de acero inoxidable. Incluimos todas las obstrucciones de colon, 446 de etiología maligna y 8 de causa benigna. Excluimos los pacientes con perforación intestinal, hemorragia grave del colon, esperanza de vida corta y lesiones situadas a menos de 5 cm del ano. Analizamos el éxito técnico, éxito clínico, las complicaciones durante el seguimiento y recogimos los datos dosimétricos. Resultados. Se obtuvo éxito técnico en un 92,26% (n = 441), éxito clínico en un 78,45% (n = 375) y un porcentaje de complicaciones durante el seguimiento del 18,5%. Las prótesis de acero tuvieron más complicaciones (OR: 3,2; IC 95%: 1,8-5,7). El valor medio de producto dosis por área fue 35 Gy.cm2. El de tiempo de fluoroscopia (p = 0,001), producto dosis por área (p = 0,029) y kerma (p = 0,001) fueron mayores si el procedimiento fue realizado exclusivamente por fluoroscopia, en vez de conjuntamente por el endoscopista y el radiólogo intervencionista. Conclusión. El procedimiento para colocar prótesis autoexpandibles de colon es eficaz y seguro, con una tasa aceptable de complicaciones. Las dosis de radiación fueron bajas, con menos dosis y tiempos de fluoroscopia cuando el procedimiento se realizó de manera conjunta con el endoscopista (AU)

Objective. To analyze the efficacy and safety of the procedure for placing self-expanding stents in the colon. To evaluate the factors associated with complications. To analyze the dose of radiation delivered in the procedure. Material and methods. This was a retrospective descriptive study of 478 procedures done at a single center to place self-expanding metallic stents in the colon. A total of 423 nitinol stents and 79 stainless steel stents were placed. We included all colonic obstructions, of which 446 had malignant causes and 8 had benign causes. We excluded patients with intestinal perforation, severe colonic bleeding, short life expectancy, or lesions located less than 5 cm from the anus. We collected the dosimetric data and analyzed the technical success, clinical success, and complications during follow-up. Results. The procedure was a technical success in 92.26% of cases (n = 441) and a clinical success in 78.45% (n = 375); complications occurred during follow-up in 18.5% of cases. Complications occurred more frequently with the stainless steel stents than with the nitinol stents (OR: 3.2; 95% CI: 1.8-5.7). The mean value of the dose area product was 35 Gy*cm2. When instead of being done by the interventional radiologist working together with an endoscopist the procedure was done exclusively by the interventional radiologist, the time under fluoroscopy (p = 0.001), dose area product (p = 0.029), and kinetic energy released per unit mass (p = 0.001) were greater. Conclusion. The procedure for placing self-expanding colonic stents is efficacious and safe with an acceptable rate of complications. The doses of radiation delivered were low, and the radiation doses and time under fluoroscopy were lower when the procedure was done together with an endoscopist (AU)

Prevención de esguinces de tobillo en jugadoras de baloncesto amateur mediante programas de propiocepción. Estudio piloto de casos-controles / Ankle sprain prevention in female amateur basketball players through a balance training program. A pilot case-control study

Objetivos: Valorar la eficacia de un programa de propiocepción específico de tobillo, de 8 semanas de duración, constatando si se generan cambios o no en el control postural estático y dinámico de tobillos con y sin historia de esguinces en jugadoras de baloncesto amateur. Participantes y métodos: Treinta jugadoras de baloncesto amateur (de entre 12-17 años) participaron en un estudio de casos-controles prospectivo que implicó el desarrollo de un programa de propiocepción de 8 semanas de duración. En todas ellas se valoraron las características antropométricas y las rutinas deportivas, así como el control postural estático y dinámico de la articulación del tobillo mediante el One Leg Standing Test (OLST) y el Star Excursion Balance Test (SEBT). Resultados: Se produjeron mejoras estadísticamente significativas (p < 0,05) en tobillos con y sin historia de esguinces en el grupo experimental (n = 17), tanto en los test de control postural estático, a excepción del OLST con ojos abiertos, como dinámico. En el grupo de control (n = 13) solo se apreciaron mejoras estadísticamente significativas en las trayectorias anterior y postero-lateral del SEBT. Conclusiones: Los programas de propiocepción para esguinces de tobillo sobre platos Böhler parecen conseguir mejoras el control postural estático y dinámico de la articulación en jugadoras de baloncesto amateur con y sin historia previa de esguinces, por lo que ha de considerarse su papel preventivo en momentos de pretemporada especialmente. Son necesarios más estudios con mayor tamaño muestral que permitan corroborar los resultados mostrados en este manuscrito

Objectives: To assess the effectiveness of an 8-week long ankle specific balance training program and to observe whether changes in static and dynamic postural control occur in female amateur basketball players (with and without a history of sprained ankles). Participants and methods: 30 female amateur basketball players aged 12-17 participated in a prospective case-control study that involved the implementation of an 8-week long balance training program. Anthropometric and sport routines as well as ankle static and dynamic postural control were assessed with the One Leg Standing Test (OLST) and Star Excursion Balance Test (SEBT). Results: There were statistically significant improvements (P < .05) for ankles with and without a history of ankle sprains in the experimental group (n = 17) for both static postural control tests, except for OLST with open eyes, and dynamic. In the control group (n = 13), statistically significant improvements were only observed in the anterior and postero-lateral pathways of SEBT. Conclusions: Balance training programs on Böhler boards for ankle sprains seem to achieve better static and dynamic postural control of the joint in female amateur basketball players with and without a history of previous sprains. Therefore, its preventive role, especially in preseason moments for basketball players, must be considered. Further studies with a larger sample size are required to corroborate the results shown in this paper

Utilidad clínica de la esclerosis con alcohol guiada con ecografía en pacientes con fístulas de mama / Clinical usefulness of ultrasound-guided alcohol sclerosis in patients with breast fistulas

Objetivo. Estudiar la utilidad clínica de la esclerosis con alcohol guiada con ecografía como tratamiento innovador y alternativo a la intervención quirúrgica de las fístulas de mama. Material y métodos. Estudio retrospectivo basado en los datos recogidos en una Unidad de mama hospitalaria durante tres años (enero de 2011 - diciembre de 2013). El procedimiento consistió en introducir en la luz de la fístula mamaria una solución esclerosante guiada con ecografía. Todos los casos fueron revisados por un comité multidisciplinar, se planteó a las pacientes la esclerosis con alcohol guiada con ecografía como primera opción terapéutica, dejando la intervención quirúrgica para los casos con resultados desfavorables. Resultados. Se reunieron 10 fístulas en 9 mujeres. La mediana de edad fue de 33 años (rango intercuartílico 18,5 años). Cinco pacientes atribuyeron los datos clínicos a mastitis de repetición (50%), cuatro a una intervención quirúrgica previa (40%) y una a la lactancia (10%). Siete pacientes eran fumadoras (78%). El procedimiento se toleró bien, 9 pacientes (90%) puntuaron un valor de uno o 2 en la escala analógica visual del dolor (dolor leve). No hubo complicaciones inmediatas. La respuesta al tratamiento se consideró excelente (ausencia de secreción y cierre completo) en 8 fístulas (80%). Conclusión. La esclerosis con alcohol guiada con ecografía es una alternativa terapéutica a la quirúrgica que ha acabado con la curación del 80% de las fístulas tratadas (AU)

Objective. To study the clinical usefulness of ultrasound-guided alcohol sclerosis as a treatment alternative to surgical intervention for breast fistulas. Material and methods. This was a retrospective study of data collected in a hospital breast unit over a three-year period (January 2011 through December 2013). The procedure consists of introducing a sclerosing solution into the lumen of the breast fistula under ultrasound guidance. All cases were reviewed by a multidisciplinary committee; patients were offered ultrasound-guided alcohol sclerosis as a first treatment option with surgical intervention as a rescue therapy for those with unsatisfactory outcomes. Results. Ten fistulas were treated in 9 women (median age, 33 y; interquartile range 18.5 y). Five patients (50%) attributed the clinical findings to recurrent mastitis, four (40%) to a previous surgical intervention, and one (10%) to lactation. Seven patients (78%) were smokers. The procedure was well tolerated: nine patients (90%) rated the pain as one or 2 (mild pain) on a visual analogue scale. There were no immediate complications. The response to treatment was considered excellent (absence of secretion and complete closure) in eight fistulas (80%). Conclusion. Ultrasound-guided alcohol sclerosis achieved excellent outcomes in 80% of cases and is a viable alternative to surgical treatment (AU)

[Clinical usefulness of ultrasound-guided alcohol sclerosis in patients with breast fistulas]. / Utilidad clínica de la esclerosis con alcohol guiada con ecografía en pacientes con fístulas de mama.

OBJECTIVE: To study the clinical usefulness of ultrasound-guided alcohol sclerosis as a treatment alternative to surgical intervention for breast fistulas. MATERIAL AND METHODS: This was a retrospective study of data collected in a hospital breast unit over a three-year period (January 2011 through December 2013). The procedure consists of introducing a sclerosing solution into the lumen of the breast fistula under ultrasound guidance. All cases were reviewed by a multidisciplinary committee; patients were offered ultrasound-guided alcohol sclerosis as a first treatment option with surgical intervention as a rescue therapy for those with unsatisfactory outcomes. RESULTS: Ten fistulas were treated in 9 women (median age, 33 y; interquartile range 18.5 y). Five patients (50%) attributed the clinical findings to recurrent mastitis, four (40%) to a previous surgical intervention, and one (10%) to lactation. Seven patients (78%) were smokers. The procedure was well tolerated: nine patients (90%) rated the pain as one or 2 (mild pain) on a visual analogue scale. There were no immediate complications. The response to treatment was considered excellent (absence of secretion and complete closure) in eight fistulas (80%). CONCLUSION: Ultrasound-guided alcohol sclerosis achieved excellent outcomes in 80% of cases and is a viable alternative to surgical treatment.

Efficacy and complications in the use of self-expanding colonic stents: an analysis of 15 years' experience.

OBJECTIVE: To analyze the efficacy and safety of the procedure for placing self-expanding stents in the colon. To evaluate the factors associated with complications. To analyze the dose of radiation delivered in the procedure. MATERIAL AND METHODS: This was a retrospective descriptive study of 478 procedures done at a single center to place self-expanding metallic stents in the colon. A total of 423 nitinol stents and 79 stainless steel stents were placed. We included all colonic obstructions, of which 446 had malignant causes and 8 had benign causes. We excluded patients with intestinal perforation, severe colonic bleeding, short life expectancy, or lesions located less than 5 cm from the anus. We collected the dosimetric data and analyzed the technical success, clinical success, and complications during follow-up. RESULTS: The procedure was a technical success in 92.26% of cases (n=441) and a clinical success in 78.45% (n=375); complications occurred during follow-up in 18.5% of cases. Complications occurred more frequently with the stainless steel stents than with the nitinol stents (OR: 3.2; 95% CI: 1.8-5.7). The mean value of the dose area product was 35 Gy*cm(2). When instead of being done by the interventional radiologist working together with an endoscopist the procedure was done exclusively by the interventional radiologist, the time under fluoroscopy (p=0.001), dose area product (p=0.029), and kinetic energy released per unit mass (p=0.001) were greater. CONCLUSION: The procedure for placing self-expanding colonic stents is efficacious and safe with an acceptable rate of complications. The doses of radiation delivered were low, and the radiation doses and time under fluoroscopy were lower when the procedure was done together with an endoscopist.

Are chlorhexidine-containing dressings safe for use with ventricular drainages?

The purpose of this report was to assess the safety and application of chlorhexidine (CHG)-containing dressings--shown to reduce central line infection rates markedly--for external ventricular drainages (EVDs) and lumbar drainages (LDs). Cerebrospinal fluid samples of patients receiving standard dressings and CHG-containing dressing (ten each) were analyzed by high-performance liquid chromatography for the presence of CHG. The application was evaluated. CHG was not detectable in all samples. The dressings' application for EVDs and LDs worked without problems. Thus, the use of CHG-containing dressings for EVDs and LDs seems to be safe. Further studies addressing their infection reduction potential are warranted.

Accuracy of ultrasound elastography in the diagnosis of thyroid cancer in a low-risk population.

OBJECTIVE: Stiffness has been associated to malignancy in prostate and breast, as well as thyroid. Ultrasound elastography objectively measures tissue elasticity, and previous studies have described it as a high sensitivity and specificity technique for the detection of malignant thyroid nodules in high-risk populations. The aim was to assess the accuracy of elastography in a population with low risk of malignancy. DESIGN AND PATIENTS: 128 consecutive patients with nodular goiter were recruited. Elastography and ultrasound-guided fine-needle aspiration were performed. When malignancy was suspected by citology, surgery was recommended. Thyroid nodules were classified by elastography according the criteria described by Ueno, and an alternative classification. Sensitivity, specificity, predictive values, and odds ratio were calculated. RESULTS: Most patients were female, aged 56.1 year, with single nodule (52.0%) or multinodular goiter (45.6%), and a few thyroiditis (2.4%). The majority of nodules were mostly elastic. Fine-needle aspiration found 86% of benign nodules, 9.3% of indeterminate, and 4.7% possibly malignant. After surgery, 3 malignant nodules were confirmed, all of them being papillary carcinomas. All the malignant nodules were mostly elastic, as well as 75% of indeterminate nodules. Low values of sensitivity and specificity were found for elastic nodules being benign and hard nodules malignant. CONCLUSION: In a low-risk population for thyroid cancer, elastography lacks accuracy for the diagnosis of malignant nodules.

La sarcoidosis torácica / Update thoracic sarcoidosis

La sarcoidosis es una enfermedad granulomatosa multisistémica de causa desconocida, que afecta principalmente a los ganglios linfáticos torácicos y a los pulmones. La estadificación, que agrupa a los pacientes con similar probabilidad de remisión espontánea, se basa en los hallazgos de la radiografía de tórax, que tiene menor sensibilidad que la tomografía computarizada de alta resolución (TCAR) para detectar la afectación ganglionar, pulmonar y bronquial. Los hallazgos en TCAR pueden ser típicos, prácticamente patognomónicos, o atípicos. La TCAR aporta información sobre la actividad de la enfermedad y detecta incipientes signos de fibrosis y otras complicaciones. Para realizar el diagnóstico es precisa la correlación clínica, radiológica, y en muchos casos anatomopatológica. La afectación cardiaca puede provocar muerte súbita; el diagnóstico, difícil, se basa en varias pruebas de imagen, como la resonancia magnética, que tiene mayor especificidad, y la tomografía por emisión de positrones; la confirmación mediante biopsia endomiocárdica se obtiene en pocos pacientes (AU)

Cardiac involvement can cause sudden death. The diagnosis of cardiac involvement is difficult; it is based on various imaging tests, like magnetic resonance imaging, which is more specific, and positron emission tomography. Diagnostic confirmation by endomyocardial biopsy is obtained in few patients. Sarcoidosis is a multisystemic granulomatous disease of unknown etiology. It mainly affects the thoracic lymph nodes and the lungs. The staging of sarcoidosis, which classifies patients according to their probability of spontaneous remission, is based on the plain chest film findings. Plain chest films are not as sensitive as high resolution computed tomography (HRCT) at detecting involvement of the lymph nodes, lungs, or bronchi. The high resolution CT findings can be typical, practically pathognomic, or atypical. High resolution CT provides information about the activity of the disease and detects incipient signs of fibrosis and other complications. To reach the diagnosis, it is necessary to correlate the clinical and radiological findings (and often the histological findings) (AU)

[Thoracic sarcoidosis]. / La sarcoidosis torácica.

Sarcoidosis is a multisystemic granulomatous disease of unknown etiology. It mainly affects the thoracic lymph nodes and the lungs. The staging of sarcoidosis, which classifies patients according to their probability of spontaneous remission, is based on the plain chest film findings. Plain chest films are not as sensitive as high resolution computed tomography (HRCT) at detecting involvement of the lymph nodes, lungs, or bronchi. The high resolution CT findings can be typical, practically pathognomic, or atypical. High resolution CT provides information about the activity of the disease and detects incipient signs of fibrosis and other complications. To reach the diagnosis, it is necessary to correlate the clinical and radiological findings (and often the histological findings). Cardiac involvement can cause sudden death. The diagnosis of cardiac involvement is difficult; it is based on various imaging tests, like magnetic resonance imaging, which is more specific, and positron emission tomography. Diagnostic confirmation by endomyocardial biopsy is obtained in few patients.

Tuberculosis pulmonar con signo de cúmulo sarcoideo en la tomografía computarizada de tórax de alta resolución. Respuesta de los autores / No disponible

No disponible

El "cúmulo sarcoideo". Un nuevo signo en tomografía computarizada de tórax de alta resolución / The "sarcoid cluster sign". A new sign in high resolution chest CT

Objetivos: Valorar la presencia de múltiples nodulillos puntiformes formando un grupo en el pulmón periférico en pacientes con sarcoidosis y describir este hallazgo como el nuevo "signo del cúmulo sarcoideo" en tomografía computarizada de alta resolución (TCAR).Material y métodos: Estudio retrospectivo de las TCAR de 91 pacientes diagnosticados de sarcoidosis torácica en el Hospital de León. Se valoró la presencia de grupos de múltiples nodulillos puntiformes en el pulmón periférico ("signo del cúmulo sarcoideo"), su morfología redonda o alargada y su distribución en los campos pulmonares. Se utilizaron reconstrucciones de máxima intensidad de proyección. Se realizó correlación radiopatológica en 3 pacientes. Material y métodos: Posteriormente, se valoró la presencia de este signo en TCAR en 120 pacientes consecutivos estudiados por sospecha de enfermedad pulmonar infiltrativa difusa (EPID). Resultados: De los 91 pacientes con sarcoidosis, 9 (6 varones y 3 mujeres, con edad media de 29 años) presentaban el "signo del cúmulo sarcoideo" en TCAR. La mayoría de los cúmulos mostraban morfología redondeada y su distribución fue predominante en la zona periférica no subpleural de los campos pulmonares superiores y medios; cuando los cúmulos tenían distribución periférica subpleural, nodulillos subpleurales formaban parte del cúmulo. Los cúmulos correspondían a granulomas no caseosos, no coalescentes, con predominio de linfocitos CD4+, sin fibrosis y con distribución linfangítica. Resultados: Únicamente 2 de los 120 pacientes con sospecha de EPID mostraban grupos periféricos de múltiples nodulillos puntiformes ("signo del cúmulo sarcoideo"); los 2 correspondían a sarcoidosis. El total de sarcoidosis diagnosticadas en este grupo fue de 1. Conclusión: El nuevo “signo del cúmulo sarcoideo” en TCAR solamente se ha observado en pacientes jóvenes con sarcoidosis pulmonar. Puede ser un hallazgo radiológico útil en el diagnóstico de esta enfermedad (AU)

Objectives: To evaluate the presence of clusters of multiple small punctiform nodules in the peripheral regions of the lung in patients with sarcoidosis, and to report this finding as a new sign "the sarcoid cluster sign" in high-resolution chest CT (HRCT). Material and methods: This is a retrospective study of the HRCT findings in 91 patients diagnosed with lung sarcoidosis at our hospital. We evaluated the presence of clusters of multiple small punctiform nodules in the periphery of the lungs (the "sarcoid cluster sign"), whether these were rounded or long in shape, and their distribution in the lung fields. We used reconstructions of maximum intensity projections (MIP). We correlated the imaging and histopathological results in three patients. Material and methods: Afterward, we evaluated the presence of the “sarcoid cluster sign” on high resolution CT findings in 120 consecutive patients studied for suspected diffuse lung disease. Results The "sarcoid cluster sign" was present at HRCT in 9 of the 91 patients with sarcoidosis (6 men and 3 women; mean age 29 years). Most clusters were rounded and most were located in the non-subpleural peripheral regions of the upper and middle fields of the lungs. When the clusters were located in the subpleural peripheral regions, the clusters contained small subpleural nodules. The correlation between the imaging and histopathological results revealed that the clusters corresponded to non caseous, noncoalescing granulomas with a predominance of CD4+ lymphocytes, without fibrosis, that were distributed in the lymph vessels. Results Only 2 of the 120 patients with suspected diffuse lung disease had peripheral clusters of multiple small punctiform nodules (the "sarcoid cluster sign"); these two patients had sarcoidosis, and a total of 21 cases of sarcoidosis were diagnosed in this group. Conclusion: The "sarcoid cluster sign" on HRCT has been observed only in young patients with lung sarcoidosis. This finding could be useful in the diagnosis in the diagnosis of this disease (AU)