Influencia de la edad en la enfermedad neumocócica invasiva y en la resistencia a antimicrobianos / Influence of age on the clinical manifestations of invasive pneumococcal disease and antibiotic resistance rates

Fundamento y objetivo: La enfermedad invasiva por Streptococcus pneumoniae (EISP) presenta variaciones epidemiológicas en relación con la edad y el serotipo de neumococo aislado. Los objetivos del trabajo fueron analizar las formas clínicas y la mortalidad de EISP, los serotipos aislados y la tasa de resistencia a antimicrobianos en diferentes grupos de edad. Pacientes y método: Se estudiaron 141 pacientes con EISP diagnosticados entre 2002 y 2008 y se clasificaron en 4 grupos: ≤ 2 años, 3-14 años, 15-64 años y ≥ 65 años. Resultados: La neumonía que la manifestación más frecuente (71%) en todos los grupos de edad. En el grupo ≤ 2 años destacó una mayor prevalencia de meningitis (28 frente a 9%, p = 0,054) y en el grupo 3-14 años el empiema fue más frecuente (31 frente a 5%, p < 0,001). La mortalidad se asoció con la edad ≥ 65 años (odds ratio [OR] 7, intervalo de confianza del 95% [IC 95%] 1,9-28,9), la bacteriemia primaria (OR 7, IC 95% 1,9-28,9) y la intubación orotraqueal (OR 9, IC 95% 1,9-41,1). Los serotipos más prevalentes en ≤ 2 años fueron 14, 19A y 19F, el serotipo 1 en el grupo 3-14 años y el 3 en ≥ 65 años. En la población pediátrica se observó una mayor tasa de cepas no sensibles a penicilina (42 frente a 18%, p = 0,007). Conclusiones: La edad se relacionó con las formas clínicas, la mortalidad y la resistencia a antimicrobianos. La bacteriemia primaria constituyó uno de los factores asociados con una mayor mortalidad (AU)

Background and objective: Invasive pneumococcal disease (IPD) shows different epidemiological characteristics depending on age and pneumococcus serotype. The aims of the work were to analyze the clinical manifestations and mortality associated with IPD, the serotype isolated and the antibiotic resistance rates in different age groups. Patients and method: Retrospectively, 141 patients with IPD diagnosed between 2002 and 2008 were studied. Patients were classified in 4 age groups: 2 year-old, 3-14 year-old, 15-64 year-old and 65 year-old. Results: Pneumonia was the most common manifestation in all age groups (71%). Pneumococcal meningitis was more prevalent in patients 2 year-old (28 vs. 9%, P = .054) and empyema was more frequent in those between 3-14 year-old (31 vs. 5%, P < .001). Mortality was associated with age 65 year-old (odds ratio [OR] 7, 95% confidence interval [95% CI] 1.9-28.9), primary bacteremia (OR 7, 95% CI 1.9-28.9) and orotracheal intubation (OR 9, 95% CI 1.9-41.1). The more prevalent serotypes among patients 2 year-old were 14, 19A and 19F. The serotype 1 was most common in patients between 3-14 year-old and serotype 3 in those 65 year-old. A higher rate of non-susceptible penicillin strains was observed in pediatric population (42 vs. 19%, P = .007). Conclusions: Age was related to the clinical manifestations, mortality and antibiotic resistance rates. Primary bacteremia was one of the risk factors of mortality (AU)

Absceso cerebral sobre infarto isquémico previo / Cerebral abscess over a previous ischemic infarction

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[Influence of age on the clinical manifestations of invasive pneumococcal disease and antibiotic resistance rates]. / Influencia de la edad en la enfermedad neumocócica invasiva y en la resistencia a antimicrobianos.

BACKGROUND AND OBJECTIVE: Invasive pneumococcal disease (IPD) shows different epidemiological characteristics depending on age and pneumococcus serotype. The aims of the work were to analyze the clinical manifestations and mortality associated with IPD, the serotype isolated and the antibiotic resistance rates in different age groups. PATIENTS AND METHOD: Retrospectively, 141 patients with IPD diagnosed between 2002 and 2008 were studied. Patients were classified in 4 age groups: ≤ 2 year-old, 3-14 year-old, 15-64 year-old and ≥ 65 year-old. RESULTS: Pneumonia was the most common manifestation in all age groups (71%). Pneumococcal meningitis was more prevalent in patients ≤ 2 year-old (28 vs. 9%, P=.054) and empyema was more frequent in those between 3-14 year-old (31 vs. 5%, P<.001). Mortality was associated with age ≥ 65 year-old (odds ratio [OR] 7, 95% confidence interval [95% CI] 1.9-28.9), primary bacteremia (OR 7, 95% CI 1.9-28.9) and orotracheal intubation (OR 9, 95% CI 1.9-41.1). The more prevalent serotypes among patients ≤ 2 year-old were 14, 19A and 19F. The serotype 1 was most common in patients between 3-14 year-old and serotype 3 in those ≥ 65 year-old. A higher rate of non-susceptible penicillin strains was observed in pediatric population (42 vs. 19%, P=.007). CONCLUSIONS: Age was related to the clinical manifestations, mortality and antibiotic resistance rates. Primary bacteremia was one of the risk factors of mortality.

High prevalence of pulmonary hypertension in patients with hereditary hemorrhagic telangiectasia.

OBJECTIVE: Hereditary hemorrhagic telangiectasia (HHT) is a vascular disorder causing mucocutaneous telangiectases and visceral arteriovenous malformations (AVMs). Pulmonary hypertension (PH) is considered an uncommon complication of HHT whose impact on the survival of these patients is currently unknown. METHODS: From January 1995 to December 2008, 29 hospitalized patients with definite HHT were included and followed until January 2011. Data on demographics, clinical symptoms and survival were recorded. PH was classified according to echocardiographic probability. RESULTS: A CT angiogram was performed in 24 of the 29 patients with HHT and AVMs were detected in 16 of them (67%): hepatic in 58%, pulmonary in 33% and spinal in 3%; 37% had both pulmonary and hepatic AVMs. Transthoracic Doppler echocardiography (TTE) was performed in 21 patients. PH was considered possible in 4 (14%) and probable in 9 (31%). The mean age at diagnosis was lower in patients with PH than in patients without PH (54±16.5 years vs 73±8.8 years, p=0.002). PH was more prevalent in patients with AVMs (56 vs. 23%, p=0.036). The mean follow-up of the entire cohort was 6±4.4 years (range: 2 months-17 years), during this time 18 patients died (62%; mean age 73±8.1 years). Patients with PH died at a younger age (68±8.4 vs. 79±2.7 years, p=0.015) than those without PH. CONCLUSIONS: PH is a severe condition that significantly reduces survival on HHT patients. PH should be suspected in all HHT patients with dyspnea and hepatic AVMs.

Synovial fluid eosinophilia: a case series with a long follow-up and literature review.

OBJECTIVES: To establish the frequency and describe the characteristics of a cohort of patients with SF eosinophilia (SFE) and a long clinical follow-up. A systematic review of the literature on this topic was performed. METHODS: From November 2005 to May 2010, 982 consecutive arthrocentesis procedures performed at a tertiary care hospital were reviewed. Clinical and analytical data of patients with SFE at the time of diagnosis and during follow-up until 31 January 2012, were recorded. According to the percentage of eosinophils in SF, SFE was classified as minor (<10%) or major (>10%). Also, a literature search of all publications on eosinophilic synovitis found in MEDLINE, EMBASE and Web of Science without publication date restrictions was performed. RESULTS: Eosinophils in SF were found in 10 of 982 (1.02%) patients: minor SFE was recorded in three patients, all of them with haemorrhagic fluid and without peripheral eosinophilia. Major SFE was found in seven patients, and only two of them had peripheral eosinophilia. In six patients, an underlying cause of the arthritis was found. Only one patient was classified as having idiopathic SFE. Most SFE promptly resolved with NSAIDs without relapses or new deformities. The literature search identified 56 patients with SFE; 49 of them (88%) had major SFE and 7 (12%) had minor SFE. CONCLUSIONS: Eosinophils are infrequently found in SF, and in most cases peripheral eosinophilia was not detected. Most patients with SFE had a benign course with prompt resolution and few relapses.

Autoimmune manifestations of Kikuchi disease.

OBJECTIVES: Kikuchi's disease (KD) has been associated with the presence of autoantibodies, systemic lupus erythematosus (SLE), and other autoimmune diseases. The aim of this study was to assess the frequency of autoimmune manifestations in a KD cohort with a long follow-up. METHODS: Twenty patients with histologically confirmed KD since January 1990 until December 2010 were studied; 12 of them were periodically followed up as outpatients. Another 7 patients were contacted by telephone to offer them a specific consultation and a complete autoimmunity study. RESULTS: Thirteen of 20 patients were women (65%) with a mean age of 29 years (range, 15-79). The age at diagnosis was higher in men (44 vs 27 years, P < 0.05). Lymphopenia was present in 75% of the patients (15/20) and was the more frequent hematological abnormality. The mean follow-up of the 17 patients included in the autoimmunity study was 119 months (range, 15-252). Autoimmune diseases were detected in 9 women (53%): SLE was diagnosed in 4 patients (2 SLE before, 1 simultaneous, and 1 after KD), 2 patients developed primary Sjögren's syndrome after KD, 1 thyroiditis before KD, 1 SLE-like, and 1 antiphospholipid antibodies after KD. Leukocytoclastic vasculitis was found in 2 patients; 1 of them eventually developed SLE. Female sex, painful adenopathies, and cytopenias were significantly associated with autoimmune diseases. CONCLUSIONS: Among patients with KD, only women developed autoimmune manifestations. Therefore, long-term follow-up and active surveillance of autoimmune diseases in patients with KD, especially women, are recommended.

Osteonecrosis asintomática de la cadera en los pacientes infectados por el virus de inmunodeficiencia humana / Asymptomatic osteonecrosis of the hip in HIV-infected patients

Introducción La osteonecrosis de la cadera (OTNC) en los pacientes infectados por el virus de inmunodeficiencia humana (VIH) se ha relacionado con el uso de corticoides, dislipidemia, alcoholismo, lipodistrofia, el tratamiento antirretroviral (ARV) y con la propia infección por VIH. El objetivo de este estudio fue evaluar la prevalencia de la OTNC asintomática en los pacientes infectados por VIH y su asociación con los distintos factores de riesgo. Métodos De un total de 1.200 pacientes de la consulta de VIH del Hospital Xeral-Cíes de Vigo, se seleccionaron aquéllos con diagnóstico de VIH previo a enero de 2006 y edad entre 20 y 70 años que acudieron a consulta entre los meses de marzo y mayo de 2008. Los pacientes diagnosticados de OTNC o con síntomas se excluyeron. Se efectuó una resonancia magnética (RM) de las caderas. Resultados Se incluyeron 97 pacientes de raza blanca, con una mediana de edad de 44 años, de los cuales 68 eran hombres. Se detectó OTNC en 4 enfermos (4,1%), 2 de éstas eran bilaterales. Los 4 pacientes eran varones, con una mediana de edad de 44,5 años. Se registraron múltiples factores de riesgo de OTNC en cada paciente. El nadir de linfocitos CD4 (p=0,034), la proporción de pacientes con estadio C (p=0,039) y el número de pacientes con tratamiento corticoideo previo (p=0,042) fueron significativamente diferentes entre los pacientes con OTNC y aquéllos con RM normal. Conclusiones La prevalencia de OTNC asintomática fue del 4,1%. Los factores de riesgo más importantes de OTNC fueron el tratamiento con corticoides, un nadir de linfocitos CD4 bajo y el diagnóstico de enfermedad definitoria de sida. El tratamiento con ARV no se asoció con osteonecrosis(AU)

Background Osteonecrosis (ON) of the hip in human immunodeficiency virus (HIV)-infected patients has been related to corticosteroid use, dyslipidemia, alcoholism, lipodystrophy, antiretroviral drug use, and HIV infection, itself. The aim of this study was to evaluate the prevalence of silent ON of the hip in HIV-infected patients and its association with several risk factors. Methods From a total of 1200 patients followed up at the HIV clinic of Xeral-Cies Hospital in Vigo (Spain), we selected those diagnosed with HIV infection before January 2006, aged 20–70 years, who came to the clinic during the period of March to May 2008. Patients with a diagnosis of ON of the hip and those with current symptoms were excluded. A magnetic resonance imaging (MRI) study of the hips was performed. ResultsNinety-seven Caucasian patients (68 men) with a median age of 44 years were included. ON of the hip was detected in 4 patients (4.1%), with bilateral involvement in 2 patients. All 4 patients were men, with a median age of 44.5 years. Several risk factors for ON of the hip were recorded in each patient. CD4 lymphocyte nadir (P=0.034), percentage of patients with CDC stage C (P=0.039), and number of patients with previous corticosteroid treatment (P=0.042) were significantly different between patients with ON of the hip and those with normal MRI findings. Conclusions The prevalence of asymptomatic ON of the hip in HIV-infected patients was 4.1%. The most important risk factors for developing this condition were corticosteroid treatment, lower CD4 lymphocyte nadir, and AIDS-defining disease. Antiretroviral treatment was not associated with osteonecrosis(AU)

[Asymptomatic osteonecrosis of the hip in HIV-infected patients]. / Osteonecrosis asintomática de la cadera en los pacientes infectados por el virus de inmunodeficiencia humana.

BACKGROUND: Osteonecrosis (ON) of the hip in human immunodeficiency virus (HIV)-infected patients has been related to corticosteroid use, dyslipidemia, alcoholism, lipodystrophy, antiretroviral drug use, and HIV infection, itself. The aim of this study was to evaluate the prevalence of silent ON of the hip in HIV-infected patients and its association with several risk factors. METHODS: From a total of 1200 patients followed up at the HIV clinic of Xeral-Cies Hospital in Vigo (Spain), we selected those diagnosed with HIV infection before January 2006, aged 20-70 years, who came to the clinic during the period of March to May 2008. Patients with a diagnosis of ON of the hip and those with current symptoms were excluded. A magnetic resonance imaging (MRI) study of the hips was performed. RESULTS: Ninety-seven Caucasian patients (68 men) with a median age of 44 years were included. ON of the hip was detected in 4 patients (4.1%), with bilateral involvement in 2 patients. All 4 patients were men, with a median age of 44.5 years. Several risk factors for ON of the hip were recorded in each patient. CD4 lymphocyte nadir (P=0.034), percentage of patients with CDC stage C (P=0.039), and number of patients with previous corticosteroid treatment (P=0.042) were significantly different between patients with ON of the hip and those with normal MRI findings. CONCLUSIONS: The prevalence of asymptomatic ON of the hip in HIV-infected patients was 4.1%. The most important risk factors for developing this condition were corticosteroid treatment, lower CD4 lymphocyte nadir, and AIDS-defining disease. Antiretroviral treatment was not associated with osteonecrosis.

Manejo de la hepatitis crónica por virus C asociada a sarcoidosis: evolución y tratamiento / No disponible

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Clinical significance of "anti-HBc alone" in human immunodeficiency virus-positive patients.

AIM: To determine the prevalence and clinical relevance of isolated antibodies to hepatitis B core antigen as the only marker of infection ("anti-HBc alone") among human immunodeficiency virus (HIV) type-1 infected patients. Occult hepatitis B infection frequency was also evaluated. METHODS: Three hundred and forty eight histories from 2388 HIV-positive patients were randomly reviewed. Patients with serological markers of hepatitis B virus (HBV) infection were classified into three groups: past hepatitis, "anti-HBc alone" and chronic hepatitis. Determination of DNA from HBV, and RNA and genotype from hepatitis C virus (HCV) were performed on "anti-HBc alone" patients. RESULTS: One hundred and eighty seven (53.7%) HIV-positive patients had markers of HBV infection: 118 past infection (63.1%), 14 chronic hepatitis (7.5%) and 55 "anti-HBc alone" (29.4%). Younger age [2.3-fold higher per every 10 years younger; 95% confidence intervals (CI) 1.33-4.00] and antibodies to HCV infection [odds ratio (OR) 2.87; 95% CI 1.10-7.48] were factors independently associated with the "anti-HBc alone" pattern. No differences in liver disease frequency were detected between both groups. Serum levels of anti-HBs were not associated with HCV infection (nor viral replication or HCV genotype), or with HIV replication or CD4 level. No "anti-HBc alone" patient tested positive for HBV DNA. CONCLUSION: "Anti-HBc alone" prevalence in HIV-positive patients was similar to previously reported data and was associated with a younger age and with antibodies to HCV infection. In clinical practice, HBV DNA determination should be performed only in those patients with clinical or analytical signs of liver injury.