[A study of the incidence and a descriptive analysis of adult non-tuberculous primary bacterial meningitis in a population in Argentina]. / Estudio de incidencia y análisis descriptivo de la meningitis bacteriana primaria no tuberculosa del adulto en una población argentina.

INTRODUCTION: Adult non tuberculous primary bacterial meningitis (PBM) represents an important cause of morbidity and mortality in hospitals. The shortage of studies based on the population in Latin America provided the motivation for this work. AIMS: To determine the incidence of PBM in the captive population of our hospital and carry out a descriptive analysis of the cases detected. PATIENTS AND METHODS: We performed an epidemiological study of the captive population (CP) of the hospital (an average of 85,200 patients in 11 years) and a retrospective descriptive examination of patients who had been admitted. The clinical histories of all patients over the age of 18 who had been admitted with PBM between 1 January 1988 and 31 December 1998 were studied. RESULTS AND CONCLUSIONS: A total number of 87 cases of primary bacterial meningitis were registered, of which 70 belonged to the CP. The overall gross rate of PBM incidence in the CP was 8.6/100,000 per year. The annual incidence rate, adjusted to the 1991 National Census on the Argentinean Population, was 5.4/100,000 per year, with a greater frequency between the ages of 70 and 79: 21/100,000 per year. Median age: 73 (lower quartile, 66; upper quartile, 78). Clinical manifestations included high temperatures (90%), consciousness disorders (87%), and a stiff neck (81%). The frequency with which it appeared remained constant over the 11 year period, without showing any seasonal variations. The most frequent etiological agent was pneumococcus (50%). No cases of PBM by Listeria were reported. Overall fatality during the stay in hospital was 23%, without any type of modification over the period we studied.

[Spontaneous infectious spondylodiscitis in adults. Analysis of 30 cases]. / Espondilodiscitis infecciosas espontáneas en adultos. Análisis de 30 casos.

We revised retrospectively 30 cases of Spontaneous Infectious Spondylodiskitis (SIS) in adults, diagnosed between 1986 and 1997. The mean age of the patients was 68.8 years; 56.7% were males. The identifiable causes were infectious endocarditis 13 (43.3%); tuberculosis 7 (23.3%); urinary tract infection 4 (13.3%); bacteremia with focus 2 (6.7%) and without focus 2 (6.7%). The cause was not identified in other 2 cases (6.7%). Infections were due to pyogenic bacteriae in 19 (63.3%); tuberculosis 6 (20%) and unknown 5 (16.7%). All patients had localized pain, 70% fever, 36.7% irradiated pain and 23.3% paraparesis. Fever was more frequent in patients with pyogenic etiology than in those with tuberculous SIS (p = 0.004). Blood cultures were positive in 70.4%. Percutaneous aspiration of the disc was performed in 13 patients; cultures were positive in 7. Causal germs were Streptococcus spp. 33.3%; Mycobacterium tuberculosis 20%; Staphylococcus spp. 16.6%; Escherichia coli 6.6%; Pseudomonas aeruginosa 6.6%. There was no bacteriological recovery in 5 (16.7%). Localization was lumbar in 18 (60%), dorsal in 8 (26.6%) and cervical in 4 (13.3%). X-ray of the spine was positive in 63.3% of the cases. Technetium scan in 90.5%, CT in 85.7% and MRI in 100% of cases in which it was carried out. All patients received antibiotic treatment with a median duration of 6 weeks for pyogenic SIS and one year for tuberculous SIS. Eighty three percent required immobilizing brace and 10% surgery for stabilization. Thirty six percent of patients presented complications, most of them related to the causal disease. There was a statistically significant association between mortality and diabetes.

Espondilodiscitis infecciosas espontáneas en adultos. Análisis de 30 casos. / [Spontaneous infectious spondylodiscitis in adults. Analysis of 30 cases]

We revised retrospectively 30 cases of Spontaneous Infectious Spondylodiskitis (SIS) in adults, diagnosed between 1986 and 1997. The mean age of the patients was 68.8 years; 56.7

were males. The identifiable causes were infectious endocarditis 13 (43.3

); tuberculosis 7 (23.3

); urinary tract infection 4 (13.3

); bacteremia with focus 2 (6.7

) and without focus 2 (6.7

). The cause was not identified in other 2 cases (6.7

). Infections were due to pyogenic bacteriae in 19 (63.3

); tuberculosis 6 (20

) and unknown 5 (16.7

). All patients had localized pain, 70

fever, 36.7

irradiated pain and 23.3

paraparesis. Fever was more frequent in patients with pyogenic etiology than in those with tuberculous SIS (p = 0.004). Blood cultures were positive in 70.4

. Percutaneous aspiration of the disc was performed in 13 patients; cultures were positive in 7. Causal germs were Streptococcus spp. 33.3

; Mycobacterium tuberculosis 20

; Staphylococcus spp. 16.6

; Escherichia coli 6.6

; Pseudomonas aeruginosa 6.6

. There was no bacteriological recovery in 5 (16.7

). Localization was lumbar in 18 (60

), dorsal in 8 (26.6

) and cervical in 4 (13.3

). X-ray of the spine was positive in 63.3

of the cases. Technetium scan in 90.5

, CT in 85.7

and MRI in 100

of cases in which it was carried out. All patients received antibiotic treatment with a median duration of 6 weeks for pyogenic SIS and one year for tuberculous SIS. Eighty three percent required immobilizing brace and 10

surgery for stabilization. Thirty six percent of patients presented complications, most of them related to the causal disease. There was a statistically significant association between mortality and diabetes.

[Ileopsoas muscle abscess]. / El absceso del músculo psoas iliáco.

The experience with 14 patients affected of abscess of the psoas iliac muscle, attended at a general hospital through 1983-1995 is analized. This is a disease difficult to diagnose; it is usually diagnosed after a long delay (average of 45 days); it affects mainly women (rate F/M 11: 3), with a mean age in our patients of 50.4 years (14-79). The most frequent sign was fever (86% of the patients). Pain involving the thigh was present in 57%, and the psoas' sign in 36%. Even when this sign was present it did not always orient to the correct diagnosis. In two cases, the abscess was considered primary and in twelve it was associated to osteomyelitis, urinary tract infection or tumor (cancer of colon, metastasis in small bowell, melanoma and cancer of cervix). Gram smears and cultures of the material obtained by puncture were useful for detecting the causal germ, but blood cultures were inferior in yielding it (1 positive in 8 cases). Gram positive germs were predominant (Staphylococci coag. + in 4, Staph. coag.--in one, beta hemolytic Streptococci, 1). Gram negative germs were associated with urinary tract infections and staghorn lithiasis. In one case the etiology was TBC. Abdominal TAC was diagnostic when correlated with clinical data in 100% of the cases; ecography was diagnostic in only 2 of 11 cases. Patients were treated with antibiotics and percutaneous drainage; the only deaths occurred in patients with cancer.

[Bacterial endocarditis in patients over 60 years of age]. / Endocarditis bacteriana en pacientes mayores de 60 años.

Bacterial endocarditis (BE) is a disease difficult to diagnose and with poor prognosis in older people. A total of 76 episodes of this disease occurring in 73 patients were studied with particular attention to clinical manifestation, underlying heart disease, etiological germs, hospitalary mortality and prognosis within 6 months from diagnosis. All patients were 60 years old or older. Mean age was 72 +/- 7 years and male/female relation 1.7/1 Fever and heart murmur were present in 93% and 89% of patients, respectively; 33% of patients complained of vertebral or paravertebral pain which can be an early symptom of this disease. BE was suspected in 47% of patients at admission. Hospitalary mortality was 33% and increased to 47% within 6 months. The mean age of survivors was 71.7 +/- 7 years, versus 73.9 +/- 6 in the deceased (p = 0.08). Lack of suspicion of BE at admission was related with increased mortality (p = 0.04). The germ more frequently isolated was Streptococcus (73%). 53% of patients had some underlying heart disease. Aortic valve was involved in 50% and mitral valve in 21% of the cases. Of all the patients that in retrospect would have had indication of surgery (n = 25) 9 patients were operated, 6 during the first admission with a mortality of 17%. In those patients who were not operated, the mortality was 100% (16/16), making this difference statistically significant, p less than 0.001.

Endocarditis bacteriana en pacientes mayores de 60 años. / [Bacterial endocarditis in patients over 60 years of age]

Bacterial endocarditis (BE) is a disease difficult to diagnose and with poor prognosis in older people. A total of 76 episodes of this disease occurring in 73 patients were studied with particular attention to clinical manifestation, underlying heart disease, etiological germs, hospitalary mortality and prognosis within 6 months from diagnosis. All patients were 60 years old or older. Mean age was 72 +/- 7 years and male/female relation 1.7/1 Fever and heart murmur were present in 93

and 89

of patients, respectively; 33

of patients complained of vertebral or paravertebral pain which can be an early symptom of this disease. BE was suspected in 47

of patients at admission. Hospitalary mortality was 33

and increased to 47

within 6 months. The mean age of survivors was 71.7 +/- 7 years, versus 73.9 +/- 6 in the deceased (p = 0.08). Lack of suspicion of BE at admission was related with increased mortality (p = 0.04). The germ more frequently isolated was Streptococcus (73

). 53

of patients had some underlying heart disease. Aortic valve was involved in 50

and mitral valve in 21

of the cases. Of all the patients that in retrospect would have had indication of surgery (n = 25) 9 patients were operated, 6 during the first admission with a mortality of 17

. In those patients who were not operated, the mortality was 100

(16/16), making this difference statistically significant, p less than 0.001.