Streptococcus agalactiae bacteremia in non-pregnant adult patients at two teaching hospitals.

Streptococcus agalactiae or group B streptococcus (GBS) is a frequent pathogen in immunocompromised adults. The aim of this study was to determine the relative frequency, clinical presentation, antimicrobial susceptibility profile, and risk factors associated with GBS bacteremia in non-pregnant adult patients. We conducted a retrospective analysis of blood cultures performed in two hospitals between the years 2009-2013. From 1110 bacteremia episodes, 13 were caused by GBS, all of which were susceptible to ampicillin. GBS bacteremia was more frequent in females and in patients older than 60 years of age. The most frequent comorbidities were chronic kidney disease, cardiac failure and neoplasia. History of appendectomy was detected in 53.8% of the patients, being the most relevant comorbidity for GBS bacteremia in the multivariate analysis (OR 4.13, p=0.012). The main presentations were primary bacteremia and soft tissue infection. GBS bacteremia was infrequent in our institution, and a history of appendectomy might be related to bacteremia occurrence.

[Community acquired pneumonia in patients requiring hospitalization]. / Neumonía adquirida en la comunidad en pacientes que requirieron hospitalización.

Community-acquired pneumonia (CAP) represents a major health issue and ≈20% of the patients require in-hospital attention. The main objective of the study was to determine clinical-imaging features of CAP episodes requiring hospitalization. The secondary objectives were to determine the diagnostic yield of microbiological analyses and the medical complications. A retrospective analytical study was conducted on adults admitted due to CAP in a third-level hospital in the period 2017-2019. Pregnant women were excluded. A total of 340 CAP episodes were identified in 321 patients; the median age was 75 years old (interquartile range 57-85). The most frequent risk factors were immunocompromise 102 (30%), neurological disease 75 (22%), and chronic kidney disease 58 (17%). According to three prognostic scores, CURB65, qSOFA and PSI/PORT, 216 (63.5%), 290 (83.5%) and 130 (38%) patients were identified as low risk, respectively. A total of 49 (14.4%) episodes required admission at the critical care unit and 39 (11.5%) required mechanical ventilation; 30 patients (8.8%) died during hospitalization. The radiologic patterns most frequently found were consolidation in 134 (39.4%), interstitial-alveolar pattern in 98 (28.8%), and the combination of both patterns in 67 (19.7%) episodes. Identification of the causal agent was achieved in 79 (23.2%) episodes. The most frequently isolated microorganisms were influenza virus in 37 (10.9%) episodes and Streptococcus pneumoniae in 11 (3.2%). Most of the hospitalized CAP patients were elderly with consolidative radiological patterns. The causal agent could be identified in less than a quarter of the patients, with the influenza test being the method with the highest diagnostic yield.

La neumonía adquirida en la comunidad (NAC) representa un importante problema sanitario y ≈20% de los pacientes requiere hospitalización. El objetivo principal del trabajo fue determinar las características clínico-imagenológicas de los episodios de NAC que requirieron internación. Los objetivos secundarios fueron determinar el rédito diagnóstico de los estudios microbiológicos e identificar las complicaciones. Realizamos un estudio analítico retrospectivo en un hospital de tercer nivel durante el período 2017-2019, en adultos admitidos por NAC, excluyendo embarazadas. Identificamos 340 episodios en 321 pacientes, la mediana de edad fue 75 años (rango intercuartil 57-85). Los factores de riesgo más frecuentes fueron inmunocompromiso (30%), enfermedad neurológica (22%) y enfermedad renal crónica (17%). Según tres scores pronósticos de gravedad, CURB65, qSOFA y PSI/PORT, 216 (63.5%), 290 (85.3%) y 130 (38%) episodios fueron identificados como de bajo riesgo, respectivamente. Del total de los episodios, 49 (14.4%) requirieron internación en unidad de cuidados intensivos, 39 (11.5%) ventilación mecánica y se registraron 30 (8.8%) muertes durante la hospitalización. Los patrones de imagen más frecuentes fueron consolidativo en 134 (39.4%), intersticio-alveolar en 98 (28.8%) y mixto entre ambos patrones en 67 (19.7%) episodios. Identificamos el agente causal en 79 (23.2%) episodios. Los microorganismos aislados más frecuentemente fueron influenza en 37 (10.9%) y Streptococcus pneumoniae en 11 (3.2%). La mayoría de los episodios afectaron pacientes ancianos y el principal patrón radiológico fue el consolidativo. El agente causal se pudo identificar en uno de cada cuatro episodios y el método con mayor rédito diagnóstico fue el test para influenza.

[Clinical, epidemiological and microbiological characterization of bacteremia produced by carbapenem-resistant enterobacteria in a university hospital in Córdoba, Argentina]. / Caracterización clínica, epidemiológica y microbiológica de bacteriemias producidas por enterobacterias resistentes a carbapenems en un hospital universitario de Córdoba, Argentina.

BACKGROUND: Enterobacteriaceae are a major cause of bloodstream infections and their antimicrobial resistance continues to increase. This leads to higher morbidity-mortality rates and public health costs. Carbapenem-resistant Enterobacteriaceae represent a serious challenge globally, since there are few therapeutic options available. AIM: Clinical/microbiological characterization of the carbapenem-resistant bacteremia observed over a period of 4 years. METHODS: Retrospective, observational and descriptive study about bacteremia caused by carbapenem-resistant and susceptible Enterobacteriaceae. RESULTS: A total of 84 patients with bacteremia including carbapenem-resistant and susceptible Enterobacteriaceae were analyzed. We found that patients infected with carbapenem-resistant strains presented a higher proportion of: previous antibiotic treatment, hospitalization in intensive care unit (ICU), onset of the bacteremia during hospitalization in ICU and previous infection with extended-spectrum-beta-lactamase producing Enterobacteriaceae. Additionally, we observed a predominance of KPC-producing Klebsiella pneumoniae and an attributable mortality rate of 52.4%. DISCUSSION: This study allowed for a better understanding of an emerging problem with high mortality, which in turn is useful for the design and adoption of infection control strategies and effective treatment regimens adapted to our local epidemiology.

Burden of Serious Fungal Infections in Argentina.

The number of fungal infections at any given time in Argentina is not known. Here we estimate the burden of serious fungal infections in Argentina for the first time. Specific population statistics were searched from multiple sources, local literature was identified, and estimates made. Some additional data were sourced from the Ministry of Health, the Global Initiative for Asthma (GINA) program, and national haematology and transplant societies. Argentina has a population of 43.8 million, with 25% of this total being children under 15 years. The predicted candidemia annual incidence is 2193 cases, with 50% occurring in the ICU. At a 6% prevalence rate, an estimated 593,695 women suffer from recurrent vulvovaginal candidiasis. Invasive aspergillosis is relatively common because of high smoking and chronic obstructive pulmonary disease (COPD) rates, with 268 cases in immunocompromised patients and another 1938 in the 168,000 COPD patients admitted to hospital. Asthma is also common, affecting 14% of adults, and so allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS) are major problems. An estimated 432 cases of cryptococcal meningitis (CM)-90% of them in AIDS patients-and 1177 cases of Pneumocystis pneumonia (PCP) occur each year. The estimated annual case number of disseminated histoplasmosis is 404 in AIDS patients, almost as frequent as CM. Paracoccidioidomycosis annual incidence is estimated at 219, and coccidioidomycosis at 16 cases. At least 881,023 people (>2.01%) in Argentina are affected by a serious fungal disease annually, with considerable morbidity and mortality.

[Bloodstream infection in patients receiving hematopoietic stem cell transplant. Seven years of experience with adults and children]. / Infección del torrente sanguíneo en pacientes receptores de trasplante de precursores hematopoyéticos. Siete años de experiencia con adultos y niños.

BACKGROUND: Bloodstream infection is a common complication, which can be life-threatening for hematopoietic stem cells transplant recipients. OBJECTIVE: To analyze the characteristics of bloodstream infections in hematopoietic stem cell transplant recipients. MATERIALS AND METHODS: Observational, retrospective study. We reviewed the records of 451 patients (autologous and allogeneic transplants) from January 2009 to October 2015. RESULTS: 99 positive blood cultures in 73 patients with bloodstream infection (16%) were found. Mortality attributable to infectious causes was 17%. From the 99 bloodstream infection, 63% were caused by gram-negative bacilli (Escherichia coli 45%, Klebsiella spp 23%, Pseudomonas spp 11% Acinetobacter spp % and other bacilli 15%), 33% by gram-positive cocci, 3% by fungi and 1% by gram-positive bacilli. The gram-negative bacilli were ciprofloxacin resistant (81%), piperacillin/tazobactam resistant (48%), extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae (40%), cefepime resistant (39%) and there was no resistance noted to amikacin. DISCUSSION: There is a higher frequency of gram-negative bacilli infection, with a high percentage of multiresistant microorganisms and high resistance to empirical antibiotic treatment.

[Infective endocarditis by Abiotrophia defectiva diagnosed by mass spectrometry (MALDI-TOF MS) in Argentina]. / Endocarditis infecciosa por Abiotrophia defectiva diagnosticada por espectrometría de masas (MALDI-TOF MS) en Argentina.

We report the case of a 63-year-old woman with congestive heart failure due to a bicuspid aortic valve and severe aortic stenosis. The patient had a febrile syndrome with positive blood cultures for Abiotrophia defectiva, Transesophageal echocardiogram revealed the presence of paravalvular abscess, which was treated by a successful valve replacement. The patient received appropriate antibiotic therapy with intravenous vancomycin, leading to a successful response. The use of MALDI-TOF MS as a rapid and specific method for the microbiological diagnosis is discussed in the following report.

Neumonía adquirida en la comunidad en pacientes que requirieron hospitalización / Community acquired pneumonia in patients requiring hospitalization

Resumen La neumonía adquirida en la comunidad (NAC) representa un importante problema sanitario y ~20% de los pacientes requiere hospitalización. El objetivo principal del trabajo fue determinar las características clínico-imagenológicas de los episodios de NAC que requirieron internación. Los objetivos secundarios fueron determinar el rédito diagnóstico de los estudios microbiológicos e identificar las complicaciones. Realizamos un estudio analítico retrospectivo en un hospital de tercer nivel durante el período 2017-2019, en adultos admitidos por NAC, excluyendo embarazadas. Identificamos 340 episodios en 321 pacientes, la mediana de edad fue 75 años (rango intercuartil 57-85). Los factores de riesgo más frecuentes fueron inmunocompromiso (30%), enfermedad neurológica (22%) y enfermedad renal crónica (17%). Según tres scores pronósticos de gravedad, CURB65, qSOFA y PSI/PORT, 216 (63.5%), 290 (85.3%) y 130 (38%) episodios fueron identificados como de bajo riesgo, respectivamente. Del total de los episodios, 49 (14.4%) requirieron internación en unidad de cuidados intensivos, 39 (11.5%) ventilación mecánica y se registraron 30 (8.8%) muertes durante la hospitalización. Los patrones de imagen más frecuentes fueron consolidativo en 134 (39.4%), intersticio-alveolar en 98 (28.8%) y mixto entre ambos patrones en 67 (19.7%) episodios. Identificamos el agente causal en 79 (23.2%) episodios. Los microorganismos aislados más frecuentemente fueron influenza en 37 (10.9%) y Streptococcus pneumoniae en 11 (3.2%). La mayoría de los episodios afectaron pacientes ancianos y el principal patrón radiológico fue el consolidativo. El agente causal se pudo identificar en uno de cada cuatro episodios y el método con mayor rédito diagnóstico fue el test para influenza.

Abstract Community-acquired pneumonia (CAP) represents a major health issue and ~20% of the patients require in-hospital attention. The main objective of the study was to determine clinical-imaging features of CAP episodes requiring hospitalization. The secondary objectives were to determine the diagnostic yield of microbiological analyses and the medical complications. A retrospective analytical study was conducted on adults admitted due to CAP in a third-level hospital in the period 2017-2019. Pregnant women were excluded. A total of 340 CAP episodes were identified in 321 patients; the median age was 75 years old (interquartile range 57-85). The most frequent risk factors were immunocompromise 102 (30%), neurological disease 75 (22%), and chronic kidney disease 58 (17%). According to three prognostic scores, CURB65, qSOFA and PSI/PORT, 216 (63.5%), 290 (83.5%) and 130 (38%) patients were identified as low risk, respectively. A total of 49 (14.4%) episodes required admission at the critical care unit and 39 (11.5%) required mechanical ventilation; 30 patients (8.8%) died during hospitalization. The radiologic patterns most frequently found were consolidation in 134 (39.4%), interstitial-alveolar pattern in 98 (28.8%), and the combination of both patterns in 67 (19.7%) episodes. Identification of the causal agent was achieved in 79 (23.2%) episodes. The most frequently isolated microorganisms were influenza virus in 37 (10.9%) episodes and Streptococcus pneumoniae in 11 (3.2%). Most of the hospitalized CAP patients were elderly with consolidative radiological patterns. The causal agent could be identified in less than a quarter of the patients, with the influenza test being the method with the highest diagnostic yield.

Caracterización clínica, epidemiológica y microbiológica de bacteriemias producidas por enterobacterias resistentes a carbapenems en un hospital universitario de Córdoba, Argentina / Clinical, epidemiological and microbiological characterization of bacteremia produced by carbapenem-resistant enterobacteria in a university hospital in Córdoba, Argentina

Resumen Introducción: Las enterobacterias son una causa principal de infecciones del torrente sanguíneo y su resistencia antimicrobiana se encuentra en aumento. Esto lleva a un incremento de la morbilidad-mortalidad y de los costos en la salud pública. Las enterobacterias resistentes a carbapenems representan un grave desafío a nivel global ya que existen escasas opciones terapéuticas disponibles. Objetivo: Caracterización clínico/microbiológica de las bacteriemias resistentes a carbapenémicos observadas en un período de 4 años. Material y Método: Estudio retrospectivo, observacional y descriptivo, sobre las bacteriemias por enterobacterias resistentes y sensibles a carbapenems. Resultados: Se analizó un total de 84 pacientes con bacteriemia por enterobacterias resistentes y sensibles a carbapenems. Entre las resistentes, observamos una mayor proporción de: tratamiento antimicrobiano previo, hospitalización en unidad de terapia intensiva (UTI), inicio de la bacteriemia en UTI y antecedentes de β-lactamasas de espectro extendido. Además, se detectó un amplio predominio de Klebsiella pneumoniae productor de KPC y una mortalidad atribuible de 52,4%. Discusión: El estudio posibilitó profundizar el conocimiento de una enfermedad emergente de elevada mortalidad, en vistas al diseño y aplicación de estrategias de control de infecciones y de esquemas de tratamiento efectivos adaptados a la epidemiologia local.

Abstract Background: Enterobacteriaceae are a major cause of bloodstream infections and their antimicrobial resistance continues to increase. This leads to higher morbidity-mortality rates and public health costs. Carbapenem-resistant Enterobacteriaceae represent a serious challenge globally, since there are few therapeutic options available. Aim: Clinical/microbiological characterization of the carbapenem-resistant bacteremia observed over a period of 4 years. Methods: Retrospective, observational and descriptive study about bacteremia caused by carbapenem-resistant and susceptible Enterobacteriaceae. Results: A total of 84 patients with bacteremia including carbapenem-resistant and susceptible Enterobacteriaceae were analyzed. We found that patients infected with carbapenem-resistant strains presented a higher proportion of: previous antibiotic treatment, hospitalization in intensive care unit (ICU), onset of the bacteremia during hospitalization in ICU and previous infection with extended-spectrum-beta-lactamase producing Enterobacteriaceae. Additionally, we observed a predominance of KPC-producing Klebsiella pneumoniae and an attributable mortality rate of 52.4%. Discussion: This study allowed for a better understanding of an emerging problem with high mortality, which in turn is useful for the design and adoption of infection control strategies and effective treatment regimens adapted to our local epidemiology.

Reactivation of Chagas Disease in a Patient With Follicular Lymphoma Diagnosed by Means of Quantitative Real-Time Polymerase Chain Reaction.

We report a case of Chagas disease reactivation in a patient with stage IIb follicular lymphoma in the cecum. He was admitted to the hospital with neutropenia and fever. He had a history of right hemicolectomy 6 months earlier and had received the sixth cycle of chemotherapy with cyclophosphamide/doxorubicin/vincristine/prednisone/rituximab. Blood and urine cultures were negative, but the fever persisted. Reactivation of Chagas disease was confirmed by means of quantitative real-time polymerase chain reaction (qRT-PCR). Parasitic load was 577 950 parasite equivalents/mL. The patient began treatment with benznidazole 5 mg/k per day every 12 hours. After 1 month, the qRT-PCR control was undetectable. The patient completed 60 days of treatment and is currently asymptomatic. Trypanosoma cruzi qRT-PCR may become a useful diagnostic method for reactivation of Chagas disease.

[Severe polyarthritis and tenosynovitis due to Streptococcus agalactiae in a patient with functional hyposplenia]. / Poliartritis y tenosinovitis grave por Streptococcus agalactiae en un paciente con hipoesplenia funcional.

Cases of arthritis caused by Streptococcus agalactiae are infrequent and in our knowledge there are no case reports of tenosynovitis caused by S. agalactiae. A 46-year-old woman presented with fever, polyarthralgia, myalgia, diarrhea and vomiting. She had a history of papillary thyroid carcinoma and functional hyposplenia. She was febrile, with arthritis in hands, wrists, elbows, right shoulder and left ankle joints, and presented tenosynovitis in both feet and left hand. Blood and right olecranon bursa sample cultures were positive for S. agalactiae. An ultrasound scan made at the musculus tibialis anterior of left foot revealed signs of tenosynovitis. She was treated with intravenous cefazolin for 20 days and oral cefuroxime for 12 days. The joint involvement completely subsided in 60 days. Streptococcus agalactiae can cause, infrequently, a polyarthritis and tenosynovitis syndrome similar to disseminated gonococcal infection.

Stenotrophomonas maltophilia endophthalmitis caused by surgical equipment contamination: an emerging nosocomial infection.

PURPOSE: We report three cases of Stenotrophomonas maltophilia endophthalmitis after uneventful extracapsular cataract extraction with intraocular lens implantation-related to surgical equipment contamination. CASE REPORT: All patients developed acute, culture-positive endophthalmitis in a period ranging from 2 to 13 days. Cultures from vitreous tap, as well as those obtained from the hand-piece of the irrigation-aspiration system, revealed S. maltophilia as the causing infectious agent. All patients received intravitreal antibiotic treatment as initial therapy, nevertheless, visual disturbance continued to be present, hence pars plana vitrectomy was required. CONCLUSION: Contamination of surgical-reusable equipment should be considered in addition to the well-known risk factors associated with development of endophthalmitis by S. maltophilia.

Streptococcus agalactiae bacteremia in non-pregnant adult patients at two teaching hospitals / Bacteriemia por Streptococcus agalactiae en pacientes adultos y mujeres no embarazadas de dos hospitales universitarios

Streptococcus agalactiae or group B streptococcus (GBS) is a frequent pathogen in immunocompromised adults. The aim of this study was to determine the relative frequency, clinical presentation, antimicrobial susceptibility profile, and risk factors associated with GBS bacteremia in non-pregnant adult patients. We conducted a retrospective analysis of blood cultures performed in two hospitals between the years 2009-2013. From 1110 bacteremia episodes, 13 were caused by GBS, all of which were susceptible to ampicillin. GBS bacteremia was more frequent in females and in patients older than 60 years of age. The most frequent comorbidities were chronic kidney disease, cardiac failure and neoplasia. History of appendectomy was detected in 53.8% of the patients, being the most relevant comorbidity for GBS bacteremia in the multivariate analysis (OR 4.13, p = 0.012). The main presentations were primary bacteremia and soft tissue infection. GBS bacteremia was infrequent in our institution, and a history of appendectomy might be related to bacteremia occurrence.

Streptococcus agalactiae o estreptococo del grupo B (SGB), es un patógeno frecuente en adultos inmunocomprometidos. El objetivo de este trabajo fue determinar la frecuencia relativa, formas de presentación, susceptibilidad antimicrobiana y factores de riesgo asociados a la bacteriemia por SGB en pacientes adultos y mujeres no embarazadas. Se realizó un análisis retrospectivo de hemocultivos en 2 hospitales entre 2009-2013. De un total de 1.110 episodios de bacteriemia, 13 fueron causadas por SGB, siendo todos los aislamientos sensibles a ampicilina. Fue más frecuente en mujeres y en pacientes mayores de 60 años. Las comorbilidades más frecuentes fueron enfermedad renal crónica, insuficiencia cardíaca y neoplasias. El 53,8% de los casos tenía antecedente de apendicectomía previa, siendo la comorbilidad más relevante según el análisis multivariado (OR: 4,13; p = 0,012). Se presentaron principalmente como bacteriemia primaria e infección de tejidos blandos. La bacteriemia por SBG fue infrecuente en nuestro medio y el antecedente de apendicectomía podría relacionarse al desarrollo de la misma.

Infección del torrente sanguíneo en pacientes receptores de trasplante de precursores hematopoyéticos. Siete años de experiencia con adultos y niños / Bloodstream infection in patients receiving hematopoietic stem cell transplant. Seven years of experience with adults and children

Resumen Introducción: La infección del torrente sanguíneo es una complicación usual, que puede comprometer la vida de los pacientes que recibieron trasplante de precursores hematopoyéticos. Objetivo: Analizar las características de las infecciones del torrente sanguíneo en receptores de trasplante de precursores hematopoyéticos. Materiales y Métodos: Estudio observacional, retrospectivo. Se revisaron los registros de 451 pacientes (trasplantes autólogos y alogénicos), desde enero de 2009 a octubre de 2015. Resultados: Hubo 99 hemocultivos positivos en 73 pacientes con infección del torrente sanguíneo (16%). Mortalidad atribuible a causas infecciosas: 17%. De las 99 infecciones sanguíneas, 63% fueron provocados por bacilos gramnegativos (Escherichia coli 45%, Klebsiella spp 23%, Pseudomonas spp 11%, Acinetobacter spp 6% y otros bacilos gramnegativos 15%), 33% por cocáceas grampositivas, 3% por hongos y 1% por bacilos grampositivos. Se observó resistencia a ciprofloxacina (81%), piperacilina/tazobactam (48%), Enterobacteriaceae productoras de β-lactamasa de espectro extendido (BLEE) (40%), cefepime (39%) y ausencia de resistencia a amikacina. Discusión: Existe mayor frecuencia de infección por bacilos gramnegativos, con un importante porcentaje de aislados multi-resistentes, y consecuente, alta resistencia al tratamiento antimicrobiano empírico.

Background: Bloodstream infection is a common complication, which can be life-threatening for hematopoietic stem cells transplant recipients. Objective: To analyze the characteristics of bloodstream infections in hematopoietic stem cell transplant recipients. Materials and Methods: Observational, retrospective study. We reviewed the records of 451 patients (autologous and allogeneic transplants) from January 2009 to October 2015. Results: 99 positive blood cultures in 73 patients with bloodstream infection (16%) were found. Mortality attributable to infectious causes was 17%. From the 99 bloodstream infection, 63% were caused by gram-negative bacilli (Escherichia coli 45%, Klebsiella spp 23%, Pseudomonas spp 11% Acinetobacter spp % and other bacilli 15%), 33% by gram-positive cocci, 3% by fungi and 1% by gram-positive bacilli. The gram-negative bacilli were ciprofloxacin resistant (81%), piperacillin/tazobactam resistant (48%), extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae (40%), cefepime resistant (39%) and there was no resistance noted to amikacin. Discussion: There is a higher frequency of gram-negative bacilli infection, with a high percentage of multiresistant microorganisms and high resistance to empirical antibiotic treatment.

Endocarditis infecciosa por Abiotrophia defectiva diagnosticada por espectrometría de masas (MALDI-TOF MS) en Argentina / Infective endocarditis by Abiotrophia defectiva diagnosed by mass spectrometry (MALDI-TOF MS) in Argentina

We report the case of a 63-year-old woman with congestive heart failure due to a bicuspid aortic valve and severe aortic stenosis. The patient had a febrile syndrome with positive blood cultures for Abiotrophia defectiva, Transesophageal echocardiogram revealed the presence of paravalvular abscess, which was treated by a successful valve replacement. The patient received appropriate antibiotic therapy with intravenous vancomycin, leading to a successful response. The use of MALDI-TOF MS as a rapid and specific method for the microbiological diagnosis is discussed in the following report.

Se presenta el caso clínico de una mujer de 63 años de edad con antecedentes de una aorta bicúspide y estenosis aórtica grave, con una insuficiencia cardíaca descompensada. La paciente tuvo un síndrome febril con hemocultivos positivos para Abiotrophia defectiva. Se constató por un ecocardiograma transesofágico la presencia de un absceso paravalvular, por lo cual se realizó un reemplazo valvular en forma exitosa. Recibió terapia antimicrobiana intravenosa con vancomicina, con buena respuesta terapéutica. Se discute la utilización del MALDI-TOF MS como un método rápido y específico para el diagnóstico microbiológico.

Cytomegalovirus-induced haemorrhagic cystitis in a patient with neurogenic bladder.

We report a case of severe cytomegalovirus induced haemorrhagic cystitis associated with neurogenic urinary bladder in a patient suffering from anaplastic spinal ependymoma. The diagnosis was established by bladder biopsy and immunohistochemical study. Haematuria resolved after ganciclovir therapy. Previous reports are reviewed.

Poliartritis y tenosinovitis grave por Streptococcus agalactiae en un paciente con hipoesplenia funcional / Severe polyarthritis and tenosynovitis due to Streptococcus agalactiae in a patient with functional hyposplenia

Cases of arthritis caused by Streptococcus agalactiae are infrequent and in our knowledge there are no case reports of tenosynovitis caused by S. agalactiae. A 46-year-old woman presented with fever, polyarthralgia, myalgia, diarrhea and vomiting. She had a history of papillary thyroid carcinoma and functional hyposplenia. She was febrile, with arthritis in hands, wrists, elbows, right shoulder and left ankle joints, and presented tenosynovitis in both feet and left hand. Blood and right olecranon bursa sample cultures were positive for S. agalactiae. An ultrasound scan made at the musculus tibialis anterior of left foot revealed signs of tenosynovitis. She was treated with intravenous cefazolin for 20 days and oral cefuroxime for 12 days. The joint involvement completely subsided in 60 days. Streptococcus agalactiae can cause, infrequently, a polyarthritis and tenosynovitis syndrome similar to disseminated gonococcal infection

Poliartritis y tenosinovitis grave por Streptococcus agalactiae en un paciente con hipoesplenia funcional / Severe polyarthritis and tenosynovitis due to Streptococcus agalactiae in a patient with functional hyposplenia

Cases of arthritis caused by Streptococcus agalactiae are infrequent and in our knowledge there are no case reports of tenosynovitis caused by S. agalactiae. A 46-year-old woman presented with fever, polyarthralgia, myalgia, diarrhea and vomiting. She had a history of papillary thyroid carcinoma and functional hyposplenia. She was febrile, with arthritis in hands, wrists, elbows, right shoulder and left ankle joints, and presented tenosynovitis in both feet and left hand. Blood and right olecranon bursa sample cultures were positive for S. agalactiae. An ultrasound scan made at the musculus tibialis anterior of left foot revealed signs of tenosynovitis. She was treated with intravenous cefazolin for 20 days and oral cefuroxime for 12 days. The joint involvement completely subsided in 60 days. Streptococcus agalactiae can cause, infrequently, a polyarthritis and tenosynovitis syndrome similar to disseminated gonococcal infection (AU)

Poliartritis y tenosinovitis grave por Streptococcus agalactiae en un paciente con hipoesplenia funcional. / [Severe polyarthritis and tenosynovitis due to Streptococcus agalactiae in a patient with functional hyposplenia]

Cases of arthritis caused by Streptococcus agalactiae are infrequent and in our knowledge there are no case reports of tenosynovitis caused by S. agalactiae. A 46-year-old woman presented with fever, polyarthralgia, myalgia, diarrhea and vomiting. She had a history of papillary thyroid carcinoma and functional hyposplenia. She was febrile, with arthritis in hands, wrists, elbows, right shoulder and left ankle joints, and presented tenosynovitis in both feet and left hand. Blood and right olecranon bursa sample cultures were positive for S. agalactiae. An ultrasound scan made at the musculus tibialis anterior of left foot revealed signs of tenosynovitis. She was treated with intravenous cefazolin for 20 days and oral cefuroxime for 12 days. The joint involvement completely subsided in 60 days. Streptococcus agalactiae can cause, infrequently, a polyarthritis and tenosynovitis syndrome similar to disseminated gonococcal infection.