[Infective complications of rheumatoid arthritis].
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Biomedical subjects
Publications and source records attributed to E Bouza Santiago.
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OBJECTIVE: In recent years the incidence of gastroenteritis due to Aeromonas spp has increased significantly. The purpose of this study was to investigate the etiology and clinical manifestations of this disease. PATIENTS AND METHODS: In the period between 1986 and 1992, we found Aeromonas spp in seventy patients (88 samples) between 0 and 16 years of age. We were able to analyze 53 of these samples. RESULTS: Of all of the patients, 66% were males and 58.5% were younger than two years old. We found a pattern in the disease with 83% of the cases occurring in summer and autumn. The infection was polymicrobial in 43% of the patients. The clinical manifestations most often found were fever (71%), vomiting (62.5%) and abdominal pain (9.4%). Diarrhea was watery in 71.7% and 64% of the cases lasted less than a week. The number of stools was 5 to 10 per day in 58% of the patients. Forty patients (75.5%) required hospitalization, with the stay being longer than 10 days in 25%. There were 30% of the patients that required antibiotic therapy, mostly due to concomitant infections and not due to the diarrheic episodes, with all of them having a satisfactory evolution.
OBJECTIVES: To determine the prevalence of M. tuberculosis isolates resistant to drugs in a general hospital and to assess its association with HIV infection. MATERIALS AND METHODS: Susceptibility analysis of all isolates of M. tuberculosis in a 4-year period (1990-1993). The proportion method was used to study the susceptibility to eight drugs. To assess the association of resistance with HIV infection a crossing was made of patients records who had M. tuberculosis recovered and that of patients with positive serology to HIV. RESULTS: Forty-two out of a total of 760 isolates (5.5%) were resistant to at least one drug, including isoniazid in 27 (3.3%), rifampin in 13 (1.6%), and pyrazinamide in 2 (0.2%). None of the isolates was resistant to ofloxacin. Twenty isolates (2.6%) were resistant to more than one drug and 9 (1.2%) were resistant to at least isoniazid and rifampin. Overall, 39% of resistance to one drug occurred in patients who had not received previous therapy with that drug. A greater incidence of resistant isolates was observed in HIV+ patients (7.3%) than in HIV- patients (4.6%), although this difference did not reach a statistical significance. CONCLUSIONS: Drug resistance rate in M. tuberculosis isolates in our hospital is still low and apparently not associated with HIV infection.
Severe infections caused by Pseudomonas aeruginosa are uncommon in patients infected with HIV. These infections are usually recurrent, bear a poor prognosis and their potential for nosocomial transmission is questioned. From May 1991 to December 1994, a total of 2,739 admissions were recorded at the VIH Unit in our hospital. Seven of those patients suffered 9 episodes of P. aeruginosa bacteremia (3.28 episodes/1,000 admissions). All cases were acquired nosocomially. The mean CD4 count was 30.7 cells/ml. Mortality associated with Pseudomonas aeruginosa bacteremia was 43%. With molecular typing techniques homologies over 98% were demonstrated for the two episodes in patient 4 and the episode in patient 3 (very close in time, 1993) and almost 99% between the isolate from patient 7 and the two isolates (identical) from patient 6. The other three isolates had relationship (to themselves and to the other isolates) lower than 97%. Our findings suggest that patient-to-patient transmission of severe infections caused by P. aeruginosa in patients with AIDS.
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A case of pseudomonas endocarditis of biliary origin with impairment of the mitral and tricuspid heart valves is reported. Former history of the patient did not reveal narcotic addiction or previous open-heart surgery. Osteomyelitis is an uncommon complication of pseudomonas endocarditis. Echocardiography was a useful diagnostic method in the present case, showing the vegetation on the tricuspid valve. The poor prognosis of cases with left valvular heart disease which are resistant to medical treatment is emphasized. Differential count of the colonies did not localize the affected heart valve in this case.
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