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Biomedical subjects

E Bouza

Publications and source records attributed to E Bouza.

265 records · Page 15Linked to original sources
PubMedDate not supplied

Surgical wound infection by Aspergillus fumigatus in liver transplant recipients.

Cutaneous aspergillosis is generally associated with immunosuppression, burns, and major trauma. Most cases are acquired by direct inoculation, although cutaneous involvement does occasionally occur with disseminated disease. Surgical wound infections caused by Aspergillus species are very unusual and to our knowledge have not been described in the setting of organ transplantation. We describe two liver transplant recipients who developed wound aspergillosis during a nosocomial outbreak of Aspergillus infection. Infection developed in the second and fourth postoperative week respectively, and in both cases wound appearance mimicked necrotizing fasciitis. Both patients died despite local debridement and antifungal therapy with amphotericin B. Aspergillus must be added to the list of potential pathogens of surgical wounds, especially in the setting of organ transplantation.

Amphotericin B↗
PubMedDate not supplied

Evaluation of the upgraded amplified Mycobacterium tuberculosis direct test (gen-probe) for direct detection of Mycobacterium tuberculosis in respiratory and non-respiratory specimens.

We evaluated the upgraded Amplified Mycobacterium Tuberculosis Direct Test kit (AMTD) (Gen-Probe Inc.) for the direct detection of Mycobacterium tuberculosis in respiratory and non-respiratory specimens, and compared the results between the traditional 30,000 RLUs cutoff criteria (C) and three equivocal ranges (30,000-100,000, R1; 30,000-500,000, R2; and 30,000-1,000,000, R3). We tested 663 respiratory and 238 non-respiratory samples from 464 patients. The gold standard was considered to be the combination of culture and clinical data. One hundred and nineteen samples were from 56 patients with pulmonary tuberculosis, and 36 samples were from 19 patients with extrapulmonary tuberculosis. When C criteria was applied, the sensitivity and specificity values were 90.8 and 93.0% for respiratory specimens, while they were 88.9 and 92.1% for non-respiratory specimens (p = NS). The sensitivity was significantly higher in smear-positive specimens (96.7%) than in smear-negative ones (81.0%) (p < 0.05). When compared with C criteria, the overall sensitivity was maintained at 90.3% for R1 criteria, and slightly decreased to 89.7% for R2 and R3 criteria (p = NS). Overall, specificity increased significantly from 92.9% (C) to 97.5% (R1), 99.1% (R2), and 99.2% (R3). Application of R2 or R3 criteria improved significantly the specificity of the test with little decrease in sensitivity.

Humans↗
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Prevalence and patterns of HGV/GBV-C infection in patients with suspected HCV-related hepatitis.

Hepatitis G virus (HGV) is a recently described hepatotropic parenterally transmitted flavivirus. The presence of HGV was tested in 61 patients with a request for confirmation of HCV active infection. Thirty-two patients were in haemodialysis and 29 were referred from wards other than nephrology. Active HCV and HGV infections were determined by detection of their viral RNA in serum. Evaluation of previous HGV infection was carried out by detection of antibodies to E2 antigen. HCV prevalence was 62.29% (38/61). HGV-active infection was found in 11.47% (7/61) of the population studied: in 18.7% (6/32) of the haemodialysed patients and in 3.4% (1/29) of patients belonging to the other group. HGV prevalence increased two-fold when previous infection was also considered. HGV clearance was prospectively detected in 5 out of the 7 patients with active infection, and at an earlier stage for those patients coinfected with HCV. Anti-E2 seropositivity was associated with HGV clearance in only two patients.

Female↗
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Lemierre's disease: postanginal bacteremia and pulmonary involvement caused by Fusobacterium necrophorum.

The combination of acute pharyngotonsillitis, neck pain, fever, and pulmonary septic emboli caused by Fusobacterium necrophorum in a healthy young person is extremely rare. The entity was described by Lemierre in 1936 as a typical syndrome easy to recognize and diagnose exclusively on clinical grounds. A case of Lemierre's disease is reported, and 10 other cases found in the medical literature are reviewed.

Adolescent↗
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Listeriosis in patients infected with human immunodeficiency virus.

Although resistance to Listeria monocytogenes infection requires intact T cell-mediated immunity, only 20 patients with human immunodeficiency virus (HIV) infection and listeriosis (including one patient described herein) have been reported to date. Listeriosis developed before AIDS in five cases. Syndromes included meningitis in nine cases, bacteremia in nine, brain abscess in one, and endocarditis in one. Eighteen patients were treated with ampicillin, penicillin, or amoxicillin with or without aminoglycosides. Clinical and microbiologic responses were obtained in one patient with bacteremia treated with vancomycin and in one patient with meningitis treated with trimethoprim-sulfamethoxazole. Three of the nine patients with meningitis died, as did the patient with brain abscess. All nine patients with bacteremia and the patient with endocarditis survived. No case of relapse was documented. L. monocytogenes, although uncommon, should be considered in the differential diagnosis of febrile illness, meningitis, and brain abscess in patients with HIV infection.

Adult↗
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Klebsiella bacteremia: an analysis of 100 episodes.

During a five-year period, 204 patients had klebsiella bacteremia at this institution; these cases constituted 6.6% of the total episodes of bacteremia. The incidence was 2.3 cases per 1,000 admitted patients. A random group of 100 cases was chosen for analysis in the present study. The disease was community acquired in 23%, nosocomially acquired in 77%, unimicrobial in 88%, or part of a polymicrobial bacteremia in 12% of episodes. Three-quarters of the episodes were caused by Klebsiella pneumoniae and the remaining one-quarter, by Klebsiella oxytoca. Portals of entry, in decreasing order of frequency, were urinary, respiratory, and biliary tracts. Twenty-four percent of the Klebsiella isolates were resistant to gentamicin. The most frequent clinical finding (in 96% of the cases) was fever. Shock occurred in 22% and pyogenic metastatic foci, in 5% of the patients. None of the patients had evidence of disseminated intravascular coagulation. Overall mortality was 25%, and factors associated with poor prognosis were inadequacy of antimicrobial chemotherapy, septic shock, type of underlying disease, and clinical condition of the patients.

Adolescent↗
PubMedDate not supplied

Brucellar meningitis.

Neurobrucellosis develops in less than 5% of cases of systemic brucellosis; however, most patients with neurobrucellosis have meningeal involvement. Seven new cases of brucellar meningitis and 17 cases from the Spanish- and English-language medical literature are analyzed in terms of epidemiologic data, clinical manifestations, laboratory results for cerebrospinal fluid and serum, treatment, and course of the disease. Brucellar meningitis mimics other neurologic and non-neurologic conditions, and its diagnosis is only suggested in the presence of adequate epidemiologic information. Isolation of Brucella from the cerebrospinal fluid is uncommon. Treatment is accomplished with the combination of tetracycline or doxycycline and streptomycin, rifampin, or both. Mean length of therapy in the seven new cases was 8.5 months. Brucellar meningitis has a better prognosis than other forms of chronic meningitis, and mortality is low for reasons that are not clear; however, the incidence of minor sequelae is high.

Adolescent↗
PubMedDate not supplied

A study of the delayed hypersensitivity response in healthy people in Spain: Spanish National Tables. National Surgical Infection Committee of the Association of Spanish Surgeons.

With a view to creating national tables of the delayed hypersensitivity response, a total of 1476 healthy persons were studied at eight different locations in Spain. For the measurement of delayed cellular immunity response, Multitest IMC was used. Of those examined, 0.7% were anergic, 21.3 were relatively anergic, and 73 were immunocompetent. Of the 766 men, 28 were relatively anergic and 3 were anergic, whereas of the 710 women, 14 were relatively anergic (p < .001) and 8% were anergic (p < .001). The highest incidence of anergy was found in women of over 70 years (p < .001). Tuberculin was the antigen with the most positive responses, 77%, followed by Candida with 58%. Trichophyton and Proteus mirabilis were the antigens least recognized by the Spaniards studied. Major geographical variations were observed, both in the overall index for the delayed hypersensitivity response and in the response to different antigens. Catalonia revealed the highest level of anergy and the Valencia region, the lowest.

Adult↗
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Nelfinavir plus nevirapine plus two NRTIS as salvage therapy for HIV-infected patients receiving long-term antiretroviral treatment.

PURPOSE: To evaluate a rescue therapy involving nevirapine plus nelfinavir plus two nucleoside reverse transcriptase inhibitors (NRTIs) in patients with prior extensive antiretroviral therapy (AT) including protease inhibitors (PIs) but not nonnucleoside reverse transcriptase inhibitors (NNRTIs). METHOD: Patients with failing regimens were prospectively enrolled. According to genotypic profile at baseline, two groups were identified: a highly resistant (HR) group, which included strains resistant to PI and NRTI, and a moderate nonresistant group (MR), which showed resistance only to PI or NRTI or no resistance. RESULTS: Twenty-two individuals were included. Average time of AT prior to enrollment was 3.7 years (range 1.4-7.6), median viral load 4.92 log(10) (interquartile range [IQR] 1.63 log(10)), and median CD4 cell count 64 cells/microL (IQR 94). After 16 weeks of treatment, seven patients (31%) achieved virological response, five of them (22.7%) with <500 c/mL (bDNA). Fourteen patients were studied for resistance. The HR group showed a poorer response than the MR group (0 vs. 7 responses; p =.034). CONCLUSION: We found a virological response in 31% of our patients, and mainly in those of the MR group some presented previous intolerance. These two factors probably reflect the number of drugs included in the rescue therapy to which the patient is sensitive. Treatment history as well as genotypic resistance assays are useful in identifying patients with the best chance of responding.

Adult↗
PubMedDate not supplied

[Evaluation of 2 fast methods for the detection of rotaviruses in fecal samples].

BACKGROUND: Rotavirus is one of the major causes of acute gastroenteritis in childhood. Several rapid methods for rotavirus detection are currently available, although their efficacy have a great variability. We performed a prospective study to evaluate two rapid tests for detection of rotavirus antigens in faeces. METHODS: Using electron microscopy as the reference method, we compared two techniques for diagnosis of rotavirus infection: a monoclonal ELISA (Rotaclone, Cambridge Bioscencer, Worcester) and a policlonal latex agglutination (Diarlex, Orion Diagnostics, Finland). We tested, in parallel, 192 stools samples received in our laboratory to investigate rotavirus. RESULTS: ELISA showed significantly better sensitivity than latex (100 vs 66.6%), while both methods had similar specificity (98.6%). CONCLUSIONS: Of the tested methods, ELISA was superior due to the high sensibility and specificity, good reproductibility and easy interpretation. It also permits the simultaneous performance of several tests.

Enzyme-Linked Immunosorbent Assay↗