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J A Capdevila

Publications and source records attributed to J A Capdevila.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Pleural cryptococcosis in patients with human immunodeficiency virus infection].

Four cases of pleural cryptococcosis as the form of onset of cryptococcosis in patients with human immunodeficiency virus (HIV) infection are reported. In two out of the four cases cryptococci were simultaneously isolated in other localizations (blood and meninges). In the two remaining patients the pleura was the only site of the disease, with serum determination of the cryptococci antigen being negative in one. The four patients evolved favourably, with three being exclusively treated with fluconazol. Pleuritis is an infrequent manifestation in cryptococcosis although it may be the form of onset and the only localization of the disease. Only 10 cases have been reported in patients with HIV infection. The present four cases represent 11% of the authors' series of cryptococcosis in AIDS patients. The diagnostic possibility of cryptococcosis should be considered in patients with human immunodeficiency virus infection presenting pleural effusion.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Nontuberculous mycobacterial meningitis: report of two cases and review.

Nontuberculous mycobacterial meningitis (NTMM) is still a rare disease despite the increase in the number of cases of disseminated mycobacterial infection related to the AIDS epidemic. Moreover, there are doubts as to the clinical relevance of the isolation of mycobacteria other than Mycobacterium tuberculosis from cerebrospinal fluid. After analyzing the clinical and pathological data, we classified the cases of NTMM into three groups: definitive (28 cases), probable (19), and doubtful (5). We found that Mycobacterium avium is the most commonly isolated species (60% of cases). M. avium meningitis presents as a disseminated disease, is usually related to serious underlying conditions (mainly immunosuppression), and is associated with a death rate that approaches 70%. Mycobacterium fortuitum meningitis is associated with previous neurosurgery or back trauma; the prognosis for this infection is better when the concomitant abscesses are drained. The clinical characteristics of Mycobacterium kansasii meningitis are similar to those of M. tuberculosis meningitis, but the mortality related to M. kansasii meningitis is high despite appropriate antibiotic treatment. Herein, we present two cases of NTMM that occurred at our center, and we review 50 additional cases reported in the English-language literature.

AIDS-Related Opportunistic Infections↗
PubMed1996

Treatment of experimental endocarditis due to Enterococcus faecalis using once-daily dosing regimen of gentamicin plus simulated profiles of ampicillin in human serum.

We compared the efficacy of ampicillin, both alone and in combination with gentamicin given once a day (q.d.) or three times a day (t.i.d.), in the treatment of experimental enterococcal endocarditis. Ampicillin was administered by using humanlike pharmacokinetics that simulated the profiles of this drug in human serum. An open one-compartment mathematical model developed in this study was used to estimate the decreasing doses administered with a computer-controlled infusion pump that simulated in rabbits the human serum pharmacokinetics after intravenous administration of 2 g of ampicillin every 4 h. Animals with catheter-induced endocarditis were infected intravenously with 10(8) CFU of Enterococcus faecalis J4 (MICs and MBCs of ampicillin and gentamicin, 2 and 128 and 16 and 64 micrograms/ml, respectively) and were treated for 3 days with ampicillin alone or in combination with gentamicin at 2 mg/kg of body weight subcutaneously t.i.d. or at 6 mg/kg subcutaneously q.d. The serum ampicillin levels and pharmacokinetic parameters of the humanlike pharmacokinetics of ampicillin in rabbits were similar to those found in humans treated with 2 g of ampicillin intravenously. The results of therapy for experimental endocarditis caused by E. faecalis J4 showed that the residual bacterial concentration in aortic valve vegetation was significantly lower in the animals treated with combinations of ampicillin plus gentamicin given q.d. or t.i.d. than in those treated with ampicillin alone (P < 0.01). The dosing interval of gentamicin did not significantly affect (q.d. versus t.i.d.; P = 0.673) the therapeutic efficacy of the combination of ampicillin plus gentamicin.

Ampicillin↗
PubMed1995

Malignant lymphoproliferative diseases in HIV-seropositive patients. A study of 40 cases at a single institution in Spain.

We identified 40 patients with malignant lymphoproliferative diseases (MLD) and HIV infection (seropositive) at a single Spanish university hospital. Thirty-two patients had non-Hodgkin's lymphoma (NHL), 6 primary central nervous system lymphoma (PCL) and 8 patients Hodgkin's disease (HD). Median age at presentation was 32 years. Four histopathological groups had distinct presenting clinical features: in 93% of the Burkitt-type lymphomas, the lymphoma itself was the AIDS defining criterion, while high and intermediate grade NHL other than Burkitt-like tended to have a more advanced HIV infection, demonstrated by antecedent AIDS criteria in 58% of these patients and a median CD4 positive cell count of 291 mm3; HD occurred in some patients without previous opportunistic infections (7/8 patients) but with median CD4 cells of 105 mm3; PCL occurred in a terminal stage of HIV infection, in patients with a low performance status, and frequent antecedent AIDS criteria. Objective response to chemotherapy could be seen in 62% of NHL patients and 100% of HD. Survival was adversely related to an antecedent diagnosis of AIDS, low performance status, and a primary localization in the central nervous system. Overall median survival was 5 months, but patients without the mentioned three adverse prognostic factors had a median survival of 10 months.

Actuarial Analysis↗
PubMed1995

[Spondylodiscitis caused by Enterococcus: an unusual entity].

BACKGROUND: Spondylodiscitis by enterococcus is a very infrequent disease with only 2 cases caused exclusively by this microorganism having been reported in the literature. METHODS: Two clinical cases of spondylodiscitis by enterococcus diagnosed in the authors' department are presented with the clinical, radiologic and evolutive features of both. RESULTS: In the first case the spondylodiscitis was secondary to endocarditis with lumbosacral involvement and formation of an anterior epidural inflammatory mass. The second case was the consequence of an infection of urinary origin with lumbosacral involvement. Both patients responded favorably with only antibiotic treatment. CONCLUSIONS: Spondylodiscitis by enterococci is an unusual disease with no therapeutic experience. The authors report 2 cases which were treated exclusively with antibiotics.

Aged↗
PubMed1994

[Disseminated aspergillosis in patients with acquired immunodeficiency syndrome].

Disseminated aspergillosis is very infrequent in patients infected by the human immunodeficiency virus and diagnosis is made usually upon necropsy. The case of a 28 year old male who presented multiple abscesses by Aspergillus sp. in the lung, thyroid glands, spleen, myocardium, pancreas, kidney and in both cerebral hemispheres is presented. The patient also concommitantly showed M. avium in the spleen, liver and central nervous system. The literature was reviewed to evaluate the clinical characteristics and predisposing factors which may contribute to diagnosis and treatment.

AIDS-Related Opportunistic Infections↗
PubMed1994

Incidence and risk factors of recurrent episodes of bacteremia in adults.

BACKGROUND: Bacteremia is a cause of high morbidity and mortality. Recurrent episodes of bacteremia, its risk factors and characteristics, have been poorly evaluated in the literature, although its occurrence has been established. PATIENTS AND METHODS: Analysis of 1426 patients who presented with 1579 episodes of bacteremia and who were prospectively evaluated in a university-affiliated hospital during a 48-month period. The risk factors for a patient to develop a recurrence of bacteremia was assessed comparing those with recurrent episodes with those who survived an episode of bacteremia with no recurrence during the follow-up period. RESULTS: A total of 105 patients presented with 248 episodes of bacteremia, of which 143 episodes were recurrent (recurrence rate, 9% of all bacteremic episodes). Two factors were independently predictive of recurrent bacteremia: (1) the presence of an underlying disease (especially a rapidly fatal one [odds ratio, 7.27]) or (2) any complication during the initial episode of bacteremia. Using these factors, the prediction model was significant, but misclassification was high, with a sensitivity of 61% and a specificity of 67% for a cutoff point that maximized both factors. CONCLUSIONS: We identified risk factors for patients who presented with an initial episode of bacteremia to develop a recurrence rate. The recurrence risk factors may be used as a form of guidance for extreme preventive measures, but these factors could not predict recurrence with a high degree of accuracy.

Bacteremia↗
PubMed1994

[Incidence and etiology of viremia in 2,619 patients].

BACKGROUND: Virus investigation, specially cytomegalovirus (CMV), in blood has increased such that the capacity of hospitalary laboratories is threatened with collapse. The causal agents of viremia are analyzed being correlated with the clinical symptoms and underlying disease to establish the selection criteria of patients for virologic study. METHODS: Two thousand six hundred nineteen patients suspected of having viral infection, fundamentally by CMV were studied over 6 years by 4,394 blood samples. Of these patients 1,646 were immunosuppressed, 824 were considered immunocompetent and this data was unknown in 149 patients. The leukocytes were separated using standardized techniques being seeded in cell cultures (human embryo lung fibroblasts). RESULTS: Three hundred forty-seven specimens corresponding to 242 patients were positive with isolation of the following pathogens: 327 strains of CMV, 4 enterovirus, 2 adenovirus, 1 herpes simplex virus, 1 varicella-zoster, another 5 unidentified cytopathic agents, 6 strains of toxoplasma and 1 Cryptococcus. With regard to the base disease, 302 positive samples to CMV pertained to 204 immunosuppressed patients: 103 (13.6% positives among the cases studied) AIDS or AIDS-related complex, 54 (21.3%) kidney transplant patients, 31 (24.8%) liver transplant patients, 2 (1.5%) lung transplant patients, and 2 (1.5%) bone marrow transplant patients. A non CMV microorganism was isolated in 13 samples from 12 immunosuppressed patients. Only 24 (2.5% of those studied) immunocompetent or with unknown immunity status had viremia by CMV, being detected in 25 samples. Non CMV cytopathic agents were isolated in another 7 samples from 6 patients. CONCLUSIONS: Analysis of blood cultures allows the isolation of cytomegalovirus and occasionally other unsuspected agents such as toxoplasma. This investigation is indicated in immunosuppressed patients but not in immunocompetent patients who present a febrile syndrome with no clinical suspicion of cytomegalovirus infection.

Adult↗
PubMed1994

[Initial clinicopathological manifestations of malignant lymphoproliferative processes in patients with human immunodeficiency virus seropositivity. Study of 40 cases].

We analyzed the series of 40 malignant lymphoproliferative diseases (MLD) in HIV positive patients, diagnosed between 1986 and 1993 in a University Hospital in Spain. Median age was 32 years. 52% of the patients belonged to the intravenous drug users risk group, and 30% were homosexual. 26 patients were diagnosed of a non-Hodgkin's lymphoma (NHL), 8 of Hodgkin's disease (HD) and 6 of a primary central nervous system lymphoma (PCL). The 6 patients with a PCL (median CD4 of 20 cells/mm3, 80% antecedent AIDS criteria) and 13 NHL with histology of immunoblastic, large cell, plasmablastic, and high grade lymphoma non-otherwise specified (median CD4 of 291, 58% with AIDS criteria) tended to appear in patients with a deteriorated clinical and immunological status due to the underlying HIV infection. However, the 14 small non-cleaved cell NHLs appeared in patients without a previous AIDS-defining condition (93% of the cases, p = 0.065 compared with other NHL histologies). Finally, 8 patients with HD had a low CD4 cell count (median 103 cells/mm3, p = 0.049 compared with median CD4 in NHL patients) without other previous AIDS criteria. In conclusion, The presenting characteristics of HIV positive patients with MLD allows to define four subgroups of patients with a high clinicopathological correlation.

Adolescent↗
PubMed1993

Successful treatment of haemodialysis catheter-related sepsis without catheter removal.

Thirty-six Permcath double-lumen catheters implanted in 36 chronic renal failure patients for haemodialysis treatment were prospectively studied. When catheter-related sepsis was suspected a quantitative blood culture was obtained simultaneously from the catheter and from a peripheral vein. If bacterial colonies in the catheter blood specimen were fourfold greater than identical bacterial colonies in the peripheral blood specimen, the test was considered indicative of catheter sepsis and an empirical antibiotic regimen was begun while the central line remained in situ. Eleven patients suffered 13 episodes of catheter-related sepsis. Staphylococcus epidermidis and Pseudomonas aeruginosa accounted for 77% of the strains isolated. All episodes were successfully treated with vancomycin or ciprofloxacin and yielded negative results on follow-up quantitative blood cultures. Fever subsided within the first 48 h of therapy and no complications occurred. None of these patients required catheter removal for cure of the catheter-related sepsis.

Adult↗