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Biomedical subjects

J Mensa

Publications and source records attributed to J Mensa.

At least 91 records · Page 5Linked to original sources
PubMed1994

[138 episodes of bacteremia or fungemia in patients with solid organ (renal or hepatic) transplantation].

BACKGROUND: To study the bacteremias and fungemias of the patients with solid organ transplantation (kidney or liver) and analyze the differences according to the type of graft. METHODS: A prospective study included in a control program of bacteremias of a 1000-bed hospital and a follow up study of the infections of the patients who had undergone kidney transplantation (KT) (1985-1991) and liver transplantation (LT) (1988-1991) were carried out. RESULTS: One hundred thirty-one bacteremias and 5 fungemias, 75 in 62 patients with KT out of a total of 568 transplantations (11%) and 63 out of 54 patients with LT out of a total of 185 transplantations (29%) were identified. The prevalence of bacteremia in LT was greater (p < 0.001). The origin was nosocomial in 95% in LT and 70% in KT (p < 0.001). Around 50% of the bacteremias occurred during the first month post LT and KT. The microorganisms isolated were: Staphylococcus sp. (21 in KT and 30 in LT), with greater incidence in LT (p < 0.05); Enterococcus sp. (9 and 5, respectively), enterobacterias (12 and 12, respectively), Pseudomonas sp. (14 and 6, respectively), Candida sp. (2 and 3, respectively) with similar rates in both transplants. The origin of bacteremia was; renal and urinary tract, most frequent in KT (21 and 2 respectively) (p = 0.001). The origin of bacteremia was: renal and urinary tract, most frequent in KT (21 and 2 respectively) (p < 0.001), intraabdominal and biliary tract, most frequent in LT (4 and 14, respectively) (p = 0.007); intravenous catheter, most frequent in LT (16 and 24 respectively) (p < 0.05); lung, most frequent in LT although without statistical significance (3 and 8, respectively), (p = NS), and finally, surgical wound (4 and 1, respectively) (p = NS). Seventeen patients died (14 with LT and 3 with KT). CONCLUSIONS: The incidence of bacteremia and the mortality related, was greater in LT than that observed in KT. The most frequent origin in KT was the kidney and urinary tract and the biliary and intraabdominal organs and the intravenous catheter were most prevalent in liver transplants. Staphylococcus sp was the most frequent germ in both types of transplantation and polymicrobian infection in liver transplants. Gram-negative germs caused higher mortality in liver transplantation.

Bacteremia↗
PubMed1994

[Incidence of enteropathogens in patients with human immunodeficiency virus infection].

BACKGROUND: To establish the incidence of diarrhea and its evolution over time, the causal microorganisms, recurrence and associated mortality in patients with AIDS or severe immunologic alterations (CD4 lymphocytes lower than 0.5 x 10(9)/l). METHODS: A prospective longitudinal study was carried out from 1984 to 1992. The following patients were included in the study: 1) all those patients with diarrhea in whom a pathogenic microorganism was identified in the stools, and 2) patients with fever and positive blood cultures for enteropathogenic bacteria. The patients belonged to a series of 1,456 patients with infection by HIV. RESULTS: Of the 1,456 controlled patients, 253 (17%) had infection by enteropathogenic microorganisms. The incidence was greater in homosexual patients (26%) than in drug addicts (12%). The most frequent germs were Cryptosporidium, in 104 episodes and Salmonella sp. in 78 episodes (31 as isolated bacteria). The mortality in the 15 days following isolation was 2%, the referred microorganisms being the most frequent responsible for the deaths. The mean of CD4 lymphocytes in the patients with enteropathogens was 0.17 x 10(9)/l). SD 0.14 x 10(9)/l). In patients with infection by Cryptosporidium the CD4 lymphocyte count was lower than that observed in the cases of infection by Isospora belli. Prior to 1988, 21% of the patients had infection by enteropathogenic bacteria and 23% by parasites, those percentages being 3% and 6%, respectively in 1991. CONCLUSIONS: Infections by enteropathogenic microorganisms in patients with infection by the human immunodeficiency virus in an advanced stage are frequent, particularly, in homosexuals. The patients with enteritis by Cryptosporidium have a greater grade of immunosuppression (CD4 lymphocytes lower than 0.1 x 10(9)/l) than patients with infection by other enteropathogenic microorganisms. In the last few years, the incidence of enteropathogenic bacteria, especially Salmonella sp. and protozoa has decreased [corrected].

Acquired Immunodeficiency Syndrome↗
PubMed1994

Analysis of factors influencing the outcome and development of septic metastasis or relapse in Salmonella bacteremia.

One-hundred seventy-two consecutive adult patients with salmonella bacteremia documented by at least one positive blood culture were prospectively evaluated over a 10-year period. Salmonella enteritidis was isolated in 121 cases (70.3%), Salmonella typhimurium in 29 (16.9%), and other Salmonella species in 22 (12.8%). Twenty-seven patients (15.7%) developed septic metastasis; 21 patients (12.2%) died of bacteremia, and 24 (16.7%) of the 144 patients who survived had at least one relapse. A logistic regression analysis selected three variables as independently influencing outcome: septic shock (P = .005), coma (P = .029), and immunosuppression (P = .04). By means of the same statistical analysis, leukopenia (a white blood cell count of < 4 x 10(9)/L) was identified as an independent risk factor for relapse (P < .0001). The possibility of salmonella bacteremia must be considered when immunosuppressed patients have fever and no obvious source of infection. Treatment with a drug active against Salmonella species is essential in this population. Patients with leukopenia should be considered as recipients of prophylaxis for relapse.

Adolescent↗
PubMed1993

Five-day treatment of non-severe, community-acquired pneumonia with josamycin.

This study assessed the efficacy of oral josamycin 1 g bd for five days as treatment for non-severe, community-acquired pneumonia in patients less than 60 years of age who were not at obvious risk of developing respiratory tract infection caused by aerobic Gram-negative bacilli. Of the 84 patients (43 male, 41 female) with a mean age of 33 years who were enrolled during a 14-month period, the clinical outcome was invariably favourable. All patients became afebrile within three days of starting therapy; the mean duration of fever after initiating treatment was 1.7 days. Therefore, according to the study protocol, josamycin therapy was discontinued on day five. A chest X-ray performed four to six weeks after completing treatment was normal in every case and no relapses were observed during a six-week follow-up period. We conclude that a five-day course of josamycin is effective monotherapy for community-acquired pneumonia in patients without the clinical features of severe infection.

Adolescent↗
PubMed1992

[Rapid method for identifying Escherichia coli and species of the Proteeae tribe in urine].

BACKGROUND: To evaluate the possibility of using the determination of beta-glucuronidase and phenylalanine deaminase activity directly from urine samples for rapid detection (2 hours) of the presence of Escherichia coli and species of the Proteeae tribe. METHODS: To detect beta-glucuronidase activity methyl-umbelipheryl-beta-D-glucuronic was used as a substrate. The presence of fluorescence after incubation at 37 degrees C for 2 hours indicated a positive reaction. While phenylalanine was used as a substrate for detecting phenylalanine deaminase activity, FeCl3 was added after incubation at 37 degrees C for 2 hours with a greenish color being observed indicating phenylalanine deaminase activity. RESULTS: The detection of Escherichia coli by beta-glucuronidase activity presented sensitivity and specificity of 0.91 and 0.99, respectively. The positive predictive value was 0.96 and the negative predictive value was 0.98, whereas the determination of the phenylalanine deaminase activity with the aim of detecting species of the Proteeae tribe presented the following results; sensitivity 0.92, specificity 0.99, positive predictive value 0.94 and negative predictive value 0.99. CONCLUSIONS: The determination of beta-glucuronidase and phenylalanine deaminase activities directly from urine sediment has been demonstrated as a rapid and specific test for detecting the presence of Escherichia coli and species of the Proteeae tribe, therefore it must be considered as a useful test in early diagnosis of urinary infection thereby facilitating the administration of appropriate antibiotic treatment.

Amino Acid Oxidoreductases↗
PubMed1992

[Cryptococcosis: presentation of 26 cases].

BACKGROUND: Cryptococcosis is more frequently observed since the appearance of the acquired immunodeficiency syndrome (AIDS). AIDS has modified the clinical and evolutive forms of the disease. This study reviews the changes produced in the infection from the context of AIDS. METHODS: The present is a retrospective study (1985-1990) including patients presenting: 1) a positive latex agglutination test (serum or spinal fluid) or 2) a Sabouraud culture positive for cryptococcus. Clinical histories were revised collecting clinical, radiologic, analytic, therapeutic and evolutive data. RESULTS: Twenty-six patients (21 males) were included in the study. Twenty patients had the human immunodeficiency virus. The clinical picture was: 22 cases with cryptococcal meningitis (13 with hematogenous participation), 3 with pulmonary cryptococcosis and one with disseminated cryptococcosis without meningeal involvement. The patients with AIDS had: greater frequency of positive hemocultures, higher serologic titers and fewer with the meningeal syndrome. The number of T4 lymphocytes was lower than 150 elements/ml in AIDS patients. In 17 patients treatment with amphotericin B and 5-fluorocytosine was administered, 5 received amphotericin B and two fluconazole and two did not receive the above since they had not been diagnosed alive. There were 6 deaths and 10 relapses in 6 AIDS patients and none in the remaining patients. CONCLUSIONS: The incidence of cryptococcosis has increased as a consequence of AIDS. In these patients the disease occurs in advanced stages of immunodeficiency and frequently in disseminated, severe and paucisymptomatic forms. Treatment is usually effective although a maintenance therapy is required to avoid relapse.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Septic arthritis in heroin addicts.

Over a 6-year period (1982 to 1988), 36 episodes of septic arthritis were diagnosed in 35 heroin addicts from Barcelona, Spain. Thirty (86%) were men and five (14%) were women, with a mean age of 24 years (range, 14 to 39). Twenty-nine episodes (80%) were monoarticular and seven (20%) were oligoarticular. The sacroiliac (16 cases), sternoclavicular (8), hip (5), and shoulder (4) joints were most frequently infected. Staphylococcus aureus and Pseudomonas aeruginosa were the etiological agents in 75% and 11% of episodes, respectively. Response to antibiotic treatment was good in 32 cases (90%), eight patients needed surgical drainage, and none died. We conclude that septic arthritis in heroin addicts localizes predominantly in axial joints. In our geographic area, infection with S aureus is more frequent than with gram-negative rods such as P aeruginosa or Serratia marcescens, which are most frequently found in reports from the United States.

Adolescent↗
PubMed1991

Risk factors for nosocomial bacteremia in a large Spanish teaching hospital: a case-control study.

OBJECTIVE: Identify independent risk factors associated with the development of nosocomial bacteremia. DESIGN: Exploratory, unmatched, case-control study. SETTING: A 970-bed Spanish university hospital. PATIENTS: All non-neutropenic adult patients with nosocomial bacteremia admitted during a 12-month period were eligible as cases. All adult non-neutropenic patients without nosocomial bacteremia were eligible as controls. RESULTS: The incidence of bacteremia in the study population was 6.9/1000 admissions/year. One hundred eighty cases and 180 controls were analyzed. Multivariate analysis (stepwise logistic regression techniques) identified seven risk factors independently associated with nosocomial bacteremia: age above 65 years; prior admission (within six months) to the hospital; underlying diseases that were ultimately or rapidly fatal; indwelling urethral catheter in place for more than three days; intravenous central lines or peripheral venous lines (if in place for more than four days); "high-risk surgery" (i.e., lower abdominal, cardiac or thoracic); and admission to an intensive care unit. CONCLUSIONS: Although five variables are not modifiable, the remaining two relate to the use and duration of devices. Our data give strong support for the value of testing strict guidelines for limiting vascular catheters and evaluating the need for prolonged urethral catheterization. If effective infection control measures are identified, we could target hospital-wide surveillance to patients whose risk factors are amenable to intervention.

Adult↗
PubMed1991

[Syphilis and human immunodeficiency virus infection: diagnostic and therapeutic problems. Presentation of 2 cases and review of the literature].

We here present the clinical cases of two homosexual patients, carriers of human immunodeficiency virus (HIV), who later presented a syphilis infection and who after receiving the usually recommended treatment, suffered a relapse of the infection six months afterwards, with neurologic involvement in one case. The clinical characteristics are discussed as well as the diagnostic and therapeutic problems which syphilis infection presents in HIV infected patients. Serological results are comparable to those of the general population, although face positives have been occasionally reported as well as some abnormally elevated titers. It is possible that neurosyphilis might be more frequent and of earlier appearance in HIV infected patients. Therefore, it might be necessary to carry out a spinal fluid exam, in these type of patients, in order to rule out the existence of an early and/or asymptomatic neurologic affectation and give the appropriate antibiotic treatment.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[Severe leptospirosis. Description of a series of 10 cases].

Clinical aspects of 10 consecutive patients hospitalized for acute human leptospirosis, confirmed by serology using the microscopic agglutination test (MAT), between 1975 and 1988 in a 1000 beds Teaching Hospital are retrospectively analyzed. All of them were male, mean age of 55, presenting a suggestive epidemiological data to be at risk for Leptospira infection. Leptospira icterohaemorrhagiae was responsible for 8 cases and Leptospira canicola for 2. 7 patients were treated, after 3-4 days of admittance, with penicillin. 5 patients died. Cause of death was gastrointestinal haemorrhage in 3 and cardiogenic shock in 2. We discuss the clinical, biochemical, pathological and therapeutic aspects of the acute human leptospirosis.

Aged↗
PubMed1990

[Acute gastroenteritis: a prospective study of 445 cases].

Four hundred and fourty-five adult patients suffering acute gastroenteritis (AG) seen at the emergency ward of two hospitals in Barcelona, have been studied. The aim of this work was to analyze the cause of AG in our community and to evaluate the utility of the biologic and clinical criteria chosen as indicators of bacteremia or of AG produced by invasive microorganisms. Stool culture was positive in 157 patients (35%) of which 140 were Salmonella sp. The most frequently isolated serotype was S. enteritidis. Eight patients (7.8%) presented Salmonella sp. bacteremia. Presence of an underlying disease, dehydration, shivers, fever, presence of occult blood in stools, septic hemogram and the history of AG in other family members were more common in patients with a positive stool culture (p less than 0.05). Patients with bacteremia presented dehydration with a significantly higher frequency than nonbacteremics. The rest of the parameters studied were similar in both groups. We conclude that Salmonella sp. is the most frequently encountered microorganisms responsible for adult AG in our community. It is possible to identify patients with AG due to Salmonella sp. based on clinical and biological parameters. On the contrary, it is necessary to perform a wider study in order to determine the parameters that may allow the identification of patients with bacteremia.

Acute Disease↗
PubMed1989

[A community outbreak of Legionnaires' disease in Barcelona: clinical and microbiological study].

In February and March 1989 a community-acquired outbreak of legionnaires' disease developed in Barcelona, involving at least 56 patients (48 males and 8 females) with a mean age of 60 years (range 22-87). 70% were smokers, 20% alcohol abusers, 50% had chronic bronchitis and 20% were immunologically depressed. The most common signs and symptoms were: fever (100%), features of lung condensation (77%), cough (51%), stupor (27%), diarrhea (18%), thoracic pain (18%, hyponatremia (53%), increased serum level of hepatic enzymes (44%) or CK (37%), and renal failure (21%). Radiological involvement was bilateral in 30% of cases. In most patients the diagnosis was made by seroconversion (70%). Late seroconversion (between 4 and 14 weeks) was seen in 20 patients, whose age was significantly higher than that of patients with early seroconversion (p less than 0.02). All cases were caused by Legionella pneumophila serogroup 1. Forty-six patients (81%) were admitted to the hospital and 10 (18%) required tracheal intubation. Although all received erythromycin, seven patients died. Hypoxemia, leukopenia, hyponatremia and renal failure were associated with a higher mortality rate. However, after multivariate analysis renal failure appeared as the only independent prognostic variable. Finally, it was concluded that in the community-acquired outbreaks of pneumonia Legionella pneumophila infection should be ruled out.

Adult↗