30 research outputs found
Patient from India with fever and uncommon findings
A 28-years-old male patient from India that had not travelled to his country in the last nine months presented to the emergency room with general discomfort, dysthermia feeling, sweating, chills, and shivering. In the physical examination, temperature was quantified in 40.5 °C. No neurological deficit or peripheral lymphadenopathy was found. Blood was taken and sent to the local laboratory for examination and then sent to our hospital in order to confirm the diagnosis. This sample was stored for almost 3 days at room temperature
Pneumocystis pneumonia in the twenty-first century: HIV-infected versus HIV-uninfected patients
Introduction: Pneumocystis pneumonia (PcP) has classically been described as a serious complication in patients infected with the human immunodeficiency virus (HIV). However, the emerging number of conditions associated with immunosuppression has led to its appearance in other patient populations, such as those receiving chronic corticosteroid therapy, those with hematological or solid malignancies, transplant recipients and those who receive immunomodulatory or biological therapy. Areas covered: This article reviews the most recent publications on PcP in the HIV-infected and HIV-uninfected population, focusing on epidemiology, diagnostic, therapy and prevention. The data discussed here were mainly obtained from a non-systematic review using Medline and references from relevant articles including randomized clinical trials, meta-analyses, observational studies and clinical reviews. Eligible studies were selected in two stages: sequential examination of title and abstract, followed by full text. Expert opinion: Widespread use of antiretroviral and prophylactic therapy in HIV-infected patients has decreased the incidence of PcP in this population. However, the growing incidence of Pneumocystis infection in the HIV-uninfected population suggests the need for new global epidemiological studies in order to identify the true scale of the disease in this population. These data would allow us to improve diagnosis, therapeutic strategies, and clinical management. It is very important that both patients and physicians realize that HIV-uninfected patients are at risk of PcP and that rapid diagnosis and early initiation of treatment are associated with better prognosis. Currently, in-hospital mortality rates are very high: 15% for HIV-infected patients and 50% in some HIV-uninfected patients. Therefore, adequate preventive measures should be implemented to avoid the high mortality rates seen in recent decades
High prevalence of S. Stercoralis infection among patients with Chagas disease: A retrospective case-control study
Background: We evaluate the association between Trypanosoma cruzi infection and strongyloidiasis in a cohort of Latin American (LA) migrants screened for both infections in a non-endemic setting. Methodology: Case-control study including LA individuals who were systematically screened for T. cruzi infection and strongyloidiasis between January 2013 and April 2015. Individuals were included as cases if they had a positive serological result for Strongyloides stercoralis. Controls were randomly selected from the cohort of individuals screened for T. cruzi infection that tested negative for S. stercoralis serology. The association between T. cruzi infection and strongyloidiasis was evaluated by logistic regression models. Principal findings: During the study period, 361 individuals were screened for both infections. 52 (14.4%) individuals had a positive serological result for strongyloidiasis (cases) and 104 participants with negative results were randomly selected as controls. 76 (48.7%) indiviuals had a positive serological result for T. cruzi. Factors associated with a positive T. cruzi serology were Bolivian origin (94.7% vs 78.7%; p = 0.003), coming from a rural area (90.8% vs 68.7%; p = 0.001), having lived in an adobe house (88.2% vs 70%; p = 0.006) and a referred contact with triatomine bugs (86.7% vs 63.3%; p = 0.001). There were more patients with a positive S. stercoralis serology among those who were infected with T. cruzi (42.1% vs 25%; p = 0.023). Epidemiological variables were not associated with a positive strongyloidiasis serology. T. cruzi infection was more frequent among those with strongyloidiasis (61.5% vs 42.3%; p = 0.023). In multivariate analysis, T. cruzi infection was associated with a two-fold increase in the odds of strongyloidiasis (OR 2.23; 95% CI 1.07-4.64; p = 0.030). Conclusions: T. cruzi infection was associated with strongyloidiasis in LA migrants attending a tropical diseases unit even after adjusting for epidemiological variables. These findings should encourage physicians in non-endemic settings to implement a systematic screening for both infections in LA individuals
Post-splenectomy acute glomerulonephritis due to a chronic infection with Plasmodium falciparum and malariae
A 38-year-old Senegalese man with no previous medical history and living in Spain since 2004 was admitted due to fever, hypotension and edemas. The patient had not traveled to malaria endemic areas for the last 2 years, and 43 days before this episode he underwent an elective splenectomy in order to rule out a hematologic neoplasm due to a 27-cm splenomegaly and pancytopenia
Protease inhibitor monotherapy is associated with a higher level of monocyte activation, bacterial translocation and inflammation
Introduction Monotherapy with protease-inhibitors (MPI) may be an alternative to cART for HIV treatment. We assessed the impact of this strategy on immune activation, bacterial translocation and inflammation. Methods We performed a cross-sectional study comparing patients on successful MPI (n=40) with patients on cART (n=20). Activation, senescence, exhaustion and differentiation stage in CD4+ and CD8+ T lymphocyte subsets, markers of monocyte activation, microbial translocation, inflammation, coagulation and low-level viremia were assessed. Results CD4+ or CD8+ T lymphocyte subset parameters were not significantly different between both groups. Conversely, as compared with triple cART, MPI patients showed a higher proportion of activated monocytes (CD14+ CD16−CD163+ cells, p=0.031), soluble markers of monocyte activation (sCD14 p=0.004, sCD163 p=0.002), microbial translocation (lipopolysaccharide (LPS)-binding protein; LBP p=0.07), inflammation (IL-6 p=0.04) and low-level viremia (p=0.035). In a multivariate model, a higher level of CD14+ CD16−CD163+ cells and sCD14, and presence of very low-level viremia were independently associated with MPI. Monocyte activation was independently associated with markers of inflammation (IL-6, p=0.006), microbial translocation (LBP, p=0.01) and low-level viremia (p=0.01). Conclusions Patients on MPI showed a higher level of monocyte activation than patients on standard therapy. Microbial translocation and low-level viremia were associated with the high level of monocyte activation observed in patients on MPI. The long-term clinical consequences of these findings should be assessed
Rapid Diagnosis of Staphylococcal Catheter-Related Bacteraemia in Direct Blood Samples by Real-Time PCR
Catheter-related bacteremia (CRB) is an important cause of
morbidity and mortality among hospitalized patients, being
staphylococci the main etiologic agents. The objective of this
study was to assess the use of a PCR-based assay for detection
of staphylococci directly from blood obtained through the
catheter to diagnose CRB caused by these microorganisms and to
perform a cost-effectiveness analysis. A total of 92 patients
with suspected CRB were included in the study. Samples were
obtained through the catheter. Paired blood cultures were
processed by standard culture methods and 4 ml blood samples
were processed by GeneXpert-MRSA assay for the detection of
methicillin-susceptible (MSSA) or methicillin-resistant (MRSA)
Staphylococcus aureus, and methicillin-resistant
coagulase-negative staphylococci (MR-CoNS). Sixteen CRB caused
by staphylococci were diagnosed among 92 suspected patients.
GeneXpert detected 14 out of 16 cases (87.5%), including 4 MSSA
and 10 MR-CoNS in approximately 1 hour after specimen receipt.
The sensitivity and specificity of GeneXpert were 87.5% (CI 95%:
60.4-97.8) and 92.1% (CI 95%: 83-96.7), respectively, compared
with standard culture methods. The sensitivity of GeneXpert for
S. aureus was 100%. Regarding a cost-effectiveness analysis, the
incremental cost of using GeneXpert was of 31.1euro per patient
while the incremental cost-effectiveness ratio of GeneXpert
compared with blood culture alones was about 180euro per life
year gained. In conclusion, GeneXpert can be used directly with
blood samples obtained through infected catheters to detect S.
aureus and MR-CoNS in approximately 1h after sampling. In
addition, it is cost-effective especially in areas with high
prevalence of staphylococcal CRB
Acute liver failure due to visceral leishmaniasis in Barcelona: a case report
Background: Leishmaniasis is an emerging infectious disease. Due to human migration and tourism, visceral
leishmaniasis may become more common in non-endemic areas. In the Mediterranean basin, visceral leishmaniasis
typically occurs in rural regions.
Case presentation: We present an unusual urban case of acute liver failure due to visceral leishmaniasis, following
a prolonged fever of unknown origin. After obtaining negative results from the bone marrow aspirate, we
performed a liver biopsy that elucidated the diagnosis. The liver involvement in visceral leishmaniasis may appear
as chronic granulomatous hepatitis. However diffuse hepatitis process, a necro-inflammatory pattern, without
forming granulomas were observed in the liver biopsy specimens in this case. Intracytoplasmic Leishmania
amastigotes were observed in the liver biopsy specimens and a polymerase chain reaction confirmed the diagnosis.
Only five pathological confirmed cases of acute hepatitis due to visceral leishmaniasis have been described so far,
just two in adults and both from Barcelona. A revision of the literature is performed.
Conclusions: Acute hepatitis is an uncommon debut of visceral leishmaniasis in immunocompetent patients.
Furthermore there are only few cases in the literature that describe the histopathological changes that we found in
this patient. In conclusion, in case of acute hepatitis leading to liver failure, leishmaniasis should be considered a
differential diagnosis (even in non-endemic countries and without clear epidemiological exposure) and liver biopsy
can elucidate the diagnosis
Prediction of poor outcome in clostridioides difficile infection: A multicentre external validation of the toxin B amplification cycle
Producción CientíficaClassification of patients according to their risk of poor outcomes in Clostridioides difficile infection (CDI) would enable implementation of costly new treatment options in a subset of patients at higher risk of poor outcome. In a previous study, we found that low toxin B amplification cycle thresholds (Ct) were independently associated with poor outcome CDI. Our objective was to perform a multicentre external validation of a PCR-toxin B Ct as a marker of poor outcome CDI. We carried out a multicentre study (14 hospitals) in which the characteristics and outcome of patients with CDI were evaluated. A subanalysis of the results of the amplification curve of real-time PCR gene toxin B (XpertTM C. difficile) was performed. A total of 223 patients were included. The median age was 73.0 years, 50.2% were female, and the median Charlson index was 3.0. The comparison of poor outcome and non–poor outcome CDI episodes revealed, respectively, the following results: median age (years), 77.0 vs 72.0 (p = 0.009); patients from nursing homes, 24.4% vs 10.8% (p = 0.039); median leukocytes (cells/μl), 10,740.0 vs 8795.0 (p = 0.026); and median PCR-toxin B Ct, 23.3 vs 25.4 (p = 0.004). Multivariate analysis showed that a PCR-toxin B Ct cut-off <23.5 was significantly and independently associated with poor outcome CDI (p = 0.002; OR, 3.371; 95%CI, 1.565–7.264). This variable correctly classified 68.5% of patients. The use of this microbiological marker could facilitate early selection of patients who are at higher risk of poor outcome and are more likely to benefit from newer and more costly therapeutic options
Modelos de crecimiento y producción en España: historia, ejemplos contemporáneos y perspectivas
En el presente trabajo se presenta una revisión sobre los modelos forestales desarrollados en España durante los últimos años, tanto para la producción maderable como no maderable y, para la dinámica de los bosques (regeneración, mortalidad). Se presentan modelos tanto de rodal completo como de clases diamétricas y de árbol individual. Los modelos desarrollados hasta la fecha se han desarrollado a partir de datos procedentes de parcelas permanentes, ensayos y el Inventario Forestal Nacional. En el trabajo se muestran los diferentes submodelos desarrollados hasta la fecha, así como las plataformas informáticas que permiten utilizar dichos modelos. Se incluyen las principales perspectivas
de desarrollo de la modelización forestal en España.In this paper we present a review of forest models developed in Spain in recent years for both timber and non timber production and forest dynamics (regeneration, mortality). Models developed are whole stand, size (diameter) class and individual-tree. The models developed to date have been developed using data from permanent plots, experimental
sites and the National Forest Inventory. In this paper we show the different sub-models developed so far and the friendly use software. Main perspectives of forest modeling in Spain are presented.The models described in this paper were funded by
different regional, national and European projects, and
some of them were elaborated by the authors. This
work was funded by the Spanish Government by the
SELVIRED network (code AGL2008-03740) and the
strategic project «Restauración y Gestión Forestal»
(code PSE-310000-2009-4)
Usefulness of bone turnover markers as predictors of mortality risk, disease progression and skeletal-related events appearance in patients with prostate cancer with bone metastases following treatment with zoledronic acid: TUGAMO study
Owing to the limited validity of clinical data on the treatment of prostate cancer (PCa) and bone metastases,
biochemical markers are a promising tool for predicting survival, disease progression and skeletal-related events (SREs) in these
patients. The aim of this study was to evaluate the predictive capacity of biochemical markers of bone turnover for mortality risk,
disease progression and SREs in patients with PCa and bone metastases undergoing treatment with zoledronic acid (ZA).
Methods: This was an observational, prospective and multicenter study in which ninety-eight patients were included. Patients
were treated with ZA (4mg every 4 weeks for 18 months). Data were collected at baseline and 3, 6, 9, 12, 15 and 18 months after
the beginning of treatment. Serum levels of bone alkaline phosphtase (BALP), aminoterminal propeptide of procollagen type I
(P1NP) and beta-isomer of carboxiterminal telopeptide of collagen I (b-CTX) were analysed at all points in the study. Data on
disease progression, SREs development and survival were recorded.
Results: Cox regression models with clinical data and bone markers showed that the levels of the three markers studied were
predictive of survival time, with b-CTX being especially powerful, in which a lack of normalisation in visit 1 (3 months after the
beginning of treatment) showed a 6.3-times more risk for death than in normalised patients. Levels of these markers were also
predictive for SREs, although in this case BALP and P1NP proved to be better predictors. We did not find any relationship
between bone markers and disease progression.
Conclusion: In patients with PCa and bone metastases treated with ZA, b-CTX and P1NP can be considered suitable predictors for
mortality risk, while BALP and P1NP are appropriate for SREs. The levels of these biomarkers 3 months after the beginning of
treatment are especially importantThis study was supported by Novartis Oncology Spai