[Meningitis caused by Salmonella non-typhi after neurosurgery in the adult].
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Biomedical subjects
Publications and source records attributed to J M Cisneros.
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We present four patients with Hodgkin's disease and human immunodeficiency virus infection (HIV). Three patients were addicts to parenteral drugs. The disease was very advanced at the time of diagnosis, stage IVB in all cases. Histologic types were mixed cellularity in two cases, nodular sclerosis in one case and it was not typifiable in the remaining case. The disturbances of cell-mediated immunity that the patients presented were those of the acquired immunodeficiency syndrome (AIDS) as well as the infectious complications. Response to treatment was poor with a high incidence of bone marrow toxicity; three patients died during the first 3 months after the diagnosis (X = 7.3 months). We emphasize the necessity of considering different prognostic and therapeutic approaches for the HD in these patients in contrast with those of seronegative patients. We pose some questions suggested by the review of the literature and the data of this series.
Meningococcal sepsis is usually a severe disease with very varied clinical manifestations. In our surrounding the most frequently appearing Neisseria meningitidis belongs to serogroup B, and only 10.2% belongs to group C. Both arthritis and exudative pericarditis are described as late, independent complications of N. Meningitidis C infections. The coexistence of both arthritis and suppurative pericarditis caused by this organism is extremely rare. A case of sepsis due to serogroup C N. Meningitidis in a patient who developed a right shoulder arthritis followed by septic shock and purulent pericarditis is presented. The characteristics of arthritis and pericarditis as complications of the acute meningococcal infection are analyzed, emphasizing the rareness of the coappearance of both as a form of clinical manifestation, as well as the purulent characteristic in order to keep them in mind and facilitate a prompt diagnosis and appropriate treatment.
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We prospectively studied 339 patients diagnosed of brucellosis over a six year period in order to evaluate the clinical and serological characteristics of brucellosis in the elderly. 319 patients (94.1%) were under 65 years of age (group A), and 20 patients (5.9%) were older than 65 (group B). No patient in group B developed splenomegaly as opposed to 69 (21.6%) in group A (p less than 0.05). The percentage of positive blood cultures (Brucella melitensis isolated in all cases) was 72.1% in group A and 60% in group B. The mean titer of IgM antibodies measured by indirect immunofluorescence test was significantly lower in the elderly patients, with no other differences in serologic response between the two groups. 103 patients (32.2%) in group A and seven patients (35%) in group B developed some complications; spondylitis was more common and severe among group B patients. There was no therapeutic failure or relapse among patients over 65. We conclude that clinical, bacteriological and serological characteristics and the outcome of brucellosis in the elderly are similar to those seen in younger patients.
A multicentre prospective study of 593 patients with brucellosis, of whom 58 (9.7%) had spondylitis, was performed in order to evaluate the possible clinical, radiological and evolutionary differences in the different segments of the spinal column. Five of the patients with cervical spondylitis (71%) had compression of the medulla or roots, versus just two (11%) in the dorsal group and nine (21%) in the lumbar group (p less than 0.05). There were no other clinical, haematological or biochemical differences between the three spinal segments, and both the serological response and the percentage of positive blood cultures were also similar in the three groups. The patients with cervical and dorsal spondylitis had a significantly higher number of paravertebral and/or epidural masses than those with lumbar spondylitis (p less than 0.05). Seventy-one percent of the patients with cervical spondylitis made unsatisfactory progress, versus 11% and 5% of those in the dorsal and lumbar groups, respectively (p less than 0.05 and p less than 0.001). In conclusion, given the high incidence of paravertebral and/or epidural masses, the neurological involvement, and the high rate of important functional disabilities, cervical spondylitis should be considered to be a very severe complication of brucellosis, and its treatment and follow-up must therefore be energetic and rigorous in order to detect and correct as early as possible compressions of the neural axis and its roots.
OBJECTIVES: To describe the methods used to impute HIV seroconversion date in the haemophiliac cohorts from GEMES project and to validate its use. METHOD: 632 haemophiliacs coming from three hemophilia units identified as HIV+ and 1.092 individuals coming from 5 project GEMES cohorts with a seroconversion window (time among test HIV and HIV+) less than 3 years where mid point (PM) was assumed as seroconversion date. For both groups, seroconversion date was imputed after estimating the probability distribution of seroconversion by means of the EM algorithm. Two imputation methods are used: one obtained from the expected value and the other from the geometric mean of 5 random samples. from the estimated distribution. Imputations have been validated in the non haemophiliacs cohorts comparing with the PM seroconversion date. Also AIDS free time and survival from the different seroconversion imputed dates were compared. RESULTS: Median seroconversion date is located in May of 1993 for the non haemophiliacs and in 1982 for the haemophiliacs. Not big differences are observed among the imputed seroconversion dates and the mid-point seroconversion date in the non-haemophiliac cohorts. Similar results are found for the haemophiliac cohorts. Also no differences are observed in the estimated AIDS-free time for both groups of cohorts. CONCLUSIONS: Geometric mean imputation from several random samples provides a good estimate of the HIV seroconversion date that can be used to estimate AIDS-free time and survival in haemophiliac cohorts where seroconversion date is ignored.
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